Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720160007&lang=es vol. 144 num. 7 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<strong>Sobrevida en hipertensión pulmonar</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700001&lng=es&nrm=iso&tlng=es <![CDATA[<strong>Sobrevida a mediano plazo en los pacientes con hipertensión arterial pulmonar en la era de terapias vasodilatadoras específicas del territorio vascular pulmonar</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700002&lng=es&nrm=iso&tlng=es Background: Pulmonary arterial hypertension (PAH) is a rare and progressive disease. Long-term survival remains poor despite of advances in specific vasodilator therapy. Aim: To describe the survival rate in a cohort of PAH patients in two referral centers in Chile. Patients and Methods: One hundred fifteen patients aged 43 ± 15.6 years (85% females) with PAH qualified for this study. Their median pulmonary artery pressure was 55.4 ± 14 mmHg and their six minutes walking capacity was 368 ± 119 m. They were followed for 58 ± 0.4 months and their actual survival rates were compared with the estimated survival using the equation proposed by the French registry of PAH. Results: One, two and three year survival rates were 97, 94 and 89%, respectively. The observed survival rates were greater than the estimated survival. Conclusions: The improvement in survival rates observed in this cohort of patients is similar to what has been described in literature. <![CDATA[<strong>¿Es eficiente la protección anti-radiación otorgada por gorros de pabellón de tungsteno-bismuto en cardiología intervencionista?</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700003&lng=es&nrm=iso&tlng=es Background: The effectiveness against radiation of tungsten bismuth caps, used in interventional cardiology is not well known. Aim: To determine the degree of radiation protection conferred by these caps in real work conditions. Material and Methods: We compared the gross electric charges received at brain lobe levels by three occupationally exposed professionals who participated in 22 consecutive procedures, inside and outside of the tungsten bismuth cap. Results: The median electric charges outside and inside the cap were 3.71 (range 1.46-5.62) and 2.2 (range 1.29-3.93) nC, which correspond to a 40% radiation attenuation. However, the protection was heterogeneous. Conclusions: Tungsten bismuth caps provide an adequate attenuation, but its degree is heterogeneous. <![CDATA[<strong>Efectos de un programa de ejercicio de fuerza-resistencia muscular en la capacidad funcional, fuerza y calidad de vida de adultos con enfermedad renal crónica en hemodiálisis</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700004&lng=es&nrm=iso&tlng=es Background: Exercise may be a therapeutic tool for improving the functional capacity in patients with chronic kidney disease (CKD) who are on hemodialysis (HD). Aim: To determine the effects on muscle strength (MS), functional capacity (FC) and quality of life related to health (QOLRH) of a resistance training program in patients with CKD on HD. Patients and Methods: Thirteen CKD patients aged 38.8 ± 3 years, (7 men) on HD for more than one year participated in an exercise program twice a week during 8 weeks. At the beginning and at the end of the program, MS using a knee extension isometric strength test, FC using the six minutes walking test (6MWT) and QOLRH using the KDQOL CV-36 questionnaire were evaluated. Heart and respiratory rates, blood pressure, oxygen saturation and modified Borg scale were measured as control variables. Results: After training, there were significant improvements in MS in both legs; in the distance travelled during 6MWT and in the physical component summary score of the KDQOL-36. Furthermore, a significant decline in diastolic blood pressure was observed. All other control variables did not change significantly. Conclusions: Exercise training during eight weeks in CKD patients in HD resulted in significant improvements in muscle strength, walking capacity and in the physical component of a quality of life score for patients with CKD. <![CDATA[<strong>Función renal al fallecimiento según causa de muerte en trasplantados renales</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700005&lng=es&nrm=iso&tlng=es Background: Death with a functioning kidney graft is now the leading cause of graft loss after renal transplantation. Aim: To determine if renal function at the last outpatient visit before the recipient’s death was different according to the following causes of death: infections, cardiovascular diseases, gastrointestinal disorders or cancer. Patients and Methods: Retrospective cooperative cohort study conducted in two kidney transplant centers. All patients who received a kidney graft in the last 32 years were included. During that lapse, 431 kidney transplants were performed. Among them, 85 patients died with a functioning graft and were classified due to their cause of death. Glomerular filtration rate (eGFR) was estimated with the Modification of Diet in Renal Disease formula. Declining renal function was defined as a &gt; 20% decline in eGFR during the last 6 months prior to the last outpatient visit. Results: Eighty four patients were included in the analysis. Of these, 28.2% died of cardiovascular causes, 35.3% of infectious diseases, 15.3% of cancer and 20% of digestive diseases. Patients dying from cancer had a significantly higher eGFR prior to death than those who died from cardiovascular causes, infectious and digestive diseases (p < 0.01). Declining renal function occurred in 34.8% of deaths from cardiovascular causes, 39.3% from infectious diseases, 16.7% from cancer and 40% from digestive diseases. There were no significant differences between groups. Conclusions: Kidney graft recipients who die with a functioning graft have better renal function prior to their death when it is due to cancer than when it originates from infectious, cardiovascular or digestive diseases. Declining renal function is similar in the four groups of death causes. <![CDATA[<strong>Evaluación de calidad de las guías de práctica clínica de los 80 problemas de salud del régimen de garantías explícitas en salud</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700006&lng=es&nrm=iso&tlng=es Background: High quality practice guidelines are of utmost importance in clinical medicine. Aim: To evaluate the methodological quality of Clinical Practice Guidelines (CPG) for 80 high burden health conditions included in the “Explicit Guarantees in Healthcare” (EGH) program available on July 2014, elaborated and published by the Ministry of Health of Chile. Material and Methods: A cross-sectional observational study using the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument to evaluate the methodological quality of the current CPGs for EGH. Two reviewers assessed each CPG independently, obtaining standardized scores according for each dimension included in the AGREE II instrument. Results: Eighty one CPGs were evaluated. They were generally considered of reasonable quality, obtaining high scores in the following domains: Scope and Purpose (81.3%), Clarity of Presentation (78.6%) and Editorial Independence (76.5%). The following domains had a score under 60%: Stakeholder Involvement (51.3%), Rigor of Development (41.4%) and Applicability (33.6%). Conclusions: The CPGs elaborated for the EGH program have high scores in domains such as the Scope and Purpose, Clarity of Presentation and Editorial Independence. Their scores in other dimensions such as Stakeholder Involvement, Rigor of Development and Applicability can be still improved. <![CDATA[<strong>Influencia de las conductas promotoras de salud de los padres en la de sus hijos adolescentes</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700007&lng=es&nrm=iso&tlng=es Background: Family behavior models may influence health promoting conducts among adolescents. Aim: To determine the association between health promoting behaviors among parents and healthy behaviors of early adolescents. Material and Methods: Analysis of the baseline assessment of a longitudinal study of early adolescents in the city of San Felipe, Region of Valparaiso, Chile. Parents and their teenage children, attending 5th to 7th grade, from ten municipal schools, participated in this study. Self-reported questionnaires were used to assess healthy lifestyles, answered separately by parents and their children. Univariable and multivariable ordinal logistic regression analyses with complete data were carried out, using the students’ health promoting behaviors as dependent variables and the same behaviors among parents as the main predictors, controlling for other personal and family variables. Results: We contacted 1,035 parents and 682 consented to participate along with 560 students. The mean age of adolescents was 11.5 ± 1.2 years (49% females) The mean age of parents was 39.8 ± 8.8 years and 90% were women. The parental behaviors associated with teenage health promoting behaviors were eating vegetables (odds ratio (OR) = 1.22, p < 0.05), having breakfast (OR = 1.27, p < 0.05), do stretching exercises every day (OR = 1.19, p < 0.05) and take some time for relaxation (OR = 1.24, p < 0.05). Conclusions: These results show an association between healthy behaviors among parents and these behaviors among their adolescent offspring. <![CDATA[<strong>Enfrentamiento de pacientes pediátricos con várices esofágicas</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700008&lng=es&nrm=iso&tlng=es Background: There is a paucity of good quality research about the diagnosis of esophageal varices and the prophylaxis and treatment of variceal bleeding in pediatric patients with portal hypertension There is little consensus and practically no evidence-based approach about the management of these patients. Aim: To describe the behavior and preferences of pediatric gastroenterologists in Chile in the management of portal hypertension in children. Material and Methods: An online survey was sent to Chilean pediatric gastroenterologists, with questions evaluating the physicians’ approaches to screening of esophageal varices in children with portal hypertension, and their preferred methods of prophylaxis and initial management of variceal bleeding. Results: Thirty five of 69 contacted physicians answered the survey (51%). Twenty nine pediatric gastroenterologists (83%) screen for esophageal varices in patients with clinical evidence of portal hypertension, and 12 (34%) in every patient with chronic liver disease. Twenty eight respondents (80%) use primary prophylaxis, mainly beta blockers. Octreotide, proton pump inhibitors and endoscopy are the most common practices in the initial management of an esophageal varix bleed. The methods mostly used as secondary prophylaxis are band ligation and beta blockers. In the case of recurrent hemorrhage, besides band ligation, management with Transjugular Intrahepatic Portosystemic Shunt (TIPS) and hepatic transplantation are more likely. Conclusions: Even though most pediatric gastroenterologists in this survey are inclined to offer endoscopic screening of esophageal varices and prophylaxis to patients with portal hypertension, this is not a universal behavior. There are different approaches mainly in the election of secondary prophylaxis and the initial management of variceal bleeding. <![CDATA[<strong>Desigualdad en la prevalencia de parasitosis intestinal en escolares de una escuela urbana y dos rurales de la comuna de Puerto Montt</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700009&lng=es&nrm=iso&tlng=es Background: Parasitic infections in children reflect social inequalities throughout the world, especially in urban and rural territories. Aim: To assess inequalities in the prevalence of infections by protozoa and intestinal helminths and associated factors in children of different geographical areas from the commune of Puerto Montt. Material and Methods: Cross-sectional study carried out in 103 students from one urban and two rural schools in the commune of Puerto Montt. A socio-demographic survey was applied and the presence parasitic infections was evaluated in serial stool samples. Results: The prevalence of Protozoan and intestinal helminthic infections were 37.5 and 68.1% in urban and rural areas respectively. A regression analysis showed that the differences between rural and urban children, disappear when the results are adjusted by family income and the quality of sewage disposal. In urban children, the prevalence of parasitic infections increases along with the decrease in family income. Conclusions: Income and sanitary conditions rather than being or urban or rural origin explain the variations in rates of childhood parasitic infections. Infections with protozoa and intestinal helminths are an indicator of social inequality in health. <![CDATA[<strong>Propiedades psicométricas del inventario breve de fatiga en personas tratadas por neoplasias hematológicas en Chile</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700010&lng=es&nrm=iso&tlng=es Background: Fatigue is one of the most common and distressing symptoms experienced by cancer patients. Aim: To validate the Brief Fatigue Inventory in people treated for hematological neoplasms. Material and Methods: In a cross-sectional study, the Brief Fatigue Inventory was answered by 122 patients aged 40 ± 14 years (50% women) treated for hematological neoplasms at an intensive hematological unit of a public hospital between July 2010 and July 2013. Socio-demographic and clinical parameters were obtained from their clinical records. Results: Fatigue was present in nearly all patients (99.2%) in minor (50%), moderate (36.9%) or severe (12.3%) levels. The average fatigue score was 4.5 ± 1.9). The Brief Fatigue Inventory had a good internal consistency (Cronbach’s alpha = 0.973) and proved to be one-dimensional (84.3% of the explained variance). Women reported that fatigue interfered more with enjoy­ment of life than men (p = 0.036). Conclusions: The Brief Fatigue Inventory is a reliable instrument that can be used in clinical practice. It allows a quick assessment of the level of fatigue. People treated for hematologic cancer have a high prevalence of fatigue. <![CDATA[<strong>La urgente necesidad de un sistema de Evaluación de Intervenciones en Salud</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700011&lng=es&nrm=iso&tlng=es Background: Fatigue is one of the most common and distressing symptoms experienced by cancer patients. Aim: To validate the Brief Fatigue Inventory in people treated for hematological neoplasms. Material and Methods: In a cross-sectional study, the Brief Fatigue Inventory was answered by 122 patients aged 40 ± 14 years (50% women) treated for hematological neoplasms at an intensive hematological unit of a public hospital between July 2010 and July 2013. Socio-demographic and clinical parameters were obtained from their clinical records. Results: Fatigue was present in nearly all patients (99.2%) in minor (50%), moderate (36.9%) or severe (12.3%) levels. The average fatigue score was 4.5 ± 1.9). The Brief Fatigue Inventory had a good internal consistency (Cronbach’s alpha = 0.973) and proved to be one-dimensional (84.3% of the explained variance). Women reported that fatigue interfered more with enjoy­ment of life than men (p = 0.036). Conclusions: The Brief Fatigue Inventory is a reliable instrument that can be used in clinical practice. It allows a quick assessment of the level of fatigue. People treated for hematologic cancer have a high prevalence of fatigue. <![CDATA[<strong>Aplicaciones torácicas del ultrasonido</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700012&lng=es&nrm=iso&tlng=es The use of thoracic ultrasound as a diagnostic tool in the emergency department, intensive care unit or in patients with pulmonary diseases is increasing steadily. It is used to guide percutaneous tracheostomies, to assess pleural effusions, to rule out pneumothorax, and to guide the placement of endovascular and pleural catheters. It is also useful in the assessment of patients with dyspnea. The aim of this review is to provide the practical and technical basics for the use of this diagnostic tool among internists and specialists in pulmonary diseases. <![CDATA[<strong>Rol de la microbiota gastrointestinal en la regulación de la respuesta inmune</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700013&lng=es&nrm=iso&tlng=es The gastrointestinal tract hosts around 10(14) bacterial microorganisms, in a constantly growing density from the stomach to the distal colon. This microbiota is composed by more than 500 species of bacteria, which are quickly acquired after birth, fairly stable during the host’s life, and essential for human homeostasis. These bacteria have important functions, such as stimulating the immune system, protecting the host from invading bacteria and viruses, and improving digestion, especially of complex carbohydrates. Also, the gut microbiota interacts directly with the immune system. However, the interaction of the intestinal epithelium and its microbiota with the immune system has yet to be fully understood. Secretory immunoglobulin A, produced by the plasma cells in Peyer’s patches and in the lamina propria, maintains non-invasive commensal bacteria and neutralize invasive pathogens. Dendritic cells migrate from the lamina propria of the secondary lymphoid organs to regulate gut immunity. They also have a key role maintaining luminal IgA and inducing the growth of regulatory T cells. Dendritic cells supervise the gut microenvironment too, keeping an immunological equilibrium and tolerance. The importance of the gut microbiota in regulating the immune system lies mostly in the homeostasis-or positive equilibrium. Thus, many diseases are a consequence of poor interactions or a loss of this equilibrium. <![CDATA[<strong>Medicina de urgencia y unidades de cuidados intensivos</strong>: <strong>Una alianza necesaria en busca de la mejoría de la atención de pacientes críticos</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700014&lng=es&nrm=iso&tlng=es The need for critical care services is increasing in Chile. Critical care beds and specialists in this area are scarce. In this article we discuss some aspects that hamper the care of critically ill patients from their arrival to the emergency department to their transfer to the ICU. Special emphasis is given to system saturation and its multiple causes. The benefits of an integrative approach between emergency medicine and critical care specialists are highlighted and some solutions are proposed to strengthen this partnership. <![CDATA[<strong>Salud mental en Chile y Finlandia</strong>: <strong>desafíos y lecciones</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700015&lng=es&nrm=iso&tlng=es This article analyses and compares the epidemiology of mental disorders and relevant public policies in Chile and Finland. In Chile, a specific mental health law is still lacking. While both countries highlight the role of primary care, Finland places more emphasis on participation and recovery of service users. Comprehensive mental health policies from Finland, such as a successful suicide prevention program, are presented. Both countries have similar prevalence of mental disorders, high alcohol consumption and high suicide rates. In Chile, the percentage of total disease burden due to psychiatric disorders is 13% and in Finland 14%. However, the resources to address these issues are very different. Finland spends 4.5% of its health budget on mental health, while in Chile the percentage is 2.2%. This results in differences in human resources and service provision. Finland has five times more psychiatric outpatient visits, four times more psychiatrists, triple antidepressant use and twice more clinical guidelines for different psychiatric conditions. In conclusion, both countries have similar challenges but differing realities. This may help to identify gaps and potential solutions for public health challenges in Chile. Finland’s experience demonstrates the importance of political will and long-term vision in the construction of mental health policies. <![CDATA[<strong>Síndrome de Cushing iatrogénico por corticoides inhalados en paciente VIH</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700016&lng=es&nrm=iso&tlng=es We report a 41-year-old man with HIV and a chronic obstructive pulmonary disease, treated for seven months with Fluticasone/Salmeterol and antiretroviral therapy (Lamivudine, Tenofovir, Atazanavir and Ritonavir). While using these medications, the patients developed a Cushing syndrome in a period of five months. After performing laboratory and imaging tests, it was concluded that the most probable cause of the syndrome was the interaction of inhaled steroids with Ritonavir. After discontinuing these medications the syndrome reverted in a period of 8 months. <![CDATA[<strong>Fístula coronaria gigante. Presentación clínica, caracterización angiográfica, tratamiento y seguimiento a largo plazo</strong>: <strong>Caso clínico</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700017&lng=es&nrm=iso&tlng=es Coronary artery fistulae are abnormal connections between a coronary artery and any cardiac chamber or other vessels. Most of them have a congenital origin. We report a 60 years old woman referring a history of progressive dyspnea and orthopnea during the last year. A continuous heart murmur was audible in the third and fourth intercostal spaces at the left sternal border. Electrocardiogram was normal and echocardiography showed mild dilation of right cavities and an image suggesting a dilated right coronary artery with flow to right atrium. Coronary angiography was performed, showing a normal left coronary artery and a very large, tortuous right coronary artery with an extensive communication to coronary venous sinus. Surgical treatment was decided and was performed without incidents. The patient is well after five years of follow up. <![CDATA[<strong>Responsabilidad médica: el dilema entre la Justicia civil y la penal</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700018&lng=es&nrm=iso&tlng=es Coronary artery fistulae are abnormal connections between a coronary artery and any cardiac chamber or other vessels. Most of them have a congenital origin. We report a 60 years old woman referring a history of progressive dyspnea and orthopnea during the last year. A continuous heart murmur was audible in the third and fourth intercostal spaces at the left sternal border. Electrocardiogram was normal and echocardiography showed mild dilation of right cavities and an image suggesting a dilated right coronary artery with flow to right atrium. Coronary angiography was performed, showing a normal left coronary artery and a very large, tortuous right coronary artery with an extensive communication to coronary venous sinus. Surgical treatment was decided and was performed without incidents. The patient is well after five years of follow up. <![CDATA[<strong>Estacionalidad de la cefalea en el hemisferio norte y el hemisferio sur: una aproximación utilizando <i>Google Trends</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000700019&lng=es&nrm=iso&tlng=es Coronary artery fistulae are abnormal connections between a coronary artery and any cardiac chamber or other vessels. Most of them have a congenital origin. We report a 60 years old woman referring a history of progressive dyspnea and orthopnea during the last year. A continuous heart murmur was audible in the third and fourth intercostal spaces at the left sternal border. Electrocardiogram was normal and echocardiography showed mild dilation of right cavities and an image suggesting a dilated right coronary artery with flow to right atrium. Coronary angiography was performed, showing a normal left coronary artery and a very large, tortuous right coronary artery with an extensive communication to coronary venous sinus. Surgical treatment was decided and was performed without incidents. The patient is well after five years of follow up.