Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720160010&lang=pt vol. 144 num. 10 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<b><i>Association of C reactive protein levels with metabolic syndrome in adults</i></b>: <b><i>a population-based study</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000001&lng=pt&nrm=iso&tlng=pt Background: Metabolic syndrome is highly prevalent among adults in Chile and represents a health risk. Aim: To determine the relationship between metabolic syndrome (MetS) and its components, with C reactive protein levels (CRP) as an inflammation marker. Material and Methods: The population studied consisted of 736 individuals born in a hospital from Valparaíso Region, aged between 32-38 years at the time of the study. MetS was identified according to the Adult Treatment Panel (ATP) III guidelines and inflammation was measured using ultra-sensitive CRP. This parameter was classified as normal for values from 0 to 3 mg/L, high for values from 3.01 to 10 mg/L and very high for values &gt; 10 mg/L. Results: Median CRP was in the normal range (1.9 mg/L, interquartile range 0.7-5.2) and was higher among women than men (2.2 and 1.4 mg/L respectively, p < 0.01). Twenty seven percent of participants had MetS. One-fourth had high blood glucose values, one-third had high triglyceride levels and 28% had blood pressure values over those established as normal in MetS. Elevated waist circumference (WC) and low HDL cholesterol were found among almost 50% of participants. A relationship between MetS and high CRP was only found among men with an Odds ratio (OR) of 2.04 (95% confidence intervals (CI): 1.11-3.73). The same association was observed for high triglyceride levels with an OR of 2.02 (CI: 1.17-3.49) and high WC with an OR of 3.89 (CI: 2.06-7.36). Among women, the only relationship observed was between abdominal obesity and very high CRP with an OR of 2. 65 (CI: 1.20-5.84). Conclusions: Metabolic syndrome, high triglyceride levels, and abdominal obesity were associated with inflammation only in men. <![CDATA[<b><i>Effect of meal frequency and carbohydrate intake on the metabolic control of patients with type 2 diabetes mellitus</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000002&lng=pt&nrm=iso&tlng=pt Background: Increasing meal frequency is commonly used in the clinical practice as part of the nutritional treatment of patients with type 2 Diabetes Mellitus (DM2), although its effect on metabolic control parameters is controversial. Aim: To evaluate the association of energy intake, meal frequency, and amount of carbohydrates with fasting plasma glucose and glycosylated hemoglobin in a group of patients with DM2 without insulin therapy. Material and Methods: Dietary intake was evaluated in 60 subjects with DM2 through three-day food records. The meal frequency was estimated establishing the main meal times considering snacks. Results: Meal frequency was 4.7 ± 1.1 times per day. There was a positive association between glycosylated and fasting blood glucose levels (p <0.01). Meal frequency was associated with energy intake (p <0.01). When meal frequency, available carbohydrates and energy intake, body mass index and fasting plasma glucose were analyzed in a multiple linear regression model, fasting blood glucose was the variable that best predicted changes in glycosylated hemoglobin (45.5%). Meal frequency had no association with glycosylated hemoglobin. Conclusions: Meal frequency showed no association with metabolic control parameters in DM2 patients. <![CDATA[<b><i>Effects of 12 sessions of high intensity intermittent training and nutrition counseling on body fat in obese and overweight participants</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000003&lng=pt&nrm=iso&tlng=pt Background: The search of efficient exercise alternatives to treat obesity is worthwhile. Aim: To demonstrate the effect of high intensity intermittent exercise on body fat reduction in overweight and obese subjects. Material and Methods: A group of 65 overweight and obese adult subjects (25 men), aged 18-65 years, participated during 12 sessions in a high intensity physical exercise program, 3 days/week. Weight, height and body fat was measured before and after the intervention by bioimpedance. Each session consisted of 1 min stationary cycling exercise at high intensity, followed by 2 min inactive rest. This cycle was repeated 10 times, thus the method is called 1*2*10. Results: There was a significant reduction of body fat of -1.88 ± 2.8 and -3.44 ± 2.7 kg, in women and men, respectively (p < 0.05). Conclusions: The 1*2*10 training protocol lasting 12 weeks in association with nutrition counseling is effective in reducing body fat in overweight persons. <![CDATA[<b><i>Implications of chilean legal framework in teen pregnancy prevention</i></b>: <b><i>conflict and insecurity in health professionals</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000004&lng=pt&nrm=iso&tlng=pt Background: Teenage pregnancy is a psychosocial and multifactorial problem described as a lack of exercise of rights in sexual and reproductive health. There are important aspects in the doctor-patient relationship and confidentiality that directly affect the continuity and quality of care. There are controversies in the laws relating to the provision of contraception and confidentiality, and those that protect the sexual indemnity, especially in adolescents under 14 years. Aim: To describe the implications of the legal framework for professional midwives in the care of adolescents younger than 14 years in sexual and reproductive health. Material and Methods: In-depth interviews were conducted to 13 female and 2 male midwives working at Primary Health Care Centers in the Metropolitan Region. Results: The attention of adolescents younger than 14 years in sexual and reproductive health involves medical-legal issues for health professionals. All professionals recognize that mandatory reporting sexual activity is a complex situation. All professionals notify pregnancies. In relation to the delivery of contraception, clinical care is problematic since professionals should take shelter from a legal standpoint. Conclusions: The medical-legal context of pregnant women under 14 years of age care generates a context of uncertainty and fear for professionals and becomes a source of conflict and insecurity in the exercise of the profession. <![CDATA[<b><i>Thrombolysis in stroke mimics</i></b>: <b><i>Experience in 10 cases</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000005&lng=pt&nrm=iso&tlng=pt Background: The effectiveness of intravenous thrombolysis (IVT) in cerebral ischemia is time dependent. Stroke mimics (SM) are frequent in emergency rooms. The effort to reduce door to needle time, can lead to administer thrombolytics to SM. Aim: To describe the frequency and prognosis of SM treated with IVT. Material and Methods: Prospective analysis of all patients evaluated in a Chilean private clinic between December 2004 and July 2015 with a suspected acute ischemic stroke (AIS). We calculated the number of SM that were treated with IVT. In these patients, we analyzed the presence of symptomatic cerebral hemorrhage defined as the presence of a neurological deterioration of four points or more on the National Institute of Health Stroke Scale, the presence of extracranial bleeding according to Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries criteria and the patient’s functional status at three months by modified Rankin scale (MRS). Results: We evaluated 1,417 patients with suspected AIS, of which 240 (16.9%) were finally diagnosed as SM. A total of 197 patients were treated with IVT, of these 10 (5%) corresponded to SM. All SM patients treated with thrombolytic drugs were functionally independent at 3 months and showed no bleeding complications. Conclusions: Occasionally SM patients were treated with IVT. This treatment was not associated with bleeding complications and the prognosis of these patients at three months was favorable. <![CDATA[<b><i>Healthcare mistreatment attributed to discrimination among mapuche patients and discontinuation of diabetes care</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000006&lng=pt&nrm=iso&tlng=pt Background: The negative impact of perceived discrimination on health outcomes is well established. However, less attention has been directed towards understanding the effect of perceived discrimination on health behaviors relevant for the treatment of diabetes in ethnic minorities. Aim: To examine the effects of healthcare mistreatment attributed to discrimination on the continuity of Type 2 Diabetes (DM2) care among mapuche patients in a southern region of Chile. Material and Methods: A non-probabilistic sample of 85 mapuche DM2 patients were recruited from public and private health systems. Eligibility criteria included having experienced at least one incident of interpersonal healthcare mistreatment. All participants answered an instrument designed to measure healthcare mistreatment and continuity of diabetes care. Results: Healthcare mistreatment attributed to ethnic discrimination was associated with the discontinuation of diabetes care. Conclusions: Healthcare mistreatment attributed to discrimination negatively impacted the continuity of diabetes care, a fact which may provide a better understanding of health disparities in ethnic minorities. <![CDATA[<b><i>Role of coronary computed tomography angiography for the diagnosis of coronary anomalies</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000007&lng=pt&nrm=iso&tlng=pt Background: Coronary anomalies are rare heart diseases that can cause sudden cardiac death, especially in young individuals. Coronary computed tomography angiography delivers a three-dimensional view of excellent quality with information of the origin, course and anatomic relationships of the anomalous vessel, allowing differentiation between benign and malignant variants, entities that require different management and treatment. Aim: To show that coronary computed tomography angiography is the non-invasive technique of choice for the evaluation of a coronary anomaly due to its high diagnostic accuracy. Material and Methods: Between 2008 and 2014, 368 coronary computed tomography angiographies were carried out. Six (1.6%) patients had a coronary anomaly. Results: The age of these six patients ranged from 38 to 82 years (five were women). The coronary computed tomography angiography was requested due to cardiac symptoms (angina and dyspnea) in two patients, after a selective coronary arteriography to obtain additional information of the coronary anomaly in three patients, and after a cardiorespiratory arrest in one patient. Three patients had an anomaly of the right coronary artery, two patients had an anomaly of the left coronary artery and one patient had absent left main coronary artery. In five patients the coronary anomaly was malignant. Conclusions: Coronary computed tomography angiography is a robust diagnostic method to evaluate patients with suspected coronary anomalies. <![CDATA[<b><i>Wellbeing of Chilean older adults is associated with group participation</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000008&lng=pt&nrm=iso&tlng=pt Background: Subjective aspects such as personal growth and the development of their potential are relevant for the perception of wellbeing of older adults. These dimensions appear to be connected with meaningful group participation. Aim: To assess the perception of psychological wellbeing of older adults in a Chilean region and determine its association with socio-demographic variables and participation in organizations. Material and Methods: Ryff’s scale of psychological wellbeing perception was applied to 101 adults (43 men) from Magallanes, aged 60 and 88 years. Sociodemographic data was also collected. Results: Mean wellbeing scores reported were 193.7 ± 20 (maximum score: 234). Those older adults who participated in organizations had higher scores than those who did not take part in them. Participation in organizations appeared to be specifically associated to positive relationships (p = 0.03) and personal growth (p < 0.01). The number of organizations in which older adults participated was positively correlated with the perception of wellbeing (p < 0.01). Greater personal wellbeing was associated with leadership roles in organizations (p = 0.01). Significant differences between level of schooling and personal growth (p = 0.01) were also observed found. There were no differences associated with sex, age and marital status. Conclusions: The perception of wellbeing of older adults is influenced by their participation in organizations. Leadership is associated with the highest levels of wellbeing. <![CDATA[<b><i>Characteristics and evolution of patients admitted to a public hospital intensive care unit</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000009&lng=pt&nrm=iso&tlng=pt Background: The epidemiology of critical patients in Chile could differ from that reported in international studies. Aim: To describe the causes of admission and evolution of patients who were admitted to the ICU (Intensive Care Unit) of a general hospital in Chile in a two-year period (2012-2013). Patients and Methods: A retrospective study was carried out using the ICU database. The following variables were registered: admission diagnosis, APACHE II (Acute Physiology and Chronic Health Evaluation), days of mechanical ventilation (MV), ICU length of stay and ICU and hospital survival. Results: We analyzed data from 1075 aged 54 ± 18 years (55% males), representing 75% of the admissions during the study period. The median ICU and MV lengths were 5 and 3 days respectively (92% of patients required MV). APACHE II was 20.5 ± 8.2. The ICU and hospital mortality rate were 19.4% and 31%, respectively. Critical neurological diseases were the most common diagnoses requiring ICU, representing 26.8% of the admissions. No differences were found between 2012 and 2013 in age, APACHE II, ICU or hospital survival. A longer post ICU length of stay was found during 2013, both for patients who survived and those who died at the hospital. Conclusions: This study highlights the high percentage of patients that required MV and the high percentage critical neurological conditions requiring ICU admission. The characteristics and evolution of patients admitted to the ICU did not differ during 2012 and 2013. <![CDATA[<b><i>Recommendations for the management of pancreatic cancer type adenocarcinoma</i></b>: <b><i>A consensus statement reached during the 2015 Latin American Symposium on Gastroenterological Oncology</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000010&lng=pt&nrm=iso&tlng=pt Pancreatic cancer is a malignancy of great impact in developed countries and is having an increasing impact in Latin America. Incidence and mortality rates are similar for this cancer. This is an important reason to offer to the patients the best treatments available. During the Latin American Symposium of Gastroenterology Oncology (SLAGO) held in Viña del Mar, Chile, in April 2015, a multidisciplinary group of specialists in the field met to discuss about this disease. The main conclusions of this meeting, where practitioners from most of Latin American countries participated, are listed in this consensus that seek to serve as a guide for better decision making for patients with pancreatic cancer in Latin America. <![CDATA[<b>Towards universal access to health care</b>: <b>incorporation of advanced practice nurses in primary care</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000011&lng=pt&nrm=iso&tlng=pt To move towards universal access to health, the Pan American Health Organization recommends strengthening primary health care (PHC). One of the strategies is to increase the number qualified professionals, both medical and non-medical, working in PHC. In Chile there is a lack of professionals in this level of care, hampering the provision of health. Physicians still prefer secondary and tertiary levels of health. International experience has shown that advanced practice nurses (APN), specialists in PHC are cost-effective professionals able to deliver a complete and quality care to patients. Strong evidence demonstrates the benefits that APN could provide to the population, delivering nursing care that incorporates medical tasks, for example in patients with chronic diseases, allowing greater availability of medical hours for patients requiring more complex management. The success in the implementation of this new role requires the support of the health team, especially PHC physicians, endorsing and promoting the benefits of the APN for the population. <![CDATA[<b>What is human infection with Zika virus?</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000012&lng=pt&nrm=iso&tlng=pt To move towards universal access to health, the Pan American Health Organization recommends strengthening primary health care (PHC). One of the strategies is to increase the number qualified professionals, both medical and non-medical, working in PHC. In Chile there is a lack of professionals in this level of care, hampering the provision of health. Physicians still prefer secondary and tertiary levels of health. International experience has shown that advanced practice nurses (APN), specialists in PHC are cost-effective professionals able to deliver a complete and quality care to patients. Strong evidence demonstrates the benefits that APN could provide to the population, delivering nursing care that incorporates medical tasks, for example in patients with chronic diseases, allowing greater availability of medical hours for patients requiring more complex management. The success in the implementation of this new role requires the support of the health team, especially PHC physicians, endorsing and promoting the benefits of the APN for the population. <![CDATA[<b><i>Antidepressants agents in breast cancer patients using tamoxifen</i></b>: <b><i>review of basic and clinical evidence</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000013&lng=pt&nrm=iso&tlng=pt Tamoxifen (Tmf), is a standard of care for women with estrogen receptor positive (ER+) breast cancer. Endoxifen is a Tmf metabolite generated by cytochrome P450 2D6 (CYP2D6). Antidepressive agents (AD) are often prescribed to women with breast cancer not only for depression, but also for anxiety and hot flashes. Some AD are substrates or inhibitors of the Tmf metabolic pathway. Therefore there may be interactions when Tmf and AD are prescribed simultaneously. Oncologic protection afforded by Tmf may become less effective or null when AD are indicated, especially in poor metabolizing patients. We performed an update of the literature about the criteria for choosing AD in women receiving Tmf. Tricyclic AD, paroxetine and fluoxetine should be avoided in patients receiving Tmf, because they are strong inhibitors of CYP2D6. Bupropion, duloxetine and sertraline are only moderate inhibitors of the cytochrome and are not contraindicated. Citalopram, desvenlafaxine, escitalopram, milnacipran and venlafaxine are recommended, because they do not influence the metabolism and clinical efficacy of Tmf and have fewer drug interactions. However, other additional pharmacological and clinical issues should be considered when choosing an antidepressant in women with breast cancer. <![CDATA[<b><i>Assessment of patients’ capacity to give a valid consent</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000014&lng=pt&nrm=iso&tlng=pt Autonomy is an inherent condition of every ethical act. This attribution is expressed, when decisions are made, as capacity. Physician-patient alliance is defied when there is a reasonable doubt of patients’ ability to make a choice, an extraordinarily complex scenario. As a response, in the last few decades multiple tools have been developed aiming to determine in a standardized fashion whether capacity is present or not. In the present article, we present a classification of the most well-known tools and discuss their usefulness, the implications for standardization of capacity, and make recommendations for their use, based in evidence. <![CDATA[<b><i>Factors affecting the educational environment in undergraduate medical schools</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000015&lng=pt&nrm=iso&tlng=pt Background: Educational environment has an important effect on the quality of learning and student satisfaction in medicine. Most of previous studies have been conducted using questionnaires that assess the phenomenon considering overall dimensions, without paying attention to the specific manifestations of this topic, especially those aspects that are related to the protagonists of the learning process: teachers and students. Aim: To describe factors that affect the educational environment in the preclinical Medical formation, according to Medical teachers in Concepción, Chile. Material and Methods: Qualitative study, using the Grounded theory method. Semi-structured interviews were performed to 10 medical teachers in Concepcion, Chile. They were selected by theoretical sampling. Data were analyzed using open coding. Results: Four emerging categories about the factors that affect the learning environment were identified: Personal factors of students, academic factors of students, personal factors of teachers and academic factors of teachers. Conclusions: According to interviewed teachers, both personal factors in teachers and students that promote a positive learning environment are related with an attitude oriented towards others and communication skills. Academic factors are related with the responsible exercise of student and teacher roles and with the promotion of participation in the educational process. <![CDATA[<b><i>Antineutrophil cytoplasmic antibody (ANCA) associated renal vasculitis and pregnancy</i></b>: <b><i>Report of one case</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000016&lng=pt&nrm=iso&tlng=pt ANCA mediated vasculitis mainly occur between the fourth and fifth decade of life; therefore, it is very uncommon to see pregnant patients with the disease. Vasculitis may affect significantly the course of pregnancy; in turn pregnancy can change the course of vasculitis. We report a 20 years old woman with ANCA-mediated renal vasculitis lasting 10 years who consulted with a pregnancy of 15 weeks. She was in remission and had amenorrhea attributed to ovarian toxicity due to cyclophosphamide. Pregnancy had an uneventful course with spontaneous delivery at the 37th week, giving birth to a healthy newborn. Proteinuria increased during the course of pregnancy with a mild deterioration of kidney function. During the year after delivery, she had nephrotic proteinuria and a worsening of renal function. <![CDATA[<b>Fatal interstitial lung disease associated with maximum androgen blockade</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000017&lng=pt&nrm=iso&tlng=pt Maximum androgen blockade is the standard endocrine treatment for advanced prostate cancer. Interstitial lung disease in different degrees of severity, with low mortality and excellent response to treatment may appear with its use. We report a 77 years old patient with advanced prostate cancer who developed severe and progressive respiratory failure associated to bilateral pulmonary infiltrates, attributed to the direct effect of maximum androgen blockade. Despite the therapeutic efforts, the patient died. Lung pathology revealed Usual Interstitial Pneumonia. <![CDATA[<b>Normoglycemic diabetic ketoacidosis in pregnancy</b>: <b>Report of one case</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000018&lng=pt&nrm=iso&tlng=pt Normoglycemic diabetic ketoacidosis should be suspected in pregnant women presenting nausea, vomiting, abdominal pain and anorexia. We report a 39 years old woman with a 32 weeks pregnancy who sought emergency care due to hyperemesis. She was hospitalized with the following diagnoses: pregnancy hypertension syndrome, gestational diabetes, morbid obesity and poor prenatal control. The evaluation of the feto-placental unit showed perception of fetal movements, non-reactive non-stress baseline record and a biophysical profile of 6/8. Fetal maturation was initiated. Laboratory tests showed a metabolic acidosis, a low pH, an increased Gap anion, elevated ketonemia and a blood glucose of 172 mg/dl. A diagnosis of normoglycemic diabetic ketoacidosis was formulated and treatment with hydration and regular insulin according to capillary blood glucose levels was started. An emergency caesarean section was performed. The newborn weighed 2.650 kg, had a length of 46 cm, was large for gestational age, had an Apgar score of 2.7, had perinatal asphyxia, convulsive syndrome and a possible congenital cardiopathy. Once the ketoacidosis was resolved during the immediate puerperium, slow acting insulin was initiated. <![CDATA[<b>Chilean Healthcare Professionals’ Perception of Knowledge about Dementia</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000019&lng=pt&nrm=iso&tlng=pt Normoglycemic diabetic ketoacidosis should be suspected in pregnant women presenting nausea, vomiting, abdominal pain and anorexia. We report a 39 years old woman with a 32 weeks pregnancy who sought emergency care due to hyperemesis. She was hospitalized with the following diagnoses: pregnancy hypertension syndrome, gestational diabetes, morbid obesity and poor prenatal control. The evaluation of the feto-placental unit showed perception of fetal movements, non-reactive non-stress baseline record and a biophysical profile of 6/8. Fetal maturation was initiated. Laboratory tests showed a metabolic acidosis, a low pH, an increased Gap anion, elevated ketonemia and a blood glucose of 172 mg/dl. A diagnosis of normoglycemic diabetic ketoacidosis was formulated and treatment with hydration and regular insulin according to capillary blood glucose levels was started. An emergency caesarean section was performed. The newborn weighed 2.650 kg, had a length of 46 cm, was large for gestational age, had an Apgar score of 2.7, had perinatal asphyxia, convulsive syndrome and a possible congenital cardiopathy. Once the ketoacidosis was resolved during the immediate puerperium, slow acting insulin was initiated. <![CDATA[<b>Older adults and hiv</b>: <b>beyond risk perception</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016001000020&lng=pt&nrm=iso&tlng=pt Normoglycemic diabetic ketoacidosis should be suspected in pregnant women presenting nausea, vomiting, abdominal pain and anorexia. We report a 39 years old woman with a 32 weeks pregnancy who sought emergency care due to hyperemesis. She was hospitalized with the following diagnoses: pregnancy hypertension syndrome, gestational diabetes, morbid obesity and poor prenatal control. The evaluation of the feto-placental unit showed perception of fetal movements, non-reactive non-stress baseline record and a biophysical profile of 6/8. Fetal maturation was initiated. Laboratory tests showed a metabolic acidosis, a low pH, an increased Gap anion, elevated ketonemia and a blood glucose of 172 mg/dl. A diagnosis of normoglycemic diabetic ketoacidosis was formulated and treatment with hydration and regular insulin according to capillary blood glucose levels was started. An emergency caesarean section was performed. The newborn weighed 2.650 kg, had a length of 46 cm, was large for gestational age, had an Apgar score of 2.7, had perinatal asphyxia, convulsive syndrome and a possible congenital cardiopathy. Once the ketoacidosis was resolved during the immediate puerperium, slow acting insulin was initiated.