Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720150001&lang=pt vol. 143 num. 1 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<strong>Adverse events associated with the treatment of inflammatory bowel disease</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100001&lng=pt&nrm=iso&tlng=pt Background: The purpose of inflammatory bowel disease (IBD) treatment is to achieve resolution of symptoms and remission of disease with a minimum of adverse events (AE). Aim: To report AE of different prescriptions used for the treatment of IBD. Material and Methods: Analysis of a registry of patients with IBD held at a private clinic from 1976 to 2013. All used medications, the occurrence and severity of AE were recorded. Results: The records of 346 patients aged 16 to 86 years, 74% with ulcerative colitis, were analyzed. The most commonly type of medications prescribed were 5-aminosalicylates (5-ASAs) in 329 patients (92%), followed by adrenal steroids in 218 (61%). Forty nine AE were recorded in the same number of patents (14%). These were more common in patients with Crohn disease (n = 19, 21%). An univariate analysis, demonstrated that extra-intestinal manifestations, hospitalizations secondary to IBD crisis, requirement of surgery and treatment with steroids, immunosuppressants or biologic agents were significantly associated with the presence of AE. AEs were more common with immunosuppressants, followed by 5-ASAs and steroids. Discontinuation of therapy was required in 79, 100 and 43% of patients taking these medications, respectively. Twenty percent of AEs were severe. Leukopenia and pancytopenia along with alopecia were the most common AEs attributable to azathioprine. Conclusions: The occurrence of AEs in patients with IBD is uncommon. Even inmunosuppressants or biologic agents have a low rate of AE and most of them mild. <![CDATA[<strong>Cardiac adverse effects of domperidone in adult patients</strong>: <strong>a systematic review</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100002&lng=pt&nrm=iso&tlng=pt Background: Domperidone is widely prescribed in patients with gastrointestinal disorders but some cardiac adverse effects have been recently reported. Aim: To evaluate the risk of QT prolongation, ventricular arrhythmias and sudden cardiac death associated with the use of oral domperidone in adults without cancer. Material and Methods: Systematic searches in MEDLINE, LILACS, SciELO, the Cochrane Library and regulatory agencies websites were performed, followed by a manual search of cited references. The search strategy consisted of combining free and indexed text words without any date or language restriction. Results: Three case-control studies met the inclusion criteria; none of them evaluated QT interval prolongation. With low risk of bias, each study quantified the risk of ventricular arrhythmia or sudden cardiac death (VA/SCD). The odds ratios for these events in these studies were 4.7 (95% confidence interval (CI): 1.4-16), 1.59 (95% CI: 1.28-1.98) and 11.02 (95% CI: 2.02-62.3) respectively. A significantly increased risk was observed in patients older than 60 years of age or receiving doses > 30 mg/day. Conclusions: Heterogeneity between selected studies did not allow the computation of a summary measure. However, evidence was found that an increased risk of VA/SCD is associated with the use of oral domperidone in adults. <![CDATA[<strong>Positron emission tomography/computed tomography for lung cancer staging</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100003&lng=pt&nrm=iso&tlng=pt Background: PET/CT (Positron Emission Tomography/Computed Tomography) is widely used in nodal and metastatic staging of lung cancer patients. Aim: To analyze PET/CT detection of metastatic disease in patients with lung cancer. Material and Methods: We reviewed retrospectively F18Fluorodeoxyglucose PET/CT scans performed between December 2008 and December 2013. We selected 143 patients aged 30 to 92 years (63% males) with confirmed lung cancer referred for staging, with no previous treatment. We reviewed whole body PET/CT and brain magnetic resonance images. SUVmax (Standardized Uptake Value maximum) of primary pulmonary lesion, hilar/mediastinal nodes, and distant metastases were calculated. Results: Histological types encountered were adenocarcinoma in 55%, squamous-cell in 15%, small-cell in 8%, large-cell in 6% and adeno-squamous in 2%. In 22 cases (15%) histology was not available. Nodal involvement was observed in 60% of patients (44% hilar and 48% mediastinal). Skip metastases (mediastinal involvement without hilum involvement) were encountered in 17% of cases, and were significantly more common among high uptake lung tumors (p < 0.01). Best SUVmax cut-off for node involvement was 4.4 for hilum and 4.0 for mediastinum (sensibility: 86.4%, specificity: 99.8%). Sixty six patients (46.2%) showed distant metastases on PET/CT. The most common metastases were osseous in 22%, adrenal in 16%, hepatic in14%, pulmonary in 14% and cerebral in 12%. PET/CT detected a second unexpected synchronic cancer in eight patients (6%). Conclusions: PET/CT is accurate for nodal staging using an uptake index as SUVmax. Distant metastases are common, especially in bone, adrenal glands and liver. <![CDATA[<strong>Primary care consultations due to respiratory diseases in the period 2003-2008</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100004&lng=pt&nrm=iso&tlng=pt Background: Respiratory diseases are the third cause of death, and the second cause of hospitalization among people aged 65 years or more in Chile. Aim: To analyze the distribution of consultations due to respiratory diseases among adults living in Metropolitan Santiago. Material and Methods: A daily registry of all consultations of patients older than 15 years old in seven public primary care centers, was carried out between January 2003 and December 2008. Consultations were classified as having non-respiratory or respiratory causes. The latter were broke down in upper or lower respiratory diseases, pneumonia, chronic obstructive pulmonary disease (COPD) and asthma. Results: A total of 1,170,941 consultations were registered and 19% were due to respiratory diseases. Of these, 46% were due to upper respiratory diseases, 31% due to lower respiratory diseases, 8% due to COPD, 6% due to pneumonia, 5% due to asthma and 4% due to other respiratory causes. Pneumonia and COPD were more frequent among consultants older than 65 years. Conclusions: Consultations due to respiratory diseases are approximately one fifth of all primary care consultations. Older people often have more chronic and severe diseases. <![CDATA[<strong>Timed up and go right and left unipodal stance results in Chilean older people with different degrees of disability</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100005&lng=pt&nrm=iso&tlng=pt Background: The Preventive Health Examination of older people in Chile incorporates the timed up and go (TUG) and right and left unipodal stance test (RUPS and LUPS) as functional assessment methods. Aim: To assess if TUG and LUPS discriminate older people with different degrees of disability. Material and Methods: TUG, RUPS and LUPS were assessed in 860 participants aged 71.3 ± 6.9 years (591 females) attending a primary health care clinic. The results of the three tests were expressed in seconds. Participants were classified as non-disabled without any risk, non-disabled with risk and in risk of dependence, using the Functional Assessment of Older People of EFAM (the Spanish acronym), previously validated for Chilean older people. Results: In all participants TUG, LUPS and RUPS values were 8.9 ± 3.6, 10 ± 10.6 and 9.7 ± 10.3 seconds (sec) respectively. Among non-disabled participants without risk, the values for TUG, RUPS and LUPS were: 7.9 ± 2.3, 12.7 ± 11.1 and 12.2 ± 10.9 sec respectively. The figures for non-disabled participants with risk were 8.4 ± 2.6, 8.8 ± 9.8 and 8.9 ± 9.8 sec respectively. The figures for participants in risk of dependence were 11.7 ± 5.3, 5.1 ± 7.8 and 4.5 ± 7.1 sec, respectively. Conclusions: In this group of older participants there is an association between the degree of disability and the results of TUG, RUPS and LUPS. <![CDATA[<strong>Psychosocial stress among health care workers</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100006&lng=pt&nrm=iso&tlng=pt Background: Health care workers are exposed to high stress levels and psychosocial risks. The imbalance between the invested efforts and received rewards acquires special importance in this setting. Aim: To assess the psychosocial risk level and its relationship with depression, distress and psychotropic drug use among health care workers. Material and Methods: Seven hundred eighty two workers (602 females; 180 males) answered self-administered questionnaires to measure psychosocial risk and mental health. Results: Twenty five percent of respondents used psychotropic drugs, 34% had a high level of distress and 23% had depressive symptoms. They also reported a low level of decisional latitude (48%), high emotional demands (47%), low social support (41%) and a significant effort-reward imbalance (67%). Those exposed to job strain (high demands and low decisional latitude), iso-strain (job strain plus low social support), and effort-reward imbalance were twice as likely to suffer symptoms of depression and elevated distress compared to non-exposed subjects. Conclusions: There are high levels of psychosocial stress among health care workers. <![CDATA[<strong>Human papillomavirus testing in cervical cancer screening at a public health service of Santiago, Chile</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100007&lng=pt&nrm=iso&tlng=pt Background: Molecular techniques for human papillomavirus (HPV) detection have a good performance as screening tests and could be included in cervical cancer early detection programs. We conducted a population-based trial comparing HPV detection and Papanicolaou as primary screening tests, in a public health service in Santiago, Chile. Aim: To describe the experience of implementing this new molecular test and present the main results of the study. Material and Methods: Women aged 25 to 64 enrolled in three public health centers were invited to participate. In all women, samples were collected for Papanicolaou and HPV DNA testing, and naked-eye visual inspection of the cervix with acetic acid was performed. Women with any positive screening test were referred to the local area hospital for diagnostic confirmation with colposcopy and biopsy of suspicious lesions. Results: Screening results were obtained for 8265 women, of whom 931 (11.3%) were positive to any test. The prevalence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was 1.1%; nine women had invasive cervical cancer. Sensitivities for the detection of CIN2+ were 22.1% (95% confidence interval (CI) 16.4-29.2) for Papanicolaou and 92.7% (95% CI 84.4-96.8) for HPV testing; specificities were 98.9% (95% CI 98.7-99.0) and 92.0% (95% CI 91.4-92.6) respectively. Conclusion: This experience showed that the implementation of a molecular test for cervical cancer screening is not a major challenge in Chile: it was well accepted by both the health team and the participants, and it may improve the effectiveness of the screening program. <![CDATA[<strong>Safety and efficacy of Vildagliptin in real life Chilean diabetic patients</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100008&lng=pt&nrm=iso&tlng=pt Background: Vildagliptin is a dipeptidyl peptidase IV inhibitor (DPP4i). Its efficacy and safety of DPP4i in Chilean real life type 2 diabetic (T2D) patients is not well known. Aim: To assess the safety profile and effectiveness of 12 weeks of treatment with Vildagliptin for glycemic control in T2D Chilean patients with a poor glycemic control. Patients and Methods: Retrospective assessment of the effects of Vildagliptin treatment during 12 weeks in 103 T2D patients aged 29 to 92 years (47% males). The main outcomes were changes in glycosylated hemoglobin and the occurrence of adverse effects. Results: After 12 weeks of Vildagliptin use, glycosylated hemoglobin decreased from 8.3 ± 1.4 to 7.2 ± 1.1% (p < 0.01). Fasting plasma glucose and the number of hypoglycemic events also decreased significantly. No significant weight change was observed. The treatment had good compliance, tolerance and patient satisfaction. Conclusions: Vildagliptin treatment reduced glycosylated hemoglobin by 1.1% and was well tolerated in this group of diabetic patients. <![CDATA[<strong>Comparison of the use of isoproterenol or nitroglycerine during the Tilt test</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100009&lng=pt&nrm=iso&tlng=pt Background: There is debate about the advantages of different protocols usefulness of tilt test for the diagnosis of vasovagal collapse. Aim: To compare the sensitivity, specificity, adverse reactions, complications and time requirements of two different Tilt test protocols. Material and Methods: A Tilt test using isoproterenol in progressive doses (2 μg for 10 min and 5 μg for 5 min posteriorly was performed in 159 patients aged 9 to 84 years (59 males). Another Tilt test using sublingual nitroglycerine in doses of 0.3 mg was performed in 201 patients aged 8 to 87 years (62 males). Also, 20 healthy volunteers were tested. Results: The positivity rates of the tests using isoproterenol and nitroglycerin were 75.5 and 77.6% respectively (NS). The figures for sensitivity were 98.4 and 99.3% (NS). The figures for specificity were 93.2 and 98.4% (NS). The test using isoproterenol requires 15 more minutes. As adverse reactions, 38% of participants experienced palpitations with isoproterenol and 22% experienced headache with nitroglycerin. Conclusions: The Tilt test with nitroglycerin is shorter, simpler, painless, with less personnel involved and has the same diagnostic accuracy than the test with isoproterenol. <![CDATA[<strong>Association between obesity and chronic renal disease</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100010&lng=pt&nrm=iso&tlng=pt A higher frequency of chronic renal disease is observed in obese patients, suggesting a pathogenic association between both conditions. Obesity unmasks clinical manifestations of chronic kidney disease such as high blood pressure, which may accelerate its progression. Obesity also promotes hyper filtration and the appearance of microalbuminuria, activates the renin-angiotensin-aldosterone system and is associated with high levels of pro-inflammatory cytokines. Therefore weight reduction may slow the progression of chronic renal disease and reduce its associated cardiovascular risk factors. <![CDATA[<strong>Return to work enablers for workers with work-related mental illness</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100011&lng=pt&nrm=iso&tlng=pt Background: There is growing interest in the treatment and return-to-work of workers with labor related mental illnesses. Aim: To perform a systematic review of practices and interventions that improve return to work. Material and Methods: Systematic literature review. Thirty articles were selected for in- depth analysis. Results: Self efficacy perception, work motivation, a lower age and a better socioeconomic status were identified as worker-related return to work facilitators. Among work environment facilitators, good communication practices, supervisor support, a good assessment and modification of work load, adjustment of expectations, a good relationship between employers and employees and positive work experiences were identified. Treatment may improve return to work using a multidisciplinary approach, reducing stress and identifying psychosocial determinants of mental problems rather than symptoms and providing a timely health care. Conclusions: Return to work of workers with labor related mental illnesses requires a constant sharing of information between health care workers, employers and employees to identify common therapeutic objectives. <![CDATA[<strong>Considerations on the new Chilean law about rights and duties of patients</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100012&lng=pt&nrm=iso&tlng=pt After years of discussion by the Chilean legislature, the Law Nº 20.584, which regulates health care related rights and duties of people, entered into force in Chile in October 2012. This bill represents an important step in the recognition and protection of health care related rights, welfare, dignity and duties of persons. It also intends to protect potential participants in clinical research. However such protective measures include explicit prohibitions such as the review of clinical records or the inclusion of people with mental or psychological handicaps as research participants. We herein discuss the implications of this law in medical research. <![CDATA[<strong>Professor Hernán Alessandri, M.D. (1900-1980)</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100013&lng=pt&nrm=iso&tlng=pt Hernán Alessandri M.D. was an astounding clinician and a leading medical educator, born in Santiago in 1900 where he died in 1980. He received his medical degree at the University of Chile in 1923, became Professor of Clinical Medicine in 1932, Full Professor and Chair of Internal Medicine in 1944. At the Hospital del Salvador, in Santiago, he chaired a teaching Department and a Clinical Service that was an example for its academic environment and dedication to patients and students. From 1958 to 1962 he was Dean of the University of Chile Faculty of Medicine, conducting a reform of teaching curricula and organizing medical residency programs for the training of specialists, originally started in his own Service in 1952. The American College of Physicians awarded him the first foreign Honorary Membership. He was a founding Member of the Chilean Academy of Medicine (1964). In 1973 the University of Chile awarded him the Emeritus Professor status. He was considered by his peers, alumni and patients a brilliant clinician and an exceptional medical educator. Since 1980 a Social and Teaching Foundation bears his name and in 2014, with the occasion of the XXXV Chilean Congress of Internal Medicine, the Sociedad Médica de Santiago-Chilean Society of Internal Medicine created an annual lecture to render tribute to distinguished physicians and his name was one of the two selected to inaugurate them. <![CDATA[<strong>Professor Hernán Alessandri, M.D.</strong>: <strong>his legacy for the new generations of physicians</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100014&lng=pt&nrm=iso&tlng=pt Professor Alessandri died in 1980. We started our residency in Internal Medicine about 30 years later. Considering the profound changes our society has witnessed, including medical practice, I would like to approach the meaning of his work for our generation. It is not the Father’s figure nor his Aura what inspires us today. Neither is his personality nor his shape. His universality comes from his transcendent image as a teacher. Today’s teachers live rough times, their social status has changed, their professional requirements have grown exponentially, they have to adapt to social phenomena like the Internet and multiculturalism. Being a teacher nowadays demands to be a multifaceted expert. Things have changed since Professor Alessandri made rounds with his patients. But a deeper look allows us to understand that everything returns to where it started: professional deontology of the teacher, never fading but transcendent. We know that Doctor Alessandri had the natural gift to keep faithful to that code with consistency and perseverance. He excelled with integrity in every aspect including professional betterment, constructive work for his institution, collegiality, a warm relationship with students and a model of social values. Beyond virtues and personal defects he will keep on being the mould in which present teachers should be formed, engraved in their souls and in the subconscious of students that seek to learn. <![CDATA[<strong>Cystic degeneration of the popliteal artery</strong>: <strong>Report of one case</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100015&lng=pt&nrm=iso&tlng=pt Cystic degeneration of the popliteal artery is an uncommon cause of intermittent claudication. We report a 52 years old male consulting for intermittent claudication referred to the calf. The angiography showed a 93% stenosis in segment of 45 mm length of the left popliteal artery with a smooth surface, suggesting an extrinsic compression. A CT angiography of the lower limb suggested the presence of a cystic degeneration. The patient was operated and the middle third of the popliteal artery was excised. The pathological study of the surgical piece was informed as artery media cystic degeneration. <![CDATA[<strong>Changes in the pattern of substance use after bariatric surgery</strong>: <strong>report of one case</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100016&lng=pt&nrm=iso&tlng=pt Even though the benefits of bariatric surgery are supported by scientific evidence, its indications and contraindications must be revised to avoid its indiscriminate use. Substance use is more common in patients subjected to bariatric surgery than in the general population. After surgery, an increase in alcohol abuse has been reported. We report a 41 years old male, with morbid obesity, alcohol and cocaine use. After bariatric surgery, his alcohol tolerance significantly decreased, increasing the doses of cocaine and starting to consume it without alcohol. His high anxiety level and paranoid delusions, motivated him to seek help in a rehabilitation center where a Substance Dependence Disorder was diagnosed and received initial treatment. The cause of this adverse effect needs further research. Functional and anatomic changes in the digestive tract lead to a greater alcohol absorption and reduced alcohol dehydrogenase activity. Also neurochemical alterations may produce a displacement from compulsive use of food to compulsive use of addictive substances. <![CDATA[<strong>Pneumomediastinum and cutaneous necrosis in dermatomyositis</strong>: <strong>Report of one case</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100017&lng=pt&nrm=iso&tlng=pt We report a 37 years old male with a dermatomyositis treated with oral cyclophosphamide. He was admitted to the hospital due to a zone of skin necrosis with purulent exudate, located in the second left toe. A complete blood count showed a leukocyte count of 2,600 cells/mm³. A Chest CAT scan showed a pneumomediastinum with emphysema of adjacent soft tissue. Cyclophosphamide was discontinued and leukocyte count improved. The affected toe was amputated and a chest CAT scan showed a partial resolution of the pneumomediastinum. We discuss and review the pathogenesis, clinical presentation and management of pneumomediastinum and cutaneous necrosis in association with dermatomyositis. <![CDATA[<strong>Manual de diabetes mellitus</strong>: <strong>Diagnóstico y tratamiento</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100018&lng=pt&nrm=iso&tlng=pt We report a 37 years old male with a dermatomyositis treated with oral cyclophosphamide. He was admitted to the hospital due to a zone of skin necrosis with purulent exudate, located in the second left toe. A complete blood count showed a leukocyte count of 2,600 cells/mm³. A Chest CAT scan showed a pneumomediastinum with emphysema of adjacent soft tissue. Cyclophosphamide was discontinued and leukocyte count improved. The affected toe was amputated and a chest CAT scan showed a partial resolution of the pneumomediastinum. We discuss and review the pathogenesis, clinical presentation and management of pneumomediastinum and cutaneous necrosis in association with dermatomyositis. <![CDATA[<strong>Diagnosis of Spinocerebellar Ataxia type 3 (Machado-Joseph disease) in Chile</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100019&lng=pt&nrm=iso&tlng=pt We report a 37 years old male with a dermatomyositis treated with oral cyclophosphamide. He was admitted to the hospital due to a zone of skin necrosis with purulent exudate, located in the second left toe. A complete blood count showed a leukocyte count of 2,600 cells/mm³. A Chest CAT scan showed a pneumomediastinum with emphysema of adjacent soft tissue. Cyclophosphamide was discontinued and leukocyte count improved. The affected toe was amputated and a chest CAT scan showed a partial resolution of the pneumomediastinum. We discuss and review the pathogenesis, clinical presentation and management of pneumomediastinum and cutaneous necrosis in association with dermatomyositis. <![CDATA[<strong>Translational research in Health topics</strong>: <strong>A road for pragmatic and interdisciplinary research</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100020&lng=pt&nrm=iso&tlng=pt We report a 37 years old male with a dermatomyositis treated with oral cyclophosphamide. He was admitted to the hospital due to a zone of skin necrosis with purulent exudate, located in the second left toe. A complete blood count showed a leukocyte count of 2,600 cells/mm³. A Chest CAT scan showed a pneumomediastinum with emphysema of adjacent soft tissue. Cyclophosphamide was discontinued and leukocyte count improved. The affected toe was amputated and a chest CAT scan showed a partial resolution of the pneumomediastinum. We discuss and review the pathogenesis, clinical presentation and management of pneumomediastinum and cutaneous necrosis in association with dermatomyositis. <![CDATA[<strong>Pyoderma gangrenosum</strong>: <strong>excellent response to topical therapy</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000100021&lng=pt&nrm=iso&tlng=pt We report a 37 years old male with a dermatomyositis treated with oral cyclophosphamide. He was admitted to the hospital due to a zone of skin necrosis with purulent exudate, located in the second left toe. A complete blood count showed a leukocyte count of 2,600 cells/mm³. A Chest CAT scan showed a pneumomediastinum with emphysema of adjacent soft tissue. Cyclophosphamide was discontinued and leukocyte count improved. The affected toe was amputated and a chest CAT scan showed a partial resolution of the pneumomediastinum. We discuss and review the pathogenesis, clinical presentation and management of pneumomediastinum and cutaneous necrosis in association with dermatomyositis.