Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720170007&lang=pt vol. 145 num. 7 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[Association between socioeconomic status and survival after a first episode of myocardial infarction]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700827&lng=pt&nrm=iso&tlng=pt Background: A low socioeconomic status is associated with higher overall mortality rates. Aim: To assess the effect of socioeconomic inequalities on survival of patients hospitalized with a first myocardial infarction. Material and Methods: Analysis of hospital discharge and mortality databases of the Ministry of Health. Patients aged over 15 years discharged between 2002 and 2011 with a first myocardial infarction (code I-21, ICD-10) were identified. Their survival was verified with the mortality registry. Survival from 0 to 28 and from 29 to 365 days was analyzed. Socioeconomic status was determined using the type of health insurance, stratified as public insurance (low and medium status) and private insurance (high status). Prais-Winsten trend (P-W) and Cox survival analyses were done. Results: We analyzed 59,557 patients (69% males). Sixty three percent were of low socioeconomic status, 19% medium and 18% high. Between 2002 and 2011 the increase in survival was higher among patients of low socioeconomic status, mainly in women (P-W coefficients 0.58:0.31-0.86 in men and 1.12:0.84-1.41 in women for 0-28 days survival and 0.24:0.09-0.39 in men and 0.48:0.37-0.60 in women for 29-365 days survival, respectively). However, age and year of hospitalization adjusted analysis showed a higher mortality risk among patients of low socioeconomic status at 0-28 days (HR 1.67:1.53-1.83 for men and 1.49:1.34-1.66 for women) and at 29-365 days (HR 2.30:1.75-2.71 for men and 1.90:1.56-1.85 for women). Conclusions: Survival after a myocardial infarction improved in the last decade especially in patients of low socioeconomic status. However, subjects of this stratum continue to have a higher mortality. <![CDATA[Association of active commuting with obesity: findings from the Chilean National Health Survey 2009-2010]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700837&lng=pt&nrm=iso&tlng=pt Background: Active commuting is associated with a lower risk for obesity in developed countries. Aim: To investigate the association between active commuting and obesity risk in Chile. Material and Methods: Active commuting was measured using the Global Physical Activity Questionnaire (GPAQ v2) in 5,293 participants from the Chilean National Health Survey 2009-2010. Body mass index (BMI) and waist circumference (WC) were the study outcomes. The association between active commuting and obesity was investigated using linear and logistic regression analysis. Results: Thirty four percent of responders [95% confidence intervals (CI): 32.6-35.1] were passive commuters. Active commuters had a lower BMI and WC than their passive counterparts. Thirty minutes increment in active commuting were associated with a −0.20 kg.m-2 lower BMI [95% CI: −0.33 to −0.07, p &lt; 0.01] and a −076 cm lower WC [95% CI: −1.08 to −0.43, p &lt; 0.01]. The odds of having a BMI &gt; 25 kg.m-2 was 0.93 [95% CI: 0.88 to 0.98, p = 0.01] per every 30 minutes’ increment in active commuting, whereas the odds for central obesity was 0.87 [95% CI: 0.82 to 0.92, p &lt; 0.01]. Conclusions: Active commuting is associated with a lower adiposity and lower risk for obesity in Chilean adults. <![CDATA[Effects of high-intensity interval training and nutritional education in patients with type 2 diabetes]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700845&lng=pt&nrm=iso&tlng=pt Background: High-intensity interval training (HIIT) improves cardiometabolic markers, but its effects on the quality of life of patients with type 2 diabetes (T2D) is not well known. Aim: To determine the effects of a 12-week HIIT exercise program on cardiometabolic and quality of life variables of T2D patients. Material and Methods: Nine T2D women were assigned to a HIIT + nutritional education (GE) and 10, to a nutritional education alone group (GC). At baseline and after each intervention, anthropometric and body composition parameters using bio-impedance were assessed, and a blood sample was obtained to measure serum lipid levels, blood glucose and glycated hemoglobin. Quality of life was assessed using the SF-12 questionnaire adapted for the Chilean population. Results: There were no significant changes on the lipid profile variables in the GE group, although HDL cholesterol was increased significantly (p &lt; 0.05) in the GC group. Total fat mass was decreased in the GE group from 43.5 ± 1.5 to 41.9 ± 1.5%, p &lt; 0.01. Fasting glucose and glycated hemoglobin decreased in the GE group. There was a significant correlation between the decrease in total fat mass and that of glycated hemoglobin. There were significant increases in quality of life parameters; physical function, physical role, pain, general health, vitality, emotional role, mental health, and social function in the GE but not in the GC group. Conclusions: A 12-week program of HIIT plus nutritional education improves cardiometabolic and quality of life parameters on type 2 diabetics. <![CDATA[Microarrays in 236 patients with neurodevelopmental disorders and congenital abnormalities]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700854&lng=pt&nrm=iso&tlng=pt Background: In 20% of neurodevelopmental disorders (NDD) and congenital abnormalities (CA) the cause would be a genomic imbalance detectable only by chromosomal microarrays (CMA). Aim: To analyze the results of CMA performed at the INTA Laboratory of Molecular Cytogenetics, during a period of four years in patients with NDD or CA. Material and Methods: Retrospective study that included all CMA reports of Chilean patients. Age, sex, clinical diagnosis and origin were analyzed, as well as the characteristics of the finding. The percentage of cases diagnosed by CMA was calculated considering all patients with pathogenic (PV) or probably pathogenic variants (VLP). Finally, we studied the association between patients’ characteristics and a positive CMA outcome. Results: A total of 236 reports were analyzed. The median age was 5.41 (range 2.25-9.33) years, and 59% were men. Ninety chromosomal imbalances were found, which corresponded mainly to deletions (53.3%), with a median size of 1.662 (range 0.553-6.673) Megabases. The diagnostic rate of CMA in Chilean patients from all over the country was 19.2%. There was a close relationship between the patient's sex and the detection of VLP/VP (p = 0.034). Conclusions: Our diagnostic rate and the association between female sex and a higher percentage of diagnosed cases are concordant with other international studies. Therefore, CMA is a valid diagnostic tool in the Chilean population. <![CDATA[Performance of an abbreviated mini mental examination to detect dementia in older people]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700862&lng=pt&nrm=iso&tlng=pt Background: The usefulness of the abbreviated Mini-Mental State Examination included in the Chilean Functional assessment of elderly people (MM-SE-EFAM) to detect Dementia has not been determined. Aim: To assess the performance of the MMSE-EFAM to detect dementia. Material and Methods: We studied a non-probabilistic sample of subjects older than 65 years who had been assessed by the MMSE-EFAM in a Chilean primary care center during a period of 6 months. Patients underwent clinical evaluation by a neurologist blinded to MMSE-EFAM score, to establish the diagnosis of dementia using DSM-IV-TR criteria. Besides, the full Mini-Mental State Examination (MMSE) was applied. Results: The clinical diagnosis of Dementia was established in 13 of the 54 peoples evaluated. MMSE-EFAM had a sensitivity of 30.8% (95% confidence intervals (CI); 9-61.4) and a specificity of 90.2% (95% CI; 76.9%-97.3%), while MMSE had a sensitivity of 84.6% (95% CI; 54.6-98.1) and a specificity of 58.5% (95% CI; 42.1-73.7). In a receiver operating characteristic (ROC) curve analysis, the areas under the curve (AUC) were 0.77 (95% CI; 0.61-0.93) and 0.82 (95% CI; 0.70-0.95) for MMSE-EFAM and MMSE, respectively. Socio-demographic variables did not influence test performance in both cases. Conclusions: MMSE-EFAM has a low sensitivity to detect patients with Dementia and it is not an effective screening tool. These results are in agreement with the evidence and international guidelines that do not support the use of cognitive screening tools to detect dementia in the older general population. <![CDATA[Assessment of a Chilean Spanish version of the Patient Assessment of Chronic Illness Care Questionnaire]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700869&lng=pt&nrm=iso&tlng=pt Background: The Patient Assessment of Chronic Illness Care (PACIC) questionnaire is a widely used instrument to assess chronic disease care from a patient's perspective. Aim: To adapt the PACIC questionnaire to Chilean Spanish and to evaluate the psychometric properties of the translation. Material and Methods: Descriptive, cross-sectional design with exploratory and confirmatory factor analysis. The PACIC questionnaire was applied, throughout an external client, to 200 users who received health care at the cardiovascular program in a Family Health Center in Concepción, Chile. Results: The confirmatory factor analysis did not show a good adjustment with the proposed structure in the original instrument. An exploratory factor analysis revealed five factors explaining 58% of total data variability. The distribution of the factor-items of the original questionnaire underwent some modifications, which are explained when analyzing the theoretical construct. A good reliability of the global scale was obtained (Cronbach's α 0.886). Conclusions: The PACIC questionnaire, Chilean version does not replicate the proposed structure of the original questionnaire. Therefore, further research about its validity, incorporating a higher number or diversity of participants is recommended. <![CDATA[Attributes and features of a community health model from the perspective of practitioners]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700879&lng=pt&nrm=iso&tlng=pt Background: The Family and Community Health Model is based on three essential principles: user-centered care, comprehensive care and continuity of care. Aim: To describe the attributes and characteristics of the guiding principles of the Family and Community Health Model (FHM) from the perspective of primary care experts. Material and Methods: This was a qualitative study. An electronic Delphi was conducted with 29 national experts on primary care. Results: The experts agree that user centered care must be based on a psycho-social model integrating the multiple factors that influence health problems. It also must integrate patients’ individual features, family and environmental issues. The proposed actions promote shared decision making. To promote integral care, anticipatory guidelines should be expanded and health care of patients with chronic conditions should be improved. Continuity of care should be promoted increasing working hours of medical centers and easing access to integrated electronic medical records, thereby generating efficient links between the different care levels. Conclusions: The results of the study can guide the clinical and administrative management of health teams, allowing the strengthening of primary health care according to the local realities. <![CDATA[Nurses’ workload in hemodialysis units]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700888&lng=pt&nrm=iso&tlng=pt Background: Knowing nurses’ workload in hemodialysis units allows a better organization of human resources. Aim: To determine nurses’ workload according to dependence and risk profiles of patients undergoing chronic hemodialysis. Material and Methods: One hundred fifty one patients from five hemodialysis units were selected and categorized in terms of dependence and risk using the instrument “Care according to dependence and risk in hemodialysis (CUDYR-DIAL). Nurses’ activities for direct and indirect care and the time taken to complete those activities were measured. Results: Per patient, nurses used 36.5 ±10.7 min for direct and 23.6 min for indirect care. The time required for direct care of patients at high risk with partial dependence and at high risk and partial self-sufficiency was 41.2 and 40.3 minutes respectively. Conclusions: During a dialysis session, nurses occupy 60% of their time providing direct care, mainly directed to patients categorized as being of high risk-partial dependence and high risk-partial self-sufficiency. <![CDATA[Abnormal expansion of C9orf72 gene in familial frontotemporal dementia]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700896&lng=pt&nrm=iso&tlng=pt Frontotemporal Dementia (FTD) and Motor Neuron Disease (MND) may share similar pathogenic mechanisms. An abnormal hexanucleotide expansion in C9orf72 gene is the most common genetic abnormality of these conditions and explains their concurrence in the same family. We report a 77-year-old female presenting with non-fluent aphasia leading to mutism and a mild Parkinsonism. A magnetic resonance imaging showed a severe atrophy of frontal and temporal lobes. Several family members of the patient suffered of atypical Parkinsonism, lateral amyotrophic sclerosis and dementia. We identified an abnormal hexanucleotide expansion in the C9orf72 gene in the proband. To the extent of our knowledge, this is the first time that this diagnosis is confirmed in our country. The knowledge of the genetic basis of neuro degenerative disorders improves diagnosis and opens expectatives for future treatments of these disabling conditions. <![CDATA[An analysis of essential health research in Chile]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700901&lng=pt&nrm=iso&tlng=pt Essential research studies of health problems affecting the majority of the population, aiming at actions that are feasible to be taken, efficiently and effectively implementing there and seeking solutions to unsolved problems. This is a complex process, which requires long lasting participation and coordinated interaction between different relevant sectors, namely the academic world, health policymakers and health-related industries. An analysis of essential health research in Chile is presented, considering factors such as shared efforts between the academic and health care sectors and the role of the Ministry of Health in research promotion. The following suggestions are made: 1) The Ministry of Health, along with universities, should stimulate, guide and monitor research activities that enrich and update the work on priority health issues; 2) To strengthen the capacity building of clinical or public health specialists by training them in applied research within medical centers, mainly teaching centers; 3) To assess the performance of National Fund for Health Research and Development (FONIS) and, if necessary, increase its resources to stimulate applied research in health; 4) To establish priorities for essential research, more specific than those proposed in 2010; 5) To reactivate the National Council for Health Research (CONIS) as an autonomous entity that coordinates applied research within the Ministry of Health. <![CDATA[Epigenetics of polycystic ovary syndrome]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700907&lng=pt&nrm=iso&tlng=pt Polycystic ovarian syndrome (PCOS) is an endocrine and metabolic dysfunction, highly prevalent in women in their reproductive years. Hyperandrogenism, oligo-ovulation, polycystic ovarian morphology are the main features of this syndrome. PCOS is a genetic disorder with a multifactorial etiology and has a strong link with environmental components. It is frequently associated with obesity and insulin resistance. Recently, epigenetic mechanisms have been involved in the pathogenesis of PCOS. Several studies showed that methylation in DNA and miRNAs is altered in women with PCOS in blood, serum, adipose tissue, granulose cells and theca. This evidence indicates that women with PCOS have a different epigenetic regulation, which might be triggered by an adverse intrauterine environment or by postnatal environmental elements such as diet and or obesity. <![CDATA[Indian ‘humor’ in medical knowledge during the 16<sup>th</sup> and 17<sup>th</sup> centuries]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700920&lng=pt&nrm=iso&tlng=pt During the first Modern Era (15th-17th c.), bodily health and expressions of physiognomy were explained under the doctrine of humors. This doctrine -based on Corpus Hipocraticum-established a close relation between humors (blood, yellow bile, phlegm, and black bile), qualities (dry, moist, warm, and cold) and the elements (water, air, earth, and fire). One of these humors -black bile-, commonly a hallmark of the melancholic temperament, was associated to the complexion and nature of American Indians. This accusation was legitimized by the empirical examination of the physiognomy of a subject that was melancholic, sad and pusillanimous. In this article, we describe, based on the analysis of colonial texts (16th-17th c.), how the essential premises of the humor theory were transferred to the New World and in particular and how the Indian complexion was defined through the examination of subjects plagued by black humor and phlegm. With this, we determine the way these individuals -referred as ‘Indians’- were inscribed in medical knowledge, during the global spread of the Hippocratic-Galenic postulates. <![CDATA[The educational context to train health care professionals. A qualitative approach]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700926&lng=pt&nrm=iso&tlng=pt Background: There are differences in the educational context in Health Sciences, between clinical and non-clinical teachers. Therefore, the didactic and reflexive peculiarities of both educational scenarios should be analyzed. Aim: To describe the conditions of the educational context in Health Sciences for the practice of the teaching role in a Chilean university. Material and Methods: Qualitative study, performed according to Grounded Theory of Strauss and Corbin. Thirty one teachers from six health sciences programs were selected according to Patton's maximum variation criterion and contacted personally, after an informed consent process. Semi-structured interviews and focus group were performed, analyzed by open coding, using the constant comparison method, with the Atlas-ti 7.5.2 software. Results: Six conditions of the educational context that can support the teaching role in these careers emerged. Namely, a clinical field suited for patient attention and teaching, classrooms designed for the new educational models, number of students in the classrooms and clinical settings, insertion programs for teachers’ training, teachers’ coordination and economic resources of the program. Conclusions: Health Sciences programs are developed in a complex educational context, having to articulate diverse elements to train professionals. Therefore, it is fundamental to understand the conditions of the educational context that can favor the practice of the teaching role, thus generating improvements in teaching-learning process. <![CDATA[Self-directed learning and academic background of 2010 to 2014 cohorts of medical students]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700934&lng=pt&nrm=iso&tlng=pt Background: The widespread growth of higher education is increasing the heterogeneity of university students in terms of socioeconomic characteristics, academic story and cultural background. Medical schools are not an exception of this phenomenon. Aim: To compare the academic background and self-directed learning behavior of students who entered to a public medial school between 2010 and 2014. Material and Methods: A non-probabilistic sample of 527 medical students aged between 17 and 29 years (60% men), was studied. Their academic information was collected from the University data base; they answered the Self-directed learning readiness scale of Fisher. Results: Students from the 2014 cohort had higher high school grades than their counterparts. The scores in mathematics of the Scholarship Aptitude Test (SAT) were higher in the cohorts of 2010 and 2011. Those of the sciences test were superior in the 2013 cohort. The 2014 cohort had the lower general score of self-directed learning behaviors. Conclusions: The lower SAT and self-directed learning scores of the students entering medical school in 2014, indicate the progressive increase in the heterogeneity of Medical students. <![CDATA[Long QT syndrome and polymorphic ventricular tachycardia due to hypopituitarism. Report of one case]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700941&lng=pt&nrm=iso&tlng=pt Symptoms of hypopituitarism are usually chronic and nonspecific, but rarely the disease can have acute and life threatening manifestations. We report a 53 years old female with a pituitary adenoma that was admitted to our hospital because of syncope. The electrocardiogram showed sinus bradycardia with a prolonged QT interval. Frequent runs of non-sustained polymorphic ventricular tachycardia were noted on telemetry. The patient had a history of severe acute headaches in the previous days and laboratory tests revealed severe secondary hypothyroidism, adrenal insufficiency and a decrease in pituitary hormones. A magnetic resonance imaging of the head showed changes in the size and contrast enhancement of the adenoma. A diagnosis of hypopituitarism secondary to pituitary apoplexy was made and treatment with hydrocortisone and, subsequently, levothyroxine was started. Hormonal disorders such as hypothyroidism, adrenal insufficiency or hypopituitarism should be considered as unusual causes for reversible cardiomyopathy, long QT syndrome and ventricular arrhythmias. <![CDATA[Large B-cell lymphoma coexisting with Castleman’s disease. Report of one case]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700945&lng=pt&nrm=iso&tlng=pt We report a 73-year-old female patient with Castleman's disease coexistent with large B cell type non-Hodgkin's lymphoma in a right axillary lymphadenopathy. An excisional biopsy was performed: microscopically, the lymph node revealed the presence of numerous plasma cells and small lymphoid cells characteristic of Castleman's disease. An analysis of another portion of the specimen revealed lymphoid cells with large abnormal nuclei gathered locally that were CDD 79+, CD 38+ and MUM-1+ as well as positive for Kaposi sarcoma-associated herpesvirus and negative for Epstein Barr virus encoded RNA-1 (EBER). <![CDATA[McKrittick-Wheelock syndrome. Report of one case]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700950&lng=pt&nrm=iso&tlng=pt McKittrick-Wheelock syndrome is caused by chronic water and electrolyte hypersecretion from an intestinal tumor, usually a villous adenoma, located in the rectum or sigmoid. Patients often have dehydration, hypovolemic shock and kidney failure associated with hypokalemia, hyponatremia, hypochloremia and metabolic acidosis. We report a 62-year-old male, suffering chronic diarrhea for eight years who was admitted after a syncope. He had severe hypokalemia, hyponatremia, metabolic acidosis, hypovolemia and acute renal failure. After his metabolic disorders were corrected, a colonoscopy showed a large rectosigmoid tumor with the characteristics of a villous adenoma. During the follow up after the complete tumor resection, the patient has remained asymptomatic. <![CDATA[Considerations in the management of ruptured mycotic aortic aneurysm secondary to salmonella aortitis]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700954&lng=pt&nrm=iso&tlng=pt McKittrick-Wheelock syndrome is caused by chronic water and electrolyte hypersecretion from an intestinal tumor, usually a villous adenoma, located in the rectum or sigmoid. Patients often have dehydration, hypovolemic shock and kidney failure associated with hypokalemia, hyponatremia, hypochloremia and metabolic acidosis. We report a 62-year-old male, suffering chronic diarrhea for eight years who was admitted after a syncope. He had severe hypokalemia, hyponatremia, metabolic acidosis, hypovolemia and acute renal failure. After his metabolic disorders were corrected, a colonoscopy showed a large rectosigmoid tumor with the characteristics of a villous adenoma. During the follow up after the complete tumor resection, the patient has remained asymptomatic. <![CDATA[Considerations about the psychometric properties of the measurement instruments on scientific publishing: Authors´ reply to Ventura-León]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700955&lng=pt&nrm=iso&tlng=pt McKittrick-Wheelock syndrome is caused by chronic water and electrolyte hypersecretion from an intestinal tumor, usually a villous adenoma, located in the rectum or sigmoid. Patients often have dehydration, hypovolemic shock and kidney failure associated with hypokalemia, hyponatremia, hypochloremia and metabolic acidosis. We report a 62-year-old male, suffering chronic diarrhea for eight years who was admitted after a syncope. He had severe hypokalemia, hyponatremia, metabolic acidosis, hypovolemia and acute renal failure. After his metabolic disorders were corrected, a colonoscopy showed a large rectosigmoid tumor with the characteristics of a villous adenoma. During the follow up after the complete tumor resection, the patient has remained asymptomatic. <![CDATA[Corrección]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000700956&lng=pt&nrm=iso&tlng=pt McKittrick-Wheelock syndrome is caused by chronic water and electrolyte hypersecretion from an intestinal tumor, usually a villous adenoma, located in the rectum or sigmoid. Patients often have dehydration, hypovolemic shock and kidney failure associated with hypokalemia, hyponatremia, hypochloremia and metabolic acidosis. We report a 62-year-old male, suffering chronic diarrhea for eight years who was admitted after a syncope. He had severe hypokalemia, hyponatremia, metabolic acidosis, hypovolemia and acute renal failure. After his metabolic disorders were corrected, a colonoscopy showed a large rectosigmoid tumor with the characteristics of a villous adenoma. During the follow up after the complete tumor resection, the patient has remained asymptomatic.