Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720020003&lang=es vol. 130 num. 3 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[Rendimiento del Spect Talio<SUP>201</SUP> reposo-redistribución para predecir viabilidad post infarto reciente del miocardio]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300001&lng=es&nrm=iso&tlng=es Background: The detection of viability after acute myocardial infarction is primordial to select the most appropriate therapy, to decrease cardiac events and abnormal remodeling. Thallium201 SPECT is one of the radionuclide techniques used to detect viability. Aim: To evaluate the use of Thallium201 rest-redistribution SPECT to detect myocardial viability in reperfused patients after a recent myocardial infarction. Patients and methods: Forty one patients with up to of 24 days of evolution of a myocardial infarction were studied. All had angiographically demonstrated coronary artery disease and were subjected to a successful thrombolysis, angioplasty or bypass grafting. SPECT Thallium201 images were acquired at rest and after 4 h of redistribution. These results were compared with variations in wall motion score, studied at baseline and after 3 or 4 months with echocardiography. Results: The sensitivity of rest-redistribution Thallium201 SPECT, to predict recovery of wall motion was 91% when patient analysis was performed and 79% when segmental analysis was done in the culprit region. The figures for specificity were 56 and 73% respectively. Conclusions: Rest-distribution Thallium201 SPECT has an excellent sensitivity to predict myocardial viability in recent myocardial infarction. The data obtained in this study is similar to that reported for chronic coronary artery disease (Rev Méd Chile 2002; 130: 243-50). <![CDATA[Prevalencia de anticuerpos anti-hantavirus en 10 comunas de la Novena Región de Chile donde se han diagnosticado casos de infección clínica por hantavirus]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300002&lng=es&nrm=iso&tlng=es Background: Thirty six cases of clinical Hantavirus Cardiopulmonary Syndrome occurred in the IX Region of Chile. Most of these patients were young males, farm or timber workers, who lived near the Andes Mountain chain. Aim: To conduct an epidemiological and serosurvey study to determine the seroprevalence of IgG antibodies against Hantavirus in the general adult population living in rural and urban areas of 10 endemic communities of the IX region of Chile. Material and methods: A total of 400 subjects were included, 40 of each community, 20 rural residents and 20 urban residents, 20 males and 20 females. Results: Seroprevalence was 7.5% in Melipeuco, 5.0% in Lonquimay, 2.5% in Curacautin, 2.5% in Pucón and 0.0% in the remaining communities. Seroprevalence was higher in rural population (2.5%) than in the urban areas (1%). All seropositive subjects worked in farms or forests and observed rodents near their homes or working places. Females were affected the same as males and no differences were observed between Chilean natives and Hispanics. Conclusions: Prevalence of Hantavirus antibodies correlated with the geographic zone (Andes Mountain chain), overgrowth of wild rodents and exposure to rodent-infested environments (Rev Méd Chile 2002; 130: 251-3) <![CDATA[Diagnóstico y seguimiento de 23 niños con acidurias orgánicas]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300003&lng=es&nrm=iso&tlng=es Background: Propionic aciduria (PA) and Methymalonic aciduria (MMA) result from an inherited abnormality of the enzymes propionyl CoA carboxylase and methylmalonyl CoA mutase respectively. This produces marked increases in the amino acids methionine, threonine, valine and isoleucine (MTVI). Their clinical presentation can be neonatal or late onset forms. Aim: To report 23 children with organic acidurias. Material and methods: Twenty three cases of organic acidurias diagnosed since 1980 (17 PA and 6 MMA) and followed at the Institute of Nutrition and Food Technology, are reported. Results: The average age of diagnosis was 3.9 days for the neonatal form and 8.3 months for the late onset form. The most frequent symptoms were hypotonia, lethargy and vomiting. Neonatal PA had mean ammonemias of 1089±678.3 µg/dl. The figure for MMA was 933±801.9 µg/dl. Seven children were dialyzed and 30% died. 16 children are followed and 81.2% have normal weight for age. Seven children required gastrostomy because of anorexia and failure to thrive. The nutritional treatment is based on natural and artificial proteins without MTVI, with periodical controls, amino acid and ammonia quantification. Some patients were submitted to enzyme assays and molecular studies. Conclusions: An early diagnosis and a very strict follow up allows a normal development of children with organic aciduras. There is a relationship between prognosis and the presentation form, the nutritional status and the emergency treatment during acute episodes. The importance of the enzymatic and molecular studies is emphasized because they facilitate treatment, accurate diagnosis and allow an adequate genetic counseling (Rev Méd Chile 2002; 130: 259-66) <![CDATA[Cómo atraer más y mejores manuscritos para publicación en las revistas biomédicas chilenas]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300004&lng=es&nrm=iso&tlng=es A survey was addressed to 57 editors of Chilean biomedical journals, on how to attract more and better manuscripts to their journals. Thirty seven editors (65%) answered this survey. According to them the main motivation of Medical Societies for editing their own journals is to improve information acquisition. To communicate an experience, followed by getting credits in their curriculum vitæ, were considered by the editors as the main motivations of authors to submit papers. The most frequent deficiencies of manuscripts received are: disorganization in their presentation and bad adherence to journal's requirements for submitting manuscripts. An improvement in the relationship between author-editor-reviewer was mentioned by most of the editors, as the mechanism to be used to enhance the quality of the manuscripts. Only 14 editors (38%) agree in that there is a decrease in the number of original papers submitted. This decrease was attributed by most of them, to a high pressure for publishing in journals with the highest impact factor. Suggestions on how to improve the Chilean biomedical journals included: a) to professionalize editorial work and to increase meticulousness when reviewing manuscripts; b) to increase the recognition of articles published in Chilean biomedical journals, when applying for academic promotions or research grants and c) to create a "national impact factor" (Rev Méd Chile 2002; 130: 267-74) <![CDATA[Caracterización molecular de mecanismos de resistencia a cloranfenicol en cepas de Shigella flexneri aisladas en niños chilenos con diarrea aguda]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300005&lng=es&nrm=iso&tlng=es Background: Chloramphenicol is one of the therapeutic options for shigellosis, but resistance to this antimicrobial is increasing. Aim: To characterize molecular mechanisms conferring resistance to chloramphenicol (CmR) in Shigella flexneri strains isolated from Chilean children with acute diarrhea. Material and methods: Thirty one Shigella filexneri strains, including 22 with the CmR phenotype were analyzed. Strains were tested for antimicrobial susceptibility by plate dilution and for the presence of an internal fragment of the cat gene encoding for chloramphenicol o-acetyl-transferase, by polymerase chain reaction and Southern blot analysis. Results: All CmR strains had a minimal inhibitory concentration over 64 µg/ml and amplified the internal fragment of the cat gene. Southern blot analyses indicated that this gene was located in the bacterial chromosome. Conclusions: Resistance to chloramphenicol in this group of Shigella flexneri strains was mediated by a chromosomally located cat gene (Rev Méd Chile 2002; 130: 275-80) <![CDATA[Situación epidemiológica actual de la triquinosis en Chile. 1991-2000]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300006&lng=es&nrm=iso&tlng=es Background: Human and animal trichinosis has been recorded in Chile since the late XIX century and is irregularly distributed along the country. From high rates of infection in the early 1900, the frequency of this parasitosis in man has progressively decreased. Aim: To describe and discuss the epidemiological situation of trichinosis in Chile during the decade 1991 - 2000. Material and methods: Human infection was assessed using annual incidence and lethality reports provided by the Ministry of Health, periodic photostrichinoscopies in corpses of non selected individuals autopsied at the Medico Legal Service and periodic national serologic surveys. The advise of one of the authors in an epidemic that occurred in 1999 in the VIII Region was also used. Animal infection was assessed using the annual prevalence of infection in pigs slaughtered in abattoirs, furnished by the Ministry of Health. Results: A total of 631 clinical cases with 4 deaths (0.6%) was recorded. A decline in the incidence, from 0.7 x 100,000 in 1991 to 0.2 x 100,000 in 2000 was recorded. The higher frequency of the parasitosis was observed in the Metropolitan, VI, VIII and X regions. Although human trichinosis has been observed in all seasons, its frequency increases in close relation with the higher pork consumption in cold seasons (45.8% in winter and 37.5% in spring). There has been a decrease of infection rates in pigs from 0.17%o in 1991 to 0.04%o in 1998 - 2000. Conclusions: The incidence and prevalence of trichinosis shows a constant decline in Chile. Considering the geographical characteristics of Chile, it is possible that an undetermined number of pigs are home reared and butchered without veterinary control, constituting an important source of human trichinosis (Rev Méd Chile 2002; 130: 281-5 <![CDATA[Deportes y trastornos de la conducta alimentaria]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300007&lng=es&nrm=iso&tlng=es Background: People who work out could have an excessive concern for diet and body weight and thus be more prone to have eating disorders. Aim: To compare psychological and behavioral traits between subjects with clinically relevant eating disorders and subjects that work out regularly. Subjects and methods: The Eating Attitudes Test (EAT-40) and the eight items of the Eating Disorders Inventory were administered to 151 patients that fulfilled the DSM-IV diagnostic criteria for eating disorders and to 396 subjects who work out regularly in gymnasiums (136 males). Results: Eighteen percent of subjects that worked out (5 males and 67 females) scored within the pathological range in the EAT-40. These subjects were classified as having a subclinical eating disorder. When comparing the EDI scores of these subjects with those of patients with clinically relevant eating disorders, they had a similar Drive for thinness (p= 0.413), Body dissatisfaction (p= 0.365), Maturity fears (p= 0.190) and Perfectionism (p= 0.907). Females had similar Interpersonal distrust (p= 0.709) scores. Males had similar Maturity fears (p= O.119), Perfectionism (p= 0.253) and Interpersonal distrust (p= 0.767) scores. Conclusions: Subjects that work out regularly and have subclinical eating disorders, display similar drive for thinness, body dissatisfaction, immaturity and perfectionism traits, than patients suffering from clinically relevant eating disorders (Rev Méd Chile 2002; 130: 287-94) <![CDATA[Características de niños y adolescentes atendidos en un consultorio psiquiátrico del sistema privado de salud en Chile]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300008&lng=es&nrm=iso&tlng=es Background: There is a 7% up to 32% prevalence of psychiatric problems in the pediatric population. Aim: To study the epidemiological features of children and adolescents attended in a psychiatric outpatient clinic. Material and methods: All admissions to a psychiatric outpatient clinic, of people aged 18 years old or less, during 1998, were reviewed. The causes of consultation and the diagnoses were classified according to diagnostic manuals (ICPC-WONCA and DSM-IV respectively), by three experienced psychiatrists. Results: The files of 376 patients were reviewed (200 males, mean age of females 12 years old, mean age of males 10.5 years old). Seventy three percent consulted spontaneously. The main causes of consultation were anxiety disorders and adolescence problems (28%). The main diagnoses were attention deficit disorder and disruptive behavior, adaptative problems, mood and anxiety disorders. There were gender differences in the diagnoses. Women attended a mean of 6.3 sessions and men attended a mean of 4 sessions. Fifty nine percent abandoned treatment. Conclusions: There is a limited access to mental health care. The low compliance with treatments must be studied and improved (Rev Méd Chile 2002; 130: 205-303) <![CDATA[Estudio de sensibilidad in vitro de cepas de Streptococcus pneumoniæ de infecciones respiratorias bajas en el Instituto Nacional del Tórax (INT)]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300009&lng=es&nrm=iso&tlng=es Background: The rising antimicrobial resistance of streptococcus pneumoniæ, requires permanent surveillance. Antimicrobial treatments of invasive infections must be modified accordingly. Aim: To assess the in vitro antimicrobial susceptibility of streptococcus pneumoniæ strains isolated from lower respiratory infections. Material and methods: Seventy five strains isolated during three periods in consecutive years were studied. In vitro susceptibility towards penicillin, erythromycin and ceftriaxone was studied using E-test technique minimal inhibitory concentrations. Results: Five percent of strains were penicillin resistant and 11% had an intermediate sensitivity. Erythromycin resistance was observed in 1.3% of strains. Eight percent of strains had an intermediate sensitivity towards ceftriaxone and no resistance was observed. Comparing susceptibility in the three studied periods, it remained low and stable. Conclusions: High and intermediate resistance of Strepfococcus pneumoniæ towards penicillin is less prevalent than in other countries. A close surveillance must be maintained (Rev Méd Chile 2002; 130: 304-8) <![CDATA[Neumonía adquirida en la comunidad: Comunicación de 8 casos de neumonía grave por Legionella pneumophila serogrupo 1 en Chile]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300010&lng=es&nrm=iso&tlng=es Legionella pneumophila is the second cause of severe community acquired pneumonia. In Chile, however, there are few reports of pneumonia caused by Legionella. We report eight patients (6 men, aged 42 to 72 years old) with community-acquired pneumonia caused by Legionella pneumophila serogroup 1, confirmed by the measurement of urinary antigen. Clinical presentation was characterized by fever or hypothermia (in one case), cough, dyspnea and neurological abnormalities in four patients. Cigarette smoking was the most frequently identified risk factor. All patients had at least one American Thoracic Society severity criteria. Complications observed were acute hypoxemic respiratory failure in seven patients, shock in four, renal failure in four and need for mechanical ventilation in three. No patient died (Rev Méd Chile 2002; 130: 309-13) <![CDATA[Captación miocárdica de pirofosfato en amiloidosis cardíaca: Caso clínico]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300011&lng=es&nrm=iso&tlng=es We report a previously healthy 73 years old woman, who was hospitalised with increasing dyspnea and signs of congestive heart failure. Echocardiography showed a normal left ventricular cavity with increased echogenicity of its walls and severe pulmonary hypertension. A lung ventilation/perfusion scintigraphy concluded that there was a low probability for pulmonary embolism. Coronary angiography was normal. A restrictive cardiomyopathy due to amyloid deposits was suspected. Myocardial pyrophosphate scintigraphy showed intense pyrophosphate uptake in the left ventricle wall. An abdominal fat tissue biopsy was positive for amyloid deposits (Rev Méd Chile 2002; 130: 315-8) <![CDATA[Bursitis Tuberculosa: Caso clínico]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300012&lng=es&nrm=iso&tlng=es We report a previously healthy 51 years old woman with a one year history of pain in the left hip associated with a mass without fever or local inflammatory changes. Magnetic resonance imaging located the mass in the medial gluteal muscle. The pathological examination of the mass disclosed unspecific inflammatory changes. Due to worsening of pain, a left throchanteric bursitis was diagnosed two weeks later and a throchanteric bursectomy was performed, obtaining a second biopsy. Aerobic, anaerobic and fungal cultures were negative. Lowenstein-Jensen culture showed development of mycobacteria and a genetic probe confirmed the presence of Mycobacterium tuberculosis. The second biopsy also identified several granulomas with areas of caseation and the Ziehl-Nielsen stain was positive for acid fast bacilli. Osteoarticular tuberculosis, specially bursitis, shoulds be suspected in the presence of chronic pain associated with swelling (Rev Méd Chile 2002; 130: 319-21) <![CDATA[Recomendaciones para el manejo de las crisis hipertensivas: Documento de Consenso de la Sociedad Chilena de Hipertensión Arterial]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300013&lng=es&nrm=iso&tlng=es The management of severe hypertension in the emergency setting demands a careful evaluation of the different underlying clinical situations, and of the impending risk for the life of the patient or of acute organ damage. Hypertensive emergencies and urgencies have to be identified, and distinguished from chronic severe hypertension, a frequent presentation to the emergency services. A thorough clinical evaluation, and not the magnitude of the blood pressure elevation, should be the basis of the differential diagnosis; this will guide the setting required for treatment (intensive care unit, ward or ambulatory), the drugs of choice, as well as the velocity of blood pressure reduction. Special emphasis has to be given to the management of cerebrovascular accidents and severe preeclampsia, as the reduction of blood pressure entails a risk of hypoperfusion of critical territories as the brain and fetus respectively. A wide range of drugs permits a tailored treatment of a variety of clinical situations. Efforts have to be made to detect and manage chronic hypertensive patients in order to reduce the consultation load represented by severe hypertensives in emergency services, by preventing hypertensive crisis, in order to focalize on real situations of risk (Rev Méd Chile 2002; 130: 322-31) <![CDATA[Caídas y alteraciones de la marcha en los adultos mayores]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300014&lng=es&nrm=iso&tlng=es There is a higher frequency of falls in the elderly than in young people, due to age related physiological changes in gait. There is a lower amplitude of pelvic movements that affects gait efficiency. Equilibrium is also disturbed since the trunk assumes the leadership of gait, displacing the pelvis. Many diseases of elderly individuals, such as Parkinson disease, spastic paraparesis, cerebrovascular accidents or neuropathies, further impair the gait. Therefore, after the age of 65, all falls must be considered symptomatic (Rev Méd Chile 2002; 130: 332-7) <![CDATA[V Simposio Chileno de Revistas en el Área de la Salud]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300015&lng=es&nrm=iso&tlng=es There is a higher frequency of falls in the elderly than in young people, due to age related physiological changes in gait. There is a lower amplitude of pelvic movements that affects gait efficiency. Equilibrium is also disturbed since the trunk assumes the leadership of gait, displacing the pelvis. Many diseases of elderly individuals, such as Parkinson disease, spastic paraparesis, cerebrovascular accidents or neuropathies, further impair the gait. Therefore, after the age of 65, all falls must be considered symptomatic (Rev Méd Chile 2002; 130: 332-7) <![CDATA[Importancia clínica de la hipercolesterolemia]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300016&lng=es&nrm=iso&tlng=es There is a higher frequency of falls in the elderly than in young people, due to age related physiological changes in gait. There is a lower amplitude of pelvic movements that affects gait efficiency. Equilibrium is also disturbed since the trunk assumes the leadership of gait, displacing the pelvis. Many diseases of elderly individuals, such as Parkinson disease, spastic paraparesis, cerebrovascular accidents or neuropathies, further impair the gait. Therefore, after the age of 65, all falls must be considered symptomatic (Rev Méd Chile 2002; 130: 332-7) <![CDATA[LA RAZÓN PROLACTINA/ESTRADIOL A LAS 38 SEMANAS DE GESTACIÓN PREDICE LA DURACIÓN DE LA AMENORREA DE LA LACTANCIA]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300017&lng=es&nrm=iso&tlng=es There is a higher frequency of falls in the elderly than in young people, due to age related physiological changes in gait. There is a lower amplitude of pelvic movements that affects gait efficiency. Equilibrium is also disturbed since the trunk assumes the leadership of gait, displacing the pelvis. Many diseases of elderly individuals, such as Parkinson disease, spastic paraparesis, cerebrovascular accidents or neuropathies, further impair the gait. Therefore, after the age of 65, all falls must be considered symptomatic (Rev Méd Chile 2002; 130: 332-7) <![CDATA[<B>SCIENTIFIC JOURNAL CONGRESS ANNOUNCEMENT</B>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000300018&lng=es&nrm=iso&tlng=es There is a higher frequency of falls in the elderly than in young people, due to age related physiological changes in gait. There is a lower amplitude of pelvic movements that affects gait efficiency. Equilibrium is also disturbed since the trunk assumes the leadership of gait, displacing the pelvis. Many diseases of elderly individuals, such as Parkinson disease, spastic paraparesis, cerebrovascular accidents or neuropathies, further impair the gait. Therefore, after the age of 65, all falls must be considered symptomatic (Rev Méd Chile 2002; 130: 332-7)