Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720070010&lang=es vol. 135 num. 10 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<b>Influencia del sistema nitridérgico en la respuesta contráctil a fenilefrina de anillos de vasos usados en revascularización coronaria</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000001&lng=es&nrm=iso&tlng=es Background: Endothelial dysfunction is associated to a lower production of nitric oxide and a reduction of endothelium mediated vasodilation. Aim: To study the effects of pharmacological agents that modify nitric oxide synthetase (NOS) activity on tension changes induced by phenylephrine in rings of internal mammary and radial arteries and saphenous vein. Material and methods: Vessel rings of 7 to 10 mm length were obtained from 32 patients subjected to coronary vascular surgery Fourteen samples of radial artery, 12 samples of internal mammary artery and 15 samples of saphenous vein were obtained. A maximal contraction was induced with KC1 and dose response curves for phenylephrine (FE) in the absence or presence of L-arginine and L-arginine methyl ester (L-NAME), were constructed. Results: The tension induced by FE in internal mammary artery and saphenous vein reached a maximum, near 90% of 80 mM KCl-induced contraction, but in the radial artery, it reached a maximum of 63% (p <0.05). In all vessels, the dose response curves were significantly shifted to the right by L-arginine and to the ¡eft by L-NAME. Conclusions: Pre-incubation of human rings with L-ARG or L-NAME, changed the response to FE induced contraction, which may be related to different degrees of endothelial nitric oxide production or NO sensitivity. The basal NO production in radial artery seems to be larger than the other vessels <![CDATA[<b>Resistencia a la terapia antirretroviral en pacientes infectados con el virus VIH-1 en Chile 2002-2005</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000002&lng=es&nrm=iso&tlng=es Background: Resistance limits the effectiveness of anti-retroviral therapy. In Chile, there is free access to highly active anti-retroviral therapy since 2001, but there is no information about the frequency of mutations associated to drug resistance. Aim: To determine the most common mutations associated to anti-retroviral drug resistance in Chile. Materials and Methods: Retrospective study of 710 genotype analysis coming from 568 patients aged 22 to 70 years (85% males) with virological failure. The analysis was performed using a commercially available sequencing kit (Trugene HIV-1 genotypic assay from Bayer S.A). Results: Mean CD4+ cell count and viral load were 154 cells/fil and 228784 RNA copies/ml, respectively. The frequency of resistance to nucleoside RT inhibitors (NRTI), non nucleoside RT inhibitors (NNRTI) and protease inhibitors (PI) was 71 %, 62% and 22%, respectively. The most common mutations found were T215Y (46%), L10F (44%), Ml84V (3896), K103N (35%) and M41L (32%). Fifty five percent of mutations corresponded to the TAM (thymidine analogue mutations) group. Multiresistance was 47% to NNRTI, 7% to NRTI, 4% to PI and 0.7% to all groups. During the four years of the study, there was a significant increase in NNRTI resistance. Conclusions: These data provides important information about the epidemiology of drug resistance mutations and should help to design newHAARTstrategies <![CDATA[<b>Sobrecrecimiento bacteriano en trastornos funcionales del intestino</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000003&lng=es&nrm=iso&tlng=es Background: Recent studies have described a high percentage of small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS). However, the prevalence of SIBO has not been well established in other functional disorders. Aim: To evaluate the prevalence of SIBO in patients with different functional gastrointestinal disorders (FGID). Material and methods: Patients with FGID completed a self-administered questionnaire providing information to diagnose functional disorders on the basis of Rome II criteria. SIBO was assessed using a standardized lactulose breath test. A basal value of breath hydrogen (H2) >20 ppm and/or two lectures of HZ values >20 ppm during the first 60 minutes were considered suggestive of SIBO. Results: We studied 367 patients with a mean age of 50 years (87% females). Of these, 225 had IBS (45 constipation predominant, 121 diarrhea predominant and 59 alternating type), 33 had functional constipation, 83 had functional bloating and 26 had functional diarrhea. SIBO was found in 76% of patients with IBS, 73% of those with functional constipation, 69% of those with functional diarrhea and 68% of those with functional bloating. Conclusions: This study confirms a high percentage of SIBO in patients with IBS and other FGID. The eradication of SIBO should be considered as a therapeutic tool in these patients <![CDATA[<b>Tratamiento con insulina aspártica bifásica en pacientes con diabetes en mal control metabólico</b>: <b>Experiencia clínica programada</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000004&lng=es&nrm=iso&tlng=es Background: Biophasic insulin aspart (InAsBi) is a mixture of 30% of rapid acting soluble aspart insulin and 70% aspart insulin retarded with protamine. The soluble portion reduces postprandial serum glucose rises and the retarded portion reduces basal glucose levels. Aim: To assess the efficacy of biphasic insulin aspart in diabetics with a bad metabolic control. Material and methods: Multicentríc study that included diabetic patients with a glycosilated hemoglobin over 7% that were transferred to treatment with InAsBi, given in one to three daily doses, according to glycemic control and followed for 12 weeks. At the end of follow up, glycosilated hemoglobin levels (HbA1c) were measured again. Results: One hundred ninety six patients were enrolled and 154, age 59± 12 (84 females), completed the follow up. HbA 1 c levels decreased in at ¡east 1% in 96 and increased in eight cases. In the total group HbA1c decreased from 10.1± 1.7 to 8.4±1.4% (p <0.01). Those with higher initial values and with oral therapy, had the greatest reductions. At the end of the observation period, 29 patients received one daily dose of InAsBi, 114 two doses and 11 three doses. Two patients had allergy, one systemic and one in the injection site. Conclusions: In this group of diabetic patients with a bad metabolic control, the use of InAsBi was associated with a significant reduction of glycosilated hemoglobin levels <![CDATA[<b>Comportamientos sexuales y diferencias de género en adolescentes usuarios de un sistema público de salud universitario</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000005&lng=es&nrm=iso&tlng=es Background: The predetermined gender roles and the emphasis on reproductive responsibility on women, excluding men, have negative consequences on their sexual reproductive health and satisfactory sexual practices. Aim: To describe and analyze changes in sexual practices and gender differences in adolescents of the lower-middle socioeconomic level, users of public health system who started their sexual activity. Material and methods: We studied 4,971 adolescents of both sexes aged between 12 and 19 years, who consulted in a clinic for adolescents between the years 1990 and 2005. Several variables related to adolescent sexuality were considered. Uni and bivariate analysis were carried out and a model of stratified lineal regression per sex was fixed to explain the following variables: age at which sexual activity is initiated, number of sexual partners, time period between start of dating and the start of sexual activity along time. Results: The average age when men and women start their sexual activity was 15.7 and 15.5years, respectively. Along years and among women but not men, there was a reduction in the age of start of sexual activity and an increase in the number of sexual partners. The mean ¡apse between start of dating and the start of sexual activity in men and women was 6.2 and 7.5 months, respectively. This figure had an 11.696 and 13.9% reduction per year of study in females and males, respectively. Conclusions: There is an increasing expansion of sexual roles in adolescents, but certain patterns of contradictory conservative reasoning are maintained <![CDATA[<b>Prevalencia de los diferentes trastornos motores primarios del esófago</b>: <b>Estudio prospectivo de 5.440 casos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000006&lng=es&nrm=iso&tlng=es Background: The esophagus can suffer several motor disturbances of striated or smooth muscle. Aim: To determine the presence of primary motor disturbances of the esophagus among a group of patients with esophageal symptoms. Material and methods: Prospective study of 5,440 patients consulting for heartburn, chest pain or dysphagia, with primary esophageal motor disturbances, studied between 1994 and 2004. AH were subjected to an esophageal manometry with eight perfused catheters connected to pressure transducers. Results: Nineteen percent of subjects had a normal esophageal manometry, 60% had unspecific motor disturbances usually associated to gastroesophageal reflux, 13% had a nutcracker esophagus, 5% had diffuse esophageal spasm, 2% had achalasia and 0,3% had an hypertensive sphincter. Conclusions: Primaryesophageal motor disturbances are common among patients with esophageal symptoms. A manometry should be performed to these patients <![CDATA[<b>Evaluación de función diastólica intraoperatoria con ecocardiografía transesofágica</b>: <b>¿es útil?</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000007&lng=es&nrm=iso&tlng=es Background: Diastolic function can be evaluated intraoperatively using transesoptiageal echocardiography. Aim: To study if intraoperative diastolic dysfunction is associated to a greater number of hemodynamic events during surgery and during the postoperative period. Material and methods: Patients with indication of intraoperative transesophageal echocardiography due to cardiovascular diseases were included in the study. Diastolic function was assessed measuring transmitral intraventricular filling delay and pulmonary vein now. Patients were divided, according to diastolic dysfunction, in those with derangements in relaxation, pseudonormalization and restrictive patterns. Hypertension, hypotension, ST segment depression, alterations in myocardial contractility, pulmonary congestion and postoperative oliguria were recorded. Results: Fifty eight patients aged 68± 12 years (39 males), were studied. Forty four had diastolic dysfunction. Intraoperative hypotension occurred in 82% of patients with diastolic dysfunction and 16% of patients without it. Likewise, hypotension and oliguria during the postoperative period were more common in patients with diastolic dysfunction. Conclusions: In this group of patients with cardiovascular disease, intraoperative diastolic dysfunction is a risk factor for hemodynamic instability <![CDATA[<b>Guías de práctica clínica en atención primaria</b>: <b>Una evaluación crítica</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000008&lng=es&nrm=iso&tlng=es Background: There are doubts about the real usefulness of clinical guidelines to induce changes in practice, specially in primary health care. Those guidelines with inconsistent recommendations can even be misleading. Aim: To assess the quality of Chilean primary health care guidelines and to identify factors associated with high quality guidelines. Material and methods: Chilean primary care guidelines published and disseminated using any strategy 1999 and 2004 were analyzed. Each selected guideline was assessed independently by two evaluators using the Appraisal of Guidelines, Research and Evaluation (AGREE) instrument following standardized instructions. Descriptive statistics for each dimension of the AGREE instrument were calculated for each guideline. Results: A total of 33 guidelines were retrieved. Fifteen were located using a manual search and 18 from electronic sources. Twenty four did not match our definition of guidelines, therefore only nine were included in the final assessment. There were important differences in the scores obtained by each guideline in different dimensions, with relevant methodological shortcomings. However, no significant differences in scores were found when guidelines were compared by year of elaboration. Conclusions: Our results suggest that previous efforts in primary health care guideline development were misdirected and that important changes are necessary to generate high quality guidelines <![CDATA[<b>Aspectos parasitológicos y epidemiológicos de los donantes de sangre seropositivos para <i>Trypanosoma cruzi,en</i> un hospital universitario</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000009&lng=es&nrm=iso&tlng=es Background: After the interruption of the transmission of Chagas disease via vector insects in Chile, there is little available epidemiological information about this parasitosis in blood banks. Aim To update the rates of T cruzi positive blood donors. To measure parasitological and epidemiological parameters in blood donors with anti T cruzi antibodies. Material and Methods: An ELISA-T cruzi test was carried out in 30,309 blood donors between 2000 and 2004. In 75 blood donors with an ELISA-T cruzi positive test and 79 donors with negative ELISA (controls), a survey about personal or parental history of biting by a kissing bug (Triatomine), was performed. A blood sample was also obtained to perform Polymerase Chain Reaction (PCR) for T cruzi and a xenodiagnostic test. Results: Annual frequency of positive ELISA for T cruzi serum antibodies in blood donors varied from 0.31% to 0.45%. Twenty eight percent of subjects with positive and 6% of subjects with negative specific antibodies answered the survey about biting. PCR and xenodiagnostic test were positive in 52 (69%) and 16 (21%) of positive ELISA-T cruzi test blood donors, respectively. Xenodiagnostic was also positive in 5 individuals who had a negative PCR. Conclusions: Seroprevalence of T cruzi antibodies decreased from 3% in 1968 to 0.3% in 2004 <![CDATA[<b>Estudio de enfermedad celíaca en pacientes con psoriasis</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000010&lng=es&nrm=iso&tlng=es Background: A possible relationship has been reported between psoriasis and celiac disease, with common pathogenic mechanisms that may need further investigation. Aim: To investigate the presence of clinical and serological markers for celiac disease in a group of Chilean psoriatic patients. Material and methods: We included 80 psoriatic patients (42 males) aged 16 to 79 years, whose serum was tested for antitransglutaminase antibodies (ATGA) and antiendomysial antibodies (AEMA). Patients with weakly positive AEMA tests were also tested for antigliadin antibodies (AGA). Results: In six patients (7.5%), AEMA and AGA were positive and one patient was positive for ATGA. An upper gastrointestinal endoscopy and duodenal biopsy was offered to these six patients and five accepted the procedure. Only one had a pathological diagnosis of celiac disease. Conclusions: Only one of 80 patients with psoriasis had celiac disease (1.2%). Other four patients with positive serologic markers had a normal duodenal biopsy. This group of patients may have latent celiac disease and they should be followed up <![CDATA[<b>Aminotransferasas séricas en pacientes con Dengue tipo 3</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000011&lng=es&nrm=iso&tlng=es Background: Dengue infections may affect the liver, causing inflammation and compromising its function. Aim: To determine serum aminotransferases in patients with Dengue. Material and methods: One hundred eighty four patients with Dengue confirmed with anti-Dengue IgG and IgM antibodies measured by ELISA, aged 1 month to 79 years, were studied. As controls, 40 patients with acute hepatitis B virus infection aged 11 to 59 years and 40 healthy individuals, aged 14 to 55 years, were also studied. Alanine and aspartate aminotransferases (ALT and AST) were determined using a colorimetric method. Results: Sixty one percent of patients with Dengue had elevated aminotransferase levels. In patients with Dengue and hepatitis B, mean ALT levels were 21.3±8.4 and 29.7±18.8 U/I, respectively. Mean AST values were 37.3±19, 19.6± 16.4 and 4.3±1.7 U/I in patients with Dengue, hepatitis B and controls, respectively. During the year 2001, there was an increase in the number of cases with hemorrhagic fever caused by Dengue and 65% had elevation of aminotransferases. Conclusions: An increase in aminotransf erase levels is common in patients with Dengue <![CDATA[<b>Trombosis venosa cortical aislada</b>: <b>Comunicación de dos pacientes</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000012&lng=es&nrm=iso&tlng=es Isolated cortical vein thrombosis is an uncommon presentation of central venous thrombosis. We report two females, aged 29 and 40 years, with isolated cortical vein thrombosis. Both presented with a focal neurological deficit and focal seizures that became generalized. The diagnosis was made with magnetic resonance imaging. Both had a history of oral contraceptive use. Both had a rapid response to unfractionated heparin. One patient had an antiphospholipid syndrome as a possible etiology. The most common manifestations of this disease are a transient or recurrent neurological deficit, visual disturbances and focal or generalized seizures, usually without intracanial hypertension. Neuroimages show ischemic abnormalities that do not follow an arterial vascular territory, often with an early hemorrhagic component. There is a good clinical response to heparin <![CDATA[<b>Coristoma pancreático en la vesícula biliar</b>: <b>Reporte de dos casos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000013&lng=es&nrm=iso&tlng=es Pancreatic choristoma is the ocurrence of normal pancreatic tissue in an abnormal location without any anatomic continuity with the main body of the gland. Although heterotopia is uncommon in the gallbladder and biliary tract, anecdotic cases of gastric mucosa, liver, adrenal gland and pancreas among other tissues have been described. We report an eight year-old male and a 22 year-old female, electively operated for symptomatic cholelithiasis. On pathology, a nodule identified as a pancreatic endocrine and exocrine choristoma, was found in the gallbladder wall of both patients. We employed immunohistochemistry to characterize this choristoma. Tubular and epithelial structures were immunoreactive to cytokeratins 7, 8, 18, 19 and 20 and to CA19-9. Exocrine activity was documented by immunoreactivity to al-antitrypsin and al-chemotrypsin. Other immunohistochemical markers such as insulin and somatostatin were positive identifying endocrine activity <![CDATA[<b>Esofagitis</b><b> tuberculosa en un paciente HIV positivo</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000014&lng=es&nrm=iso&tlng=es Tuberculosis rates in Chile are higher than expected during the last years. This is directly related to the increase of immunodeficiency associated to human immunodeficiency virus (HIV) infection. Gastrointestinal tuberculosis is the sixth in frequency of extra pulmonary localizations. We report an HIV(+) 55 year-old male, that presented with fever and epigastric pain. In an upper GI endoscopy small elevated lesions were described in the esophagus. Pathological study was suggestive of tuberculous infection. The definitive diagnosis of esophageal tuberculosis was obtained by a PCR test of the biopsy sample. Antituberculous therapy was started and one year later there was a regression but not disappearance of esophageal lesions and granulomas in the pathological study <![CDATA[<b>Efecto de un inhibidor tirosina kinasa (imatinib) en pacientes con tumores estromales gastrointestinales metastásicos</b>: <b>Experiencia preliminar</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000015&lng=es&nrm=iso&tlng=es Gastrointestinal stromal tumors (GIST) have mutations of the tyrosine kinase receptor. When they are localized, the treatment of choice is surgical excision, but advanced tumors have a limited response to chemo or radiotherapy. Imatinib (STI571 or Glivec®) is a selective inhibitor or tyrosine kinase proteins that has been used successfully in the treatment of advanced GIST. We report four patients (two women) with a metastatic GIST that were treated with Imatinib 400 mg day and followed for 40 months. The disease tumor stabilized in three patients and in one it had an initial reduction and progressed at the end of follow up. Therefore Imatinib can be a therapeutic alternative in patients with metastatic GIST <![CDATA[<b>Fisiopatología de la hipertensión asociada al síndrome de apnea obstructiva del sueño</b>: <b>Evidencia de estudios clínicos y modelos animales de hipoxia crónica intermitente</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000016&lng=es&nrm=iso&tlng=es There is a well established relationship between the obstructive sleep apnea syndrome and hypertension. Current evidence suggests that the increase in arterial pressure is secondary to an enhanced sympathetic tone through peripheral chemoreflexes triggered by intermittent hypoxic stimulation of the carotid bodies. Chronic intermittent hypoxia would activate renal and systemic vasoactive systems through potentiated hypoxic chemoreflexes. These early changes in autonomic tone can be detected through cardiovascular variability and baroreflex sensitivity analysis. Both are relatively simple and noninvasive techniques. The multiplicity of pathogenic mechanisms in obstructive sleep apnea-associated hypertension emphasizes the need of increasing diagnostic sensitivity to detect and correct this common condition, which significantly increases cardiovascular risk <![CDATA[<b>Las contradictorias exigencias a la Educación Superior en Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000017&lng=es&nrm=iso&tlng=es Chile should become a member of the "society of knowledge". Therefore, undergraduate curricula of university careers should be revised, to offer shorter programs that prepare for a permanent training during the whole professional life. This proposal requires an agile academic team, endowed with the adequate methodological tools, but also a contingent of interested and motivated students with comprehension and expression skills and a study discipline. This article comments on the training deficiences of students that are admitted to Chilean universities and the difficulties of university teachers to compensate this training deficiencies in order to teach their subjects in shorter lapses <![CDATA[<b>Medicina y otras Carreras de la Salud en Chile</b>: <b>Un análisis preliminar</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000018&lng=es&nrm=iso&tlng=es Background: During 2006, Chilean universities had 586,000 students, corresponding to 41% of the population aged 18 to 23 years. Aim: To evaluate the situation of health care teaching in Chile. Material and Methods: Data from 6,212 careers were elaborated, considering the area of knowledge taught, level of teaching, geography, number and type of students, admission and tuition fees. Results: There are 537 programs for health care teaching in Chile. Of these, 231 are for nursing or dentistry aide personnel. The system has 60,648 matriculated students and it collected a total of US$250 millions in tuition fees. Only 9,8% of programs are accreditated. The students who chose health careers had the highest scores in the National University Selection Examination or PSU. Between 2000 and 2006, there was a significant increase in the number of medical students and every year, 1,000 new physicians will receive their title. During 2007, 1,634 new posts were offered in medical schools, 3,873 in nursing and 5,671 for kinesiology. Conclusions: There is a disharmonic growth of University teaching in Chile, that will solve historical deficits of professionals such as nurses but will introduce important changes in Chilean medicine <![CDATA[<b>¿Qué causó la demencia de Friedrich Nietzsche?</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000019&lng=es&nrm=iso&tlng=es Background: During 2006, Chilean universities had 586,000 students, corresponding to 41% of the population aged 18 to 23 years. Aim: To evaluate the situation of health care teaching in Chile. Material and Methods: Data from 6,212 careers were elaborated, considering the area of knowledge taught, level of teaching, geography, number and type of students, admission and tuition fees. Results: There are 537 programs for health care teaching in Chile. Of these, 231 are for nursing or dentistry aide personnel. The system has 60,648 matriculated students and it collected a total of US$250 millions in tuition fees. Only 9,8% of programs are accreditated. The students who chose health careers had the highest scores in the National University Selection Examination or PSU. Between 2000 and 2006, there was a significant increase in the number of medical students and every year, 1,000 new physicians will receive their title. During 2007, 1,634 new posts were offered in medical schools, 3,873 in nursing and 5,671 for kinesiology. Conclusions: There is a disharmonic growth of University teaching in Chile, that will solve historical deficits of professionals such as nurses but will introduce important changes in Chilean medicine <![CDATA[<b>Eficacia clínica de una insulina de acción intermedia en diabéticos descompensados con hipoglicemiantes orales</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872007001000020&lng=es&nrm=iso&tlng=es Background: During 2006, Chilean universities had 586,000 students, corresponding to 41% of the population aged 18 to 23 years. Aim: To evaluate the situation of health care teaching in Chile. Material and Methods: Data from 6,212 careers were elaborated, considering the area of knowledge taught, level of teaching, geography, number and type of students, admission and tuition fees. Results: There are 537 programs for health care teaching in Chile. Of these, 231 are for nursing or dentistry aide personnel. The system has 60,648 matriculated students and it collected a total of US$250 millions in tuition fees. Only 9,8% of programs are accreditated. The students who chose health careers had the highest scores in the National University Selection Examination or PSU. Between 2000 and 2006, there was a significant increase in the number of medical students and every year, 1,000 new physicians will receive their title. During 2007, 1,634 new posts were offered in medical schools, 3,873 in nursing and 5,671 for kinesiology. Conclusions: There is a disharmonic growth of University teaching in Chile, that will solve historical deficits of professionals such as nurses but will introduce important changes in Chilean medicine