Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720110012&lang=es vol. 139 num. 12 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[Relación entre ideación suicida y estilos parentales en un grupo de adolescentes chilenos]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200001&lng=es&nrm=iso&tlng=es Background: In Chile, there has been an increase in suicide rates from 1.1 to 2.6 per 100,000 among adolescents aged 10 to 14 years and from 4.4 to 8.9 per 100,000 among those aged 15 to 19 years Aim: To identify protective factors for suicidal ideation according to parenting styles, as described by Barber et al. Material and Methods: The relation between suicidal ideation and parenting styles was assessed in a random sample of 2,346 Chilean school attending adolescents aged 13 to 20 years old (59% women) from three cities: Antofagasta (Northern Chile, II Region), Santiago (Central, Metropolitan Region) and Concepción (Southern, VIII Region). Participants were tested with the Chilean adaptation of the Cross National Adolescents Program (CNAP) Plus questionnaire developed by Barber et al. The relation between suicidal ideation and parenting styles was assessed using regression analyses. Results: Correlations between suicidal ideation and parenting styles were mostly significant, yet weak. High odds ratios were observed among parents who had a strong psychological control, inconsistent control, lack of expression of affection and covered marital hostility. Conclusions: High adolescent self-esteem, a good relationship with parents, psychological parental autonomy, expression of physical affection, social support and paternal monitoring were protective factors against suicidal ideation. <![CDATA[<b>Formulación de una ecuación para predecir la masa grasa corporal a partir de bioimpedanciometría en adultos en un amplio rango de edad e índice de masa corporal</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200002&lng=es&nrm=iso&tlng=es Background: Bioelectrical impedance (BIA) has a good correlation and agreement with reference techniques, such as dual energy X-ray absorptiometry (DEXA), to assess body composition. Aim: To develop and assess the concordance of an equation to predict body fat mass derived from anthropometric data, gender, age and resistance obtained from bioelectrical impedance in adults, using DEXA as the reference method. Patients and Methods: Cross-sectional study of 62 women and 59 men aged 18 to 64 years with a body mass index ranging from 18.5 to 34.8 kg/ m². The equation was constructed using a predictive statistical model, considering sex, age, weight, resistance index (height²(cm)/ resistance (ohms)), as independent variables, and fat mass as the dependent variable. Results: The R² of the regression model was 0.96, and the standard error of estimation was 2.58 kg (p < 0.001). When comparing with DEXA, no significant differences were observed for the estimation of FM, between the equation developed in this work and that proposed by the manufacturer of the BIA equipment. However, the latter equation, underestimated FM by -2.5 ± 9.5% (p &gt; 0.05) and - 4.5 ± 8,9% (p < 0.05) in both genders and in women, respectively. Conclusions: The concordance between estimation of fat mass by the formula developed in this work and by DEXA was better than the estimation obtained using the formula proposed by the manufacturer of the BIA equipment. <![CDATA[<b>Resultados alejados de la cirugía reparadora de la insuficiencia mitral isquémica</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200003&lng=es&nrm=iso&tlng=es Background: The preferred treatment for ischemic mitral insufficiency is mitral valve repair with a prosthetic ring, because it does not deteriorate left ventricular function, allowing better immediate and long-term results. Aim: To assess long-term results of mitral annuloplasty with a prosthetic ring for ischemic mitral insufficiency. Patients and Methods: One hundred patients (68 men), with a mean age of 65.7 ± 8.6 years were included. They underwent a mitral annuloplasty with a prosthetic ring to treat ischemic mitral insufficiency, between February 1992 and May 2009. Fortyfour had a history of prior myocardial infarction and 46 had an evolving acute coronary syndrome. The inferior left ventricular wall was involved, exclusively or associated with an adjacent wall, in 72 cases. Coronary artery bypass grafts were performed in 92 patients and 32 required intra-aortic balloon pumping at some time during the peri-operative period. Results: Operative mortality was 10% (10 patients). During follow-up 30 patients died, at an average of 39 months after surgery (range: 3-142 months). Actuarial long-term survival rates at 1, 3 and 5 years were 79%, 72% and 64.5%, respectively. Trans esophageal echocardiogram performed in the operating room showed none or minimal residual mitral insufficiency in 96% of the cases. Echocardiographic follow-up was completed in 80% of the survivors; 79% of them had no or minimal mitral insufficiency. Only one patient was re-operated on due to severe mitral insufficiency and 4 required a permanent pacemaker. Conclusions: Considering the critical illness of these patients, good long-term results were observed after treatment of ischemic mitral regurgitation performing a mitral annuloplasty with a prosthetic ring. <![CDATA[<b>Disfunción cognitiva después de cirugía cardiaca</b>: <b>Saturación cerebral e índice biespectral: estudio longitudinal</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200004&lng=es&nrm=iso&tlng=es Background: Neuropsychological dysfunction is a major cause of morbidity and mortality after cardiac surgery. Aim: To evaluate if intraoperative cerebral desatu-ration and depth of anesthesia measured by bispectral index are related to postoperative cognitive dysfunction in cardiac surgery. Material and Methods: Prospective study in patients undergoing elective cardiac surgery with cardiopulmonary bypass. A comprehensive neuropsychological assessment was applied preoperatively and 3 months after surgery. Postoperative dysfunction was defined as a decrease of at least one standard deviation in two or more neuropsychological tests. Cerebral oxygenation and bispectral index were continuously recorded and corrected throughout surgery. Cerebral oxygenation data were analyzed by the mean value and at three thresholds: 50%, 40% and < 25% of the basal value. Bispectral index was analyzed at threshold of 45. Results: Fifty-six patients were initially enrolled and 48 completed the study. Nine of these (18.8 %) presented postoperative cognitive dysfunction. Mean cerebral saturation and bispectral index data were not different among the patients with or without cognitive dysfunction. There was no association between cerebral desaturation and bispectral index with changes in neurocognitive tests or with length of stay in the intensive care unit. A significant but weak correlation was found between baseline Ray-neurocognitive score and intensive care unit stay (rho = -0.46; P = 0.001). Conclusions: We did not find a significant association between cerebral desaturation and depth of anesthesia with postoperative cognitive decline in this population of patients. <![CDATA[<b>Reducción de la actividad física en pacientes con enfermedad pulmonar obstructiva crónica</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200005&lng=es&nrm=iso&tlng=es Background: Patients with chronic obstructive pulmonary disease (COPD) decrease their physical activity. However, it is unknown at which stage of the disease the reduction occurs and whether dyspnea is a limiting factor. Aim: To compare physical activity between patients with COPD and controls of similar age and to assess its association with disease severity. Material and Methods: We studied 112 patients with mild to very severe COPD and 55 controls. Lung function, six-minutes walking test (SMWT), and physical activity through the International Physical Activity Questionnaire (IPAQ) were measured. Results: Compared to controls, physical activity was significantly reduced in COPD patients (1823 ± 2598 vs. 2920 ± 3040 METs min/week; p = 0.001). Patients were more frequently sedentary (38 vs. 11%), while controls were more often very active (31 vs. 19%) or moderately active (58 vs. 43%). Physical activity was reduced from Global Initiative for Obstructive Chronic Lung Disease (GOLD) stage 2 and from Modified Medical Research Council (MMRC) dyspnea grade 1. Weak relationships were observed between lung function, SMWT and physical activity. Conclusions: Physical activity decreases early in the course of the disease and when dyspnea is still mild, among patients with COPD. (Rev Med Chile 2011; 139:1562-1572). <![CDATA[<b>Prevalencia de consumo de drogas en estudiantes universitarios que cursan primer y cuarto año</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200006&lng=es&nrm=iso&tlng=es Background: University students are especially vulnerable towards substance abuse Aim: To describe and compare drug consumption in students of a Chilean university who attended first and fourth year of studies, according to gender and faculty. Material and Methods: A representative, stratified and proportional sample of305 students was randomly chosen by faculty, career, grade and gender during2009. The consumption of alcohol, tobacco and illicit drugs was evaluated using an anonymous survey. Results: Students from health care faculties had the lower prevalence of consumption of tobacco, alcohol, tobacco-alcohol and marijuana, during the first and fourth year. Education area and social sciences faculties had the highest prevalence of consumption. Fourth year students had higher rates of consumption than their first year counterparts. Females had significantly lower rates of alcohol and marijuana consumption. Conclusions: Alcohol, tobacco and marijuana consumption was higher among students from education and social sciences faculties and those attending the fourth year of studies. <![CDATA[<b>Niveles séricos del antígeno prostático específico en varones expuestos y no expuestos al arsénico en el agua de bebida en Tucumán, Argentina</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200007&lng=es&nrm=iso&tlng=es Background: There is an association between arsenic exposure and prostatic cancer mortality. Aim: To analyze and to compare the serum levels of total prostatic specific antigen (TPSA) in asymptomatic men of a rural zone, exposed and not exposed to high concentrations of arsenic (As) in drinking water. Material and Methods: The study included 161 men that were subjected to a clinical evaluation, serum TPSA determination and a trans rectal ultrasonography. Exposed and non-exposed subjects were divided in groups GA, GB and GC according to TPSA levels (<4 ng/ml, 4.1-10 ng/ml and &gt;10.1 ng/ml respectively). Results: Exposed and non-exposed subjects had similar TPSA levels. Among exposed subjects, 88.2, 8,8 and 3% were ascribed to groups GA, GB and GC respectively. The figures for non-exposed subjects were 90. 6, 6,3 and 3,1%. The area under the receiver operating characteristic (ROC) curve for TPSA in exposed and non-exposed subjects was 0.64 (95% confidence intervals (CI) 0.40-0.9) and 0.71 (95% CI 0.6-0.8) respectively. Conclusions: No differences in TPSA levels between subjects exposed and non-exposed to arsenic were observed in this study. <![CDATA[<b>Meningomielitis asociadas a infección por herpes virus humano 7</b>: <b>Comunicación de dos casos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200008&lng=es&nrm=iso&tlng=es Human herpesvirus 7 (HHV-7) may cause encephalomyelitis in immune competent adults. We report two patients infected by the virus. A 34-year-old male presenting with paraparesis and a sensitive deficiency located in D6 dermatome. Cerebrospinal fluid had 35 white blood cells per mm³ and 75 mg protein per dl. A PCR-microarray examination was positive for HHV-7. The patient was treated with prednisolone and ganciclovir with full recovery. A 27-year-old male presenting with headache, fever and diarrhea. Cerebrospinal fluid analysis showed 160 cells per mm³ and 75 mg protein per dl. Viral RNA detection was positive for HHV-7. The patient was managed with analgesia and rest and was discharged with the diagnosis of viral meningitis. Our communication supports the notion that HHV-7 may be considered as pathogen factor in humans, even in immune competent ones. <![CDATA[<b>Síndrome de Sweet asociado a leucemia mieloide aguda y factor estimulante de colonias de granulocitos</b>: <b>Caso clínico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200009&lng=es&nrm=iso&tlng=es Sweet's syndrome, also known as acute febrile neutrophilic dermatosis, is characterized by fever, neutrophilia, erythematous and tender skin lesions that typically show a diffuse infiltrate of neutrophils in the upper dermis. This disorder has been associated with myeloproliferative syndromes. We report the case of a 53-year-old woman with an acute myeloid leukemia, presenting a Sweet's syndrome. A worsening of cutaneous lesions injuries was observed when granulocyte colony stimulating factor was added to treatment. <![CDATA[<b>Ergotismo secundario a la asociación ergotamina-ritonavir</b>: <b>A propósito de 3 casos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200010&lng=es&nrm=iso&tlng=es Ergotism is a complication of the acute intoxication or chronic abuse of ergot derivatives. It may be manifested by a vasomotor syndrome with peripheral vascular disease frequently involving extremities. We report three patients infected with human immunodeficiency virus (HIV), in antiretroviral treatment (ART) that included a protease inhibitor as ritonavir, and had received self-medicated ergotamine. They developed symptoms of peripheral vascular disease and the physical examination showed no arterial pulses in the affected vessels. Arterial Doppler confirmed signs of diffuse arterial spasm in all of them. An arteriography was performed to the second patient and it showed obliteration of the distal sector of the ulnar and radial arteries. Ergotism secondary to ergotamine-ritonavir association was diagnosed. Patients were treated discontinuing the administration of involved drugs, arterial vasodilators and prophylactic anticoagulation, with marked improvement of symptoms. <![CDATA[<b>Mutación en el gen EDA1, Ala349Thr en paciente con displasia ectodérmica hipohidrótica ligada a X</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200011&lng=es&nrm=iso&tlng=es Hypohidrotic ectodermal dysplasia (HED) is a very rare disease characterized by the absence of eccrine glands, dry skin, scanty hair, and dental abnormalities. It is caused by mutations within the ED1 gene, which encodes a protein, ectodysplasin-A (EDA). Clinical characteristic are frontal bossing, saddle nose, pointed chin, a prominent supraorbital ridge with periorbital hyperpigmenta-tion, and anodontia. Those affected show great intolerance to heat. We report the first Mexican 2-year-old boy with an Ala349Thr missense mutation from Tamaulipas, México. <![CDATA[<b>Factores de virulencia de <i>Mycobacterium</i><i> tuberculosis</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200012&lng=es&nrm=iso&tlng=es Mycobacterium tuberculosis, the etiological agent of human tuberculosis, causes annually three million deaths and latently infects about two billion people. Immunodeficiency caused by malnutrition, senescence or co-infection with HIVenhances the risk of developing active tuberculosis, either from a primary infection or by reactivation of a latent infection. The increasing appearance of multidrug-resistant strains to existing drugs is worrisome, since it leaves patients practically without treatment options. The understanding of the mechanisms of transmission, pathogenesis and virulence of M. tuberculosis is important. The analysis of its genome shows the presence of alternative sigma factors, transcriptional repressors and activators, two component signaling systems, metabolic enzymes and cellular secretory systems, that are associated with virulence in a series of pathogenic micro-organisms. Environmental stimuli such as pH, temperature, osmolality, oxygen availability are processed, activating or repressing virulence genes. The molecular mechanisms of action of these genes have been elucidated in in vitro and in vivo models. <![CDATA[<b>Informática biomédica</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200013&lng=es&nrm=iso&tlng=es Biomedical Informatics is a new discipline that arose from the need to incorporate information technologies to the generation, storage, distribution and analysis of information in the domain of biomedical sciences. This discipline comprises basic biomedical informatics, and public health informatics. The development of the discipline in Chile has been modest and most projects have originated from the interest of individual people or institutions, without a systematic and coordinated national development. Considering the unique features of health care system of our country, research in the area of biomedical informatics is becoming an imperative. <![CDATA[<b>Garantía de oportunidad, artrosis y autorreporte de salud en personas con artrosis en una comuna de la Región Metropolitana</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200014&lng=es&nrm=iso&tlng=es Background: Mild to moderate osteoarthritis of the knee in people over 55 years of age is one of the diseases whose management is covered by the explicit guaranties in health system (GES) in Chile. All beneficiaries with the disease should be informed about their rights to receive free treatment. Aim: To assess the degree of awareness about their rights among patients with knee osteoarthritis, admitted to GES. Material and Methods: Two hundred forty one patients aged 55 to 93 years (180 women) with knee osteoarthritis admitted to GES, answered at their homes a survey about their rights to receive health care, included in the GES system and about their disease. Results: Fifty percent of patients did not know what GES system was, 26% admitted to have a limited knowledge and 24%, a full knowledge. Sixty two percent were not informed about the nature of their disease and 42% perceived their health as less than optimal. There was a significant association between the level of knowledge about GES and osteoarthritis and their self-perception of health. Conclusions: Half of the patients with knee osteoarthritis surveyed, were not aware of their health care rights included in GES and received scanty information about their disease. <![CDATA[<b>Agencia nacional de medicamentos (ANAMED)</b>: <b>una oportunidad para ser aprovechada</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011001200015&lng=es&nrm=iso&tlng=es Background: Mild to moderate osteoarthritis of the knee in people over 55 years of age is one of the diseases whose management is covered by the explicit guaranties in health system (GES) in Chile. All beneficiaries with the disease should be informed about their rights to receive free treatment. Aim: To assess the degree of awareness about their rights among patients with knee osteoarthritis, admitted to GES. Material and Methods: Two hundred forty one patients aged 55 to 93 years (180 women) with knee osteoarthritis admitted to GES, answered at their homes a survey about their rights to receive health care, included in the GES system and about their disease. Results: Fifty percent of patients did not know what GES system was, 26% admitted to have a limited knowledge and 24%, a full knowledge. Sixty two percent were not informed about the nature of their disease and 42% perceived their health as less than optimal. There was a significant association between the level of knowledge about GES and osteoarthritis and their self-perception of health. Conclusions: Half of the patients with knee osteoarthritis surveyed, were not aware of their health care rights included in GES and received scanty information about their disease.