Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720210007&lang=en vol. 149 num. 7 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[Epidemiology of acute pancreatitis in Chile between 2013 and 2018]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000700961&lng=en&nrm=iso&tlng=en Background: The worldwide incidence of acute pancreatitis (AP) is increasing. Aim: To determine the national incidence of AP between 2013 and 2018. Material and Methods: Analysis of hospital discharge records available at the web page of the Statistical and Information Service of the Chilean Ministry of Health. We recorded the number of patients discharged with a diagnosis of AP, excluding chronic pancreatitis and pancreatic cancer, between 2013 and 2018. We also recorded length of hospital stay, age, etiology, and lethality. Rates of raw and age-adjusted incidence were calculated. Results: During the study period, 46,420 patients with AP were discharged, with an incidence rate ranging between 39 and 43.7/100,000 inhabitants, and a non-significant increase along time of 8.6%. There are important differences between the average adjusted rates of Northern (Arica to Metropolitan) and Southern regions (O’Higgins to Magallanes), with rates of 36.9 and 53.6/100,000 inhabitants respectively (p &lt; 0.01). The average hospital stay was 11 days. Two thirds of cases were aged between 20 and 64 years. The case fatality was 4.2%, with no decrease between 2013 and 2018. The mortality rate was 1.6/100,000 inhabitants. Conclusions: The annual incidence of AP is 42.6/100,000 inhabitants, with geographical differences from North to South, which can be associated with the high frequency of biliary tract disease in aboriginal ethnic groups. The age distribution and length hospital stay were stable over time. <![CDATA[Coverage rates of eye fundus examinations among Chilean patients with diabetes mellitus]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000700971&lng=en&nrm=iso&tlng=en Background: Timely eye fundus examinations are essential to prevent the consequences of retinopathy among patients with type 2 diabetes mellitus. Aim: To assess the coverage rate (CR) of eye fundus examination in the Chilean diabetic population, between 2011 and 2019. Material and Methods: Analysis of monthly statistical summaries of the Cardiovascular Health Program published online by the Chilean Ministry of Health. The number of patients aged 15 years or more with a diagnosis of Type 2 diabetes mellitus and the number of those who had an eye fundus examination within the same year, were obtained. Data was analyzed at a national and regional level. Results: The national eye fundus examination CR was 19.1% in 2011. In 2016, the figures became significantly higher, reaching 32.5%. In 2019, the highest value of 36.5% was recoded although not significantly different from 2016. The highest average annual CR was observed in Ñuble Health Service (49.5%), and the lowest in Central Metropolitan Service (15%). The highest CR positive absolute and relative variation between 2011 and 2019 was observed in Viña del Mar Quillota Health Service (38.9 and 489% respectively), and the lowest negative variation was observed in Araucania Norte Health Service (-8.42 and -24.21% respectively). Conclusions: There is a low eye fundus examination CR in Chile, with important differences between regional health services. <![CDATA[Effects of COVID-19 pandemic on food insecurity perception in Chilean households]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000700980&lng=en&nrm=iso&tlng=en Background: The coronavirus 2 pandemic (COVID-19) has caused intense changes in lifestyles, feeding, and nutrition habits. Aim: To analyze food insecurity and eating habits during the period of quarantine in a group of Chilean individuals. Material and Methods: An online survey was conducted in 2,767 households with questions about the sociodemographic composition of the household, household food purchasing habits in the quarantine period for COVID-19, and perception of food insecurity. Results: More than 60% of households (p &lt; 0.01) were worried about not having enough food, especially when children under 18 years of age lived in them. This perception increased in urban households (p &lt; 0.01) and those located in the Central-Southern and Southern regions (p &lt; 0.01). During the pandemic, the consumption of healthy products such as milk increased in 50% of households, legumes in 72%, eggs in 79%, fruits in 54%, vegetables in 67% and water in 81%. There was also a lower consumption of unhealthy and ultra-processed foods such as hot-dogs in 90% of households, sausages in 73%, sugary drinks in 79% and ice cream in 83%. Conclusions: The COVID-19 pandemic in Chile increased the perception of food insecurity in households with vulnerable conditions. However, the consumption of healthier foods increased. <![CDATA[Use of web 2.0 Tools in the flipped classroom methodology: an option for distance learning]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000700989&lng=en&nrm=iso&tlng=en Background: The flipped classroom is an active method where information in delivered before class and the time allocated for it is dedicated to achieving more complex learning objectives. Diverse resources are used in each phase of the methodology. However, Web 2.0 or “Social Web” tools allow greater personal and remote interaction. Aim: To describe the perception about flipped classroom methodology implemented using web 2.0 tools in 48 medical students from the University Mayor. Material and Methods: The students were invited to view four video-classes available on Edpuzzl. During the activity, questions about the topic were inserted to promote understanding, research, and teamwork, then the topic was discussed using Case-Based Learning through the Quizizz program. A survey composed of 12 closed items and an open question was applied to analyze the perceptions of students. Data were analyzed using the SPSS and Atlas-Ti programs. Results: A high satisfaction rate was observed about the way in which the content, discussion and communication of the information was presented. The methodology encouraged the development of generic competences, but it was not always positively perceived. Conclusions: The flipped classroom methodology developed with Edpuzzle was very well evaluated by students. This teaching method may be particularly useful in the epidemiological context of COVID-19 and other situations which require distant learning. <![CDATA[Opinion about clinical ethics consultation among intensivist physicians]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000700997&lng=en&nrm=iso&tlng=en Background: Clinical ethics consultation services and their methods vary and they are seldom evaluated. Only one formal system of individual clinical ethics consultation has been reported in Chile, with a ten-year registry. Aim: To evaluate the opinion of intensivist physicians about the contribution of clinical ethics consultation. Material and Methods: An anonymous and voluntary questionnaire consulting their opinion about clinical ethics consultations was sent to 38 intensivist physicians. Results: The questionnaire was answered by 28 professionals. Eighty four percent of respondents considered that ethics consultation contributed to improve patients' quality of care, 92% responded that this practice helps in decisions about limitation of treatments or life support, and 96% expressed that it also was a positive support for patients and their relatives. Seventy two percent of respondents considered that ethics consultations enhanced their ethical sensibility, 76% that they improved their understanding of clinical ethics topics, and 72% declared that it decreased their stress in complex decision-making. Conclusions: Clinical ethics consultation provides a positive support for improvements in clinical decision-making and in the quality of patients' care. <![CDATA[Suicide rates in the Araucania Region of Chile]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701004&lng=en&nrm=iso&tlng=en Background: Suicide is a public health problem in the world. In Chile, suicide rates increased since 1990 with regional differences in rates. Aim: To analyze the geographical distribution of deaths due to suicide that occurred in the Region of Araucanía between the years 2004-2015. Material and Methods: The geographic distribution of suicide in the Araucania Region at district level (2004-2015) was analyzed using death data available at the web page of the Ministry of Health. Socio-demographic variables of suicide were characterized. The spatial distribution of suicide rates was represented using cartography, and suicide spatial clusters were identified through spatial-temporal exploration. Results: There were 1,562 suicides, 86% in men, with a mean rate of 13.07 x105 inhabitants. The highest rates were registered in people aged over 70 years. Most individuals committing suicide were active workers. Hanging was the most common method to accomplish suicide. The territories from the coastal area in Cautín, and Nahuelbuta registered the highest suicide rates. Two statistically significant conglomerates with high incidence of suicide cases were identified. Conclusions: The use of geographic methods and the disaggregation of suicide cases at district level, allowed the identification of territorial variability in the distribution of suicide rates within the Araucanía Region. Spatial patterns of areas with high suicide risk were found. <![CDATA[Construction of text resources for automatic identification of clinical information in unstructured narratives]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701014&lng=en&nrm=iso&tlng=en Background: A significant proportion of the clinical record is in free text format, making it difficult to extract key information and make secondary use of patient data. Automatic detection of information within narratives initially requires humans, following specific protocols and rules, to identify medical entities of interest. Aim: To build a linguistic resource of annotated medical entities on texts produced in Chilean hospitals. Material and Methods: A clinical corpus was constructed using 150 referrals in public hospitals. Three annotators identified six medical entities: clinical findings, diagnoses, body parts, medications, abbreviations, and family members. An annotation scheme was designed, and an iterative approach to train the annotators was applied. The F1-Score metric was used to assess the progress of the annotator's agreement during their training. Results: An average F1-Score of 0.73 was observed at the beginning of the project. After the training period, it increased to 0.87. Annotation of clinical findings and body parts showed significant discrepancy, while abbreviations, medications, and family members showed high agreement. Conclusions: A linguistic resource with annotated medical entities on texts produced in Chilean hospitals was built and made available, working with annotators related to medicine. The iterative annotation approach allowed us to improve performance metrics. The corpus and annotation protocols will be released to the research community. <![CDATA[Prevalence and features of chronic pain among patients with schizophrenia]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701023&lng=en&nrm=iso&tlng=en Background: People with schizophrenia generally refrain from manifesting somatic symptoms, and may not complain of pain. Therefore these patients may have an insensitivity to pain. Aim: To determine the prevalence of chronic pain in a sample of patients with schizophrenia. Patients and Methods: The McGill Pain Questionnaire (MPQ) was answered by 79 outpatients with schizophrenia with a mean age of 47 years (67% men) attended at a public hospital in Chile. Results: Chronic pain, defined as lasting more than six months, was reported by 15.2 % of patients. Acute pain was reported by 63% of patients. No significant differences were observed in sociodemographic characteristics or duration of illness between patients with acute or chronic pain. The assessment of the different pain dimensions showed a predominance of sensory and affective components, with pain rating indexes of 0.82 and 0.71, respectively. Conclusions: These results indicate that the prevalence of pain among people with schizophrenia, is similar to that of the general population. <![CDATA[Physical and emotional sequelae after hospitalization for COVID-19]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701031&lng=en&nrm=iso&tlng=en Background: Facing a severe life-threatening disease has physical and emotional consequences for patients. Aim: To evaluate the physical and emotional sequelae in patients who survived COVID-19 pneumonia. Material and Methods: This cross-sectional study collected data from post-COVID-19 pneumonia patients admitted to an outpatient follow-up program in a public hospital in Chile. One month after hospital discharge, the evaluation of physical capacity was carried out through the 1-minute sit-to-stand test (1STST). In addition, the Clinical Frailty Scale (CFS) and the Hospital Anxiety and Depression scale were applied. Results: We included 70 patients aged 63 ± 13 years (54% women). Eighty-five percent of the patients were able to execute the 1STST with an average of 20.6 ± 4.8 repetitions. Forty-eight percent of the patients had a performance below the 2.5th percentile according to the reference values and 28% of patients had exertional desaturation. The CFS classified as mildly vulnerable or with some degree of frailty to 33% of patients. Twenty-five percent of the patients presented symptoms of depression and 33% of anxiety. Conclusions: Patients who survived COVID-19 have a decrease in physical capacity and a significant proportion of depression and anxiety one month after hospital discharge. <![CDATA[Pharmacokinetic interactions of fruit juices and herbal preparations]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701036&lng=en&nrm=iso&tlng=en Drug disposition in the human body is strongly influenced by transporters and metabolizing enzymes expressed in key organs including intestine, liver and kidney. Since drugs and chemicals present in foods such as fruit juices and herb-based products are substrates of the above-mentioned proteins, there is a high probability of pharmacokinetic interactions. Findings from preclinical and clinical studies helped to characterize the mechanisms by which the components of fruit juices and herbs act as perpetrators of pharmacokinetic interactions. The aim of this review is to provide an overview of pharmacokinetic fruit juice- and herb-drug interactions that could be relevant in the clinical setting. <![CDATA[General and infant mortality trends in Chile from 1909 to 2017]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701047&lng=en&nrm=iso&tlng=en Background: During the twentieth century, Chile experienced an important reduction in general mortality. Aim: To describe both general and infant mortality of Chile from 1909 to 2017. Material and Methods: Analysis of information about births and deaths published by the Chilean National Institute of Statistics for the period between 1909 and 2017. Results: Both general and infant mortality rates declined sharply from the 1930s to the late 1990s. However, during the last few years, general mortality rates increased slightly. This is the first increase in over a century. Another positive aspect is that there was a dramatic decrease in mortality rate gaps across Chilean regions, for both general and infant mortality. However, intraregional inequalities in infant mortality continue to be a detrimental factor. Conclusions: Public health efforts should be carried out to further reduce socioeconomic and regional gaps in adult and infant mortality in Chile. <![CDATA[Experiences of medical students belonging to sexual and gender diversity: a systematic review]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701058&lng=en&nrm=iso&tlng=en Background: Students belonging to sexual and gender diversity experience chronic stress due to stigmatization and discrimination. Aim: To identify the experiences of lesbian, gay, bisexual, transgender/transsexual, and queer (LGBTQ+) medical students. Material and Methods: Systematic literature review using the PRISMA protocol in PubMed, ERIC, EMBASE, and LILACS databases. Articles published in Spanish or English were considered. Three authors independently reviewed and synthesized information from the selected articles, according to the PRISMA criteria. Results: Fifteen studies met the inclusion criteria. Forty-three experiences were reported, which were finally classified into four categories: i) Relationship between peers in the educational context (23%), ii) Relationship between students and teachers in the educational context (23%), iii) Relationship with the educational institution (34%), and iv) Curriculum and training experience (19%). The relationship with the educational institution was identified as the most relevant category. Students with a strong sense of belonging to their institution were more likely to be persistent and make an effort in learning. The second most relevant experiences, mainly negative, derive from interactions with peers and teachers. Conclusions: LGBTQ+ medical students still experience more discrimination than inclusion during their training. Therefore, medical schools should render medical education a more inclusive space for the LGBTQ+ population. <![CDATA[The impact of COVID-19 pandemic on doctor-patient relationship]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701070&lng=en&nrm=iso&tlng=en Doctor-patient relationship (DPR) is the cornerstone of clinical medicine, mobilizing powerful human resources. This article analyzes the impact of COVID-19 pandemia on DPR. Due to fear of contagion, the use of telephone or digital consultation was preferred, in which only the results of laboratory and imaging tests can be reviewed, and the patient receives a diagnostic conclusion. Patients are afraid of face-to-face consultations, and healthcare centers developed measures to reduce patient influx. Thus, a new relationship ensued, generating suspicion, mistrust and fear. The empathy and affection that the doctor must project and deliver to the patient was reduced. Depending on the duration of the pandemia, doctors and patients will eventually get used to this type of relationship and a paradigm shift will occur, in which Hippocratic medicine gives way to digital medicine. <![CDATA[Remarks on the “Dignified death and palliative care” bill]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701075&lng=en&nrm=iso&tlng=en The Chilean House of Representatives is discussing the bill on “Dignified death and palliative care”, which regulates the so-called medical assistance in dying or euthanasia. This paper will critically analyze the different aspects of the bill, particularly concerning four main dimensions, namely, the patient's condition at the time of requesting euthanasia; the doctor-patient relationship and respect for the autonomy of both parties; the idea of medicine involved in it; and the possible therapeutic alternatives to euthanasia. This critical analysis raises the need to discuss in more depth a project that has to do with such important decisions about our lives and that implies a radical change in the way of thinking and practicing medicine. <![CDATA[Bilateral adrenal hemorrhage after severe COVID-19 infection. Report of one case]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701081&lng=en&nrm=iso&tlng=en We report a 47-year-old male with a severe disease caused by COVID-19, who required mechanical ventilation for 18 ays. During the hospital stay he received dexamethasone and anticoagulation with heparin. After discharge a new chest CT scan showed homogeneous hypo vascular enlargement of both adrenal glands, not present in the initial imaging studies. It was interpreted as a subacute bilateral adrenal hemorrhage. The patient remained stable and without any complaint. <![CDATA[Subacute encephalopathy associated with relapsing polychondritis. Report of one case]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701085&lng=en&nrm=iso&tlng=en Relapsing polychondritis (RP) is a rare multisystemic autoimmune disorder characterized by the inflammation and destruction of cartilages, with preference for auricular, nasal and laryngotracheal cartilages. RP may also affect proteoglycan-rich structures, such as, blood vessels, eyes, kidneys, and heart. The central nervous system (CNS) is involved in less than 3% of patients. We report a 32-year-old female with RP associated with a progressive subacute encephalopathy characterized by behavioral disturbances, auditory and visual hallucinations. The EEG showed generalized slow activity and a mononuclear pleocytosis with increased protein was found in the cerebrospinal fluid. The brain magnetic resonance imaging showed multiple supra and infratentorial nodular inflammatory lesions. After initiating treatment with corticosteroids and cyclophosphamide, a significant improvement in chondritis and neurological status was observed. <![CDATA[Persistent foramen ovale as a cause of persistent hypoxemia after a pneumonia caused with COVID-19. Report of one case]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701090&lng=en&nrm=iso&tlng=en In patients with severe COVID-19, it has been proposed as mechanism of respiratory failure, intra and extrapulmonary shunt. However, there are no reported or documented cases of this mechanism. Also, there are studies showing this mechanism is not relevant. In this report, we present the case of a patient with severe COVID-19 pneumonia, who after two months, during his rehabilitation period, presented persistent hypoxemia with orthodeoxia. Persistent oval foramen with shunt from right to left was diagnosed. The patient underwent a percutaneous closure of the defect and at 48 hours oxygen therapy could be discontinued and the patient discharged. <![CDATA[The HIV Epidemic on Pandemic Times: Situation in Chile]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701093&lng=en&nrm=iso&tlng=en In patients with severe COVID-19, it has been proposed as mechanism of respiratory failure, intra and extrapulmonary shunt. However, there are no reported or documented cases of this mechanism. Also, there are studies showing this mechanism is not relevant. In this report, we present the case of a patient with severe COVID-19 pneumonia, who after two months, during his rehabilitation period, presented persistent hypoxemia with orthodeoxia. Persistent oval foramen with shunt from right to left was diagnosed. The patient underwent a percutaneous closure of the defect and at 48 hours oxygen therapy could be discontinued and the patient discharged. <![CDATA[Cognitive status and exercise in patients with type 2 diabetes mellitus]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701094&lng=en&nrm=iso&tlng=en In patients with severe COVID-19, it has been proposed as mechanism of respiratory failure, intra and extrapulmonary shunt. However, there are no reported or documented cases of this mechanism. Also, there are studies showing this mechanism is not relevant. In this report, we present the case of a patient with severe COVID-19 pneumonia, who after two months, during his rehabilitation period, presented persistent hypoxemia with orthodeoxia. Persistent oval foramen with shunt from right to left was diagnosed. The patient underwent a percutaneous closure of the defect and at 48 hours oxygen therapy could be discontinued and the patient discharged. <![CDATA[Older people and their incorporation into new technologies, shows their resilience and defeat of old-fashioned stereotypes]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701097&lng=en&nrm=iso&tlng=en In patients with severe COVID-19, it has been proposed as mechanism of respiratory failure, intra and extrapulmonary shunt. However, there are no reported or documented cases of this mechanism. Also, there are studies showing this mechanism is not relevant. In this report, we present the case of a patient with severe COVID-19 pneumonia, who after two months, during his rehabilitation period, presented persistent hypoxemia with orthodeoxia. Persistent oval foramen with shunt from right to left was diagnosed. The patient underwent a percutaneous closure of the defect and at 48 hours oxygen therapy could be discontinued and the patient discharged. <![CDATA[Multidisciplinary productivity about COVID-19 in Chile: Bibliometric study of sources from Web of Science]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000701099&lng=en&nrm=iso&tlng=en In patients with severe COVID-19, it has been proposed as mechanism of respiratory failure, intra and extrapulmonary shunt. However, there are no reported or documented cases of this mechanism. Also, there are studies showing this mechanism is not relevant. In this report, we present the case of a patient with severe COVID-19 pneumonia, who after two months, during his rehabilitation period, presented persistent hypoxemia with orthodeoxia. Persistent oval foramen with shunt from right to left was diagnosed. The patient underwent a percutaneous closure of the defect and at 48 hours oxygen therapy could be discontinued and the patient discharged.