Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720140008&lang=es vol. 142 num. 8 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<strong>Prevalencia de síndrome metabólico en individuos de etnia Mapuche residentes en zonas rurales y urbanas de Chile</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800001&lng=es&nrm=iso&tlng=es Background: Metabolic Syndrome (MS) increases the risk of diabetes and mortality associated with cardiovascular disease. However, the prevalence of MS could differ by ethnicity and lifestyle factors. Aim: To determine the prevalence of MS in Mapuche individuals living in urban and rural environments in Chile and to investigate whether the prevalence and risk of MS in urban and rural environments differs by sex, age and nutritional status. Material and Methods: A total of 1077 Mapuche participants were recruited from urban (MU = 288) and rural (MR = 789) settings. Body mass index, waist circumference and blood pressure were measured. A fasting blood sample was obtained to measure serum glucose, HDL cholesterol and triacylglycerol. The prevalence of MS was determined using the unified IDF and ATP-III criteria. Results: An environment and sex interaction was found for the prevalence of MS (p = 0.042). The prevalence was significantly lower in male MR (13%) compared to other groups (22, 23 and 25% among female MR, female MU and male MU respectively). Also, the prevalence of central obesity and low HDL-cholesterol were significantly lower in male MR. MU are at an increased risk of developing MS compared to MR, with an odds ratio of 1.59 (95% confidence intervals 1.1 to 2.2). This risk increases along with age or body mass index of the population. Conclusions: The adoption of an urbanized lifestyle increases the risk of developing MS in Mapuche individuals. This risk is enhanced by age and nutritional status. <![CDATA[<strong>Variables perinatales de recién nacidos de madres Aymara sugieren adaptación genética a la altura</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800002&lng=es&nrm=iso&tlng=es Background: Studies performed in Andean populations living in high altitude, indicate that the reduced availability of oxygen could be associated to both a fetal growth retardation and a lower birth weight. These variables are predictive of morbidity and mortality during the first year of life. Aim: To study perinatal variables of newborns of mothers living at contrasting altitudinal levels, harboring different degrees of Aymara ancestry. Subjects and Methods: Review of medical records of 5,295 women whose deliveries occurred between February 2004 and August 2010. Information was obtained on place of residence, grouped into two categories: coast (150 to 3,000 m) and high plateau (3,000 to 4,300 m), ancestry was estimated using number of Aymara surnames that were homologated to percentages of Amerindian admixture, gestational age, birth weight, height, head circumference and obstetric variables. Results: Gestational age showed a tendency to increase and birth weight, height and head circumference to decrease with altitude of residence. Only weight reached statistical significance. Women with Aymara ancestry gave birth to children with a significantly higher gestational age, weight and cranial circumference. Conclusions: Altitude of residence is related to a decrease in perinatal variables that proved to be less pronounced in newborns of mothers with a higher degree of Aymara ancestry. Results suggest a genetic adaptation to hypoxia that could be related to candidate genes linked to the capture, transport or utilization of oxygen. <![CDATA[<strong>Clasificación de los fenotipos de síndrome de ovario poliquístico de acuerdo a los criterios de Rotterdam</strong>: <strong>¿una condición estática o variable?</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800003&lng=es&nrm=iso&tlng=es Background: Polycystic Ovary Syndrome (PCOS) is tightly associated with insulin resistance and obesity and characterized by hyperandrogenism, chronic oligo-anovulation and polycystic ovarian morphology when fully expressed. The 2003 Rotterdam consensus proposed that two or three of these features were necessary to make the diagnosis, which generated four phenotypes. Several studies have suggested that these phenotypes could differ in their metabolic and endocrine characteristics and that they could vary in the same patient when analyzed throughout life. Aim: To determine if the initial classification of PCOS phenotypes is modified by different physiological conditions. Material and Methods: We performed a non-concurrent prospective analysis of 88 women with PCOS according to the Rotterdam criteria. The effect of physiological conditions such as changes in body weight, pregnancy and ageing more than five years on PCOS phenotype expression was analyzed. Results: Twenty four percent of women became pregnant, 37% decreased and 24% increased their body weight during follow up. These conditions modified significantly the proportion of the different phenotypes (c2 = 32.2, p < 0.001). For instance, weight reduction was associated with a change to a better phenotype (p = 0.047) and even a normalization of the PCOS condition in 27% of the patients. On the other hand, an increase in body weight modifying body mass index in one unit, conferred an 8% probability of changing to a worst phenotype. Conclusions: Pregnancy and changes in body weight significantly modify PCOS phenotypes. <![CDATA[<strong>Prácticas parentales y conductas de riesgo del peatón en una muestra de adolescentes chilenos</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800004&lng=es&nrm=iso&tlng=es Background: Traffic accidents are the second leading cause of death among adolescents and young adults in Chile. However, few studies have examined this behavior among this age group. Parental practices have a great influence on risk behaviors in adolescents, such as substance use, sexuality and violence, among others. Specifically, we propose that these practices will influence pedestrian risk behaviors among adolescents. Aim: To study the role of parental practices such as mother and father support, and behavioral control (monitoring and presence of rules) in pedestrian risk behaviors of teenagers. Material and Methods: A sample of 470 adolescents attending schools in the Metropolitan Region of Santiago, Chile were studied. They answered a self-administered questionnaire in which they were asked about parental practices and pedestrian risk behaviors. Analyses were performed using descriptive and inferential statistics, using multiple regression. Results: Paternal support and the presence of rules were protective factors for pedestrian risky behaviors. However, maternal support or monitoring did not influence these behaviors. Conclusions: Parental practices influence pedestrian behaviors of teenagers. The study provides further evidence for the importance of these practices in the development of behavioral self-regulation. <![CDATA[<strong>Tratamiento de la hemorragia subaracnoidea aneurismática en el Hospital Clínico de la Universidad de Chile</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800005&lng=es&nrm=iso&tlng=es Background: One third of patients with subarachnoid hemorrhage caused by intracranial aneurysms, die. Aim: Review of medical records of patients with subarachnoid hemorrhage treated at a clinical hospital. Material and Methods: Review of medical records of patients discharged from the hospital between 2006 and 2011 with the diagnosis of subarachnoid hemorrhage. Patients initially or subsequently treated elsewhere were not analyzed. Results: The medical records of 82 patients aged 24 to 100 years (77% females), were analyzed. The clinical diagnosis at the onset of the condition was correct in 82% of cases. In 95% of patients, an angiographic study and subsequent surgical intervention of the aneurysm were carried out within 24 hours of diagnosis. Global mortality was 23%. Twelve patients died prior to any possible treatment, due to the severity of the disease. Seventy six aneurysms in 70 patients were treated with clips or coils in 37 and 39 cases, respectively. Seven patients died. Forty seven patients had a Rankin disability score of two or less. Conclusions: The presence of an intracranial hematoma or acute hydrocephaly on admission and clinical vasospasm during evolution were associated with a bad prognosis. <![CDATA[<strong>Aspectos relevantes en el desarrollo del tutorial en aprendizaje basado en problemas desde la perspectiva de los tutores de la Facultad de Medicina de la Universidad de La Frontera</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800006&lng=es&nrm=iso&tlng=es Background: In 2004 the Faculty of Medicine of Universidad de La Frontera in Chile implemented curricular changes, incorporating small group problem based learning in different carriers. Aim: To explore aspects that hamper or facilitate tutorial problem based learning from the perspective of tutors. Material and Methods: Six in depth interviews and a focus group with tutors were carried out in 2010 and 2011. Data were analyzed through constant comparisons using the program ATLAS ti, guaranteeing credibility, reliance, validation and transferability. Results: Five hundred and twenty eight (528) significance units were identified and 25 descriptive categories emerged. The categories of tutor motivation, methodological domain, tutor responsibility, tutor critical capacity, disciplinary domain, student participation and tutor-student interaction were emphasized. Three qualitative domains were generated, namely tutor skills, transformation of student roles and institutional commitment. Conclusions: Tutorial teaching is favored by teachers when the institutions train them in the subject, when there is administrative support and an adequate infrastructure and coordination. <![CDATA[<strong>Impacto clínico de un sistema de farmacovigilancia activa realizado por un farmacéutico en el reporte y subnotificación de reacciones adversas a medicamentos</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800007&lng=es&nrm=iso&tlng=es Background: Despite the importance of notifying and preventing adverse drug reactions (ADRs), they are under reported and their consequences are not adequately evaluated. Aim: To assess the impact of a pharmacovigilance system carried out by a pharmacist. Material and Methods: In an internal medicine service, the spontaneous report of ADRs was compared blindly with an active pharmacovigilance system in which a pharmacist detected, monitored and prevented ADRs. Results: A total of 1,196 patients was included. Of these 604 were hospitalized in intervened wards, where 50 suspected ADRs in 47 patients were reported. In non-intervened wards, only three ADRs were spontaneously reported. Therefore, the pharmacovigilance system significantly improved the detection and report of ADRs with a risk ratio of 15.4 (95% confidence intervals 4.8-49.1). Sixty six percent of ADRs were classified as severe. Antimicrobials were the main group of medications causing ADRs in 44% of reports. Forty three percent of ADRs were preventable and prolonged hospital stay by a mean of eight days. Conclusions: An active pharmacovigilance system carried out by pharmacists improves the detection of ADRs and promotes its prevention. <![CDATA[<strong>Enfermedad inflamatoria intestinal a partir de una experiencia local</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800008&lng=es&nrm=iso&tlng=es Background: The incidence and prevalence of Inflammatory Bowel Disease (IBD) has increased. Aim: To determine demographic and clinical characteristics of patients with IBD in a Chilean private hospital. Patients and Methods: Review of a prospective registry of patients with IBD, started on 2012. It includes clinical, imaging, endoscopical and pathological information of patients. Results: Data of 316 patients with IBD, aged 16 to 86 years (56% females), were analyzed. Ulcerative Colitis (UC), Crohn´s and non-classifiable IBD were diagnosed in 230, 77 and 9 patients, respectively. The disease was diagnosed in 82% of patients in the period between 2002 and 2012. There was a peak in the diagnosis of both UC and CD between 20 and 39 years of age, without gender differences. The disease switched from UC to CD in six patients. In four, there was a change in disease behavior. Thirty eight patients were treated with biological therapy. The median lapse between the diagnosis and the use of biological therapy was 1 year in patients diagnosed after 2007, compared with 5.5 years among those patients diagnosed before 2007 (p = 0.001). There was a trend towards a higher requirement of surgery until 2006. Subsequently there was a stabilization of the requirement, concomitant with the incorporation of biological therapy. Conclusions: An adequate registry of IBD patients is necessary to improve demographic and clinical characteristics. A national registry is needed to assess the epidemiological changes of IBD in Chile. <![CDATA[<strong>Violencia intrafamiliar en Chile y su impacto en la salud</strong>: <strong>una revisión sistemática</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800009&lng=es&nrm=iso&tlng=es According to recent surveys, there is a high prevalence of domestic violence (DV) in Chile. A systematic review was conducted in PubMed, Scielo, and Lilacs with the MesH terms “Chile”, “Mental Health”, “Health”, “Domestic Violence”, to explore the impact of DV on health in Chile. Eleven studies fulfilled the inclusion criteria. Two studies were prospective, exploring the influence of DV on maternal-infant health. Nine studies explored the influence of DV on mental health in adults. DV was associated with deranged mental health indicators specially anxiety and depressive symptoms and suicidal ideation. Similar results were observed among mothers who were victims of violence and their children. It is concluded that DV is a complex phenomenon with serious effects on health. However the number of studies on the subject is low and new follow up studies are required. Predictive models for DV and effective preventive measures are urgently needed. <![CDATA[<strong>Estimación del impacto económico de la equinococosis quística en Chile y análisis de las posibles causas que han dificultado su erradicación</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800010&lng=es&nrm=iso&tlng=es Background: Hydatid disease or cystic echinococcosis, caused by the parasite Echinococcus granulosus, has a worldwide distribution, affecting people of working age and can cause high levels of morbidity and even death. Aim: To estimate the economic impact at the human and animal level caused by the disease in Chile. Material and Methods: We analyzed information about the disease obtained from reports and publications emanated from the Chilean Ministry of Health, United Nations Food and Agriculture Organization, the U.S. National Institute of Statistics and the National Agricultural Service. Animal derived costs were estimated evaluating the expenses for pharmacological treatment of infected dogs and animal production losses derived from confiscations and reductions in meat production. Results: The total number of patients who underwent surgery to remove a hydatid cyst in Chile during 2012, was estimated as 767 individuals. The annual costs derived only from surgical treatment, were estimated in USD 2.46 million. Summing the costs of sick leaves and loss of productivity, the costs at the human level ascended to USD 3.13 million. Considering human and animal costs, the annual economic burden of the disease was estimated in USD 14.35 million. Conclusions: The Analysis of the regional distribution of human and animal hydatidosis, suggests a significant environmental contamination with parasite eggs in high incidence regions such as Aysén, Araucanía, BioBío and Coquimbo. The efficiency of control programs for the disease would be greatly improved if the causes for these regional contaminations are elucidated. <![CDATA[<strong>Estado actual de la terapia con células madre en el tratamiento de las cardiopatías</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800011&lng=es&nrm=iso&tlng=es Available medical therapy is unable to completely prevent or revert the pathological cardiac remodeling secondary to ischemia or other injuries, which is responsible for the development of heart failure. Regenerative medicine through stem cells had an explosive development in the cardiovascular area during the past decade. Stem cells possess the capacity to regenerate, repair or substitute damaged tissue, allowing the reestablishment of its function. Stem cells can also modulate apoptosis, angiogenesis, fibrosis and inflammation, favoring the endogenous regenerative process initiated by the damaged tissue. These capacities have been corroborated in several animal models of cardiovascular diseases with positive results. In humans, therapies with bone marrow mononuclear stem cells, mesenchymal stem cells and cardiac stem cells are safe. Most randomized clinical trials in patients with myocardial infarction or cardiomyopathies of different etiologies have reported benefits on ventricular function, quality of life and even over mortality of treated patients. This article reviews the state of art of stem cell therapy in cardiovascular diseases, focusing on the most common cellular types used in patients with acute myocardial infarction and chronic cardiomyopathies of different etiologies. <![CDATA[<strong>Detección precoz del cáncer cervicouterino en Chile</strong>: <strong>tiempo para el cambio</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800012&lng=es&nrm=iso&tlng=es Mortality rates for cervical cancer (CC) in Chile are higher than those of developed countries and it has an unequal socioeconomic distribution. The recognition of human papilloma virus (HPV) as the causal agent of cervical cancer in the early 80’s changed the prevention paradigms. Current goals are to prevent HPV infection by vaccination before the onset of sexual activity and to detect HPV infection in women older than 30 years. This article reviews CC prevention and early detection methods, discusses relevant evidence to support a change in Chile and presents an innovation proposal. A strategy of primary screening based on HPV detection followed by triage of HPV-positive women by colposcopy in primary care or by cytological or molecular reflex testing is proposed. Due to the existence in Chile of a well-organized nationwide CC prevention program, the replacement of a low-sensitivity screening test such as the Papanicolau test with a highly sensitive one such as HPV detection, could quickly improve the effectiveness of the program. The program also has a network of personnel qualified to conduct naked-eye inspections of the cervix, who could easily be trained to perform triage colposcopy. The incorporation of new prevention strategies could reduce the deaths of Chilean women and correct inequities. <![CDATA[<strong>Cambio educativo en las Facultades de Medicina</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800013&lng=es&nrm=iso&tlng=es This paper reports the reflections of a group of members of the University of Chile Faculty of Medicine, about the changes in teaching methods that medical schools should incorporate. In a complex scenario, not only new and better knowledge should be transmitted to students but also values, principles, critical reasoning and leadership, among others. In the first part, a proposal to understand this educational development in the context of complex universities, incorporating pedagogical skills and reviewing institutional leadership, is carried out. In the second part, the training of teaching physicians, as part of the changes, is extensively discussed. Physicians hired as academics in the University should have the opportunity to work mainly as teachers and be relieved of research obligations. For them, teaching should become a legitimate area of academic development. <![CDATA[<strong>Pneumorraquis, espondilitis y meningitis secundarios a cistitis enfisematosa</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800014&lng=es&nrm=iso&tlng=es We report a 57-year-old woman who presented with low back pain, fever and impairment of consciousness. The patient was admitted to the intensive care unit in Glasgow 8, with neck stiffness, peritoneal irritation, leukocytosis, hyperglycemia requiring insulin and a urine test suspecting an infection. Brain CT was unremarkable, while CT of the abdomen and pelvis evidenced emphysematous cystitis, retropneumoperitoneum and pneumorrhachis. Blood, urine and cerebrospinal fluid cultures were positive to Escherichia coli. She was treated with ceftriaxone, ciprofloxacin and amikacin during one month followed by ciprofloxacin until completing 100 days. The air in the spinal canal and bladder decreased. However she suffered several infectious complications such as multiple paravertebral, epidural and psoas abscesses, L5-S1 spondylitis and a L3 fracture. As an inflammatory complication she developed a bulbar infarction and tetraparesis. She had a good clinical response with medical treatment, partial improvement of the paresis and reduction of epidural abscesses. <![CDATA[<strong>Pericarditis constrictiva como presentación grave e infrecuente de lupus eritematoso sistémico</strong>: <strong>reporte de un caso y revisión de la literatura</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800015&lng=es&nrm=iso&tlng=es Constrictive Pericarditis (CP) is an unusual disease. Its most common causes are idiopathic or secondary to cardiac surgery. Less frequently it is caused by connective tissue diseases. We report a 30 years old woman hospitalized due to progressive dyspnea, chest pain and signs of right sided heart failure. During her stay, a Systemic Lupus Erythematosus (SLE) was diagnosed. The echocardiogram suggested a CP and the diagnosis was confirmed by cardiac catheterization. Pericardiectomy was successfully performed. The biopsy confirmed a nonspecific chronic pericarditis, with extensive fibrosis and absence of caseating granulomas. The patient had a satisfactory recovery. <![CDATA[<strong>Suplementos dietéticos para reducir de peso</strong>: <strong>dilemas médicos y éticos</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800016&lng=es&nrm=iso&tlng=es Obesity is an important public health problem. Dietetic supplements are commonly used by obese patients who are not aware of the effectiveness or potential harms of these products. The aim of this paper is to discuss the ethical dilemma associated with the use of these supplements. The principles of autonomy, beneficence and justice are involved. Obesity as a chronic disease, requires qualified medical care. Obese individuals should be aware of their disease and voluntarily agree to receive professional care. <![CDATA[<strong>Fístula colecistocutánea espontánea en una paciente mayor</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800017&lng=es&nrm=iso&tlng=es Obesity is an important public health problem. Dietetic supplements are commonly used by obese patients who are not aware of the effectiveness or potential harms of these products. The aim of this paper is to discuss the ethical dilemma associated with the use of these supplements. The principles of autonomy, beneficence and justice are involved. Obesity as a chronic disease, requires qualified medical care. Obese individuals should be aware of their disease and voluntarily agree to receive professional care. <![CDATA[<strong>Prostatitis crónica/síndrome de dolor pélvico crónico</strong>: <strong>Un reto terapéutico</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800018&lng=es&nrm=iso&tlng=es Obesity is an important public health problem. Dietetic supplements are commonly used by obese patients who are not aware of the effectiveness or potential harms of these products. The aim of this paper is to discuss the ethical dilemma associated with the use of these supplements. The principles of autonomy, beneficence and justice are involved. Obesity as a chronic disease, requires qualified medical care. Obese individuals should be aware of their disease and voluntarily agree to receive professional care. <![CDATA[<strong>Comparación de variables estadísticas</strong>: <strong>clavando un tornillo</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800019&lng=es&nrm=iso&tlng=es Obesity is an important public health problem. Dietetic supplements are commonly used by obese patients who are not aware of the effectiveness or potential harms of these products. The aim of this paper is to discuss the ethical dilemma associated with the use of these supplements. The principles of autonomy, beneficence and justice are involved. Obesity as a chronic disease, requires qualified medical care. Obese individuals should be aware of their disease and voluntarily agree to receive professional care. <![CDATA[<strong>Obesidad y cáncer</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000800020&lng=es&nrm=iso&tlng=es Obesity is an important public health problem. Dietetic supplements are commonly used by obese patients who are not aware of the effectiveness or potential harms of these products. The aim of this paper is to discuss the ethical dilemma associated with the use of these supplements. The principles of autonomy, beneficence and justice are involved. Obesity as a chronic disease, requires qualified medical care. Obese individuals should be aware of their disease and voluntarily agree to receive professional care.