Scielo RSS <![CDATA[Revista médica de Chile]]> vol. 144 num. 12 lang. es <![CDATA[SciELO Logo]]> <![CDATA[<strong>Etiología viral en la neumonía adquirida en la comunidad</strong>]]> <![CDATA[<strong>Participación de los virus respiratorios en la neumonía del adulto inmunocompetente adquirida en la comunidad</strong>]]> Background: Community-acquired pneumonia (CAP) is a relevant worldwide cause of morbidity and mortality in adult population, however its etiology is often not identified and therapy is empirical. Aim: To assess the etiology of CAP in immunocompetent adult hospitalized patients using conventional and molecular diagnostic methods. Material and Methods: We prospectively studied 240 adult patients who were hospitalized for CAP to identify the microbial etiology. Sputum and blood cultures were obtained as well as serology testing for Mycoplasma pneumoniae and Chlamydophila pneumoniae, urinary antigen testing for Legionella pneumophila and Streptococcus pneumoniae, and a nasopharyngeal swab for the detection of sixteen respiratory viruses by reverse transcriptase polymerase chain reaction (RT-PCR). Results: In 100 patients (41.7%) a single respiratory pathogen was identified. In 17 (7.1%) cases, a mixed bacterial and viral infection was detected and no pathogen was identified in 123 cases (51%). The most commonly identified pathogens identified were: influenza virus (15.4%), parainfluenza virus (10.8%), rhinovirus (5%), Streptococcus pneumoniae (5%), respiratory syncytial virus (2.9%) and Mycoplasma pneumoniae (2.5%). Infectious agent detection by RT-PCR provided greater sensitivity than conventional techniques. Viral respiratory infections were more prevalent in older patients with comorbidities and high risk patients, according to the Fine index at hospital admission. The clinical severity and outcome were independent of the etiological agents detected. Conclusions: The use of molecular diagnostic techniques expanded the detection of respiratory viruses in immunocompetent adults hospitalized with CAP. <![CDATA[<strong>Comportamiento antibacteriano de partículas de cobre frente a microorganismos obtenidos de úlceras crónicas infectadas y su relación con la resistencia a antimicrobianos de uso común</strong>]]> Background: The antimicrobial activity of copper (Cu+2) is recognized and used as an antimicrobial agent. Aim: To evaluate the antimicrobial activity of copper against microorganisms obtained from chronic cutaneous wound infections. Material and Methods: Five chemical products that contained copper particles in their composition were tested (zeolite, silica, acetate, nitrate and nanoparticle of copper). The antimicrobial activity against antibiotic resistant strains usually isolated from chronic cutaneous wound infections was determined for two of the products with better performance in copper release. Results: The minimal inhibitory and minimal bactericidal concentrations of copper acetate and nitrate were similar, fluctuating between 400-2,000 µg/ml. Conclusions: The studied copper salts show great potential to be used to control both gram positive and gram negative, antibiotic resistant bacteria isolated from wound infections. <![CDATA[<strong>Validación de cuestionario autoaplicable para un índice de alimentación mediterránea en Chile</strong>]]> Background: Availability of brief dietary indexes that can effectively evaluate dietary patterns and their association with health is critical for prevention and management of several chronic disease conditions. Aim: To adapt a self-applicable Mediterranean Dietary Index in Chile (Chilean-MDI). Material and Methods: The Chilean-MDI was developed based on a previous Mediterranean eating score that was adapted to Chilean dietary habits. This index was further validated in a sample of 153 adults by comparing the concordance between the results obtained by self-application of the Chilean-MDI with those obtained by a trained nutritionist. Additionally, the index was applied in a sample of 53,366 Chilean adults in order to describe the diet quality of our population. Results: There was an adequate concordance between findings obtained by self-application of the Chilean-MDI and those achieved by the nutritionist. The application of the index in Chilean adult population showed a better diet quality (high Mediterranean diet adherence) among women, with advanced age and among people with higher educational levels. Conclusions: The Chilean-MDI can be successfully self-applied to portray the overall diet quality in the Chilean adult population. Additionally, this dietary index describes overall food intake in Chilean adults, showing demographic trends that are comparable to those obtained with similar indexes applied in other populations. <![CDATA[<strong>¿Es la pancreatitis crónica una enfermedad rara en Chile?</strong>: <strong>¿Subdiagnóstico, baja prevalencia o ambos?</strong>]]> Background: Chronic pancreatitis (CP) is a rare disease in Chile, without a clear explanation for this low prevalence. Aim: To analyze the characteristics of our patients with pancreatitis. Material and Methods: Retrospective analysis of a database of patients with pancreatitis of a clinical hospital. Morphological proof of diagnosis (calcifications/calculi, alterations of ducts, local complication or histology) was obtained for every patient. History of acute pancreatitis was recorded and exocrine-endocrine function was assessed. Results: We retrieved information of 121 patients with pancreatitis (86 males) in a period of 20 years. The number of cases increased markedly every five years. The calculated incidence and prevalence was 0.8/100,000/year and 6/100,000, respectively. Pancreatic calcifications were initially observed in 93 patients and became evident during the follow-up in another six patients. Severe pain or local complications occurred in 27 patients, requiring surgery in 10 or endoscopic treatment in 15. During the years of follow-up, 55 patients were free of symptoms. Exocrine and endocrine insufficiency was demonstrated and treated in 81 and 67 patients, respectively. Alcoholic etiology was evident in 40% of patients. In 29% no etiology was identified. Mapuche origin was exceptional. Conclusions: Late diagnosis of CP is common, since most of our patients presented with advanced stages. Even though CP is increasingly diagnosed in our hospitals, the number of cases is still far fewer when compared to other countries. Underdiagnosis alone cannot explain this difference and genetic factors might be of importance. <![CDATA[<strong>Población objetivo del tamizaje de cáncer cervicouterino en el sistema público de atención chileno y su relación con la cobertura de PAP</strong>: <strong>Implicancias en políticas de salud y asignación de recursos públicos</strong>]]> Background: Pap smear coverage in Chile has gradually decreased in the last years, from 67% to 59%, making it necessary to determine the causes of this decline. Aim: To analyze the relationship between the characteristics of the cervical cancer screening target population in the public health care system and the percentage of PAP coverage. Material and Methods: This study was carried out in women aged between 25 and 64 years, belonging to a public health care system and registered in any of the eight primary healthcare centers of a Metropolitan Santiago low income community. The analysis considered information from the recruitment database (n = 6,058) and interviewed women database (n = 1,042). Results: In 52% of cases there were difficulties in recruiting women, mainly due to wrong addresses. Among contacted women, 4.1% had a hysterectomy or had cervical cancer and 1.4% were dead. When analyzing the variable “adherence to cervical cancer screening” in the interviewed women, 76.8% reported to comply with the ministerial guidelines. From that group, 20.5% reported to attend screening at the private health care system. Seventy seven percent of women who had timely screening visits, reported attending screening periodically every 3 years or less. Conclusions: Pap smear coverage must be analyzed considering the different factors that affect it. Among the latter, the exclusion of some women from the target population and performing the screening in private clinics stand out. <![CDATA[<strong>Síndrome de piernas inquietas (enfermedad de Willis-Ekbom)</strong>: <strong>seguimiento a largo plazo de una serie de pacientes</strong>]]> Background: Restless legs syndrome (RLS) affects 10% of the general population. Aim: To analyze a series of patients with a minimum follow-up period of four years, treated during an interval of 14 years. Material and Methods: Retrospective analysis of medical records of 200 patients assessed and followed by the authors at a private outpatient clinic. Results: Fifty patients aged 25 to 90 years (34 females), who had a mean follow-up of 6,3 years (range 4-14 years), were selected. Sixty percent responded to therapy that initially consisted in dopamine agonists in 78% of cases. Thirty four percent remained symptomatic and 4% worsened. RLS severity scale improved from an initial score of 19,2 to 12,5 at the last follow-up visit (p < 0.05). Thirty-three patients (66%) experienced an overall worsening of symptoms beyond pretreatment levels during follow-up. The strategies to overcome this augmentation were the change to another agonist, use of ligands such as pregabalin and gabapentin, opioids and iron. Low ferritin was common in most of the patients in whom it was measured (24 of 45 results), mainly in those with augmentation (p < 0,05). Six percent of patients treated with dopamine agonist developed an impulse control disorder. Conclusions: RLS is a treatable condition during a long period of follow-up in most patients. We found a high rate of potentiation at presentation which can be explained by the inadequate use of high doses of dopaminergic agents. <![CDATA[<strong>Calidad de vida en pacientes chilenas sobrevivientes de cáncer de mama</strong>]]> Background: Quality of Life (QOL) assessment may evaluate the impact of diseases and their treatment on the overall well-being of patients. Aim: To assess QOL in Chilean breast cancer survivors. Patients and Methods: Ninety one female breast cancer patients aged 60 ± 10 years, who finished their oncologic treatment at least a year prior to the assessment, who were disease free and in medical follow-up were included in the study. They completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 core questionnaire and the breast cancer module QLQ-BR23. Results: Forty eight percent of respondents were long term survivors (more than five years). Global QOL scores were high (73.6 ± 18.2), emotional scale had the lowest scores in QLQ-C30 functional scales (72.1). Symptoms with the highest scores were: Insomnia (= 21.2), pain (= 20.8), and fatigue (= 19.1). Body image, sexual function, and concern about the future were the most relevant problems. Body image was superior in patients with breast-conserving surgery (p = 0.008), and cognitive function was better in patients in early disease stage (p = 0.03) and in those with more than five years of survival (p = 0.04). Conclusions: Even when global QOL scores were high, some symptoms were prevalent. Awareness about these problems and symptoms should improve their diagnosis and treatment. <![CDATA[<strong><i>Niveles de GRP78, distribución regional del tejido adiposo y cáncer endometrial</i></strong>]]> Background: The association of obesity with endometrial cancer is supported by the presence of endoplasmic reticulum (ER) stress in the adipocyte. Glucose-regulated protein 78 (GRP78) is a marker for ER stress. This protein is a central regulator of ER stress due to its major anti-apoptotic role. It plays an important role in tumor development, progression and chemoresistance. Aim: To look for an association between android and gynoid obesity, plasma GRP78 levels and endometrial cancer. Material and methods: Forty four patients with endometrial cancer aged 72 ± 6 years and 44 healthy women aged 55 ± 9 years were studied. Android and gynoid fat distribution were determined by dual X-ray absorptiometry and plasma GRP78 levels were measured. Results: GRP78 plasma levels were significantly higher in patients with endometrial cancer as compared to the control group. Android fat distribution had a positive correlation with plasma GRP78 levels (p<0.01). Gynoid fat had a negative correlation with plasma GRP78 levels (p<0.01). Conclusions: GRP78 levels are associated with the distribution of adipose tissue and are higher in patients with endometrial cancer.<hr/>Antecedentes: La asociación de obesidad con cáncer endometrial puede depender de la presencia de estrés del retículo endoplásmico (RE) en el adipocito. La proteína 78 regulada por glucosa (GRP78) es un marcador de estrés del RE. Esta proteína regula el estrés de RE gracias a su rol antiaopoptótico. Ella juega un rol en el desarrollo, progresión y quimio-resistencia de tumores. Objetivo: Buscar una asociación entre obesidad androide o ginoide, niveles plasmáticos de GRP78 y cáncer endometrial. Material y métodos: Se estudiaron 44 mujeres con cáncer endometrial de 72 ± 6 años and 44 mujeres sanas de 55 ± 9 años. La distribución androide o ginoide de la grasa fue determinada por densitometría radiológica de doble fotón (DEXA) y se midieron los niveles plasmáticos de GRP78. Resultados: Los niveles de GRP78 fueron significativamente más altos en mujeres con cáncer endometrial. Se observó una correlación positiva entre la distribución de grasa androide y los niveles de GRP78 (p< 0.01). Se observó una correlación negativa entre distribución de grasa ginoide y niveles de GRP78. Conclusiones: Los niveles de GRP78 se correlacionan con la distribución del tejido adiposo y son mayores en mujeres con cáncer endometrial. <![CDATA[<strong>Efectos adversos de finasteride</strong>: <strong>mitos y realidades. </strong><strong>Una revisión actualizada</strong>]]> Finasteride is a 5-α reductase inhibitor that is widely used in the management of benign prostate hyperplasia and male pattern hair loss. It is well known that these agents improve the quality of life in men suffering from these conditions. However, they are associated with some transient and even permanent adverse effects. The aim of this article is to clarify the controversies about the safety of finasteride by analyzing the evidence available in the literature. <![CDATA[<strong>Psiquiatría y Ley de Enfermedades Profesionales en Chile</strong>: <strong>revisión histórica y crítica de una relación compleja</strong>]]> The Work Accidents and Occupational Diseases Act exists in Chile since 1968. It uses a single model for the understanding and management of both somatic diseases like silicosis and psychiatric disorders. During the last decade in Chile, the consultation rates due to psychiatric conditions of probable labor origin has rose over 1,000%, a factor that underscored the deficiencies of this model. The aim of this paper is to analyze the consequences of the application of this act in the psychiatric field for almost 50 years after its promulgation. This article contains an historical overview and an epistemological debate based on the authors’ experience dealing with clinical and administrative work both in occupational psychiatry departments and in regulatory entities. The development of occupational mental health in Chile is examined as part of an historical process that initially did not consider the relationship between work and mental suffering as relevant. The application of a single causality model in psychiatry, as well as the effects of building a psychiatric nosology upon legal rather than medical criteria is contested. <![CDATA[<strong>Eutanasia en Chile</strong>: <strong>una discusión pendiente</strong>]]> Euthanasia is a complex medical procedure. Even though end of life decisions are common situations in health practice, there is a lack of consensus about their terminology. In this manuscript, the main concepts about this issue are defined and delimited; including active and passive euthanasia and limitation of therapeutic effort. Then, a revision is made about the international experience on euthanasia, to then go through the Chile’s history in euthanasia and the population’s opinion. In Chile, euthanasia is an act that has been removed from the social dialogue and legislation. In order to have an open discussion in our population about the issue, the debate has to be opened to the citizens, accompanied by clear medical information about the procedure. <![CDATA[<strong>Módulos interactivos en línea de semiología médica</strong>: <strong>Una herramienta para estandarizar el aprendizaje clínico</strong>]]> Background: The learning process for medical semiology depends on multidisciplinary teaching activities, including simulation tools. These tools should achieve a standardization level aiming at a same level of basic knowledge in each student. Aim: To evaluate an interactive online semiology learning tool. Material and Methods: An interactive online learning method for medical semiology was developed. It focused mainly on physical examination and incorporated audiovisual and self-explanatory elements, to strengthen the acquisition of skills and basic knowledge for each standardized clinical learning simulation session. Subsequently, a satisfaction survey was conducted. Also the performance of students in a clinical examination was compared with that of students of the previous year. Results: Student satisfaction was outstanding, and there was a significant improvement in the performance on the final exam. Conclusions: The use of interactive self-learning online content for medical semiology provides an effective tool to improve student learning. <![CDATA[<strong>Mesotelioma benigno como causa de dolor abdominal inespecífico en un paciente con Enfermedad de Crohn</strong>]]> Benign multicystic peritoneal mesothelioma is an uncommon lesion arising from the peritoneal mesothelium. It is asymptomatic or presents with unspecific symptoms. Imaging techniques may reveal it, however the final diagnosis can only be made by histopathology. Surgery is the only effective treatment considering its high recurrence rate. We report a 19 years old male with Crohn’s disease. Due to persistent abdominal pain, an abdominal magnetic resonance imaging was performed, showing a complex cystic mass in the lower abdomen. The patient underwent surgery and the lesion was completely resected. The pathological study reported a benign multicystic peritoneal mesothelioma. <![CDATA[<strong>Síncope secundario a mixoma gigante del anillo mitral</strong>: <strong>Reporte de un caso</strong>]]> We report a 23-year-old woman, with three recent exertional syncopes. Transthoracic (TTE) and transesophageal (TEE) echocardiography found a large heterogeneous mass (38 x 35 mm) arising from the posterior mitral annulus, protruding in systole through the left ventricular outflow tract (LVOT). Heart MRI confirmed the echocardiography findings, suggesting a cardiac myxoma. Cardiac surgery accomplished the complete resection of the lesion, confirming a mass arising from the posterior mitral annulus and preserving mitral anatomy and function. Pathology was positive for a myxoma. Uneventful evolution allowed the discharge of the patient at the fifth postoperative day. Control TTE discarded any complication. <![CDATA[<strong>La importancia de conocer “lo esperado para la edad” en la evaluación cognitiva del adulto mayor</strong>]]> We report a 23-year-old woman, with three recent exertional syncopes. Transthoracic (TTE) and transesophageal (TEE) echocardiography found a large heterogeneous mass (38 x 35 mm) arising from the posterior mitral annulus, protruding in systole through the left ventricular outflow tract (LVOT). Heart MRI confirmed the echocardiography findings, suggesting a cardiac myxoma. Cardiac surgery accomplished the complete resection of the lesion, confirming a mass arising from the posterior mitral annulus and preserving mitral anatomy and function. Pathology was positive for a myxoma. Uneventful evolution allowed the discharge of the patient at the fifth postoperative day. Control TTE discarded any complication.