Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720200001&lang=es vol. 148 num. 1 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Un formulario de declaración para trabajos presentados para publicación en revistas médicas: una proposición del Comité Internacional de Editores de Publicaciones Médicas]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100007&lng=es&nrm=iso&tlng=es <![CDATA[Frecuencia de malignidad en incidentalomas tiroideos detectados con tomografía por emisión de positrones/tomografía computada (PET/CT) con F18-FDG de cuerpo entero]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100010&lng=es&nrm=iso&tlng=es Background: Thyroid incidentalomas detected by 18F-Fludeoxyglucose (FDG) PET/CT are defined as an incidental and unexpected thyroid focus present in a patient studied for a non-thyroid disease. Aim: To assess the frequency of malignancy of nodular thyroid incidentalomas, and their association with 18F-FDG avidity (standard uptake value (SUV) max). Material and Methods: Whole body PET/CT performed from December 2008 to December 2017 were reviewed selecting those that showed nodular thyroid foci. Glands with diffuse increased uptake were excluded. Thyroid ultrasonography and fine-needle aspiration cytology (FNAC) performed after PET/CT were reviewed. Bethesda score and SUVmax were correlated. Results: Of 5,100 whole body 18F-FDG PET/CT, 119 showed a thyroid nodular uptake (2.3%). Forty eight percent of these patients were studied with FNAC or surgery, 50% of which (29/58) were confirmed as malignant. Benign nodules showed significantly lower 18F-FDG uptake (n = 20, SUVmax: 3.5 ± 1.7) than Bethesda V-VI (n=24, SUVmax: 8.2 ± 5.2) and thyroid metastases (n=5, SUVmax: 6.3 ± 2.1). The best cut-off value to distinguish between benign and malignant nodules was a SUVmax of 5.0, with a sensitivity of 76% (95% confidence intervals (CI) 56-90%), a specificity of 85% (95% CI 62 - 97%), and positive likelihood ratio of 5 (95% CI 1.8 – 14.6). The size of the thyroid nodule was not predictive of malignancy. Conclusions: Half of nodular thyroid incidentalomas detected by 18F-FDG PETC/CT are malignant. A nodule with a SUVmax ≥ 5,0 is highly suggestive of malignancy, regardless of its size. <![CDATA[Los costos basados en actividades de Unidades Médico Quirúrgica y de Cuidados Medios en un hospital público]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100017&lng=es&nrm=iso&tlng=es Background: Hospitals must have management tools that allow them to fulfil all their requirements with the allocated resources. Aim: To evaluate the number of bed-days according to the discharge diagnosis in a High Complexity Hospital in Chile. Material and Methods: An activity Based Cost (ABC) calculation was used. The stages were gathering of procedures, identification of the resources used, analysis of discharge diagnosis, definition of cost objects, resource cost drivers, cost of procedures, procedures cost drivers and cost of the cost objects that corresponds to bed-day by each medical specialty. Costs were calculated for Medical-Surgical and Intermediate Care units. Results: There were significant differences in costs according to medical specialty when comparing the costs obtained using the Management information system (WinSig) and ABC. Respiratory, Renal and Circulatory-Cardiovascular specialties accounted for the most expensive bed-days. Conclusions: This study identified bed-day costs and provides disaggregated information about the causes of cost differences between medical specialties. <![CDATA[El efecto del cuidado informal en la salud de los cuidadores familiares de personas mayores dependientes en Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100030&lng=es&nrm=iso&tlng=es Background: Care required by dependent older people is mostly provided by close family members. Caregiving is a demanding task, negatively affecting the physical and mental health of the caregiver. Aim: To describe the sociodemographic characteristics of informal caregivers of dependent elderly people in Chile and to evaluate the effect of providing care on the health of caregivers. Material and Methods: Data from the Economic Characterization Survey (CASEN) done in 2015 was used. Using as index cases older people who were receiving care from a family member, 4,313 informal caregivers were identified, whose characteristics were analyzed. Descriptive statistics and matching through propensity score were estimated, based on a logistic model, which included covariates such as sex, age, marital status, education, occupation, and income. Finally, the effect of being an informal caregiver versus not being a caregiver on the perception of health was calculated. Results. Forty four percent of the caregivers were offspring and 33.6% couples. Sixty seven percent were women, with a mean age of 56.5 years. Half of them had a partner, 43% had basic education or less, and 61% were inactive. Being a caregiver had a significant effect of health perception. Conclusions: People belonging to certain more vulnerable groups are more likely to assume caregiving. Providing care to a dependent older person has a negative effect on health perception. <![CDATA[Comparación de los niveles de actividad física medidos con cuestionario de autorreporte (IPAQ) con medición de acelerometría según estado nutricional]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100037&lng=es&nrm=iso&tlng=es Background: It is unknown if nutritional status could influence the accuracy of self-reported physical activity (PA) levels. Aim: To compare PA measured using the international physical activity questionnaire (IPAQ) and by accelerometry (ActiGraph) according to nutritional status in Chilean adults. Material and Methods: This is an observational cross-sectional study that used information from the GENADIO project carried out in Chile between 2009-2011. The sample consisted of 322 people. PA levels and sitting time were determined through the IPAQ self-report questionnaire and ActiGraph accelerometers (GTM1). The nutritional status was determined according to body mass index (BMI). Results: Compared with the measurement made with accelerometry, the IPAQ self-report questionnaire underestimated the levels of light PA, total PA and sedentary time in −171.5, −54.8 and −40.6 min / day, respectively. However, IPAQ overestimated the levels of moderate PA and vigorous PA in 91.0 and 47.3 min/day respectively, compared with accelerometry. Compared with normal weight, obese subjects reported higher levels of moderate PA (105.5 and 48.9 min/day, respectively) and vigorous PA (54.1 and 38.3 min/day respectively). Total PA had a greater delta of underestimation between IPAQ and accelerometer measurements in normal weight than in obese subjects (-122.1 vs −16.5 min/day, respectively). Conclusions: The measurement of PA by means of a self-report questionnaire was discrepant with its objective measurement with an accelerometer. The discrepancy is even higher in obese people. <![CDATA[Asociación entre niveles de vitamina B-12 y mortalidad en pacientes hospitalizados adultos mayores]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100046&lng=es&nrm=iso&tlng=es Background: Supplementation of vitamin B12 in older adults is a common practice to avoid vitamin B12 insufficiency. However, there is a paucity of information about the effects of cobalamin excess. Aim: To asses any potential effects of high levels vitamin B12 on mortality on adults aged ≥ 65 years admitted to an internal medicine service. Material and Methods: We Prospectively studied patients admitted to an internal medicine service of an academic hospital from September 2017 to September 2018, who were able to give their consent and answer questionnaires. We tabulated age, gender, medical history, comorbidity index (Charlson), frailty score (Fried scale), admission diagnosis and blood tests performed within 48 hours of admission. The primary outcome was death by any cause in less of 30 days or after one of year follow up, determined according to death certificates. Results: We included 93 patients aged 65 to 94 years (53% males). Fifteen patients died during the year of follow up (five within 30 days of admission). Those who died had higher cobalamin levels than survivors (1080.07 ± 788.09 and 656.68 ± 497.33 pg/mL respectively, p = 0.02). Patients who died had also a significantly lower corrected serum calcium, sodium (p = 0.04) and a medical history of chronic liver disease (p = 0.03). In the multivariable analysis, only vitamin B12 preserved the association with mortality (p = 0.009). Conclusions: There was a significant association between high levels of cobalamin and all-cause mortality in this group of patients aged ≥ 65 years-old. <![CDATA[Prueba diagnóstica de disfunción sudomotora en la detección precoz de la neuropatía diabética]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100054&lng=es&nrm=iso&tlng=es Background: Sudomotor dysfunction may appear in early stages of diabetic neuropathy. Aim: To evaluate the diagnostic capacity of the Neuropad test, based on the detection of sudomotor dysfunction, as an early indicator of diabetic neuropathy. Material and Methods: In Forty-two type 2 diabetic patients, the Neuropad test was compared with the 10 g monofilament test (proposed in the technical orientation of diabetic foot of the Ministry of Health of Chile), deep and thermal sensitivity. Results: The surface sensitivity assessed with a brush had a sensitivity and specificity of 18.8 and 100% respectively when compared with the 10 g monofilament. When compared with the Neuropad, the figures were 9 and 100%, respectively. Pain perception sensitivity and specificity were 13 and 100% respectively when compared with the 10 g monofilament. The figures were 6 and 100%, when compared with the Neuropad. Thermal discrimination had a sensitivity and specificity of 88 and 33% respectively when compared with the 10 g monofilament. The figures were 75 and 25% respectively when compared with the Neuropad. The deep sensitivity evaluated with a 128 Hz tuning fork had a sensitivity and specificity of 31 and 100% respectively when compared with the 10 g monofilament. The figures were 16 and 31% respectively when compared with the Neuropad. The Neuropad had a sensitivity and specificity of 94 and 29% respectively were compared with the 10 g monofilament. Conclusions: Neuropad had a good diagnostic yield for the early detection of sudomotor dysfunction. <![CDATA[Medición de la calidad del trato al usuario tras la introducción del asistente-alumno en centros de salud familiar en Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100060&lng=es&nrm=iso&tlng=es Background: The time dedicated to patients and how they are treated are crucial in the evaluation of health care quality. Medical students acting as medical assistants could improve the perception of a good quality of care among ambulatory patients. Aim: To evaluate if the presence of Student-Assistants improves the patients’ perception of health care quality in ambulatory primary care. Patients and Methods: Quasi–experimental exploratory study. In two health care centers, patients answered a questionnaire about their perception of how they were treated at baseline and after an intervention period. In one center, prior to the appointment of the patient with the doctor, the student interviewed patients focusing on chief complaints and registered their vital signs, orally presenting this information to the clinician. In the other center, there was no student intervention. Patients answered the questionnaire at the end of appointments. Results: At baseline 103 patients answered the questionnaire (58 in the experimental and 45 in the control center). After the intervention, 121 patients answered it (56 in the experimental and 65 in the control center). Basal scores were 6,25 and 6,06 in experimental and control center, respectively (p = NS). After the intervention, the scores were 6,49 and 6,15, respectively (p = 0,01). Conclusions: These data support the hypothesis that the presence of a Student-Assistant could improve the perception of patients about how they are treated at primary health care centers. <![CDATA[Relación entre estado nutricional antropométrico y condición física funcional en adultos mayores independientes]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100069&lng=es&nrm=iso&tlng=es ABSTRACT Background: The functional fitness of older people may be associated with their nutritional status. Aim: To assess the association between of anthropometric measures with functional fitness in older people. Material and Methods: Cross-sectional study conducted in 75 participants aged 65 to 89 years. Body mass index (BMI), waist-to-height ratio (WHtR), fat mass (FM) and skeletal muscle mass index (SMI) were calculated from anthropometric measures. The functional fitness was determined using the Senior Fitness Test battery. Results: BMI and FM indicated obesity, and WHtR indicated cardiometabolic risk in 49%, 55% and 83% of participants, respectively. SMI indicated a low muscle mass in 91% of females. Performance standards of chair stand, arm curl, 2-min step test and 8-foot up-and-go tests were met in 1%, 8%, 1% and 89% of participants, respectively. Significant negative correlations were found between 2-min step test and BMI, WHtR and FM (r = −0.26, −0.31 and −0.48 respectively). Back scratch had a negative correlation with BMI (r = −0.23) and SMI (rho = −0.28). Significant positive correlations were found between 8-foot up-and-go, WHtR (rho = 0.28) and FM (rho = 0.23), and between 2-min step test and SMI (rho = 0.28). The coefficient of determination (R2) between 2-min step test with BMI, WHtR and FM were 0.05, 0.08 and 0.22, respectively, while the R2 between back scratch and BMI was 0.04. Multiple regression models indicated that FM affected the 2-min step test independently of BMI and WHtR (adjusted R2 = 0.22), however age and sex negatively influenced these associations. Conclusions: Functional fitness of older adults is influenced by nutritional anthropometric measures, particularly BMI, WHtR and FM for aerobic capacity, and BMI for upper limb flexibility.<hr/> Introducción: El estado nutricional y la condición física funcional (CFF) pueden estar relacionados en adultos mayores. Objetivo: Analizar la influencia de medidas antropométricas nutricionales sobre CFF. Material y Método: Estudio transversal realizado en 75 adultos de 65 a 89 años. Las variables antropométricas fueron índice de masa corporal (IMC), razón cintura-talla (RCT), masa adiposa (MA) e índice de masa muscular esquelética (IMME). La evaluación de CFF se efectuó con la batería Senior Fitness Test. Resultados: El IMC y MA indicaron obesidad, y RCT indicó riesgo cardiometabólico en 49%, 55% y 83% de los participantes, respectivamente. IMME indicó una baja masa muscular en 91% de las mujeres. El estándar de rendimiento para las pruebas sentarse-levantarse, flexión-codo, paso-2-minutos y levantarse-caminar-sentarse se logró en 1%, 8%, 1% y 89% de los participantes, respectivamente. Se encontraron correlaciones significativas negativas entre paso-2-minutos con IMC, RCT y MA (r = −0.26,-0.31 y-0.48 respectivamente. La misma asociación se observó entre juntar-manos-espalda con IMC (r = −0.23) e IMME (rho = −0.28). Se encontraron correlaciones significativas positivas entre levantarse-caminar-sentarse con RCT (rho=0.28) y MA (rho = 0.23), y entre paso-2-minutos con IMME (rho = 0.28). Los R2 entre paso-2-minutos e IMC, RCT y MA fueron 0.05, 0.08 y 0.22, respectivamente, mientras que el R2 entre juntar-manos-espalda e IMC fue 0.04. Los modelos de regresión múltiple indicaron que MA afectó la prueba paso-2-minutos independientemente de IMC y RCT (R2 ajustado = 0.22), aunque la edad y sexo afectaron negativamente estas asociaciones. Conclusiones: La CFF de adultos mayores es influenciada por alteraciones evidenciadas por medidas antropométricas nutricionales, particularmente IMC, RCT y MA sobre la capacidad aeróbica, e IMC sobre la flexibilidad de extremidad superior. <![CDATA[Mixoma cardíaco: experiencia de 28 años en resección quirúrgica]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100078&lng=es&nrm=iso&tlng=es Background: The incidence rates of cardiac tumors are low. Aim: To report the clinical presentation of cardiac myxomas and long-term evolution after resection. Material and Methods: Review of a database of surgical patients undergoing surgical resection of a cardiac myxoma in a public hospital between 1990 and 2018. Results: Seventy-eight patients aged 53 ± 15 years (65% females) were included. The most frequent comorbidities were arterial hypertension (40.5%), hypothyroidism (15%) and diabetes mellitus (12%). The main presenting symptoms were dyspnea (33%), neurological deficit secondary to embolism (30%) and acute pulmonary edema (5%). The most common location was the left atrium, in 87%. During surgery, cardiopulmonary bypass and aortic cross-clamp times were 50.2 ± 19.6 and 33.4 ± 15.2 min, respectively. One patient died due to severe neurological involvement. Follow-up was completed in seventy-seven patients, with a mean echocardiographic follow-up time of 10.4 ± 7.7 years. Thirty-four patients were followed for more than 10 years. Six patients (7.7%) died during the follow-up and in six patients (7%) a recurrence was identified. Conclusions: Cardiac myxoma usually has nonspecific symptoms. Surgical excision offers excellent short and long-term results. Complications and recurrence rates are low in non-hereditary myxomas but obligates to perform echocardiographic follow-up for early diagnosis of recurrence. <![CDATA[Endoscopía luego de cirugía bariátrica: Lo que debe saber el endoscopista]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100083&lng=es&nrm=iso&tlng=es Endoscopy is essential in the assessment and treatment of the bariatric patient, especially in the postoperative state. Since bariatric surgery is increasing exponentially, endoscopists should be familiar with the anatomy and how to manage possible complications. New less invasive therapeutic tools will have a major impact on the prognosis of these patients. Dreaded complications such as leaks, stenosis or weight regain can be successfully assessed and treated by endoscopy. Postoperative evaluation of symptoms requires the precise search of details that can change patient's management. <![CDATA[Impacto cardiovascular secundario a la terapia para el control del cáncer]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100093&lng=es&nrm=iso&tlng=es Cardiovascular diseases and cancer account for 27 and 25% of mortality in Chile, respectively. In the last decades, survival of people with cancer has improved due to preventive programs, early detection strategies, advances in technology and development of new antineoplastic therapies. Consequently, a progressive number of cancer-surviving patients have been generated, who may develop cardiovascular diseases, secondary to the same cancer therapy. Cardio-Oncology has emerged as the necessary link between both specialties to promote the prevention and early detection of cardiac complications, in patients undergoing oncological therapies. The aim is to curb cardiovascular complications. Also, to acquire knowledge about the mechanisms and effects of drugs that lead to heart damage aiming to develop efficient cardioprotective therapies. In this article we review and propose a didactic organization and classification of the main cardiovascular effects of cancer control therapy. We recognize that there is still a knowledge gap in basic sciences about the mechanisms that underlie these alterations. <![CDATA[Artículos de Revisión]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100103&lng=es&nrm=iso&tlng=es This paper summarizes the main features of review articles in medical topics. Articles can be classified as narrative reviews, systematic reviews or meta-analysis. Narrative reviews are appropriate to update etiology, pathophysiology or clinical aspects of diseases, and advances in basic and preclinical sciences. In systematic reviews the authors define its purpose, limit its scope, describe the literature search, define the inclusion and exclusion criteria adopted to select primary studies, and the criteria applied to assess the quality of their results and conclusions. Meta-analysis are quantitative, statistically analysed systematic reviews that consider mainly primary studies conducted prospectively with simultaneous randomized controls, pooling the data obtained from each of these primary studies in order to get a single estimate of effect. Systematic analysis and meta-analysis are important to evaluate new diagnostic and therapeutic tools, and they are most relevant to evidence-based medicine, mainly for the design of clinical guidelines and the adoption of new health care policies. Review articles published in Revista Médica de Chile were compared in one or two-year periods separated by ten years in between: in the “2001 period” 26 reviews were all narrative; in the “2010 period” 30 reviews were narrative and another 4 were systematic reviews; in the “2019 period” 14 reviews were narrative and another 7 were systematic reviews. No meta-analysis had been published in these periods, in this journal. Meta-analysis including primary studies performed in Chile by Chilean investigators have been published in English language in other medical journals. The educational and professional role of review articles is recognised, with a word of caution on a strict adherence to ethical rules adopted by scientific and clinical publications, mainly with respect to authorship and potential conflicts of interest. <![CDATA[Como interpretar una revisión sistemática con comparaciones múltiples o network metaanálisis]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100109&lng=es&nrm=iso&tlng=es Systematic reviews evaluating multiple interventions can be useful in different clinical situations. However, some concerns arise when more than two interventions are compared and there is a paucity of good quality randomized clinical trials. A novel statistical method based on indirect comparisons, called network meta-analysis (NMA), can be a useful approach to find a clinical answer when multiple interventions are evaluated for the same outcome or comparator. The aim of this review is to describe the main characteristics and provide a user guide for a critical analysis of NMA focusing on its three main domains, namely homogeneity, transitivity and consistency. <![CDATA[Necrosis papilar renal bilateral de resolución espontánea como causa de hematuria microscópica. Caso clínico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100118&lng=es&nrm=iso&tlng=es Renal papillary necrosis is an infrequent cause of hematuria characterized by ischemic necrosis of the renal medulla, especially the papilla. Its most common cause is analgesic abuse. Despite being oligo-symptomatic, in many cases its presence is associated with serious functional sequelae. Imaging, especially computed tomography, is essential to make the diagnosis. We report a 63-year-old female studied for an asymptomatic microscopic hematuria whose tomographic study showed a bilateral renal papillary necrosis. No etiology was found, and she evolved with a spontaneous complete remission. <![CDATA[Aspectos éticos de la epidemia del Coronavirus]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100123&lng=es&nrm=iso&tlng=es Renal papillary necrosis is an infrequent cause of hematuria characterized by ischemic necrosis of the renal medulla, especially the papilla. Its most common cause is analgesic abuse. Despite being oligo-symptomatic, in many cases its presence is associated with serious functional sequelae. Imaging, especially computed tomography, is essential to make the diagnosis. We report a 63-year-old female studied for an asymptomatic microscopic hematuria whose tomographic study showed a bilateral renal papillary necrosis. No etiology was found, and she evolved with a spontaneous complete remission. <![CDATA[Coronavirus como amenaza a la salud pública]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100124&lng=es&nrm=iso&tlng=es Renal papillary necrosis is an infrequent cause of hematuria characterized by ischemic necrosis of the renal medulla, especially the papilla. Its most common cause is analgesic abuse. Despite being oligo-symptomatic, in many cases its presence is associated with serious functional sequelae. Imaging, especially computed tomography, is essential to make the diagnosis. We report a 63-year-old female studied for an asymptomatic microscopic hematuria whose tomographic study showed a bilateral renal papillary necrosis. No etiology was found, and she evolved with a spontaneous complete remission. <![CDATA[La mayoría de las enfermedades cardiovasculares se atribuyen a factores de riesgo que podrían ser modificados con cambios de los estilos de vida]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100126&lng=es&nrm=iso&tlng=es Renal papillary necrosis is an infrequent cause of hematuria characterized by ischemic necrosis of the renal medulla, especially the papilla. Its most common cause is analgesic abuse. Despite being oligo-symptomatic, in many cases its presence is associated with serious functional sequelae. Imaging, especially computed tomography, is essential to make the diagnosis. We report a 63-year-old female studied for an asymptomatic microscopic hematuria whose tomographic study showed a bilateral renal papillary necrosis. No etiology was found, and she evolved with a spontaneous complete remission. <![CDATA[Pacientes Policonsultantes: variabilidad de concepto]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000100128&lng=es&nrm=iso&tlng=es Renal papillary necrosis is an infrequent cause of hematuria characterized by ischemic necrosis of the renal medulla, especially the papilla. Its most common cause is analgesic abuse. Despite being oligo-symptomatic, in many cases its presence is associated with serious functional sequelae. Imaging, especially computed tomography, is essential to make the diagnosis. We report a 63-year-old female studied for an asymptomatic microscopic hematuria whose tomographic study showed a bilateral renal papillary necrosis. No etiology was found, and she evolved with a spontaneous complete remission.