Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720170012&lang=es vol. 145 num. 12 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Resultados del tratamiento del cáncer de mama, Programa Nacional de Cáncer del Adulto]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201507&lng=es&nrm=iso&tlng=es Background Breast cancer is the most common malignant tumor in women in the world. In 2005, it was incorporated to the Explicit Guaranties Health System (GES) in Chile. Aim To describe the demographic and clinical characteristics of breast cancer patients and to determine the effect of incorporating these women to GES. Material and Methods Medical records of 5,119 women with breast cancer aged 59 ± 14 years, attended at six public hospitals between 2000 and 2010 were reviewed. Median follow up was 87 months (range 1-182). Mortality was assessed using death certificates obtained at the National Identification Registry. Results Sixty six percent of women were in stage I-II, 29% in stage III and 5% in stage IV. Surgery was performed in 4023/5119 cases (79%), adyuvant radiotherapy in 3627/4517 cases (80%), chemotherapy in 3,204/3,424 cases (94%) and hormone therapy in 1,695/2,375 cases (71%). Between 2000 and 2010, there was a significant increase in the proportion of cases in stage I, from 8% to 25%, (p &lt; 0.01). Overall survival (OS) increased 1% per year, since the beginning of GES system (p = 0.024). Five year OS was 75.1%. The figures for Stage I, II, III and IV were 93, 84, 62 and 27% respectively (p &lt; 0.01). Patients without lymph node involvement and who were not triple negative, had a significantly better OS. Conclusions There was a significant increase in stage I cases, and a 1% per year OS improvement after GES system started, compared with the previous period. <![CDATA[Predictores de remisión del trastorno depresivo mayor en tratamiento en el nivel secundario de atención]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201514&lng=es&nrm=iso&tlng=es Background The knowledge of predictive factors in depression should help to deal with the disease. Aim To assess potential predictors of remission of major depressive disorders (MDD) in secondary care and to propose a predictive model. Material and Methods A 12 month follow-up study was conducted in a sample of 112 outpatients at three psychiatric care centers of Chile, with baseline and quarterly assessments. Demographic, psychosocial, clinical and treatment factors as potential predictors, were assessed. A clinical interview with the checklist of DSM-IV diagnostic criteria, the Hamilton Depression Scale and the List of Threatening Experiences and Multidimensional Scale of Perceived Social Support were applied. Results The number of stressful events, perceived social support, baseline depression scores, melancholic features, time prior to beginning treatment at the secondary level and psychotherapeutic sessions were included in the model as predictors of remission. Sex, age, number of previous depressive episodes, psychiatric comorbidity and medical comorbidity were not significantly related with remission. Conclusions This model allows to predict depression score at six months with 70% of accuracy and the score at 12 months with 72% of accuracy. <![CDATA[Uso de sustancias psicoactivas y calidad de vida relacionada con la salud en adolescentes escolarizados]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201525&lng=es&nrm=iso&tlng=es Background The use of psychoactive substances among adolescents is a major social and public health concern. Aim To analyze association of substance abuse and multiple drug use with health-related quality of life (HRQOL) in adolescents attending a high school in Valparaiso, Chile. Material and Methods Analytical cross-sectional study conducted in a sample of adolescents attending high school. HRQOL was assessed using KIDSCREEN-52 questionnaire and substance use was measured using the Global school-based student health survey. Participants had to complete online, self-administered, anonymous questionnaires. Multiple logistic regression analyses were conducted to calculate Odd ratios. Results A total of 550 adolescents aged 16 ± 1 years old completed the questionnaires. Thirty nine percent consumed alcohol during the last month, 31% smoked, 33% used marijuana and 33% admitted the use of multiple drugs. High-risk alcohol consumption was associated with a lower perception of psychological well-being, self-perception and school environment. This last dimension was affected in those who admitted marijuana use during the last month. Multiple drug use (three substances) was associated with a lower perception of physical and psychological well-being, self-perception, relationship with parents, family life and school environment. Conclusions High-risk alcohol consumption and multiple drug use (three substances) have a negative impact on the HRQOL of school age adolescents. <![CDATA[Actividad física y perfil de estilos de vida promotores de la salud en adultos mayores chilenos]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201535&lng=es&nrm=iso&tlng=es Background Part of having healthy lifestyles should be a regular practice of physical activities. Aim To evaluate the association between the practice of physical activity and healthy lifestyles in older people. Material and Methods The Health-Promoting Lifestyle Profile survey was applied to 1688 older people living in the community, aged 72 ± 7 years (61% women). This survey includes questions about regular physical activity. Results Twenty four percent of surveyed participants declared to practice physical activities at least three times per week, without gender differences. Sedentariness increased along with age. There was a negative association between low physical activity and healthy lifestyles (odds ratio (OR): 3.2 confidence intervals (CI): 2.3-4.5). There was also an association between sedentariness and low self-realization (OR 2.4 CI: 1.8-3.3), low responsibility with health (OR 1.6 CI: 1.22.1), low concern about nutrition (OR 1.8 CI: 1.4-2.4), low stress management (OR 2.0 CI: 1.5-2.7) and low interpersonal support (OR 2.0 CI: 1.5-2.6). Conclusions Sedentariness is negatively associated with health promoting lifestyles in this group of older people. <![CDATA[Características de la población y las atenciones de rehabilitación que recibe en un hospital general]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201541&lng=es&nrm=iso&tlng=es Background Patients discharged from general hospitals with a potentially disabling condition can benefit in their recovery with the aid of physical medicine and rehabilitation services. Aim To determine the proportion of patients discharged from a general hospital with a potentially disabling condition, who were derived to physiatry for rehabilitation. Material and Methods Review of the discharge database of a general hospital, identifying all discharges with a potentially disabling condition, and those who were effectively derived for rehabilitation. Results Only 7% of patients with a potentially disabling condition were effectively evaluated by Physiatry. Among these patients, 20% had neurological diseases and 19% had an amputation. Those attended by physiatry had a higher proportion of multidisciplinary care by the rehabilitation team. Conclusions A low proportion of patients discharged with a potentially disabling conditions are referred for an adequate rehabilitation therapy. <![CDATA[Caracterización de cepas de <em>Campylobacter jejuni</em> obtenidas desde carne de pollo y heces de aves de corral de la zona central de Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201551&lng=es&nrm=iso&tlng=es Background Campylobacter jejuni is one of the main causal agents of food borne diseases. Infections with this pathogen are mainly caused by chicken meat consumption. Aim To characterize antibiotic resistance and virulence factors in C. jejuni strains obtained from chicken meat and poultry feces in Central Chile. Material and Methods The presence of C. jejuni in 30 meat and 40 feces samples from poultry was studied. From these samples, we obtained 40 strains which were characterized at the molecular level for the presence of 16 genes involved in virulence using PCR. In parallel, antibiotic resistance for ciprofloxacin, nalidixic acid, tetracycline, erythromycin, azithromycin, chloramphenicol y ampicillin was analyzed. Results Twenty and 63% of feces and chicken meat samples were positive for C. jejuni, respectively. Moreover, a high percentage of strains showed antibiotic resistance, where 27% of strains were resistant to all tested antibiotics, except for azithromycin. Finally, 10% of the strains coming from feces contained 14 out of 16 virulence genes evaluated. Only 23% of the strains did not contain any of these genes. Conclusions A high percentage of feces and chicken meat samples are contaminated with C. jejuni. Moreover, these strains show a high genetic and phenotypic diversity represented by their antibiotic resistance profiles and the presence of virulence factors. <![CDATA[Portación de <em>Staphylococcus aureus</em> enterotoxigénico tipo A, en frotis nasofaríngeos en manipuladores de alimentos]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201559&lng=es&nrm=iso&tlng=es Background Staphylococcus aureus produces 11 serotypes of endotoxins that may cause food poisoning. Aim To determine the prevalence of type A enterotoxigenic Staphylococcus aureus carriage among food service workers in Chillan, Chile. Material and Methods Pharyngeal swabs were obtained from 100 food service workers and were cultured in Agar plates. After identifying the presence of Staphylococcus aureus, DNA was extracted to identify type A toxin by conventional PCR. Results Thirty eight percent of samples were colonized with Staphylococcus aureus. Among these, 26% were toxin A producers. Conclusions Half of the sampled workers carried Staphylococcus aureus and a quarter of these produced type A enterotoxin. <![CDATA[Prescripción de opioides al alta de un servicio de urgencia]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201565&lng=es&nrm=iso&tlng=es Background There is a worrisome increase in opioid prescription worldwide. Their use and overuse may cause adverse outcomes. Aim To determine incidence and characteristics of opioid prescription at discharge at an emergency department (ED). Material and Methods A prospective observational study in a random sample of adult patients attended at an ED of a teaching hospital. We reviewed medical records prescriptions for each patient to collect information about drugs prescribed, reason and medical indication of use (doses and duration). Results A total of 1,001 patients aged 50 ± 20 years (61% women) were studied. Seven percent of patients received an opioid prescription at discharge from the ED, mainly to treat renal and back pain. The dose, duration of treatments or both were incompletely described in 54% of prescriptions. The dose of tramadol in drops was incomplete in 96% of prescriptions. Conclusions Seven percent of patients discharged from an ED received an opioid prescription, mainly to treat non-oncological acute pain. The lack of information detected in the prescriptions affected quality, safety and effectiveness of the treatment, especially when pharmaceutical formulations were drops. <![CDATA[¿Es tiempo de modificar la vinculación pregrado postgrado en la educación médica chilena? Reflexiones sobre una vía de doble titulación Médico cirujano/Doctor en ciencias médicas]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201569&lng=es&nrm=iso&tlng=es In the last 150 years, scientific research has produced extraordinary discoveries in Medicine and there is no doubt that research will continue contributing substantially in the future but there is no the same conviction regarding how to provision such capacities in medical graduates. In Chile, the Faculties of Medicine created several doctorate programs in Medical Sciences (Ph.D.) to strengthen medical research. However, the low number of physicians who apply to these programs is a caveat. These programs provide the advanced third-cycle competencies expected by students aspiring for an excellence research certification and their incorporation into academia. Universities stand out in their capacity to adapt themselves to educational needs, developing programs designed to fill specific gaps. Ph.D. programs intercalated to the medical career show that this is the correct approach. The development of specific doctorate programs for the small number of physicians interested in research and for medical students with a strong interest in research could be an innovative solution to motivate and encourage them to develop a career in clinical investigation. Using this approach, Medical Schools and Doctorate in Medical Sciences programs would jointly stimulate the training of medical scientists. <![CDATA[Alteraciones del neurodesarrollo en pacientes con hipotiroidismo congénito: Recomendaciones para el seguimiento]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201579&lng=es&nrm=iso&tlng=es Congenital hypothyroidism (CH) is the most common cause of preventable cognitive disability worldwide. Generally, it is produced by an alteration in the embryogenesis of the thyroid gland or by an alteration in the synthesis of thyroid hormones, which determine that affected patients have low or absent thyroid hormone concentrations. The importance of this fact is that brain development during the first three years of life is highly dependent on thyroid hormones. Prior to the implementation of national neonatal screening programs around the world, 8 to 27% of children with CH had an IQ lower than 70. Nowadays, this percentage is close to 0 in countries that have implemented the program. In Chile, CH neonatal screening program achieved national coverage in 1996. Currently, the incidence of the disease in our country is 1: 3163. The degree of disability produced by CH not only depends on the time of detection of the disease and the prompt start of therapy, but also on an adequate monitoring. Despite screening programs, neurocognitive impairment in schoolchildren and teenagers with CH is still observed, reflected in lower scores in cognitive, language and gross motor assessments, receptive communication, expressive communication, fine motor and gross motor skills compared to healthy children. Also, lesser achievements in learning and language disorders are observed. The objective of this review is to update the information available on neurodevelopment of patients with CH. <![CDATA[Evaluación de la actividad física en pacientes con enfermedad pulmonar obstructiva crónica]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201588&lng=es&nrm=iso&tlng=es The prevalence and mortality of chronic obstructive pulmonary disease (COPD) is increasing in Chile, constituting a public health problem. Pulmonary and systemic consequences of COPD affect physical activity, as the disease progresses. There are multiple means for physical activity assessment, from low cost and easily applicable questionnaires to sophisticated laboratory tests. Physical inactivity is a modifiable risk factor for morbidity and mortality in patients with COPD. Physical activity interventions not only contribute to decrease the likelihood of mortality, but also protect from comorbidities, especially cardiovascular ones. It also plays a major role avoiding functional limitations of these subjects. Dyspnea and fatigue render exercise as an unpleasant activity for most patients with COPD. If psychological alterations such as anxiety and depression are summed, these patients drift towards an inactive lifestyle. This article analyzes several tools available to assess physical activity is patients with COPD, useful in clinical practice. <![CDATA[Estimación del impacto del consumo de sal en los niveles de presión arterial en población no hipertensa entre 15 y 64 años]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201597&lng=es&nrm=iso&tlng=es Background There is conflicting evidence regarding the role of salt intake in blood pressure (BP). Aim To estimate the impact of salt consumption on the BP level of a non-hypertensive population aged between 15 and 64 years. Material and Methods Analytical-observational study using data from the National Health Survey 2009-2010. A BP cut-off point at 120/80 mmHg BP was considered to determine risk. Salt consumption was divided into four strata. The prevalence ratios (PR) were determined using the Poisson model with robust variance. The formulas of the studies of Dal Grande and Walter for the estimation of population attributable fraction (PAF) were used. Results The sample was constituted by 1,263 individuals and 24.3% had BP at risk. A statistically significant association was observed between high salt intake and risk BP with PR of 1.91 (95% confidence intervals (CI) 1.44-2.57) in the consumption stratum of 11 g / day and more. It was estimated that 4.7% (95% CI 4.2-5.2) of BP risk can be attributed to salt consumption, when controlling by age group, sex and educational level. Conclusions The 4.7% PAF is lower than the figure of 30% reported abroad. Interventions to reduce salt consumption in the entire population and the identification of risk groups are recommended. <![CDATA[Implementación de la vacunación contra el virus papiloma humano en Chile: una mirada desde los determinantes sociales de la salud “ingreso” y “género”]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201605&lng=es&nrm=iso&tlng=es Cervical cancer is the fourth most common neoplasm in women worldwide and its incidence is associated with profound social inequities. In Chile, it is the second cause of death in women of reproductive age. The Chilean clinical guideline identifies the vaccine against Human Papillomavirus (HPV) as the main preventive measure. Since 2014, the Ministry of Health has implemented free immunization against HPV for girls and female adolescents. This article critically analyzes this public policy from the viewpoint of health equity, using as framework the Social Determinants of Health Model. Specifically, we address the structural determinants of income and gender, which act as material and social barriers for achieving immunization, affecting protection against cervical cancer. These barriers correspond to the high cost of the vaccine, and social attitudes/cultural beliefs towards sexual behavior in Latin America and Chile that affect the acceptability of vaccination. The Social Determinants of Health Model constitutes a useful tool for identifying health inequities and understanding public policy from an equity viewpoint that complements the biomedical and epidemiological understanding of disease. In this topic, the initiative aims to strengthen the idea of health as a human right and health promotion as an essential function of public health policy. <![CDATA[Herramientas útiles y métodos de búsqueda bibliográfica en PubMed: guía paso a paso para médicos]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201610&lng=es&nrm=iso&tlng=es Developing skills to search the medical literature has potential benefits on patient care and allow physicians to better orient their efforts when answering daily clinical questions. The objective of this paper is to share useful tools for optimizing medical literature retrieval in MEDLINE using PubMed including MeSH terms, filters and connectors. <![CDATA[Semblanza del Profesor Ramón Ortúzar Escobar. Presentada en el XXXVII Congreso Chileno de Medicina Interna]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201619&lng=es&nrm=iso&tlng=es Developing skills to search the medical literature has potential benefits on patient care and allow physicians to better orient their efforts when answering daily clinical questions. The objective of this paper is to share useful tools for optimizing medical literature retrieval in MEDLINE using PubMed including MeSH terms, filters and connectors. <![CDATA[Severo edema inducido por la terapia dopaminérgica en la enfermedad de Parkinson. Caso clínico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201624&lng=es&nrm=iso&tlng=es The main adverse effects of dopaminergic drugs used in Parkinson's disease are hypotension, somnolence, hallucinations and impulse control disorder. Less common is leg edema. We report on a 68-year-old male receiving levodopa and pramipexole consulting for severe leg edema lasting two years, whose etiology was not ascertained with multiple lab tests. This edema subsided substantially when pramipexole was discontinued and the dose of levodopa was increased to treat motor symptoms. <![CDATA[Miastenia gravis y su asociación con trastornos linfoproliferativos: casos clínicos]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201626&lng=es&nrm=iso&tlng=es Myasthenia gravis (MG) is a rare autoimmune disease of the neuromuscular junction. It is characterized by variable weakness and excessive fatigability of skeletal muscles. In the last few years, numerous reports have been published showing the association between autoimmune diseases, such as systemic erythematous lupus or rheumatoid arthritis, with lymphoid neoplasias. The association between MG and lymphoid neoplasia seems to be less frequent. To analyze this association we reviewed the MG patients in the Department of Neurology, Hospital Salvador of Santiago, Chile. During a three-year period we identified four patients who developed different lymphoproliferative disorders: two with B-cell lymphoma, one with chronic lymphocytic leukaemia and one plasmacytoma with an associated amyloidosis. The MG was generalized but mild, all cases classified as type IIa according to the definition proposed by the MG Foundation of America. The neoplasia appeared two to 36 years after the onset of MG. These cases provide additional evidence of the association between MG and lymphoproliferative disorders. <![CDATA[Inactividad física en Chile: debemos responder al llamado global]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201631&lng=es&nrm=iso&tlng=es Myasthenia gravis (MG) is a rare autoimmune disease of the neuromuscular junction. It is characterized by variable weakness and excessive fatigability of skeletal muscles. In the last few years, numerous reports have been published showing the association between autoimmune diseases, such as systemic erythematous lupus or rheumatoid arthritis, with lymphoid neoplasias. The association between MG and lymphoid neoplasia seems to be less frequent. To analyze this association we reviewed the MG patients in the Department of Neurology, Hospital Salvador of Santiago, Chile. During a three-year period we identified four patients who developed different lymphoproliferative disorders: two with B-cell lymphoma, one with chronic lymphocytic leukaemia and one plasmacytoma with an associated amyloidosis. The MG was generalized but mild, all cases classified as type IIa according to the definition proposed by the MG Foundation of America. The neoplasia appeared two to 36 years after the onset of MG. These cases provide additional evidence of the association between MG and lymphoproliferative disorders. <![CDATA[Chile necesita mejores estadísticas y mayor cobertura en tamizaje de retinopatía diabética]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201633&lng=es&nrm=iso&tlng=es Myasthenia gravis (MG) is a rare autoimmune disease of the neuromuscular junction. It is characterized by variable weakness and excessive fatigability of skeletal muscles. In the last few years, numerous reports have been published showing the association between autoimmune diseases, such as systemic erythematous lupus or rheumatoid arthritis, with lymphoid neoplasias. The association between MG and lymphoid neoplasia seems to be less frequent. To analyze this association we reviewed the MG patients in the Department of Neurology, Hospital Salvador of Santiago, Chile. During a three-year period we identified four patients who developed different lymphoproliferative disorders: two with B-cell lymphoma, one with chronic lymphocytic leukaemia and one plasmacytoma with an associated amyloidosis. The MG was generalized but mild, all cases classified as type IIa according to the definition proposed by the MG Foundation of America. The neoplasia appeared two to 36 years after the onset of MG. These cases provide additional evidence of the association between MG and lymphoproliferative disorders. <![CDATA[Desafíos del Modelo de Salud Intercultural: desde la coexistencia geográfica al diálogo científico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017001201635&lng=es&nrm=iso&tlng=es Myasthenia gravis (MG) is a rare autoimmune disease of the neuromuscular junction. It is characterized by variable weakness and excessive fatigability of skeletal muscles. In the last few years, numerous reports have been published showing the association between autoimmune diseases, such as systemic erythematous lupus or rheumatoid arthritis, with lymphoid neoplasias. The association between MG and lymphoid neoplasia seems to be less frequent. To analyze this association we reviewed the MG patients in the Department of Neurology, Hospital Salvador of Santiago, Chile. During a three-year period we identified four patients who developed different lymphoproliferative disorders: two with B-cell lymphoma, one with chronic lymphocytic leukaemia and one plasmacytoma with an associated amyloidosis. The MG was generalized but mild, all cases classified as type IIa according to the definition proposed by the MG Foundation of America. The neoplasia appeared two to 36 years after the onset of MG. These cases provide additional evidence of the association between MG and lymphoproliferative disorders.