Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988719990009&lang=pt vol. 127 num. 9 lang. pt <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<I>Antimicrobial resistance of agents causing urinary tract infections in 11 Chilean hospitals. </I>: <I>Pronares project</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900001&lng=pt&nrm=iso&tlng=pt Background: The computer program WHONET generates a common database to analyze local or general antimicrobial resistance of bacteria. A surveillance of agents causing urinary tract infections in Chile has been performed using this program. Aim: To report the results after 12 months of urinary tract infection agent surveillance. Material and methods: Since November, 1997, a surveillance of in vitro antimicrobial resistance, using agar diffusion techniques, has been performed in 20 to 40 bacterial strains per month, isolated from 11 hospitals in the country. Results have been analyzed using WHONET program. Results: In first 12 months, 3144 strains, 1625 coming from outpatients, have been studied. Seventy four percent of isolated strains were E coli, 19% were other enterobacteria, 4.1% were non fermenting bacilli and 2.1% were Gram (+) cocci. Sixty five percent of E coli strains were resistant to ampicillin, 11% to cefazolin, 2.5% to cefuroxime, 19% to ceftriaxone, 9% to ceftazidime, 4.2% to gentamicin 1.3% to amikacin, 5.6% to ciprofloxacin, 8.4% to grepafloxacin, 4.3% to nitrofurantoin and 43% to trimeproprim/sulphamethoxazole. Eighty two percent of other enterobacteria strains were resistant to ampicillin, 45.5% to cefazolin, 33.5% to cefuroxime, 26.6% to ceftriaxone, 21.5% to ceftazidime, 30.3% to gentamicin 17.2% to amikacin, 21% to ciprofloxacin, 16.3% to grepafloxacin, 48.2% to nitrofurantoin and 44.6% to trimeproprim/sulphamethoxazole. There were differences in betalactamic resistance among hospitals. Conclusions: Noteworthy is the high resistance rates to third generation cephalosporins, evidenced when the new cutoff values for E coli and Klebsiella spp are used. This national surveillance provides updated information on antimicrobial resistance of agents causing urinary tract infections. <![CDATA[<I>Natural history of gastric cancer and cerebrovascular disease in Chile.</I>: <I>Analysis of the salt theory</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900002&lng=pt&nrm=iso&tlng=pt Background: In the last forty years, a sustained reduction in the gastric cancer and cerebrovascular disease mortality has been recorded. Joossens has postulated that sodium intake has an influence in the natural history of both diseases. Aim: To analyze the mortality caused by both diseases in Chile. Material and methods: The mortality of people aged 35 to 64 years old, due to gastric cancer and cerebrovascular diseases in the period 1955-1994, was analyzed. An analysis according to regions, using temporal series and correlation techniques was performed. Results: In the studied period, the mortality due to gastric cancer decreased by 71.6% in men and by 79.5% in women. Mortality due to cerebrovascular diseases decreased by 56.9% in men and by 63.9% in women. There was a correlation coefficient of + 0.91 between the mortality due to both diseases. Cerebrovascular disease mortality appears as a predictor of gastric cancer mortality in temporal series analysis. Conclusions: Joossenstheories are supported by the present data. Prospective studies should be designed to confirm the hypothesis. <![CDATA[<I>Microbiological study of gallbladder bile in a high risk zone for gallbladder cancer</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900003&lng=pt&nrm=iso&tlng=pt Background: Gallbladder cancer is frequent in Chile and there is sparse information about the association between this type of cancer and the presence of bacteria in the gallbladder bile. Aim: To determine the presence of aerobic bacteria in gallbladder bile in patients with and without gallbladder cancer. Material and methods: A microbiological analysis of bile and pathological study was performed in 608 gallbladders, obtained during to cholecystectomies performed to 513 women and 95 men aged 44 years old as a mean. Results: Pathological study showed a chronic cholecystitis in 468 cases (77%), an acute cholecystitis in 140 (33%), cancer in 24 (3.9%) and dysplasia in 5 cases (0.8%). A positive culture was obtained in 22.5% of women and 28.5% of males. Twenty seven percent of women over 30 years old had positive cultures compared with 10% of younger women (p &lt;0.001). Thirty two percent of acute cholecystitis had positive cultures, compared with 24% of chronic cholecystitis (p=0.03). E Coli was isolated in 51% of positive cases, Streptococci-Enterococci in 24%, Enterobacter sp in 9%, Klebsiella and Proteus in lower proportions. Salmonella sp was isolated in 4 cases, being all women with chronic cholecystitis. Thirteen of 29 cases with cancer or dysplasia had positive cultures (45%), compared with 25% of patients with inflammatory gallbladder diseases (p=0.02). Streptococci-Enterococci were isolated in 7 cases and Enterobacter sp in three. Conclusions: The presence of Salmonella sp in gallbladder bile was not frequent in the studied patients. Its role in the pathogenesis of gallbladder cancer must be reassessed. <![CDATA[Paternity analysis using four DNA markers amplified by polymerase chain reaction]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900004&lng=pt&nrm=iso&tlng=pt Background: DNA typing in forensic analysis is a useful tool to analyze paternity due to its high discrimination power. Aim: To report the experience of Servicio Medico Legal in Santiago, resolving cases of dubious paternity. Subjects and methods: Four highly polymorphic loci, amplified by polymerase chain reactions, were analyzed in 153 cases of uncertain paternity. The paternity index was calculated for each case. Results: The four genetic markers analyzed provided an exclusion probability of 0.933 for the general population in Santiago. Thirty seven cases were excluded as parents. In 31 cases, the paternity index ranged from 19 to 100, considered as probable paternity and 77 cases had an index of over 100, considered as almost certain paternity. Eight cases had an index between 0.5 and 19, considered as inconclusive. All loci met Hardy-Weinberg expectations and their frequencies were similar to other data from people living in Santiago. Conclusions: The use of these genetic markers proved to be very useful, reliable and with a high exclusion power for paternity analysis <![CDATA[<I>Systematic surveillance of influenza, syncytial respiratory, parainfluenza and adenovirus in children with acute respiratory infections</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900005&lng=pt&nrm=iso&tlng=pt Background: The efficacy of influenza vaccination programs depends on the antigenic similitude between vaccine and the influenza virus circulating in the community. Therefore the surveillance of clinical activity and antigenic features of influenza virus is of utmost importance. Aim: To perform a systematic surveillance of clinical activity and antigenic characteristics of influenza virus. Material and methods: Since 1996 and during the cold months (May to September), 20 samples of upper respiratory secretions per week, were obtained from children with acute respiratory infections consulting to the emergency room of a public hospital. Using indirect immunofluorescence and cellular cultures, the presence of influenza, syncytial respiratory, parainfluenza and adenovirus was assessed. The weekly number of consultations in the emergency room and the number of hospital discharges due to acute respiratory infections, were registered. Results: Influenza and syncytial respiratory were the predominant virus detected since 1996. In 1996 and 1998, the weekly detection of influenza virus followed a single seasonal curve. The maximal weekly positively results reached 85 and 80% of the obtained samples, respectively. During 1997, two curves of influenza virus activity were observed, but none reached more than 50% of weekly positive samples. The demand for outpatient care evolved in parallel to the weekly detection of influenza virus. The hospital discharges due to acute respiratory infections paralleled the syncytial respiratory virus detection rates. Conclusions: This surveillance model is effective for the detection of influenza and other virus responsible for acute respiratory infections and their relationship with the demand for health care during the cold months. <![CDATA[<I>Influence of respiratory viruses, cold weather and air pollution in the incidence of lower respiratory tract infections in infants children</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900006&lng=pt&nrm=iso&tlng=pt Background: All winters, there is an increase in the number of pediatric consultations, associated to three factors: cold weather, air pollution and respiratory virus epidemics. Aim: To study the influence of these three factors in the demand for pediatric consultations between March and September, in an area of Metropolitan Santiago. Patients and Methods: The number of consultations between March and September 1998 in the emergency room and the number of hospital discharges due to lower respiratory tract infections, were registered in a public pediatric hospital of Santiago. A respiratory virus surveillance (respiratory syncytial virus, adenovirus, influenza and parainfluenza virus) was done among children admitted for lower respiratory infections. Atmospheric temperature values and air pollution, measured as the number of particles of 10 µm or more per m3 (MP 10), were obtained from local health services. Results: Two elevation waves of outpatient consultations were detected at weeks 19 and 26, that coincided with the periods of maximal detection of influenza and syncytial respiratory virus, respectively. The epidemics of respiratory syncytial virus coincided with the maximal number of hospital admissions for lower respiratory tract infections at week 27. There was no correlation between air pollution and the number of pediatric consultations. The lower ambient temperatures coincided with the higher detection of respiratory syncytial virus at week 28, moment in which the demand for consultations or hospital admissions was descending. Conclusions: There is a direct relationship between respiratory virus epidemics and the demand for pediatric consultations. There is also a minor influence of ambient temperature. <![CDATA[<I>Influence of body posture in the prevalence of craniomandibular dysfunction</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900007&lng=pt&nrm=iso&tlng=pt Background: Postural alterations of the shoulders, dorsal spine and hips could have an influence on the development of craniomandibular dysfunctions. Aim: To study the influence of body posture on the prevalence of craniomandibular dysfunction. Subjects and methods: One hundred thirty six dental students and 41 patients assisting to the temporomandibular joints (TMJ) clinic at the Freie Universität at Berlin, were studied. Masticator, cervical muscles, temporomandibular joints and occlusions were clinically examined. The position of shoulders and hips was measured with the use of an acromiopelvimeter. Results: No relationship was found between postural alterations of the hips and shoulders, articular noises and sensibility or pain while palpating the temporomandibular joints. Among students, a relationship between postural alterations of the shoulders and the sensibility or pain while palpating the TMJ, was observed. When all muscles were considered, a significant relationship between asymmetric shoulders or hips and muscular pain while palpating was observed among students. Conclusions: Some symptoms, especially muscular sensibility is more pronounced in people with hip and shoulder asymmetries. This relation is more pronounced in dental students than in patients. <![CDATA[<I>Non linear analysis of the infectious disease dynamics in Chile</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900008&lng=pt&nrm=iso&tlng=pt Background: The incidence of infectious diseases generally has large fluctuations, probably due to interactions between seasonal fluctuations and those secondary to case-susceptible host interactions. Aim: To analyze the complexity and attractant topological resemblance of seven infectious diseases in Chile. Material and methods: The annual incidence of measles, whooping cough, scarlet fever, meningococcal meningitis, diphtheria, typhoid fever and poliomyelitis was obtained from the annual reports of diseases. Correlation dimensions and the largest Lyapunov series exponents were estimated. The resemblance among their attractants was assessed by Hausdorff distance. The measures were performed both before and after seasonal filtering. Results: All series showed a dynamics near low dimensional chaos. The correlation dimensions ranged between 2.12 and 2.76. The correlation dimensions did not change after seasonal differentiation. Apart from one, all disease dynamics had large Lyapunov exponents, near 0.6 Bits/year. These decreased if series were differentiated. Before differentiation, the topological resemblance was mainly caused by the seasonal component of the dynamics but thereafter, the resemblance increased. In spite of different transmission mechanisms and etiologies, all analyzed infectious diseases conformed a truly single group, during cluster analyses. Conclusions: These results suggest that beneath the dynamics of infectious diseases, obscured by seasonal environmental factors, lays a very consistent nonlinear agent-susceptible host dynamics. <![CDATA[<I>Long term results of reconstructive surgery for mitral insufficiency</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900009&lng=pt&nrm=iso&tlng=pt Background: Surgical repair is the procedure of choice for mitral insufficiency since it preserves better left ventricular structure and function. Aim: To assess the long term clinical and echocardiographic results of mitral valve reconstructive surgery. Material and methods: A review of clinical and echocardiographic data of 68 patients (34 male, age range 17 to 82 years), subjected to surgical mitral valve repair between December 1991 and March 1998. Preoperative functional capacity of these patients was 2.96 ± 0.7. Surgical repair was assessed using transesophagic echocardiography in all subjects. Results: The etiology of mitral insufficiency was degenerative in 43 patients, rheumatic in 10, infectious in 6, ischemic in 5 and miscellaneous in 4. The most frequent pathological findings were dilatation of the mitral ring in 42% of patients, chordae tendinae rupture in 32% and enlargement in 24%. A mitral anuloplasty was done in 90% of patients, a cuadrilateral resection of posterior leaflet in 52% and chordae tendinae transference in 12%. An additional surgical procedure was done in 34% of subjects. Three patients died during hospitalization (4.4%). During the follow up of 36.5 ± 22.3 months, five patients died and one required a mitral valve replacement. The actuarial survival probability was 95.3 ± 2.6% at one year and 83.5 ± 6.5% at five years. The reoperation free survival was 100% at one year and 97.4 ± 2.5% at five years. At the end of follow up the functional capacity improved to 1.25 ± 0.4. Echocardiography showed absence of mitral insufficiency in 48.4% of patients, minimal, mild and moderate insufficiency in 35.5, 14.5 and 1.6% of patients respectively. Conclusions: Surgical valve reconstruction in mitral insufficiency has satisfactory long term results and should be the procedure of choice for eligible patients. <![CDATA[<I>Coronary angioplasty and stent placement through the radial artery.</I>: <I>Report of one case</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900010&lng=pt&nrm=iso&tlng=pt Coronary angiography and percutaneous treatment of stenotic lesions have expanded in the last few years, due to availability of better diagnostic equipment. The femoral technique applied to this aims has prevailed, considering its efficacy, safety and wide acceptance. Since the beginning of this decade, an alternative access has been developed, in relation to miniaturization of the required elements to perform coronary diagnostic and therapeutic procedures. This new radial artery access is supported by multiple reports from many centers around the world that are increasingly using the technique. With this access it is possible to perform all the regular procedures done regularly through the femoral route. This case report illustrates a coronary angiography study through the radial access, followed by a stent implantation, through the same route. <![CDATA[<I>Simultaneous occurrence of chronic myeloid leukemia and non Hodgkin lymphoma in a patient</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900011&lng=pt&nrm=iso&tlng=pt Chronic myeloid leukemia is a myeloproliferative disorder caused by a clonal disturbance of the trunk cell and the accumulation of granulocytic series in the marrow, blood and other organs. We report a 63 years old male, carrier of a chronic myeloid leukemia whose clinical condition was complicated by the appearance of a T cell lymphoma. He was subjected to chemotherapy, that reduced the size of adenopathies and improved his general condition. Further studies are required to determine if there is a relationship between these two clinical entities. <![CDATA[Neck located hydatid cysts.: Report of two cases]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900012&lng=pt&nrm=iso&tlng=pt Neck located hydatid cysts are of rare occurrence. We report two patients with such condition. A 66 years old male with a slowly progressive painless 4 cm nodule located in the right thyroid. It did not concentrate 131I and a fine needle aspiration cytology was informed as an acute thyroiditis. A 5 years old boy presented with a 5 cm painless right submaxillary cyst. Ultrasound examination showed that it was unilocular, and fine needle aspiration biopsy disclosed unspecific findings. In both cases surgical findings and the pathological study showed hydatid cysts. Both patients had normal chest x ray and abdominal ultrasound examinations. They had an uneventful postoperative evolution. Echinococcosis must be considered in the differential diagnosis of cervical cysts in endemic area. <![CDATA[<I>Identification of molecular defects in liver diseases</I>: <I>Recent advances</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900013&lng=pt&nrm=iso&tlng=pt Recent molecular studies have resulted in the identification of genetic alterations underlying several hereditary disorders of the liver. Cloning of disease genes are increasing our understanding of the basic defects in liver diseases. This review focuses on selected inherited liver diseases such as hyperbilirubinemic syndromes, hemochromatosis, Wilson disease and genetic cholestatic syndromes and illustrate the knowledge gained on these disorders from molecular studies. Potential implications of the identification of disease genes such as practical applications for diagnosis, information on prognosis and the possibility to design new therapies are discussed. <![CDATA[<I>Cesarean section and vaginal delivery.</I>: <I>An ethical perspective</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900014&lng=pt&nrm=iso&tlng=pt The increasing number of cesarean sections is worrisome. In this article, several causes that could cause this phenomenon are invoked and a primary cause that explains all others is proposed. The hierarchical analysis of different values such as safety, costs and mother autonomy at the moment of medical decision, is discussed. <![CDATA[<I>Metabolic and dietary factors involved in the etiology of obesity in Chilean women</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900015&lng=pt&nrm=iso&tlng=pt This review discusses the factors involved in the aetiology of obesity. The effect of dietary macronutrient composition on the metabolic fate of fat (oxidation or storage) is emphasised. Available information on dietary intake in adults from food balance sheets or dietary surveys, show that females eat a relatively low amount of fat (50-70 g/d on average), although this seems to be rising. The increasing prevalence of obesity in our population could be related to the glycemic index of meals, their fatty acid composition and the time interval between meals. This paper compares the oxidation rates of different fatty acids, particularly polyunsaturated fatty acids (PUFA), and among these, the high oxidation rates found for a-linolenic and linoleic acids. Medium chain saturated fatty acids (C8 to C12) are more likely to be oxidised in comparison with PUFA and longer chain saturated fatty acids. The latter are more likely to be directed to fat storage, particularly when they are combined with highly glycemic carbohydrates (CHO) in the same meal. Given the large proportion of CHO in the usual diet, the relevance of de-novo lipogenesis from CHO is questioned. It is concluded that this route is not readily used in humans consuming normal diets. Therefore, this mechanism can not be responsible for the rising prevalence of obesity. <![CDATA[<I>The future of medicine</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900016&lng=pt&nrm=iso&tlng=pt Predicting the future of medicine is daring. One can speculate about some of its future traits at the most. The spectacular progress in biological sciences has nurtured the hope that medicine will be able to dominate all ailments, improve the quality of life and longevity. Physicians are uncomfortable with the weak knowledge that they have about some diseases such as cancer, connective tissue diseases, degenerative diseases, mental and psychosocial conditions. They are also worried about the aggressive and mutilating surgical procedures that are required nowadays. One can foresee that molecular medicine and applied technology will advance at a great speed and will modify the therapy of several diseases and the social organization of health care. Scientific progress will also change our values and will pose new political and economical challenges. I believe that medical ethics and bioethics will become a growing concern for medical education and professional organizations. The so called biotechnology century will also be the bioethics century. The revision and elucidation of the fundamentals of medicine will differentiate, in the future, a medicine devoted to mankind with a solid ethical background from an impersonal health care that considers man as an object or maybe a merchandise. The second option will cast medical care through the abyss of decadence, to its end. <![CDATA[<I>The physician-patient relationship and the system of health care</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900017&lng=pt&nrm=iso&tlng=pt Predicting the future of medicine is daring. One can speculate about some of its future traits at the most. The spectacular progress in biological sciences has nurtured the hope that medicine will be able to dominate all ailments, improve the quality of life and longevity. Physicians are uncomfortable with the weak knowledge that they have about some diseases such as cancer, connective tissue diseases, degenerative diseases, mental and psychosocial conditions. They are also worried about the aggressive and mutilating surgical procedures that are required nowadays. One can foresee that molecular medicine and applied technology will advance at a great speed and will modify the therapy of several diseases and the social organization of health care. Scientific progress will also change our values and will pose new political and economical challenges. I believe that medical ethics and bioethics will become a growing concern for medical education and professional organizations. The so called biotechnology century will also be the bioethics century. The revision and elucidation of the fundamentals of medicine will differentiate, in the future, a medicine devoted to mankind with a solid ethical background from an impersonal health care that considers man as an object or maybe a merchandise. The second option will cast medical care through the abyss of decadence, to its end. <![CDATA[<I>A tribute to Profesor Mario Plaza de los Reyes, MD </I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900018&lng=pt&nrm=iso&tlng=pt Predicting the future of medicine is daring. One can speculate about some of its future traits at the most. The spectacular progress in biological sciences has nurtured the hope that medicine will be able to dominate all ailments, improve the quality of life and longevity. Physicians are uncomfortable with the weak knowledge that they have about some diseases such as cancer, connective tissue diseases, degenerative diseases, mental and psychosocial conditions. They are also worried about the aggressive and mutilating surgical procedures that are required nowadays. One can foresee that molecular medicine and applied technology will advance at a great speed and will modify the therapy of several diseases and the social organization of health care. Scientific progress will also change our values and will pose new political and economical challenges. I believe that medical ethics and bioethics will become a growing concern for medical education and professional organizations. The so called biotechnology century will also be the bioethics century. The revision and elucidation of the fundamentals of medicine will differentiate, in the future, a medicine devoted to mankind with a solid ethical background from an impersonal health care that considers man as an object or maybe a merchandise. The second option will cast medical care through the abyss of decadence, to its end. https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900019&lng=pt&nrm=iso&tlng=pt https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900020&lng=pt&nrm=iso&tlng=pt <![CDATA[Posthumous tribute to Héctor Ducci, MD]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98871999000900021&lng=pt&nrm=iso&tlng=pt Predicting the future of medicine is daring. One can speculate about some of its future traits at the most. The spectacular progress in biological sciences has nurtured the hope that medicine will be able to dominate all ailments, improve the quality of life and longevity. Physicians are uncomfortable with the weak knowledge that they have about some diseases such as cancer, connective tissue diseases, degenerative diseases, mental and psychosocial conditions. They are also worried about the aggressive and mutilating surgical procedures that are required nowadays. One can foresee that molecular medicine and applied technology will advance at a great speed and will modify the therapy of several diseases and the social organization of health care. Scientific progress will also change our values and will pose new political and economical challenges. I believe that medical ethics and bioethics will become a growing concern for medical education and professional organizations. The so called biotechnology century will also be the bioethics century. The revision and elucidation of the fundamentals of medicine will differentiate, in the future, a medicine devoted to mankind with a solid ethical background from an impersonal health care that considers man as an object or maybe a merchandise. The second option will cast medical care through the abyss of decadence, to its end.