Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720000002&lang=es vol. 128 num. 2 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Cáncer gástrico y regulación del crecimiento tumoral.: Estudio de marcadores de proliferación celular y del complejo proteínas p53/p21<SUP>WAF1/CIP1</SUP>/mdm-2]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200001&lng=es&nrm=iso&tlng=es Background: p53/p21WAF1/CIP1 and mdm-2 proteins play an important role in cell cycle regulation. The study of the pathogenesis of gastric cancer is important to understand how these tumors progress during their natural history. Aim: To study the relationship between the immunohistochemical expression of p53/p21WAF1/CIP1 and mdm-2 and cell proliferation in gastric cancer. Material and methods: Fifty one gastrectomy specimens with gastric cancer were studied using immunohistochemistry for p53/p21WAF1/CIP1 and mdm-2. Cell proliferation was determined by immunolabelling with PCNA and Ki67 antigens. Mitosis figures were counted in 10 high power microscopic fields. Results: Patients from whom gastric cancer specimens were obtained had a mean age of 59.3 years. Ki67 and mitosis counting showed the highest correlation index with proliferation indexes studied. No correlation was found between the expression of protein complex p53/p21WAF1/CIP1 and mdm-2 and morphological characteristics of gastric tumors. Mdm-2 protein overexpression was the only marker that showed an independent correlation with cell proliferation. Moreover, mdm-2 positive tumors showed the highest proliferation indexes when p53 was not immunohistochemically over-expressed, as determined by PCNA labelling index. Conclusions: In gastric cancer, a direct correlation between mdm-2 overexpression and cell proliferation was observed. Moreover, the fact that mdm-2 positive tumors showed the highest cell proliferation when p53 was not overexpressed, entitles us to hypothesize that mdm-2 overexpression could play a major role in gastric carcinogenesis. <![CDATA[Factores de riesgo del cáncer de mama en mujeres de Santiago]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200002&lng=es&nrm=iso&tlng=es Background: Epidemiological studies suggest a relation between breast cancer, diet and life styles. Aim: To analyze the association between food patterns, obesity, smoking, alcohol consumption and breast cancer risk in women of Santiago. Patients and methods: A case-control study design (170 cases and 340 controls), matched by age and sex, was used. Through a food frequency questionnaire the average daily intake of vegetables, fruits, ß-carotene, vitamin A, C, E and fiber was analyzed. Other exposures to non-nutritional risks (parity, smoking, cancer history) were also studied. Conditional logistic regression was calculated to determine the odds ratio associated with variations in food and nutrient intake and nonnutritional factors. Results: Cases had a greater BMI and a higher prevalence of obesity than controls (p< 0.02). No differences were observed in either group food patterns. The ORs for breast cancer associated with obesity and alcohol consumption were 1.65 (95% CI 1.06-2.64) and 1.61 (95% CI 1.06-2.54) respectively (p< 0.05). Multiparity had a protective effect with 0.66 less risk (95% CI 0.44-0.99). No protective effect associated to a greater intake of vegetables, fruits or natural antioxidants was observed. Multivariate analysis model disclosed obesity as a risk factor (OR 1.79, p< 0.02) and parity ³ 4 as protective (OR 0.62, p<0.02). Conclusions: This study does not support a protective role for natural antioxidants against breast cancer but indicate a weakassociation with obesity. <![CDATA[Recambio óseo en nodrizas adolescentes: evaluación al término de la gestación, lactancia y postdestete]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200003&lng=es&nrm=iso&tlng=es Background: There is paucity of information about bone metabolism during pregnancy or breast feeding in teenagers. Aim: To study bone turnover at the end of pregnancy and during breast feeding in teenagers and correlate it with environmental, hormonal or nutritional variables. Subjects and methods: Thirty teenagers during their breast feeding period after a first pregnancy and 30 nulliparous girls matched for age, age of menarche and body mass index were assessed three weeks after delivery (period 1), at six months of breast feeding (period 2) and one year after the lactating period (period 3). Calcium intake and plasma calcium, phosphorus, alkaline phosphatases, parathormone, estradiol and prolactin were measured. Calcium, creatinine and hydroxyproline were also measured in a morning urine sample. Results: Lactating and control girls were aged 16.3±0.8 and 16.1±0.7 years old respectively. Calcium intake in lactating and control girls was 798±421 and 640±346 g/day respectively in period 1, 612±352 and 592±309 mg/day in period 2 and 495±180 and 456±157 g/day in period 3. During periods 1 and 2, lactating girls had higher alkaline phosphatases (161±37 compared to 119±28 U/l and 149±37 compared to 106±23 U/l), parathormone (4.3±2.6 compared to 2.8±0.8 ng/dl and 3.6±1.6 compared to 3.0±0.9 ng/dl) and urinary hydroxyproline (95±16 compared to 63±15 mg/g creatinine and 84±19 compared to 59±15 mg/g creatinine). No differences were observed in period 3. No correlation between bone turnover variables, body mass index or hormonal parameters, was observed. Conclusions: In teenagers, there is an increase in bone turnover at the end of pregnancy, that persists during the lactating period. These changes are not related to nutritional or hormonal variables. <![CDATA[Relación entre leptina e insulina sanguíneas en mujeres chilenas obesas y no obesas]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200004&lng=es&nrm=iso&tlng=es Background: Leptin, a product of ob gene and insulin blood levels, are proportional to the amount of adipose tissue. Insulin could have an independent regulatory effect on leptin secretion. Aim: To assess the relationship between serum leptin and plasma insulin levels in obese and lean Chilean women. Material and methods: One hundred forty five women, aged 20 to 60 years old, were studied. Weight, height, waist and hip circumference, fasting blood glucose, insulin and leptin levels were measured. Insulin resistance was assessed using the homeostasis model assessment. The relationship between different variables was determined using multiple linear regression, variance analysis and non parametric correlation. Results: Leptin serum concentrations were positively correlated with body mass index, insulin plasma levels and degree of insulin resistance. The association of leptin with insulin was independent of body mass index and persisted after adjustments by body fat distribution and age. Conclusions: Insulin and insulin resistance are associated to high blood leptin levels and this association is independent of the degree of adiposity and body fat distribution. <![CDATA[Prevalencia de malformaciones congénitas al nacer y factores asociados en Isla de Pascua, Chile (1988-1998)]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200005&lng=es&nrm=iso&tlng=es Background: Consanguinity plays an important role in the genetic etiology of congenital malformations. In Easter Island the degree of consanguinity could be higher than in continental Chile. Therefore the study of the prevalence of congenital malformations in this island seems worthwhile. Aim: To study the prevalence of congenital malformations at birth in Easter Island. Material and methods: A review of personal and family features of all children born alive between 1988 and 1998 in the Rapa Nui Hospital of Easter Island. Results: During the study period, 772 newborns were reviewed and 22 were found to have congenital malformations. Among the latter, birth weight fluctuated between 3001 and 4000 g and the male/female ratio was 0.54. No differences in maternal age between children with and without malformations was observed. Heart and circulatory malformations, hemangiomas and Down syndrome were the predominant malformations. Conclusions: The prevalence of congenital malformations at birth in Easter Island is similar to that of continental Chile. No neural tube defects were detected in this sample. <![CDATA[Colitis eosinofílica por alergia a proteína de leche de vaca]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200006&lng=es&nrm=iso&tlng=es Eosinophilic colitis is one of the clinical manifestations of allergy to cow’s milk during the first year of life. We report a series of 9 infants who, under 9 months of age and while clinically well, presented rectal bleeding of variable magnitude, with or without diarrhea, shortly after a cow’s milk-based formula was initiated (n=6); yet, 3 cases received only breast feeding. Bleeding disappeared in all patients after milk withdrawal from the diet. Challenges were planned after 12 months of treatment; three patients have not yet reached this moment, 3 had a negative challenge at 12, 18 and 28 months of age and are on a complete diet, and 3 are still on cow’s milk free diet because ingestion of milk at 12, 18 and 25 months still induced rectal bleeding. This series of patients gathered in 3 years, follows the trend reported in many countries that there is a relative increase of patients diagnosed with allergy conditions early in life <![CDATA[Categorización de usuarios: una herramienta para evaluar las cargas de trabajo de enfermería]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200007&lng=es&nrm=iso&tlng=es Background: Client categorization is a management tool that allows an objective and structured assessment of the care demands imposed by patients and nursing workloads. Aim: To characterize the need for direct nursing care of patients admitted to a university hospital. Patients and methods: During two months, all patients admitted to intensive, intermediate care units and general services were categorized, their need for nursing care and the time invested by nurses in their care was registered. All patients were classified as maximal, high, median or low risk and as independent, totally or partially dependent on nursing care. Considering four degrees of risk and three degrees of dependency, 12 categories of patients were defined. Results: Patients admitted to intensive care units were of maximal risk and totally dependent and required 1 nurse per 2.2 patients. Those admitted in intermediate care units required 1 nurse per 3.8 patients and those in general services, 1 nurse per 11.5 patients. Conclusions: Client categorization is a reproducible method that determines a standard measuring unit to define nursing needs. This allows the comparison of workloads between different services within a hospital or between hospitals <![CDATA[Factores causales de infertilidad masculina: Contribución del factor endocrino]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200008&lng=es&nrm=iso&tlng=es Background: Male infertility is responsible for 35% of infertile couples. Aim: To investigate the causes of male infertility and the relative importance of endocrine factors. Patients and methods: Patients referred to an andrology clinic due to an abnormal spermiogram were studied. A testitular examination, spermiogram and determination of FSH, LH, testosterone and prolactin were done to all. Testicular biopsy was done to patients with severe oligospermia or azoospermia. Causes of infertility were defined and classified as pretesticular, testicular, posttesticular or unclassified. Results: Two hundred fifty seven males were studied. In 3.5% of them, the cause of infertility was defined as pretesticular (that included hypothalamic and pituitary endocrine causes), in 66.9% it was classified as testicular, in 15.6% as posttesticular and in 14%, as unclassified. Thirty percent of infertility cases were idiopathic, 17.9% were associated to varicocele, 12.8% were associated to cryptorchidism, 8.9% to Klinefelter syndrome and 6.6% to exposure to toxic substances. In 50% of patients with cryptorchidism, this abnormality was found during the specialized andrological examination and referrals for surgical correction were made late. Two thirds of patients with Klinefelter syndrome were hypoandrogenic. Conclusions: Causes for male infertility should be investigated and diagnosed accurately. Primary hypoandrogenic testicular failures must be treated with hormone replacement therapy <![CDATA[Cambios en los factores de riesgo metabólicos en pacientes obesos en tratamiento]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200009&lng=es&nrm=iso&tlng=es Background: Obesity is a threaten to health due to its association with cardiovascular risk factors. Aim: To assess the change in metabolic risk factors after weight reduction in obese patients. Patients and methods: A retrospective analysis of 277 obese patients (198 female) aged 39.5±12 years old, that completed a six month treatment period, consisting in a calori restricted diet (800-1200 Kcal/day), physical activity, education and group psychological counseling. At the beginning and at the end of the program, weight, waist circumference, resting energy expenditure (REE), serum lipid profile, plasma glucose and plasma insulin levels were measured. Results: During the treatment period, body mass index decreased from 38±7 to 33.2±6.4 kg/m2 with a weight loss of 11.7 kg, waist circumference decreased from 106.6±14.6 to 93.9±13.5 cm, REE decreased from 1774±383 to 1585±267 Kcal/day, blood glucose fell by 5.8%, plasma insulin fell by 40.4%, total cholesterol fell by 7.5%, LDL cholesterol fell by 8.7%, triglycerides fell by 26.6%, and total cholesterol/HDL ratio fell by 12.2%. Conclusions: Weight loss was associated with improvement in metabolic cardiovascular risk factors in obese patients <![CDATA[Síndrome coronario agudo asociado a neumonía por <I>Chlamydia pneumoniae</I>, en dos casos: <I>Report of two cases</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200010&lng=es&nrm=iso&tlng=es Epidemiological and clinical studies attribute to Chlamidia pneumoniae infections a pathogenetic role in atherosclerotic vascular lesions. We report two patients in whom this infection was followed by acute coronary events. A 51 years old male presented with a right lower lobe pneumonia and a positive immunofluorescence serology for Chlamidia pneumoniae, with a IgM titer of 1/64. On the second day of evolution, he experienced an acute myocardial infarction. A coronary arteriography demonstrated a 80% obstruction of anterior coronary artery and an angioplasty was performed. A 84 years old male was admitted with a right lower lobe pneumonia and a positive serology for Chlamidia pneumoniae, with an IgM titer of 1/32. On the fourth day of evolution, he developed unstable angina with electrocardiographic changes. A coronary arteriography demonstrated a three vessel disease. In both cases, a tight chronological association was observed between Chlamidia pneumoniae infection and acute coronary events. <![CDATA[Tumor papilar peritoneal seroso de bajo potencial maligno.: Comunicación de un caso]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200011&lng=es&nrm=iso&tlng=es Papillary serous carcinoma with low malignant potential, similar to those described in the ovary, can also originate in the peritoneum. Characteristically they show peritoneal spread without involvement of the ovary and, if present, it corresponds to a superficial implant similar to those seen in the rest of the peritoneal cavity. Histologically they correspond to a low malignant potential tumor; they are slow growing and have good prognosis. They are common in young women, usually they present few symptoms and are frequently discovered during other surgical procedures. The treatment is surgical and it can be conservative in cases of women who want to preserve their fertility, without coadyuvant therapy. We report a 34 years old woman with a primary peritoneal serous carcinoma with low malignant potential and discuss its management. <![CDATA[Eritrocitosis post trasplante renal y su tratamiento farmacológico: inhibidores de la enzima convertidora de angiotensina versus bloqueadores de los receptores de angiotensina en un caso]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200012&lng=es&nrm=iso&tlng=es A 35 years old male is presented. Eight months after receiving a renal allograft his hypertension worsened and his packed red cell volume raised to 53.7%. Enalapril was started and a 500 ml phlebotomy was performed. In three occasions packed red cell volumes decreased excessively and enalapril was discontinued. Finally, the drug was replaced with losartan, normalizing blood pressure values and stabilizing packed red cell volumes. This case illustrates the different reductions in packed red cell volumes induced by enalapril and losartan. These differences could have a therapeutic relevance. <![CDATA[Importancia del ácido fólico en la medicina actual]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200013&lng=es&nrm=iso&tlng=es Lately, folic acid deficiency is gaining a predominant role in the pathogenesis of congenital malformations and cardiovascular diseases in adults. The planning of individual and population preventive strategies for these diseases must consider this deficiency. This paper reviews the anatomical, biochemical and molecular bases of neural tube defects and cardiovascular diseases in adults. In these two frequent diseases, folic acid supplementation has shown a clear cut protective effect. <![CDATA[Exposición severa a plomo ambiental en una población infantil de Antofagasta, Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200014&lng=es&nrm=iso&tlng=es Background: In Antofagasta, Chile, lead is gathered in bulk in urban zones, contaminating surrounding schools and houses. Aim: To verify if the environmental lead exposure results in high blood lead levels in children living near lead storage sites. Material and methods: Four hundred eighty six children under 7 years old, living near lead storage sites and 75 children living far away form these sites, were studied. An inquiry was applied and venous blood was drawn. Air, soil and water lead concentrations were also measured. Results: Lead geometric mean concentrations in exposed children were 8.7 µg/dL and 4.22 µg/dL in unexposed children. Forty seven percent of exposed children and no unexposed children had lead levels over 10 µg/dL. The distance of dwellings from lead storage sites, their geographic location and their antiquity were significantly associated with high blood lead levels. Multivariate models disclosed that people living in contaminated sites have an odds ratio of 24.9 for high blood lead levels. Conclusions: Environmental lead contamination is significantly associated with high blood lead levels. <![CDATA[Caracterización de la región 5’ no codificante del virus de la hepatitis C]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200015&lng=es&nrm=iso&tlng=es Background: In Antofagasta, Chile, lead is gathered in bulk in urban zones, contaminating surrounding schools and houses. Aim: To verify if the environmental lead exposure results in high blood lead levels in children living near lead storage sites. Material and methods: Four hundred eighty six children under 7 years old, living near lead storage sites and 75 children living far away form these sites, were studied. An inquiry was applied and venous blood was drawn. Air, soil and water lead concentrations were also measured. Results: Lead geometric mean concentrations in exposed children were 8.7 µg/dL and 4.22 µg/dL in unexposed children. Forty seven percent of exposed children and no unexposed children had lead levels over 10 µg/dL. The distance of dwellings from lead storage sites, their geographic location and their antiquity were significantly associated with high blood lead levels. Multivariate models disclosed that people living in contaminated sites have an odds ratio of 24.9 for high blood lead levels. Conclusions: Environmental lead contamination is significantly associated with high blood lead levels. <![CDATA[Bacteriología de la bilis vesicular]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200016&lng=es&nrm=iso&tlng=es Background: In Antofagasta, Chile, lead is gathered in bulk in urban zones, contaminating surrounding schools and houses. Aim: To verify if the environmental lead exposure results in high blood lead levels in children living near lead storage sites. Material and methods: Four hundred eighty six children under 7 years old, living near lead storage sites and 75 children living far away form these sites, were studied. An inquiry was applied and venous blood was drawn. Air, soil and water lead concentrations were also measured. Results: Lead geometric mean concentrations in exposed children were 8.7 µg/dL and 4.22 µg/dL in unexposed children. Forty seven percent of exposed children and no unexposed children had lead levels over 10 µg/dL. The distance of dwellings from lead storage sites, their geographic location and their antiquity were significantly associated with high blood lead levels. Multivariate models disclosed that people living in contaminated sites have an odds ratio of 24.9 for high blood lead levels. Conclusions: Environmental lead contamination is significantly associated with high blood lead levels. <![CDATA[REVISTA DE REVISTAS]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200017&lng=es&nrm=iso&tlng=es Background: In Antofagasta, Chile, lead is gathered in bulk in urban zones, contaminating surrounding schools and houses. Aim: To verify if the environmental lead exposure results in high blood lead levels in children living near lead storage sites. Material and methods: Four hundred eighty six children under 7 years old, living near lead storage sites and 75 children living far away form these sites, were studied. An inquiry was applied and venous blood was drawn. Air, soil and water lead concentrations were also measured. Results: Lead geometric mean concentrations in exposed children were 8.7 µg/dL and 4.22 µg/dL in unexposed children. Forty seven percent of exposed children and no unexposed children had lead levels over 10 µg/dL. The distance of dwellings from lead storage sites, their geographic location and their antiquity were significantly associated with high blood lead levels. Multivariate models disclosed that people living in contaminated sites have an odds ratio of 24.9 for high blood lead levels. Conclusions: Environmental lead contamination is significantly associated with high blood lead levels. <![CDATA[<b>CRONICA</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000000200018&lng=es&nrm=iso&tlng=es Background: In Antofagasta, Chile, lead is gathered in bulk in urban zones, contaminating surrounding schools and houses. Aim: To verify if the environmental lead exposure results in high blood lead levels in children living near lead storage sites. Material and methods: Four hundred eighty six children under 7 years old, living near lead storage sites and 75 children living far away form these sites, were studied. An inquiry was applied and venous blood was drawn. Air, soil and water lead concentrations were also measured. Results: Lead geometric mean concentrations in exposed children were 8.7 µg/dL and 4.22 µg/dL in unexposed children. Forty seven percent of exposed children and no unexposed children had lead levels over 10 µg/dL. The distance of dwellings from lead storage sites, their geographic location and their antiquity were significantly associated with high blood lead levels. Multivariate models disclosed that people living in contaminated sites have an odds ratio of 24.9 for high blood lead levels. Conclusions: Environmental lead contamination is significantly associated with high blood lead levels.