Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720000010&lang=pt vol. 128 num. 10 lang. pt <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<I>Detection of Salmonella enteritidis in samples of poultry products for human consumption in the Chilean Metropolitan Area</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000001&lng=pt&nrm=iso&tlng=pt Background: Salmonella enteritidis (SE) is a frequent cause of diarrhea, and is transmitted mainly by SE contaminated eggs or poultry meat. The frequency of SE contaminated eggs or chicken meat and the risk for acquiring this pathogen is unknown in Chile. Aim: To measure SE contamination in eggs poultry meat and entrails offered in retail markets in the Metropolitan Area during two consecutive years (1998-1999). Material and methods: Samples were placed in sterile bags and transported to the laboratory before 4 hours at 4°C. Microbiologic detection was done using a standard procedure and an immunodetection assay. Results: SE was found in one of 1081 egg samples (0.09%). The contaminated sample was offered in a supermarket under their own commercial name. Six percent of 1154 poultry meat samples were contaminated by SE and 2.3% by other Salmonella serotypes. Entrails had even higher rates with 10.2% of 370 samples harboring SE and 2,7% other serotypes. Total Salmonella sp. isolates and SE isolates declined during 1999. Nine SE phagotypes were identified, predominating types 4 and 7. Conclusions: Eggs and other avian products are contaminated by different SE phagotypes and other Salmonella serotypes, implicating a risk for the consumers (Rev Méd Chile 2000; 128: 1075-83). <![CDATA[<I>Retinal involvement in type 2 diabetics with microalbuminuria</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000002&lng=pt&nrm=iso&tlng=pt Background: In patients with type 2 diabetes, the presence of microalbuminuria, reflecting a widespread vascular damage, can be a marker of nephropathy, retinophaty and cardiovascular diseases. Aim: To study the relationship between microalbuminuria and the frequency, severity and outcome of retinopathy in patients with type 2 diabetes mellitus. Patients and methods: One hundred patients with type 2 diabetes were subjected to a clinical examination, serial monitoring of blood pressure and quarterly measurement of microalbuminuria by RIA. Annually, a fundoscopy, a color photography of the posterior pole and retinal angiofluorescence were performed. Retinophaty was classified as basal (mild to moderate), preproliferative and proliferative. Sixty four normoalbuminuric patients (urinary albumin of less than 30 mg/24 h) were included in group 1 and 36 patients with a urinary albumin over 30 mg/24 h in group 2. Fifty seven patients with normal blood pressure were randomly treated with enalapril or placebo and those with hypertension received enalapril or acebutolol to normalize blood pressure. Results: Sixty one percent of group 1 patients and 41% of group 2 patients has retinopathy (p < 0.05). The retinal lesions were proliferative in 41% of group 2 patients and in 8% of group 1 patient (p < 0.05). Retinopathy was present in 67% of hypertensive patients of group 2 and in 41% of hypertensive patients of group 1. An unfavorable evolution of retinopathy was observed in 22% of group 2 patients and in 5% of group 1 patient (p < 0.05). Conclusions: In type 2 diabetic patients, the presence of microalbuminuria is a prediction of a higher frequency, severity and dismal evolution of diabetic retinopathy (Rev Méd Chile 2000; 128: 1085-92). <![CDATA[<I>Fetal drug addiction as a consequence of maternal cocaine free base abuse during pregnancy</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000003&lng=pt&nrm=iso&tlng=pt Background: Fetal drug addiction is a serious public health problem. In the United States 10 to 15% of children have been exposed "in utero" to cocaine. In a Chilean public health service, more than 200 offspring of cocaine free base abuser have been detected. Aim: To analyze the clinical and social features of 100 children exposed to cocaine free base during fetal development. Patients and methods: Clinical features of children born from cocaine free base consume mothers were described at birth. During subsequent follow up, growth and development, disease episodes, developmental alterations and social situation were recorded. Data was compared with other newborns from the same health service. Results: Compared to their normal counterparts, exposed children has a lower birth weight, the frequency of premature babies was thrice higher, and small-for-gestational age children were four times more common. There was also a higher prevalence of cardiac malformations, seizures and apnea. Hospital admissions were more frequent, prolonged and required more complex facilities. During follow up, undernutrition and stunting were more prevalent. Psychomotor retardation was present in 67% of children and behavioral disturbances in 93%. Most of these children are governmental protection. Conclusions: Strategies to prevent drug abuse during pregnancy and its devastating medical and social consequences should be urgently developed (Rev Méd Chile 2000; 128: 1093-1100) <![CDATA[<I>Use of amphotericin B as lipid emulsions to decrease its toxicity in critical patients</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000004&lng=pt&nrm=iso&tlng=pt Background: Amphotericin B is efficacious for the treatment of systemic candidiasis, however it has potentially serious toxic effects. Administration as lipid emulsions has been advocated to decrease its toxicity. Aim: To compare the safety and tolerance of amphotericin B administered as lipid emulsion or dissolved in dextrose in water. Patients and methods: Forty five patients with confirmed or highly suspected systemic candidiasis were studied. Between January 1996 and June 1997 amphotericin B was administered in dextrose in water to 17 patients (group 1). Between July 1997 and December 1998, the drug was delivered in lipid emulsions (Intralipid, group 2). Clinical and laboratory parameters (serum creatinine, urea nitrogen and potassium), were assessed daily. Results: Both treatment groups were clinically comparable and had the same survival. Accumulative amphotericin B dose administered was 343.2 ± 197 and 414.6 ± 518 mg respectively. Hypokalemia was more frequent in group 2 (52 and 25 % respectively, p < 0.05). There were no differences in the outcome of renal function or other adverse reactions. Conclusions: Administration of amphotericin B as lipid emulsions did not reduce its toxicity in critical patients (Rev Méd Chile 2000; 128: 1101-07) <![CDATA[<I>Situation of Mepraia spinolai, a wild vector for Chagas disease in Chile, compared to others vectors, from the perspective of their alimentary profile</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000005&lng=pt&nrm=iso&tlng=pt Background: Three triatomine species, Triatoma infestans, Mepraia spinolai and Mepraia gajardoi, are vectors for Chagas disease in Chile. Aim: To compare the alimentary profile of Mepraia spinolai, the Chilean wild vector of Chagas disease, with that of the several other triatomines. Material and methods: The alimentary profile of Mepraia spinolai was compared with that of other triatomines using cluster analysis (Q and R techniques) with the Jaccard index. Results: Three basic groups of triatomines were identified: domestic, wild and specialists, such as P. coreodes and C. pilosa. Our wild vector M. spinolai was in an intermediate position between wild and domestic clusters, grouping with T. rubrovaria, T. sordida and P. megistus. The feeding sources, animals of the domestic and peri-domestic habitat and wild animals, corresponded to the clusters of the two groups. Conclusions: Mepraia spinolai, being a preponderantly wild species, approaches human dwellings and obtains food from domestic animals and eventually, from human blood (Rev Méd Chile 2000; 128: 1108-12) <![CDATA[<I>17 OH progesterone measurement in blood in Chilean newborns, as a background to start a Congenital Adrenal Hyperplasia screening program</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000006&lng=pt&nrm=iso&tlng=pt Background: The early diagnosis and therapy of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency can prevent adrenal crises and erroneous gender assignment in affected newborns. To achieve this goal neonatal mass-screening programs have been developed, measuring blood 17 alpha-hydroxyprogesterone (17OHP). In Chile there is no experience with this type of screening. Aim: To develop a method for measuring 17OHP in filter paper blood specimens. To obtain reference ranges and determine neonatal 17OHP threshold levels according to gestational age and birth weight. To analyze factors affecting the cost-efficiency ratio and suggest recommendations for the organization of a neonatal screening program for CAH in Chile. Material and methods: Nine hundred twenty two newborns were studied. 17OHP was measured using double antibody radioimmunoassay in filter paper blood samples obtained 48 h after birth. Reference ranges were determined according to gestational age and birth weight and a cutoff point of 25 ng/ml was established. Results: Seventeen newborns had 17OHP over the cutoff value. They were assessed by a pediatric endocrinologist and in none of them, CAH was confirmed. Therefore the false positive rate of the determination was 1.8%. Among these newborns with elevated 17OHP, 66% had a birth weight below 1.5 kg and 5.8%, a birth weight between 1.5 and 2.5 kg. The cost per reported result was US $ l. Timing of the recall was between the 3 and 10 days of life. No newborn missed the follow-up. Discussion: To increase the cost-efficiency ratio of an eventual neonatal screening program, newborns with birth weights below 1.5 kg should be excluded and cutoff points should be defined according to birth weight (Rev Méd Chile 2000; 128: 1113-18) <![CDATA[<I>Serological assessment of Helicobacter pylori eradication in peptic ulcer patients</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000007&lng=pt&nrm=iso&tlng=pt Background: Measurement of changes in serum antibodies is an excellent predictor of Helicobacter pylori eradication after antibiotic treatment. Aim: To measure the changes in serum antibody titers to Helicobacter pylori, before and after treatment. Material and methods: IgG antibodies to H. pylori were prospectively evaluated in 107 duodenal ulcer patients treated either with antibiotics (amoxicillin, metronidazole and bismuth subsalicylate) plus omeprazole or omeprazole alone. IgG antibody levels were determined using an "in house" ELISA in sera from 49 eradicated patients that received quadruple therapy and 58 non-eradicated patients (12 in whom antibiotic therapy failed and 46 that received omeprazole alone). Endoscopy, urease test, microscopy, and culture of gastric biopsies confirmed H. pylori eradication. Results: Patients in whom H. pylori was eradicated, showed a maintained drop in serum antibody titers that ranged from 15%, 62%, 74% to 76% at 28 days, 4, 8 and 12 months respectively. Such reduction was not observed in patients treated with omeprazole. Patients, in whom quadruple therapy failed to eradicate H. pylori, showed a discrete and transient decrease in antibody titers. By the fourth month, patients in whom eradication with quadruple therapy was not achieved, irrespective of whether they received quadruple therapy or omeprazole alone. Conclusions: A 45% decrease in IgG titer after 4 months is indicative of therapeutic success in H. pylori eradication. Therefore, serology may be useful to monitor the outcome of antibiotic therapy (Rev Méd Chile 2000; 128: 1119-26) <![CDATA[<I>Bone mineral density and uterine size</I>: <I>A practical relationship for climacteric women</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000008&lng=pt&nrm=iso&tlng=pt Background: Double beam bone densitometry allows to select climacteric women who will benefit from hormone replacement. However, it is not always affordable in clinical practice. Aim: To study possible alternative markers of bone mineral density. Patients and methods: A retrospective survey of climacteric women in whom bone mineral density was measured when hormone replacement therapy was started. Eighty one women were studied and in 27, uterine size index was obtained from pelvic ultrasound examinations. Women with and without uterine size index measurements were analyzed separately. Relationships of bone mineral density with age, lapse from menopause, body mass index and uterine size index were sought. Results: There was a significant regression between the lapse in years from menopause and lumbar bone mineral density in the group without uterine size index measurements (r2=0.228, ANOVA p=0.014). There was also a significant regression of lumbar bone mineral density with the uterine size index (r2=0.236, ANOVA p=0.01) in those women in whom this measurement was available. No other variables were associated with bone mineral density. Conclusion: In this group of patients, the lapse after menopause and uterine size index are predictors of lumbar bone mineral density (Rev Méd Chile 2000; 128: 1127-31). <![CDATA[<I>Jejunal diverticulosis as cause of gastrointestinal hemorrhages</I>: <I>Case report</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000009&lng=pt&nrm=iso&tlng=pt Jejunal diverticulosis is a very uncommon acquired disease. Clinical manifestations include acute life threatening complication such as perforation, obstruction and bleeding. Jejunal diverticulosis is an extremely rare site of origin of gastrointestinal bleeding, with fewer than seventy cases reported in the literature. We report a 77-year -old patient with a recurrent severe gastrointestinal bleeding manifested by melena and hematochaezia. During the hospitalization the tagged red blood cell scanning was positive for bleeding in the jejunum. At laparotomy, several large-mouthed diverticula at the proximal jejunum were identified. Approximately 30 centimeters of the involved segment was resected with primary end-to-end anastomosis. Postoperative 7 month evolution has been favorable, without any evidence of rebleeding. This report reviews the literature concerning this disease, discusses some diagnostic methods of studying small bowel bleeding and highlights the need to consider this diagnosis in old patients with a gastrointestinal hemorrhage of unknown origin (Rev Méd Chile 2000; 128: 1133-38). <![CDATA[<I>Fatal lactic acidosis in a patient with acquired immunodeficiency syndrome treated with highly active antiretroviral therapy</I>: <I>Report of one case</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000010&lng=pt&nrm=iso&tlng=pt Type B lactic acidosis occurs without any evidence of cellular hypoxia and is associated with the use of drugs or toxins. We report a 36 years old woman with acquired immunodeficiency syndrome that was admitted to the hospital with a severe lactic acidosis. She had been treated with didanosine, stavudine and efavirenz for four months prior to admission. Despite the use of high bicarbonate doses and vasoactive drugs, the patient had a catastrophic evolution and died in shock and multiple organ failure, 68 hours after admission. (Rev Méd Chile 2000; 128: 1139-43). <![CDATA[<I>Adult mortality in Chile</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000011&lng=pt&nrm=iso&tlng=pt Background: The study of mortality of human groups is important to judge the health conditions of population. Aim: To study the main mortality features among Chilean adults. Material and methods: Information about mortality in Chile from the Instituto nacional de Estadísticas and The World Health Organization, was analyzed. Data was expressed mainly as rates. Results: Annual mortality risk among Chileans is 812 per 100,000 inhabitants and is low compared to the rest of Latin America. In the last 30 years it has decreased systematically at a rate of 1% per year in both genders. The risk of mortality caused by cerebrovascular disease, coronary heart disease, hepatic cirrhosis, gastric cancer and tuberculosis has decreased. On the other hand, the risk of mortality caused by diabetes,hypertension and lung, gallbladder, prostate and colorectal cancer has increased. Mortality varies from 604 per 100,000 in Atacama to 934 per 100,000 in Valparaiso. The most factor that influences thiis variation is population aging. Mean survival at the start of adulthood is 54 years in men and 61 years in women. At 60 years, the expectancy is 19 and 24 years respectively. Mean age of death in Chile was 71,5 years in 1998. Seventy six percent of deaths occurs in the elderly and 33%, in people of 80 years or more. Conclusions: Chile is one of the four Latin American countries with lower mortality risk. In the last 30 years, the main causes of deaths among adults, with exception of pneumonia, have decreased. Therefore health care of the adult is in the correct track (Rev Méd Chile 2000; 128: 1144-49). <![CDATA[<I>Phosphorylation in eukaryotic cells</I>: <I>Role of phosphatases and kinases in biology, pathogenesis and control of intracellular and bloodstream protozoa</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000012&lng=pt&nrm=iso&tlng=pt Cells respond to environmental or cellular changes, rapidly switching protein activities from one state to another. In eukaryotes, a way to achieve these changes is through protein phosphorylation cycles, involving independent protein kinase and protein phosphatase activities. Current evidences show that phosphatases and kinases are also involved in the molecular basis of immune response and in diseases such as diabetes obesity and Alzheimer. In protozoan parasites like Trypanosoma and Leishmania, several kinases and phosphatases have been identified, many of them have been cloned but in several cases their biological role remains undetermined. In this review, the state-of-the art is summarized and the role of phosphatases and kinases in biological phenomena such as remodeling, invasion and pathogenic capacity of protozoan parasites is described. The real chance to use these components of signal transduction pathways as target for chemotherapeutic intervention is also discussed (Rev Méd Chile 2000; 128: 1150-60). <![CDATA[<I>Health reform in Chile and the role of Medical Schools</I>: <I>an attempt of synthesis</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000013&lng=pt&nrm=iso&tlng=pt During the last ten years different institutions from the medical, educational, political and administrative settings have performed studies and made recomendations towards a health reform in Chile. In spite of frequent and sometimes strong ideological differences, most of these studies share the diagnosis of the main deficiencies and shortcomings of our public and private health systems. Furthermore, many of their recommendations are converging towards broad solutions -based on technical reasons- for the insurance systems and for the primary, secondary and tertiary care leveles. This article tries to identify these convergences and describes the vital role of the Medical Schools in their eventual implementation (Rev Méd Chile 2000; 128: 1161-66). <![CDATA[<I>Number of physicians</I>: <I>current and prospective estimate, and an international comparison</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000014&lng=pt&nrm=iso&tlng=pt Background: In the last decades, the number of Universities with medical schools has increased dramatically in our country. Aim: To introduce a conceptual model to estimate the number of physicians that are incorporated to the profession in Chile every year as well as the cumulative number of active physicians in specific time frame. To provide information about the number of available physicians in the country and compare it with the international context. Material and methods: This model includes information about the number of students that are admitted in all medical schools of the country, the dropout rate, the number of immigrant physicians from other countries, and the cumulative number of active physicians in the previous period. Results: There is an increased number of new medical students starting in 1994 that will produce, starting in 2001, a significant increased in the number of new physicians graduated from Chilean Universities. Meanwhile the increased number of new physicians in recent years is mainly explained by a significant increase in immigrant physicians. The number of active physicians estimated by the year 2000 is 18,549 and this number will be 25,704 by the year 2007. With these estimated numbers, we introduce a qualitative model that allowed us to compare the current number of active physicians in Chile with other countries, especially those with a comparable degree of development. This model uses first The Human Development Index and later the per capita income of different countries adjusted by purchasing power in USA. According to these calculations, Chile has a lower number of physicians than similar countries, and this difference will persist, even after the significant increase in the new physicians expected for the new future. Conclusions: Chile continues to have a lower number of physicians than countries with similar human development indices (Rev Méd Chile 2000; 128: 1167-76). <![CDATA[<I>Cox-2 inhibitor in renal function</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872000001000015&lng=pt&nrm=iso&tlng=pt Background: In the last decades, the number of Universities with medical schools has increased dramatically in our country. Aim: To introduce a conceptual model to estimate the number of physicians that are incorporated to the profession in Chile every year as well as the cumulative number of active physicians in specific time frame. To provide information about the number of available physicians in the country and compare it with the international context. Material and methods: This model includes information about the number of students that are admitted in all medical schools of the country, the dropout rate, the number of immigrant physicians from other countries, and the cumulative number of active physicians in the previous period. Results: There is an increased number of new medical students starting in 1994 that will produce, starting in 2001, a significant increased in the number of new physicians graduated from Chilean Universities. Meanwhile the increased number of new physicians in recent years is mainly explained by a significant increase in immigrant physicians. The number of active physicians estimated by the year 2000 is 18,549 and this number will be 25,704 by the year 2007. With these estimated numbers, we introduce a qualitative model that allowed us to compare the current number of active physicians in Chile with other countries, especially those with a comparable degree of development. This model uses first The Human Development Index and later the per capita income of different countries adjusted by purchasing power in USA. According to these calculations, Chile has a lower number of physicians than similar countries, and this difference will persist, even after the significant increase in the new physicians expected for the new future. Conclusions: Chile continues to have a lower number of physicians than countries with similar human development indices (Rev Méd Chile 2000; 128: 1167-76).