Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720010006&lang=es vol. 129 num. 6 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Alimentación, tabaquismo e historia reproductiva como factores de riesgo del cáncer de cuello del útero]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600001&lng=es&nrm=iso&tlng=es Background: Epidemiological studies have suggested that smoking, nutrition and sexual patterns are major risk factors for cervical cancer. Aim: To study the association between food consumption patterns, smoking and sexual behavior and the risk of cervical cancer. Material and methods: A matched case control study of 170 cases and 340 controls. Food and nutrient intakes were assessed by a food frequency questionnaire considering 58 antioxidant rich food items. Median daily intake of vegetables, fruits, antioxidant vitamins and fiber was calculated. A conditional logistic regression model was used to determine odds ratios associated with variations in nutritional intake and no nutritional factors (age at first delivery, parity, body mass index, family history of cancer and smoking). Results: High intakes of vegetables, fruits, beta carotene, vitamin C, E and fiber were associated with a lower risk of cervical cancer (Odds ratios ranging from 0.56 to 0.78). The risk for cancer was inversely associated with the age at first delivery and directly associated with the total number of pregnancies and smoking. Multivariate analysis model showed a protective effect for vegetable and vitamin E consumption (odds ratio of 0.6 with confidence intervals of 0.5 to 0.8 p<0.001) and a higher risk associated to smoking (odds ratio 2.8, confidence intervals 1.5-5.5 p<0.002) and a younger age at the first delivery (odds ratio 3.37 confidence intervals 2-5.3 p<0.001). Conclusions: Cervical cancer is associated with reproductive and food consumption behaviors. A higher intake of vegetables and foods rich in vitamin E can reduce its risk (Rev Méd Chile 2001; 129: 597-603) <![CDATA[La clasificación de lesiones coronarias de la <I>Society for Cardiac Angiography and Interventions</I> predice mejor el éxito de la angioplastia coronaria que la del <I>American College of Cardiology</I>/American Heart Association]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600002&lng=es&nrm=iso&tlng=es Background. The classification of coronary lesion complexity, using the American College of Cardiology/American Heart Association (ACC/AHA) is a predictor of balloon angioplasty success. Stents have improved results even in complex lesions. Aim. To compare the ACC/ AHA and the new Society for Cardiac Angiography (SCAepsilonI) coronary lesion scores as predictors of angioplasty success. Patients and Methods. Alí consecutive angioplasty procedures (n=346, 456 lesions, 47% stents) were prospectively analized from August 1996 to March 1999. Coronary lesions were classified using the ACC/AHA and SCA&I scores. Angiographic success was assesed and its multivariate predictors determined with logistic regression analysis. Results. According to the ACC/AHA score, angiographic success was 97, 92.7, 93.3, and 82.3% in A, Bl, B2 and C lesions respectively (p=0.013). There only were significant differences in success between C and A, Bl or B2 lesions. According to the SCAepsilonI score success was achieved in 97.3, 97.9, 75.8 and 33.3% in nonCP, CP, nonCO and CO lesions respectively (P<0.001). With the SCAepsilonI score statistically significant differences in angiographic success were found for all lesion score comparisons, except between nonCP and CP lesions. No other variables had predictive value for angiographic success. Conclusions. Coronary angioplasty angiographic success is better predicted by the new SCAepsilonl lesion score than with the ACC/AHA lesion clasification in a group of patiens with frequent use of stents. (Rev Méd Chile 2001,129: 605-10) <![CDATA[Perfil de auto-anticuerpos y lactancia materna en pacientes diabéticos tipo 1]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600003&lng=es&nrm=iso&tlng=es Background: Islet cell-specific autoantibodies such as islet cell antibody (ICA), antiinsulin (IAA), anti-glutamic acid decarboxylase (GAD) and anti-tyrosine phosphatase (IA2) can be present in patients with type I diabetes. Breast feeding duration and the early exposure to milk substitutes are environmental factors associated to etiology of type 1 diabetes. Aim To study the frequency of the anti-GAD, anti-IA-2 e ICA antibodies in Chilean type 1 diabetic patients and determine the possible modulator effect of the breast feeding. Patients and methods: One hundred thirty four type I diabetic patients, aged one to 15 years old, were studied at the moment of their diagnosis. Patients were classified according to the duration of exclusive breast feeding. IA-2 and GAD were determined by radio immuno assay and ICA by means of indirect immunofluorescence. Results: Subjects with three months or less and those with more than three months of breast feeding were positive for ICA in 78.8 and 90.6% of cases respectively, for GAD in 75 and 54.6% of cases respectively (p=0.024) and for IA-2 in 73 and 43.8% of cases respectively (p=0.001). All three antibodies were positive in 53.9 and 21.8% of children with less or more than three months of breast feeding (p=0.001). Conclusion: Both IA-2 and GAD antibodies are less frequently positive in type 1 diabetic patients who have been breast fed for more than three months. These findings suggest a possible attenuating role of exclusive breast feeding on pancreatic aggression events in patients with type 1 diabetes (Rev Méd Chile, 2001; 129: 611-9) <![CDATA[Diagnóstico de diarrea por <I>Clostridium difficile</I>: en busca de un enfoque clínico más eficiente]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600004&lng=es&nrm=iso&tlng=es Background: The clinical parameters for the suspicion of Clostridium difficile infections, namely the use of antimicrobials and diarrhea, have a low predictive value for the diagnosis. Aim: To search other clinical variables and determine a clinical prediction model for (Clostridium difficile diarrhea. Patients and methods: All patients to whom a Clostridium difficile study was requested, were prospectively studied during 5 months. Clinical variables of these patients were registered. The diagnosis of Clostridium difficile was done using the cytotoxicity test in fibroblast cultures. Results: Ninety two patients were analyzed and in 26, the diagnosis of Clostridium difficile was confirmed. A logistic regression model disclosed an age over 60 years old, the presence of mucus in the stools and a temperature over 37.8 °C in the previous 24 h, as significant predictors of the infection. The correlation of the model, between the predicted probability and the observed condition, was 81.5%. Conclusions: The presence of the clinical variables identified in this study are associated with a high probability of an infection by Clostridium difficile in patients with diarrhea and the recent use of antimicrobials (Rev Méd Chile 2001; 129: 620-625) <![CDATA[Diagnóstico clínico y psicométrico de la depresión en pacientes de medicina general]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600005&lng=es&nrm=iso&tlng=es Background: The Hamilton scale, applied by an external evaluator and the self rating Beck inventory for depression, can give discrepant results in psychiatric patients with depression. Aim: To compare depression scores obtained with the Hamilton scale and the Beck inventory in general medical patients. Patients and methods: Patients attending an outpatient clinic of a University Hospital were studied. Clinical psychiatric diagnoses were based on DSM-III. Hamilton scale was applied to 100 patients and 80 answered the Beck depression inventory. Results: Patients with major depression obtained the higher scores with both scales. However, Beck inventory had false positive and false negative results. Moreover, some patients overstated their depressive symptoms. Conclusions: self assessment of depression can be distorted by anxiety and somatic symptoms. (Rev Méd Chile 2001; 129: 627-33) <![CDATA[Significado clínico y frecuencia de la alteración genético/molecular 11q23/MLL en lactantes con leucemia aguda en Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600006&lng=es&nrm=iso&tlng=es Background: Acute leukemia (AL) in infants generally shows distinctive biologic features and has a poor prognosis. Aim: To study the frequency of the cytogenetic alteration of11q23 chromosome or the recombination of MLL gene in infants less than 18 months old, with acute leukemia. Patients and methods: We analyzed 37 cases of AL in infants less than 18 months of age diagnosed in Chile from 1989 to 1999. The clinical features and cytogenetic/molecular defects of 11q23MLL gene rearrangement and their influence in prognosis were determined. Results: There were 18 cases of acute Lymphoblastic leukemia (ALL) characterized by female sex (67%) high presenting leukocyte count (median 99 x109/L), blast cells with a CD10 negative phenotype (50%) and 11q23/MLL rearrangement (39%). Molecular abnormalities of 11q23 were significantly associated with adverse prognosis, with an event free survival (EFS) of only 14 ± 12%. Interestingly, infants with germ line 11q23 had a very good outcome with an EFS of 73 ± 11% (p<0.025). There were 19 cases of acute myeloblastic leukemia (AML) characterized by male sex (63%) high leukocyte count (median 93 x 109/L), FAB-MS morphology (53%) and 11q23/MLL rearrangement (53%). EFS was very poor, 20 ± 9% and 33±4% for rearranged and germinal group respectively (p=NS), due to a high mortality rate during the first month of diagnosis. Conclusions: These findings demonstrate that Chilean ALL infants with 11q23 abnormalities have a very poor prognosis. However those with germinal state can enjoy a prolonged disease free survival with the current treatment protocols (Rev Méd Chile2001; 129: 634-642) <![CDATA[Susceptibilidad in vitro de cepas de <I>Helicobacter pylori</I>: aislamiento de cepas resistentes a claritromicina]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600007&lng=es&nrm=iso&tlng=es Background: Our laboratory has carried out an epidemiological surveillance of Helicobacter pylori antimicrobial susceptibility since 1997. Aim: To report the antimicrobial susceptibility of H pylori strains, isolated in Chile from August 1997 to August 2000. Material and methods: Ninety one H pylori strains, obtained from antral gastric biopsies during upper gastrointestinal endoscopies were studied. Susceptibility towards clarithromycin, amoxicillin, bismuth subcitrate and metronidazole was studied by an agar diffusion technique. Results: All strains were susceptible to amoxicillin and two strains were resistant to clarithromycin. Forty two percent of strains were resistant to metronidazole and 13% were resistant to bismuth subcitrate. Conclusions: These results underscore the need to maintain an epidemiological surveillance of H pylori antimicrobial susceptibility, to modify its eradication therapy accordingly. (Rev Méd Chile 2000; 129; 643-6 <![CDATA[Automedicación en individuos de la Región de la Araucanía con problemas musculoesqueléticos]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600008&lng=es&nrm=iso&tlng=es Background Self-medication is a common behavior in the general population, specially among those suffering from chronic pain. Aim: To study the prevalence and characteristics of self medication. Subjects and Methods: Aiming to know the prevalence and features of self medication, a structured interview was applied to 272 out of 419 individuals from the general population, that reported musculoskeletal symptoms. Results: Sixty five percent of those interviewed recognised self medication. No gender differences were observed and there was a trend towards a higher frequency of self medication among older individuals. The frequency of self-medication was higher in low socioeconomic groups, subjects with long lasting pain, those with more severe pain and among subjects with a previous prescription. The drugs more frequently used were dipyrone, piroxicam and aspirin. The average daily piroxicam dose reported was 27 mg. Self medication was not associated with the labor condition of the subjects or the time of occurrence of symptoms. Conclusions: Self medication is a frequent behavior, particularly among low socio-economic groups and those with long lasting and more severe pain (Rev Méd Chile 2001; 129: 647-52 <![CDATA[Características de la hospitalización reumatológica en un hospital de nivel terciario]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600009&lng=es&nrm=iso&tlng=es Background: The diagnostic profile of patients with rheumatic diseases admitted to a general hospital is variable. Aim: To report the epidemiological profile of patients with rheumatic diseases admitted to a tertiary care hospital. Material and methods: All admissions to a Medicine ward of a general hospital and seen by the Rheumatology team were prospectively registered during one year in 1999. Patients were classified as primarily admitted for a rheumatic disease or admitted for other cause that required a consultation with the Rheumatology team. Results: One hundred forty five admissions due to rheumatic diseases were registered. Of these, 82 were due to primary rheumatic diseases. Systemic lupus erythematosus, rheumatoid arthritis and vasculitis were the main diagnoses and the mean hospital stay was 18.5 days. Sixty three patients required a consultation with the Rheumatology team specially due to osteoarthritis and crystal induced diseases. Conclusions: Admissions due to rheumatic diseases are prolonged, correspond to 0.46% of all admissions and the main responsible disease is systemic lupus erythematosus (Rev Méd Chile 2001; 129: 653-9) <![CDATA[Intoxicación aguda por hierro en un caso]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600010&lng=es&nrm=iso&tlng=es The ingestion of iron-containing products is a potential toxicological emergency. It is a leading cause of pediatric unintentional ingestion fatalities because some iron-containing compounds are readily available (vitamin mixtures, iron pills). Among adults, it has been described as accidental overdoses (mainly in pregnancy) and as suicidal attempts. We report a 42 years old woman, admitted due to the intentional ingestion of iron pills with suicidal purposes. A plain abdominal X ray showed at least 20 pills in the gastric fundus and antrum. She was successfully treated with intravenous desferroxamine chelation. Plain abdominal X ray examination can be very useful in the diagnosis of acute iron poisoning (Rev Méd Chile 2001; 129: 660-2) <![CDATA[Carcinoma mamario en tejido mamario ectópico: Caso clínico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600011&lng=es&nrm=iso&tlng=es Ectopic breast tissue, that includes supernumerary breasts and aberrant breast tissue, develops along the mammary line. Malignancies rarely develop in this tissue. We report a 44 years old female subjected to a resection of a 3 cm Ø tumor located 2 cm below the right lower mammary sulcus. The pathological study reported an infiltrating ductal carcinoma. The patient was operated again and a metastatic carcinoma was detected in three resected axillary lymph nodes. Adjuvant chemotherapy and radiotherapy was indicated (Rev Méd Chile 2001; 129: 663-5) <![CDATA[Gota familiar y nefropatía en una mujer joven: Caso clínico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600012&lng=es&nrm=iso&tlng=es We report a 29 years old woman with a chronic tophaceous gout, whose disease started at the age of 18. On clinical examination, the blood pressure was elevated. The laboratory assessment showed a serum uric acid of 15 mg/dl, a urinary uric acid of 155 mg/24 h, a creatinine clearance of 59 ml/min/1.73 m² and a uric acid excretion fraction off 1.3% (normal 7 to 12%). The clinical and laboratory features of this patient suggest the diagnosis of a familial juvenile gouty nephropathy (Rev Méd Chile 2001, 129: 666-670) <![CDATA[Glucotoxicidad y lipotoxicidad: factores en la patogénesis y evolución de la diabetes tipo 2]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600013&lng=es&nrm=iso&tlng=es Glucose toxicity refers to the structural and functional damage in the beta cells and target tissues of insulin, caused by chronic hyperglycemia. These alterations cause a lower hormonal secretion and action (insulin resistance). Lipid toxicity refers to the damage caused by persistently high free fatty acid levels, as a consequence of triacylglycerol catabolism. Since elevated glucose and lipid levels cause a similar damage and interact, the term glucose and lipid toxicity refers to their additive effects. This toxicity can be implicated in the pathogenesis of type II diabetes and in the secondary failure of oral hypoglycemic drugs, leading to the requirement of insulin treatment. Insulin resistance with normal glucose levels, glucose intolerance and clinical diabetes are the three recognized stages in the development of type 2 diabetes. Considering that the first two stages are reversible, a good metabolic control to avoid glucose and lipid toxicity could revert or avoid the development of clinical diabetes (Rev Méd Chile 2001; 129: 671-9) <![CDATA[Aspectos éticos de la investigación biomédica: Conceptos frecuentes en las normas escritas]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600014&lng=es&nrm=iso&tlng=es Most codes and declarations pertaining to the ethics of research involving human subjects have been formulated in response to specific events mostly of a painful or embarrasing nature. Several concepts appearing repeatedly in their texts are highlighted in this paper: principles of respect for persons, beneficence and justice, vulnerability and research propriety. Along with some comments on current revisions of many international guidelines and the role of bioethics committees, a plea is made to have a proactive rather than a reactive stance in ethical regulation of biomedical research (Rev Méd Chile 2001; 129: 680-4 <![CDATA["A Milena" (Un ensayo de Medicina Narrativa)]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600015&lng=es&nrm=iso&tlng=es Narrative medicine is becoming an increasingly popular way of communicating medical problems. This a letter that the author sends to a recently deceased patient. He describes his apprehensions on the use of invasive forms of diagnosis or treatments and the use of repeated hospital admissions in the context of a chronic and progressive disease. He also discusses the use of methods to "accelerate" death in suffering patients. He finally describes the dignity of his patient to face a chronic and debilitating condition (Rev Méd Chile 2001; 129: 685-7) <![CDATA[Potencia de músculos inspiratorios en insuficiencia cardíaca y en enfermedad pulmonar obstructiva crónica]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600016&lng=es&nrm=iso&tlng=es Narrative medicine is becoming an increasingly popular way of communicating medical problems. This a letter that the author sends to a recently deceased patient. He describes his apprehensions on the use of invasive forms of diagnosis or treatments and the use of repeated hospital admissions in the context of a chronic and progressive disease. He also discusses the use of methods to "accelerate" death in suffering patients. He finally describes the dignity of his patient to face a chronic and debilitating condition (Rev Méd Chile 2001; 129: 685-7) <![CDATA[Efectos adversos del ácido 3,5,3´ Triyodotiroacético en el tratamiento de la obesidad]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600017&lng=es&nrm=iso&tlng=es Narrative medicine is becoming an increasingly popular way of communicating medical problems. This a letter that the author sends to a recently deceased patient. He describes his apprehensions on the use of invasive forms of diagnosis or treatments and the use of repeated hospital admissions in the context of a chronic and progressive disease. He also discusses the use of methods to "accelerate" death in suffering patients. He finally describes the dignity of his patient to face a chronic and debilitating condition (Rev Méd Chile 2001; 129: 685-7) <![CDATA[La Revista Médica de Chile en el sitio WEB www.scielo.cl]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600018&lng=es&nrm=iso&tlng=es Narrative medicine is becoming an increasingly popular way of communicating medical problems. This a letter that the author sends to a recently deceased patient. He describes his apprehensions on the use of invasive forms of diagnosis or treatments and the use of repeated hospital admissions in the context of a chronic and progressive disease. He also discusses the use of methods to "accelerate" death in suffering patients. He finally describes the dignity of his patient to face a chronic and debilitating condition (Rev Méd Chile 2001; 129: 685-7) https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600019&lng=es&nrm=iso&tlng=es https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000600020&lng=es&nrm=iso&tlng=es