Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720020004&lang=pt vol. 130 num. 4 lang. pt <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<I>Changes in the epidemiology of infectious diseases in Chile</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400001&lng=pt&nrm=iso&tlng=pt In the last decade in Chile, there was a large reduction in the rate of communicable diseases, especially typhoid fever, and those preventable through the universal vaccination programs. Exceptions were hepatitis A and Pertussis. The reduction in tuberculosis, has lead the country to a threshold in which the elimination of tuberculosis as a public health problem is reachable. The HIV epidemic is still expanding, at higher rate among women and heterosexual men, keeping drug addiction as a low ranked risk factor. At the end of the century, universal or expanded access to HIV therapy was still not a reality. Cholera was a well controlled emerging infection, but Hantavirus infection has become a major threat in many regions. Syphilis and especially gonorrhea have decreased, but condyloma has increased dramatically. The nosocomial infection scenario has changed somehow, due to more severely ice and complex patients admitted to hospitals. Multiresistant nosocomial pathogens continue expanding (S aureus, fermentor and non fermentor gram negative rods, especially A baumannii). The country has been able to expand control programs to almost all hospitals. Antimicrobial resistance has continued growing. The massive and indiscriminate use of antibiotics, largely responsible for the resistance, grew worse until the sale of antimicrobials in pharmacies was restricted by law. This had a major impact, with important reduction in sales of most, but not all, antibiotics. The impact in resistance rate of this reduction, if any, has yet to be assessed (Rev Méd Chile 2002; 130: 353- 362 <![CDATA[<B><I>Immunophenotyping by flow cytometry of peripheral blood lymphocytes from Chilean chronic chagasic patients</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400002&lng=pt&nrm=iso&tlng=pt Background: Cellular immune mechanisms of the resistance to infection by T cruzi as well as the pathogenesis of Chagas disease are still controversial. Aim: To quantify and analyse the peripheral blood immune cells from chagasic and non chagasic patients by flow cytometry. Patients and methods: Peripheral blood samples were taken from 21 individuals seropositive for Chagas disease, under no specific treatment. Control samples from 21 healthy blood donors were also obtained. To quantify immune cells populations by flow cytometry, antibodies against CD3, CD4, CD8, CD16/56, CD45/14, CD19 and HLA-DR markers were used. Results: The percentage of CD8+ cells was low and the CD4+/CD8+ ratio was high in chagasic patients, compared to their non infected counterparts. No statistically significant differences in the number of CD4+, NK, B, CD4+HLADR+ and CD8+HLADR+ cells, were observed within the two groups. Conclusions: These results show that Chilean chronic chagasic patients have lower percentage of CD8+ cells and higher CD4+/CD8+ ratio than non infected individuals (Rev Méd Chile 2002; 130: 363-367 <![CDATA[<I>Reduction of acute myocardial infarction mortality in Chilean hospitals</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400003&lng=pt&nrm=iso&tlng=pt Background: The characteristics of patients with acute myocardial infarction (MI) admitted to 37 Chilean hospitals (GEMI Registry Group), have been analyzed in the periods 1993-1995 and 1997-1998. Aim: To report the changes in hospital mortality between these 2 periods, with a particular emphasis on the impact of treatment. Patients and methods: Between 1993-1995 we collected information from 2,957 patients and between 1997-1998 we registered 1,981 patients with MI. Analysis of the changes in mortality between periods was adjusted by demographic variables, coronary risk factors, MI location, Killip class on admission and the different therapeutic strategies utilized. The effects of different treatments on hospital mortality were adjusted by the previously determined mortality risk variables. Results: Hospital mortality decreased from 13.3% to 10.8% between both periods (Odds Ratio (OR) 0.78, confidence intervals (95%) (CI) 0.65-0.93). A significant reduction in mortality was observed among patients below 60 years of age, in men, in diabetics and in subjects with an infarction classified as Killip class over II. The use of beta blockers (OR 0.65, CI 0.42-0.99) and intravenous nitrates (OR 0.78, CI 0.61-0.99) and the lower use of calcium channel blockers (OR 0.72, CI 0.60-0.87) were significantly associated with a lower mortality. The administration of angiotensin converting enzyme inhibitors was associated with a 29.3% mortality reduction (OR 0.69, CI 0.47-1.02). Conclusions: There has been a significant reduction in the mortality rate for MI in Chilean hospitals during the 2 registry periods analyzed, which was significant among some high risk patients and was related to treatment changes, according to evidence based guidelines (Rev Méd Chile 2002; 130: 368-378) <![CDATA[Mortality and morbidity of treated essential arterial hypertension. A 26 years follow up]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400004&lng=pt&nrm=iso&tlng=pt Background: Treatment has a definitive impact on mortality in hypertension. The magnitude of blood pressure reduction, the type of drug used and the associated risk factors may modulate the effect of treatment on mortality. Aim: To report the effects of treatment of essential hypertension, in a cohort followed for up to 26 years. Patients and methods: A cohort of 1,172 essential hypertensive patients followed up to 26 years. Patients were treated with different antihypertensive drugs, alone or in combination (diuretics, beta blockers, calcium channel blockers and angiotensin converting enzyme inhibitors) according to international rules and consensus. Subjects were followed until death or loss from follow-up. Blood pressure reduction was aimed to obtain figures near 140/ 90 mm Hg. Causes of death and complications were obtained from hospital records, phone and death certificates. Survival was studied using life tables (Kaplan Meier method and intention to treat analysis) and Cox proportional hazard analysis. Results: Initial blood pressure dropped significantly from 181/109 to 154/92 mm Hg, p <0.001. Mean follow-up time was 10.6±6.1 years. There were 143 cardiovascular deaths, 142 acute myocardial infarctions, 101 strokes, 83 subjects had cardiac failure and 49 had renal failure. The observed rates were 0.92% per year for cardiovascular mortality, 1.36% per year for coronary heart disease, 0.94% per year for stroke. Conclusions: Our mortality rate is lower than that found in classical randomized studies but similar or slightly higher than the more recent ones. Morbidity rates were also very similar. Except for mortality rate, frequency of complications did not change in comparison to our previous report after 15 year of follow up. Aging did not seem to negatively influence mortality rates in adequately treated hypertensive patients (Rev Méd Chile 2002; 130: 379-38 ) <![CDATA[<I>Morphological prognostic factors in gallbladder cancer</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400005&lng=pt&nrm=iso&tlng=pt Background: The exact survival rates and prognostic factors of gallbladder cancer are still incompletely known. Aim: To report the actuarial survival of patients with gallbladder cancer. Material and methods: Six hundred thirty seven women, aged 59 years old as a mean and 108 men, aged 64 years old as a mean, with gallbladder cancer are reported. Patients were followed for up to 150 months. Results: Two hundred twenty four patients had an early and 521 had an advanced carcinoma. Overall survival was 38% at ten years. Sex or ethnic origin did not influence survival. Early tumors had a 92% survival at 10 years whereas the survival of advanced tumors was 16% at 5 years. Subserous tumors had a 5 years survival of 32% whereas serous tumors had a 5 years survival of 11%. Well-differentiated advanced tumors had a significantly better survival than moderately or poorly differentiated tumors. Vascular or lymphatic infiltration was also associated to a lower survival. All patients with advanced tumors and vascular infiltration died before 5 years. Conclusions: Tumor infiltration and differentiation degree were the most important prognostic independent factors in gallbladder cancer (Rev Méd Chile 2002; 130: 387-395) <![CDATA[<I>Acanthamoeba keratitis treated with propamidine and polyhexamethyl biguanide</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400006&lng=pt&nrm=iso&tlng=pt Background: The diagnosis of acanthamoeba keratitis has increased since 1985 due to the massive use of contact lenses and a better knowledge of the disease by ophthalmologists. The use of biassociated therapy has resulted in a better prognosis and lower complication rate. Aim: To report patients with acanthamoeba keratitis treated with the association of propamidine (Brolene(r)) and polyhexamethylbiguanide (PHMB) 0.02%. Patients and methods: Retrospective analysis of 27 patients (31 eyes) with acanthamoeba keratitis (bilateral in four cases), diagnosed by culture, biopsy or characteristic clinical features. Results: Ninety six percent of patients used rigid contact lenses. Acanthamoeba cultures were positive in 71% of cases. The delay in the diagnosis was between 1 and 5 months. Early treatment was possible in 29% of patients. Infection was erradicated in all cases with the biassociated therapy. A tectonic keratoplasty to treat a trophic perforation was done in eight eyes. No patient required therapeutic keratoplasty to resolve the infection. Visual acuity at the end of follow up was better than 20/40 in nine patients and in eight it was in the range of count fingers or less. Conclusions: In patients with the clinical picture of acanthamoeba keratitis, early or late antiamoebic treatment is warranted even in the absence of positive cultures. The visual results of the treatment are highly dependent on the precocity of treatment. Prevention is imperative and is based on a strict contact lens hygiene (Rev Méd Chile 2002; 130: 396-401) <![CDATA[<I>Periodontal disease in Chilean diabetic patients</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400007&lng=pt&nrm=iso&tlng=pt Background: The prevalence of periodontal diseases, gingivitis and periodontitis, is higher in diabetic patients and can have severe functional and esthetic consequences early in their lives. Aim: To evaluate the prevalence of periodontal disease in type 1 diabetics, aged between 18 and 30 years old, living in Santiago de Chile. Subjects and methods: One hundred male and female type 1 diabetics were examined. Glycated hemoglobin A1c, microalbuminuria, and fundoscopy were assessed in a sample of 52 subjects, separated in two groups according to the presence of periodontal disease. Results: The prevalence of gingivitis was 22%, periodontitis 41%. Only 37% of subjects were free of periodontal disease. When compared with patients without periodontal disease, in the group of patients with the disease there was a higher proportion of subjects with diabetes lasting more than 10 years (28 and 55% respectively) and a higher proportion of patients with chronic complications of diabetes (42 and 58% respectively). Conclusions: A high prevalence of periodontal diseases was observed in this sample of diabetic patients. A long history of diabetes and the presence of chronic complications were risk factors for these diseases in the analyzed sample (Rev Méd Chile 2002; 130: 402-408) <![CDATA[<I>Chemical stability of acetylsalicylic acid tablets during storage in pharmacies of Concepción, Chile</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400008&lng=pt&nrm=iso&tlng=pt Background: The chemical stability of a pharmaceutical product depends, among other factors, on environmental factors during transport, storage and manipulation of the product. Aim: To study the chemical stability of acetylsalicylic acid (AAS) tablets during ten months of storage in five pharmacies of Concepción, Chile. Material and methods: Tablets were randomly collected at the beginning of the study and at the third, sixth and tenth month. Quantitative analyses of AAS tablets was carried out by instrumental thin layer chromatography (HPTLC). Results: AAS in tablets was between 99 and 109% at the beginning of the study, between 76 and 110% at three months, between 71% and 112% at six months and between 86 and 110% at ten months of storage. Conclusions: There was a progressive decrease in the content of acetylsalicylic acid in tables during storage, but it remained between the limits accepted by the United States Pharmacopoeia (USP) (90-110%) (Rev Méd Chile 2002; 130: 409-415) <![CDATA[<I>Identification and antifungal susceptibility of Candida spp isolated from invasive mycoses. Influence of growth inhibition percentage to determine minimal inhibitory concentration </I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400009&lng=pt&nrm=iso&tlng=pt Background: An increase in the frequency of resistant strains to antifungal drugs has been detected in the last decade. Aim: To report the minimal inhibitory concentration (MIC) to amphotericin B, fluconazole, ketoconazole and itraconazole. To compare the MIC obtained with 80% and 50% of growth inhibition to the azoles. Material and methods: Fifty yeast strains isolated between 1998 and 1999, from 17 adults and 33 children with invasive mycosis were studied. Susceptibility was determined by broth microdilution method with RPMI 1640 plus glucose 2% according to the National Committee for Clinical Laboratory Standards (1997). Results: The most frequently isolated strains were C albicans in 27 cases and C parapsilosis in 12. All isolates were susceptible to amphotericin B. According to the MICs obtained with 80% of inhibition, 12 strains had MICs considered as resistant to azoles. Five strains were resistant both to fluconazole and itraconazole. Considering MICs obtained with 50% of inhibition, only five strains were found resistant to azoles (p <0.05). Using this criterion, only one C glabrata strain was found to be simultaneously resistant to fluconazole and itraconazole. Conclusions: Similar results in the pattern of susceptibility of Candida spp to azoles, to those reported abroad, are obtained when the MIC is calculated using 50% inhibition (Rev Méd Chile 2002; 130: 416-423) <![CDATA[<I>Immunocytochemical localization of estrogen and progesterone receptors and corticoid binding globulin in a woman with idiopathic endometrial decidual reaction</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400010&lng=pt&nrm=iso&tlng=pt Endometrial decidual reaction in postmenopausal women without an evident exogenous or endogenous progesterone stimulus, is uncommon. The morphological findings are decidual transformation of the endometrial stroma, necrosis, cellular pleomorphism and in some cases hyperplastic glands that exhibit focal atypia raising the possibility of malignancy. We report the case of a 55 years old woman with an idiopathic endometrial decidual reaction. In this woman, immunocytochemistry of endometrial tissue demonstrated the absence of cytoplasmatic and nuclear estrogen receptors. Staining of nuclear progesterone receptors and cytoplasmatic corticoid binding globulin, exceeded the immunoreactivity observed in any period of the menstrual cycle (Rev Méd Chile 2002; 130: 425-429) <![CDATA[<I>Irreversible acute heart failure caused by cardiac hemochromatosis secondary to multiple transfusions</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400011&lng=pt&nrm=iso&tlng=pt We report a 64 years old male, admitted for dyspnea and edema of two weeks duration. A sideroblastic anemia, requiring multiple transfusions, was diagnosed four years earlier. The chest X-ray showed an enlarged heart and right pleural effusion. A low left ejection fraction was evidenced by echocardiogram. Doppler analysis of the mitral flow revealed a restrictive hemodynamic pattern. A diagnosis of secondary cardiac hemochromatosis deposit was made. Nine days after admission the patient died due to heart failure. The clinical presentation of cardiac hemochromatosis as a sudden and irreversible heart failure, as well as the importance of early diagnosis and surveillance of high-risk patients is emphasized (Rev Méd Chile 2002; 130: 430-432) <![CDATA[<I>Spontaneous hemoperitoneum caused by intraabdominal variceal rupture. Report of one case</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400012&lng=pt&nrm=iso&tlng=pt Spontaneous hemoperitoneum secondary to intraabdominal variceal rupture, is an uncommon and highly lethal complication of cirrhosis. We report a case of a 68 years old male submitted because of abdominal pain and fainting. The clinical and laboratory work up concluded that the patient had cirrhosis and hemoperitoneum. He was operated on and the exploration showed a massive hemoperitoneum caused by bleeding gastro-splenic varices. The patient died in the immediate postoperative period (Rev Méd Chile 2002; 130: 433-436) <![CDATA[<I>Improvement of medical student's academic performances in times of curricular reform</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400013&lng=pt&nrm=iso&tlng=pt Background: During the last decade, academic life at the medical school of the Pontificia Universidad Católica de Chile has been thoroughly affected by a curricular reform process. Changes started in 1993 and have continued up until now. This reform did not have an experimental design to allow for a scientific evaluation of its effects. However, it seems interesting to study the evolution of indices of academic performance of our students during this period. Aim: To evaluate the academic performance of medical students between 1989 and 1999. Subjects and Methods: All undergraduate students enrolled between 1989 and 1999. Academic performance was evaluated by 1) failure to pass one or more courses, 2) delay to complete the third year of studies, 3) withdrawal from school and 4) medical school grades. Results: All indices of academic performance changed during the period of study. Failure to pass, delay and withdrawal from school significantly decreased, whereas medical school grades improved, particularly in basic and pre-clinical subjects. Conclusions: Academic performance of medical students improved consistently between 1989 and 1999. While specific causal relationships cannot be established, we believe that this improvement is likely related to the curricular reform. This reform included horizontal and vertical integration of academic contents, greater emphasis in problem-based learning and additional instances of evaluation such as the repetition exam (Rev Méd Chile 2002; 130: 437-445) <![CDATA[<I>Cost-effectiveness analysis of a screening program for gallbladder disease in Chile</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400014&lng=pt&nrm=iso&tlng=pt Background. Chilean women have one of the highest mortality rates from gallstone disease in the world. There is no primary prevention for the disease and the benefits of prophylactic cholecystectomy in high risk groups have not been studied. Aim: To analyze the cost and effectiveness of a screening program for gallbladder disease in the Chilean women population. Methods. A decision analytic model is used to compare lifetime cost and effectiveness of standard care with three screening strategies. The first two strategies consider "universal ultrasound screening" for all women 40 years old and laparoscopic cholecystectomy for those with gallstones ("elective intervention") or with calculous ≥3 cm ("high risk intervention"). The third strategy is based on "selective screening" for obese women. Results. The lifetime probability of a 40 years old Chilean woman of dying from gallbladder disease is reduced by 70% in the universal screening/elective intervention, by 63% in the high risk intervention and by 18% in the selective screening strategy. Her lifetime expectancy increases by 5.25, 4.64 and 1.24 months respectively. The incremental cost-effectiveness ratio of each screening strategy is US$ 180, US$ 147 and US$ 481 respectively. Conclusion. A screening program for gallbladder disease in a high risk population achieves significant benefits at a low incremental cost and acceptable cost-effectiveness <![CDATA[<I>Chronic myeloid leukemia with chromosome 8 trisomy and negative ABL/BCR translocation</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400015&lng=pt&nrm=iso&tlng=pt Background. Chilean women have one of the highest mortality rates from gallstone disease in the world. There is no primary prevention for the disease and the benefits of prophylactic cholecystectomy in high risk groups have not been studied. Aim: To analyze the cost and effectiveness of a screening program for gallbladder disease in the Chilean women population. Methods. A decision analytic model is used to compare lifetime cost and effectiveness of standard care with three screening strategies. The first two strategies consider "universal ultrasound screening" for all women 40 years old and laparoscopic cholecystectomy for those with gallstones ("elective intervention") or with calculous ≥3 cm ("high risk intervention"). The third strategy is based on "selective screening" for obese women. Results. The lifetime probability of a 40 years old Chilean woman of dying from gallbladder disease is reduced by 70% in the universal screening/elective intervention, by 63% in the high risk intervention and by 18% in the selective screening strategy. Her lifetime expectancy increases by 5.25, 4.64 and 1.24 months respectively. The incremental cost-effectiveness ratio of each screening strategy is US$ 180, US$ 147 and US$ 481 respectively. Conclusion. A screening program for gallbladder disease in a high risk population achieves significant benefits at a low incremental cost and acceptable cost-effectiveness <![CDATA[<I>Assessment of clinical competence: a need in medical education</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400016&lng=pt&nrm=iso&tlng=pt Background. Chilean women have one of the highest mortality rates from gallstone disease in the world. There is no primary prevention for the disease and the benefits of prophylactic cholecystectomy in high risk groups have not been studied. Aim: To analyze the cost and effectiveness of a screening program for gallbladder disease in the Chilean women population. Methods. A decision analytic model is used to compare lifetime cost and effectiveness of standard care with three screening strategies. The first two strategies consider "universal ultrasound screening" for all women 40 years old and laparoscopic cholecystectomy for those with gallstones ("elective intervention") or with calculous ≥3 cm ("high risk intervention"). The third strategy is based on "selective screening" for obese women. Results. The lifetime probability of a 40 years old Chilean woman of dying from gallbladder disease is reduced by 70% in the universal screening/elective intervention, by 63% in the high risk intervention and by 18% in the selective screening strategy. Her lifetime expectancy increases by 5.25, 4.64 and 1.24 months respectively. The incremental cost-effectiveness ratio of each screening strategy is US$ 180, US$ 147 and US$ 481 respectively. Conclusion. A screening program for gallbladder disease in a high risk population achieves significant benefits at a low incremental cost and acceptable cost-effectiveness https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000400017&lng=pt&nrm=iso&tlng=pt