Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720020006&lang=es vol. 130 num. 6 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Evaluación de técnicas moleculares e inmunoenzimáticas para la detección de E coli enterohemorrágico en brotes de toxi-infecciones alimentarias]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600001&lng=es&nrm=iso&tlng=es Background: Enterohemorrhagic Escherichia coli (EHEC), is an emergent pathogen that causes sporadic infections and outbreaks of gastroenteritis associated with consumption of contaminated food products. Because detection of EHEC in diarrhea patients is not routinely performed, infection is most probably underestimated. Aim: To compare three techniques to detect EHEC: Colony hybridization with DNA probes, polymerase chain reaction (PCR) for the detection of stx1 and stx2 genes and immunoenzymatic detection by ELISA (Premier EHEC) of Stx1 and Stx2 toxins. Material and methods: Four outbreaks of food-borne gastroenteritis were studied including 16 patients and 78 strains of E coli. Twenty one (26,9%) strains, hybridized with the stx1 probe, 1 (1,3%) hybridized only with the stx2 probe and 36 (46,1%) with both probes. PCR amplification for cytotoxin genes was observed in 6 strains (7,7%) from the second outbreak studied. The immunoenzimatic assay detected the cytotoxins in 18 (23,0%), of the 78 studied strains. Agreement between probes and ELISA was 44,8%, between PCR and probes 34,7% and 82,4% between ELISA and PCR. Conclusions: These results indicate a variable yield among different EHEC detection techniques. Considering PCR as the gold standard, ELISA technique showed a better sensitivity and specificity than probes (Rev Méd Chile 2002; 130: 603-9) <![CDATA[Epidemiología de la hipertensión en hemodiálisis crónica]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600002&lng=es&nrm=iso&tlng=es Background: Hypertension is a common and important cardiovascular risk factor in patients on chronic hemodialysis. Aim: To report the prevalence and characteristics of hypertension among patients on chronic hemodialysis. Patients and methods: Cross sectional study of 313 patients (192 male, aged 57 ± 18 years) dialyzed in 7 representative centers in Santiago, Chile. Results: Patients were on hemodialysis for a mean of 68 ± 53 months and 67 (21%) were diabetic. 230 (74%) were hypertensive and 223 of these (97%) had predialysis hypertension. A multivariate analysis showed that hypertension was associated with increased weight gain between dialysis, failure to achieve the postdialysis dry weight, increasing age and the presence of diabetes. Among hypertensive patients, 61% were receiving antihypertensive medications, compared with 27% of patients with normal blood pressure. Conclusions: High blood pressure is highly prevalent among patients on chronic hemodialysis and is associated to hypervolemia, age and the presence of diabetes (Rev Méd Chile 2002; 130: 610-5) <![CDATA[Perfil del hipertenso adulto mayor tratado]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600003&lng=es&nrm=iso&tlng=es Background: There is concern about the consequences that hypertension has on the well being and mortality of elderly people. Aim: To compare the morbidity and mortality of young and old treated hypertensive subjects. Material and methods: Retrospective analysis of hypertensive subjects treated and followed for a period of 10 ± 9 years. Subjects that started treatment at an age of less than 65 years and those that started treatment after 65 years of age, were analyzed separately. The antihypertensive drugs used for treatment and blood pressure reduction were similar in both groups. Results: Subjects that started treatment after 65 years of age (157 females and 133 males) had lower serum cholesterol levels and a higher prevalence of end organ damage than their younger counterparts. Women over 65 had a higher body mass index than women of less than 65. Males over 65 years had a higher prevalence of diabetes than younger males. Mortality and complications of hypertension were higher in subjects that started treatment after 65 years of age. Conclusions: The higher mortality of subjects that start hypertensive treatment after 65 years of age, is indicative of the need to detect and treat hypertension at the earliest possible moment. (Rev Méd Chile 2002; 130: 616-22 <![CDATA[Detección de secuencias del gen BCR-ABL mediante RT-PCR en pacientes con leucemia en la IX Región: Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600004&lng=es&nrm=iso&tlng=es Background: The BCR-ABL fusion gene is the molecular expression of the Philadelphia chromosome. This cytogenetic aberration is the most frequent alteration found in leukemias, which is produced by the translocation t(9;22). Two different fusion proteins are produced depending on the break point (210 kD and 190 kD). The detection of this gene has both diagnostic and prognostic importance, associated with poor prognosis in acute lymphoblastic leukemia (ALL). Aim: To detect BCR-ABL gene sequences in patients with leukemia from the IX Region of Chile. Material and methods: We studied 58 patients: 5 chronic myeloid leukemia (CML), 35 ALL, 15 acute myeloid leukemia (AML) and 3 biphenotypic leukemia. The gene sequences were detected using reverse transcriptase polymerase chain reaction (RT-PCR). Results: BRC-ABL gene sequences were positive in all patients with CML, 2 of 35 ALL (one child and one adult). The remaining patients were negative. We found p210 and p190 co-expression in 2 CML and 1 ALL. Conclusions: Our results are in agreement with other reports. The detection of these and other genetic alterations will allow us to have invaluable diagnostic and prognostic information from our patients with leukemia (Rev Méd Chile 2002; 130: 623-30) <![CDATA[Síndrome de Williams: estudio clínico, citogenético, neurofisiológico y neuroanatómico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600005&lng=es&nrm=iso&tlng=es Background: Williams syndrome (WS) is a genetically based disorder caused by deletion of elastin and contiguous genes on chromosome 7q11.23. This syndrome is characterized by multiorganic involvement with dysmorphic facial features and a distinctive cognitive profile. It is an interesting model for elucidation of relationships between brain, cognition and genes. Patients have a visual-spatial cognition impaired with relative strengths in social and language abilities. Aim: To report clinical, cytogenetic, neurophysiological and neuroanatomic features in 44 patients referred as WS. Patients and methods: Forty four patients, aged 2 to 17 years, with the clinical diagnosis of Williams syndrome were studied with fluorescence in situ hybridization (FISH). In three cases, electrophysiological and neuroimaging studies were performed. Result: The deletion was confirmed in 23 patients. In three patients with neurophysiological studies, event related potentials suggested a cognitive difficulty in detecting and processing visual stimuli. Magnetic resonance imaging showed normal brain morphology. SPECT showed hypoperfusion of the right frontal lobe and bilateral anterior cingulum hyperperfusion. Conclusions: There are functional alterations in the brains of patients with Williams, which may be related to the cognitive deficits (Rev Méd Chile 2002; 130: 631-37) <![CDATA[Hijo no deseado después del parto: medición de frecuencia y análisis de tendencia]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600006&lng=es&nrm=iso&tlng=es Background: A significant proportion of pregnancies occurring in Metropolitan Santiago are unplanned and unwanted. It is reasonable to postulate that the frequency of unwanted children must be high. Aim: To measure the frequency of unwanted children in newborns of a public hospital of Santiago. Material and methods: In a period of fourteen months a score assigning survey to detect unwanted children was applied, after birth, to 741 women delivering at San Juan de Dios Hospital in Metropolitan Santiago. Women whose newborns were hospitalized or had congenital malformations were excluded from the survey. Results: Forty children (5.4%) scored as unwanted while 52 (7%) qualified as being in a doubtful situation. When compared to desired children, unwanted infants had a lower frequency of suitable pregnancy controls (p <0.0002) and a higher incidence of mothers declaring bad relations with children’s father (p <0.0002). A trend towards higher frequency of single mothers (p: 0.044) was observed. A lower frequency of first born children (p: 0.017) and a higher frequency of children born in the fourth place, was observed among unwanted newborns (p <0.002). Conclusions: In the last 15 years, previous studies, carried out with similar methodologies, have showed a comparable frequency of unwanted children. These condition seems to be associated with poor pregnancy control, high birth order and bad relations with the child’s father (Rev Méd Chile 2002; 130: 638-643) <![CDATA[Deficiencia de vitamina D en niños con enfermedades crónicas evaluados por osteopenia]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600007&lng=es&nrm=iso&tlng=es Background: Chronic diseases in children may determine limited sun exposure, use of drugs, and other risk factors of osteopenia. Objective: to evaluate vitamin D deficiency and their risk factor, in children with chronic diseases with suspected osteopenia. Methods: We measured bone mineral density, bone remodeling markers, calcium, phosphate, parathormone, and 25 hydroxyvitamin D levels, and wrist X-ray. Results: We found 8 children of 25 with suspected osteopenia, with biochemical abnormalities suggestive of vitamin D deficiency. All children had low levels of 25 hydroxyvitamin D, 5 had reduced bone mineral density, 4 had hyperparathyroidism, 2 had hyperphosphatasemia, and 1 hypocalcemia and hypophosphatemia. None had rickets. Discussion: Osteopenia in chronic sick children is due to multiple factors; however, vitamin D deficiency is a preventable disorder. We recommend that all children with a chronic disease with risk factors for vitamin D deficiency should be monitored with 25 hydroxyvitamin D serum levels (Rev Méd Chile 2002; 130: 645-650) <![CDATA[Prevalencia de trastornos psiquiátricos por uso de alcohol y otras sustancias en hombres y mujeres hospitalizados en medicina interna de un hospital de Santiago de Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600008&lng=es&nrm=iso&tlng=es Background: Studies done in Chile and abroad report a high frequency of substance abuse among patients hospitalized in general medical services. Aim: To report the frequency of substance abuse in a sample of patients hospitalized in a public hospital of Santiago. Material and methods: A structured psychiatric interview for the Third Revised Version of The Diagnostic and Statistical Manual (DSM-III-R) was applied to 203 males, aged 58.5 years and 203 females, aged 52,9 years, hospitalized in an internal medicine Service of a public hospital. All subjects had a low educational and income level. Results: The discharge diagnoses of studied patients were digestive diseases in 32%, circulatory diseases in 19%, cancer, diabetes mellitus and genitourinary diseases in 11% respectively and mental or behavioral diseases in 5%. Thirty eight percent of males and 6% of females qualified for alcohol dependency or abuse in some moment of their lives. The figures for benzodiazepine dependency were 1% among males and 6% among females. The figures for cannabis, cocaine or stimulant abuse were 1.5% for males and 1% for females. Other conditions of the axis 1 of DSM-IIIR were diagnosed in 47% of males and 65% of females with substance abuse. Conclusions: Substance abuse underlies medical conditions in a high proportion of patients admitted to medical services in general hospitals (Rev Méd Chile 2002; 130: 651-660) <![CDATA[Infecciones sistémicas por levaduras en un hospital general: Correlación entre estudio de susceptibilidad in vitro y supervivencia de los pacientes al episodio de infección fúngica]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600009&lng=es&nrm=iso&tlng=es Background: Fungi are important causal agents of nosocomial infections, that usually have high mortality rates. Aim: To evaluate the species distribution and susceptibility patterns of deep yeast infections in a General Hospital and to correlate those results with patient survival. Material and methods: Twenty one strains (from five pediatric and 16 from adult patients) were studied. Antifungal Susceptibility Testing (AST) to Amphotericin B (Anfb), Fluorocytosine (5FC), Fluconazole (FZ) and Itraconazole (IZ) was performed according to the EUCAST document. Clinical data of patients was obtained and survival to the infection was recorded. Results: C. albicans was isolated in 11 samples (52%), C. parapsilosis in three samples (14%), C. glabrata in two samples (9%), C. tropicalis in one sample (5%) and C. neoformans in four samples (19%). Twenty three percent of fungi were recovered at the Surgical Intensive Care Unit. The MICs ranged between 0.25 and 0.5 µg/mL for Anfb; between 0.25 and 16 µg/ml for SFC, between 0.12 and 32 µg/mL for FZ and 0.015 and 0.5 µg/mL for IZ. No association between antifungal susceptibility and patient survival was observed. Conclusions: C. albicans continues to be the most frequently isolated yeast, however, non-albicans species are an emergent group causing nosocomial infections. Surgical procedures are the main source of fungal infections in this sample (Rev Méd Chile 2002; 130: 661-65) <![CDATA[Colitis isquémica inducida por cocaína: Caso clínico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600010&lng=es&nrm=iso&tlng=es We report a 29 years old male, with a history of cocaine abuse and excessive alcohol intake, who was admitted to the hospital with an acute peritonitis. The patient was operated and multiple perforations of the cecum were found. A right hemicolectomy was performed and the pathological study of the surgical piece showed an ischemic colitis. A literature review reveals 22 reported cases of ischemic colitis associated to cocaine abuse (Rev Méd Chile 2002; 130: 667-670). <![CDATA[Glucagonoma: Evolución y tratamiento]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600011&lng=es&nrm=iso&tlng=es Glucagonomas are alpha pancreatic islet cell tumors that, when they are active, produce a syndrome characterized by necrolytic migratory erythema, diabetes mellitus, weight loss, anemia, glossitis, thromboembolism, neuropsychiatric disturbances and hyperglucagonemia. We report a 43 years old male presenting with a five years history of dermatological lesions, associated with weight loss, glossitis and onicodystrophy. Serum glucagon was 2200 pg/ml and a CAT scan showed a tumor in the tail of the pancreas. The tumor was surgically excised but one year later, hepatic metastases were found. These were excised surgically, treated with long acting octeotride and finally treated with radiotherapy using Y-DOTATOC. In the last control in November, 2001, the patient is asymptomatic (Rev Méd Chile 2002; 130: 671-676) <![CDATA[Síndrome hemolítico-urémico y <I>Streptococo pneumoniae</I>: <I>Report of one case</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600012&lng=es&nrm=iso&tlng=es Hemolytic-uremic syndrome (HUS) is an uncommon complication of pneumococcal infection. Highly suggesting findings in a patient with Streptococcus pneumoniae infection are: microangyopatic hemolytic anemia, thrombocytopenia and acute renal failure. We report a 41 years old woman, admitted to the hospital due to a severe pneumonia, that required the surgical drainage of an empyema. On admission, a drop in packed red cell volume from 41 to 25%, the presence of schistocytes in the blood smear, an elevation of LDH to 1,700 IU/L, a fall in haptoglobin to 5.8 mg/dL and a thrombocytopenia of 72,000 per mm3 were detected. These alterations coincided with an oliguric acute renal failure. She was treated with hemodialysis and the hemolytic syndrome was managed with plasmapheresis. She was discharged 35 days after admission and in the follow up, after 2.5 months, her serum creatinine is 1.2 mg/dL and her packed red cell volume is 41% (Rev Méd Chile 2002; 130: 677-680) <![CDATA[<I>Enfermedad hepática alcohólica</I>: <I>desde el daño molecular a su tratamiento</I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600013&lng=es&nrm=iso&tlng=es Although the interaction between alcohol and the liver has been the subject of intensive investigation since many years, several uncertainties remain to be solved. Good examples of what we need to learn are: The real number of patients with alcohol-induced liver disease (AILD), the dose of alcohol "safe" for the liver, the genetic predisposition to the damage or, on the other side of the coin, protecting from the damage. Rather recently, however, part of these questions started to be clarified, thus permitting a better definition of the role of each of these factors in AILD. In parallel to the clinical approach to AILD, the unveiling of the molecular and biochemical mechanisms involved in AILD has progressed and proved to be important in both a better understanding of the disease and, more important, in a more rational treatment of these disorders. This review will focus on what we currently know of AILD in clinical, biochemical and molecular terms and what we need to address in the future (Rev Med Chile 2002; 130: 681-690).<hr/>Aunque la interacción entre el alcohol y el hígado ha sido un tema de intensa investigación desde hace muchos años, varias incertidumbres requieren todavía ser resueltas. Buenos ejemplos de lo que necesitamos aprender son: el número real de pacientes con enfermedad hepática alcohólica (EHA), la dosis "segura" de alcohol (que no dañaría el hígado), la predisposición genética para el daño hepático o, en la otra cara de la moneda, que protege de este daño. Sin embargo, recientemente comenzaron a aclararse algunas de estas preguntas, permitiendo una mejor definición del rol de cada uno de estos factores en la patogenia de la EHA. Paralelamente con el enfoque clínico de la EHA, la pesquisa de los mecanismos moleculares y bioquímicos involucrados en la EHA ha progresado, demostrando su importancia tanto para una mejor comprensión de la enfermedad como para diseñar su tratamiento más racional. Esta revisión actualiza los conocimientos clínicos, bioquímicos y moleculares sobre la EHA y bosqueja lo que debemos seguir investigando <![CDATA[Insuficiencia hepática fulminante]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600014&lng=es&nrm=iso&tlng=es Fulminant hepatic failure (FHF) is an acute and eventually fatal illness, caused by a severe hepatocyte damage with massive necrosis. Its hallmarks are hepatic encephalopathy and a prolonged prothrombin time (<40%). FHF is currently defined as hyperacute (encephalopathy appearing within 7 days of the onset of jaundice), acute (encephalopathy appearing between 8 and 28 days) or subacute (encephalopathy appearing between 5 and 12 weeks). FHF can be caused by viruses, drugs, toxins, and miscellaneous conditions such as Wilson’s disease, Budd-Chiari syndrome, ischemia and others. However, a single most common etiology is still not defined. Factors that are valuable in assessing the likelihood of spontaneous recovery are age, etiology, degree of encephalopathy, prothrombin time and serum bilirubin. The management is based in the early treatment of infections, hemodynamic abnormalities, cerebral edema, and other associated conditions. Liver transplant has emerged as the most important advance in the therapy of FHF, with a survival rate that ranges between 60 and 80%. The use of hepatic support systems, extracorporeal liver support and auxiliary liver transplantation are innovative therapies (Rev Méd Chile 2002; 130: 691-698). <![CDATA[Avances tecnológicos: La radiología que viene]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600015&lng=es&nrm=iso&tlng=es We are living in a changing world, acknowledging all kinds of changes: social, technological, and ethical. This is the environment encircling medical and radiological work: demanding, with high expectations and a cohort of amazing technological advances, in all areas of human knowledge. We need to make the necessary reflections about these faster and faster changes. Radiology, as an important part of clinical work, is facing no minor challenges: technological and other most prevalent like: Who will be specialists in the next future? How are we prepared to face the radiological teaching and formation of radiologists? How to finance this technological developments? Meanwhile, in our context of an underdeveloped country, this sounds as far as the Moon, but changes will reach us sooner or later. We must resolve some problems that are a little bit more basic, such as a good level of education and healthcare for our people, then we will be ready to incorporate some of these amazing new technologies (Rev Méd Chile 2002; 130: 699-703) <![CDATA[Importancia clínica de la hipercolesterolemia]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600016&lng=es&nrm=iso&tlng=es We are living in a changing world, acknowledging all kinds of changes: social, technological, and ethical. This is the environment encircling medical and radiological work: demanding, with high expectations and a cohort of amazing technological advances, in all areas of human knowledge. We need to make the necessary reflections about these faster and faster changes. Radiology, as an important part of clinical work, is facing no minor challenges: technological and other most prevalent like: Who will be specialists in the next future? How are we prepared to face the radiological teaching and formation of radiologists? How to finance this technological developments? Meanwhile, in our context of an underdeveloped country, this sounds as far as the Moon, but changes will reach us sooner or later. We must resolve some problems that are a little bit more basic, such as a good level of education and healthcare for our people, then we will be ready to incorporate some of these amazing new technologies (Rev Méd Chile 2002; 130: 699-703) <![CDATA[Síndrome confusional agudo asociado al uso de Clormezanona]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600017&lng=es&nrm=iso&tlng=es We are living in a changing world, acknowledging all kinds of changes: social, technological, and ethical. This is the environment encircling medical and radiological work: demanding, with high expectations and a cohort of amazing technological advances, in all areas of human knowledge. We need to make the necessary reflections about these faster and faster changes. Radiology, as an important part of clinical work, is facing no minor challenges: technological and other most prevalent like: Who will be specialists in the next future? How are we prepared to face the radiological teaching and formation of radiologists? How to finance this technological developments? Meanwhile, in our context of an underdeveloped country, this sounds as far as the Moon, but changes will reach us sooner or later. We must resolve some problems that are a little bit more basic, such as a good level of education and healthcare for our people, then we will be ready to incorporate some of these amazing new technologies (Rev Méd Chile 2002; 130: 699-703) <![CDATA[PREMIO EN BIOÉTICA Dr. MANUEL VELASCO-SUÁREZ 2002]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600018&lng=es&nrm=iso&tlng=es We are living in a changing world, acknowledging all kinds of changes: social, technological, and ethical. This is the environment encircling medical and radiological work: demanding, with high expectations and a cohort of amazing technological advances, in all areas of human knowledge. We need to make the necessary reflections about these faster and faster changes. Radiology, as an important part of clinical work, is facing no minor challenges: technological and other most prevalent like: Who will be specialists in the next future? How are we prepared to face the radiological teaching and formation of radiologists? How to finance this technological developments? Meanwhile, in our context of an underdeveloped country, this sounds as far as the Moon, but changes will reach us sooner or later. We must resolve some problems that are a little bit more basic, such as a good level of education and healthcare for our people, then we will be ready to incorporate some of these amazing new technologies (Rev Méd Chile 2002; 130: 699-703) <![CDATA[BIBLIOGRAFÍA]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872002000600019&lng=es&nrm=iso&tlng=es We are living in a changing world, acknowledging all kinds of changes: social, technological, and ethical. This is the environment encircling medical and radiological work: demanding, with high expectations and a cohort of amazing technological advances, in all areas of human knowledge. We need to make the necessary reflections about these faster and faster changes. Radiology, as an important part of clinical work, is facing no minor challenges: technological and other most prevalent like: Who will be specialists in the next future? How are we prepared to face the radiological teaching and formation of radiologists? How to finance this technological developments? Meanwhile, in our context of an underdeveloped country, this sounds as far as the Moon, but changes will reach us sooner or later. We must resolve some problems that are a little bit more basic, such as a good level of education and healthcare for our people, then we will be ready to incorporate some of these amazing new technologies (Rev Méd Chile 2002; 130: 699-703)