Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720030002&lang=pt vol. 131 num. 2 lang. pt <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<B><I>Prevalence of cardiovascular risk factors among Chilean employees</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200001&lng=pt&nrm=iso&tlng=pt Cardiovascular diseases are the main causes of death in Chile and there is a high prevalence of cardiovascular risk factors in the population. Aim: To assess the prevalence of those risk factors in a group of employees. Subjects and methods: We studied 2,219 individuals, 1,378 males with a mean age of 46.2±10.4 years and 841 females with a median age of 41.9±10.3 years. Results: High blood pressure was observed in 39.7% of men and in 21.8% of women. A serum cholesterol between 200 and 239 mg/dl was observed in 38% of men and 31.3% of women. A cholesterol over this value was seen in 23.7% of men and 18.8% of women. A low proportion of those with high blood pressure, or elevated cholesterol, were under treatment. Prevalence of smoking was high in men and women: 43.5 and 48.9.2%, respectively. Eighty four percent of men and 61.3% of women over 54 years were overweight or obese. The prevalence of diabetes mellitus was 4.5%. Twenty percent of men and 13% of women exercised regularly, at least 3 times a week. Conclusions: There is a high prevalence of untreated cardiovascular risk factors in this population (Rev Méd Chile 2003; 131: 129-34) <![CDATA[<B><I>Distribution of alleles of DRD4 and DAT1 genes of the dopaminergic system in the mixed Chilean population</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200002&lng=pt&nrm=iso&tlng=pt Genes for dopamine receptor DRD4 and dopamine transporter DAT1 are highly polymorphic. Two alleles of these genes, namely the DRD4.7 and the DAT1*9 are frequently associated to the attention deficit disorder with hyperactivity. In Europe, the allele for DRD4 receptor with four repetitions (DRD4.4) has the highest frequency, with a median of 69%, followed by DRD4.7, with a frequency of 15%. South American indigenous populations have higher frequencies for DRD4.7 (61%) than for DRD4.4 (29%). The ten repetition allele for DAT1 transporter has a high frequency among Europeans (72%) and Amerindians (100%). The allele DAT1*9 is the second most frequent allele. Aim: To study the frequency of DRD4 and DAT1 alleles in a Chilean population sample. Material and methods: One hundred serum samples were obtained from blood donors in two public hospitals in Santiago. Polymorphic regions for DRD4 and DAT1 were amplified by polymerase chain reaction. Results: The allele DRD4.4 had a frequency of 59% and DRD4.7 a frequency of 27%. The allele DAT1*10 had a frequency of 74%, followed by DAT 1*9, with a frequency of 23%. Discussion: In a Chilean population sample, the frequency of DRD4 and DAT1 alleles was very similar to that of European populations (Rev Méd Chile 2003; 131: 135-43) <![CDATA[<B><I>Molecular epidemiology of a Streptococcus pyogenes related nosocomial outbreak in a burn unit</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200003&lng=pt&nrm=iso&tlng=pt Group A Streptococcal (GAS) infections have increased in frequency and severity worldwide. During April 1996, a nosocomial outbreak associated to GAS infections affected seven patients admitted to a pediatric burn unit. The causative organism was likely disseminated from the source patient to another child in the emergency room before he was transferred to the burn unit. Patients developed burn infections or invasive disease. One of them died due to a toxic shock syndrome and 3 other lost their skin grafts. Perineal and nasal microbiological surveillance of 42 related health care workers identified only one of them as carrier of S pyogenes. Aim: To report a molecular analysis of an apparently clonal outbreak. Material and methods: The available isolates were analyzed by molecular methods including random amplified polymorphic DNA analysis (RAPD) with 4 different primers, Sma-I pulsed field gel electrophoresis (PFGE) analysis, and speA, speB and speC detection by polymerase chain reaction (PCR). Results: Two phylogenetically distant and sequentially isolated bacterial groups were identified either by RAPD analysis with selected primers or by Smal-PFGE analysis. The first group involved isolates identified in two patients that included the lethal case. The second bacterial group comprised 5 clinical isolates and the perineal and nasal isolates obtained from a health care worker. Only strains belonging to the first group harbored the speA gene and were associated with invasive disease. The second group could be split further in two subgroups according to their speB profile. Conclusions: RAPD analysis with selected primers can reproduce the PFGE-discriminating ability on the epidemiological analysis of GAS infections (Rev Méd Chile 2003; 131: 145-54) <![CDATA[<B><I>Yield and costs of complementary examinations to study the dissemination of stage I and II breast carcinoma</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200004&lng=pt&nrm=iso&tlng=pt Chest X ray, abdominal ultrasound and bone scintigraphy are usually requested to study a possible dissemination of breast carcinoma. Aim: To study the yield and costs of these exams in the study of dissemination of stage I and II breast carcinoma. Material and methods: A retrospective analysis of patients operated for a breast carcinoma in a public surgical service. A chest X ray, abdominal ultrasound and bone scintigraphy was requested to all patients in the immediate postoperative period. Age, stage according to pathological TNM and costs per patient were registered. Results: Of 210 women operated, 40 were in stage I (19%) and 85 in stage II (41%). Dissemination study was negative in all stage I patients and in all but two patients in stage II. The yield for detection of distant metastases in these patients was 0.9% for chest X ray, 0% for abdominal ultrasound and 0.9% for bone scintigraphy. The total cost of the study, in Chilean pesos, was $10,369,620 in a public hospital and $16,535,400 in a private clinic. Discussion: Additional exams to detect distant metastases in early stages of breast carcinoma have a low yield and high costs (Rev Méd Chile 2003; 131: 155-8) <![CDATA[<B><I>Mental health of teachers from 12 basic schools in a suburban community, in Chile</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200005&lng=pt&nrm=iso&tlng=pt Mental health of teachers is a primary concern, considering the important deficiencies in the Chilean educational system. Aim: To explore mental health in teachers from local primary schools. Material and methods: The 12 question version of the Goldberg health questionnaire (a self administered instrument) was applied to 139 teachers working in basic schools in a suburban community. Results: One hundred twenty teachers (99 females) answered the questionnaire. A possible emotional problem was detected in 28.6%. The life prevalence of mental health problems was 32%. Relationships with children were the best perceived and relationships with superiors were the worst perceived. A higher social valuation of teachers and better salaries were the two variables associated with a better satisfaction with work. The number of working hours were directly related to mental health problems. Multivariate analysis showed that age was independent and negatively correlated with Goldberg score and that general satisfaction with work was directly related to the quality of relationships with superiors. Conclusions: Age and number of working hours were two risk factors for mental problems identified in this sample. A better social valuation of teachers work, better salaries and a good relationship with children and superiors should improve labor satisfaction (Rev Méd Chile 2003; 131: 159-67) <![CDATA[<B><I>Hantavirus pulmonary syndrome</B></I>: <B><I>current situation among rodent reservoirs and human population in the Xth Region, Chile</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200006&lng=pt&nrm=iso&tlng=pt In Chile, three Hantavirus seropositive rodent species (O longicaudatus, A olivaceus and A longipilis) are distributed from the Pacific coast to the Andes mountains and represent nearly 90% of the rodents captured in the Xth Region. Aim: To study the seroprevalence of Hantavirus among captured rodent species and its relationship with the appearance of human cases of pulmonary syndrome. Material and methods: From May 1998 to September 2001, 675 rodents were captured in the region. Serum samples were tested by ELISA for the presence of IgG antibodies against Andes and Sin Nombre virus. Sera from human cases with a suspected Hantavirus infection were analyzed for IgM antibodies against Black Lagoon virus and for IgG antibodies against Andes and Sin Nombre virus. Results: Twenty two of the 675 rodents were seropositive for the virus, 18 O longicaudatus and 4 A longipilis. Regional seroprevalence changed from 2.2% in 1998, 0.0% in 1999, 1.0% in 2000 and up to 7.1% in 2001. A total of 77 positive human cases were studied from 1998 to March 2002. Although there were positive cases in all seasons, data showed a spring-summer seasonal preponderance. A relationship between the flowering of "colihue" bushes and the increased values of rodent abundance, seroprevalence and positive animals was established. Conclusions: A dispersal movement of O longicaudatus to open habitats close to human outdoor activities during the dry season was confirmed (Rev Méd Chile 2003; 131: 169-76) <![CDATA[<B><I>Chronic subdural hematoma</B></I>: <B><I>a disease of elderly people</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200007&lng=pt&nrm=iso&tlng=pt The lack of specificity and heterogeneity of the clinical picture of chronic subdural hematoma, hampers its diagnosis. Aim: To report the experience of a Neurosurgical Service in chronic subdural hematoma. Patients and methods: One hundred patients (77 male, mean age 77±13 years) with chronic subdural hematoma were analyzed. Results: The main clinical presentations were mental status changes (50%) and progressive focal neurological deficit (46%). Five cases presented as a transient neurological deficit. All patients were treated with burr hole drainage. Thirteen had recurrence of the hematoma and they were reoperated. The surgical mortality was 3%. Eighty seven patients were followed for a mean of 66 months. Eighty one of these had a complete recovery, 6 had permanent neurological deficit and 2 of these were unable to care for themselves. Bad prognosis was associated with the absence of a previous trauma to explain the hematoma and symptoms of dementia as the clinical presentation. Conclusions: Most patients with chronic subdural hematoma treated with burr hole drainage have a good outcome (Rev Méd Chile 2003; 131: 177-82) <![CDATA[<B><I>Hepatic resection in localized Caroli disease</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200008&lng=pt&nrm=iso&tlng=pt Caroli disease is a cystic congenital malformation of the intrahepatic biliary tract, frequently associated with lithiasis. Commonly, cystic dilatations are bilateral and infrequently they affect only one hepatic lobule or segment. We report six patients with localized Caroli disease, three in the right and three in the left hepatic lobule, that were subjected to a hepatic resection. There were no postoperative complications or mortality. After 28 months of follow up, patients are asymptomatic and with normal hepatic function and ultrasonography. The importance of diagnosing localized Caroli disease, in which hepatic resection can be curative, is emphasized (Rev Méd Chile 2003; 131: 183-9) <![CDATA[<B><I>Frequency of digestive system congenital malformations detected at the University of Chile Hospital in the period 1991-2001</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200009&lng=pt&nrm=iso&tlng=pt There were 26,617 births attended at the University of Chile Clinical Hospital, of which 0.63% were stillborn. A frequency of malformations of 7.2 per born alive and of 22.1 per stillborn was detected in this population. Aim: To report the frequency of digestive system congenital malformations in this population. Material and methods: Analysis of data from the births that occurred at the University of Chile Hospital, that was gathered using codified form for the Latin American Collaborative Study for Congenital Malformations. Results: Ninety seven digestive congenital malformations were detected, with a rate of 26.4 per 10,000 born alive and 12.2 per 10,000 stillborn. Diaphragmatic hernia was the most frequent malformation found, followed by imperforated anus, onphalocele and esophageal atresia. There was a secular increase in the frequency of these malformations. Conclusions: The frequency of digestive system malformations is higher than in the rest of hospitals participating in the Latin American Collaborative Study for Congenital Malformations (Rev Méd Chile 2003; 131: 190-6) <![CDATA[<B><I>Relapse of Hodgkin disease after 17 years of complete remission</B></I>: <B><I>Report of one case</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200010&lng=pt&nrm=iso&tlng=pt A 45 years old male in whom a Hodgkin disease, nodular sclerosis variety, IIIBS, with splenectomy was diagnosed at the age of 27 years of age, is reported. He was treated initially with chemotherapy C-MOPP and radiotherapy, obtaining a complete remission of the disease two years later. In December 2000, after 17 years of remission, the disease relapsed with generalized lymph node enlargement and lung involvement. He was treated with ABVD chemotherapy, but died after 5 cycles due to a febrile neutropenia, bronchopneumonia and respiratory distress (Rev Méd Chile 2003; 131: 197-9) <![CDATA[<B><I>Use of dinamic lung computed tomography to orient mechanical ventilation in adult respiratory distress syndrome</B></I>: <B><I>Report of one case with acute mediastinitis</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200011&lng=pt&nrm=iso&tlng=pt Lung computed tomography (CT) is being used increasingly to assess lung morphology in patients on mechanical ventilation. Lung CT under known levels of airway pressure (dynamic CT) can also assess the response of lung parenchyma to ventilatory therapy. We report a patient with acute respiratory distress syndrome secondary to descending necrotizing mediastinitis, in whom lung dynamic CT oriented ventilatory management. Independent lung ventilation improved gas exchange and helped patient recovery (Rev Méd Chile 2003; 131: 200-8) <![CDATA[<B><I>Medical training in Chile at the present time</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200012&lng=pt&nrm=iso&tlng=pt Lung computed tomography (CT) is being used increasingly to assess lung morphology in patients on mechanical ventilation. Lung CT under known levels of airway pressure (dynamic CT) can also assess the response of lung parenchyma to ventilatory therapy. We report a patient with acute respiratory distress syndrome secondary to descending necrotizing mediastinitis, in whom lung dynamic CT oriented ventilatory management. Independent lung ventilation improved gas exchange and helped patient recovery (Rev Méd Chile 2003; 131: 200-8) <![CDATA[<B><I>Catch up growth</B></I>: <B><I>An unresolved challenge</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200013&lng=pt&nrm=iso&tlng=pt Factors that modulate catch up growth influence the quantity and quality of the recovered tissue. Insulin and IGF-1 respond to dietary changes in carbohydrates and proteins; evidence shows that IGF-1 and leptin may be good indicators of nutritional recovery. The optimal diet to promote catch up growth is still controversial. There is consensus on the need to adjust the energy-protein intake to the growth velocity observed, without encouraging excessive eating, to avoid obesity. Zinc supplementation and physical activity appear as relevant factors to promote the synthesis of lean mass. In some models of early malnutrition, a better catch up growth during childhood, is associated with a higher frequency of chronic diseases and mortality in adulthood. In this context, we will review some factors that seem relevant to the modulation of catch up growth, which should be taken into account when reviewing the therapeutic guidelines to treat malnourished children (Rev Méd Chile 2003; 131: 213-9) <![CDATA[<B><I>Recognition of classical works in the history of genetics</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200014&lng=pt&nrm=iso&tlng=pt The classical Mendelian genetics forged the development of biomedical sciences in the twentieth century. However, the classical works that allowed the sequencing of human genoma, have not received the recognition that they deserve. The author does a historical revision of works, considered classic in genetics and its specialties such as cytogenetics, biochemical genetics, immunogenetics and molecular genetics, published between 1990 and 1999. Authors that received the Nobel Prize are identified and the works are sorted in chronological order. Most founders of genetics specialties, have not received the Nobel Prize. Only 26 of 80 classical works have been awarded with such distinction. Almost all founders of Mendelian genetics and human cytogenetics, have been unrewarded. The author proposes to create the "Johan Gregory Mendel Prize" for geneticists (Rev Méd Chile 2003; 131: 220-4) <![CDATA[<B><I>Synptomatic hyponatremia induced by oxcarbazepine</B></I>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200015&lng=pt&nrm=iso&tlng=pt The classical Mendelian genetics forged the development of biomedical sciences in the twentieth century. However, the classical works that allowed the sequencing of human genoma, have not received the recognition that they deserve. The author does a historical revision of works, considered classic in genetics and its specialties such as cytogenetics, biochemical genetics, immunogenetics and molecular genetics, published between 1990 and 1999. Authors that received the Nobel Prize are identified and the works are sorted in chronological order. Most founders of genetics specialties, have not received the Nobel Prize. Only 26 of 80 classical works have been awarded with such distinction. Almost all founders of Mendelian genetics and human cytogenetics, have been unrewarded. The author proposes to create the "Johan Gregory Mendel Prize" for geneticists (Rev Méd Chile 2003; 131: 220-4) https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000200016&lng=pt&nrm=iso&tlng=pt