Scielo RSS <![CDATA[Revista médica de Chile]]> vol. 131 num. 7 lang. <![CDATA[SciELO Logo]]> <![CDATA[<I>Identification of B and F human immunodeficiency virus subtypes in Chilean patients</I>]]> Background: Type I human immunodeficiency virus (HIV) is characterized by a great genetic variability. There are three groups of virus throughout the world: O, N and M. Group M is responsible for AIDS pandemic and is subdivided in 9 genetic subtypes. Most viral strains in South America are subtype B. Aim: To determine the frequency of HIV subtypes in Chilean patients. Material and methods: Genetic analysis of C2-V3-C3 region of the gene env in HIV strains coming from 77 Chilean subjects infected by different means. DNA heteroduplex mobility assay was used to determine HIV subtypes. Results: Sixty eight cases were infected with subtype B (88.3%) and nine cases were infected with subtype F (11.7%). Conclusions: Subtype B is the predominant HIV in Chile, but subtype F is also present (Rev Méd Chile 2003; 131: 711-8) <![CDATA[<I>Comparison of laparoscopic and operative surgery in diverticular disease</I>]]> Background: Elective surgery in diverticular disease (DD) consists classically in performing an open sigmoidectomy. Laparoscopic surgery of the colon can have results that are comparable to those of open surgery. Aim: To compare the results of laparoscopic and conventional surgery for DD. Materials and Methods: Retrospective review of preoperative, operative and postoperative variables of patients operated by laparoscopic surgery between the years 2000 and 2002. These results were compared with those of patients treated with conventional surgery in the same period. Results: Thirty nine patients, mean age 59 years old, were operated via laparotomy and 18 patients, mean age 47 years old, were treated with laparoscopic surgery. Both groups were comparable in gender, amount of previous laparotomies, type of surgery performed and American Society of Anestesiologists classification. The operative time was significantly higher in the laparoscopic surgery group (230 v/s 130 min), but the opioid requirements, stay in an intensive surgical care ward, postoperative ileus and hospital stay were significantly shorter in the laparoscopic group. Eleven percent of the patients included in the laparoscopic group and 31% of the patients treated with operative surgery had complications (p=0.07). The length of the excised colon, the degree of inflammation and treatment costs were comparable. Conclusions: Laparoscopic surgery in DD is feasible, safe, requires less analgesia and allows a faster recovery of post-operative ileus and a lower hospital stay (Rev Méd Chile 2003; 131: 719-26) <![CDATA[<I>Integrons and antimicrobial resistance gene cassettes in Shigella flexneri strains</I>]]> Background: The resistance of Shigella flexneri to antimicrobial agents can be associated to the presence of integrons that may contain and express antimicrobial resistance gene cassettes. Aim: To study antimicrobial resistance and the presence of integrons and antimicrobial gene cassettes in Shigella flexneri strains. Material and methods: In vitro susceptibility to 27 antimicrobials was studied in twenty four Shigella flexneri strains isolated from stools. The presence of integrons class 1, 2 and 3 and antimicrobial resistance gene cassettes was investigated by polymerase chain reaction (PCR) using specific primers for each gene. Results: Most strains were resistant to one of the following antimicrobials: ampicillin, sulphonamide, trimethoprim, tetracycline, streptomycin, sulfamethoxazole-trimethoprim or chloramphenicol. Twenty nine percent were simultaneously resistant to all these antimicrobials. Integrons class 1 and 2 were found in 19 strains (79%). Class 3 integrons were not found. Gene cassettes dfrA1 and ant(3")I were associated to integrons class 2 in most strains (15/20, 75%). Genes cat, tetB and blarTEM were detected in 18/24 (75%), 7/24 (29%) and 4/24 (17%) of the strains, respectively and were not associated to any of the studied integrons. Genes that codify enzymes AAC(6')Ib and APH(3')VI were not detected in any strain. Conclusions: The high frequency of integrons found in the studied strains, could partly explain the increasing antimicrobial resistance of Shigella flexneri strains, isolated in Chile (Rev Méd Chile 2003; 131: 727-33) <![CDATA[<I>Ultrasound diagnosis of pilomatrixoma</I>]]> Background: Pilomatrixoma is a benign tumor of the skin, preferentially found in children. The final diagnosis is made by biopsy. High resolution ultrasound (US) is a non invasive method for its diagnosis. Aim: To describe the US findings in children with pilomatrixoma. Material and methods: Fifty five patients with 62 clinically suspected pilomatrixomas were studied by US. All examinations were done with an ATL HDI 5000, linear 5-12 MHz transducer. Pathological study confirmed the diagnosis pilomatrixoma in 52 cases. Results: Fifty of 52 pilomatrixomas were diagnosed by US, with a sensitivity of 96%. The mean age of patients was 7.5 years. Forty seven lesions (90%) were located in the head, neck or upper extremities and their mean size was 8.5 mm. Thirty two lesions were hypodermal, 14 were dermohypodermal and 6 were dermal. In 44 lesions the contour was regular and non delineated, 44 lesions were oval, 41 lesions had an acoustic shadow, 36 were echogenic or hyperechogenic, 31 had a peripheral halo (60%), 55 had calcifications (98%), nine had perilesional vessels, 2 had intratumoral vessels and 7 had inflammatory changes. US excluded the diagnosis of pilomatrixoma in 10 lesions formulating a correct differential diagnosis in eight, with a specificity of 80%. Conclusions: Pilomatrixomas had two US types of presentation. The first is a well defined nodule with peripheral halo partially calcified or with microcalcifications. The second is a completely calcified nodule without peripheral halo and with a strong acoustic shadow. US is a useful, sensitive and specific diagnostic method for pilomatrixoma (Rev Méd Chile 2003; 131: 735-40) <![CDATA[<I>Frequency of abdominal aortic aneurysms in subjects with cardiovascular risk factors</I>]]> Background: The incidence of abdominal aortic aneurysms has increased. Its predisposing factors are smoking, high blood pressure and dislipidemia. Progressive aneurysmal enlargement may lead to its rupture, which is associated to a mortality rate above 80%. Aim: To assess the prevalence of abdominal aortic aneurysms in Chilean subjects with cardiovascular risk factors. Subjects and methods: Through announcements in open media we invited individuals aged over 60 years, who smoked, had hypertension and/or had occlusive arterial disease, to participate in a study that included medical history and physical examination. An aortic ultrasound was performed in all subjects in whom the aorta was not palpable or there was a suspicion of dilatation. Aortic diameter over 3 cm was considered aneurysmal. Results: Three hundred fifty six subjects aged 67.1±6.7 years, (73.9% males), were evaluated. The study group included 62% hypertensives, 39% with abnormal lipids and 46% smokers. Known coronary heart disease or peripheral arterial diseases were present in 14% and 10%, respectively. Ultrasound was required in 159 subjects. Aneurysms were detected in 21 persons (5.9%), 7.6% in males and 1.1% in females. The mean transverse diameter of the aneurysm was 4.1 cm (3-7.5). Aneurysm was found in 2.3% of subjects younger than 65 years and 8.3% of subjects aged over 65 years. Conclusions: In this sample the prevalence of abdominal aortic aneurysms was 5.9%, affecting predominantly males, with a notorious increase with advanced age (Rev Méd Chile 2003; 131: 741-7) <![CDATA[<I>Clinical features and gender identity among eating disordered patients subtypes</I>]]> Background: Gender identity is a relevant issue in the approach to eating disorders. Aim: To compare psychological and behavioural characteristics and traits of gender identity among women with eating disorders and its subtypes and non eating disordered female subjects. Material and Methods: An structured clinical interview based on the DSM-IV diagnostic criteria for eating disorders, the EAT-40 (Eating Attitudes Test), the Eating Disorders Inventory (EDI) and the Bem Sex Role Inventory (IBRS) were administered to 58 compulsive-purgative anorectics (AN/BN group), 15 restrictive anorectics (AN group), 33 patients suffering from eating disorder not otherwise identified, 33 purgative bulimics and to 82 female students without eating disorders. Results: Patients with eating disorders ranked significantly higher on the EAT-40 and EDI and all its items (p <0.001). The AN/BN group ranked significantly higher on the EDI (p <0.001) and on Drive for thinness, Perfectionism and interpersonal distrust (p <0.001). The AN group ranked higher on Maturity fears (p <0.001). The BN group ranged higher on Body dissatisfaction, Ineffectiveness and Interoceptive awareness (p <0.001). Patients with eating disorders were significantly identified with Feminine category and subjects without eating disorders with Androgynous and Undifferentiated categories on the IBRS (p=0.002). The AN group showed the highest percentage on Feminine category and the lowest on Androgynous and Undifferentiated categories. All the groups rejected and approved feminine, masculine and neutral qualities. Conclusions: Femininity emerged as the main trait of gender identity in patients suffering from eating disorders, in contrast to androgyny, showed by healthy women (Rev Méd Chile 2003; 131: 748-58) <![CDATA[<I>Infections caused by Varicella Zoster virus in cancer bearing children aged less than 15 years old</I>]]> Background: Infections caused by Varicella Zoster virus in children with cancer have a high rate of complications and mortality. Aim: To report the outcome of this infection in children with cancer. Patients and methods: Retrospective analysis of medical records of 216 children aged less than 15 years old with the diagnosis of an hematological or solid tumor, admitted to the National Program of Antineoplastic Drugs (PINDA). Results: Eighty seven children had a Varicella Zoster virus infections, 73 (84%) had varicella, 8 (9%) had herpes zoster and 6 (7%) had varicella and herpes zoster. Ninety four percent acquired the infection during antineoplastic treatment and 78% received Acyclovir as antiviral therapy. During a nosocomial outbreak of varicella, three patients with an Acute Lymphoblastic leukemia died in the initial phase of chemotherapy, in spite of an early administration of Acyclovir. No patient with herpes zoster died. Conclusions: The incidence of varicella was higher in children with leukemia or lymphoma than in children with other types of cancer. Virus reactivation was uncommon and had a benign course. Varicella mortality in these children could be favorably modified through an active immunization of immunocompetent children (Rev Méd Chile 2003; 133: 759-64) <![CDATA[<I>Evidence for association between microsatellite markers located on 6p22-25 and nonsyndromic cleft lip palate using the case-parents trio design in the Chilean population</I>]]> Background: Genetic studies indicate that nonsyndromic cleft lip/palate (NSCLP) has the characteristics of a complex genetic trait. Reports from different authors have suggested several candidate genes mapping in different chromosome regions. Association studies have suggested that a clefting locus is located on chromosome 6p. On these grounds we have investigated the possible association between five microsatellite markers located on 6p22-25 and NSCLP. Aim: To test the hypothesis on the possible association of a clefting locus with microsatellite markers located in 6p22-25. Patients and Methods: The sample consisted of 54 unrelated case-parent trios that comprise 54 NSCLP probands and 108 parents. Five microsatellite markers spanning the region 6p22-25 were analyzed for each individual by means of polymerase chain reaction with fluorescent labeled microsatellite markers. Electrophoresis of the PCR products was performed on a laser-fluorescent DNA sequencer. Nonparametric ETDT and MCETDT programs, were used to analyze the genotype data. Results: The family based association study showed that for the genotype wise analysis, only D6S259 presented a significant p-value (0.03). Nevertheless no individual allele of this marker showed an evident preferential transmission from heterozygous parents to affected offspring. Conclusions: The results of the present study do not show a clear evidence that a candidate gene for NSCLP may be located within or near the analyzed chromosome region in our sample. Nevertheless, it must be emphasized that the genotype wise analysis shows a significant p-value for D6S259 marker (Rev Méd Chile 2003; 131: 765-72) <![CDATA[<I>Missed diagnosis of osteoporosis and failure to treat elderly adults with hip fracture in Chile</I>]]> Background: Hip fractures are the most severe complication of osteoporosis, yet patients who suffer hip fracture rarely receive adequate treatment. Aim: To assess diagnosis and treatment of osteoporosis in patients with hip fracture. Patients and methods: a retrospective study in 203 patients admitted for hip fracture surgery at two medical institutions in Santiago, Chile. Clinical data from 101 patients from the Hospital Clínico Pontificia Universidad Católica de Chile (a university tertiary care hospital, HCPUC) and 102 patients from Hospital de Urgencia de la Asistencia Pública (a public emergency hospital, HUAP) were reviewed. We also evaluated incidence of new fractures, further treatment of osteoporosis and functionality, by means of a telephonic survey of 48% of patients (n=99) 12.3±5.3 months after hip fracture in HCPUC and 16.5±3.0 months for HUAP. Results: A previous diagnosis of osteoporosis was present in 2.9% and 1% of cases, and treatment prior to fracture in 3.9% and 0% of cases from HCPUC and HUAP, respectively. None of the patients in HUAP were diagnosed with osteoporosis during hospital stay or given treatment for this condition at discharge, in comparison to 0.9% (n=1) and 2% (n=2), respectively, in HCPUC. Seven and six percent of cases presented prior hip fractures. Telephonic follow up of patients revealed that 75.6% persisted without treatment for osteoporosis. At follow up, 2.9% and 3% of patients in HCPUC and HUAP had presented new hip fractures. At the time of survey 30.9% and 34% of patients, respectively, were considered invalid. Conclusions: Missed diagnosis and failure to treat osteoporosis occurred in over 90% of patients admitted for hip fracture, regardless of the different complexities in the hospitals of admission. The data suggest that lack of medical action on these issues may play a role in failure to prevent new hip fractures (Rev Méd Chile 2003; 131: 773-8) <![CDATA[<I>Complete recovery of life-threatening hungry bone syndrome using long-term ambulatory intravenous calcium infusion</I>: <I>Report of one case</I>]]> We report a 29 years old woman with a highly symptomatic primary hyperparathyroidism. After parathyroid adenoma excision, she presented a prolonged and life threatening hypocalcemia, due to a severe hungry bone syndrome. Conventional treatment with oral and intravenous calcium and calcitriol supplementation failed to raise serum and urinary calcium or to relief symptoms. After one month, we indicated a continuous intravenous calcium infusion allowing, during 6 months, an adequate outpatient management. Initial T scores for bone density were markedly low (L2-L4: -3.14; femoral neck: -3.07) and they increased 17% after 18 days of calcium infusion. After 147 days of treatment bone density was normal, increasing by 61%. The present case shows that the hungry bone syndrome can be a real risk for patients and a complex therapeutic challenge. With an appropriate calcium supply an early, fast and complete recovery of bone mass can be achieved (Rev Méd Chile 2003; 131: 779-84) <![CDATA[<I>Hypothyroidism after the excision of a Struma ovarii</I>]]> Struma ovarii is a teratoma composed of thyroid tissue and can be a rare cause of hyperthyroidism. We report a 35 years old woman with a left ovarian mass whose pathology revealed a Struma ovarii. This tumor was partially excised initially to avoid fertility problems and after a successful gestation, the tumor was completely removed during a cesarean section. Sixty days after delivery a hypothyroidism was diagnosed. Levothyroxine was started and euthyroidism was achieved (Rev Méd Chile 2003; 131: 785-7) <![CDATA[<I>Decentralization of health care and medical teaching</I>: <I>The Chilean experience</I>]]> In Chile there has been a close interaction between medical teaching and health care. In 1943, the University of Chile School of Medicine (founded in 1833) created Chairs in several public hospitals. The University of Chile School of Public Health (founded in 1943) played a key role in the creation in 1952 of a centralized National Health Service (NHS). The NHS had outpatient clinics and hospitals all over the country and was responsible for health care and for the promotion of health and disease prevention programs. In 1954, the NHS and the School of Medicine set up Residencies and General Practitioners programs aimed at improving the distribution of specialists and general practitioners throughout the country. In 1979, the NHS was replaced with 27 autonomous Health Services headed by the Ministry of Health, while the administration of primary care outpatient clinics was transferred to the municipal government. However, sanitary programs were still managed at the central level. Higher education also expanded and was decentralized. There are currently 60 universities and 17 medical schools, compared to eight and six, respectively, in 1981. The number of students in higher education has increased by 370% in 20 years. At the present time, the Chilean health case system is a predominantly public system with a strong and sizeable private system. Sixty two percent of the population is covered by public health insurance, while 27% is covered by private insurance. New and well equipped private clinics have multiplied. Private non profit institutions manage the prevention and treatment of work related injuries and diseases. Chile's outstanding health indicators (fertility rate: 17.2 x 1,000; mortality: 5.4 x 1,000; maternal mortality: 2.3 x 10,000; neonatal mortality: 4.5 x 1,000; life expectancy: 76 years) are a direct consequence of the improved social, cultural and economic condition of the general populations as well as of the sanitary programs sustained over the past half century (Rev Méd Chile 2003; 131: 788-98) <![CDATA[<I>Discrimination in medical assistance</I>: <I>An overview based on medical oaths</I>]]> Background: All humans have the right to receive a thorough medical attention, and should not be discriminated. Aims: To determine if there is a significant relationship between Medical Oaths that commit to the principle of no discrimination in health care and the time, origin and source of the modifications to the Hippocratic Oath. To specify which are the conditions for no discrimination. Materials and Methods: Fifty Oaths found in different articles and publications were analyzed and selected considering their historical context. Results: Of the fifty Oaths that were analyzed, nineteen express a commitment towards no discrimination, whereas one of the texts is discriminatory. The only significant relationship found was the origin and source of the texts. The most frequently discriminating factors found are social class, religion, nationality and race. At present, other factors can be found such as ideology, moral, aptitude, sex and political and sexual preferences. Conclusions: The commitment towards no discrimination is not widely found in Medical Oaths of all times (30/50). According to the bioethics principle of justice, physicians should find the limit of their obligation as doctors in providing medical assistance to everyone alike, wealthy or poor; Christians, Hebrews or Muslims; men or women; children, adults or old; with or without infectious diseases. Non discrimination should be a vow that physicians must be willing to take despite any of the factors that could influence health care (Rev Méd Chile 2003; 131: 799-807) <![CDATA[<I>Biographical notes on Salvador Allende, MD</I>]]> Thirty years have elapsed since the tragic death of Salvador Allende, MD. He occupies a high position as a symbol of the fall of real socialism. He became the most famous physician/politician of his times in Chile and the tracks of his life became imprinted, during the past century, in the pages of Revista Médica de Chile. This is a proper time to reconstruct his historical memory from a more reflexive perspective (Rev Méd Chile 2003; 131: 809-14) <![CDATA[<I>Who owns medical records?</I>]]> Thirty years have elapsed since the tragic death of Salvador Allende, MD. He occupies a high position as a symbol of the fall of real socialism. He became the most famous physician/politician of his times in Chile and the tracks of his life became imprinted, during the past century, in the pages of Revista Médica de Chile. This is a proper time to reconstruct his historical memory from a more reflexive perspective (Rev Méd Chile 2003; 131: 809-14) <![CDATA[<I>Meditations on medical ethics problems</I>]]> Thirty years have elapsed since the tragic death of Salvador Allende, MD. He occupies a high position as a symbol of the fall of real socialism. He became the most famous physician/politician of his times in Chile and the tracks of his life became imprinted, during the past century, in the pages of Revista Médica de Chile. This is a proper time to reconstruct his historical memory from a more reflexive perspective (Rev Méd Chile 2003; 131: 809-14)