Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720030008&lang=en vol. 131 num. 8 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<B><I>Evidence Based Medicine, in Revista Médica de Chile</B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800001&lng=en&nrm=iso&tlng=en Since the beginning of the 20th century, the principles of the experimental method in biological sciences have been progressively applied in biomedical and clinical research. After the pioneering work of AB Hill et al, biostatistics became a fundamental tool in the appraisal of new therapeutic agents or methods, and of diagnostic tests. From 1990 on, «Evidence based Medicine» has been added to it. This journal opens in this issue a section containing critical analysis of articles published in the medical literature deserving the attention of its readers. However, as several other medical journals have stressed, we recommend that the conclusions of these analysis should not be used as a substitute for clinical judgment and they do not represent an official position of our journal. Revista Médica de Chile welcomes the new Section and invites contributions to it (Rev Med Chile 2003; 131: 835-6 <![CDATA[<B><I>Biochemical phenotypes and phage types of Salmonella enteritidis strains isolated in Antofagasta during the period 1997-2000</B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800002&lng=en&nrm=iso&tlng=en PhP-S48 (Phene Plate Techniques AB), a method based on biochemical phenotypes has been developed and used successfully to typify S enteritidis strains in epidemiological studies. Aim: To identify phenotypes of S enteritidis isolated from eggs, chicken meat and infected humans in Antofagasta during the period 1997-2000. Material and Methods: PhP-S48 and phage typing were used to identify phenotypes of 33 S enteritidis strains, sixteen isolated from poultry and 17 from clinical sources. S enteritidis ATCC17036 was used as control strain. Results: Twelve biochemical phenotypes (BTs) including 4 common (C) and 8 single (S) were identified. BTs C1 y C3 containing 16 and 5 strains, respectively, accounted for 63.6% of the isolates. BT C1 was found in poultry and human sources in the period 1997-2000, and BT C3 was isolated from humans, in the period 1999-2000. Using phage typing, 5 phage types (PT) and 3 strains could be not typed (NTs). PT1 and PT21 were the dominant phage types, with 14 and 13 strains respectively. Strains of PT1 were isolated from poultry and human sources in the period 1997-2000. PT21 was found in poultry samples in the period 1997-1998 and in clinical samples, in the period 1997-1998. Combination of biochemical phenotypes and phage typing divided the strains into 5 phenotypes (BT:PT). Two phenotypes were the most frequently isolated, phenotype C1:1 with 8 isolates found in eggs and humans in 1999, and phenotype C1:21 with 5 strains isolated in 1997-1999. Conclusions: These results indicate the presence of one persistent and one recently emerged phenotype among S enteritidis in Antofagasta, Chile. PhP-S48 also provided information about a relationship among the strains (Rev Méd Chile 2003; 131: 837-45) <![CDATA[<B><I>Medical outcomes and antimicrobial compliance according to the Chilean Society of Respiratory Diseases guidelines for hospitalized patients with community acquired pneumonia</B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800003&lng=en&nrm=iso&tlng=en The Chilean Society of Respiratory Diseases (SER) developed guidelines for the empirical treatment of community acquired pneumonia (CAP). Aim: To evaluate the degree of adherence to antibiotic treatment recommended by SER guidelines and its influence on medical outcomes. Patients and Methods: We prospectively evaluated 453 consecutive immunocompetent adults (mean age±SD: 69±19 years) hospitalized for CAP. Patients were stratified according to the Pneumonia Severity Index (PSI), and initial antibiotic regimen was classified as being consistent or inconsistent with the SER guidelines. Rate of medical complications, switch therapy rate, length of stay (LOS), and 30 days mortality were compared between those treated consistently or inconsistently with the SER guidelines. Results: Adherence to SER guidelines was 46%. Patients treated consistently with the SER guidelines were older (mean age±SD: 72±16 v/s 65±20 years), had more comorbidities (84 v/s 69%) and a higher proportion belonged to the high-risk PSI categories (69 v/s 49%). There were no significant differences in medical complication rate, switch therapy rate or LOS between both groups. Adherence to SER guidelines did not affect mortality after adjusting for PSI and for prognostic factors associated with 30 days mortality by multivariate analysis. Conclusions: The degree of adherence to antibiotic treatment recommended by SER guidelines was moderate and they were applied mainly in patients with high risk CAP. This fact can explain the lack of evidence of improved medical outcome in patients treated according to SER guidelines (Rev Méd Chile 2003; 131: 847-56) <![CDATA[<I>Results of a multidisciplinary and intensified treatment program for type 1 Diabetes Mellitus in a Chilean Public Hospital</I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800004&lng=en&nrm=iso&tlng=en During the last decade, the importance of glycemic control in the prevention of the microvascular complications of type 1 Diabetes Mellitus (DM1) was clearly demonstrated. Aim: To evaluate the metabolic and anthropometric results of a multidisciplinary intensified treatment program of DMI in children and adolescents. Patients and methods: Report of 54 patients treated during 2001. The intensified treatment consisted of: multiple daily doses of insulin, frequent glycemic control, nutritional, psychological and educational support, and permanent availability of a diabetes nurse for telephonic support. Results: Thirty one patients were female, their mean age was 10.4±0.5 years old and 52% were experiencing puberty. Fifty three percent of the patients used 3 insulin doses per day, 95% changed rapid insulin dose based on glucose levels and 18% considered carbohydrates in their rapid insulin dosing. Mean glycosilated hemoglobin was 8.18±0.23% without differences by sex or pubertal status. Sex, pubertal stage and the number of insulin doses did not contribute to glycosilated hemoglobin changes. There were no differences in weight or BMI, but there was a decrease in height Z score from the admission to the program until the last control (0.1±0.1 vs -0.3±0.1 DS; p <0.01). Conclusions: A modified intensified modality of DM1 therapy for pediatric patients in a public hospital in Chile is feasible, achieving similar metabolic control, compared to international large centers (Rev Méd Chile 2003; 131: 857-64) <![CDATA[<B><I>Bovine serum albumin (BSA) antibodies in children with recently diagnosed type 1 diabetes</B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800005&lng=en&nrm=iso&tlng=en Background : Environmental and genetic factors (viruses, toxins and diet) are involved in the aetiology of type 1 diabetes. Among the dietary factors, the role of breast feeding and exposure to cow's milk proteins deserve special attention. Aim: To determine the anti-BSA-IgG levels in type 1 diabetic children and to analyse the possible association with breast feeding duration, exposure to cow's milk and ß pancreatic auto-antibodies. Patients and methods: Blood samples were collected from 161 diabetic children and 144 controls to measure anti-BSA-IgG level, GAD65, IA-2 and ICA autoantibodies. All children answered a questionnaire about dietary habits during infancy. Results: anti-BSA-IgG was positive (using a cut off point of 25.6 ng/ml) in 98% of diabetic children and 0% of the control population. The length of breast feeding or early exposure to cow's milk did not influence the concentration of anti-BSA-IgG. Positive BSA titers did not increase the ß pancreatic reactivity (ICA+, GAD+, IA-2+). Conclusions: Our data confirm the high frequency of anti-BSA-IgG among diabetic children. However, a specific role in the immunological process of type 1 diabetes cannot be attributed to this protein (Rev Méd Chile 2003; 131: 865-72) <![CDATA[<B><I>Tobacco smoking and mental health </B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800006&lng=en&nrm=iso&tlng=en Smoking continues to be one of the most important health burdens worldwide. Aim: To describe smoking habits and associated risk factors in the population of Santiago, Chile. Material and methods: A cross sectional study of a representative sample of the population, from 16 to 64 years old, residents of Santiago, Chile (total population: 3,237,286). A structured interview that included questions about use of tobacco, the CIS-R interviews, used for common mental disorders, were applied. Results: From the sample of 4,693 households, 3,870 people were interviewed (52.2% women, 47.8% men) and 10% refused. Forty percent of the population currently smoked (52.5% men, 47.8% women). «Being a current smoker» was associated with being younger than 55, male sex, and having a common mental disorder. Discussion: Smoking is highly prevalent in Chile, as compared with developed countries and with some developing countries. Gender differences in use of tobacco have decreased. A higher risk of smoking for people with mental disorders is confirmed (Rev Méd Chile 2003; 131: 873-80) <![CDATA[<B><I>Clinical assessment of subjects infected with Trypanosoma cruzi</B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800007&lng=en&nrm=iso&tlng=en Trypanosoma cruzi infection is endemic in Northern/Central Chile. Aim: To perform a clinical assessment of patients infected with Trypanosoma cruzi. Patients and methods: Two hundred sixty three subjects with a positive serology for Trypanosoma cruzi, were invited by mail to a clinical assessment in a Regional Hospital. In a subsample of these, a polymerase chain reaction for Trypanosoma cruzi, was done. Results: Of all the invited subjects, 183 responded and were assessed at the hospital. Of these, 60 had cardiac affections, 52 had colon problems and 17, esophageal disease. Seventy four were asymptomatic. Of the 64 patients in whom polymerase chain reaction was done, 35 had a positive result. Conclusions: A high percentage of subjects infected with Trypanosoma cruzi, had clinical consequences of the infection. Polymerase chain reaction showed persistency of the parasite in more than half of the infected patients (Rev Méd Chile 2003; 131: 881-6) <![CDATA[<B><I>Falls in institutionalized elderly subjects</B></I>: <B><I>Features and geriatric assessment</B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800008&lng=en&nrm=iso&tlng=en Falls are an important cause of disability and mortality among elderly subjects. Aim: To study the features and incidence of falls in institutionalized elderly subjects. Patients and methods: Prospective recording of all falls, occurring in a period of eight months, to 453 subjects older than 60 years, living a home for the elderly. Evaluation of functional status of subjects suffering falls, using the Spanish Red Cross score. One hundred and two subjects living in the same place, but not suffering falls, were considered as controls. Results: One hundred and three subjects, aged 80±6 years (24% of the sample) suffered falls. Most falls were during the day and while walking. Seventy percent of subjects suffering falls did not have a history of previous falls. Nine percent of those falling, suffered a fracture. Compared to controls, falling subjects had a more deteriorated functional and mental status and consumed more benzodiazepines and neuroleptics. Conclusions: There is an association between functional status and psychotropic medication consumption and the incidence of falls in institutionalized elderly subjects <![CDATA[<B><I>Geriatric assessment of elderly subjects consulting in a public primary care outpatient clinic </B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800009&lng=en&nrm=iso&tlng=en A good medical care program for the elderly requires a thorough assessment of the functional capacity and limitations of the consulting patients. Aim: To perform a geriatric assessment to elderly subjects consulting in a public outpatient clinic. Patients and methods: A cross sectional assessment of subjects over 60 years old, beneficiaries of the public health care system and consulting in 4 outpatient clinics of a poor community of Metropolitan Santiago. Evaluation included a complete medical history, the Katz score for activities of daily living (ADL), Lawton score for instrumental activities for daily living (IADL) and Folstein Mini Mental state examination. Results: During the study period 1,023 subjects, 73% female, aged 74±7 years, were assessed. Thirteen percent were illiterate, 78% elementary school, 8% had high school and 0.2% university education. Eighty eight percent lived with relatives, 79% did not participate in community groups and 7% smoked. The most common chronic disease detected was high blood pressure in 61%, followed by obesity in 32%, osteoarthritis in 22%, diabetes mellitus in 17%, depression in 11%, cardiac diseases in 8%, hypothyroidism in 3% and epilepsy in 1%. ADL score showed partial dependency in 11% and total dependency in 2%. IADL score showed partial dependency in 41% and total dependency in 4%. Mini Mental score was abnormal in 31% of subjects. Conclusions: High blood pressure, osteoarthritis, depression and cognitive impairment are the most common health problems in this sample of elderly subjects. ADL score showed a low rate of dependency (Rev Méd Chile 2003; 131: 895-901) <![CDATA[<B><I>The influence of respiratory virus infections and environmental conditions on pediatric health care demand during winter-2002 in Santiago, Chile</B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800010&lng=en&nrm=iso&tlng=en The increase in winter related health pediatric demand is associated with three factors: cold and rainy weather, air pollution and respiratory viral epidemics. During the winter of 2002 there was, successively, heavy rain, air pollution, cold weather and a respiratory syncytial virus (RSV) epidemic in Santiago. Aim: To study the influence of environmental factors and RSV epidemic on pediatric health care demand. Patients and methods: The number of hospital admissions and outpatient consultations for acute lower respiratory infections (ALRI) from April to October 2002 (Autumn to Spring in Chile), were registered in a public pediatric hospital of Santiago. A respiratory virus surveillance (RSV, adenovirus influenza and parainfluenza virus) was carried out among children admitted for ALRI. Climate conditions and air pollution (number of particles of more than 10 microns/mm3) values were provided by local environmental health services. Results: As expected, a rise in winter hospital admissions and outpatient consultations was detected, that peaked in week 29. This rise coincided with the higher RSV detection week. There was heavy rain in weeks 22, 23 and 30, as well as cold weather in June-July (weeks 23, 24, 26, 27 and 30; mid Winter), that did not increase health care demand. Likewise, high air pollution, registered from weeks 24 to 26, did not increase health care demand. Conclusions: RSV epidemic is the principal factor associated to the increase in health burden during winter in Santiago (Rev Méd Chile 2003; 131: 902-8) <![CDATA[<B><I>Reversion of hypophosphatemia after the excision of a composite hemangioendothelioma in a great toe. Report of one case </B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800011&lng=en&nrm=iso&tlng=en We report a 43 years old male admitted to the hospital for progressive lumbar pain, lasting 20 years, that caused severe disability. On admission the patient had a serum phosphate of 2 mg/dl, an urine phosphate excretion over 300 mg/dl and serum alkaline phosphatases over 750 U/L. Serum intact parathormone was normal and tubular maximum phosphorus/glomerular filtration was 0.7 mg/dl. Bone scintigraphy showed an increased radionuclide uptake in condro-costal joints. Bone densitometry showed femoral osteoporosis. A violet colored mass was detected in a great toe. It was removed and the pathological diagnosis was a composite hemangioendothelioma. After tumor excision, serum phosphate levels returned to normal values and symptoms disappeared within 15 days (Rev Méd Chile 2003; 131: 909-14) <![CDATA[<B><I>Dementia caused by vitamin B12 deficiency</B></I>: <B><I>Report of one case </B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800012&lng=en&nrm=iso&tlng=en Cyanocobalamin (vitamin B12) deficiency can cause polyneuropathy, myelopathy, blindness, confusion, psychosis and dementia. Nonetheless, its deficiency as the sole cause of dementia is infrequent. We report a 59 years old man with a 6 months history of progressive loss of memory, disorientation, apathy, paranoid delusions, gait difficulties with falls, and urinary incontinence. He had suffered a similar episode 3 years before, with a complete remission. On examination there was frontal type dementia with Korsakoff syndrome, a decrease in propioception and ataxic gait. Cerebrospinal fluid examination showed a protein of 0.42 g/L. Brain computed tomography showed sequelae of a frontal left trauma. Brain single photon computed tomography (SPECT) was normal. Complete blood count showed a macrocytic anemia with a hematocrit 29% and a mean corpuscular volume of 117 µ3. Plasma vitamin B12 levels were undetectable, erythrocyte folate levels were 3.9 ng/ml and plasma folate was normal. The myelogram showed megaloblastosis and the gastric biopsy showed atrophic gastritis. Treatment with parenteral B12 vitamin and folic acid reverted the symptoms, with normalization of the neuropsychological tests and reintegration to work (Rev Méd Chile 2003; 131: 915-9) <![CDATA[<B><I>Rhomboencephalitis caused by listeria monocytogenes infection</B></I>: <B><I>Report of three cases </B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800013&lng=en&nrm=iso&tlng=en Listeria monocytogenes infections can involve the central nervous system in the form of a rhomboencephalitis. Three possible cases of rhomboencephalitis by Listeria monocytogenes are reported (2 females, aged 44 and 49 and a man of 36 years old). The three cases were preceded by an unspecific prodrome of headache, vertigo and fever in absence of a meningeal syndrome. The neurological stage was defined by the unilateral involvement of cranial nerves and the cerebellum and a clear inflammatory cerebrospinal fluid (CSF) with the presence of polymorphonuclear leukocytes, and normal glucose and protein levels. A magnetic nuclear resonance (MRI) showed the appearance of characteristic images, present in the bulboprotuberancial region. These images are one of the most constant features of this disease, reported in the literature. The early diagnosis of rhomboencephalitis was based on the clinical picture, the study of the CSF and the MRI, allowing the use of antimicrobials, prior to microbiological identification. Therefore, the risk of brain stem and cardiac complications of the disease is reduced (Rev Méd Chile 2003; 131: 921-8) <![CDATA[<B><I>Abraham Horwitz, MD (1910-2000) a Leading Man of Pan American Public Health </B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800014&lng=en&nrm=iso&tlng=en The Chilean physician Abraham B Horwitz (1910-2000) was an outstanding personality of World and Pan American public health during the second half of the twentieth century. He was member of a family that, emigrating due to ethnic persecutions in Russia, took refuge in Chile. He became a relevant physician, a specialist in infectious diseases and public health. He was highly influential in the birth of the Public Health School at the University of Chile and the Chilean Health Service. He became Executive Director of the Pan American Health Organization, holding that position for 16 years. During this period, the institution experienced a great development. He stimulated research in the areas of basic sanitation, nutrition and eradication of transmissible diseases. He also opened unexplored areas such as the relation between economy, modern administration and health. During his last years, he chaired a successful Nutrition Committee at the United Nations. The most outstanding achievement of this Committee was the promotion of widespread vitamin A use. His intellectual and social deed is continued by The Pan American Foundation for Health and Education and this institution established an annual prize in his memory. (Rev Méd Chile 2003; 131: 929-34) <![CDATA[<B><I>Master of Internal Medicine </B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800015&lng=en&nrm=iso&tlng=en Master of Internal Medicine is the highest award granted by the Chilean Society of Internal Medicine (Sociedad Médica de Santiago) to its members. This article outlines the sense and transcendence of this award and provides an abridged, certainly incomplete, data of the recipients since 1981 when this award was first given. Those who have received it are not the only ones that have the attributes to deserve such distinction. There are many members with similar or even better merits, and therefore the Directory of the Society is usually exposed to a very hard decision when facing each new nomination. When a member is awarded, he becomes a model to be emulated or surpassed by the future generations; thus assumes the great responsibility of maintaining the spirit, the prestige and the projection of Internal Medicine into the future (Rev Méd Chile 2003; 131: 935-8) <![CDATA[<B><I>Evidence based medicine revisited </B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800016&lng=en&nrm=iso&tlng=en Evidence based medicine (EBM) appeared early in the 1990s and since then it has been developed and expanded worldwide. A decade later we summarize the history of EBM, the initial debates and the evolution to the current concept of evidence based health care (EBHC) as a tool for clinical decision making. We also describe the process of EBHC, some insights to current dilemmas and the situation of EBM in Chile (Rev Méd Chile 2003; 131: 939-46) <![CDATA[Introducción]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800017&lng=en&nrm=iso&tlng=en Evidence based medicine (EBM) appeared early in the 1990s and since then it has been developed and expanded worldwide. A decade later we summarize the history of EBM, the initial debates and the evolution to the current concept of evidence based health care (EBHC) as a tool for clinical decision making. We also describe the process of EBHC, some insights to current dilemmas and the situation of EBM in Chile (Rev Méd Chile 2003; 131: 939-46) <![CDATA[Glosario de Medicina Basada en Evidencia]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800018&lng=en&nrm=iso&tlng=en Evidence based medicine (EBM) appeared early in the 1990s and since then it has been developed and expanded worldwide. A decade later we summarize the history of EBM, the initial debates and the evolution to the current concept of evidence based health care (EBHC) as a tool for clinical decision making. We also describe the process of EBHC, some insights to current dilemmas and the situation of EBM in Chile (Rev Méd Chile 2003; 131: 939-46) <![CDATA[<B><I>Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal Women</B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800019&lng=en&nrm=iso&tlng=en CONTEXT: Despite decades of accumulated observational evidence, the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain. OBJECTIVE: To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States. DESIGN: Estrogen plus progestin component of the Women's Health Initiative, a randomized controlled primary prevention trial (planned duration, 8.5 years) in which 16608 postmenopausal women aged 50-79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993-1998. INTERVENTIONS: Participants received conjugated equine estrogens, 0.625 mg/d, plus medroxyprogesterone acetate, 2.5 mg/d, in 1 tablet (n = 8506) or placebo (n = 8102). MAIN OUTCOMES MEASURES: The primary outcome was coronary heart disease (CHD) (nonfatal myocardial infarction and CHD death), with invasive breast cancer as the primary adverse outcome. A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke, pulmonary embolism (PE), endometrial cancer, colorectal cancer, hip fracture, and death due to other causes. RESULTS: On May 31, 2002, after a mean of 5.2 years of follow-up, the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits. This report includes data on the major clinical outcomes through April 30, 2002. Estimated hazard ratios (HRs) (nominal 95% confidence intervals [CIs]) were as follows: CHD, 1.29 (1.02-1.63) with 286 cases; breast cancer, 1.26 (1.00-1.59) with 290 cases; stroke, 1.41 (1.07-1.85) with 212 cases; PE, 2.13 (1.39-3.25) with 101 cases; colorectal cancer, 0.63 (0.43-0.92) with 112 cases; endometrial cancer, 0.83 (0.47-1.47) with 47 cases; hip fracture, 0.66 (0.45-0.98) with 106 cases; and death due to other causes, 0.92 (0.74-1.14) with 331 cases. Corresponding HRs (nominal 95% CIs) for composite outcomes were 1.22 (1.09-1.36) for total cardiovascular disease (arterial and venous disease), 1.03 (0.90-1.17) for total cancer, 0.76 (0.69-0.85) for combined fractures, 0.98 (0.82-1.18) for total mortality, and 1.15 (1.03-1.28) for the global index. Absolute excess risks per 10.000 person years attributable to estrogen plus progestin were 7 more CHD events, 8 more strokes, 8 more PEs, and 8 more invasive breast cancers, while absolute risk reductions per 10.000 person years were 6 fewer colorectal cancers and 5 fewer hip fractures. The absolute excess risk of events included in the global index was 19 per 10.000 person years. CONCLUSIONS: Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2 years follow up among healthy postmenopausal US women. All cause mortality was not affected during the trial. The risk benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD <![CDATA[<B><I>Who should certify specialists in Forensic Medicine, in Chile</B></I>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800020&lng=en&nrm=iso&tlng=en CONTEXT: Despite decades of accumulated observational evidence, the balance of risks and benefits for hormone use in healthy postmenopausal women remains uncertain. OBJECTIVE: To assess the major health benefits and risks of the most commonly used combined hormone preparation in the United States. DESIGN: Estrogen plus progestin component of the Women's Health Initiative, a randomized controlled primary prevention trial (planned duration, 8.5 years) in which 16608 postmenopausal women aged 50-79 years with an intact uterus at baseline were recruited by 40 US clinical centers in 1993-1998. INTERVENTIONS: Participants received conjugated equine estrogens, 0.625 mg/d, plus medroxyprogesterone acetate, 2.5 mg/d, in 1 tablet (n = 8506) or placebo (n = 8102). MAIN OUTCOMES MEASURES: The primary outcome was coronary heart disease (CHD) (nonfatal myocardial infarction and CHD death), with invasive breast cancer as the primary adverse outcome. A global index summarizing the balance of risks and benefits included the 2 primary outcomes plus stroke, pulmonary embolism (PE), endometrial cancer, colorectal cancer, hip fracture, and death due to other causes. RESULTS: On May 31, 2002, after a mean of 5.2 years of follow-up, the data and safety monitoring board recommended stopping the trial of estrogen plus progestin vs placebo because the test statistic for invasive breast cancer exceeded the stopping boundary for this adverse effect and the global index statistic supported risks exceeding benefits. This report includes data on the major clinical outcomes through April 30, 2002. Estimated hazard ratios (HRs) (nominal 95% confidence intervals [CIs]) were as follows: CHD, 1.29 (1.02-1.63) with 286 cases; breast cancer, 1.26 (1.00-1.59) with 290 cases; stroke, 1.41 (1.07-1.85) with 212 cases; PE, 2.13 (1.39-3.25) with 101 cases; colorectal cancer, 0.63 (0.43-0.92) with 112 cases; endometrial cancer, 0.83 (0.47-1.47) with 47 cases; hip fracture, 0.66 (0.45-0.98) with 106 cases; and death due to other causes, 0.92 (0.74-1.14) with 331 cases. Corresponding HRs (nominal 95% CIs) for composite outcomes were 1.22 (1.09-1.36) for total cardiovascular disease (arterial and venous disease), 1.03 (0.90-1.17) for total cancer, 0.76 (0.69-0.85) for combined fractures, 0.98 (0.82-1.18) for total mortality, and 1.15 (1.03-1.28) for the global index. Absolute excess risks per 10.000 person years attributable to estrogen plus progestin were 7 more CHD events, 8 more strokes, 8 more PEs, and 8 more invasive breast cancers, while absolute risk reductions per 10.000 person years were 6 fewer colorectal cancers and 5 fewer hip fractures. The absolute excess risk of events included in the global index was 19 per 10.000 person years. CONCLUSIONS: Overall health risks exceeded benefits from use of combined estrogen plus progestin for an average 5.2 years follow up among healthy postmenopausal US women. All cause mortality was not affected during the trial. The risk benefit profile found in this trial is not consistent with the requirements for a viable intervention for primary prevention of chronic diseases, and the results indicate that this regimen should not be initiated or continued for primary prevention of CHD <link>http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872003000800021&lng=en&nrm=iso&tlng=en</link> <description/> </item> </channel> </rss> <!--transformed by PHP 10:05:33 07-05-2021-->