Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720040006&lang= vol. 132 num. 6 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<B>Cardiac failure in Chilean hospitals</B>: <B>results of the National Registry of Heart Failure, ICARO</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600001&lng=&nrm=iso&tlng= Background: Heart failure (HF) is a major public health problem. In Chile hospitalized patients due to HF have not been characterized. Aim: To evaluate clinical profile and outcome of patients hospitalized for heart failure in Chilean hospitals. Patients and Methods: Prospective registry of 14 centers. Patients hospitalized for HF in functional class III and IV were included. Epidemiological and clinical data, functional class, type of presentation, decompensation cause, electrocardiogram, echocardiogram, treatment and evolution were registered. Results: Three hundred seventy two patients aged 69±13 years old, 59% men, were assessed. The main etiologies of HF were ischemic in 31.6%, hypertensive in 35.2%, valvular in 14.9% and idiopathic in 7.4%. There was a history of hypertension 69%, diabetes in 35%, myocardial infarction in 22%, atrial fibrillation (AF) in 28%. The presentation form of HF was chronic decompensated in 86%, acute in 12%, refractory in 2%. The causes of decompensation were non compliance with diet or medical prescriptions in 28%, infections in 22% and AF 17%. ECG showed AF in 36% and left bundle branch block in 16%. Echocardiography was performed in 52% of the patients, 69% had left ventricular ejection fraction <40%. On admission, 39% received angiotensin converting enzyme (ACE) inhibitors, 15% beta-blocker, 25% digoxin, 16% spironolactone and 53% furosemide. The mean hospital stay was 11±10 days and mortality was 4.5%. Conclusions: The elderly is the age group most commonly admitted to hospital due to HF. The main etiologies were ischemic and hypertensive. The main causes for decompensations were noncompliance with diet or medical prescriptions and infections. A significant proportion had a relatively well preserved ventricular systolic function (Rev Méd Chile 2004; 132: 655-62) <![CDATA[<B>Molecular and genetic characterization of Changos descendants living in Paposo Cove</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600002&lng=&nrm=iso&tlng= Background: There are geographic and ethno historic evidences that relate Paposo cove, located 150 km south of the city of Antofagasta, with old fishermen-collector populations known as Changos, that lived in that zone in the XVII and XVIII centuries. Aim: To perform a genetic and molecular characterization of current Paposo inhabitants, through mitochondrial DNA polymorphism analysis and molecular analysis of classical ABO and Duffy blood groups. Material and methods: Forty unrelated individuals were studied. The presence of restriction polymorphisms that define A, B, C, and D Amerindian founder mitochondrial haplogroups was studied and molecular determination of classical blood groups were done by PCR. Results: One individual had A haplogroup (2.5%), 19 had B haplogroup (47.5%), six had C haplogroup (15%) and 11 had D haplogroup (27.5%). Three subjects (7.5%) did not have any of these haplogroups. Among ABO blood groups, the frequency of O101 allele was 0.39, that of allele O201 was 0.53 and that of A allele was 0.08. Duffy blood group frequencies were 0.58 for FY*A and 0.42 for FY*B. FY null allele was not found. Conclusions: The frequency distribution of Amerindian mitochondrial haplogroups in Paposo inhabitants suggest that these individuals are related with Aymara and Atacameño Amerindians that can be considered culturally and geographically close populations. This proposal is supported by the results of the molecular determination of classical blood groups. Our findings in Paposo cove may represent the distribution of these markers in Chango Indians, of whom there is limited physical evidence and that became extinct near 1890 (Rev Méd Chile 2004; 132: 663-72) <![CDATA[<B>Clinicopathological features of gallbladder polyps and adenomas</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600003&lng=&nrm=iso&tlng= Background: Chile has a high frequency of gallbladder cancer. Polyps are common lesions of gallbladder mucosa but there is little information about their morphological features. Aim: To report the clinical and pathological features of 219 gallbladder polyps. Material and methods: Cholecystectomies samples in which a polypoid lesion was diagnosed microscopically. In all cases, complete clinical information and digitalized images of the complete surgical specimens was reviewed. Results: In a period of 10 years, 21.412 gallbladders were processed. Among these, 884 carcinomas were diagnosed and in 219 cases (1%) a polyp was found. One hundred and eighty three patients were females (mean age 49.3 years) and 36 males (mean age 53.4 years). The preoperative diagnosis of gallbladder polyp was done only in 26 cases (12%). Eighty five percent of polyps were non-neoplastic (metaplastic in 32%, cholesterol in 29%, hyperplastic in 22% and inflammatory in 2%). The remaining 15% were adenomas. Seventy five percent of non-neoplastic polyps were located in the proximal half of the gallbladder and 88% of adenomas in the distal half. Ninety five percent of non-neoplastic polyps measured less than 10 mm. Among adenomas, 47% measured less than 5 mm and 28% more than 10 mm. Smaller polyps were of cholesterol and larger polyps were adenomas. Eight adenomas were associated with an adenocarcinoma, two had less than 5 mm lenght. Mean age of patients with adenomas associated to cancer was higher than patients with pure adenomas (64.6 and 44.3 years respectively, p >0.001). Conclusions: There are size and location differences between non neoplastic polyps and adenomas. Adenomas associated to cancer may measure less than 5 mm. Therefore the polyp size criteria to decide surgical behavior in symptomatic gallstone patients may be misleading (Rev Méd Chile 2004; 132: 673-9) <![CDATA[<B>Dual X-ray absorptiometry [DEXA] in normal Chilean women</B>: <B>Correlation between reference values and anthropometric variables</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600004&lng=&nrm=iso&tlng= Background: Bone mineral density results are expressed as the number of standard deviations from reference values in similar populations. However, these reference values have not been obtained locally and there may be discrepancies between Chilean and other Hispanic populations. Aim: To evaluate the results of DEXA in healthy Chilean women and to correlate them with reference values and anthropometric parameters. Material and Method: We studied prospectively 166 normal women aged between 15 and 55 years, using a Hologic QDR 1000 equipment, yielding bone mineral density (BMD), bone mineral content (BMC) and bone area (A) in the lumbar spine (LS) and femoral neck (FN). These bone densitometric variables were correlated with weight, height and age of women and compared against the reference values of the Hologic equipment. Relation between BMC and A was evaluated using a regression analysis. Results: BMD and BMC were lower to reference values in most age groups, especially for LS. There was a significant correlation of BMD with A in LS (r: 0.278, p <0.001), weight in both LS (r: 0.382, p <0.0001) and FN (r: 0.266, p <0.001), height in LS (r: 0.258, p <0.001) and age in FN (r: -0.231, p <0.01). Only in LS, regression analysis between A and BMC did not show direct proportionality. Conclusions: BMD of healthy Chilean women was lower than the reference values of the Hologic equipment for most age groups. Bone densitometric variables are non uniformly influenced by weight, height and size of bone structures (A) in normal women, especially in LS. Correct interpretation of DEXA requires the validation of reference values and to assess the value of bone area measurements (Rev Méd Chile 2004; 132: 681-90) <![CDATA[<B>Carcinoembryonic antigen (CEA) as an independent prognostic factor in colorectal carcinoma</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600005&lng=&nrm=iso&tlng= Background: CEA is widely used in the follow up of patients with colorectal carcinoma. Aim: To study the value of preoperative CEA as an independent prognostic factor in colorectal carcinoma. Patients and methods: Analysis of 373 operated patients (204 females, age range 21-92 years) with colorectal carcinoma and a mean follow up of 53 months. The cutoff value for CEA was 5 ng/ml. Ninety four percent of patients had an excisable tumor, 79% had involvement of perirectal/pericolonic adipose tissue and 46% had lymph node involvement. Staging was done using Dukes-Turnbull and TNM classifications. Results: CEA was normal in 61% of cases, over 5 ng/ml in 39% and over 15 ng/ml in 22%. There was a strong correlation between mean preoperative CEA and tumor stage, depth and lymph node involvement. During the follow up, 140 patients died, 57 with normal and 83 with elevated CEA. Cancer mortality in patients subjected to a curative excision of the tumor (Dukes A-C2/TNM I-III) was 9% for colonic tumors and 36% for rectal tumors (p <0.001). There were no survival differences in patients with Dukes B/TNM II tumors according to preoperative CEA. Among Dukes C/TNM III tumors, survival difference was only significant for rectal tumors. A Cox model disclosed tumor stage, location and preoperative CEA as independent prognostic factors for survival. Conclusions: CEA is an independent prognostic factor for survival in colorectal carcinoma and high levels suggest an advanced disease (Rev Méd Chile 2004; 132: 691-700) <![CDATA[<B>Assessment of 1497 Chilean nursing home residents, using the Resource Utilization Group method, RUG T-18</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600006&lng=&nrm=iso&tlng= Background: There is little information about Chilean elderly residents of long term care facilities, regarding their characteristics and need for resources. Aim: To describe main characteristics and resource utilization of residents of one of the largest nursing homes in Chile, Fundación Las Rosas de Ayuda Fraterna. Material and Methods: In a cross sectional and descriptive study, all residents were evaluated using the RUG T-18 method, that assess activities of daily living and the complexity of their clinical situation. Results: We assessed 1497 subjects 60 years old and over (73% women), with an age range of 60-106 years. Thirty six percent had urinary incontinence, 19% required assistance for feeding, and 38% needed help for walking or moving. Fifty seven percent were in the lowest category of complexity, «Institutionalization». Very few residents were in the most demanding categories, no one classified as «Rehabilitation», and only 0.7% were in «Special Care». Conclusions: This study is an important start point to learn more about elderly subjects living in nursing homes in Chile (Rev Méd Chile 2004; 132: 701-6) <![CDATA[<B>Relationship between the cause of admission and the cause of death in patients admitted to an internal medicine departament </B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600007&lng=&nrm=iso&tlng= Background: When patients are admitted to an internal medicine ward, they and their relatives believe that they will leave the internal medicine service in a better health condition or, if they die, their cause of death will be the same that motivated the hospital admission. Sometimes, patients die due to a different disease than the cause of admission or due to complications of diagnostic or therapeutic procedures. Aim: To assess the proportion of deaths that occurred in internal medicine wards for causes that differ from the cause for admission and the proportion of deaths related to complications of diagnostic or therapeutic procedures. Patients and methods: Three hundred and three consecutive patients were studied during 28 months. Their cause of death was classified in four groups: A. If it was the same illness of admission; B. A frecuent or expected complication of the illness that motivated the admission; C. A complication of one of their chronic diseases and not the one of admission; D. If it was not related to an already present chronic illness or the cause for admission. Results: Sixty nine percent of deaths corresponded to group A, 7.9% to group B, 11.2% to group C and 11.9% to group D. Diagnostic or therapeutic procedures were the cause of death in 0.7 and 3.6% of cases respectively. Conclusions: Twenty three percent of patients died due to causes that differ from the cause of admission. A low percentage of deaths were related to procedures and most of them were due to complications of therapeutic measures (Rev Méd Chile 2004; 132: 707-17) <![CDATA[<B>Change in reproductive partner among women delivering at a Metropolitan Santiago public hospital</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600008&lng=&nrm=iso&tlng= Background: Previus studies in Metropolitan Santiago, showed that at least 10% of mothers changed their reproductive partner. Aim. To study the frequency of reproductive partner change and its associated factors among women delivering in a public hospital. Subjects and methods: We interviewed 859 non primiparous women that gave birth to a child in a public hospital of Metropolitan Santiago, between March 2001 and February 2002. Results: Mean maternal age rose according to birth order from 27.4 to 33.6 years from the second to the fourth sibling. Married women were the largest group and single ones decreased from the second to the third sibling. Twenty two percent had some activity out of home and those with a high birth order (fourth or more) exhibited poorer schooling. Unwanted pregnancies increased with birth order, reaching 55% among «fourth and over» births. Thirty four percent of women delivering their second child, changed their partner. Among women delivering their third child, 38.6% had one sibling with a different father; 20.4% had changed partner during their second pregnancy and 20% during the current one. Among those in the «fourth and over» group, 56.1% had at least one sibling with a different father; 18.3% had changed partner in the second sibling; 15%, in the third and 27.8%, in the fourth and over. In all birth orders, mothers with activity out of home exhibited a higher frequency of partner change. The most common reasons to change partner were infidelity, abandon or a personal decision, while economic reasons were uncommon. Conclusions: A great number of children are exposed to bonding ruptures and to the consequential mental health or behavioral problems (Rev Méd Chile 2004; 132: 719-24) <![CDATA[<B>Liaison psychiatry in two public hospitals of Santiago</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600009&lng=&nrm=iso&tlng= Background: Medical and surgical teams consult psychiatrists when abnormal behavior or psychopathological traits are observed in their patients. Aim: To describe the experience of liaison psychiatry teams in public hospitals. Material and methods: Analysis of 128 consultations, involving 110 patients. Eighty eight patients were subjected to the structured Clinical Interview for DSM-IV-TR Axis I Disorders - Patient Edition, the Mini Mental State score and to a search for personality disorders. Results: The most commonly consulted problems were depression in 44 patients, substance abuse in 29 and suicidal behavior in 21. The psychiatric study detected that 8% of patients were asymptomatic, 8% had stress reactions, 16.5% had substance abuse, 14.6% had alcohol abuse, 11% had a major depression, 10% had delirium or dementia, 9% had anxiety disorders, 4% schizophrenia, 18% personality disorders and 19% had suicidal behaviors. Conclusions: Psychiatric consultations in medical and surgical services are common and have a wide variety of severity (Rev Méd Chile 2004; 132: 725-32) <![CDATA[<B>Congenital hepatic fibrosis</B>: <B>Report of five cases</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600010&lng=&nrm=iso&tlng= Background: Congenital hepatic fibrosis (CHF) is an autosomic dominant disease that has been associated with polycystic kidney disease. Aim: To describe the medical management of 5 children with CHF and to evaluate the presence and extension of the associated renal disease. Patients and methods: Retrospective review of the medical charts of 5 children with CHF, aged 2 to 14 years. Results: Three children presented autosomic recessive polycystic kidney disease, which was diagnosed before the appearance of liver disease manifestations. They presented a more severe liver damage, with a more aggressive clinical course requiring use of transjugular intrahepatic porto-systemic shunts (TIPS) or surgical porto-systemic shunts to control portal hypertension. The other two children, in whom the diagnosed was based on asymptomatic hepatomegaly, had normal renal function and structure with a more benign clinical course. Conclusions: The diagnosis of CHF should be suspected not only in children with polycystic kidney disease but in those children with persistent, hard consistency, left lobe predominance hepatomegaly (Rev Méd Chile 2004; 132: 733-41) <![CDATA[<B>Acute interstitial nephritis associated to lamotrigine use</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600011&lng=&nrm=iso&tlng= Acute interstitial nephritis is a mononuclear and sterile inflammation of the renal interstice caused by drugs, infections or immune phenomena. The clinical presentation is characterized by the triad of rash, fever and eosinophilia. We report a 32 years old man, in treatment with lamotrigine for depression, admitted to the hospital due to fever, abdominal pain, jaundice, cutaneus rash and malaise. Due to an oliguric renal failure of acute onset, a renal biopsy was done. The pathological study showed a granulomatous acute interstitial nephritis. He was started on hemodialysis and treated with cessation of the drug and corticosteroids, with complete recovery of the renal function (Rev Méd Chile 2004; 132: 742-6) <![CDATA[<B>Peri-ileostomic pyoderma gangrenosum</B>: <B>Report of one case</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600012&lng=&nrm=iso&tlng= We report a 39 years old woman with Ulcerative Colitis unresponsive to medical treatment. A total colectomy with Brooke ileostomy was performed, as the first operation. After six weeks she developed a peri-ileostomic Pyoderma Gangrenosum. She was treated by a multidisciplinary team, and after seven months with local treatment and systemic medication, the skin healed. Her bowel transit was reconstructed later with an ileoanal pouch and she was reinserted into her previous job (Rev Méd Chile 2004: 132: 747-9) <![CDATA[<B>Analysis of the new health module of the National Socioeconomic Characterization Survey 2000</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600013&lng=&nrm=iso&tlng= Background: The National Socioeconomic Characterization Survey (CASEN) was modified in the year 2000, to include an assessment of the inequalities in the access to health services. Aim: To analyze the health issues of year 2000 survey database. Material and methods: During 2000, 38338 urban and 26698 rural dwellings were surveyed, totaling 240000 people analyzing ascription to public or private health services and the need demand and use of these services. Results: A higher risk population (lower income, higher age and women) is ascribed to public health services. Sixty five percent of the population self perceives their health as good, this figure decreases along with age and women have a worse self perception than men. In the 30 days prior to the survey, 13% of the population had a health related event; this figure was higher among women and the lower income quintiles. Expressed health demand was higher among women and lower income quintiles. A multivariate analysis identified an age below 14 years, pertaining to a minority ethnic group, ascription to private health services, residing in rural areas, pertaining to the lower income quintile and male sex, as factors associated to a lack access to health care. In the adjusted model, pertaining to the National Health Fund (a public system) is a protective factor to receive health services. Conclusions: The significant inequalities in the access to health care should be corrected with the new Health Reform. The new module incorporated to the National Socioeconomic Characterization Survey, is usefel to assess the access to health care in Chile (Rev Méd Chile 2004; 132: 750-60) <![CDATA[<B>Atmospheric pollution and cardiovascular damage</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600014&lng=&nrm=iso&tlng= The damaging effect of atmospheric pollution with particulate matter and toxic gases on the respiratory system and its effect in the incidence and severity of respiratory diseases, is well known. A similar effect on the cardiovascular system is currently under investigation. Epidemiological studies have demonstrated that the inhalation of particulate matter can increase cardiovascular disease incidence and mortality, specially ischemic heart disease. The damage would be mediated by alterations in the autonomic nervous system, inflammation, infections and free radicals. In human studies, environmental pollution is associated with alterations in cardiac frequency variability and blood pressure and with changes in ventricular repolarization. Experimentally, an enhancement of ischemia, due to coronary obstruction, has been demonstrated. The study of the toxic effects of environmental pollution over the cardiovascualr system, is an open field, specially in Chile, were the big cities have serious contamination problems (Rev Méd Chile 2004; 132: 761-7) <![CDATA[<B>The change in medical practice</B>: <B>Psycho-social challenges for the profession</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600015&lng=&nrm=iso&tlng= This article analyzes important changes in medical practice, focusing in those most deeply perceived by a group of physicians from the Metropolitan Region of Santiago, included in a joint research conducted by the Departments of Psychiatry and Mental Health (East) of the Medical Faculty at the University of Chile and Public Health of the Catholic University of Santiago, during 2003. These are the perceived changes in the relationship between doctors and patients; increased limits in professional autonomy and the fragmentation of medical practice. Reflecting transformations in social relationships in general, they have added new stress and frustrations, as well as new opportunities and rewards to the medical profession. The perceptions identified are commented within the structural determinants of medical practice. These issues call for a refreshing discussion on the values supporting medical professionalism and the concept of profession in itself, in view of the challenges posed by the current social and cultural changes (Rev Méd Chile 2004; 132: 768-72) <![CDATA[Dangerous spiders in Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600016&lng=&nrm=iso&tlng= This article analyzes important changes in medical practice, focusing in those most deeply perceived by a group of physicians from the Metropolitan Region of Santiago, included in a joint research conducted by the Departments of Psychiatry and Mental Health (East) of the Medical Faculty at the University of Chile and Public Health of the Catholic University of Santiago, during 2003. These are the perceived changes in the relationship between doctors and patients; increased limits in professional autonomy and the fragmentation of medical practice. Reflecting transformations in social relationships in general, they have added new stress and frustrations, as well as new opportunities and rewards to the medical profession. The perceptions identified are commented within the structural determinants of medical practice. These issues call for a refreshing discussion on the values supporting medical professionalism and the concept of profession in itself, in view of the challenges posed by the current social and cultural changes (Rev Méd Chile 2004; 132: 768-72) <![CDATA[<b>Manual de Electrocardiografía</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004000600017&lng=&nrm=iso&tlng= This article analyzes important changes in medical practice, focusing in those most deeply perceived by a group of physicians from the Metropolitan Region of Santiago, included in a joint research conducted by the Departments of Psychiatry and Mental Health (East) of the Medical Faculty at the University of Chile and Public Health of the Catholic University of Santiago, during 2003. These are the perceived changes in the relationship between doctors and patients; increased limits in professional autonomy and the fragmentation of medical practice. Reflecting transformations in social relationships in general, they have added new stress and frustrations, as well as new opportunities and rewards to the medical profession. The perceptions identified are commented within the structural determinants of medical practice. These issues call for a refreshing discussion on the values supporting medical professionalism and the concept of profession in itself, in view of the challenges posed by the current social and cultural changes (Rev Méd Chile 2004; 132: 768-72)