Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720040010&lang=pt vol. 132 num. 10 lang. pt <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<B>A national birth weight distribution curve according to gestational age in Chile from 1993 to 2000</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000001&lng=pt&nrm=iso&tlng=pt Background: The World Health Organization recently defined the criteria for constructing birth weight curves using population based data. Aim: To construct a national curve of weight, size and ponderal index at birth for Chile, following the criteria suggested by the World Health Organization (WHO) expert committee report from 1995. Material and methods: A national database from the Chilean Institute for Statistics was used. All alive singleton deliveries during the period from 1993 to 2000 were included. A birth weight curve for the total population as well as for size and ponderal index at birth was construted, including percentile distribution, mean and standard deviation of values for gestational age. Stratification by sex was performed. Results: A total of 2,049,446 singleton deliveries were analyzed. The 10 percentiles (raw data) for birth weight throughout gestation from 22 to 42 weeks were: 470, 520, 560, 630, 660, 749, 810, 926, 1,031, 1,160, 1,320, 1,480, 1,680, 1,920, 2,190, 2,500, 2,750, 2,910, 3,010, 3,080 and 3,090 g, respectively. Conclusions: A national birth weight for Chilean population (a predominant Hispanic population) was constructed. There are not differences between this curve and the standard proposed by WHO (population from California, USA) suggesting that under comparable perinatal indices, ethnicity is not a relevant factor determining birth weight (Rev Méd Chile 2004; 132: 1155-65) <![CDATA[<B>Weight maintenance in humans</B>: <B>Could it mimic calorie restriction of animal models?</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000002&lng=pt&nrm=iso&tlng=pt Background: Energy restriction (ER) extends life span in animals, by decreasing oxidative stress. Aim: To compare adiposity, metabolic variables and DNA oxidative damage, among adults, reporting a constant body weight (weight maintainers), versus those reporting a progressive increase (weight gainers). Subjects and Methods: Clinical history, dietary recall, anthropometric measures, abdominal CT scan and fasting blood samples (to measure lipoproteins, glucose and insulin), were obtained in 44 males. These subjects were classified as weight maintainers if they had a change in weight of 3 kg or less in the last 10 years, or weight gainers, if they had a weight increment of more than 6 kg in the same lapse. Oxidative damage was assessed by 8-hydroxydeoxyguanosine (8-OHdG), in DNA extracted from circulating lymphocytes, in 5 weight maintainers, 8 weight gainers and 5 healthy elders. Results: Energy intake was 18% higher in weight gainers (p <0.01). Adiposity and central fat were higher among weight gainers (p <0.01). Abdominal fat correlated with serum lipoproteins, glucose and insulin sensitivity, assessed by the Homeostasis Model Assessment (HOMA). 8-OHdG levels did not differ between groups. Conclusions: The analysis of weight change based on the clinical history correlates with actual body composition, thus it may be a reliable indicator of long term energy intake. This method could be comparable to weight clamp models employed in animals to study aging (Rev Méd Chile 2004; 132: 1166-72) <![CDATA[<B>Resistance to gentamicin, amikacin and ciprofloxacin among nosocomial isolates of Klebsiella pneumoniae subspecie pneumoniae producing extended spectrum ß-lactamases</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000003&lng=pt&nrm=iso&tlng=pt Background: Klebsiella pneumoniae is a pathogenic bacterium frequently isolated from nosocomial samples, specially the subspecie pneumoniae, with extensive antibiotic resistance profiles, including third generation cephalosporins, aminoglycosides and quinolones. This is specially true for those strains producing extended spectrum beta lactamases (ESBL). Aim: To investigate the susceptibility to gentamicin, amikacin and ciprofloxacin and the presence of some aminoglycoside modifying enzyme (AMEs) among nosocomial strains of K pneumoniae subspecie pneumoniae producing ESBL. Material and methods: The antibiotic resistant patterns and the level of resistance (minimal inhibitory concentration, MIC) of 100 strains, isolated from several hospitals of different Chilean cities, were determined. The presence of some aminoglycosides modifying enzyme (AMEs) was investigated by PCR. Results: Sixty five percent of strains were resistant to gentamicin, 47% were resistant to amikacin and 29% were resistant to ciprofloxacin. The most frequent AMEs genes detected were the aac(6')-Ib gene (6'-N-Acetyltransferase type Ib enzyme) in 69% of strains, conferring resistance to amikacin, kanamycin, tobramycin, and neomycin, and the gene aac(3)-IIa (3-Acetyltransferase type 3-IIa enzyme), in 36% of strains, conferring resistance to gentamicin. Conclusions: Among nosocomial strains of K pneumoniae subspecie pneumoniae isolated from Chilean hospitals, there is an association between the production of ESBL and the resistance to others antimicrobial agents, especially aminoglycosides. Nevertheless, 71% of isolates are susceptible to ciprofloxacin (Rev Méd Chile 2004; 132: 1173-8) <![CDATA[<B>Hyper-IgM Syndrome in members of two unrelated Chilean families</B>: <B>molecular and mutation analysis</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000004&lng=pt&nrm=iso&tlng=pt Background: Hyper-IgM syndrome (HIGM) is a rare primary immunodeficiency used to describe a heterogeneous group of disorders characterized by recurrent bacterial infections, normal or elevated serum IgM levels and low or absent serum IgG, IgA and IgE. Aim: To make definitive diagnosis, detect mutations in carriers and perform genetic counseling in patients with HIGM. Patients and methods: We studied the expression of CD40L, CD40 and made a mutation analysis of the CD40L gene in 3 males of 2 unrelated Chilean families diagnosed as a possible syndrome of hyper-IgM and 3 relatives. Results: We identified a deletion frameshift in the exon 2 (delA225) of the extracellular domain of CD40L gene in one patient and verified the carrier status of his mother and sister. The other patients showed a low expression of CD40L in activated T cells (65.3% and 65.5%) and a normal expression of CD40. No alterations were found in the single strand conformation polymorphism analysis of the CD40L. Conclusions: These result allowed us to make a definitive diagnosis of HIGM1 of a patient, detect female carriers and suggest a HIGM of recessive inheritance with normal CD40 expression in the patients of the second family (Rev Méd Chile 2004; 132: 1179-88) <![CDATA[<B>Prevalence of type 2 diabetes and obesity in two Chilean aboriginal populations living in urban zones</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000005&lng=pt&nrm=iso&tlng=pt Background: The prevalence of cardiovascular risk factors is increasing in aboriginal populations in Chile. Aim: To study the prevalence of obesity, type 2 diabetes and serum lipids in two aboriginal populations, Mapuche and Aymara, that were transferred from a rural to a urban environment. Subjects and Methods: Two groups of subjects over 20 years were analyzed, Mapuche and Aymara. The Mapuche group was formed by 42 men and 105 women, living in four urban communities of Santiago, and an Aymara group formed by 42 men and 118 women, living in Arica, in Northern Chile. Anthropometric measurements, blood pressure, lipid profile, oral glucose tolerance test, fasting insulin and serum leptin were determined. Results: The prevalence of type 2 diabetes was 6.9% in Aymara and 8.2% in Mapuche subjects. The frequency of glucose intolerance was similar in both groups, but greater among men. A total blood cholesterol over 200 mg/dl was observed in 43.1% of Aymara and 27.9% of Mapuche subjects (p <0.008). Serum triglycerides over 150 mg/dl were observed in 16.9 and 23.1% of Aymara and Mapuche individuals, respectively (p= NS). Conclusions: The prevalence of type 2 diabetes and dyslipidemia in urban aboriginal populations is higher than that of their rural counterparts. A possible explanation for these results are changes in lifestyles that come along with urbanization, characterized by a high consumption of saturated fat and refined sugars and a low level of physical activity (Rev Méd Chile 2004; 132: 1189-97) <![CDATA[<B>Yield of biopsy, brushing and bronchial washing through fiberbronchoscopy in the diagnosis of lung cancer with visible lesions</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000006&lng=pt&nrm=iso&tlng=pt Background: The combination of endobronchial biopsy with cytological brushing is considered the best procedures for the diagnosis of lung cancer during bronchoscopy. Aim: To asses the diagnostic yield for lung cancer (with visible endobronchial alterations at endoscopy) of three fiberoptic bronchoscopy procedures: endobronchial biopsy, cytological brushing and bronchial cytological washings. Material and Methods: Prospective study of 160 consecutive patients referred for fiberoptic bronchoscopy for clinically suspected lung cancer. Sequential bronchial washing, brushing and biopsies, were performed to all patients with a visible endobronchial alteration. Results: One hundred and nine patients had a visible endobronchial alteration at fiberoptic bronchoscopy, but only 86 of them completed the protocol (21 patients were not subjected to the three diagnostic bronchoscopy procedures, because of bleeding or tolerance problems, and in two patients all the data required was not available). In twenty three, the diagnosis was a benign lesion, whereas lung cancer was diagnosed in 63. Fifty four of these 63 patients had at least one of the three endoscopic procedures (endobronchial biopsy, cytological brushing and bronchial cytological washings) positive for lung cancer (85.7%). The association of endobronchial biopsy with cytological brushing was positive for lung cancer in 49 cases (78%), and was the best association of two procedures. The diagnostic yield of each procedure was: endobronchial biopsy 50/63 (79%), cytological brushing 18/63 (28.5%). Conclusions: The best yield for the diagnosis of lung cancer is obtained with the association of the two procedures (endobronchial biopsy, cytological brushing). Cytological washings have a very low diagnostic yield (Rev Méd Chile 2004; 132: 1198-203) <![CDATA[<B>Comparison of spirometric reference values in Chilean children</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000007&lng=pt&nrm=iso&tlng=pt Background: The interpretation of lung function tests must be based on reference normal values obtained in the same population. In Chile an expert panel recommended the use of values obtained by Gutierrez et al locally, that are higher than those obtained by Knudson, for forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1). Aim: To analyze the clinical application of both reference values in a selected population. Material and methods: Retrospective review of 499 spirometries done in our laboratory to 285 males and 214 females, aged 4.5 to 18 years. The reports using either Gutierrez (G) or Knudson (K) reference values were compared. The 5th percentile was considered the inferior limit for normality. Results: The height range of patients was 110-178 cm (median 130, 3rd quartile 143). Referral diagnoses were probable asthma in 349 (70%), asthma in 119 (24%), to rule out restrictive disease in 12 (2%) and others 19 (4%). FEV1/FVC ratio was > or = 84% in 290 patients. Using K values, lung function was interpreted as within normal limits in 321 patients (64.3%), as mild obstructive disease (MOD) in 171 (34.3%), as combined limitation (CL) in 2, mild restrictive disease (MRD), moderate restrictive disease (MR) and severe restrictive disease (SRD) in 1 patient each. Using G values, lung function was interpreted as within normal limits in 133 patients (26.7%), MOD in 343 (68.7%), MRD in 6, CL in 4 and MR in 2. In 193 spirometries (39%) there was lack of concordance between the interpretations using K or G values. Conclusions: There is a wide rante of variability when G or K values are used to interpret lung function in children in Chile. Redefinition of local standards would be necessary (Rev Méd Chile 2004; 132: 1205-10) <![CDATA[<B>Antimicrobial susceptibility of Shiga toxin producing E coli (STEC) strains isolated from human infections and food</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000008&lng=pt&nrm=iso&tlng=pt Background: Shiga toxin-producing E coli (STEC) are zoonotic pathogens associated to sporadic episodes of bloody diarrhea, foodborne outbreaks, and Hemolytic Uremic Syndrome (HUS), with worldwide public health impact. Antibiotic use in STEC infections is controversial because of the potential to increase production and secretion of Shiga toxins. Aim: To study the in vitro antimicrobial susceptibility profile of STEC. Material and methods: The in vitro susceptibility profile against 10 antimicrobials of STEC strains isolated from 29 meat products, 20 patients with diarrhea and 9 HUS patients was studied. Minimal Inhibitory Concentrations (µg/ml) by agar dilution method for ampicillin, cloramphenicol, ciprofloxacin, amikacin, gentamycin, cotrimoxazol, ceftriaxone, tetracycline, fosfomycin and azithromycin were measured according to NCCLS recommendations. Results: Strains from patients with diarrhea or HUS were all susceptible to the 10 antimicrobials and only 13.7% had intermediate resistance to cloramphenicol. Strains from meat products had a similar susceptibility profile, with only 3.5% resistance to tetracycline, 3.5% intermediate resistance to cloramphenicol and 7% to fosfomycin. All 58 strains were considered resistant to azithromycin (MIC >32 ug/ml). Conclusions: Similarity of susceptibility profiles between STEC strains from human and food origin suggests a role of food chain in transmission to humans (Rev Méd Chile 2004; 132: 1211-6) <![CDATA[<B>Malignant middle cerebral artery territory infarct in one patient with bacterial meningitis</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000009&lng=pt&nrm=iso&tlng=pt The mortality of acute bacterial meningitis (BM) has remained stable in the last decades in spite of the use of new antibiotics, probably due to vascular complications. We report a 68-year-old woman with BM who had a malignant infarction of left middle cerebral artery territory 72 hours after admission to the hospital. The patient experienced a bad evolution and died four days after admission. The arterial involvement in patients with BM is explained by vasospasm of large arteries and vasculitis of small arteries. The medical treatment of a malignant middle cerebral artery infarct has a high mortality (Rev Méd Chile 2004; 132: 1217-20) <![CDATA[<B>Carotid cavernous fistula</B>: <B>Report of two cases</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000010&lng=pt&nrm=iso&tlng=pt A carotid cavernous fistula is an abnormal communication between a branch of the carotid artery and the cavernous sinus generating an arteriovenous fistula that can cause severe ocular damage. We hereby report two cases of carotid cavernous fistulas. A 69-year-old male with a 2-month history of right eyelid swelling and red eye aggravated by diplopia, exophthalmus, and limitation of ocular movements one week before consulting. On admisson his visual acuity in the right eye was good (0.5) and biomicroscopy showed arterialization of conjunctival vessels. An orbital CAT scan showed a dilatation of the superior orbital vein characteristic of carotid cavernous fistula. A balloon tamponade of the fistula was performed too late (after 3 weeks) and the eye went blind. A 39-year-old female consulted for an acute proptosis of the right eye and severe visual loss. Biomicroscopy showed arterialization of the conjunctival vessels and the CAT scan disclosed a dilatation of the superior orbital vein. She was immediately subjected to a neuroradiological fistula closure with recovery of visual acuity to 1.0 (20/20). Our main purpose is to emphasize the importance of the opportune diagnosis and treatment of these fistulas to prevent visual loss and eventual blindness, as occurred in our first patient (Rev Méd Chile 2004; 132: 1221-6) <![CDATA[<B>Mortality caused by acute myocardial infarction in Chile in the period 1990-2001</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000011&lng=pt&nrm=iso&tlng=pt Background: Acute myocardial infarction is the first cause of death among adults in Chile. It caused 5,650 deaths during 2001. Aim: To analyze the evolution and mortality of Acute Myocardial Infarction in Chile between 1990 and 2001. Material and methods: Analysis of data on mortality caused by Acute Myocardial Infarction in Chile, obtained from the databases of the Ministry of Health. The adjusted mortality rates and disability adjusted life years (DALY) were calculated for the period. Results: In the study period, adjusted mortality decreased from 86 to 67.6 deaths/100,000 inhabitants. The DALYs ratio between men and women increased from 2.7 to 2.9. The mean death age for men and women was 69.9 and 76.5 years respectively (p <0.001). Forty five percent of women and 51% of men died at home, 78% of women and 66% of men received medical attention. Conclusions: Although there was a reduction in mortality caused by acute myocardial infarction in the study period, there are still gender differences in the age of death, and access to medical care (Rev Méd Chile 2004; 132: 1227-33) <![CDATA[<B>Junk food consumption and child nutrition in Chile</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000012&lng=pt&nrm=iso&tlng=pt The increasing consumption of junk food and snacks in Chile in recent years and its association with marketing strategies and prevalent diseases, is reviewed. In the context of world economy, junk food is a global phenomenon. The availability of junk food and snacks at low prices and marketing has triggered an evolution of consumption of foods that require neither the structure nor the preparation of a formal meal. Many studies have suggested that the increase in snack consumption is associated with an increase in obesity, tooth decay and other chronic diseases among children and adolescents. The hypothesis suggests a link between the pattern of snack consumption and an increase in the energy density of food consumed, a decrease in satiety, passive over consumption, and an increase in obesity. Between 1977 and 1996, the contribution of snacks to daily energy intake among children between 2 and 5 years increased by 30% in the United States. In each age group in Chile, the frequency of non-transmissible chronic diseases is increasing due primarily to a westernized diet that is high in fat, cholesterol, sodium, and sugar and a sedentary lifestyle. Education about junk food consumption and healthy eating habits in the family, starting since childbirth and public policies about healthy lifestyles should be strengthened (Rev Méd Chile 2004; 132: 1235-42) <![CDATA[<B>The evaluation of decision making capacity in health care and its relationship to informed consent</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000013&lng=pt&nrm=iso&tlng=pt The decision making capacity of patients will acquire special relevance with the introduction of informed consent in clinical practice and the new normative that will appear in the future when the bills about health services are approved in the Congress. This paper reviews the concept of decision making capacity in the context of health care and its legal background in Chile. The main problems that arise from the comprehension, use and assessment of decision making capacity, are analyzed. The assessment of this capacity is, in most cases, subjective since there are no criteria, protocols or standards to be used. In courts of justice, the «exercise capacity» assessment is requested to experts. These specialized physicians will evaluate the mental health of the subject and its implications in the capacity to make decisions. In practice, it is difficult to integrate the concept of capacity from the law or health care perspective. It is concluded that the elaboration of criteria, standards and procedures to evaluate the decision capacity of patients, is mandatory (Rev Méd Chile 2004; 132: 1243-8) <![CDATA[<B>Consensus report on the diagnosis and management of non palpable thyroid nodules</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000014&lng=pt&nrm=iso&tlng=pt With the availability of new diagnostic techniques, numerous alterations are found, whose real importance for health is uncertain. The term «incidentalomas», is used for non apparent tumors found in diagnostic procedures. In Endocrinology, the incidental finding of thyroid nodules is common. The occurrence of those incidental nodules requires a review of the «classical» statements for the management of palpable nodules. The most important issue is to rule out the presence of cancer. The Chilean Society of Endocrinology, Metabolism and Nutrition appointed a group of experts to generate a consensus on the management of non palpable nodules. These experts reviewed international literature, and the local experience, analyzed the value of thyroid ultrasound examination and the efficiency of fine needle aspiration biopsy. This consensus is a clinical guide for the management of non palpable thyroid nodules, considering that a unique and optimal approach is still lacking (Rev Méd Chile 2004; 132: 1249-55) <![CDATA[<B>Thyroid nodules in children</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000015&lng=pt&nrm=iso&tlng=pt With the availability of new diagnostic techniques, numerous alterations are found, whose real importance for health is uncertain. The term «incidentalomas», is used for non apparent tumors found in diagnostic procedures. In Endocrinology, the incidental finding of thyroid nodules is common. The occurrence of those incidental nodules requires a review of the «classical» statements for the management of palpable nodules. The most important issue is to rule out the presence of cancer. The Chilean Society of Endocrinology, Metabolism and Nutrition appointed a group of experts to generate a consensus on the management of non palpable nodules. These experts reviewed international literature, and the local experience, analyzed the value of thyroid ultrasound examination and the efficiency of fine needle aspiration biopsy. This consensus is a clinical guide for the management of non palpable thyroid nodules, considering that a unique and optimal approach is still lacking (Rev Méd Chile 2004; 132: 1249-55) <![CDATA[<B>Bacteremic pneumococcal pneumonia and antibiotics</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000016&lng=pt&nrm=iso&tlng=pt With the availability of new diagnostic techniques, numerous alterations are found, whose real importance for health is uncertain. The term «incidentalomas», is used for non apparent tumors found in diagnostic procedures. In Endocrinology, the incidental finding of thyroid nodules is common. The occurrence of those incidental nodules requires a review of the «classical» statements for the management of palpable nodules. The most important issue is to rule out the presence of cancer. The Chilean Society of Endocrinology, Metabolism and Nutrition appointed a group of experts to generate a consensus on the management of non palpable nodules. These experts reviewed international literature, and the local experience, analyzed the value of thyroid ultrasound examination and the efficiency of fine needle aspiration biopsy. This consensus is a clinical guide for the management of non palpable thyroid nodules, considering that a unique and optimal approach is still lacking (Rev Méd Chile 2004; 132: 1249-55) <![CDATA[<B>XV congreso chileno de endocrinología y diabetes 2004 y jornadas chileno-argentinas </B>: <B>Resúmenes de trabajos libres de Endocrinología y Diabetes 2004 y Jornadas Chileno-Argentinas</B>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872004001000017&lng=pt&nrm=iso&tlng=pt With the availability of new diagnostic techniques, numerous alterations are found, whose real importance for health is uncertain. The term «incidentalomas», is used for non apparent tumors found in diagnostic procedures. In Endocrinology, the incidental finding of thyroid nodules is common. The occurrence of those incidental nodules requires a review of the «classical» statements for the management of palpable nodules. The most important issue is to rule out the presence of cancer. The Chilean Society of Endocrinology, Metabolism and Nutrition appointed a group of experts to generate a consensus on the management of non palpable nodules. These experts reviewed international literature, and the local experience, analyzed the value of thyroid ultrasound examination and the efficiency of fine needle aspiration biopsy. This consensus is a clinical guide for the management of non palpable thyroid nodules, considering that a unique and optimal approach is still lacking (Rev Méd Chile 2004; 132: 1249-55)