Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720060002&lang=es vol. 134 num. 2 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b>Seguimientos de anticuerpos contra hepatitis A y E en una cohorte de niños de bajo nivel socioeconómico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200001&lng=es&nrm=iso&tlng=es Background: The seroprevalence of antibodies against hepatitis A virus (HAV) is decreasing in many Latin American countries, along with improvements in sanitary standards. However, there is no information available about low socioeconomic status (LSE) populations. Aim: To assess the evolution of hepatitis A and E virus antibodies in a cohort of LSE Chilean children. Material and methods: One hundred sixty eight children aged four years, 97 males, coming from public primary care clinics, were studied. Two blood samples were obtained with an interval of one year. Anti-HAV and anti-hepatitis E virus (HEV) antibodies, were detected by ELISA using Abbott kits. Results: Anti-HAV was positive in 19 children (11.3%). After one year of follow-up, only 10 children had sustained reactivity (52.6%). Fourteen children, initially negative, became positive during the follow up (9.4%). Antibody titers to HAV were significantly higher in samples that remained positive, compared with those that lost reactivity. Anti-HEV was found positive in two children (1.2%). One remained positive and the other became negative. Conclusions: In this cohort of LSE Chilean children, the prevalence to antibodies against HAV and HEV is low. Follow-up detected loss of reactivity to HAV in nearly one half of the children, probably related to lower antibody levels <![CDATA[<b>Apendicectomía en la embarazada</b>: <b>Experiencia en un hospital público chileno</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200002&lng=es&nrm=iso&tlng=es Background: Acute appendicitis is the most common non obstetric surgical emergency during pregnancy. Aim: To asses our experience in the diagnosis and management of acute appendicitis occurring during pregnancy. Patients and methods: Data from all pregnant patients who were subjected to an appendectomy for a suspected acute appendicitis from January 1998 to December 2002, were retrospectively analyzed. All pathological, surgical, clinical records and the delivery outcome registry of each patient were reviewed. Results: Among 47,322 deliveries, 46 pregnant women aged 29±9 years and with a gestational age of 21±7 weeks, were operated because of a presumptive acute appendicitis. Forty (87%) had a histopathologically proven appendicitis; ten (25%) cases had a perforated appendix and 30 (75%) had a non-perforated appendicitis. Five (10.9%) patients had a negative laparotomy and one had a necrotic ovarian tumor. Patients with perforated and non perforated appendices had a similar lapse from the onset of symptoms to operation (69±45 and 50±34 hours respectively, NS) and a similar white cell count (15,667±3,707 and 13,006±5,206 cells/mm³, respectively, NS). Wound infection was the most common surgical complication in 15%. Seven (15%) patients had a premature delivery and there was one fetal death (2.2%). There were no pregnancy complications on negative appendectomy cases. Conclusions: Acute appendicitis continues to be a challenge in diagnosis and treatment during pregnancy. Maternal and fetal outcome was better than previously reported <![CDATA[<b>Aumento de la mortalidad por cáncer de colon en Chile, 1990-2003</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200003&lng=es&nrm=iso&tlng=es Background: In Chile, colorectal cancer is the third cause of mortality due to digestive cancer. Aim: To assess the evolution of colon cancer mortality rates in the period 1990-2003. Material and methods: Information was obtained from demography and vital statistics yearbooks, published by the Chilean National Statistics Institute. Mortality tendecies and slopes, were calculated using Pearson correlation analysis and linear regression. Proportions were compared using Chi square. Results: There was a significantly rising tendency in mortality for colon cancer in the general population (r= 0.964, p <0.001), in men (r=0.926, p <0.001) and in women (r=0.943, p <0.001). This tendency was not modified if rates were corrected by age. Mortality among women was significantly higher in all study years. The increase in mortality rates in the period was 0.175/100,000 inhabitants per year. The higher mortality rates were observed during 2003, reaching 6.2/100,000 inhabitants. Conclusions: There was a steady increase in colon cancer mortality during the studied period <![CDATA[<b>Autoanticuerpos anti-galectina-8 en pacientes con lupus eritematoso sistémico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200004&lng=es&nrm=iso&tlng=es Background: The family of lectins known as galectins (galectins 1-14) are involved in the regulation of the immune system and in oncogenesis. During a search for antigens recognized by antibodies produced by a patient with systemic lupus erythematosus (SLE) we found reactivity against galectin-8, for which autoantibodies have not been previously described. Aim: To determine the frequency of autoantibodies against galectin-8 in lupus patients compared with healthy controls. Patients and Methods: Galectin-8 was purified from a bacterial expression system and used in immunoblot assays as antigen to screen the sera of 55 SLE patients and matched controls. Disease activity was evaluated using the Mexican Modification of the Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI). Results: Reactivity against galectin-8 was detected in 30% of SLE patients, compared to 7% of controls (p=0.003). We could not detect any particular SLE manifestation associated to the presence of these autoantibodies. Conclusions: This is the first description of autoantibodies against galectin-8. Its higher frequency in patients with SLE suggests a pathogenic role. Further studies are needed to determine their clinical relevance <![CDATA[<b>Complicaciones asociadas a la trombocitopenia profunda en pacientes con dengue</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200005&lng=es&nrm=iso&tlng=es Background: Thrombocytopenia is a distinctive characteristic of dengue; however, few studies have related thrombocytopenia with its clinical severity. Aim: To identify the complications of dengue, associated to severe thrombocytopenia, defined as a platelets count below 50,000/mm³). Patients and Methods: Patients with clinical and serologic (positive IgM) diagnosis of dengue, consulting at hospitals located in Santander, Colombia, during the period 1993-1998, were studied. Clinical findings and laboratory tests (including hematocrit and platelets counts) were registered. The association between severe thrombocytopenia and the presence of complications, such as hemorrhagic manifestations (positive tourniquet test, petechiae, ecchymoses, bleeding from gums, epistaxis, hematemesis, hematuria and metrorrhagia) and signs of plasma leakage (pleural effusions and haemoconcentration), were evaluated using a univariate and multivariate analysis. Results: Of the 790 patients enrolled, 502 had a platelet count below 50,000/mm³. Severe thrombocytopenia was associated with hemorrhagic manifestations (OR= 3.16; 95% CI: 2.09-4.76; p <0.0001) and signs of plasma leakage (OR= 2.67; 95% CI: 1.86-3.84; p <0.0001). The associations between severe thrombocytopenia and the complications of dengue (with exception of bleeding from gums, hematuria and metrorrhagia), were confirmed with the multivariated analysis (p <0.05). Conclusion: There was a strong association between deep thrombocytopenia and the severity of dengue <![CDATA[<b>Susceptibilidad a penicilina en cepas de <i>Streptococcus pneumoniae</i> aisladas en el Hospital de Puerto Montt, 1995-2003</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200006&lng=es&nrm=iso&tlng=es Background: The emergence and dissemination of resistance to penicillin among Streptococcus pneumoniae changed the approach to empiric antimicrobial therapy. Aim: To evaluate the in vitro susceptibility to penicillin in all S. pneumoniae strains isolated in Puerto Montt Hospital between 1995 and 2003. Material and methods: We revised all Microbiology Laboratory files of this period. Identification and antimicrobial susceptibility study methods for S pneumoniae did not change during the study period. Results: Six hundred eighteen S pneumoniae strains were identified. Of these, 66% came from adults and 48% from invasive diseases. Only 1.9% of strains were penicillin resistant and 7.6% had intermediate sensibility. Strains isolated from children and those isolated from non sterile sources had non significantly higher resistance levels. The susceptibility did not change along the years of the study. Conclusions: Among S pneumoniae strains isolated at Puerto Montt Hospital, the prevalence of penicillin resistance is low <![CDATA[<b>¿Existe en la constipación idiopática severa un trastorno difuso de la motilidad intestinal? </b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200007&lng=es&nrm=iso&tlng=es Background: Studies in patients with chronic severe constipation, suggest the presence of a diffuse motor disorder of the gastrointestinal tract. Aim: To investigate small bowel motor activity in a group of patients with severe constipation. Material and Methods: Forty three patients (age range 13 to 70 years, 40 women) with severe constipation referred to our motility laboratory, where studied. Ten had a previous colectomy. Radiological examinations showed a megacolon in 30 and dilatation of small intestinal loops in nine; the remaining X rays studies were normal. Small intestinal motility was studied using perfused catheters and external transducers. Results: Ten patients had normal motor recordings. Eight patients showed a neuropathic disorder characterized by a continuous irregular pattern of contractions of normal amplitude, with absence of phase III of the migrating motor complex (MMC). Sixteen presented a normal MMC associated to a decreased amplitude of contractions (Miopatic disorder). Nine showed both types of motor disorders (Mixed pattern). Normal radiological findings were more commonly associated to normal manometric recordings. By contrast, an altered motor activity, mainly of myopathic and mixed type motor disorder, was observed in all patients with dilated small intestinal and colonic loops. Conclusions: The presence of small intestinal motor disorders was a frequent finding in this selected group of patients with chronic constipation <![CDATA[<b>Comparación entre el aspecto endoscópico del cardias, hallazgos manométricos y pHmetría de 24 horas en pacientes con síntomas de reflujo gastroesofágico crónico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200008&lng=es&nrm=iso&tlng=es Background: The endoscopic view of the gastric cardia could be related with the manometric competence of the lower esophageal sphincter (LES) and with pathological gastroesophageal reflux. Aim: To compare the endoscopic aspect of the cardia with the results from esophageal manometry and 24 h esophageal pH monitoring. Materials and Methods: The cardia of a group of 150 patients (aged 19 to 72 years, 89 women) with gastroesophageal reflux symptoms was classified as normal or open, during upper gastrointestinal endoscopy. All subjects were subjected to a manometric study to measure LES pressure and determine LES incompetence and to a 24 h esophageal pH measurement. Results: LES pressure was 14.7±6.2 and 8.7±4.2 mmHg in patients with normal and open cardia, respectvively (p <0.001). Likewise, 43 and 79% of patients with normal and open cardia had an incompetent LES, respectively (p <0.001). Pathological acid reflux was present in 43 and 71% of patients with normal or open cardia, respectively (p <0.001). Conclusions: The endoscopic appearance of the cardia can identify patients with pathological gastroesophageal reflux <![CDATA[<b>Parásitos intestinales en caninos y felinos con cuadros digestivos en Santiago, Chile</b>: <b>Consideraciones en Salud Pública</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200009&lng=es&nrm=iso&tlng=es Background: There is an increasing importance of pet-transmitted infections, some of those are considered emerging infections. Aim: To determine the species and frequency of intestinal parasites in pets with diarrhea (hemorrhagic gastroenteritis excluded). Material and methods: A descriptive retrospective study. Fecal samples from 972 dogs and 230 cats consulting in two veterinary practices in Santiago, between 1996 and 2003, were studied using Burrows' technique. Results: Protozoa were found in 64.8% of dogs and in 66.5% of cats; helminthes in 24% of dogs and 45.2% of cats. The species found in dogs were Blastocystis sp. in 36%, Ameba sp. in 31%, Giardia intestinalis in 22%, Toxocara canis in 11%, Chilomastix sp. in 10%, Isospora sp. in 9%, Trichuris vulpis in 9%, Trichomonas sp. in 5%, Sarcocystis sp. in 4%, Dipylidium caninum in 2%, Ancylostomideos in 2%, Toxascaris leonina in 1%, Physaloptera sp. in 1%, Taenia sp. in 0.4%. Species found in cats were Blastocystis sp. in 37%, Ameba sp. in 30%, G intestinalis in 19%, Chilomastix sp. in 12%, Isospora sp. in 12%, Toxocara cati in 10%, D caninum in 7%, Sarcocystis sp. in 5%, Trichomona sp. in 5%, Toxoplasma gondii in 4%, Taenia sp. in 2% and Physaloptera sp. in 1%. Forty eight percent of parasites found in dogs and 49% found in cats have zoonotic potential. In dogs younger than six months Blastocystis sp., Ameba sp., G intestinalis, Chilomastix sp., Isospora sp. and T canis were significantly more common; the same was observed for Isospora in young cats. Approximately 60% of infected animals bore more than one parasite. Conclusions: A high rate of intestinal parasitism in pets with diarrhea was found; an important proportion of them have zoonotic potential <![CDATA[<b>Utilidad de isosorbide sublingual en la reversibilidad de la hipertensión pulmonar reactiva, en pacientes candidatos a trasplante cardíaco</b><b> </b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200010&lng=es&nrm=iso&tlng=es Background: Continuous infusion of short life vasodilators are employed to test reversibility of pulmonary hypertension in cardiac transplant candidates. Sublingual isosorbide administration has not been described in the literature and it might be a simpler alternative. Aim: To evaluate sublingual isosorbide administration as a test of reversibility of pulmonary hypertension in heart failure. Patients and Methods: Prospective evaluation of patients referred for cardiac transplant evaluation. Patients underwent right catheterization for hemodynamic measurements at baseline and after repeated doses of 5 mg sublingual isosorbide every 5 minutes until observing a decrease in pulmonary vascular resistance decrease or symptomatic hypotension. Results: Twenty one patients, 18 men, age 49±15 years, were studied. Fourteen (66%) were transplanted. The mean sublingual isosorbide dose was 15±5 mg. After isosorbide administration, there was a significant decrease in mean arterial pressure (80±8.5 to 71±6.6 mmHg, p <0.0001), mean pulmonary artery pressure (38±11 to 26±7.8 mmHg, p <0.0001), systemic vascular resistance (1540±376 to 1277±332 dyn*s/cm5 p <0.001), pulmonary vascular resistance (3.5±2.2 to 2,5±1.6 Wood Units, p <0.05) and transpulmonary gradient (13±7 a 10±4 mmHg, p <0.004). The cardiac output increased from 3.96±0.7 to 4.38±0.9 L/min, p=0.05. The relation between pulmonary and systemic vascular resistance before and after isosorbide was 0.17 and 0.15, respectively (p=0.04). One transplanted patient with partial reversibility of pulmonary hypertension developed acute right heart failure. Conclusions: Sublingual isosorbide administration is useful and well tolerated to evaluate the reversibility of pulmonary hypertension prior cardiac transplant <![CDATA[<b>Atrapamiento de la arteria poplítea</b>: <b>Comunicación de un caso </b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200011&lng=es&nrm=iso&tlng=es Popliteal artery entrampment is a rare condition, occurring in young subjects, that causes ischemia of the extremity. The anatomical background is the compression or occlussion of the popliteal artery caused by forced plantar or dorsal flexion. We report a 32 year-old sportsman who presented with gangrene of the right first toe and a history of three months of progressive claudication. The Ankle-Brachial index and pulse volume curve registries showed a severe ischemia below the knee. Angiography showed a medial deviation of the popliteal artery associated to stenosis and aneurysm formation. A CT scan of the contralateral artery was normal. The patient was operated using a posterior approach, performing a reverse saphenous vein bypass graft and excising the popliteal artery. The postoperative period was uneventful <![CDATA[<b>Insuficiencia renal aguda secundaria a rabdomiólisis de esfuerzo</b>: <b><i>Report of three cases</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200012&lng=es&nrm=iso&tlng=es Renal failure secondary to effort rhabdomyolysis is uncommon. We report three males age 28, 37 (military sportsmen) and 44 years (sedentary obese), with this condition. Episodes occurred after a training session to run a triathlon, during the course of a mini marathon and during a rescue attempt of a drowning person. All three subjects experienced intense muscle symptoms, hemoglubinuria, oliguria, rise of blood urea nitrogen and a significant rise in muscle enzymes. Creatinekinase reached a maximum of 41 times normal, aspartate aminotransferase a maximum 35 times normal and lactacte dehydrogenase a maximum of 11 times normal. There was a rapid elevation of serum creatinine, reaching values of 6.6 and 9.8 mg/dl on the third day after the physical effort. This parameter had a disproportionate elevation in relation to urea nitrogen, in two subjects. All subjects were managed with saline hydration, sodium bicarbonate and furosemide. Only one required hemodialysis for two days. All normalized their renal function 18 to 48 days after the physical exertion. No subject had other predisposing conditions for acute renal failure <![CDATA[<b>Síndrome miasteniforme de Lambert-Eaton idiopático</b>: <b><i>Report of one case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200013&lng=es&nrm=iso&tlng=es Lambert-Eaton myasthenic syndrome (LEMS) is an autoinmune idiopathic or paraneoplastic syndrome producing antibodies agaisnt presynaptic voltage calcium channels. The clinical features of patients with LEMS are muscle weakness and autonomic dysfunction. We report a 40 years old man with a four years history of proximal weakness, absent tendon reflexes and dry mouth. The diagnosis was confirmed by characteristic electromyographic findings, showing a low-amplitude muscle response that increased dramatically after activation. Circulating antibodies to voltage-gated calcium channel were present. The search for malignant tumors was negative. The patient was treated with prednisone and azathioprine and after four months, he was able to walk and signs of autonomic dysfunction started to subside <![CDATA[<b>Prevensión cardiovascular y actitud de cambio frente a los factores de riesgo</b>: <b>un análisis crítico del estado actual</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200014&lng=es&nrm=iso&tlng=es In recent years the main focus of cardiovascular prevention has been to identify people without clinical evidence of coronary disease, but with a high risk of developing a clinical event. Long term follow up studies show that a young person with a high "Relative Risk" of presenting a cardiovascular event becomes an adult with a high "Absolute Risk" of suffering it. The aim of primary prevention is to avoid the appearance of cardiovascular diseases, delaying the development of atherosclerosis and its consequences. In this scenario, the first step is to increase awareness among healthy people of their own cardiovascular risk, enhancing their knowledge of their risk parameter values and generating a correct perception of the risk burden that those values mean. Literature review reveals that significant percentages of healthy individuals are unaware of their own values of blood pressure, total cholesterol and blood glucose. Furthermore, people aware of having abnormal parameters have low treatment compliance rates or evidence inconsistency between knowledge and behavior. This paper reviews educational strategies and other factors that influence this knowledge-behavior gap, such as the stages of behavior changes of the Prochaska and Diclemente Model. Evidence has shown that knowledge about cardiovascular risk factors is not enough to influence behavior and that the degree of preparation of people towards behavior changes is a strong predictor of the success of educational and counseling interventions. Local Chilean data from the RICAR project also shows that the profile of behavior change is different for each modifiable cardiovascular risk factor <![CDATA[<b>Sospecha de patologías sistémicas a través de alteraciones ungueales</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200015&lng=es&nrm=iso&tlng=es Nails are protective, thin, horny growth at the end of fingers and toes. Abnormalities of the fingernails and toenails can provide both subtle and obvious clues to common medical problems or severe systemic diseases. Inheritance, minor injuries, common habits, the use of cosmetics and a variety of infections account for many changes in the appearance of nails. Awareness of normal nail variants, abnormalities and their disease associations will be beneficial to detect systemic diseases <![CDATA[<b>Análogos de insulina</b>: <b>en búsqueda del reemplazo fisiológico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200016&lng=es&nrm=iso&tlng=es Insulin analogues, developed by molecular engineering, have structural changes in the A and B insulin chains. These modifications change their action profile, rendering insulin replacement closer to physiology. Rapid acting analogues like lispro, aspart and glulisine, are absorbed rapidly from the subcutaneous tissue to the circulation. In addition, two long acting insulin analogues have been developed: glargine and detemir. The combination of a long acting insulin, to maintain baseline levels, and multiple daily doses of a rapid acting analogue are the mainstay of basal-bolus therapy. Multiples studies have compared human insulin (NPH and regular) with insulin analogues in patients with type 1 or 2 diabetes mellitus, showing an improvement in the metabolic control, fewer hypoglycemic events and better quality of life. In summary, insulin analogues offer new therapeutic options and allow an individualized intensive treatment <![CDATA[<b>Responsabilidad profesional</b>: <b>máximos, mínimos, excelencia y veracidad</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200017&lng=es&nrm=iso&tlng=es Professional responsibility provides the groundwork for medicine since the existence of the Hippocratic Oath. Physicians must be prepared to justify their decisions and actions, based on scientific issues but also considering the underlying professional responsibilities. Ethical theories form a major part of such justification. A number of competing ethical theories may be identified. The maximal, minimal and excellence ethical theories agree with our experience with moral uncertainties. But veracity ethics is a new form of answering moral questions. Clinical situations are unavoidably conflictive. Lucid understanding of the necessary character of these conflicts leads to self-recognition and the itinerary of veracity ethics runs from misunderstanding to recognition. The self-awareness that veracity offers to physicians is difficult and painful due to the narcissistic humiliation that it inflicts on them <![CDATA[<b>Diagnóstico etiológico de síndromes febriles y exantemáticos en Venezuela</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200018&lng=es&nrm=iso&tlng=es Professional responsibility provides the groundwork for medicine since the existence of the Hippocratic Oath. Physicians must be prepared to justify their decisions and actions, based on scientific issues but also considering the underlying professional responsibilities. Ethical theories form a major part of such justification. A number of competing ethical theories may be identified. The maximal, minimal and excellence ethical theories agree with our experience with moral uncertainties. But veracity ethics is a new form of answering moral questions. Clinical situations are unavoidably conflictive. Lucid understanding of the necessary character of these conflicts leads to self-recognition and the itinerary of veracity ethics runs from misunderstanding to recognition. The self-awareness that veracity offers to physicians is difficult and painful due to the narcissistic humiliation that it inflicts on them <![CDATA[<b>RÉPLICA</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000200019&lng=es&nrm=iso&tlng=es Professional responsibility provides the groundwork for medicine since the existence of the Hippocratic Oath. Physicians must be prepared to justify their decisions and actions, based on scientific issues but also considering the underlying professional responsibilities. Ethical theories form a major part of such justification. A number of competing ethical theories may be identified. The maximal, minimal and excellence ethical theories agree with our experience with moral uncertainties. But veracity ethics is a new form of answering moral questions. Clinical situations are unavoidably conflictive. Lucid understanding of the necessary character of these conflicts leads to self-recognition and the itinerary of veracity ethics runs from misunderstanding to recognition. The self-awareness that veracity offers to physicians is difficult and painful due to the narcissistic humiliation that it inflicts on them