Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720060004&lang=es vol. 134 num. 4 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b>Función pancreática exocrina en diabetes mellitus</b>: <b>Determinación de elastasa fecal</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400001&lng=es&nrm=iso&tlng=es Background: One of the complications of diabetes mellitus is the development of pancreatic exocrine insufficiency. Aim: To study pancreatic exocrine function in diabetics patients. Material and methods: Seventy two diabetic patients were included in the protocol, but two were withdrawn because an abdominal CAT scan showed a chronic calcified pancreatitis, previously undiagnosed. Fecal elastase was measured by ELISA and the presence of fat in feces was assessed using the steatocrit. Results: Mean age was 60±12 years and 67 (96%) patients had a type 2 diabetes. Fecal elastase was normal (elastase >200 µg/g) in 47 (67%) patients, mildly decreased (100-200 µg/g) in 10 (14%) and severely decreased in 13 (19%). There was a significant association between elastase levels and time of evolution of diabetes (p=0.049) and between lower elastase levels and the presence of a positive steatocrit (p=0.042). No significant association was found between elastase levels and other chronic complications of diabetes such as retinopathy, nephropathy, neuropathy, microangiopathy or with insulin requirement. Conclusions: One third of this group of diabetic patients had decreased levels of fecal elastase, that was associated with the time of evolution of diabetes. Patients with lower levels of elastase have significantly more steatorrhea. Among diabetics it is possible to find a group of patients with non diagnosed chronic pancreatitis <![CDATA[<b>Transferecia de de ß-lactamasas de espectro extendido desde</b><b> </b><b>cepas hospitalarias de</b><b> </b><b><i>Klebsiella pneumoniae</i></b><b> </b><b>a otras especies de enterobacterias</b><b> </b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400002&lng=es&nrm=iso&tlng=es Background: Klebsiella pneumoniae is an important pathogenic bacterium, frequently isolated from nosocomial samples, that exhibits wide antimicrobial resistance profiles, including third generation cephalosporins (3GC), aminoglycosides and quinolones. The resistance to 3GC is mainly due to the synthesis of extended spectrum beta lactamases (ESBL), encoded by conjugative plasmids. Aim: To investigate the potential transference of resistance to 3GC from nosocomial strains of K. pneumoniae to other clinical strains of various species of Enterobacteriaceae. Material and methods: The mating experiments were carried out in liquid media and three nosocomial strains of K. pneumoniae were used as donors. These strains were ESBL-producers and resistant to, at least, one of the 3GC assayed. One strain of Citrobacter freundii, Salmonella typhimurium, Serratia marcescens and Escherichia coli, isolated from clinical specimens, were used as recipients. The presence of bla genes was investigated by PCR. Results: The three nosocomial strains of K. pneumoniae were able to transfer the resistance to 3GC and the genes encoding the ESBL to the susceptible recipient strains of enterobacteria. The frequency of transference was as high as 3.2 x 10-2 transconjugants/recipient cell when the strain of Citrobacter freundii was used as recipient. All transconjugants exhibited high level of resistance to the 3GC assayed. Conclusions: Strains of K. pneumoniae isolated from Chilean hospitals are able to disseminate the ESBL genes to clinical strains of others species of Enterobacteriaaceae <![CDATA[<b>Malaria</b>: <b>revisión retrospectiva de 12 casos no autóctonos en Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400003&lng=es&nrm=iso&tlng=es Malaria is a protozoan infection caused by four Plasmodia species transmitted by female Anopheles mosquito. Nearly 40% of the world population is at risk of acquiring the disease because of increasing resistance to treatment, climate changes and travels to endemic zones. We report twelve patients with diagnosis of malaria, supported by the identification of parasites on blood smear. All cases had traveled to endemic zones (Peru, Ecuador, Central America, Africa), but only three used chemoprophylaxis. Seven cases were infected with Plasmodium vivax and five cases with P. falciparum. Three of latter required intensive care. All patients were treated with standard drugs according to the severity and Plasmodium specie, with excellent results and no mortality <![CDATA[<b>Resecabilidad y mortalidad operatoria de la gastrectomía subtotal y total en pacientes con cáncer gástrico avanzado, entre 1969 y 2004</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400004&lng=es&nrm=iso&tlng=es Background: The only curative treatment for gastric cancer is its surgical excision associated to a lymph node dissection. Aim: To study the evolution of resectability and operative mortality of total and subtotal gastrectomy for gastric cancer, in a period of 35 years. Material and methods: Review of medical records of 3000 patients with gastric cancer, operated between 1969 and 2004. Resectability and mortality of total and subtotal gastrectomy was compared in four successive periods (1969 to 1979, 1980 to 1989, 1990 to 1999 and 2000 to 2004). Results: In the four periods there was a steady and significant increase in resectability rate from 49 to 85%. Mortality of total and subtotal gastrectomy decreased significantly from 17 to 2% and from 25 to 1%, respectively. Conclusions: Resectability and mortality rates of total and subtotal gastrectomy have improved with time. Probably a better pre and postoperative care and the experience of the surgical team have an influence in this favorable change <![CDATA[<b>Evaluación del efecto de una intervención cognitivo-conductual sobre los niveles de presión arterial en adultos mayores hipertensos bajo tratamiento médico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400005&lng=es&nrm=iso&tlng=es Background: Cognitive and behavior therapy can be used as an adjunct to medications to reduce blood pressure in hypertensive patients. Aim: To design a brief psychological intervention for hypertensive patients and assess its effects on blood pressure. Material and methods: Thirty eight hypertensive subjects (35 women, age range 63-77 years) were studied. They were randomly divided in a control and experimental group. The latter group attended eight sessions of a cognitive-behavioral intervention, lasting two hours each, during one month. In each session, subjects were trained in relaxation techniques, cognitive modeling and psycho education. The main outcome assessed was a change in blood pressure levels. Results: In the experimental group, there was a significant reduction from baseline to the second post test assessment, in systolic and diastolic blood pressure levels from 134±9 to 123±8 mmHg and from 87±5 to 73±6 mmHg, respectively. Conclusions: The psychological intervention used in the present study achieved significant reductions in blood pressure levels in this group of hypertensive subjects <![CDATA[<b>Coma anóxico-isquémico en 46 pacientes</b>: <b>Evolución a treinta días y su relación con los reflejos de tronco</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400006&lng=es&nrm=iso&tlng=es Background: Anoxic-ischemic coma has a poor outcome with a high rate of mortality and morbidity. Therefore, clinical predictors of prognosis are needed for therapeutic decision-making. Patients and methods: Prospective analysis of 46 patients, 31 male, age range 19-85 years, with anoxic-ischemic coma following cardiac arrest. All the patients included in our study remained comatose with a Glasgow Coma Scale (GCS) score of six or less points, after their stabilization in the Intensive Care Unit. They were evaluated clinically using the pupillary light reflex, corneal reflex and vestibulo-ocular reflex testing, induced by caloric stimulation with cold water. Survival was evaluated using life tables. All patients were followed until the thirtieth day after the anoxic-ischemic event. Results: Thirty five patients (76%) died within the next twenty-nine days, 8 patients (18%) reached the vegetative state, 2 patients (4%) achieved a recovery with disability, and only 1 patient (2%) was discharged without sequelae. One day, five and 30 days survival rates were 89, 53 and 29%, respectively. The abolition of all brainstem reflexes was not a predictor of mortality. Conclusion: Thirty day survival in this group of patients was 29% and the absence of brainstem reflexes was not a predictor of mortality <![CDATA[<b>Estrés organizacional y salud en funcionarios de centros de atención primaria de una comuna de Santiago</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400007&lng=es&nrm=iso&tlng=es Background: Demands on primary health care services in Chile are increasing. The staff perception of specific sources of tension at work is not known. This knowledge is necessary to avoid preventable health problems caused by distress. Aim: To identify specific work stressors in primary health care facilities and to examine individual characteristics that could mediate their effects on health. Material and Methods: We evaluated organizational stressors (Perceived Work Characteristics for Health Services Survey), personal characteristics (Work Locus of Control Scale, Ways of Coping Check List) and distress (Goldberg General Health Questionnaire, Cooper Stress Symptoms Checklist) in a representative sample of 129 workers of 5 public Primary Health Care Centers of a borough in Santiago. Results: Women and non-professional personnel reported more psychological and physical stress symptoms. Regression analysis showed that work stressors significantly explained the variance of psychological (26%) and physical (28%) distress symptoms. Perception of more role conflicts, less support of peers and superiors and less workload were predictors significantly associated with higher stress outcomes. Avoidance coping strategies were associated with more distress and mediated the effect of organizational stressors on health. Conclusions: We identified the groups at risk of stress in Primary Health Care Centers and specific sources of tension in the organization, as well as individual risk factors. Both should be addressed in interventions to reduce distress and prevent consequences on health <![CDATA[<b>Prevalencia de síntomas de rinitis alérgica y su relación con factores de riesgo en escolares de Santiago, Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400008&lng=es&nrm=iso&tlng=es Background: The prevalence of asthma and allergic rhinitis experienced a steady increase in the last years, probably associated to changes in lifestyles. Aim: To assess the prevalence of allergic rhinitis, to evaluate changes over time (1994-2000), and to describe risk factors. Material and Methods: The International Study of Asthma and Allergies in Childhood (ISAAC) core questionnaire, with questions added about socioeconomic status (SES), was applied to 4594 children between 6-7 years old and 13-14 years old during october-december 2000. Attendance to public or private schools was also used a SES proxy. The results were compared with those of a similar survey in 5281 children, performed in 1994. Rhinitis symptoms (ever) (SR), rhinitis symptoms within last 12 months (SR12) and medical diagnosis of rhinitis (DR) were assessed. Results: There was a significant increase in the prevalence of SR, SR 12 and DR in both age groups in 2000, compared to 1994. SR older children showed a higher prevalence of SR compared with the youngest group (p=0.003). No age differences were observed in the prevalence of SR12 and DR. Both SR and SR12 were more prevalent at schools of medium and low-medium SES (p=0.003 and p=0.002 respectively). DR was significantly more prevalent among children of high SES. A better mother educational level was associated to higher prevalence of SR and SR12 (p=0.03 and p=0.04). Father educational level was associated to DR (p=0.007). The prevalence of SR12 was higher in households with carpets (p=0.017). The prevalence of DR was higher in houses with smokers (p=0.03) and gas heating (p=0.005). None of the three variables were related to gender. Conclusions: The prevalence of SR, SR12 and DR increased significantly in a short time period (6 years). Our results support a positive association between DR and high SES <![CDATA[<b>Susceptibilidad<i> in vitro</i> de bacterias anaeróbicas en infecciones pleuropulmonares</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400009&lng=es&nrm=iso&tlng=es Background: Aspirative pleuropulmonary infections are usually caused by anaerobic flora of the mouth, mainly Prevotella, Fusobacterium and Peptostreptococcus spp. Penicillin in high doses is the traditional treatment for this type of infections but the rising resistance developed in recent years has induced the empiric use of clindamycin, increasing treatment costs. Aim: To study antimicrobial susceptibility of anaerobic bacteria isolated from pleuropulmonary infections. Material and methods: Thirty two strains obtained from bronchoalveolar lavage and 15 strains isolated from pleural effusions between 2000 and 2002, were studied. The phenotype of strains was identified using the semiautomated API 20 A method and their susceptibility to penicillin (PNC), clindamycin (CM) and chloramphenicol (CAF) was tested using the E test methods. Results: All the strains were susceptible to CAF, 95% to CM and 74.4% to PNC. The predominant genus was Prevotella, which also exhibited the higher resistance. Conclusions: As CM and CAF are active "in vitro", high rates of clinical response should be expected. In contrast, PNC is less effective, especially against pigmented Prevotella <![CDATA[<b>Cirrosis biliar primaria</b>: <b>experiencia de trece años en dos centros de referencia</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400010&lng=es&nrm=iso&tlng=es Background: Primary biliary cirrhosis (PBC) is a chronic cholestatic disease, which can progress to hepatic failure. Aim: To study the clinical presentation, pathological features, treatment and outcome of a group of patients with PBC. Material and methods: Retrospective review of medical records of 115 patients (110 females, age range 30-76 years) with PBC. Clinical presentation, pathological stage, treatment, outcome and eventual use of liver transplantation, were recorded. Result: Seventy eight percent of patients were symptomatic at presentation (itching in 69% and malaise in 62%). Antimitochondrial antibodies were positive in 56%. No clinical or laboratory differences were observed between symptomatic patients or those with positive antimitochondrial antibodies and the rest of the study group. Sjögren syndrome was present in 38%, hypothyroidism in 13%, scleroderma in 7% and rheumatoid arthritis in 5%. Initially, 61% had fibrosis and/or cirrhosis, and ursodeoxycholic acid was indicated in 94% of the patients. Fifteen patients underwent liver transplantation due to upper digestive bleeding or itching. Survival has been 67% at 36 months after transplantation. In one transplanted liver, PBC recurred. Conclusions: An early diagnosis and treatment of a progressive disease such as PBC will reduce the incidence of complications and the use of costly treatments <![CDATA[<b>Vasculitis ANCA-positivo en pacientes hipertiroideos usuarios de propiltiouracilo</b>: <b><i>Report of four cases</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400011&lng=es&nrm=iso&tlng=es Antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis is an uncommon complication of the use of propylthiouracil. When it occurs, it affects multiple organs as any systemic vasculitis. We report three females and one male, aged 30, 40, 43 and 41 years respectively, that after a lapse of 12 to 28 months of propylthiouracil use, presented clinical signs of vasculitis. All had high titers of ANCA against myeloperoxidase. In three patients, a skin biopsy confirmed the diagnosis. The condition subsided when propylthiouracil was discontinued, but one female patient required the use of prednisone <![CDATA[<b>Tumores estromales gastrointestinales duodenales</b>: <b><i>Report of one case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400012&lng=es&nrm=iso&tlng=es Gastrointestinal stromal tumors (GIST) are lesions whose diagnosis and treatment have varied in the last decade. We report a 76 year-old male with a history of eight episodes of upper gastrointestinal bleeding. A duodenography showed an elevated lesion in the third portion of the duodenum with a central ulceration. It was initially managed with tumorectomy and primary closure of the duodenum. The pathological study of the surgical specimen revealed a low grade gastrointestinal stromal tumor. Three years later, the tumor recurred and pancreatoduodenectomy was performed. Due to the high risk of malignant potential, tumor size, number of mitoses and the presence of necrosis, imatinib mesylate was started. The patient had a satisfactory evolution, without evidences of recurrence after 15 months of follow up <![CDATA[<b>Endometriosis del íleon como causa de obstrucción intestinal</b>: <b><i>Report of two cases</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400013&lng=es&nrm=iso&tlng=es Endometriosis is a common, chronic, benign, estrogen dependent gynecological disorder associated to pelvic pain and infertility. Its main characteristic is the presence of endometrial tissue outside the uterus. The prevalence of pelvic endometriosis ranges between 6% and 10% women during their reproductive years. Clinical symptoms of pelvic endometriosis are pelvic pain, dysmenorrhea, dispareunia and infertility. Distal ileum endometriosis is an uncommon cause of intestinal obstruction with a frequency of 7% to 23% of all cases with intestinal involvement. We report two patients, 30 and 34 years old, with terminal ileum endometriosis and intestinal obstruction that required surgery and intestinal resection. Both patients are well one year after the operation <![CDATA[<b>Hierro, oxígeno y desarrollo placentario en la génesis de la preeclampsia</b>: <b>Efectos de la altura en Ecuador</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400014&lng=es&nrm=iso&tlng=es Preeclampsia is the second cause of maternal death in Ecuador. The etiology of this condition is probably a placental alteration, although the details are not well known. The development of the placenta is closely related to the availability of oxygen. A defect in the differentiation of trophoblastic cells due to a faulty sensitization to changes in oxygen pressure, could be the cause of the alteration in placental development. The role of iron and local environmental conditions of a susceptible population, should be considered in the study of the etiology of preeclampsia. In the Andrean area of Ecuador, the high incidence of preeclampsia could be explained by the high prevalence of anemia and high altitude. However more studies are required to establish a close link between the environmental conditions of this area and the imperfect placental development <![CDATA[<b>Famacogénica del cáncer</b>: <b>Estudio de variaciones genéticamente determinadas en la susceptibilidad a cáncer por exposición a xenobióticos</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400015&lng=es&nrm=iso&tlng=es Pharmacogenetics is the study of genetically determined variations in the response to drugs and toxic agents, and their implications on disease. Recently, the discipline has acquired great relevancy due to the development of non-invasive molecular techniques that identify genetic variants in human beings. There is also a need to explain the individual differences in susceptibility to drug actions and disease risk. Genetic variants can modify the magnitude of a pharmacologic effect, toxicity threshold, secondary effects and drug interactions. There are approximately thirty families of drug-metabolizing enzymes with genetic variants that cause functional alterations and variations in pharmacologic activity. We summarize the general knowledge about genetic variants of biotransformation enzymes, their relationship with cancer risk and the role of ethnicity. Cancer pharmacogenetics is another promising and exciting research area that will explain why people with an almost identical group of genes, have a different susceptibility to cancer, whose etiology has genetic and environmental components <![CDATA[<b>Los Comités de de Ética Asistencial y las repercusiones jurídicas de sus informes</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400016&lng=es&nrm=iso&tlng=es Clinical Ethics Committees and Research Ethics Committees have their own specific roles. The Clinical Ethics Committee's pronouncements have an advisory function, whereas Research Ethics Committees' decisions are binding. This article analyzes the legal impact of the Clinical Ethics Committees' reports. Legal and medical reasoning share the same practical nature. Both can have several correct answers to the same situation. Clinical Ethics Committees deliberate about these alternatives and analyze the involved values. Their conclusions are non-compulsory recommendations. They do not replace nor diminish the doctor's personal responsibility. Even though the Clinical Ethics Committees' reports are not binding, they constitute a sort of "expert's opinion", expressed by qualified professionals, who assume their own professional responsibility as advisors. The members' behavior is necessarily subject to constitutional and legal regulations. When judges review the Clinical Ethics Committee's reports, they must realize that their nature is advisory, and also consider them an essential element to reduce the gap between the medical and legal fields. In this way, the problem of increasingly transforming medicine into a legal issue can be prevented <![CDATA[<b>El sentido social del profesionalismo médico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400017&lng=es&nrm=iso&tlng=es This essay looks into the meaning of today's professionalism and the apparent inconsistency between its growing status and a context of profound changes and dissatisfaction with medical practice. The cultural climate of our times is reviewed, as the framework for understanding changes in the social organization of medicine. One of the critical traits of professions has been their power to manage specialized knowledge under their own standards, without external control. The limits of this self regulation of expertise have faded, representing an important threat for professionalism. Together with the fundamental changes and tensions of work conditions for professionals, however, the appeal of professionalism is on the rise. Because of its ability to submit devastating individualism to collective interests, professionalism can contribute to the stability of social systems, as a third logic, between the market and public organizations. In medicine, professionalism as a value based system and ideology, also emerges as a response to the challenges posed to its practice. It represents reflection and preservation of traditional values inspiring a practice of excellence, which will undoubtedly restore and enhance public confidence in medicine <![CDATA[<b>Ecografía transcraneal</b>: <b>Una nueva herramienta útil en el diagnóstico de la enfermedad de Parkinson</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400018&lng=es&nrm=iso&tlng=es This essay looks into the meaning of today's professionalism and the apparent inconsistency between its growing status and a context of profound changes and dissatisfaction with medical practice. The cultural climate of our times is reviewed, as the framework for understanding changes in the social organization of medicine. One of the critical traits of professions has been their power to manage specialized knowledge under their own standards, without external control. The limits of this self regulation of expertise have faded, representing an important threat for professionalism. Together with the fundamental changes and tensions of work conditions for professionals, however, the appeal of professionalism is on the rise. Because of its ability to submit devastating individualism to collective interests, professionalism can contribute to the stability of social systems, as a third logic, between the market and public organizations. In medicine, professionalism as a value based system and ideology, also emerges as a response to the challenges posed to its practice. It represents reflection and preservation of traditional values inspiring a practice of excellence, which will undoubtedly restore and enhance public confidence in medicine <![CDATA[<b>Epidemiología de la enfermedad cerebro vascular en Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400019&lng=es&nrm=iso&tlng=es This essay looks into the meaning of today's professionalism and the apparent inconsistency between its growing status and a context of profound changes and dissatisfaction with medical practice. The cultural climate of our times is reviewed, as the framework for understanding changes in the social organization of medicine. One of the critical traits of professions has been their power to manage specialized knowledge under their own standards, without external control. The limits of this self regulation of expertise have faded, representing an important threat for professionalism. Together with the fundamental changes and tensions of work conditions for professionals, however, the appeal of professionalism is on the rise. Because of its ability to submit devastating individualism to collective interests, professionalism can contribute to the stability of social systems, as a third logic, between the market and public organizations. In medicine, professionalism as a value based system and ideology, also emerges as a response to the challenges posed to its practice. It represents reflection and preservation of traditional values inspiring a practice of excellence, which will undoubtedly restore and enhance public confidence in medicine <![CDATA[<b>Crónica</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000400020&lng=es&nrm=iso&tlng=es This essay looks into the meaning of today's professionalism and the apparent inconsistency between its growing status and a context of profound changes and dissatisfaction with medical practice. The cultural climate of our times is reviewed, as the framework for understanding changes in the social organization of medicine. One of the critical traits of professions has been their power to manage specialized knowledge under their own standards, without external control. The limits of this self regulation of expertise have faded, representing an important threat for professionalism. Together with the fundamental changes and tensions of work conditions for professionals, however, the appeal of professionalism is on the rise. Because of its ability to submit devastating individualism to collective interests, professionalism can contribute to the stability of social systems, as a third logic, between the market and public organizations. In medicine, professionalism as a value based system and ideology, also emerges as a response to the challenges posed to its practice. It represents reflection and preservation of traditional values inspiring a practice of excellence, which will undoubtedly restore and enhance public confidence in medicine