Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720060012&lang=es vol. 134 num. 12 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b>Factores biológicos y psicosociales predictores del estilo de vida promotor de salud</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200001&lng=es&nrm=iso&tlng=es Background: One of the goals of the national health reform is to promote a healthy lifestyle in all the population. The determinants of healthy lifestyles need to be identified to guide people towards this purpose. Aim: To analyze the health promoting lifestyle (HLP) in a community of Concepción and to identify the personal factors that might be predictors of such lifestyle. Material and methods: Pender's health promotion model was used as the conceptual framework for exploring the HLP among 360 persons aged from 15 to 64 years, free from chronic diseases. Data were obtained by a semi structured questionnaire and the following scales were used to measure HLP: perceived health status, perceived self esteem, and perceived self efficacy. Relationships between personal factors and HLP were studied. Data were processed with SAS software and analyzed with descriptive and inferential statistics. Results: Only 52.2% of the sample had a healthy lifestyle. The variables sex, age, occupation, access to health care, self esteem, perceived health status and perceived self efficacy had a significant effect on HLP. A regression model showed that self esteem, self efficacy, sex, age, occupation and access to health care explained 30% of the variation in health lifestyle. Conclusions: Only half of the studied sample had a healthy lifestyle. The variables obtained with the regression model, should be considered to create effective interventions encouraging persons to integrate healthy behaviors to their life <![CDATA[<b>Nivel de conocimiento de los pacientes con artritis reumatoide acerca de su enfermedad y tratamiento</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200002&lng=es&nrm=iso&tlng=es Background:The transfer of information in the physician-patient relationship is important, especially in chronic diseases such as Rheumatoid Arthritis (RA), since it influences the perception and behavior that the patient has about his or her illness. Aim: To evaluate the level of knowledge and concern of their illness and treatment and their relationship with functional disability, perception of the pain and global assessment of disease activity, in patients with RA. Patients and Methods: Cross sectional study of 104 patients (mean age 56 years, 100 women) with RA. Demographic and clinical variables were registered. The knowledge about their illness and requirement of further information and concern about aspects of the illness and treatment, were assessed. Physical functioning was measured using the Health Assessment Questionnaire (HAQ). A visual analogue (VAS) and Likert scales were used for a global assessment of disease activity. Results: Sixty percent of patients had only primary school studies. The median evolution of the illness was 14 years. Ninety eight percent knew their diagnosis and 91% required further information. There was a high degree of concern about the disease and treatment. The average HAQ score was 0.9. There was a statistically significant relationship between HAQ score and pain VAS (r =0.41, p <0.01). There was a moderate agreement between the global assessment of disease activity made by patients and physicians (Kappa =0.499; p =0.000). Conclusions: Even though patients with RA are informed about their disease, they require further information. Their highest concern is about the functional consequences of RA and they perceive a higher activity of the disease than their treating physicians <![CDATA[<b>La insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosa</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200003&lng=es&nrm=iso&tlng=es Background: The basis of the treatment of painful diabetic neuropathy is the use of drugs that block the transmission of pain (antineuritics) and a good metabolic control of underlying disease. Aim: To describe the outcomes of 17 type-2 diabetics with painful neuropathy, treated between 1988 and 2005 with symptomatic therapy plus intensified insulin. Material and methods: Review of medical records of 17 type-2 diabetic patients, aged 63±11 years and a duration of diabetes of 15±8 years. All patients received intensified insulin therapy with 0.35 units/kg of NPH insulin (2/3 before breakfast and 1/3 evening meal), plus capillary glucose measurements and regular insulin (with sliding-scale centered in ~0.1 units/kg) before the 3 main meals. All patients were also treated with gabapentin, nortriptyline or clomipramine. Pain was assessed using a visual analog score of 10 points. Results: After 1 year, glycosilated hemoglobin decreased from 10.0±1.4% to 7.7±1.2% (p~=0.003). Pain decreased from 10 to 5.1±3.3 at one month, 2.3±3.2 at six months, and 3.1±3.6 at 1 year (p <0.01). There was a direct statistical correlation between the reduction of HbA1C and pain decline (r =0.736; p =0.037). Pain scores were lower than those reported elsewhere for Pregabalin (n =76; p =0.05), Lamotrigine (n =27; p <0.0005), Topiramate (n =208; p <0.005), and Gabapentin (n =84; p <0.025). The lack of difference to Sodium Valproate (n =21; p =0.07) had borderline significance. Conclusions: The addition of intensified insulin therapy to the symptomatic treatment of painful neuropathy in type-2 diabetics, significantly enhanced the reduction of pain. The lowering of glycosilated hemoglobin was a significant predictor of success in pain reduction <![CDATA[<b>Percepción de conductas abisivas en estudiantes de medicina</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200004&lng=es&nrm=iso&tlng=es Background:Even though studying Medicine and perceiving abuse seem to be two opposite situations, recent investigations in Chile and abroad find that this is a frequent and pervasive combination. These studies also report the negative effects in the lives of students as well as the impact on the profession as a whole. Aim: To ascertain the perception of abusive situations in medical students during training at the University of Chile. Material and Methods: Descriptive and cross sectional study in which a questionnaire was applied to all the students enrolled in 2nd, 3rd, 5th and 7th year during 2001 and 2002. Using short vignettes, they were asked if they had experienced verbal, psychological, physical and sexual abuse, at least once, during their training, by whom and the eventual effects derived from it. Results: We obtained 757 questionnaires. Of the surveyed students, 91% reported having perceived at least one abusive episode during training. Teachers and fellow students were identified as the main offenders. Among the effects of such behavior, 32% mentioned that they considered dropping out of the career as a consequence of this experience. Discussion: The perception of abuse in medical students is common and has adverse effects. Efforts should be made to draw attention to this problem to prevent it <![CDATA[<b>Barostato rectal en el síndrome de intestino irritable</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200005&lng=es&nrm=iso&tlng=es Background: Many patients with irritable bowel syndrome (IBS) have lowered sensory thresholds to rectal distention when compared to control subjects, a phenomenon called visceral hypersensitivity. Aim: To investigate the usefulness of a rectal barostat as a diagnostic tool in IBS and if there are differences in visceral hypersensitivity in different groups of IBS patients. Patients and Methods: Ten healthy subjects and 19 IBS patients, defined using Rome II criteria (12 with constipation, three with diarrhea and four alternating between diarrhea and constipation), were studied. Sequential isobaric rectal distentions, from 2 mmHg up to a maximal pressure of 52 mmHg or when the patients reported pain, were carried out. Visceral hypersensitivity was defined as a pain threshold under 38 mmHg. Results: Only 26% of IBS patients had visceral hypersensitivity (16% and 43% of patients with IBS and constipation and IBS and diarrhea or alternating symptoms, respectively, p =NS). Pain threshold in controls, patients with IBS and constipation and patients with IBS and diarrhea or alternating symptoms was 43.8±6.6, 45.3±9.2 and 40.8±9.2 mmHg, respectively (p =NS). Conclusions: Our results do not support the usefulness of the electronic rectal barostat as a diagnostic method to diagnose IBS <![CDATA[<b>Reacciones adversas a L-asparaginasa en pacientes con leucemia linfoblástica aguda</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200006&lng=es&nrm=iso&tlng=es Background: The low notification of Adverse Drug Reactions (ADR) underscores the need for pharmacological surveillance systems that allow their detection, evaluation, prevention and registry especially in patients receiving multiple medications. Aim: To communicate the ADR observed with the use E coli asparaginase (E coli ASP) in children with Acute Lymphatic Leukemia (ALL). Patients and Methods: Cross-sectional study of clinical records of all the patients aged less than 15 years with ALL (n =52) and treated between January 1996 and April 2000. The suspicion of ADR to E coli ASP was evaluated using the Karch and Lasagna algorithm. Probable and definitive cases of ADR to E coli ASP were subjected to a protocol of clinical and epidemiological data. The risk factors associated to ADR to E coli ASP, were also determined. Results: Fifty children aged 1 to 13 years (33 men) were studied. In 20 (40%), an ADR to E coli ASP, was suspected. After the use of the algorithm, the ADR was considered definite in two patients, probable in 17 and possible in one. The registered clinical events were urticaria in 17, anaphylactic shock in four, transient alterations of hepatic functions test in seven and hypofibrinogenemia in four. The test of cutaneous sensitivity to the administration of E coli ASP, performed prior to the administration of the drug, were positive in nine of the 20 children with adverse reactions. No children died. Conclusions: The application of the Karch anbd Lasagna algorithm, allowed us to objectively classify suspected cases of ADR by E coli ASP <![CDATA[<b>Cuadro clínico de inicio de la diabetes tipo 1 en el niño</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200007&lng=es&nrm=iso&tlng=es Background: Type 1 diabetes mellitus (DM1) is a disease of increasing incidence among children. The time elapsed between the beginning of symptoms and the diagnosis of the disease is, in most cases, very extended. Aim: To report the clinical picture at onset and laboratory features of children with DM1. Material and methods: Retrospective review of all medical records of patients admitted to the hospital with a DM1 of recent onset. Results: Sixty three males aged 95±47 months and 34 females aged 109±51 months, were studied. Males were significantly younger than females (p <0.05). The lapse between symptoms onset and the diagnosis of the disease was longer in girls than in boys (46±46 and 26±26 days respectively, p <0.02). There was an inverse correlation between plasma glucose and the lapse between symptoms onset and the diagnosis of disease. The most common clinical picture of the disease was the classical symptoms of diabetes (polyuria, polydipsia, weight loss), in 60% of cases. Thirty seven percent had developed ketoacidosis at the time of the diagnosis. Ketoacidosis was more common between 1988 and 1995, as compared with the period 1996-2003 (50% and 28.8%, respectively). The onset of symptoms occurred between April and August (Winter in the Southern Hemisphere) in 38% of cases. Conclusions: DM1 is a disease of increasing incidence among children, whose diagnosis is delayed, even though symptoms are evident. The lower incidence of ketoacidosis in our patients between 1996 and 2003 is encouraging <![CDATA[<b>Estudio genético de una familia chilena con tres fenotipos dentales diferentes</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200008&lng=es&nrm=iso&tlng=es Background: Congenital dental anomalies can affect up to 25% of the population. Aim: To report the genetic study of a family with dental anomalies. Material and methods: We studied a Chilean family presenting with three independent dental phenotypes: third molar agenesis, supernumerary teeth, and dentinal dysplasia type I. We searched for mutations in candidate genes proposed for tooth agenesis and supernumerary teeth: IRF6, FGFR1, MSX1, MSX2, PAX9, PRDM16 and TGFA. We also studied DSPP as a candidate gene for dentinal dysplasia type I. Results: We did not find mutations in FGFR1, MSX2, PAX9, PRDM16, or TGFA. We found a MSX1 mutation (G16D) in both affected and unaffected family members. Also, we found a genetic variation not described before in IRF6 in the dentinal dysplasia type I case. Conclusions: Further investigation is necessary to evaluate if these variants are functional in nature. Finally, we are reporting a mutation in DSPP in an asymptomatic 2-year-old child, which illustrates the ethical pitfalls of interpreting molecular data for genetic counseling of young and/or asymtomatic individuals <![CDATA[<b>Vigilancia epidemiológica del síndrome de Down en Chile, 1972 a 2005</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200009&lng=es&nrm=iso&tlng=es Background:There are some records shrowing that the frequency of Down syndrome is experiencing an increase over time. Aim: To verify whether the frequency of Down syndrome is increasing in the maternity of the University of Chile Clinical Hospital, or in other Chilean hospitals participating in the Latin American Collaborative Study of Congenital Malformations (ECLAMC) and compare the rates with other world registries of congenital malformations. Material and methods: The information was obtained from the ECLAMC databases of the maternity. The Down syndrome incidence rates were calculated from 1997 to 2005 and rate curves were constructed. Results: The overall rate of Down syndrome was 3.36 per 10,000 born alive. This rate experienced a significant increase in the study period. These rates differ in the different Chilean regions, being higher in Santiago and lower in the Southern regions of the country. The mean age of mothers of newborns with or without Down syndrome was 36±6 and 29±6 years, respectively, p >0.001. Conclusions: The rates of newborns with Down syndrome increased in the period 1972-2005, bearing a close relationship with the increase in maternal ages/ <![CDATA[<b>TRAPS, un síndrome autoinflamatorio</b>: <b>Casos</b><b> cínicos</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200010&lng=es&nrm=iso&tlng=es Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPS) is an autoinflammatory disorder associated to a mutation of the Tumor Necrosis Factor Receptor 1 (TNFR1) whose clinical presentation consists on recurrent episodes of prolonged fever, abdominal pain, myalgias, migratory cutaneous erythema, conjunctivitis or periorbitary edema. The diagnosis is confirmed by genetic analysis of the TNFR1 gene. Its main complication is amyloidosis and the treatment is based on the use of corticosteroids or anti-TNF antibodies. We report a 17 year-old male and 23 year-old female with the syndrome. Both cases had heterozygous mutations of the TNFR1 gene, C30R in the first case and T50M in the second case <![CDATA[<b>Anisakiasis</b><b> en un paciente portadora de una pequeña hernia hiatal</b>: <b>Caso</b><b> clínico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200011&lng=es&nrm=iso&tlng=es We describe the presence of anisakiasis in a patient who had a small hiatal hernia. A 60 year-old women presented general malaise, burning pain, flatulence, persistent nausea and abdominal distension during five days before consulting. She referred that she ate a dish of marinated raw fish with lemon and pepper ("cebiche") and after a few hours the symptoms began. An esophagogastroscopy showed a white colour larva of approximately three cm with the cephalic end partially adhered and localized in the mucosa of the hiatal hernia. During the procedure the worm was easily extracted. The morphologic study of the specimen identified it as a stage IV larva of Pseudoterranova sp. The clinical condition of the patient improved after the extraction of the parasite <![CDATA[<b>Crisis de pánico en un paciente con acné tratado con isotretinoína</b>: <b>Caso</b><b> clínico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200012&lng=es&nrm=iso&tlng=es The use of isotretinoin as a treatment for acne is related to psychiatric syndromes such as psychosis and depression. On the other hand, several drugs have been identified as causing panic attacks. A relationship between dermatologic and psychiatric disease has also been established. We report a 20 year-old male who started to suffer panic attacks after using isotretinoin for acne <![CDATA[<b>Manejo de la neumonía comunitaria del adulto mayor en el ámbito ambulatorio</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200013&lng=es&nrm=iso&tlng=es Community Acquired Pneumonia (CAP) is the first cause of death by respiratory disease in Chile and the first specific cause of death in people over 80 years of age. The geriatric population has a greater risk of suffering pneumonia, its complications and consequently dying. This is not only related to chronological age but also to certain factors related to ageing such as the presence of comorbidity, malnutrition, and cognitive impairment. An atypical presentation that delays the diagnosis and treatment also increases the risk of complications. CAP in the elderly is caused by the same pathogens that cause it in younger patients. S pneumoniae is the main pathogen followed by viral infections particularly in winter. An important strategy to reduce CAP related health costs, is the identification of patients who are at low risk of complications and who therefore could be managed at home. Optimum management of CAP in the elderly includes early diagnosis and the definition of clinical severity, early antibiotic treatment at the right dose and for an adequate length of time and a correct decision whether the patient should be managed in hospital or at home <![CDATA[<b>Conflicto de intereses en la práctica clínica</b>: <b>Análisis ético de algunas relaciones con la industria</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200014&lng=es&nrm=iso&tlng=es Sometimes, the prescription practice of physicians can be influenced by factors that are not related to scientific evidence due to the appearance of several conflicts of interest. These conflicts cause social concern and have prompted actions to regulate the ethics of individual and corporative activities related to healthcare. We analyzed the ethical problems involved in the physician-industry relationship. For this purpose, we considered as the main actors related to this problem, the pharmaceutical industry and their marketing strategies, medical doctors and the independence and objectivity that should guide prescriptions and, finally, patients and their right to receive prescriptions based on scientific evidence. From the point of view of the Bioethics principles, Beneficence would not be respected when gifts or other donations received from the industry affect doctor's independence. Non Maleficence principle could be jeopardized if there is an increased risk of treatment failure and finally Justice could be altered if there is a cost increase for either patients or health institutions. As a conclusion, we consider that the presence of conflicts of interest in the relationship of physicians with the pharmaceutical industry is an important ethical problem. In consequence, this group endorses the recommendations of the Chilean Association of Medical Scientific Societies and advices to include ethical guidelines on this topic in the curriculum of medical schools <![CDATA[<b>Intercambiabilidad</b><b> de medicamentos de origen biológico (biofármacos)</b>: <b>Consideraciones acerca de la aprobación de formulaciones biosimilares (biogenéricos) en Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200015&lng=es&nrm=iso&tlng=es Once drug patents expire, the health authorities can approve the registry of similar products. They must request to the manufacturer, the bibliographic background of the original product and the analytical results that certify drug quality. An inspection of the premises of the manufacturer is also required. The main goal of this approval is to decrease cost, considering that the original product is usually more expensive. This is a current situation due to the imminent expiration of the patents of many biopharmaceutical products. Therefore, in Chile, the Public Health (ISP) and the Ministry of Health should consider that for this kind of products, until now, there are no interchangeable generic drugs, and that the similar drugs that are offered have a different chemical composition, since they have been manufactured through different processes. In the case of biological drugs (e.g. erythropoietir, somatotropin, heparin) the quality and homogeneity depend from the manufacture process. Its complete composition can not be absolutely elucidated; therefore small impurities or conformational variants can elicit an altered immune response or unexpected adverse reactions. This indicates that the approval of a biogeneric drug requires in addition to pharmacokinetic studies, preclinical and clinical analytical studies such as physicochemical assays, biological and immunological test. This issues have been established by WHO and have been incorporated for the main drug registry entities all over the world (FDA, EMEA, ANVISA) to approve biogeneric products <![CDATA[<b>Mielopatía</b><b> por déficit de vitamina b12 en el bienio 2003-2005</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200016&lng=es&nrm=iso&tlng=es Once drug patents expire, the health authorities can approve the registry of similar products. They must request to the manufacturer, the bibliographic background of the original product and the analytical results that certify drug quality. An inspection of the premises of the manufacturer is also required. The main goal of this approval is to decrease cost, considering that the original product is usually more expensive. This is a current situation due to the imminent expiration of the patents of many biopharmaceutical products. Therefore, in Chile, the Public Health (ISP) and the Ministry of Health should consider that for this kind of products, until now, there are no interchangeable generic drugs, and that the similar drugs that are offered have a different chemical composition, since they have been manufactured through different processes. In the case of biological drugs (e.g. erythropoietir, somatotropin, heparin) the quality and homogeneity depend from the manufacture process. Its complete composition can not be absolutely elucidated; therefore small impurities or conformational variants can elicit an altered immune response or unexpected adverse reactions. This indicates that the approval of a biogeneric drug requires in addition to pharmacokinetic studies, preclinical and clinical analytical studies such as physicochemical assays, biological and immunological test. This issues have been established by WHO and have been incorporated for the main drug registry entities all over the world (FDA, EMEA, ANVISA) to approve biogeneric products <![CDATA[<b>Cuidados Paliativos en Nefrología</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200017&lng=es&nrm=iso&tlng=es Once drug patents expire, the health authorities can approve the registry of similar products. They must request to the manufacturer, the bibliographic background of the original product and the analytical results that certify drug quality. An inspection of the premises of the manufacturer is also required. The main goal of this approval is to decrease cost, considering that the original product is usually more expensive. This is a current situation due to the imminent expiration of the patents of many biopharmaceutical products. Therefore, in Chile, the Public Health (ISP) and the Ministry of Health should consider that for this kind of products, until now, there are no interchangeable generic drugs, and that the similar drugs that are offered have a different chemical composition, since they have been manufactured through different processes. In the case of biological drugs (e.g. erythropoietir, somatotropin, heparin) the quality and homogeneity depend from the manufacture process. Its complete composition can not be absolutely elucidated; therefore small impurities or conformational variants can elicit an altered immune response or unexpected adverse reactions. This indicates that the approval of a biogeneric drug requires in addition to pharmacokinetic studies, preclinical and clinical analytical studies such as physicochemical assays, biological and immunological test. This issues have been established by WHO and have been incorporated for the main drug registry entities all over the world (FDA, EMEA, ANVISA) to approve biogeneric products