Scielo RSS <![CDATA[Revista médica de Chile]]> vol. 137 num. 4 lang. pt <![CDATA[SciELO Logo]]> <![CDATA[<b><i>New series on Clinical Laboratory in Revista Médica de Chile</i></b>]]> The Chilean Autonomous Commission for Medical Specialties Certification recognized Clinical Laboratory as a specialty in 1994. This decision was based on the great development of the specialty that incorporated new methodologies and developed automatic computerized methods. The main objective of the Clinical Laboratory specialist is to work as a consultant to define the laboratory diagnostic strategies that have the best cost effectiveness ratio. He must also select and assess diagnostic methods, supervise their implementations and assure the quality of the results generated. He must also be an efñcient laboratory director and administrator. <![CDATA[<b><i>Illicit and psychotropic drug use among medical students at the Pontificia Universidad Católica de Chile</i></b>]]> Background: Illicit drug abuse is a public health problem, generally starting in adolescence. Medical students are not an exception. Aim: To assess the consumption of illicit drugs among medical students of the Pontificia Universidad Católica de Chile. Material and Methods: A questionnaire used by the National Council for the Control of Substance Abuse (CONACE) to evalúate substance use and the Goldberg Health Questionnaire (GHQ-12), were applied to medical students. The questionnaires were self administered under supervisión. Results: The survey was completed by 569 of 775 students (74%). "Ever used" reached 33% for marijuana, 1.196 for cocaine, 2.1% for amphetamines without prescription, 6.9% for not prescríbed benzodiazepines and 5.8% for not prescríbed antidepressants. The use ofthese substances was only associated for ever used marijuana and level of career (p <0.01), with the highest rate in the seventh final year (51.4%). Benzodiazepine use was also associated with the level of career (p <0.01) with less than 6% prevalence from first to fourth and the highest in seventh year (32.4%). Non prescríbed antidepessant use was significantly higher among women. Tobáceo and alcohol use were associated with consumption of marijuana (p <0.0001) and benzodiazepines (p <0.0001). Conclusions: Our medical students have low marijuana consumption rates, only above Turkey. Cocaine and amphetamines use is low, benzodiazepine consumption is higher among final year students. Antidepressant use is higher among women. <![CDATA[<b><i>Application of Millon Adolescent Clinical Inventory (MACI) to drug abuser adolescents</i></b>]]> Background: Adolescence is the most vulnerable development stage to start drug abuse in our country. Moreover, adolescent personality may be an individual rísk factor for drug abuse. Aim: To characterize the personality of adolescent drug abusers using the Millon Adolescent Clinical Inventory (MACI) and its Chilean norms. Patients and methods: Adolescents consulting in a mental health facility were studied. MACI was applied to 46 subjects, aged 16 ± 1 years (30 males) with a history of drug abuse and compared with 58 peers aged 15 ± 2 years (34 males) without such history. Results: Male and female drug abuser adolescents had a transgressor type of personality. Males had a high degree of sociability and unrestrained sexuality while females present signs of sexual abuse, suicide rísk, and a more severe personality disorder. Conclusions: The personality traits detected in this group of drug abuser adolescents using Chilean norms is similar to those detected abroad and should help to plan rehabilitation. <![CDATA[<b><i>Frequency of depression among hypertensive subjects in a primary care clinic</i></b>]]> Background: Severe depression and hypertension are two common conditions in the Chilean population. There is a possibility that the coexistence ofthese diseases is not a coincidence and that hypertension can be pathogenically related to depression. Aim: To assess the frequency of depression among hypertensive subjects consulting in a primary care clinic. Patients and methods: Beck depression inventory a sociodemographic survey and a risk scale for depression elaborated by the Chilean Ministry ofHealth were applied to 442 hypertensive patients consulting in a public primary care clinic. Results: According to Beck depression inventory score, 53%, 33% and 14% of subjects had a mild, modérate or severe depression, respectively. Most individuáis were housewives with incomplete primary education. There was a significant association between depression scores, family Apgar score, mood perception, family violence, alcohol consumption and smoking. Conclusions: There is a high frequency of depression among adults with hypertension consulting in a public primary care clinic. <![CDATA[<b><i>Quality of life of patients operated for gastric cancer</i></b>]]> Background: Gastric cancer is the first cause of death by cáncer in Chile. Quality of Life is a multidimensional construct that explores functionality and well-being, including physiological, psychological and social aspects. Aim: To assess Quality of Life of patients operated for gastric cancer. Patients and methods: The European Organization Research and Treatment of Cáncer Quality of Life Questionnaire (EORTC QLQ-30), translated into Spanish, was applied to 33 patients, aged 42 to 82 years (25 males), subjected to curative total or subtotal gastrectomy for gastric cancer, between January 2004 and December 2006. Results: The average lapse from the moment of the surgical intervention to the interview, was 52.2 weeks. Fifty five percent perceived their Quality of Life in the "good" category. Male patients and those with less than 6 months of surgery, obtained better scores in psychological aspects of quality of life. Conclusions: A high percentage of patients operated for gastric cancer qualified their quality of life as good in spite of the severity of the underlying disease and invasiveness of the intervention. This is probably explained by the importance of psychological factors that influence quality of life. <![CDATA[<b><i>Outcome of surgical treatment of liver metastasis from colorectal cancer</i></b>]]> Background: Surgical resection is the only treatment associated with long-term cure in patients with liver metastasis from colorectal cancer, achieving a 30% to 40% five years survival. Aim: To evaluate the results of liver resection for metastatic colorectal cancer in our centre. Patients and methods: Retrospective study. Epidemiological, perioperative and follow up data of patients undergoing liver resection for metastatic colorectal cancer between January 1990 and July 2007 were assessed. We compared the results between two periods; period 1 (1990-1997) and period 2 (1998-2007). Results: Sixty six patients aged 61± 12 years (46 males) underwent 75 resections. An anatomical excision was performed in 54 (72%) cases, a right hepatectomy in 18, an extended right hepatectomy in 11, a left hepatectomy in 1, and a segmentectomy in 24. In 24 (32%) patients the liver resection was simultaneous with the colorectal cancer resection. Operative time was 221±86 min. Hospital stay was 11±5 days. Postoperative morbidity was 35% and surgical mortality was 0%. Resection margin was free of tumor in 53 (80%) patients. Five years overall and hepatic disease-free survival was 38% and 23%, respectively. In period 2, more anatomical resections than in period 1 were performed (77% and 55%, respectively, p =0.04), without an increase in complications (35% and 34%, respectively; p =ns), but with a better five years survival (45% and 21 %, respectively, p =0.04). Conclusions: Five years survival for excision of liver metastatic colorectal cancer in our center is similar to that reported abroad. During the second period there has been a trend toward more extensive resections which was associated with a better survival, without an increase in complications or mortality . <![CDATA[<b><i>Effects of the consumption of Phlebodium Decumanum on plasma cortisol and testosterone levels in subjects participating in an exercise program</i></b>]]> Background: Phlebodium Decumanum is a type of fern that could have an immune or stress response modulating action. Aim: To evaluate if the consumption of a preparation obtained from Phlebodium Decumanum, modifies the changes induced by exercise in plasma levels of testosterone and cortisol. Material and methods: Fourteen male subjects aged 22 ± 2 years were randomized to consume Phlebodium Decumanum and 10 subjects, aged 23 ± 1 years were ascribed to consume a placebo. Both groups performed a standard exercise program, three times a week during one month. Plasma free testosterone and cortisol levels were measured before and 48 hours after the last session of the exercise program. Results: Cortisol levels increased significantly from 18.9 ± 6.8 to 26.2 ± 5.9 fig/dl, in the control group. In the group consuming the study product, no changes were detected (20.0 ±4.6 and 20.9 ± 5.9) fig/dl before and after the exercise program, respectively). Plasma free testosterone decreased significantly in both groups from 36.1 ± 11.04 to 20.7 ±4.3 pg/ml in the control group and from 33.7 ± 10.0 pg/ml to 18.6 ± 4.9 pg/ml in study group. Conclusions: The cortisol levels increased significantly in the control group but not in the study group. Therefore we can suggest that consumption of Phlebodium Decumanum would be able to modulate the response of this hormone to physical stress. <![CDATA[<b><i>Relationship between periodontal diseases and ascending bacterial infection with preterm delivery</i></b>]]> Background: There is an association between periodontal diseases and preterm delivery. Aim: To assess the relationship between periodontal diseases, ascending bacterial infection and placental pathology with preterm delivery. Patients and methods: A periodontal examination and collection of amniotic Huid and subgingival plaque samples were performed in women with preterm labor with intact membranes, without an evident clinical cause or preterm premature rupture of membranes, without clinical chorioamnionitis or labor and a gestational age between 24 and 34 weeks. Microbial invasión ofthe amniotic cavity was defined as the presence of a positive amniotic Buid culture. Cervicovaginal infection was defined as a bacteríal vaginosis orpositive culture ofcervix or vagina with a high neutrophil count. Ascending bacterial infection was diagnosed as the microbial invasión of the amniotic cavity by ascending bacteria or cervicovaginal infection. Corioamnionitis, funisitis or vellositis were diagnosed. Resulte: Fifty-nine women were included: forty-two with preterm labor with intact membranes and seventeen with preterm premature rupture of membranes. The prevalence of periodontal diseases was 93.2%. Microbial invasión of the amniotic Buid was detected in 27.1% of patients. periodontal pathogenic bacteria were isolated in 18.6% of amniotic Buid samples and 71.2% of subgingival plaque samples. The prevalence of ascending bacterial infection was 83.1% and in 72.9% of women it was associated with periodontal disease. Preterm delivery (&lt;37 weeks) occurred in 64.4% of patients and was significantly associated with generalized periodontal disease and with the association of ascending bacterial infection and periodontal diseases. Patients with preterm delivery and generalized periodontal disease had a higher frequency of chorioamnionitis and funisitis. Conclusions: Generalized periodontal disease and its association with ascending bacterial infection are related to preterm delivery and placental markers of bacteríal ascending infection. <![CDATA[<b><i>Evaluation of a rapid diagnostic test to assess the prevalence of maternal syphilis in Bolivia</i></b>]]> Background: Syphilis is still a public health problem in Latin America and the Caribbean. Therefore maternal screening is of great importance for public health. Aim: To estímate the prevalence of maternal syphilis and to evaluate a rapid diagnostic test for the disease among Bolivian women. Material and methods: A total of 489 women delivering in a Public Hospital in Cochabamba, Bolivia, answered a questionnaire about socioeconomic and reproductive characteristics and access to health care services. Syphilis was diagnosed by using RPR and FTA-ABS tests. The rapid test Determine syphilis TP was evaluated taking as reference FTA-ABS test. Results: Twenty two women (4.5%) were positive both for RPR and FTA-ABS tests and fifty (10.2%) were positive for the rapid diagnostic test and FTA-ABS. Compared with FTA-ABS, the sensitivity and specificity of the rapid test were 98% and 99.8%, respectively Only 15% of women that had at least one antenatal care visit had a syphilis screening test and 40% of the women in whom the test was performed, did not receive its results. Increasing age, low socioeconomic level and a history of a sexually transmitted disease were independently associated with syphilis infection. Conclusions: The magnitude of syphilis infection among the studied women was still high in Cochabamba. The rapid test showed excellent overall performance for maternal syphilis screening. Few women of all attended in the hospital had a screening syphilis test and half of those screened were not aware of the results. Maternal syphilis affected older women of low socioeconomic level and with a history of a sexually transmitted disease. <![CDATA[<b><i>Early markers for atherosclerosis and metabolic syndrome in children</i></b>]]> Background: The high prevalence of obesity in children favors the appearance of metabolic syndrome (MS), increasing their cardiovascular risk. Aim: To evaluate components of MSin children and to comtate them with surrogate markers of atherosclerosis and subclinical inflammation. Material and methods: We studied 209 children aged 11.5 ± 2 years (50% girls, 30% prepuberal). Fifty percent had normal weight, 18% were overweight, 29% were obese and 3% were undernourished. A fasting blood sample was obtained to measure lipid levels, glucose, insulin, adiponectin and ultrasensitive C-reactive protein (usCRP). Subclinical atherosclerosis was evaluated using flow mediated dilatation of brachial artery (FMD) and carotid intima-media thicknes (IMT). For diagnosis of MS we adapted Cook's criteria. Results: Five percent of all children and 18% ofthose with overweight had MS. Children with more components had significantly higher fasting insulin and Homeostasis Model Assessment (HOMA) values. Clustering of MS components was also associated to higher values of usCRP and non significantly to lower adiponectin levels. We did not find differences in FMD. In obese children there was a tendency towards a higher IMT with clustering of MS components, although not significant. Conclusions: Children with overweight presented a higher risk of a clusteríng of MS components, which was also associated with insulin resistance and increase in ultrasensitive C reactive protein. <![CDATA[<b><i>Concomitant presence of a gastric adenocarcinoma and gastrointestinal stromal tumor</i></b>: <b><i>Report of one case</i></b>]]> The concomitant presence of a primary gastric adenocarcinoma and a gastrointestinal stromal tumor in the stomach is uncommon. We report a 68-year-old male with an advanced gastric adenocarcinoma. During gastrectomy, a nodular intramural lesion was found. The pathological study, revealed a gastrointestinal stromal tumor, positive form CD117. After six months of follow up, there is no evidence of recurrence of either tumor). <![CDATA[<b><i>Detection of neuroendocrine tumors by positron emission tomography-computed tomography with </i><sup>68</sup><i>Ga-DOTATATE</i></b>: <b><i>Report of one case</i></b>]]> We report a 74-year-old maie with liver metastases from a neuroendocrine tumor (NET) of unknown origin. Conventionai imaging studies with ultrasound, computed tomography coionoscopy and Positron emission tomography-computed tomography (PET/CT) with 18Flúor odeoxyglucose did not identify the site of orígin of the primary tumor. The patient was submitted for a PET/CT sean with a new radiopharmaceuticai, the somatostatin anaiogue 68Ga-DOTATATE. This new technique demostrated increased focal uptake at the ileocecal valve. This lesión and other two liver metastases were surgically removed. The histopathology and immunohistochemistry analysis confirmed the diagnosis of NET (carcinoid). This case illustrates the advantages of the PET/CT sean with 68Ga-DOTATATE. <![CDATA[<b><i>Satoyoshi syndrome</i></b>: <b><i>Report of one case</i></b>]]> Satoyoshi  syndrome is a rare multisystemic disease of presumed autoimmune etiology characterized by progressive painful intermittent muscle spasms, diarrhea frequently associated with malabsorption, alopecia, skeletal abnormalities and endocrine disorders with a poor long-term prognosis due to early crippling. We report a 14-year-old Chilean girl with clinical and radiological features of the syndrome who has been successfully treated with prednisone and carbamazepine. She remarkably recovered from muscle spasms, alopecia and diarrhea. At follow up, 24 months later, she persists asymptomatic with considerable improvement in her quality of life. <![CDATA[<b><i>Cutaneous histiocytic sarcoma</i></b>: <b><i>Report of one case</i></b>]]> Histiocytic sarcoma (HS) is a rare hematologic malignancy with morphologic and immunophenotypic evidence of histiocytic differentiation. Previously known as "true histiocytic lymphoma", the tumor follows an aggressive clinical course. Involvement of lymph nodes, skin, and extranodal sites has been described. Among the latter, approximately 29 cases involving the skin have been reported. On pathology, the lesion shows a diffuse proliferation of large epitheloid histiocytes with marked pleomorphism. We report a 78 year-old male who presented with a nodular lesion in the forehead, involving the skin and son tissue. The pathological diagnosis was a HS. The patient waslost from follow up. <![CDATA[<b><i>Genetic markers as prognostic factors in multiple myeloma</i></b>]]> The search for prognostic factors in multiple myeloma has identified the genetic profile of the tumor as the main determinant of patient survival and response to treatment. There is an association between a dismal prognosis and the presence of t(4:14) translocations or 17p deletion, determined by fluorescent in situ hybridization (FISH) or the detection of chromosome 13 deletion using conventional cytogenetic techniques. These alterations define a subpopulation that comprises 25% of patients with a bad prognosis even if they are treated with high dose chemotherapy These patients should be early derived to more specific therapies. In the other hand, the other 75% of patients without a genetic risk factor, have a higher probability of success with conventional treatment. <![CDATA[<b><i>Review of the results of medical and surgical treatment of morbid obesity</i></b>]]> This is a review of publications comparing the results of medical and surgical treatment of morbid obesity. An overall conclusions is that the frequency of cardiovascular complications or cancer is higher among patients receiving medical treatment. Surgical treatment is associated with a better weight loss, reduction in complications and quality of life. Mortality risk decreases significantly after surgical treatment, when compared with patients receiving medical therapy Therefore, management of morbid obesity should be carried out by multidisciplinary teams with experience on gastrointestinal surgery. In this way the complications and mortality of bariatric surgery would be minimized. <![CDATA[<b><i>Johannes Vermeer and Anthon van Leeuwenhoek</i></b>: <b><i>Delft</i></b><b><i> Art and Science together during the golden Dutch century</i></b>]]> Johannes Vermeer and Anthon van Leeuwenhoek are among the greatest geniuses in Art and Science respectively. During the seventeenth century, they achieved innovative advances. Vermeer, in painting, created a new intímate view of people specially women, developing the treatment of light and details. Leeuwenhoek, friend of Vermeer, influenced him in the use of the obscure camera in his works. In spite of having no formal academic education, he made extremely relevant discoveries with the use of microscope. He showed for first time human spermatozoids, red blood cells, brain, nerve and muscle structures and described many living animals. These two brilliant contemporary Dutch men made a great contribution to our civilization. <![CDATA[<b><i>"Autoimmune curriculitis"</i></b>: <b><i>A not so new curricular disease</i></b>]]> Thirty years ago, Abrahamson described the main curriculum problems in undergraduate medical education as "diseases of the curriculum". Based on our own experience and knowledge, we propose the inclusión of a new condition named "autoimmune curriculitis", which is produced by the students themselves. In this condition, the students are who decide to "swell" the curriculum, by excessively participating in múltiple intra and extramural activities, competing to markedly improve their academic performance. Unlike other curriculum diseases, this one may directly affect the students personal Ufe and health, especially ifit begins as early as in the first semester of the career Two main aspects of medical education have a keyrole in the génesis ofthis disease: the so-called hidden curriculum and the selection process used in the postgraduate programs in Chile. Unfortunately the prevalence and severíty of this curriculum disease is a growing threat, due to the increasing number of undergraduate students in Chile without an equivalent increment of postgraduate programs. Given its characteristics, eradicating this disease seems quite difficult. To do so, it is necessary for postgraduate selection committees to give a clear sign regarding the most relevant attributes they consider when choosing the candidates and, consequently to discourage the exaggerated collection of curriculum records. Moreover, we need a group of students faithful to their own interests, who will keep growing in depth those that are more meaningful to them. <![CDATA[<b><i>The contribution of critical laboratory values to patients' safety and care</i></b>]]> Critical values are those laboratory values that are so abnormal that may threaten the life of a patient unless immediate corrective or therapeutic actions are undertaken. Among laboratory procedures, this definition has been incorporated to standards that watch over patients' safety. Health institutions should incorpórate this practice and monitor its effectiveness. <![CDATA[<b><i>PENICILLIN G IN STREPTOCOCCUS INFECTIONS</i></b>]]> Critical values are those laboratory values that are so abnormal that may threaten the life of a patient unless immediate corrective or therapeutic actions are undertaken. Among laboratory procedures, this definition has been incorporated to standards that watch over patients' safety. Health institutions should incorpórate this practice and monitor its effectiveness.