Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720090006&lang=en vol. 137 num. 6 lang. en <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b><i>Cystatin C and adiponectin in diabetics with and without coronary artery disease</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600001&lng=en&nrm=iso&tlng=en Background: Patients with type 2 diabetes have a high incidence of coronary artery disease, which is even higher among those with renal failure. A serum level of cystatin C are used to assess renal function and is a potential cardiovascular risk factor. Adiponectin is an anti-atherogenic factor. Aim: To measure cystatin C and adiponectin in type 2 diabetic patients with and without coronary artery disease. Material and methods: Nine diabetic patients with coronary artery disease aged 76± 10 years, 20 diabetics without coronary artery disease aged 61 ±5 years and 20 non diabetic subjects aged 57±10 years, were studied. Results: Serum levels of cystatin C (mg/L) were 1.5 (range 0.89-219), 0.81 (range 0.71-1.08) and 0.68 mg/L (range 055-0.75) in diabetics with and without coronary artery disease and controls, respectively (p <0.0001). No differences in adiponectin between groups and no association between cystatin C and adiponectin, were observed. No association between both parameters and body mass index orglycosilated hemoglobin Ale was observed. Cystatin C had a positive correlation with serum creatinine (r =0.57p <0.001). Conclusions: Diabetics with coronary artery disease have higher levels of cystatin C, that are closely correlated with serum creatinine levels. <![CDATA[<b><i>Association between cardiorespiratory fitness and cardiovascular risk factors in healthy individuals</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600002&lng=en&nrm=iso&tlng=en Background: Cardio respiratory fitness (FIT) is associated with a better profile in most modifiable cardiovascular risk factors (RF). In Chile, sedentary lifestyle is highly prevalent, reaching almost 90%. Aim: To determine the association between FIT and traditional and emergent RF in a primary prevention population. Material and methods: We prospectively studied 1973 subjects (36% women, mean age 56± 13 years) without history of cardiovascular disease and absence of ischemic changes on exercise testing. We assessed cardiovascular RF and determined body mass index (BMI), waist circumference, systolic and diastolic blood pressure, fasting blood lipids, glucose, C-reactive protein (CRP) and fibrinogen. FIT was measured by a Sci f-reported physical activity questionnaire and by a maximal treadmill exercise test, expressed in metabolic equivalents (METs). Results: Subjects in the highest FIT according to the treadmill test had significantly lower BMI, waist circumference, systolic and diastolic blood pressure, total cholesterol, triglycerides, glucose, CRP and fibrinogen, and higher HDL cholesterol (adjusted by age and gender). LDL cholesterol did not show significant changes. The same pattern of RF (including LDL cholesterol) and CRP was observed when using Sci f-reported physical activity as a FIT parameter There was a significant association between both methods to measure FIT (p <0.0001, Chi-square Mantel-Haenszel). Conclusions: Our findings show that a better level off IT, assessed by exercise testing or through Sci f report is associated with improved levels of traditional and emergent RF. <![CDATA[<b><i>Professionalism of physicians from the point of view of physicians and students</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600003&lng=en&nrm=iso&tlng=en Background: Professionalism should be included as a fundamental component in the curriculum of undergraduate as well as graduate students of Medicine. Future physicians should be aware of the attributes that a professional should possess. Aim: To analyze the ideal medical doctor attributes from the point of view of physicians and students of Medicine. Material and methods: One hundred four physicians (MD) and 47 students answered a free association test on the attributes they would assign to a good physician. The test was applied via Internet to professionals, and students were tested in group dynamics at the beginning of the class on Bioethics and Professionalism. Data were processed according to the Lexical Availability Model (LAM) which provides quantitative as well as qualitative evaluations. Results: The attributes with higher scores among MD's were honesty (0.379), regular academic updating (0.373), ability (0.325) and empathy (0.241). Among students, the selected attributes were excellence (0.625), empathy (0.511), responsibility (0.280) and ability (0.209). A general agreement was found among physicians and students, excepts by the fact that MD's consider continuing academic updating as the most important attribute. Conclusions: The attributes that physicians and medical students evaluate as essential in professionalism were identified using the LAM approach. At the beginning of the career, students have a definite humanistic approach to their future profession. <![CDATA[<b><i>Access to social networks and health care among extremely poor people</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600004&lng=en&nrm=iso&tlng=en Background: Extremely poor people have more problems to have access to social networks and health care. Aim: To evaluate the access to health services and the perception about these services of adults living in conditions of extreme poverty. Material and methods: A survey was applied to 361 people living in slums aged 15 to 77 years (83% females), that were living in these conditions for a mean of 11 years. Twenty six in-depth interviews were also performed to prototypical subjects living in extreme poverty. Results: Ten percent of subjects were illiterate. Sixty two percent were unsatisfied with their access to health services and 32% were not registered in primary health clinics. Among children of less than 6 years of age, 22% were delayed in their vaccination schedule and 32% were not withdrawing the milk delivered by the complementary feeding program of the clinic. The qualitative analysis revealed that the lack of access to health care is associated with the feeling of exclusion, mutual distrust and lack of resolution of health problems. Conclusions: People living in extreme poverty are distrustful and perceive obstacles to have access to the health care system. <![CDATA[<b><i>Ethical problems in medical services from the patients' point of view</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600005&lng=en&nrm=iso&tlng=en Background: There is a paucity of information on the perception of patients about ethical issues in medical practice. Aim: To determine the type and frequency of ethical problems perceived by patients hospitalized in public and private hospitals. Material and methods: Eighty eight subjects aged 65years (48% women), admitted to a public hospital and 44 subjects aged 59 years (52% women) admitted to a private clinic answered a survey about ethical problems. The main issues covered were medical information management, participation in decision making and intimacy of patients. Results: Fifty three percent of patients perceived at least one ethical problem. Patients admitted to the public hospital perceived more communication and intimacy problems than their peers admitted to a private clinic. Conclusions: Approximately half of the interviewed patients acknowledged the presence of ethical problems, especially in the communication and intimacy areas). <![CDATA[<b><i>Fecundity reduction and aging in fertile women population in the period 1990-2004 in Chile</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600006&lng=en&nrm=iso&tlng=en Background: Chile is in the advanced stage of demographic transition with a low natural growth and a progressively aging population. Aim: To analyze births by range of maternal age and to establish if population aging is expressed in the women's fertile age range. Material and methods: Trend analysis of births and age-specific birth rates in the period 1990-2004, in the Chilean women population of reproductive age. Raw data were obtained from the Vital Statistics Yearbooks of the National Institute of Statistics. Trends were studied by linear regression and Generalized Estimating Equation (GEE). Results: The general trend of births descended significantly from 1999 to 2004 (r: -0.996; p <0.001). Births significantly decreased in the range of ages from 20 to 34 years. There was an increase in the range of ages from 35 to 44 and from 10 to 14 years. The age-specific birth rate declined in all ranges, with the exception of women aged 10 to 14 years. The number of women increased significantly at all age ranges, except for the 20-24 year-old range where no significant change was observed and the 25-29 year-old range that experienced a significant reduction. Conclusions: In the period from 1990 to 2004, there was a significant reduction of births and age-specific birth rates in Chile. There was also an increased birth rate among women aged 35 to 44 years and an aging of the fertile women population. <![CDATA[<b><i>Prevalence of drug abuse among children in basic schools</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600007&lng=en&nrm=iso&tlng=en Background: Peer methodology (PM) is an adaptation of the privileged access interviewer methodology and is used for prevalence studies. PM estimates higher drug consumption frequencies among school and college students than self reports, since it minimizes underreporting. Aim: To assess drug abuse among students using PM. Material and methods: A random sample of 234 school students of middle and low-middle socioeconomic status, aged 9 to 14 years (53% women) were interviewed using PM about drug consumption. Results: The frequency of licit drug consumption during the last year was 29% and 15% during the last month (current consumption). The consumption of tobacco and alcohol was 20% and 18% respectively during the last year. The figures for the last month were 11% and 8% respectively. The beginning age for smoking and alcohol consumption were 11.1 ±1.5 and 11.3± 1.8 years respectively. The frequency of illicit drug consumption was 3.5%. Illicit drug users began licit drug consumption at earlier ages their non user peers. Conclusions: There is a high frequency of illicit drug consumption among school age children. <![CDATA[<b><i>Eating disorders inventory scores among mothers of adolescents with and without eating disorders</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600008&lng=en&nrm=iso&tlng=en Background: Parents have a control role in the development and treatment of eating disorders among teenagers. Aim: To compare attitudes, beliefs and behaviors between mothers of patients with eating disorders and mothers of teenagers without these disorders. Material and methods: Twenty one mother-sibling pairs of adolescents with eating disorders and 15 pairs of adolescents without this condition, but of similar age, were studied. The eating disorders inventory (EDI-2), a self administered questionnaire that includes 91 items, was applied. Results: No differences in any of the subscales of EDI-2 were observed between mothers of teenagers with or without eating disorders. No differences in perfectionism, maturity fears, impulsivity and interpersonal distrust were observed between adolescents with and without eating disorders. The latter had a lesser drive for thinness and inefficacy. Conclusions: In this sample, no differences in behaviors, attitudes and beliefs about food, were observed between mothers of adolescents with and without eating disorders. <![CDATA[<b><i>Rosenberg self-esteem scale</i></b>: <b><i>Validation in a representative sample of Chilean adults</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600009&lng=en&nrm=iso&tlng=en Background: Self-esteem is positively associated to the well being of people and could be a good mental health indicator. Aim: To determine the reliability and validity of the Rosenberg Self-esteem Scale in a Chilean adult sample. Material and methods: The instrument was applied to 473 subjects living in the Metropolitan Region of Santiago, evenly distributed according to gender, age, educational level and income. The Neugarten Life Satisfaction index (LSI-A) was also applied to the sample. Results: Cronbach's alpha for reliability of the scale was 0.754. There was no gender bias and factor analysis grouped items into two factors (5positive and 5 negative). The instrument had a correlation of 0.455 with the LSI-A. Conclusions: The Rosenberg Self-esteem Scale meets the criteria for validity and reliability of a quality instrument to measure self-esteem in Chile. <![CDATA[<b><i>Intravascular hypothermia for the management of Intracranial hypertension in acute liver failure</i></b>: <b><i>Case report</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600010&lng=en&nrm=iso&tlng=en Acute liver failure has a mortality rate in excess of 80%. Most deaths are attributed to brain edema with intracranial hypertension and herniation of structures, where ammonium plays a major role in its generation. We report an 18 year-old female with a fulminant hepatic failure caused by virus A infection. The patient developed a profound sopor and required mechanical ventilation. A CT scan showed the presence of brain edema and intracranial hypertension. A Raudemic® catheter was inserted to measure intracranial pressure and brain temperature. Intracranial hypertension became refractory and intravascular hypothermia was started, reducing brain temperature to 33°C. Seventy two hours later, a liver transplantation was performed. After testing graft perfusion, rewarming was started, completing 122 hours of hypothermia at 33°C. The patient was discharged in good conditions after 69 days of hospitalization. <![CDATA[<b><i>Primary vasculitis of the Central Nervous System</i></b>: <b><i>Report of one case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600011&lng=en&nrm=iso&tlng=en A primary central nervous system vaculitis is an uncommon and invalidating disease, which has a fatal course if left untreated. We report a 63 year-old woman presenting with a history of two months of cognitive impairment, dysarthria, gait instability and tremor. After four months of evolution a right hemianopsia and a flaccid paresis of upper right limb appeared. A brain biopsy was performed and the histological findings confirmed the suspicion of primary cerebral vasculitis. The patient was treated with cyclophosphamide and prednisone, observing a partial recovery of cognitive and motor function. <![CDATA[<b><i>Coronary spasm secondary to an allergic reaction or Kounis syndrome</i></b>: <b><i>Report of one case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600012&lng=en&nrm=iso&tlng=en We report a 79 year-old mate with a history of an acute coronary syndrome subjected to coronary angioplasty and stent placement in the right coronary artery (RCA) four months ago. Since the patient continued with symptoms, a coronary angiography was performed. During the procedure, the patient developed a cutaneous allergic reaction and bronchospasm probably related to contrast media and a severe spasm of the RCA with inferior ST elevation in the absence of rest enosis, that was difficult to treat. The presence of angina or an acute coronary syndrome and allergic reactions is known as the Kounis syndrome. <![CDATA[<b><i>Cerebrotendinous xanthomatosis</i></b>: <b><i>Report of one case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600013&lng=en&nrm=iso&tlng=en Cerebrotendinous xanthomatosis is an inherited autosomal recessive disease caused by a mutation in the gene for the sterol 27-hydroxylase enzyme, which determines the accumulation of plasmatic cholestanol in various tissues. The natural history of this disease is characterized by chronic diarrhea beginning in childhood, cataract in youth, tendinous xanthomas in adulthood and later progressive neurological dysfunction manifested as dementia, psychiatric disorders, cerebellar, pyramidal or extra pyramidal signs or seizures. We report a 39 year-old male with a history of diarrhea during childhood and bilateral cataracts requiring surgery at 20 years of age, who evolves later with psychiatric disorders and bilateral increased volume in Achules tendons. High levels of plasmatic cholestanol and magnetic resonance imaging confirmed the diagnosis of this disease. <![CDATA[<b><i>On errors in medicine</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600014&lng=en&nrm=iso&tlng=en Errors in medical practice may seriously harm patients. This damage is not always attributable to the action of a doctor. We must bear in mind that all human activity is susceptible of errors and that the effects of those errors will depend on the target of such activity. Therefore the consequences of doctor's errors will necessarily be the patient's health and the only possible preventive action of professionals is to take the measures to reduce the occurrence of errors to a minimum. This essay is a reflection about the nature of errors in medicine, about when they can be attributed to the action of doctors and from where they arise. We therefore analyze errors in different human activities. We distinguish errors in science, arts and techniques. We also consider errors that arise from the act itself and analyze if this is the source of errors imputable to doctors. <![CDATA[<b><i>Adipogenesis and osteoporosis</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600015&lng=en&nrm=iso&tlng=en Mesenchymal stem cells (MSCs) found in bone marrow stroma, are able to differentiate into osteoblasts and adipocytes, among other cellphenotypes. In normal bone marrow balance osteoblastic an adipocytes cell differentiation favour bone formation, while in osteoporosis there is an increased adipocytes content. Since osteoblasts and adipocytes originate from a common MSC precursor cell, here we discuss whether quantitative and qualitative stem cell defects may be the cause of alterations in the number and function of differentiated cells. This review analyzes some conditions that contribute to different osteogenic/adipogenic potentials in human bone marrow MSCs obtained from control and osteoporotic postmenopausal women. We analyze the protective effect exerted by locally generated factors like estradiol and leptin on MSCs differentiation, because altered bioavailability of these factors may play a role in osteoporosis. Osteoporotic MSCs (o-MSCs) are characterized by increased adipogenic potential as compared to control cells. Leptin exerted a direct protective action against adiposeness only in control cells. In contrast, leptin action on o-MSCs is hampered, suggesting that inadequate leptin action may be associated to lipid accumulation in bone marrow. <![CDATA[<b><i>Recombinant activated factor VII for perioperative bleeding</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600016&lng=en&nrm=iso&tlng=en Recombinant activated factor VII (rFVIIa) is a new haemostatic drug, originally used for the treatment of patients with hemophilia A and B. At the present time it is used for other bleeding conditions such as the perioperative period. When used prophylactically there is a reduction in the number of bleeding episodes but no changes in the need for blood transfusion or other blood products. The adverse effects are arterial or venous thromboembolic events that are mostly related to the severity of the underlying disease of the patient and the concurrent administration of other haemostatic agents, rather than the use of rFVIIa. Its use is recommended when there is a persistent bleeding after the reposition of blood products and when surgical causes of bleeding have been discarded. The cost of the medication should also be considered before its use. <![CDATA[<b><i>Vaccines against hepatitis A and B in Chile</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600017&lng=en&nrm=iso&tlng=en The mode of transmission and epidemiological approach for hepatitis A and B are different. However, both are preventable with vaccines whose efficacy and long lasting protection has been demonstrated. This review describes the secular tendency of both infections in Chile, their risk factors that have contributed to their persistence in the country and the interventions that have been carried out to reduce the disease burden. Although the vaccine for hepatitis B was incorporated to the immunization program in 2005, the vaccine for hepatitis A persists in the list of interventions that must be assumed with priority by the Ministry of Health. If Chilean health authorities pretend to reach the enteric disease indicators of developed countries, they must accelerate the epidemiological transition towards the elimination of hepatitis A. <![CDATA[<b><i>The medical history of Edgar Allan Poe</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600018&lng=en&nrm=iso&tlng=en The mode of transmission and epidemiological approach for hepatitis A and B are different. However, both are preventable with vaccines whose efficacy and long lasting protection has been demonstrated. This review describes the secular tendency of both infections in Chile, their risk factors that have contributed to their persistence in the country and the interventions that have been carried out to reduce the disease burden. Although the vaccine for hepatitis B was incorporated to the immunization program in 2005, the vaccine for hepatitis A persists in the list of interventions that must be assumed with priority by the Ministry of Health. If Chilean health authorities pretend to reach the enteric disease indicators of developed countries, they must accelerate the epidemiological transition towards the elimination of hepatitis A. <![CDATA[<b><i>Algebra, calculus and geometry of contagion at the early evolution of a A (H1N1) pandemic spread</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600019&lng=en&nrm=iso&tlng=en The mode of transmission and epidemiological approach for hepatitis A and B are different. However, both are preventable with vaccines whose efficacy and long lasting protection has been demonstrated. This review describes the secular tendency of both infections in Chile, their risk factors that have contributed to their persistence in the country and the interventions that have been carried out to reduce the disease burden. Although the vaccine for hepatitis B was incorporated to the immunization program in 2005, the vaccine for hepatitis A persists in the list of interventions that must be assumed with priority by the Ministry of Health. If Chilean health authorities pretend to reach the enteric disease indicators of developed countries, they must accelerate the epidemiological transition towards the elimination of hepatitis A. <![CDATA[<b><i>Forensic reports</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600020&lng=en&nrm=iso&tlng=en The mode of transmission and epidemiological approach for hepatitis A and B are different. However, both are preventable with vaccines whose efficacy and long lasting protection has been demonstrated. This review describes the secular tendency of both infections in Chile, their risk factors that have contributed to their persistence in the country and the interventions that have been carried out to reduce the disease burden. Although the vaccine for hepatitis B was incorporated to the immunization program in 2005, the vaccine for hepatitis A persists in the list of interventions that must be assumed with priority by the Ministry of Health. If Chilean health authorities pretend to reach the enteric disease indicators of developed countries, they must accelerate the epidemiological transition towards the elimination of hepatitis A. <![CDATA[<b>Catálogo de publicaciones OPS</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000600021&lng=en&nrm=iso&tlng=en The mode of transmission and epidemiological approach for hepatitis A and B are different. However, both are preventable with vaccines whose efficacy and long lasting protection has been demonstrated. This review describes the secular tendency of both infections in Chile, their risk factors that have contributed to their persistence in the country and the interventions that have been carried out to reduce the disease burden. Although the vaccine for hepatitis B was incorporated to the immunization program in 2005, the vaccine for hepatitis A persists in the list of interventions that must be assumed with priority by the Ministry of Health. If Chilean health authorities pretend to reach the enteric disease indicators of developed countries, they must accelerate the epidemiological transition towards the elimination of hepatitis A.