Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720090009&lang= vol. 137 num. 9 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<strong><i>Laboratory alert value reporting by the clinical laboratory at an academic medical network</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900001&lng=&nrm=iso&tlng= Background: An alert value is a result suggesting that the patient is at imminent danger unless appropriate remedial actions begin promptly. Report of alert values (AV) by the clinical laboratories has taken special relevance in recent years due to its contribution to patient's care. Aim: To report results of AV informed during 2007 within the Health Network of the Pontificia Universidad Católica de Chile. Material and methods: Analysis of AV recorded in a centralized database of the laboratories of the health network, between January and December, 2007. Results: Total number of AV was 5.366, which represented 0.3% of total examinations and corresponded mainly to the clinical chemistry area. Potassium levels generated the higher number of AV detected, followed by positive blood cultures. Eighty two percent of AV corresponded to hospitalized patients. The greater number of AV was reported to intermediate and intensive care services. Thirty two percent of AV was informed to the physician or professional in charge of the patient within 5 minutes of obtaining the results and 79% within 30 minutes. Conclusions: To obtain a real impact on patient management, it is fundamental to shorten the ¡apse between the obtainment of tests results and the warning, supported on appropriate computerized systems, and to spread the procedure to all personnel involved in patient's care (RevMéd Chile 2009; 137: 1137-44). <![CDATA[<strong><i>Natural history of diabetic retinopathy in a retrospective cohort of type 1 diabetics</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900002&lng=&nrm=iso&tlng= Background: Diabetic retinopathy is one of the most common causes of blindness among adults. Aim: To report the natural history of diabetic retinopathy among Chilean patients with type 1 diabetes followed for a mean of 18 years. Material and methods: Retrospective review of medical records of 39 patients aged 26 to 70 years, (20 females, 78 eyes) with type 1 diabetes controlled by the same ophthalmologist from 1971 to 2008. A questionnaire was sent to each patient and their treating physician to request information about the evolution of the disease and metabolic control. Results: The questionnaire was answered by 24 patients (62%) and 21 attending physicians (54%). Small hard drusen were observed in 25 patients (64%). In 12 cases the drusen were detected before the development of any type of retinopathy. Eleven women became pregnant and retinopathy progressed in four of them. Twently three patients (59%) developed proliferative diabetic retinopathy (PDR). Patients with PDR had a significantly longer duration of diabetes and worse glycemic control. There was a higher frequency of diabetic nephropathy in the PDR group, but only 13 patients out of 23 with PDR had nephropathy. The retinopathy progressed to high risk PDR two years after successful kidney-pancreas transplantation in one patient. Conclusions. In patients with type 1 diabetes mellitus, small hard drusen may be the initial manifestation of diabetic retinopathy. Risk factors for progression to PDR were duration of diabetic and poor glycemic control. Nephropathy was more prevalent in patients with PDR, but a significant group of PDR patients did not have demonstrable nephropathy (RevMéd Chile 2009; 137:1145-52). <![CDATA[<strong><i>Early and late morbidity and mortality of aortic valve replacement with mechanical or biological prostheses during the last decade</i></strong>: <strong><i>The gold standard</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900003&lng=&nrm=iso&tlng= Background: There is a growing interest in alternative techniques for aortic valve replacement (AVR). Therefore it is important to have updated results of conventional AYR as a valid comparative standard. Aim: To evaluate both perioperative and ¡ate morbidity and mortality in patients undergoing conventional AVR, with either mechanical (RVAm) or biological (RVAb) prostheses. Patients and methods: Retrospective review of medical records and operative protocols of patients undergoing AVR between January 1995 and December 2005. Patients with previous cardiac surgery, aortic balloonplasty or simultaneous cardiovascular procedures were excluded. Results: During the study period, 788 patients underwent AVR and 317 met the inclusion criteria. Of the latter, 175patients aged 13 to 83years (63% males) were subjected to AVRm and 142patients aged 49 to 87 years (64% males), were subjected to AVRb. Five (1.6%) patients died during the perioperative period (one AVRm and four AVRb). All were older than 65years. Perioperative complications were recorded in 29 and 25% of patients in AVRm and AVRb groups, respectively (NS). During a median follow-up of six years, complications were recorded in 12 and 4% of patients in AVRm and AVRb groups, respectively (p <0.05). The actuarial survival for AVRm group at 1, 5 and 10years, was 96, 92 and 87%, respectively. The figures for AVRb group were 95, 86 and 83%, respectively (NS). The 10 year reintervention free survival was 97% for the AVRm group and 84% for the AVRb (p <0.05). Conclusions: Perioperative mortality and rates of complications of AVR in this series of patients are low, which compares favorably with other series (Rev Méd Chile 2009; 137:1153-62). <![CDATA[<strong><i>Factor analysis of health related quality of life in patients admitted to a short stay medical unit</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900004&lng=&nrm=iso&tlng= Background: Disease and hospital admission have a great impact on the quality of life of an individual: Aim: To identify the factors associated with health related quality of life (HRQL) in patients admitted to a Short Stay Medical Unit (SSMU). Patients and methods: Prospective cohort study of 335 patients aged 15 to 99 years (196 males) consecutively admitted to the SSMU. In all we recorded sociodemographic data, number of previous hospital admissions, admission type, main diagnosis, ¡enght of stay, comorbidities, the Goldberg Depression and Anxiety Scale, the Karnofsky Perfomance Scale, the Barthel Index and quality of life with the EuroQol-5D instrument. After studying the associations between variables, we carried out a factor analysis of those that were significantly related to HRQL. Results: Mean body mass index was 27.7 Kg/m² and 83% were emergency admissions. Heart failure, chronic obstructive pulmonary disease exacerbation, acute coronary syndromes and cardiac arrhythmias, constituted 56% of all admissions. HRQL was statistically related to age, gender, educational status, caregiving situation, number of previous admissions, main diagnosis, length of stay, Goldberg scale and Karnofsky, Barthel and Charlson indexes. Factor analysis reduced the original variables to five, which explained 67.8% of the variance, as follows: Factor 1- Karnofsky and Barthel indexes (27.8%); Factor 2- age, educational status, caregiving situation (12.3%); Factor 3- the Goldberg scale (10.4%); Factor 4- admission type (8.8%); Factor 5- main diagnosis (8.4%). Conclusions: HRQL in patients admitted to Short Stay Medical Unit is partially related to perfomance status, age, social and psychological status, admission type an the main diagnosis (RevMéd Chile 2009; 137:1163-72). <![CDATA[<strong><i>Diagnostic value of frozen section biopsy during surgery for breast lesions or neoplasms</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900005&lng=&nrm=iso&tlng= Background: During the surgical treatment of breast neoplasms (benign or malignant), frozen section biopsy is frequently requested to assess the kind of lesion and determine the surgical margins. Aim: To assess the diagnostic yield of frozen section breast biopsy. Material and methods: AH the pathological reports of frozen section biopsies and definitive biopsies of 337 women aged 26 to 88 years, operated for suspected breast neoplasms between 2002 and 2006, were reviewed. The sensitivity, specificity and predictive value of frozen section biopsy, were calculated using the definitive biopsy as the gold standard. Results: The definitive biopsy confirmed the presence of cancer in 290 women (86%). There were two false negative (0.59%) and no false positive frozen section biopsies for cancer detection. The sensibility for cancer detection was 99.3% and the specificity 100%. The positive predictive value was 100% and the negative predictive value 96.1%. The diagnosis of phyllodes tumor was missed by frozen section biopsy in three cases. The margins were informed in the 258 frozen section biopsies (79%) and in 59 cases (18%), these were positive for cancer. Conclusions: Frozen section biopsy is useful and reliable for cancer detection and margin status assessment in breast cancer surgery (RevMéd Chile 2009; 137: 1173-8). <![CDATA[<strong><i>Cardiovascular risk profile and insulin resistance according body mass index, waist circumference and hypertriglyceridemic waist in adult subjects</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900006&lng=&nrm=iso&tlng= Background: Insulin plays a determinant role in the individual metabolic profile. Obesity, the most common cause of insulin resistance (IR), can be diagnosed by body mass index (BMI). Waist circumference (WC), specifically, measures accumulation of abdominal fat. The cardiovascular risk of an individual is strongly related to a combination of abdominal obesity with hypertiiglyceridemia or hypertriglyceridemic waist (HTW). Aim To assess the metabolic profüe of cardovascular risk and RI according to BMI, WC and HTW in adult patients. Material and methods: Weight, height, BMI, blood pressure (BP), WC, HTW, blood glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides and insulin were assessed and IR calculated by the homeostasis model assessment (HOMA) in 63 females aged 46±11 years and 12 males aged 4 7± 10 years. Results: Differences in weight, WC, BP, lipids, glucose, insulin and HOMA, were observed as BMI increased. When patients were grouped according to WC, there were significant differences only in systolic pressure, triglycerides, insulin and HOMA. Individuals with HTW had a more adverse metabolic profüe than those without HTW or with only high WC. A multiple regression equation determined that body mass index, total cholesterol and diastolic blood pressure were independent predictors of insulin resistance. Conclusions: Patients with HTW displayed an unfavorable cardiac risk profile (Rev Méd Chile 2009; 137:1179-86). <![CDATA[<strong><i>Factors associated with maintenance of contraception among adolescents</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900007&lng=&nrm=iso&tlng= Background: Factors such as personal issues, family, sexuality and sexual partner characteristics are strongly associated with contraceptive continuation among single, nulliparous female adolescents. Aim To determine factors associated to contraceptive maintenance among female nulliparous adolescents. Material and methods: A cohort of 2,811 adolescents, who confidentially requested contraception in a sexual and reproductive health university center from 1990 to 2006 was analyzed. Two years after the request, their clinical records were reviewed to determine the time and length of contraception. Using life table analysis, the variables related to continuation or discontinuation of contraception were identified. Results: Factors associated with a longer contraceptive use were a lower age at the moment of initiating the method, a better academic achievement and aspirations, higher schooling of the partner, higher age of the mother, having an adolescent mother, supervision of permissions by people different than parents and not attending to religious services. Variables associated with a higher risk for abandonment were a higher age of the adolescent, greater number of sexual partners, lack of communication with parents, non-catholic religious affiliation, use of oral hormonal contraceptive, greater number of siblings, commenting sexual issues with relatives or friends, having a partner without academic activity or working and to live without parents. Conclusions: Several personal, familial and environmental factors influence contraceptive use continuity among adolescents (RevMéd Chile 2009; 137:1187-92). <![CDATA[<strong><i>Non-toxigenic hemolytic Vibrio cholerae non-O1non-O139 fatal septicemia</i></strong>: <strong><i>Report of one case</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900008&lng=&nrm=iso&tlng= We report a 70-year-old woman, who had recently consumed shellfish, that was admitted to the intensive care unit with septic shock and died 19 hours later due to a multi-organic failure. Microbiological, serological and molecular assays confirmed a hemolytic tdh+ Vibrio cholerae non-01, non 0139 as the etiologic agent (Rev Méd Chile 2009; 137: 1193-6). <![CDATA[<strong><i>Gastrointestinal stromal tumor (GIST) in a patient with neurofibromatosis type </i></strong><strong>1. <i>Report of one case</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900009&lng=&nrm=iso&tlng= Neurofibromatosis Type 1 (NF1) is an autosomic dominant condition affecting the central nervous systema and presenting a disposition towards development of gastrointestinal stromal tumors (GIST). We report a 38year-old female patient with neurofibromatosis type 1 that required emergency surgery due to a perforated GIST originating in the fourth duodenal portion. The GIST, and the fourth duodenal portion, were excised and a primary duodenum-jejunal anastomosis was performed. The pathological study showed a partially necrotic solid-cystic tumor with 1 to 2 mitoses per 50-high-power fields. The cells stained positively to CD 117, CD34 and Desmin, and were negative to S-100, Vimentin, and Smooth Muscle a-Actin. The patient is currently asymptomatic and under follow-up during the last 11 months after surgery (Rev Méd Chile 2009; 137:1197-200). <![CDATA[<strong><i>Fatal neonatal sepsis caused by vertical transmission of Morganella morganii. </i></strong><strong><i>Report of one case</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900010&lng=&nrm=iso&tlng= We report a term neonate who developed early-onset sepsis due to Morganella morganii. The child was vaginally delivered after a short labor, and presented signs of perinatal asphyxia. Blood cultures taken soon after birth and from mother's lochia were positive for this microorganism. The infection was unresponsive to treatment with cefotaxime, to which the microorganism was susceptible, and the infant died at 17 days of age. M morganii is an opportunistic and uncommon pathogen, causing disease mainly in patients with underlying illness or after surgery. It is a rare perinatal pathogen, causing severe disease in premature infants, in association with maternal chorioamnionitis and premature rupture of the membranes (RevMéd Chile 2009; 137: 1201-4). <![CDATA[<strong><i>Endemic pemphigus foliaceus in a pregnant woman</i></strong>: <strong><i>Report of one case</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900011&lng=&nrm=iso&tlng= Endemic pemphigus foliaceus (EPF) in an autoinmune skin disease present in areas of the Amazonia. We report a 36 year-old woman who presented EPF at 17 weeks of pregnancy. At 29 weeks, she started antimicrobial treatment and steroids. At the moment of delivery, the disease was in remission and cutaneous lesions were not seen in the neonate. Indirect immunofluorescence titers of total IgG in the mother and in the neonate were negative. Sixteen months later, IgG titers in the offspring were 1/20 and remained negative in the mother, who was on low doses of oral corticosteroids (Rev Méd Chile 2009; 137: 1205-8). <![CDATA[<strong><i>Hypocretin system and narcolepsy</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900012&lng=&nrm=iso&tlng= Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep-onset rapid eye movement (REM) sleep periods. It is now identified as a neurodegenerative disease because there is a massive loss of specific neurons in the brain. These neurons contain the neuropeptides hypocretin-1 and hypocretin-2, which are also known as orexin-A and orexin-B. Cerebrospinal fluid hypocretin-1 measurements are diagnostic for primary narcolepsy. The cause of neural loss could be autoinmune since most patients have the HLA DQB1*0602 alíele that predisposes to the disorders. The discovery of hypocretin deficiency is redefining the clinical entity of narcolepsy and offering novel diagnostic procedures. This article reviews the current understanding of narcolepsy and discusses the implications of hypocretin discovery (Rev Méd Chile 2009; 137:1209-16). <![CDATA[<strong><i>Association between air pollution and cardiovascular risk</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900013&lng=&nrm=iso&tlng= A clear cut relationship between particulate matter air contamination and the mortality and morbidity due to respiratory disease has been observed in the last decades. However there is also a relationship between air pollution and cardiovascular diseases. In big cities, a big or small particle concentration increase of 10 ¡xg/m³ is associated with a significantly higher risk of ischemic heart disease and myocardial infarction, both when acute or chronic exposures are considered. The risk is higher for small particles. Similar risk increases are observed in patients with hypertension, stroke or severe arrhythmias. This association is independent of environmental distracters such as weather, temperature or humidity and of classical cardiovascular risk factors such as age, diabetes, dyslipidemia and obesity. Physicians should be aware of the problem and explain their patients the increased risk that they are facing due to air pollution (Rev Méd Chile 2009; 137: 1217-24). <![CDATA[<strong><i>Leptin-melanocortin system, body weight regulation and obesity</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900014&lng=&nrm=iso&tlng= Obesity is a multifactorial disease that is rarely associated to single gene defects. However, due to their direct cause-effect relationships, those genetic defects that cause some forms of monogenic obesity are relevant in the study of mechanisms that contribute to increased energy intake and body fat accumulation. Most of the genes that have been shown to cause monogenic obesity are related to the leptin-melanocortin system. The functionality of this system has been elucidated through natural mutations (Agouti, ob and db) in mice and knock-out models. Mutations related to human monogenic obesity have been described in leptin, leptin receptor, proopiomelanocortin, prohormone convertase 1 or melanocortin receptor 4 genes. Therapy with human recombinant leptin in patients with genetic deficiency of the hormone is an effective medical treatment of obesity, although only applicable to very few families. The use of leptin-melanocortin agonists, drugs to avoid leptin resistance or combinations of treatments with leptin and other satiating peptides are currently being investigated for multifacotiral human obesity (Rev Méd Chile 2009; 137:1225-34). <![CDATA[<strong><i>Update of consensus reccomendations of the Chilean Hypertension Society about ambulatory blood pressure monitoring</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900015&lng=&nrm=iso&tlng= Ambulatory blood pressure monitoring (ABPM) is a valuable tool to evaluate the blood pressure pattern, to identify hypertensive patients, to diagnose white coat and masked hypertension and in situations in which a tight control of hypertension is crucial. This is an update of 1999 consensus recommendations about the use to ABPM, considering that there is new evidence concerning its benefits, and the clinical experience with its application has increased. Equipment programming, its installation, the interpretation and analysis of the data are described, and a report sheet for patients is included. New recommendations have been added to the accepted indications. Normal blood pressure ranges for children and pregnant women have been replaced by new data (Rev Méd Chile 2009; 137:1235-47). <![CDATA[<strong><i>Ignacio Matte Blanco, MD, and the development of psychiatry teaching to medical students</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900016&lng=&nrm=iso&tlng= Ignacio Matte Blanco had an important role in organizing the teaching of Psychiatry in medical school. In this paper we describe his training, that began as a physiologist, but turned into psychiatric and psychoanalysis in his formation in the United States and the United Kingdom during the forties. After returning to Chile, in the Chair of Psychiatry at the Faculty of Medicine of the Universidad de Chile he developed pioneering ideas about undergraduate teaching of psychiatry, that were exposed not only in Chile but to the Pan-American Health Organization. He advocated decreasing the time spent in lectures, and increase clinical practice and group dynamic experiences centered in the students. He insisted that teaching had to be focused in issues useful for general physicians and non psychiatric specialists, as well as in the need to extend the psychosocial curriculum to the internship. He also pointed to the need of increasing the humanistic formation of medical students. When Matte Blanco emigrated to Rome in 1966, his influences seemed to wane, since most of his disciples ¡eft the Clínica Psiquiátrica Universitaria, where he taught. However, since the eighties, several of his viewpoints have been included in the medical curricula of Chilean schools of medicine (Rev Méd Chile 2009; 137:1248-52). <![CDATA[<strong><i>Sixty years of mitral valve surgery</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900017&lng=&nrm=iso&tlng= On June 10, 1948, Charles Bailey, MD, operated successfully a mitral valve stenosis in Philadelphia and six days later, Dwight Harken, MD, performed the same operation in Boston, marking the onset of cardiovascular surgery. These successful operations were preceded by several failures and even deaths, that had to be overcome by both pioneers. This manuscript reviews several cases and situations that these surgeons had to face during the development of cardiovascular surgery, that changed the natural history of cardiac diseases. The history culminates with the successful mitral valve replacement, performed by Albert Starr using a mechanical valve designed by him and Lowell Edwards, a retired engineer whose primary interest was to develop an artificial heart. The first mitral commissurotomy in Chile was performed by Svante Tornvall, MD, and Pedro Uribe, MD, at van Buren Hospital in Valparaiso in December, 1950. The first mitral valve replacement was performed by Hugo Salvestrini, MD, in 1964 at the Catholic University Hospital (Rev Méd Chile 2009; 137:1253-60). <![CDATA[<strong><i>Are blood glucose measurements made with portable glucometers reliable?</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900018&lng=&nrm=iso&tlng= Examinations performed beside the bed of patients ('Point-ofcare testing, POCT") provide immediate results and are simple to perform. The most common of these tests is the self control of blood glucose levels in diabetic patients. The use of these devices at the hospital level, introduces a new set of requirements to health institutions, which should monitor all aspects of the process, including training of final users, proper quality control, development of written procedures for use and even participation in surveys of external quality control, avoiding the generation of errors and guaranting patient safety (Rev Méd Chile 2009; 137:1261-4).<hr/>los exámenes realizados al lado de la cama del enfermo f'Point of care testing, POCT") tienen como mayor ventaja la rapidez en la entrega de resultados y la simplicidad de uso, siendo su principal aplicación el autocontrol de la glicemia en pacientes diabéticos. El uso de estos equipos a nivel hospitalario introduce exigencias a las instituciones de salud, las cuales deben monitorizar todos ¡os aspectos del proceso, incluyendo la capacitación de los usuarios, el adecuado control de calidad, el desarrollo de procedimientos escritos para su uso e inclusive la participación en encuestas de control de calidad externo, evitando la generación de errores y colaborando así con la seguridad del paciente. <![CDATA[<b><i>Scientific journals for medical students ln Chile</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000900019&lng=&nrm=iso&tlng= Examinations performed beside the bed of patients ('Point-ofcare testing, POCT") provide immediate results and are simple to perform. The most common of these tests is the self control of blood glucose levels in diabetic patients. The use of these devices at the hospital level, introduces a new set of requirements to health institutions, which should monitor all aspects of the process, including training of final users, proper quality control, development of written procedures for use and even participation in surveys of external quality control, avoiding the generation of errors and guaranting patient safety (Rev Méd Chile 2009; 137:1261-4).<hr/>los exámenes realizados al lado de la cama del enfermo f'Point of care testing, POCT") tienen como mayor ventaja la rapidez en la entrega de resultados y la simplicidad de uso, siendo su principal aplicación el autocontrol de la glicemia en pacientes diabéticos. El uso de estos equipos a nivel hospitalario introduce exigencias a las instituciones de salud, las cuales deben monitorizar todos ¡os aspectos del proceso, incluyendo la capacitación de los usuarios, el adecuado control de calidad, el desarrollo de procedimientos escritos para su uso e inclusive la participación en encuestas de control de calidad externo, evitando la generación de errores y colaborando así con la seguridad del paciente.