Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720100002&lang=es vol. 138 num. 2 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b>Apoyo psicológico en desastres</b>: <b>Propuesta de un modelo de atención basado en revisiones sistemáticas y metaanálisis</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200001&lng=es&nrm=iso&tlng=es A search for meta analyses and systematic reviews on psychological support to disaster victims was carried out to devise a local support model. Based on 36 meta analyses and systematic reviews, the support should be carried out in five echelon levels: diffusion, social support, general medical care, general psychiatric care and psychiatric care carried out by experts. Only victims with well-established formal psychiatric disorders should receive psychotherapy or psychotropic medication. The rest should only receive psychological first aid. According to the best evidence available, a model for psychological care is proposed. <![CDATA[<b>Mediciones de adiposidad intraabdominal por ultrasonido y factores asociados con riesgo cardiovascular en niños obesos</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200002&lng=es&nrm=iso&tlng=es Background: Cardiovascular risk factors are commonly present in obese children. Aim: To evaluate the association among radiological measurements of intra-abdominal adipose tissue, and cardiovascular risk factors, in prepuberal obese children. Patients and Methods: We evaluated 30 obese (body mass index > p95) children aged 6 to 12 years (15 males). Anthropometry and blood pressure were measured. Subcutaneous and intra-abdominal fat thickness and fat area were measured by ultrasound (US) and computed tomography. Serum insulin, glucose and lipid profile were measured in a fasting blood sample. Homeostasis model assessment (HOMA) was calculated as an index of insulin resistance. Results: There was a significant correlation between US intra-abdominal fat thickness and HOMA (r = 0.47, p < 0.01), serum triglycerides (r = 0.46, p < 0.05) and with positive criteria for metabolic syndrome (r = 0.66, p < 0.01). A receiver operating curve (ROC) analysis showed that, above a cut-off of 45 mm for intra-abdominal fat thickness, US was able to identify insulin resistance with a sensibility and specificity of 79 and 69% respectively and metabolic syndrome with sensibility and specificity of 100 and 67% respectively. US and computed tomography measurements for intra-abdominal fat thickness were significantly correlated (r= 0.62, p < 0.01). Conclusions: US measurements of intra-abdominal fat thickness identify obesity-associated damage in childhood. Age-specific measurements of intra-abdominal adipose tissue may improve the detection power of this approach. <![CDATA[<b>Diferencias clínicas entre adolescentes hospitalizados por intento suicida y adolescentes hospitalizados por otra causa psiquiátrica</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200003&lng=es&nrm=iso&tlng=es Background: Suicide is the third cause of death among adolescents in United States and between 5 to 12% of teenagers have a history of suicide attempt. Therefore, suicide is a public health problem in this age group. Aim: To compare the clinical characteristics of hospitalized adolescents who attempted suicide with those without a history of suicide attempt. Material and Methods: The clinical records of adolescents aged less than 18years, hospitalized in a psychiatric clinic, were analyzed. Forty six patients aged 15 ±2years (72% females) had a history of suicide attempt and were considered cases and 81 patients aged 15 ±2 years (52% females) did not have a history of suicide attempt and were considered controls. Demographical and clinical characteristics of both groups were compared. Psychiatric diagnoses were based on the Diagnostic and Statistical Manual of Mental Disorders IV (DSMIV). Results: No significant differences were found between groups in the length of hospital stay. The most common psychiatric diagnosis was depressive disorder, found in 71 and 35% of suicide and non-suicide attempters, respectively (p < 0.01). Personality diagnosis was deferred in most studied cases. Conclusions: Depression is more common among hospitalized adolescents who attempt suicide. <![CDATA[<b>Determinación de los niveles de cortisol salival en una muestra de sujetos de Santiago de Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200004&lng=es&nrm=iso&tlng=es Background: Salivary cortisol measurement is recommended as a screening mea-sure when a Cushing Syndrome is suspected. Theproposed cut-offpointfor aprobable diagnosis is 0.16 ug/dL. Aim: To determine salivary cortisol concentrations during the day inpatients with and without Cushing syndrome and with depression. Material and Methods: Salivary cortisol was measured by competitive enzyme immuno assay (EIA), in samples obtained at 8:00,15:00 and 23:00 h in 78 patients without Cushing syndrome, aged 40 ± 15years (28 males), 30 patients with depression aged 40 ± 12years (nine males) and four jemales with Cushing syndrome aged 42 ± 17 years. Results: Salivary cortisol was higher among patients with Cushing syndrome than the rest of patients. A salivary cortisol over the cut-off value of O.16 ug/dL was found in 42% of subjects without Cushing syndrome and in 33% of patients with depression. Median values among patients without Cushing syndrome, depression and with Cushing syndrome were 0.21 (range < 0.1-1.42), 0.2 (range 0,12-0.9) and 0.58 (range 0.37-1.1) ug/dL, respectively Conclusions: Salivary cortisol measured by EIA method was higher among patients with Cushing syndrome but there was a great overlap with values obtained in subjects without the syndrome. <![CDATA[<b>Factores de riesgo de alteraciones citológicas del cuello uterino en mujeres chilenas</b>: <b>Un estudio de casos y controles</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200005&lng=es&nrm=iso&tlng=es Background: Cervical cancer is the third cause of cancer death among Chilean women, affecting mainly women from low socioeconomic status. Aim: To determine main risk factors (RF) including human papilomavirus (HPV) types associated with abnormal cervical cytology (Atypical Squamous Cells of Undetermined Significance or ASCUS) among Chilean women from low socioeconomic status in Santiago, Chile. Material and Methods: A random population based sample of616 women from La Pintana (a low-income district in Santiago) participated in 2001 in a HPV prevalence study and were re-evaluated in 2006 through a risk factors questionnaire, Papanicolaou test and DNA detection for HPV. The Papanicolaou test was analyzed in Santiago and HPV analysis (PCR_GP5+/GP6+) was conducted in Vrije University, Amsterdam. Cases included 42 women with cervical lesions and controls included 574 women with normal cytology during the period 2001-2006. Logistic regression with uni and multivariate analysis was performed to identify RF for cervical lesions. Results: During the study period, there was a significant increase in the proportion of single women, from 8.3 to 14.8% (p < 0.05), of women with 3 or more sexual partners from 8.9 to 13.3 and of women high risk HPV, from 9.1 to 14.3%. The proportion of abnormal Papanicolaou tests remained stable (3.08 and 3.9% > ASCUS). High risk HPV was the most significant factor associated with cervical lesions (odds ratio (OR) = 9.695%> confidence intervals (CI) = 4.4-21.1) followed by oral contraceptive use (OR = 2.58 95%> CI= 1.2-5.7). Among women infected by high risk HPV, the use of oral contraceptives was a risk factor while compliance with screening was protective for cervical lesions. Conclusions: From 2001 to 2006, there was an increase in the proportion of women with high-risk HPV infections. <![CDATA[<b>Estrategia de prevención de obesidad en escolares</b>: <b>Efecto de un programa aplicado a sus profesores (2007-2008)</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200006&lng=es&nrm=iso&tlng=es Background: In 2007, a preventive strategy for childhood obesity, that included food education and an increase in physical activity, was implemented in seven public schools located in Santiago. In four of these schools, a counseling program about healthy lifestyles for teachers was also carried out. Aim: To test if counseling had an effect in the intervention for children. Material and Methods: Anthropometric measures were assessed in children at baseline and after two years of intervention. Teachers were also evaluated with anthropometry and a blood sample was obtained to measure blood glucose and serum lipids. Results: Four hundred twelve children from schools whose teachers had counseling and 237 children from schools whose teachers did not have it were evaluated. Twenty-eight teachers with and 19 with no counseling were assessed. In children, the overall prevalence of obesity decreased from 20.2 to 18.3% (p = 0.03). This reduction was only significant among females. BMIZ score decreased significantly in children of both genders. No effect of counseling was observed on weight reduction. Among teachers that received counseling, the prevalence of obesity decreased from 25 to 22.4%, with significant improvements in blood glucose and HDL cholesterol. Conclusions: Counseling directed at teachers did not improve the effect of a program to reduce obesity among schoolchildren. <![CDATA[<b>Morbilidad en mujeres postmenopáusicas pobres</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200007&lng=es&nrm=iso&tlng=es Background: Less favored social classes usually have more unhealthy life-styles and a more difficult access to Health Resources. Aim: To study the possible association between poverty and some common diseases, in a population of postmenopausal women. Material and Methods: Four hundred and forty nine poor women aged 56 ± 12 years and 776 consecutive women aged 53 ± 12 years, answered a personal interview about their lifestyles and medications used. Their medical records were reviewed and they were subjected to a complete physical examination, including weight and height measurement. A fasting blood sample was also obtained. Poverty was defined according to criteria of the Spanish National Institute of Statistics that is based on the income in Euros and the number of family members that share such income. Results: A higher proportion of poor women live in rural areas. They were shorter, had a higher weight and thus a higher body mass index, smoked less and drank less alcohol than their non-poor counterparts drink. The consumption of caffeine, the actual calcium intake and the physical activity during leisure time was similar in both groups. Compared with their counterparts, poor women had a higher prevalence of diabetes mellitus (15.9 and 10.1% respectively, p = < 0.01), obesity (44.2 and 24.3% respectively, p < 0.01) hypertension (24.3 and 16.4%o respectively, p<0.01) and autoimmune rheumatic diseases (7.8 and 4.8%> respectively, p = 0.03). A multiple logistic regression model showed that obesity, hypertension, diabetes mellitus, smoking, alcohol consumption and living in rural areas, were independently associated to poverty. Conclusions: Poor postmenopausal women have a higher prevalence of diabetes mellitus, obesity, autoimmune rheumatic diseases and hypertension and lower frequency of smoking and alcohol consumption than their affluent counterparts do. <![CDATA[<b>¿Están preparados los residentes e internos para enseñar?</b>: <b>Percepción de estudiantes de medicina de pre y postgrado</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200008&lng=es&nrm=iso&tlng=es Background: Every doctor is expected to be competent in teaching. There are few initiatives to prepare medical students for this role. Aim: To explore residents (graduate students) and interns (final year undergraduate students) perceptions of the importance of acquiring teaching skills and how prepared they feel to meet this role. To determine the importance that undergraduate students give to such teaching. Material and Methods: Residents and interns participated in focus groups, and completed the Medical Education Readiness Questionnaire (METRQ), 5th year medical students were also invited to complete it. Results: Three hundred and seventy seven subjects answered the questionnaire. The perceived importance of having teaching skills was 6.1 ±1.2 among residents and 5.7 ± 1.6 among interns, in a scale 1 to 7. Their perception of their own preparation for teaching was 4.3 ± 1.6 for both groups in the same scale. Students evaluated the preparation of the residents for teaching as 5.2 ± 1.6 and that of the interns as 4.4 ±1.7. Seventy-eight percent of 5th year medical students reported to learn more than two. 5 hours a week from residents. Fifty-nine percent of residents and 66% of interns reported to teach up to 2.5 hours per week to the same students. Focus groups participants agreed that teaching is an important role for a physician, and that to do it properly requires personal characteristics, along with teaching skills. They also found that the best opportunities to learn how to teach are during practical training. Conclusions. Our study contributes to the recognition of the teaching role of physicians and the need for teaching training among medical students. <![CDATA[<b>Impacto del asma en escolares de dos centros de salud primaria</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200009&lng=es&nrm=iso&tlng=es Background: Asthma is one of the chronic diseases that generate an impact on quality of life and major health care expenses. Aim: To evaluate the impact of asthma on primary attention expenses, the health related quality of life (HRQOL) and the sanitary resources use. Material and Methods: Follow up of a cohort of 56 asthmatic children aged 6 to 14 years (56% women), during 12 months. The severity and the impact of the disease on HRQOL was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) video questionnaire and the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) respectively Costs were derived from the number of medical attentions, hospital admissions, medication requirements, school absenteeism among patients and work absenteeism among caregivers. Results: Patients required twice the number of medical attentions than the general population. Fourteen percent of children had severe asthma. Compared with subjects without severe asthma, the latter required more attentions (3.8 and 9.7 attentions per year respectively, p< 0.01), had a lower PAQLQ score (4.1 ±0.11 and 5.2 ± 1 respectively, p< 0.05) and a higher school absenteeism (10 and 27 days per year respectively, p < 0.01). Medication use was not different between patients with and without severe asthma. They early cost per patient was $ 106,550 (Chilean pesos). Conclusions: Asthma has a great impact on HRQOL and the use of primary attention resources, specially those children with severe asthma. <![CDATA[<b>Cierre espontáneo de fístula residual post cierre quirúrgico de fístula aorto-ventricular derecha traumática</b>: <b>Caso clínico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200010&lng=es&nrm=iso&tlng=es We report a 16-year-old boy, who suffered a right vent ride penetrating injury caused by a sharp blade that evolved to cardiac tampon. He underwent surgery and was discharged four days later. Thirteen days later, a cardiac murmur was found. An echocardiography showed an aorta-right ventricular fistula. Surgical closure was performed through an aortotomy on cardiopulmonary by pass. The control echocardiography showed a small residual fistula, which closed spontaneously three months later. <![CDATA[<b>Ataxia hemiparética en un infarto lacunar lentículo-capsular con evolución favorable</b>: <b>Algunas consideraciones fisiopatológicas</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200011&lng=es&nrm=iso&tlng=es Hemi paretic ataxia (HA) is a lacunars syndrome that presents with motor deficit and pyramidalism associated to ipsilateral ataxia out of proportion to such deficit. Topography of lesions is wide and acute infarcts have been recognized at the infernal capsule, pons, thalamus, corona radiate and cortex. Symptoms are associated to involvement of pyramidal and corticopontocerebellar tracts. We report a 44-year-old mole presenting with right hemi paresis and severe ataxia. The magnetic resonance imaging showed a sub acute infarction of the left lenticular nucleus and infernal capsule. The patient was treated with physiotherapy, anti platelet agents and statins and was discharged with an evident recovery. <![CDATA[<b>Ulceración perianal</b>: <b>Dos casos de una rara manifestación de tuberculosis extrapulmonar</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200012&lng=es&nrm=iso&tlng=es Perianal tuberculosis is an uncommon variant of extra pulmonary tuberculosis and mimics other common perianal conditions. We report two patients with perianal tuberculosis. An 82-year-old male presenting with purulent perianal discharge and weight loss. A pelvic magnetic resonance imaging showed a low trans sphincteric anorectal fistula with abscess formation. A fistulectomy was performed and the pathological study showed a granulomatous-tuberculous chronic inflammation. Mycobacteria were recovered from gastric contents. A 48-year-old male with the same symptoms. An ulcerated lesion in the anal region was biopsied, disclosing a granulomatous inflammatory process with Ziehl-Nielsen stainable organisms. <![CDATA[<b>Rol de la evaluación preparticipativa en adolescentes, en el diagnóstico de enfermedades cardiovasculares y prevención de muerte súbita</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200013&lng=es&nrm=iso&tlng=es Promotion of physical activity must be apriority in all modern societies, but there are some persons with medical conditions that can develop serious symptoms associated with sports, that can even be fatal, such as sudden death (SD). Adolescents are the age groups with the higher level of participation in recreation or competitive sports. International studies have demonstrated that approximately 1:250.000 adolescents die during the practice of sports. Of these, 50% had a prodrome 24 hours before the event and 75% had an underlying cardiovascular disease. Therefore, adolescents should be screened for cardiovascular diseases prior to their engagement in sports. This review gives a scientific approach to this issue, usually oversized by mass media. It also analyzes and reports international governmental strategies and practical tools for the clinician that must perform this type of screening. <![CDATA[<b>Manipulación del transporte y consumo de oxígeno en la sepsis</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200014&lng=es&nrm=iso&tlng=es Maintaining an adequate tissue oxygen delivery (DO) and consumption (VO) is crucial in the treatment of septic patients. A fall in V02 is associated with a higher mortality. The early recognition of shock or tissue hypo perfusion impacts on patient prognosis. In occasions, hypovolemia or important regional oxygen debts are not recognized, since macro homodynamic variables have been compensated. In this situation, the use of metabolic hypo perfusion markers such as lactate, central venous oxygen saturation and gastric goniometry, can be helpful. However, interpretation of these markers should be cautious and always considering the overall clinical status of the patient. In the initial stages of sepsis, the dependency ofV02 on DO 2predominates as histopathological mechanism of multiple organic failure. In late stages, other factors predominate as determinants of multiple organic failure and mortality, such as hyper or hypo immune response, microcirculatory alterations and cytopathic hypoxia. <![CDATA[<b>¿Puedo conducir un automóvil, doctor?</b>: <b>Evaluación para el manejo de automóviles en personas con discapacidad y su importancia en la rehabilitación</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200015&lng=es&nrm=iso&tlng=es One of the main objectives in the rehabilitation of people with disability is to give them the possibility of mobilizing independently and a car is a modern and effective tool for achieving this objective. It is essential to make a specific assessment that includes at least the visual, cognitive and motor area before deter-mining whether the individual can drive a car, or also what kind of adaptations may be required. It is also essential to properly know the Traffic Law in force in our country to be able to guide the steps that the patient has to follow to obtain a driver's license. The objective of this review is to study deeply this interesting subject and all the edges that have been mentioned above. <![CDATA[<b>Origen de los Changos</b>: <b>Análisis de ADNmt antiguo sugiere descendencia de pescadores de la cultura Chinchorro (7.900 - 4.000 A.P.)</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200016&lng=es&nrm=iso&tlng=es Sophisticated molecular genetics techniques allow the typification and posterior comparison of antique haplogroups and mitochondrial DNA sequences from prehistoric groups with contemporary populations. This adds a chronological dimension to these studies and contributes to have a better knowledge of the genetic composition of the Chilean population. This article gives scientific support, using molecular methodology, to the alleged biological links that joined the descendants of proto historic Chango fishermen from Puposo cove, a place located 15 kilometers north of Taltal, with prehistoric fishermen from Chinchorro culture, that developed in Northern Chile and Southern Peru between 7900 and 4000 A.C. <![CDATA[<b>Primer Curso Latinoamericano de Cuidados Paliativos en Diálisis y Nefrología</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200017&lng=es&nrm=iso&tlng=es Sophisticated molecular genetics techniques allow the typification and posterior comparison of antique haplogroups and mitochondrial DNA sequences from prehistoric groups with contemporary populations. This adds a chronological dimension to these studies and contributes to have a better knowledge of the genetic composition of the Chilean population. This article gives scientific support, using molecular methodology, to the alleged biological links that joined the descendants of proto historic Chango fishermen from Puposo cove, a place located 15 kilometers north of Taltal, with prehistoric fishermen from Chinchorro culture, that developed in Northern Chile and Southern Peru between 7900 and 4000 A.C. <![CDATA[<b>¿Es la medicina hospitalaria una alternativa para nuestros internistas?</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000200018&lng=es&nrm=iso&tlng=es Sophisticated molecular genetics techniques allow the typification and posterior comparison of antique haplogroups and mitochondrial DNA sequences from prehistoric groups with contemporary populations. This adds a chronological dimension to these studies and contributes to have a better knowledge of the genetic composition of the Chilean population. This article gives scientific support, using molecular methodology, to the alleged biological links that joined the descendants of proto historic Chango fishermen from Puposo cove, a place located 15 kilometers north of Taltal, with prehistoric fishermen from Chinchorro culture, that developed in Northern Chile and Southern Peru between 7900 and 4000 A.C.