Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720110005&lang=es vol. 139 num. 5 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b>Disponibilidad de médicos y especialistas en Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500001&lng=es&nrm=iso&tlng=es The availability and planning of Human Resources are important issues in many countries, as it is a key factor to cope with the critical challenges of Health Care Systems. In Chile, the Ministry of Health has undertaken several studies in order to improve knowledge about the medical workforce both in public and private sectors. The aim of this paper is to update and systematize the existing data on physicians and specialists availability in Chile. Several information sources were crossed to obtain new and more precise figures about this topic. According to the Internal Revenue System, 29.996 physicians practice medicine in the country, 43% of them hired in public services, part or full time. There is a high concentration of professionals in the central regions of Chile. Being the overall density of physicians of one per 559 inhabitants, the figures in the central region is one per 471 and one per more than 800 in the South and North. Between 2004 and 2008, the public sector increased its physician workforce by more than 80% in primary health care and more than 20% in the secondary and tertiary levels. This paper presents a method for a more rigorous identification of the categories of general practitioner and specialist respectively, and the results obtained from the databases used. <![CDATA[<b>Descripción de manifestaciones ansiosas, depresivas y autoconcepto en pacientes obesos mórbidos, sometidos a cirugía bariátrica</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500002&lng=es&nrm=iso&tlng=es Background: There is conflicting evidence about the emotional impact of bariatric surgery among obese individuals. Aim: To evaluate anxiety, depression and self-concept, before and after bariatric surgery among patients with morbid obesity. Material and Methods: Fifteen males and 5 females aged 28 to 61 years with a mean body mass index of 42.6 ± 5 kg/m², were studied. Grid Technique (TR), Personal Self Evaluation Questionnaire (OQ-45.2) and Anxiety Sate-Trait Inventory (STAI) were applied before and six months after bariatric surgery. Results: After surgery, the scores of self-esteem, well-being, flexibility, attraction, self-acceptance, confidence and guilt improved significantly. STAI and OQ-45.2 anxiety and depressive symptoms assessment were in the normal range before and after surgery. However, after surgery, there was a significant decrease in these sub scales in the OQ-45.2. No significant changes in anxiety measured using the STAI, were observed after surgery. Conclusions: Six months after bariatric surgery, positive changes were found in self-concept, and overall well-being. <![CDATA[<b>Validación del cuestionario de calidad de vida (WHOQOL-BREF) en adultos mayores chilenos</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500003&lng=es&nrm=iso&tlng=es Background: The WHOQOL-BREF is a generic questionnaire to measure quality of life created by the Study Group on Quality of Life of the World Health Organization. Aim: To adapt and evaluate the psychometric properties of the Spanish version of the WHOQOL-BREF instrument in a group of Chilean older subjects living in Metropolitan Santiago. Material and Methods: A linguistic-cultural adaptation of the Spanish version of the WHOQOL-BREF was performed and tested in a pilot study. Subsequently, the modified scale was applied to a group of 1186 older women aged 72 ± 8 years and 334 men aged 72 ± 7 years. The psychometric properties such as internal consistency, item-total correlation of responses, and construct validity were evaluated. A confirmatory factor analysis was done to check if the dimensions described in the original version, were evaluated. Analyses were performed with STA-TA statistical software 10.0 and LISREL 8.50. Results: Confirmatory factor analysis confirmed that the dimensionsphysical health, psychological, social relationships and environment, described by the authors in their original description, were maintained. The instrument had a good internal consistency with a Cronbach alpha of 0.88 for the total scale and rangingfrom 0.70 to 0.79 in each of the dimensions. Conclusions: The evaluated version of the WHOQOL-BREF has an acceptable reliability and validity, and suggests that it is suitable for the assessment of Quality of Life in elderly people in Chile. <![CDATA[<b>Enfermedad celíaca silente en epilepsia criptogénica del adulto</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500004&lng=es&nrm=iso&tlng=es Background: Celiac disease (CD) is predominant in women and young people. Atypical, non-enteric symptoms are more common among adults. There is also an association between CD and neurological disorders, especially with cerebellar ataxia, polyneuropathy and epilepsy. Aim: To study the frequency of CD in a group of adults with cryptogenic epilepsy. Material and Methods: Twenty one patients with cryptogenic epilepsy, aged 20 to 65years (14 women) were studied, measuring IgA-anti transglutaminase antibodies and deamidated gliadin peptide (DGP) IgG and IgA antibodies. Results: One patient had elevated titers of both types of antibodies. Small bowel biopsy showed villous atrophy and lymphocytic infiltration compatible with CD. Conclusions: One of 21 adult patients with cryptogenic epilepsy had a silent CD. <![CDATA[<b>El programa nacional para el diagnóstico y tratamiento de depresión en atención primaria</b>: <b>una evaluación necesaria</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500005&lng=es&nrm=iso&tlng=es Background: Depression is highly prevalent among Chilean adults, therefore a primary care treatment program was devised. Aim: To evaluate the Program for detection, diagnosis and integral treatment of depression, implemented in Chilean Primary Health Care Centers. Material and Methods: A three and six months follow-up study was conducted among women admitted to the program at seven primary health care centers in two regions of Chile. Socio-demographic data, treatments provided and compliance with the program were assessed. A clinical standardized interview (with ICD-10) was carried out and the intensity of depressive symptoms was evaluated using Beck Depression Inventory (BDI). Results: The initial sample was composed by 201 women aged 25 to 65 years. At 6 months, 35% were lost from follow up. Depression was mild, moderate or severe in 12, 63 and 25% of women, respectively. The severity of depression was underestimated by primary care teams. Among women with regular and irregular attendance to medical appointments and those that abandoned treatment, BDIscore decreased by 35,37and 13%, respectively. Conclusions: This primary care program for depression was effective to reduce BDI scores. Diagnostic precision of primary care teams must be improved. <![CDATA[<b>Riesgo de déficit atencional/hiperactividad en escolares Aymara, Rapa-Nui y de Santiago de Chile</b>: <b>Posible contribución de polimorfismos genéticos del sistema dopaminérgico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500006&lng=es&nrm=iso&tlng=es Background: Attention deficit/hyperactivity disorder (ADHD) is a common, highly heritable neurobiological disorder of childhood onset, characterized by hyperactivity, impulsiveness or inattentiveness. Aim: To search for differences in risk for ADHD and its components among Chilean native and mixed populations and to look forpossible associations with dopamine receptor D4 (DRD4) and dopamine transporter 1 (DAT1) polymorphisms. Material and Methods: School teachers were requested to complete the Conners test, which uses DSM-IV criteria, to screen for ADHD risk among Aymara and Rapa-Nui students. Results: Rapa-Nui children from Easter Island had the highest risk of hyperactivity/impulsiveness. Aymara children from the Arica-Parinacota Region had lower scores. Although inattentiveness scores had lower differences between groups, overall ADHD score differences among studied populations were highly significant. DRD4 and DAT1 alleles had a heterogeneous distribution. Easter islanders had more divergent frequencies, mostprobably as a result of separate migration routes utilized at different timeperiods during the colonization of America and Polynesia. Conclusions: The comparison of ADHD risk parameters between Rapa-Nui and Aymara children showed marked differences. Allele distri-bution of dopamine polymorphisms in Easter Island was also significantly different from northern Chile, due probably to different colonization histories. These findings suggest that higher ADHD risk scores in Easter Island children may be linked to the presence of different DRD4 alleles. <![CDATA[<b>Asociación entre el índice de masa corporal y la talla desde el nacimiento hasta los 5 años en preescolares chilenos</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500007&lng=es&nrm=iso&tlng=es Background: It has been shown that excess weight gain during childhood is associated with a greater risk of obesity; this relationship may be mediated by growth in height. Aim: To quantify the associations between z scores for body mass index (BMIZ) and height for age (HAZ) from birth to 5 years of age and to assess how this association varies according to age and adiposity. Material and Methods: Weight and height were recorded at 11 occasions from birth on a cohort of1089 Chilean five year-old children with a birth weight &gt; 2500 g. BMI, BMIZ, HAZ and prevalence of obesity were calculated. We determined the cross-sectional association between BMIZ and HAZ for the total sample and by 3 BMI Z categories, using Pearson correlation. We determined the probability of obesity according to four HAZ categories. Results: Obesity increased continuously reaching approximately 16% at 5 years. Stunting was virtually nonexistent. No association between BMIZ and HAZ was observed at birth, while at 1 and 2 months, leaner infants had lower stature. No association between theseparameters was observed between 6-24 months, while after 3 years, a clear relationship was observed. Conclusions: The probability of a preschool child of being obese is less than 10% with a HAZ is < 0. Nevertheless, children with heights above the median (even within the normal range) have an increased risk of obesity, especially after 3 y of age. Between 0-5 years, the relationship between weight and height varies by age and adiposity. <![CDATA[<b>Evaluación de la embriotoxicidad de misoprostol utilizando el ensayo cultivo de embriones postimplantación</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500008&lng=es&nrm=iso&tlng=es Background: Approximately 15% of misoprostol-induced-abortions may not be successful, leading to in utero exposure to the drug and to the induction of a series of defects including central nervous system, limb and visceral defects. A commonproposal is that the drug causes disruption of the fetal vasculature leading to embryonic or fetal hypoxia. Aim: To evaluate the teratogenicity of misoprostol using the rat post-implantation embryo culture. Material and Methods: Rat embryos were collected at the beginning of organogenesis and cultured in rat serum containing misoprostol at concentrations of 200, 2,000 or 20,000 pg/ml. Functionality, morphology and morphometry parameters were evaluated. Results: Misoprostol induced a dose-dependent embryotoxic effect causing a decrease in embryo viability and function (poor vascular development and survival) and morphometry (alterations in branchial arches, heart and cephalic portions of the neural tube, among others). Conclusions: All the manifestations observed are indicative of the ability of misoprostol to directly induce developmental retardation and alterations. <![CDATA[<b>Síntomas climatéricos y calidad de vida de usuarias de consultorios de atención primaria de salud, Santiago</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500009&lng=es&nrm=iso&tlng=es Background: During menopause the quality of life of women can be seriously deteriorated and influenced by lifestyles. Aim: To assess the prevalence of menopausal symptoms and their relationship with lifestyles and quality of life. Material and Methods: The Menopause Rating Scale (MRS), a survey that measures menopausal symptoms and has questions related to lifestyles, was applied to 1023 women aged 54 ± 6years (range 45 to 64years), consulting in primary health care clinics. A multiple linear regression analysis was used to evaluate the association between menopausal symptoms and lifestyle. Results: Fifty six percent of women did not have a paid work, 64% were nonsmokers and 90% did not perform any physical exercise. The most frequent menopausal symptoms referred were muscle and joint ailments (85%) followed by mental and physical exhaustion (80%). Sedentary women, smokers or those who did not to have time for leisure activities showed worst quality of life scores. Conclusions: Postmenopausal women with unhealthy lifestyles had the lower quality of life scores and more menopausal symptoms. <![CDATA[<b>Eficacia de una intervención educativa sobre conocimientos de ley chilena de SIDA en trabajadores de salud primaria</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500010&lng=es&nrm=iso&tlng=es Background: In Chile, members of the civil society and government achieved the passing of the HIV/AIDS Law (19.779). The level of knowledge of the law held by healthcare workers in Chile is not well known. Aim: To analyze the effect of an intervention on knowledge of the existence of the law and its application in clinical practice amongprimary healthcare workers in southeastern Santiago. Material and Methods: Healthcare workers of primary care centers were invited to participate in the study. One group received an educational intervention lasting a total of 16 hours, about AIDS physiopathology, sexually transmitted diseases, communication with patients and current legislation. A control group did not receive the educational intervention. Both groups answered a self-administered questionnaire about the HIV/AIDS law at baseline and three months after the intervention. Results: The intervention was carried out in 262 workers and 293 participated as controls. The initial evaluation revealed that only 16.3% (n = 89) had heard of the law, without any significant difference between intervention and control groups. The knowledge about the law improved by 65% in the intervention group and did not change in controls. At the end of the education period, the intervention and control groups improved their global knowledge by 29 and 3%, respectively (p < 0.05). Conclusions: The educational intervention was effective in improving knowledge of the HIV/AIDS Law among Chilean healthcare workers. <![CDATA[<b>Pénfigo familiar crónico benigno</b>: <b>Informe de un caso</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500011&lng=es&nrm=iso&tlng=es Benign chronic familial pemphigus (Hailey-Hailey disease) is a rare autosomal dominant blistering skin disorder characterized by suprabasal cell separation (acantholysis) of the epidermis. The Hailey brothers first described it in 1939. Hailey-Hailey disease usually appears in the third or fourth decade, although it can occur at any age. Heat, sweating and friction often exacerbates the disease, and most patients have worse symptoms during summer. It is characterized clinically by a recurrent eruption of vesicles and bullae at the sites of friction and intertriginous areas. We report a 51-year-old male presenting with grey-brown hyperkeratosis with partial papillomatosis and lichenification in the axillary and inguinal areas and infiltrated erythematous lesions in the infraorbitary region, on the side of the face. Biopsies obtained from inguinal and axillar areas revealed parakeratotic crusts overlying an acantholytic epidermis. A biopsy from one of the lesions from the infraorbital area showed a Jessner-Kanof lymphocytic infiltration. The patient was treated with antimicrobials and four days later, topical Pimecrolimus was started, leading to an improvement of the clinical picture. The efficacy of Pimecrolimus in our case suggests that cellular immunity couldplay a role in thepathogenesis of Hailey-Hailey disease. <![CDATA[<b>Deterioro cognitivo e hiperparatiroidismo primario: resultado favorable después de cirugía</b>: <b>Caso clínico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500012&lng=es&nrm=iso&tlng=es We report a 79-year-old male patient presenting with progressive memory loss associated with anxiety and muscularpain. An extensive biochemical control revealed high serum calcium and parathormone levels, and normal thyroid hormones. Cognitive assessment prior to surgery was compatible with mild cognitive impairment, showing significant improvement two months after parathyroidectomy. Our case suggests that, although rare, primary hyperparathyroidism should be considered as a possible cause of cognitive decline in the elderly. <![CDATA[<b>Eutanasia y acto médico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500013&lng=es&nrm=iso&tlng=es Right to life -as the prohibition of intentionally and arbitrarily taking life, even with authorization of the concerned one- is an internationally recognized right. In many countries, debate regarding euthanasia is more centered in its convenience, social acceptability and how it is regulated, than in its substantial legitimacy. Some argue that euthanasia should be included as part of clinical practice of health professionals, grounded on individual's autonomy claims-everyone having the liberty to choose how to live and how to die. Against this, others sustain that life has a higher value than autonomy, exercising autonomy without respecting the right to life would become a serious moral and social problem. Likewise, euthanasia supporters some-times claim a 'right to live with dignity', which must be understood as a personal obligation, referred more to the ethical than to the strictly legal sphere. In countries where it is already legalized, euthanasia practice has extended to cases where it is not the patient who requests this but the family or some healthcare professional, or even the legal system-when they think that the patient is living in a condition which is not worthy to live. Generalization of euthanasia possibly will end in affecting those who need more care, such as elder, chronically ill or dyingpeople, damaging severely personal basic rights. Nature, purpose and tradition of medicine rule out the practice of euthanasia, which ought not be considered a medical act or legitimately compul-sory for physicians. Today's medicine counts with effective treatments for pain and suffering, such as palliative care, including sedative therapy, which best preserves persons dignity and keeps safe the ethos of the medical profession. <![CDATA[<b>Matar, dejar morir y eutanasia en el proyecto de ley sobre derechos de las personas y en la doctrina chilena</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500014&lng=es&nrm=iso&tlng=es The Bill of Rights for Patients provides the patient with autonomy for disposing of his life, enabling him to reject those treatments that unnecessarily prolong his life. However, the bill does not allow an artificial acceleration of death. Therefore, the bill does not permit euthanasia (at least, certain form of it) nor assisted-suicide. However, according to the practice of medicine and also Chilean doctrine, it is permitted to inject morphine to a patient to relieve his pain, even though that could hasten his death. In consequence, it is allowed for the patient to dispose of his life and also to inject in him morphine for pain relief, endangering his life, but neither euthanasia nor assisted-suicide is allowed. Is this coherent? According to Chilean doctrine, it could be coherent under the condition of accepting the distinction between killing and letting die and also the double effect doctrine. The problem is that there is abundant English literature in the realm of moral philosophy to disregard both conditions. Therefore, it is possible to claim that the Bill is not coherent and that the Chilean doctrine is based upon a distinction and a doctrine that are not acceptable. <![CDATA[<b>Aloinjertos óseos y la función del banco de huesos</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500015&lng=es&nrm=iso&tlng=es The use of bone grafts is a common practice in musculoskeletal surgery to provide mechanical stability where there is a defect and it allows skeletal reconstruction. Classically auto and allografts have been used. The latter are the choice in large, complex defects. Allografts can be transplanted despite cell death, have osteoconduction and osteoinduction capacity, low antigenicity and biomechanica lproperties similar to the original bone. They can be obtained from living and death donors. They are stored by cryopreservation and lyophilization in entities called bone banks. This is a review about bone allografts and the organization and function of the bone banks. <![CDATA[<b><i>Mal praxis </i></b><b>en el equipo médico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500016&lng=es&nrm=iso&tlng=es To be successful, modern medical acts require the participation ofseveral professionals and assistants and, as such, there has been a steady trend from individual medicine to the collective practice of the profession. This format raises issues in determining when a medical professional or other practitioner is liable for the acts of a colleague. This thesis proposes to resolve the problems involved in the collective practice of medicine by restricting liability to a physician responsible for another practitioner, only to those cases where he/she has been willingly introduced into the medical act. <![CDATA[<b>Aplicabilidad de un estudio sobre tests diagnósticos</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500017&lng=es&nrm=iso&tlng=es To be successful, modern medical acts require the participation ofseveral professionals and assistants and, as such, there has been a steady trend from individual medicine to the collective practice of the profession. This format raises issues in determining when a medical professional or other practitioner is liable for the acts of a colleague. This thesis proposes to resolve the problems involved in the collective practice of medicine by restricting liability to a physician responsible for another practitioner, only to those cases where he/she has been willingly introduced into the medical act. <![CDATA[<b>Análisis crítico de un artículo</b>: <b>colonografía por tomografía computada tuvo buen rendimiento para la pesquisa de cáncer colorrectal en pacientes de alto riesgo</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500018&lng=es&nrm=iso&tlng=es To be successful, modern medical acts require the participation ofseveral professionals and assistants and, as such, there has been a steady trend from individual medicine to the collective practice of the profession. This format raises issues in determining when a medical professional or other practitioner is liable for the acts of a colleague. This thesis proposes to resolve the problems involved in the collective practice of medicine by restricting liability to a physician responsible for another practitioner, only to those cases where he/she has been willingly introduced into the medical act. <![CDATA[<b>Tuberculosis, 3<sup>ra</sup> edición</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500019&lng=es&nrm=iso&tlng=es To be successful, modern medical acts require the participation ofseveral professionals and assistants and, as such, there has been a steady trend from individual medicine to the collective practice of the profession. This format raises issues in determining when a medical professional or other practitioner is liable for the acts of a colleague. This thesis proposes to resolve the problems involved in the collective practice of medicine by restricting liability to a physician responsible for another practitioner, only to those cases where he/she has been willingly introduced into the medical act. <![CDATA[<b>Cirugía endovascular como tratamiento de la Esclerosis Múltiple</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500020&lng=es&nrm=iso&tlng=es To be successful, modern medical acts require the participation ofseveral professionals and assistants and, as such, there has been a steady trend from individual medicine to the collective practice of the profession. This format raises issues in determining when a medical professional or other practitioner is liable for the acts of a colleague. This thesis proposes to resolve the problems involved in the collective practice of medicine by restricting liability to a physician responsible for another practitioner, only to those cases where he/she has been willingly introduced into the medical act. <![CDATA[<b>¿Como enfrentar el aumento de conductas individuales de riesgo para la salud en Chile?</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500021&lng=es&nrm=iso&tlng=es To be successful, modern medical acts require the participation ofseveral professionals and assistants and, as such, there has been a steady trend from individual medicine to the collective practice of the profession. This format raises issues in determining when a medical professional or other practitioner is liable for the acts of a colleague. This thesis proposes to resolve the problems involved in the collective practice of medicine by restricting liability to a physician responsible for another practitioner, only to those cases where he/she has been willingly introduced into the medical act. https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000500022&lng=es&nrm=iso&tlng=es