Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720110006&lang= vol. 139 num. 6 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b>Compliance with Chilean diagnostic guidelines among patients with ischemic stroke admitted to a public hospital</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600001&lng=&nrm=iso&tlng= Background: Acute ischemic stroke in adults was given an Explicit Guarantee of diagnosis and treatment (GES) with Clinical Guidelines in 2007 as part of the on-going Chilean National Health Reform. Aim: To evaluate the adherence to official guidelines with regard to the use of diagnostic methods for patients with acute ischemic stroke during their stay in a public hospital. Patients and Methods: The study included a review of the medical records of 101 patients aged 70 ±13 years (49 males and 52 females) diagnosed with acute ischemic stroke and discharged within August and September of 2008 and 2009 from a public hospital. Three trained ob-servers independently determined the degree of dependency of patients at discharge using the Modified Rankin score. The completion of recommended diagnostic tests (electrocardiogram, carotid Doppler ultrasound and echocardiogram) as well as their overuse was evaluated. Results: Ten patients died before discharge, 38% were discharged with and 52% were discharged without disabilities. Nineteen percent of patients with a Modified Rankin score of two or less (corresponding to a slight disability) had a complete diagnostic workup, compared with 87% of patients with a score of 3 to 5 (moderate to severe disability). In 27% of the patients, there was an overuse of diagnostic tests. No association between the diagnostic test use adequacy and year of discharge was observed. Conclusions: There exists a disparity between the recommended diagnostic testing and the actual tests completed among patients with acute ischemic stroke. <![CDATA[<b>Results of treatment with peginterferon plus ribavirin in patients with chronic hepatitis C</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600002&lng=&nrm=iso&tlng= Background: The current treatment recommendation for chronic hepatitis C virus infection is the combination of peginterferon and ribavirin for 24 or 48 weeks, depending on the viral genotype. The aim of the therapy is to obtain a sustained virological response. Aim: To report our experience in the treatment of chronic hepatitis C. Material and Methods: Analysis of 52 patients treated between September 2000 and June 2009. Patients with genotype 1 or 5 were treated with peginterferon alpha 2a (180 ug/week) and ribavirin (1000 mg/day for those weighing less than 75 kg and 1200 mg/day for those weighing more than 75 kg) during 48 weeks. Patients with genotypes 2 and 3 were treated for 24 weeks with the same dose of peginterferon and ribavirin 800 mg /day. Results: Viral genotypes 1, 2, 3 and 5 were present in 81, 4, 11 and 4% of patients, respectively. Twenty four patients (46 %), 18 with genotype 1, achieved a sustained viral response. Age was the only variable that infl uenced the response to treatment. Conclusions: Approximately half of the patients with chronic hepatitis C, achieve a sustained viral response with peginterferon and ribavirin. <![CDATA[<b>Combined influence of preconception body mass index and gestational weight gain on fetal growth</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600003&lng=&nrm=iso&tlng= Background: The Chilean Ministry of Health has been using standards for nutritional evaluation and weight gain recommendations during pregnancy in the last 25 years. In the meantime new standards have been developed. Aim: To study the combined infl uence of preconception maternal nutritional status and gestational weight gain, using new standards to classify those parameters, on perinatal outcomes. Material and Meihods: A cohort of 11,465 healthy pregnant women was prospectively followed until term. Their pre-gestational nutritional status was classified using the body mass Índex cut-offs in use in the United States (USA). Their gestational weight gain was classified using categories proposed in a Danish study. Perinatal outcomes included were risky birth weight, i.e. < 3000 g and ≥ 4000 g, and cesarean delivery. Relative risks for those perinatal outcomes were calculated for all combined categories of pre-gestational nutritional status and gestational weight gain. Results: Relative risks of almost all gestational weight gain results were statistically significant for women having a normal pre-gestational nutritional status meanwhile all of them were not significant for underweight women. Overweight and obese women had similar relative risks valúes as normal women. However, many of them were not significant, especially in obese women. Conclusions: There is an independent and combined infl uence of preconception nutritional status and gestational weight gain on perinatal outcomes, when using standards to classify those parameters developed in the USA and Denmark, respectively. <![CDATA[<b>Association between atherosclerosis and periodontitis</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600004&lng=&nrm=iso&tlng= Background: Chronic infl ammation and infections are involved in the development and progression of atherosclerotic vascular disease. Aim: To evaluate the association between periodontitis and early atherosclerosis. Material and Methods: Fifty-three subjects who received periodontal treatment and regular maintenance for at least 10 years, and 55 subjects with periodontitis but without a history of periodontal treatment were studied. Carotid artery intima-media wall thickness (CIMT) was measured with high-resolution B-mode ultrasonography. A blood sample was obtained to measure high sensitivity C-reactive protein, fibrinogen, lipoprotein cholesterol, leukocyte count and erythrocyte sedimentation rate. Covariates included age, gender, smoking, level of education, body mass index and physical activity. The benzoyl-DL-arginine-naphthylamide (BANA) test was used to determine the number of periodontal sites with periodontal pathogens. Results: CIMT value was significantly higher in subjects with periodontitis than those without it (0.775 ± 0.268 and 0.683 ± 0.131 mm respectively, p = 0.027). C-reactive protein, leukocyte count and percentage of sites with periodontal pathogens were also significantly higher in subjects with periodontitis. Regression analysis identified age, periodontitis, and smoking as independent predictors of CIMT. Conclusions: These results suggest that untreated periodontitis is associated with early atherosclerotic carotid lesions and higher levels of infl ammatory markers. <![CDATA[<b>Cross sectional geriatric assessment of Mexican older people</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600005&lng=&nrm=iso&tlng= Background: Due to the progressive aging of our population, it is imperative to evaluate the life conditions and health limitations of older people. Aim: To report the results of an integral geriatric evaluation of Mexican older people. Material and Methods: A cross-sectional assessment of 324 older subjects of a median age of 70 years (57% females) beneficiaries of the Mexican Institute of Social Security of the city of Querétaro. Social, demographic, medical, functional and cognitive variables were evaluated. Results: Of the studied subjects, 37% were illiterate, 61% lived with a partner and 47% were dedicated to household activities. Thirty three percent had visual impairment, 54% had hearing impairment, 39% had urinary incontinence, 26% reported falls in the last six months, 34% had nutritional problems, 38% were functionally dependent, 49% had sleeping problems, 25% had cognitive impairment and 25% had depression. Conclusions: The general health outlook of this population is encouraging, considering that more than half are not functionally impaired. <![CDATA[<b>Prevalence of metabolic syndrome in children and adolescents who consult with obesity</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600006&lng=&nrm=iso&tlng= Background: The higher prevalence of chüdhood obesity has led to search for metabolic syndrome (MS) in this age group. Aim: To study the prevalence of MS in obese children and adolescents. Material ana Methods: Cross sectional study of 255 obese children and adolescents aged 11.3 ± 2.4 years, 45% males, 60% pubertal, with a body mass Índex (BMI) z score of 2.7 ± 0.6, who were evaluated for obesity. MS was defined as the presence of at least three of the following criteria, according to Ferranti: fasting glucose (FG) ≥ 100 mg/dl, triglycerides (TG) ≥ 100 mg/dl, HDL < 50 mg/dl, waist circumference (WC) &gt; percentile (p) 75 and blood pressure (BP) &gt; p90. Patients were also classified using Cook criteria: FG ≥100 mg/dl, TG ≥ 110 mg/dl, HDL < 40 mg/dl, WC &gt; p 90, BP &gt; p 90. Results: MS was observed in 45 and 22.7% of patients, according to Ferranti and Cook definitions, respectively. WC was the most frequent criteria and glucose was the most uncommon. Males had higher body mass Índex, WC and TG levéis than femóles. According to Ferranti and Cook áefinitions, MS prevalence was 53.5 and 28% in males and 37.6 andl8.4% in fernales (p < 0.05). Fifty and 26.1% of pubertal patients exhibited MS vs 36.9 and 17.5% in pre-pubertal subjects (p < 0.05) using Ferranti and Cook criteria, respectively. The frequency of MS increased along with a higher BMI. Conclusions: MS is a prevalent condition in obese children and adolescents, especially in males and pubertal children. It is necessary to have a better and universal definition for MS in pediatrics including all ages, in order to be focused in obesity prevention and treatment. <![CDATA[<b>Vulnerability of pregnant women living in a community of Metropolitan Santiago</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600007&lng=&nrm=iso&tlng= Background: The program “Chile grows with you” is a part of the Chilean social protection system oriented to decrease social inequities from pregnancy (a socially secure pregnancy) to four years of age, directed to the poorest 40% of the popula-tion. Aim: To determine the incidence of social vulnerability and its determinants, starting at the gestation period. Material and Methods: Data was obtained from anonymous secondary data based on the records of the first assessment of pregnant women and from social protection surveys, provided by the Ministry of Planning and Cooperation. Results: The incidence of social vulnerability was high. However there was a disparity between the figures obtained from the social protection records and the survey carried out during the first assessment of pregnant women (91 and 27% respectively). The psychosocial risk was higher among vulnerable women (42% compared to 28% among women not considered vulnerable). This risk was associated with lack of family support, depressive symptoms, gender violence, substance abuse and maternity confl icts. Working conditions were precarious with a low level of social security, there were habitability problems, disability, dependency, female householders and a mean income below the threshold of poverty. Conclusions: Among vulnerable families, there are adverse determinants that attempt against a socially secure preg-nancy and integral development of children. <![CDATA[<b>Demographic characteristics in preeclamptic women in Macedonia</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600008&lng=&nrm=iso&tlng= Background: Worldwide, pre-eclampsia and eclampsia contribute to the death of a pregnant woman every three minutes. Aim: To determine the demographic risk factors and values of blood pressure to predict preeclampsia. Material and Methods: Demographic and clinical features of 300 normotensive pregnant women aged 28 ±5 years and 100 preeclamptic women aged 28 ±6 years, were assessed. Women with multiple pregnancies were excluded from the study. Results: Women with less educational attainment had a higher risk of mild and severe preeclampsia. Weight gain during pregnancy in control and pre eclamptic women were 14 ±3 and 20 ±5 kg, respectively (p < 0.01). Women with severe preeclampsia had high significantly shorter gestations then the other two patient groups (p < 0.01). Compared to nor-motensive women, at 6 to 12 weeks of gestation, pre eclamptic women had higher systolic (102 ±7 and 113 ±9 mmHg respectively), diastolic ( 64 ±5 and 74 ±10 mmHg respectively) and mean arterial pressure (77 ±5 and 87 ±8.01 mmHg res-pectively). Conclusions: Women with basic education or illiterate have a higher risk of developing preeclampsia. During the first or second trimester of pregnancy, mean arterial pressure is the best predictor for preeclampsia.<hr/>Antecedentes: La pre eclampsia contribuye a la muerte de una mujer embarazada cada 3 minutos a nivel mundial. Objetivo: Analizar los factores de riesgo demográficos y los valores de presión arterial predictores de pre eclampsia. Material y Métodos: Se estudiaron las características demográficas y clínicas de 300 mujeres embarazadas con presión arterial normal de 28 ±5 años y 100 mujeres con pre eclampsia de 28 ±6 años. Resultados: Las mujeres con menor nivel educacional tuvieron un riesgo mayor de presentar pre eclampsia moderada o severa. La ganancia de peso durante el embarazo de mujeres con pre eclampsia y presión normal fue de 20 ±5 kg y 14 ±3, respectivamente (p < 0,01). Las mujeres con pre eclampsia severa tuvieron gestaciones significativamente más cortas que el resto de los grupos. Comparadas con mujeres normotensas, a las 6 a 12 semanas de gestación, las mujeres con pre eclampsia tenían mayor presión arterial sistólica (102 ±7 y 113 ±9 mmHg respectivamente), diastólica (64 ±5 y 74 ±10 mmHg respectivamente) y media (77 ±5 y 87 ±8,01 mmHg respectivamente). Conclusiones: Las mujeres analfabetas o con educación básica tienen el mayor riesgo de desarrollar pre eclampsia. La presión arterial media durante el primer trimestre es el mejor predictor de preeclampsia. <![CDATA[<b>Effects on blood glucose of prophylactic dexamethasone for postoperative nausea and vomiting in diabetics and non-diabetics</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600009&lng=&nrm=iso&tlng= Background: Postoperative nausea and vomiting (PONV) prophylaxis with dexamethasone may produce significant hyperglycemia in the postoperative period. Aim: To evaluate if this effect is of greater severity in type 2 diabetics compared with non-diabetic patients. Material and Methods: Forty non-diabetic and thirty type 2 diabetic patients undergoing laparoscopic cholecystectomy were studied in a prospective and double-blind fashion manner. Patients were randomly distributed into 4 groups: Group I, non-diabetics control (n = 20), Group II, non-diabetics dexamethasone (n = 20), Group III, type 2 diabetics control (n = 15), and Group I V, type 2 diabetics dexamethasone (n = 15). Immediately after induction, patients in groups I and III received isotonic saline and patients in the dexamethasone groups received 8 mg iv of the steroid. Capillary blood glucose concentrations were measured at baseline and every 2 hours during the first 12 hours since the start of surgery. A linear mixed effect model, adjusted for baseline capillary glucose concentration, age and duration of surgery was used to analyze the data. Results: No effect of the presence of diabetes mellitus was observed in the evolution of glucose concentrations. There was a difference in capillary glucose concentrations between patients who received dexamethasone and placebo that started 2 hours post-intervention, reaching a mean maximum difference of 34 mg/dl (adjusted model, p < 0.001) at 10 hours post-intervention. Conclusions: In this study, Type 2 diabetic patients did not show a higher susceptibility than non-diabetics to develop postoperative hyperglycemia after the use of prophylactic dexamethasone for PONV. <![CDATA[<b>Training of specialists in the Chilean national health services</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600010&lng=&nrm=iso&tlng= Several institutions, such as the Ministry of Health, Universities, the Chilean Medical Association, Scientific societies and public opinion, recognize that there is a deficiency of specialized physicians in Chile. To overcome this shortage of specialists, the Ministry of Health, along with universities, is developing diverse initiatives to train specialists and cope with the requirements of the country. Seventy five percent of posts offered were filled by physicians. The number of positions increased from 173 in 2007 to 576 in 2010, with a cumulative total of 1582 physicians in four years. Fifty two percent are being trained in Basic Primary Specialties and 48% in primary specialties. Thirty three percent of graduates have the obligation to continue working in the public service during a certain lapse. This figure will increase to 50% in the following years. These specialists are mainly working in the more densely populated regions of the country. The universities that offer the higher number of training positions are the University of Chile, The Catholic University of Chile and the University of Santiago. <![CDATA[Primary left atrial hemangiopericytoma: Report of one case]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600011&lng=&nrm=iso&tlng= We report a 41-year-old male presenting with progressive dyspnea lasting one month. A CAT scan disclosed a left atrial mass, that was surgically excised. The pathological study of the surgical piece showed a primary hemangiopericytoma. One month later, the patient consulted for cervical pain and a positron emission tomography showed multiple metastases. The patient died two months later. <![CDATA[Severe disseminated tuberculosis in a patient on immunosuppressive treatment: Report of one case]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600012&lng=&nrm=iso&tlng= Patients on immunosuppressive therapy are at increased risk of developing tuberculosis. We report a 39-year-old female with an ulcerative colitis receiving prednisone, azathioprine and azulfidine that was admitted to hospital due to fever, anemia, diarrhea and hematochezia. A chest CT scan showed multiple miliary micronodular images diffusely distributed and mediastinal enlarged lymph nodes with central necrosis, suggestive of disseminated tuberculosis. Antituberculous treatment was started but discontinued and the patient was treated as a bronchiolitis obliterans with methylprednisolone pulses and discharged. She was readmitted in shock one week later and died. After her death cultures for Mycobacterium tuberculosis were informed as positive. The clinical picture of the patient is known as sepsis tuberculosa gravissima. <![CDATA[Herpes simplex virus type 1 as risk factor associated to Alzheimer disease]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600013&lng=&nrm=iso&tlng= Herpes simplex virus type 1 (HSV-1) is ubiquitous, neurotropic, and the most common pathogenic cause of sporadic acute encephalitis in humans. Herpes simplex encephalitis is associated with a high mortality rate and significant neu-rological, neuropsychological, and neurobehavioral sequels. HSV-1 infects limbic system structures in the central nervous system (CNS), and has been suggested as an environmental risk factor for Alzheimer’s disease. The possibility that HSV-1 reactivates in CNS neurons causing chronic progressive damage at cellular level and altering the neuronal functionality has not been thoroughly investigated. Currently it is ignored if recurrent reactivation of HSV-1 in asymptomatic patients involves some risk of progressive deterioration of the CNS functions caused, in example, by a neuroinflammatory response against the virus or by direct toxicity of the pathogen on neurons. Therefore, studies regarding the routes of dissemination of HSV-1 from the peripheral ganglions to the CNS, as well as the possible cellular and molecular mechanisms implied in generating neuronal damage during latent and productive infection, are of much relevance. <![CDATA[<b>Coronary stents and non-cardiac surgery</b>: <b>current management strategies</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600014&lng=&nrm=iso&tlng= The care of patients with coronary stents in the perioperative period of non-cardiac surgery requires anesthesiologists, surgeons and cardiologists. The management of dual antiplatelet therapy should be handled depending on type and urgency of the surgery, the risk of bleeding, type of coronary stent implanted, time from placement and the risk of stent thrombosis. For patients identified as high risk of stent thrombosis, surgery should be planned at hospitals with cardiac catheterization facilities. These patients require postoperative monitoring and antiplatelet therapy should be restarted immediately. Stent thrombosis should be recognized early and treated aggressively with percutaneous coronary intervention. <![CDATA[<b>Possible association between <i>Mycobacterium avium </i>subsp <i>paratuberculosis </i>infection and Crohn's disease</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600015&lng=&nrm=iso&tlng= Paratuberculosis is a chronic intestinal disease of animals caused by Mycobacte-rium avium subsp. paratuberculosis (MAP), which has some pathological features similar to Crohn's disease (CD) in humans. The presence of MAP in food for human consumption and in affected tissues of patients with CD has been detected. Therefore, a causal association between this microorganism and the disease in humans, has been postulated. However, several related studies have failed to confirm this hypothesis and the scientific acceptance of MAP as a zoonotic agent remains controversial. This review presents the main findings related to this issue, contrasting evidences for and against an association between MAP and CD. The need to promote national studies focusing on this area is suggested. <![CDATA[<b>Cholesteryl</b><b> ester transfer protein inhibition in the management of atherosclerotic cardiovascular disease</b>: <b>second act "A rebirth of hope"</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600016&lng=&nrm=iso&tlng= Despite the clinical use of statins to reduce serum levels of LDL cholesterol and treat atherosclerotic cardiovascular disease, a high proportion of patients remain at significant residual cardiovascular risk. In this context, low HDL cholesterol levels are an additional risk factor and intervention studies suggest that a fraction of the cardiovascular protection achieved with pharmacotherapy is explained specifically by the increase in serum levels of HDL cholesterol. Pharmacological inhibitors of the cholesteryl ester transfer protein (CETP) can induce a significant elevation in HDL cholesterol and, potentially, lead to better control of residual cardiovascular risk beyond the benefit demonstrated by statins. While the use of torcetrapib had unexpected side effects, dalcetrapib and anacetrapib are new CETP inhibitors with a better safety profile and are currently under study to evaluate their effects on vascular lesions and clinical events in patients at high cardiovascular risk. If these studies show positive findings, we will witness a new biomedical advance as significant as was the clinical. <![CDATA[<b>Florence Nightingale (1820-1910), 101 years after her death</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600017&lng=&nrm=iso&tlng= We herein describe Florence Nightingale's life and work. She is considered one of the pioneers in nursing practice. Her greatest success was during the Crimean war when, along with 38 voluntary nurses, she cleaned and refurbished the hospital in Scutari and reduced the mortality rate from 40 to 2%. She used to make rounds at night in the wards under the light of a lamp, and therefore she was named "The Lady with the Lamp". Queen Victory gave her the Royal Red Cross and she was the first woman who was honored with the Order of Merit in 1907. She had solid knowledge on Statistics and Mathematics which were useful for her nursing job. <![CDATA[<i>The teaching profession</i>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600018&lng=&nrm=iso&tlng= We herein describe Florence Nightingale's life and work. She is considered one of the pioneers in nursing practice. Her greatest success was during the Crimean war when, along with 38 voluntary nurses, she cleaned and refurbished the hospital in Scutari and reduced the mortality rate from 40 to 2%. She used to make rounds at night in the wards under the light of a lamp, and therefore she was named "The Lady with the Lamp". Queen Victory gave her the Royal Red Cross and she was the first woman who was honored with the Order of Merit in 1907. She had solid knowledge on Statistics and Mathematics which were useful for her nursing job. <![CDATA[<b><i>Economic Evaluation in Health Care in Chile</i></b>: <b><i>towards a broader framework</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600019&lng=&nrm=iso&tlng= We herein describe Florence Nightingale's life and work. She is considered one of the pioneers in nursing practice. Her greatest success was during the Crimean war when, along with 38 voluntary nurses, she cleaned and refurbished the hospital in Scutari and reduced the mortality rate from 40 to 2%. She used to make rounds at night in the wards under the light of a lamp, and therefore she was named "The Lady with the Lamp". Queen Victory gave her the Royal Red Cross and she was the first woman who was honored with the Order of Merit in 1907. She had solid knowledge on Statistics and Mathematics which were useful for her nursing job. <![CDATA[<b><i>Importance of chain of custody of evidences</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000600020&lng=&nrm=iso&tlng= We herein describe Florence Nightingale's life and work. She is considered one of the pioneers in nursing practice. Her greatest success was during the Crimean war when, along with 38 voluntary nurses, she cleaned and refurbished the hospital in Scutari and reduced the mortality rate from 40 to 2%. She used to make rounds at night in the wards under the light of a lamp, and therefore she was named "The Lady with the Lamp". Queen Victory gave her the Royal Red Cross and she was the first woman who was honored with the Order of Merit in 1907. She had solid knowledge on Statistics and Mathematics which were useful for her nursing job.