Scielo RSS <![CDATA[Revista médica de Chile]]> vol. 139 num. 10 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Sex education as a cornerstone for a healthy teenage sexuality</b>]]> Sexuality is more than reproduction, it is an intrinsic part of each of us, is how we develop and relate with others and with the environment of the society to which we belong. Adolescence is a period with special vulnerability for the development of risky behaviors. In Chile, a progressive decrease in the age of sexual activity onset is observed, particularly in lower socioeconomic strata. The main consequences in sexual health are teenage pregnancies and the risk of acquiring sexually transmitted infections such as HIV. The main strategy for the prevention of this risks is a thorough sexual education, that has to be timely, objective, based on scientific evidence, friendly and confidential. <![CDATA[<b>Incidence and case fatality due to acute myocardial infarction in Chile in the period 2001-2007</b>]]> Background: Acute myocardial infarction (AMI) causes 73.6% of coronary heart disease (CHD) deaths in Chile. Aim: To estimate the incidence and case fatality of AMI and analyze their trends between 2001-2007. Material and Methods: A time-series study analyzing all cases of AMI (according to the International Classification of Diseases (ICD)-10, I21 code), registered in the National Hospitalizations and Death databases. Annual incidence rates and case fatality by sex and age groups were calculated. The direct method was used to standardize rates by age, using the World Health Organization 2000 Population. Prais-Winsten regression models were used to evaluate trends, expressed as relative change. Results: Between 2001 and 2007, we estimated that 83,754 cases of AMI occurred. Standardized annual incidence rate was 74.4 per 100,000 inhabitants (98.0 in men and 51.0 in women). Incidence rates increased by 34% in individuals < 45 years of age and 9.2% in the group 55-64 years (p < 0.001, both). Total case fatality was 49.5% (45.4% in men and 57.2% in women; p < 0.001), and its trend analysis showed a significant annual reduction of 1.2% in men and 0.81% in women. In-hospital case fatality was 14.2% (11.3 and 20.4% in men and women, respectively; p < 0.001). There was a significant annual reduction of mortality (0.57 and 1.01% in men and women, respectively (p < 0.05). Conclusions: The incidence of AMI was stable in the whole population, but increased in younger age groups. Total and in-hospital case-fatality decreased. Despite the greater reduction of case fatality in women, they still have a higher risk of dying while in hospital. <![CDATA[<b>CRF-BP and SLC6A4 gene polymorphisms among restrained eaters</b>]]> Background: Restrained eaters (RE) are a group of individuals who constantly restrict their eating. However, they usually alternate restriction with periods of overeating. Aim: To evaluate the possible association of CRF-BP and SLC6A4 gene polymorphisms with chronic alimentary restriction. Material and Methods: The Spanish version of the Revised Restraint Scale was applied to 132 women aged 18 to 25 years. They were divided in a group classified as restrained eaters (RE) and a group of unrestrained eaters. The 5-HTTLPR and CRF-BPs11 polymorphisms of the SLC6A4 and CRF-BP genes were evaluated by polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (RFLP), respectively. Results: There was a significant association between the s/s homozygous genotype for the 5-HTTLPR polymorphism of SLC6A4 gene and RE condition (p = 0.033). However, this association was not observed for the CRF-BPs11 polymorphism. Conclusions: The presence of s/s genotype is associated with the RE condition, being the presence of a s allele, a risk factor for this condition. <![CDATA[<b>Education about healthy sexual behaviors among high school students</b>]]> Background: The need to educate adolescents about healthy sexual behavior motivated the development of an education program on sexuality. Aim: To describe the knowledge of students about sexuality and the implementation of a sexual education project. Material and Methods: Sixty students aged 14 years (34 females), attending the third year of secondary education participated in dynamic workshops about healthy sexual behaviors. Results: The most common reactions of students when facing situations related to sexual behavior were shame, anxiety, fear and lack of knowledge. Group dynamics improved the practical knowledge of students about sexual behavior, allowing them to make informed decisions. Conclusions: These innovative educational techniques should be expanded to other students. <![CDATA[<b>Socioeconomic inequalities in active life expectancy and disability related to obesity among older people</b>]]> Background: The rapid increase in life expectancy in Chile, with obesity as the main nutritional problem in all age groups, makes it necessary to ask whether the years gained are healthy. Aim: To study the trajectories of disability associated with obesity in Chilean elderly groups from different socio-economic and demographic backgrounds. Material and Methods: Longitudinal study of 3 cohorts of older adults from Santiago: the SABE cohort including 1235 people born before 1940; the Alexandros cohort including 950 people born between 1940 and 1948 from Primary Health Care centers and the ISAPRES cohort of 266 people from private health insurance registries (ISAPRES) born before 1947. An interview yielded socio demographic data and history of diseases. Anthropometric measurements and hand dynamometry were performed. Cognitive status was assessed by the mini mental state examination, depressive symptoms through the geriatric depression socore-5 and functional limitations through self-reporting of basic (ADL), instrumental (IADL) and advanced daily living (AADL) activities. Results: We report here baseline results from ISAPRES and SABE cohorts. Important social and gender differentials were observed. After adjustment by age and gender, a significant lower frequency of limitations in ADL (odds ratio (OR) = 0.17; 95% confidence intervals (CI): 0.079-0.343), IADL (OR = 0.27; 95%CI: 0.159-0.452), and AADL (OR = 0.42; 95%CI: 0.298-0.599) persisted in the ISAPRE cohort, compared to the SABE cohort. Obesity was associated with functional limitations only in AADL (OR = 1.65; 95%CI: 1.18-2.31) and hand dynamometry was associated with lower functional limitation in ADL, IADL and AADL. Conclusions: This study demonstrates profound socio-economic and gender inequalities in older people, thus showing that the years of healthy life gained are not the same for the whole society. <![CDATA[<b>Efficacy and safety of a very-low-calorie diet in a group of overweight or obese Chilean women</b>]]> Background: Very low calorie diets (VLCDs) have been used to induce a rapid decrease in total body weight. Aim: To evaluate the efficacy and safety of a VLCD in a group of overweight and obese Chilean women. Material and Methods: Thirty women with a body mass index (BMI) > 27 kg/m2 were enrolled to a 4 weeks intervention with a VLCD (using liquid meal replacement). Anthropometric and metabolic parameters were evaluated at baseline and at the end of the intervention. Results: Twenty five women (83%) completed the total intervention period. Average weight loss was 5.7 ± 1.5 kg (-6.9% of the initial weight) corresponding to a 34.7 ± 13.4% of the excess of weight. Significant improvements in triglycerides, total cholesterol and LDL cholesterol (Low Density Lipoproteins) were observed. Insulin resistance determined by Homeostasis model assessment (HOMA), decreased significantly from 3.3 ± 1.8 to 2.0 ± 0.9 (p = 0.003). No serious adverse events were reported. Conclusions: Short term use of VLCDs is safe and effective to induce rapid weight loss in Chilean women. <![CDATA[<b>Mini bronchoalveolar lavage in patients with severe respiratory failure</b>]]> Background: To recognize the etiological agent responsible for severe acute respiratory failure (ARF) in patients in mechanical ventilation (MV) is important to determine their treatment and prognosis, and to avoid the excessive use of antibiotics. Mini bronchoalveolar lavage (mini BAL) is a blind, non bronschoscopic procedure, used to obtain samples from the lower respiratory tract from patients on mechanical ventilation (MV). Aim: To assess the feasibility, complications and preliminary results of mini BAL among patients with severe ARF on MV. Material and Methods: Prospective study in 17 patients with acute lung injury (ALI ) or acute respiratory distess syndrome (ARDS) on MV and with negative conventional microbiological studies. Mini BAL was performed using standardized protocols. Hemodynamic and respiratory parameters where measured before and after the procedure. Samples obtained were sent to quantitative cultures. Results: At baseline: APACHE II score of 22 ± 6,7, PaO2/FiO2 ratio was 176.6 ± 48.6 and the oxygenation index was 9.74 ± 3.78. All procedures were performed by an ICU resident. Thirty five percent of the procedures had positive cultures and no complications related to the procedures were reported. The procedure lasted an average of 12 minutes and the instilled and rescued volume were 60 ml and 19.6 ml, respectively. There were no significant differences between hemodynamic and respiratory variables before and after the procedure. Conclusions: Mini BAL is a safe, fast and easy technique for obtaining samples from the inferior airway in patients with ALI or ARDS on MV. <![CDATA[<b>Mental disorders among immigrants in Chile</b>]]> Background: Chile is receiving immigrant populations coming from other Latin-American countries. Aim: To determine the prevalence of Common Mental Disorders (CMD) among immigrants who live in Independencia, a quarter in Santiago, Chile. Material and Methods: A cross sectional study was carried out in the primary health care clinic and in the state-funded school of Independencia. A representative sample of 282 adults and 341 children were interviewed. Mental disorders were diagnosed using CIS-R and MINI structured interviews. Results: The interviewed immigrants came mostly from Peru. The prevalence of mental disorders in the adult population was 17.8% and among children, it was 29.3%. Conclusions: The adult immigrants have a lower prevalence of mental disorders than the Chilean population but it increases among children. Barriers of access to health services, that should be solved, were detected. <![CDATA[<b>A survey about physicians’ professional satisfaction</b>]]> Background: A change in the social structure of medicine and its impact on clients has occurred in the last decades. Aim: To perform a survey about subjective wellbeing among physicians. Material and Methods: A physician’ professional satisfaction survey consisting in 90 questions, was applied to 580 physicians (70% males), working in Metropolitan Santiago. Results: Physicians perceive changes in all the examined professional domains and approximately 50% of the changes are evaluated as negative. Change perception is a general phenomena among physicians, since there were no differences in relation to gender and only in few aspects with respect to age and medical specialty. There was a predominant positive attitude, based on the profession, to face changes. Conclusions: The positive evaluation of changes and the frequent use of managing strategies are associated with a higher satisfaction among physicians. <![CDATA[<b>Association of interleukin-1 genetic polymorphism and CagA positive <em>Helicobacter pylori</em> with gastric cancer in Colombia</b>]]> Background: There is an association of interleukin (IL)1B polymorphism with gastric cancer risk. However systematic reviews of the existing evidence have shown that such association varies across populations with different genetic ancestry. Aim: To evaluate the association of IL-1B-511 and IL-1RN polymorphism and Helicobacter pylori IgG antibodies CagA, with gastric cancer in two Colombian cities located in a high risk area for gastric cancer. Material and Methods: A case-control study including 46 gastric cancer cases and 99 controls with non-atrophic gastritis from a high risk zone for gastric cancer. Polymorphism genotyping was carried out by polymerase chain reaction (PCR) and IgG CagA status by ELISA. Results: IgG CagA seropositive individuals had an increased gastric cancer risk (odds ratio (OR) = 11.56; 95% confidence intervals (CI) 2.62-50.91 in Tunja and OR = 19.66, 95%CI 0.98-395 in Bogotá). IL-1B-511TT carriers in Tunja had increased risk of gastric cancer (OR = 11.31; 95%CI 1.20-106.54)), while IL-1RN*2 alelle carriers in Bogotá showed an inverse association with gastric cancer risk (OR = 0.03; 95%CI 0.01-0.65). Conclusions: This study adds evidence to the positive association of Helicobacter pylori CagA positive strains with non-cardial gastric cancer etiology. There is a possible heterogeneity in the association of IL-1B gene polymorphism with cancer, in populations of similar ethnic background and settled in the same risk area. <![CDATA[<b>Cardiovascular risk factors among young subjects with high carotid intima media thickness</b>]]> Background: Cardiovascular risk factor (RF) assessment is essential to prevent and predict cardiovascular disease. The presence of RF at early ages, are determinant for the presence of atherosclerosis later in life. Aim: To determine the RF profile of young subjects with high carotid intima media thickness (CIMT). Material and Methods: We studied 689 subjects (50% women, mean age 36±6 years) from Santiago, Chile. We determined body mass index (BMI), waist circumference, blood pressure, fasting serum lipids, blood glucose and C-reactive protein. CIMT was assessed by ultrasound using an automatic border recognition software. Results: Body mass index, waist circumference, blood pressure and serum lipids were significantly higher among subjects located in the higher CIMT quartile. Also, subjects in the higher quartile of CIMT had a higher prevalence of three or more RF compared with the lower quartile (p = 0.01). Finally, individuals with three or more RF showed three times more risk of being in the higher CIMT quartile, than subjects with no RF (odds ratio = 3.1, p < 0.01). Conclusions: There is a negative influence of cardiovascular RF on CIMT among young subjects. <![CDATA[<b>Large cell calcifying Sertoli cell tumor</b>: <b>Report of one case</b>]]> Sertoli Cell Tumors are less than 1% of all testicular tumors. We report a 14-year-old male presenting with a left testicular mass. Orchiectomy was carried out and the pathological study informed a large cell calcifying Sertoli cell tumor (LCCSCT). Its association with the Carney complex and Peutz-Jeghers Syndrome was subsequently discarded. Surgical excision was completed with a radical orchiectomy. After eight months of follow up, there is no evidence of tumor relapse. <![CDATA[<b>Fulminant hepatic failure by hepatitis B virus in a patient with human immunodeficiency virus infection</b>: <b>Report of one case</b>]]> The human immunodeficiency virus (HIV) and hepatitis B virus (HBV) co-infection is a common problem in the world, with an estimated prevalence of up to 8%. We report a 27-year-old man admitted to the intensive care unit with an acute liver failure by HBV. During hospital stay, a co-infection with HIV virus was detected. Treatment with early antiviral therapy was started with emtricitabine, tenofovir and raltegravir, to cover both HBV and HIV. Despite therapy, the patient died two weeks after admission. <![CDATA[<b>Acute encephalopathy associated with the use of intravenous immunoglobulin. Report of one case</b>]]> Adverse reactions to intravenous immunoglobulin (ivIg) therapy, such as anaphylaxis, acute encephalopathy, aseptic meningitis, or thrombotic phenomena are uncommon. We report a 58-year-old man with hypertension presenting with muscle weakness which led to paraparesia and respiratory failure. With the diagnosis of Guillain-Barré syndrome (GBS), he was treated with ivIg. He developed an acute encephalopathy few hours after the administration of ivIg, with a decreased level of consciousness and agitation. A CT scan revealed moderate and diffuse brain edema. Encephalopathy resolved 96 hours after ivIg withdrawal and use of plasma exchange. A CT scan performed seven days after showed the resolution of brain edema. <![CDATA[<b>Catheter associated bacteremia caused by <em>Ochrobactrum anthropi</em> in a patient on hemodialysis</b>: <b>Report of one case</b>]]> Ochrobactrum anthropi is a rare pathogen in humans that is usually related to infections in inmunocompromised patients or people with indwelling medical devices. There are very few reported cases of O. anthropi bacteremia in patients on hemodialysis. We report a 19-year-old female on hemodialysis through a jugular catheter, with fever and malaise lasting one month. The catheter was withdrawn and Ochrobactrum anthropi was isolated from it and from blood cultures. The patient was successfully treated with levofloxacin. <![CDATA[<b>New oral anticoagulant drugs</b>]]> Thromboembolic disease (TED) is the leading cause of morbidity and mortality worldwide. The hallmark of oral long-term anticoagulant therapy has been the use of vitamin K antagonists, whose anticoagulant effect is exerted inhibiting vitamin K epoxide reductase. Warfarin and acenocoumarol are the most commonly used. In the last five years several new drugs for long term anticoagulation have been developed, which can inhibit single clotting factors with the purpose of improving drug therapeutic range and, ideally, minimizing bleeding risks. This review addresses the state of the art on the clinical use of inhibitors of activated factor X and thrombin. <![CDATA[<b>Tandem mass spectrometry as screening for inborn errors of metabolism</b>]]> The use of tandem mass spectrometry for the diagnosis of inborn errors of metabolism has the potential to expand the newborn screening panel to include a vast number of diseases. This technology allows the detection, in the same spot of dried blood on filter paper and during one single analytical run, of different metabolic diseases. Tandem mass spectrometry is rapidly replacing the classical screening techniques approach of one-metabolite detected per analysis per disease by its ability of simultaneous quantification of several metabolites as markers of many diseases, such as acylcarnitines and amino acids. It is clear that a single metabolite can be a biomarker for several diseases, so the multiplex approach of using tandem mass spectrometry enhances, on average, the sensitivity and specificity of the screening. However, there are differences for particular metabolites and the diseases they detect within the same method. Disorders such as the tyrosinemias and among the organic acidemias, the methylmalonic acidemias, have a substantially higher false-positive rate than other more common metabolic diseases such as medium-chain acyl-CoA dehydrogenase deficiency and phenylketonuria. Before introducing this technology into routine newborn screening programs it is necessary to consider the frequency of each disease, as well as the response to early treatment or variables related to the collection of the sample. <![CDATA[<b>William Wilkie Collins</b>: <b>Medicine as an aid for enriching the creation of fiction literature</b>]]> William Wilkie Collins (WWC) is a well-known prolific and innovator English writer of the Victorian age. After 150 years he is still being extensively read and all his main works are translated into Spanish. Furthermore, WWC has been acclaimed by famous writers such as JL Borges and TS Eliot as one of the best story-tellers of all times, and a master of the complexities of the plot of stories. WWC mentioned on his works many innovator aspects of medicine, demonstrating an uncanny power of observation and real interest in science. Notoriously, WWC described posttraumatic epilepsy, the clinical effects of opium, the introduction of people with sensorial deficits, such as blindness and deafness, as main figures in his novels. WWC also showed an interest in the management of mental disorders and the use of music as a potential therapy. In this review, we comment these interesting aspects of the creative work of this genius of the fiction literature. <![CDATA[<b>Clinical differences between patients consulting for occupational neurosis and common illnesses</b>]]> Background: In Chile, occupational illnesses are defined by the "Work-related accidents and occupational illnesses law". The institutions that administer that law have the legal obligation to determine the "occupational" or "common" origin of accidents and diseases. Aim: To compare symptoms and problems at work in a group of workers consulting for presumptive occupational neurosis (ON), distinguishing cases of OC from cases of common illness (CI). Material and Methods: Two consecutive series of patients were reviewed: 100 cases diagnosed as ON (71% women) and 200 cases diagnosed as CI (69% women). The general health questionnaire-30 (GHQ-30) and a questionnaire specially devised at the institution to evaluate ON were applied to participants. Social and demographic features, reasons for consulting and clinical diagnoses were compared in both types of patients. Results: Age, marital status, educational level and type of work were similar among patients with ON and CI. Subjects with CI had a higher frequency of depressive symptoms. The main reason to consult among patients with ON was work overload. The reasons for consulting among patients with CI were interpersonal conflicts and feeling of undervaluation. Conclusions: Patients with CI are predominantly depressive and those with ON have a feeling of work overload. <![CDATA[<b>Bioethics today</b>: <b>Heidegger’s questions</b>]]> Bioethics was born not only as an aftermath of medical technological advance but also from underlying philosophical conceptions about man, that determine scientific research. Analyzing occidental ethics, Heidegger showed that animalism was the only human dimension considered and thereby the domain of measurable objectiveness. He postulated that the essence of human existence as being-in-the-world is ethical and revealed through an original consciousness. Unlike moral conscience, original conscience calls to authenticity, to hear his constitutive nihilism as a "Being-refered-to-death". The founding ground of bioethics may be to listen to this primary being-guilty prior to the derived guilts, e.g. faults, deficiencies and shortcomings of specific daily actions. <![CDATA[<b>Ocular and cardiac toxicity by chloroquine</b>]]> Bioethics was born not only as an aftermath of medical technological advance but also from underlying philosophical conceptions about man, that determine scientific research. Analyzing occidental ethics, Heidegger showed that animalism was the only human dimension considered and thereby the domain of measurable objectiveness. He postulated that the essence of human existence as being-in-the-world is ethical and revealed through an original consciousness. Unlike moral conscience, original conscience calls to authenticity, to hear his constitutive nihilism as a "Being-refered-to-death". The founding ground of bioethics may be to listen to this primary being-guilty prior to the derived guilts, e.g. faults, deficiencies and shortcomings of specific daily actions.