Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720120004&lang= vol. 140 num. 4 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Design and validation of an instrument to assess families at risk for health problems]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400001&lng=&nrm=iso&tlng= Background: There is a paucity of screening instruments with a high clinical predictive value to identify families at risk and therefore, develop focused interventions in primary care. Aim: To develop an easy to apply screening instrument with a high clinical predictive value to identify families with a higher health vulnerability. Material and Methods: In the first stage of the study an instrument with a high content validity was designed through a review of existent instruments, qualitative interviews with families and expert opinions following a Delphi approach of three rounds. In the second stage, concurrent validity was tested through a comparative analysis between the pilot instrument and a family clinical interview conducted to 300families randomly selected from a population registered at a primary care clinic in Santiago. The sampling was blocked based on the presence of diabetes, depression, child asthma, behavioral disorders, presence of an older person or the lack of previous conditions among family members. The third stage, was directed to test the clinical predictive validity of the instrument by comparing the baseline vulnerability obtained by the instrument and the change in clinical status and health related quality of life perceptions of the family members after nine months of follow-up. Results: The final SALUFAM instrument included 13 items and had a high internal consistency (Cronbach's alpha: 0.821), high test re-test reproducibility (Pearson correlation: 0.84) and a high clinical predictive value for clinical deterioration (Odds ratio: 1.826; 95% confidence intervals: 1.101-3.029). Conclusions: SALUFAM instrument is applicable, replicable, has a high content validity, concurrent validity and clinical predictive value. <![CDATA[Cardiovascular risk factors among university students]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400002&lng=&nrm=iso&tlng= Background: Cardiovascular diseases are related to particular lifestyle patterns and the presence of cardiovascular risk factors (CVRF). Aim: To evaluate the presence of CVRF in students from Universidad Austral de Chile (UACh). Material and Methods: CVRF were evaluated in 385 university students aged 17 to 26years (63% women). Personal background, lifestyle, anthropometry, blood pressure, serum lipids and blood glucose were evaluated. Results: Eighty eight percent of evaluated students had sedentary habits, 19% had high LDL cholesterol levels, 40% had high blood pressure, 28% smoked, 29% were overweight or obese and 20% had some stress level. Conclusions: There is a high frequency of non-healthy lifestyles and cardiovascular risk factors in this sample of university students. <![CDATA[Relation of genetic variants of CYP2A6 with tobacco dependence and smoking habit in Chilean subjects: A pilot study]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400003&lng=&nrm=iso&tlng= Background: Genetic and metabolic factors associated with nicotine metabolism may be related to smoking behavior. Aim: To assess the prevalence of allelic and genotype variants of CYP2A6 in a sample of Chilean subjects and to evaluate their relationship with smoking and tobacco dependence. Material and Methods: The genotype frequencies for *2, *3 and *4 of CYP2A6*1 (wild type) gene were determined by polymerase chain reaction (PCR) in 54 volunteers. Addiction to tobacco was evaluated using the Fagerstrom Test. The association between the presence of allelic variants of CYP2A6 and smoking and tobacco dependence was evaluated with chi square test. Results: The prevalence of *1, *2 (wt/*2), *3 (wt/*3 or *31*3) and *4 (del/del) were 92.6%, 3.7%, 0% y 3.7%, respectively. No significant association was observed between being a carrier of a variant genotype of CYP2A6 and smoking or tobacco dependence. Conclusions: In this sample of Chilean individuals we did not find a relation between any CYP2A6 genotype with smoking or tobacco dependence. <![CDATA[Evaluation of olfaction in healthy subjects using the sniffing sticks battery]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400004&lng=&nrm=iso&tlng= Background: Olfaction dysfunction is linked to neurodegenerative diseases, therefore the evaluation of this function is becoming important Aim: To evaluate olfaction in healthy participants. Material and Methods: We evaluated 44 healthy males and 55 females, aged 21 to 89 years with the sniffing sticks battery to determine normal values in Chilean population. During the test, participants must correctly identify 12 different odors. Results: Normal olfaction, hyposmia and anosmia were defined. An age related decline in olfaction was observed, especially among males aged 59 years or more. Conclusions: This study provides age and gender specific normal values for the sniffing sticks battery. <![CDATA[Prevalence of psychiatric disorders among Chilean children and adolescents]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400005&lng=&nrm=iso&tlng= Background: Psychiatric disorders that appear during childhood or adolescence should be a public health priority. Aim: To report the results of a national representative survey in the Latin American region examinig the prevalence of DSM-IV psychiatric disorders in children and adolescents. Material and Methods: Subjects aged 4 to 18 years were selected using a stratified multistage design. The Diagnostic Interview Schedule for Children Version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses, and was supplemented with questionnaires examining family riskfactors, socioeconomic status and service use. Results: A sample of1558 children and adolescents (51% males) was evaluated. Fifty three percent of the sample were children aged 4 to 11 years and the rest were adolescents aged 12 to 18 years. The prevalence rate for any psychiatric disorder without impairment was 38.3% (33.5% for boys and 43.3% for girls). The prevalence rate was higher among children as compared to adolescents (42.9% and 33.2%, respectively). A third of participants receiving a diagnosis sought some form of assistance. Nearly a quarter of those using services, did not have a psychiatric diagnosis in the past year. Comorbidity was found in 27% of those with a disorder, but only 7% had three or more diagnoses. Conclusions: The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to re-evaluate mental health services provided to children and adolescents in our country. <![CDATA[Children with special health care needs: prevalence in a pediatric hospital and associated]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400006&lng=&nrm=iso&tlng= Background: "Children with special health care needs" (CSHCN) is a novel definition for pediatric patients with chronic diseases, adopted by the Chilean Pediatric Society in 2008. As life expectancy in Chile increases, prevalence of CSHCN is progressively growing, leading to higher health costs. Aim: To describe the epide-miological profile and clinical characteristics of hospitalized CSHCN, and compare the risk assessment of adverse events during hospitalization using two definitions for CSHCN. Patients and Methods: A cohort of hospitalized CSHCN in a Pediatric Center at Santiago, Chile, was followed from September to December 2009. Clinical and demographic data were registered in a database, including admission to intensive care unit (ICU), nosocomial infections and prolonged hospitalization (&gt; 7 days). Incidence ratios for these events were compared between CSHCN and non-CSHCN, and between children attended by three or more health care professionals (CSHCN-3) and non-CSHCN. Results: Nine hundred twenty patients were included (54% male), with a median age 14 months (0-221) and median days of hospitalization 4 days (1-229). Prevalence of CSHCN was 60.8% of hospitalized children. When using CSHCN definition and comparing with non-CSHCN, no excess of risk was documented. On the other hand, prevalence of CSHCN-3 was 19.9%. Compared to non-CSHCN, these patients had a higher risk of ICU admission (relative risk (RR) 1.58; 95% confidence intervals (CI) = 1.22-2.05; p < 0.01), nosocomial infections (RR 2.28; 95% CI = 1.54-3.39; p < 0.001) and prolonged hospitalization (RR 1.99; 95% CI = 1.52-2.60; p < 0.001). Conclusions: One in five hospitalized children met CSHCN-3 definition. These patients had an increased risk of adverse events during their hospitalization compared to non-CSHCN. <![CDATA[Scientific production in clinical medicine and international collaboration networks in South American countries]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400007&lng=&nrm=iso&tlng= Background: International collaboration is increasingly used in biomedical research. Aim: To describe the characteristics of scientific production in Latin America and the main international collaboration networks for the period 2000 to 2009. Material and Methods: Search for papers generated in Latin American countries in the Clinical Medicine database of ISI Web of Knowledge v.4.10 - Current Contents Connect. The country of origin of the corresponding author was considered the producing country of the paper. International collaboration was analyzed calculating the number of countries that contributed to the generation of a particular paper. Collaboration networks were graphed to determine the centrality of each network. Results: Twelve Latin American countries participated in the production of253,362 papers. The corresponding author was South American in 79% of these papers. Sixteen percent of papers were on clinical medicine and 36% of these were carried out in collaboration. Brazil had the highest production (22,442 papers) and the lower percentage of international collaboration (31%). North America accounts for 63% of collaborating countries. Only 8% of collaboration is between South American countries. Brazil has the highest tendency to collaborate with other South American countries. Conclusions: Brazil is the South American country with the highest scientific production and indicators of centrality in South America. The most common collaboration networks are with North American countries. <![CDATA[Differentiation of <i>entamoeba histolytica</i> from <i>entamoeba dispar</i> using Gal/GalNAc-lectin and polymerase chain reaction]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400008&lng=&nrm=iso&tlng= Background: Entamoeba histolytica and Entamoeba dispar are morphologically identical. However, the former is highly pathogenic and the latter is not. Aim: To differentiate Entamoeba histolytica from Entamoeba dispar through ELISA and PCR techniques in Colombian isolates from feces. Material and Methods: Descriptive study of Colombian fecal samples from 53 males and 47 women, that were positive for the complex E. histolytica/E. dispar on light microscopy. Positive samples were cultured on Robinson medium to isolate trophozoites. The presence of specific Gal/ GalNAc-lectin was determined by ELISA and polymerase chain reaction in genomic DNA, using the combination of three nucleotides that recognize a variable region of 16S small subunit ribosomal RNA, generating a 166 base pair (bp) product for E. histolytica and 752 pb product for E. dispar. Results: After verification, only eight of the 100 samples were positive for the complex E. histolytica/E. dispar and were cultivated. Isolates were obtained in six cultures, one corresponded to E. histolytica and six to E. dispar. Conclusions: The presence of E. histolytica/E. dispar complex was largely overestimated with light microscopy. In the few samples where isolates were obtained, the technique described differentiated between both strains. <![CDATA[Main characteristics of current biomedical research, in Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400009&lng=&nrm=iso&tlng= Background: Biomedical research is a fundamental tool for the development of a country, requiring human and financial resources. Aim: To define some current characteristics of biomedical research, in Chile. Methods: Data on entities funding bio-medical research, participant institutions, and the number of active investigators for the period 2007-2009 were obtained from institutional sources; publications indexed in PubMedfor2008-2009 were analysed. Results: Mostfinancial resources invested in biomedical research projects (approximately US$ 19 million per year) came from the "Comisión Nacional de Investigación Científica y Tecnológica" (CONICYT), a state institution with 3 independent Funds administering competitive grant applications open annually to institutional or independent investigators in Chile. Other sources and universities raised the total amount to US$ 26 million. Since 2007 to 2009, 408 investigators participated in projects funded by CONICYT. The main participant institutions were Universidad de Chile and Pontificia Universidad Católica de Chile, both adding up to 84% of all funded projects. Independently, in 2009,160 research projects -mainly multi centric clinical trials- received approximately US$ 24 million from foreign pharmaceutical companies. Publications listed in PubMed were classified as "clinical research" (n = 879, including public health) or "basic biomedical research" (n = 312). Conclusions: Biomedical research in Chile is mainly supported by state funds and university resources, but clinical trials also obtained an almost equivalent amount from foreign resources. Investigators are predominantly located in two universities. A small number of MD-PhD programs are aimed to train and incorporate new scientists. Only a few new Medical Schools participate in biomedical research. A National Registry of biomedical research projects, including the clinical trials, is required among other initiatives to stimulate research in biomedical sciences in Chile. <![CDATA[Cutaneous tuberculosis: Report of one case]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400010&lng=&nrm=iso&tlng= Background: Tuberculosis is uncommonly located in the skin, corresponding to 1 to 2% of extrapulmonary forms. We report a 61-year-old woman, referred due to a two months history of erythematous plaques covered with honey-colored crusts in the left preauricular region and below the chin. The lesions were previously treated as pyoderma with poor response. She was otherwise healthy, without any other symptom. Skin biopsy showed exudative tuberculoid granulomas with caseation necrosis. Koch culture was positive for Mycobacterium tuberculosis. Complementary studies ruled out other foci. Lupus vulgaris was diagnosed and antituberculous therapy started, achieving regression of cutaneous lesions. <![CDATA[AA amyloidosis with cutaneous manifestations: Report of one case]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400011&lng=&nrm=iso&tlng= Background: Systemic amyloidosis is a rare disease that can affect any organ. Its clinical manifestations are varied and nonspecific. The skin involvement of this disease is common and can be easily recognized on physical examination. We report a 57-year-old male presenting with a two years history of malaise, dyspnea and myalgias. On physical examination, ungueal dystrophy, orange pigmentation of eyelids with periocular petechiae and mild macroglossia were observed. Incisional biopsies of the eyelids, cheeks and hands were obtained. The pathological study demonstrated amyloid deposits. Since protein electrophoresis was normal, the diagnosis of AA amyloidosis was postulated. <![CDATA[Spurious hypoxemia due to hyperleukocytosis: Report of one case]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400012&lng=&nrm=iso&tlng= Background: Arterial gasometry is considered the gold standard for establishing a diagnosis of respiratory failure of any etiology. However, there are some circumstances in which it loses specificity, making necessary to consider other tests such as pulse oximetry to adequately determine hypoxemia. We report a 67 years old patient with sudden hypoacusia, right hemiparesis and polypnea. His laboratory exams on admission, showed extreme hypoxemia in several readings, without correlation to the patient's clinical condition nor the pulse oximetry, and a leukocytosis of 800.000 cells x ml, with many immature cells. Chronic myeloid leukemia was diagnosed and treatment with hydroxyurea was initiated, achieving normalization in the arterial gases in accordance with the fall of the white cell count. Interpretation of laboratory findings according to the general clinical context of the patient allowed to suspect a spurious hypoxemia, saving the patient from unnecessary and risky interventions. <![CDATA[Cocaine-induced vascular damage: Report of one case]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400013&lng=&nrm=iso&tlng= Background: Cocaine abuse is associated with an increased risk of cardiac and cerebrovascular events, such as myocardial infarction, sudden cardiac death, and ischemic stroke. The underlying mechanisms leading to these complications are not fully understood although intravascular thrombus formation and accelerated atherosclerosis are prominent findings. We report a 39-year-old male addicted to cocaine, who presented with three consecutive ischemic events characterized by an acute myocardial infarction and two ischemic strokes complicated by cardiac failure and severe neurological sequelae. The pathophysiology of cocaine-induce vascular damage and the management of the ischemic complications are discussed. <![CDATA[Soy isoflavones and human health: breast cancer and puberty timing]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400014&lng=&nrm=iso&tlng= Background: Accumulated exposure to high levels of estrogen is associated with an increased incidence of breast cancer. Thus, factors such as early puberty, late menopause and hormone replacement therapy are considered to be risk factors, whereas early childbirth, breastfeeding and puberty at a later age are known to consistently decrease the lifetime breast cancer risk. Epidemiological studies suggest that consumption of isoflavones correlates with a lower incidence of breast cancer. Data from human intervention studies show that the effects of isoflavones on early breast cancer markers differ between pre- and post-menopausal women. The reports from experimental animals (rats and mice) on mammary tumors are variable. These results taken together with heterogeneous outcomes of human interventions, have led to a controversy surrounding the intake of isoflavones to reduce breast cancer risk. This review summarizes recent studies and analyzes factors that could explain the variability of results. In mammary tissue, from the cellular endocrine viewpoint, we analyze the effect of isoflavones on the estrogen receptor and their capacity to act as agonists or antagonists. On the issue of puberty timing, we analyze the mechanisms by which girls, but not boys, with higher prepuberal isoflavone intakes appear to enter puberty at a later age. <![CDATA[Evolutionary perspective of eating disorders]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400015&lng=&nrm=iso&tlng= Background: Evolutionary theory has contributed with physiological, psychological and behavioral explanations to the comprehension and treatment of eating disorders (ED). The aim of this review is to analyze the relationship between ED and the attachment theory and natural selection based hypotheses (famine flight, reproductive suppression and intrasexual competition). Insecure attachment is characteristic of ED and significantly interferes in the individuation developmental process. Maternal attachment is usually ambivalent; mainly avoidant in anorexics and anxious in bulimics. Anorexic syndrome evokes ancestral adaptive mechanisms to face food scarcity, status achievement and threat of group exclusion. Suppression of reproductive capacity in anorexics, favored by family dynamics, represents a self-sacrifice to obtain the benefit of its members through genetic altruism. Feminine intrasexual competence is related to nubile features in order to attract and retain high quality and long-term partners. Therefore, from an evolutionary perspective, ED symptomatology may be described as a self-destructive adaptive state of lack of control, in response to a particular genetic phenotype plasticity, environmental factors and cognitive processes. <![CDATA[Guy de Maupassant: medical aspects of his lustful and creative life]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400016&lng=&nrm=iso&tlng= Background: The French writer Guy de Maupassant is considered one of the most important story-tellers of all times. In his short life, he produced relevant works which are full of interesting medical descriptions, as sleep palsy and unconscious memory, depicted on his famous tale The Horla. Furthermore, many of his novels and tales contain precise and very insightful descriptions of physicians, many of whom he contacted because of suffering severe migraine. Maupassant became psychotic on his last years as a result of neurosyphilis and died in an asylum. In this review, we analyze some medical aspects of his intense life and provide references of unknown medical descriptions in his works. <![CDATA[Evaluation of a faculty development program in curriculum development for program directors of medical specialties]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400017&lng=&nrm=iso&tlng= Background: Few medical teaching institutions provide faculty development in curriculum development to program directors of medical specialties (PD), despite the increased demand for renewal of residency programs and the evaluation of outcomes. Aim: To describe and evaluate a training program in curriculum development for PD developed in 2008 and 2009. Material and Methods: Thirty PD attended an on campus course of fifteen hours. Evaluation was done using Kirkpatrick model through an end-of-course questionnaire, a retrospective pre/post self-assessment test of skills, the assessment of learning and the final projects developed by PD. Results: All PD finished the course and answered the questionnaire. In level 1 (Reaction), 100% reported high satisfaction and would recommend it highly to others, with perceived mean achievement of course objectives of 81%. In level 2 (Learning), all the differences between the retrospective pre and posttest were statistically significant (p < 0.01), and achievement of learning was in average 82.9%. In level 3 (Behavior), 100% felt they would apply what was learnt and 17 PD (57%) sent projects. Conclusions: This model of faculty development was highly accepted by PD and had a positive evaluation based in high satisfaction, the improvement in pre/posttest assessment, the achievement of learning objectives and the development of projects. <![CDATA[The outstanding achievements of Adolf Kussmaul]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400018&lng=&nrm=iso&tlng= Background: Adolf Kussmaul was born in Graben, close to Karlsruhe, Germany, on February 22,1822. He graduated at Heidelberg University in 1845 and he received his medical degree in 1855. He made original descriptions, such as the ophthalmoscope, the gastroscope or endoscope, and Kussmaul signs, besides the respiration named after him. He was the first to perform a thoracocenteses, peritoneal and gastric lavages. He rediscovered progressive bulbar paralysis (previously described by Guillaume Duchenne in 1861), polyarteritis nodosa (which was described by Karl von Rokitan-sky en 1852), dyslexia, (described by Thomas Willis in 1672) and pulsus paradoxus named after him, but that was reported by Richard Lower in 1669. During his 80 years of life, he wrote about different issues and topics (cardiology, rheumatology, endocrinology, gastroenterology, psychiatry, and neurology). Kussmaul was a student and professional without limits in his observation capacity. He preached with his own example in pursuit of science: observation, hypothesis, experimentation and analysis. <![CDATA[CRÓNICA]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400019&lng=&nrm=iso&tlng= Background: Adolf Kussmaul was born in Graben, close to Karlsruhe, Germany, on February 22,1822. He graduated at Heidelberg University in 1845 and he received his medical degree in 1855. He made original descriptions, such as the ophthalmoscope, the gastroscope or endoscope, and Kussmaul signs, besides the respiration named after him. He was the first to perform a thoracocenteses, peritoneal and gastric lavages. He rediscovered progressive bulbar paralysis (previously described by Guillaume Duchenne in 1861), polyarteritis nodosa (which was described by Karl von Rokitan-sky en 1852), dyslexia, (described by Thomas Willis in 1672) and pulsus paradoxus named after him, but that was reported by Richard Lower in 1669. During his 80 years of life, he wrote about different issues and topics (cardiology, rheumatology, endocrinology, gastroenterology, psychiatry, and neurology). Kussmaul was a student and professional without limits in his observation capacity. He preached with his own example in pursuit of science: observation, hypothesis, experimentation and analysis. <![CDATA[Elderly and impoverished cancer patients need urgent help in India]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400020&lng=&nrm=iso&tlng= Background: Adolf Kussmaul was born in Graben, close to Karlsruhe, Germany, on February 22,1822. He graduated at Heidelberg University in 1845 and he received his medical degree in 1855. He made original descriptions, such as the ophthalmoscope, the gastroscope or endoscope, and Kussmaul signs, besides the respiration named after him. He was the first to perform a thoracocenteses, peritoneal and gastric lavages. He rediscovered progressive bulbar paralysis (previously described by Guillaume Duchenne in 1861), polyarteritis nodosa (which was described by Karl von Rokitan-sky en 1852), dyslexia, (described by Thomas Willis in 1672) and pulsus paradoxus named after him, but that was reported by Richard Lower in 1669. During his 80 years of life, he wrote about different issues and topics (cardiology, rheumatology, endocrinology, gastroenterology, psychiatry, and neurology). Kussmaul was a student and professional without limits in his observation capacity. He preached with his own example in pursuit of science: observation, hypothesis, experimentation and analysis. <![CDATA[Normal Distribution: <b>Is it as frequent as it seems?</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000400021&lng=&nrm=iso&tlng= Background: Adolf Kussmaul was born in Graben, close to Karlsruhe, Germany, on February 22,1822. He graduated at Heidelberg University in 1845 and he received his medical degree in 1855. He made original descriptions, such as the ophthalmoscope, the gastroscope or endoscope, and Kussmaul signs, besides the respiration named after him. He was the first to perform a thoracocenteses, peritoneal and gastric lavages. He rediscovered progressive bulbar paralysis (previously described by Guillaume Duchenne in 1861), polyarteritis nodosa (which was described by Karl von Rokitan-sky en 1852), dyslexia, (described by Thomas Willis in 1672) and pulsus paradoxus named after him, but that was reported by Richard Lower in 1669. During his 80 years of life, he wrote about different issues and topics (cardiology, rheumatology, endocrinology, gastroenterology, psychiatry, and neurology). Kussmaul was a student and professional without limits in his observation capacity. He preached with his own example in pursuit of science: observation, hypothesis, experimentation and analysis.