Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720120012&lang=es vol. 140 num. 12 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b>Endocarditis infecciosa</b>: <b>características clínicas, complicaciones y mortalidad en 506 pacientes y factores pronósticos de sobrevida a 10 años (1998-2008). Estudio cooperativo nacional en endocarditis infecciosa en Chile (ECNEI-2)</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200001&lng=es&nrm=iso&tlng=es Background: Rates ofmorbidity and mortality in Infective Endocarditis (IE) remain high and prognosis in this disease is still difficult and uncertain. Aim: To study IE in Chile in its active phase during inpatient hospital stay and long term survival rates. Material and Methods: Observational prospective national cohort study of 506 consecutive patients included between June 1,1998 and July 31, 2008, from 37 Chilean hospitals (secondary and tertiary centers) nationwide. Results: The main findings were the presence of Rheumatic valve disease in 22.1 % of patients, a history of intravenous drug abuse (IVDA) only in 0.7%, the presence of Staphylo-coccus aureus in 29.2% of blood cultures, negative blood cultures in 33.2%, heart failure in 51.7% and native valve involvement in 86% ofpatients. Echocardiographic diagnosis was achieved in 94% of patients. Hospital mortality was 26.1% and its prognostics factors were persisting infection (Odds ratio (OR) 6.43, Confidence Interval (CI) 1.45-28.33%), failure of medical treatment and no surgical intervention (OR 48.8; CI 6.67-349.9). Five and 10 years survival rates were 75.6 and 48.6%, respectively. The significant prognostic factors for long term mortality, determined by multivariate analysis were the presence of diabetes, Staphylococcus aureus infection, sepsis, heart failure, renal failure and lack of surgical treatment during the IE episode. Conclusions: The microbiologic diagnosis of IE must be urgently improved in Chile. Mortality rates are still high (26.1%) partly because of a high incidence of negative blood cultures and the need for more surgical valve interventions during in-hospital period. Long term prognostic factors for mortality should be identified early to improve outcome. <![CDATA[<b>Resultados del tratamiento de la hepatitis crónica por virus C en un hospital público, en Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200002&lng=es&nrm=iso&tlng=es Background: Chronic hepatitis C is an important health problem in Chile. In 2005, the Ministry of Health started a pilot treatment program with peg interferon and ribavirin, to be developed in public hospitals all over the country. Aim: To report the results ofhepatitis C treatment obtained at our institution. Patients and Methods: Between 2005 and 2009, 63 patients were referred for treatment. In all, the viral load and genotype were determined. Peg interferon alpha-2a or alpha-2b plus ribavirin were used for therapy for up to 48 weeks in genotypes (G) 1 or 4 or 24 weeks in genotypes 2 or 3. If at the end oftreatment, viral load measured by polymerase chain reaction (PCR) was negative, it was repeated 6 months later. A negative viral load at that time was considered a sustained viral response (SVR). Results: Among the 51 patients who started treatment, 42 (80.4%) were G1,1 was G2,1 was G4 and 7 were G3. A SVR was reached in 51.1% ofG 1 and 4 and in 87.5% in G 3 and 2. In a univariate analysis, the variables significantly associated with a positive viral response were the degree offibrosis and body mass index. Conclusions: These results are similar to those obtained in other international series, demonstrating that Hispanic ethnicity does not influence the response to treatment. Our good results could be explained by the excellent compliance of the patients to the treatment. A higher degree offibrosis and a higher BMI were associated with a poor response. <![CDATA[<b>Medición volumétrica de grasa visceral abdominal con resonancia magnética y su relación con antropometría, en una población diabética</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200003&lng=es&nrm=iso&tlng=es Background: Visceral fat accumulation is associated with the development of metabolic diseases. Anthropometry is one of the methods used to quantify it. aim: to evaluate the relationship between visceral adipose tissue volume (VAT), measured with magnetic resonance imaging (MRI), and anthropometric indexes, such as body mass index (BMI) and waist circumference (WC), in type 2 diabetic patients (DM2). Patients and Methods: Twenty four type 2 diabetic patients aged 55 to 78 years (15 females) and weighting 61.5 to 97 kg, were included. The patients underwent MRI examination on a Philips Intera® 1.5T MR scanner. The MRI protocol included a spectral excitation sequence centered at the fat peak. The field of view included from L4-L5 to the diaphragmatic border. VAT was measured using the software Image J®. Weight, height, BMI, WC and body fat percentage (BF%), derived from the measurement offour skinfolds with the equation of Durnin and Womersley, were also measured. The association between MRIVAT measurement and anthropometry was evaluated using the Pearson's correlation coefficient. Results: Mean VAT was 2478 ± 758 ml, mean BMI29.5 ± 4.7 kg/m², and mean WC was 100 ± 9.7 cm. There was a poor correlation between VAT, BMI (r = 0.18) and WC (r = 0.56). Conclusions: BMI and WC are inaccurate predictors of VAT volume in type 2 diabetic patients. <![CDATA[<b>Empiemas pleurales por <i>Gemella</i> spp</b>: <b>una etiología no tan infrecuente</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200004&lng=es&nrm=iso&tlng=es Background: Gemella genus bacteria can produce localized or generalized severe infections, but very rarely they have been described as causingpulmonary infections or pleural empyemas. Aim: To characterize patients with empyema caused by Gemella genus bacteria. Material and Methods: The database of a Microbiology laboratory of a Spanish hospital was reviewed, searchingfor Gemella positive cultures ofpleural effusions in a period offive years. Results: We identified 12 patients (11 males) with Gemella spp pleural empyema. Eight were infected with G. haemolysans and four with G. morbillorum. All patients had predisposingfactors such as poor oral hygiene, smoking, chronic cardiovascular or respiratory disease, alcoholism or malignancies. In ten cases, a thoracic drainage tube was placed with fibrinolysis in seven. One patient needed surgery because of a relapse of the empyema. Two patients died because of an advanced neoplasm, and the empyema was resolved in the rest. Conclusions: Gemella pleural empyema can occur and its isolation must not be seen as a contamination. <![CDATA[<b>Validación del cuestionario de calidad de vida ConQol, en niños chilenos portadores de cardiopatías congénitas</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200005&lng=es&nrm=iso&tlng=es Background: ConQoL questionnaire assesses health related quality of life among children with congenital heart diseases. It has a version for children aged 8 to 11 years and anotherfor children aged 12 to 16years. Aim: To validate ConQol questionnaire for Chilean children with a congenital heart disease. Material and Methods: Using a multicentric cross sectional design, 334 children from four hospitals (54% males), were surveyed. Among them 45% were aged 8 to 11 years and 55%, 12 to 16 years. The study involved three stages: cross cultural adjustment of the original questionnaire, pre-test study, and estimation of its psychometric properties. Content, construct and criterion validity and internal consistency with Cronbach's alpha, were assessed. Results: The version for children aged 8 to 11 years and comprised by three domains (symptoms, activity and relationships), obtained and α ≥ 0.60. In the questionnaire for children aged 12 to 16years, there is one more domain called coping, which obtained an α of 0.53, that was different to the other three domains that obtained an α &gt; 0.70. The correlation between Health Quality of Life and Perception of Health Quality of Life was statistically significant for both groups. The association between Health Quality ofLife and health capability was only significant among children aged 12 to 16years (p < 0.01). Conclusions: The adapted ConQol questionnaire matched properly with the original one. The adapted questionnaire is valid and reliable to assess Health Quality ofLife among Chilean children with congenital heart diseases. <![CDATA[<b>Evaluación del ambiente educacional en programas de especialización médica</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200006&lng=es&nrm=iso&tlng=es Background: The Postgraduate Hospital Education Environment Measure (PHEEM) questionnaire, is a valid and reliable instrument to measure the educational environment (EE) in postgraduate medical education. Aim: To evaluate the EE perceived by the residents of a postgraduate training program using the PHEEM. Material and Methods: The PHEEM was applied in 2010-2011 in 35 specialty programs. We calculated their individual results and compared means of both global and individual domain scores of the PHEEM, by gender, university of origin and nationality. Cronbach's alpha coefficients and D study (Generalizability theory) were performed for reliability. Results: Three hundred eighteen residents were surveyed (75.7% of the total universe). The mean score of the PHEEM was 105.09 ± 22.46 (65.7% of the maximal score) which is considered a positive EE. The instrument is highly reliable (Cronbach's alpha = 0.934). The D study found that 15 subjects are required to obtain reliable results (G coefficient = 0.813). There were no significant differences between gender and university of origin. Foreigners evaluated better the EE than Chileans and racism was not perceived. The programs showed a safe physical environment and teachers with good clinical skills. The negative aspects perceived were a lack of information about working hours, insufficient academic counseling, and scanty time left for extracurricular activities. Conclusions: This questionnaire allowed us to identify positive aspects of the EE, and areas to be improved in the specialty programs. The PHEEM is a useful instrument to evaluate the EE in Spanish-speaking participants of medical specialty programs. <![CDATA[<b>Estudio multicéntrico para la validación de la versión en español del</b> <b><i>Eating Disorder Diagnostic Scale</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200007&lng=es&nrm=iso&tlng=es Background: The Eating Disorders Diagnostic Scale (EDDS) is a self-administered low cost psychometric instrument with excellent levels of temporal reliability and validity. Aim: To adapt and validate the EDDS in Chile. Material and Methods: Thefactorial structure, internal consistency and test-retest reliability ofthe Spanish-language version of the EDDS was analyzed in a sample of1964 university and high school students. The concurrent validity was tested in a sample of 50 primary care patients with ED and 59 controls, comparing its results with those of a structured psychiatric interview (CIDI). Results: The EDDS showed a high internal consistency, moderate test-retest reliability, an appropriate factorial structure (in women) and an excellent convergent validity. Also, the diagnosis of ED obtained with the EDDS is moderately consistent with the structured psychiatric interview. Conclusions: The Spanish-language version of the EDDS showed a satisfactory psychometric behavior and a good capacity for detecting ED, according to the DSM criterion. <![CDATA[<b>Calidad de la alimentación y estado nutricional en estudiantes universitarios de 11 regiones de Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200008&lng=es&nrm=iso&tlng=es Background: The Chilean population has inadequate lifestyles and high prevalence ofchronic diseases. Aim: To analyze eating behaviors, nutritional status and history ofprevious diseases, in students of higher education. Material and Methods: Cross-sectional study in students of 54 higher education centers across the country. They answered a survey about dietary habits, physical activity, smoking, previous diseases and opinion oftheir nutritional condition. Weight and height were measured under standardized conditions and nutritional status classified according to body mass index. Results: We studied 6,823 students aged 17 to 29 years. Forty seven percent did not have breakfast and 35% did not have lunch every day. A low proportion had a daily consumption of vegetables (51.2%), fruits (39.4%) and dairy products (57.5%). There was a high frequency of soft drinks, chips, cakes and sweets consumption. Seventy six percent were sedentary, 40.3% smokers and 27.4% overweight or obese. The latter had a significantly higher frequency ofdiabetes, hypertension and hypercholesterolemia. There was a poor agreement between actual nutritional status and self-perception, especially in males (Kappa index 0.38). Recipients of a food scholarship provided by the Ministry of Education ate lunch usually with a higher frequency (p < 0.05). Conclusions: A high prevalence of inadequate eating and physical activity patterns in these young subjects with good educational level was observed. The food scholarship has some positive effects, although differences in socioeconomic levels limited comparisons. <![CDATA[<b>Remisión completa de síndrome nefrótico asociado a carcinoma cervicouterino luego de tratamiento del tumor</b>: <b>Comunicación de 2 casos</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200009&lng=es&nrm=iso&tlng=es Nephrotic syndrome secondary to paraneoplastic glomerulopathies is exceptional. We are aware of only three cases reported of cervical carcinomas associated with nephrotic syndrome. Two women, aged 40 and 79 years, presented with nephrotic syndrome. The first had a membranous nephropathy and the second was not biopsied. The first women had a metrorrhagia after 8 months of unsuccessful therapy with corticosteroids and immunosuppressive drugs. An advanced cervical carcinoma with lymph node metastases was found. In the second patient, a cervical carcinoma and hematometra was discovered two months after diagnosis ofa nephrotic syndrome. The syndrome subsided completely, nine months after radiotherapy and chemotherapy in the first patient and 10 months after hysterectomy in the second patient. <![CDATA[<b>Signo de Leser-Trélat asociado a adenocarcinoma gástrico</b>: <b>Caso clínico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200010&lng=es&nrm=iso&tlng=es We report a 66-year-old male presenting with malaise, heartburn and pruritic seborrheic keratoses in both feet of sudden onset, suggesting a Leser-Trélat sign. An upper gastrointestinal endoscopy disclosed a gastric cancer. The patient was subjected to a total gastrectomy and duringfollow up, the skin lesions had disappeared. <![CDATA[<b>Foliculitis necrotizante herpética</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200011&lng=es&nrm=iso&tlng=es Herpes folliculitis is a rare manifestation of herpes virus infection. It usually represents a diagnostic challenge, due to the absence of characteristic skin manifestations such as vesicles or pustules. The reported cases are mainly associated with varicella zoster virus (VZV) and less commonly with herpes simplex viruses (HSV-1 y HSV-2). We report a 51-year-old male with a relapsing non-Hodgkin Lymphoma under chemotherapy, with history of extensive follicular lesions lasting one month. The pathologic study of the lesions was consistent with necrotizing herpes folliculitis. The patient was treated with Valacyclovir, achieving remission of the lesions. The appearance of folliculitis, especially in an immunocompromised patient, should raise the suspicion of herpes virus infection. Polymerase chain reaction may help to elucidate the diagnosis when pathologic findings are non-specific. <![CDATA[<b>Bases fisiopatológicas para una clasificación de la neuropatía diabética</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200012&lng=es&nrm=iso&tlng=es Nowadays, Diabetic Neuropathy (DN) is considered the most common cause of peripheral neuropathy in clinical practice. It can affect sensitive, motor or autonomic nerve fibers, with symmetric, asymmetric, acute or chronic presentations. Due to this variability, with multiple physiopathologic mechanisms involved, a complex clinical classification has been used until recently. The aim of this review is to present a new classification of diabetic neuropathy, based on its physiopathology. It is divided in metabolic microvascular and hypoxic, autoimmune and inflammatory, compressive, secondary to complications ofdiabetes and related to treatment. It must be understood that DN is notjust a functional disease, but a complication of diabetes with molecular and pathological substrates caused by hyperglycemia. Therefore, normalization of blood glucose is a fundamental step towards the successful prevention and treatment of DN. <![CDATA[<b>Competencias esenciales para la gestión en red</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200013&lng=es&nrm=iso&tlng=es We suggest that in order to fulfill the health needs of the majority of the Chilean population, which is beneficiary ofthe public health system, essential organizational skills should be developed for network administration among Self-administered Hospitals, Network Manager and Primary Health Care facilities. Self-administered Hospitals should be competent in managing service options according to their strategy for development, reference and counter-reference mechanisms and waiting lists, to optimize queuing. The Network Manager should be competent in demand management that is regulated, investments management that determines future development in terms of population needs and stakeholders' management, which is a political viability type of management. Finally, the Primary Health Care manager should be competent in demand management as a strategic partner of the Network Manager, community participation and management of interlinked areas, articulating social networks and sanitary impact management. At each level and within levels, there are crossroads that promote synergies. Based on the development of essential skills, a practice with strategic intentions, organization managers will develop team work skills. <![CDATA[<b>Bioimpedancia</b>: <b>¿Necesitamos utilizar gel?</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200014&lng=es&nrm=iso&tlng=es We suggest that in order to fulfill the health needs of the majority of the Chilean population, which is beneficiary ofthe public health system, essential organizational skills should be developed for network administration among Self-administered Hospitals, Network Manager and Primary Health Care facilities. Self-administered Hospitals should be competent in managing service options according to their strategy for development, reference and counter-reference mechanisms and waiting lists, to optimize queuing. The Network Manager should be competent in demand management that is regulated, investments management that determines future development in terms of population needs and stakeholders' management, which is a political viability type of management. Finally, the Primary Health Care manager should be competent in demand management as a strategic partner of the Network Manager, community participation and management of interlinked areas, articulating social networks and sanitary impact management. At each level and within levels, there are crossroads that promote synergies. Based on the development of essential skills, a practice with strategic intentions, organization managers will develop team work skills. <![CDATA[<b>Hacia guías de práctica clínica más confiables</b>: <b>La Guía para el manejo de la Influenza del Ministerio de Salud</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200015&lng=es&nrm=iso&tlng=es We suggest that in order to fulfill the health needs of the majority of the Chilean population, which is beneficiary ofthe public health system, essential organizational skills should be developed for network administration among Self-administered Hospitals, Network Manager and Primary Health Care facilities. Self-administered Hospitals should be competent in managing service options according to their strategy for development, reference and counter-reference mechanisms and waiting lists, to optimize queuing. The Network Manager should be competent in demand management that is regulated, investments management that determines future development in terms of population needs and stakeholders' management, which is a political viability type of management. Finally, the Primary Health Care manager should be competent in demand management as a strategic partner of the Network Manager, community participation and management of interlinked areas, articulating social networks and sanitary impact management. At each level and within levels, there are crossroads that promote synergies. Based on the development of essential skills, a practice with strategic intentions, organization managers will develop team work skills. <![CDATA[<b>Investigación biomédica en Chile</b>: <b>Algunos comentarios</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200016&lng=es&nrm=iso&tlng=es We suggest that in order to fulfill the health needs of the majority of the Chilean population, which is beneficiary ofthe public health system, essential organizational skills should be developed for network administration among Self-administered Hospitals, Network Manager and Primary Health Care facilities. Self-administered Hospitals should be competent in managing service options according to their strategy for development, reference and counter-reference mechanisms and waiting lists, to optimize queuing. The Network Manager should be competent in demand management that is regulated, investments management that determines future development in terms of population needs and stakeholders' management, which is a political viability type of management. Finally, the Primary Health Care manager should be competent in demand management as a strategic partner of the Network Manager, community participation and management of interlinked areas, articulating social networks and sanitary impact management. At each level and within levels, there are crossroads that promote synergies. Based on the development of essential skills, a practice with strategic intentions, organization managers will develop team work skills. <![CDATA[<b>Investigación biomédica en Chile</b>: <b>Algunos comentarios. </b><b>Respuesta</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200017&lng=es&nrm=iso&tlng=es We suggest that in order to fulfill the health needs of the majority of the Chilean population, which is beneficiary ofthe public health system, essential organizational skills should be developed for network administration among Self-administered Hospitals, Network Manager and Primary Health Care facilities. Self-administered Hospitals should be competent in managing service options according to their strategy for development, reference and counter-reference mechanisms and waiting lists, to optimize queuing. The Network Manager should be competent in demand management that is regulated, investments management that determines future development in terms of population needs and stakeholders' management, which is a political viability type of management. Finally, the Primary Health Care manager should be competent in demand management as a strategic partner of the Network Manager, community participation and management of interlinked areas, articulating social networks and sanitary impact management. At each level and within levels, there are crossroads that promote synergies. Based on the development of essential skills, a practice with strategic intentions, organization managers will develop team work skills. <![CDATA[<b>Principios y Práctica de la Cardiología</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001200018&lng=es&nrm=iso&tlng=es We suggest that in order to fulfill the health needs of the majority of the Chilean population, which is beneficiary ofthe public health system, essential organizational skills should be developed for network administration among Self-administered Hospitals, Network Manager and Primary Health Care facilities. Self-administered Hospitals should be competent in managing service options according to their strategy for development, reference and counter-reference mechanisms and waiting lists, to optimize queuing. The Network Manager should be competent in demand management that is regulated, investments management that determines future development in terms of population needs and stakeholders' management, which is a political viability type of management. Finally, the Primary Health Care manager should be competent in demand management as a strategic partner of the Network Manager, community participation and management of interlinked areas, articulating social networks and sanitary impact management. At each level and within levels, there are crossroads that promote synergies. Based on the development of essential skills, a practice with strategic intentions, organization managers will develop team work skills.