Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720140012&lang=pt vol. 142 num. 12 lang. pt <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<strong>Autologous hematopoietic cell transplantation in patients with multiple myeloma. Experience in 53 patients</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200001&lng=pt&nrm=iso&tlng=pt Background: Autologous hematopoietic cell transplantation (THA) in patients with multiple myeloma and amyloidosis is the standard of care to promote disease free survival and quality of life. Aim: To report our experience with THA in patients with multiple myeloma. Material and Methods: Retrospective review of the hematopoietic cell transplantation database of a hospital of a Medical School. Forty seven patients with multiple myeloma and six with amyloid light chain amyloidosis were identified. Clinical and demographic data were obtained from the records. Results: The overall five year survival of patients was 55%. Transplant-related or non-relapse mortality occurred in 7%. We found no differences in outcomes among patients younger or older than 50 years. Conclusions: Our data supports that THA can be done in our country with similar results to those obtained in international transplantation centers. Chronological age should not be a limitation to offer this therapy to patients with multiple myeloma and amyloidosis. <![CDATA[<strong>Changes in cerebral blood flow velocity in supine and sitting position in patients with aneurysmal subarachnoid hemorrhage</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200002&lng=pt&nrm=iso&tlng=pt Background: Early mobilization in intensive care units (ICU) provides respiratory, neurological and cardiovascular benefits in hospitalized patients. However, the orthostatic effects of changing from a supine to a sitting position may interfere with cerebral hemodynamics of patients with aneurysmal subarachnoid hemorrhage (aSAH). Aim: To describe the changes in mean cerebral blood flow velocity (MCBFV) in supine and sitting position, in adult patients with aSAH, with asymptomatic vasospasm (AVS) or without vasospasm (VS) at a neurosurgical ICU. Material and Methods: Descriptive case series study in 21 patients with aSAH, both with and without VS. They were positioned in a supine 30° position and then seated at the edge of bed for six minutes. MCBFV was measured by transcranial Doppler (TCD), and hemodynamic variables in both positions were registered. After this basal assessment and for 21 days after the episode of SAH, patients were seated once a day and signs of VS were recorded. Results: No significant changes in MCBFV or hemodynamic variables were detected during position changes, except for an increase in heart rate in the sitting position. No patient with AVS at the onset, had symptomatic VS during the 21 days of follow up when patients were seated. Among patients with a normal MCBFV at baseline, five patients (24%) had VS at a mean of three days after the first time that they were seated on the edge of bed. Conclusions: Sitting patients at the edge of the bed is a safe mobilization alternative for patients who suffered aSAH who did not have VS or had AVS. <![CDATA[<strong>Serum anti endomysial and anti transglutaminase antibodies in patients with connective tissue diseases</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200003&lng=pt&nrm=iso&tlng=pt Background: The detection of anti-transglutaminase IgA (tTG) and anti-endomysial (EMA) is used for screening of celiac disease (CD) with a sensitivity and specificity of 90 and 99% respectively. There is an association between CD and connective tissue diseases (CTD). Aim: To report the frequency of IgA tTG and EMA in patients with a definite diagnosis of CTD and inflammatory arthropathies (IA). Material and Methods: One hundred forty nine patients, aged 19 to 86 years (133 females) with CTD and IA were studied. tTG were determined by ELISA and EMA by indirect immunofluorescence. Results: Eight participants had at least one positive antibody (5.4%, confidence intervals (CI) = 1.8-9), six had both (4.0% CI = 0.9-7.2) and two had only tTG positive. An intestinal biopsy was performed in four of these participants, finding a marked villous atrophy in three and partial atrophy in one. Conclusions: Five percent of this group of patients with CTD or IA had positive antibodies for CD. <![CDATA[<strong>Alcohol consumption among traveling Chilean older people</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200004&lng=pt&nrm=iso&tlng=pt Background: Problems associated with alcohol consumption are prevalent in Chile, but little is known about the situation in the elderly. Aim: To perform a screening to detect alcohol-related problems and risks in the Chilean older people who travel. Material and Methods: The Alcohol Use Disorders Identification Test (AUDIT) questionnaire was answered by 1,076 travelers aged 60 to 93 years (66% females), who participated in trips organized by the Chilean National Tourism Service (SERNATUR). Results: Seventy six percent of respondents acknowledged to have ingested an alcoholic drink during the last month. The average AUDIT score was of 2.2 ± 2.6. Only 3.7% of the sample had a score equal or higher than eight, considered as risky use. Within this last group, 60% had symptoms of alcohol dependence. A higher alcohol consumption was associated with male gender (p < 0.01), being younger than 75 years of age (p < 0.01), having a medium-low economic income (p < 0.01) and having a higher education level (p = 0.03). There was no significant association with the respondents´ occupation. Conclusions: In this sample of Chilean traveling older people, there was a high prevalence of alcohol consumption, and nearly 4% of respondents had alcohol related problems. <![CDATA[<strong>Effects of neonatal nutritional status on the risk for metabolic syndrome in Chilean obese children</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200005&lng=pt&nrm=iso&tlng=pt Background: Neonatal malnutrition defined by birth weight (BW) is a risk factor for obesity and cardio-metabolic diseases in adults. Neonatal ponderal index (NPI) may have better diagnostic value than BW to establish nutritional status. Aim: To determine the effect of neonatal nutritional status, established by the three NPI curves available in Chile, on the risk of Metabolic Syndrome (MS) in obese school children. Material and Methods: A nested case/control study in a sample of 410 obese school children aged 10 to 16 years (57% males) was performed. The dichotomous response variable was the presence of MS defined as International Diabetes Federation (IDF) or Cook’s criteria. The exposure variable was having NPI < percentile (p) 10. Results: The frequency of MS was 36 and 39% according to the IDF and Cook criteria, respectively. The proportion of children with neonatal malnutrition exceeded 20%. A significantly increased risk for MS was only found when PNI was defined according to Lagos´s Table and MS was defined using IDF criteria. Having a PNI &gt; p90, however, showed a trend towards a reduced risk of MS, which only reached significance using Lagos´s Table and Cook´s Criteria. Conclusions: Neonatal malnutrition defined by NPI is common in obese school children. The condition of neonatal under nutrition defined as PNI < p10 may be a risk factor for developing MS. Instead, having a NPI &gt; p90 could be protective. <![CDATA[<strong>Cambios en el consumo aparente de lácteos, bebidas azucaradas y jugos procesados en el Gran Santiago. </strong><strong>Chile. 1987-2007</strong>: <strong>Changes in the consumption of dairy products, sugary drinks and processed juices in the Chilean population</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200006&lng=pt&nrm=iso&tlng=pt Background: Nowadays, Chilean population tends to replace or eat a lower amount of food with health protective properties and a higher proportion of unhealthy foodstuff. Aim: To describe and compare the intake of dairy products, sugary drinks and processed juices among Chileans. Material and Methods: An analysis of data compiled from the Survey on Household Budget and Expenses carried out by the Chilean National Institute of Statistics (INE), using a representative sample of households. The sample was surveyed between 1987 and 2007. The analysis was performed for all households surveyed and for households belonging to the second (highest incomes) and fifth quintile (lowest incomes). The Chilean Food Guide and the international recommendations of the Institute of Medicine of the United States and the American Heart Association (in the case of sugars) were used as reference. Results: Even though the intake of dairy products increased during the period of the survey, it was lower than the intake of sugary drinks and juices, which increased. Also, calcium recommendations were not covered. On the other hand, the intake of added sugars increased to figures over current recommendations. Conclusions: The intake of dairy products and calcium is below the recommended amounts established by international organisms, and added sugars intake is greater than the advisable levels recommended by international organisms. <![CDATA[<strong>Contribution of Chilean research to the formulation of national clinical guidelines</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200007&lng=pt&nrm=iso&tlng=pt Background: In Chile, 80 diseases were included in a health care system called Health Care Guarantees (GES) and clinical guidelines were elaborated for their management. Aim: To assess the scientific background of guidelines and if they were based on research financed by the Chilean National Commission for Science and Technology. Material and Methods: The references of the 82 guidelines developed for 80 diseases were reviewed, registering their number, authors, country of origin and funding source. Results: The guidelines had a total of 6,604 references. Of these, only 185 were Chilean (2.8%) and five (0.08%) originated from research financed by the National Commission for Science and Technology. Conclusions: The contribution of research funded by national agencies to the formulation of clinical guidelines is minimal. <![CDATA[<strong>Adaptation and validation of checklists to detect medication prescription and dispensing errors</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200008&lng=pt&nrm=iso&tlng=pt Background: Adverse effects of medications are an important source of morbidity. Prescription and dispensing errors are an important cause of these adverse effects. Aim: To adapt and validate two checklists, one to measure errors in handwritten prescriptions and other to detected errors in the medication dispensing process of hospital pharmacies for outpatient care. Material and Methods: The study was conducted in three stages. First, checklists for medication errors developed elsewhere were adapted. Afterwards, the checklists were reviewed by experts. Finally, the inter and intra-observer reliability of each checklist was assessed, testing them in 32 occasions by two independent observers. Results: The checklists for medication prescription and dispensing were composed by 12 and seven items, respectively. They were corrected according to experts’ opinions. The intraclass correlations of the results of each tester were 0.68 and 0.82 for the prescription and dispensing error checklists, respectively. Conclusions: The developed checklists for the detection of errors in prescription and dispensing of medications are reliable en can be applied in future studies. <![CDATA[<strong>Effects of alpha lipoic acid and pirfenidone on liver cells antioxidant modulation against oxidative damage</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200009&lng=pt&nrm=iso&tlng=pt Background: Liver fibrogenic processes are related to cellular redox state. Glutathione (GSH) is the major cellular antioxidant. GSH induced activation could be related to antifibrogenic effects. Aim: To explore the association between the antifibrogenic effect and pro-antioxidant mechanisms of alpha-lipoic acid (ALA) and pirfenidone (PFD). Material and Methods: HepG2 cells and primary HSC cultures were exposed to menadione 0.1 μM (MEN) as oxidative stress inducer and treated to ALA (5 mM) or PFD (10 μM, 100 μM y 1000 μM). Results: In HSC, PFD decreased cell proliferation and the expression of COL1A1, TGF-β1, TIMP1, IL6, TNFα and MCP1 induced by MEN. Furthermore it was confirmed that ALA and PFD activate diverse antioxidants mediators, however MEN decreases this response. Then, MEN, ALA and PFD induce an antioxidant response, the first one as a response to injury and the latter two as pro-antioxidant inducers. Therefore, when cells are exposed to oxidative stress, endogenous systems activate a battery of mediators that increase the antioxidant potential. When these cells are treated with ALA and PFD, de novo formation of protective genes decreases since previous elicited protection induced in response to injury, enhance ALA and PFD effects. Conclusion: Regardless of the route of action, ALA and PFD induce the biosynthesis of antioxidants mediators which is associated with modulation of fibrogenic processes. <![CDATA[Causal relationship between the use of gadolinium based contrast media and nephrogenic systemic fibrosis]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200010&lng=pt&nrm=iso&tlng=pt Nephrogenic systemic fibrosis (NSF) is a severe iatrogenic disease that affect patients with impaired renal function exposed to gadolinium-based contrast agents. Clinically, symptoms develop within days or weeks after the exposure and mimic a scleromyxedema. The causal relationship between use of gadolinium-based contrast agents and NSF led to develop clinical guidelines aiming to limit the use of this contrast medium in high risk patients. These guidelines decreased the incidence of NSF in the last years. Unfortunately there is no specific treatment for NSF yet. Thus, strict adherence to current guidelines is key to prevent new cases. Renal dysfunction is increasingly common in our population. Therefore, practicing physicians should be aware of this potential complication of the use of gadolinium based contrast media. <![CDATA[<strong>Use of hyperbaric oxygenation for wound management</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200011&lng=pt&nrm=iso&tlng=pt Hyperbaric oxygenation consists in exposing patients to increased gas pressures while inhaling pure oxygen. It involves the use of hyperbaric chambers that can double or triple gas pressure inside them. Hyperbaric oxygenation may be useful in different clinical situations, but mostly for the treatment of decompression syndrome. In the last decades, it has been used for the management of different kinds of wounds. Hyperbaric oxygenation not only increases the delivery of oxygen to damaged tissues, but also stimulates angiogenesis, collagen synthesis, stem cell migration and local immune response. Clinical trials that have addressed the use of hyperbaric oxygenation are difficult to compare due to their heterogeneity in terms of experimental design, kind of injuries involved and assessment of outcome. Even though, most studies support the concept that hyperbaric oxygenation accelerates the healing process. <![CDATA[<strong>Management of the potential organ donor</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200012&lng=pt&nrm=iso&tlng=pt Solid organ transplantation is limited by donor availability. The loss of brain function produces hemodynamic, respiratory, hormonal and metabolic changes that lead to hypotension and organ dysfunction. Management of a potential donor is similar to any critically ill patient. Cardiovascular stability and protective ventilatory support must be pursued, aimed at minimizing the local and systemic inflammatory response that is triggered by brain death. There is no consensus on protocols for hormonal supplementation. The administration of vasopressin analogues and steroids may be beneficial under certain conditions. Appropriate medical management helps to optimize the function of different organs prior to transplantation. This may increase the number of harvested organs and improve their functional outcome in the recipient. <![CDATA[<strong>Nutrient intake of Chilean older people according to body mass index</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200013&lng=pt&nrm=iso&tlng=pt Background: An adequate consumption of micro and macro nutrients is essential to maintain an adequate health among older people. Aim: To compare the consumption of micro- and macronutrients in older people from three Chilean cities, according to their nutritional status. Material and Methods: Body mass index (BMI) was assessed and a food consumption tendency survey was applied to 976 non-disabled older people, living in the community. Thinness was defined as a BMI < 23 kg/m². Results: Twenty percent of females and 17% of males had a BMI < 23 kg/m². Participants with a higher BMI had a greater intake of micro- and macronutrients. In females, micronutrient intake was adequate among those with higher BMI, although mean intake of calcium and vitamin B-12 were below recommendations. In males, iron, zinc, calcium, magnesium, vitamin A, vitamin B6, vitamin B12 and pantothenic acid intake were below recommendation. Conclusions: Thin older adults, regardless of sex, had a lower intake of calories and micro- and macronutrients. Additionally, an overall low consumption of zinc, calcium, magnesium and vitamin B12 was detected. <![CDATA[<strong>Cutaneous involvement in multiple myeloma</strong>: <strong>Report of one case</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200014&lng=pt&nrm=iso&tlng=pt Cutaneous involvement in multiple myeloma (MM) is extremely rare. It may correspond to plasmocytomas, secondary amyloidosis, paraneoplastic syndromes or drug reactions. We report a 75-year-old female with skin lesions, corresponding to extramedullary plasmacytomas (EPs), as a manifestation of MM progression. Most EPs appear in the upper airway and gastrointestinal tract, but have also been described in the genitourinary tract, lung, kidney, thyroid and in 2% of cases, in the skin. Cutaneous lesions are generally associated with terminal stages of the disease and a poor prognosis. <![CDATA[<strong>Meningitis-retention syndrome. Report of one case</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200015&lng=pt&nrm=iso&tlng=pt The Meningitis-Retention Syndrome associates aseptic meningitis and neurogenic bladder, with a vesical dysfunction that outlasts meningitis widely. Urodynamic assessment shows a detrusor palsy with normal function of the external sphincter. We report a 24-year-old male admitted for headache, fever, myalgias and acute urinary retention, which was diagnosed as a urinary tract infection. Worsening of symptoms and slight meningeal signs prompted for a lumbar puncture that yielded a cerebrospinal fluid with 94 lymphocytes, in which etiological evaluation was inconclusive. Meningeal syndrome and myalgia subsided by the fifth day, while urinary retention persisted. A magnetic resonance imaging of the brain and spinal cord done at the fifth day, showed high intensity signals in basal ganglia and central spinal cord, not altered by contrast. These images disappeared in the imaging control performed two months later. Bladder dysfunction lasted at least until the second month of follow up. <![CDATA[<strong>Manuel Núñez Butrón, M.D.</strong>: <strong>A world pioneer of Primary Medical Care</strong><strong> </strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872014001200016&lng=pt&nrm=iso&tlng=pt The Meningitis-Retention Syndrome associates aseptic meningitis and neurogenic bladder, with a vesical dysfunction that outlasts meningitis widely. Urodynamic assessment shows a detrusor palsy with normal function of the external sphincter. We report a 24-year-old male admitted for headache, fever, myalgias and acute urinary retention, which was diagnosed as a urinary tract infection. Worsening of symptoms and slight meningeal signs prompted for a lumbar puncture that yielded a cerebrospinal fluid with 94 lymphocytes, in which etiological evaluation was inconclusive. Meningeal syndrome and myalgia subsided by the fifth day, while urinary retention persisted. A magnetic resonance imaging of the brain and spinal cord done at the fifth day, showed high intensity signals in basal ganglia and central spinal cord, not altered by contrast. These images disappeared in the imaging control performed two months later. Bladder dysfunction lasted at least until the second month of follow up.