Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720150005&lang= vol. 143 num. 5 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<strong><i>Clinical predictors of bacteremia in immunocompetent adult patients hospitalized for community-acquired pneumonia</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500001&lng=&nrm=iso&tlng= Background: The clinical usefulness of blood cultures in the management of patients hospitalized with community-acquired pneumonia (CAP) is controversial. Aim: To determine clinical predictors of bacteremia in a cohort of adult patients hospitalized for community-acquired pneumonia. Material and Methods: A prospective cohort of 605 immunocompetent adult patients aged 16 to 101 years (54% male) hospitalized for CAP was studied. The clinical and laboratory variables measured at admission were associated with the risk of bacteremia by univariate and multivariate analysis using logistic regression models. Results: Seventy seven percent of patients had comorbidities, median hospital stay was 9 days, 7.6% died in hospital and 10.7% at 30 days. The yield of the blood cultures was 12.6% (S. pneumoniae in 69 patients, H. influenzae in 3, Gram negative bacteria in three and S. aureus in one). These results modified the initial antimicrobial treatment in one case (0.2%). In a multivariate analysis, clinical and laboratory variables associated with increased risk of bacteremia were low diastolic blood pressure (Odds ratio (OR): 1.85, 95% confidence intervals (CI) 1.02 to 3.36, p < 0.05), leukocytosis e" 15,000/mm³ (OR: 2.18, 95% CI 1.22 to 3.88, p < 0.009), serum urea nitrogen e" 30 mg/dL (OR: 2.23, 95% CI 1.22 to 4.05, p < 0.009) and serum C-reactive protein e" 30 mg/dL (OR: 2.20, 95% CI 1.22 to 3.97, p < 0.01). Antimicrobial use before hospital admission significantly decreased the blood culture yield (OR: 0.14, 95% CI 0.04 to 0.46, p < 0.002). Conclusions: Blood cultures do not contribute significantly to the initial management of patients hospitalized for community-acquired pneumonia. The main clinical predictors of bacteremia were antibiotic use, hypotension, renal dysfunction and systemic inflammation. <![CDATA[<strong><i>Global DNA methylation and homocysteine levels are lower in type 1 diabetes patients</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500002&lng=&nrm=iso&tlng= Background: The worldwide rise in the incidence of Type 1 Diabetes (T1D), and the concordance rate between monozygotic twins (50%), indicate a strong effect of the environment as an underlying factor of this disease. This process can occur throughout epigenetic modifications of gene expression such as DNA methylation, in which several nutrients participate as cofactors. Aim: To determine DNA methylation status in T1D patients and if it is related to plasma levels of folates and homocysteine (Hcy). Material and Methods: We obtained blood samples from 25 T1D patients aged 13.7 ± 5.9 years (11 males) and 25 healthy subjects aged 31.1 ± 7.8 years (16 males). DNA methylation was measured using a colorimetric kit in extracted DNA. Results are expressed as median (interquartile range). Results: Compared with healthy controls, T1D patients had lower global DNA methylation (0.85 (0.91) % and 1.25 (1.16) % respectively, p < 0.02) and Hcy levels (4.8 (1.1) µmol/L and 7.3 (1.4) µmol/L respectively p < 0.01). There were no differences in folate levels between groups. A significant association between folates and global DNA methylation status was observed in T1D patients (r = -0.564, p < 0.01) and healthy subjects (r = 0.440, p = 0.03). Conclusions: TD1 patients had lower levels of Hcy and global DNA methylation. It is relevant to further investigate if this imbalance also induces epigenetic changes in a gene-specific manner, especially in key genes involved in T1D pathogenesis. <![CDATA[<i>Assessment of adherence to antihypertensive therapy</i>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500003&lng=&nrm=iso&tlng= Background: Lack of adherence with medications is the main cause of antihypertensive treatment failure. Aim: To assess adherence to antihypertensive drugs and its determinants. Material and Methods: The Morinsky-Green questionnaire to determine treatment adherence was applied to 310 hypertensive patients from primary care centers, aged 60 ± 10 years (65% females) in treatment for 4 ± 1 months. Socio-demographic features, use of medications and quality of life using EQ5D questionnaire were also assessed. Results: Twenty percent of patients were diabetic and 19% were smokers. Fifty four percent were adherent to therapy. A higher age and being unemployed were associated with a higher compliance. The main reasons to justify the lack of adherence were forgetting to take the pills in 67% and adverse effects in 10%. Only diastolic pressure was lower in adherent patients, compared with their non-adherent counterparts (78 ± 12 and 81 ± 17 mmHg, respectively p < 0.01). Conclusions: Only half of hypertensive patients comply with their antihypertensive therapy. <![CDATA[<strong>Dress syndrome</strong>: <strong>Report of nine cases</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500004&lng=&nrm=iso&tlng= Background: DRESS Syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is an uncommon disease caused by drugs. It is characterized by a polymorphic disseminated eruption with fever and multiple organ dysfunction. Aim: To report the etiology, characteristics, treatment, prognosis, and follow up of patients with DRESS Syndrome admitted to a clinical hospital. Material and Methods: Review of medical records of patients admitted for drug reactions, selecting those patients complying with clinical criteria for DRESS Syndrome. Drugs used during three months prior to the onset of symptoms were evaluated as possible causes of the disease. Results: Nine patients aged 16 to 68 years (six males) complied with the clinical criteria for the disease. The causative medications were carbamazepine in three patients, phenytoin in three, antituberculous drugs in two and amoxicillin in one. All were treated with systemic steroids with a complete clinical resolution. Conclusions: DRESS syndrome is usually underdiagnosed and has a good response to systemic steroids. <![CDATA[<strong>Skin manifestations in adults with a liver allograft</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500005&lng=&nrm=iso&tlng= Background: Skin manifestations after liver transplantation are increasing due to long term immunosuppressive therapy along with an increase in patient survival. Several studies have reported dermatologic complications following renal transplant, but few have studied dermatologic problems after liver transplantation. Aims: To describe the different types of cutaneous lesions encountered in adults receiving a liver allograft. To evaluate the frequency of cutaneous manifestations of patients in the liver transplant waiting list. Material and Methods: Eighty patients submitted to a liver transplant and 70 patients in the liver transplant waiting list were evaluated with a complete dermatological physical examination. Results: Sixty one percent of patients with a liver allograft had at least one skin manifestation. Of these, 34% had superficial fungal infections, 31% had viral infections, 20% had cutaneous side effects due to immunosuppressive treatment, 10% had malignant lesions, 2% had bacterial infections and one patient had a graft versus host disease. Only 28% of patients in the liver transplant waiting list had dermatologic problems, and the vast majority were lesions linked to liver cirrhosis. Conclusions: Cutaneous infections were the most common skin problems in liver transplant patients. Although neoplastic lesions are the most commonly mentioned lesions in the literature, only a 10% of our liver transplant patients presented these type of lesions. <![CDATA[<strong><i>Association between food addiction and nutritional status in Chilean college students</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500006&lng=&nrm=iso&tlng= Background: High calorie foods, especially high in sugar and sodium may have an addictive potential. Experimental rats are able to develop symptoms and neurochemical changes, comparable to those observed in drug abuse, when they are exposed intermittently to sucrose. Aim: To evaluate the association between nutritional status and the prevalence of food addiction in Chilean college students. Material and Methods: Food addiction was assessed using the Yale Food Addiction Scale in 292 Chilean students aged 18-39 years (35% males). Height and weight were measured and body mass index (weight/height²) was calculated. Results: Eleven percent of participants met the criteria for food addiction. Women had a higher prevalence than men (14.4% and 4.8%, respectively). Thirty percent of individuals with a body mass index over 30 kg/m² met the criteria for food addiction. Conclusions: In these Chilean students, food addiction was more prevalent in women and a higher prevalence was observed in obese individuals. <![CDATA[<strong>Individual, social and environmental determinants of overweight and obesity among Chilean adolescents</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500007&lng=&nrm=iso&tlng= Background: In Chile, overweight and obesity are pressing issues in public health. Aim: To identify individual, social and environmental factors that affect the likelihood of adolescents to become overweight or obese. Material and Methods: We used physical condition data of a sample of 900 urban eighth grade students from Santiago, obtained in the 2011 National Study of Physical Education. This information was complemented with georeferenced data from the place of residence of students and the environment in which they live. We used three logistic regression models to estimate the relationship between individual, social and environmental factors and the likelihood of being overweight or obese. Results: Men and students of high socioeconomic status (SES) have a lower probability of being overweight (-6 percentage points (pp.) and -12 pp. respectively). Furthermore, the determinants that affect overweight depend on SES. Namely, only men of middle and low SES have a lower probability of being overweight (-7 pp.). Participation in school sporting activities reduces the likelihood of being overweight only for students of middle and low SES (-5,5 pp.). For adolescents of high SES, the distance between their school and the nearest fast food restaurant decreases the likelihood of being overweight (-4.7 pp. per km.). Conclusions: The determinants of overweight differ by SES. Public policy design should consider socioeconomic inequalities that characterize the Chilean reality. <![CDATA[<strong>The cost of polypharmacy in patients with type 2 diabetes mellitus</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500008&lng=&nrm=iso&tlng= Background: Polypharmacy or the concomitant use of three or more medications, may increase the complexity of health care and its costs. Aim: To determine the costs of polypharmacy in patients with Type 2 Diabetes Mellitus in a Mexican population sample. Patients and Methods: Analysis of health care costs in 257 patients with Type 2 Diabetes Mellitus from two family care facilities, who had at least five consultations during one year. The cost of professional care by family physicians, pharmacological care and medications were considered to calculate the total expenses. The price of medications and the number of units consumed in one year were used to determine pharmacological expenses. Medications were grouped to determine costs derived from complications and concomitant diseases. Costs were calculated in US dollars (USD). Results: The mean cost derived from family physician fees was USD 82.32 and from pharmacy fees USD 29.37. The mean cost of medications for diabetes treatment was USD 33.31, for the management of complications USD 13.9 and for management of concomitant diseases USD 23.7, rendering a total cost of USD 70.92. Thus, the total annual care cost of a diabetic patient was USD 182.61. Conclusions: Medications represent less than 50% of total expenses of diabetic patients with polypharmacy. <![CDATA[<strong>Functional geriatric assessment in primary health care</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500009&lng=&nrm=iso&tlng= The functional assessment of moderately or severely dependent older people encompasses social, psychological and biological aspects that may influence their quality of life and their degree of independence. This paper reviews the global geriatric assessment that should be performed in primary health care (PHC) for moderately or severely dependent older people. Since 2012 in PHC in Chile, the norm establishes that the degree of independence of older people should be assessed using the Barthel scale and caregiver stress should be evaluated using Zarit scale. People with severe disability should receive home care. We recommend to evaluate also cognitive aspects using the minimental state examination (MMSE) to Barthel Index or using the Functional Independence Measure (FIM), since they are closely associated with functional capacity. <![CDATA[<strong>Non-celiac gluten sensitivity</strong>: <strong>Another condition that responds to gluten</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500010&lng=&nrm=iso&tlng= Remission of gastrointestinal and general symptoms after gluten withdrawal has been described in some non-celiac individuals for nearly 30 years. Only recently, efforts have been made to define this entity, now referred to as "non- celiac gluten sensitivity". It includes patients that clinically respond to gluten free diet without exhibiting allergic or autoimmune features to explain such response. Wheat allergy, celiac disease, irritable bowel syndrome and symptoms induced by high FODMAPs (Fermentable, Oligo-, Di-, Mono-saccharides And Polyols) consumption are the main differential diagnoses. The relationship with neuropsychiatric disorders such as schizophrenia and autism has not been demonstrated, but currently it gives ground to great hope in families with affected children. Epidemiology of non-celiac gluten sensitivity is not clear. It is described as more common among women and less common in children. Genetic and immune factors, changes in intestinal microbiota and non-gluten components present in wheat grains are main factors postulated in the pathogenesis of this condition. To date, there are no specific biomarkers for non-celiac gluten sensitivity and diagnosis is reached by excluding other causes of disease. A trial with gluten-free diet and subsequent gluten challenge is the methodology most frequently used to confirm diagnosis. <![CDATA[<strong>Causes and management of severe acute liver damage during pregnancy</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500011&lng=&nrm=iso&tlng= Abnormalities in liver function tests appear in 3% of pregnancies. Severe acute liver damage can be an exclusive condition of pregnancy (dependent or independent of pre-eclampsia) or a concomitant disease. HELLP syndrome and acute fatty liver of pregnancy are the most severe liver diseases associated with pregnancy. Both appear during the third trimester and have a similar clinical presentation. Acute fatty liver may be associated with hypoglycemia and HELLP syndrome is closely linked with pre-eclampsia. Among concomitant conditions, fulminant acute hepatitis caused by medications or virus is the most severe disease. Its clinical presentation may be hyper-acute with neurological involvement and severe coagulation disorders. It has a high mortality and patients should be transplanted. Fulminant hepatic failure caused by acetaminophen overdose can be managed with n-acetyl cysteine. Because of the high fetal mortality rate, the gestational age at diagnosis is crucial. <![CDATA[<strong>Second Consensus of the Chilean Society of Endocrinology and Diabetes about insulin resistance</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500012&lng=&nrm=iso&tlng= Insulin resistance is a prevalent condition commonly associated with unhealthy lifestyles. It affects several metabolic pathways, increasing risk of abnormalities at different organ levels. Thus, diverse medical specialties should be involved in its diagnosis and treatment. With the purpose of unifying criteria about this condition, a scientific-based consensus was elaborated. A questionnaire including the most important topics such as cardio-metabolic risk, non-alcoholic fatty liver disease and polycystic ovary syndrome, was designed and sent to national experts. When no agreement among them was achieved, the Delphi methodology was applied. The main conclusions reached are that clinical findings are critical for the diagnosis of insulin resistance, not being necessary blood testing. Acquisition of a healthy lifestyle is the most important therapeutic tool. Insulin-sensitizing drugs should be prescribed to individuals at high risk of disease according to clinically validated outcomes. There are specific recommendations for pregnant women, children, adolescents and older people. <![CDATA[<strong>An assessment of the Dundee ready education environment measure (DREEM) in Chilean university students</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500013&lng=&nrm=iso&tlng= Background: The entry to a University requires an adaptation process that not all students solve with the same kind of success. Even though students social adaptation and emotional skills are essential, the educational environmental that they perceive has a significant influence in their academic life. Aim: To describe the changes in the perception about academic environment that medical students experience during the first three years of undergraduate career. Material and Methods: The Dundee Ready Education Environment Measure (DREEM) scale was applied to 525 first to third year medical students and an exploratory factorial analysis was made. Results: Four factors were identified: Academic Perception: academic quality that students attribute to the process in which they take part, as well as to the assessment that they do of their learning outcomes (coefficient ± = 0.85); Academic Experience: refers to positive emotions that students experience during the career such as confidence, pleasure and energy (coefficient ± = 0.76); Atmosphere Perception, comfort and calm that students experiment during their academic activities (coefficient ± = 0.79); Teachers Perception: the perception that students have of teachers about their interest and disposition towards students (coefficient ± = 0.50). Conclusions: The assessment of academic environment quality is inversely associated with the lapse that the students have spent in their undergraduate careers. <![CDATA[<strong>Maria Montessori (1870-1952)</strong>: <strong>Women's emancipation, pedagogy and extra verbal communication </strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500014&lng=&nrm=iso&tlng= Maria Montessori is one of the most well-known women in Italian history. Although she was the first woman who graduated in medicine in Italy, she is mostly known as an educator. Her teaching method -the Montessori Method- is still used worldwide. Because she could not speak English during the imprisonment in India, there was a big obstacle for her communication with children. However, the need to adopt a non-verbal communication, led her to a sensational discovery: children use an innate and universal language. This language, made of gestures and mimic, is called extra verbal communication. <![CDATA[<strong>Spontaneous clearance of hepatitis C virus after liver transplantation</strong>: <strong>Report of two cases</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500015&lng=&nrm=iso&tlng= The spontaneous clearance of hepatitis C virus infection is rare, especially after liver transplantation, condition in which recurrence is almost universal. We report two cases in which clearance of the virus was achieved after liver transplantation. We reviewed the literature and described possible mechanisms explaining this phenomenon, with emphasis on therapeutic implications. <![CDATA[<strong>Treatment of a severe Clostridium difficile infection with colonic lavages. Report of one case</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500016&lng=&nrm=iso&tlng= A loop ileostomy with intraoperative anterograde colonic lavage has been described as an alternative to colectomy in the management of cases of Clostridium difficile infection refractory to medical treatment. We report a 69 years old diabetic women admitted with a septic shock. An abdominal CAT scan showed a pan-colitis that seemed to be infectious. A polymerase chain reaction was positive for Clostridium Difficile. Due to the failure to improve after full medical treatment, a derivative loop ileostomy and intra-operatory colonic lavage were performed, leaving a Foley catheter in the proximal colon. In the postoperative period, anterograde colonic instillations of Vancomycin flushes through the catheter were performed every 6 hours. Forty eight hours after surgery, the patient improved. A colonoscopy prior to discharge showed resolution of the pseudomembranous colitis. <![CDATA[<strong>Left hepatic artery (LHA) emerging from the gastroduodenal artery</strong>: <strong>Report of one case</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500017&lng=&nrm=iso&tlng= Anatomic variations of the hepatic artery, which occur in 30 to 50% of patients, are a very important factor to be considered for Whipple procedure. The most common variations are those coming from the superior mesenteric artery, left gastric artery and the aorta. We report a 58-year-old woman with a story of one month of epigastric pain, jaundice and progressive itching. Magnetic resonance imaging showed a mass in the head of the pancreas. During pancreatoduodenectomy a left hepatic artery (LHA) emerging from the gastroduodenal artery and an accessory LHA emerging from the left gastric artery, were observed. The rest of the surgery was performed with no incidents. The patient had an uneventful postoperative evolution. <![CDATA[<strong>Resilience, Poverty and Rurality</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500018&lng=&nrm=iso&tlng= Anatomic variations of the hepatic artery, which occur in 30 to 50% of patients, are a very important factor to be considered for Whipple procedure. The most common variations are those coming from the superior mesenteric artery, left gastric artery and the aorta. We report a 58-year-old woman with a story of one month of epigastric pain, jaundice and progressive itching. Magnetic resonance imaging showed a mass in the head of the pancreas. During pancreatoduodenectomy a left hepatic artery (LHA) emerging from the gastroduodenal artery and an accessory LHA emerging from the left gastric artery, were observed. The rest of the surgery was performed with no incidents. The patient had an uneventful postoperative evolution. <![CDATA[<em><b>The National Health Survey of Chile gives useful information to health policy planning</b></em>: <em><b>Analysis of Diabetic Nephropathy as an index of potential saving</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500019&lng=&nrm=iso&tlng= Anatomic variations of the hepatic artery, which occur in 30 to 50% of patients, are a very important factor to be considered for Whipple procedure. The most common variations are those coming from the superior mesenteric artery, left gastric artery and the aorta. We report a 58-year-old woman with a story of one month of epigastric pain, jaundice and progressive itching. Magnetic resonance imaging showed a mass in the head of the pancreas. During pancreatoduodenectomy a left hepatic artery (LHA) emerging from the gastroduodenal artery and an accessory LHA emerging from the left gastric artery, were observed. The rest of the surgery was performed with no incidents. The patient had an uneventful postoperative evolution. <![CDATA[<strong>Serious adverse effects of law N° 20.584</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000500020&lng=&nrm=iso&tlng= Anatomic variations of the hepatic artery, which occur in 30 to 50% of patients, are a very important factor to be considered for Whipple procedure. The most common variations are those coming from the superior mesenteric artery, left gastric artery and the aorta. We report a 58-year-old woman with a story of one month of epigastric pain, jaundice and progressive itching. Magnetic resonance imaging showed a mass in the head of the pancreas. During pancreatoduodenectomy a left hepatic artery (LHA) emerging from the gastroduodenal artery and an accessory LHA emerging from the left gastric artery, were observed. The rest of the surgery was performed with no incidents. The patient had an uneventful postoperative evolution.