Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720150008&lang=pt vol. 143 num. 8 lang. pt <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<strong>Influence of weight gain during the first year after kidney transplantation in the survival of grafts and patients</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800001&lng=pt&nrm=iso&tlng=pt Background: After receiving a kidney allograft, patients tend to gain weight acquiring the risk associated with overweight and obesity. Aim: To compare the evolution during 10 years after transplantation of patients who gained more than 15% of their initial weight during the first year after receiving the graft with those who did not experience this increase. Material and Methods: Cohort study of 182 patients transplanted in a single hospital between 1981 and 2003. Demographic data, weight gain during the first year, drugs used, complications and evolution of patients and grafts were recorded. Results: Seventy two patients gained more than 15% of their weight during the first year. These were discharged after receiving the graft with a lower serum creatinine than their counterparts (1.46 ± 0.71 and 1.97 ± 1.74 mg/dl respectively, p = 0.02). Ten years mortality with a functioning kidney was higher among weight gainers (25 and 12.7% respectively, p = 0.03). No other differences were observed between groups. Conclusions: Patients who gained more than 15% of their initial weight during the first year after receiving a kidney graft have a higher 10 years mortality with a functioning kidney. <![CDATA[<strong>Effects of an intervention to reduce cardiovascular risk factors in university students</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800002&lng=pt&nrm=iso&tlng=pt Background: Interventions aiming to reduce obesity and sedentary behaviors in young adults could be a feasible and effective approach to prevent cardiovascular diseases. Aim: To evaluate the effect of a lifestyle-based intervention on reducing cardiovascular risk factors in university students. Material and Methods: Sixty university students aged 21 ± 1 years (n = 44 females) took part on a 17 weeks lifestyle intervention consisting in education about healthy lifestyles and physical training, during a curricular course about health promotion and healthy lifestyles. At baseline and at the end of the intervention participants completed a lifestyles questionnaire and provided fasting blood samples to quantify glucose and lipids profile. Results: After the intervention significant reductions in the prevalence of hyperglycemia (-10.0%), high blood pressure (-16.7%) and physical inactivity (-26.7%) were observed. Moreover, a significant reduction in body weight, waist circumference, blood pressure, total cholesterol, triglycerides and an increase in HDL cholesterol were observed after intervention. Conclusions: The implementation of an intervention to promote healthy lifestyles is an effective way of reducing cardiovascular risk factors in university students. <![CDATA[<strong>An analysis of Chilean biomedical publications in PubMed in the years 2008-2009</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800003&lng=pt&nrm=iso&tlng=pt Background: During the years 2008 and 2009, 1,191 biomedical articles authored by Chilean investigators working in Chile were indexed in PubMed. Aims: To evaluate the potential visibility of those articles, according to scientometric indexes of the journals where they were published. Methods: Those journals where the articles had been published were identified and each journal’s Impact Factor (JIF), 5-year JIF, SCImago Journal Rank (SJR), SCImago Quartiles (Q) for 2010 and the Source Normalized Impact per Paper (SNIP) for 2008-2009 were identified. Results: Three hundred and twelve articles (26,2%) were dedicated to experimental studies in animals, tissues or cells and they were classified as “Biomedicine”, while 879 (73,8%) were classified as “Clinical Medicine”; in both areas the main type of articles were original reports (90% and 73.6%, respectively). Revista Médica de Chile and Revista Chilena de Infectología concentrated the greater number of publications. Articles classified in Biomedicine were published more frequently in English and in journals with higher scientometric indexes than those classified in Clinical Medicine. Conclusions: Biomedical articles dealing with clinical topics, particularly case reports, were published mostly in national journals or in foreign journals with low scientometric indexes. It can be partly attributable to the authors’ interest in reaching local readers. The evaluation of research productivity should combine several scientometric indexes, selected according to the field of research, the institution's and investigators’ interests, with a qualitative and multifactorial assessment. <![CDATA[<strong>Social security and labor absenteeism in a regional health service</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800004&lng=pt&nrm=iso&tlng=pt Background: Absenteism can generate important economic costs. Aim: To analyze the determinants of the time off work for sick leaves granted to workers of a regional health service. Material and Methods: Information about 2033 individuals, working at a health service, that were granted at least one sick leave during 2012, was analyzed. Personal identification was censored. Special emphasis was given to the type of health insurance system of the workers (public or private). Results: Workers ascribed to the Chilean public health insurance system (FONASA) had 11 days more off work than their counterparts ascribed to private health insurance systems. A higher amount of time off work was observed among older subjects and women. Conclusions: Age, gender and the type of health insurance system influence the number of day off work due to sick leaves. <![CDATA[<strong>Association of grip strength with gender age and handedness in 116 older people</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800005&lng=pt&nrm=iso&tlng=pt Background: Hand grip strength could be influenced by gender, age and handedness. Aim: To describe differences in grip strength for age, gender and upper extremity handedness in non-disabled community-dwelling older adults. Material and Methods: We studied 47 males aged 72.3 ± 5.6 years and 69 females 72.4 ± 6.0 years who were divided in two age groups (65-70 and ≥ 71 years old). Grip strength was determined by a standardized protocol using a hand dynamometer. Results: There was an inverse correlation between grip strength and age in both hands only among men (p ≤ 0.05). When analyzing both genders, there was a significant inverse correlation between grip strength and age only in the dominant hand (p ≤ 0.05). Strength was higher in the dominant hand in both genders (p ≤ 0.05). It was also higher in men, compared to women in the two age groups studied (p ≤ 0.05). Conclusions: Grip strength is higher in men than women, it decreases with age and is higher in the dominant hand. <![CDATA[<strong>Usefulness of antimicrobial prophylaxis with ciprofloxacin prior to flexible cystoscopy</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800006&lng=pt&nrm=iso&tlng=pt Background: Flexible cystoscopy is a common test in clinical practice done with or without antibiotic prophylaxis. Aim: To evaluate the efficacy of antibiotic prophylaxis with ciprofloxacin to reduce the incidence of urinary infection. Material and Methods: Prospective, non-randomized observational study that included 60 patients divided into two groups. Group 1 received prophylactic ciprofloxacin 500 mg, one hour prior to the procedure and group 2 did not receive prophylaxis. The presence of bacteriuria, symptoms or signs of urinary infection or attending Emergency rooms or primary care for these symptoms were recorded during the seven days after the cystoscopy. Results: In groups 1 and 2, four and one patients had a positive urine culture, respectively. Only one patient in group 1 consulted in primary care for symptoms. No significant differences in symptoms or signs of urinary infection between groups were observed. Conclusions: In this group of patients, antibiotic prophylaxis with ciprofloxacin 500 mg prior to cystoscopy had no benefit. <![CDATA[<strong>Development of MEDUC-PG14 survey to assess postgraduate teaching in medical specialties</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800007&lng=pt&nrm=iso&tlng=pt Background: Feedback is one of the most important tools to improve teaching in medical education. Aim: To develop an instrument to assess the performance of clinical postgraduate teachers in medical specialties. Material and Methods: A qualitative methodology consisting in interviews and focus-groups followed by a quantitative methodology to generate consensus, was employed. After generating the instrument, psychometric tests were performed to assess the construct validity (factor analysis) and reliability (Cronbach’s alpha). Results: Experts in medical education, teachers and residents of a medical school participated in interviews and focus groups. With this information, 26 categories (79 items) were proposed and reduced to 14 items (Likert scale 1-5) by an expert’s Delphi panel, generating the MEDUC-PG14 survey, which was answered by 123 residents from different programs of medical specialties. Construct validity was carried out. Factor analysis showed three domains: Teaching and evaluation, respectful behavior towards patients and health care team, and providing feedback. The global score was 4.46 ± 0.94 (89% of the maximum). One teachers’ strength, as evaluated by their residents was “respectful behavior” with 4.85 ± 0.42 (97% of the maximum). “Providing feedback” obtained 4.09 ± 1.0 points (81.8% of the maximum). MEDUC-PG14 survey had a Cronbach’s alpha coefficient of 0.947. Conclusions: MEDUC-PG14 survey is a useful and reliable guide for teacher evaluation in medical specialty programs. Also provides feedback to improve educational skills of postgraduate clinical teachers. <![CDATA[<strong>Legal recognition of transsexuality in Chile through the judicial procedure for name change</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800008&lng=pt&nrm=iso&tlng=pt Do transsexual people in Chile have a right to have their gender identity or their sex reassignment legally recognized? The absence of any legislation on gender identity or transsexualism could lead us to believe that it is not the case. However, a quantitative review of decisions issued by Chilean courts during the last years on name-and sex-change requests filed by transsexual people reveals that most of these courts have accepted these requests. From the perspective of the well-being of transsexual people, this is a positive result. However, the fact that a few rejections exist reminds us of the need to enact an explicit legislation in this issue. Lastly, a qualitative analysis of those decisions suggests that the traditional reluctance of courts to interpret the law in a creative way has been overcome in these cases by the use of knowledge and discourses belonging to healthcare sciences. This is an example of an epistemological complementariness between medicine and law. <![CDATA[<strong>Opinions of medical students about complementary therapies</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800009&lng=pt&nrm=iso&tlng=pt Background: There is increasing national and worldwide interest on complementary therapies (CT). Aim: To describe and analyze the opinions and interest about CT among medical students. Material and Methods: An anonymous and voluntary survey with questions used in previous studies, was applied to students from first to fifth year. Results: The survey was answered by 526 medical students, corresponding to 86% of the target population. The students knew about an average of 4.7 therapies, out of 12 displayed. The better known therapy was acupuncture, followed by homeopathy and reiki, which raised the greater interest. The knowledge and interest was higher among women, who also had a more favorable opinion about CT. The interest decreases and the proportion of unfavorable opinions increases among students of upper level courses. Forty nine percent of respondents have used CT for themselves and 22% had no experience whatsoever with them. Conclusions: In general, there is an appreciable knowledge, experience, interest and positive opinions toward CT. This favorable attitude is higher in women and decreases as career progresses. Medical students consider that they should have some approach to CT during their career. <![CDATA[<strong>Job satisfaction and organizational culture as predictors of absenteeism</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800010&lng=pt&nrm=iso&tlng=pt Background: Absenteeism caused by sick leaves generates an important economic burden. Aim: To determine if job satisfaction, psychological climate, hierarchic level and age are predictors of absenteeism caused by sick leaves. Material and Methods: FOCUS-93 survey that measures organizational culture and the satisfaction scale of Warr, Cook and Wall were distributed to 1387 workers of a hospital and answered by 874. Absenteeism data was obtained from the justified absenteeism registry of the Chilean Health Services. Results: Absenteeism is influenced by job satisfaction and organizational culture. Age has no influence. Hierarchic level has a negative influence on absenteeism among men and a negligible effect among women. Conclusions: Those workers that are not satisfied with their work have higher rates of absenteeism. <![CDATA[<strong>Graves’ orbitopathy in pediatrics</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800011&lng=pt&nrm=iso&tlng=pt Graves’ orbitopathy (GO) is rare in pediatric patients, however is the most common extrathyroid manifestation of Graves’ disease (GD), being present in 30-67% of patients. GO is an autoimmune inflammatory disorder involving orbital connective and fatty tissues as well as the extraocular muscles. In children, GO is less common and less severe than in adults. The most common symptoms are upper eyelid retraction, conjunctival injection, and proptosis and periorbital edema. Severe complications include dysthyroid optic neuropathy, corneal ulceration and eyeball subluxation. The diagnosis is established by clinical, laboratory and imaging findings. There are no management guidelines for GO in children but adult recommendations include the assessment of clinical activity and its severity, to implement the best treatment. Supportive therapies are intended to relieve symptoms and prevent corneal damage in mild cases. Tobacco exposure should also be avoided. The first line of treatment is systemic administration of corticosteroids in active and severe cases. Other options as somatostatin use and retrobulbar radiation have not been used in children, therefore their use is not recommended. <![CDATA[<strong>Autoimmune diseases in type 1A diabetes mellitus</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800012&lng=pt&nrm=iso&tlng=pt Type 1A diabetes (DM1A) is an autoimmune disease that comprises 10% of patients with diabetes mellitus. Its frequency is gradually increasing in countries like Mexico. Patients with DM1A commonly have hypothyroidism, Addison disease, celiac disease and less common diseases such as polyglandular syndrome. These diseases are related to susceptibility genes such as HLA, CTLA-4 and PTPN22, which induce central and peripheral immunologic tolerance. This review article emphasizes the importance of searching other autoimmune diseases in patients with DM1A, to improve their prognosis and quality of life. <![CDATA[<strong>Therapeutic monitoring of antibiotics</strong>: <strong>New methodologies: biosensors</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800013&lng=pt&nrm=iso&tlng=pt The pharmacokinetics of antibiotics, especially in severely ill patients, may be profoundly altered due to multiple pathophysiological changes. Recent studies have shown that empiric dosing recommendations for ICU patients are inadequate to effectively treat a broad range of susceptible organisms and need to be reconsidered. Therapeutic drug monitoring (TDM) is an important mean for optimizing drug utilization and doses for the purpose of improving the clinical effectiveness. However, it is very challenging to quantify plasma antibiotic concentrations in clinical situations as a routine practice, because of the high costs and complexities associated with advanced instrumental techniques. Currently there are not routine and low cost methods to determine the presence and concentration of β-lactam antibiotics in plasma patients in a clinical setup. Indeed, such analytical methods are based on chromatographic techniques mainly used in research. Here we describe and comment different techniques, focusing on our preliminary experience using biosensors. <![CDATA[<strong>A standardized practical examination for title revalidation of graduates of foreign medical schools</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800014&lng=pt&nrm=iso&tlng=pt Background: The University of Chile, backed by its extensive experience in Objective Structured Clinical Examinations (OSCEs), performs the practical exam to graduates of foreign medical school in this format. This test format would give more guarantees of validity and fairness as compared with the previous oral examination that was required for title revalidation. Aim: To compare the performance of graduates of foreign medical schools and last year medical students of the University of Chile in the same internal medicine OSCE. Material and Methods: Seventy-seven last year medical students and thirty-three graduates of foreign medical schools participated in the same Internal Medicine OSCE, but in different moments. At the end of the examination, graduates of foreign medical schools answered a questionnaire about their prior experience with OSCEs and about their perception about this type of examination. Results: The performance of graduates of foreign medical schools was lower than those of our last year medical students in four of the eight stations of the examination. Graduates of foreign medical schools considered the examination objective, fair, and that it assessed skills adequately and that the degree difficulty was homogeneous for all examinees. Conclusions: The possibility of obtaining comparable results in a transparent process makes the OSCE the assessment tool of choice for title revalidation of physicians migrating from foreign countries. <![CDATA[<strong>A biographical sketch of Albert Szent-Györgyi</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800015&lng=pt&nrm=iso&tlng=pt Albert Szent-Györgyi was a Hungarian biochemist and physiologist. He identified the structure and function of vitamin C, naming it as ascorbic acid. His research on cellular respiration and oxidation provided the basis for Krebs’ citric acid cycle. He was awarded the Nobel Prize in 1937. With his collaborators, he discovered the biochemical basis of muscle contractility, isolating the basic proteins, giving them the name myosin and actin. Later on, he worked on the theory of carcinogenesis, linked to electron movements. He was one of the first researchers to describe the connection between free radicals and cancer. He lived a long, very complete life, defending always his opinion and freedom. <![CDATA[<strong>Invasive disease due to Streptococcus pyogenes in a patient with A H1N1 influenza infection. Report of one case</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800016&lng=pt&nrm=iso&tlng=pt Bacterial superinfection is a known complication among patients affected by viral respiratory tract infections. Streptococcus pyogenes, a major bacterial agent involved in acute tonsillopharyngitis, skin and soft tissue infections, was reported as a co-infecting microorganism during the 2009 A H1N1 influenza pandemic. We report a 65-year-old male patient who evolved with multifocal pneumonia and multiple organ failure with a fatal outcome. Influenza A H1N1 was detected by a polymerase chain reaction-based technique from a tracheal aspirate sample. S. pyogenes was identified by a rapid test from a nasopharyngeal sample and isolated afterwards from a positive blood culture. <![CDATA[<strong>Intravascular lymphoma</strong>: <strong>Report of one case</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800017&lng=pt&nrm=iso&tlng=pt Intravascular lymphoma is a rare subtype of extranodal diffuse large B-cell lymphoma characterized by clonal proliferation of lymphocytes inside of small and medium caliber vessels. Its incidence is estimated at one case per million. The clinical picture is very variable, but frequently has skin and central nervous system involvement. It is diagnosed by demonstrating pathological blood vessel infiltration by lymphoma cells. We report a 44 years old male presenting with fever, malaise and erythematous lesions in the abdominal wall. An abdominal wall biopsy showed dilated vascular vessels with atypical cells in their lumen, compatible with large B-cell intravascular lymphoma. He was treated with rituximab, cyclophosphamide, adriamycin, vincristine and prednisone and an autologous hematopoietic stem cell transplantation, achieving a complete remission that has lasted two years. <![CDATA[<strong>Type I persistent proatlantal artery associated with fusiform subclavian artery aneurysm</strong>: <strong>Report of one case</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800018&lng=pt&nrm=iso&tlng=pt We report a 61 years old male presenting with a right cerebral infarction, along with a type I persistent left proatlantal artery (PA), which is a form of primitive carotid-basilar anastomosis. The patient had an absence of the ipsilateral vertebral artery (VA) and hypoplasia of the contralateral VA, while the basilar artery was supplied by the PA. Other vascular anomalies present were a fusiform aneurysm of the right subclavian artery, and an A1 segment aplasia of the hypoplastic anterior right cerebral artery, which originated from the anterior communicating artery. To our knowledge these anomalies were not described previously. <![CDATA[<strong>Recurrence of Tako-Tsubo syndrome</strong>: <strong>Case report</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800019&lng=pt&nrm=iso&tlng=pt We report a 61 years old male presenting with a right cerebral infarction, along with a type I persistent left proatlantal artery (PA), which is a form of primitive carotid-basilar anastomosis. The patient had an absence of the ipsilateral vertebral artery (VA) and hypoplasia of the contralateral VA, while the basilar artery was supplied by the PA. Other vascular anomalies present were a fusiform aneurysm of the right subclavian artery, and an A1 segment aplasia of the hypoplastic anterior right cerebral artery, which originated from the anterior communicating artery. To our knowledge these anomalies were not described previously. <![CDATA[<strong>The BRAIN initiative</strong>: <strong>Is it only studied in computers?</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800020&lng=pt&nrm=iso&tlng=pt We report a 61 years old male presenting with a right cerebral infarction, along with a type I persistent left proatlantal artery (PA), which is a form of primitive carotid-basilar anastomosis. The patient had an absence of the ipsilateral vertebral artery (VA) and hypoplasia of the contralateral VA, while the basilar artery was supplied by the PA. Other vascular anomalies present were a fusiform aneurysm of the right subclavian artery, and an A1 segment aplasia of the hypoplastic anterior right cerebral artery, which originated from the anterior communicating artery. To our knowledge these anomalies were not described previously. <![CDATA[<strong>Sedentary behaviour and physical inactivity is not the same!</strong>: <strong>An update of concepts oriented towards the prescription of physical exercise for health</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872015000800021&lng=pt&nrm=iso&tlng=pt We report a 61 years old male presenting with a right cerebral infarction, along with a type I persistent left proatlantal artery (PA), which is a form of primitive carotid-basilar anastomosis. The patient had an absence of the ipsilateral vertebral artery (VA) and hypoplasia of the contralateral VA, while the basilar artery was supplied by the PA. Other vascular anomalies present were a fusiform aneurysm of the right subclavian artery, and an A1 segment aplasia of the hypoplastic anterior right cerebral artery, which originated from the anterior communicating artery. To our knowledge these anomalies were not described previously.