Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720170001&lang=en vol. 145 num. 1 lang. en <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<strong><i>Air pollution</i></strong>: <strong><i>chemical composition affects the risk</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100001&lng=en&nrm=iso&tlng=en <![CDATA[<strong><i>Effect of copper sulphate on the lung damage induced by chronic intermittent exposure to ozone</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100002&lng=en&nrm=iso&tlng=en Background: Ozone exposure could increase lung damage induced by airborne particulate matter. Particulate matter lung toxicity has been attributed to its metallic content. Aim: To evaluate the acute effect of intratracheal administration of copper sulfate (CuSO4) on rat lungs previously damaged by a chronic intermittent ozone exposure. Material and Methods: Two-months-old male Sprague-Dawley rats were exposed to 0.5 ppm ozone four h per day, five days a week, during two months. CuSO4 was intratracheally instilled 20 h after ozone exposure. Controls breathed filtered air or were instilled with 0.9% NaCl or with CuSO4 or were only exposed to ozone. We evaluated lung histopathology. F2 isoprostanes were determined in plasma. Cell count, total proteins, γ glutamyl-transpeptidase (GGT) and alkaline phosphatases (AP) were determined in bronchoalveolar lavage fluid (BALF). Results: Ozone increased total cell count, macrophages, proteins and AP in BALF (p < 0.05), and induced pulmonary neutrophil inflammation. CuSO4 plus air increased plasma F2 isoprostane levels and total cell count, neutrophils and proteins in BALF (p < 0.05). Histopathology showed foamy macrophages. Ozone plus CuSO4 exposed animals showed a neutrophil inflammatory lung response and an increase in total cell count, proteins, GGT and AP in BALF (p < 0.05). Foamy and pigmented alveolar macrophages were detected in all lungs of these animals (p < 0.001). Conclusions: Intratracheal instillation of a single dose of CuSO4 in rats previously subjected to a chronic and intermittent exposure to ozone induces a neutrophil pulmonary inflammatory response and cytoplasmic damage in macrophages. <![CDATA[<strong><i>Comparative evaluation of survival prognosis using MELD or Child-Pugh scores in patients with liver cirrhosis in Chile</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100003&lng=en&nrm=iso&tlng=en Background: Currently, most liver units use the Child-Pugh (CP) or the Model for End-Stage Liver Disease (MELD) scores to establish survival prognosis among patients with liver cirrhosis. Which classification is superior, is not well defined. Aim: To compare CP and MELD classification scores to predict survival among adult patients with liver cirrhosis in Chile. Material and Methods: Follow-up of 137 consecutive adult patients with liver cirrhosis aged 59 ± 12 years (55% women). The diagnosis was reached by clinical, laboratory and image studies at three different centers of Santiago. Patients were staged with CP and MELD classification scores at baseline and followed over a period of 12 months. The predictive capacity of the scores for survival was analyzed using a multivariate statistical analysis (Kaplan-Meier curves). Results: The most common etiology was alcohol (37.9%). The actuarial survival rate was 79.6% at 12 months of follow-up. When comparing groups with areas under curve of receiver operating characteristic curves (AUROC), there was no statistically significant difference in survival between less severe and advanced disease, assessed with both survival scales. The AUROC for MELD and CP were 0.80 and 0.81, respectively. Conclusions: This clinical study did not find a statistically significant difference between the two classifications for the prediction of 12 months survival in patients with cirrhosis. <![CDATA[<strong><i>Comorbidity in people with depression seeking help at primary health care centers in Santiago, Chile</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100004&lng=en&nrm=iso&tlng=en Background: International evidence has shown the complex interaction between depression and chronic physical diseases. Depression in scenarios involving multiple comorbidities has not received enough attention in Chile. Aim: To characterize the depressed people who consult at Primary Health Care Centers (PHCCs), taking into account the presence of chronic physical or psychiatric comorbidity. Materials and Methods: A secondary analysis of databases used in a clinical trial. Two hundred fifty six adults seeking professional help were recruited in four PHCCs located in the Metropolitan Region. These people had a major depressive episode, identified with a structured psychiatric interview (MINI), and gave their informed consent to participate. Socio-demographic information was collected, depressive symptomatology was measured with the patient health questionnaire 9 (PHQ-9), psychiatric morbidity was assessed using the Mini International Neuropsychiatric Interview (MINI), and chronic physical diseases were self-reported by the patients. Descriptive analyses of all the variables were conducted. Results: Seventy percent of patients had a history of depression, with a median of two prior depressive episodes. Depressive symptoms were mostly considered as moderate to severe and severe and 31% of the patients had high suicide risk. Seventy eight percent displayed a physical or psychiatric comorbidity. Of these patients, 29% only had a chronic physical comorbidity, while 46% suffered from an additional psychiatric disorder. Conclusions: Depressed individuals who seek help at PHCCs constitute an especially complex population that must be treated taking into account multiple comorbidities. <![CDATA[<strong><i>Errors in prescriptions and their preparation at the outpatient pharmacy of a regional hospital</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100005&lng=en&nrm=iso&tlng=en Background: Adverse effects of medications are an important cause of morbidity and hospital admissions. Errors in prescription or preparation of medications by pharmacy personnel are a factor that may influence these occurrence of the adverse effects Aim: To assess the frequency and type of errors in prescriptions and in their preparation at the pharmacy unit of a regional public hospital. Material and Methods: Prescriptions received by ambulatory patients and those being discharged from the hospital, were reviewed using a 12-item checklist. The preparation of such prescriptions at the pharmacy unit was also reviewed using a seven item checklist. Results: Seventy two percent of prescriptions had at least one error. The most common mistake was the impossibility of determining the concentration of the prescribed drug. Prescriptions for patients being discharged from the hospital had the higher number of errors. When a prescription had more than two drugs, the risk of error increased 2.4 times. Twenty four percent of prescription preparations had at least one error. The most common mistake was the labeling of drugs with incomplete medical indications. When a preparation included more than three drugs, the risk of preparation error increased 1.8 times. Conclusions: Prescription and preparation of medication delivered to patients had frequent errors. The most important risk factor for errors was the number of drugs prescribed. <![CDATA[<strong><i>Encapsulating peritoneal sclerosis</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100006&lng=en&nrm=iso&tlng=en Background: Encapsulating peritoneal sclerosis (EPS) is a complication of peritoneal dialysis (PD) with a low prevalence but high mortality. It is characterized by peritoneal inflammation and fibrosis with subsequent development of intestinal encapsulation. It is associated with a long lapse on PD, frequent episodes of peritonitis, high glucose solution use, and high peritoneal transport status. Aim: To report the clinical features of patients on PD, who developed EPS. Material and Methods: Review of medical records of 12 patients aged 43 ± 10 years (eight women) who developed EPS. Results: The mean time spent on PD was 98 months. The main clinical manifestations were abdominal pain in 82% and ultrafiltration failure in 63%. In 92%, there was a history of peritonitis and 75% had high peritoneal transport at the time of diagnosis. The main findings in computed tomography were peritoneal calcification and thickening. There was a biopsy compatible with the diagnosis in 10 cases. Treatment consisted in withdrawal from PD, removal of PD catheter and the use of corticoids and tamoxifen. After withdrawal from PD 50% of patients became asymptomatic. The rest had intermittent abdominal pain and altered bowel movements. Two patients died (17%). Conclusions: EPS is a serious complication of PD, which should be suspected in any patient with compatible clinical symptoms, long time on PD, multiple episodes of peritonitis and high peritoneal transport profile. <![CDATA[<strong><i>Evaluation of an instrument assessing the satisfaction of ophthalmological emergency service users in Chile</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100007&lng=en&nrm=iso&tlng=en Background: Ocular trauma is a distressing condition feared by the general public. Aim: To evaluate the construct validity and internal consistency of an instrument to measure the level of user satisfaction in patients treated at an Ocular Trauma and Ophthalmological Emergency Unit. Material and Methods: A survey to measure user satisfaction was applied to patients consulting at the Ocular Trauma Unit in a public hospital on April 2014. Internal consistency and construct validity from the estimated Cronbach alpha coefficient and factor analysis were assessed. Results: Surveys answered by 138 patients aged 45 ± 15 years (93% men), were analyzed. The reliability obtained for the final questionnaire was 0.88. The factor analysis yielded four factors responsible for explaining 74.1% of the total variance, related to “quality of clinical information”, “treatment by health care personnel”, “lighting conditions, environment and noise” and “waiting time and overall assessment of service”. Conclusions: These results allow to consider the instrument as a useful and reliable tool that can be applied to ophthalmological emergency service users in Chile. <![CDATA[<strong><i>Association between physical fitness parameters and health related quality of life in Chilean community-dwelling older adults</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100008&lng=en&nrm=iso&tlng=en Background: There is no conclusive evidence about the association between physical fitness (PF) and health related quality of life (HRQOL) in older adults. Aim: To seek for an association between PF and HRQOL in non-disabled community-dwelling Chilean older adults. Material and Methods: One hundred and sixteen subjects participated in the study. PF was assessed using the Senior Fitness Test (SFT) and hand grip strength (HGS). HRQOL was assessed using eight dimensions provided by the SF-12v2 questionnaire. Binary multivariate logistic regression models were carried out considering the potential influence of confounder variables. Results: Non-adjusted models, indicated that subjects with better performance in arm curl test (ACT) were more likely to score higher on vitality dimension (OR > 1) and those with higher HGS were more likely to score higher on physical functioning, bodily pain, vitality and mental health (OR > 1). The adjusted models consistently showed that ACT and HGS predicted a favorable perception of vitality and mental health dimensions respectively (OR > 1). Conclusions: HGS and ACT have a predictive value for certain dimensions of HRQOL. <![CDATA[<strong><i>Mechanical and pharmacomechanical trombolysis in deep venous thrombosis with no clinical response to conventional treatment</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100009&lng=en&nrm=iso&tlng=en Background: Conventional treatment of deep vein thrombosis (DVT) is anticoagulation, bed rest and limb elevation. Proximal DVT patients with persisting edema, pain and cyanosis of extremities despite of conventional therapy may develop ischemia. Direct treatment of thrombosis becomes necessary. Aim: To report our experience with mechanical trombolysis of proximal lower extremity DVT. Material and Methods: Retrospective review of medical records of proximal DVT patients treated with thrombolysis between March 2012 and August 2015. Thirteen patients, 14 limbs, median age 34 years (22-85), 8 women, were admitted with pain and swelling of recent onset; one patient with venous gangrene. All patients initially received heparin in therapeutic doses without clinical improvement. Results: In all 13 cases, mechanical thrombolysis was performed using AngioJet®, and associated with single dose thrombolytic agent in 9. Additional angioplasty for residual stenosis was performed in 12 (7 stents) and IVCF were implanted in 8. All patients were subsequently anticoagulated. Early outcomes with disappearance of pain and decrease of edema, with no mortality or bleeding complications. The patient with foot gangrene required amputation. Conclusions: Mechanical thrombolysis with a single dose of a thrombolytic agent is safe and effective in patients with proximal DVT with an unfavorable evolution. <![CDATA[<strong><i>The opportunity to develop hospitals of high-quality care and high standards of teaching for Chile</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100010&lng=en&nrm=iso&tlng=en Background: Conventional treatment of deep vein thrombosis (DVT) is anticoagulation, bed rest and limb elevation. Proximal DVT patients with persisting edema, pain and cyanosis of extremities despite of conventional therapy may develop ischemia. Direct treatment of thrombosis becomes necessary. Aim: To report our experience with mechanical trombolysis of proximal lower extremity DVT. Material and Methods: Retrospective review of medical records of proximal DVT patients treated with thrombolysis between March 2012 and August 2015. Thirteen patients, 14 limbs, median age 34 years (22-85), 8 women, were admitted with pain and swelling of recent onset; one patient with venous gangrene. All patients initially received heparin in therapeutic doses without clinical improvement. Results: In all 13 cases, mechanical thrombolysis was performed using AngioJet®, and associated with single dose thrombolytic agent in 9. Additional angioplasty for residual stenosis was performed in 12 (7 stents) and IVCF were implanted in 8. All patients were subsequently anticoagulated. Early outcomes with disappearance of pain and decrease of edema, with no mortality or bleeding complications. The patient with foot gangrene required amputation. Conclusions: Mechanical thrombolysis with a single dose of a thrombolytic agent is safe and effective in patients with proximal DVT with an unfavorable evolution. <![CDATA[<strong>Physical activity and breast cancer</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100011&lng=en&nrm=iso&tlng=en In Chile breast cancer (BC) is the first cause of death in women. While the most important risk factor for its development is estrogenic stimulation, environmental factors and lifestyles also contribute to its pathogenesis. Epidemiological studies show a direct relationship between physical activity (PA), incidence and recurrence of BC. Supervised PA practice is recommended in most cancer patients to improve their quality of life, to reduce adverse effects from treatment and eventually to improve the prognosis of the disease. We review the epidemiological evidence linking PA and BC and the biological basis of this relationship. We also review the relevant interventional studies and we explore some practical indications of PA in patients with BC, as a model for other tumors of epidemiological importance. <![CDATA[<strong>Origin, components and mechanisms of action of the Mediterranean diet</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100012&lng=en&nrm=iso&tlng=en The Mediterranean diet is currently considered a healthy dietary pattern. It includes a great variety of foods, which are eaten in moderation and within a positive social environment. The generic term “Mediterranean diet” was born after the “Seven Countries Study” led by Ancel Keys around 1960. This dietary pattern is characterized by a high intake of fruits and vegetables, whole grains, legumes, nuts, fish, white meats and olive oil. It also includes moderate consumption of fermented dairy products, low intake of red meat and drinking wine with moderation during meals. Nutritionally, this diet is low in saturated fats and animal protein, high in antioxidants, fiber and monounsaturated fats, and exhibits an adequate omega-6/omega-3 fatty acid balance. The main bioactive compounds, which explain the health benefits of this dietary pattern, are antioxidants, fiber, monounsaturated and omega-3 fatty acids, phytosterols and probiotics. This diet is not exclusively confined to the Mediterranean Basin. Central Chile has a Mediterranean climate and our agriculture and culinary traditions are similar to those found in Mediterranean countries. Therefore, it is fundamental to increase awareness about the richness of our natural produce as well as our culinary culture, which may bring many health benefits and improve the quality of life in our population. <![CDATA[<strong>Management of severe ulcerative colitis</strong>: <strong>An up-to-date</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100013&lng=en&nrm=iso&tlng=en Ulcerative Colitis (UC) is a chronic inflammatory disease involving the colon, with alternating periods of remission and activity. Exacerbations can be severe and associated with complications and mortality. Diagnosis of severe UC is based on clinical, biochemical and endoscopic variables. Patients with severe UC must be hospitalized. First line therapy is the use of intravenous corticoids which achieve clinical remission in most patients. However, 25% of patients will be refractory to corticoids, situation that should be evaluated at the third day of therapy. In patients without response, cytomegalovirus infection must be quickly ruled out to escalate to second line therapy with biological drugs or cyclosporine. Total colectomy must not be delayed if there is no response to second line therapy, if there is a contraindication for second line therapies or there are complications such as: megacolon, perforation or massive bleeding. An active management with quick escalation on therapy allows to decrease the prolonged exposure to corticoids, reduce colectomy rates and its perioperative complications. <![CDATA[<strong><i>Epidemiological analysis of breast cancer mortality in women in Chile</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100014&lng=en&nrm=iso&tlng=en Background: Among women, breast cancer is the leading cause of death due to cancer worldwide. Aim: To describe the epidemiology of breast cancer mortality in Chilean women by age, time trend and explore its ecological association with socio-demographic variables. Material and Methods: Descriptive study of age specific death rates (2009-2013), and time trend analysis of crude mortality rates (1995-2013) using RiskDiff analysis. Additionally, time trend analysis of age specific death rates was done using Jointpoint regression. The relationship between county mortality risk and socio-demographic variables in the period 2001-2008 was done through an ecological analysis. Socio-demographic variables were: education, income, occupation, housing and living in rural areas. Results: Breast cancer mortality in Chilean women increases with age, with a sharp increase from 80 years old on. In the 1995-2013 period the increase in the crude death rate was 21.8%, this increment was due to changes in demographic structure (43.4%) and decrease in risk (21.7%). The county relative risk of breast cancer mortality is positively associated with education level and negatively associated with living in rural areas. Conclusions: The risk of dying from breast cancer in women has decreased in the period 1995-2013. Nonetheless, the crude death rate has increased in the same period. At an ecological level (counties), breast cancer mortality in Chile is associated with a higher socioeconomic status, measured by educational level and living in rural areas. <![CDATA[<strong><i>Blastic plasmacytoid dendritic cell neoplasm with complete clinical remission with chemotherapy and central nervous system relapse</i></strong>: <strong><i>Report of one case</i></strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100015&lng=en&nrm=iso&tlng=en Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, clinically aggressive hematologic malignancy that most commonly manifests as cutaneous lesions with or without bone marrow involvement and leukemic dissemination. The demonstration of tumor cells with the characteristic immunophenotype with expression of CD56, generally CD4 and dendritic cell antigens (CD123, cyTCL-1, HLA-DR), in the absence of myeloid or lymphoid lineage markers is required for the diagnosis. Responses to chemotherapy are initially satisfactory, with frequent systemic and central nervous system relapses. We report a 24 year-old male with BPDCN, initially diagnosed and treated as non-Hodgkin CD4+ T-cell lymphoma, with initial complete remission who evolved with early central nervous system relapse. A second attempt of chemotherapy failed and the patient died two months later. <![CDATA[<strong>Anomalous left coronary artery origin from the pulmonary artery causing angina</strong>: <strong>Report of one case</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100016&lng=en&nrm=iso&tlng=en Anomalies of the origin of coronary arteries are detected in 0.5-1.5% of all angiographies. Anomalous origin of the left main trunk is the most uncommon and its origin from pulmonary artery in adults is exceptional, usually because it is associated with a short survival. We report a 49-year-old female, presenting with a two months history of angina. The exercise electrocardiogram suggested ischemia. A coronary angiography was performed, showing the absence of the left main trunk in the left coronary sinus, a dilated right coronary artery, with no lesions and extensive collateral circulation to the anterior descending and circumflex arteries, with inverted flow and the left main trunk draining to the pulmonary artery. The left ventricle was mildly dilated with middle and apical anterior hypokinesia. Global systolic function was conserved. A surgical correction was decided, occluding the left main anomalous origin and performing a coronary artery bypass grafting from the left internal thoracic artery. The patient was discharged with no complications. At two years of follow-up she is symptom free and has a normal physical capacity. <![CDATA[<strong>Ictal catatonia presentation as a non-convulsive status epilepticus</strong>: <strong>A case report</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100017&lng=en&nrm=iso&tlng=en The differential diagnosis of non-convulsive status epilepticus (NCSE) is often complex due to a wide clinical variability of its presentation, including psychiatric manifestations. We report a 68 years old male with a history of depression treated with venlafaxine, mirtazapine, quetiapine and risperidone, presenting in the emergency room with confusion and generalized rigidity. A brain CT scan did not show lesions. A neuroleptic syndrome was initially suspected. At the third day the obtundation worsened and an electroencephalogram (EEG) was performed, which showed epileptiform abnormalities. Treatment with valproic acid resulted in disappearance of such abnormalities. After three weeks of mechanical ventilation, the patient was extubated and remained lucid and partially orientated in time and space. <![CDATA[<strong>IgG4 associated nephritis and recurrent hemoptysis</strong>: <strong>Case report</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100018&lng=en&nrm=iso&tlng=en IgG4 disease is a multi-systemic condition involving pancreas, salivary glands and lymph nodes. Less frequently, it causes interstitial nephritis and involves the lungs. We report a 58 years old male with a four years history of hemoptysis and renal dysfunction characterized by hematuria and proteinuria, responsive to steroidal therapy. The renal biopsy established the diagnosis of IgG4 associated interstitial nephritis. Lung involvement was considered secondary to the same systemic disease. <![CDATA[<em><b>Migrant children and eating behavior</b></em><em><b>: </b></em><em><b>cultural and health challenges</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100019&lng=en&nrm=iso&tlng=en IgG4 disease is a multi-systemic condition involving pancreas, salivary glands and lymph nodes. Less frequently, it causes interstitial nephritis and involves the lungs. We report a 58 years old male with a four years history of hemoptysis and renal dysfunction characterized by hematuria and proteinuria, responsive to steroidal therapy. The renal biopsy established the diagnosis of IgG4 associated interstitial nephritis. Lung involvement was considered secondary to the same systemic disease. <![CDATA[<strong>National holidays ahoy! Basic rationale and considerations to prevent weight gain in schoolchildren</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100020&lng=en&nrm=iso&tlng=en IgG4 disease is a multi-systemic condition involving pancreas, salivary glands and lymph nodes. Less frequently, it causes interstitial nephritis and involves the lungs. We report a 58 years old male with a four years history of hemoptysis and renal dysfunction characterized by hematuria and proteinuria, responsive to steroidal therapy. The renal biopsy established the diagnosis of IgG4 associated interstitial nephritis. Lung involvement was considered secondary to the same systemic disease. <![CDATA[<strong>Massive open online courses on psychotherapy</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000100021&lng=en&nrm=iso&tlng=en IgG4 disease is a multi-systemic condition involving pancreas, salivary glands and lymph nodes. Less frequently, it causes interstitial nephritis and involves the lungs. We report a 58 years old male with a four years history of hemoptysis and renal dysfunction characterized by hematuria and proteinuria, responsive to steroidal therapy. The renal biopsy established the diagnosis of IgG4 associated interstitial nephritis. Lung involvement was considered secondary to the same systemic disease.