Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720190011&lang=es vol. 147 num. 11 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Niveles de colesterol no HDL en la población chilena y su asociación con enfermedad cardiovascular y diabetes mellitus: estudio de corte transversal en Encuesta Nacional de Salud 2009-2010]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101365&lng=es&nrm=iso&tlng=es Background Despite aggressive treatment aimed at lowering LDL cholesterol (LDL-C) levels with statins, there is a high residual prevalence of cardiovascular diseases, which may depend on plasma cholesterol transported in other atherogenic lipoproteins. Aims To describe non-HDL cholesterol (non-HDL-C) levels in the Chilean population and their association with diabetes mellitus and cardiovascular disease. To evaluate compliance with non-HDL-C therapeutic goals -according to individual cardiovascular risk- at different levels of triglycerides, in comparison with LDL-C goal achievement. Material and Methods: We analyzed data from 2,792 Chilean subjects aged ≥ 15 years who were included in the 2009-2010 National Health Survey and had valid data for blood lipids, diabetes, and cardiovascular disease. Results Forty five percent of subjects had high non-HDL-C levels. The proportion of diabetic and non-diabetic subjects with high non-HDL-C levels was 81 and 42%, respectively (p &lt; 0.01). A significant discordance was observed in the achievement of therapeutic objectives when LDL-C or non-HDL-C levels were considered, particularly in presence of triglycerides ≥ 150 mg/dl. Namely, 8% of the population showed elevated levels of high non-HDL-C despite adequate LDL-C levels. Conclusions Evaluation and management of elevated non-HDL-C in patients with adequate levels of LDL-C seems worthwhile considering the discordance observed between these blood cholesterol fractions. This strategy may be effective to reduce the residual cardiovascular risk in the Chilean population. <![CDATA[Impacto pronóstico de remisión renal en pacientes con mieloma múltiple de reciente diagnóstico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101374&lng=es&nrm=iso&tlng=es ABSTRACT Background Renal failure (RF) is a common complication in patients with newly diagnosed multiple myeloma (NDMM). Aim To evaluate the frequency of RF in NDMM patients, and the prognostic impact of its reversibility. Material and Methods A retrospective study evaluating demographic and clinical characteristics of 154 consecutive patients with NDMM was carried out. Estimated glomerular filtration rate (eGFR) was calculated at the beginning and at the end of the induction therapy. In addition, we evaluated renal responses (RR) according to the International Myeloma Working Group (IMWG) criteria. The induction regimen was based on thalidomide in all cases. Results Fifty-three patients had RF (34.4%). Complete renal response (RR) was achieved in 51%. Three years overall survival in patients without RF, with RF and complete RR, and patients with RF and any other RR, was 66, 47 and 13%, respectively. Median survival was 53, 27 and 6 months, respectively (p &lt; 0.01). In the multivariate analysis, RF and hypercalcemia were independent predictors of a worse outcome. Conclusions Achieving a complete RR in patients with NDMM, is associated with a better survival.<hr/> Antecedentes La falla renal (FR) es una complicación frecuente en pacientes con mieloma múltiple (MM). Objetivo Evaluar la frecuencia de FR en pacientes con reciente diagnóstico de MM y determinar la importancia pronóstica de su reversibilidad. Material y Métodos Se realizó un estudio retrospectivo de 154 pacientes consecutivos con MM. La función renal se evaluó mediante la tasa estimada de filtración glomerular al inicio y final de la terapia de inducción. Además, evaluamos las respuestas renales (RR) de acuerdo con los criterios del International Myeloma Working Group (IMWG). El régimen de inducción se basó en talidomida en todos los casos. Resultados Cincuenta y tres pacientes presentaron FR (34,4%) al diagnóstico. La RR completa se logró en 51%. La sobrevida global (SG) a 3 años en pacientes sin FR, con FR y RR completa, y pacientes con FR y cualquier otra RR, fue de 66, 47 y 13%, respectivamente. La SG media fue de 53, 27 y 6 meses (p &lt; 0,01), respectivamente. En el análisis multivariado, la FR y la hipercalcemia fueron factores independientes de menor sobrevida. Conclusiones Lograr una RR completa en pacientes con MM recién diagnosticado se asocia con una mejor sobrevida. <![CDATA[La derivación protocolizada a endoscopía asociada a la detección de <em>Helicobacter pylori</em> mediante antígeno en deposiciones disminuye lista de espera para endoscopía y optimiza la detección de lesiones pre-malignas y cáncer gástrico incipiente]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101382&lng=es&nrm=iso&tlng=es Background Chile has one of the highest mortality rates by gastric cancer (GC) worldwide. Primary prevention of GC and detection of pre-neoplastic and early neoplastic lesions should be a national priority. Aim To assess the impact of the protocolization of endoscopy referral and the use of H. pylori stool antigen test (HPSA) in the management of dyspepsia to decrease the waiting list for endoscopy and increase the detection of gastric pre-neoplastic and early neoplastic lesions. Material and Methods We included all patients referred to the Endoscopy Unit of a regional hospital, from January 2015 to December 2017. We also included patients with known pre-neoplastic lesions and all those with first degree relatives with GC. We implemented protocols for referral of patients with dyspepsia considering the use of HPSA test, prioritizing to endoscopy those with a higher risk of GC. Results A total of 4,641 endoscopies and 2,631 HPSA tests were carried out. After the adoption of these protocols, we observed a 52% decrease in the waiting time for endoscopy. The GC detection rate in this period was 1.8 to 3.1 cases per 100 endoscopies. After the adoption of the protocols, we observed a significant increase in early GC detection rate (from none in 2015 to 13% in 2017, p = 0.03). Conclusions The protocolization of the referral for endoscopy associated with widespread use of HPSA test in the management of patients with dyspepsia, are successful strategies to decrease waiting lists for endoscopy and optimize the detection rate of pre-neoplastic lesions and early GC. <![CDATA[Recuperación de peso perdido en pacientes que han tenido cirugía bariátrica: Una mirada psicológica]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101390&lng=es&nrm=iso&tlng=es Background Approximately 15 to 40% of bariatric patients regain a significant percentage of their weight lost after surgery. Among psychological variables, control and self-efficacy loci are associated with behaviors related to weight loss. Also, family support can be a risk or protection factor for the maintenance of weight loss. Aim To evaluate the association between psychological variables with weight maintenance or regain after bariatric surgery. Material and Methods We evaluated 97 patients at 4.1 ± 3.4 years after their bariatric surgery. They answered questionnaires about self-efficacy to lose weight, locus of weight control and family functioning style. Regain after surgery was also calculated, through self-report. Results Seventeen percent of patients gained weight. Locus of control (Z = -3.09, p &lt; 0.01), family identity (Z = -3.71, p &lt; 0.01) and self-efficacy (Z = -2.44, p = 0.01), differentiated patients who maintained weight loss from those who re-gained at least 15% of their lost weight. An inverse and significant relationship was observed between the percentage of weight regain and locus of control (r = -0.42, p &lt; 0.01), family identity (r = -0.36, p &lt; 0.01) and self-efficacy (r = -0.34, p &lt;0.01). Conclusions The psychological variables “locus of weight control” and “family identity” are inversely and moderately associated with weight regain in patients subjected to bariatric surgery. <![CDATA[¿Cuál es la asociación entre el tiempo destinado a dormir y el desarrollo de deterioro cognitivo en adultos mayores chilenos?]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101398&lng=es&nrm=iso&tlng=es Background Sleep duration may be a risk factor for cognitive impairment. Aim To investigate the association between sleep duration and cognitive function in Chilean older adults. Material and Methods We analyzed information from 1,384 participants aged &gt; 60 years participating in the National Health Survey 2009-2010 who were assessed with the Mini Mental State Examination (MMSE) and self-reported their average daily sleep hours. Logistic regression analysis was performed to investigate the association between MMSE and sleep duration. Results Compared to those participants who reported sleeping 7 hours per day, those that reported sleeping &lt; 5 hours had a higher odd for cognitive impairment (Odds ratio (OR): 3.66 [95% confidence intervals (CI: 1.69; 7.95], p &lt; 0.01). Similarly, those who reported sleeping &gt; 8 hours per day also showed a higher odd for cognitive impairment (OR: 2.56 [95% CI: 1.32; 4.95], p &lt; 0.01). This association was even stronger for people who reported more than 10 hours of sleep per day (OR: 4.46 [95% CI: 1.32; 4.95], p &lt; 0.01). Conclusions Long and short sleep duration is associated with cognitive impairment in older adults in Chile independent of major confounding factors. <![CDATA[Factores sociales del estado de salud autorreportado de personas mayores, en Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101407&lng=es&nrm=iso&tlng=es Background Self-reported health is subjective and depends on external factors such as socioeconomic status, presence of chronic diseases and working status, among others. Aim To determine which factors influence self-reported health among older people in Chile. Material and Methods A secondary analysis of the National Socioeconomic Characterization survey done in 2015. A dichotomous response model was used classifying health status as good or bad. A logit regression model was carried out. Results The model had a good calibration and correctly classified 72 and 68% of men and women, respectively. The main factors that influenced health status self-perception were: not having health problems; having undergone a mental health interview, to receive supplemental nutrition, education, to have a productive work; and to having a social network. Conclusions There are health, cultural, economic and environmental factors that influence self-perceived health status. <![CDATA[Niveles de vitamina D en médicos: ¿son los anestesiólogos el único grupo de riesgo?]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101415&lng=es&nrm=iso&tlng=es Background Sun exposure is the main source of 25-hydroxy-vitamin D. Since anesthesiologists work inside operating rooms, they are identified as a deficiency risk group. As medical activity in general occurs indoors, added to the work excess and sedentary lifestyle, physicians in general have low sun exposure. Aim To investigate the determinants of vitamin D levels in physicians. Material and Methods Anesthesiologists and physicians not working in operating rooms were included. A survey that comprised working hours, diet, skin color, sunscreen use and outdoor activities was also applied. Measurements of vitamin D and parathormone levels in blood were performed. Results We analyzed samples from 81 volunteers. Median vitamin D values of the whole sample were in the range of insufficiency (25.3 [interquartile range 12.4] ng/ml). Multiple linear regression analysis detected no differences between anesthesiologists and non-anesthesiologists. A higher body mass index was a risk factor for vitamin D deficiency, (p = 0.025). The only protective factor was the intake of a vitamin D supplement (p &lt; 0.01). Conclusions Anesthesiologists and other specialists were both at risk for vitamin D deficiency. Obesity was a risk factor and the use of a vitamin D supplement was the only protective factor. <![CDATA[¿Son efectivas las intervenciones psicológicas para mejorar el control de la Diabetes Mellitus tipo 2 en adultos?: una revisión sistemática y metaanálisis]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101423&lng=es&nrm=iso&tlng=es Background Affordable interventions to improve metabolic control of Type 2-Diabetes Mellitus are increasingly necessary. Aim To review systematically the existing literature on the effects of psychological interventions on Type-2 Diabetes Mellitus compensation. Material and Methods We performed a systematic literature review and meta-analysis on the effectiveness of psychological interventions implemented for Type-2 Diabetes Mellitus patients. Research included the following electronic databases: PubMed, Bireme, Web of Science, SciELO, Embase, EBSCOhost, SCOPUS, Psychology Database. Results Most studies showed a decrease in the level of glycated hemoglobin after interventions, which applied different initiatives complementary to standard medical treatment. Mainly, these interventions encompassed training for self-monitoring and control of diabetes based on cognitive behavioral psychology, counseling, self-assessment and physical-spiritual work based on transpersonal psychology. Conclusions Psychological tools could be an adjunct to the standard medical treatment for patients with Type-2 Diabetes Mellitus, reducing glycated hemoglobin levels and improving self-regulation, disease awareness and adherence from the self-efficacy perception perspective. <![CDATA[Un modelo para predecir el consumo de oxígeno según signos vitales y hábitos de vida en estudiantes universitarios]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101437&lng=es&nrm=iso&tlng=es Background Maximal oxygen uptake (V̇O 2 max) is measured using maximal and submaximal exercise tests or can be predicted using demographic variables, body adiposity, vital signs and lifestyles. Aim To elaborate an equation to predict the V̇O 2 max in the absence of cardiopulmonary test in university students. Material and Methods V̇O 2 max was measured directly using a cardiopulmonary test on a treadmill in 121 students aged 22 ± 2 years (59 males). Data about drug and medication use, physical activity [PA], vital signs at rest, and basic anthropometry were collected. The independent variables were included in a multivariate equation and the validity of the model was checked through distribution assumptions and according to the concordance limits of the Bland-Altman diagram. Results The best predictive equation for V̇O 2 max incorporated sex, age, body mass index, blood pressure, heart rate, smoking habits and PA as independent variables. The distributional assumptions were fulfilled (p &gt; 0.05), there were no differences between the equation and the measurement of V̇O 2 max (p = 0.854) with a bias of -0.08 ml·kg·min -1 (95% confidence intervals [-0.95; 0.78]). Conclusions The resulting equation predicts V̇O 2 max based on body adiposity, physiological parameters and life habits. <![CDATA[Entrenamiento físico en personas con enfermedad renal crónica avanzada: beneficios de su implementación en la práctica clínica]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101443&lng=es&nrm=iso&tlng=es Chronic kidney disease is associated with an increase in cardiovascular risk and mortality, and a decrease in the health-related quality of life. It is known that the physical capacity of patients with chronic kidney disease is lower than their healthy counterparts. It also decreases progressively after the start of hemodialysis, even leading to the loss of functional independence. There is a positive association between exercise and improvement of many targets in chronic kidney disease, especially in dialysis patients, such as cellular apoptosis, immune improvement and inflammation. In addition, several clinical studies and systematic reviews show an improvement in different clinical and laboratory variables and suggest a lower mortality, proving a reduction of health care economic costs. Exercise intervention in dialysis is safe. Although different guidelines promote exercise, it is necessary to work on its implementation on a large scale. <![CDATA[Lipodistrofias primarias: presentación clínica y diagnóstico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101449&lng=es&nrm=iso&tlng=es Lipodystrophies are a heterogeneous group of syndromes defined by a severe reduction of the adipose tissue. These can be congenital or acquired. Anatomically, they can be partial or generalized. The etiology of several lipodystrophies is well known. However, the cause of many others remains unknown. The commonest lipodystrophy worldwide is secondary to highly active anti-retroviral therapy in HIV-infected patients. By contrast, primary lipodystrophies (those not associated to any known disease or condition) are much less common and represent a diagnostic challenge. The major complications of lipodystrophies are metabolic, often resulting in severe insulin resistance, diabetes and dyslipidemia. No cure is available for lipodystrophies but the supplementation with recombinant leptin potently controls the metabolic abnormalities when there is a leptin deficiency. Herein, we review the clinical presentation, diagnostic process and therapeutic principles of the main primary lipodystrophy syndromes. <![CDATA[Enfermedades pulmonares intersticiales. Una perspectiva actual]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101458&lng=es&nrm=iso&tlng=es Interstitial lung diseases are a broad, diverse, challenging group of diseases, most of them chronic whose prognosis is not good. In the last two decades there have been considerable advances in the knowledge of the epidemiology, pathological and genetic bases and treatment of several of these diseases. This article summarizes and presents updated information about their classification, new knowledge on genetics and treatments in idiopathic pulmonary fibrosis, advances in the diagnosis and management of hypersensitivity pneumonitis and a review of the broad spectrum of interstitial diseases associated with connective tissue diseases. Several clinical trials are currently underway whose results will be available in the coming years and will provide more information and tools to improve the treatment of these patients. <![CDATA[Recomendaciones de actividad física y ejercicio en el paciente adulto sometido a cirugía bariátrica. Documento de Consenso]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101468&lng=es&nrm=iso&tlng=es Physical exercise is useful in people who underwent bariatric surgery. However, the right dosage is still a topic for discussion. The aim of this article is to consolidate the prescription criteria for physical activity and exercise in bariatric patients. A panel of experts to whom the topics were previously assigned for review, met to reach a consensus. Each topic was presented and subjected to discussion and voting by the participants and attendants who were exercise professionals from different obesity treatment centers. We report the conclusions reached for aerobic exercise, strength training, protein supplementation and physical activity for weight maintenance in bariatric patients. <![CDATA[Glioma difuso de línea media H3K27M positivo en adulto. Caso clínico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101487&lng=es&nrm=iso&tlng=es The 2016 WHO Classification of Tumours of the Central Nervous System incorporates a new diagnostic entity: the mutant diffuse midline glioma H3K27, a tumor with a characteristic location and special molecular biology. We report the case of a 51-year-old male patient with progressive diplopia. The imaging study showed a mesencephalic tumor; the stereotacic biopsy disclosed an Anaplastic Astrocytoma Isocitrate dehydrogenase (IDH) wild type. The molecular study concludes H3K27 mutation. The patient was treated with radiotherapy with concurrent and adjuvant chemotherapy (temozolomide) with partial recovery of the diplopia. <![CDATA[Obesidad y cáncer – Los dos escenarios que Chile liderará]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101491&lng=es&nrm=iso&tlng=es The 2016 WHO Classification of Tumours of the Central Nervous System incorporates a new diagnostic entity: the mutant diffuse midline glioma H3K27, a tumor with a characteristic location and special molecular biology. We report the case of a 51-year-old male patient with progressive diplopia. The imaging study showed a mesencephalic tumor; the stereotacic biopsy disclosed an Anaplastic Astrocytoma Isocitrate dehydrogenase (IDH) wild type. The molecular study concludes H3K27 mutation. The patient was treated with radiotherapy with concurrent and adjuvant chemotherapy (temozolomide) with partial recovery of the diplopia. <![CDATA[La interacción de nuestros genes con el ambiente obesogénico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101493&lng=es&nrm=iso&tlng=es The 2016 WHO Classification of Tumours of the Central Nervous System incorporates a new diagnostic entity: the mutant diffuse midline glioma H3K27, a tumor with a characteristic location and special molecular biology. We report the case of a 51-year-old male patient with progressive diplopia. The imaging study showed a mesencephalic tumor; the stereotacic biopsy disclosed an Anaplastic Astrocytoma Isocitrate dehydrogenase (IDH) wild type. The molecular study concludes H3K27 mutation. The patient was treated with radiotherapy with concurrent and adjuvant chemotherapy (temozolomide) with partial recovery of the diplopia. <![CDATA[Ansiedad y características en expositores de un concurso científico de estudiantes de medicina peruano 2019]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872019001101495&lng=es&nrm=iso&tlng=es The 2016 WHO Classification of Tumours of the Central Nervous System incorporates a new diagnostic entity: the mutant diffuse midline glioma H3K27, a tumor with a characteristic location and special molecular biology. We report the case of a 51-year-old male patient with progressive diplopia. The imaging study showed a mesencephalic tumor; the stereotacic biopsy disclosed an Anaplastic Astrocytoma Isocitrate dehydrogenase (IDH) wild type. The molecular study concludes H3K27 mutation. The patient was treated with radiotherapy with concurrent and adjuvant chemotherapy (temozolomide) with partial recovery of the diplopia.