Telemedicina en el control de la hipertensión arterial

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Introduction: Arterial hypertension is the great challenge of health policies in the world. Its high prevalence, the lack of control (linked to poor adherence to antihypertensive treatment) and its high "burden" (as a non-communicable disease) are responsible for the increase in cardiovascular morbidity and mortality. Objetive: To evaluate, as a pilot test, the benefit of real-time telemonitoring applied to blood pressure (BP) control. Metodology: Inclusion criteria: Diagnosed hypertensives, under pharmacological treatment, assisted in the Maciel Hospital polyclinic in the period June-October 2019. Exclusion criteria: pregnancy and upper arm circumference less than 22 cm or greater than 42 cm. Home blood pressure monitoring was implemented, using a validated electronic blood pressure monitor and a smart cell phone connected to a private web platform in real time. Analytical, experimental, prospective study. Qualitative variables were expressed in absolute frequency and percentage relative frequency. Quantitative variables were expressed as mean and standard deviation. The normality of the distribution was verified using the Kolmogorov Smirnov test. Results: Of a total of 57 patients, the mean age was 59 ± 12.8 years, female sex 64.9%. Presenting 22.8% poor knowledge of the disease. Regarding the control of BP figures, 31.6% reported not checking regularly. Adherence to pharmacological treatment at the beginning of the monitoring was 33.3%. Figures lower than those described by RENATA-2, where half of the treated hypertensives complied with the treatment. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analyzed at the beginning and end of the study. Pre-monitoring measurements were mean SBP: 138.6 ± 17.8 mmHg and mean DBP: 85.4 ± 14.8 mmHg. The records at the end of the immediate monitoring were 131.5 ± 19.9 mmHg and 81.5 ± 14.2 mmHg for PAS and PAD, respectively. Finding a significant difference between the means of the PAS (p 0.019), but not between the means of the DBP (p 0.06). Discussion: Although the percentage of patients achieving good BP control was significant, these results may be closely related to a subtype of observed performance bias, rather than the outcome of the intervention. The mean days of telemonitoring were 8, 85, number of shots was 34.12, and number of interventions performed by the observer (medication change) was 0.30. User satisfaction with the method used was 96.4%, and 100% considered it Easy or very easy to use. 87.5% would use it for long periods of time, including older adults. Conclusions: The studied method shows potential benefits for the control of BP figures, with a wide acceptance by users, facilitating access to the health system, and quality medical care.

Introdução: A hipertensão arterial é o grande desafio das políticas de saúde no mundo. Sua alta prevalência, o descontrole (ligado à baixa adesão ao tratamento anti-hipertensivo) e sua alta "carga" (como doença não transmissível) são responsáveis ​​pelo aumento da morbimortalidade cardiovascular. Objetivo: foi avaliar como teste piloto, o benefício do telemonitoramento em tempo real, aplicado ao controle da pressão arterial (PA). Metodologia: Critérios de inclusão: Hipertensos diagnosticados, em tratamento farmacológico, atendidos na policlínica do Hospital Maciel no período de junho a outubro de 2019. Critérios de exclusão: gravidez e circunferência do braço menor que 22 cm ou maior que 42 cm. Foi implementado o monitoramento domiciliar da pressão arterial, utilizando um monitor eletrônico de pressão arterial validado e um telefone celular inteligente conectado a uma plataforma web privada em tempo real. Estudo analítico, experimental, prospectivo.As variáveis ​​qualitativas foram expressas em frequência absoluta e frequência relativa percentual. As variáveis ​​quantitativas foram expressas como média e desvio padrão. A normalidade da distribuição foi verificada por meio do teste de Kolmogorov Smirnov. Resultados: De um total de 57 pacientes, a média de idade foi de 59 ± 12,8 anos, sexo feminino 64,9%. Apresentando 22,8% conhecimento ruim sobre a doença. Em relação ao controle dos valores da PA, 31,6% relataram não verificar regularmente. A adesão ao tratamento farmacológico no início do acompanhamento foi de 33,3%, valores inferiores aos descritos pelo RENATA-2, onde metade dos hipertensos tratados aderiu ao tratamento. A pressão arterial sistólica (PAS) e a pressão arterial diastólica (PAD) foram analisadas no início e no final do estudo. As medições de pré-monitoramento foram PAS média: 138,6 ± 17,8 mmHg e PAD média: 85,4 ± 14,8 mmHg. Os registros ao final do monitoramento imediato foram de 131,5 ± 19,9 mmHg e 81,5 ± 14,2 mmHg para PAS e PAD, respectivamente. Encontrando diferença significativa entre as médias do PAS (p 0,019), mas não entre as médias do DBP (p 0,06). Discussão: Embora a porcentagem de pacientes que alcançaram um bom controle da PA tenha sido significativa, esses resultados podem estar intimamente relacionados a um subtipo de viés de desempenho observado, e não ao resultado da intervenção. A média de dias de telemonitoramento foi 8, 85, o número de disparos foi 34,12, e o número de intervenções realizadas pelo observador (mudança de medicação) foi de 0,30. A satisfação dos usuários com o método utilizado foi de 96,4%, sendo que 100% consideraram fácil ou muito fácil de usar. 87,5% usariam por longos períodos de tempo, inclusive idosos adultos. Conclusões: O método estudado apresenta potenciais benefícios para o controle dos valores da PA, com ampla aceitação pelos usuários, facilitando o acesso ao sistema de saúde e assistência médica de qualidade.

Hematoma retroperitoneal como presentación de cáncer testicular / Retroperitoneal hematoma debut as testicular cancer

Resumen Introducción: El hematoma retroperitoneal (HR) es una enfermedad infrecuente con una elevada morbimortalidad, siendo complicado cuando se presenta con dolor y shock hipovolémico. Presentación del caso: Paciente del sexo masculino, de 20 años de edad, sin antecedentes mórbidos. Ingresa en Urgencias por dolor abdominal en el flanco izquierdo, irradiado a dorso y testículo ipsilateral, de 6 h de evolución, de inicio súbito e intensidad severa; el paciente está pálido, hemodinámicamente estable, sin signos de irritación peritoneal. Se solicita pielo-TC por sospecha de litiasis ureteral, que muestra un extenso HR, probable aneurisma aórtico roto. Una angio-TC informa HR adyacente y anterior a psoasilíaco izquierdo, de20 × 11 × 8,5 cm, volumen 972 cc, adenopatías retroperitoneales paraaórticas bilaterales sangrantes y múltiples nódulos pulmonares bilaterales indicativos de diseminación secundaria. Se constata testículo derecho duro, de tamaño normal, eco testicular con masa sólida quística, que indica de lesión orgánica. Discusión: Trauma y enfermedad tumoral son las principales causas de HR. El cáncer testicular suele presentarse en pacientes jóvenes, requiriendo una pronta derivación y estudio debido a su rápida progresión. En nuestro caso, el HR fue un hallazgo imagenológico, destacando que el sangrado de un conglomerado de adenopatías es anecdótico.

Abstract Introduction: Retroperitoneal hematoma (RH) is a rare disease with high morbidity, being complicated when presented with pain and hypovolemic shock. Case report: Male, 20 years old, no morbid history. Arrive to Emergency Service for abdominal pain in the left flank radiating to the back and ipsilateral testis, 6 h of evolution, sudden onset, high intensity; pacient pale, hemodynamically stable without signs of peritoneal irritation. Pielo-TC is requested on suspicion of ureteral stones showing extensive RH, likely ruptured aortic aneurysm. CT angiography reports RH and adjacent preceding left iliopsoas, 20 × 11 × 8.5 cm, volume 972 cc, retroperitoneal bleeding bilateral para-aortic lymphadenopathy and multiple bilateral pulmonary nodules suggestive of secondary spread. Hard right testicle with normal size, testicular ultrasound pointing solid cystic mass, suggestive of organic lesion. Discussion: Trauma and tumor pathology are the main causes of RH. Testicular cancer usually occurs in young patients, requiring early referal and study because of its rapid progression. In our case, the HR was an imaging finding, highlighting that the bleeding of a cluster of lymph nodes is anecdotal.

The role of a national scientific association of medical students: The Chilean experience / El papel de una asociación científica nacional de estudiantes de medicina: La experiencia chilena

There are many reasons which biomedical research is needed, emphasizing the search for new solutions to health problems. Declining physician-scientists and need replacement has been described some years ago in countries like the United States of America (USA) and Chile (1-2). The physician-scientists have the task of linking the laboratory to clinical practice and public health. Have been reported from the undergraduate research is associated with further research in professional performance (3).

Son muchas las razones por las que se necesita investigación biomédica, destacando la búsqueda de nuevas soluciones a los problemas de salud. Los médicos-científicos en declive y la necesidad de reemplazo se han descrito hace algunos años en países como los Estados Unidos de América (EE. UU.) Y Chile (1-2). Los médicos-científicos tienen la tarea de vincular el laboratorio con la práctica clínica y la salud pública. Se han informado a partir de la investigación de pregrado que se asocia con una mayor investigación en el desempeño profesional (3).

Test de Tolerancia a la Glucosa para diagnóstico de Diabetes Mellitus tipo 2 y sus estadios previos, experiencia de un Centro de Salud Primaria de Chile: Estudio preliminar / Test of Glucose Tolerance for diagnosis of type 2 Diabetes Mellitus and its previous stages, experience of a Primary Health Center of Chile: Preliminary study

El objetivo de este estudio fue caracterizar a los pacientes con sospecha de diabetes mellitus tipo 2 con glicemia en ayunas previa menor a 126 mg/dl diagnosticados precozmente a través del test de tolerancia a la glucosa. Se realizó un estudio descriptivo transversal, en el Centro de Salud Familiar Violeta Parra de Chillán-Chile. La población estudiada fueron los pacientes con glicemias en ayuno menores de 126 mg/dl, que ingresaron al monitoreo de sospecha de diabetes mellitus tipo 2, a los cuales se les realizó el test de tolerancia oral a la glucosa. Se realizó la revisión de los registros de pacientes que ingresaron entre julio y diciembre de 2011 a monitoreo para diagnóstico de diabetes mellitus tipo 2. Las principales medidas del estudio fueron la frecuencia de diagnóstico de diabetes mellitus tipo 2 y de los estadios pre-diabéticos. Se usó estadística descriptiva para el análisis de los datos, de 364 registros de pacientes en monitoreo, se excluyeron 61 por haber sido ingresados al monitoreo sin test de glicemia en ayunas, de los 303 pacientes con registros adecuados, a 49 (16, 1%) se les diagnosticó diabetes mellitus tipo 2, de éstos 14(4,6%) habían presentado glicemia en ayunas de 110 mg/dl o menos, 176 (58%) pacientes presentaron alteraciones pre-diabéticas y 89 (29,3%) pacientes no presentaron alteraciones. Un alto porcentaje que no sería diagnosticado como diabetes mellitus tipo 2 logra serlo a través del test de tolerancia a la glucosa, lo que justifica la realización del mismo.

The Objective of this study was to characterize patients with suspected diabetes mellitus type 2 with fasting glucose less prior to 126mg/dl diagnosed early through the test of glucose tolerance.We did a cross sectio-nal study in the Family Health Center Violeta Parra de Chillan, Chile. The populations studied were patients with fasting blood glucose less than 126mg/dl, who entered the monitoring of suspected diabetes mellitus 2, to which test they performed oral glucose tolerance. A revision of the records of patients admitted from July to December 2011 monitoring for diagnosis of type 2 diabetes mellitus.The main measures of the study were the frequency of diagnosis of type 2 diabetes mellitus and other pre diabetic stage. Descriptive statistics were used to analyze the data. Of 364 patient records 61 were exclused for being admitted to monitoring blood glucose test without fasting. Of the 303 patients with adequate records, 49 (16.1%) were diagnosed with type 2 diabetes mellitus, of these 14 (4.6%) had fasting glucose of 110mg/dL or less. Pre-diabetes abnormalities had 176 (58%) patients. Only 89 (29.3%) patients showed no abnormalities. A high percentage would not be diagnosed as type 2 diabetes mellitus be achieved through the test of glucose tolerance, which justifies the realization.

Tratamiento con altas dosis de corticoides de Púrpura Trombocitopénica Inmune en paciente con Diabetes Mellitus y Obesidad Mórbida, un desafío metabólico / Treatment of Inmune Thrombocytopenic Purpura whit high doses of steroids in patients with Diabetes Mellitus and Morbid Obesity, a metabolic challenge

El manejo de la púrpura trombocitopénica inmune con altas dosis de corticoides en pacientes con diabetes mellitus y obesidad mórbida no está definido. Mujer de 64 años con obesidad mórbida, diabetes mellitus 2 y púrpura trombocitopénico inmune presenta trombocitopenia severa de 2 000 plaquetas asociada a equimosis extensas en ambas extremidades inferiores y glicemia descompensada. Se inició tratamiento con Metilprednisolona 500mg por tres días y luego Prednisona 60mg/día, al quinto día se aumentó dosis a 1 1 0mg/día. Se usó Metformina (850mg, tres veces al día), insulina NPH e insulina cristalina, logrando pasar de una glicemia capilar promedio de 322mg/ dl (primer día) a 122mg/dl (decimotercer día). Al decimocuarto día, con 86 000 plaquetas, fue dada de alta con tratamiento vía oral y control en policlínico. Se logró compensación metabólica con altas dosis de insulina NPH y Metformina. Es posible usar altas dosis de corticoides en pacientes con diabetes mellitus 2 y obesidad mórbida.

The immune thrombocytopenic purpura management with high doses of corticosteroids in patients with diabetes mellitus and morbid obesity is not defined.A 64 years old woman with morbid obesity, type 2 diabetes mellitus and immune thrombocytopenic purpura, presents sever thrombocytopenia with 2000 platelets, associated to extensive bruising in both legs and decompensate glucose. It was treated with Methylprednisolone 500 mg for three days and then Prednisone 60 mg/day, at the fifth day the dose was increased to 110 mg/day. Metformin was used (859 mg/ three times daily), NPH insulin and crystalline insulin achieving an average capillary glycemia of 322 mg/dl (first day) and 122 mg/dl (thirteenth day). At the fourteenth day with a recount of 86000 platelets she was discharged with oral treatment and clinical control. Metabolic compensation was achieved with high doses of NPH insulin and Metformin. It is possible to use high doses of corticosteroids in patients with type 2 diabetes mellitus and morbid obesity.