Incidencia de infarto agudo de miocardio en Chile, 2008-2016 / Incidence of acute myocardial infarction in Chile between 2008 and 2016

Background: There is no recent information on the incidence of acute myocardial infarction (AMI) in Chile. Aim: To describe and evaluate the temporal incidence trend of AMI in Chile between 2008 and 2016. Material and Methods: A time series study. We included all AMI cases (ICD10 = I21) that were registered in Chile between 2008 and 2016 in the national hospital discharge and death databases. Rates were stratified according to sex and age group. We calculated crude and standardized rates (direct method). Time trends were evaluated using Prais-Winsten (PW) regression models. Results: There were 132,784 cases of AMI. The mean age of cases was 67 ± 14 years, 67% were men. Crude and standardized rates were 84.4 and 73.1 cases per 100,000 inhabitants, respectively. Standardized incidence increased in total population and women, whose PW coefficients were 0.43 (0.01-0.82; p = 0.045) and 0.26 (0.005-0.47; p = 0.02), respectively. Regarding age, an upward trend was observed in the younger age groups, whose coefficients were 0.20 (0.08 − 0.31; p = 0.004) for cases < 45 years, 1.31 (0.81-1.81; p < 0.01) for cases between 45 and 54 years, and 2.68 (1.31 − 4.04; p = 0.002) for cases between 55 and 64 years. Conclusions: An increase in the number of cases with AMI was observed, especially in younger age groups. This estimation could be useful for planning and evaluating public policies.

Electrocirugía en procedimientos dermatológicos en pacientes portadores de dispositivos eléctricos cardíacos implantables / Electrosurgery in dermatological procedures in patients with implantable cardiac electrical devices

Debido al acelerado envejecimiento de la población, cada vez es mayor la cantidad de usuarios portado-res de dispositivos electrónicos cardíacos implan-tables (DECI). Muchos de estos pacientes se verán enfrentados a procedimientos dermatológicos que con frecuencia utilizan equipos de electrocirugía. Es-tos tienen riesgo potencial de producir interferencias electromagnéticas (IEM), y por lo tanto alterar el fun-cionamiento de estos dispositivos. Si bien no todos los DECI tienen las mismas características, las nuevas tec-nologías de estos dispositivos han disminuido, aunque no eliminado completamente, el riesgo de IEM. Este artículo tiene como propósito revisar el tema y recopilar las recomendaciones generales que todo dermatólogo debe conocer tanto en la fase preoperatoria, intraoperatoria, como postoperatoria al utilizar equipos de electrocirugía en un paciente con DECI.

Due to the accelerated population aging, an increa-sing number of users is carrying cardiac implantable electronic devices (CIEDs). Many of these patients will face dermatological procedures that often use electrosurgical equipment. The latter has the poten-tial to produce electromagnetic interference (EMI), and therefore alter the operation of these devices. While not all CIEDs have the same characteristics, new technologies for these devices have decreased if not eliminated completely the risk of EMI.The purpose of this article is to review CIED topic and compile general recommendations that every dermatologist should be aware of, both in the preoperative, intraoperative, and postoperative phases when using electrosurgery equipment in a patient with CIED.

Variación estacional de las hospitalizaciones por infarto agudo de miocardio según sexo y edad en Chile / Seasonal variation in hospital admissions due to acute myocardial infarction according to sex and age in Chile

Background: The incidence of acute myocardial infarction (AMI) varies according to seasonality, being higher in winter. The effect of sex on this phenomenon is not clear. Aim: To evaluate the effect of seasonality in men and women hospitalized for AMI at different ages. Material and Methods: We included all patients with a primary diagnosis of AMI admitted in public and private hospitals in Chile during 2002-2011 (codes I21-I22, of the tenth international classification of diseases). We obtained data from the National Discharge databases available at the Ministry of Health website. We estimated the number of discharges per month and per seasonality (cold /template), and the Standardized Incidence Ratio (SIR) with the formula: number of observed cases/expected cases (average annual hospitalizations), stratified by sex and age (< 50 years, 50-64 years, 6574 years, ≥ 75 years). We evaluated the effect of sex with binomial regressions for the different age strata. Results: We assessed 59,557 AMI hospitalizations (69% men, with and without ST elevation segment). May, June and July (austral winter) had a SIR of 1.10; 1.12 and 1.10, respectively. Women had a 20% excess of hospitalizations during cold seasons at any age. In men, the excess of hospitalizations increased from 9% in those aged < 50 years to 21% in those ≥ 75 years (p = 0.043). When comparing women and men, women aged < 50 years showed the higher risk of being hospitalized during cold seasons (adjusted risk ratio = 1.06; 95% confidence intervals 1.01-1.13). Conclusions: Women have a stronger seasonal pattern in AMI hospitalizations than men. While this effect increases with age in men, in women it remains constant at all ages.

Tendencia en la sobrevida de pacientes hospitalizados por infarto agudo de miocardio según nivel socioeconómico: Chile, 2002-2012 / Association between socioeconomic status and survival after a first episode of myocardial infarction

Background: A low socioeconomic status is associated with higher overall mortality rates. Aim: To assess the effect of socioeconomic inequalities on survival of patients hospitalized with a first myocardial infarction. Material and Methods: Analysis of hospital discharge and mortality databases of the Ministry of Health. Patients aged over 15 years discharged between 2002 and 2011 with a first myocardial infarction (code I-21, ICD-10) were identified. Their survival was verified with the mortality registry. Survival from 0 to 28 and from 29 to 365 days was analyzed. Socioeconomic status was determined using the type of health insurance, stratified as public insurance (low and medium status) and private insurance (high status). Prais-Winsten trend (P-W) and Cox survival analyses were done. Results: We analyzed 59,557 patients (69% males). Sixty three percent were of low socioeconomic status, 19% medium and 18% high. Between 2002 and 2011 the increase in survival was higher among patients of low socioeconomic status, mainly in women (P-W coefficients 0.58:0.31-0.86 in men and 1.12:0.84-1.41 in women for 0-28 days survival and 0.24:0.09-0.39 in men and 0.48:0.37-0.60 in women for 29-365 days survival, respectively). However, age and year of hospitalization adjusted analysis showed a higher mortality risk among patients of low socioeconomic status at 0-28 days (HR 1.67:1.53-1.83 for men and 1.49:1.34-1.66 for women) and at 29-365 days (HR 2.30:1.75-2.71 for men and 1.90:1.56-1.85 for women). Conclusions: Survival after a myocardial infarction improved in the last decade especially in patients of low socioeconomic status. However, subjects of this stratum continue to have a higher mortality.

Manejo médico de la hiperhidrosis / Medical management of hyperhidrosis

La hiperhidrosis es un aumento patológico de la sudoración, que puede asociarse a patologías médicas y fármacos, afectando en forma significativa la calidad de vida. La hiperhidrosis focal primaria es una patología común, cuyo manejo es un desafío. Están disponibles múltiples terapias para el tratamiento de hiperhidrosis, incluyendo productos tópicos, iontoforesis, toxina botulínica, fármacos sistémicos, cirugía y nuevos equipos para destrucción selectiva de las glándulas sudoríparas. El propósito de este artículo es revisar la literatura, enfocándose en las terapias no quirúrgicas y opciones de tratamiento emergentes.

Hyperhidrosis is a pathological excessive sweating. It can be associated with medical conditions or drugs and affect significantly the quality of life. Primary focal hyperhidrosis is a common disorder for which treatment is often a therapeutic challenge. Multiple therapies are available for the treatment of hyperhidrosis, including topical products, iontophoresis, botulinum toxin, systemic medications, surgery and new devices aimed at the destruction of ecrine glands. The purpose of this article is to review the literature, with a focus on non-surgical therapies and emerging treatment options.

Suturas: lo usual y lo nuevo / Sutures: the usual and the new

En la actualidad, existen numerosas estrategias para enfrentar el cierre de una herida quirúrgica. Éstas son suturas, corchetes y adhesivos, teniendo cada una de ellas indicaciones precisas. Las suturas constituyen la estrategia más antigua, existiendo en la actualidad una gran variedad de suturas absorbibles y no absorbibles con distintas características. El presente documento hará una breve revisión de las suturas existentes y abordar algunas líneas de desarrollo nuevos métodos de cierre de heridas, orientadas principalmente a reducir la incidencia de complicaciones.

Nowadays, there are numerous strategies to close a surgical wound. These are sutures, staples and adhesive materials. Each one has precise indications. Sutures are the most antique strategy and there are multiple absorbable and non-absorbable sutures with different characteristics. This document will review actual sutures and will discuss some new advances in wound closures in order to reduce complications.

Endocarditis infecciosa: características clínicas, complicaciones y mortalidad en 506 pacientes y factores pronósticos de sobrevida a 10 años (1998-2008). Estudio cooperativo nacional en endocarditis infecciosa en Chile (ECNEI-2) / Clinical characteristics, complications and mortality in 506 patients with infective endocarditis and determinants of survival rate at 10 years

Background: Rates ofmorbidity and mortality in Infective Endocarditis (IE) remain high and prognosis in this disease is still difficult and uncertain. Aim: To study IE in Chile in its active phase during inpatient hospital stay and long term survival rates. Material and Methods: Observational prospective national cohort study of 506 consecutive patients included between June 1,1998 and July 31, 2008, from 37 Chilean hospitals (secondary and tertiary centers) nationwide. Results: The main findings were the presence of Rheumatic valve disease in 22.1 % of patients, a history of intravenous drug abuse (IVDA) only in 0.7%, the presence of Staphylo-coccus aureus in 29.2% of blood cultures, negative blood cultures in 33.2%, heart failure in 51.7% and native valve involvement in 86% ofpatients. Echocardiographic diagnosis was achieved in 94% of patients. Hospital mortality was 26.1% and its prognostics factors were persisting infection (Odds ratio (OR) 6.43, Confidence Interval (CI) 1.45-28.33%), failure of medical treatment and no surgical intervention (OR 48.8; CI 6.67-349.9). Five and 10 years survival rates were 75.6 and 48.6%, respectively. The significant prognostic factors for long term mortality, determined by multivariate analysis were the presence of diabetes, Staphylococcus aureus infection, sepsis, heart failure, renal failure and lack of surgical treatment during the IE episode. Conclusions: The microbiologic diagnosis of IE must be urgently improved in Chile. Mortality rates are still high (26.1%) partly because of a high incidence of negative blood cultures and the need for more surgical valve interventions during in-hospital period. Long term prognostic factors for mortality should be identified early to improve outcome.

Incidencia y letalidad por infarto agudo del miocardio en Chile: 2001-2007 / Incidence and case fatality due to acute myocardial infarction in Chile in the period 2001-2007

Background: Acute myocardial infarction (AMI) causes 73.6 percent of coronary heart disease (CHD) deaths in Chile. Aim: To estimate the incidence and case fatality of AMI and analyze their trends between 2001-2007. Material and Methods: A time-series study analyzing all cases of AMI (according to the International Classification of Diseases (ICD)-10, I21 code), registered in the National Hospitalizations and Death databases. Annual incidence rates and case fatality by sex and age groups were calculated. The direct method was used to standardize rates by age, using the World Health Organization 2000 Population. Prais-Winsten regression models were used to evaluate trends, expressed as relative change. Results: Between 2001 and 2007, we estimated that 83,754 cases of AMI occurred. Standardized annual incidence rate was 74.4 per 100,000 inhabitants (98.0 in men and 51.0 in women). Incidence rates increased by 34 percent in individuals < 45 years of age and 9.2 percent in the group 55-64 years (p < 0.001, both). Total case fatality was 49.5 percent (45.4 percent in men and 57.2 percent in women; p < 0.001), and its trend analysis showed a significant annual reduction of 1.2 percent in men and 0.81 percent in women. In-hospital case fatality was 14.2 percent (11.3 and 20.4 percent in men and women, respectively; p < 0.001). There was a significant annual reduction of mortality (0.57 and 1.01 percent in men and women, respectively (p < 0.05). Conclusions: The incidence of AMI was stable in the whole population, but increased in younger age groups. Total and in-hospital case-fatality decreased. Despite the greater reduction of case fatality in women, they still have a higher risk of dying while in hospital.

Mortalidad por cardiopatía isquémica en Chile: quiénes, cuántos y dónde / Mortality from ischemic heart disease in Chile: who, how many, and where

OBJETIVO: Describir las características de la mortalidad por cardiopatía isquémica en Chile y su evolución temporal, e identificar los factores asociados a mortalidad extrahospitalaria por esta patología entre 1997 y 2007. MÉTODOS. Estudio de serie temporal que utiliza las bases de defunciones del Departamento de Estadísticas e Información en Salud entre 1997 y 2007. De un total de 917 029 muertes notificadas, se seleccionaron aquellas cuya causa primaria fue cardiopatía isquémica (códigos I20 a I25 de la CIE-10). Se calcularon tasas crudas y ajustadas por edad y sexo para analizar la tendencia. Se analizaron las características de la mortalidad según el lugar de defunción, evaluando posibles factores asociados a mortalidad extrahospitalaria (casa/habitación u otro lugar), incluidos edad, ruralidad, estado civil, educación y sexo, así como el efecto de la incorporación del infarto agudo al miocardio a la ley de garantías en salud (GES), con regresión binomial. RESULTADOS: Durante el período estudiado se notificaron 87 342 muertes por cardiopatía isquémica, de las cuales 57,7 por ciento eran hombres y 59,5 por ciento ocurrieron fuera del hospital. La tasa de mortalidad ajustada por edad disminuyó de 52,9 a 40,4 por 100 000 habitantes. Los factores asociados a mortalidad extrahospitalaria en hombres fueron ruralidad, riesgo relativo (RR) 1,24 (1,21-1,27); edad mayor a 70 años, RR 1,03 (1,01-1,05); estado civil soltero, RR 1,10 (1,08-1,12), mientras que en las mujeres los valores correspondientes fueron 1,13 (1,10-1,18); 1,31 (1,27-1,36) y 1,07 (1,04-1,09). La adopción de la GES se asoció con un aumento en el porcentaje de muertes intrahospitalarias en mujeres, RR 0,95 (0,92-0,97). CONCLUSIONES: †La mortalidad por cardiopatía isquémica en Chile ha disminuido. El mayor porcentaje de las muertes ocurren fuera de hospitales o clínicas. Los factores asociados a mortalidad extrahospitalaria en ambos sexos fueron edad avanzada, estado civil soltero y ruralidad.

OBJECTIVE: To describe the characteristics of mortality from ischemic heart disease in Chile and its trend over time, and to identify the factors associated with extra-hospital mortality from this pathology between 1997 and 2007. METHODS: A time-series study was conducted using the mortality database of the Department of Health Statistics and Information for 1997 to 2007. Of the total of 917 029 deaths reported in this period, those whose primary cause was ischemic heart disease (ICD-10 codes I20-I25) were selected. Crude and adjusted rates were calculated by age and sex in order to analyze the trend. Mortality characteristics were analyzed by the place of death, evaluating potential factors associated with extra-hospital mortality (death at home or elsewhere outside a hospital or clinic). The factors considered, using binomial regression, were age, rurality, marital status, education, and sex, as well as the effect of the incorporation of acute myocardial infarction into the explicit health guarantees law. RESULTS: During the period in question, 87 342 deaths from ischemic heart disease were reported, 57.7 percent of which were in males and 59.5 percent outside the hospital. The age-standardized mortality rate declined from 52.9 to 40.4 per 100 000 population. Factors related to extra-hospital mortality in men were rurality, relative risk (RR) 1.24 (1.21-1.27); age of over 70 years, RR 1.03 (1.01-1.05); and being single, RR 1.10 (1.08-1.12). In women, the respective values were rurality, 1.13 (1.10-1.18); advanced age, 1.31 (1.27-1.36); and being single, 1.07 (1.04-1.09). Passage of the explicit health guarantees law was associated with an increase in the percentage of in-hospital deaths in women, RR 0.95 (0.92-0.97). CONCLUSIONS: Mortality from ischemic heart disease in Chile has declined. The majority of deaths from this cause occur outside hospitals or clinics. The factors associated with extra-hospital mortality in both sexes were advanced age, being single, and rurality.

Análisis de la tendencia de la mortalidad por cirrosis hepática en Chile: Años 1990 a 2007 / Mortality trend from liver cirrhosis in Chile from 1990 to 2007

Background: There is a worldwide tendency towards a reduction in the rates of deaths due to cirrhosis. In Chile, a decrease in the number of hospital admissions due to this disease has been recorded. Aim: To assess general characteristics and temporal evolution of liver cirrhosis mortality in Chile between 1990 and 2007. Material and Methods: National death records and population databases were reviewed. Crude and age-adjusted mortality rates for alcoholic and non-alcoholic cirrhosis were calculated, evaluating their evolution in the study period and the relative risk by gender. Results: In the study period, 44,894 deaths caused by cirrhosis were recorded. Mortality rate was 16.6 deaths per 100,000 inhabitants. 54 percent of deaths were attributed to non-alcoholic cirrhosis. There was a reduction in mortality rates for both types of cirrhosis. Males accounted for 83 and 65 percent of deaths caused by alcoholic and non-alcoholic cirrhosis, respectively. The figures for relative risk of death were 5 and 1.9, respectively. Conclusions: Alcoholic cirrhosis was the preponderant cause among liver cirrhosis deaths. A decrease in mortality rates was observed in the study period. Improvements in disease treatment and control could possibly explain this trend.