Características sociodemográficas y clínicas de pacientes diagnosticados con depresión en Centros Comunitarios de Salud Mental (COSAM) de Santiago, Chile / Sociodemographic and clinical characteristics of patients diagnosed with depression in Community Mental Health Centres (COSAM) in Santiago, Chile

Introduction: The study aimed to characterize a sample of depressive patients who attend to Community Mental Health Centres (COSAM) in Santiago, regarding their sociodemographic and clinical characteristics and the associations among these variables. Method: 88 patients treated at 5 different COSAM in Santiago were assessed with self-report questionnaires regarding sociodemographic variables, severity of depressive symptoms (BDI), general and social functioning (OQ-45) and health-related quality of life (SF-36). Descriptive and correlational analyses were performed to describe sociodemographic and clinical features of the participants, and to address the associations between depressive symptomatology, general functioning and quality of life. Results: Participants were mostly women, with chronic and severe depressive symptoms and high frequency of comorbid physical illnesses, they presented reduced quality of life and impairments in general and social functioning. Female gender and a history of physical illness were significant predictors of the severity of depressive symptoms. The latter, in turn, showed moderate to high correlations with the different dimensions of general functioning and quality of life, especially with lack of vitality, impact of health and emotional problems in social life, work and daily activities and, the perception of an impaired mental health. Conclusion: Depressive disorders in patients treated at COSAM are highly limiting and are associated with low quality of life. The observed profile describes mainly women patients with severe chronic symptoms, in whom physical, emotional and personality vulnerabilities are intertwined, suggesting the need for an articulated approach to physical and mental health and therapeutic resources considering these characteristics.

Este estudio describe características sociodemográficas y clínicas en una muestra de pacientes depresivos atendidos en Centros Comunitarios de Salud Mental (COSAM) en Santiago, y explora asociaciones entre estas variables. 88 pacientes consultantes en 5 COSAM fueron evaluados mediante cuestionarios de auto-reporte, respecto a variables sociodemográficas, severidad de los síntomas depresivos (BDI), funcionamiento general y social (OQ-45) y calidad de vida (SF-36). Se realizaron análisis descriptivos y correlacionales para describir características sociodemográficas y clínicas, y estudiar las asociaciones entre variables sociodemográficas y gravedad de la sintomatología depresiva, y entre esta última y el funcionamiento general y calidad de vida. Los participantes fueron mayoritariamente mujeres, con síntomas depresivos crónicos y severos, y alta frecuencia de comorbilidad médica. Presentaron disminución de su calidad de vida y alteraciones en el funcionamiento general y social. Sexo femenino e historia de enfermedad física fueron predictores significativos de gravedad de los síntomas depresivos. Estos, a su vez, mostraron correlaciones significativas con diferentes dimensiones del funcionamiento general y la calidad de vida, especialmente con la falta de vitalidad, impacto de la salud y problemas emocionales en la vida social, trabajo y actividades cotidianas, y percepción de una salud mental deteriorada. Los trastornos depresivos en pacientes atendidos en COSAM son altamente limitantes y están asociados a una baja calidad de vida. El perfil observado describe principalmente mujeres, con sintomatología severa y crónica, en la que se entrelazan vulnerabilidades físicas, emocionales y de personalidad, lo que sugiere la necesidad de un enfoque articulado de la salud física y mental y recursos terapéuticos que consideren estas características.

Manifestaciones cutáneas de los inhibidores del receptor del factor de crecimiento epidérmico (EGFR) / Cutaneous manifestations of epidermal growth factor receptor inhibitor

Los Inhibidores del Receptor del Factor de Crecimiento Epidérmico (EGFRI) son nuevos agentes terapéuticos para el manejo de cánceres como el de pulmón y colorrectal en etapas avanzadas. Pueden ser anticuerpos monoclonales contra el EGFR (Cetuximab, Panitumumab) o inhibidores tirosin-kinasa de bajo peso molecular (Gefitinib, Erlotinib). Estos agentes han demostrado tener un perfil toxicológico sistémico reducido, pero casi siempre producen efectos secundarios a nivel cutáneo. El propósito de este trabajo es revisar los principales efectos cutáneos de estos medicamentos, su fisiopatología y eventuales alternativas terapéuticas, para mejorar así la adherencia al tratamiento.

Epidermal Growth Factor Receptor Inhibitors (EGFRI) are new agents for the treatment of cancers, such as advanced stages of lung and colorectal cancer. They can be monoclonal antibodies against EGFR (Cetuximab, Panitumumab) or low molecular weight EGFR tyrosine kinase inhibitors (Gefitinib, Erlotinib). These agents have demonstrated to have reduced systemic toxicity, but almost always cause secondary dermatologic effects. We review the main cutaneous effects of these drugs, their pathophysiology and possible therapeutic alternatives, to improve patient compliance.

Estudio histomorfológico comparativo del endometrio de ovejas prepúberes de razas de distinta prolificidad / Comparative histomorphological study of prepuberal ewe endometrio of different prolificity races

El objetivo del presente estudio fue sentar bases morfológicas para realizar análisis inmunocitoquímicos e hibridación in situ de la presencia y distribución de receptores de estrógeno y progesterona en ovejas de distinta prolificidad y en distintos planos de nutrición, centrando nuestro interés en el endometrio por su relevancia en los mecanismos reproductivos. Se utilizaron ovejas prepúberes Romney Mash de alta prolificidad (n=2) y Araucanas de prolificidad standard(n=2) de las cuales inmediatamente después del sacrificio se tomaron muestras para estudio histológico del útero, oviducto y ovario. Para el análisis histológico los cortes fueron teñidos con Hematoxilina-Eosina, Van Giesson, Arteta y Ácido Periódico de Schiff (P.A.S.). Los resultados mostraron en las dos razas adecuado desarrollo endometrial, con ßreas carunculares e intercarunculares glandulares bien desarrolladas indispensables estas últimas para una buena implantación y crecimiento del embrión. Las glándulas, numerosas, eran tubulares, tortuosas, algo ramificadas y se extendían hasta el miometrio. No se observaron diferencias histológicas significativas entre ambas razas ni cambios morfológicos durante el transcurso de los días 93 al día 117 post natal, siendo su aspecto similar al de endometrio de la oveja adulta.

The aim of the present study was to sit morphological bases for the inmumocitochemical and hybridazion in situ study of the presence and distribution of estrogen and progesterone receptors in sheep of different prolificity and in different nutrition plane, centering our interest in the endometrium for its relevance in the reproductive mechanisms. We used sheep prepuberal Romney Mash of high prolificity (n=2) and Araucanian of standard prolificity(n=2) Immediately after slaughter uterine tissue was taken for histhological study from uteri , oviduct and ovary. Cross sections were stained with Hematoxilina-eosina, Van Giesson, Arteta and Periodic Acid of Schiff (P.A.S.). The results showed in both races a good endometrial development, with caruncular and glandular intercaruncular glandular areas well defined, the later necessary for embryo implantation and growth the numerous, tubular, coiled, glands, extend to the miometrium. No significant histological differences were observed between both races neither morphological changes between days 93 to 117 of post natal life, being their aspect similar to the endometrium of mature sheep

Conocimientos y hábitos de exposición solar de la población chilena / Sun exposure behaviors and knowledge among Chileans

Background: Ultraviolet light exposure has a pathogenic effect on the development of skin cancer, whose prevalence increases worldwide. In Chile and the rest of the world, preventive educational campaigns are carried out to change high risk sun exposure behaviors. Aim: To study the behavior of the Chilean population towards skin cancer prevention and to identify erroneous preventive practices and concepts. Material and methods: A survey containing 17 questions about sun exposure behaviors, photoprotective measures and knowledge about ultraviolet radiation and skin cancer was used. It was applied during January and February 2004, to 1,143 subjects (mean age 30 years, 409 males), taking vacations in beach resorts in Chile. Results: The hours of higher sun exposure ranged from 12 AM to 4 PM. Thirty seven percent of subjects were exposed more than 2 hours during this high risk lapse. Women and subjects aged less than 25 years were those with the riskiest behaviors. Fifty four percent used some type of photoprotection and 50% used ocular protection. Seventy percent used creams with sun screen and 74% used a sun protection factor higher than 15. Seventy percent applied the sun screen as recommended. Thirty eight percent had at least one sun burn in the last two years. More than 90% of subjects were aware of the relationship between sun exposure and skin cancer but 60% did not know the hours of higher ultraviolet radiation. The information about sun exposure was obtained from television in 57% of surveyed individuals. Conclusions: More educational campaigns about the risk of sun exposure are needed to reduce risky behaviors in the Chilean population.

Diagnóstico diferencial de enfermedades ampollares en el embarazo: a proposito de dos casos clínicos / Differential diagnosis of blistering disease during pregnancy: apropos of two clinical cases

Durante el embarazo se producen algunas enfermedades ampollares, dentro de las cuales las más frecuente es el herpes gestationis o penfigoide del embarazo. Sin embargo, es importante tener en cuenta otros diagnósticos diferenciales. En el presente artículo se revisan, a propósito de dos casos clínicos, los conocimientos actuales sobre el herpes gestationis y sus diagnósticos diferenciales.

Eritema discrómico perstans (dermatosis cenicienta) / Erythema dyschromicum perstans (ashy dermatosis)

El Eritema Discrómico Perstans (EDP) o Dermatosis Cenicienta es una condición poco común y se caracteriza por máculas grisáceas bien definidas y de contornos policíclicos. En la histopatología los hallazgos son característicos, pero no patognomónicos, y corresponden a una dermatitis liquenoide. La causa del EDP continúa siendo un misterio; se han propuesto causas infecciosas, alteraciones del sistema inmune, e incluso, factores ambientales. Para el diagnóstico, la mayoría de las veces el cuadro clínico es muy típico. Aún no existe un tratamiento efectivo probado para el EDP, sin embargo, la clofazimina parece ser la mejor alternativa.

Fototerapia con UVB de banda angosta en pacientes pediátricos: a propósito de un caso clínico / Phototherapy with narrow band UVB pediatrics patients: apropos of a clinical case

En los niños, enfermedades como la psoriasis, dermatitis atópica o pitiriasis liquenoide son enfrentadas inicialmente con tratamientos tópicos; sin embargo, cuando éstos fallan, las siguientes opciones terapéuticas tienen importante efectos adversos (metotrexato, ciclosporina, acitretin), situación en la cual se presenta la fototerapia como una alternativa posible. Recientemente, el uso selectivo de luz ultravioleta centrado en un rango de longitud de onda entre 310-311 nm (UVB-banda angosta) ha demostrado ser más efectivo y menos eritematógeno que la fototerapia convencional de banda ancha.

Aneurisma aórtico abdominal en pacientes mayores de 80 años: tratamiento quirúrgico convencional en 80 casos consecutivos / Abdominal aortic aneurysms in patients over 80 years of age: conventional surgical treatment in 80 consecutive cases

BACKGROUND: Abdominal aortic aneurysms (AAA) may be lethal unless appropriately and timely treated. Since age is a surgical risk, octogenarians are usually not considered as candidates for surgical intervention. AIM: To asses surgical complications and mortality in octogenarians treated for AAA. SUBJECTS AND METHODS: Patients aged 80 years older, treated consecutively between 1984-2001 were retrospectively analyzed. RESULTS: Sixty one patients were male, and their age ranged from 80 to 95 years. All were treated with open surgery. The operation was elective in 58 and as an emergency in 22 patients (symptomatic or ruptured AAA). Aortic diameter was 6.8 +/- 1.4 cm in asymptomatic patients and 7.7 +/- 1.8 cm in emergency cases (p = 0.024). Thirty days postoperative mortality was 5.1% in elective surgery compared to 40.6% in emergency operations (p < 0.01). Five years survival rate was 44.7% in asymptomatic patients compared to 10.4% in the emergency cases (p < 0.023). CONCLUSIONS: Elective surgery for asymptomatic AAA can be performed with low operative mortality in octogenarians. However, surgery in emergency cases has an 8 fold increase in risk. Accordingly, octogenarian patients should be considered for elective AAA repair in a selective basis.

Frecuencia de aneurisma aórtico abdominal en población adulta con factores de riesgo conocidos / Frequency of abdominal aortic aneurysms in adult population with known risk factors

BACKGROUND: The incidence of abdominal aortic aneurysms has increased. Its predisposing factors are smoking, high blood pressure and dislipidemia. Progressive aneurysmal enlargement may lead to its rupture, which is associated to a mortality rate above 80 per cent. AIM: To assess the prevalence of abdominal aortic aneurysms in Chilean subjects with cardiovascular risk factors. SUBJECTS AND METHODS: Through announcements in open media we invited individuals aged over 60 years, who smoked, had hypertension and/or had occlusive arterial disease, to participate in a study that included medical history and physical examination. An aortic ultrasound was performed in all subjects in whom the aorta was not palpable or there was a suspicion of dilatation. Aortic diameter over 3 cm was considered aneurysmal. RESULTS: Three hundred fifty six subjects aged 67.1 +/- 6.7 years, (73.9 per cent males), were evaluated. The study group included 62 per cent hypertensives, 39 per cent with abnormal lipids and 46 per cent smokers. Known coronary heart disease or peripheral arterial diseases were present in 14 per cent and 10 per cent, respectively. Ultrasound was required in 159 subjects. Aneurysms were detected in 21 persons (5.9 per cent), 7.6 per cent in males and 1.1 per cent in females. The mean transverse diameter of the aneurysm was 4.1 cm (3-7.5). Aneurysm was found in 2.3 per cent of subjects younger than 65 years and 8.3 per cent of subjects aged over 65 years. CONCLUSIONS: In this sample the prevalence of abdominal aortic aneurysms was 5.9 per cent, affecting predominantly males, with a notorious increase with advanced age.