Asociación entre deterioro del flujo espiratorio máximo y prevalencia de enfermedades cardiovasculares y metabólicas en población adulta chilena: hallazgos preliminares de la Cohorte del Maule (MAUCO) / Peak expiratory flow and prevalence of cardiovascular and metabolic diseases in a Chilean adult population: preliminary findings from the Maule Cohort (MAUCO)

Introducción: La enfermedad respiratoria crónica determina alta morbimortalidad y frecuencia de comorbilidades cardiometabólicas. Evaluamos la asociación entre flujo espiratorio máximo (FEM) y algunas condiciones cardiometabólicas en adultos de una zona semirural, en la medición basal de la cohorte MAUCO (MAUle COhort). Material y Método: Estudio transversal (3.465 adultos, 40-74 años). Se midió el flujo espiratorio máximo (FEM) (mini-Wright, estándar ATS) utilizándose valores de Gregg y Nunn (FEM deteriorado ≤ 80% del teórico). Se obtuvo autorreporte/mediciones de hipertensión arterial (HTA), enfermedad cerebrovascular (ECV), infarto al miocardio (IAM), diabetes mellitus 2 (DM2), presión arterial, glicemia, colesterol, peso y talla. Actividad física y tabaquismo se evaluaron por encuesta, previa aprobación Ética. Se calcularon medidas de asociación, prevalencia y Odds Ratio (OR). Resultados: Muestra de 63,9% de mujeres edad media 55 (± 9) años, escolaridad media 9 (± 4) años. 84,7% tuvo exceso de peso, 81,5% inactividad física 29,4% fumadores actuales. Prevalencia de FEM bajo: 50,6% (IC 95% 48,9-52,3). El autorreporte fue: ACV 2,2% IAM 3,3, sospecha de hipertensión 24% y DM2 2,7%. Los OR crudos fueron significativos en mujeres que autorreportaron HTA, ECV, IAM y autorreporte/sospecha de DM2, y en hombres con autorreporte de ECV, sospecha de DM2 y autorreporte/sospecha de HTA. La asociación se mantuvo post-ajuste en mujeres para autorreporte de IAM y deterioro moderado (OR = 2,49) y severo del FEM (OR = 2,60) y en hombres para sospecha de DM2 y deterioro leve (OR = 5,24) y severo del FEM (OR = 6,19). Conclusiones: FEM resultó significativamente asociado con las enfermedades cardiometabólicas seleccionadas, con efecto sexo- específico para IAM (mujeres) y sospecha de DM2 (hombres). Se constata alta prevalencia de FEM alterado, y de enfermedades cardiometabólicas crónicas en la población estudiada.

Introduction: Chronic respiratory diseases determine high morbimortality and cardiometabolic comorbidities. We evaluated the association between peak expiratory flow (PEF) and cardiometabolic conditions in adults in a semi-rural area, in the baseline of MAUCO cohort (MAUle COhort). Material and Method: Cross-sectional study (3,465 adults, 40-74 years). Peak expiratory flow (PEF) (mini-Wright, ATS standard) was measured (Gregg & Nunn; impaired PEF ≤ 80% predicted). Self-reported/measured hypertension (HT), cerebrovascular disease (CVD), myocardial infarction (AMI), diabetes mellitus 2 (DM2), blood pressure, glycemia, cholesterol, weight and height were obtained. Physical activity and smoking were surveyed, after Ethical approval. Association's measures, prevalence and Odds Ratio (OR) were calculated. Results: Sample of 63.9% of women, mean age 55 (± 9) years, schooling 9 (± 4) years. 84.7% had overweight, 81.5%physical inactivity 29.4% smokers. Low PEF: 50.6% (48.9-52.3). Self-reported was: CVD 2.2% AMI 3.3%, suspicion of hypertension 24% and DM2 2.7%. Crude OR`s were significant for women by self-reported hypertension, stroke, AMI and self-reported/suspicion DM2; in men for self-reported CVD, suspected DM2 and self-reported/suspected hypertension. The association remained post-adjusted in women self-reported AMI -moderate deterioration (OR = 2.49) and severe PEF (OR = 2.60) and in men suspected DM2 and mild (OR = 5.24) and severe deteriorated PEF (OR = 6.19). Conclusions: PEF was significantly associated with cardiometabolic diseases; sex- specific findings for AMI (women) and suspicion of DM2 (men). High prevalence of altered PEF and chronic cardiometabolic diseases were detected among the studied population.

Flujo espiratorio máximo: caracterización en un estudio en población adulta chilena; resultados basales de la cohorte del Maule (MAUCO) / Peak expiratory flow rate: characterization study in Chilean adult population; baseline results of the Maule cohort (MAUCO)

Resumen Introducción: Las enfermedades respiratorias crónicas tienen alta prevalencia en países en desarrollo, en poblaciones rurales y deprivadas. El flujo espiratorio máximo (FEM) obtenido mediante espiración forzada tiene uso clínico y de investigación. Describimos valores de medición del FEM en la medición basal de un estudio de cohorte en curso (Cohorte del Maule-MAUCO). Material y Método: Diseño transversal en 3.465 adultos (40-74 años) con registros de FEM (ATS). (Flujómetro Mini-Wright), usando valores de Gregg y Nunn. Valores < 80% del predicho se consideraron disminuidos. Se obtuvo sexo, edad, nivel educacional, actividad física y tabaquismo; se calculó índice de masa corporal (IMC) usando mediciones antropométricas. Resultados: La muestra tuvo 63,9% de mujeres; edad media de 55 (± 9) años, escolaridad de 9 (± 4) años; sobrepeso y obesidad fueron 43,1% y 41,5%: 81,5% fueron inactivos y 29,4% fumadores actuales. El valor medio de FEM fue 330 (± 80) L/min (mujeres) y 460 (± 119) L/min (hombres): el FEM disminuido alcanzó el 50,6% ([48,9-52,3]) con diferencias según edad, educación, IMC y actividad física. Conclusiones: Se observó alta prevalencia de FEM disminuido con variaciones según sexo, edad, escolaridad, IMC e inactividad física. Como otros estudios latinoamericanos, los valores bajos también fueron altamente prevalentes, sugiriendo sobreestimación de valores predichos al usar valores de Gregg & Nunn. Estos resultados sugieren la conveniencia de estudiar factores ambientales locales.

Introduction: Chronic respiratory (CRD) diseases show high prevalence in developing countries, rural and deprived populations. Peak expiratory flow rate (PEFR) is a functional measurement obtained through forced expiratory used for clinical and research purposes. We described PEFR in a rural setting in an ongoing cohort study (Maule Cohort-MAUCO). Material and Method: Cross-sectional design in 3,465 adults (40-74 years) with PEFR ATS standard records (Mini-Wright flowmeter) using Gregg and Nunn values. PEFR ≤ 80% predicted were considered decreased. Sex, age, educational level, physical activity and tobacco smoking were obtained. Body mass index (BMI) was calculated based on anthropometrical measurements. Main Results: Sample had 63.9% of women; mean age of 55 (± 9) years, schooling of 9 (± 4) years. Overweight and obesity were 43.1% and 41.5%. Physical inactivity was 81.5% and 29.4% were current smokers. PEFR mean value was 330 (± 80) L/min (women) and 460 (± 119) L/min (men): Decreased PEFR was 50.6% ([48.9-52.3]) with significant differences by age, schooling, BMI and physical activity. Conclusions: High prevalence of decreased PEFR was observed: PEFR showed variations according to sex, age, schooling, BMI and physical activity. As other Latin-American studies show, low values were also highly prevalent, suggesting that Gregg & Nunn overestimated PEFR values. These results suggests the convenience of studying local environmental factors.

Cáncer de la vesícula biliar: estudios necesarios para el diseño de estrategias de prevención y diagnóstico precoz / Gallbladder cancer: necessary studies to design strategies for prevention and early diagnosis

Chile tiene la mayor tasa de incidencia de cáncer de vesícula biliar (CVB) en el mundo (> 30 por 100.000). Siendo la principal causa de muerte por cáncer entre las mujeres chilenas. Para diseñar estrategias de prevención y diagnóstico precoz del CVB hay que entender los factores etiológicos del proceso carcinogénico vesicular. Hay consenso que para el desarrollo de este cáncer concurren factores -genéticos, hormonales, infecciones crónicas, e inflamaciones crónicas asociadas a litiasis vesicular; y también que este cáncer ocurre en condiciones de pobreza. Desafortunadamente es insuficiente el conocimiento sobre la carcinogénesis vesicular, sobre el mecanismo de acción de los factores de riesgo clásicos y sobre cuáles son relevantes en la iniciación y promoción del CVB. En este artículo centramos la discusión en la litiasis vesicular, considerado el principal factor de riesgo del CVB. Se analiza las estrategias de prevención y control y se discuten los programas actuales. Finalmente se presentan dos estudios sobre factores de riesgo y de susceptibilidad para CVB que están siendo implementados en Chile.

Chile has the highest gallbladder cancer (GBC) incidence rate in the world (>30 per 100,000 person-years) and is the leading cause of cancer deaths among Chilean women. To design strategies of prevention and early diagnosis of GBC we must understand the etiological factors of the gallbladder carcinogenic process; There is consensus that in the development of this cancer concurs genetic and hormonal factors, infection, and chronic inflammation associated with lithiasis; and that is strongly associated with poverty conditions; But unfortunately there is not enough information about this process or how the classic risk factors associated play a role in its development. There is also no information on which are important in the initiation and promotion of GBC. In this article we focus the discussion in gallstones, considered the main risk factor for GBC. We analize some strategies of prevention and control and discuss some aspects of the current program. Finally we will point out two studies on risk factors and genetic susceptibility to GBC that are being implemented in Chile.

Genotipos de virus papiloma humano (VPH) en pacientes con cáncer cervico-uterino en un hospital público y una clínica privada de Santiago, Chile / Human papillomavirus (HPV) genotypes in cervix uterine cancer patients in a public hospital and private clinic from Santiago, Chile

We compared HPV genotypes among squamous cervical cancer samples from a public hospital (n = 55) and a private clinic (n = 35 cases) of Santiago. Paraffin-embedded specimens were analyzed by PCR followed by an immunoenzimatic assay. Reverse line blotting was used for the identification of 36 HPV genotypes. We found HPVDNAm 94.4 percent of all cancers. Single mfections: HPV16: 40.0 percent, (clinic 37.1 percent, hospital 41.8 percent) VPH18:7.8 percent (clinic 2.9 percent, hospital 10.9 percent); single+multiple mfections: VPH16: 61.1 percent (clinic 53.1 percent, hospital 71.7 percent), VPH18: 34.4 percent (clinic 21.9 percent, hospital 45.2 percent). HPV16 orHPV18 occurredin 75.6 percent of cases, higher inthe hospital than the clinic (87.3 percent-95 percent CI: 84.9-96.3 - and 57. l percent-95 percent CI: 46.6-66 - respectively, p = 0.002). Other genotypes in single mfections: HPV 26, 31, 33, 45, 58, 67; in co-mfections: HPV 35,52,56,59 and 66. HPV16 but specially HPV 18 were significantly more frequent in the public hospital; 75.6 percent of squamous cervical cancer were associated to the vaccine preventable HPV16/18.

Se comparan los genotipos de VPH en casos de cáncer cérvico-uterino escamocelular de una clínica privada (n: 35) y de un hospital público (n: 55) atendidos entre 1996 y 2006 en Santiago, Chile. Se analizaron por RPC y ensayo inmunoenzimático muestras tumorales en bloques de parafina, genotipificándose con reverse Une blotting para 36 genotipos de VPH. Se detectó VPH en 94,4 por ciento de los casos: infecciones únicas por: VPH 16: 40,0 por ciento>, (clínica 37,1 por ciento, hospital 41,8 por ciento) VPH 18: 7,8 por ciento (clínica 2,9 por ciento, hospital 10,9 por ciento); total de infecciones por VPH 16 61,1 por ciento (clínica 53,1 por ciento, hospital 71,7 por ciento), por VPH 18 34,4 por ciento (clínica 21,9 por ciento, hospital 45,2 por ciento). Co-infección: VPH 16/18 75,6 por ciento (clínica 57,1 por ciento; IC95 por ciento = 46,6-66,0 hospital 87,3 por ciento; IC95 por ciento = 84,9-96,3, p = 0,002). Se identificó otros 11 genotipos oncogénicos en infecciones únicas (VPH: 26, 31, 33, 45, 58, 67) o en co-infección con VPH 16/18 (VPH: 35, 52, 56, 59, 66). VPH 16 y VPH 18 fueron significativamente más frecuentes en el hospital público, particularmente VPH18; 75,6 por ciento> de los cánceres se asociaron a los genotipos VPH 16/18, tipos prevenibles por vacuna.

Reacciones adversas a vacuna DPT del Programa Nacional de Inmunizaciones / Adverse reactions to diphtheria-pertussis-tetanus vaccine in the Chilean Immunization Program

Background: During 2005, the surveillance system of the Chilean Immunization Program detected an increased number of adverse reaction notifications associated to diphtheria, pertussis and tetanus whole-cell vaccine (DPT), coincidentiy with a change in the vaccine manufacturer. Aim: To compare the reactogenicity of two DPT formulations (vaccines 1 and 2) in 18-month-old infants and 4-year-old children. Material and methods: Severe adverse reactions to DPT were studied at the emergency room of two hospitals of Santiago in a case-control study (110 cases and 171 controls, who consulted for other causes). Simultaneously the incidence of total adverse reactions (mild and severe) for vaccine 1 and 2 was estimated in a cohort of 1,017 children vaccinated in an ambulatory health center of the same área. The formulation of DPT received by all participants was verífied, as well as the temporal relation with consultation or symptoms referred by their caregivers. Results: There was a greater probability of consulting at the emergency rooms for severe adverse reactions among children who received vaccine 1 (odds ratio (OR) =7.1; p <0.001), being greater among 4-year-old children (OR =18.9; p <0.001). Coincidentiy, in the cohort of vaccinated children, those who received vaccine 1 had a higher risk of presenting adverse reactions (RR =2.9; p <0.001), being high fever the commonest. Conclusions: We confirmed that vaccine 1 was associated to a higher risk of adverse reactions, especially among 4-year-old children. These results allowed the sanitary authority to adopt an informed decisión. The usefulness of observational studies in vaccine adverse reactions is confirmed.

Fiebre tifoidea: Emergencia, cúspide y declinación de una enfermedad infecciosa en Chile / Typhoid fever: rise, peak and fall of an infectious disease in Chile

En este artículo se presenta la historia de la fiebre tifoidea (FT) en Chile desde su reconocimiento como entidad nosológica hasta su situación actual. De la historia destaca la confusión que hubo en Chile durante muchos años entre esta enfermedad y el tifus exantemático a pesar de que la fiebre tifoidea ya había sido individualizada y caracterizada en la primera mitad del siglo XIX en Europa. Esto se podría explicar porque tenían ciertas manifestaciones clínicas similares (fiebre alta y delirio) y por ocurrir en condiciones de déficit ambiental. Esta confusión se soluciona recién en 1918 en relación con la gran epidemia de tifus exantemático que permite a los clínicos identificarlo con toda claridad. Una vez distinguida la FT fue posible describir su comportamiento, caracterizado por un alto nivel de endemia, de preferencia en zonas urbanas con alzas estivales y ciclos epidémicos. De la historia contemporánea de la FT resalta la Gran Epidemia de 1976-1985, asociada al brusco deterioro socioeconómico y ambiental, y la igualmente abrupta caída de la enfermedad en 1992, reducción que persiste hasta nuestros días. Este último fenómeno, fue el resultado del carácter cuasi-experimental de las intervenciones de salud pública y educación sanitaria realizadas en 1992 para evitar la epidemia de cólera que estaba extendiéndose en el Perú. Concluimos que, si bien la hipótesis de la contaminación ambiental como el factor clave en la persistencia de la FT estuvo presente desde el reconocimiento de la enfermedad en 1894, sólo se abordó de manera eficaz y tal vez definitiva casi 100 años más tarde

This article presents the history of typhoid fever in Chile since its definition as a clinical entity until our days. From this history is evident the long lasting confusion with typhus (rickettsial spotted fever) in Chile although the identity and characteristics of typhoid fever had been established in the first half of nineteenth century in Europe. This confusion could be explained because some clinical features are similar in both diseases (high fever and delirium) and because of its ocurrence in poor hygienic conditions. This misconception was resolved only during 1918 on occasion of a major typhus outbreak that allowed physicians to clearly diagnose this rickettsial disease. Once typhoid fever was recognized it was possible to describe its epidemiological pattern with high endemic incidence mainly in urban districts, with summer increases and epidemic cycles. In the contemporary history of typhoid fever it is remarkable a huge outbreak during 1976-1985, associated to abrupt socioeconomical and environment crisis, as well as an abrupt diminution of the disease in 1992, with a marked reduction that persists until now. This last phenomenon was the consequence of a cuasi-experimental public health intervention and sanitary education conducted in 1992 to avoid the cholera epidemic that was spreading in Perú, a neighboring country. We conclude that, although the hypothesis of environment contamination as the cornerstone in typhoid persistence was present since the recognition of the disease in 1894, it was faced efficiently only and perhaps in a definitely manner only almost 100 years later

Cáncer de vesícula biliar: Tendencia y distribución del riesgo en Chile / Gallbladder cancer: trend and risk distribution in Chile

Background: Gallbladder cancer (GBC) is the first cause of death by cancer among Chilean women and mortality has not improved in the last 20 years. Aim: To study GBC mortality trend from 1985-2002, analyze risk differentials by age, sex, geographic region and accessibility to surgery. Material and Methods: Mortality data was obtained from death certificate databases. Population data was obtained from the census and biliary surgery information, from Ministry of Health registries. Standardized Mortality rates were based in the world population; trend was analyzed with point of change methods. Results: From 1985 to 2002, 27,183 GBC deaths occurred, 1,510 per year. The absolute number of deaths increased in 65% but standardized mortality rates remained unchanged at 11.3 per 100,000. These were higher among women than men (15.6 and 7.0, respectively, with a risk ratio of 2.2). Sex ratio peaked at ages 35-54 with risk ratio of 4.1. Death risk increased from North to South, peaking in poorer areas, especially in places with rural population and Mapuche ethnic admixture. Mortality appear to correlate with the rate of people waiting for gallbladder surgery, but not reaching statistical significance (r2 0.27, ns). Compared with other countries, Chile has a higher rate of GBC deaths in relation to its gross domestic product per capita. Conclusions: There is a high and persistent persistent risk for GBC in Chile, particularly among women, from the Southern regions where gallbladder surgery is insufficient for the needs, as reflected by the rates of people waiting for biliary surgery. GBC rates could be dropped by offering gallbladder surgery to everyone waiting for it and to those incident cases with gallstones.

Seroprevalencia de legionella pneumophila en Santiago: evidencias de exposición durante la infancia / Seroprevalence of legionella pneumophila in Santiago: evidence of exposure during chilhood

Se evaluó la exposición previa a legionella pneumophila de un grupo de 120 sujetos chilenos, sanos, menores de 20 años, estratificados según nivel socioeconómico. Las muestras de suero fueron analizadas, para la detección de anticuerpos de legionella pneumophila serogrupos 1 a 6, por técnica de inmunofluorescencia indirecta considerando positivos títulos iguales o mayores a 1:64. Doce de los 120 sujetos fueron positivos (10 por ciento); se observaron distintos grados de seroprevalencia según niveles socioeconómicos: 0/40 para el mas bajo; 2/40 (5 por ciento) en el nivel medio y 10/49 (25 por ciento) alto. El mayor título registrado fue 1:128. El nivel socioeconómico alto está asociado con la prevalencia mas alta de anticuerpos anti-legionella pneumophila en población chilena