Calidad de Vida en Pacientes Hemodializados de la Comuna de Chillán Viejo / Quality of Life in Hemodialyzed Patients From the Commune of Chillán Viejo

Resumen Introducción: La enfermedad renal crónica afecta a los riñones de forma irreversible, generando un gran impacto emocional en el paciente y su entorno familiar y social; determina cambios en los hábitos alimentarios, físicos y sociales perturbando, de esta manera, su calidad de vida. Objetivo: Valorar la calidad de vida de pacientes que se encuentran en tratamiento hemodialítico de la comuna de Chillán Viejo. Material y métodos: Diseño descriptivo, de corte transversal, no experimental. Fue implementado en una población de 62 pacientes en tratamiento de hemodiálisis en Chile. Se utilizó el cuestionario Kidney Disease and Quality of Life (KDQOL), que presenta puntajes de satisfacción entre 0 a 100, para evaluar calidad de vida en hemodializados. Resultados: Según sus medias de logros, las dimensiones más afectadas son: salud general (30,65 ±21,81), rol físico (23,15 ±31,4), carga de la enfermedad renal (25,46±20,49), situación laboral (23,15±35,97), función cognitiva (22,59±20,70) y calidad de las relaciones sociales (22,22±23,13).Conclusiones: Es importante poner en práctica actividades educativas y de prevención destinadas a pacientes que realizan diálisis, para evitar posibles complicaciones asociadas a la enfermedad renal y sus comórbidas, disminuir el deterioro de su calidad de vida y promover el apoyo al paciente y su familia.

Abstract Introduction: Chronic kidney disease affects the kidneys irreversibly, creating a great emotional impact on the patient and their family and social environment, and making changes in eating, physical and social habits, which disturb, in this way, their quality of life. Objective: To assess the quality of life of patients undergoing hemodialysis treatment in the commune of Chillán Viejo. Methods: A descriptive, cross-sectional, non-experimental study was conducted. It was implemented in a population of 62 patients undergoing hemodialysis treatment in Chile. The Kidney Disease and Quality of Life (KDQOL) survey, which presents satisfaction scores between 0 and 100, was used to assess quality of life in hemodialysis patients. Results: According to their average of achievement, the most affected dimensions are: general health (30.65 ± 21.81), physical role (23.15 ± 31.4), burden of kidney disease (25.46 ± 20,49), employment status (23.15 ± 35.97), cognitive function (22.59 ± 20.70) and quality of social relations (22.22 ± 23.13). Conclusions: It is important to implement educational and prevention activities aimed at patients who are on dialysis, so as to avoid possible complications associated with kidney disease and its comorbid diseases, reduce the deterioration of their quality of life and promote support for the patient and their family.

Rescue flap: alternativa de colgajo en cirugía de base de cráneo / Rescue flap: alternative in skull base surgery

RESUMEN Introducción: La elaboración de colgajos ha representado un cambio en reconstrucción de defectos resultantes de exéresis de tumoraciones de base de cráneo. No siempre indispensables, existen circunstancias, planificados o no, donde debemos emplearlos. Preservando los pedículos de la mucosa, damos cobertura a urgencias intraquirúrgicas, como fístula LCR no sospechada, así como reintervenciones. Objetivo: Presentar nuestra experiencia en pacientes, a quienes hemos realizado colgajo tipo rescue flap. Material y método: Se diseña este colgajo, sin comprometer su pedículo. En caso de fístula, sospecha de ésta o herniación del diafragma selar, se extiende, cubriendo el defecto. Resultados: De 34 pacientes intervenidos de patología hipofisaria endoscópicamente, en 18 diseñamos colgajo tipo rescue flap. 12 casos se elaboraron, no utilizándolos. En 4 pacientes con extenso tumores lo empleamos preventivamente. En 1 caso, de reintervención, previamente con colgajo Hadad izquierdo, realizamos colgajo de mucosa contralateral. En otro, diseñamos un rescue flap derecho, al objetivar salida de LCR, sellamos con este colgajo. No evidenciamos fístulas. Discusión: Esta técnica consiste en levantar parcialmente mucosa del potencial colgajo, preservando su pedículo, pudiendo utilizarse en casos de fístula LCR no programada, o reintervenciones. Sin realizar colgajos innecesariamente. Conclusión: La técnica rescue flap favorece un corredor quirúrgico, menos invasivo, manteniendo mucosa para eventuales reintervenciones.

ABSTRACT Introduction: The development of flaps has represented a change in reconstruction of defects resulting from excision of skull base tumors. It not always indispensable, there are circumstances, planned or not, where we must use them. Preserving the pedicles of the mucosa, we cover intraoperative emergencies, such as unsuspected CSF fistula, as well as reinterventions. Aim: We present our experience where we performed rescue flap. Material and method: This flap is designed without compromising its pedicle. In case of fistula, suspicion of this or herniation of the selar diaphragm, it extends, covering the defect. Results: Of 34 patients who underwent endoscopic surgery for pituitary pathology, in 18 we designed a rescue flap. 12 cases were made, not using them. In 4 patients with extensive tumors we used it preventively. In 1 case, of reintervention previously with left Hadad flap, we performed contralateral mucosa flap. In another, we designed a right rescue flap, when we observed LCR output, we seal with this flap. We did not show fistulas. Discussion: This technique consists in partially lifting the mucosa of the potential flap, preserving its pedicle, and may be used in cases of unscheduled CSF fistula, or reinterventions. Without flapping unnecessarily. Conclusions: The Rescue Flap technique favors a less invasive surgical corridor, maintaining mucosa for posible reinterventions.

Evaluación de un programa ministerial para manejo del síndrome metabólico en adultos con sobrepeso y obesidad / Evaluation of a program for management of metabolic syndrome in adults with overweight and obesity

Background: The Chilean Ministry of Health developed a healthy lifestyles intervention directed to adults with overweight and cardiovascular risk factors, called "Program on Healthy Eating and Physical Activity" (PASAF). Aim: To evaluate the impact of PASAF on nutritional status and metabolic parameters. Patients and Methods: We analyzed databases from three primary care centers belonging to a municipality of Metropolitan Santiago. We selected adults enrolled in the PASAF during three years (2007-2009). The program lasted four months and included an assessment of anthropometric and metabolic parameters at baseline and at the end, eight workshops with a nutritionist, seven with a psychologist and 32 sessions of physical activity. Result: We evaluated 526 subjects aged ≥ 18 years (93% females), of whom 85.6% attended the last appointment for assessment. Analyzing available data, attendance to workshops was < 50% of the scheduled sessions. Weight, body mass index and waist circumference decreased significantly (median: -1.4 kg, -0.6 kg/m² and -3 cm, respectively). The median weight loss was 1.8% of initial weight and 17.1% of participants experienced a decrease ≥ 5% of their initial weight. There were significant improvements in lipid levels and blood pressure among participants with lower initial excess weight. A reduction in fasting blood glucose was observed only among subjects who lost ≥ 5% of their initial weight. Conclusions: The PASAF modestly reduced nutritional parameters. Correction of metabolic parameters was especially effective in less obese subjects. The attendance to workshops was low.

Posta de Salud Stella Maris: una apuesta por un modelo de atención más humano, integral y democrático / . Stella Maris post health: A commitment for a more human, more integrative and more democratic care model

Posta de Salud Stella Maris es un dispositivo de cuidados en domicilio, que trabaja pensando la accesibilidad como encuentro entre usuarios, donde lo vincular supera otras barreras. Hemos puesto a las personas delante de las enfermedades, acercando un plan de cuidados integral para las familias en sus hogares y su barrio. Trabajamos desde 2012 en el barrio Stella Maris. Cuentan con un hospital interzonal y tres unidades sanitarias en un radio de 1 km. Los vecinos describen dificultades para acceder a la atención dado el gran tamaño poblacional, que es de 370 familias. La posta realiza visitas domiciliarias de primer contacto y de Seguimiento familiar. Además, se llevan a cabo jornadas especiales de promoción de la salud. Creemos que hemos podido revalorizar la visita domiciliaria y el espacio en el barrio como espacio de trabajo de los equipos de salud del como lugar más idóneo que el centro de salud para abordar el Proceso Salud Enfermedad.

The Stella Maris post health care is a device that works at home thinking about accesibility as the meeting betwen health workers and users, where linking it overcome the barriers of accessibility. We had put the people before disease, approaching a plan of integral cares in their home and in their neighborhood. Since 2012 we are working in Stella Maris neighborhood, where we canfind an intezone hospital and three health units around a mile. Neighbors decribed difficuties in accesing the care given to the large population size, that is 370 families. The post makes home visits and familiy first contact monitoring. The post also conducts special sessions of health promotion We believe we could reassess the home visits and the space in the neighborhood as workspace health team as more appropriate that the health center place to address the process of health - disease.