ABSTRACT
Resumen Objetivo: Comprender las dinámicas mediante las cuales los pacientes significan su experiencia de la depresión. Metodología: Se utilizó una metodología cualitativa, basada en la Teoría Fundamentada. Se realizaron entrevistas semiestructuradas a 10 pacientes diagnosticados de un trastorno del ánimo con episodio depresivo, por el que habían estado en tratamiento psicoterapéutico previamente. Las entrevistas fueron analizadas desde un enfoque descriptivo-relacional, para reconocer las principales unidades temáticas referidas por los participantes y luego identificar sus relaciones y significados subyacentes. Resultados: El significado de la experiencia de la depresión se reveló como un proceso denominado "Construcción subjetiva de la experiencia de la depresión", caracterizado por tres momentos. (1) "La experiencia de un malestar sin nombre"; (2) "Anclaje de la experiencia del paciente en la palabra depresión"; (3) "Apropiación de la experiencia de la depresión". Conclusión: la experiencia de la depresión se presenta como un proceso dinámico de interacción entre el malestar subjetivo y la construcción de significados asociados a él; transitando de una experiencia desconcertante observada en el cuerpo, el ánimo y/o lo conductual, hacia una experiencia elaborable discursivamente, a través de una referencia semántica (depresión) que integra los significados y origina un proceso de apropiación de lo que implica para cada individuo tener depresión o estar deprimido.
Abstract Objective: To understand the dynamics by which patients signify their depressive experience. Methodology: A qualitative methodology was used, based on the Grounded Theory. Semi-structured interviews were conducted with 10 patients diagnosed with a mood disorder with depressive episode, who had been in a psychotherapy treatment about it. The interviews were analyzed from a descriptive-relational approach, recognizing the main thematic units referred by the participants, and then identifying their relationships and underlying meanings. Results: The meaning of "depression" experience was revealed as a process, named "subjective construction of depression experience", characterized by three moments: (1) "The experience of an unnamed discomfort"; (2) "Anchoring the patient's experience in the word depression"; (3) "Appropriation of depression experience". Conclusion: The depressive experience is presented as a dynamic process of interaction between subjective discomfort and the construction of meanings associated to it. Transitioning from a disconcerting experience observed on their body, mood, and/or their behaviour, to something available to be elaborated discursively, through a semantic reference (depression) that integrates them, originates a process of appropriation about what it implies for each individual to be depressed or have depression.
ABSTRACT
Background: Upper gastrointestinal bleeding (UGIB) is one of the main reasons of hospitalization due to gastrointestinal causes. Reported mortality rates range from 5 to 12%. Aim: To determine hospital mortality and associated risk factors in hospitalized patients with UGIB. To compare the clinical characteristics and outcomes of patients with variceal versus non-variceal UGIB. Material and Methods: Review of medical records of 249 patients (62% males) discharged with the diagnosis of UGIB at a clinical hospital between 2015 to 2017. Demographic and clinical characteristics and adverse clinical outcomes (surgery, length of hospital stay and in-hospital mortality) were recorded. A comparative analysis between patients with Variceal and Non-variceal UGIB was carried out. Results: Seventy two percent of UGIB were non-variceal (peptic ulcer in 44%). Two patients required surgery (both died). Median of length of hospital stay was seven days (interquartile range (IQR) 4-13). Overall hospital mortality was 13 and 4% in variceal and non-variceal UGIB, respectively (p = 0.024). The variables associated with mortality were: red blood cell transfusion (odds ratio (OR): 18.7, p < 0.01), elevated creatinine on admission (OR: 3.30, p = 0.03) and variceal bleeding (OR: 3.23, p = 0.02). Conclusions: Hospital mortality of UGIB remains high, especially in variceal UGIB. Elevated creatinine levels on admission, the need of transfusion of red blood cells and variceal etiology are risk factors for mortality.
Subject(s)
Humans , Upper Gastrointestinal Tract , Varicose Veins , Esophageal and Gastric Varices , Retrospective Studies , Gastrointestinal Hemorrhage , Length of StayABSTRACT
Las desigualdades en las condiciones de vida impactan negativamente sobre la salud mental de las personas y comunidades. Este artículo tiene por objetivo describir algunas de las principales líneas de investigación y reflexión en torno a la relación entre desigualdad y salud mental. Más que una revisión sistemática, se trata de una discusión orientada a contribuir al debate público en torno a las dimensiones materiales, simbólicas y subjetivas de la desigualdad, mencionando algunos mecanismos que permiten comprender su relación con la salud mental. Entre estas dimensiones abordamos las desigualdades de ingreso y de género, además de otras que han recibido menor atención en los estudios nacionales e internacionales: las desigualdades en la participación, en la interacción cotidiana, y las desigualdades socio-territoriales y en el uso del tiempo. Finalmente, mencionamos algunas limitaciones teóricas de la investigación tradicional sobre desigualdad en salud y sugerimos potenciales líneas de investigación que pueden orientar los estudios en torno a desigualdades y salud mental
Subject(s)
Humans , Social Justice , Mental Health , Social Determinants of Health , Socioeconomic Factors , ChileABSTRACT
Background: Helicobacter pylori (HP) is the most widespread chronic human infection worldwide and the most important pathogenic factor of gastric cancer. The calculated prevalence at the Clinical Hospital of the University of Chile from 2002 to 2005 was 44.9%. Aim: To determine the current prevalence of HP in patients undergoing an upper gastrointestinal endoscopy (UGI) and analyze its distribution according to age and endoscopic findings. Material and Methods: We reviewed 3.433 UGI performed during the year 2015, selecting those in which rapid urease test (RUT) was done. A positive RUT or a positive gastric biopsy (GB) were considered as HP infection. Results: RUT was done in 1862 UGI (55%) performed in patients aged 51 ± 17 years, (66% women). In 23% of these endoscopies, the RUT was positive. A GB was obtained 43% of endoscopies and 30% were positive for HP. In 105 patients the RUT was negative and the GB positive (rendering a 19.5% false negative rate). HP was detected by RUT and GB in 29% of endoscopies. The highest prevalence of infection (38.1%) was found between 40 and 49 years. HP infection had odds ratio of 4.24 for nodular gastropathy, 2.63 for gastric ulcer and 2.14 for duodenal ulcer (p < 0.05). Conclusions: HP prevalence in our center decreased significantly from 44.9% to 28.9% in 11 years. False negative RUT results may bias this finding. The use of proton pump inhibitors and antimicrobials that can interfere with the detection of HP should be registered to properly analyze the results of the RUT.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Helicobacter pylori/isolation & purification , Helicobacter Infections/diagnosis , Gastrointestinal Diseases/microbiology , Biopsy , Chile/epidemiology , Prevalence , Cross-Sectional Studies , Retrospective Studies , Endoscopy, Gastrointestinal , Helicobacter Infections/epidemiology , Age Distribution , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiologyABSTRACT
Management of gastrointestinal bleeding caused by fundal varices is particularly difficult to manage. The options are: transjugular intrahepatic portosystemic shunt (TIPS), endoscopic injection of cyanoacrylate or balloon-occluded retrograde transvenous obliteration (BRTO). We report a 63 year-old male with a cirrhosis caused by hepatitis C and a 66 year-old female with a cirrhosis caused by a non-alcoholic steatohepatitis. Both patients had a gastrointestinal bleeding caused by fundal varices and were treated with sclerotherapy with cyanoacrylate assisted with BRTO. Flow was interrupted in the gastro-renal shunt by a femoral access in both patients. The male patient had a new bleeding two months later and died. In the female patient an endosonography performed nine months after the procedure showed absence of remaining varices.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Esophageal and Gastric Varices/therapy , Sclerotherapy/methods , Cyanoacrylates/therapeutic use , Balloon Occlusion/methods , Gastrointestinal Hemorrhage/therapy , Portal Vein , Portacaval Shunt, Surgical , Esophageal and Gastric Varices/complications , Reproducibility of Results , Treatment Outcome , Fatal Outcome , Gastrointestinal Hemorrhage/etiology , Liver Cirrhosis/complicationsABSTRACT
Background: Ménétrier disease is a rare disorder of the stomach, characterized by giant hypertrophic folds that usually involve the gastric body and fundus, associated to hypoalbuminemia due to serum protein loss across the gastric mucosa. We report a 55-years-old male presenting with abdominal pain, vomiting, weight loss and hypoalbuminemia. Diffuse hypertrophic gastric folds, elevated ulcerated sessile lesions and focal duodenal involvement were seen at endoscopy. Biopsies showed foveolar hyperplasia and glandular atrophy with cystic dilatation. A total gastrectomy was performed with a good outcome.