Descripción de las publicaciones de la Revista Otorrinolaringología y Cirugía de Cabeza y Cuello durante los años 2003 a 2008 / Description of articles published in the journal Revista Otorrinolaringología y Cirugía de Cabeza y Cuello from 2003 to 2008

Introducción: La literatura médica ha aumentado exponencialmente en los últimos años, y la otorrinolaringología no ha estado ajena a este fenómeno. Sin embargo estudios internacionales revelan que la mayoría de los artículos publicados en revistas de esta especialidad corresponden a diseños de estudio con un alto riesgo de sesgo. Objetivo: Evaluar las publicaciones de la Revista Otorrinolaringología y Cirugía de Cabeza y Cuello, con respecto al diseño de los estudios incluidos, tema de la especialidad a la cual se refieren y lugar donde se realizaron los estudios. Material y método: Se realizó un estudio retrospectivo donde dos revisores analizaron de manera independiente todos los artículos publicados en esta revista durante los años 2003 a 2008. Resultados: El diseño de serie de casos fue el más utilizado, con 62,9 por ciento. El 31,4 por ciento de los trabajos abordó un tema de otología/otoneurología y 78,1 por ciento de los artículos fueron realizados en un centro formador de especialistas en otorrinolaringología. Discusión: Los artículos publicados en la revista seleccionada corresponden principalmente a estudios con alto riesgo de sesgo. En la actualidad existe un desbalance importante entre los temas que están siendo estudiados, y también entre los centros donde se está llevando a cabo la investigación en otorrinolaringología.

Introduction: Medical literature has experienced an important growth in past years, and otorhinolaryngology has not been the exception. However, international studies have revealed that most articles published in journals of this specialty correspond to study designs with a high risk of bias. Aim: To evaluate all articles published in the journal of Revista Otorrinolaringología y Cirugía de Cabeza y Cuello, according to the study design, area of the specialty that is involved and place where the studies were conducted. Material and method: Two reviewers independently analyzed the original articles published in this journal from 2003 to 2008. Results: Case series design was the most commonly used, with 62.9 percent of the studies. 31.4 percent of the articles were about otology/neurotology and 78.1 percent were performed in an educational and academic center where otorhinolaryngology specialists are trained. Discussion: Articles published in the selected journal corresponded mainly to studies with a high risk of bias. There is an imbalance in the areas of the specialty that have been studied, and also in the places where these studies have been conducted.

¿Podemos mantenernos actualizados en medicina en el siglo XXI? / How can an internist keep updated in the XXIst century?

The amount of information in health care has steadily grown in the past years and this trend will probably continue in the near future. Traditional ways to keep updated are no longer sufficient, particularly in broad areas of knowledge as Internal Medicine or Family Medicine. Therefore, it is necessary to use new approaches. The present article describes five proposals for the clinician that tries to maintain updated but feels overwhelmed by the amount of available information.

Análisis crítico de un artículo: la profilaxis primaria de peritonitis bacteriana espontánea disminuye la aparición de síndrome hepatorrenal y mejora la sobrevida en pacientes cirróticos avanzados / Critically appraised article: primary prophylaxis of spontaneous bacterial peritonitis delays hepatorenal syndrome and improves survival in cirrhosis

Background & Aims: Norfloxacin is highly effective in preventing spontaneous bacterial peritonitis recurrence in cirrhosis, but its role in the primary prevention of this complication is uncertain. Methods: Patients with cirrhosis and low protein ascitic levéis (<15 g/L) with advanced liver failure (Child-Pugh score >9 points with serum bilirubin level >3 mg/dL) or impaired renal function (serum creatinine level >1.2 mg/dL, blood urea nitrogen level >25 mg/dL, or serum sodium level <130 mEq/L) were included in a randomized controlled trial aimed at comparing norfloxacin (35 patients) vs placebo (33 patients) in the primary prophylaxis of spontaneous bacterial peritonitis. The main end points of the trial were 3-month and 1-year probability of survival. Secondary end points were 1-year probability of development of spontaneous bacterial peritonitis and hepatorenal syndrome. Results: Norfloxacin administration reduced the 1-year probability of developing spontaneous bacterial peritonitis (7 percent vs 61 percent, P <0.001) and hepatorenal syndrome (28 percent vs 41 percent, P 0.02), and improved the 3-month (94 percent vs 62 percent, P 0.003) and the 1-year (60 percent vs 48 percent, P 0.05) probability of survival compared with placebo. Conclusions: Primary prophylaxis with norfloxacin has a great impact in the clinical course of patients with advanced cirrhosis. It reduces the incidence of spontaneous bacterial peritonitis, delays the development of hepatorenal syndrome, and improves survival.

Análisis crítico de un artículo: Levofloxacino profiláctico en pacientes neutropénicos / Critically appraised article: Levofloxacin to Prevent Bacterial Infection in Patients with Cancer and Neutropenia

Background: The prophylactic use of fluoroquinolones in patients with cancer and neutropenia is controversial and is not a recommended intervention. Methods: We randomly assigned 760 consecutive adult patients with cancer in whom chemotherapy-induced neutropenia (<1000 neutrophils per cubic millimeter) was expected to occur for more than seven days to receive either oral levofloxacin (500 mg daily) or placebo from the start of chemotherapy until the resolution of neutropenia. Patients were stratified according to their underlying disease (acute leukemia vs solid tumor or lymphoma). Results: An intention-to-treat analysis showed that fever was present for the duration of neutropenia in 65 percent of patients who received levofloxacin prophylaxis, as compared with 85 percent of those receiving placebo (243 of 375 vs 308 of 363; relative risk, 0.76; absolute difference in risk, -20 percent; 95 percent confidence interval, -26 to -14 percent; P=0.001). The levofloxacin group had a lower rate of microbiologically documented infections (absolute difference in risk, -17 percent; 95 percent confidence interval, -24 to -10 percent; P <0.001), bacteremias (difference in risk, -16 percent; 95 percent confidence interval, -22 to -9 percent; P <0.001), and single-agent gram-negative bacteremias (difference in risk, -7 percent; 95 percent confidence interval, -10 to -2 percent; P <0.01) than did the placebo group. Mortality and tolerability were similar in the two groups. The effects of prophylaxis were also similar between patients with acute leukemia and those with solid tumors or lymphoma. Conclusions: Prophylactic treatment with levofloxacin is an effective and well-tolerated way of preventing febrile episodes and other relevant infection-related outcomes in patients with cancer and profound and protracted neutropenia. The long-term effect of this intervention on microbial resistance in the community is not known.

Síndrome neuroléptico maligno y poliserositis en paciente usuaria de clozapina: una asociación infrecuente / Malignant neuroleptic syndrome and polyserositis associated to clozapine use: report of one case

Malignant neuroleptic syndrome is a complication of antipsychotic medication use. Clozapine use is also associated with polyserositis and eosinophilia. We report a 17 years old female treated with clozapine, valproic acid, lithium carbonate and lorazepam that consulted in the emergency room for confusion, lethargy, catatonia, rigidity, myalgya and fever. Complete blood count showed eosinophilia. An abdominal CAT scan showed ascites and pleural effusion. Clozapine was discontinued and bromocriptine was started. One week after admission, the patient remained febrile and liver enzymes were elevated. Valproic acid was discontinued. Inflammatory parameters stated to subside and the patient was discharged afebrile days after admission.

Análisis crítico de ensayos clínicos randomizados publicados en revistas biomédicas chilenas / Critical assessment of randomized controlled trials published in biomedical Chilean journals

Background: Well designed clinical trials yield the strongest evidence for the effect of health care interventions. Aim: To assess the methodological quality of the design and report of randomized clinical trials in a sample, published in biomedical Chilean journals between 1980 and 2002. Material and methods: All trials identified by hand search by the Unit of Evaluation of Technologies in Health, were assessed for quality of randomization, blinding, analysis of results and other characteristics of trial design, along with the application of Jadad's Score, that assesses the methodological quality of clinical trials in a scale that ranges from 0 to 5. Results: Twenty eight trials were found and assessed, 75 percent (n=21) specified the method used for randomization, 29 percent (n=8) described a correct allocation concealment and 39 percent (n=11) were double blinded. Withdrawals and dropouts were correctly reported in 21 percent (n=6) of the articles, whereas intention to treat analysis was done only in one. Thirteen trials had a Jadad score equal or higher than 3 points. Conclusions: Several design deficiencies were found in the trials assessed. It is difficult to know if methodological weaknesses are due to incomplete reports or to methodologically poor designs. Adopting initiatives like the CONSORT can help improve the quality of randomized clinical trials published in Biomedical Chilean journals.

Revisiones sistemáticas y metaanálisis: ¿son la mejor evidencia? / Systematic reviews and metaanalysis: are the best evidence?

Las RS representan el más alto nivel de evidencia, sí y sólo sí, han sido realizadas con las precauciones necesarias para reducir la posibilidad de sesgo durante su realización, de modo que sintetice de manera confiable toda la evidencia de alta calidad disponible.

Composición corporal de neonatos con alteraciones en el crecimiento fetal / Body composition of newborn infants with abnormal fetal growth

Con el objetivo de estudiar la asociación entre la composición corporal en recién nacidos con elpeso al nacer y las alteraciones del crecimiento fetal se estimó las masas magra y grasa de 224 recién nacidos de familias de bajos ingresos en Santiago de Chile , utilizando el método antropométrico de Dauncey. En el total de estos niños sanos de término la proporción de masas grasa fue 16.5 por ciento. hubo una fuerte y significativa asociación positiva del peso al nacer con la masa magra (r² = 58,2 por ciento). Aunque la masa grasa constituyó solo 16,5 por cientodel peso al nacer, explicó una gran proporción de su varianza (58,2 por ciento). En los neonatos con retardo de crecimiento fetal o con bajo índice ponderal hubo una composición corporal particular. Esos recién nacidos tuvieron valores absolutos inferiores tanto de la masa grasa como de la masa magra, pero sólo la masa fue proporcionalmente menor que los niños normales o con sobrepeso. El déficit nutricional de estos niños está asociado con mayor riesgo de afecciones perinatales, por lo que debiera ser prevenido con una adecuada alimentación de la madre durante el embarazo. Los resultados obtenidos, similares a los estudios previos en países desarrollados, sugieren que la composición corporal podría ser útil para evaluar el crecimiento fetal al momento del nacimiento