ABSTRACT
Introducción: La inflamación y alteraciones en la biodisponibilidad del óxido nítrico (NO) han sido involucradas en la fisiopatología de la enfermedad cerebrovascular. Objetivo: El objetivo del estudio fue determinar el valor pronóstico de la medición de metabolitos del NO y marcadores inflamatorios en pacientes con infarto cerebral agudo. Materiales y métodos: Se incluyeron 158 pacientes con diagnóstico de infarto cerebral agudo en un estudio observacional de cohorte. Entre 48 y 72 horas del inicio de los síntomas se tomó una muestra de sangre para determinación del perfil bioquímico, marcadores inflamatorios (PCR, IL1-β, IL6, TNF-α) y nitritos/nitratos plasmáticos. Se realizó seguimiento durante 2 años para determinar la aparición de un nuevo evento (infarto cerebral, infarto de miocardio, falla cardiaca) o muerte de origen vascular. Un análisis de regresión multivariada de Cox permitió determinar los factores asociados independientemente con el desenlace. Resultados: La edad promedio fue 70,5 ± 12,8 años. El 39,2% de los sujetos incluidos presentó el desenlace durante los primeros 24 meses de seguimiento. Los niveles de PCR > 12 mg/L (HR 2,22, IC 95% 1,07-4,59) y el puntaje > 13 en la escala NIHSS al ingreso (HR 2,81 IC 95% 1,46-5,41) se encontraron significativamente asociados con mayor riesgo de presentar un nuevo evento. La combinación de niveles de PCR < 12 mg/L y nitritos/nitratos < 35,5 µmol/L se identificó como un factor protector (HR 0,21, IC 95% 0,06-0,71). Conclusión: Este estudio sugiere que la determinación de nitritos/nitratos en conjunto con los niveles de PCR puede ser de utilidad para estratificar el riesgo de nuevos eventos en pacientes con infarto cerebral agudo.
Introduction: Inflammation and alterations in the bioavailability of nitric oxide (NO) have been involved in the pathophysiology of cerebrovascular disease. Objective: The aim of the study was to determine the prognostic value of measuring NO metabolites and inflammatory markers in patients with acute ischemic stroke. Materials and methods: A total of 158 patients with acute ischemic stroke were included in an observational cohort study. Between 48 and 72 hours post admission, a fasting blood sample was taken to determine the biochemical profile, inflammatory markers (CRP, IL1-β, IL6, TNF-α) and nitrites/nitrates plasma levels. The cohort's follow-up was conducted for two years to determine the occurrence of a new event (stroke, myocardial infarction, heart failure) or death of vascular origin. Comparisons between groups were made using the log-rank test. A Cox multivariate regression analysis permitted to determine factors independently associated with the outcome. Result: The mean age was 70.5 ± 12.8 years. 39.2% of the subjects presented the outcome during the first 24 months of follow-up. CRP levels > 12 mg/L (HR 2.22, 95% CI 1.07-4.59) and a score > 13 on the NIHSS scale at admission (HR 2.81 95% CI 1.46-5.41) were significantly associated with an increased risk of a new event. The combination of CRP levels < 12 mg/L and nitrites/nitrates levels < 35.5 mmol/L was identified as a protective factor (HR 0.21, 95% CI 0.06-0.71). Conclusion: This study demonstrates that the determination of CRP and NOx levels could be beneficial in clinical practice to stratify the risk of future events or death of vascular origin in acute ischemic stroke patients.
Subject(s)
C-Reactive Protein , Cerebral Infarction , Inflammation , Nitric OxideABSTRACT
Se presentan aquí los resultados de un estudio que comparó la habilidad diagnóstica y la capacidad predictiva de los puntos de corte de dos instrumentos para guiar el incremento de peso durante el embarazo. Ellos son la curva de Rosso y Mardones (RM), que utiliza el porcentaje del peso estándar para clasificar nutricionalmente a la embarazada, y una propuesta de puntos de corte que utiliza el índice de masa corporal para el mismo propósito. Los datos de 1.745 madres de Santiago de Chile, sirvieron para realizar estos análisis. Las variables dependientes fueron las incidencias de peso al nacer de riesgo < 300 g para las madres de bajo peso => 4000 g para las madres con sobrepeso. Los puntos de corte se compararon a la semana 10 y a la semana 40 de edad gestacional. La mayoría de los estadígrafos para la confiabilidad diagnóstica y para la capacidad predictiva fueron mayores en la curva RM, indicando que es un mejor examen para el tamizaje. La similitud de los puntos de corte para diagnosticar sobrepeso de ambos patrones contribuyó a que varios estadígrafos no tuvieran diferencias, especialmente para el peso al nacer => 4000 g al inicio del mismo
Subject(s)
Humans , Female , Infant, Newborn , Pregnancy , Maternal Nutrition/standards , Weight Gain/physiology , Body Mass Index , Forecasting , Infant, Low Birth Weight , Nutritional Status , Risk Factors , Socioeconomic FactorsABSTRACT
Background: Pregnant women with low weight/height (wt/ht) have lower plasma volume and reduced birth weight than women with normal wt/ht. Aim: To explore the hormonal mechanisms involved in these alterations. Patients and methods: Plasma volume, and several hormones related to plasma volume regulation were determined in 24 near term pregnant women with low wt/ht and in 30 with normal wt/ht. Results: Newborns's weight, height and ponderal index were reduced in the low wt/ht group. Plasma volume (3042 ñ 101 vs 3631 ñ 101 ml, p< 0.001); plasma renin activity (7.5 ñ 0.9 vs 11.1 ñ 0.9 ng/ml/h, p< 0.01) and aldosterone (428 ñ 47 vs 710 ñ 58 pg/ml, p< 0.001) were significantly reduced in the low wt/ht group. Similar reductions were observed in serum estradiol and progesterone levels. Urinary kallikrein activity (354 ñ 112 vs 824 ñ 134 nmoles/24 h, p< 0.05), 6-keto-prostaglandin F1a (561 ñ 90 vs 1121 ñ 165 ng/24 h, p< 0.05) and thromboxane B2 (110 ñ 29 vs 280 ñ 29 ng/24 h, p< 0.05) were also reduced in low wt/ht women. Conclusions: We postulate that the reduced levels of vasoactive hormones observed in pregnant women with low wt/ht may interfere with plasma volume expansion and, in turn, cause low birth weight
Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications/physiopathology , Plasma Volume/physiology , Progesterone/blood , Body Weight , Nutritional Status , Renin/blood , Aldosterone/blood , Estradiol/blood , Nutrition Disorders/complications , Kallikreins/urine , Nutrition AssessmentABSTRACT
Background: A low weight for height of pregnant women at the start of pregnancy has a negative impact of fetal growth. Aim: To report the design of a weight gain chart for pregnant women that allows to classyfy mothers according to their nutritional status and to monitor weight gain during gestation. Material and methods: Data from 1745 Chilean mothers who delivered their newborns in 1983 and 1984 were used to build this chart. Results: The instrument could diagnose, from gestational week 10 onwards, mothers at risk of delivering babies with birth weight under 3000 g and set weight gain goals for each individual mother based on ber nutritional status. Similarly, mothers at risk of delivering babies with birth weight over 3999 g could be early diagnosed during pregnancy and guided to have a prudent weight gain. Conclusions: The chart can be easily used in prenatal clinics of developing countries and is currently applied in several Latin American countries
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Pregnancy Complications/diagnosis , Weight by Height/physiology , Birth Weight , Reference Standards , Nutrition Assessment , Maternal Nutrition/standards , Pregnancy Complications/diagnosis , Reference Values , Weight Gain/physiology , Anthropometry , Nutritional Status/physiology , Prospective Studies , Prenatal Care/methods , Prenatal Diagnosis/methods , Body Mass Index , Infant, Low Birth WeightABSTRACT
The Medical School of the Pontifical Catholic University is devoted to a reform process aiming to adequate undergraduate training to scientific, technological, cultural and social changes in medical practice in Chile and to incorporate novel teaching methodology. One of the main modifications is the change of the resulting professional from "a general physician capable of resolving most medical problems of rural or urban populatins" to "a physician with a solid general training but qualified for a subsequent specialization". This requires curricular flexibility to obtain different professional profiles. Other important changes are a reduction in curricular contents and their vertical and horizontal integration, modernization of teaching methodologies with the incorporation of computing techniques and problem oriented teaching and the incorporation of new subjects such as molecular biology, clinical genetics, health economics. To achieve these objectives, a semi-flexible curriculum was devised, the curricular mesh has been modified extensively, an outpatient and a nine months elective internship were added. Most modifications have been implemented, remaining changes in 4th and 5th years. These changes required a reorganisation of academic structure, the use of new selection, training and perfecting criteria for teachers, better salaries for outstanding professors and improvement of teaching infrastructure. This reform must be seen as a medium term integral change in the context of an integral academic development plan
Subject(s)
Humans , Curriculum/trends , Education, Medical, Undergraduate/trends , Schools, Medical/trends , Organizational Objectives , Educational Measurement , Public Health/trendsABSTRACT
El artículo que se presenta a continuación describe el Programa de Mejoramiento de la Calidad de Atención que se implementará en el Hospital Clínico de la Pontificia Universidad Católica de Chile; a partir del presente año. Se destaca en este programa la aplicación de metodologías utilizadas en Europa, especialmente en España como son: el modelo europeo de calidad Iso 9000; y los Métodos Serqual y de Pactos
Subject(s)
Humans , Total Quality Management/methods , Quality of Health Care , Strategic PlanningABSTRACT
Se comparó las características evolutivas del embarazo, parto y recién nacido entre un grupo de 163 embarazadas obesas (índice peso para la talla mayor de 120%) y 163 controles (índice peso para la talla entre 94 y 106%) pareadas por edad y paridad. Las embarazadas obesas presentaron una significativa mayor frecuencia de hipertensión arterial (p<0,005), de preeclamsia (p<0,05), de cesáreas (p<0,027) y de infección puerperal (p<0,01) que el grupo control. No se encontró diferencia en la incidencia de diabetes gestacional y hemorragias postparto. El peso de nacimiento fue significativamente superior en los hijos de madres obesas (p<0,004), al igual que la incidencia de niños grandes para la edad gestacional (p<0,037). No se observaron diferencias en la morbilidad neonatal ni en las características de la lactancia al mes de edad entre ambos grupos. Se concluye que la obesidad durante el embarazo, aún de intensidad moderada, constituye un importante riesgo obstétrico