Experiencia en cirugía de condilomas anales en mayores de 15 años / Experience in anal condyloma surgery in patients older than 15 years

Resumen Objetivo: Describir la experiencia en cirugía electiva de condilomas anales en pacientes mayores de 15 años en un hospital terciario de la Región Metropolitana. Material y Método: Estudio observacional retrospectivo y descriptivo, en el cual se analizan las intervenciones quirúrgicas electivas realizadas entre 2008 a 2021. Resultados: Dentro del período analizado se obtuvo 165 cirugías de condilomas anales, lo que corresponde a 137 pacientes en total. El 85% de los pacientes son de sexo masculino, el 68% de los pacientes son VIH positivo, un 87% de los pacientes MSM (hombres que tienen sexo con otros hombres) son VIH positivo, el 34% de los pacientes tiene antecedente de ETS, el 46% de los pacientes recibió terapia tópica como tratamiento preoperatorio o posoperatorio. Un 25% de los pacientes presenta recidiva en su historia personal, un 21% de los pacientes presenta lesiones anales intraepiteliales de alto grado, un 6% presenta carcinoma escamoso infiltrante. No hubo mortalidad descrita. Discusión: El presente estudio, describe la experiencia en cirugía de condilomas de un hospital terciario de la Región Metropolitana de Chile, cuya población corresponde a un estrato socioeconómico medio y bajo. Se logra describir a la población que es intervenida de condilomas acuminados, además de sus resultados quirúrgicos precoces y a largo plazo. Conclusión: El presente estudio, presenta una población de 137 pacientes operados de condilomas anales, a partir de los hallazgos de la cirugía. Se cumple el objetivo del estudio de caracterizar en un período de 12 años los resultados quirúrgicos de dicha serie, algo no reportado previamente en la literatura chilena.

Objective: To describe the experience in elective surgery for anal condylomas in patients over 15 years of age in a tertiary hospital in the Metropolitan Region. Materials and Method: Retrospective and descriptive observational study about elective surgical interventions performed between 2008 to 2021. Results: Within the analyzed period, 165 anal warts surgeries were obtained, corresponding to 137 patients. 85% of the patients are male, 68% are HIV positive, 87% of the MSM patients are HIV positive, 34% of the patients have a history of STDs, 46% of the patients received topical therapy as preoperative or postoperative treatment. 25% present recurrence in their personal history, 21% present high-grade anal intraepithelial lesions, 6% present infiltrating squamous carcinoma. There was no reported mortality. Discussion: The present study describes the experience in condyloma surgery in a tertiary hospital in the Metropolitan Region of Chile, whose population corresponds to a medium and low socioeconomic stratum. It is possible to describe the population that undergoes surgery for this reason, in addition to its early and long-term surgical results. Conclusion: The present study presents a population of 137 patients operated on for anal condylomas, based on the findings of the surgery. The objective of the study to characterize the surgical results of this series over a 12-year period is fulfilled, something not previously reported in the Chilean literature.

Consumo de huevo y diabetes mellitus tipo 2: Una revisión de la literatura científica / Egg intake and diabetes mellitus type 2: A review of the scientific literature

RESUMEN El huevo es un alimento altamente nutritivo con potenciales beneficios para la salud. Sin embargo, debido a su elevado contenido de colesterol, su consumo ha sido restringido en la población general. El objetivo de esta revisión es difundir en la comunidad científica la evidencia más reciente sobre los efectos del consumo de huevo específicamente en sujetos con diabetes mellitus. Estudios observacionales muestran que el consumo de hasta un huevo al día no se asocia a una mayor prevalencia de enfermedad cardiovascular en la población general, pero podría aumentar el riesgo entre los diabéticos. Asimismo, algunos de estos estudios han mostrado que un elevado consumo de huevo se asocia a un aumento en la incidencia de diabetes en la población general. Por otro lado, estudios de intervención a corto plazo en este subgrupo muestra que el consumo de huevo no afecta negativamente los factores de riesgo cardiovascular ni control glicémico en estos pacientes. Además, su consumo podría aumentar el impacto del uso de dietas hipocalóricas en la disminución de peso corporal, una importante herramienta en el manejo médico de la diabetes.

ABSTRACT Eggs are a highly nutritious food with potential health benefits. However, because of its high cholesterol content, physicians have recommended consumption restrictions in the general population. The aim of this review is to update the scientific community on the latest research about the impact of egg consumption in subjects with diabetes mellitus. Although several observational studies show that an intake of one egg a day does not increase cardiovascular risk in the general population, however risk may increase among diabetics. Additionally, some prospective cohorts have associated associated higher egg intake with an increased diabetes incidence in the general population. On the other hand, short-term intervention studies have not shown any adverse outcome in terms of cardiovascular risk or glycemic control with egg intake. Moreover, there are studies that suggest a beneficial effect of egg consumption in weight reduction, an important therapeutic tool in diabetes management.

Validación de cuestionario autoaplicable para un índice de alimentación mediterránea en Chile / Validation of self-applicable questionnaire for a Mediterranean dietary index in Chile

Background: Availability of brief dietary indexes that can effectively evaluate dietary patterns and their association with health is critical for prevention and management of several chronic disease conditions. Aim: To adapt a self-applicable Mediterranean Dietary Index in Chile (Chilean-MDI). Material and Methods: The Chilean-MDI was developed based on a previous Mediterranean eating score that was adapted to Chilean dietary habits. This index was further validated in a sample of 153 adults by comparing the concordance between the results obtained by self-application of the Chilean-MDI with those obtained by a trained nutritionist. Additionally, the index was applied in a sample of 53,366 Chilean adults in order to describe the diet quality of our population. Results: There was an adequate concordance between findings obtained by self-application of the Chilean-MDI and those achieved by the nutritionist. The application of the index in Chilean adult population showed a better diet quality (high Mediterranean diet adherence) among women, with advanced age and among people with higher educational levels. Conclusions: The Chilean-MDI can be successfully self-applied to portray the overall diet quality in the Chilean adult population. Additionally, this dietary index describes overall food intake in Chilean adults, showing demographic trends that are comparable to those obtained with similar indexes applied in other populations.

Evidencia actual sobre los beneficios de la dieta mediterránea en salud / Current evidence on health benefits of the mediterranean diet

The Mediterranean diet is currently considered a functional diet with an increasing amount of scientific evidence that supports its beneficial effects in human health. Several observational cross-sectional and prospective cohort studies show an association between this diet and a lower prevalence and incidence of chronic diseases, such as cardiovascular disease, cancer, metabolic syndrome, diabetes, and neurodegenerative diseases as well as a reduced overall mortality. Additionally, clinical interventional studies, particularly the PREDIMED (Prevención con Dieta Mediterránea) initiative, have shown, with high quality scientific evidence, that a Mediterranean diet -supplemented either with olive oil or nuts- can lower by 30% the incidence of cardiovascular disease, reverse the metabolic syndrome, and prevent the development of diabetes and aging-related cognitive decline. Chile has one of the five Mediterranean ecosystems in the world, and therefore the implementation of this food pattern and lifestyle in our country may determine large benefits to the health status and quality of life in the Chilean population.

Actividad física y su asociación con factores de riesgo cardiovascular: Un estudio en adultos jóvenes / Physical activity and cardiovascular risk factors among Chilean young men and women

Background: Physical activity (PA) has a protective role in cardiovascular diseases. Aim: To quantify PA in young adults and to correlate it with cardiovascular risk factors. Material and Methods: A cross-sectional study was performed employing the international physical activity questionnaire (IPAQ), to measure the PA of 983 randomly selected young adults from Valparaiso region born between 1974 and 1978. Its results were associated with levels of obesity, insulin resistance and cardiovascular risk factors defined by the National Cholesterol Education Program-Adult Treatment Panel III (NCEP- ATP III) Results: Mean physical activity among men and women was 3731 ± 3923 and 1360 ± 2303 METs-minutes/week, respectively (p < 0.001). Fifty percent of women and 21.5 percent of men had an insuffcient level of physical activity (p < 0.001). Sixty percent of men and 23.4 percent of women had an intense level of physical activity (p < 0.001). There was an inverse association of physical activity and insulin resistance. A high physical activity was protective, specially among men, against a low HDL cholesterol level and high triglyceride levels with Odds Ratios of 0.59 (confdence interval (CI): 0,35-0.98) and 0.49 (CI: 0,27-0,87) respectively, after adjusting for body mass index and age. Conclusions: In this sample, men had higher levels of physical activity, that was protective against insulin resistance and the presence of cardiovascular risk factors.

Características clínicas y metabólicas de los estados de intolerancia a la glucosa y glicemia de ayuno alteradas / Clinical and metabolic features of subjects with glucose intolerance and high fasting glucose levels

Background: Subjects with glucose intolerance or high fasting glucose levels have a higher cardiovascular risk and frequently become diabetic. Aim: Toassess clinical and metabolic characteristics of patients with glucose intolerance or high fasting glucose levels. Material and methods: Fasting and post glucose load serum glucoseand insulin levels were measured in 1404 people, aged 42,0 ± 14,2 years (81% women) with high diabetic risk. We categorized subjects in different alterations of blood glucose, accordingto 2006 American Diabetes Association categories. Insulin resistance (RI), insulin secretion (ß %) and insulin disposition (ID), were calculated using fasting blood glucose and insulin levels, using the homeostasis model assessment (HOMA I and II). Results: Sixty percent of studied subjects had first grade relatives with diabetes mellitus and 1097 (78%) were categorized as normal (N), 45 (3%) as Diabetes Mellitus (DM), 161 (11%) as high fasting glucose levels (GAA) and 103 (7%) as glucose intolerant (ITG). Fifty three of the 106 subjects with GAA (50%), were also glucose intolerant. Subjects with GAA had similar insulinsensitivity and lower ß cell function than N (insulin disposition 58 ± 12 and 111 ± 32%, respectively, p <0.01). ITG had less insulin sensitivity than N (HOMA-IR 2.6 ± 1.50 ± and 2.0 ± 1.30, respectively) and only a mild decrease in ß cell function (insulin disposition 96 ± 26 and 111 ± 32% respectively, p < 0.01). Patients GAA plus ITG had similar alterations than those with DM (HOMA-IR 3.8 ± 2.2 and 4.4 ± 3.7 respectively; insulin disposition 57 ± 10 and 56.0 ± 26% respectively. Conclusions: Patients with higher fasting glucose levels behavedifferently from those with glucose intolerance. High fasting glucose levels are highly prevalent in subjects with high risk of DM and must be considered as risk indicator in preventive programs for diabetes mellitus.

Prevalencia de desnutrición calórico proteica en pacientes hemodializados crónicos / Prevalence of caloric protein malnutrition among patients in chronic hemodialysis

Background: Malnutrition has been strongly associated with morbidity and mortality in hemodialysis patients. In the other hand, dialysis allows a nutritional improvement in patients with more than 12 months in dialysis. Aim: To study the prevalence of malnutrition among patients in hemodialysis. Patients and methods: We measured clinical, anthropometric and biochemical parameters of nutritional status in chronic hemodialysed patients. Results were related to individual time in dialysis. Patients with more and less than 12 months in dialysis were compared. Results: Twenty nine patients (18 male) aged 14 to 65 years old, were studied. Mean caloric intake was 23,8 Cal/Kg and protein intake was 0,7 g/Kg. Mean body mass index was 21.7ñ3.7 kg/m2 Thirty eight percent of patients had a body mass index of less than 20 kg/m2. Mean serum albumin was 4.1ñ0.7 g/L; mean prealbumin was 33.5ñ7.9 mg percent and creatinine was 9.6ñ2.8 mg percent. Serum cholesterol was 182 mg percent and triacylglycerol 129 mg percent. PCR was 42.2ñ18.8 and Kt/V was 1.45ñ0.3. We did not find a correlation between nutritional markers and time in dialysis or a difference in nutritional parameters between patients with less or more than 12 months in dialysis. Conclusions: These patients in chronic dialysis have a high prevalence of caloric malnutrition, which may be due to a poor caloric intake. Protein malnutrition parameters were normal in most patients. The absence of abnormal lipid levels, common in chronic renal failure, is noticeable

Nutrición parenteral central en diabéticos / Total parenteral nutrition in diabetic patients

Se analiza la evolución metabólica, durante la Nutrición Parenteral Total Central (NPTC), de 10 pacientes diabéticos insulino no dependientes. Un primer grupo, constituido por 4 pacientes recibió un aporte calórico predominante como hidratos de carbono (HdeC) (75%% del aporte calórico diario total); mientras que en el segundo grupo, de 6 pacientes, la fuente energética fue mixta, a base de HdeC y de emulsiones de lípidos diarias (50% y 25% del aporte calórico total respectivamente). El grupo que recibió emulsiones de lípidos diariamente, requirió menos dosis de insulina cristalina para mantener las cifras de glicemia estables, presentó menor número de episodios de hiperglicemias e hipoglicemias (p < 0,005) mientras se mantuvo en NPTC. Ninguno de los 2 grupos registró ocurrencia de cetoacidosis o coma hiperosmolar no cetócico durante la NPTC

Nutrición enteral: II. Efecto de diferentes aportes energéticos y proteicos en pacientes no hipercatabólicos / Enteral Nutrition: II. Effect of different energy and protein intake in non hypercatabolic patients

El objetivo de la asistencia nutricional es mantener un adecuado estado nutricional y recuperar al paciente desnutrido. Se presenta la evolución de 27 pacientes no hipercatabólicos sometidos a nutrición enteral por períodos variables entre 6 a 89 días (-x 24 + ou - 18) con aportes de 53 + ou - 23 Calorías y 1,8 + ou - 0,8 g de proteínas/kg día. Los niveles de albuminemia mejoraron significativamente de 3,1 a 3,4 g/dL (p < 0,02), aunque los índices antropométricos no sufrieron cambios. Entre los pacientes mantenidos en balance energético positivo, el balance nitrogenado mejoró significativamente (p < 0,01) con el mayor aporte proteico y no se relacionó con el aporte calórico. Ello sugiere la necesidad de incrementar el aporte nitrogenado para una mayor repleción de masa magra

Nutrición enteral: I. Evolución nutricional en pacientes hipercatabólicos / Enteral nutrition: I. Nutritional evolution in patients

La asistencia nutricional en pacientes hipercatabólicos se orienta a mantener un equilibrio energético y proteico evitando el deterioro de la composición corporal. Se analiza la evolución de 10 adultos hipercatabólicos en nutrición enteral durante 7 a 48 días con aportes diarios de (x + ou - DS) 32 + ou - 14 Calorías y 1,1 + ou - 0,5 g de proteínas por kg de peso. El estado nutritivo (antropometría, albuminemia y linfocitos) se mantuvo sin variación significativa y el balance nitrogenado estimado fue cercano al equilibrio. El balance nitrogenado se relaciona significativamente (p<0.01) con el aporte calórico y proteico, sugiriendo que pacientes hipercatabólicos requieren sobre 45 Calorías y 1,6 g de proteínas/kg de peso al día para lograr balances nitrogenados >- 0 cuando el porcentaje de calorías como proteínas está entre 11 y 18%