Caracterización espirométrica de pacientes con fibrosis quística / Spirometric caracterization of cystic fibrosis patients

INTRODUCCIÓN: El pronóstico de los pacientes con fibrosis quística (FQ) ha mejorado en forma notable. La evaluación de la progresión de la enfermedad se basa en la medición del Volumen Espirado al primer segundo (VEF1). OBJETIVOS: 1. Describir volúmenes y flujos espiratorios forzados y comparar su interpretación según diferentes patrones de referencia (Knudson, multiétnicas Global Lung Initiative, Gutiérrez); 2. Comparar evolución de VEF1 según diferentes patrones de referencia; 3. Describir respuesta a broncodilatador. PACIENTES Y MÉTODO: Estudio retrospectivo de fichas clínicas y espirometrías de pacientes con FQ controlados en Hospital Dr. Sótero del Río. Se obtuvo antecedentes demográficos, resultados de prueba de sudor, estudio genético, estudio bacteriológico. Se evaluó respuesta a broncodilatador (salbutamol 400 ugr), considerando significativo un aumento en 12% en el VEF1. El valor de cloro en sudor se obtuvo mediante método de Gibson y Cooke. Se registraron: Capacidad Vital Forzada (CVF), Volumen Espirado al primer segundo (VEF1) y relación VEF1/CVF. Para graficar la progresión del VEF1 en el tiempo y las curvas teóricas de GLI, Knudson y Gutiérrez, se utilizó el software de libre distribución R versión 3.3.1. RESULTADOS: Se incluyeron 14 pacientes, 7 varones, edad entre 6 y 24 años, mediana 15 años, me diana índice de masa corporal (IMC) 18,15 (rango 14,6-23,3), mediana cloro en sudor 76 mEq/l (rango 50,2- 119), 7 pacientes con al menos 1 mutación F508del. Al utilizar fórmulas predictivas multiétnicas y de Gutiérrez, el compromiso de la función pulmonar ocurría con anterioridad en relación al uso de ecuaciones de Knudson. Ninguno de los pacientes presentó respuesta significativa a broncodilatador. CONCLUSIÓN: El grupo de pacientes descritos presenta en su mayoría compromiso funcional respiratorio y no tiene respuesta a broncodilatador. La interpretación del compromiso funcional respiratorio varía según los valores teóricos utilizados.

INTRODUCTION: The prognosis of patients with cystic fibrosis (CF) has remarkably improved. The as sessment of the disease progression is based on the measurement of the FEV1 (Forced Expiratory Volume in one second). OBJECTIVES: 1. To describe forced expiratory flows and volumes and com pare their interpretation according to different reference standards (Knudson, Gutiérrez, and multi ethnic GLI); 2. To describe bronchodilator response. Patients and Method: The medical records and spirometries of all patients with CF controlled at the Dr. Sotero del Rio Hospital were reviewed. Demographic background, sweat test results, genetic study , and bacteriological study were obtained. In addition, Forced Vital Capacity (FVC) was recorded as well as FEV1 and FEV1/FVC ratio. RESULTS: Data from 14 patients, were analyzed, seven males, aged 6-24 years, median 15 years, median BMI 18.15 (range 14.6-23.3), median sweat chloride test 76 mEq/l (range 50,2-119 mEq/l), seven patients with at least one F508del mutation. Using multi-ethnic and Gutierrez predictive formulas, lung function involvement occurred previously in relation to the use of Knudson equations. None of the patients had a significant bronchodilator response. CONCLUSION: The group of patients descri bed mostly presents functional respiratory involvement and had no bronchodilator response. The interpretation of functional respiratory involvement varies according to the theoretical values used.

Score genético predice agresividad del cáncer de próstata / Genetic score predicts aggressiveness of prostate cancer

Establecer un score genético utilizando los polimorfismos de nucleótido único (SNPs) del gen que codifica para Ribonucleasa L (RNASEL)y regiones cromosómicas 8q24 y 17q12-24 en combinación con el antígeno específico de la próstata (PSA) para predecir la agresividad del cáncer de próstata (CaP). Pacientes y métodos: hombres con CaP tratados con prostatectomía radical. Se analizaron variables clínicas y patológicas: edad al diagnóstico, PSA al diagnóstico, el volumen tumoral (TV) y extensión extracapsular (ECE) según el TNM (tumour, node and metastasis) (ECE ≥T3) y score de Gleason. Desarrollamos un modelo de puntaje genético usando regresión logística multivariable. Resultados: se incluyeron 86 pacientes sometidos a prostatectomía radical. Edad promedio fue de 62 ± 7,5 años. El promedio de PSA fue de 11,3 ± 10,6 ng/mL. Treinta y un pacientes (36 por ciento) tuvieron ECE. La mediana del TV fue de 3,8 cc. Un PSA ≥ 10 ng/mL se asoció con una mayor tasa de ECE (p <0,05) y TV más alto (p = 0,032). En el análisis univariable, los pacientes con > 1 SNP tienen mayor riesgo de ECE que los pacientes con ≤ 1 SNP (42 por ciento vs. 10,5 por ciento, p = 0,01), y los pacientes con ≥ 3 SNP tienen más TV que los pacientes con <3 SNP (60 por ciento vs. 32 por ciento, p = 0,015). Se crearon dos modelos de riesgo usando el número de SNP y PSA ≥ o <10 ng/mL para predecir ECE (sensibilidad 67 por ciento y especificidad 84 por ciento) y TV (sensibilidad 59 por ciento y especificidad 70 por ciento). Conclusiones: El score genético presentado en este estudio es una herramienta novedosa para predecir indicadores de agresividad del CaP, como ECE y TV.(AU)

To establish a genetic score using SNPs (from RNAsel and chromosomal regions 8q24 and 17q12-24) in combination with Prostate Specific Antigen (PSA) at diagnosis to predict aggressiveness of PCa (tumor volume (TV) and extracapsular extension (ECE)). Patients and methods: Men with PCa diagnosed by needle biopsy and treated with radical prostatectomy (RP). Clinical and pathological variables such as age at diagnosis, PSA at diagnosis, TV, extension of tumor according TNM (ECE ≥T3) and Gleason score where analyzed. We developed a genetic score model using Multivariate Logistic Regression. Results: We included 86 patients who underwent RP. Mean age 62 ± 7.5 years. Mean PSA was 11.3 ± 10.6 ng/mL. Thirty-one patients (36 percent) had ECE. Median TV was 3.8 cc. PSA ≥ 10 ng/mL was associated with increased rate of ECE (p <0.05) and higher TV (p = 0.032). In univariate analysis, patients with more than 1 SNP had a greater risk of ECE than patients with ≤ 1 SNP (42 percent vs. 10.5 percent, p = 0.01), and patients with ≥ 3 risk SNPs had more TV than patients with <3 SNPs risk (60 percent vs. 32 percent, p = 0.015). Two models of risk using the number of SNPs and PSA ≥ or <10 ng/mL to predict ECE (sensitivity 67 percent and specificity 84 percent) and TV (sensitivity 59 percent and specificity 70 percent) were created. Conclusions: Genetic score usingdescribed SNPs and preoperative PSA can predict aggressiveness of PCa, which would be useful to define a management with more information at diagnosis especially in localized cancers.(AU)

Caracterización epidemiológica de mordeduras en personas, según registro de atención de urgencia: Provincia de Los Andes, Chile / Epidemiological characterization of bites on people, as emergency care record: Province of Los Andes, Chile

Background: Bites constitute a public health problem worldwide. Aim: To characterize epidemiologically bites by animals happened in the province of Los Andes (2005-2007). Method: Descriptive, retrospective epidemiological study. Studied variables: Bitten person (BP), accident by bite, biting animal and bite. It was not feasible to obtain more updated information by law of patient protection. Results: 2,360 BP were assisted in the emergency unit of San Juan de Dios Hospital and Rio Blanco clinic. An annual average rate of 729 BP/100,000 inhabitants and 1.99 daily average was recorded. The male gender was most affected (53.5%) and the age group from 6 to 10 years old. (Rate: .521/100,000). Most frequent topographic location was the lower limb, except in children under 5 year olds in whom predominated head and neck. The biting animal according to frequency was: the dog (67.1%) spider (7.1%) and cat (3.9%). The animal property was 35.6% known and 30.7% own. The most frequent problems were: nonspecific allergy; toxic effect by spider bites and among the infections, the disease made by cat’s scratch stands out. Regarding the record system, the biting animal complaint was applied to 47.6% of the BP and the 92.8% of the recorded information was incomplete. Conclusions: Bites reported higher rates in the province of Los Andes than the average of the country (729 versus 188/100,000), standing out the higher magnitude in 6 to 10 year-old-children. It is noticed that the record is low and incomplete. In this province, no bite control programs or updated studies have been carried out.

Introducción: Las mordeduras constituyen un problema de salud pública mundial. Objetivo: Caracterizar epidemiológicamente las mordeduras por animales ocurridos en la provincia de Los Andes (2005-2007). Método: Estudio epidemiológico descriptivo retrospectivo. Variables estudiadas: Persona mordida (PM), accidente por mordedura, animal mordedor y mordedura. No fue factible obtener información más actualizada por ley de protección del paciente. Resultados: Se atendieron 2.360 PM en los Servicios de Urgencia del Hospital San Juan de Dios y Clínica Río Blanco. Se registró una tasa anual promedio de 729 PM/100.000 hbts. y promedio diario 1,99. El género más afectado fue el masculino (53,5%), y el grupo etario de 6 a 10 años (tasa:1.521/100.000). La ubicación topográfica más frecuente fue extremidad inferior, excepto en niños bajo 5 años de edad en quienes predominó cabeza-cuello. El animal mordedor según frecuencia fue: perro (67,1%) araña (7,1%) y gato (3,9%). La propiedad del animal fue 35,6% conocida y 30,7% propios. Las complicaciones más frecuentes fueron alergia no específica, efecto tóxico por mordedura de arañas y entre las infecciones destaca la enfermedad por rasguño de gato. La notificación de animal mordedor se aplicó a 47,6% de las PM; 92,8% de la información contenida estaba incompleta. Conclusiones: Las mordeduras en la Provincia de Los Andes presentaron tasas mayores que el promedio país (729 versus 188/100.000), destacando la mayor magnitud en niños de 6 a10 años. En la provincia no se han realizado programas de control de mordeduras o estudios actualizados.

Sobrevida alejada de pacientes operados por cáncer gástrico incipiente / Long term survival of patients operated for early gastric cancer

Background: Early gastric cancer involves mucosa and submucosa, independent of lymph node involvement. Radical gastrectomy is the standard treatment. Aim: To assess long term survival of patients operated for an early gastric cancer. Material and methods: Retrospective Rev iew of medical and pathology records of patients subjected to a gastrectomy for an early gastric cancer, between 1975 and 2002. All were treated using a standardized protocol and staged according to 2002 TNM classification of the American Joint Committee of Cáncer (AJCC). Demographic and pathologic features, operation performed and long term survival were recorded. Survival was analyzed using Kaplan-Meier method. Results: The series is comprised by 64 males and 41 females aged 61 + 1 years. Tumor was located in the upper third of the stomach on 33 subjects and a total gastrectomy was performed in 53. Pathology showed an intestinal type adenocarcinoma in 82 and a diffuse type in 23. In patients with involvement of mucosa and submucosa, 24 ± 14 and 22 ± 14 lymph nodes were excised, respectively. Lymph node involvement was present in 8 percent and 22 percent of patients with involvement of mucosa and submucosa, respectively. Five years survival was 94 percent and 78 percent in patients without and with lymph node involvement, respectively. Survival among patients in stage IA and IB was 94 percent and 76 percent, respectively. Multivariate analysis showed that the lymph node involvement was an independent mortality risk factor. Conclusions: Total gastrectomy in patients with early gastric cancer is associated with a good survival. Lymph node involvement is a mortality risk factor.

Prevalencia de la incontinencia fecal en centros de salud y casas de reposo / Prevalence of fecal incontinence in health centers and nursing home residents

Background: Fecal and urinary incontinence (FI and UI) are psychologically and socially debilitating and embarrassing conditions. Aim: To determine the prevalence of FI and associated factors in patients assessed in health centers (HC) and nursing home (NH) residents. Material and Methods: Prospective, multicentric survey carried out in 3 HC and 16 NH of Santiago. Patients and residents of NH were interrogated about FI between March and July 2004. Results: The questionnaire was answered by 618 patients attending health centers aged 18 to 87 years (75 percent females) and 128 nursing home residents aged 40 to 103 years (80 percent females). The prevalence of liquid or solid FI in HC and NH was 2.7 and 45 percent, respectively. Among the latter, the incontinence for liquids and solids was 19 percent and 42 percent, respectively. The prevalence of UI was 30.1 and 62.7 percent in HC patients and NH residents, respectively. Among patients attending HC, multivariable analysis showed a relation between older age and urinary incontinence with liquid or solid FI Among NH residents, multivariate analysis showed a relation between urinary incontinence and motor disabilities with liquid or solid FI Conclusions: The prevalence of liquid or solid FI among patients assessed in health center is 2.7 percent. This figure increases in older people, those with UI and in NH residents.

Estimation of individual neonatal survival using birthweight and gestational age: a way to improve neonatal care.

The study was conducted to determine the combined effect of birthweight and gestational age at birth on neonatal mortality using individually-identified livebirths. Logistic regression was used for studying the interactive effect of birthweight and gestational age on the individual probability of neonatal death. All livebirths from Chile in 2000 were included in a linked file. Odds ratio models for birthweight and gestational age were developed for each sex. The probability of neonatal death by sex was presented using contour plots. The models were statistically significant, and odds ratios were different and non-linear for the effects of birthweight and gestational age. Contour plots of constant neonatal mortality according to birthweight and gestational age were presented; they were similar for each sex. A single graph for both sexes that estimates the survival potential of infants born too early or too small would improve neonatal care in developing countries.

Features associated with the development of non-motor manifestations in Parkinson's disease

Parkinson's disease (PD) is a neurodegenerative disorder, predominantly characterized by the presence of motor symptoms. However, the non motor manifestations (NMM) are a frequent complaint in the PD patients. There is a lack of information about the risk factors associated with the NMM in these patients. The aim of this study is to evaluate the prevalence of the more common NMM in a population of PD patients and to determine the features associated with its development. We studied 124 ambulatory PD patients. NMM were defined by the presence of neuropsychiatric manifestations, cognitive disorder, autonomic dysfunction or sleep related problems. In a multivariate analysis we found that the years of evolution of the PD and the presence of cognitive dysfunction are the risk factors for the neuropsychiatric and autonomic manifestations, whereas axial impairment is a risk factor for cognitive disorders and dyskinesias is for sleep related problems. In conclusion, this study shows that the features related to the PD progression appear as the main risk factors associated with NMM.

La enfermedad de Parkinson (EP) es un trastorno neurodegenerativo, caracterizado predominan-temente por la presencia de síntomas motores. No obstante, la presencia de manifestaciones no motoras (MNN) son frecuentes en los pacientes con EP. Existe escasa información sobre los factores de riesgo asociados con la aparición de MNN en dichos pacientes. El objetivo de este estudio fue evaluar la prevalencia de las MNN más comunes en una población de pacientes portadores de EP y determinar los factores de riesgo asociados con su aparición. Estudiamos 124 pacientes portadores de EP atendidos en forma ambulatoria. La presencia de MNN fue definida por la aparición de manifestaciones neuropsiquiátricas, trastorno cognitivo, disfunción autonómica o alteraciones del sueño. En el análisis multivariado encontramos que los años de evolución de la EP y la presencia de disfunción cognitiva son los principales factores de riesgo para las manifestaciones neuropsiquiátricas y autonómicas, mientras que el compromiso axial es el mayor factor de riesgo para la aparición de manifestaciones cognitivas y la presencia de discinesias es el principal factor asociado con la aparición de trastornos del sueño. En conclusión, este estudio muestra que los factores asociados a la progresión de la EP son los principales factores de riesgo para la aparición de las MNN en nuestra población.

Sexualidad de la mujer histerectomizada: modelo predictivo al seto mes posterior a la cirugía / A predictive model for the quality of sexual life in hysterectomized women

Background: The effects of hysterectomy on sexuality has been extensively studied. Aim: To establish a model to predict the quality of sexual life in hysterectomized women, six months after surgery. Material and Methods: Analytical, longitudinal and prospective study of 90 hysterectomized women aged 45±7 years. Two structured interviews at the time of surgery and six months later were carried out to determine the characteristics of sexuality and communication within the couple. Results: In the two interviews, communication and the quality of sexual life were described as "good" in 72 and 77 percent of women, respectively (NS). The variables that had a 40 percent influence on the quality of sexual life sixth months after surgery, were oophorectomy status, the presence of orgasm, the characteristics of communication and the basal sexuality with the couple. Conclusions: The sexuality of the hysterectomized women will depend, on a great extent, of pre-surgical variables. Therefore, it is important to consider these variables for the education of hysterectomized women.

Práctica transfusional en pacientes adultos sometidos a cirugía cardíaca con circulación extracorpórea: experiencia de la Pontificia Universidad Católica de Chile / Prediction of blood transfusion need in patients undergoing open heart surgery: the experience of Catholic University Hospital, Chile

Antecedentes: La cirugía cardíaca se asocia a un alto consumo de sangre homóloga. Si conocemos los factores quepredicen una mayor necesidad de transfusión, podremos implementar mejores estrategias de ahorro sanguíneo. Objetivo: Describir la práctica transfusional en pacientes adultos sometidos a cirugía con circulación extracorpórea (CEC) en la Pontificia Universidad Católica de Chile. Materiales y métodos: Se recolectaron en forma retrospectiva los datos de 194 pacientes adultos sometidos a cirugía cardíaca con CEC, entre octubre de 2003 y marzo de 2004. Se realizó una descripción de la práctica transfusional y un análisis de riesgo uni y multivariado. Resultados: El 61,8 por ciento de los pacientes se transfundieron durante la hospitalización. La transfusión intraoperatoria se relacionó con sangrado y la transfusión postoperatoria con la corrección de un hematocrito bajo. Los factores predictores de transfusión fueron cirugía de urgencia, tiempo prolongado de CEC, edad avanzada y un menor hematocrito al momento de ingresar a la unidad de cuidado postoperatorio. El hematocrito bajo al inicio de la cirugía, una menor temperatura durante CEC y un mayor sangrado en el postoperatorio predijeron el uso de más de dos unidades de glóbulos rojos (GR).Los pacientes que recibieron más de 2 unidades de GR presentaron en forma significativa mayor incidencia de neumonía, insuficiencia respiratoria y sepsis. Conclusiones: La transfusión sanguínea en cirugía cardíaca se relaciona directamente con la complejidad de los pacientes y los procedimientos. Las técnicas de ahorro de sangre deben dirigirse hacia la disminución del sangrado, la hemodilución y a estrictos criterios de transfusión intra y postoperatorios.

Background: Cardiac surgery is associated with frequent use of homologous blood. The knowledge of factors that influence the need for transfusion might help us implement strategies to avoid unnecessary blood administration. Objective: To describe the current transfusion practices in adults undergoing open cardiac surgery with extra corporeal circulation (ECC) at the Pontificia Universidad Católica of Chile Hospital. To identify factors that predict the use of transfusion. Methods: Data from 194 adult patients submitted to cardiac surgery with ECC between October 2003 and March 2004 were obtained retrospectively. Transfusional practices were identified. Uni and multivariate risk analysis was used to predict the need for transfusion.Results: 61,8 percent of patients were transfused during their hospital stay. Intraoperative transfusion was related to bleeding while post operative transfusion was performed to correct a low hematocrit value. Factors predicting transfusion were: emergency surgery, prolonged EEC time, older age and lower hematocrit value when entering the ICU. Preoperative hematocrit, lower temperature during ECC and post operative bleeding predicted the use of more than 2 red blood cell (RBC) packs. Patients receiving more than 2 RBC packs had a significantly higher incidence of pneumonia, sepsis and respiratory failure. Conclusion: Blood transfusion during cardiac surgery is directly related to complexity of procedures and severeness of patient illness. Blood saving techniques must be directed to reducing the amount of bleeding, allowing hemodilution and defining strict criteria for intra and post operative transfusions.

Procura de hígado para transplante hépatico ortotópico: comparación entre dos técnicas / Liver procurement for orthotopic liver transplantation: comparison between two techniques

Diversas modificaciones a la técnica convencional de procura del hígado en donantes cadavéricos con perfusión aórtica y portal (PAP), han sido propuestas para simplificar el procedimiento. La técnica de perfusión aórtica exclusiva (PAE), evita la disección del hilio hepático y extrae en bloque el injerto. Nuestro objetivo es comparar los resultados obtenidos con la aplicación de ambas técnicas de procuramiento. Métodos: Entre marzo - 1994 y octubre - 2002, fueron realizados 32 procuramientos hepáticos consecutivos: 16 (50 por ciento) con la técnica de PAE. Se comparó retrospectivamente datos demográficos de donantes, tiempos de isquemia /operatorios, volumen de solución preservante utilizada, biopsias de reperfusión, causas de injertos descartados, frecuencia de procedimientos a distancia y sobrevida de injerto y paciente. Resultados: No hubo diferencias en edad, sexo y causas de muerte encefálica de los donantes. Los tiempos promedios (SEM) de isquemia total fueron similares en ambos grupos. Los tiempos operatorios fueron: PAE: 117,4 (2,9) vs PAP: 186,7 (8,9) min (p<0,0001) y el volumen perfundido de solución preservante fue: PAE: 4.800 (168) vs PAP: 5.563 (128) ml(p<0,001). No hubo diferencias en las biopsias de reperfusión. Procuras a distancia (>100 KM) se realizaron en 12,5 por ciento de los casos de PAP y en 43,8 Por ciento de los donantes con PAE (p<0,05). Hubo un caso de falla primaria del injerto en el grupo de PAP. La sobrevida al año de injerto y paciente fue similar en ambos grupos. Conclusión: La procura del hígado del donante con la técnica de PAE es segura, más rápida y economiza solución preservante.

Autoevaluación sobre formación en medicina paliativa en una cohorte de residentes / Self assessment about proficiency on palliative care in a cohort of residents

Background: Little is known about the status and level of medical education on palliative care, symptom control and aspects of end of life care provided by medical school programs in Chile. Aim: To determine if a cohort of residents had palliative care and end of life care education during pre graduate and post graduate training. Residents were also asked to self assess their proficiency in these areas. Material and Methods: In 2002, we contacted 200 of a total of 327 residents of the postgraduate programs of the Pontificia Universidad Catolica de Chile. They were asked to anonymously answer a preformed questionnaire addressing different aspects related to palliative care, symptom control and end of life issues. Results: Less than 25 percent of residents received some degree of palliative care education during their studies, and approximately half of them considered that the level of proficiency reached was less than 25 percent. This contrasted with a good self assessment in the management of pain and gastrointestinal symptoms. For the treatment of the anorexia-cachexia syndrome and delirium, approximately 50 percent of the cohort had a mean self assessment score of 3 in a scale of 1 to 7. More than 80 percent of residents considered that palliative medicine education is important for their medical career. Conclusions: Chilean medical schools must improve palliative care and end of life training as part of their mandatory curriculum in both the pre and post graduate levels.