Encuesta de síntomas SNOT-20 para rinitis alérgica y rinosinusitis: validación en Chile / Validation of the sino-nasal outcome test in Chile

Background: Allergic rhinitis and sinusitis are common diseases that affect quality of life of pediatric and adult patients. Aim: To adapt and validate the Sino-Nasal Outcome Test 20 indicators (SNOT-20) survey in Chilean subjects. Material and Methods: In a psychometric validation study, an adapted version of the SNOT-20 adapted version was applied to 181 volunteers on two different occasions, three weeks apart. Feasibility (response time and perceived difficulty), reliability (internal consistency and test-retest) and validity (concurrent validity, correlating results with an independent instrument; predictive validity assessing its sensitivity to detect changes and discriminate validity, assessing receiver operating characteristic (ROC) curves), were assessed. An exploratory factor analysis was performed to confirm the presence of previously described underlying constructs. Results: Eighty percent of participants considered SNOT-20 easy to complete. This task was completed in less than 5 minutes. Cronbach's alpha was 0.946. Temporal stability on a healthy subgroup was strong with an intraclass correlation coefficient of0.92. SNOT-20 had a correlation coefficient of0.82 with an independent instrument and its score significantly decreased after 3 weeks of treatment (p = 0.003). The area under ROC curve was 0.895. Factor analysis identified four principal components which possessed identical structure as previously described. Conclusions: SNOT-20 survey was valid, reliable and easy to implement among Chilean subjects.

La manipulación del paciente inconsciente con fines docentes / Using unconscious patients for teaching purposes

Se comenta, analizando el relato de un caso clínico, lo impropio de utilizar pacientes inconscientes para fines docentes, justificados solo en el hecho de que por su alteración de conciencia no se negarán al examen físico ni se sentirán incómodos por el mismo y que ello además autoriza a docentes y estudiantes a prácticas mas libres al respecto. Se destaca la absoluta importancia de respetar los derechos de los pacientes, especialmente la autonomía que puede ejercer decidiendo si accede o no a ser examinado por alumnos y que si no puede ejercerla, sean sus familiares o su médico tratante, quien o quienes la resguarden y que por ningún motivo debe olvidarse que el sujeto de estudio, consciente o inconsciente, es un ser humano, persona con dignidad que no puede vulnerarse en circunstancia alguna