RESUMEN
Introducción y objetivos: Describir los cambios en las características clínicas de los pacientes operados por endocarditis infecciosa (EI) en el centro-sur de Chile durante las últimas cuatro décadas. Métodos: Estudio retrospectivo de la serie de pacientes con diagnóstico de EI con indicación de cirugía de un hospital público chileno entre 1983 y 2020. La cohorte (n = 306) se dividió en cuatro grupos según el periodo de la cirugía: 1983-1990 (n = 50), 1991-2000 (n = 53), 2001-2010 (n = 44) y 2011-2020 (n = 159). Se compararon variables sociode-mográficas y clínicas entre los grupos utilizando la prueba de Kruskal-Wallis e independencia de Chi-cuadrado. Se calcularon supervivencias acumuladas que se compararon con la prueba de Gehan-Breslow-Wilcoxon. Resultados: Se observó un aumento de la edad al momento del diagnóstico (p < 0,001), de la frecuencia de comorbilidades (p < 0,001), de la presentación clínica compatible con lesión renal aguda (p < 0,001), de la afectación independiente de la válvula mitral (p < 0,001), de la positividad de los cultivos (p < 0,012) y de la supervivencia acumulada (p = 0,015). Hubo una disminución del tiempo desde el inicio de síntomas hasta el diagnóstico (p = 0,003), en la presentación clínica compatible con insuficiencia cardíaca (p < 0,001), la afectación independiente de la válvula aórtica (p < 0,001) y la indicación quirúrgica por gran vegetación (p < 0,001). Conclusiones: El perfil de la EI de los pacientes atendidos en un hospital público del centro-sur de Chile ha experimentado cambios significativos durante las últimas cuatro décadas.
Aim: To describe the changes observed in operated patients with infective endocarditis (IE) in the south-central region of Chile during the last four decades. Methods: Case series study. The target population was patients diagnosed with IE and indication for valve surgery between 1983 and 2020 from a Chilean public hospital. The universe (n = 306) was divided into four groups according to the period of valve surgery. Sociodemographic and clinical variables between these groups were compared using the Kruskal-Wallis and Chi-square tests for independence. Cumulative survivals were calculated and compared using the Gehan-Breslow-Wilcoxon test. Results: Age at diagnosis (p < 0.001), frequency of comorbidities (p < 0.001), clinical presentation compatible with acute kidney injury (p < 0.001), independent mitral valve involvement (p < 0.001), positivity of microbiological cultures (p < 0.012) and cumulative survival (p = 0,015) increased. The delay from symptom onset to diagnosis (p = 0.003), clinical presentation compatible with heart failure (p < 0.001), independent involvement of the aortic valve (p < 0.001), and surgical indication for large vegetation (p < 0.001) decreased. Conclusions: The IE profile of patients seen in a public hospital in the south-central region of Chile has undergone significant changes during the last four decades.
RESUMEN
BACKGROUND: Medical specialists are an essential resource for the functioning of the health system and in Chile there is a growing deficit of these specialists. To address this shortage, the government has strategies for training health professionals, such as a national public contest for medical scholarships, named CONISS, which stands out for its high capacity to produce medical specialists. The scoring system of this contest is used for the allocation of training resources to the best candidates. AIM: To describe the results of the CONISS scoring system between 2016 and 2020. MATERIAL AND METHODS: Analysis of public registries of physicians participating in the CONISS contest between 2016 and 2020. RESULTS: During the study period 7,373 physicians participated in this contest (49% females). Annual participation increased progressively. The participants graduated from 21 Chilean universities and a variable number from foreign universities. The scores obtained by participants improved by 1.47 points between the first and last year of the study period. CONCLUSIONS: Interpretation of these results is complicated by the characteristics and limitations of the measurements of the CONISS scoring system. This precludes establishing whether this system effectively filters out the best candidates for medical specialization programs.