Conocimientos y opiniones de estudiantes de medicina de quinto año acerca de las medicinas alternativas y complementarias / Knowledge and opinions of fifth-year medical students about alternative and complementary medicines

Objetivos: Identificar conocimientos y opiniones de estudiantes Medicina acerca de las Medicinas Alternativas y Complementarias (MAC). Material y Métodos: Se aplicó una encuesta autoadministrada a 106 estudiantes de quinto año de Medicina de la Pontificia Universidad Católica de Chile en 2005. Esta encuesta incluyó estimadores de nivel de conocimientos, percepción de utilidad e interés por adquirir conocimientos sobre cuatro terapias: medicina mapuche, homeopatía, acupuntura y reiki. También incluyó una medición del nivel de acuerdo con doce afirmaciones generales sobre MAC. Resultados: La tasa de respuesta fue de 90,5%. El porcentaje de personas que desconocían o sólo reconocían el nombre de las distintas terapias fue variable: 11,3% para homeopatía, 19,8% para acupuntura, 54,1% para reiki y 55,2% para medicina mapuche. La mejor percepción sobre utilidad fue para la acupuntura (78,7% la considera útil o muy útil), siendo semejante para hombres y mujeres. Las otras terapias tuvieron fueron evaluadas como útiles principalmente por mujeres, con diferencias estadísticamente significativas. Se identificó un amplio interés por adquirir conocimientos generales sobre el tema. Las mujeres mostraron mayor acuerdo con las afirmaciones generales favorables hacia las MAC y mayor desacuerdo hacia las afirmaciones críticas. Discusión: Los estudiantes de Medicina presentan conocimientos limitados sobre las MAC, pero un elevado interés en el tema. Las mujeres tienen una actitud más favorable hacia las MAC que los hombres. (AU)

Frecuencia de los genes de fusión TEL/AML1 y BCR/ABL en pacientes pediátricos con leucemia linfoblástica aguda / Frequency of TEL/AML1 and BCR/ABL fusion genes in children with acute lymphoblastic leukemia

Background: t(12;21) (p12;q22) and t(9;22) (q34;q11) translocations have prognostic significance in acute lymphoblastic leukemia (ALL). The fusion genes TEL/AML1 y BCR/ABL, generated by these translocations, can be easily detected using molecular biology technique. Aim: To study the frequency of TEL/AML1 y BCR/ABL fusion genes in children with ALL. Material and methods: Fifity six children with ALL (age range 1 month- 14 years) were studied, thirty eight from our Temuco Hospital and 18 from the Metropolitan Region. TEL/AML1 y BCR/ABL fusion genes were detected in bone marrow samples using a reverse transcriptase nested polymerase chain reaction (RT-PCR). Results: TEL/AML 1 and BCR/ABL fusion gene transcripts were detected in 13 (23 percent) and 2 (4 percent) children, respectively. No differences in survival were observed between children with positive or negative transcripts for TEL/AML1 fusion gene. However, those positive for BCR/ABL fusion gene, had a significantly lower survival. Conclusions: The frequency of TEL/AML1 and BCR/ABL fusion gene transcripts in these children with ALL is similar to that described by other authors.

Subdiagnóstico de delirium en adultos mayores hospitalizados / Delirium in Chilean elderly inpatients: an overlooked problem

Background: Delirium is a common underdiagnosed and undertreated problem in elderly inpatients, associated to higher morbidity, mortality and health cost. Aim: To evaluate the prevalence of delirium at hospital admission in medically ill elderly patients and the attending physician's diagnosis and treatment of delirium. Patients and methods: In a prospective and descriptive study, consecutive patients aged 65 years or more, admitted to an internal medicine ward were evaluated by independent physicians, during the first 48 h of admission, to asses the presence of delirium. Diagnosis of delirium was based on the Confusion Assessment Method. Medical and nurse records were reviewed. Family was interviewed when necessary. Results: One hundred eight patients (52% women, age range 65-94 years) with an APACHE II score of 11.6±5, were evaluated. Fifty seven patients (53%) had delirium (32% hyperactive, 72% hypoactive and 5% mixed). Delirium prevalence was significantly higher in older patients (66% among those aged 75 years or older versus 30% in younger, p <0.05) and among patients with more severe conditions (88% among those with an APACHE score over 16 versus 47% below that value, p <0.05). Medical records of patients with delirium showed that this diagnosis was present only in 32% and cognitive deficit was described in 73%. Ten percent of patients with delirium received sedative medication and 38% were physically restricted. There were no environmental interventions to prevent or control delirium. Conclusions: Delirium in elderly inpatients at this unit is an extraordinarily prevalent problem, seriously under diagnosed (68%) and under treated. This study should alerts our medical community to improve the diagnosis and management of delirium in elderly inpatients.

Densitometría ósea en niños leucémicos al completar el primer mes de quimioterapia / Bone mineral density in leukemic children after completing one month of chemotherapy

Background: An important loss of bone mineral density, associated to pain and fractures, has been reported in children with acute lymphoblastic leukemia (ALL). Aim: To measure bone mineral density among children with acute lymphoblastic leykemia (ALL) that completed the remission induction phase with chemotherapy, that lasts 30 days. Patients and methods: children with ALL, admitted to the oncology unit of a general hospital were considered eligible for the study. body composition and bone mineral density were measured by dual energy x ray absorptiometry (DEXA). each child with ALL was paired with a healthly control. Results: Fourteen children age 1 to 11 years, completed the study, Spine and femoral bone mineral desities were significantly lower than in their matched controls. No differences in total body bone mineral density or content were observed. Children with ALL had a lower fat free mass and a higher fat mass than their matched controls. There was a significant correlation between fat free mass and bone mineral content. Conclusions: After one month of chemotherapy, children with ALL had a lower bone mineral density in the spine and femur and a lower fat free mass.

Recomendaciones de tratamiento en la menopausia / Treatment of menopause: recommendations

El objetivo de este documento es entregar una guía práctica de tratamiento del climaterio, debido a la confusión producida por el estudio WHI en 2002. La TH debe ser solo utilizada cuando exista una indicación clara para su uso. La paciente sintomática es la principal beneficiada del tratamiento. No existe un tratamiento alternativo a los estrógenos o estrógeno/progestina tan eficaz en el alivio de la sintomatología y en reducción de fracturas. La indicación de un tratamiento prolongado debe ser revisada anualmente.

Prevalencia de lesiones musculo-esqueléticas y factores de riesgo en trabajadores de plantas procesadoras de crustáceos en Chile / Prevalence of musculoskeletal disorders and risk factors in a crustacean proccessing plant workers in Chile

Una actividad económica de exportación importante para Chile es el procesamiento de crustáceos, que tiene la presencia de tareas repetitivas y de carga de materiales y cuyas empresas mantienen caracteristicas similares de tecnología y procesos de trabajo. En esta actividad no existe informacion epidemiologica ni programas ergonómicos establecidos en estos procesos.Este estudio se desarrollo en una empresa de procesamiento de crustáceos en la XII Región de Chile. Se senalaron las tareas criticas desde el punto de vista musculo-esqueletico, a las cuales se les determinó el riesgo de las lesiones de extremidad superior mediante la aplicacion de herramientas ergonómicas como Strain Index, RULA y OCRA. Por otro lado, se reunio la evidencia clinica de riesgo por movimientos repetitivos con un examen fisico y musculo-esqueletico. La percepcion subjetiva de los trabajadores se resgistro con la aplicacion de una encuesta basada en el cuestionario musculo-esqueletico nordico.Este estudio senala el precedente de la existencia de desórdenes musculo-esqueléticos en estas actividades, situación no descrita en la literatura, a partir de lo cual se pueden disenar criticas de formacion continua y vigilancia permanente, en la implementación de un Programa de Vigilancia Epidemiologica que establezca criterios comunes de evaluacion de estas actividades.

Detección de secuencias del gen BCR-ABL mediante RT-PCR en pacientes con leucemia en la IX Región Chile / Detection of BCR-ABL gene sequences using polymerase chain reaction reverse transcriptase in patients with leukemia from the IX Región of Chile

Background: The BCR-ABL fusion gene is the molecular expression of the Philadelphia chromosome. This cytogenetic aberration is the most frequent alteration found in leukemias, which is produced by the translocation t(9;22). Two different fusion proteins are produced depending on the break point (210 kD and 190 kD). The detection of this gene has both diagnostic and prognostic importance, associated with poor prognosis in acute lymphoblastic leukemia (ALL). Aim: To detect BCR-ABL gene sequences in patients with leukemia from the IX Region of Chile. Material and methods: We studied 58 patients: 5 chronic myeloid leukemia (CML), 35 ALL, 15 acute myeloid leukemia (AML) and 3 biphenotypic leukemia. The gene sequences were detected using reverse transcriptase polymerase chain reaction (RT-PCR). Results: BRC-ABL gene sequences were positive in all patients with CML, 2 of 35 ALL (one child and one adult). The remaining patients were negative. We found p210 and p190 co-expression in 2 CML and 1 ALL. Conclusions: Our results are in agreement with other reports. The detection of these and other genetic alterations will allow us to have invaluable diagnostic and prognostic information from our patients with leukemia

Parámetros clínicos y radiológicos de pacientes con tromboembolismo pulmonar diagnosticado a través de cintigrafías de ventilación / perfusión de alta probabilidad / Clinical and radiological parameters of patients with lung thromboembolism, diagnosed by high probability ventilation / perfusion scintigraphies

Introducción: el tromboembolismo pulmonar (TEP) es una patología compleja y de difícil enfrentamiento para el clínico, por lo que el uso de métodos de diagnóstico por imágenes se han incluido desde hace décadas en los algoritmos diagnósticos. Objetivos: establecer los parámetros clínicos y radiológicos presentes en pacientes con tromboembolismo pulmonar diagnosticado a través de cintigrafías de ventilación perfusión de alta probabilidad. Materiales y métodos: se estudió 91 pacientes a quienes se les realizó estudios cintigráficos V/Q por sospecha de TEP. Sólo se consideraron aquellas cintigrafías informadas como de alta o baja probabilidad para TEP. El promedio de edad fue de 63,1 años (rango: 20 - 89 años), 43 hombres y 48 mujeres. Resultados: existió significancia estadística para cuatro parámetros: hemoptisis (p=0,01, razón de chance=8,925), taquicardia (p=0,02, razón de chance=3,5), dolor toráxico (p=0,01, razón de chance =1,87) y la condición del postoperatorio reciente (p=0,02, razón de chance=2,762). Destacó la ausencia de hallazgos positivos en la radiografía de tórax, ya que en la gran mayoría de los casos se obtuvo una imagen normal (70,7 por ciento con valor p<0,0001). Discusión: los parámetros clínicos y radiológicos encontrados en los pacientes a los cuales se les realiza diagnóstico de TEP a través de cintigrafía V/Q fueron: dolor toráxico, hemoptisis, antecedente de postoperatorio reciente y radiografía de tórax normal. Esto es importante, ya que ayudaria a elegir al grupo de pacientes en que la cintigrafía V/Q alcanzará su mayor rendimiento

Cáncer salival: estudio de los factores de pronóstico / Salivary glands cancer: study of the prognostic factors

El cáncer de las glándulas salivales se caracteriza por su baja incidencia y gran polimorfismo histológico. El objetivo de la investigación fue la evaluación de los factores de pronóstico en la sobrevida de los pacientes tratados. Se observaron 115 pacientes en el período comprendido entre enero 1963 y diciembre 1995 con el diagnóstico confirmado por biopsia y clasificados según los criterios morfológicos de la OMS. Fueron excluidos 35 pacientes. Las variables de pronósticos estudiadas fueron edad, sexo, tipo histológicos, estado clínico, agresividad y forma de tratamiento. Para el análisis estadístico se utilizaron comparaciones de curvas de sobrevida usando los métodos de Kaplan-Meier, log rank test y análisis de riesgos proporcionales de Cox. Hubo 35 hombres y 45 mujeres; edad promedio 49,9 ñ 18 años. La probabilidad de sobrevida fue de 50 por ciento hacia el final del período de observación. En el análisis unifactorial la edad, histología, agresividad y el estadio clínico aparecieron como variables estadísticamente significativas. El análisis de riesgos proporcionales seleccionó como factores de pronóstioc determinantes: el estadio (p = 0.005) y la edad mayor de 50 años (p = 0,005)

Estudio clínico epidemiológico de los pacientes ingresados a UCI según grupo etáreo / Clinical epidemiological study of patients admitted at ICU according to age

The charts of all patients admitted to an intensive care unit of a University Hospital, during 1 year, were reviewed. The diagnosis that caused the admission was considered the main disease. Severity at the moment of admission was assesses using the Apache asore. A total of 777 patients were admitted during the study period. Twenty had to be excluded due to lack of reliable data. Four hundred thirty two (57 percent) were over 65 years old. Cardiovascular diseases were the main cause of admission in young and old patients. Mortality was 14,8 percent of patients over 65 years old and 18.7 percent in younger patients. Main causes of death were cardiac arrest, cardiogenic shock, sepsis and cerebrovascular disease. No differences in causes of death were observed between young and old patients. Patients older than 65 years old admitted to intensive care units are very similar to the younger counterparts in their prognosis and causes of admission

Pacientes con síndrome de distress respiratorio agudo del adulto: efectos del óxido nítrico inhalado sobre intercambio gaseoso y la hemodinamia / Patients with acute adult respiratory distress syndrome: effects of inhalated nitric oxide on gas exchange and hemodynamics

Adult respiratory distress syndrome is highly prevalent in intensive care units and has a high mortality. Lately, nitric oxide has been used as adjuvant therapy. To study the effects of nitric oxide inhalation in patients with adult respiratory distress syndrome, 12 patients were subjected to nitric oxide inhalation at a concentration of 10 parts per million, during 30 minutes. At the end of the nitric oxide inhalation period, there was an improvement of PaO2/FIOa ratio from 89ñ32 to 111ñ43 mm Hg and 16 percent reduction of lung shunting (Qs/Qt). Nitric oxide inhalation at a concentration of 10 parts per million improved arterial oxygenation and reduced pulmonary shunting in patients with adult respiratory distress syndrome

Tromboendarterectomía pulmonar: tratamiento quirúrgico del tromboembolismo pulmonar crónico bajo paro circulatorio con hipotermia profunda en un caso / Pulmonary thromboendarterectomy: surgical treatment of chronic pulmonary thromboembolism under circulatory arrest and with deep hypothermia in 1 case

Pulmonary thromboendarterectomy under circulatory arrest and deep hypothermia is presently a curative treatment for pulmonary hypertension secondary to chronic pulmonary artery thromboembolic occlusion, but is still not frequently performed around the world. We report here the first successful pulmonary thromboendarterectomy under circulatory arrest performed in Chile. The patient was a 37 years old white man, high school teacher, with a 5 months history of effort dyspnea and cough. Pulmonary hypertension secondary to chronic pulmonary thromboembolism was confirmed by angiography and echocardiography. The patient was operated on april 27, 1995. After the operation the patient had an enmediate and maintained normalization of his pulmonary hemodynamics. He presented periods of delirium that postponed mechanical ventilation disconnection until the 7th postoperative day, after which he had an uneventful neurological recovery. Before hospital discharge a control angiography showed complete patency of the pulmonary artery system with no evidence of residual thrombi. Presently he is enjoying a normal life and back to his teaching activities

Pronóstico vital en insuficiencia hepática aguda grave: valor de los índices cuantitativos de evaluación / Life prognosis in severe acute hepatic failure: value of assessment quantitative index

The aim of this study was to assess the predictive value for mortality of admission and daily APACHE II score, mortality due to multiple organ failure and the organ failure score in patients with acute hepatic failure. We retrospectively studied 15 such patients admitted to an intensive care unit. Thirteen patients died (87 percent) and their admission APACHE II score was 22ñ7.5 compared to 21ñ8.5 in survovors. Daily APACHE II score, mortality due to multiple organ failure and multiple organ failure score had a 100 percent sensitivity to predict mortality and a 69.2, 76.9 and 76.9 percent specificity respectively. The predictive accuracies of multiple organ failure and multiple organ failure score were 80 percent and significantly better than the accuracy of admission APACHE II score (53 percent). We conclude that these prognostic scores can be useful in the assessment of patients with acute hepatic failure

Estudio multidisciplinario de los accidentes vasculares encefálicos: II perfil cardiovascular de los accidentes vasculares oclusivos / Multidisciplinary study of encephalic vascular accidents: II cardiovascular profile of occlusive vascular accidents

Ischemic stroke constitute a major cause of morbidity and mortality in the adult population, particulary in the elderly. Heart disease may predispose to ischemic stroke, especially in the presence of transient or permanent precipitating factors such as atrial fibrillation. To elucidate the role of heart disease in predisposing to ischemic stroke we studied the clinical and non invasive cardiac profile (EKG, 2D-Echo, Holter) of 186 consecutive patients, 91 of them embolic (Gl) and 96 non embolic (lacunar, atherotrombotic, others) (Gll), as determided by brain CT scan and through clinical evaluation. Age and male/female ratio were significantly different (71 + 13 vs 65 + 12 years, 40/60 vs 65/35, p <0.003). Hypertension was equally common in both groups (38 and 40 percent). Patients in Gl had higher prevalence of valvular heart disease (23 vs 1 percent), and atrial fibrillation (67 vs 10 percent), 2D Echo left atrial enlargement (45 vs 16 percent) and supraventricular ectopy in Holter (59 vs 32 percent) p< 0,001. By contrast absence of heart disease (45 vs 19 percent), ST-T changes in EKG (28 vs 14 percent), left ventricular hypertrophy in 2D Echo (28 vs 9 percent) and ventricular ectopy in Holter (54 vs 23 percent) were more prevalent in Gll patients, p<0.001. Multiple stepwise logistic regression analysis showed that age> 70years (relative risk (RR) 1.67), valvular heart disease (RR 2.25), chronic AF (RR 2.44) and paroxysmal AF (RR 1.89) were significant independient predictors of embolic stroke, whereas the presence of left ventricular hypertrophy in 2D-Echo (RR 0.76) and frequent ventricular premature beats in Holter (RR 0.47) were predictors of occlusive non embolic stroke. Thus, the clinical and non invasive cardiac profile of embolic and non embolic ischemic stroke is significantly different, which is relevant to preventive strategies