Epidemiología de las consultas respiratorias de adultos en Santiago de Chile desde 2003 a 2008 / Primary care consultations due to respiratory diseases in the period 2003-2008

Background: Respiratory diseases are the third cause of death, and the second cause of hospitalization among people aged 65 years or more in Chile. Aim: To analyze the distribution of consultations due to respiratory diseases among adults living in Metropolitan Santiago. Material and Methods: A daily registry of all consultations of patients older than 15 years old in seven public primary care centers, was carried out between January 2003 and December 2008. Consultations were classified as having non-respiratory or respiratory causes. The latter were broke down in upper or lower respiratory diseases, pneumonia, chronic obstructive pulmonary disease (COPD) and asthma. Results: A total of 1,170,941 consultations were registered and 19% were due to respiratory diseases. Of these, 46% were due to upper respiratory diseases, 31% due to lower respiratory diseases, 8% due to COPD, 6% due to pneumonia, 5% due to asthma and 4% due to other respiratory causes. Pneumonia and COPD were more frequent among consultants older than 65 years. Conclusions: Consultations due to respiratory diseases are approximately one fifth of all primary care consultations. Older people often have more chronic and severe diseases.

Epidemiología de las consultas pediátricas respiratorias en Santiago de Chile desde 1993 a 2009 / Epidemiology of pediatric respiratory consultations in Santiago de Chile, from 1993 to 2009

OBJETIVO: El presente trabajo se propone describir la metodología de análisis y la distribución global de las consultas de morbilidad -particularmente las de tipo respiratorio- en menores de 15 años de edad de la ciudad Santiago de Chile, Chile, con el objetivo de conocer sus diferencias según grupos etarios, su comportamiento estacional y su evolución a lo largo de los años. MÉTODOS: Se investigó la distribución de las consultas de morbilidad pediátrica (CP) -en especial las respiratorias- y su evolución en un período de 17 años. En siete centros centinela de Santiago de Chile se recolectó prospectivamente información diaria de todas las CP, agrupadas en infecciones no respiratorias e infecciones respiratorias agudas (IRA). RESULTADOS: Entre enero de 1993 y diciembre de 2009 se registraron 1 947 477 CP, de las cuales 1 188 029 (61,0%) fueron por causa respiratoria: 656 567 (33,7%) por enfermedad respiratoria aguda de vía aérea baja (IRAb), 418 932 (21,5%) por síndrome bronquial obstructivo (SBO) y 48 669 (2,5%) por neumonía. Neumonía y SBO fueron más frecuentes en menores de 5 años. Las IRAb, SBO y neumonía presentaron una significativa tendencia a la disminución durante el período observado. Las IRA constituyen la primera causa de CP en atención primaria de salud y el SBO es la primera causa específica de consulta pediátrica. CONCLUSIONES: Estos resultados enfatizan la necesidad de asignar o redestinar recursos en programas de promoción, educación, prevención y tratamiento de estas enfermedades, con la debida focalización que determina su variación estacional.

OBJECTIVE: This paper describes the analytical methodology and overall distribution of these consultations-particularly respiratory consultations-for children under 15 years of age in Santiago de Chile, Chile. The aim is to understand differences by age groups, as well as seasonal trends and trends over the years. METHODS: The research covered the distribution of consultations and their evolution over a period of 17 years. Information was collected on a daily basis from all pediatric consultations, grouped into nonrespiratory and acute respiratory categories, in seven sentinel centers of Santiago de Chile. RESULTS: Between January 1993 and December 2009, 1 947 477 cases of pediatric illnesses were recorded, of which 1 188 029 (61.0%) were for respiratory causes. Of those, 656 567 (33.7%) were for acute lower respiratory tract illnesses, 418 932 (21.5%) were for broncho-obstructive syndrome, and 48 669 (2.5%) were for pneumonia. Pneumonia and broncho-obstructive syndrome were more frequent in children under age 5. Lower respiratory tract illnesses, broncho-obstructive syndrome, and pneumonia showed a significant downward trend during the period observed. Lower respiratory tract illnesses are the leading cause of pediatric morbidity in primary health care, while broncho-obstructive syndrome is the leading specific reason for pediatric consultations. CONCLUSIONS: These results point to the need to allocate or reallocate resources for programs for promotion, education, prevention, and treatment of these illnesses with the targeting necessary to address seasonal variations.

Hallazgos clínicos y radiográficos de terceros molares con indicación de extracción: resultados preliminares / Clinical and radiographic findings of third molars with extractions indications: preliminary results

Una de las cirugías orales realizadas con más frecuencia en el mundo es la exodoncia de terceros molares (3Ms). Las indicaciones de extracción son muy variadas, siendo algunas de ellas aun controversiales. Se diseñó una completa investigación sobre el estatus de 3Ms con indicación de exodoncia. 158 3Ms correspondientes a 145 pacientes fueron evaluados. Los pacientes incluidos en el estudio acudieron voluntariamente a un centro quirúrgico privado, a un centro público de especialidades odontológicas y al centro odontológico universitario. La relación hombre:mujer fue de 0,56:1 y la edad mas frecuente de consulta fue desde los 18 a los 25 años. Casi el 70 por ciento de los pacientes fueron derivados desde centros de menor complejidad, 43 por ciento presento dolor como motivo de consulta, 23 por ciento presento pericoronitis y el 27 por ciento tuvo experiencia de caries. El dolor se asocio significativamente con la edad del paciente (p < 0,05). La mayoría de los molares se encontraba semierupcionado (35 por ciento) y con posición vertical (44 por ciento).

The most frequent oral surgeries in the world are the extractions of the third molars (3Ms). The extraction indications vary as some of them are yet controversial. A complete research program was designed on the status of 3Ms with extraction indications. One hundred fifty eight 3Ms corresponding to 145 patients were evaluated. The patients included in this investigation arrived at a private surgical centre, a public centre of odontologic specialties and at the university clinic voluntarily. The relation men: women was 0,56:1 and the average age of the consulting patient was between 18 and 25 years of age. Almost 70 percent of the patients were diverted to the minor odontologic centre, 43 percent presented pain justifying the consultation, 23 percent presented pericoronitis and 27 percent experienced caries. The pain was significantly associated with the age of the patient (p < 0,05). The majority of the molars were “semi erupted” (35 percent) and in vertical position (44 percent).

Ventilación mecánica invasiva domiciliaria (VMI): una propuesta para un nuevo programa / Domiciliary invasive mechanical ventilation: proposal for a new program

El presente escrito resume las recomendaciones, que como extensión del Programa Nacional de Asistencia Ventilatoria no Invasiva Domiciliario (AVNI), se han considerado por los autores, como las más apropiadas para ser incluidas en una propuesta que permita la entrega de prestaciones de ventilación mecánica invasiva en domicilio en niños.

Contaminación atmosférica y daño cardiovascular / Atmospheric pollution and cardiovascular damage

The damaging effect of atmospheric pollution with particulate matter and toxic gases on the respiratory system and its effect in the incidence and severity of respiratory diseases, is well known. A similar effect on the cardiovascular system is currently under investigation. Epidemiological studies have demonstrated that the inhalation of particulate matter can increase cardiovascular disease incidence and mortality, specially ischemic heart disease. The damage would be mediated by alterations in the autonomic nervous system, inflammation, infections and free radicals. In human studies, environmental pollution is associated with alterations in cardiac frequency variability and blood pressure and with changes in ventricular repolarization. Experimentally, an enhancement of ischemia, due to coronary obstruction, has been demonstrated. The study of the toxic effects of environmental pollution over the cardiovascualr system, is an open field, specially in Chile, were the big cities have serious contamination problems (Rev Méd Chile 2004; 132: 761-7).