Prevalencia de hipotiroidismo subclínico en pacientes con síndrome coronario agudo / Prevalence of subclinical hypothyroidism in patients with acute coronary syndrome

INTRODUCTION: Subclinical hypothyroidism (SH) is characterized by elevation of thyroid stimulating hormone (TSH) with normal free thyroxine (FT4). SH has been associated with cardiovascular risk factors (CVRF) such as increased blood pressure, lipid level and atherosclerosis; however, its association with coronary heart disease is controversial. OBJECTIVES: The primary objective was to know the prevalence of SH in patients with acute coronary syndrome (ACS) in 3 hospitals of the Viña del Mar-Quillota Health Service. The secondary objective was to know the prevalence of CVRF in patients with SH and euthyroidism. MATERIAL AND METHOD: A cross-sectional study that included patients admitted for ACS. CVRF and thyroid hormone levels were recorded. RESULTS: Of the 81 patients recruited, 11 (13.6 percent) had SH. AHT was present in 68.3 percent of euthyroid and 90.9 percent of SH (p = 0.16). 55 percent of euthyroid and 63.6 percent of SH had dyslipidemia (p = 0.74). Overweight or obesity was found in 76.6 percent of euthyroid and 54.5 percent of SH (p = 0.15). The median CVRF was 3 (IQR 2-4) in euthyroid and 3 (IQR 3-4) in SH (p = 0.78). CONCLUSIONS: The prevalence of SH in patients with ACS was not higher than that reported in the general population and there were no differences in CVRF between SH and euthyroid. We require prospective cohort studies with a larger sample size to establish incidence and risk of adverse cardiovascular outcomes in SH.

Tiroiditis subaguda con ausencia de captación cintigráfica unilateral inicial / Subacute thyroiditis with initial unilateralabsence of scintigraphic uptake

Subacute thyroiditis is a transient inflammatory process of the thyroid gland and the most common cause of painful thyroiditis. It usually involves the whole thyroid. We present a clinical case of a 45 years old woman developing tachycardia, fever and painful sensation in the left anterior cervical region after an upper respiratory tract infection. In addition the patient presented an enlarged and painful left thyroid lobe. Laboratory analysis demonstrated elevated acute phase reactants, high T4 levels and suppressed thyrotropin with absence of antithyroid antibodies. Thyroid scintigram showed an absent left radioactive iodine uptake. One month later the patient started with malaise, fatigue with an enlarged painful right thyroid lobe. A new scintigram showed complete absence of radioactive iodine uptake. A course of prednisone was initiated with excellent clinical response. Four months later the patient was asymptomatic with normal thyroid function.

Experiencia subjetiva de estudiantes y docentes que vivencian un cambio curricular / Subjective experience of students and teachers who experience a curriculum change

Objetivo: Conocer la experiencia subjetiva de estudiantes y docentes respecto del cambio curricular. Metodología: Estudio transversal, muestra de 169 estudiantes de cuarto año curricular y 32 docentes. Información recogida en cuestionario “Inquietudes y procedimientos para adoptar Innovaciones Educativas” (IPIE) validado y adaptado al estudio. Análisis descriptivo. Estudio respetó normas éticas y consentimiento informado. Resultados: 26,0 por ciento de alumnos correspondió a Tecnología Médica; 22,5 por ciento Enfermería y Nutrición, respectivamente, y 29,0 por ciento Obstetricia. Edad media de 21,3+/-1,43 años. Mujeres 68,1 por ciento. En “Información”, los estudiantes mostraron el promedio más alto en el ítem “Quisiera saber lo que otros están haciendo en esta área” (4,1+/-0,9), y los docentes en “Me gustaría saber si se contará con los recursos para mantener esta innovación en un futuro inmediato” (4,7+/-0,4). En “Funcionalidad”, promedio más alto correspondió a “Me gustaría saber qué es lo que esta innovación va a requerir para mantenerla en el futuro” (4,3+/-0,8) y el más bajo en “Estoy totalmente ocupado/a en otras cosas, para mí la innovación no es prioridad” (2,4+/-1,4). En “Resultados”, los docentes presentaron el promedio más alto en “Me interesa evaluar mi impacto sobre los estudiantes” y “Quisiera que otros equipos de docentes se motiven con los logros que tenemos en este proceso de innovación curricular” (4,6+/-0,4; 4,6+/-0,4). Conclusiones: Estudiantes y docentes se mostraron conformes con la experiencia del cambio curricular. Aún existen dudas respecto de cómo este cambio afectará las competencias del estudiantado y la sustentabilidad en el tiempo. Es necesario continuar esta línea investigativa durante el ejercicio profesional de egresados.

Objective: To determine the subjective experience of students and teachers on curriculum change. Methodology: Cross-sectional study in a sample of 169 Regular fourth-year students and 32 teachers. Information collected in the survey “Concerns and procedures to adopt educational innovations” (IPIE) validated and adapted to the study. Descriptive analysis with means, medians, ranges, percentages and averages compared with t-test and ANOVA. Study respected ethical and informed consent. Results: 26.0 percent of students accounted for Medical Technology, Nursing and Nutrition 22.5 percent, 29.0 percent respectively and Obstetrics. Mean age 21.3 +/- 1.43 years. 68.1 percent women. In “Information”, students showed the highest average item “I want to know what others are doing in this area” (4.1 +/- 0.9), and teachers in “I wonder if they have the resources to keep this innovation in the immediate future “(4.7 +/- 0.4). In “Functionality” highest average corresponded to “I wonder what this innovation will be required to keep it in the future” (4.3 +/- 0.8) and lowest in the scale “I am fully occupied / to other things, for innovation is not my priority “(2.4 +/- 1.4). In teaching, in “Results” highest average “I am interested in evaluating my impact on students” and “I want other teachers to motivate teams with the achievements we have in this curricular innovation process” (4.6 +/- 0, 4, 4.6 +/- 0.4). Conclusions: students and teachers were satisfed with the experience of curriculum change. Still, there are doubts about how this will affect the student skills and sustainability over time. It is necessary to continue this line of research for the professional practice of graduates, to objectively assess the skills of the new student-centered curriculum.

Aneurisma verdadero en arteria ciática persistente: caso clínico / Persistent sciatic artery aneurysm: a case report

We report the case of a 71 years old female patient, who had a partially thrombosed true aneurysm in a persistent sciatic artery (PSA), treated in the Surgery Department of Hospital Dr. Eduardo Pereira of Valparaiso. The sciatic artery arises from the umbilical artery and during early embryological state is the main blood supply of the lower limbs. Later, the superficial femoral artery appears with the subsequent progressive involution of the sciatic artery. PSA is a rare congenital vascular anomaly that occurs when sciatic artery fails to regress during fetal development. This is associated with superficial femoral artery hipoplasia and the PSA becomes the dominant arterial inflow to the lower limb. This anatomic abnormality may be bilateral and can remain asymptomatic for many years, however, it has been described aneurysmal degeneration, like in this case, symptoms of sciatic nerve compression, aneurysm thrombosis and distal embolization.

Se reporta el caso de una paciente de 71 años, que presenta un aneurisma verdadero, parcialmente trombosado, en una Arteria Ciática Persistente (ACP), tratada en el Servicio de Cirugía del Hospital Dr. Eduardo Pereira de Valparaíso. La arteria ciática se origina en la arteria umbilical y durante las primeras fases embriológicas es el principal aporte sanguíneo de la extremidad inferior. Posteriormente aparece la arteria femoral superficial y se produce la progresiva involución de la arteria ciática. La ACP constituye una rara anomalía y ocurre por la falta de desarrollo de la arteria femoral superficial. La ACP se origina en el adulto en la arteria hipogástrica, transcurre hacia la región glútea a través de la escotadura ciática y sigue hacia distal por la parte posterior del muslo continuándose después con la arteria poplítea. Se acompaña de un variable menor desarrollo del eje arterial anterior de la arteria ilíaca externa y femoral superficial. Esta anomalía anatómica puede ser bilateral y puede permanecer asintomática durante muchos años, sin embargo, se ha descrito la degeneración aneurismática, como en este caso, y síntomas por compresión del nervio ciático, trombosis del aneurisma y embolización distal.

Alimentación enteral: vías de infusión / Enteral feeding: routes of food intake

The study of digestive pathophysiology and scientific advnces showed a better knowledge related to the invaluable usefulness of the nutritional stage and the importance of the intestinal route for feeding purposes. In this consideration, the enteral feeding is elective considered not only in patients with an adquate digestive function but further more with some difficulties or swallowing disturbances, but also in those patients that because of their underlying pathology can not feed tremselves by mouth in a temporary way. The caloric support by the intestinal route con be performed by nasoenteral tubes or osteomas as gastrostomies, gastrojejunostomy, jejunostomies and hepato-jejunostomies. The aim of this report eas to show our results with the different ways of enteral feeding. These results are presented and discussed.

Hemorroidectomía, método quirúrgico alternativo: experiencia inicial en un hospital público / Surgical treatment of hemorrhoids: harmonic scalpel hemorrhoidectomy as a safe and rapid alternative to conventional open techniques

This report describe the surgical treatment of hemorrhoids. In the last years, encouraging results have been presented using a harmonic or ultrasonic scalpel (Ultracision). Harmonic scalpel hemorrhoidectomy ia a safe and rapid alternative to conventional open techniques.

Transfusiones de globulos rojos; estudio evaluativo 2004 hospital de Vallenar / Red cell transfusion; evaluation study at hospital Vallenar 2004

El uso de hemoderivados requiere criterios cada vez más específicos, por lo que el Hospital de Vallenar ha incorporado Normas de Glóbulos Rojos (Tx GR), al igual que otros centros asistenciales. Esta revisión busca conocer el grado de cumplimiento de dichas normas e información específica de las transfusiones efectuadas. Se revisaron las solicitudes de Tx GR emitidas en el Hospital de Vallenar entre julio y diciembre de 2004. Se efectuaron 123 Tx GR, sin gran variación mensual, ni la diferencia por sexo y la mayoría en forma urgente (dentro de 8 horas); fueron solicitadas mayormente por médicos internistas y de turnos, en los servicios clínicos de Medicina, Unidad de Cuidados Especiales (UCE) Y Unidad de Cuidados Intermedios, constituyendo las patologías crónicas los principales motivos diagnósticos de Tx. Se alcanzó un 68,3 por ciento de cumplimiento de las normas, lo que puede estar subvalorado por falta de información en las órdenes de solicitud de Tx GR.