Mortalidad en recién nacidos de muy bajo peso al nacer en la Red Neonatal NEOCOSUR: causalidad y temporalidad / Mortality in very low birth weight (VLBW) infants in South American NEOCOSUR Neonatal Network: timing and causes

Introducción. La mortalidad de los recién nacidos de muy bajo peso de nacimiento (RNMBPN) se ha mantenido en ~26 % en los últimos 16 años en la Red Neonatal NEOCOSUR. Objetivo. Determinar la causa de muerte de los RNMBPN y su temporalidad en el período 20072016 en la Red Neonatal NEOCOSUR. Población y métodos. Estudio observacional de cohorte multicéntrica; análisis retrospectivo de datos obtenidos prospectivamente. Se incluyeron recién nacidos entre 24 y 31+6 semanas de edad gestacional y peso de nacimiento de 500-1500 g, en 26 centros de la Red Neonatal NEOCOSUR. Las causas de muerte se analizaron según ocurriera en sala de partos (SP) o durante la estadía en la unidad de cuidados intensivos neonatales (UCIN). La edad posnatal de muerte se determinó a través de análisis de Kaplan-Meier. Resultados. Se incluyeron un total de 11.753 RNMBPN con una mortalidad global del 25,6 %. Las causas de muerte predominantes en SP fueron malformaciones congénitas (43,3 %), enfermedades respiratorias (14,3 %) y prematuridad (11,4 %). Las causas de muerte predominantes en UCIN fueron las respiratorias (24,2 %) e infecciosas (24,1 %). La edad promedio de muerte fue de 10,2 días y mediana de 4 días. El 10,2 % de las muertes ocurrieron en SP; el 21,5 %, durante el primer día; el 52 % ocurrió en los primeros 4 días y el 63,8 %, durante la primera semana de vida. Conclusiones. Se encuentran importantes diferencias en las causas de muerte de RNMBPN según ocurra en SP o en UCIN. Las infecciosas y respiratorias son las más relevantes luego del ingreso a la unidad de cuidados intensivos.

Introduction. Mortality in very low birth weight infants (VLBWIs) has remained at ~26% in the past 16 years in the NEOCOSUR Neonatal Network. Objective. To determine the cause of death of VLBWIs and its temporality in the 2007-2016 period in the NEOCOSUR Neonatal Network. Population and methods. Observational, multicenter cohort study; retrospective analysis of data collected prospectively. Newborn infants born between 24 and 31+6 weeks of gestation age with a birth weight between 500 and 1500 g in the 26 sites of the NEOCOSUR Neonatal Network were included. The causes of death were analyzed depending on whether they occurred in the delivery room (DR) or in the neonatal intensive care unit (NICU). The postnatal age at time of death was determined using the KaplanMeier test. Results. A total of 11 753 VLBWIs were included; overall mortality was 25.6%. The prevailing causes of death in the DR were congenital malformations (43.3%), respiratory diseases (14.3%), and prematurity (11.4%). The prevailing causes of death in the NICU were respiratory diseases (24.2%) and infections (24.1%). The average and median age at death were 10.2 and 4 days, respectively. Also, 10.2% of deaths occurred in the DR; 21.5% on day 1, 52% in the first 4 days, and 63.8% in the first week of life. Conclusions. Important differences were observed in the causes of death of VLBWIs depending on their occurrence in the DR or the NICU. Infectious and respiratory conditions were the most relevant factors following admission to the NICU.

Estudio de metales urinarios y plomo en sangre: parámetros poblacionales en Antofagasta, 2018 / Urinary heavy metals and blood lead levels among residents of Antofagasta, Chile

Background: The presence of toxic metals in human populations is strongly associated with chronic diseases. Aim: To determine levels of lead, chromium, cadmium, mercury and inorganic arsenic (AsIn) in the general population aged over 5 years in Antofagasta, Chile. Material and Methods: People living in Urban Antofagasta for at least five years were considered eligible. Biological samples were obtained to measure heavy metals. Results: One thousand two hundred three participants with a median age of 43 years (656 women) were studied. Their mean time of residence in the city was 30 years, and 52% smoked. Eight percent of the adult population and 12% of children had AsIn values above 35 µg/L, while 75% of the population had levels below 21.9 µg/L. The other metals were below the risk levels defined by the health authority (10 µg/L for chromium, 10 µg/L for mercury, 2 µg/L for cadmium, 5 and 10 μg/dL for blood lead for children and adults, respectively). The factors associated with high levels of AsIn in adults were male sex, living more than 200 meters from monitoring points, and low schooling. In children, the associated variables were high intake of seafood products and having a caregiver with less than 8 years of schooling. Contrary to expectations, the greatest risk of presenting altered levels of the metals occurred in the population living more than 500 meters from the identified risk sources (90% of the population). Conclusions: The findings of this study suggest that all potential sources of exposure to AsIn should be evaluated, and surveillance actions should be established to reduce involuntary exposure to this metalloid.

Niveles de colesterol no HDL en la población chilena y su asociación con enfermedad cardiovascular y diabetes mellitus: estudio de corte transversal en Encuesta Nacional de Salud 2009-2010 / Non-HDL cholesterol levels in Chilean population and their association with diabetes mellitus and cardiovascular disease

Background Despite aggressive treatment aimed at lowering LDL cholesterol (LDL-C) levels with statins, there is a high residual prevalence of cardiovascular diseases, which may depend on plasma cholesterol transported in other atherogenic lipoproteins. Aims To describe non-HDL cholesterol (non-HDL-C) levels in the Chilean population and their association with diabetes mellitus and cardiovascular disease. To evaluate compliance with non-HDL-C therapeutic goals -according to individual cardiovascular risk- at different levels of triglycerides, in comparison with LDL-C goal achievement. Material and Methods: We analyzed data from 2,792 Chilean subjects aged ≥ 15 years who were included in the 2009-2010 National Health Survey and had valid data for blood lipids, diabetes, and cardiovascular disease. Results Forty five percent of subjects had high non-HDL-C levels. The proportion of diabetic and non-diabetic subjects with high non-HDL-C levels was 81 and 42%, respectively (p < 0.01). A significant discordance was observed in the achievement of therapeutic objectives when LDL-C or non-HDL-C levels were considered, particularly in presence of triglycerides ≥ 150 mg/dl. Namely, 8% of the population showed elevated levels of high non-HDL-C despite adequate LDL-C levels. Conclusions Evaluation and management of elevated non-HDL-C in patients with adequate levels of LDL-C seems worthwhile considering the discordance observed between these blood cholesterol fractions. This strategy may be effective to reduce the residual cardiovascular risk in the Chilean population.

Conflicto decisional en personas con diabetes mellitus e hipertensión arterial usuarias del nivel primario de atención de salud de Chile / Decisional conflict among people with diabetes mellitus or hypertension attending primary care

Background: Decisional conflict refers to the personal uncertainty about which course of action to take when the choice involves risk, regret, or challenge to personal life values. Aim: To determine the level of decisional conflict (DC) of people with Diabetes Mellitus (DM) or High Blood Pressure (HBP) attending primary care centers (PCC) in Chile. Patients and Methods: A Spanish version of the Decisional Conflict Scale (DCS) was applied to patients who were recruited if they had DM or HBP, were 18 years old or older, and had an appointment at the PCC the day of the recruitment. The scale was self-administered. Analysis of covariance (ANCOVA) was used to determine association between DC and other variables of interest while controlling confounding variables. Results: The scale was answered by 1075 participants from 24 PCC aged 62 ± 14 years (74% female). Average score for the DCS scale was 16.8 ± 12.9 of a maximum of 100 points indicating a higher DC. The sub-scale "information" had the highest score (19.9 ± 20.0). Low educational level and older age were significantly associated with higher DCS scores (p < 0.05). Having a bad health perception, deciding to initiate a medical treatment and being attended by a doctor were significantly associated with higher DC. These associations persisted when confounding variables such as sex, age and education were controlled. Conclusions: People with DM or HBP who have a poor health perception, who initiated their treatment and were attended by a doctor had higher levels of DC, independent of their age and educational level.

Lactancia materna, obesidad y síndrome metabólico en la edad escolar / Breastfeeding, obesity and metabolic syndrome at school age

INTRODUCCIÓN: La lactancia materna (LM) puede ser un factor protector de la obesidad y sus complicaciones metabólicas. OBJETIVO: Determinar la asociación entre el antecedente de amamantamiento y la presencia de obesidad, síndrome metabólico (SM) y resistencia insulínica (RI). PACIENTES Y MÉTODOS: Estudio transversal en 20 escuelas públicas de Santiago, Chile. Se evaluó antropometría, presión arterial, perfil lipídico, glicemia, insulinemia e índice HOMA. Los padres respondieron una encuesta sobre el antecedente de LM. Se definió SM según criterios de Cook y RI como HOMA > percentil 90. RESULTADOS: Se recibieron 3.278 encuestas válidas. La edad promedio fue de 11,4 ± 1 años, siendo 52,3% mujeres. La mayoría (98,2%) recibió LM, con una prevalencia de 15,9% de obesidad versus 18,6% en los que no la recibieron (p = 0,039). Hubo una tendencia no significativa a que SM y sus componentes, excepto RI, fueran más prevalentes en el grupo no amamantado. Los escolares que recibieron LM por 3-6 meses presentaron una menor prevalencia de obesidad y de algunos componentes de SM que los que recibieron menor tiempo o no la recibieron; el efecto fue inverso cuando la LM se prolongó por más de 9 meses. CONCLUSIONES: La prevalencia de obesidad fue mayor en los escolares que no fueron amamantados. Durante el primer semestre, la LM de mayor duración se asoció a menor prevalencia de obesidad y complicaciones metabólicas.

INTRODUCTION: Breastfeeding (BF) can be a protective factor against obesity and its associated metabolic complications. OBJECTIVE: To determine the association between breastfeeding history and present obesity, metabolic syndrome (MS) and insulin resistance (IR). PATIENTS AND METHODS: Cross-sectio nal study in 20 public schools in Santiago, Chile. Anthropometry and blood pressure were assessed. Blood lipids, glucose, insulin and HOMA index were measured in a fast blood sample. Parents answe red a survey on BF. MS was defined according to Cook's criteria and IR as HOMA > 90th percentile. Parents answered a survey about the antecedent of breastfeeding. Chi2 and Fischer tests were used (SSPS). RESULTS: 3,278 surveys were valid. Average age: 11.4 ± 1 years, 52.3% were female. Most of them (98.2%) were breasted, with a 15.9% prevalence of obesity versus 18.6% in the group that was not breastfed (p = 0.039). There was a non-significant trend of higher prevalence in MS and its components (except IR) in the non-breastfed group. The group breastfed from three to six months had a lower prevalence of obesity and MS components than the 0 to 3 months group ; the effect was the opposite when BF lsted longer than nine months. CONCLUSIONS: The prevalence of obesity was higher in children that did not received breastfeeding. A longer breastfeeding time during the first semester of life was associated with lower prevalence of obesity and metabolic complications.

Una regla de predicción clínica ¿anticipa el diagnóstico de la faringitis estreptocóccica en niños de 2 a 15 años? / Does a clinical prediction rule anticipate the diagnosis for streptococcal pharyngitis in children aged 2 to 15?

Resumen Introducción: La etiología estreptocóccica de una faringitis debe ser confirmada con métodos de laboratorio para evitar un sobre-tratamiento antimicrobiano, exámenes que agregan costo a la atención del paciente. Los scores diseñados para aplicar en niños y adultos son imperfectos. Objetivo: Desarrollar una regla de predicción clínica para contribuir al diagnóstico de la faringitis estreptocóccica (FE) en niños. Pacientes y Métodos: Se incluyeron 318 pacientes de 2 a 15 años que fueron evaluados por sospecha de FE en el Servicio de Urgencias Pediátricas y la Unidad de Pediatría Ambulatoria de la Red Salud UC-Christus. Se obtuvo un cultivo faríngeo y una prueba rápida de detección de antígeno para Streptococcus pyogenes de cada paciente. Los datos se analizaron para posibles predictores clínicos de FE con análisis de regresión múltiple. Resultados. Setenta y tres casos de FE fueron diagnosticados (23,9%). En el análisis univariado, la fiebre se asoció inversamente con FE (p = 0,002). La odinofagia, las petequias palatinas y la estación del año (otoño e invierno) se asociaron positivamente con FE (p = 0,007, p < 0,001 y p = 0,03 respectivamente). En el análisis de regresión múltiple, los modelos no tuvieron suficiente poder para predecir etiología por S. pyogenes. Conclusión: Los predictores clínicos analizados, incluso los incluidos sistemáticamente en reglas de predicción clínica, no mostraron suficiente poder predictor para incluir o excluir de forma segura la FE en este contexto y, por lo tanto, sería necesario mejorar el acceso a las pruebas de confirmación.

Background: The etiology of a streptococcal pharyngitis must be documented by laboratory techniques to avoid unnecessary antimicrobial treatment, but this strategy increases cost for the patient. Available scores applied in children or adults are imperfect. Aim: To develop a clinical prediction rule to aid the diagnostic process of streptococcal pharyngitis (SP) in children in a low-resource setting. Methods: Three hundred and eighteen patients aged 2 to 15 years who were evaluated for suspected SP at the Pediatric Emergency Department and the Pediatric Ambulatory Unit of Red Salud UC-Christus entered the study. A throat culture and a rapid antigen detection test for Streptococcus pyogenes were obtained from each patient. Data were analyzed for possible clinical predictors of SP with univariate and multiple regression analyses. Results: Seventy-three cases of SP were diagnosed (23.9%). In the univariate analysis, fever was inversely associated with SP (p = 0.002). Odynophagia, palatal petechiae, and season of the year (autumn and winter) were positively associated with SP (p = 0.007, p < 0.001 and p = 0.03 respectively). In multiple regression analysis the models did not have sufficient power to predict streptococcal etiology. Conclusion: Clinical predictors, even those systematically included in clinical prediction rules, did not show sufficient predictive power to safely include or exclude SP in this setting, and thus, it is necessary to improve access to confirmatory tests.

Resultados a mediano plazo del implante de stents imbricados en pacientes con infarto con supradesnivel del ST: el rol de los stents medicados / Midterm results of overlapping stents implantation in patients with ST elevation myocardial infarction

Resumen: Introducción: El implante de dos stents imbricados (SIMB) es una práctica frecuente en el laboratorio de hemodinamia. Sin embargo, evidencia reciente sugiere que en pacientes con infarto con supradesnivel del segmento ST (IAMc/SDST) esta técnica puede asociarse a mejores resultados cuando se utilizan exclusivamente stents medicados. Objetivo: Evaluar en una cohorte de pacientes chilenos las causas, características clínicas y sobrevida a 2 años de los pacientes con IAMc/SDST que son tratados con SIMB, en función del tipo de dispositivo y combinación utilizada; metálico/metálico (BMS/BMS), metálico/medicado (BMS/DES), medicado/medicado (DES/DES). Método: Se realizó un estudio prospectivo, caso incidente, entre enero del año 2012 y mayo del año 2016 en nuestro laboratorio de hemodinamia. Se recolectó la información clínica, angiográfica y sobrevida a 2 años de los pacientes ingresados por IAMc/SDST que fueron tratados con SIMB. Para el análisis estadístico se utilizó chicuadrado, regresión logística y análisis multivariado en programa SPSS, considerando significativa una p<0,05. Resultados: De 2403 pacientes evaluados, el 13% (n=312) recibió tratamiento con SIMB. La edad pro-medio fue de 68 ± 6,6 años y el 71% correspondió a hombres. La presencia de DMII fue de 37%, HTA 65%, tabaquismo 41%, dislipidemia 29% y cardiopatía coronaria previa 18%. Se observó que la fracción de eyección promedio fue de 45 ± 3,5%, medida por método de Simpson. Las causas para imbricar stents fueron la disección post implante de stent en 72%, desplazamiento de placa en 22,5% y extensión de placa más allá de la longitud del stent en un 5,5%. El 38% fue tratado con 2 stents BMS, el 26% con stents BMS/DES y el 36% con DES/DES. El diámetro y largo promedio de SIMB fue de 2,8 ± 2,6 mm y 41,3 ± 6,4 mm, respectivamente. Se observó una mortalidad a 2 años de 11% en el grupo BMS/BMS, 8% BMS/DES y 6% DES/DES (p<0,01) y la necesidad de revascularización fue 8%, 5,2% y 2% respectivamente (p=0,02). El usar la combinación BMS/ BMS se asoció a una mayor mortalidad a 2 años en análisis de regresión logística univariado (OR 5,2, IC 95% 2,0-17,9, p<0,01) y multivariado (ajustado por variables clínicas, número de vasos enfermos y presentación clínica) [OR 5,5, IC 95% 1,9-21,0, p<0,01]). Excluyendo a los pacientes con mortalidad temprana, como marcador de severidad de presentación clínica, la mortalidad a 2 años en el grupo BMS/BMS tuvo un OR de 5.9, 95% CI 2.1- 19.5 (p < 0.01). No se observó diferencia en la mortalidad de pacientes tratados con 2 SIMB DES/DES y los tratados con 1 stent DES. Conclusión: El implantar stents imbricados en pacientes con IAMc/SDST es una práctica común en el laboratorio de hemodinamia. Nuestros resultados sugieren que los resultados a mediano plazo son significativamente mejores cuando al menos uno de los stents utilizados es medicado, lo cual es concordante con reportes recientes.

Abstracts: Background: Coronary angioplasty using two overlapping (OL) stents is a frequent practice at the cath laboratory, however the impact this strategy has on patient prognosis and the preferred stent type are largely unknown. Aim: To evaluate 2-year outcomes of STEMI patients who underwent treatment with OL stents and assess the impact of different types of stents combinations:(BMS/BMS), (BMS/DES), or (DES/DES). Methods: Patients presenting with STEMI undergoing primary angioplasty with 2 OL stents between January 2012 to May 2016 were included. Baseline and procedural information was collected, clinically-driven new revascularizations were recorded, and 2-year survival status was confirmed from the national database registry. OL stents technique was defined as a segment with a double layer of stents of at least 1 mm and less than 5 mm long. Statistical analyses were performed with SPSS v21.0 (IBM, Armonk, NY, USA), at with p<=0.05 being considered significant. Results: Of 2403 STEMI patients treated within this period, in 312 (13%) the OL was used. Mean age was 68 ± 6.6 years. 71% males. Type 2 diabetesmellitus was present in 37%, arterial hypertension in 65%, smoking in 41%, dyslipidemia in 29% and previously treated coronary heart disease (either CABG or PCI) in 18% of patients. Mean left ventricular ejection fraction (LVEF) as assessed by 2D Simpson method was 48±3.5%. Indications for overlapping stents were plaque extension in 72%, edge dissection after stent implantation in 22.5%, and plaque displacement in 5.5%. One, 2 or 3 vessels disease was present in 23%, 34% and 43%, respectively. Thirty-eight percent of patients were treated with 2 BMS stents, 26% with BMS/DES stents and 36% with two DES stents. The mean stent diameter and length were 2.8 ± 2.6 mm and 41.3 ± 6.4 mm, respectively, with no difference between the 3 groups. Post procedure target vessel revascularization was 8% for BMS/BMS, 5.2% for BMS/DES and 2% for DES/DES groups (p=0.02). Two-year cardiovascular mortality was 11% for the BMS/BMS group, 8% for the BMS/DES group and 6% for the DES/DES (p <0.01). BMS/BMS combination was associated with a greater cardiovascular 2-year mortality in both univariate (OR 5.2, 95% CI 2.0-17.9, p <0.01) and multivariate analyses ([OR 5.5, 95% CI 1.9-21.0, p <0.01]). After excluding early mortality cases during the first week (due to their overall severity at presentation), 2-year cardiovascular mortality in the BMS/BMS group had an adjusted OR of 5.9, 95% CI 2.1-19.5 (p< 0.01). There were no differences between the treatment with 2 OL DES stents and the treatment with BMS/DES. Conclusion: Overlapping stent technique is a common practice in our cath lab, mainly driven by an initial unfavorable result with the first stent. The reported findings suggest that midterm results are better when at least on of the imbricated stents is These results are in agreement with recent reports on the subject.

Causas de rinoplastía secundaria: análisis de 277 casos / Secondary rhinoplasty causes: analysis of 277 cases

Introducción: La rinoplastía secundaria cada día es más frecuente debido a la creciente popularidad de la cirugía estética y también por las mayores expectativas del paciente y del cirujano. La rinoplastía secundaria ha llegado a ser un campo en evolución con desafíos únicos. Para enfrentarlo adecuadamente el cirujano debe analizar y comprender las necesidades específicas del paciente y las causas anatómicas que generaron el problema y cómo corregirlo. Objetivo: Identificar los problemas anatómicos más frecuentemente encontrados en 277 rinoplastías secundarias y sistematizarlos para una mejor evaluación preoperatoria y planificación quirúrgica. Material y método: Análisis retrospectivo de 1.160 rinoplastías operadas por el otorrinolaringólogo Dr. Luis Villarroel entre el 1 de enero de 2006 y el 31 de marzo de 2015, de las cuales 277 son rinoplastías secundarias (24%). En ellas se encontraron 1.197 problemas o deformidades (4,3 promedio), que se dividieron en tercio superior, medio, inferior y endonasales, con una subdivisión de deformidades individuales dentro de cada grupo. También se comparan los resultados encontrados según si la cirugía primaria fue de otro cirujano (rinoplastías secundarias) o del mismo autor (rinoplastías de revisión). Resultados: El 85% de los pacientes presentó problemas en el tercio inferior. Los problemas más frecuentes fueron desviación del tabique nasal (problema endonasal) (56%), punta hiporotada (47%), desviación del dorso óseo (34%) y desviación del dorso cartilaginoso (30%). Las rinoplastías de revisión, comparadas con las secundarias, presentan un porcentaje mayor de problemas de insuficiente resección del dorso óseo y menos dorsos cartilaginosos estrechos. Conclusión: Existen diferentes razones por las que un paciente busca una rinoplastía secundaria. Es importante conocer las causas más frecuentes con el fin de identificar los errores cometidos en el primer caso y evitar dichas prácticas. Es preferible una cirugía primaria conservadora porque evita problemas difíciles de resolver. Esta clasificación nos ayuda a sistematizar el análisis preoperatorio, a saber, dónde estamos teniendo problemas y así corregirlos y obtener mejores resultados quirúrgicos.

Introduction: Secondary rhinoplasty is becoming increasingly common due to the growing popularity of cosmetic surgery and also by higher expectations of the patient and the surgeon. Secondary rhinoplasty has become an evolving field with unique challenges. To repair the surgeon must properly analyze and understand the specific concerns of the patient and the anatomical causes of why you need a new operation. Aim: To identify anatomical problems most frequently found in 277 secondary and systematize rhinoplasty for better preoperative evaluation and surgical planning. Material and method: Retrospective analysis of 1160 rhinoplasty operated by otolaryngologist Dr. Luis Villarroel between January 1006 and March 31, 2015, of which 277 are secondary rhinoplasty (24%). In this study we found 1197 problems or deformities (average 4.3), They were classified into upper, middle, bottom third ,and endonasal, with an individual deformities subdivision within each group. The results are compared if the primary surgery was another surgeon (secondary rhinoplasty of others) or by the same author (revision rhinoplasty). Results: 85% of patients had problems in the lower third. The most common individual problems identificated were deviated septum (56%), drop tip (47%), bone dorsum deviation (34%), and cartilaginous dorsum desviation (30%). The author presents a higher percentage of insufficient bone resection and less cartilaginous dorsum narrow. Conclusion: There are different reasons why a patient seeks a secondary rhinoplasty. It is important to know the most frequent causes in order to identify the mistakes made in the first instance and avoid them. It's preferable one conservative primary surgery because it avoids difficult problems. This classification helps us to systematize the preoperative analysis and better results.

Escala numérica para evaluar síntomas espirituales en cuidados paliativos / A scale to assess spiritual symptoms in palliative care

Background: Spiritual issues are an important dimension of health care, but seldom addressed by professionals. Thus, a scale that assesses the presence and intensity of seven spiritual symptoms was developed. Aim: To validate the instrument in palliative care settings. Material and Methods: The spiritual symptoms scale was applied to 103 patients, aged 59 ± 17 years (58% women), admitted to hospice care in two centers located in Santiago. The reproducibility of the scale was evaluated in 33 patients and its internal consistency and liability in 70. Results: The Fleiss Kappa to assess reproducibility was 0.82 and the analysis of variance had a p of 0.94. Cronbach alpha to assess internal consistency was 0.74. Conclusions: The scale renders similar results when applied by different evaluators and has a good liability. Therefore, it can be a reliable instrument to assess spiritual symptoms in palliative care settings. Further studies would be needed to verify its utility in other settings.

Strain auricular izquierdo y biomarcadores cardíacos como predictores de accidente cerebrovascular en pacientes con fibrilación auricular de reciente comienzo / Left atrial strain and biomarkers for stroke in patients with recent onset atrial fibrillation

Introducción: La miopatía y fibrosis auricular representan el sustrato protrombótico y proarrítmico en pacientes con fibrilación auricular (FA). Estudios recientes muestran relación entre el strain auricular izquierdo (SAI), eventos cardiovasculares y recurrencia en pacientes con FA. La asociación entre SAI y bio-marcadores cardíacos como predictores de accidente cerebrovascular silente (ACVs) en pacientes con FA de reciente comienzo (FArc) no ha sido estudiada. Objetivo: Determinar si la asociación entre SAI y biomarcadores cardíacos contribuye a la predicción de ACV en pacientes con FArc. Métodos: Se realizó un estudio prospectivo que permitió reclutar 57 pacientes con FArc (primer episodio de < de 8 semanas de evolución). Obtenido consentimiento informado (CI) se realizó recolección de datos clínicos y muestras de sangre para determinación de Pro-BNP, Dimero-D y GDF-15. Se realizó resonancia nuclear magnética cerebral (RNMc) y ecocardiograma transtorácico (ETT) durante los primeros 3 días de inclusión y en ritmo sinusal. Para la evaluación de SAI se consideró la curva de deflexión positiva durante la sístole ventricular (SAIs), derivada de speckle tracking, considerando el promedio de 5 ciclos. Se utilizó Mann Whitney U test y Spearman Rho para análisis estadístico. Resultados: La edad promedio fue 70±8,2 años y el 70% fueron hombres. El CHA2DS2-VASc score promedio fue 3,1±1 y el promedio de pro-BNP, Di-mero-D y GDF-15 fue 96,1±12,4 pg/ml, 990±140 ng/ ml y 12 ng/ml respectivamente. 15% de los pacientes (n=9) presentaban ACVs en la RNMc al momento del diagnóstico. Se observó, además, que los pacientes con ACV presentaban un SAIs más bajo que los pacientes sin eventos (5,5±1,1% y 14,6±7,3% respectivamente p=0.04). Adicionalmente, se encontró una correlación significativa entre SAIs y pro-BNP, Dimero-D y GDF-15. Conclusiones: En este trabajo se evidenció que el 15% de los pacientes con FArc presenta ACVs al momento del diagnóstico. El SAIs bajo se correlaciona de forma inversa con los biomarcadores de sobrecarga, trombogénesis, fibrosis auricular y presencia de ACV silente. Estos resultados pueden ser utilizados para una mejor estratificación del riesgo de ACV en pacientes con FA.

Introduction: Atrial myopathy and fibrosis constitute a pro-arrhythmic and pro-thromboembolic substrate in patients with atrial fibrillation (AF). Recent studies using left atrial strain (LAS) have shown that LAS contributes to predict AF recurrence in patients with paroxysmal AF. The association between LAS and cardiac biomarkers in predicting silent stroke (SS) in patients with new AF has not been studied. Aim: The association of LAS and cardiac biomarkers contribute to predict SS in patients with new AF. Methods: We have prospectively evaluated 57 consecutive patients with new AF (first episode with less than 8 weeks of evolution). Baseline clinical characteristics and blood samples for determinations of Pro-BNP, D-Dimer and GDF-15 were obtained. Brain magnetic resonance (BMRI) and 2D Echo were performed within 3 days. In sinus rhythm, the positive deflection during ventricular systole of the LAS curve derived from speckle tracking was considered (mean of 5 cycles) (LASS). Mann Whitney U test and Spearman Rho were used for statistical analysis. Results: Mean age was 70±8,2 years, 70% were men. The mean CHA2DS2-VASc score was 3,1±1. Mean pro-BNP, D-Dimer and GDF-15 were 96,1±12,4 pg/ml, 990±140 ng/ml and 12 ng/ml, respectively. Fifteen percent of patients (n=9) had evidence of previous SS in BMRI. Patients with SS had significantly less LASS than patients without events (5,5±1,1% and 14,6±7,3% respectively p=0,04). In addition, a significant correlation between LASs and pro-BNP, D-Dimer and GDF-15 was found. Conclusion: Evidence of SS was found in 15% of patients with new AF. This was associated with LASs impairment, which was inversely correlated with cardiac biomarkers of LV overload, thrombogenesis and LA fibrosis. These findings could be utilized for a better risk stratification of stroke in patients with new AF.

Validación de cuestionario autoaplicable para un índice de alimentación mediterránea en Chile / Validation of self-applicable questionnaire for a Mediterranean dietary index in Chile

Background: Availability of brief dietary indexes that can effectively evaluate dietary patterns and their association with health is critical for prevention and management of several chronic disease conditions. Aim: To adapt a self-applicable Mediterranean Dietary Index in Chile (Chilean-MDI). Material and Methods: The Chilean-MDI was developed based on a previous Mediterranean eating score that was adapted to Chilean dietary habits. This index was further validated in a sample of 153 adults by comparing the concordance between the results obtained by self-application of the Chilean-MDI with those obtained by a trained nutritionist. Additionally, the index was applied in a sample of 53,366 Chilean adults in order to describe the diet quality of our population. Results: There was an adequate concordance between findings obtained by self-application of the Chilean-MDI and those achieved by the nutritionist. The application of the index in Chilean adult population showed a better diet quality (high Mediterranean diet adherence) among women, with advanced age and among people with higher educational levels. Conclusions: The Chilean-MDI can be successfully self-applied to portray the overall diet quality in the Chilean adult population. Additionally, this dietary index describes overall food intake in Chilean adults, showing demographic trends that are comparable to those obtained with similar indexes applied in other populations.

Evaluación de la anticoagulación con rivaroxaban, en pacientes con fibrilación auricular no valvular de reciente diagnóstico / Evaluation of oral anticoagulation with rivaroxaban, in patients with new onset non valvular atrial fibrillation

Background: Atrial fibrillation (AF) generates a hypercoagulable state with an increased thrombin generation and raised levels of thrombin-antithrombin complexes, which results in a high risk of stroke and thromboembolism. Aim: To evaluate the anticoagulant effect of rivaroxaban by anti-Xa factor activity and its correlation with thrombin-antithrombin complexes, thrombin generation and prothrombin time in patients newly diagnosed with non-valvular AF. Patients and Methods: Prospective study in patients with indication of anticoagulation. Demographic variables, cardiovascular risk factors, CHA2DS2-VASc and HAS-BLED scores were recorded. Blood samples were taken at baseline, at 3 and 24 hours after the administration of the drug and at 30 days. Rivaroxaban levels, anti-Xa activity, prothrombin time, thrombin generation and plasma levels of thrombin-antithrombin complexes were determined. Results: We studied 20 patients aged 76.3 ± 8.0 years (60% female) with a CHA2DS2-VASc score > 2 points. The anti-Xa factor activity correlated with rivaroxaban plasma levels at 3 hours (r = 0.61, p < 0.01), at 24 hours (r = 0.85, p < 0.01) and at 30 days (r = 0.99, p < 0.01), with prothrombin time at 3 hours (r = -0.86, p = 0.019) and at 30 days (r = -0.63, p = 0.02) and with a sustained decrease in thrombin generation at 30 days of follow-up (r = -0.74, p < 0.01). There was no correlation with thrombin-antithrombin complexes (r = -0.02, p = 0.83). Conclusions: Rivaroxaban consistently inhibited the mild pro-coagulant state found in newly diagnosed non-valvular AF patients through the first 24 hours and this effect was maintained at 30 days. Plasma levels of the drug correlated with anti-Xa factor activity, thrombin generation and prothrombin time

Síndrome de Moebius. A propósito de un caso / Moebius Syndrome: A Case Report

Anomalía congénita caracterizada por afectación del VI y VII par craneano que determina una parálisis facial, uni o bilateral, aunque el compromiso puede ser más extenso. Se describe paciente masculino de 4 años de edad, obtenido por cesárea, con antecedentes de amenaza de aborto en cuatro oportunidades a partir de la décima semana de gestación; en el período de lactancia presentó dificultad para la succión y deglución. Al examen físico, facies inexpresiva, boca en carpa, parálisis facial bilateral, estrabismo, nistagmos, puente nasal ancho, micronagtia, paladar hendido, pie equino varo bilateral y sindactilia en mano derecha. Se relaciona con eventos y fármacos (misoprostol) que puedan producir una disrupción vascular e insuficiencia placentaria. Se sugiere como causa, la afección hipóxico/isquémica transitoria del feto debido a alteraciones en la circulación materno-fetal durante primer trimestre de embarazo, por amenaza de aborto y probablemente exposición a teratógenos como el misoprostol.

Congenital anomaly characterized by involvement of the VI and VII cranial nerve that causes a bilateral facial paralysis, or uni, but the commitment may be longer. Is described, male patient aged 4, obtained by cesarean section with a history of threatened abortion four times from the tenth week of pregnancy; in lactancy, presented difficulty in sucking and swallowing. On physical examination, expressionless face, mouth in tents, bilateral facial paralysis, strabismus, nystagmus, broad nasal bridge, micrognathia, cleft palate, clubfoot and bilateral syndactyly in right hand. It relates to events and drug (misoprostol) that produce vascular disruption and placental insufficiency. In this patient had been suggested as a cause transient hypoxic / ischemic disease of the fetus due to alterations in maternal-fetal circulation during early pregnancy, threatened abortion and likely exposure to teratogens such as misoprostol.

Efectos de la pentoxifilina en la formación de adherencias peritoneales postoperatorias en ratas / Pentoxifylline effects on the formation of postoperative peritoneal adhesions in rats

Las adherencias son una consecuencia común y desafortunada de muchas de las cirugías abdominales. Algunos pacientes forman extensas adherencias permanentes que pueden causar dolor abdominal o pélvico, infertilidad y obstrucción intestinal. Los estudios epidemiológicos han puesto en evidencia la magnitud de este problema y el costo de los servicios de salud, y aunque hay numerosos enfoques para prevenir la formación de adherencias minimizando el daño peritoneal, el uso de barreras, diversos tópicos y agentes farmacológicos, ningún método hasta ahora ha resultado totalmente eficaz en ensayos aleatorios controlados. En este estudio, se decidió evaluar los efectos de la administración intraperitoneal de Pentoxifilina en la prevención de adherencias peritoneales postoperatorias en ratas.Veinte ratas hembras Sprague-Dawley, fueron sometidas a laparotomía. Las adherencias peritoneales postoperatorias fueron inducidas por abrasamiento de la superficie serosa del colon. Los animales fueron divididos al azar en dos grupos experimentales: un grupo que recibió Pentoxifilina, y el otro como grupo control. Y fueron sacrificados y evaluados a los 15 días, observándose una disminución en cuanto a número (p=0,025), severidad (p=0,0018), extensión (p=0,0013), densidad (p=0,0071), grado de inflamación (p=0,0020), proliferación vascular (p=0,0007) y fibrosis (p=0,0047) de las adherencias en el grupo tratado con Pentoxifilina, en relación al grupo control. En conclusión, este estudio demostró que la administración de Pentoxifilina por vía intraperitoneal disminuye de forma significativa la formación de adherencias peritoneales postoperatorias, y por tanto, puede ser útil en la prevención de las mismas.

The Adhesions are a common and unfortunate consequence of most abdominal surgical operations. Some patients form extensive permanent adhesions that can cause abdominal or pelvic pain, infertility and bowel obstruction. Epidemiological studies have highlighted the extent of this problem and the cost to the health service, and although there are numerous approaches to prevent adhesions formation by decreasing peritoneal injury, the use of various adhesion barriers and topical pharmacological agents, no method so far has proved completely efficacious in randomized controlled trials. In this study, it decided to evaluate the effects of peritoneal exposure to Pentoxifylline in post-surgical adhesions in rats. Twenty female Sprague-Dawley rats underwent laparotomy. Postoperative peritoneal adhesions was induced by scarping serosal the surface of the colon. The animals were divided randomly into two experimental groups: a group treated with Pentoxifylline, and a control group. And were killed and evaluated at 15 postoperative days, decrease was observed in the number (p=0,025), severity (p=0,0018), extension (p=0,0013),density (p=0,0071), inflammation (p=0,0020), vascular proliferation (p=0,0007) and fibrosis score (p=0,0047) of adhesions in the group treated with Pentoxifylline, when compare to control group. In conclusion, this study demonstrated that the administration of Pentoxifylline intraperitoneally decrease significantly the peritoneal adhesions formation, and thus, may be useful for its prevention of same.

Valores espirométricos en niños y adolescentes chilenos sanos / Spirometric values in healthy Chilean children and adolescents

Background: Spirometric flow and volume measurement are essential to evaluate patients with pulmonary disease. In Chile, several reference equations are used. Aim: To measure flow and expiratory volumes in healthy children and adolescents and compare their results with theoretical values according to Knudson, Quanjer, Gutierrez and NANHES III. Subjects and Methods: Spirometries were performed according to international standards in 1589 healthy children and adolescents aged 6 to 18 years (861 females) who lived in Santiago, Chile. Results: The obtained values for forced vital capacity, expiratory volume in one second, peak expiratory flow, were significantly higher than those calculated according to the above mentioned standards (p < 0.0001) with differences up to 18.7%. We constructed reference formulas for ages ranging from 6 to 18 years, separated by gender, using age, weight and height as independent variables. The latter had the greater influence on formula construction. Conclusions: The use of these new local formulas with allow the correct interpretation of spirometric results obtained in Chilean children and adolescents.

Autores clásicos en psiquiatría: evaluación de un modelo de enseñanza de la psicopatología para residentes de psiquiatría / Classical authors in psychiatry: evaluation of a teaching model of psychopathology for psychiatry residents

Introducción: El aprendizaje de la psicopatología ha sido considerado una piedra angular en la formación de los residentes de psiquiatría. Objetivo: Evaluar el impacto de la enseñanza de un curso sobre autores clásicos de la psiquiatría y psicopatología en los residentes del programa de psiquiatría para determinar cambios en el nivel de conocimientos y valoración de la historia y fundamentos de la psicopatología. Método: Estudio de corte transversal pre post, con una encuesta anónima y voluntaria que se aplicó a todos los residentes con evaluación de las características socio demográficas, interés, utilidad y pertinencia de los contenidos, entre otros. Al inicio de cada seminario, evaluación de los conocimientos con una prueba escrita de desarrollo. Resultados: Participaron 24 residentes en total, 14 del programa adultos y 10 de infantojuvenil. La tasa de participación promedio fue de 87,5 por ciento. El 87,5 por ciento declaró tener conocimientos insuficientes o muy insuficientes. Entre las características de los residentes destacaron el interés por el deporte, la música y la literatura. Un 95,8 por ciento se proyecta como clínico y solo un 12,5 por ciento como docente. Al inicio del seminario solo hubo 29,16 por ciento de respuestas correctas en relación al origen y autor de los conceptos psicopatológicos revisados lo que aumentó a 65,4 por ciento al finalizar la serie de seminarios. Un 83 por ciento consideró los seminarios muy interesantes y el 75 por ciento muy útil para conocer la historia de la psiquiatría y mejorar su práctica clínica. Conclusión: La enseñanza de la psicopatología a partir de las descripciones clínicas de autores clásicos de la psiquiatría es altamente valorada por los residentes de psiquiatría en múltiples aspectos incluyendo el enriquecimiento de su práctica clínica.(AU)

Objective: To evaluate the impact of learning psychopathology in seminars, focusing on clinical cases described by classic psychiatry authors. Methods: A specially designed questionnaire was administered to 24 residents of the psychiatry program at the beginning and end of a series of 12 seminars analyzing the life, work and selected clinical cases of classic psychiatry authors including S. Freud, K. Kraepelin, E. Bleuler and K. Schneider. Data were collected included respondents characteristics, how interesting and useful the seminars were perceived to be and respondents' knowledge of classic psychiatry authors. Results: Respondents were interested in sports, music and literature; 95.8 percent regarded themselves as clinicians and 12.5 percent regarded themselves as teachers. The seminars were rated very interesting by 83.0 percent and very useful by 58.3 percent; they were considered to contribute to knowledge of the history of psychiatry, professional development and clinical practice. Most respondents (87.5 percent ) stated that their knowledge of classic authors was inadequate or very inadequate. At the beginning of the seminar series only 29.2 percent of responses about the origin and author of the psychopathological concepts covered in the seminars were correct; increasing to 65.4 percent by the end of the course. Conclusion: Teaching psychopathology through the study of classical cases is valued by residents for various reasons, including its potential to enrich clinical practice.(AU)

¿Cuánta información desean recibir y cómo prefieren tomar sus decisiones pacientes con cáncer avanzado atendidos en una Unidad del Programa Nacional de Dolor y Cuidados Paliativos en Chile? / Information disclosure and decision making preferences of patients with advanced cancer in a Pain and Palliative Care Unit in Chile

Information disclosure and decision making process are important steps in advanced cancer patients management; however, there is no research done in this area in Chile. Aims: To know the preferences of patients with advanced cancer related to information disclosure and style of decision making process. Methods: Prospective observational study with patients in the Palliative Care Unit of Sótero del Río Hospital, in Santiago, Chile. The preferences were evaluated with a Disclosure Information and a Decision Making Preferences Questionnaire. Results: 100 patients were recruited, 52% males, average age 63 years; 90% wanted to receive complete information about diagnosis and 89% complete information about prognosis. The preferences related to decision making process style were: 60% shared, 27% passive and 13% active. The expressed satisfaction with the information received was 89% and 87% with the way decisions were actually made. Conclusions: A majority of patients preferred to receive complete information about diagnosis and prognosis and to make shared decisions. The satisfaction with information disclosure and decision making process was very high. The data of this study supports the need of an adequate information disclosure and of exploring the individual preferences of our patients, with the goal of promoting an informed decision making process that respects the preferences of our patients.

Efectos de la Metilprednisolona en la formación de Adherencias Peritoneales postoperatorias en ratas / Methylprednisolone effects on postoperative Peritoneal Adhesions formation in rats

Las adherencias peritoneales son bandas fibróticas patológicas que se forman entre órganos y tejidos de la cavidad abdominal que normalmente se encuentran separados. Se presentan en el 93% de los pacientes luego de una cirugía abdominal o pélvica, y son causa de dolor abdominal y obstrucción intestinal. Algunos autores han propuesto que el uso de esteroides puede disminuir la cantidad y severidad de las adherencias. Los objetivos fueron: Evaluar los efectos de la metilprednisolona, en la formación de adherencias peritoneales postoperatorias en un modelo animal. El método utilizado fue un estudio experimental, ensayo de laboratorio en modelo animal. A 10 ratas hembras Sprague-Dawley se les practicó cirugía formadora de adherencias peritoneales y fueron distribuidas de forma aleatoria en 2 grupos, un grupo que recibió dosis única de metilprednisolona intraperitoneal, y el otro como grupo control. A los 15 días los animales fueron sacrificados y evaluados. Se evidenció una disminución significativa de la inflamación (p=0,027) en el grupo con administración de metilprednisolona. Sin embargo, no hubo diferencias significativas entre los grupos en cuanto al número (p=0,482), severidad (p=0,489), grado de proliferación vascular (p=0,207) y fibrosis (p=0,095) de las adherencias peritoneales. Este estudio demostró que la administración de metilprednisolona no afecta de forma significativa la formación de adherencias peritoneales postoperatorias, y por tanto, no tiene un efecto preventivo de las mismas.

Peritoneal adhesions are pathological fibrotic bands formed between organs and tissues of the abdominal cavity that are normally separated.They present in 93% of patients after abdominal or pelvic surgery and, they are cause of abdominal pain and intestinal obstruction. Some authors have suggested that the use of steroids may decrease the number and severity of adhesions.The goal was to experimentally evaluate the effects of methylprednisolone, in postoperative peritoneal adhesions in an animal model. So an experimentally study was done, a laboratory assay in an animal model. In 10 female Sprague-Dawley rats, peritoneal adhesions were induced, and then randomly assigned to 2 groups: a group treated with methylprednisolone, and a control group.The animal were killed and evaluated at the 15th day after surgery. A significant decrease in inflammation (p=0.027) in the group with administration of methylprednisolone was evident. However, there were no significant differences between the groups in relation to the number (p=0.482), severity (p=0.489), vascular proliferation (p = 0.207) and fibrosis score (p=0.095) of peritoneal adhesions.This study demonstrated that the administration of methylprednisolone doesn't affect the postoperative peritoneal adhesions formation, and therefore, is not have a preventive effect of them.

Prevalencia de síndrome de Gilbert y sus determinantes genéticas en población chilena / Prevalence of Gilbert syndrome and its genetic determinants in Chile

Background: In Europeans the TATA box TA7 repeat promoter variant in the UGT1A1 gene (UGT1A1*28) is the major determinant of bilirubin levels. Aim: To study the prevalence of Gilbert Syndrome (GS) and its genetic determinants in Chile. Material and Methods: Three different studies were conducted. The prevalence of GS in Chile was assessed in 991 subjects with normal liver tests (ALT and GGT) from the 2nd National Health Survey. We defined GS as a total bilirubin (TB) between 1.4-5mg/dL. The second study assessed the genotype prevalence of SNP rs6742078 (in LD with UGT1A1*28) and rs4149056 in 500 DNA samples of non-related Hispanics. Finally, a case-control study was designed to assess the phenotype-genotype correlation. UGT1A1*28 and rs4149056 variants were determined by direct sequencing and allelic discrimination assays (TaqMan), respectively. Results: Prevalence of GS in the general Chilean population was 2.6% (4.5% in males and 0.5% in female). No correlation with age, educational level or home location was found. Genotypes for UGT1A1*28 (TA6/6 50.5%, TA6/7 37.8%, TA7/7 11.7%) and rs4149056 (TT 74.1%, CT 22.8%, and CC 3.1%) variants were similar to Europeans. In the case-control study, most patients with GS were homozygotes for UGT1A1*28 (TA7/7, 74%). Of note, 44% of patients with intermediate TB levels were also TA7/7, compared to 7% in normal subjects. SLCO1B1 genotype was not correlated with TB levels. Conclusions: While the prevalence of GS was lower in Chile compared to Europeans (~5%), the prevalence of UGT1A1*28 homozygotes was similar (~12%). In Chilean Hispanics, the UGT1A1*28 variant explain 75% of GS phenotype.

Síndrome de muerte súbita del lactante: prevalencia y cambios en los últimos años en Chile / Prevalence of sudden death syndrome among children

Background: The sudden infant's death syndrome (SD) is the leading cause of death in children under one year. Despite advances in its study, the pathogenesis has not been yet fully elucidated. Aim: To assess the prevalence of SD in Chilean infants and its changes in recent years. Material and Methods: Review of birth and death databases of the Ministry of Health from 1997 to 2009. All cases diagnosed as SD, according to the lnternational Classification of Diseases, 10th edition, were selected. A demographic analysis was performed and mortality rates for each year were calculated. Results: We identified 1442 cases of SD (847 males, 517 deaths at home). The median age of death was 2 months (0 to 11.0 months). Ninety six percent of deaths occurred in children aged <6 months. Mortality rate for SD was 0.45/1000 live births. There was a 23% reduction between 1997 and 2009. When analyzing geographic distribution, more cases were found in the Southern latitudes of the country. Conclusions: The overall rate of SD in Chile is higher than in European countries and in North America. The observed decrease in cases over the years is still far from optimal.