[Assessment of creative thinking among medical students]. / Determinación de pensamiento creativo en estudiantes de medicina de una universidad chilena.

BACKGROUND: Creativity is a highly valued quality in different fields. Despite this, it is rarely included in the curricula of medical careers. AIM: To assess creative thinking among undergraduate medical students. MATERIAL AND METHODS: Sixty-seven students aged 18 to 31 years (45% women) from the first (16), third (26) and seventh year (25) of medical school answered a sociodemographic questionnaire and the Torrance Test of Creative Thinking (TTCT). RESULTS: Median creativity index according to age was in percentile 52 (range 2-99). Percentiles for fluency, originality, elaboration, abstraction of titles and resistance for premature closure were 31, 32, 79, 53 and 17 respectively. There were no significant differences between students of different levels (p = 0.73). CONCLUSIONS: In this group of students, there is a high performance in elaboration and a low score in Resistance to premature closure.

Determinación de pensamiento creativo en estudiantes de medicina de una universidad chilena / Assessment of creative thinking among medical students

Background: Creativity is a highly valued quality in different fields. Despite this, it is rarely included in the curricula of medical careers. Aim: To assess creative thinking among undergraduate medical students. Material and Methods: Sixty-seven students aged 18 to 31 years (45% women) from the first (16), third (26) and seventh year (25) of medical school answered a sociodemographic questionnaire and the Torrance Test of Creative Thinking (TTCT). Results: Median creativity index according to age was in percentile 52 (range 2-99). Percentiles for fluency, originality, elaboration, abstraction of titles and resistance for premature closure were 31, 32, 79, 53 and 17 respectively. There were no significant differences between students of different levels (p = 0.73). Conclusions: In this group of students, there is a high performance in elaboration and a low score in Resistance to premature closure.

Metabolic consequences of snoring in adolescents and younger adults: a population study in Chile.

STUDY OBJECTIVES: To investigate the potential association between snoring and other symptoms indicative of sleep-disordered breathing and metabolic syndrome (MetS) in Hispanic adolescents and younger adults using a large population-based survey. METHODS: Sleep-related information, anthropometric measurements and fasting blood samples markers of MetS were obtained from subjects aged 15-40 years collected through the 2nd Chilean Health Survey. Regression models were constructed to evaluate the associations of snoring with MetS, hypertension and serum cholesterol levels. The modulating effect of sleep duration was accounted for in the models. RESULTS: A total of 2147 subjects (42% males, mean age 27.9±7.6 years) were included. Snoring and short sleep duration were present in 43.5 and 25% of the entire population, respectively. MetS was detected in 19.5% of the subjects. In the adjusted regression model, the odds of MetS among snoring subjects were 2.13 times higher (95% confidence interval (CI): 1.52-2.99; P<0.01), and 1.53-fold higher odds of elevated cholesterol also emerged (95% CI: 1.12-2.10; P<0.01). However, the odds of hypertension were not increased by the presence of snoring after adjusting for confounders. In addition, snoring was associated with an increase of 7.26 and 6.56 mg dl-1 for total and low-density lipoprotein cholesterol, respectively, even after adjusting for age, sex and body mass index. Short sleep duration was associated with a small albeit significant risk increase for high systolic blood pressure. CONCLUSIONS: In this large population-based sample of young Hispanic adults and adolescents, snoring, but not sleep duration, emerged as an independent risk factor for dyslipidemia and MetS, but not for hypertension.

Pregnancy outcomes and the use of two standards to assess adequacy of maternal body mass index in early gestation.

The maternal weight gain chart proposed by Rosso and Mardones (RM) was subsequently modified by Atalah et al. (AEA). Both charts are widely used in Latin America. The purpose of this study was to compare birth length (BL) and birth weight (BW) outcomes of both charts. A prospective study of pregnant women and their offspring's was performed in Santiago, Chile. From a total sample of 27,613 pregnant women a sub-sample of 11,465 term healthy singleton pregnant women was selected for additional analyses. κ statistics was used to study the degree of agreement of both charts in the diagnosis of maternal nutritional status. Obese and underweight women were classified using both standards at the beginning of pregnancy and compared in terms of BL4250 g proportions. Sensitivity and specificity values of at risk newborns, whose categories were considered as gold standard, were obtained for obese and underweight women of each chart. There was a moderate agreement in the nutritional classification of these charts. Proportions of BL4250 g were similar at each nutritional category; however, absolute figures for at risk newborns were much higher in the RM underweight and obese women. The RM chart showed higher sensitivity values than the AEA chart. The higher sensitivity of the RM chart would support its use for prevention purposes. This chart is advisable for Latin American countries and also for most developing countries.

A risk prediction model for severe intraventricular hemorrhage in very low birth weight infants and the effect of prophylactic indomethacin.

OBJECTIVE: Develop a risk prediction model for severe intraventricular hemorrhage (IVH) in very low birth weight infants (VLBWI). STUDY DESIGN: Prospectively collected data of infants with birth weight 500 to 1249 g born between 2001 and 2010 in centers from the Neocosur Network were used. Forward stepwise logistic regression model was employed. The model was tested in the 2011 cohort and then applied to the population of VLBWI that received prophylactic indomethacin to analyze its effect in the risk of severe IVH. RESULT: Data from 6538 VLBWI were analyzed. The area under ROC curve for the model was 0.79 and 0.76 when tested in the 2011 cohort. The prophylactic indomethacin group had lower incidence of severe IVH, especially in the highest-risk groups. CONCLUSION: A model for early severe IVH prediction was developed and tested in our population. Prophylactic indomethacin was associated with a lower risk-adjusted incidence of severe IVH.

Association of perinatal factors and school performance in primary school Chilean children.

The associations between school performance and cognitive abilities with birth characteristics have mostly been studied without taking into consideration the effects of gestational age (GA). Our aim was to study the association between prenatal growth and cognitive function in term-born Chilean school children. A cohort of over 200,000 term-born fourth graders who took the regular national test for school performance was studied. Outcome parameters were language and mathematics test scores in relation to prenatal growth. A total of 256,040 subjects took the test and 220,940 were included in the final study sample. Prenatal growth was modestly, but significantly, associated with school performance. Adjusted ß coefficients for 1 cm increase in birth length were 1.28 and 0.77 for mathematics and language, respectively; the corresponding values for 100 g increase in birth weight were 0.59 and 0.34, respectively. Increased GA was associated with lower test scores. Adjusted ß coefficients for the birth measurements generally had a lower strength of association than those of socio-economic factors. However, the confounders most strongly associated with educational achievements were socio-economic factors, known to be associated with birth size. Lower socio-economic status is known to negatively influence both prenatal growth and cognitive function, supporting the overall importance of prenatal growth in relation to cognitive outcomes.

Wheat flour fortification with folic acid: changes in neural tube defects rates in Chile.

In January 2000, Chilean Ministry of Health mandated the addition of folic acid (FA) to wheat flour in order to reduce the risk of neural tube defects (NTDs). This policy resulted in significant increases in serum and red cell folate in women of fertile age 1 year after fortification. To evaluate the effect of wheat flour fortification on the prevalence of NTDs in Chile we designed a prospective hospital-based surveillance program to monitor the frequency of NTDs in all births (live and stillbirths) with birth weight≥500 g at the nine public maternity hospitals of Santiago, Chile from 1999 to 2009. During the pre-fortification period (1999-2000) the NTD rate was 17.1/10,000 births in a total of 120,566 newborns. During the post-fortification period (2001-2009) the NTD rate decreased to 8.6/10,000 births in a total of 489,915 newborns, which translates into a rate reduction of 50% (RR: 0.5; 95% CI: 0.42-0.59) for all NTDs. The rate reduction by type of NTD studied was: 50% in anencephaly (RR: 0.5; 95% CI: 0.38-0.67), 42% in cephalocele (RR: 0.58; 95% CI: 0.37-0.89), and 52% in spina bifida (RR: 0.48; 95% CI: 0.38-0.6). Rates showed significant reduction both in stillbirths and live births: 510.3 to 183.6/10,000 (RR=0.36; 95% CI: 0.25-0.53) and 13.3 to 7.5/10,000 (RR=0.56; 95% CI: 0.47-0.68), respectively. In Chile, fortification of wheat flour with FA has proven to be an effective strategy for the primary prevention of NTDs.

Prenatal growth and metabolic syndrome components among Chilean children.

The association of prenatal growth with metabolic syndrome (MS) components and insulin resistance (IR) in children has not been studied in Chile and most developing countries. Some associations found in developed countries are controversial. A retrospective cohort study was designed linking present information on MS components and IR in children with register-based information on birth weight (BW), birth length (BL) and gestational age (GA). Examinations included anthropometry and blood pressure (BP), as well as self-report of pubertal status. A fasting blood sample was taken to determine lipids, glucose, insulin and homeostasis model assessment (HOMA)-IR was calculated. The study cohort of 2152 children was on average 11.4 ± 1.0 years old. The prevalence of MS, IR and overweight were 7.6%, 24.5% and 34%, respectively. Elevated BP was negatively associated with dichotomized risk categories of the perinatal factors studied (BW, BL and GA). Contingency tables showed that high waist circumference (WC) and elevated BP had a U-shaped association with various categories of BW and BL, respectively. Stepwise linear regressions selected: (a) WC as inversely associated to GA and directly associated to BW, (b) BP as inversely associated to GA and (c) HOMA-IR as inversely associated to BL. Non-optimal prenatal growth seems to predispose to high WC, elevated BP and IR in school-age children, supporting the early life origin of several non-communicable diseases. Those associations were rather weak as estimated by the slopes of the regressions and probably reduced by their U-shaped nature; they would reasonably become stronger with a longer follow-up.

(-)-istanbulin a.

THE TITLE COMPOUND (SYSTEMATIC NAME: 9a-hydr-oxy-3,4a,5-trimethyl-4a,6,7,8a,9,9a-hexa-hydro-4H,5H-naphtho[2,3-b]furan-2,8-dione), C(15)H(20)O(4), is a sesquiterpene lactone showing the typical eremophilanolide skeleton, which has been isolated from the plant Senecio candidans collected in the Chilean Magallanes region. The present study confirms the atomic connectivity assigned on the basis of (1)H and (13)C NMR spectroscopy, as well as the relative stereochemistry of the 4α-methyl,5α-methyl,8ß-hydr-oxy,10ß-H unit. The crystal structure is stabilized by inter-molecular O-H⋯O hydrogen bonds involving the hydr-oxy group as donor and the oxo group as acceptor, giving chains along the a axis. The absolute structure was not determined because of the lack of suitable anomalous scatters.

Social capital and self-rated health in urban low income neighbourhoods in Chile.

OBJECTIVE: To examine the potential association between social capital and self-rated health within a low income community of Santiago, Chile. METHOD: Cross-sectional survey, based on in-home interviews in the municipality of Puente Alto in Santiago, Chile. The participants were 781 residents of four neighbourhoods within Puente Alto (mean age 45.5 years). RESULTS: Principal components analysis with varimax rotation identified five domains of social capital: perceived trust in neighbours, perceived trust in organisations, reciprocity within the neighbourhood, neighbourhood integration, and social participation (Cronbach alphas: 0.58 to 0.77). Trust and reciprocity were significantly associated with better self-rated health. For example, a one standard deviation increase in trust in neighbours was associated with an adjusted odds ratio of 1.10 (95% confidence interval, CI: 1.05 to 1.15) for reporting good self-rated health. By contrast, social participation was associated with a lower odds (0.89, 95% CI: 0.89 to 1.06) of reporting good health. CONCLUSION: Neighbourhood social cohesion, measured by trust and reciprocity, is associated with higher self-rated health. However, social participation did not appear to be associated with better health in this predominantly low income neighbourhood. These findings provide preliminary support to the relevance for social capital as a determinant of health in Chile.

Metronizadol Vs. nitazoxanida en el manejo de giardia lamblia / Nitazoxanide vs metronidazole in the management of giardia lamblia

Las infecciones gastrointestinales mundialmente consideradas entre las enfermedades más frecuentes, son producidas por una variedad de agentes virales, parásitos, hongos, bacterias y constituyen la principal causa de muerte en la primera infancia.Entre las infecciones intestinales más frecuentes y sintomáticas se encuentran las producidas por protozoos, en especial Giardia inestinalis, parásito de amplia distribución mundial y de indudable acción patógena que puede causar diarreas disenteriformes, duodenitis, yeyunitis y puede colonizar la vesícula biliar, aunque no ha sido involucrada directamente en los cuadros de colecistitis (1,2). Su mayor prevalencia se encuentra en zonas tropicales y subtropicales, donde afecta hasta el 30% de los adultos. Es más frecuente en niños, personas internadas en orfanatos o cárceles, homosexuales y viajeros. Es la parasitosis intestinal más frecuente en EEUU (3,4). En México las cifras de infección por este parásito son muy variables, desde 1 hasta 60% de la población estudiada; la incidencia guarda estrecha relación con las condiciones sanitarias, vivienda, higiene personal y nivel educativa (5,6).

¿Cuál es el resultado de una vacunación con alérgeno en un paciente no sensibilizado? A propósito de un caso / Which is the effect of an allergen vaccine administration to a non-sensitized patient? One case reported

Presentamos un caso anecdótico de una paciente con anafilaxia por sensibilización alérgica a veneno de Vespula y con estudio alergológico al veneno de abeja negativo, a la que accidentalmente se trató con inmunoterapia de veneno de abeja mediante una pauta tradicional. A partir de la cuarta dosis administrada, se observaron reacciones locales inflamatorias tardías que alteraron su calidad de vida de forma importante. Esto obligó a ralentizar la pauta de administración. Tras 2 meses de tratamiento, con un total de 8 dosis administradas del extracto, se detectó el error y se repitió el estudio alergológico al veneno de abeja; se observó que se habían positivizado tanto las pruebas cutáneas como la determinación de IgE específica sérica. Se informó a la paciente de su sensibilización al veneno de abeja desencadenada por la administración del extracto erróneo y se inició la vacunación con un extracto de avispa, que se toleró desde las primeras dosis. Actualmente, casi 5 años después de haberse suspendido la inmunoterapia errónea, la paciente mantiene un estudio alergológico positivo, con concentraciones de IgE específica sérica estables en los últimos 4 años

We present an anecdotic case of a patient who suffered from an anaphylactic reaction after a wasp sting and with positive allergy study to wasp venom and negative to bee venom, who was submitted unintentionally to bee venom immunotherapy by conventional protocol. From the fourth dose, the patient suffered from large local late reactions with impairment of her quality of life, which induce us to change the administration protocol. After two months of the beginning of immunotherapy administration, with a total of 8 doses received, the mistake was detected and immediately an allergy study to bee venom was performed. This study become positive in skin tests and in the specific IgE determination. The patient was informed about the mistaken bee venom immunotherapy, and about the induction of hypersensitivity to bee venom, and she was treated with wasp venom immunotherapy with good tolerance since the first dose. Nowadays, nearly 5 years after interruption of the erroneous immunotherapy, the patient keeps with a positive allergy study to bee venom, remaining without changes in the last 4 years

Diseño de un índice pronóstico clinico para el manejo de la neumonía del adulto adquirida en la comunidad / Development of an instrument to assess the severity of community acquired pneumonia among hospitalized patients

BACKGROUND: Community acquired pneumonia (CAP) severity assessment is crucial. AIM: To develop a practical clinical severity assessment model for stratifying immunocompetent adult patients hospitalized with CAP into different management groups. PATIENTS AND METHODS: During a 24 months period, 455 adult patients (250 male, mean age 69 +/- 19 years old) were evaluated. All the relevant clinical information recorded and they were followed during hospital stay until discharge or death. Mortality until 30 days after admission was determined. RESULTS: The mean hospital length of stay was 9.9 +/- 9.4 days and 76% had an underlying disease. In hospital mortality was 7.6% and 10.1% at 30 days follow up. Admission prognostic factors associated with high mortality at 30 days follow up were: advanced age, presence of comorbidity, suspicion of aspiration, duration of symptoms < or = 2 days, altered mental status, absence of cough, fever and cbills, low blood pressure, tachypnea, hypoxemia and multilobar radiographic pulmonary infiltrates. A clinical prognostic index derived from a logistic regression analysis including five independent variables associated with mortality (confuson, comorbidity, low systolic blood pressure, temperature < 37.5 degrees C and respiratory rate > 20/min), enabled patients to be stratified according to increasing risk of mortality: class 1: 0.9%, class 2: 4.9%, class 3: 14.2%, and class 4: 35.6%. CONCLUSION: A simple clinical severity assessment tool based on confusion, comorbidity, blood pressure, temperature and respiratory rate could be used to stratify patients with CAP into different risk class categories and management groups.

Anemia en las embarazadas de la comuna de Puente Alto, Chile / Anemia in pregnant women from the community of Puente Alto, Chile

BACKGROUND: Micronutrient deficiencies, specially iron, render pregnant women as one of the most vulnerable groups to have anemia. AIM: To report the prevalence of anemia during pregnancy and its associated features in women attending public clinics in the Puente Alto County. MATERIAL AND METHODS: We studied 1683 pregnant women aged 18 years old or more. Hemoglobin concentration was determined using the cianmetahemoglobin method. Anemia was defined using the 5th percentile cut-off for each week of gestational age as proposed by R Yip from the Centers of Disease Control, 1989. The influence of maternal age, parity, nutritional status classified using weight/height, diseases and smoking habits on hemoglobin concentration were analyzed using logistic regression with a stepwise procedure. RESULTS: Thirteen percent of the study population was anemic. The single factor significantly associated with anemia was nutritional status. Twenty one percent of women with a low weight for height were anemic. CONCLUSIONS: These results support the concept that pregnant women with a low weight for height have the greatest risk for anemia and should be specially benefited with preventive or treatment programs to avoid this problem.

Heliotropium huascoense resin exudate: chemical constituents and defensive properties.

From the resinous exudate of Heliotropium huascoense a new compound, rel-(8R,9R)-carrizaloic acid, (1) (3-[rel-(8R,9R-9-hydroxy-9,13,13-trimethyl-12-oxo-10-cyclohexenyl)methyl]-4-methoxybenzoic acid), and three known flavonoids, [3-methylgalangin, 3,7-dimethylgalangin, and (-)-alpinone] have been isolated. The structure of 1 was determined by spectral and chemical methods. Several plant defensive properties of 1 (insecticidal and antifungal) have been evaluated.

Defensive chemistry of Senecio miser.

Three eremophilanolides, 1alpha-acetoxy-8beta-methoxy-10betaH-eremophil-7(11)-en-8alpha,12-olide (1); 1alpha-angeloyloxy-6beta-hydroxy-8beta-methoxy-10betaH-eremophil-7(11)-en-8alpha,12-olide (2); and 1alpha-angeloyloxy-8betaH,10betaH-eremophil-7(11)-en-8alpha,12-olide (3), and two pyrrolizidine alkaloids, integerrimine (4) and its N-oxide (5), were isolated from bioactive fractions of Senecio miser. The structures of the new compounds 1 and 2 were established by NMR spectroscopic analysis and chemical transformation. The X-ray analysis of compound 1 was also performed. Eremophilanolides 1 and 2 and alkaloids 4 and 5 were found to be strong insect antifeedants, further supporting a proposed defensive role for these classes of compounds.

Dermatitis de contacto profesional por fotopolímero. Remisión clínica tras la realización de pruebas epicutáneas / Occupational dermatitis to photopocymer. Clinical remission after epicutaneous test

Se presenta el caso de un varón de 61 años, trabajador en una imprenta, que presentaba desde hacía 4 años dermatitis en las manos; en el ejercicio de su actividad laboral manipulaba habitualmente películas fotográficas y planchas de fotopolímero YET®. Las pruebas epicutáneas fueron positivas con un raspado de la placa de fotopolímero YET®, etilenglicol dimetacrilato, e hidroxietil metacrilato. Esto sugirió que el paciente presentaba una dermatitis alérgica de contacto profesional por acrilatos presentes en el fotopolímero. Se repitieron las pruebas epicutáneas con el fotopolímero a los 11 días, observando una disminución en la intensidad de las mismas. A los 3 meses acudió a la consulta totalmente asintomático, refiriendo una mejoría paulatina de las lesiones, sin tratamiento ni medidas preventivas. (AU)

[Academic performance of medical students: a predictable result?]. / Desempeño académico de los estudiantes de medicina: un resultado predecible?

BACKGROUND: Traditionally, medical schools demand their students a high dedication in time, responsibility and integrity. AIM: To assess the predictive capacity of several specific variables, on the academic performance of medical students. MATERIAL AND METHODS: All students who entered during 1984-1995 period were studied. The academic performance was assessed using two indices: an overall evaluation of successfulness as determined by the approval rate in different courses and grade-point average obtained during the first three years at the Medical School. The variables used to predict academic performance were year of enrollment, high school grades, university admission test scores, biomedical and demographic characteristics. All these were measured at the time when the student was enrolled. RESULTS: Eight hundred and eight students were studied at the end of the third year. The most important predictive variables selected for both performance indices were: high school grades, admission biology test scores, place were high school studies were done, and previous university studies. In addition verbal and mathematics admission academic performance tests scores were selected for grade-point average index. Although, the overall admission score and high school academic performance were significantly associated with the two outcomes, they were not selected in the final models. CONCLUSIONS: The best predictors of an optimal academic performance in these medical students were high school grades, admission biology test scores, residing in Metropolitan Santiago and previous university studies.