Pupillary Light Reflexes are Associated with Autonomic Dysfunction in Bolivian Diabetics But Not Chagas Disease Patients.

Autonomic dysfunction is common in Chagas disease and diabetes. Patients with either condition complicated by cardiac autonomic dysfunction face increased mortality, but no clinical predictors of autonomic dysfunction exist. Pupillary light reflexes (PLRs) may identify such patients early, allowing for intensified treatment. To evaluate the significance of PLRs, adults were recruited from the outpatient endocrine, cardiology, and surgical clinics at a Bolivian teaching hospital. After testing for Chagas disease and diabetes, participants completed conventional autonomic testing (CAT) evaluating their cardiovascular responses to Valsalva, deep breathing, and orthostatic changes. PLRs were measured using specially designed goggles, then CAT and PLRs were compared as measures of autonomic dysfunction. This study analyzed 163 adults, including 96 with Chagas disease, 35 patients with diabetes, and 32 controls. PLRs were not significantly different between Chagas disease patients and controls. Patients with diabetes had longer latency to onset of pupil constriction, slower maximum constriction velocities, and smaller orthostatic ratios than nonpatients with diabetes. PLRs correlated poorly with CAT results. A PLR-based clinical risk score demonstrated a 2.27-fold increased likelihood of diabetes complicated by autonomic dysfunction compared with the combination of blood tests, CAT, and PLRs (sensitivity 87.9%, specificity 61.3%). PLRs represent a promising tool for evaluating subclinical neuropathy in patients with diabetes without symptomatic autonomic dysfunction. Pupillometry does not have a role in the evaluation of Chagas disease patients.

Chagas cardiomyopathy in the context of the chronic disease transition.

BACKGROUND: Patients with Chagas disease have migrated to cities, where obesity, hypertension and other cardiac risk factors are common. METHODOLOGY/PRINCIPAL FINDINGS: The study included adult patients evaluated by the cardiology service in a public hospital in Santa Cruz, Bolivia. Data included risk factors for T. cruzi infection, medical history, physical examination, electrocardiogram, echocardiogram, and contact 9 months after initial data collection to ascertain mortality. Serology and PCR for Trypanosoma cruzi were performed. Of 394 participants, 251 (64%) had confirmed T. cruzi infection by serology. Among seropositive participants, 109 (43%) had positive results by conventional PCR; of these, 89 (82%) also had positive results by real time PCR. There was a high prevalence of hypertension (64%) and overweight (body mass index [BMI] >25; 67%), with no difference by T. cruzi infection status. Nearly 60% of symptomatic congestive heart failure was attributed to Chagas cardiomyopathy; mortality was also higher for seropositive than seronegative patients (p = 0.05). In multivariable models, longer residence in an endemic province, residence in a rural area and poor housing conditions were associated with T. cruzi infection. Male sex, increasing age and poor housing were independent predictors of Chagas cardiomyopathy severity. Males and participants with BMI

[Quality of life of patients operated for gastric cancer]. / Análisis de calidad de vida en pacientes gastrectomizados por cáncer gástrico.

BACKGROUND: Gastric cancer is the first cause of death by cancer in Chile. Quality of Life is a multidimensional construct that explores functionality and well-being, including physiological, psychological and social aspects. AIM: To assess Quality of Life of patients operated for gastric cancer. PATIENTS AND METHODS: The European Organization Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30), translated into Spanish, was applied to 33 patients, aged 42 to 82 years (25 males), subjected to curative total or subtotal gastrectomy for gastric cancer, between January 2004 and December 2006. RESULTS: The average lapse from the moment of the surgical intervention to the interview, was 52.2 weeks. Fifty five percent perceived their Quality of Life in the "good" category. Male patients and those with less than 6 months of surgery, obtained better scores in psychological aspects of quality of life. CONCLUSIONS: A high percentage of patients operated for gastric cancer qualified their quality of life as good in spite of the severity of the underlying disease and invasiveness of the intervention. This is probably explained by the importance of psychological factors that influence quality of life.

Análisis de calidad de vida en pacientes gastrectomizados por cáncer gástrico / Quality of life of patients operated for gastric cancer

Background: Gastric cancer is the first cause of death by cáncer in Chile. Quality of Life is a multidimensional construct that explores functionality and well-being, including physiological, psychological and social aspects. Aim: To assess Quality of Life of patients operated for gastric cancer. Patients and methods: The European Organization Research and Treatment of Cáncer Quality of Life Questionnaire (EORTC QLQ-30), translated into Spanish, was applied to 33 patients, aged 42 to 82 years (25 males), subjected to curative total or subtotal gastrectomy for gastric cancer, between January 2004 and December 2006. Results: The average lapse from the moment of the surgical intervention to the interview, was 52.2 weeks. Fifty five percent perceived their Quality of Life in the "good" category. Male patients and those with less than 6 months of surgery, obtained better scores in psychological aspects of quality of life. Conclusions: A high percentage of patients operated for gastric cancer qualified their quality of life as good in spite of the severity of the underlying disease and invasiveness of the intervention. This is probably explained by the importance of psychological factors that influence quality of life.

Caracteristicas de los consultantes en el centro del adolescente "Las Condes" / Characteristics of patients in the Adolescent Center \"Las Condes\"

Se trata de la única publicación hecha en Chile que describe las características de los consultantes de un Centro de Atención Integral con problemas de salud propios del adolescente, en una Comuna de Santiago. Estas características según diagnóstico, edad y sexo, son relacionadas con los problemas familiares y escolares que denunciaron los consultantes, con la evolución clínica de los casos y con la frecuencia del consumo de sustancias psicotrópicas. 250 adolescentes ingresados en los primeros 10 meses de trabajo fueron diagnosticados como desadaptación el 59,8% y como ansiedad y angustia el 10,8%. 45 jóvenes, 18%, consumían excesivamente bebidas alcohólicas y drogas. 21 casos de consumo de marihuana y otras drogas eran en su mayoría consumo social u ocasional. Fuera de un 6,4% de casos de depresión los demás desórdenes mentales fueron escasos. Los cuadros más graves: retardo mental, esquizofrenia y psicopatías, concentraron más varones que niñas; la mayoría con graves problemas familiares. Los casos de agresividad e hiperkinesia se dieron en varones. Los consultantes denunciaron más problemas graves familiares que escolares, los esquizofrénicos y psicópatas en el hogar y los hiperkinéticos en el colegio. La ecuacón sano-mejoró, vesus desertó indica un buen rendimiento terapéutico