Revista medica de Chile最新文献

Adrenal insufficiency (AI) requires a prompt diagnosis to avoid associated mortality. New etiologies have been added to the classic causes.

Aim: To establish the frequency of different causes of AI and to describe, the characteristics of patients treated at a university center.

Methodology: Retrospective review of clinical records, laboratory tests and images of patients diagnosed with AI over a 11-year period. The cases were divided according to diagnosis into primary (PAI) or secondary (SAI).

Results: Of 102 patients (51 females (F), 40 (39%) had PAI, (15M/25F) and 62 (61%) SAI (36M/26F). Evolution of disease: 4.6±9.5 (0-38) and 5.5±7.7 (0-32) years in PAI and SAI respectively. Age at diagnosis: 43.6±16 years in PAI and 46.6±18.6 years in SAI. The most frequent etiologies were: Addison's disease (AD) (65%) in PAI and macroadenomas in SAI (64.5%). HIV infection was associated with one case of PAI and one case of SAI. Two cases of SAI were secondary to pembrolizumab-induced hypophysitis. Symptoms such as asthenia, weight loss, abdominal pain and muscle fatigue were significantly more frequent in PAI. Five percent of cases with SAI did not show symptoms of hypocortisolism. Fifty eight percent of patients with AD (15/26) had associated autoimmune thyroid disorders. We observed a trend to hyponatremia, hypercalcemia and in PAI, although to hyperkalemia and increased ACTH and plasma renin activity.

Conclusion: The clinical picture in AI is nonspecific but asthenia, associated with other symptoms and signs characteristics, together with laboratory findings, may guide the diagnosis, as well as the presence of endocrinopathies or autoimmune diseases. The high prevalence of HIV infection and the increasingly use of check point inhibitors make it necessary to implement AI screening protocols in these groups.

In Chile, the public health policy known as "Explicit Health Guarantees" (GES) allows the referral of patients with suspected Colorectal Cancer (CRC) to a tertiary center for colonoscopy within 45 days of evaluation. The correlation of these symptoms with the diagnosis has not been analized.

Aim: This study aims to analyze variables linked to CRC diagnosis, those in GES guidelines and other clinically important, and to develop a symptom-based predictive model for CRC diagnosis.

Methods: A retrospective analytical study was conducted from July 2016 to December 2021. Inclusion criteria were patients referred for colonoscopy as per GES guidelines. Colonoscopy variables were evaluated for test quality. Sixteen variables were included in the predictive model, ten from the GES guidelines and six of clinical interest. Statistical univariate analysis with SPSS 26® (p<0.05). Multivariate analysis used binary logistic regression with ROC analysis and 95% confidence intervals for comparison.

Results: The cohort included 1099 patients with a mean age of 63.9±13.3 years; 61.1% were female. 148 patients (13%) were diagnosed with neoplasia with 66.9% stage III-IV. Significant variables in the predictive model included age, gender, diarrhea, lower gastrointestinal bleeding, compromised general condition, anemia, palpable rectal mass, suggestive ultrasound, and CT scan, with an AUC of 0.86 (95%CI 0.83-0.89). A model without imaging variables achieved an AUC of 0.81 (95%CI 0.78-0.85).

Conclusion: The GES policy enabled a CRC detection rate of 13% in this cohort. Predictive models were developed to optimize referrals for colonoscopy and enhance public health policy. The models require validation in an independent cohort to determine their real-world applicability.

The importance of Primary Health Care to resolve people's demand is increasing. For that purpose, trained personnel are required throughout the country.

Aim: to know a model of continuing education for nursing technicians in rural health posts, methodology, results and future perspectives.

Methods: description of the methodology and results of the Training Program in Health Promotion and Local Development in 536 nursing technicians from 201 rural communities in 16 Health Services. The modality was 150 hours (120 remote and 30 in-person), except for the years 2020 and 2021 when it was only remote due to COVID-19. The Moodle platform version 3.5.1 of the virtual classroom of the INTA, University of Chile was used, and the presencial event was in the host city of each Health Service. The contents were organized into modules and units, with permanent tutorial support and evaluation of learning, the complete program and students´satisfaction.

Results: The approval of the Course was 93% and the average final grade was 6.3 out of 7. The follow-up survey showed that 73% achieved some job change; 72% applied what they learned and implemented their final work, with satisfaction close to 100%.

Conclusion: this modality allows us to reach the most remote places in the country to train and support the work of nursing technicians.

Epithelioid hemangioendothelioma (EHE) is an extremely rare vascular sarcoma, with an estimated incidence of 0.32 to 0.38 cases per million person-years. We present the case of an 18-year-old woman with slowly progressive metastatic EHE. The patient experienced persistent abdominal pain and sought emergency care on multiple occasions without receiving a final diagnosis. Three years later, imaging studies revealed multiple hepatic lesions, and a biopsy confirmed the diagnosis of EHE. Although therapeutic options such as surgical resection and chemotherapy were considered, an active surveillance approach was chosen due to the slow disease progression and the absence of severe symptoms. After 26 months of follow-up, the patient shows no signs of tumor progression and leads a normal life, with occasional abdominal pain responsive to symptomatic treatment. This case suggests that active surveillance may be a valid strategy for managing EHE in selected patients, allowing for the avoidance of overtreatment and the complications associated with aggressive medical-surgical interventions.

Obesity, characterized by an excess of body fat, is commonly diagnosed using the Body Mass Index (BMI), with obesity defined as a BMI greater than 30 kg/m2. This condition, steadily increasing worldwide, affects millions of people.

Aim: To highlight the anatomical and physiological changes secondary to obesity and its effects on respiratory function, presenting perioperative optimization alternatives.

Method: Narrative review of studies related to ventilatory management in the perioperative obese patient.

Results: Obesity significantly impacts respiratory function due to anatomical and physiological changes, increasing airway resistance, reducing lung capacity, and raising the incidence of cardiorespiratory diseases. During the perioperative period, factors such as anesthesia, surgical technique, and patient positioning can exacerbate these problems, increasing postoperative respiratory complications up to 18% in obese patients. Therefore, perioperative optimization becomes crucial.

Conclusion: Proper preparation to face the perioperative period in obese patients is essential given the predicted increase in the prevalence of this condition.

The sense of coherence is a salutogenic construct, defined as an orientation towards life. People with a high sense of coherence are known to have a better quality of life.

Aim: To make the transcultural adaptation and to analyze the psychometric properties of the SOC-13 scale for its use in Chilean university students.

Methods: Descriptive cross-sectional study, with a stratified sampling by proportional allocation of 238 university students who answered it online. Transcultural adaptation of the scale was carried out and certain psychometric aspects of it were analyzed; content validity, reliability analysis (internal consistency and split-half reliability), and construct validity (convergent validity, exploratory and confirmatory factor analyses).

Results: Adaptation of the SOC-13 scale to Chilean Spanish. For content validity, Aiken's V coefficient was 0.83 [0.55-0.95]. Coefficient for internal consistency: alpha= 0.74 and omega= 0.76; Spearman-Brown= 0.675, and Guttman= 0.652, while alpha coefficients for dimensional reliability varied between 0.314 and 0.696. These values did match up to self-efficacy (r= 0.496; p= 0.01). These results were the basis for a three-factor model that explains 51.92% of the variance, with adequate adjustment indexes (CFI= 0.908; RMSEA= 0.067; SRMR= 0.066).

Conclusions: The Chilean version of the SOC-13 scale has been made for easy application and comprehension, has been fully adapted to Chilean culture, and is reliable and valid for use in university population.

Death preparedness amongst caregivers is described as an essential process to accompany a peaceful passing. Nevertheless, it has been difficult to define its content and operationalization; therefore, its use in research and clinical practice is unclear. This work aims to describe death preparedness and its clinical implications in the support of caregivers of elderly people in end-of-life stages. A narrative review of scientific publications from the years 2010-2020 was conducted, which allows us to identify that, despite the absence of a consensus definition of death preparedness, studies agree on its nature as a process of acknowledging death and making necessary adjustments for caregiving practices. The importance of educational interventions and the support provided by the healthcare professionals to individuals at the end of life and those who care for them is also emphasized.

Aim: To measure nurse staffing ratios in critical care and med-surgical units in public hospitals in Chile and to analyze the gap between them and ministerial standards. To assess patient complexity and to examine alignment to beds' complexity definition and staffing.

Methods: Multicenter, cross-sectional study.

Population: high-complexity public hospitals, with more than 150 beds (n = 48) and bed-side registered nurses working in adult and pediatric critical care or med-surgical units (n = 6,086). No sampling methods were needed.

Main variables: nurse staffing ratios, measured through an online nurse survey, and patient complexity, measured through the CUDYR instrument that assesses patients' risk and self-sufficiency. Descriptive and comparative analyses, as per type of variable.

Results: Hospitals' response rate 85% (n = 41) and nurses' response rate 68% (n = 4,146). Unequal staffing ratios between hospitals. Mean patients-per-nurse, day shift, adult / pediatric units: ICU 2.9 / 2,6, step-down 4.9 / 5,5, med-surgical 9,6 / 7,7. Mean patients-per-nurse, might shift, adult / pediatric units: ICU 2,9 / 2,5, step-down 4,8 / 6,4, med-surgical 10,6 / 7,3. Low adherence to day-shift ministerial staffing recommendations. Eighty percent of patients occupying "basic level of care" beds, and 30% of patients occupying "medium level of care" beds are more complex than what would be expected for those beds.

Conclusions: There is a gap between hospital registered nurse staffing ratios and ministerial recommendations and between patient complexity and bed complexity definitions. There is a need to update ministerial staffing standards, to redistribute hospital beds based on complexity, and to adjust staffing ratios to the new distribution.