Revista medica de Chile最新文献

Non tuberculous mycobacteria (NTM) are important opportunistic infection in patients with AIDS.

Aim: To present 4 cases of disseminated infections by NTM in patients with AIDS.

Results: These cases were associated with prolonged symptoms of fever, weight loss, diarrhea or cough, with hepatosplenomegaly, anemia and thrombocytopenia. None were receiving prophylaxis, had a low CD4 lymphocyte count (median 20/mm3), and three had discontinued their antiretroviral therapy (ART). The diagnosis was established by culture in bone marrow, sputum or bronchioalveolar lavage samples and in two cases also by PCR. Histological features included foamy histiocytes and positive acid fast bacilli in tissues. The species identified were Mycobacterium avium in 3 cases and M. genavense in the remaining case. Patients were treated with combinations of ethambutol, macrolides, quinolones, amikacin or rifampicin on a long-term basis (median 19 months) and even parenterally for severe diarrhea. Three patients survived and one died from disseminated Kaposi's sarcoma. Multiple complications were observed including severe malnutrition, renal failure, calcium and phosphorus metabolism disorders, healthcare-associated infections, co-infections, and neoplasms. All required readmissions and ART adjustments to compensate for interactions with rifampicin.

Conclusions: NTM infections in patients with AIDS generate a prolonged morbidity, frequent readmissions, require an extended combination treatment that may present interactions with ART, and are associated with different complications, including calcium and phosphorus disorders. Its diagnosis is complex in the absence of special blood cultures, requiring a microbiological study in multiple samples and with different techniques, including the support of histopathology.

Multiple sclerosis (MS) is a pathology that mainly affects the young population, causing irreversible disability without treatment. The national multiple sclerosis program improves access to diagnosis, treatment, and prognostic of patients with relapsing-remitting multiple sclerosis (RRMS).

Aim: Describe the biggest cohort of patients with RRMS in the Chilean public health system, analyze the impact of the national program in the clinical evolution and the diagnostic opportunity (time in years between the first outbreak and entry into the program) before and after 2010, date of incorporation of the pathology to the explicit health guarantees program (GES) of the Ministry of Health (MINSAL).

Methods: A cross-sectional and retrospective study was carried out with the information extracted from 921 clinical records of patients with RRMS from 2008 to 2018. The impact on the clinical evolution was evaluated by comparing the initial EDSS with the control. Diagnostic opportunity was analyzed by comparing the data before and after 2010. Multivariate analysis was carried out to objectify its relationship with age, gender, clinical presentation, initial disability, and region of origin.

Results: The mean age of the patients was 34.5 years. The female-to-male ratio was 2.2:1. 40.5% of patients were admitted with EDSS (expanded disability status scale) greater than or equal to 3. At the clinical reevaluation, this percentage decreased to 32.5%. No demographic variable affected the diagnostic opportunity.

Conclusion: Access to the RRMS program is not affected by age, gender, clinical presentation, disability, or region of origin, despite the unequal distribution of patients with RRMS in the country and the differences in access to diagnostic technologies in each of them.

Asthma is a chronic non-communicable disease considered a serious health problem worldwide. The Chronic Care Model promotes the self-management of patients' chronic conditions. This process requires an active engagement of health professionals to provide education for patients to manage their disease better.

Aim: this study sought to explore the education process carried out by primary health care providers for asthma patients in two regions of Chile.

Methods: Nine group interviews with 35 health providers in nine primary health care centers were conducted in two of the country's major urban areas, the Valparaíso and Biobío Regions. Data were analyzed using an inductive approach, with coding followed by category construction and interpretation.

Results: Based mainly on age and educational level, health professionals construct a patient profile to adjust the information provided and the strategies employed to educate patients. The education is focused on pharmacological treatment and inhalation techniques. Educational strategies are primarily direct instruction through individual one-on-one sessions. Fewer actions were described to help patients choose, control, and correct their daily routines and lifestyle and involve patients in self-awareness and self-regulating their behavior.

Conclusions: The health care education process for asthma patients focuses on delivering information about the disease and medical treatment. Some issues of the Chronic Care Model, which promotes self-management, are still not addressed.

This report describes the case of a 64-year-old female patient, with multiple comorbidities which presented an ecthyma gangrenosum due to Klebsiella pneumoniae confirmed by blood and tissue cultures. It finally ended in the amputation of the limb. The case is presented given the low prevalence of positive cultures for this microorganism in this pathology associated to devastating consequences for the patient.

Glomerular filtration rate estimates are usually indexed to a standard body surface area (BSA) of 1.73 m2. This allows comparing values of individuals of different sizes but has the potential of affecting individuals with extremes BSA.

Aim: evaluating the differences in GFR estimates with or without indexing for BSA in a large cohort of ambulatory patients grouped by different body mass index (BMI) and how indexing affects CKD classification.

Methods: demographic and anthropometric data of 390 patients evaluated with ambulatory 24-hour creatinine clearance were registered in an anonymous database. Patients were divided in 3 groups according to BMI (18-24.9; 25-29.9; >30 kg/m2). GFR was estimated using creatinine clearance (CrCl), CKD-EPI 2009 and 2021 equations, both indexed to a standardized BSA of 1.73 m2 and using the actual BSA of the patients. CKD classification was performed with and without indexing.

Results: 224 of 390 patients were men (57.4%). 103 (26.4%) had normal BMI (group 1), 193 (49.5%) BMI of 25-29.9 (group 2) and 94 (24.1%) had BMI of 30 or more kg/m2 (group 3). Mean CrCl was 67.9 +/- 32.7 ml/min. Indexed to a BSA of 1.73 m2 CrCl was 64.8 +/- 30.5 ml/min (difference of -3.1 ml/min) (p< 0.001). The difference between real and indexed CrCl was +2.2 ml/min, -2.9 ml/min y -9.3 ml/min in groups 1, 2 and 3, respectively. Real CrCl was significantly higher in group 3 compared to group 1. Indexed ClCr was similar between the 3 groups. GFR estimation using equations was over 2 mL/min higher when removing indexation for standard BSA. Group 1 had higher indexed GFR estimates than groups 2 and 3. However, when removing indexing the 3 groups had similar GFR estimates. Classification of CKD was significantly affected by removing indexing, with almost 20% of the patients changing CKD stage. Diagnosis of GFR <60 mL/min was less frequent when removing indexing.

Conclusion: Indexing to standard BSA lowers GFR estimation in overweight and obese patients, leading to a higher prevalence of GFR < 60 mL/min and CKD diagnosis.

Aim: To analyze tuberculosis (TB) incidence, demographic profiles, and associated risk factors in migrant and national populations, in order to understand the impact of migration, overcrowding, and socioeconomic factors on TB prevalence and care-seeking behaviors.

Material and methods: Data from various communes within the Metropolitan Region and other parts of the national territory were analyzed to assess TB incidence, demographic characteristics, and care-seeking behaviors among migrant and national populations.

Results: TB disproportionately affects males in both migrant and national populations. Migrants exhibit a younger demographic profile, higher proportion of HIV coinfection. Migration and overcrowding positively influence the Risk of Morbidity from TB (RME) in specific communes, whereas socioeconomic income negatively impacts the RME, being the most relevant explanatory factor.

Conclusions: TB remains a significant public health challenge influenced by migration, overcrowding, and socio-economic disparities. Tailored interventions focusing on high-risk groups and specific geographic areas are essential for effective control strategies. Future research should explore the impact of the COVID-19 pandemic on TB dynamics and associated socio-health factors.

A 36-year-old woman with ulcerative colitis presented with progressive chest pain and neurovegetative symptoms. The electrocardiogram showed ST segment elevation in the inferior wall. The patient had a previous history of fatigue and night sweats. She underwent coronary angiography, which revealed severe disease of two coronary vessels, with successful primary angioplasty of the culprit vessel. Aortitis was suspected, which led to additional studies, among which a slight elevation of inflammatory activity indices stood out, and a computed tomography angiography showed periaortic fibrotic thickening and significant stenosis in multiple arteries, suggesting Takayasu vasculitis. She was treated with prednisone and methotrexate and underwent delayed myocardial revascularization surgery with good results. This case highlights the complexity of Takayasu arteritis, its possible association with ulcerative colitis, and the importance of early diagnosis for adequate management.

Endometriosis is a chronic disease characterized by the growth of the endometrium outside the uterine cavity. In response to estradiol, this tissue begins to proliferate and grow, forming lesions and nodules, which can invade the tissues, causing pelvic pain and infertility. The most widely used pharmacological treatment is progesterone, which manages to reduce symptoms, but approximately one-third of patients develop resistance to treatment.

Aim: To determine the expression levels of progesterone receptors in biopsies of recto-vaginal nodules, considering central and invasive regions of the lesions.

Materials and methods: Biopsies from 16 patients diagnosed with deep endometriosis were used, and fragments from the center of the nodule and the invasive area were selected. Histological sections and immunohistochemical staining for progesterone receptors, KI67 and E-Cadherin (ECad) were prepared and quantified by image analysis.

Results: The glands in the center (less invasive area) compared to the front (invasive area) have a significantly lower level of mitosis (KI67 0,486±0,014 vs. 0,719±0,026 +nuclei/total nuclei) and greater thickness (13,430±0,169 vs. 6,160 ±0,166 μm), higher level of ECad expression (0,525±0,048 vs. 0,338±0,063 times over control), and higher expression of RP (stroma 0,382±0,267 vs. 0,165±0,191 and epithelium 0,728±0,043 and 0,386±0,063 times over control).

Conclusion: The glands have different molecular and morphological characteristics depending on the area of the lesion. Invasive areas are more proliferative and express fewer progesterone receptors. However, further studies are required to determine if these differences translate into the ability to respond to progesterone treatment.