Revista medica de Chile最新文献

Information and communication technologies constitute a resource that can improve the effectiveness of programs focused on people with chronic diseases, especially those with type 2 diabetes mellitus, strengthening the care management provided by the nursing professional.

Aim: To evaluate the available evidence to understand the effects of information and communication technologies on glycaemic control in people with type 2 diabetes.

Material and methods: Databases used for research were Web of Science, PubMed, and Scopus between January and March of 2023. Natural language was used, joined by OR or AND operators. The clinical trials met the following selection criteria: Trials in adults 18 years old or above with type 2 diabetes who went through interventions with information and communication technologies and for whom glycosylated hemoglobin A was a primary outcome. Each author reviewed these trials independently.

Results: Out of 1201 clinical trials that went through interventions with information and communication technologies and that glycosylated hemoglobin A was a primary result of it, only 12 were randomly chosen to be included in the present review article; in the majority of them, the mobile cell phone was used as the main tool.

Conclusions: The use of information and communication technologies proved to have favorable effects on the participants' glycemic control by showing a decrease in the glycosylated hemoglobin A. Text messages and web platforms stood out as the more efficient resource for glycemia monitoring.

Population aging has caused a rise in neurodegenerative diseases among which includes Parkinson's disease. However, in Chile, there is still little knowledge about how Parkinson's disease is associated with functionality in elderly people.

Aim: to examine the association between Parkinson's disease and functionality in elderly people of Maipú, Metropolitan region, between the years 2017-2019.

Methods: A quantitative study with an observational design was conducted. A sample of 4.843 elderly people (≥65 years) enrolled in CESFAM Michelle Bachelet in Maipú was used. To examine the association between Parkinson's disease and functionality, we use logistic regression models adjusted by demographic, socioeconomic, and health variables.

Results: People with Parkinson's disease are 3.3 times more likely to experience functional limitation (p-value<0.001). At the same time, males (OR= 1.3; 95% CI 1,1-1,5; p-value<0.001), of old age (OR= 10; 95% CI 7,9-12,6; p-value<0.001, on people 85 years old) with low schooling (OR= 1,7) and belonging to A-B segment of FONASA (OR= 1,3) have more chances of having functional limitations.

Conclusion: The study shows a significant association between Parkinson's disease and functional limitations, supported by the literature. Although this study accounts for the specific reality of a territory, its results can be useful in designing strategies and interventions that could help improve the quality of life of people with Parkinson's disease and their families in other urban territories of the country.

Fibromyalgia is a syndrome of widespread chronic pain, associated with fatigue, sleep disorders, and a wide range of additional symptoms, among which balance disorders are a common complaint.

Aim: To determine a correlation between balance disorders and severity of fibromyalgia.

Methods: An observational cross-sectional study was conducted at the Pain Treatment Unit of the Clinical Hospital of the University of Chile. The Berg Balance Scale (BBS) was used to assess balance disorders, the Revised Fibromyalgia Impact Questionnaire (FIQ-R) was used to measure the severity of fibromyalgia, and the Activities Specific Balance Confidence (ABC-16) was used to evaluate balance confidence.

Results: A total of 35 patients were recruited (97.14% women), with a mean age of 50.97 years. 97.14% of the patients showed a moderate to severe impact on the FIQ-R. The mean score obtained on the Berg Balance Scale was 49.57 points, revealing a significant negative correlation between the FIQ score and the Berg Balance Scale score (rPearson=-0.64 to -0.70). The mean score obtained on the ABC-16 was 47%, exhibiting a moderate correlation with the Berg Balance Scale score (rPearson=0.54). Additionally, 54.29% of the patients reported having experienced one or more falls in the last 6 months.

Conclusion: A significant inverse correlation was found between balance disorders and the severity of fibromyalgia impact. Additionally, a moderate correlation was observed between balance confidence and Berg Balance Scale scores.

Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant disease with an estimated prevalence of 2 per 100,000. This disease is caused by a mutation in the tumor suppressor gene MEN1, which is located on chromosome 11 and codifies the menin protein. It is characterized by a predisposition of parathyroids, enteropancreatic, and anterior pituitary tumors, affecting the quality of life and lifespan of those who have the disease. Clinical case: We present a case of a 24-year-old woman with recurrent episodes of symptomatic hypoglycemia and first-degree relatives who were diagnosed with insulinoma. Initial studies showed endogenous hyperinsulinism secondary to two pancreatic tumors, the main one measured 8.2 × 4.2 cm, and PTH-dependent hypercalcemia secondary to a parathyroid adenoma. Further studies, based on magnetic resonance imaging of the pituitary, showed a macroadenoma. Additionally, we performed a genetic study that evidenced a deletion in the IAT gene, which is compatible with MEN1 syndrome. Pancreatic and parathyroid surgery were performed, and function substitution therapies were initiated. Discussion: The diagnosis is established in the presence of two or more defining NEM1 tumors or at least one associated with compatible genetic testing or a first-degree relative with a history of MEN1. Screening and surveillance in patients with confirmed MEN1 diagnosis would enable the reduction of the disease burden, with a nonclear impact on lifespan.

In Chile, there is limited information regarding the effects on the quality of life of patients undergoing colorectal resective surgery. Although the GES guideline of management of Colorectal Cancer (2013) includes a quality-of-life survey, presented in a non-translated version to Spanish, without instructions regarding its application method, and recently validated (2023). On the other hand, post-surgical and oncological follow-ups focus on evaluating symptoms, signs, and complementary tests associated with recurrences, leaving the non-standardized evaluation of quality of life to the discretion of the healthcare provider. Therefore, the need arises for a standardized instrument that evaluates the quality of life of patients diagnosed, treated, and monitored for colorectal cancer.

Aim: This article presents and discusses the results of the content validation of the FACT-C survey by experts from the colorectal surgery team of the UC-Christus Health Network for its application in Chilean patients diagnosed with colorectal cancer (in a second phase).

Methods: Validation was performed through an evaluation and calculation of the Content Validity Coefficient (CVC) of each item using a Likert-type survey that evaluated their coherence, clarity, and relevance, as well as the sufficiency of each dimension.

Results: An average of CVCs above 0.9 were observed, wich means an excellent an average of general CVCs above 0.9, which means an excellent correlation between the experts regarding the ability of the survey to measure quality of life. In addition, minor modifications were made to allow for a better understanding of four items.

Conclusion: Our results affirm that the FACT-C survey has an excellent CVC, allowing us to continue with the next stage of the validation process in a sample of Chilean patients to ensure its applicability in our population.

Bivalvular infective endocarditis is a clinical presentation that is associated to a greater extent with adverse outcomes. The involvement of the intervalvular mitral-aortic fibrosa is a rare complication associated with high mortality rates, requiring high complexity surgery. We report a case of a young male presenting to the emergency department with bivalvular endocarditis and mitral-aortic intervalvular fibrosa involvement.

Liver transplantation (LT) is a cost-effective therapy for advanced liver disease. Although LT significantly improves long-term survival, it requires strict control of immunosuppressants and their potential complications. Several available immunosuppressive drugs include glucocorticoids, calcineurin inhibitors, mycophenolate, mTOR inhibitors, and anti-CD25 antibodies. These drugs act particularly in T lymphocytes, depleting them, deviating their traffic, or blocking their response pathways. The main complications after LT include renal failure and infectious, immunological, biliary, vascular adverse events, metabolic, cardiovascular, and neoplastic diseases, especially during the first months. Bacteria, viruses, and fungi can cause infections in these patients. Prophylaxis against Herpes simplex virus, Varicella zoster virus, Cytomegalovirus, Pneumocystis jirovecii, Candida spp., and Aspergillus spp. should be considered according to the presence of risk factors. Among immunological complications, acute cellular rejection is common (30% of LT) but usually responds to immunosuppressive escalation. Also, chronic rejection appears in 3-17% of LT, but only half of the recipients respond to increased immunosuppressants. Appropriate treatment of the underlying etiology is essential, especially in autoimmune diseases, hepatitis B and C virus infection. Lifestyle changes must be encouraged in all patients, and alcohol consumption avoided (especially in alcohol use disorder). Due to the increased risk of cancer, neoplasms must be actively monitored, as well as osteoporosis and other metabolic disorders such as diabetes and cardiovascular disease.