Revista medica de Chile最新文献

Atopic dermatitis (AD) is a common chronic inflammatory disease with a variable course, particularly prevalent in the pediatric population. Targeted therapies-such as monoclonal antibodies (mAbs) and Janus kinase (JAK) inhibitors-represent emerging treatment options. Dupilumab was the first mAb approved by the U.S. Food and Drug Administration (FDA) for the treatment of severe AD.

Aim: To describe a case series of patients under 12 years of age with moderate-to-severe AD treated with dupilumab, and to provide practical considerations for its clinical use.

Methods: A multicenter, retrospective, descriptive observational study was conducted, including pediatric patients with moderate-to-severe AD treated with dupilumab. Demographic, clinical, and treatment response variables were collected.

Results: Ten patients with moderate-to-severe AD (mean baseline EASI score of 24.4 [SD 12]) and a history of prior treatment failure were included. A mean reduction of 13.5 points in EASI score [range: 5.9-25.8] was observed after 6 months of treatment, along with a sustained decrease in individual scores over time. Follow-up duration ranged from 12 to 24 months. Reported adverse effects were mild and did not lead to treatment discontinuation.

Conclusions: The findings of this study are consistent with existing literature supporting the efficacy and safety of dupilumab in children under 12 years of age with moderate-to-severe AD. Furthermore, the study provides practical guidance for its use in real-world clinical settings.

Currently, the techniques for installing peritoneal dialysis catheters are divided into advanced laparoscopic (LAP) or minimally invasive (MMI) methods, which include percutaneous and mini-laparotomy approaches. International registries don't favor one technique or operator (surgeon or nephrologist) over the other.

Aim: To compare early and late complications of CPD installation via MMI by a nephrologist versus LAP.

Methods: This is a retrospective study of the patient database from the Hospital Clínico de la Universidad de Chile between January 2014 and August 2022, who underwent CPD installation. Early and late complications were evaluated, with a 30-day limit from the procedure. STATA 14 software was used, employing a p<0.05 for statistical significance.

Results: A total of 264 patients were identified, with a mean age of 53.4 years. 50% were women, and 26.9% were diabetic. In 61.7% of CPDs, the MMI approach was used. The overall complication rate was 43.9%, with early complications accounting for 27.6% of these. The most frequent early complication was repositioning (7.6%), with 80% occurring in the MMI group. For late complications, peritonitis was the most frequent (44%). There was no mortality associated with the procedure. Comparing MMI and LAP groups, no statistically significant differences were found in early or late complications (p= 0.21 and p= 0.11, respectively). Analysis of the repositioning subgroup also showed no superiority of either technique (MMI: 9.8% vs LAP 4%; p= 0.096).

Conclusions: The LAP approach is not superior to MMI performed by a nephrologist in terms of early or late complications or overall mortality. However, a trend towards a lower repositioning rate was observed in the LAP group.

The Family Health Plan (FHP) outlines healthcare interventions to be implemented at the primary healthcare level (PHC) and serves as a basis plan for calculating transfers to this level of care. Its updates align with the current technical and programmatic guidelines from the Ministry of Health (MINSAL), although they are not necessarily explicitly linked to the regulatory coverage instruments established by MINSAL, showing significant differences between these and its own definitions. As such, the FHP presents particular challenges for its coordinated updating alongside other coverage systems.

Aim: To develop a structural and normative classification of the healthcare interventions included in the FHP.

Methods: From a disaggregated list of interventions included in the latest FHP decree, we classified those corresponding to each coverage system. We also identified those interventions to be carried out in PHC that are not included in the FHP. Finally, we classified the services according to whether they constituted a public health good, a service within the general guarantee system, a service within a system of explicit guarantees (GES), or a minimum PHC service.

Results: A total of 220 interventions to be carried out in PHC were identified, of which only 176 were recorded in the FHP. The majority of interventions in the FHP (80) did not have an explicit relationship with any coverage system. Of the 44 interventions that should be provided in PHC but are not included in the FHP, eleven corresponded to GES interventions.

Conclusions: The interventions included in the FHP originate from diverse regulatory frameworks, which facilitates discrepancies between some of these coverage regimes and the FHP.

Cancer is the leading cause of mortality in Chile. Between 30% and 50% of cancers are related to modifiable risk factors. However, there is insufficient evidence on its distribution in the Chilean population.

Aim: To estimate the frequency of risk factors for the 3 most important oncological pathologies (breast, lung and CRC) in a healthy population affiliated to the cancer insurance of a private cancer center.

Methods: Population-based, cross-sectional study of healthy beneficiaries of cancer insurance at a private cancer center, both sexes, between 40 and 75 years of age during 2021. Data were collected via REDCap® and analyzed in a descriptive and inferential manner, using R v4.04.

Results: 2,091 healthy beneficiaries responded to the survey with a gender distribution of 68% women and 32% men. 64% of the participants had a direct family member with a history of some type of cancer, the most prevalent BMI was the overweight range with a frecuency of 46%, 55% performed physical activity at least 1 time/ week and 19% were active smokers. Of the breast cancer survey (n=851), 66% reported having a family history of cancer ok any kind, and 91% had used some form of contraception, 23.6% had a family history of breast cancer, and 9.3% had a family history of ovarian cancer. In colorectal cancer (n=506), 62,8% had relatives cancer of any kind and 14,4% with CRC, 43.5% reported meat consumption and 25.1% consumption of sausages 2-3 times/week. In lung cancer (n=734), 63,1% had a family history of cancer and 13,2% had a family member with lung cancer. In relation to smoking, 14% reported smoking cigarettes at least once a week, however, 71.6% of smokers expressed the desire to quit smoking.

Conclusions: Although these results are still incipient, and not exactly representative of the Chilean population, these are the first data that aim to collect information on specific risk factors associated with 3 different types of cancer. It is essential to know and quantify the risk factors in our population in order to design prevention programs and alleviate the burden of disease that this diagnosis entails in our country.

The five-repetition STS test (5-STS) is a field test utilized for evaluating physical function, primarily assessing the risk of falls, and is also included as a component in other assessments, such as the Short Physical Performance Battery (SPPB). This test proves to be easily implementable and of significant clinical utility; however, no reference values are currently available for the Chilean population.

Aim: To establish reference values for the 5-STS in the adult Chilean population.

Methods: A multicenter cross-sectional study encompassed data acquisition from five distinct sites across Chile. Healthy adults aged between 18 and 80 were enrolled as participants. Anthropometric measures, physical activity levels, smoking history, Borg scale assessments, and the time to complete five repetitions were registered. Reference values were subsequently established based on sex and specific age categories.

Results: 463 subjects were included in the study, comprising 269 women. The median (and LIN) of time of 5 repetitions in women was: 18-29 years: 7.4 (10.6), 30-39 years: 7.7 (11.4), 40-49 years: 8.5 (13.1), 50-59 years: 9.2 (14.0), 60-69 years: 9.7 (15.3) and 70-80 years: 11.3 (17.7). While in men it was: 18-29 years: 7.8 (10.3), 30-39 years: 6.5 (11.4), 40-49 years: 8.1 (11.5), 50-59 years: 9.8 (15.1), 60-69 years: 11 (15.8), 70-80 years: 13 (18.5). The predictive equations are as follows: Men: 5-STS= 4.698 + (age(y) * 0.096); Women: 5-STS= -3.185 + (age(y) *0.074) + (height(cm) *0.055).

Conclusion: This study successfully established reference values for the adult Chilean population, providing essential data for the accurate assessment of the physical capacity of the people when using the 5-STS.

Reed syndrome is a rare genodermatosis characterized by the presence of cutaneous leiomyomas, typically of pilar origin, and their association with uterine leiomyomas in women. We present the case of a 23-year-old male patient with a history of papulopustular acne, who developed painful skin lesions on the anterior thorax. Dermoscopic examination and skin biopsy confirmed the diagnosis of piloleiomyomas. Considering the maternal history of multiple cutaneous and uterine leiomyomas, the case was diagnosed as Reed syndrome. Accurate and timely diagnosis of multiple cutaneous leiomyomas is essential, as they are the primary clinical clue for suspecting Reed syndrome-a condition associated with both benign and malignant tumors.