Revista medica de Chile最新文献

Autologous Stem-Cell Transplantation (ASTC) has proven efficacy in several hematological malignancies. The greatest antineoplastic effect achieved with intensified chemotherapy is associated with severe myelotoxicity. The infusion of autologous hematopoietic precursors and transfusion support during the period of aplasia reduces the time and depth of cytopenias, decreasing the risk of bleeding, anemia and life-threatening infections. With the use of stimulants of the three main hematopoietic series, it has been possible to offer this treatment to patients who refuse to receive transfusions, such as Jehovah's Witnesses (JW). This article describes a local protocol to implement ASCT without transfusion support and shows our experience in four patients, two with multiple myeloma and two with relapsed/refractory lymphomas. Despite critical hemoglobin and platelet values observed, no serious complications or treatment-related mortality were observed. At the time of the report, all patients were alive and without progression of their neoplasms. Autologous stem-cell transplantation without transfusion support is feasible in centers with experience in this procedure and can benefit JW among other populations.

Pancreatoduodenectomy represents the only curative alternative in patients with periampullary tumors, currently with acceptable morbidity and mortality rates. However, there is little evidence in octogenarian patients.

Aim: To describe the experience of octogenarian patients undergoing pancreatoduodenectomy for tumors of the periampullary area at the Hospital Clínico de la Pontificia Universidad Católica de Chile.

Material and method: Retrospective study. All patients aged 80 years or older who underwent pancreatoduodenectomy for tumors in the periampullary area between 2002 and 2022 were included. Descriptive analysis and survival calculation with the Kaplan-Meier curve were performed.

Results: 24 patients were included. Median age 82 years (80-88); 62.5% were men. The tumor origin was 20 in the head of the pancreas (83.3%), 2 in the ampulla (8.3%), and 2 in the distal bile duct (8.3%), 100% of malignant origin. No patient received neoadjuvant treatment. 91.7% were classified as ASA II. 2 patients presented major complications, both of a medical nature. One patient presented with a type B pancreatic fistula. No patient presented hemorrhagic or biliary complications nor required reoperation or readmission. There was no postoperative mortality at 30 or 90 days. Adjuvant treatment was performed in 4 patients (16.7%). The 5-year overall survival was 20.1%, with a median of 22 months.

Conclusion: Pancreatoduodenectomy is an appropriate treatment alternative in patients over 80 years of age with tumors of the periampullary area, which can offer low morbidity and mortality rates if they are correctly selected in the context of a multidisciplinary preoperative evaluation in high-volume centers.

Intestinal tuberculosis is a bacterial infection that represents 10% of extrapulmonary tuberculosis. It is known as the great mimicker due to its clinical presentation similar to other diseases such as Crohn's Disease or Neoplastic Intestinal Disease. Its diagnosis is complex, given the paucibacillary characteristic of the disease. We present the case of a 57-year-old patient with an initial diagnosis of Crohn's Disease, starting immunosuppressive therapy. After no response to the initial therapy and with a new endoscopic and anatomopathological study, Intestinal Tuberculosis was concluded, which after starting therapy evolved favorably.

There is a divergence in the results of studies that have explored the association between body mass index (BMI) and health outcomes in different contexts.

Aim: This study investigated the association between BMI and all-cause mortality in older Chilean people.

Methods: 1.205 participants (≥60 years) from the Chilean National Health Survey 2009-2010 were included. The association between BMI categories and all-cause mortality was carried out using Cox proportional regression models, adjusting by confounding factors.

Results: Over a median follow-up of 10.9 years (interquartile range: 8.7-11.0), 404 individuals died (33.5%). In the minimally adjusted model (model 1), the participants underweight had 1.46-times (95 CI %: 1.10;1.94) higher mortality risk, while those with obesity II exhibited a 1.73-times (95 CI %: 1.05; 2.83) higher risk of dying due to all-causes compared with the normal-weight. After adjusting for models 2 and 3, the observed association remained significant.

Conclusion: Older people categorized as underweight and obese II had a higher risk of all-cause mortality than their normal-weight peers, regardless of confounding factors.

Histiocytosis are caused by pathogenic myeloid cells, and can be classified as Langerhans cell histiocytosis (LCH) and non-LCH. Erdheim-Chester disease (ECD) is a non-LCH, characterized by multi-organ involvement, typical imaging findings, and confirmatory histological studies. A case with multi-organ involvement and histological confirmation is presented. A male patient, 50 years old, presented muscle weakness associated with elevated inflammatory parameters, visual disturbances, and exophthalmos. Imaging studies revealed a non-specific retro-orbital mass and retroperitoneal fibrotic mass with perivascular, myocardial, and perirenal infiltration and bone hypermetabolism. Systemic corticosteroids were started, and a biopsy of the retroperitoneal mass informed foamy histiocytes, positive for CD68, negative for CD1a, and positive for BRAFV600 mutation. Treatment with Vemurafenib was started with a good response. Less than 500 cases of ECD have been reported in the literature. It has been described to present with multi-organ involvement, including bone, orbital, renal, and endocrinological involvement, among others. Its diagnostic criteria include imaging and histological alterations, consistent with those described in this patient. The first line of treatment is interferon alpha, which has been shown to improve survival but is associated with adverse effects. As a second line, it has been proposed Vemurafenib when BRAFV600 mutation is present.

Education in older adults is a powerful tool for transforming themselves and their environment; through it, it is possible to change beliefs and attitudes that allow for deep and meaningful learning, enabling this age group to transmit what they have learned to their peers.

Aim: To describe the perceived benefits six months after completing the Senior-FITT Peer Instructors Diploma, a pioneering virtual educational program in Chile.

Materials and methods: A qualitative study was conducted based on a theoretical, methodological approach that derives from grounded theory. The 28 graduates of the Diploma were invited to participate in a focus group and telephone interviews. This program, implemented during the pandemic context, aimed to train leaders in physical activity and health among older people to generate an impact on their health centers and communities.

Results: Benefits such as changes in body weight, muscle strengthening, independence, and physical mobility were described. Also, community and psycho-emotional benefits, such as transmitting knowledge and strengthening emotional bonds. All participants continued to engage in physical activity and transmit the knowledge learned six months after the program, and 50% guided other groups of older people.

Conclusion: Virtual educational programs can be an effective tool to improve the physical and mental well-being of older adults. These programs provide useful knowledge and skills for daily life, promote physical independence, and strengthen emotional bonds. In addition, participants become agents of change in their communities by transmitting the knowledge acquired.

Mumps infections primarily affect childhood and the hallmark of infection is swelling of the parotid glands. The mumps cases decreased noticeably in Chile with the introduction of the triple virus vaccine.

Aim: During 2018 and 2019, an outbreak occurred and affected persons between 20 and 35 years old. In the present work are the laboratory findings, carried out by the Institute of the Public Health, in the epidemiological surveillance program for mumps during this outbreak.

Methods: Between January 2018 and March 2019, 592 suspected cases of viral infection were analyzed for the presence of anti-mumps virus IgM and IgG. 69 cases were analyzed by qRT-PCR to evaluate the presence of viral nucleic acid in urine and saliva samples and sequencing of viral gene sh was performed.

Results: The 19,8% (n= 117) and 95,9% (n= 568) of the cases were IgM and IgG positive, respectively. 56,4% (n= 66) of the IgM positive cases were men and 43,6% (n=51) were women. The distribution of the cases was between 1 to 90 years old, nevertheless 42,7% (n=50) had 20 to 29 years old. Genetic sequencing showed the presence of G and N genotype in 20 cases.

Conclusions: The laboratory findings were essential for the accurate diagnosis of cases and the establishment of the outbreak by the epidemiological surveillance program.

Lung cancer is the leading cause of cancer death worldwide, also in Chile, where the main risk factor is smoking. Early detection using low-dose computed tomography has been shown to reduce mortality from this cause, but there are still no formal screening recommendations in Chile.

Aim: This initiative aimed to develop recommendations for lung cancer screening in Chile through an expert consensus process.

Methods: A mixed approach was used in this study. A literature review was conducted to identify recommendations. A group of 18 Chilean experts was selected to form the Delphi panel. The RAND/UCLA method and evidence-based decision-making criteria were used to guide the evaluation process. Three rounds of voting and one synchronous meeting were conducted.

Results: Following a literature review and expert evaluation, 25 recommendations relevant to lung cancer screening in Chile were selected. These recommendations cover the selection of the target population, the frequency and duration of the program, and the implementation and characteristics of the programs and the health institutions that would host them.

Conclusions: Experts expressed concerns about the feasibility and acceptability of implementing screening programs in the local context, noting possible barriers, such as lack of awareness and costs. Local evidence needs to be generated to address the regional particularities and ensure the feasibility and effectiveness of lung cancer screening programs in Chile.

Early recognition of acute kidney injury is essential to prevent progression to chronic kidney disease. We present the case of a 19-year-old man with multiple emergency department visits for fatigue, abdominal pain, and intermittent dark urine. Upon admission, he had pancytopenia with elements suggestive of hemolysis and acute kidney injury. Thrombotic thrombocytopenic purpura was suspected, so he was treated with dexamethasone and plasmapheresis. The complementary study ruled out this suspicion, and plasmapheresis was suspended. The renal histology showed an acute kidney injury consistent with paroxysmal nocturnal hemoglobinuria (PNH), and bone marrow biopsy excluded marrow infiltration. The diagnosis of PNH was confirmed by flow cytometry. He was treated with prednisone, anticoagulation, iron, and folic acid supplementation. He progressed with a favorable clinical and laboratory response.

Individuals with psychiatric disabilities face significant challenges in achieving workforce inclusion, presenting a critical public health issue. The enactment of Law 21.015 on this matter offers an opportunity for improvement.

Aim: This study aims to provide healthcare teams with practical strategies for including individuals with psychiatric disabilities in the workforce, along with recommendations for their implementation.

Methods: A qualitative study was conducted through a narrative review of policy documents and programs related to the employment inclusion of individuals with psychiatric disabilities.

Results: A total of 40 articles were included in the final analysis. The topics were categorized into three main areas: (1) employment inclusion and its relation to disability, (2) types of interventions in employment inclusion, and (3) elements of labor legislation concerning disability in Chile. An overview is presented of how scientific evidence has been addressed in public policies of various countries, alongside the main strategies from national and international experiences.

Conclusions: Key elements discussed include the necessity of early support for employment, the effectiveness of supported employment strategies, and the importance of coordinating mental health and employment services. General recommendations for the employability of individuals with psychiatric disabilities are provided. Healthcare teams should be familiar with the legal aspects of employability, as well as the available intersectoral networks, and be prepared to guide individuals with psychiatric disabilities who express a desire to work. They should support these individuals in job placement and maintain open communication channels among the components of the intersectoral network.