Revista medica de Chile最新文献

Cardiovascular pathology is the leading cause of death in Chile, with an inverse relationship between socioeconomic status and morbidity/ mortality. Currently, there is a lack of information regarding the Macro North Zone of Chile. Our aim is to describe the profile of patients undergoing interventions in a public hospital over a decade.

Methods: An observational ecological study was conducted on patients who underwent interventions from 2012 to 2022. Data were obtained through standardized searches using FONASA codes, including "major" cardiovascular interventions. "Minor" interventions and patients operated on in other centers were excluded. Data collection took place between 2021 and 2023. A database was created and analyzed using descriptive statistics, considering variables such as age range, health insurance, and the number of patients treated per year.

Results: A total of N= 9.075 records were obtained, with 8.908 corresponding to FONASA. The age ranges with the highest number of interventions were 18-60 years (49,8%) and over 60 years (49,6%). Since 2017, more than 50% of interventions have been in individuals over 60 years old. Annual interventions presented an increase in the percentage variation by 117%. Regarding interventions based on health insurance, tier B accounted for 46,7% (4.335) and tier A for 24,2% (2.194). We observed an increase in tier A by 24%.

Conclusion: We found that patients are older and belong to lower-income tiers. Additionally, there is a migration towards tier A in recent years and an increase in interventions.

Corynebacterium urealitycum is a gram-positive bacillus, usually found as a colonizer on the skin. However, a pathogenic role has been described in susceptible patients, where it can cause urinary tract infection, nephrolithiasis, pyelitis, and encrusted cystitis.

Methods: Retrospective cohort study of patients older than 18 years with positive urine cultures for C. urealyticumin the Laboratory of the Microbiology of the UC Health Network - CHRISTUS, between 2017 and 2020.

Results: 6 positive urine cultures were obtained, corresponding to 5 patients. One case presented as encrusted pyelitis, with an associated reinfection, one case as lower urinary tract infection, and three as asymptomatic bacteriuria. All patients had some relevant risk factor. All patients presented urine tests with triple phosphate crystals and alkaline pH between 7.5 and 9.0.

Conclusions: Patients with positive urine cultures for C. urelyticum represent a low percentage of all agents isolated from urine cultures. Although it may be asymptomatic, the development of encrusted pyelitis is a possible manifestation associated with an extended hospital stay. Urinalysis with alkaline pH and the presence of triple phosphate crystals is characteristic. More extensive clinical series and antibiotic susceptibility studies are necessary for a more standardized management of these patients. Finally, the authors' key lesson is remembering how unusual bacteria, such as C. urealyticum, can cause serious complications secondary to their phytopathogenic mechanism of urine alkalinization.

Obstructive sleep apnea (OSA) and cardiovascular (CV) risk co-existence is frequent. However, the implications of novel metrics used in the diagnosis of OSA in patients with CV risk are scarce in the Hispanic/Latino population.

Aim: To determine the association between the respiratory disturbance index (RDI) and the Time under 90% of SpO2 (CT90%) with CV risk using the predictive model of Framingham 2008. In addition, we analyzed the diagnostic performance of the baseline CV risk model, adjusted for RDI, CT90%, and their combination to predict CV mortality. in patients with clinical suspicion of AOS.

Methods: Single-center prospective cohort study, including 1560 subjects. All patients underwent a clinical evaluation for OSA, blood pressure, and anthropometric variables. To determine the association of the indices of interest with CV risk, a linear multivariate regression was performed between the RDI or CT90% score. All analyses were performed using R software (R-project), and a p-value < 0.05 was considered statistically significant.

Results: RDI and CT90% showed significant differences for CV (p-value= <0.001). In addition, a percentage increase was demonstrated in each quartile of the RDI and CT90% (p-value= <0.001).

Conclusions: The RDI and CT90% showed a significant and incremental association with the CV risk of the cohort. However, predictive analyses of CV mortality using the RDI and CT90% were not significant.

In patients with symptomatic severe aortic stenosis (SAS), who are at high surgical risk and who require transcatheter aortic valve implantation (TAVI), anatomic factors can determine if patients are suitable for this technique. A very large aortic annulus is a technical challenge given the limited options of adequate valve sizes, and, in most of them, using them in this type of patient is an off-label indication. We present the case of a 59-year-old man with symptomatic ASOS with surgical risk secondary to chronic liver damage referred for TAVI with an aortic annulus greater than 900 mm2. A Myval #32 valve was implanted with overexpansion without complications and early discharge.

Acquired epidermodysplasia verruciformis is a rare condition, secondary to a state of acquired immunosuppression and is characterized by a susceptibility to infection by human papillomavirus of the beta genus, which carries an increased risk of developing non-melanoma skin cancer. We report the case of a 39-year-old woman receiving a kidney transplant, treated with prednisone and tacrolimus, who after starting immunosuppressive therapy developed papules and warty plaques in the inguinal region. A skin biopsy was performed that was consistent with epidermodysplasia verruciformis, so it was decided to adjust immunosuppressive therapy to everolimus, which achieved a reduction in lesions. There are only 13 other cases of acquired epidermodysplasia verruciformis in kidney transplant recipients; to our knowledge this is the first case reported in Chile.

The use of digital means of communication and socialization among young people brings with it new stressors, risks, and forms of ag- gression, such as cyberbullying.

Aim: To evaluate the relationship between cyberbullying and major depressive symptoms in young Chileans between 15 and 29 years.

Methods: Survey through the StatKnows platform. Sampling was probabilistic and stratified with allocation proportional to the size of biphasic selection. The sample and the data were accessed virtually, respecting the bioethical standards of research with humans.

Results: At all ages studied, the probability of experiencing depressive symptoms increases as levels of cyber aggression do, especially in the group between 19 and 24 years.

Conclusions: The results reflect various factors of emerging adulthood that make this group more vulnerable, emphasizing the importance of studying the phenomenon at non-school ages since this form of aggression is not exclusive to adolescence, and neither are its effects on mental health.

Eighty percent of depressed patients in Primary Health Care (PHC) have a comorbidity. It is essential to contribute local evidence on the characteristics of patients with physical and psychiatric comorbidities to better address clinical practice.

Aim: To characterize depressed patients from the cardiovascular program (PCV) of eight family health centers (CESFAM) in two communes of the Metropolitan Region.

Material and methods: Secondary analysis of data from a cluster-randomized clinical trial recruiting 359 program enrollees aged 18 years or older with a Patient Health Questionnaire 9-item (PHQ-9) score greater than or equal to 15. The inclusion criteria for participants were to be 18 years of age or older, to have a score on the Patient Health Questionnaire 9-item (PHQ-9) greater than or equal to 15, and to be enrolled in the cardiovascular program of the respective health center.

Results: These are mainly women users of the cardiovascular program with depressive symptoms of moderate to severe intensity with a previous depressive history (60.39%), previously treated in a (75.69%). Only 17.7% were using antidepressant drugs at the time of the interview.97.1% of the interviewees were using drugs for hypertension and/or diabetes.

Conclusions: These are people with depressive episode, hypertension and/or diabetes who, having a personal and family history of depression, are not receiving pharmacological treatment for depression, which probably affects their quality of life. Better adherence to clinical guidelines for the treatment of depression is required.

Death processes have been progressively transferred to hospital spaces due to biomedicalization and the use of technologies, generating important challenges for healthcare systems. The COVID-19 pandemic exposed the lack of unified criteria and principles for a dignified death in the hospital. This study corresponds to a narrative review using Higgins & Green's methodological framework as a reference. A systematized search was carried out with the question: What are the elements considered in the decision-making of hospital teams regarding access and use of life support technology and dying processes in adult critically ill patients? The searches conducted during October 2022 in MEDLINE/PubMed, Scopus, Science Direct, CINAHL, Biblioteca Virtual en Salud (BVS), Cochrane Library, and Scielo identified 1499 records for screening, and 148 were retrieved for full-text review. Eighty-four articles were included in the review, identifying seven categories. The evidence shows variability in decision-making associated with the clinical status of the patient, the criteria of the medical professional, added to structural elements of the health system and political-legal aspects. The literature recommends reflexive, dynamic, flexible, and individualized decision-making processes that consider the patient's preferences, clinical judgment, prognosis, and available resources. Communication, advance care planning, interdisciplinary discussions, external consultations, and the involvement of ethical committees are crucial throughout the process.

Cerebrospinal fluid (CSF) involvement in B cell non-Hodgkin lymphomas is a poor prognostic sign and diagnosis is made using techniques such as flow cytometry (FCM) and conventional cytology (CC).

Aim: To evaluate the frequency of CSF involvement in B-NHL by both techniques in a public hospital.

Material and methods: 97 CSF samples were analyzed in tubes with cell preservative belonging to 70 patients, 71% male, median age 56 years (18-85 years), with a diagnosis of B-NHL and risk of infiltration according to medical criteria. Most were patients from new diagnosis (89%), diffuse large B cell lymphoma (60%), and Ann-Arbor stage III-IV (77%). In 67 samples (69%), CC and CMF were performed simultaneously.

Results: Of the samples analyzed by CMF, 99% were valuable, while by CC, only 67% (p<0,05). Globally, 25% of the samples showed infiltration by CMF, while 18% by CC (p<0,0001). Forty-four valuable samples were evaluable and analyzed by CC and CMF, finding a similar frequency of positive cases (27%), with two-thirds positive only by CC or CMF. Positive samples in diffuse large B cell lymphoma were 28% by CC and/or CMF.

Conclusions: A higher proportion of infiltration cases were detected by CMF than by CC. In valuable cases, CC complements CMF.