Revista medica de Chile最新文献

Heart failure (HF) and chronic kidney disease (CKD) often coexist, sharing common risk factors and pathophysiological mechanisms. Sodium-glucose cotransporter-2 inhibitors (iSGLT-2) have shown renal and cardiovascular benefits, but their renal protective effect varies depending on ejection fraction (EF).

Aim: To assess whether the renal protective effect of SGLT-2i depends on EF in HF patients.

Methods: A meta-analysis was conducted with five randomized controlled trials comparing iSGLT-2 versus placebo in HF patients. Risk of bias was assessed using EPHPP. The primary outcome was major adverse kidney events (MAKE). Subgroups were defined by EF: HFrEF (≤40%) and HFpEF (>40%).

Results: A total of 23,163 patients were included. Global analysis showed a non-significant trend towards a reduction in MAKE (RR 0.76 [0.56-1.02], I²= 68%). In HFrEF, iSGLT-2 significantly reduced MAKE (RR 0.58 [0.44-0.75], I²= 0%), whereas no benefit was observed in HFpEF (RR 1.01 [0.83-1.23], I²= 0%). Heterogeneity disappeared when stratified by EF.

Conclusions: iSGLT-2 reduce MAKE in HFrEF but not in HFpEF, suggesting that EF modulates their renal effect. These findings highlight the importance of tailoring cardiorenal syndrome management according to HF phenotype.

International migration has a profound impact on the perinatal mental health of women, particularly during pregnancy and the postpartum period. Factors such as acculturative stress, economic and language barriers, and experiences of discrimination increase vulnerability to conditions such as anxiety and depression. Although migrant women often arrive in a new country with better physical health -a phenomenon known as the "healthy immigrant effect"- this advantage does not extend to mental health.

Aim: To analyze the structural and economic barriers that exacerbate mental health inequities between migrant and native women during the perinatal period. The study also aims to identify risk and protective factors and to assess interventions designed to address the specific needs of migrant women.

Methods: A narrative review of 45 studies published between 2011 and 2025 was conducted. The analysis focused on how barriers to healthcare access contribute to mental health disparities. Structural and economic challenges, as well as risk and protective factors and available interventions, were explored.

Results: Recent migrants face a higher risk of perinatal mental health disorders due to social isolation and lack of cultural integration. Women with longer residence tend to show some improvement, although significant inequities persist. Social and familial networks emerge as key protective factors, but their effectiveness depends on the presence of inclusive and culturally competent public policies. Programs specifically tailored for migrant women have proven effective in reducing perinatal disorder symptoms.

Conclusions: A comprehensive approach-combining strengthened community networks, inclusive public policies, and equitable access to healthcare- is essential to reducing perinatal mental health inequities among migrant women. Implementing these strategies has the potential to significantly improve the mental health and well-being of this vulnerable population.

Meropenem, linezolid, and quinolones are alternatives for managing tuberculosis (TB) in cases of drug-related adverse reactions, critical ill patients, organ failure, or inability to use the oral route.

Aim: To report the experience with the combined use of these compounds in cases of TB not associated with drug-resistant tuberculosis.

Methods: Observational study of patients hospitalized for TB between 2020 and 2024 treated with these compounds at a regional hospital in Chile.

Results: Ten male patients (median age 43.5 years), were treated with this combination either by adverse drug reactions (4 cases), hepatitis- liver failure (3 cases), respiratory failure, suspected gastrointestinal bleeding or a critical condition (1 each one). Combination therapy was used during the initial intensive (9 cases) or continuation phase (1 case). Median meropenem doses was 3 g/day for 2 weeks, 1,200 mg/day of linezolid for 2 weeks, and 750 mg/day of levofloxacin in 7 cases for 3 weeks or moxifloxacin (400 mg/day). Five patients were admitted to critical intensive care units. In 2 cases with a prolonged alternative treatment (≥ 4 weeks), M. tuberculosis culture became negative. Anemia secondary to linezolid was observed in 6 cases, one requiring transfusion. Linezolid and meropenem therapeutic drug monitoring was applied in one case. WHO treatment outcome was classified as treatment success in 4 cases, dead in 4 (3 treated on a premortem basis), abandonment in one, and one still under treatment.

Conclusions: The combined use of meropenem, linezolid, and quinolones may be a viable option for managing hospitalized TB patients with contraindications to standard oral treatment and may contribute to microbiological control and patient recovery. In some cases, it represents a desperate measure and may be associated with hematological adverse effects.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality. Stereotactic body radiotherapy (SBRT) is a promising alternative for inoperable patients or those not eligible for other locoregional therapies.

Aim: To characterize patients with HCC treated with SBRT at the Clínica IRAM (Chile) and to evaluate imaging responses at 3 months. Secondarily, we aim to analyze overall survival (OS) and treatment toxicity. Materials / Methods: This retrospective study included patients treated with SBRT between June 2016 and September 2022. Patients were not candidates for other locoregional therapies. Clinical and demographic characteristics, imaging responses based on mRECIST and LIRADS-TRA (v.2018) criteria, overall survival (OS), and treatment toxicity were recorded.

Results: A total of 63 treatments were performed on 57 patients (median age: 68.6 years). The median tumor size was 5.5 cm (range: 0.95-13 cm), with 89% of cases classified as Barcelona Clinic Liver Cancer B-C stages. The imaging response rate at 3 months was 93% (39.5% complete and 46.5% partial). The 12-month OS rate was 65.2% (95% CI: 50.9-76.6), with a median survival of 10.8 months. Tumor size was significantly associated with worse OS (HR 3.4; p <0.01). Toxicity was manageable, with grade ≥3 events in 9.1% of patients.

Conclusion: SBRT is a safe and effective option with high tumor response rates, even in patients with intermediate and advanced HCC stages. This study underscores the importance of a multidisciplinary approach and supports the inclusion of SBRT as a real integral treatment option in HCC.

Stroke is the third leading cause of death in Chile. The Explicit Health Guarantees Regime (GES) ensures that post-discharge evaluation of patients with ischemic stroke (IS) is performed within 10 days. The time to complete the etiological study of a stroke is crucial due to the high risk of recurrence in patients without a specific identified cause.

Aim: To estimate the times for control and etiological study in stroke patients at a high-complexity regional hospital. To identify factors associated with compliance with the GES follow-up guarantee.

Methods: Consecutive patients with stroke from the vascular neurology clinic of Dr. Hernán Henríquez Aravena Hospital (HHHA) in Temuco between January 1, 2019, and December 31, 2023. Times for the first control and the performance of the etiological study exams were recorded.

Results: 479 patients were included: 426 (88.9%) with IS and 53 (11.1%) with intracerebral hemorrhage (ICH). The median time for the first control was 23 days for IS and 42 days for ICH. Only 20.7% of IS patients were controlled within 10 days post-discharge. The medians for transthoracic echocardiography, transesophageal echocardiography, and Holter monitor were 9, 21, and 35.5 days, respectively. In the logistic regression model, only the year of admission to the clinic reached statistical significance for control within 10 days.

Conclusions: A low percentage of IS patients comply with the GES follow-up guarantee. The time to perform the etiological study is significantly longer than that reported in private clinics in Chile.

Disconnected pancreatic duct syndrome (DPDS) was described in 1991. It consists of a rupture of the main pancreatic duct, with the formation of fluid connections alimented by the secretion of disconnected pancreatic segments. Its treatment is challenging, and the diagnosis is frequently established with considerable delay.

Aim: To describe our experiences with the diagnosis and treatment of DPDS.

Method: Observational retrospective study of clinical files of patients admitted to our hospital between 2015 and 2024 with DPDS diagnosis. Analysis of demographic data, interventions, and late outcomes of patients.

Results: 21 patients were included, 15 males, aged 53 years (range 24-76). All patients had severe necrotizing pancreatitis. The diagnostic delay of DPDS was 20 (range 1-432) weeks. None of the patients was sent with an established diagnosis. All patients required multiple endoscopic and/or radiologic interventions, three of which were operated on. One patient died in the acute phase. New onset diabetes mellitus was observed in 11 patients; 5 of them required insulin treatment. Exocrine pancreatic insufficiency was detected in 12 cases. One patient died after a nine-year follow-up.

Conclusion: DPDS is a frequently overlooked complication of necrotizing pancreatitis. Management requires multiple minimally invasive interventions, with frequent relapses. Mortality is low and late consequences include exocrine and endocrine pancreatic insufficiency.

There is extensive evidence regarding the role of physical inactivity and an increased risk of all-cause mortality. However, to date, no follow-up studies have been conducted in Chile that analyze this association considering sociodemographic, lifestyle, and health factors.

Aim: To analyze the association between physical inactivity and the risk of all-cause mortality in the Chilean population over 15 years of age, considering the differential effects of sociodemographic, lifestyle, and health factors on this relationship.

Methods: This study is a secondary analysis of the 2009-2010 National Health Survey (NHS) conducted by the Chilean Ministry of Health. This is a prospective study with 10.3 years of follow-up with 4539 participants (59.7% women, 46.2 ± 18.4 years). Physical inactivity was determined with the Global Physical Activity Questionnaire (GPAQ), and mortality was obtained by linking death data from the Civil Registry and Identification of Chile until December 2020. The analysis was stratified according to sociodemographic factors.

Results: Physically inactive people had a higher risk of mortality compared to those who were active (HR: 3.12; 95% CI: 2.60 to 3.73), which was maintained after adjusting for confounding variables, including sociodemographic, lifestyle, and health factors (HR: 1.62; 95% CI: 1.34 to 1.97). Inactive people had an average of 5.8 years less to live compared to those who met the physical activity recommendations. The risk of mortality was higher in inactive people aged 60 years or older, women, and residents of urban areas with medium/high educational levels and high economic income.

Conclusion: Physical inactivity was identified as a risk factor for mortality for the Chilean population, where certain sociodemographic characteristics could increase and accelerate said risk.

Osteochondrodysplasias are a heterogeneous group of abnormalities in bone and cartilage development. Metaphyseal chondroplasia Schmid type is the most frequent within its subgroup, however it has a low incidence when compared to skeletal disorders that appear in childhood, which limits its diagnostic suspicion due to the limited knowledge about this pathology. It is caused by a variant of the COL10A1 gene, which alters endochondral ossification. It is characterized by short limbs with genu varum or valgus, in addition to increasingly shorter stature with age. This case is related to a female patient of 4 years old, who presented adequate anthropometric development until the age of one year old and exhibits currently pathological proportionate short stature with an evident varum deformity. Sequence and deletion/duplication analysis was performed by a skeletal disorders panel, n which a variant in the COL 10A1 gene is reported, which together with the phenotypic and radiological findings, confirms the diagnosis. The confusion arises from the fact of considering that all bowlegs are due to rickets or the categorization of these children as idiopathic genu varum. It is important to know the osteochondrodysplasias to be able to make an adequate diagnostic suspicion in a patient with these characteristics, which are not explained under another pathology. The importance of an early diagnosis lies in the implementation of a multidisciplinary treatment, to avoid limitations in mobility and chronic pain in the patient. In addition to the family genetic screening due to its genetic dominance, facilitating genetic counseling if the biological couple is in reproductive age.

Recovery times are a relevant problem in occupational health.

Aim: To identify the social health factors impacting workers' longer recovery times affected by occupational accidents.

Methods: A qualitative systematic review of the academic literature in English was carried out. A total of 4,409 articles were identified, applying the inclusion and exclusion criteria, 22 articles were selected.

Results: The aging of the working population is a relevant issue for occupational health; after 45 years of age, workers require significantly longer recovery after an occupational accident. Men have the longest recovery days in the most severe accidents and are associated with the most severe accidents (e.g., traumatic amputations and falls from height). The circumstantial variables indicate that those accidents with longer recovery times happen towards the end of the week, at the end of the workday, and night, all of which would indicate that the fatigue and tiredness factor would be present in the accidents with the most severe consequences. Likewise, although the most significant number of accidents occur in large companies, to local workers, and at the workplace, the accidents with the most meaningful lost time ensue in small companies, to immigrant workers, and when commuting. In addition, the accidents with the highest lost time are related to fractures, internal injuries, and multiple injuries, with the prominent involvement of the limbs.

Conclusions: Knowing the social factors and circumstances related to occupational accidents involving longer recovery times provides additional elements for health decision-making and formulating public policies and occupational safety programs.

Suicide is a major cause of death among people aged 60 and over. Suicide attempts (SA) are a significant risk factor.

Aim: To describe and evaluate the relationship between sociodemographic and clinical characteristics with SA in elderly patients hospitalized in the Psychiatry Unit of Herminda Martin Hospital in Chillán, Chile, and to follow up on this behavior over 13 years.

Methods: Correlational study with statistically based data and a 13-year case series follow-up. The study included 49 elderly individuals with SA and 194 without SA who were hospitalized in psychiatric care between January 1, 2011, and December 31, 2023. Follow-up continued until October 2024. Sociodemographic and clinical variables were analyzed. Descriptive and bivariate analysis was performed.

Results: SA was significantly associated with older age groups (over 70 years), male sex, the presence of stress factors in the primary support group, and housing problems. The most common suicide methods were medication ingestion and asphyxiation by hanging. Suicidal behavior was significantly associated with psychiatric diagnoses, particularly depressive disorder, but not with comorbid medical illnesses. A considerable percentage had previous SA and repeated the behavior after discharge. The most cited precipitating factors and reasons for wanting to die were family conflicts and adverse emotions. During follow-up, one suicide, two deaths from complications of a new SA, and one death from medical conditions during hospitalization for SA were recorded.

Conclusions: The characteristics of SA in the elderly resemble those of suicide. In this age group, prevention efforts should focus not only on detecting and treating depression but also on addressing previous suicidal behavior, adverse psychosocial factors, and ensuring continuity of care with follow-up interventions.