Revista medica de Chile最新文献

Convalescent Plasma (CP) from patients who recovered from COVID-19 may present neutralizing antibodies against viral protein S of SARS-CoV-2 and emerged as a potential therapeutic alternative for patients with severe infection at the beginning of the COVID-19 pandemic breakout. Thus, this study aimed to evaluate the effect and safety of CP treatment in patients with severe COVID-19.

Methods: We designed a quasi-experimental study that included 156 patients with SARS-CoV-2 infection confirmed by RT-qPCR and severe symptoms who received CP. As a control group, we selected a historical cohort of 113 individuals admitted with COVID-19 and severe symptomatology before the starting date of the study. Clinical status and mortality during the study period were recorded.

Results: There were no adverse reactions to CP administration. In the CP group, days on mechanical ventilation were significantly lower than the control group (2.8±5.08 days vs. 4.7±6.19 days; p= 0.0081). Moreover, a significant difference was observed in the number of days stayed in the critical patient unit (CPU) in CP vs. controls (4.2±5.47 vs. 5.8±6.39 days, p= 0.0281).

Conclusions: We observed no association between CP administration and survival at 14 days. Treatment with CP was safe and not associated with adverse events. In addition, using CP was associated with a reduction in both stay at the CPU and connection to mechanical ventilation.

Cancer diagnosis is a dramatic event severely affecting the quality of life of patients and their family group. Clear and precise information during the disease course and treatment is crucial.

Aim: To adapt and assess the psychometric properties of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-INFO25 questionnaire in Chilean patients.

Methods and patients: The EORTC QLQ-INFO25 was trans-culturally adapted according to EORTC instructions. The psychometric performance of the adapted instrument was assessed in 265 patients (between 18 and 85 years of age) in different stages of their disease (diagnostic and treatment). The convergent and discriminant validity of the items was calculated using multi-trait and multi-item matrices. Cronbach's α coefficient was used to evaluate the instrument's internal consistency and temporal stability was evaluated by test-retest correlations.

Results: Most of the participants were female (66%) and had ambulatory treatment (84.2%). The internal consistency of the instrument was 0.92. The multi-trait and multi-item matrix showed the highest correlations between items from scales of information about medical tests, treatments, and other services, which agrees with the instrument's hypothetical structure. However, the dimension of the illness shows partial agreement with the expected structure. The test-retest correlations were significant, exhibiting an average of 0.68±0.14 (SD).

Conclusion: The adapted version of the EORTC QLQ-INFO25 questionnaire presents adequate psychometric properties and, therefore, is a reliable tool for Chilean patients.

Tricuspid regurgitation (TR) is the most frequent valvular complication after heart transplantation with different clinical sequelae. In its most severe form, it can cause right heart failure with a poor long-term prognosis. Its management is complex, both medical, surgical, and percutaneous. The TricValve system, a bicaval system with two self-expanding valves (superior vena cava and inferior vena cava), dedicated to treating symptomatic IT refractory to medical therapy, is safe and effective in improving quality of life. We present the first heart transplant patient with severe symptomatic TR who underwent successful bicaval valve (TricValve) implantation.

Medical consultations play a crucial role in the collaboration between health centers, particularly in primary care settings, when managing complex pathologies beyond their scope. Analyzing the characteristics of consultations and their prioritization is essential for enhancing referrals to higher complexity centers. This study aims to profile the consultations referred from the primary health care of the South East Metropolitan Health Service to the Otorhinolaryngology Service of the Sótero del Río Hospital, while also evaluating the concordance in their prioritization.

Aim: The main objectives of this study are to characterize the profile of consultations referred from primary health care to the Otorhinolaryngology Service and to assess the agreement in their prioritization.

Methods: Data from consultations sent to the Otorhinolaryngology Service from primary care were collected and analyzed. The prioritization of these consultations was evaluated using the Kappa Index, which measures the level of agreement between the two parties involved.

Results: The analysis revealed a Kappa Index of 0.086, indicating a poor level of concordance in the prioritization. This finding highlights potential issues in the referral process from primary care to the higher complexity center.

Conclusion: Evaluating the concordance in the prioritization of consultations is essential for gaining insights into the reality of referrals from primary care to higher complexity centers. Identifying the quality of these referrals can lead to the implementation of strategies to improve the process. Our study suggests that there is a need of improving the communication and education between higher complexity centers and primary health care centers.

Aging is associated with physiological, economic, and psychological changes that can compromise nutritional and functional status.

Aim: To determine the nutritional status of institutionalized older people living in a long-term nursing home "Fundación las Rosas" (FLR), the largest long-stay establishment in Chile, in 2019, and its relationship with functionality.

Methods: Descriptive study of analysis of secondary data in 1646 older adults institutionalized in FLR (60% women). The information collected was weight, height, Body mass index (BMI), Barthel Index, Mini-Mental State Examination, area, macrozone, sex, age, and date of admission to FLR. Logistic regression models of functionality and nutritional status, unadjusted and adjusted, were performed.

Results: The percentage of normal-weight people was 40.3%; 38.1% presented some degree of malnutrition due to deficit, and 9.5% presented severe malnutrition (BMI≤18.5 kg/m2). 70% of people present total dependency. The low educational level reached 73%. Logistic regressions determined that people who were overweight, 70 years of age or older, had a low level of education, and cognitive impairment were positively associated with dependency, excluding bedridden people, with the strongest associations being not having any level of schooling and having cognitive impairment. The persons of low weight, with cognitive impairment, and with a low educational level were positively associated with institutionalized bedridden elderly, the strongest associations being not having any level of schooling and having cognitive impairment.

Conclusions: In this study, malnutrition due to deficit and excess are positively associated with decreased functionality, and a low educational level is associated with dependency and being bedridden.

The requirements of health care facilities (HCF) being recognized as having 'university' status are relevant for providing high-quality clinical education to health profession students. However, no previous studies have reported the key features of the Chilean HCF as having university rank.

Aim: To review international experiences and Chilean regulations to identify hospitals' requirements for university status.

Methods: A qualitative content analysis was carried out in 6 phases, taking Caceres' proposal as a methodological reference.

Results: 66 units of analysis were obtained, which were grouped into 8 codes: comprehensive management, teaching care agreement, strategic link, infrastructure, academic human resources, care-teaching-research management department, quality and safety in health and research, which were subsequently categorized into administrative-managerial, transversal collaboration and evidence-based healthcare. Codes that were later grouped into main and advanced dimensions, therefore, embrace the criteria found to designate a health establishment as a Teaching Care establishment.

Conclusions: The findings represent a significant contribution to the requirements that must be considered to strengthen and develop health facilities that currently welcome students, in order to comprehensively develop safe and quality care, teaching and research, promoting effective collaboration between these institutions.

Since its foundation, the Hospital Emergency Public Assistance in Santiago, Chile, has been the national reference center for managing severe burn patients. In 2007, more than 6,000 hospital admissions for burns were registered in Chile due to the severity of the clinical condition. These patients must be treated in intensive care units. Therefore, the use of orotracheal tubes is essential for its management. The correct stabilization of these devices avoids complications or airway risks. In the Major Burn Unit, cotton cloth restraints and transpore-type adhesives are used on the user's face, but in patients with facial territory compromise, these cause tissue damage; due to this, the Dental Unit has innovative techniques of orotracheal tube fixation, using stainless steel and plastic wire ties, which have allowed to reduce the risks of extubation and accidental displacement of the tube, improving its stability. This work describes the technique used in orotracheal tube fixation in two patients with severe burns, performed by the Dental Unit of the Hospital Emergency Public Assistance, Dr. Alejandro del Río, Chile.

Quality of life (QoL) significantly improves in the short term after bariatric surgery (BS). However, evidence on the long-term QoL of patients with BS is limited.

Aim: To analyze the long-term QoL of patients who underwent Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

Methods: We evaluated 257 patients from three private clinics in Santiago, Chile, with ~10-y since surgery. The Bariatric Analysis and Reporting Outcome System (BAROS) was used.

Results: Median values for the BAROS score indicated good results of treatment:4.3 (2.3-6.0) and 4.1 (2.1-6.4) for RYGB and SG patients, respectively. The Moorehead-Ardelt Quality of Life (MAQoL) score was higher in patients with SG compared to RYGB (1.5 vs. 1.3, p = 0.047). A moderate, positive, and significant correlation was observed between the percentage excess weight loss and MAQoL score (rho= 0.48, p<0.001).

Conclusions: Patients undergoing BS showed a good QoL even in the long term (~10 y).

The diagnosis of blast cell presence in cerebrospinal fluid (CSF) in acute leukemias (AL) is made using techniques such as flow cytometry (FCM) and conventional cytology (CC). This study aims to evaluate CSF blast cell presence frequency in LA using both techniques (CC and FCM) in our center.

Methods: We analyzed three hundred and eight CSF samples belonging to 175 patients, 57% male, with a median age of 46 years (1-70 years) were analyzed. Diagnoses were acute B lymphoblastic leukemia (B-ALL, 84%), acute T lymphoblastic leukemia (T-ALL 5%), acute myeloblastic leukemia (AML, 11%). The immunophenotype was performed with an 8-color panel adapted to the diagnosis.

Results: The proportion of non-assessable CSF samples in LA was higher for CC (46%) than FCM (4%) (p<0.05). Overall, infiltration was found in 78/308 samples by FCM (25.3%) and in 8/77 by CC (10.4%) (p<0.0001). Seventy of 259 samples were positive in B-ALL (27%) and 6/34 in AML (17%). There were no CC+ cases in AML or T-ALL. The samples that were FCM+/CC+ had more significant infiltration (59.5%) than CMF+/CC-ones (30%) (p<0.0001).

Conclusions: CMF detects more than twice as many CSF blast-positive cases in LA as CC and is, therefore, suitable for routine use along with CC.