Revista medica de Chile最新文献

Suicidal behavior is a global public health issue, particularly among adolescents, where it stands as one of the leading causes of death in this age group. In Chile, adolescent suicide rates have alarmingly increased over recent decades, with psychological, clinical, and socio-familial factors emerging as key contributors. However, existing theoretical models face limitations when applied to specific sociocultural contexts.

Aim: To explain suicidal behavior in a clinical sample of Chilean adolescents, integrating psychological, clinical and socio-familial factors.

Methods: A non-experimental cross-sectional study was carried out in 388 adolescents (59.3% female; mean age: 15.63 years) admitted to the healthcare system in the Maule Region. Validated instruments were applied, including the BIS-11, DASS-21, DERS, ISI, GHSQ-V, and C-SSRS, to assess impulsivity, emotional regulation, anxious-depressive symptoms, and suicide risk. Multiple logistic regression models were fitted to identify significant predictors of suicidal ideation and attempts. Model quality was assessed through ROC analysis.

Results: For the suicidal ideation model, significant predictors included maternal responsiveness, depressive symptoms, family history of mental illness, prior hospitalization due to suicide attempts, and victimization through bullying and sexual abuse. In the suicidal attempt model, relevant factors were the absence of siblings, unplanned impulsivity, emotional interference, previous hospitalizations for mental health, suicidal ideation, and serious intent to attempt suicide. The models demonstrated adequate predictive performance with areas under the curve (AUC) of 0.89 and 0.94, respectively.

Conclusions: The findings highlight the multidimensional nature of adolescent suicidal behavior, revealing the interplay between individual and contextual factors. These models contribute to understanding the phenomenon and could guide targeted preventive interventions and public policies aimed at this vulnerable group. Expanding the analysis to different regions and populations is suggested to validate and enrich the results.

Multiple myeloma (MM) is a malignancy derived from plasma cells. Advances in treatment have improved survival in MM patients; however, it remains incurable, and most patients will relapse. Rescue treatments based on daratumumab, carfilzomib, and pomalidomide have shown good results internationally, but there is a lack of data on their effectiveness and safety in Chile.

Aim: To evaluate the outcomes of these treatments in patients with relapsed or refractory multiple myeloma (RRMM) treated at the Clinical Hospital of the University of Chile.

Materials and methods: A retrospective descriptive study was conducted, including patients over 18 years of age with RRMM treated with regimens based on daratumumab, carfilzomib and/ or pomalidomide. Data were obtained from electronic medical records. The response rates, progression-free survival (PFS), overall survival (OS), and adverse events were analyzed.

Results: A total of 15 patients with RRMM were included, with a mean age of 67 years and an average of 3 prior treatment lines. Of the patients, 86.6% were refractory to lenalidomide, and 46.6% were refractory to both lenalidomide and bortezomib. The response rates were as follows: 6.6% stable disease, 26.6% partial response, 53.3% very good partial response, and 13.3% complete response. The median PFS was 20 months, and the OS was not reached. Four patients (26.6%) died-three from progression of the myeloma and one from infection. The most common adverse events were infections and infusion reactions. Treatments were well tolerated.

Conclusions: Rescue treatment with daratumumab, carfilzomib, and/or pomalidomide was shown to be effective and safe in heavily pretreated patients with RRMM. PFS and OS were favorable compared to international studies, although the responses were less deep. These results are relevant for advocating the inclusion of these medications in the national health guarantees program, where treatment options for RRMM are very limited.

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe cutaneous manifestations of adverse drug reactions. This first review aims to provide an update on the epidemiological, pathophysiological, clinical manifestations, diagnostic, and prognostic aspects of these conditions.

Aim: To establish an updated clinical approach to SJS/TEN based on current evidence.

Methods: A search was conducted in indexed databases (PubMed, SciElo, LILACS), selecting 68 articles and 2 clinical guidelines from the Ministry of Health of Chile (MINSAL), from March to September 2024.

Results: SJS/TEN affects genetically susceptible individuals with inappropriate immune responses triggered by drugs or non-pharmacological factors, leading to keratinocyte apoptosis and high mortality. Three hypotheses for T-cell activation are proposed: hapten/prohapten, p-i interaction, and altered peptide model. Key mediators include FasL, perforins, granzymes, and granulysin. Genetic factors, such as HLA alleles and CYP450 variants, influence susceptibility. Diagnosis relies on clinical and histopathological evaluation. Skin biopsy is crucial for confirmation, though treatment should not be delayed if there is a high suspicion. Tools such as causality algorithms and developing biomarcadores may aid in early identification of SJS/TEN, though further research is needed.

Conclusions: Diagnosing Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) is challenging due to their variable clinical presentations and similarities with differential diagnoses. Biopsy is essential, but histopathological findings do not always distinguish between forms of SJS and TEN. Causality assessment tools and advancements in biomarkers show potential, but further validation is needed. This initial review allows for understanding the rationale behind the recommendations outlined in the second part of the review.

Lamotrigine is a drug that was initially used as an anticonvulsant and later its use was extended to mood disorders such as severe depression and bipolar disorder, being a safe drug with few adverse effects. Lamotrigine poisoning can present with mild symptoms such as palpitations and headache to more severe symptoms such as seizures, compromised consciousness, coma and cardiogenic shock. There is no described antidote for the treatment of this intoxication, so management is supportive; however, given the pharmacokinetic nature of the drug, extracorporeal therapies may be an option for severe cases. We present a case of severe lamotrigine poisoning managed with daily hemodialysis with a good clinical response.

This report describes the case of a 97-year-old male patient, completely dependent on his activities of daily living (ECOG 3), with a 6-month-old tumor lesion in the anterior area of the chest. Skin biopsy informs a trichilemmal carcinoma. The patient received 5 weekly radiotherapy sessions of 7 Gy each (35 Gy total), with partial tumor response. It is intended to apply new sessions of radiotherapy to the affected area. The case is presented due to the low prevalenceand the dermoscopy findings of this type of carcinoma associated with a partial response to radiotherapy, a treatment rarely reported as first-line for this pathology.

International studies show that bisexual people tend to experience higher levels of mental health problems than gays, lesbians, and heterosexuals. However, there is little research on this group in the Latin American and Chilean context.

Aim: To describe and compare the mental health of bisexual women and men in Chile, with respect to their gay, lesbian and heterosexual counterparts.

Materials and method: A stratified and multistage probabilistic sample of 20,392 people aged 18 years and over, residing in urban areas of Chile, obtained through the Second National Survey on Health, Sexuality, and Gender (ENSSEX-2022) was used. Participants completed a 305-question survey, including the Patient Health Questionnaire-4 (PHQ-4) to assess depressive and anxiety symptomatology, and a question to assess sexual orientation. Weighted linear regression models were performed to compare levels of depression and anxiety between different sexual orientation groups, using bisexual women as the reference group. The variables of age and educational level were controlled.

Results: The analyses revealed that bisexual women reported significantly higher scores on depressive and anxious symptoms compared to the other groups (heterosexual women, heterosexual men, lesbian women, gay men), except for bisexual men, who also exhibited high levels in both variables.

Conclusions: Our study provides information that can support public policies, support and awareness programs, as well as the promotion of equality towards different sexual orientations, with a particular focus on bisexual women.

The high cost of health procedures can cause financial problems for individuals and their families, becoming a catastrophic expense when it exceeds 40% of the family budget. In this regard, in Chile in 2015, Law 20,850 was enacted, which provides a Financial Protection System for High-Cost Diagnoses and Treatments.

Aim: Analyze the phenomenon of study based on the modeling of the existing literature around the public policy of the Ricarte Soto Law in its formulation process.

Methodology: Idiographic case study mediated by a theoretical and empirical, transdisciplinary documentary review; bibliographic search (2010-2023, English and Spanish languages) on the concepts related to this public policy. After the theoretical analysis, the information is classified according to the stages of public policy formulation; six indicators are grouped into three dimensions: resources, conflict, and impact, according to Pechmann.

Results: 50 articles were analyzed. The Ricarte Soto Law creates a financial protection system for the diagnosis and treatment of high-cost diseases; from its formulation to its implementation as a public health policy in 2015, it has revealed some strengths and complexities that have impacted said protection, covering 27 pathologies at this moment.

Conclusion: In recent years, there has been an increase in interest on the part of health systems in implementing more transparent, ethical, scientific, evidence-based decision-making processes for the coverage of these diseases. In this, the case study presented allowed to analyze the formulation of the public policy of the Ricarte Soto law, as well as present different opportunities for improvement in the face of the current threats of the socio-political environment and sociodemographic challenges.

This study investigates the exposure of the Chilean population to heavy metals, specifically arsenic, lead, mercury, and cadmium, using data from the 2016-2017 National Health Survey (NHS). Chronic exposure to these metals poses significant health risks, including cancer, cardiovascular diseases, and neurological effects.

Aim: The study aims to analyze metal levels across different demographics and identify factors associated with elevated exposure.

Methods: A cross-sectional analysis was conducted using NHS data, which includes metal levels in blood and urine, alongside demographic, socioeconomic, and lifestyle information. The sample consisted of 3.600 participants aged 18 and older. Metal levels were measured using mass spectrometry and spectrophotometry. Statistical analyses, including quantile and logistic regression, were performed to assess the impact of various covariates on metal levels.

Results: The study found that 91.04% of the population had arsenic levels below the reference value of 35 pg/L, while 8.45% had levels between 35 and 100 pg/L, and 0.51% exceeded 100 pg/L. Elevated arsenic levels were associated with younger age, male sex, rural residence, northern macrozone, and high fish consumption. Lead, mercury, and cadmium levels were generally within limits, with notable variations based on age, sex, and geographic region.

Conclusion: The findings highlight significant arsenic exposure in certain demographics, necessitating targeted public health interventions. While lead, mercury, and cadmium levels are mostly within limits, ongoing biomonitoring and public awareness are crucial to mitigate health risks. The study underscores the importance of tailored policies to reduce metal exposure and protect vulnerable populations in Chile.