Revista medica de Chile最新文献

Background: The rate of survival to hospital discharge is less than 10% for out-of-hospital cardiac arrest (OHCA).

Aim: To develop and implement a Chilean prospective, standardized cardiac arrest registry following the Utstein criteria.

Material and methods: We conducted a prospective registry for patients presenting at an urban, academic, high complexity emergency department (ED) after having an OHCA. The facility serves approximately 10% of the national population. Data were registered and analyzed following the Utstein criteria for reporting OHCA.

Results: For three years, 289 patients aged 59 ± 19 years (63% men) were included. Fifty seven percent of patients were taken to a health care facility for the first medical assessment by relatives or witnesses and 34% was assisted and transferred by prehospital personnel. In the subgroup of non-traumatic OHCA, 28% (n = 54) received bystander cardiopulmonary resuscitation (CPR). The registered cardiac rhythms were asystole (61%), pulseless electrical activity (PEA) (25%) and ventricular tachycardia (VT) or ventricular fibrillation (VF) (11%). The overall survival rate to discharge from the hospital was 10%, while survival with mRankin score 0-1 was 5%. The median hospitalization length of stay was 18 days among those who survived, compared with five days for the group of patients that died during the hospital stay.

Conclusions: OHCA is an important cause of death in Chile. The development of a national registry that follows the International Liaison Committee on Resuscitation guidelines is the first step to assess the profile of OHCA in the region. It will provide crucial information to identify prognostic factors and variables that can help develop standards of care and set up the basis to optimize cardiac arrest management within our country and region.

Background: Prostate cancer is the tumor with the highest incidence among men and one of Chile's leading causes of death.

Aim: To analyze temporal trends in prostate cancer mortality in Chile.

Material and methods: Mortality rates in Chile for the period between 1955 and 2019 were calculated. The number of deaths was obtained from the national demographic yearbooks and the Ministery of Health mortality registries. Population estimates from the demographic center of the Economic Commission for Latin America and the Caribbean of the United Nations were used. Chilean census population of 2017 was used as reference to calculate adjusted rates. Trends were analyzed using a join point regression.

Results: Crude mortality rates of prostatic cancer increased between 1995 and 2012 in three different phases, namely between 1955 and 1989 with a 2.7% annual increase, between 1989 and 1996 at a 6.8% annual rate, and between 1996 to 2012 with a 2.8% annual increase. From 2012 the rate remained stable. Adjusted mortality rates increased slowly at a 1.7% rate from 1955 to 1993, accelerating between 1993 and 1996, when they increased 12.1% per year. From 1996 onwards there was a significant decrease in mortality at a 1.2% annual rate. This decrease was significant and observed within all age groups but more importantly at older ages.

Conclusions: Prostate cancer mortality in Chile has decreased significantly during the last two decades, like that observed in developed nations.

The systemic effects of oxygen deficiency or excess are not thoroughly described. Knowledge is evolving towards the description of beneficial and detrimental effects of both extremes of partial pressure of oxygen (PaO2). The cellular and tissue mediators derived from the modulation of the oxidative tone and the production of reactive oxygen species (ROS) are widely characterized biochemically, but the pathophysiological characterization is lacking. Preclinical models support the use of hypobaric hypoxia preconditioning, based on its beneficial effects on ventricular function or its reduction in infarct size. A very important use of oxygen today is in commercial diving. However, novel clinical indications for oxygen such as the healing of diabetic foot ulcers and bone injury caused by radiotherapy are increasingly used. On the other hand, the modulation of the hypoxic response associated with exposure to high altitude environments (hypobaric), favors Chile and its highlands as a natural laboratory to determine certain cardiovascular, cerebral and metabolic responses in the resident population. Also, the consequences of the intermittent exposure to high altitudes in workers also deserves attention. This review discusses the physiopathological response to hypo and hyperoxemia, associated with environments with different oxygen concentrations, and brings back the concept of oxygen as a pharmacological mediator in extreme environments such as high altitudes and hyperbaric medicine in divers, decompression sickness, osteonecrosis associated with radiotherapy and sudden sensorineural hearing loss.

Background: COVID-19 pandemic increased the prevalence of burnout syndrome.

Aim: To describe the prevalence of burnout syndrome in health care workers of a private clinic in the Metropolitan Region of Chile.

Material and methods: Cross-sectional study, the study population were health care workers of a private clinic. An online version of Maslach Burnout Inventory-Human Service Survey was applied during June 2020. Variables such as age, sex, marital status, number of children, service, occupation, and night shift were studied.

Results: We collected 846 responses. A 36% (95% confidence intervals (CI) [32,8-39,2]) prevalence of high levels of burnout syndrome was found. Thirty one percent (95% CI [28,1-34,3]) of the respondents had high levels of emotional exhaustion (AE), 33% (95%CI [29,8-36,2]) had low personal fulfillment (RP) and 30% (95%CI [26,6-32,7]) had high levels of depersonalization (DP).

Conclusions: Healthcare workers showed concerning levels of burnout syndrome. It is recommended to pay special attention to high levels of emotional exhaustion in nursing and night shift staff. Institutions should develop and apply prevention and emotional support strategies in health personnel.

Musculoskeletal tumors are uncommon. However, the true burden of all bone and soft tissue tumors of extremities is underestimated. Usually, the diagnosis of sarcomas is missed or delayed. Therefore, an adequate clinical and radiological assessment, along with the awareness and application of simple guidelines for referral to a specialized center, are of utmost importance. These are critical steps for an appropriate diagnosis and treatment of sarcomas, improving their prognosis.

Clostridioides difficile infection (CDI) is a major public health problem and responsible for significant morbidity and mortality. Eighty percent of CDIs occur in adults older than 65 years of age due to a decreased gastrointestinal microbial diversity, immunosenescence and frailty. Thus, the most reported risk factor for recurrent CDI is older age since nearly 60% of cases occur in individuals aged ≥ 65 years. Fecal microbiota transplantation (FMT) is a highly cost-effective alternative to antibiotic treatment for patients with recurrent CDI. We report a 75-year-old male with recurrent CDI, who received a FMT after several unsuccessful antimicrobial treatments. He had a satisfactory evolution after the procedure and remained without diarrhea during the ensuing five months.

Background: Mycophenolate mofetil (MMF) is a largely used immunosuppressive agent in the prevention of transplant rejection and lupus nephritis. Its use has been extended to other immune-mediated diseases (ID).

Aim: To assess the off-label use of MMF, its performance as a glucocorticoid sparing agent, the therapeutic response, and its adverse effects.

Material and methods: A retrospective study was performed. One hundred-seven patients aged 58 ± 16 years (83% females) who received MMF for ID in off label uses between 2016 and 2018 were included. The study variables were cause of MMF indication, sex, age, use as a first- or second-line treatment and maintenance dosing. The cumulative doses of glucocorticoids six months before and after MMF indication were compared.

Results: MMF was used as a second-line therapy in 66 patients (62%). The mean maintenance dose of MMF was 1,500 ± 540 mg/day. Prednisone cumulative doses were 3,908 ± 2,173 and 1,672 ± 1,083 milligrams six months before and six months after starting MMF, respectively (p < 0.01). Adverse effects were identified in 21 (20%) cases, none of them serious.

Conclusions: Mycophenolate has a favorable response profile as a second line immunosuppressive agent. It is effective as a glucocorticoid sparing drug. The safety profile is also favorable as adverse effects were scanty and mild.

This article analyzes the feeding forms and care, in a record made by the nursing friars of the Hospital San Juan de Dios of La Serena in 1796. The food intake of both patients and hospital staff, is examined through a quantitative and qualitative perspective. In this context, it is proposed that food intake, in a monastic space dedicated to the care of the poor and sick, responded to doctrinal elements typical of the Western Catholic tradition, but above all to local economic conditions. It supported the poor who wandered in a city with economic and social growth at the end of the 18th century.

Background: The treatment of Crohn's disease (CD) is based on medical therapy and surgery is reserved for failure of medical management or complications.

Aim: To evaluate endoscopic, clinical, and surgical recurrence of CD after surgery.

Material and methods: In a prospectively maintained database, consecutive patients older than 15 years subjected to an ileocecal resection for ileocolic disease from January 2011 to April 2021, were identified. The diagnosis of CD was confirmed with the pathologic report. Patients with less than one year of follow-up were excluded. Information was obtained retrospectively from the database and clinical records.

Results: Fourteen patients were identified. The mean age at the time of surgery was 38 years. Surgery was performed at a median of 41.5 months (0-300) after the diagnosis of CD, nine elective and five emergency procedures. In five patients there were four major and two minor postoperative complications, with no anastomotic leakage. Six patients had endoscopic recurrence and seven had clinical recurrence (50%) at a mean of 15 months, one of whom required a second operation. There was no mortality.

Conclusions: After the surgical treatment of CD, the clinical and endoscopic recurrence rate continues to be high.

Background: The adoption of sanitary measures due to the SARS-CoV-2 pandemic hampered teaching and learning methods in medicine.

Aim: To communicate the results of a wound suture training workshop, based on the Basic Procedural Skills Training methodology and adapted to the pandemic context.

Material and methods: One hundred fourteen students were randomized in small groups due to sanitary measures and trained with a modification of the Basic Procedural Skills Training methodology. An informed consent was obtained from every student. The suturing skills were evaluated before and after the intervention with "The Objective Structured Assessment Of Technical Skills" (OSATS) instrument. The perception of the workshop and the implementation of the COVID-19 prevention measures were also evaluated.

Results: The students showed a statistically significant improvement after the intervention. In the OSATS verification list, the average score increased from 4.5 to 8.6 (p < 0.01). In the OSATS global scale, the average score increased from 13.0 to 25.3 (p < 0.01). The perception of the workshop and the prevention measures were well evaluated.

Conclusions: Despite all the limitations of the pandemic context, we achieved a significant improvement after the intervention and a very good perception by the students.