Revista medica de Chile最新文献

Sulfhemoglobin (SulfHb) is formed by hemoglobin (Hb) oxidation by sulfur compounds. Sulfhemoglobinemia is mainly associated with drugs or intestinal bacterial overgrowth. Patients present with central cyanosis, an abnormal pulse oximetry and normal arterial oxygen partial pressure. These features are shared with methemoglobinemia (MetHb) whose diagnosis requires an arterial co-oximetry. Depending on the device used, SulfHb may produce interference with this technique. We report two females aged 31 and 43 years, consulting at the emergency room with cyanosis. Both had a history of acute and chronic, high dose zopiclone ingestion. Pulse oximetry showed desaturation but with normal arterial oxygen partial pressure. Cardiac and pulmonary diseases were ruled out. Co-oximetry in two different analyzers showed interference or normal MetHb percentages. No other complications ensued, and cyanosis decreased over days. Since MetHb was discarded among other causes of cyanosis in a compatible clinical context, the diagnosis of sulfhemoglobinemia was made. The confirmatory method is not available in Chile. The presence of SulfHb is difficult to diagnose, confirmatory tests are not readily available, and it frequently interferes with arterial co-oximetry. This is attributed to a similar absorbance peak of both pigments in arterial blood. Venous co-oximetry can be useful in this context. SulfHb is a self-limited condition in most cases, however it must be differentiated from methemoglobinemia to avoid inappropriate treatments like methylene blue.

Background: The use of glucose lowering agents with favorable weight profile is a growing practice in Diabetology.

Aim: To characterize medication combinations in patients with type 2 Diabetes (T2D) and their effect on metabolic control.

Material and methods: Review of medical records of 249 outpatients with T2D with a median age of 66 years, cared for at a medical network. Clinical characteristics, glycated hemoglobin (HbA1c), details of Diabetes treatment (types of drugs or insulin), renal function, lipids and B12 vitamin levels were registered.

Results: The median disease duration was 16 years. The most recent HbA1c was 7.4%. No patient was using sulfonylureas, 45 were using Dipeptidyl peptidase 4 inhibitors, 113 were using Sodium-glucose Cotransporter-2 (SGLT2i) Inhibitors, 21 used Glucagon-like Peptide-1 Receptor Agonists (GLP1ra), 158 used basal insulin and 61 on basal plus bolus insulin. The use of SGLT2i or GLP1ra was associated with a metabolic control similar to those patients not using them, while patients on rapid insulin had a significantly worse metabolic control and a tendency to greater body mass index. The use of basal insulin and rapid insulin was significantly associated with more hypoglycemia events.

Conclusions: The use of SGLT2i and GLP1ra in patients with T2D is associated with better metabolic control than rapid insulin with less risk of hypoglycemia. The use of these therapies should be prioritized in the future.

Background: Negative beliefs about vaccines can threaten herd immunity and pandemic control. Although beliefs about vaccines influence vaccination intention, there are no valid instruments that evaluate this in the Latin American population.

Aim: To evaluate the psychometric properties of two scales that measure negative beliefs towards vaccines in general and against SARS-CoV-2 and provide evidence of their association with vaccination intention (convergent validity) in a Chilean sample.

Material and methods: Two studies were carried out. The first included 263 people who answered the beliefs towards vaccines in general scale (CV-G) and the beliefs towards the SARS-CoV-2 vaccine scale (CV-COVID). Exploratory factor analyses were conducted. In the second study, 601 people answered the same scales. Confirmatory factor analyses and structural equation modeling were performed to provide evidence of validity.

Results: Both scales had an unifactorial structure and excellent reliability and showed associations with the intention of vaccination against SARS-CoV-2, providing evidence of convergent validity.

Conclusions: The scales evaluated here are reliable and valid measures that showed associations with vaccination intention in the Chilean population.

Background: Undergraduate Pathology training in medicine is based on modalities centered on the teacher and associated with controlled motivation, with low satisfaction with the educational process. According to the Self-determination Theory, an early participation with responsibilities in clinical practice and an educational environment that promotes autonomy and basic psychological needs satisfaction (BPNS), would generate intrinsic motivation.

Aim: To develop an educational intervention based on the pathologists' workplace model, which supports a learning environment intended to the satisfaction of BPNS in medical students. To evaluate the results of the intervention on the levels of motivation and satisfaction.

Material and methods: In the first phase of the study, an educational modality focused on the student was planned, consisting of the design of a pathological clinical case (DPC), performing the specialist's steps under minimal supervision and a contextualized environment. In the second phase, the level of satisfaction (Scale of student experience) and intrinsic motivation in 3rd year medical students was evaluated.

Results: After the intervention, 99 students showed high levels of satisfaction (94% of agreement) and intrinsic motivation (6.7 of 7 points), including all sub-scales. They considered that their competences had increased and assessed the intervention as useful.

Conclusions: DPC is an innovative, feasible and attractive methodology for Pathology learning, with a high degree of satisfaction and intrinsic motivation. This experience can be extended to similar disciplines.

Background: Caregiver stress is a common problem observed in nursing homes.

Aim: To determine the association between the level of resilience and stress, anxiety and depression in formal caregivers of older people institutionalized in long-stay establishments during the COVID-19 pandemic.

Material and methods: One hundred ninety eight formal caregivers working at 11 long term residences for older people in southern Chile were invited to answer the SV-RES resilience and the DASS-21 anxiety and depression scales and 102 agreed to participate.

Results: We observed a significant association between the resilience scale score and variables such as weekly working hours (p < 0.01), current hours of sleep (p < 0.01), self-perception of sleep (p < 0.01), anxiety level (p < 0.01) and stress level (p < 0.01).

Conclusions: A higher score on the Resilience Scale was associated with the absence of anxiety and stress, working between 22 and 43 hours per week, sleeping between 7 and 8 hours of sleep and a satisfactory self-perception of sleep. Studying the factors associated with resilience in formal caregivers of the elderly allows healthcare personnel to focus preventive actions, intervening promptly in risk areas associated with the work context, and strengthening the personal resources of caregivers.

Background: Mechanical thrombectomy is the accepted treatment for acute ischemic stroke in Large Vessel Occlusion. The Barros Luco Trudeau hospital developed endovenous thrombolysis in 2010, and since 2012, implemented endovascular management, becoming the neurovascular center in the southern area of the metropolitan region.

Aim: To describe endovascular management of acute ischemic stroke in a Chilean public hospital.

Material and methods: Analysis of patients with acute ischemic stroke that were treated with mechanical throm-bectomy from 2012 to 2019 in the Barros Luco Hospital.

Results: In the study period, a mechanical thrombectomy was carried out in 149 patients aged 61 ± 15 years (46% females). The average National institute of Health Stroke Scale (NIHSS) at presentation was 19 ± 4-5. Anterior or posterior circulation involvement was present in 89.9 and 10.1 % of patients. Twenty-five percent of patients were referred from other public centers. The mean lapse between onset of symptoms and thrombectomy was 266 ± 178 in. Ninety days after the procedure, 58% of patients had minimal or absent disability (Modified Ranson score of 0-2), and 19,2% died.

Conclusions: Mechanical thrombectomy, according to this experience, has favorable clinical outcomes in patients with high NIHSS scores at entry.

Bad news communication is a frequent and difficult task for health care professionals. There are valuable protocols that systematize this task through a series of steps. However, these protocols have important limitations. The objective of this work is to analyze the main shortcomings of the protocols for CMN, according to the available ethical and clinical evidence. An orientation by objectives is recommended, considering that communication of bad news is a contextual process that involves different actors, and that requires reflection and flexibility to determine the best course of action according to the circumstances of each particular case. The importance of affectionate attention for patients and their relatives is highlighted.