Revista medica de Chile最新文献

Background: SARS-CoV-2 affects all age groups, but higher mortality rates are recorded in older people, men and with comorbidities, mainly hypertension, diabetes and obesity.

Aim: To describe the main clinical characteristics, evolution and prognostic factors for death in older patients hospitalized for COVID-19.

Materials and methods: Retrospective analysis of 128 patients aged 73 years, 66% men, hospitalized at a clinical hospital, with a diagnosis of COVID-19, admitted from May 1 to August 1, 2020. Data were collected from the clinical records, a description of the study population was made, and a univariate analysis and logistic regression were performed.

Results: Seventy-two percent of patients had two or more comorbidities, mainly arterial hypertension in 66%, diabetes mellitus in 34% and cardiovascular disease in 19%. Forty-one percent were admitted to intensive care and 31% were connected to mechanical ventilation. In-hospital mortality was 26.6%. A multivariate analysis was performed in two blocks, finding in the first that arterial hypertension and older age significantly predict mortality. However, when previous institutionalization and immuno-suppression were included as variables in the second block, age ceased to be a significant predictor.

Conclusions: Prognostic factors associated with death in this age group are arterial hypertension and previous institutionalization.

Background: COVID-19 pandemic disturbed mental health of healthcare personnel. Residents of the specialization programs could be at risk, since they were reassigned in their functions.

Aim: To describe the impact of COVID-19 pandemic on symptoms of depression, stress, anxiety and resilient coping in residents of Anesthesiology, Internal Medicine and Emergency Medicine Material and Methods: Residents were invited to answer an online survey containing the DASS-21 scale for anxiety, stress and depression symptoms and the Brief Resilient Coping Scale (BRCS) for resilience skills.

Results: Fifty four out of 90 residents answered the survey. Eighteen to 24% of respondents had symptoms of depression, anxiety and stress at severe and extremely severe levels. Those with severe and extremely severe symptoms had also the lowest score on the BRCS resilience scale. We did not find an association between severity of symptoms and gender.

Discussion: A proportion of respondent residents had severe psychological symptoms and lower resilience scores during the COVID-19 pandemic.

Angiomyolipomas (AML) are mesenchymal tumors belonging to the group of perivascular epithelioid cell tumors, which, rarely, can display a malignant behavior. They are composed of adipose tissue, vessels, and muscle tissue in different proportions, and constitute a differential diagnosis for other focal liver lesions. We report a 34-year-old woman in whom a focal hepatic lesion was discovered incidentally. The pathology report of an ultrasound guided biopsy informed an epithelioid angiomyolipoma, a rare variant of these lesions. During ten years of imaging follow, the size and features of the lesion has not changed. The patient rejected a surgical excision.

Background: Social isolation and hand washing are effective measures to prevent COVID-19 transmission Aim: To evaluate the predictive role of risk perception and preventive efficacy perception, along with sociodemographic and health factors, for adherence to hand washing and isolation behavior of Chilean adults.

Material and methods: In a Web-based cross-sectional study, 695 adults between 18 and 60 years old answered the COVID-19 Risk Perception Scale and a questionnaire on perception of preventive efficacy, preventive adherence, sociodemographic and health variables.

Results: Seventy seven percent of respondents adhered to hand washing and 71% to isolation behavior. The average risk perception of respondents was 67.2 ± 12.6%. Age, gender and perception of risk (considering its affective component and preventive efficacy perception), were identified in two predictive models as factors associated with compliance with hand washing.

Conclusions: Preventive behaviors are associated with several psychosocial factors, allowing to distinguish groups at higher risk, which should be the focus of COVID-19 preventive interventions.

Background: Cardiorespiratory fitness (CRF) is inversely associated with metabolic diseases and adiposity markers.

Aim: To assess the association of CRF with body mass index (BMI), waist circumference (WC) and obesity in a representative sample of the Chilean population.

Material and methods: Data from 5,958 participants in the Chilean National Health Survey 2016-1027 aged 15 years or above were analyzed. CRF was estimated by an equation that included sociodemographic, anthropometric and health-related data and expressed in metabolic equivalent units (METs). The association between CRF and adiposity was assessed using linear and Poisson regression models and the results were presented as Prevalence Ratio (PR).

Results: One MET increment in CRF was associated with a 3.27 kg/m2 (95% confidence intervals (CI): -3.35; -3.2) and 4.56 kg/m2 (95% CI: -4.67; -4.46) lower BMI in men and women, respectively. Waist circumference was 6.7 cm [95% CI: -6.98; -6.42] and 9 cm [95% CI: -9.33; -8.67] lower per 1-MET increment in CRF. With one MET increment, the probability of being obese was 34% (PR = 0.66 [95%CI: 0.63; 0.69]) and 36% (PR = 0.64 [95%CI: 0.61; 0.67]) lower in men and women, respectively. The probability of having a central obesity was 26% (PR = 0.74 [95%CI: 0.71; 0.77]) and 30% (PR = 0.70 [95%CI: 0.68; 0.73]) lower in men and women, respectively.

Conclusions: A higher estimated CRF was associated with lower adiposity levels and a lower risk of being obese in both men and women. Public health policies aiming to increase physical activity are needed to increase the CRF of the Chilean population.

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.

Historically, the wards of hospitals were divided by services such as medicine, surgery and traumatology, among others. To optimize the use of beds, undifferentiated medical surgical services were implemented in different hospitals in the country. This work organization had consequences in several areas, such as teamwork, the sense of belonging, the quality of teaching and travel times, among other factors. In 2018, at a Clinical hospital, we started a quality improvement project that consisted of assigning low complexity internal medicine teams to limited geographic areas, aiming to have sectorized teams. Through some PlanStudy-Do-Act (PDSA) cycles of continuous improvement, more than 80% of the patients were quickly sectorized, however there were multiple threats during the project. Pre- and post-implementation surveys were conducted with nurses, internal medicine residents, and medical Staff, highlighting an improvement in multiple aspects concerning the quality of communication, interdisciplinary work, the time of visits, and satisfaction, among others.

Severe metabolic acidosis is defined by a pH < 7.2 with HCO3- < 8 mE- q/L in plasma. Its best treatment is to correct the underlying cause. However, acidemia produces multiple complications such as resistance to the action of catecholamines, pulmonary vasoconstriction, impaired cardiovascular function, hyperkalemia, immunological dysregulation, respiratory muscle fatigue, neurological impairment, cellular dysfunction, and finally, it contributes to multisystemic failure. Intravenous NaHCO3 buffers severe acidemia, preventing the associated damage and gains time while the causal disease is corrected. Its indication requires a risk-benefit assessment, considering its complications. These are hypernatremia, hypokalemia, ionic hypocalcemia, rebound alkalosis, and intracellular acidosis. For this reason, therapy must be "adapted" and administered judiciously. The patient will require monitoring with serial evaluation of the internal environment, especially arterial blood gases, plasma electrolytes, and ionized calcium. Isotonic solutions should be preferred instead of hypertonic bicarbonate. The development of hypernatremia must be prevented, calcium must be provided for hypocalcemia to improve cardiovascular function. Furthermore, in mechanically ventilated patients, a respiratory response similar to the one that would develop physiologically, must be established to be able to extract excess CO2 and thus avoid intracellular acidosis. It is possible to estimate the bicarbonate deficit, speed, and volume of its infusion. However, the calculations are only for reference. More important is to start intravenous NaHCO3 when needed, administer it judiciously, manage its side effects, and continue it to a safe goal. In this review we address all the necessary elements to consider in the administration of intravenous NaHCO3, highlighting why it is the best buffer for the management of severe metabolic acidosis.

Background: Despite recent initiatives and efforts, gender inequality still exists in medicine and academia. There is a higher proportion of male authors in international scientific publications.

Aim: To compare the proportion of female and male authors in the scientific publications of the main medical journals in Chile.

Material and methods: We reviewed 1,643 Scientific articles published between 2015 and 2020 in two medical journals from Chile. Three authors analyzed the title, abstract, and authors of all published articles, recording the sex of the first author, co-authors, and corresponding author.

Results: The reviewed articles had a mean of 5.3 authors and there was a significant difference between men and women (a mean of 2.8 men and 2.4 women; p < 0.001). Forty-six percent (n = 761) of the articles had a female first author. In a higher proportion of papers, men completed both positions (1st and corresponding author) simultaneously.

Conclusions: There are fewer female authors in scientific publications. Chile is one of the countries with a high rate of gender gap in the world. The underrepresentation of women in academia is an example of this.