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Las dualidades del 2020 2020年的二元性
Pub Date : 2019-03-16 DOI: 10.5354/2735-7996.2019.69986
María Patricia Gómez Morales
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引用次数: 0
Uso de telepsiquiatría para apoyar la atención primaria de salud mental en el tratamiento de niños, niñas y adolescentes con vulneración de derechos: resultados preliminares 利用远程精神病学支持初级精神卫生保健治疗侵犯权利的儿童和青少年:初步结果
Pub Date : 2019-03-16 DOI: 10.5354/2735-7996.2019.69988
M. Irarrázaval D., Adrian Mundt, Pablo Martínez D., Olga Fernández G., G. Rojas C.
The aim of this study was to present preliminary results of a video-based consultation-liaison psychiatry service (telepsychiatry) to enhance the delivery of mental health services in primary health care (PHC) for institutionalized children and adolescents (ICA). A mixed-methods study was carried out at two PHC clinics in Quilpué, Chile, to assess the feasibility of a telepsychiatry service (TPS). TPS consisted of bimonthly, remotely conducted video-conference sessions between PHC teams and child and adolescent consultant psychiatrists located at the Psychiatric University Hospital in Santiago, to discuss mental health problems of ICA. During July to December 2018 thirteen TPS sessions were carried out, and a total of 15 ICA were discussed to elaborate diagnostic and/or therapeutic recommendations. The intervention was useful and acceptable to PHC providers. Participants perceived that better coordination between substitute care facilities and PHC clinics would be useful, and that training opportunities to address the mental health needs of ICA were required. A TPS to enhance the delivery of mental health services in PHC for ICA was feasible, further studies are needed to determine benefits for ICA.
本研究的目的是介绍一种基于视频的咨询联络精神病学服务(远程精神病学)的初步结果,以加强在初级卫生保健(PHC)中为制度化的儿童和青少年(ICA)提供的精神卫生服务。在智利quilpu的两个初级保健诊所进行了一项混合方法研究,以评估远程精神病学服务(TPS)的可行性。TPS包括两个月一次的远程视频会议,由初级保健小组与圣地亚哥精神病学大学医院的儿童和青少年心理咨询医生举行,讨论ICA的心理健康问题。2018年7月至12月期间,开展了13次TPS会议,共讨论了15项ICA,以详细阐述诊断和/或治疗建议。干预措施对初级保健提供者是有用的和可接受的。与会者认为,替代护理设施和初级保健诊所之间更好的协调将是有益的,并且需要提供培训机会,以解决ICA的心理健康需求。通过TPS来加强初级保健区为ICA提供的精神卫生服务是可行的,但需要进一步研究以确定ICA的益处。
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引用次数: 0
Alergia a ß-lactámicos en niños 儿童对ß-内酰胺过敏
Pub Date : 2019-03-16 DOI: 10.5354/2735-7996.2019.70008
A. Guzmán, Rocío Tordecilla, M. A. González
Allergy to Betalactams is a widely suspected pathology, which is not regularly studied in Chile, leading to a misusage of antibiotics of other families. In this article a case report in a pediatric patient will be described, and a discussion about the studies needed for this pathology, and treatment will be made in accordance to the experiences and tools available in Chile, and specifically in University of Chile Clinical Hospital. In our Hospital we study these cases following international guidelines for the diagnosis of allergy to Betalactams.
对Betalactams过敏是一种广泛怀疑的病理,在智利没有定期研究,导致其他家庭滥用抗生素。在这篇文章中,将描述一个儿科患者的病例报告,并讨论该病理所需的研究,并根据智利,特别是智利大学临床医院的经验和工具进行治疗。在我们的医院,我们研究这些病例遵循国际准则诊断过敏的Betalactams。
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引用次数: 0
Estatinas, drogas de amplio espectro de acción y beneficios 他汀类药物,广谱药物的作用和益处
Pub Date : 2019-03-16 DOI: 10.5354/2735-7996.2019.70039
Ildefonzo Arocha-Rodulfo
Prevention and treatment of dyslipidemia should therefore be considered as an integral part of individual cardiovascular prevention interventions, which should be addressed primarily to those at higher risk who will benefit most. Statins are the most commonly used options for the pharmacologic treatment of dyslipidemia. In recent decades, numerous clinical trials have demonstrated the efficacy of these drugs to reduce cardiovascular mortality and major non-fatal atherothrombotic events in heterogeneous populations through both primary and secondary prevention. This group of drugs is part of the recommendations of both US and European guidelines, and should be prescribed to all patients who have already had a cardiovascular event and have no specific contraindication. However, a large percentage of patients that would benefit from a statin treatment do not receive them, have been prescribed a low dose or for a limited time.
因此,血脂异常的预防和治疗应被视为个人心血管预防干预措施的一个组成部分,应主要针对高危人群,他们将受益最多。他汀类药物是治疗血脂异常最常用的药物。近几十年来,许多临床试验已经证明,这些药物通过一级和二级预防在异质人群中降低心血管死亡率和主要非致命性动脉粥样硬化血栓事件的有效性。这组药物是美国和欧洲指南推荐的一部分,应该开给所有已经有心血管事件且没有特定禁忌症的患者。然而,很大一部分本应受益于他汀类药物治疗的患者并没有接受他汀类药物治疗,而是被开了低剂量或有限时间的处方。
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引用次数: 0
Factores pronósticos de morbimortalidad cardiovascular en pacientes egresados con infarto agudo al miocardio seguidos por un año 急性心肌梗死患者心血管发病率和死亡率的预后因素随访1年
Pub Date : 2019-03-16 DOI: 10.5354/2735-7996.2019.70038
H. Ugalde P., Ignacio Cifuentes R., Pablo Romero A., Ariel Castro L.
Acute myocardial infarction is one of the main causes of death in the world, this occurs in the in-hospital period as well as in the follow-up. It has been much studied what occurs in the in-hospital period, but much less what occurs in the follow-up of patients with this pathology. The objective of this study was to follow patients discharged after myocardial infarction for 1 year and analyze predictors of cardiovascular events. 1174 patients were followed for 1 year, of which 17% presented some serious cardiovascular event, associated with the presence of male sex, older age, arterial hypertension, previous history of angina, hospital treatment only pharmacological, inclusion of positive inotropes in the initial treatment and use of calcium channel blockers, factors already shown by international literature but less analyzed in our country, and furthermore, the demonstration that invasive management with coronary angioplasty or bypass surgery are protective factors of the occurrence of events in this period, which reinforces the idea of a more intensive and invasive management in patients with this pathology.
急性心肌梗死是世界上死亡的主要原因之一,它既发生在住院期间,也发生在随访期间。人们对住院期间发生的情况进行了很多研究,但对患有这种病理的患者的随访情况研究得很少。本研究的目的是对心肌梗死后出院的患者进行为期一年的随访,并分析心血管事件的预测因素。1174例患者随访1年,其中17%出现严重心血管事件,与男性、年龄较大、动脉性高血压、既往心绞痛史、仅在医院接受药物治疗、初始治疗纳入正性肌力药物和使用钙通道阻滞剂等因素相关,这些因素在国际文献中已有报道,但在我国分析较少。冠状动脉成形术或搭桥手术的侵入性治疗是这一时期事件发生的保护因素,这加强了对这种病理患者进行更强化和侵入性治疗的想法。
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引用次数: 0
Evaluación de la corrección angular de la integral velocidad tiempo en ecocardiografía. Estudio piloto 超声心动图中积分速度时间角校正的评价。试点研究
Pub Date : 2019-03-16 DOI: 10.5354/2735-7996.2019.70006
D. Ugalde C, Solange Brugere O., Angela Pino L.
Background: Echocardiography has now a pivotal role as a tool for hemodynamic monitoring, particularly in the critically ill. However, the ideal acoustic window for relevant measurements such as the velocity time integral are not always available. We propose to evaluate if angular correction of this variable is accurate in comparison with standard technique. Patients and methods: Adult patients were evaluated in the echocardiography unit during Juny 2017, having velocity time integral measured with angulation and standard technique, with convenience sampling. Analysis included difference, means and correlation between basal results and maximal angulation, in Stata 12. Results: 25 patients were included, mean velocity time integral was 23,01cm and with a mean angulation of 32,56º the integral was 24,27cm, with 5,5% difference, statistically significant, linear correlation had a 0,932 coefficient with R-square of 0,7897. Bland-Altman analysis revealed mean difference -1,256cm and agreement limits of -5,219 to 2,707. Discussion: In this study the result of the velocity time integral with angular correction had a good correlation and acceptable precision compared with non-angled measurements, which could allow its use when the acoustic window is sub-optimal, however, these findings should be replicated in critically ill patients.
背景:超声心动图已成为血液动力学监测的重要工具,特别是在危重病人中。然而,用于相关测量(如速度时间积分)的理想声窗并不总是可用的。我们建议评估该变量的角度校正与标准技术相比是否准确。患者和方法:于2017年6月在超声心动图单元对成年患者进行评估,采用成角法和标准技术测量速度时间积分,方便采样。分析包括基础结果和最大成角之间的差异、平均值和相关性,见Stata 12。结果:纳入25例患者,平均速度时间积分为23.01 cm,平均成角为32.56º积分为24.27 cm,差异5.5%,有统计学意义,线性相关系数为0.932,r平方为0.7897。Bland-Altman分析显示平均差值为-1,256cm,一致限为-5,219 ~ 2,707。讨论:在本研究中,与非角度测量相比,经角度校正的速度时间积分结果具有良好的相关性和可接受的精度,这可以允许其在声窗不理想的情况下使用,然而,这些发现应在危重患者中得到重复。
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引用次数: 0
Diseño de un protocolo de telegenética como asistencia al proceso de diagnóstico y registro de los recién nacidos con anomalías congénitas en las regiones de Los Lagos y de Arica y Parinacota 设计一项远程遗传学方案,以协助洛斯拉各斯、阿里卡和帕里纳科塔地区先天性异常新生儿的诊断和登记过程
Pub Date : 2019-03-16 DOI: 10.5354/2735-7996.2019.69991
S. Castillo T., Andrea Pardo V
The majority of clinical geneticists in Chile work in the Metropolitan Region (78%). To expand the area of Telemedicine and support the management of the Ministry of Health, we present this Telegenetics development project that includes innovation of assistance and educational nature directed to regions. The implementation of the National Registry of Congenital Anomalies in Chile (RENACH) in the public and private systems, in December 2015, and the obligation to record and describe the anomalies in all newborns, constitutes a favorable scenario that would benefit from the support of clinical geneticists. This proposal brings together a team of 18 specialists and 6 fellows, professionals from different Universities and / or Hospitals of Health Services, in a collaborative project in the area of clinical genetics, which, supported by the HCUCH + CIMT Telemedicine project, will contribute to two regions of Chile better tools for the diagnosis and comprehensive management of newborn patients with congenital anomalies. It can serve as a pilot for a new way to support the registration of malformations throughout Chile and teach clinical genetics concepts. The expected benefits are to improve the quality of care and health management in patients with little-known diseases.
智利大多数临床遗传学家在首都地区工作(78%)。为了扩大远程医疗领域和支持卫生部的管理,我们提出了这一远程遗传发展项目,其中包括针对地区的援助和教育性质的创新。2015年12月,智利在公共和私人系统中实施了国家先天性异常登记处(RENACH),并有义务记录和描述所有新生儿的异常情况,这构成了一个有利的局面,将受益于临床遗传学家的支持。该提案将18名专家和6名研究员(来自不同大学和/或卫生服务医院的专业人员)聚集在临床遗传学领域的一个合作项目中,该项目在HCUCH + CIMT远程医疗项目的支持下,将为智利两个地区提供更好的工具,用于诊断和综合管理先天性异常的新生儿患者。它可以作为一种新方法的试点,以支持整个智利的畸形登记,并教授临床遗传学概念。预期的好处是提高鲜为人知的疾病患者的护理质量和健康管理。
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引用次数: 0
Estandarización de la técnica Real Time PCR para la detección molecular de la mutación V617F en el gen de JAK-2 en neoplasias mieloproliferativas crónicas 慢性骨髓增生性肿瘤JAK-2基因V617F突变分子检测实时PCR技术的标准化
Pub Date : 2019-03-16 DOI: 10.5354/2735-7996.2019.70005
C. Pérez N., Liliam León V., Araceli Pinto L., G. Muñoz G., J. Alfaro L., M. Larrondo L
V617F mutation in exon 14 of Janus Kinase 2 gene (jak-2) is used as a molecular marker for the diagnosis of Philadelphia negative myeloproliferative neoplasms (Phi-) such as Polycythemia Vera (PV), Essential Thrombocythemia (ET) and Primary Myelofibrosis (MFP). To detect this mutation, we used conventional polymerase chain reaction technique (PCR), a simple and inexpensive technique, however, has some drawbacks that current technology allows to solve. During the last years, more sensitive molecular techniques have been incorporated in clinical practice to support the diagnosis, prognosis and follow-up of hematological patients. For its implementation in the clinical routine should be considered technical and economic aspects, so in this work, we evaluate the Real Time PCR technique as a diagnostic method for the detection of the Jak-2-V617F mutation, using in house primers design. Our result show that the technique implemented has a concordance index of 0.87 with the conventional PCR used in the molecular diagnosis of myeloproliferative neoplasms. In addition, it has the same specificity, greater sensitivity and, shorter execution time in relation to conventional PCR. The implementation of this diagnostic method in our Hospital is technically possible and commercially convenient.
Janus Kinase 2基因(jak-2)外显子14中的V617F突变被用作费城阴性骨髓增殖性肿瘤(Phi-)的诊断分子标记,如真性红细胞增多症(PV)、原发性血小板增多症(ET)和原发性骨髓纤维化(MFP)。为了检测这种突变,我们使用了传统的聚合酶链反应技术(PCR),这是一种简单而廉价的技术,然而,目前的技术可以解决一些缺点。在过去的几年里,更敏感的分子技术已被纳入临床实践,以支持血液病患者的诊断、预后和随访。由于Real Time PCR技术在临床常规应用中需要考虑技术和经济方面的问题,因此在本研究中,我们采用室内引物设计,对Real Time PCR技术作为检测Jak-2-V617F突变的诊断方法进行了评价。结果表明,该技术与常规PCR在骨髓增生性肿瘤分子诊断中的一致性指数为0.87。此外,它具有与传统PCR相同的特异性、更高的灵敏度和更短的执行时间。该诊断方法在我院的实施在技术上是可行的,在商业上是方便的。
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引用次数: 0
Primera Jornada de Investigación Multidisciplinaria Hospital Clínico Universidad de Chile 2018 2018年智利大学临床医院多学科研究第一天
Pub Date : 2019-03-01 DOI: 10.5354/2735-7996.2019.70253
Revista Hospital Clínico Universidad de Chile
Dentro de la misión de nuestro hospital universitario está la generación de nuevos conocimientos en áreas múltiples. Es por ello que en diciembre recién pasado se desarrolló la Primera Jornada de Investigación Multidisciplinaria del Hospital Clínico Universidad de Chile, espacio que reunió exitosamente a investigadores de diversas disciplinas y facultades, resultando esta instancia un espacio para generar lazos, pensar y abordar los innumerables problemas no resueltos, así como los terrenos inexplorados que podrían ser susceptibles de innovación y mejoramiento. De esta manera comprobamos que los avances sanitarios no solo se gestan dentro de los centros hospitalarios, sino que también a través de la asociación de miradas y métodos de cada disciplina, permitiéndonos ampliar el contexto y la mirada. A continuación presentamos los abstracts que corresponden a una parte de las presentaciones orales y posters presentados en la Jornada
我们大学医院的使命是在多个领域产生新的知识。正是出于这个原因,在今年12月第一天美好的临床医院的多学科研究智利大学空间不同学科和学院的科学家成功了,这个空间产生联系,思考和处理无数inexplorados土地未解决的问题,以及可能的创新和改良。通过这种方式,我们验证了健康进步不仅发生在医院中心,而且还通过每个学科的外观和方法的结合,使我们能够扩展背景和外观。以下是与当天口头报告和海报相对应的摘要。
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引用次数: 0
Test radiológico
Pub Date : 2019-03-01 DOI: 10.5354/2735-7996.2019.69996
Jorge Contardo P., Daniel Rodríguez D.
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引用次数: 0
期刊
Revista Hospital Clínico Universidad de Chile
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