Universidad Andrés Bello

Universidad Católica del Norte (Chile)

University of Concepción

Universidad Austral de Chile

Pontificia Universidad Católica de Chile

University of Santiago, Chile

University of Desarrollo

Universidad de La Frontera

University of Chile

New York Medical College

University of Glasgow

London School of Hygiene and Tropical Medicine

Universidad de Concepcion

Publication of the Sociedad Médica de Santiago. Mission: La REVISTA MÉDICA DE CHILE publica trabajos originales sobre temas de interés médico y de Ciencias Biomédicas, dando preferencia a los relacionados con la Medicina Interna y sus especialidades derivadas.

Revista médica de Chile

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Low plasma HDL cholesterol levels are an independent risk factor for atherosclerotic cardiovascular disease. During the past years, the study of HDL has been stimulated by the discovery of novel genes and proteins, which have provided new insights into the molecular and cellular mechanisms involved in HDL metabolism. In addition, recent clinical studies focused on treating low HDL as primary objective in high cardiovascular risk patients have been very encouraging. Furthermore, new drugs for raising HDL cholesterol are under development. This article reviews the recent progress in the HDL field and its important implications for the pathophysiology and treatment of atherosclerosis. In the near future, we expect that new drugs with specific and beneficial effects on HDL metabolism and the associated cardiovascular risk should improve the current approach to this disease with high burden on health systems and society

El colesterol HDL: ¿un nuevo objetivo terapéutico en el manejo de las dislipidemias y la ateroesclerosis?

Maintaining an adequate tissue oxygen delivery (DO) and consumption (VO) is crucial in the treatment of septic patients. A fall in V02 is associated with a higher mortality. The early recognition of shock or tissue hypo perfusion impacts on patient prognosis. In occasions, hypovolemia or important regional oxygen debts are not recognized, since macro homodynamic variables have been compensated. In this situation, the use of metabolic hypo perfusion markers such as lactate, central venous oxygen saturation and gastric goniometry, can be helpful. However, interpretation of these markers should be cautious and always considering the overall clinical status of the patient. In the initial stages of sepsis, the dependency ofV02 on DO 2predominates as histopathological mechanism of multiple organic failure. In late stages, other factors predominate as determinants of multiple organic failure and mortality, such as hyper or hypo immune response, microcirculatory alterations and cytopathic hypoxia.

Manipulación del transporte y consumo de oxígeno en la sepsis

Femoroacetabular impingement as a cause of inguinal pain Femoroacetabular impingement is an anatomical disturbance of the hip, caused by a deformity of the acetabulum, femur or both that causes an abnormal contact between both structures during certain movements. Its prevalence is 10 to 15% and causes chronic inguinal pain. It can be confused with several other causes of inguinal pain such as hernias, facet syndromes, a renal colic, etc. Patients with this condition are usually young individuals with inguinal pain that may appear after a minor trauma. During examination, pain may be elicited by internal rotation and abduction movements of hip, flexed in 90º. Plain hip X ray is the most commonly used diagnostic method. Non steroidal anti inflammatory drugs and physical therapy can be used to alleviate pain, but the definitive treatment is surgical (Rev Med Chile 2010; 138: 102-108).

Pinzamiento femoroacetabular: Conceptos básicos en una nueva causa de dolor inguinal

Gastric lipoma removed by laparoscopic subtotal gastrectomy. Report of one case Gastric lipoma is a rare benign gastric tumor. We report a 62-year-old man, who presented with abdominal pain, vomiting and weight loss. An upper gastrointestinal endoscopy showed a gastric antral, submucosal tumor. Abdominal ultrasound and computed tomography revealed a large antral lesion with content of high echogenicity and fat density, measuring 11 x 6 cm. The patient was treated with a laparoscopic distal subtotal gastrectomy, and a Roux-en-Y reconstruction. The patient had no postoperative morbidity, was started on a liquid diet on the third postoperative day and was discharged on the fifth postoperative day. The pathological study revealed a gastric lipoma with clear margins. This laparoscopic procedure represents a good alternative in the treatment of this benign gastric tumor. (Rev Med Chile 2013; 141: 927-931).

Lipoma gástrico gigante sintomático tratado con gastrectomía subtotal laparoscópica: caso clínico

Pemphigus is an autoimmune bullous disease that involves skin and mucous membranes caused by autoantibodies against antigens on the surface of keratinocytes. We report a 30-year-old male presenting with a five months history of pruriginous alopecic and crusted lesions in the scalp, that extended posteriorly to the trunk and limbs. Mucous membranes were not involved. A skin biopsy was performed, showing extensive loss of epidermis and acantholysis. Immuno fluorescence was positive for C3 and intercellular and epidermic IgG. With the presumptive diagnosis of pemphigus vulgaris (PV) without mucous involvement, the patient was treated with prednisone, observing an excellent clinical response. There are only few cases published in the literature of PV without mucous involvement. Some authors refer to this subtype of PV as "Cutaneous pemphigus vulgaris".

Pénfigo vulgar tipo cutáneo: Caso clínico

Background: Drug abuse is one of the main public health problems and mostly involves young people. Aim: To determine the prevalence of drug consumption among university students and its associated social factors. Material ana Methods: A questionnaire exploring consumption of drugs and social-demographic, economic and religious variables, was applied to 1577 third year students aged 22 ±2 years (54% females) of a public university. Results: Sixty eight percent of the students were of middle socioeconomic class, 71 % belonged to some religion and 29% declared themselves as agnostic. Ninety six percent drank alcohol at least once and 29% never smoked. Among illicit drugs, marijuana was consumed by 22% followed by cocaine in 5.3%o, hallucinogenic drugs in 2.6 %>, inhalants in 2.3%> and cocaine free base in 1.4%). Six percent consumed stimulants and 13.8%>, sedatives. A higher economic income facilitated drug consumption and the adscription to a religion was protective against it. Conclusions: Alcohol is the most commonly consumed drug, and is the substance that generates more problems to students.

Estudio cuantitativo del consumo de drogas y factores sociodemográficos asociados en estudiantes de una universidad tradicional chilena

We report the case of a 60 year old woman with multiple pancreatic nodules found on abdominal computed tomography. Thirteen years earlier she had undergone a left nephrectomy for renal cell carcinoma. The patient underwent surgery with a preoperative diagnosis of multifocal metastatic or neuroendocrine tumor. At surgery, two metastatic nodules of renal cell carcinoma were found and excised. After four years of follow up there is no evidence of recurrence.

Metástasis pancreáticas tardías secundarias a cáncer de células renales: Caso clínico

The contribution of Goldstein and Brown to the study of cholesterol metabolism In December 1985, the Nobel Prize of Medicine was awarded to Drs. Joseph L. Goldstein and Michael S. Brown for their fundamental scientific work on the regulation of cholesterol metabolism mediated by the low density lipoprotein receptor pathway. This article briefly reviews the academic and research accomplishments of Drs. Brown and Goldstein as a tribute to these physician-scientists for their well-deserved award and enormous contribution to biomedical science worldwide. (Rev Med Chile 2012; 140: 1053-1059).

Rememorando la contribución de Goldstein y Brown al estudio del metabolismo del colesterol: a un cuarto de siglo del Premio Nobel de Medicina

PSICOLOGÍA GENERAL Y EVOLUTIVA

IgG4 disease is a multi-systemic condition involving pancreas, salivary glands and lymph nodes. Less frequently, it causes interstitial nephritis and involves the lungs. We report a 58 years old male with a four years history of hemoptysis and renal dysfunction characterized by hematuria and proteinuria, responsive to steroidal therapy. The renal biopsy established the diagnosis of IgG4 associated interstitial nephritis. Lung involvement was considered secondary to the same systemic disease.

Hemoptisis recurrente asociada a falla renal y hematuria: otra de las mil caras de la enfermedad relacionada a IgG4

Background: 
The inability to carry out activities of daily living (ADL) is prevalent in elderly people and it is associated with hypertension and stroke.

Aim: 
To evaluate ADLs using the T-ADLQ in hypertensive patients with minor stroke.

Subjects and methods: 
T-ADLQ, Cognitive tests (Minimental and Addenbrooke), and Hamilton depression test were applied to 100 hypertensive ambulatory patients (55 without symptomatic stroke and 45 with ischemic stroke, Rankin ≤ 2).

Results: 
In stroke patients the ability to perform ADL was significantly reduced compared with hypertensive patients without stroke. Cognitive dysfunction and depressive symptoms were associated with a lower ADL performance.

Conclusions: 
The T-ADLQ is useful to evaluate ADL in hypertensive ambulatory patients with ischemic stroke.

Cuestionario de actividades de la vida diaria (T-ADLQ): utilidad en pacientes con accidente cerebrovascular menor

Chronic obstructive pulmonary disease (COPD) has no curative treatment, and in moderate to advanced stages, functional parameters and quality of life are affected. Lung volume reduction improves respiratory parameters and quality of life of these patients. Endoscopic lung volume reduction is a minimally invasive procedure that uses endobronchial valves or coils. Valves are unidirectional, blocking the air from entering the target lobe during inspiration, allowing the exit of air and secretions during expiration. Complete fissure and absence of collateral ventilation are needed for an adequate functioning of endobronchial valves. Endobronchial coils cause mechanical retraction of the lung parenchyma. We report two patients who underwent endoscopic lung volume reduction by endobronchial valves. One patient was on continuous positive pressure non-invasive ventilation due to his severe emphysema.

Reducción de volumen pulmonar endoscópica en enfisema pulmonar avanzado: Casos clínicos

The prescription of medications is a weak link in the therapeutic chain of a drug. Medication errors can be associated with the use of so-called unsafe abbreviations in medical prescription. When they are mistakenly interpreted by the person who reads the prescription, error becomes imminent. We herein review the literature about the use of unsafe abbreviations in medical prescriptions and their association with medication errors. PubMed and Lilacs were reviewed, and 29 studies were analyzed, extracting information about the use of abbreviations, common abbreviations, reasons for their use and tools to reduce this conduct. A list with the main risky health abbreviations adapted to Chile was generated. It became clear that the use of abbreviations has increased, appearing in almost all medical prescriptions. The most commonly used abbreviations are the acronym “u” referring to units, followed by “sc” referring to subcutaneous. One of the causes for the use of acronyms the limited time that doctors have at the time of prescription. One way to reduce the use of these abbreviations, is to remind constantly about those that may have the greatest risk in each health institution. A list of unsafe abbreviations, to be used by Chilean health services, is proposed.

Uso de abreviaturas inseguras en la prescripción médica y errores de medicación: una revisión narrativa

Knowing what characterizes an excellent teacher is relevant to guide training, evaluation, and continuous improvement of the clinical teacher. We performed a systematic review using the PRISMA protocol, aiming to identify the attributes of an excellent clinical teacher. MEDLINE, ERIC, ScienceDirect, and Scopus databases were searched for articles published in English and Spanish, between 2007 and 2019. Two independent reviewers extracted and synthesized data from articles that met the PRISMA pre-established criteria. Twelve studies met the inclusion criteria. Of the 106 attributes reported by the studies, 49 (46,2%) were generic. The most frequently mentioned attribute was respectfulness. Forty-six attributes (43,3%) were pedagogical. Feedback and planning were those most frequently mentioned. Eleven attributes (10,3%) were disciplinary and clinical skills was the most mentioned. We conclude that generic and pedagogical dimensions had a greater representation in the literature, in comparison with the disciplinary dimension. This could be explained, considering that having adequate clinical skills is the minimal necessary requisite to become a clinical teacher, but does not make a difference in how their performance is perceived, contrary to the generic and pedagogical dimensions.

Los atributos de un tutor clínico de excelencia: una revisión sistemática [A systematic review about the most important attributes of clinical teachers]

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