RESUMO
BACKGROUND: In Chile, gastric cancer (GC) is a major cause of cancer related deaths. The current screening strategy consists of an upper gastrointestinal endoscopy (UGE) for people aged 40 years or more with epigastric pain. AIM: To evaluate the diagnostic coverage of the use of UGE for early detection of GC in Chile. MATERIAL AND METHODS: As part of the digestive module of the 2009-10 National Health Survey, 5293 adults over 15 years were asked about the presence of epigastric pain, possible upper gastrointestinal bleeding (PUGB), use of proton pump inhibitors (PPIs) or histamine H2-receptor antagonists (H2RAs), family history of GC and having performed an UGE. RESULTS: Persistent epigastric pain was observed in 3.4% of the population. PUGB signs were observed in 3.3% of the population. The prevalence of PPIs and H2RAs use was 4.3% and 2.2% respectively, reaching 21.6% in people aged 70 years and older. Life span prevalence of UGE was 18.3%, with differences by region, health insurance and educational level. UGE coverage in people aged 40 years or older with and without persistent epigastric pain was 14.4% and 3.2% respectively (Odds ratio 4.8, p < 0.01). The prevalence of UGE was similar among people with or without PUGB or family history of CG. CONCLUSIONS: The estimated coverage of the current GC prevention strategy in Chile is 14.4%, evaluated at a population level. Further studies are required to determine the impact of this strategy on early GC diagnosis and mortality.
Assuntos
Endoscopia Gastrointestinal/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Neoplasias Gástricas/prevenção & controle , Dor Abdominal/tratamento farmacológico , Dor Abdominal/epidemiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Chile/epidemiologia , Escolaridade , Endoscopia Gastrointestinal/métodos , Feminino , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/epidemiologia , Antagonistas dos Receptores H2 da Histamina/uso terapêutico , Humanos , Masculino , Programas de Rastreamento/métodos , Análise Multivariada , Prevalência , Inibidores da Bomba de Prótons/uso terapêutico , Características de Residência/estatística & dados numéricos , Distribuição por Sexo , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/epidemiologiaRESUMO
BACKGROUND: In Chile, gallbladder cancer (GBC) is one of the most important causes of death and gallstone disease (GSD) is its main risk factor. Abdominal ultrasonography (AU) is used for the diagnosis of GSD and cholecystectomy is used to prevent it. AIM: To estimate GSD prevalence in the general population and to assess the diagnostic and therapeutic coverage of GSD as a preventive strategy for GBC in Chile. MATERIAL AND METHODS: A standardized digestive symptoms questionnaire of the 2009-2010 Chilean National Health Survey was answered by 5412 adults over 15 years old. Self-reports of AU, GBD and cholecystectomies were recorded. RESULTS: The prevalence of biliary-type pain was 7.1%. During the last five years, the prevalence of AU was 16%. GSD was reported in 20% of these tests and 84% of them were asymptomatic. The prevalence of AU was significantly lower in Araucanía region and among people with less than 12 years of education. Life cholecystectomy prevalence was 11% and reached 40% in people aged over 60 years. Women accounted for 75% of total cholecystectomies. Twenty-one percent of individuals who referred biliary-type pain, were studied with an AU. Only 60% of people with GSD confirmed by AU underwent a cholecystectomy. CONCLUSIONS: GSD affects at least 27% of the Chilean adult population. Important deficits and inequities in GSD diagnostic and therapeutic coverage were identified.
Assuntos
Neoplasias da Vesícula Biliar/epidemiologia , Inquéritos Epidemiológicos/estatística & dados numéricos , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Adulto , Chile/epidemiologia , Colecistectomia/métodos , Colecistectomia/estatística & dados numéricos , Colecistolitíase/diagnóstico , Colecistolitíase/epidemiologia , Escolaridade , Feminino , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Características de Residência/estatística & dados numéricos , População Rural/estatística & dados numéricos , Prevenção Secundária , Distribuição por Sexo , Inquéritos e Questionários , Ultrassonografia , População Urbana/estatística & dados numéricosRESUMO
Background: In Chile, gallbladder cancer (GBC) is one of the most important causes of death and gallstone disease (GSD) is its main risk factor. Abdominal ultrasonography (AU) is used for the diagnosis of GSD and cholecystectomy is used to prevent it. Aim: To estimate GSD prevalence in the general population and to assess the diagnostic and therapeutic coverage of GSD as a preventive strategy for GBC in Chile. Material and Methods: A standardized digestive symptoms questionnaire of the 2009-2010 Chilean National Health Survey was answered by 5412 adults over 15 years old. Self-reports of AU, GBD and cholecystectomies were recorded. Results: The prevalence of biliary-type pain was 7.1%. During the last five years, the prevalence of AU was 16%. GSD was reported in 20% of these tests and 84% of them were asymptomatic. The prevalence of AU was significantly lower in Araucanía region and among people with less than 12 years of education. Life cholecystectomy prevalence was 11% and reached 40% in people aged over 60 years. Women accounted for 75% of total cholecystectomies. Twenty-one percent of individuals who referred biliary-type pain, were studied with an AU. Only 60% of people with GSD confirmed by AU underwent a cholecystectomy. Conclusions: GSD affects at least 27% of the Chilean adult population. Important deficits and inequities in GSD diagnostic and therapeutic coverage were identified.
Assuntos
Animais , Masculino , Ratos , Regulação da Expressão Gênica no Desenvolvimento , Poli(ADP-Ribose) Polimerases/metabolismo , Células de Sertoli/metabolismo , Antioxidantes , Catalase/genética , Catalase/metabolismo , Diferenciação Celular , Glutationa Transferase/genética , Glutationa Transferase/metabolismo , Poli(ADP-Ribose) Polimerases/genética , RNA Mensageiro/metabolismo , Ratos Wistar , Células de Sertoli/citologia , Superóxido Dismutase/genética , Superóxido Dismutase/metabolismoRESUMO
Background: In Chile, gastric cancer (GC) is a major cause of cancer related deaths. The current screening strategy consists of an upper gastrointestinal endoscopy (UGE) for people aged 40 years or more with epigastric pain. Aim: To evaluate the diagnostic coverage of the use of UGE for early detection of GC in Chile. Material and Methods: As part of the digestive module of the 2009-10 National Health Survey, 5293 adults over 15 years were asked about the presence of epigastric pain, possible upper gastrointestinal bleeding (PUGB), use of proton pump inhibitors (PPIs) or histamine H2-receptor antagonists (H2RAs), family history of GC and having performed an UGE. Results: Persistent epigastric pain was observed in 3.4% of the population. PUGB signs were observed in 3.3% of the population. The prevalence of PPIs and H2RAs use was 4.3% and 2.2% respectively, reaching 21.6% in people aged 70 years and older. Life span prevalence of UGE was 18.3%, with differences by region, health insurance and educational level. UGE coverage in people aged 40 years or older with and without persistent epigastric pain was 14.4% and 3.2% respectively (Odds ratio 4.8, p < 0.01). The prevalence of UGE was similar among people with or without PUGB or family history of CG. Conclusions: The estimated coverage of the current GC prevention strategy in Chile is 14.4%, evaluated at a population level. Further studies are required to determine the impact of this strategy on early GC diagnosis and mortality.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Endoscopia Gastrointestinal/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Neoplasias Gástricas/prevenção & controle , Dor Abdominal/tratamento farmacológico , Dor Abdominal/epidemiologia , Distribuição por Idade , Chile/epidemiologia , Escolaridade , Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/epidemiologia , /uso terapêutico , Programas de Rastreamento/métodos , Análise Multivariada , Prevalência , Inibidores da Bomba de Prótons/uso terapêutico , Características de Residência/estatística & dados numéricos , Distribuição por Sexo , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/epidemiologiaRESUMO
Ischemic stroke due to embolic air is uncommon. There are few reports of patients with air embolic stroke as a complication of endoscopic procedures. The temporal relationship between the stroke and this procedure is the most important clue for the diagnosis. CT scan and MRI of the brain are confirmatory tests. The morbidity and mortality is high. Patients should be hospitalized in a critical care service and treated as soon as possible with oxygen in a pressure camera. We report a 52 years old woman with an ovarian cancer that, during an upper gastrointestinal endoscopy, had a severe alteration of consciousness that did not respond to the use of Flumazenil. A CT scan showed multiple areas of air embolism in the watershed area between anterior and middle right cerebral arteries. A conservative treatment was decided and the patients died 48 hours later.
Assuntos
Embolia Aérea/etiologia , Endoscopia Gastrointestinal/efeitos adversos , Infarto da Artéria Cerebral Anterior/etiologia , Infarto da Artéria Cerebral Média/etiologia , Artéria Cerebral Anterior , Embolia Aérea/diagnóstico , Evolução Fatal , Feminino , Humanos , Infarto da Artéria Cerebral Anterior/diagnóstico , Infarto da Artéria Cerebral Média/diagnóstico , Pessoa de Meia-Idade , Artéria Cerebral Média , Tomografia Computadorizada por Raios XRESUMO
Introduction: The importance of identifying the final competences of pre and postgraduate students is a growing a concern at national and international level due to the need of developing curricula aimed at educating competent professionals that respond to the society´s needs. Objetive: To identify the competencies of a general gastroenterologist (GG). Methods: Modified Delphi technique with a 3-round survey to a group of experts at national level. Sixty-eigth experts were surveyed including gastroenterologists, professionals of related specialties, representatives of scientific societies, and organizations that provide accreditation of both medical study programs and specialties certification. The first survey proposed a list of 224 competencies. Then, in the second and third rounds, the experts must prioritize the competencies according to the importance, usin a 0-4 Likert-type scale. Results: In the first round, 41 experts (60.3 percent) prioritized the 332 identified competencies. Og those, 255 were considered important or very important. In the third round, 252 competencies were confirmed as relevant by 38 experts (55.9 percent). Of the 49 practical procedures identified, only 15 were finally considered as part of the competencies of the GG.A significant percentage of procedures were considered of a higher level of training, particularly, complex endoscopic procedures. Conclusion: Identified competencies will be highly useful in the desing of competencies based curricula and in the implementation of evaluation systems appropriate for each competency. Specialty programs and their graduates might be evaluated according to these competencies.
Introducción: Identificar las competencias terminales de los egresados de pre y postgrado es de creciente interés nacional e internacional debido a la necesidad de desarrollar currículos enfocados en la formación de profesionales competentes, que respondan a las necesidades de la sociedad. El Gastroenterólogo General (GG), debe adquirir competencias cognitivas, destrezas psicomotrices y actitudes. Objetivo: Identificar las competencias del GG. Método: Encuesta de 3 rondas con técnica Delphi modificada a un grupo de expertos a nivel nacional para priorizar las competencias del GG según importancia utilizando una escala Likert de 0 a 4. Se encuestó a 68 expertos incluyendo gastroenterólogos, profesionales de especialidades relacionadas, representantes de Sociedades Científicas, organismos acreditadores de programas y certificadores de especialidades médicas. Resultado: En la primera ronda, se ofreció una lista de 224 competencias a 37 profesionales (54,4 por ciento del total de expertos) quienes agregaron 108 competencias adicionales. En la segunda ronda, 41 expertos (60,3 por ciento) priorizaron las 332 competencias identificadas. De ellas, 255 fueron consideradas importantes o muy importantes. En la tercera ronda, 252 competencias fueron confirmadas como relevantes por 38 expertos (55,9 por ciento). De los 49 procedimientos prácticos identificados, sólo 15 fueron finalmente considerados como parte de las competencias del GG. Un alto porcentaje de los procedimientos fueron considerados en un nivel de entrenamiento superior, en particular los procedimientos endoscópicos complejos. Conclusión: Las competencias identificadas serán de gran utilidad en el diseño de currículos basados en competencias e implementación de sistemas de evaluación apropiados para cada competencia. Los programas de especialidad así como sus egresados podrán ser evaluados de acuerdo a estas competencias.
Assuntos
Humanos , Masculino , Feminino , Competência Clínica , Gastroenterologia , Técnica Delphi , Chile , Competência ProfissionalRESUMO
Bile duct disease and gallstone (cholelithiasis) have been considered an uncommon cause of acute abdominal pain in children compared to adults. However, there are significant differences with the adult gallstone disease: increased proportion of patients with an underlying condition, higher incidence of acalculous cholecystitis and lower frequency of choledocolithiasis. With ultrasound examination, it is possible to detect early gallstone in the fetal period and in asymptomatic patients, explaining the increase in gallstone incidence. This disease is more common than suggested in western literature and its diagnosis is increasing as well. The high prevalence of gallstone in adult population in Chile creates an ideal setting for cholesterol and gallstone candidate gene testing. Although the clinical diagnosis of gallstone is simple, there is no consensus about the best therapy in children, explained partially by the lack of knowledge of the natural history of the disease. The role of gallstone disease acquired early in life in gallbladder carcinoma deserves special attention.
Las enfermedades de la vía biliar y los cálculos vesiculares (colelitiasis) han sido consideradas como una causa poco frecuentes de dolor abdominal agudo en niños, a diferencia de lo que ocurre en adultos. Sin embargo, existen diferencias sustanciales con el adulto como son una mayor proporción de casos con causa identificable, mayor incidencia de colecistitis sin cálculos y menor frecuencia de coledocolitiasis. Con la masificación del ultrasonido es posible detectar litiasis biliar en etapa intrauterina, y en pacientes asintomáticos, lo que estaría explicando, en parte, el aumento de su incidencia. La litiasis biliar es más frecuente de lo sugerido clásicamente en la literatura occidental y su diagnóstico está en aumento. La alta prevalencia de colelitiasis en población adulta chilena, posicionan a nuestro país como un escenario ideal para el estudio de genes candidatos asociados a la etiopatogénesis de la litiasis de colesterol. Si bien el diagnóstico de la litiasis es relativamente simple, no hay consenso en la terapia de elección, lo que se explica fundamentalmente por una historia natural desconocida. El rol de la litiasis de colesterol a edades tempranas en la etiopatogénesis de procesos neoplásicos de la vía biliar merece especial atención.
Assuntos
Humanos , Criança , Colelitíase/epidemiologia , Colelitíase/fisiopatologia , Colelitíase/complicações , Colelitíase/terapia , Dor Abdominal/etiologia , PrevalênciaRESUMO
Chile tiene la mayor tasa de incidencia de cáncer de vesícula biliar (CVB) en el mundo (> 30 por 100.000). Siendo la principal causa de muerte por cáncer entre las mujeres chilenas. Para diseñar estrategias de prevención y diagnóstico precoz del CVB hay que entender los factores etiológicos del proceso carcinogénico vesicular. Hay consenso que para el desarrollo de este cáncer concurren factores -genéticos, hormonales, infecciones crónicas, e inflamaciones crónicas asociadas a litiasis vesicular; y también que este cáncer ocurre en condiciones de pobreza. Desafortunadamente es insuficiente el conocimiento sobre la carcinogénesis vesicular, sobre el mecanismo de acción de los factores de riesgo clásicos y sobre cuáles son relevantes en la iniciación y promoción del CVB. En este artículo centramos la discusión en la litiasis vesicular, considerado el principal factor de riesgo del CVB. Se analiza las estrategias de prevención y control y se discuten los programas actuales. Finalmente se presentan dos estudios sobre factores de riesgo y de susceptibilidad para CVB que están siendo implementados en Chile.
Chile has the highest gallbladder cancer (GBC) incidence rate in the world (>30 per 100,000 person-years) and is the leading cause of cancer deaths among Chilean women. To design strategies of prevention and early diagnosis of GBC we must understand the etiological factors of the gallbladder carcinogenic process; There is consensus that in the development of this cancer concurs genetic and hormonal factors, infection, and chronic inflammation associated with lithiasis; and that is strongly associated with poverty conditions; But unfortunately there is not enough information about this process or how the classic risk factors associated play a role in its development. There is also no information on which are important in the initiation and promotion of GBC. In this article we focus the discussion in gallstones, considered the main risk factor for GBC. We analize some strategies of prevention and control and discuss some aspects of the current program. Finally we will point out two studies on risk factors and genetic susceptibility to GBC that are being implemented in Chile.
Assuntos
Humanos , Prevenção de Doenças , Diagnóstico Precoce , Neoplasias da Vesícula Biliar/prevenção & controle , Cálculos Biliares , Fatores de RiscoRESUMO
Ischemic stroke due to embolic air is uncommon. There are few reports of patients with air embolic stroke as a complication of endoscopic procedures. The temporal relationship between the stroke and this procedure is the most important clue for the diagnosis. CT scan and MRI of the brain are confirmatory tests. The morbidity and mortality is high. Patients should be hospitalized in a critical care service and treated as soon as possible with oxygen in a pressure camera. We report a 52 years old woman with an ovarian cancer that, during an upper gastrointestinal endoscopy, had a severe alteration of consciousness that did not respond to the use of Flumazenil. A CT scan showed multiple areas of air embolism in the watershed area between anterior and middle right cerebral arteries. A conservative treatment was decided and the patients died 48 hours later.
Assuntos
Pessoa de Meia-Idade , Embolia Aérea/diagnóstico , Embolia Aérea/etiologia , Endoscopia Gastrointestinal/efeitos adversos , Artéria Cerebral Média , Evolução FatalRESUMO
Background: The analysis of mitochondrial DNA restriction site polymorphisms assigns most Latin American aborigines to four haplogroups. These are characterized by determined polymorphic restriction sites and a deletion of 9 base pairs in the intergenic region V. Aim: To study the distribution of mitochondrial DNA haplogroups in Chilean aboriginal groups, as well as in the mixed population of Santiago. Material and methods: One hundred twenty Aymara subjects and 23 Atacame-o subjects from the Northern part of Chile and 162 randomly chosen subjects residing in Santiago were studied. DNA was extracted from peripheral lymphocytes. Mitochondrial DNA was amplified by means of polymerase chain reaction. Results: The frequency of haplogroup B decreases from north to south. Aymaras in the north have the highest frequency (64 percent) and it is absent among the Yamanas (previously studied) in the extreme South. Haplogroups C and D show an inverse tendency. It is noteworthy that 84 percent of mitochondrial haplogroups of the mixed population of Santiago are of Amerindian origin whereas the Y-chromosomes are mainly European. Conclusions: The peculiar distribution of haplotypes indicate that the population of Santiago is the result of an asymmetric mating system in which the females ancestors were mainly Amerindian and the male ancestors mainly European