Tasa de egreso hospitalario por episodio depresivo recurrente en los años 2018-2021 en Chile / Hospital discharge rate due to recurrent depressive episode in the years 2018-2021 in Chile

Introducción: La depresión es un trastorno del ánimo frecuente, cuya recurrencia altera su manejo y pronóstico. El objetivo del trabajo es describir la tasa de egreso hospitalario (TEH) por episodio depresivo recurrente (EDR) entre 2018-2021 en Chile, según sexo, edad y gravedad. Materiales y métodos: Estudio observacional y transversal que considera los egresos hospitalarios por EDR en el período 2018-2021 en Chile (N=1551). Se utilizaron las bases de datos del Departamento de Estadísticas e Información de Salud y el Instituto Nacional de Estadística. Las variables estudiadas fueron sexo, grupo etario y gravedad. No requirió aprobación de comité de ética. Resultados: Se observó la menor TEH en 2020 con 1,91 egresos por cada 100.000 habitantes. Las mujeres sobresalieron durante todo el período con una TEH de 3,68 egresos por cada 100.000 habitantes. Destacó el grupo de 15 a 19 años con la mayor TEH en ambos sexos con 5,3 egresos por cada 100.000 habitantes. Respecto a gravedad, las hospitalizaciones se concentraron en pacientes de diagnóstico no especificado. Discusión: La pandemia de COVID 19 podría explicar la disminución de la TEH en 2020, al reducirse el diagnóstico y hospitalización por EDR; presumiblemente debido al fenómeno de reconversión de camas. La TEH es mayor en el sexo femenino, lo cual es concordante con la literatura. El predominio del grupo de 15 a 19 años discrepa de la evidencia, la cual indica que suele concentrarse en individuos de 25 a 64 años. Conclusión: Las TEH por EDR se concentraron en mujeres jóvenes. Es relevante conocer la epidemiología local para focalizar los recursos en la detección oportuna de factores de riesgo, para evitar episodios graves y disminuir su recurrencia.

Introduction: Depression is a common mood disorder, whose recurrence alters its management and prognosis. The aim of the paper is to describe the hospital discharge rate (HED) for recurrent depressive episode (RDE) between 2018-2021 in Chile, according to sex, age and severity. Materials and methods: Observational and cross-sectional study considering hospital discharges due to DRE in the period 2018-2021 in Chile (N=1551). The databases of the Department of Health Statistics and Information and the National Institute of Statistics were used. The variables studied were sex, age group and severity. Ethics committee approval was not required. Results: The lowest HTE was observed in 2020 with 1.91 discharges per 100,000 inhabitants. Females stood out during the entire period with an HTE of 3.68 discharges per 100,000 population. The 15-19 years age group stood out with the highest HTE in both sexes with 5.3 admissions per 100,000 inhabitants. In terms of severity, hospitalizations were concentrated in patients with unspecified diagnosis. Discussion: The COVID 19 pandemic could explain the decrease in HTE in 2020, with a reduction in diagnosis and hospitalization for RDE, presumably due to the bed conversion phenomenon. HTE is higher in the female sex, which is consistent with the literature. The predominance of the 15 to 19 years age group disagrees with the evidence, which indicates that it tends to be concentrated in individuals aged 25 to 64 years. Conclusion: HTE due to DRE was concentrated in young women. It is important to know the local epidemiology in order to focus resources on the timely detection of risk factors to avoid serious episodes and reduce their recurrence.

[Undergraduate teaching of internal medicine in a private hospital]. / Docencia de pregrado en medicina interna en un hospital privado: diez años de experiencia.

There is a 10 years teaching experience for fourth year medical students and interns in a Chilean private hospital. The students attend an eight weeks practical course. The interns rotate during 16 weeks by specialties and make shifts. The hospital structure with Clinical Services and Medical-Surgical departments facilitates the teaching process. There are approximately 30,000 admissions per year with a mean stay of 3.7 days, that allow the students to be in touch with patients with different diseases that are managed with updated technology. We emphasize the ethical and clinical management of concrete problems of patients, learning and communication skills. The students evaluate their stay answering surveys and with semi structured interviews. Teaching is assessed by tutors and heads of departments, in clinical rounds, sometimes prepared by the students, by a thorough revision of problem oriented medical records and with practical and theoretical tests. The results of the program have been quite satisfactory for participants.

Correlación entre estudio ultrasonográfico (US) y estudio electromiográfico (EMG) en el diagnóstico del síndrome del túnel carpiano (STC) / Correlation between ultrasonographic (US) and electromyographic study (EMG) in the diagnosis of carpal tunnel syndrome (CTS)

Objetivo y método: Evaluar la correlación entre la electromiografía (EMG) y la ultrasonografía (US) de 19 pacientes con síndrome del túnel carpiano (STC) clínico. Resultados: Debieron ser descartados dos pacientes por presentar nervios medianos bíjidos. Se hallaron 15 nervios medianos con US alterada y18 nervios medianos con electromiografía alterada. Se encontró correlación positiva entre US y electromiografía en 12/24 túneles carpianos, y se observó una concordancia de lateralidad entre el tamaño del nervio y su alteración electrofisiológica en cinco pacientes. Se detectó sinovitis de muñeca en seis túneles carpianos (dos pacientes con artritis reumatoide, uno con osteoartritis erosiva). Conclusión: La US músculo-esquelética es una herramienta complementaria a la electromiografía en el estudio del STC en el paciente reumático, aportando información adicional con relación a la patología de base.

Objective: Compare high-resolution ultrasonography (US) and electromyography (EMG) of 19 patients with carpal tunnel syndrome (CTS) Results: Two patients were ruled out because of bifid median nerves. We found 15 median nerves with abnormal US appearance and 18 median nerve with abnormal EMG. We found a positive correlation between US and EMG in 12/24 carpal tunnels, and lateral agreement between nerve size and EMG alteration in 5 patients. Wrist synovitis was detected in six carpal tunnels (two patients with rheumatoid arthritis and one with osteoarthritis). Conclusion: Musculoskeletal ultrasound is a complementary tool to electromyography in the CTS study of rheumatologic patients, thus providing additional information in relation to the basal pathology.

Docencia de pregrado en medicina interna en un hospital privado: Diez años de experiencia / Undergraduate teaching of internal medicine in a private hospital

There is a 10 years teaching experience for fourth year medical students and interns in a Chilean private hospital. The students attend an eight weeks practical course. The interns rotate during 16 weeks by specialties and make shifts. The hospital structure with Clinical Services and Medical-Surgical departments facilitates the teaching process. There are approximately 30,000 admissions per year with a mean stay of 3.7 days, that allow the students to be in touch with patients with different diseases that are managed with updated technology. We emphasize the ethical and clinical management of concrete problems of patients, self ¡earning and communication skills. The students evaluate their stay answering surveys and with semi structured interviews. Teaching is assessed by tutors and heads of departments, in clinical rounds, sometimes prepared by the students, by a thorough revision of problem oriented medical records and with practical and theoretical tests. The results of the program have been quite satisfactory for participants.

Fracturas extendidas de la cara (tipo Le Fort): clínica y tratamiento / Extended fractures of the face (Le Fort type): clinical aspects and treatment

Se presentan 17 casos de fracturas de Le Fort correspondientes al 3.18% de las 533 fracturas maxilo-faciales observadas en el Instituto Traumatológico y Clínica de las Condes en los 6 años comprendidos entre 1980 y 1986. La casuística se clasifica de acuerdo a edad, sexo, etiología, tiempo de evolución, tipo de fractura según la tipificación clásica de Le Fort, presentación clínica, lesiones asociadas, mortalidad y tratamiento. Se discuten las alternativas terapéuticas, las que varían ampliamente e incluyen medidas generales como reposo y analgésicos y maniobras quirúrgicas de reducción, inmovilización y reconstrucción primaria. Se concluye que el óptimo manejo de éstos pacientes se basa sobre un diagnóstico correcto, un tratamiento quirúrgico oportuno y la adecuada atención de las complicaciones debidas al trauma