[Prevalence of cardiovascular risk factors in a rural Aymara population from northern Chile]. / Factores de riesgo cardiovascular en la población Aymara rural del norte de Chile.

BACKGROUND: Some rural non-Caucasian ethnic groups have genetic protective factors for the development of chronic non-communicable diseases. Studies performed in Mapuche and Aymara ethnic groups in Chile, found significantly lower prevalence rates. Aymaras are the second most common ethnic population in Chile. AIM: To determine the prevalence of cardiovascular risk factors in a native Aymara ethnic population. MATERIAL AND METHODS: We studied 276 native Aymara people with a median age of 53 years (63% women), registered in the rural clinics of Camiña and Putre. The frequency of hypertension, Type 2 Diabetes Mellitus (DM2), dyslipidemia, overweight, obesity and smoking were determined. RESULTS: The frequency of overweight and obesity was 38% and 38.4% respectively. The prevalence of hypertension and DM2 were 18.5% and 6.9% respectively. Thirty-five percent had elevated total cholesterol, 21% had high LDL cholesterol, 48% had low HDL cholesterol and 45.7% had high triglyceride levels. Two percent smoked. CONCLUSIONS: In this group of Aymara individuals, we found a markedly lower prevalence of hypertension and DM2, despite the high prevalence of obesity and dyslipidemia.

Mestizos with systemic lupus erythematosus develop renal disease early while antimalarials retard its appearance: data from a Latin American cohort.

OBJECTIVES: The objective of this paper is to assess the predictors of time-to-lupus renal disease in Latin American patients. METHODS: Systemic lupus erythematosus (SLE) patients (n = 1480) from Grupo Latino Americano De Estudio de Lupus (GLADEL's) longitudinal inception cohort were studied. Endpoint was ACR renal criterion development after SLE diagnosis (prevalent cases excluded). Renal disease predictors were examined by univariable and multivariable Cox proportional hazards regression analyses. Antimalarials were considered time dependent in alternative analyses. RESULTS: Of the entire cohort, 265 patients (17.9%) developed renal disease after entering the cohort. Of them, 88 (33.2%) developed persistent proteinuria, 44 (16.6%) cellular casts and 133 (50.2%) both; 233 patients (87.9%) were women; mean (± SD) age at diagnosis was 28.0 (11.9) years; 12.2% were African-Latin Americans, 42.5% Mestizos, and 45.3% Caucasians (p = 0.0016). Mestizo ethnicity (HR 1.61, 95% CI 1.19-2.17), hypertension (HR 3.99, 95% CI 3.02-5.26) and SLEDAI at diagnosis (HR 1.04, 95% CI 1.01-1.06) were associated with a shorter time-to-renal disease occurrence; antimalarial use (HR 0.57, 95% CI 0.43-0.77), older age at onset (HR 0.90, 95% CI 0.85-0.95, for every five years) and photosensitivity (HR 0.74, 95% CI 0.56-0.98) were associated with a longer time. Alternative model results were consistent with the antimalarial protective effect (HR 0.70, 95% CI 0.50-0.99). CONCLUSIONS: Our data strongly support the fact that Mestizo patients are at increased risk of developing renal disease early while antimalarials seem to delay the appearance of this SLE manifestation. These data have important implications for the treatment of these patients regardless of their geographic location.

[The influence of smoking habits of Chilean physicians on the use of the structured medical advice about smoking]. / Consumo de tabaco y uso del consejo médico estructurado como estrategia preventiva del tabaquismo en médicos Chilenos.

BACKGROUND: Structured medical advice on smoking is the prevention strategy with better cost-effectiveness ratio. AIM: To evaluate smoking among health care providers affect the application of this preventive strategy. MATERIAL AND METHODS: We surveyed 235 physicians working in public and private hospitals in different cities over the country, about their smoking habits, their views on smoking as cardiovascular risk factor and the implementation of three key points of the structured medical advice about smoking. RESULTS: Physicians aged less than 44 years had the lower frequency of smoking and the higher frequency of ex-smokers concentrated among those aged 60 years or more. All surveyed physicians agreed that smoking is a cardiovascular risk factor. However, 21% considered that this risk appears only among those that smoke more than three cigarettes per day. Independent of their smoking habits, 18% of physicians not always ask their patients about smoking, 25% do not warn about the risk of smoking and 22% not always give advice about quitting. This last action is carried out with a significantly lower frequency by smoking physicians. CONCLUSIONS: To improve physician's compliance with their preventive role in clinical practice, it is essential to consider their own smoking habits, and the information and attitudes that they have towards smoking as a cardiovascular risk factor.

[Sigmoid colon duplication: an adult case report.]. / Duplicación de colon sigmoides. Informe de un caso en adulto.

Colonic duplication is a very uncommon congenital malformation. Most cases are detected during childhood and may occur with other systemic malformations. Since 1950, less than 90 cases of colonic duplication have been reported. In this study, we report the case of a 33-year-old female who was referred to our coloproctology service for evaluation. Since 16 years ago, she has noticed an intermittent left side painless abdominal mass that sometimes spontaneously disappears. In the last months, she reported that the frequency of this complaint has been more frequent. A barium enema X ray study revealed a significant dilation of the descendent and sigmoid colon. An exploratory laparotomy was performed and sigmoid colon duplication was found. The abnormal segment was removed and an end-to-end anastomosis was performed. There were no complications in the postoperative period and she was discharged at day 7. This case describes the difficulties in detecting this rare malformation that should be considered as part of the differential diagnosis of abdominal masses in adult patients.

[25-Hydroxyvitamin D levels in infants. Relation with breast-feeding]. / Niveles de 25-hidroxivitamina D en lactantes. Relación con la lactancia materna.

OBJECTIVE: To determine the prevalence of subclinical vitamin D deficiency among infants in Valencia, Spain (latitude 39.5 degrees N) and its relation with breast- feeding. MATERIAL AND METHODS: Serum levels of calcium, phosphate, alkaline phosphatase, 25-hydroxyvitamin D (25-OHD) and intact parathyroid hormone (PTH) were measured in 60 term infants aged between 1 and 6 months (mean age: 3.9 months), with no known bone, gastrointestinal or renal disease (33 exclusively breast-fed, 27 bottle-fed). Data on vitamin D supplementation and weekly direct sunlight exposure were also gathered. RESULTS: All infants had normal serum calcium, phosphate and PTH levels. Five infants (8.3 %) had 25-OHD levels < 10 ng/ml (lower limit of normality) and all of these infants were breast-fed (15.1 % of the group). None of these five infants received vitamin D supplementation. Infants with vitamin D deficiency had slightly elevated serum alkaline phosphatase. Only 48 % of breast-fed infants received regular vitamin D supplementation. The mean serum 25-OHD concentration of breast-fed infants in winter (16.8 ng/ml) was significantly lower than that in bottle-fed infants in summer (23.6 ng/ml, p < 0.05). CONCLUSIONS: In breast-fed infants, the association of limited sunshine exposure and poor dietary vitamin D supplementation confers a high risk of subclinical vitamin D deficiency, even in regions with a temperate climate.

Análisis de factores de riesgo cardiometabólicos y nutricionales en pacientes diabéticos tipo 2 e hipertensos esenciales usuarios de atención privada y pública / Analysis of cardiometabolic and nutritional risk factors in patients with diabetes type 2 and essential hypertension users of private and public care

La enfermedad cardiovascular es una de las principales causas de morbimortalidad en Chile, según resultados entregados por la Encuesta Nacional de Salud 2017 un 3,3% de la población ha presentado un infarto agudo al miocardio, un 2,6% reporta haber sufrido un ataque cerebrovascular, el 74% de los chilenos presenta obesidad y un 87% sedentarismo, siendo la diabetes mellitus tipo 2 (DM2) con un 12% y la hipertensión arterial con un 28% resultados que preocupan por su importante incremento. La investigación tuvo un diseño observacional de corte transversal. Se realizó en 69 pacientes con DM2 e hipertensos esenciales, entre 40 y 80 años de edad, pertenecientes al Sistema salud municipal (SMS) y privado (SPS) en la ciudad de Iquique. Se realizó encuesta alimentaria, medición antropométrica y exámenes bioquímicos y presión arterial. Al analizar ambos grupos se destaca los siguientes resultados: actividad física 17,24% SPS y 42,5% en SSM, presión arterial controlada 55,2% SPS y 87,5% en SSM, control de hemoglobina glicosilada 26,9% SPS y 52,5% en SSM, colesterol total alterado 17,9% SPS y 45% en SSM, síntomas depresivos 96,5% SPS y 26,3% en SSM. Se evidenció una prevalencia de mal nutrición por exceso de un 89,7% SPS y 95% SSM, riesgo cardiovascular (RCV) según circunferencia de cintura (CC) 96,5% SPS y 92,3% SSM. En relación a la encuesta alimentaria se observó que un 44,8% en usuarios SPS y 52,5% de SSM presentaron consumo alimentario hipercalórico. Los usuarios de atención privada y pública presentaron factores de riesgo cardiovascular, donde destacan la obesidad, sedentarismo y RCV según CC. Al comparar ambos grupos los usuarios SPS presentan menor control metabólico de su enfermedad y factores de riesgo cardiovascular aumentados en relación a los usuarios SSM.

Cardiovascular disease is one of the main causes of morbidity and mortality in Chile, according to the results provided by the 2017 National Health Survey, 3.3% of the population has presented acute myocardial infarction, 2.6% reported have suffered a cerebrovascular accident, 74% of Chileans are obese and 87% have sedentary behavior, belonging to type 2 diabetes mellitus (DM2) into 12% and arterial hypertension into 28%, alarming results due to their significant increase. The research had a cross-sectional observational study design. 69 patients with DM2 and essential hypertensive patients, between 40 and 80 years of age were studied, belonging to the municipal (SSM) and private (SPS) health systems in the city of Iquique. A food intake survey, anthropometric measurements, and biochemical and blood pressure tests were taken. When analyzing both groups, the following results stand out: physical activity 17.24% in SPS and 42.5% in SSM, controlled blood pressure 55.2% in SPS and 87.5% in SSM, controlled glycosylated hemoglobin 26.9% in SPS and 52.5% in SSM, altered values of total cholesterol 17.9% in SPS and 45% in SSM, depression symptoms 96.5% in SPS and 26.3% in SSM. Prevalence of malnutrition due to excess 89.7% in SPS and 95% in SSM, cardiovascular risk (RCV) according to waist circumference (CC) 96.5% in SPS and 92.3% in SSM were evidenced. In relation to the food intake survey, it was observed that 44.8% of SPS users and 52.5% of SSM users consume hypercaloric diet. The users of private and public care presented cardiovascular risk factors, where the obesity, sedentary lifestyle and RCV related to CC stand out. When comparing both groups, SPS users have less control of their disease in relation to SSM users.

[Underlying causes of recurrent pneumonia]. / Causas subyacentes de neumonía recurrente.

OBJECTIVE: To determine the relative frequency and describe the predisposing causes of recurrent pneumonia in infants and children aged between 1 month and 14 years. METHODS: We retrospectively reviewed the medical records of a tertiary care pediatric hospital covering a 10-year period, from January 1994 through December 2003. Children with cystic fibrosis were not included in the analysis. Recurrent pneumonia was defined as at least two pneumonia episodes in a 1 year period or at least three episodes over a lifetime. RESULTS: Of 1644 children hospitalized with pneumonia, 106 (6.4 %) met the criteria for recurrent pneumonia. An underlying cause was identified in 92 patients (86.7 %). Of these, the underlying cause was diagnosed prior to pneumonia in 67 (72.8 %), during the first episode in 12 (13 %) and during recurrence in 13 (14.1 %). Underlying causes included asthma in 28 patients (30.4 %), congenital cardiac defects in 27 patients (29.3 %), aspiration syndrome in 25 patients (27.1 %), immune disorder in nine patients (9.7 %), pulmonary anomalies in two patients (2.1 %), and anhidrotic ectodermal dysplasia in one patient (1 %). CONCLUSIONS: Recurrent pneumonia occurred in 6.4 % of all children hospitalized for pneumonia. The underlying cause was identified in 86.7 % of the children. The most common causes were asthma, congenital cardiac defects, and aspiration syndrome.

The bronchitis index. A semiquantitative visual scale for the assessment of airways inflammation.

Flexible fiberoptic bronchoscopy has been proven to be an effective tool for the assessment and characterization of airway inflammation. Visual inspection of airways affected by chronic bronchitis discloses an abnormal appearance characterized by erythema, edema, secretions, and friability. It was hypothesized that the visual appearance of airway inflammation could be assessed in a semiquantitative manner. A bronchitis index (BI) was developed that scores the visual appearance of airways according to the presence or absence of abnormal edema, erythema, secretions, and friability (0 = normal, 3 = remarkably abnormal). The BI was determined in three study groups: 86 subjects with chronic bronchitis, 15 subjects who smoked cigarettes, but did not have chronic bronchitis, and 25 normal, nonsmoking control subjects. The reproducibility of the BI was determined by comparing the results from pairs of two independent observers assessing 249 subjects undergoing fiberoptic bronchoscopy under various investigative protocols. In total, nine investigators scored the airways. For the three observer pairs with more than six observations, there were no differences noted in the BI (p = 0.43, 0.67, 0.82). To control for the effect of cough upon the BI, lidocaine usage was recorded. No correlation was found between lidocaine usage and BI. As previously noted for a smaller group of subjects, the BI was found to be elevated in those with chronic bronchitis (13.2 +/- 0.53) compared with both asymptomatic smokers (8.5 +/- 0.89, p < 0.0005) and normal volunteers (2.3 +/- 0.55, p < 0.0001); the latter two groups also differed significantly (p < 0.0001). The BI was also found to correlate significantly with bronchial sample lavage fluid neutrophil content in lavage fluid obtained after determination of the BI and with cigarette smoking as quantitated by pack years. Conversely, the BI correlated negatively with the spirometric measures of airway obstruction, FEV1, FEV1/FVC, FEV25-75, and FEFmax. Thus, the BI appears to be a reproducible, semiquantitative assessment of the visual appearance of airway inflammation. It may be a useful bronchoscopic adjunct for the assessment of airway inflammation in clinical investigations.

Protease injury in airways disease.

In summary, proteases are present in the airway in inflammatory airways disease. These enzymes can damage the airway epithelium. As a consequence, airway function can be altered, and long-term changes in airway anatomy can result. Although the exact cellular and biochemical mechanisms that lead to these changes are incompletely described, it seems likely that they will play important roles in clinical airways disease. As such, these pathways may represent novel opportunities for therapeutic intervention.

A field evaluation in Mexico of four baits for oral rabies vaccination of dogs.

We evaluated four baits for the delivery of oral rabies vaccines to dogs. In a controlled study in a town in rural Mexico, 177 randomly selected dogs were assigned to receive one of four experimental baits (two of which were developed by the Denver Wildlife Research Center [DWRC]): one of two cylindrical polyurethane sponges with a corn meal coating (one fried in corn oil [DWRC-corn], the other in fish oil [DWRC-fish]), a fish-flavored polymer bait, or a wax bait. Each dog was also offered a commercial dog biscuit. We recorded whether or not the bait was completely consumed, and used the following measures to estimate the amount of oropharyngeal contact with each bait: total chewing time, presence of pieces of bait on the ground following administration, the total area of ground surrounding the location of ingestion that was covered with green dye contained in each bait, and condition of ampules that contained the dye. The dog biscuits were completely consumed significantly more often than the baits (155 of 176 [88%] for the biscuits versus 89 of 176 [50.5%] for the four baits; P less than 10(-6)), but were chewed for a significantly shorter time than the baits (mean time 34 sec for the biscuit versus 60-82 sec for the four baits: P less than 0.001). The ideal bait would probably combine the attractiveness of the commercial biscuit and the ability of the sponge baits to promote contact with the mucous membranes.

Prevention of canine rabies in rural Mexico: an epidemiologic study of vaccination campaigns.

We compared three vaccination strategies in three rural communities in Mexico to determine the factors associated with the success of vaccination programs in areas where canine rabies is poorly controlled. In town A, intensive publicity and community participation were used; owners were instructed to bring their dogs to temporary centralized clinics for vaccination. In town B, only brief precampaign publicity was used, followed by vaccination at a centralized site. Minimal publicity was also used in town C, but the vaccination campaign was conducted house to house. A total of 5,426 residents and 1,597 dogs were counted in the three towns (mean human:dog ratio 3.4:1). In Town A, 70.1% (472 of 673) of the dogs were vaccinated; the campaign required 40 person-minutes per dog. Significantly greater proportions were vaccinated in town B (262 of 318 [82.4%]; P less than 0.001) and town C (483 of 561 [86.1%]; P less than 0.00001); each of these latter campaigns required 10 person-minutes per dog. The following factors were positively associated (by multivariate analyses) with vaccination of individual dogs: non-intensive publicity, house-to-house vaccination, dogs owned by a single member of the household, and dogs acquired greater than 15 days after birth. Intensive publicity did not increase the overall success of the vaccination program; the efficiency of centralized versus and house-to-house vaccination was comparable.

Indirect immunofluorescent assay (IFA) in buffy coat as a rapid diagnostic test for invasive candidiasis.

In order to have a diagnostic test for invasive candidiasis, an immunofluorescent assay (IFA) in buffy coat was developed and evaluated. This test was compared to buffy coat culture and blood culture. The study was divided into two parts: evaluation of the diagnostic test in a rabbit model, and for diagnosis in patients at high risk for invasive candidiasis. Part I: Rabbits were experimentally infected. Of 13 rabbits with disseminated candidiasis blood was drawn from central venous catheter and from peripheral veins. From catheters, Candida was detected in 13/13, 10/13 and 8/13, by buffy coat culture, IFA, and blood culture, respectively. From peripheral veins, Candida was detected in 10/10 by buffy coat cultures, in 6/10 by IFA and in 3/10 by blood cultures. The gold standard was histopathological diagnosis; sensitivity for IFA was 60% with peripheral blood and 76% with catheter blood samples. Part II: IFA and blood cultures were compared in clinical samples from hospitalized children. Forty patients were included. Candida was isolated from blood cultures in four patients whereas IFA detected Candida in 22 patients. Differences were statistically significant (p < 0.05). We conclude that IFA in buffy coat smears is a reliable test to detect candidemia, and would be a useful tool to help physicians with treatment decisions with amphotericin B.

Nasoenteric feeding tubes in critically ill patients (fluoroscopy versus blind).

Numerous complications have been encountered with small-bore nasoenteric feeding tubes, some potentially life threatening. Patients particularly at risk are those with anatomic abnormalities, debilitation, or neurologic impairment. Fluoroscopy has been reported to be a safe, efficacious modality for the placement of these tubes. Thirty critically ill patients were studied to assess caloric delivery, costs, and complications associated with both fluoroscopically and blindly placed feeding tubes. All patients had either a tracheostomy or an endotracheal tube. They were randomized to group A (fluoroscopy) or group B (blind). Caloric delivery was greater in group A patients on days 1 through 5, with statistically significant differences on days 1 through 4. The mean daily calories per patient over the study period was 1135 +/- 96 and 662 +/- 110 (mean +/- SEM) in groups A and B, respectively (P < 0.01). Costs were similar in both groups. The most frequent problems encountered were difficult insertion, tubes requiring replacement, and failure to intubate the duodenum. We conclude that critically ill patients intubated either endotracheally or with tracheostomy should have nasoenteric feeding tubes placed with the guidance of fluoroscopy.

[Natural and unnatural history of the univentricular heart]. / Historia natural y modificada del corazón univentricular.

We examined the cases of 90 patients found to have univentricular heart at catheterization from January 1971 to January 1988. These patients are the 3.8% of the 2,322 children diagnosed of congenital heart disease by catheterization and angiography in this 17-year period of time. The mean follow-up was 9.5 years. The prognosis is poor: of the 90 patients, 50 died (55.5%) 43 of them in the first year of life. The actuarial survival rate is only the 38.5% at 5 years. Between the 56 children unoperated the mortality rate was the 62.5% and only the 16% (9 patients) survived with good functional results, class I and II of the New York Heart Association. The earlier palliative surgery changes the prognostic and the adverse natural history. The mortality rate in the operated group was the 44.1%. Another 44.1% (15 patients) of the operated group survived, 14 patients in class II and one in class III. The systemic-pulmonary artery shunts are the elective surgical procedure for important pulmonary stenosis, and the Fontan-type procedure is the elective for posterior, definitive repair.

[Mortality and survival in total anomalous pulmonary venous drainage]. / Mortalidad y supervivencia en el drenaje venoso pulmonar anómalo total.

The results in the management of 36 cases of isolated total anomalous pulmonary venous connection are presented. This patients are the 1.55% of the 2,322 children diagnosed of congenital heart disease by catheterization and angiography in our hospital at the 1971-1988 period. Nineteen had a type I, five a type II, eight a type III and four a mixed type lesion. The total mortality rate was 63.8%. Twenty six infants underwent surgical correction at a mean age of 2.5 months with an operative mortality rate of the 57.7%. Eleven infants survived operation. There have been no late deaths but one children developed stenosis at the anastomosis. The final actuarial survival rate was the 34.4% in the total group and the 42.3% in the operated group. The strongest determinants of survival were the type of lesion and pulmonary venous obstruction. No improving in the total and the surgical results has been observed in the last 10 years.

[Involuntary weight loss as a clinical problem]. / La pérdida ponderal involuntaria como problema clínico.

Weight loss can herald the existence of an underlying serious disease. The purpose of this study was to ascertain the frequency of the involuntary weight loss at the Internal Medicine inpatient service of our Institution and the different conditions associated with it. The study was undertaken from March 1984 to February 1985. All patients who had lost at least 10% of their total body weight 6 months prior to admission were included. Those patients who had an evident organic disease, which could explain their weight loss, were excluded. A complete clinical history was performed in all cases; additional data concerning family and employment aspects and symptoms of depression were recorded. The evaluation also included screening laboratory examinations and specific diagnostic procedures. The study group consisted of 50 patients, 32 males and 18 females whose average age was 57.6 and 62.5 years, respectively. Mean average percentage of weight loss was 19%. The involuntary weight loss turned out to be clearly related to an organic cause in only 17 patients (34%), five of which had a malignant neoplasm. On the other hand, in 21 cases, factors such as stress inductors and depression seemed directly related to the involuntary weight loss. It is concluded that malignant diseases are not the pathology most frequently associated with unexplained involuntary weight loss in our Institution. Differential diagnosis must consider other organic and psychiatric disorders. Particular attention should be paid to those data relative to dietary habits, the patient's family and symptoms of depression in order to attain a more integral view of the patients.

Factores de riesgo cardiovascular en la población Aymara rural del norte de Chile / Prevalence of cardiovascular risk factors in a rural Aymara population from northern Chile

Background: Some rural non-Caucasian ethnic groups have genetic protective factors for the development of chronic non-communicable diseases. Studies performed in Mapuche and Aymara ethnic groups in Chile, found significantly lower prevalence rates. Aymaras are the second most common ethnic population in Chile. Aim: To determine the prevalence of cardiovascular risk factors in a native Aymara ethnic population. Material and Methods: We studied 276 native Aymara people with a median age of 53 years (63% women), registered in the rural clinics of Camiña and Putre. The frequency of hypertension, Type 2 Diabetes Mellitus (DM2), dyslipidemia, overweight, obesity and smoking were determined. Results: The frequency of overweight and obesity was 38% and 38.4% respectively. The prevalence of hypertension and DM2 were 18.5% and 6.9% respectively. Thirty-five percent had elevated total cholesterol, 21% had high LDL cholesterol, 48% had low HDL cholesterol and 45.7% had high triglyceride levels. Two percent smoked. Conclusions: In this group of Aymara individuals, we found a markedly lower prevalence of hypertension and DM2, despite the high prevalence of obesity and dyslipidemia.