[Exposure to nitrates in drinking water and its association with thyroid gland dysfunction]. / Exposición a nitratos en agua y su relación con disfunción de la glándula tiroides: revisión sistemática ¿Existen riesgos para la salud de la población?

BACKGROUND: Nitrate exposure may be associated with thyroid gland dysfunction. AIM: To review the available evidence about the relationship between nitrates in drinking water and thyroid gland dysfunction. MATERIAL AND METHODS: A wide search was performed using Medline, Cochrane, Lilacs, IBECS and Scielo databases using pertinent keywords, finding a total of 66 related studies. After filtering and in depth reviewing, a total of 12 studies were included in this review. RESULTS: The main results reveal the importance of this ion for human health, finding evidence both in animals and human beings that suggest pathological changes in the gland as its relationship with the occurrence of subclinical hypothyroidism, and potentially cancer of the thyroid gland. In Chile, nitrate is not considered a critical contaminant so its regular measuring and control is not enforced. CONCLUSIONS: In light of the present review we believe that there is evidence to consider nitrate as a critical contaminant whose measurement, registration and correct implementation of valid policies would have a direct benefit for the population of this country. Without this information, it is not possible to quantify the damage to human health, especially in vulnerable groups residing in areas at greatest risk of exposure.

Exposición a nitratos en agua y su relación con disfunción de la glándula tiroides: revisión sistemática ¿Existen riesgos para la salud de la población? / Exposure to nitrates in drinking water and its association with thyroid gland dysfunction

Background: Nitrate exposure may be associated with thyroid gland dysfunction. Aim: To review the available evidence about the relationship between nitrates in drinking water and thyroid gland dysfunction. Material and Methods: A wide search was performed using Medline, Cochrane, Lilacs, IBECS and Scielo databases using pertinent keywords, finding a total of 66 related studies. After filtering and in depth reviewing, a total of 12 studies were included in this review. Results: The main results reveal the importance of this ion for human health, finding evidence both in animals and human beings that suggest pathological changes in the gland as its relationship with the occurrence of subclinical hypothyroidism, and potentially cancer of the thyroid gland. In Chile, nitrate is not considered a critical contaminant so its regular measuring and control is not enforced. Conclusions: In light of the present review we believe that there is evidence to consider nitrate as a critical contaminant whose measurement, registration and correct implementation of valid policies would have a direct benefit for the population of this country. Without this information, it is not possible to quantify the damage to human health, especially in vulnerable groups residing in areas at greatest risk of exposure.

Vitamina D: ¿qué es lo que debe saber un traumatólogo? / Vitamin D: what should an orthopaedist know?

La única patología asociada al déficit de vitamina D fue durante el siglo XX el raquitismo. Nuevas consecuencias asociadas a esta deficiencia han surgido destacando la osteomalacia, mayor riesgo de fracturas, mayor incidencia de caídas en los adultos mayores y una peor coordinación neuromuscular. El propósito de la presente revisión es proporcionar una actualización dirigida a especialistas en ortopedia y traumatología, respecto a definiciones, beneficios, patologías relevantes y guías de manejo que el especialista debe conocer respecto a este problema.

The only condition related to vitamin D deficiency during the 20th century was rickets. New conditions associated with this deficiency have been increasingly reported including: osteomalacia, increased fracture risk, greater incidence of falls among the elderly population, and a worse neuromuscular coordination. The main purpose of this review is to present an update regarding the useful aspects for the orthopaedic community related to vitamin D deficiency, including definitions, benefits, significant diseases, and management guidelines that the specialist must know.

Salmonelosis pulmonar en una preescolar de 3 años / Pulmonary Salmonellosis in a preschool child of 3 years old

La salmonelosis es una enfermedad causada por bacterias del género Salmonella que puede manifestarse en las formas intestinal y extraintestinal, ocurriendo ésta última con más frecuencia en personas con factores de riesgo como inmunosupresión. Algunos serotipos producen el cuadro clínico conocido como fiebre tifoidea caracterizado por compromiso del estado general, síntomas gastrointestinales y complicaciones de distinto tipo como la neumonía, que se presenta en el 1 por ciento de los casos y que en la edad pediátrica afecta con más frecuencia a los niños entre las edades de recién nacidos y los cinco años.

Causalgia: caso clínico y revisión del tema / Causalgia: clinical case and literature review

El síndrome de dolor regional complejo tipo II (cuasalgia) corresponde a una condición crónica caracterizada por un fuerte dolor quemante, asociado a hiperactividad del sistema nervioso simpático. El factor desencadenante es la lesión parcial de un nervio periférico mayor o de sus ramas principales, producida generalmente después de un evento traumático. Su diagnóstico y manejo precoz son fundamentales para evitar complicaciones tardías con repercusiones funcionales y psicológicas. Se presenta un caso clínico complejo diagnosticado inicialmente como posible causalgia y se realiza una revisión del tema

Embarazo heterotópico: caso clínico / Heterotopic pregnancy: a clinical case

El embarazo heterotópico corresponde a la ocurrencia sumultánea de un embarazo normotópico asociado a un ectópico. Es un evento obstétrico poco frecuente, que tiene incidencia de 1:20.000 embarazos. Su diagnóstico es a menudo tardío, lo que trae repercuciones graves tanto para la madre como para el feto. Habitualmente se presenta en embarazos que ocurren después de una inducción de ovulación o en mujeres sometidas a algún tipo de fecundación asistida. Se presenta un caso clínico de embarazo intrauterino asociado a uno ectópico tubario complicado, en una paciente con duplicidad genital operada y sin inducción previa de la ovulación. Se revisa la literatura pertinente y se comentan algunos elementos importantes en el diagnóstico

Trombosis espontánea de la vena subclavia: sindrome de Paget-Schroetter: caso clínico / Spontaneus thrombosis of the subclavian vein: Paget-Schroetter' syndrome: a clinical case

La trombosis espontánea de la vena subclavia es un tipo poco frecuente de trombosis venosa profunda que afecta preferentemente a pacientes jóvenes y sin patología asociada. Entre los factores desencadenantes se ha propuesto la compresión extrínseca de la vena subclavia y los estados de hipercoagulabilidad. Se presenta un caso clínico y se comentan los aspectos propios de este tipo de trombosis profunda

Mejorando la calidad de la enseñanza de entrevista clínica: evaluación de una intervención en estudiantes de medicina / Improving the quality of interviewing teaching to medical students: an evaluation

Background: Quality of clinical interview is a key issue both for patient satisfaction and for diagnostic efficiency. Its adequacy relates to better clinical diagnosis treatment plans and patient compliance. Aim: To measure the quality of interviews performed by medical students in three Chilean medical schools before receiving specific training on the subject and to compare the scores obtained after introductory courses on interview. Material and methods: The interviews were videotaped and then evaluated using an objective scale, that measures 33 skills grouped in six areas: opening, problem exploration, non verbal facilitation, interpersonal. patient reaction and closing. The students were assigned to an experimental group that received an interactive workshop with roleplays, vignettes and videotape feedback, and to a non intervention group that received the usual bedside training on medical interviews. Results: Both groups shared the same skill level before the training, with better scores on nonverbal, patient reaction and problem exploration, and worse ones on closing and interpersonal skills. Comparing pre and post-test results, the overall score improved in the experimental group (from 33.2 to 38.3, p=0.002) and worsened among non intervened students. There were statistically significant changes for opening (p< 0.002), problem exploration (p< 0.05), non verbal facilitation (p< 0.0001) and closing (p< 0.0001). Conclusions: It is important to train students not only in specific knowledge contents but in the process of interview. This training should encourage the development of empathy and closing skills