Riesgo de uso indebido de opioides prescritos en pacientes con dolor crónico no oncológico en un hospital del sistema mutual en Chile / Risk of misuse of prescribed opioids in patients with chronic non-cancer pain in a workers compensation system hospital in Chile

Introducción:En algunos países el uso indebido de opioides está aumentando considerablemente, sin embargo en Chile no hay datos oficiales. El objetivo de este estudio fue identificar y describir a todos los pacientes en tratamiento por dolor crónico no oncológico (DCNO) con riesgo de uso indebido de opioides del Departamento de Rehabilitación del Hospital del Trabajador, Santiago de Chile, entre el 14 de agosto de 2018 y el 2 de febrero de 2020.Material y métodos:Se realizó un estudio descriptivo transversal en 120 pacientes usuarios de opioides, con diagnóstico de DCNO. Se les aplicó una encuesta estructurada para caracterizarlos en base a datos demográficos, clínicos, uso indebido de opioides (COMM(r)) y calidad de vida relacionada con salud (SF 36 v.2).Resultados:Se encontraron 35 pacientes (29,17 %) con riesgo de uso indebido de opioides. La mediana de edad fue de 50,7 años. El tiempo medio de consumo de opioides fue de 32,4 meses. El tramadol en asociación con paracetamol fue el opioide más utilizado. Se observó un mayor uso indebido, estadísticamente significativo, en los pacientes con diagnóstico de amputación (p = 0,026) y consumo de alcohol (p = 0,003). Además, el uso indebido se asoció de manera significativa con una menor puntuación en los dominios de rol físico (p = 0,0299), salud general (p = 0,0166), vitalidad (p = 0), salud mental (p = 0) y puntuación global de la escala SF 36 (p = 0,0003).Conclusión:Nuestro estudio arrojó una prevalencia de un 29,1 % de riesgo de uso indebido de opioides, siendo esta similar a la encontrada en la literatura. Existe una relación entre uso indebido de opioides y consumo de alcohol, diagnóstico de amputación y una menor calidad de vida, lo que genera una mayor discapacidad en estos pacientes. Este es el primer informe en Chile al respecto.(AU)

Introduction:In some countries, the abuse of opioids is increasing considerably, however, in Chile there is no official data. The aim of this study was to identify and to describe all patients in treatment for chronic non-cancer pain (CNCP) at risk of opioid misuse within the Rehabi­litation Department of Hospital del Trabajador, Santiago de Chile, from August 14, 2018 to February 02, 2020.Material and methods:A descriptive cross-sectional study was carried out in 120 opioid users with a diagnosis of CNCP. A structured survey was applied to characterize them based on demographic, clinical data, opioid misuse (COMM(r)), and health-related quality of life (SF 36 v.2).Results:We found 35 patients (29.17 %) with risk of opioid abuse. The median age was 50.7 years. The mean time of opioid consumption was 32.4 months. Tramadol in association with paracetamol was the most widely used opioid. Statistically significant increased misuse was observed in patients diagnosed with amputation (p-value = 0.026) and alcohol use (p-value = 0.003). Furthermore, misuse was significantly associated with a lower score in the domains of physical role (p-value = 0.0299), general health (p-value = 0.0166), vitality (p-value = 0), mental health (p-value = 0) and global score of the SF 36 scale (p-value = 0.0003).Conclusion:Our study showed a 29,1 % prevalence of risk of opioid misuse, which is similar to that found in the literature. There is a relationship between opioid misuse and alcohol consumption, amputation diagnosis, and a lower quality of life, which generates greater disability in these patients. This is the first report in Chile.(AU)

Niveles de vitamina D en pacientes con lesión medular traumática en Chile / Vitamin D levels in patients with traumatic spinal cord injury in Chile

Introducción. La vitamina D cumple un importante rol en el metabolismo óseo y en diversas funciones a nivel extraesquelético. El objetivo de este estudio es determinar la prevalencia de hipovitaminosis D en pacientes con lesión medular traumática (LMT) y describir su asociación con las características de la LMT y demográficas de los pacientes. Material y método. Estudio descriptivo prospectivo en 76 pacientes del Departamento de Rehabilitación del Hospital del Trabajador entre el 30 de julio 2015 y el 30 de julio de 2016. Se realizó la medición de 25-hidroxivitamina D (25-OH-D) en sangre mediante el método de radioinmunoanálisis y una encuesta estructurada a los pacientes. Los resultados se analizaron mediante estadística descriptiva, prueba de Kruskall Wallis, rangos signados de Wilcoxon, Chi cuadrado, Fisher y análisis de correlación de Spearman. Resultados. La mediana de la edad fue 49,5 años (±DE 15,05), el tiempo de evolución de LMT entre un mes hasta 36 años. El promedio de 25-OH-D fue 16,4ng/mL (4,2 - 45,9ng/mL). El 94,7% de los sujetos presentaban hipovitaminosis D (<30 ng/mL) y un 27,6% deficiencia severa (<10 ng/mL). No se encontraron diferencias significativas entre la asociación de hipovitaminosis con sexo, nivel y grado de compromiso de LMT, estación del año, tiempo de exposición al sol y zona donde habitan. Existe una correlación inversa con tendencia a disminuir los niveles de 25-OH-D por cada año de evolución de LMT (Ro=-0,33; p value=0,0040). Conclusión. La hipovitaminosis D es altamente prevalente en pacientes con LMT. Es importante diagnosticar oportunamente para su adecuada suplementación y disminuir la prevalencia de complicaciones (AU)

Introduction. Vitamin D plays an important role in bone metabolism and in various extra-skeletal functions. The aim of this study was to determine the prevalence of vitamin D deficiency in patients with traumatic spinal cord injury (TSCI) and to describe its association with the characteristics of TSCI and patients’ demographic characteristics. Material and method. A prospective descriptive study was conducted in 76 patients treated at the Rehabilitation Department of Hospital del Trabajador between July 30, 2015 and July 30, 2016. Blood measurement of 25-hydroxyvitamin D (25-OH-D) was performed by the radioimmunoassay method and a structured survey. The results were analysed using descriptive statistics, the Kruskall-Wallis test, Wilcoxon signed-rank test, chi-square test, Fisher test and Spearman rank correlation coefficient. Results. The median age was 49.5 years (SD 15.05) and the time from TSCI was between 1 month and 36 years. The mean 25-OH-D level was 16.4ng/mL (4.2-45.9ng/mL). Vitamin D deficiency (<30 ng/mL) was found in 94.7% of the participants and severe deficiency (<10ng/mL) in 27.6%. No significant differences were found between the association of vitamin deficiency with sex, neurologic level, or severity of TSCI, season, amount of time of sun exposure or geographical area of residence. There was s an inverse correlation with a tendency to decrease 25-OH-D for each year from the onset of TSCI (Ro=-0.33, p value=.0040). Conclusion. Vitamin D deficiency is highly prevalent in patients with TSCI. An early diagnosis is important to provide adequate supplementation in order to decrease the prevalence of complications (AU)

[The prevalence of irritable bowel symptoms in a population of shopping mall visitors in Santiago de Chile]. / Prevalencia de síntomas de intestino irritable en población asistente a centros comerciales de Santiago de Chile.

BACKGROUND: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain or discomfort that is associated with altered bowel habit. Both its prevalence and clinical characteristics vary throughout Latin America. A percentage of patients does not seek medical attention, therefore a reliable prevalence figure can only be established by interviewing non-selected populations. AIMS: To study the prevalence and clinical characteristics of IBS symptoms in non-selected subjects in Santiago, Chile. METHODS: A total of 437 shopping mall visitors above the age of 15 years (246 women) participated in the study by answering the Rome II validated questionnaire for IBS. The demographic and socioeconomic backgrounds, comorbidities, and a family history of IBS were registered. RESULTS: A total of 64.1% subjects reported having gastrointestinal symptoms and 28.6% had symptoms suggestive of IBS. When the subjects with IBS symptoms were compared with the asymptomatic individuals, a predominance of women (65.6 vs. 42.9, P<.001) and a greater cholecystectomy frequency (33.6 vs. 12.9% P<.05) were observed in the former. The age of symptom onset was 30.4 years. An equal percentage of subjects (42.4%) presented with diarrhea and constipation and 15.2% presented with alternating IBS. Participants with a higher educational level reported a lower percentage of IBS (P<.05). A family history of the disease was present in 40% of the subjects with IBS, compared with 14.9% in the asymptomatic individuals (P<.05). Only 39.2% of the subjects had seen a physician for their symptoms and the treatment and tests ordered were inappropriate. CONCLUSION: The prevalence of IBS symptoms in the population studied is one of the highest described. Therefore, health teams should have the necessary knowledge and skill required for its management.