Relación entre alfabetización en salud y autocuidado en estudiantes de enfermería en Concepción, Chile, CHILE / Relationship Between Health Literacy And Selfcare In Nursing Students In Concepción, Chile

El nivel bajo de alfabetización en salud constituye un problema de salud pública y se asocia con escaso conocimiento, mayor uso de los servicios públicos y menores conductas de autocuidado. La presente investigación busca determinar la relación entre alfabetización en salud y autocuidado en estudiantes de enfermería. El estudio presentó un diseño descriptivo-correlacional utilizando dos escalas validadas: “Cuestionario H1 Alfabetización en Salud” y “Escala de agencia de autocuidado”. El índice de alfabetización en salud se relaciona de manera positiva y estadísticamente significativa con el puntaje de autovaloración del estado de salud, confirmando así la relación entre ambas variables. (AU)

Low health literacy constitutes a public health problem associated with low knowledge, greater use of public services, and less self-care behaviors. This research examines the link between health literacy and nursing students' self-care. The study presented a descriptive-correlational design using two validated scales: the "H1 Health Literacy Questionnaire" and the "Self-care agency scale." The health literacy index is positively and statistically significantly related to the self-assessment score of the state of health, thus confirming the relationship between both variables. (AU)

Spanish translation, retranslation, and content validation of the Quality of Life in Alzheimer's Disease scale in patients with Alzheimer's dementia. / Traducción al español, retraducción y validación de contenido de la escala Quality of Life in Alzheimer's Disease en pacientes con demencia Alzheimer.

Introduction: It is estimated that by the year 2050, persons over 60 will account for 22% of the world population. Consequently, the incidence and prevalence of Alzheimer's disease will increase correspondingly. One of the pillars of the treatment of this condition is to improve the quality of life. In this sense, questionnaires such as the Quality of Life in Alzheimer's Disease allow us to measure the quality of life in patients and caregivers. Objective: To translate into Chilean Spanish and carry out the content validation of the Quality of Life in Alzheimer's Disease scale in patients with Alzheimer's dementia at the Guillermo Grant Benavente Hospital in Concepción, Chile. Methods: Translation, back-translation and content validity were carried out by expert judgment, using Lawshe analysis, pre-test and semantic validation using the respondent debriefing strategy. Results: The translated and retranslated versions were compared with each other and with the original version. Lawshe indicates that a Content Validity Ratio equal 0.49 is adequate to consider the item valid when 15 experts participated in the content validation process, as in our study. The analysis yielded a content validity ratio greater than 0.49 in 11 of the 13 items on the scale. Of these, 8 obtained a value greater than 0.8 and 3 between 0.49 and 0.79. In semantic validation using the respondent debriefing strategy, the scale was applied to five people with Alzheimer's and their respective caregivers. With the data obtained, modifications were generated in those items that obtained a content validity ratio of less than 0.49. Conclusions: The version obtained in Spanish of the Quality of Life in Alzheimer's Disease scale is valid from the point of view of its content and equivalent to its original version.

Introducción: Se estima que para el año 2050 los mayores de 60 años corresponderán al 22% de la población mundial y con ello aumente la incidencia y prevalencia de enfermedad de Alzheimer. Uno de los pilares del tratamiento de esta condición es mejorar la calidad de vida, en este sentido surgen herramientas como la Quality of Life in Alzheimer's Disease Scale que permite medir calidad de vida en pacientes y sus cuidadores. Objetivo: Realizar la traducción al español chileno y validación de contenido de la Quality of Life in Alzheimer's Disease Scale en pacientes con demencia por Alzheimer del Hospital Guillermo Grant Benavente de Concepción, Chile. Métodos: Se llevó a cabo la traducción, retraducción y validez de contenido por juicio experto, utilizando el análisis Lawshe, pre-test y validación semántica usando la estrategia de respondent debriefing. Resultados: Las versiones traducidas y retraducidas fueron comparadas entre ellas y con la versión original. Lawshe indica que una razón de validez de contenido de 0,49 es adecuado para considerar aceptable el ítem cuando en el proceso de validación de contenido han participado 15 expertos como en este estudio. El análisis arrojó una razón de validez de contenido mayor a 0,49 en 11 de los 13 ítems de la escala. De estos, ocho obtuvieron un valor superior a 0,8 y tres entre 0,49 y 0,79. En la validación semántica mediante la estrategia de se aplicó la escala a cinco personas con enfermedad de Alzheimer y a sus respectivos cuidadores. Con los datos obtenidos, se generaron modificaciones en aquellos ítems que obtuvieron una razón de validez de contenido menor a 0,49. Conclusión: La versión obtenida en español de la resulta ser válida desde el punto de vista de su contenido y equivalente a su versión original.

Traducción al español, retraducción y validación de contenido de la escala Quality of Life in Alzheimer's Disease en pacientes con demencia Alzheimer / Spanish translation, retranslation, and content validation of the Quality of Life in Alzheimer's Disease scale in patients with Alzheimer's dementia

Introducción Se estima que para el año 2050 los mayores de 60 años corresponderán al 22% de la población mundial y con ello aumente la incidencia y prevalencia de enfermedad de Alzheimer. Uno de los pilares del tratamiento de esta condición es mejorar la calidad de vida, en este sentido surgen herramientas como la Quality of Life in Alzheimer's Disease Scale que permite medir calidad de vida en pacientes y sus cuidadores. Objetivo Realizar la traducción al español chileno y validación de contenido de la Quality of Life in Alzheimer's Disease Scale en pacientes con demencia por Alzheimer del Hospital Guillermo Grant Benavente de Concepción, Chile. Métodos Se llevó a cabo la traducción, retraducción y validez de contenido por juicio experto, utilizando el análisis Lawshe, pre-test y validación semántica usando la estrategia de respondent debriefing. Resultados Las versiones traducidas y retraducidas fueron comparadas entre ellas y con la versión original. Lawshe indica que una razón de validez de contenido de 0,49 es adecuado para considerar aceptable el ítem cuando en el proceso de validación de contenido han participado 15 expertos como en este estudio. El análisis arrojó una razón de validez de contenido mayor a 0,49 en 11 de los 13 ítems de la escala. De estos, ocho obtuvieron un valor superior a 0,8 y tres entre 0,49 y 0,79. En la validación semántica mediante la estrategia de se aplicó la escala a cinco personas con enfermedad de Alzheimer y a sus respectivos cuidadores. Con los datos obtenidos, se generaron modificaciones en aquellos ítems que obtuvieron una razón de validez de contenido menor a 0,49. Conclusión La versión obtenida en español de la resulta ser válida desde el punto de vista de su contenido y equivalente a su versión original.

Introduction It is estimated that by the year 2050, persons over 60 will account for 22% of the world population. Consequently, the incidence and prevalence of Alzheimer's disease will increase correspondingly. One of the pillars of the treatment of this condition is to improve the quality of life. In this sense, questionnaires such as the Quality of Life in Alzheimer's Disease allow us to measure the quality of life in patients and caregivers. Objective To translate into Chilean Spanish and carry out the content validation of the Quality of Life in Alzheimer's Disease scale in patients with Alzheimer's dementia at the Guillermo Grant Benavente Hospital in Concepción, Chile. Methods Translation, back-translation and content validity were carried out by expert judgment, using Lawshe analysis, pre-test and semantic validation using the respondent debriefing strategy. Results The translated and retranslated versions were compared with each other and with the original version. Lawshe indicates that a Content Validity Ratio equal 0.49 is adequate to consider the item valid when 15 experts participated in the content validation process, as in our study. The analysis yielded a content validity ratio greater than 0.49 in 11 of the 13 items on the scale. Of these, 8 obtained a value greater than 0.8 and 3 between 0.49 and 0.79. In semantic validation using the respondent debriefing strategy, the scale was applied to five people with Alzheimer's and their respective caregivers. With the data obtained, modifications were generated in those items that obtained a content validity ratio of less than 0.49. Conclusions The version obtained in Spanish of the Quality of Life in Alzheimer's Disease scale is valid from the point of view of its content and equivalent to its original version.

Acute kidney injury in neurocritical patients: a retrospective cohort study.

BACKGROUND /OBJECTIVE: Acute kidney injury (AKI) is a significant complication in critical care units (CCU). Non-neurological complications such as AKI are an independent predictor of poor clinical outcomes, with an increase in morbidity and mortality, financial costs, and worse functional recovery. This work aims to estimate the incidence of AKI and evaluate the risk factors and complications of AKI in neurocritical patients hospitalized in the CCU. METHODS: A retrospective cohort study was conducted. Patients admitted to the neurocritical care unit between 2016 and 2018 with a stay longer than 48 h were retrospectively analyzed in regard to the incidence, risk factors, and outcomes of AKI. RESULTS: The study population comprised 213 neurocritical patients. The incidence of AKI was 23.5%, with 58% KDIGO 1 and 2% requiring renal replacement therapy. AKI was an independent predictor of prolonged use of mechanical ventilation, cerebral edema, and mortality. Cerebral edema [OR 4.40 (95% CI 1.98-9.75) p < 0.001] and a change in chloride levels greater than 4 mmol/L at 48 h (OR 2.44 (95% CI 1.10-5.37) p = 0.027) were risk factors for developing AKI in the first 14 days of hospitalization. CONCLUSION: There is a high incidence of AKI in neurocritical patients; it is associated with worse clinical outcomes regardless of the CCU admission etiology or AKI severity.

[Therapeutic plasma exchange. Experience in 102 patients]. / Intercambio plasmático terapéutico por plasmafiltración: experiencia de 11 años de un centro.

BACKGROUND: Therapeutic Plasma Exchange (TPE) is a procedure in which plasma and harmful macromolecules are separated from the rest of the blood components by centrifugation or filtration through membranes and are replaced with solutions with albumin and/or plasma. AIM: To communicate our experience using TPE by filtration. MATERIAL AND METHODS: Review of records of 655 TPE sessions performed in 102 patients aged 50 ± 18 years (64% women). The requirement of renal replacement therapy (RRT) and seven days and one year mortality were recorded. RESULTS: Forty five percent of patients had hypertension or diabetes. The main indications for TPE were pulmonary-renal syndrome (PRS) (62%) and antibody mediated graft rejection (29%), followed by neurological diseases (36%). Fifteen percent of patients required RRT for one year. Mortality at seven days and one year was 20 and 30%, respectively. Out of the total of deaths associated with kidney diseases, 88% corresponded to PRS and ANCA vasculitis. The main complications were thrombocytopenia in 41%, hypocalcemia in 18%, and hypotension in 16%. CONCLUSIONS: In our experience, TPE by filtration is a safe technique, with mild and preventable complications. Despite this, the reported mortality is high, which reflects the severity of the diseases that motivated the indication for TPE.

Resultados a siete años de la cirugía de reemplazo valvular aórtico en mayores de 80 años / Seven-year results of aortic valve replacement surgery in patients over 80 years of age

Resumen Objetivo: Describir las características clínicas y los resultados operatorios y a siete años del reemplazo valvular aórtico en una cohorte de pacientes mayores de 80 años. Materiales y métodos: Estudio descriptivo retrospectivo de 75 pacientes consecutivos mayores de 80 años, intervenidos de reemplazo valvular aórtico exclusivo entre 2007 y 2019 en el Hospital Guillermo Grant Benavente. Se estudian sus características demográficas, clínicas, ecocardiográficas, riesgo operatorio, cirugías, complicaciones y mortalidad operatoria y supervivencia alejada hasta el 15 de marzo 2021. Resultados: La edad media de la cohorte fue 83,05 ± 2,9 años (rango 80-95) y 43 pacientes eran mujeres (57,3%). La lesión valvular predominante fue la estenosis aórtica (89,3%). 10 pacientes tenían enfermedad coronaria asociada (13,3%) y 2 endocarditis activa. El riesgo de mortalidad operatoria calculado por EuroSCORE aditivo, logístico, II y STS score fue 7,58 ± 1,8; 9,88 ± 6,5%; 3,72 ± 3,5% y 4,27 ± 3,2%, respectivamente. Se utilizó prótesis biológica en 70 (92%) pacientes. Hubo 29 complicaciones operatorias y fallecieron 11 (14,7%) pacientes. El seguimiento promedio fue 7,1 años (rango 2-14), durante el cual fallecen 28 pacientes. La supervivencia a uno, tres y cinco años fue 82, 76, 66 y 48% respectivamente. Conclusiones: La cirugía de reemplazo valvular aórtico en octogenarios en nuestro medio es un procedimiento poco frecuente. La mortalidad observada fue mayor que la estimada por las escalas de riesgo. El reemplazo valvular quirúrgico es una alternativa de tratamiento de la enfermedad de la válvula aórtica en pacientes seleccionados. Se deben evaluar estrategias para mejorar los resultados.

Abstract Objective: To describe the clinical characteristics and operative and 7-year results of aortic valve replacement in a cohort of patients older than 80 years. Materials and methods: Retrospective descriptive study of 75 consecutive patients older than 80 years of age who underwent exclusive aortic valve replacement between 2007 and 2019 at the Guillermo Grant Benavente Hospital. Demographic, clinical, echocardiographic characteristics, operative risk, surgeries, complications and operative mortality and long-term survival until March 15, 2021 are studied. Results: The mean age of the cohort was 83.05 ± 2.9 years (range 80-95) and 43 patients were women (57.3%). The predominant valve lesion was aortic stenosis (89.3%). Ten patients had an associated coronary artery disease (13.3%) and 2 had active endocarditis. The risk of operative mortality calculated by EuroSCORE additive, logistic, II and STS score was 7.58 ± 1.8; 9.88 ± 6.5%; 3.72 ± 3.5% and 4.27 ± 3.2%, respectively. A biological prosthesis was used in 70 (92%) patients. There were 31 operative complications and 11 (14.7%) patients died. The mean follow-up was 7.1 years (range 2-14), during which 28 patients died. Survival at 1, 3, and 5 years was 82, 76, 66 and 48%, respectively. Conclusions: Aortic valve replacement surgery in octogenarians in our setting is a rare procedure. The observed mortality was higher than that estimated by the risk scales. Surgical valve replacement is an alternative treatment for aortic valve disease in selected patients. Strategies to improve results should be evaluated.

Intercambio plasmático terapéutico por plasmafiltración: experiencia de 11 años de un centro / Therapeutic plasma exchange: experience in 102 patients

BACKGROUND: Therapeutic Plasma Exchange (TPE) is a procedure in which plasma and harmful macromolecules are separated from the rest of the blood components by centrifugation or filtration through membranes and are replaced with solutions with albumin and/or plasma. AIM: To communicate our experience using TPE by filtration. MATERIAL AND METHODS: Review of records of 655 TPE sessions performed in 102 patients aged 50 ± 18 years (64% women). The requirement of renal replacement therapy (RRT) and seven days and one year mortality were recorded. RESULTS: Forty five percent of patients had hypertension or diabetes. The main indications for TPE were pulmonary-renal syndrome (PRS) (62%) and antibody mediated graft rejection (29%), followed by neurological diseases (36%). Fifteen percent of patients required RRT for one year. Mortality at seven days and one year was 20 and 30%, respectively. Out of the total of deaths associated with kidney diseases, 88% corresponded to PRS and ANCA vasculitis. The main complications were thrombocytopenia in 41%, hypocalcemia in 18%, and hypotension in 16%. CONCLUSIONS: In our experience, TPE by filtration is a safe technique, with mild and preventable complications. Despite this, the reported mortality is high, which reflects the severity of the diseases that motivated the indication for TPE.

Social Support, Stress and Emotional Symptoms Among LGBTQ+ College Students in Chile.

Objective: to compare the relationships between emotional symptomatology and perceived social support according to gender identity and sexual orientation in LGBTQ+ university students. Methods: 322 Chilean LGBTQ+ college students answered an online survey based on sociodemographic information and validated instruments. Analysis of variance and linear regressions were made. Results: Transgender people have more emotional symptoms and stress and less perceived social support from family than the rest of LGBTQ+ students. Depression and anxiety are negatively associated with perceived social support from friends and family. Conclusions: Perceived social support decreases emotional symptomatology even when controlling for current stress in LGBTQ+ students.

Resultados de la cirugía de reparación valvular mitral en el Hospital Guillermo Grant Benavente de Concepción (2009-2020) / Results of surgical mitral valve repair at Guillermo Grant Benavente Hospital, Concepción, Chile

Resumen: Objetivo: Describir las características clínicas, resultados operatorios inmediatos y a 5 años de la cirugía de reparación valvular mitral. Material y métodos: Estudio retrospectivo de la cohorte de pacientes operados de reparación valvular por insuficiencia mitral (IM) en el Hospital Guillermo Grant Benavente desde el 2009 hasta marzo 2020 (N=206). Se comparan los pacientes con IM primaria y secundaria en sus características clínicas, ecocardiográficas, técnicas quirúrgicas empleadas, cirugías asociadas, morbimortalidad operatoria, sobrevida y reintervenciones hasta el 30 de mayo de 2020. Resultados: 124(60,2%) hombres. Edad media 62,6±10,5 años. La IM fue primaria en 134 y secundaria en 72. En comparación con los pacientes portadores de IM primaria, aquellos con IM secundaria tuvieron más enfermedad coronaria (69,4% versus 11,9%; p<0,001) y mayor riesgo operatorio (EuroSCORE logístico 7,7±6,7 versus 5,2±7,3; EuroSCORE II 3,4±4,8 versus 2,4±4,7; p<0,001). El mecanismo más frecuente de IM primaria fue tipo II (65,7%) y en las secundarias fue el tipo III (48,6%) seguido del tipo I (30,6%). Las IM primarias se corrigieron principalmente con procedimientos para disminuir el prolapso (76,1%). En las secundarias la técnica más utilizada fue el implante de un anillo exclusivo (76,4%). Hubo 116 cirugías asociadas y 10 (4,9%) conversiones a reemplazo valvular. Hubo 57 complicaciones operatorias y fallecieron 12 (5,8%) pacientes, 5 (3,7%) con IM primaria y 7(9,7%) con IM secundaria. La sobrevivencia global a 5 años fue 83,5% (90% en las primarias y 78% en las secundarias) y hubo 6 reintervenciones. Conclusiones: La cirugía de reparación valvular, tanto en pacientes con IM primaria como secundaria, tuvo una baja mortalidad operatoria y excelentes resultados a 5 años.

Abstract: Aim: To describe the clinical characteristics, operative and long term results of surgical mitral valve repair. Material and methods: Retrospective study of the cohort of patients undergoing valve repair due to mitral regurgitation (MR) at the Guillermo Grant Benavente Hospital from 2009 to March 2020 (N = 206). Patients with primary and secondary MR were compared on clinical and echocardiographic characteristics, surgical techniques, associated surgeries, operative morbidity and mortality, survival and reinterventions up to May 30, 2020. Results: 124 (60.2%) were men. The average age was 62.6±10.5 years. Type of MR was primary in 134 and secondary in 72. Compared to patients with primary MR, those with secondary MR had more coronary artery disease (69.4% versus 11.9%; p <0.001) and greater operative risk (logistic EuroSCORE 7.7±6, 7 versus 5.2±7.3; EuroSCORE II 3.4±4.8 versus 2,4±4.7; p<0.001). The most frequent mechanism of MR was type II in primary (65.7%) and type III (48.6%) followed by type I (30.6%) in secondary MR. Primary MR was corrected mainly with procedures to decrease prolapse (76.1%). In secondary MR the main technique used was the implantation of an exclusive ring (76.4%). There were 116 associated surgeries and 10(4.9%) conversions to valve replacement. There were 57 operative complications and 12(5.8%) patients died, 5 (3.7%) with primary MR and 7 (9.7%) with secondary MR. Overall survival at 5 years was 83.5% (90% in primary MR and 78% in secondary MR) and there were 3 reoperations. Conclusions: Valve repair surgery in both primary and secondary MR patients was associated to a low operative mortality and excellent results at 5 year post surgery.

Resultados de la cirugía coronaria sin circulación extracorpórea en dos períodos de uso de la técnica / Off pump coronary artery surgery: comparison of two consecutive periods with the technique

OBJETIVO: Describir los resultados inmediatos y alejados de la cirugía coronaria sin circulación extracorpórea (CEC) y comparar los resultados de la estrategia de indicación de la técnica en dos períodos. PACIENTES Y MÉTODOS: Estudio retrospectivo de 428 pacientes intervenidos de cirugía coronaria sin CEC entre 2004 y 2019 en el Hospital Guillermo Grant Benavente. Se dividen en Grupo 1, período 2004-2008 (N=216) y Grupo 2, período 2009-2019 (N=212). Se estudiaron sus características clínicas, resultados quirúrgicos, morbi-mortalidad operatoria y eventos adversos al 31 de junio de 2019 y se compararon los resultados de los grupos a 5 años. RESULTADOS: No hubo diferencias en la distribución por sexo, edad, factores de riesgo y patologías asociadas entre los grupos. Hubo diferencias en las lesiones coronarias entre los Grupos 1 y 2: lesión de un vaso en 45 (20,4%) versus 125 (59%) y tres vasos en 75 (34,5%) versus 19 (9%) respectivamente (p<0,001). El riesgo operatorio por EuroSCORE logístico fue 3,3±3,95 versus 5,4±7,7 (p<0,001). Se confeccionaron 2,3±0,9 anastomosis distales en el Grupo 1 versus 1,3±0,6 en Grupo 2 (p<0,001). La tasa de complicaciones fueron 17,6% en el Grupo 1 y 5,7% en el 2 (p<0,001). La mortalidad operatoria globral fue 4 pacientes (0,9%). El seguimiento comprendió 9,2±3,8 años. La sobrevida a 10 años fue 76,9% y tasa de eventos cardiovasculares mayores 37,6%. No hubo diferencia entre los grupos a los 5 años. CONCLUSIONES: La selección de pacientes con anatomía más favorables o de mayor riesgo operatorio tuvo tasas de sobrevida y eventos similares a los observados con la estrategia menos selectiva a 5 años de seguimiento.

AIM: To describe the immediate and long-term results of off pump coronary artery surgery without cardiopulmonary bypass (OPCABG) comparing the results observed in two consecutive periods. PATIENTS AND METHODS: A retrospective study of 428 patients undergoing OPCABG between 2004 and 2019 at the Guillermo Grant Benavente Hospital. Group 1 patients operated between 2004 - 2008 (N = 216) and Group 2 operated between 2009 and 2019 (N = 212). RESULTS: There were no differences in sex, age, risk factors and co morbidities between groups. There were differences in the number of coronary lesions between groups: one vessel disease in 45 (20.4%) versus 125 (59%) and three vessels in 75 (34.5%) versus 19 (9%) in Group 1 vs Group 2, respectively (p <0.001). The operative risk for logistic EuroSCORE was 3.3 ± 3.95 in Group 1 versus 5.4 ± 7.7 in Group 2 (p <0.001). 2.3 ± 0.9 distal anastomoses were performed in Group 1 compared to 1.3 ± 0.6 in Group 2 (p<0.001). Adverse events occurred in 17.6% o patients in Group 1 compared to 5.7% in Group 2 (p<0.001). Overall, 4 patients died (0.9%). Mean overall survival at 10 years was 76.9% and the rate of major cardiovascular events was 37.6%, no differences being observed between groups. CONCLUSIONS: At 5 years of follow-up the selection of patients with more favorable anatomy or greater operative risk had similar survival rates and events than those observed with the least selective strategy.

[Coronary artery disease in pre and postmenopausal women. The influence of type 2 diabetes mellitus]. / Enfermedad coronaria en mujeres pre y postmenopáusicas y su relación con la diabetes mellitus tipo 2.

BACKGROUND: Postmenopausal women have higher severity of coronary heart disease (CHD) than premenopausal women and type 2 diabetes mellitus (T2DM) is an independent risk factor. AIM: To assess the severity of CHD in pre and postmenopausal patients undergoing coronary angiography and the impact of T2DM in both groups. MATERIAL AND METHODS: A coronary angiography was performed to 707 women due to suspected CHD during 2013 and 2014. Of these, 579 were older than 55 years and were considered as postmenopausal. Factors such as hypertension, obesity, smoking, creatinine and T2DM were registered. The severity of CHD in coronary angiography was evaluated according to the number of vessels with more than 50% stenosis. RESULTS: Compared to their postmenopausal counterparts, premenopausal women had less frequency of T2DM (31% and 42% p < 0.033), hypertension (52 and 78%, p < 0.001) and alteration of renal function (11 vs. 39%, p < 0.001). Absence of coronary lesions was found in 44 and 32% of premenopausal and postmenopausal women, respectively (p < 0.01). Premenopausal women with T2DM had a higher frequency of multi-vessel disease than those without the disease (25 and 4.5%, p < 0.001). The frequency of multi-vessel disease was higher in postmenopausal than premenopausal women (24 and 11%, p < 0.01). Hypertension, T2DM and renal involvement were associated with a higher frequency multiple vessel disease. CONCLUSIONS: The severity of CHD is higher in postmenopausal women and T2DM is associated with the disease.

Factores asociados a respuesta favorable de tratamiento corticoidal en pacientes con polirradiculoneuropatía desmielinizante inflamatoria crónica / Variables associated with a good response to steroids in chronic inflammatory demyelinating polyradiculoneuropathy

Background: The treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is based on corticosteroids, immunoglobulin and plasmapheresis. In our Health System, corticosteroids are commonly used as first line therapy for economic reasons and accessibility. However, the factors associated with a good response are not well known. Aim: To assess the association of demographic, clinical and laboratory variables with a favorable response to corticosteroid therapy in patients with CIDP. Material and Methods: Observational, descriptive, longitudinal and retrospective study of 33 patients with a diagnosis of typical, definitive or probable CIDP, treated with corticosteroids for at least six months. Results: Twenty-three patients had a good clinical response to corticosteroid treatment and 10 were non-responders. The variables significantly associated with a good response to steroids were a disease lasting less than 1 year prior to the start of treatment, the absence of axonal damage in electromyography a relapsing-recurrent course and a favorable response within two months of treatment. Conclusions: Most of these patients with CIDP had good response to corticosteroid therapy.

Impacto de diferentes medidas de mitigación en el curso de la pandemia de COVID-19 en Chile: proyección preliminar para el período del 14 de abril al 14 de mayo / Impact of mitigation measures on the COVID-19 pandemic in Chile: preliminary data for the period April 14 to May 14

RESUMEN Objetivo Modelar el curso de la pandemia COVID-19 en Chile y proyectar la demanda de recursos hospitalarios y letalidad en escenarios simulados: primero, recurriendo a distintas medidas de mitigación para contener la propagación en un mes -desde el 14 de abril hasta el 14 de mayo del 2020- y, segundo, en el supuesto contagio del 70% de la población, según edad, sin límite de tiempo. Métodos Utilizamos como base el número de contagios confirmados con SARS-CoV-2 en Chile hasta el 14 de abril del 2020 (8 273 casos, 94 muertes). Para los distintos escenarios, asumimos un número reproductivo básico que va desde R0=2,5 hasta R0=1,5. La proyección de la demanda hospitalaria y letalidad por edad se fundamentaron en reportes italianos y británicos. Resultados Estimamos que para el 14 de mayo del 2020 habría en Chile 2 019 775 contagiados y 15 068 fallecidos en ausencia de medidas de mitigación (R0=2,5). Al implementar medidas que reduzcan R0 a 1,5 (detección temprana y aislamiento de casos, cuarentena y distanciamiento social de mayores de 70 años), el número de contagios y letalidad disminuirían a 94 235 y 703 respectivamente. Sin embargo, la demanda hospitalaria aún sobrepasaría la capacidad de respuesta. La población de mayor riesgo la componen los mayores de 60 años. Conclusión Encontramos evidencia a favor de las medidas de mitigación implementadas por el Gobierno chileno. Sin embargo, medidas más estrictas son necesarias para no colapsar el sistema sanitario, que cuenta con menos recursos hospitalarios que los proyectados. Es esencial aumentar la capacidad hospitalaria en términos de equipamiento y entrenamiento del personal de salud.(AU)

ABSTRACT Objetive To model disease progression, healthcare demand and case fatality rate attributed to COVID-19 pandemic that may occur in Chile in 1-month time, by simulating different scenarios according to diverse mitigation measures hypothetically implemented. Furthermore, we aimed to estimate the same outcomes assuming that 70% of the population will be infected by SARS-CoV-2, with no time limit assumption. Methods We based on the number of confirmed COVID-19 cases in Chile up to April 14th 2020 (8 273 cases and 94 deaths). For the simulated scenarios we assumed basic reproduction numbers ranging from R0=2.5 to R0=1.5. The estimation of the number of patients that would require intensive care and the age-specific case fatality rate were based on data provided by the Imperial College of London and the Instituto Superiore di Sanità en Italia. Results If no mitigation measures were applied (R0=2.5), by May 25, Chile would have 2 019 775 cases and 15 068 deaths. If mitigations measures were implemented to decrease R0 to 1.5 (early detection of cases, quarantine, social distancing of elderly), the number of cases and deaths would importantly decrease. Nonetheless, the demand for in-hospital care including intensive care would exceed the available resources. Our age-specific analysis showed that population over 60 years are at higher risk of needing intensive care and death. Conclusion Our evidence supports the mitigation measures implemented by the Chilean government. Nevertheless, more stringent measures are needed to prevent the health care system's collapse due to shortfall of resources to confront the COVID-19 pandemic.(AU)

Enfermedad coronaria en mujeres pre y postmenopáusicas y su relación con la diabetes mellitus tipo 2 / Coronary artery disease in pre and postmenopausal women. The influence of type 2 diabetes mellitus

Background: Postmenopausal women have higher severity of coronary heart disease (CHD) than premenopausal women and type 2 diabetes mellitus (T2DM) is an independent risk factor. Aim: To assess the severity of CHD in pre and postmenopausal patients undergoing coronary angiography and the impact of T2DM in both groups. Material and Methods: A coronary angiography was performed to 707 women due to suspected CHD during 2013 and 2014. Of these, 579 were older than 55 years and were considered as postmenopausal. Factors such as hypertension, obesity, smoking, creatinine and T2DM were registered. The severity of CHD in coronary angiography was evaluated according to the number of vessels with more than 50% stenosis. Results: Compared to their postmenopausal counterparts, premenopausal women had less frequency of T2DM (31% and 42% p < 0.033), hypertension (52 and 78%, p < 0.001) and alteration of renal function (11 vs. 39%, p < 0.001). Absence of coronary lesions was found in 44 and 32% of premenopausal and postmenopausal women, respectively (p < 0.01). Premenopausal women with T2DM had a higher frequency of multi-vessel disease than those without the disease (25 and 4.5%, p < 0.001). The frequency of multi-vessel disease was higher in postmenopausal than premenopausal women (24 and 11%, p < 0.01). Hypertension, T2DM and renal involvement were associated with a higher frequency multiple vessel disease. Conclusions: The severity of CHD is higher in postmenopausal women and T2DM is associated with the disease.

[Impact of mitigation measures on the COVID-19 pandemic in Chile: preliminary data for the period April 14 to May 14]. / Impacto de diferentes medidas de mitigación en el curso de la pandemia de COVID-19 en Chile: proyección preliminar para el período del 14 de abril al 14 de mayo.

OBJETIVE: To model disease progression, healthcare demand and case fatality rate attributed to COVID-19 pandemic that may occur in Chile in 1-month time, by simulating different scenarios according to diverse mitigation measures hypothetically implemented. Furthermore, we aimed to estimate the same outcomes assuming that 70% of the population will be infected by SARS-CoV-2, with no time limit assumption. METHODS: We based on the number of confirmed COVID-19 cases in Chile up to April 14th 2020 (8 273 cases and 94 deaths). For the simulated scenarios we assumed basic reproduction numbers ranging from R0=2.5 to R0=1.5. The estimation of the number of patients that would require intensive care and the age-specific case fatality rate were based on data provided by the Imperial College of London and the Instituto Superiore di Sanità en Italia. RESULTS: If no mitigation measures were applied (R0=2.5), by May 25, Chile would have 2 019 775 cases and 15 068 deaths. If mitigations measures were implemented to decrease R0 to 1.5 (early detection of cases, quarantine, social distancing of elderly), the number of cases and deaths would importantly decrease. Nonetheless, the demand for in-hospital care including intensive care would exceed the available resources. Our age-specific analysis showed that population over 60 years are at higher risk of needing intensive care and death. CONCLUSION: Our evidence supports the mitigation measures implemented by the Chilean government. Nevertheless, more stringent measures are needed to prevent the health care system's collapse due to shortfall of resources to confront the COVID-19 pandemic.

[Variables associated with a good response to steroids in chronic inflammatory demyelinating polyradiculoneuropathy]. / Factores asociados a respuesta favorable de tratamiento corticoidal en pacientes con polirradiculoneuropatía desmielinizante inflamatoria crónica.

BACKGROUND: The treatment of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is based on corticosteroids, immunoglobulin and plasmapheresis. In our Health System, corticosteroids are commonly used as first line therapy for economic reasons and accessibility. However, the factors associated with a good response are not well known. AIM: To assess the association of demographic, clinical and laboratory variables with a favorable response to corticosteroid therapy in patients with CIDP. MATERIAL AND METHODS: Observational, descriptive, longitudinal and retrospective study of 33 patients with a diagnosis of typical, definitive or probable CIDP, treated with corticosteroids for at least six months. RESULTS: Twenty-three patients had a good clinical response to corticosteroid treatment and 10 were non-responders. The variables significantly associated with a good response to steroids were a disease lasting less than 1 year prior to the start of treatment, the absence of axonal damage in electromyography a relapsing-recurrent course and a favorable response within two months of treatment. CONCLUSIONS: Most of these patients with CIDP had good response to corticosteroid therapy.

[Exclusive coronary revascularization with both mammary arteries. Analysis of 73 patients]. / Resultados a 5 años de la revascularización exclusiva con dos arterias mamarias en pacientes con enfermedad coronaria multivaso.

BACKGROUND: Exclusive coronary revascularization with both mammary arteries could result in lower rates of adverse events in the long term. AIM: To describe the five-year evolution of a cohort of patients operated on with this technique. MATERIAL AND METHODS: Follow up analyzing survival of 73 patients aged 59 ± 9 years (82% men) who underwent exclusive coronary surgery with two mammary arteries between December 1,2010 and April 12,2017. We studied their clinical characteristics, surgical results, operative morbidity and mortality and adverse events up to June 30, 2018. RESULTS: Six patients had two-vessel lesions and 67 three-vessel lesions. The operative risk calculated by additive and logistic EuroSCORE was 2.5 and 2.3%, respectively. A mean of 3.75 anastomoses /patient were performed, 116 with left mammary artery (73 to the anterior descending artery, 38 to a diagonal artery and 5 for other objectives) and 158 with right mammary artery (69 to a first marginal artery, 23 to a second marginal artery and 64 to posterior descending artery). There was one case of mediastinitis and one (1.5%) patient died. The mean follow-up was 64.6 ± 23.7 months. The 5-year survival was 90.4%. CONCLUSIONS: Coronary revascularization with two exclusive mammary arteries allowed a complete revascularization of the heart with a low rate of complications and adverse effects at five years.

¿Son efectivas las intervenciones psicológicas para mejorar el control de la Diabetes Mellitus tipo 2 en adultos?: una revisión sistemática y metaanálisis / Psychological interventions for patients with type 2 diabetes mellitus. A systematic review and meta-analysis

Background Affordable interventions to improve metabolic control of Type 2-Diabetes Mellitus are increasingly necessary. Aim To review systematically the existing literature on the effects of psychological interventions on Type-2 Diabetes Mellitus compensation. Material and Methods We performed a systematic literature review and meta-analysis on the effectiveness of psychological interventions implemented for Type-2 Diabetes Mellitus patients. Research included the following electronic databases: PubMed, Bireme, Web of Science, SciELO, Embase, EBSCOhost, SCOPUS, Psychology Database. Results Most studies showed a decrease in the level of glycated hemoglobin after interventions, which applied different initiatives complementary to standard medical treatment. Mainly, these interventions encompassed training for self-monitoring and control of diabetes based on cognitive behavioral psychology, counseling, self-assessment and physical-spiritual work based on transpersonal psychology. Conclusions Psychological tools could be an adjunct to the standard medical treatment for patients with Type-2 Diabetes Mellitus, reducing glycated hemoglobin levels and improving self-regulation, disease awareness and adherence from the self-efficacy perception perspective.