Revista medica de Chile最新文献

{"title":"[Driving Equity: The Critical Need to Integrate Gender Perspectives in Medical Training and Organizational Culture].","authors":"Solange Rivera, Margarita Bernales, Andrea Cárdenas, Francisca Elgueta, Leonardo Estrada","doi":"10.4067/s0034-98872025000700539","DOIUrl":"https://doi.org/10.4067/s0034-98872025000700539","url":null,"abstract":"","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 7","pages":"539-540"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Relationship Between Sleep Quality, Smartphone Addiction, and Academic GPA in Medical Students].","authors":"Cristel Iona Kennedy Cuevas, Hugo Ariel Cabrera Britez, Keyla Noemí Vázquez Ovelar","doi":"10.4067/s0034-98872025000700475","DOIUrl":"https://doi.org/10.4067/s0034-98872025000700475","url":null,"abstract":"<p><p>Sleep quality and smartphone use are factors that could influence academic performance, since sleep deprivation decreases concentration and smartphone use is related to not planning work.</p><p><strong>Aim: </strong>To evaluate the relationship between sleep quality and smartphone addiction with the grade point average (GPA) in medical students.</p><p><strong>Methods: </strong>Analytical cross-sectional study. 181 medical students were included. Data were collected through an electronic survey. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), smartphone addiction with the Smartphone Addiction Scale - Short Version (SAS-SV) and GPA based on the average of the last semester. Chi2, t-test and Wilcoxon tests were used to analyze the relationship between the variables.</p><p><strong>Results: </strong>The students were 116 (64.09%) female and 65 (35.91%) male. The median age was 22 years (IQR 21-24). The ICSP results were 91 (50.28%) with poor sleep quality and 90 (49.72%) with good sleep quality. The SAS-SV results were 119 (65.75%) without smartphone addiction and 62 (34.25%) with smartphone addiction. The GPA was 3.96 (SD ±0.66). A significant difference was found between the GPA of the group of students without smartphone addiction and GPA of the group of students with smartphone addiction (p value 0.0007). A significant difference was also observed in the sleep efficiency of the group of students without smartphone addiction and the sleep efficiency of the group of students with smartphone addiction (p value 0.0425).</p><p><strong>Conclusion: </strong>The GPA and sleep efficiency are lower in medical students with smartphone addiction.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 7","pages":"475-484"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Chilean Healthcare Personnel During the War of the Pacific (1879-1884): Doctors Vicente Izquierdo Sanfuentes, Manuel Barros Borgoño, and Francisco Puelma Tupper].","authors":"Manuel E Cortés, Martín Lara, Jaime Zañartu","doi":"10.4067/s0034-98872025000700541","DOIUrl":"https://doi.org/10.4067/s0034-98872025000700541","url":null,"abstract":"","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 7","pages":"541-543"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Reflecting on the Pathophysiology of Idiopathic Pulmonary Fibrosis: The Role of Genetics and the Path Toward Personalized Therapy].","authors":"Felipe Reyes C, Daniel Ramos S, Matías Florenzano V, Hugo Valenzuela C, Juan Carlos Rodríguez D, Álvaro Undurraga P, Verónica Wolff C","doi":"10.4067/s0034-98872025000700527","DOIUrl":"https://doi.org/10.4067/s0034-98872025000700527","url":null,"abstract":"<p><p>Interstitial lung diseases are a heterogeneous group of disorders characterized by inflammation and/or fibrosis of the lung parenchyma, leading to a progressive loss of lung function. Idiopathic pulmonary fibrosis (IPF) is a representative model with a pathophysiology common to other types of pulmonary fibrosis.</p><p><strong>Aim: </strong>This review presents the pathophysiological mechanisms and existing and developing antifibrotic therapies of IPF.</p><p><strong>Method: </strong>Qualitative study through a narrative review of the pathophysiological phenomena of IPF and advances in antifibrotic therapy.</p><p><strong>Results: </strong>The role of the alveolar epithelium, fibroblast/myofibroblast activity, cellular senescence and aging, immune system activity, oxidation-reduction mechanisms and genetic characteristics have been identified, which reveal the complex pathophysiology of this disease. Currently, there are only two therapies available to mitigate the effects of pulmonary fibrosis, Pirfenidone and Nintedanib, and the development and research of other antifibrotic drugs is still pending.</p><p><strong>Conclusions: </strong>There are multiple pathophysiological phenomena in IPF. Understanding them is the basis for the development and evolution of antifibrotic therapies.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 7","pages":"527-538"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Co-Occurrence of Mental Health Problems in University Students and Their Relationship With Sociodemographic Variables].","authors":"Ignacio Lillo, Marcelo A Crockett, Antonia Errázuriz, Vania Martínez","doi":"10.4067/s0034-98872025000700505","DOIUrl":"https://doi.org/10.4067/s0034-98872025000700505","url":null,"abstract":"<p><p>Mental health problems during university years are highly prevalent and often co-occur. Studying the factors associated with the co-occurrence of mental health problems could contribute to the development of preventive and therapeutic interventions.</p><p><strong>Aim: </strong>To describe the co-occurrence of depressive symptoms, generalized anxiety symptoms, and problematic substance use among university students, and to analyze the relationship between sociodemographic factors and the presence of co-occurring mental health problems.</p><p><strong>Method: </strong>A total of 1,470 university students (53.8% female; mean age 19.6) completed self-report questionnaires on depressive symptoms (PHQ-9), generalized anxiety symptoms (GAD-7), and substance use risk (ASSIST). Data were analyzed using bivariate hypothesis testing and logistic regression models.</p><p><strong>Results: </strong>Among the students, 69.6% reported moderate to severe depressive symptoms, 46.9% moderate to severe generalized anxiety symptoms, and 52.5% substance use risk. A total of 58.6% screened positive for two or more mental health problems. High co-occurrence was observed (between 56.0% and 93.9%, p<0.05) among depressive symptoms, generalized anxiety symptoms, and problematic substance use risk. Female students, non-heterosexual individuals, those from low and middle socioeconomic backgrounds, and those simultaneously studying and working were more likely to experience co-occurring mental health problems (OR ≥1.08; p ≤0.024).</p><p><strong>Conclusion: </strong>A high percentage of students scored above clinically relevant cut points for mental health, with high co-occurrence of depressive symptoms, generalized anxiety symptoms, and risky substance use. Various factors were significantly associated with the presence of co-occurring mental health problems. Based on these findings, it is recommended to consider the co-occurrence of mental health problems in the diagnosis, treatment, and prevention of mental health issues during university years.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 7","pages":"505-516"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Evaluation of the FRAX® Tool for Identifying Menopausal Women Under 65 Eligible for Bone Densitometry Screening].","authors":"Bernardita Blumel, Andrea Maluenda, Francisca Bahamondes, María Paz Veloso, Juan Andrés Ortiz, Iván Rojas","doi":"10.4067/s0034-98872025000700485","DOIUrl":"https://doi.org/10.4067/s0034-98872025000700485","url":null,"abstract":"<p><p>Osteoporosis have been defined as the decrease in bone resistance that predisposes to fragility fractures. 50% of women over 50 years of age will suffer an osteoporotic fracture during their lifetime. Densitometry allows detecting mineral density and women with osteoporosis. The FRAX tool combines risk factors and permit calculating the high risk of major fracture than 10 years, the cutoff point in Chile being 3.2%.</p><p><strong>Aim: </strong>To assess the ability of the FRAX tool to identify osteoporosis in menopausal women under 65 years of age.</p><p><strong>Materials and methods: </strong>Retrospective study of patients aged 50 to 64 years treated in the climacteric program at Clínica Santa María between 2019 and 2022.</p><p><strong>Results: </strong>A total of 264 women had bone densitometry (DXA) and FRAX assessment at baseline. The mean age was 57.4 years (SD ±4). A total of 53 patients had a calculated 10-year major osteoporotic fracture risk ≥3.2%. Bone densitometry with a T-score <-2.5 was found in 33 women. The sensitivity of FRAX to identify women with osteoporosis on DXA was 24.2%, detecting only 8 of the 33 women with T-score <-2.5.</p><p><strong>Conclusion: </strong>Our results show that the FRAX alone fails to identify the majority of patients under 65 years of age at high risk of fracture who benefit of bone densitometry. More studies are needed to characterize menopausal women younger than 65 years with a T-score less than -2.5 in DO and a FRAX MOF risk less than 3.2%.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 7","pages":"485-491"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Renal Protection by SGLT2 Inhibitors in Patients with Heart Failure Depends on Ventricular Function: Pooled Analysis and -Analysis].","authors":"Sebastián Cabrera, Daniel Vivanco, Daniela Lizama, Miriam Alvo, Alejandra Hernandez, Luis Michea","doi":"10.4067/s0034-98872025000700468","DOIUrl":"10.4067/s0034-98872025000700468","url":null,"abstract":"<p><p>Heart failure (HF) and chronic kidney disease (CKD) often coexist, sharing common risk factors and pathophysiological mechanisms. Sodium-glucose cotransporter-2 inhibitors (iSGLT-2) have shown renal and cardiovascular benefits, but their renal protective effect varies depending on ejection fraction (EF).</p><p><strong>Aim: </strong>To assess whether the renal protective effect of SGLT-2i depends on EF in HF patients.</p><p><strong>Methods: </strong>A meta-analysis was conducted with five randomized controlled trials comparing iSGLT-2 versus placebo in HF patients. Risk of bias was assessed using EPHPP. The primary outcome was major adverse kidney events (MAKE). Subgroups were defined by EF: HFrEF (≤40%) and HFpEF (>40%).</p><p><strong>Results: </strong>A total of 23,163 patients were included. Global analysis showed a non-significant trend towards a reduction in MAKE (RR 0.76 [0.56-1.02], I²= 68%). In HFrEF, iSGLT-2 significantly reduced MAKE (RR 0.58 [0.44-0.75], I²= 0%), whereas no benefit was observed in HFpEF (RR 1.01 [0.83-1.23], I²= 0%). Heterogeneity disappeared when stratified by EF.</p><p><strong>Conclusions: </strong>iSGLT-2 reduce MAKE in HFrEF but not in HFpEF, suggesting that EF modulates their renal effect. These findings highlight the importance of tailoring cardiorenal syndrome management according to HF phenotype.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 7","pages":"468-474"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Mental Health in Migrant Women: Challenges and Strategies to Reduce Inequities].","authors":"Nicolás Fernández-Barra, Rafael Velasco, Bernardo Cepeda, María Belén Saffie, Sylvia Díaz, Margarita Bernales","doi":"10.4067/s0034-98872025000700517","DOIUrl":"https://doi.org/10.4067/s0034-98872025000700517","url":null,"abstract":"<p><p>International migration has a profound impact on the perinatal mental health of women, particularly during pregnancy and the postpartum period. Factors such as acculturative stress, economic and language barriers, and experiences of discrimination increase vulnerability to conditions such as anxiety and depression. Although migrant women often arrive in a new country with better physical health -a phenomenon known as the \"healthy immigrant effect\"- this advantage does not extend to mental health.</p><p><strong>Aim: </strong>To analyze the structural and economic barriers that exacerbate mental health inequities between migrant and native women during the perinatal period. The study also aims to identify risk and protective factors and to assess interventions designed to address the specific needs of migrant women.</p><p><strong>Methods: </strong>A narrative review of 45 studies published between 2011 and 2025 was conducted. The analysis focused on how barriers to healthcare access contribute to mental health disparities. Structural and economic challenges, as well as risk and protective factors and available interventions, were explored.</p><p><strong>Results: </strong>Recent migrants face a higher risk of perinatal mental health disorders due to social isolation and lack of cultural integration. Women with longer residence tend to show some improvement, although significant inequities persist. Social and familial networks emerge as key protective factors, but their effectiveness depends on the presence of inclusive and culturally competent public policies. Programs specifically tailored for migrant women have proven effective in reducing perinatal disorder symptoms.</p><p><strong>Conclusions: </strong>A comprehensive approach-combining strengthened community networks, inclusive public policies, and equitable access to healthcare- is essential to reducing perinatal mental health inequities among migrant women. Implementing these strategies has the potential to significantly improve the mental health and well-being of this vulnerable population.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 7","pages":"517-526"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Use of Meropenem, Linezolid, and Quinolones for Non-Drug-Resistant Tuberculosis in Critically Ill Patients and Other Settings: A Descriptive Series.","authors":"Gabriel Uribe, Alberto Fica, Esteban Teneb, Mario Oñat, Luis Galvez, Nelson Toro, Daniel Muñoz","doi":"10.4067/s0034-98872025000700492","DOIUrl":"10.4067/s0034-98872025000700492","url":null,"abstract":"<p><p>Meropenem, linezolid, and quinolones are alternatives for managing tuberculosis (TB) in cases of drug-related adverse reactions, critical ill patients, organ failure, or inability to use the oral route.</p><p><strong>Aim: </strong>To report the experience with the combined use of these compounds in cases of TB not associated with drug-resistant tuberculosis.</p><p><strong>Methods: </strong>Observational study of patients hospitalized for TB between 2020 and 2024 treated with these compounds at a regional hospital in Chile.</p><p><strong>Results: </strong>Ten male patients (median age 43.5 years), were treated with this combination either by adverse drug reactions (4 cases), hepatitis- liver failure (3 cases), respiratory failure, suspected gastrointestinal bleeding or a critical condition (1 each one). Combination therapy was used during the initial intensive (9 cases) or continuation phase (1 case). Median meropenem doses was 3 g/day for 2 weeks, 1,200 mg/day of linezolid for 2 weeks, and 750 mg/day of levofloxacin in 7 cases for 3 weeks or moxifloxacin (400 mg/day). Five patients were admitted to critical intensive care units. In 2 cases with a prolonged alternative treatment (≥ 4 weeks), M. tuberculosis culture became negative. Anemia secondary to linezolid was observed in 6 cases, one requiring transfusion. Linezolid and meropenem therapeutic drug monitoring was applied in one case. WHO treatment outcome was classified as treatment success in 4 cases, dead in 4 (3 treated on a premortem basis), abandonment in one, and one still under treatment.</p><p><strong>Conclusions: </strong>The combined use of meropenem, linezolid, and quinolones may be a viable option for managing hospitalized TB patients with contraindications to standard oral treatment and may contribute to microbiological control and patient recovery. In some cases, it represents a desperate measure and may be associated with hematological adverse effects.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 7","pages":"492-504"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Times for Control and Etiological Study in Patients with Stroke in a High-Complexity Regional Hospital].","authors":"Álvaro Soto V, Gladys Morales I, Cecilia Valeria T","doi":"10.4067/s0034-98872025000600392","DOIUrl":"https://doi.org/10.4067/s0034-98872025000600392","url":null,"abstract":"<p><p>Stroke is the third leading cause of death in Chile. The Explicit Health Guarantees Regime (GES) ensures that post-discharge evaluation of patients with ischemic stroke (IS) is performed within 10 days. The time to complete the etiological study of a stroke is crucial due to the high risk of recurrence in patients without a specific identified cause.</p><p><strong>Aim: </strong>To estimate the times for control and etiological study in stroke patients at a high-complexity regional hospital. To identify factors associated with compliance with the GES follow-up guarantee.</p><p><strong>Methods: </strong>Consecutive patients with stroke from the vascular neurology clinic of Dr. Hernán Henríquez Aravena Hospital (HHHA) in Temuco between January 1, 2019, and December 31, 2023. Times for the first control and the performance of the etiological study exams were recorded.</p><p><strong>Results: </strong>479 patients were included: 426 (88.9%) with IS and 53 (11.1%) with intracerebral hemorrhage (ICH). The median time for the first control was 23 days for IS and 42 days for ICH. Only 20.7% of IS patients were controlled within 10 days post-discharge. The medians for transthoracic echocardiography, transesophageal echocardiography, and Holter monitor were 9, 21, and 35.5 days, respectively. In the logistic regression model, only the year of admission to the clinic reached statistical significance for control within 10 days.</p><p><strong>Conclusions: </strong>A low percentage of IS patients comply with the GES follow-up guarantee. The time to perform the etiological study is significantly longer than that reported in private clinics in Chile.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"153 6","pages":"392-400"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}