Revista medica de Chile最新文献

{"title":"[Training Present and Future Doctors for Chile: How Many and For What? The Urgent Need to Review the Physician Quota Generation Model].","authors":"Miguel O'Ryan G, Pablo Roncagliolo B","doi":"10.4067/s0034-98872024000800909","DOIUrl":"10.4067/s0034-98872024000800909","url":null,"abstract":"<p><p>Before 1990, Chile showed fewer medical schools, six in total, increasing to 13 by 2000. From then on, there was an explosive increase, reaching 29 faculties or schools by 2024. Medical students increased from 1,816 in 2010 to 3,000 by 2024. The number of doctors in the country in 2010 was 24,455, rising to 65,737 by 2023, of which 25% are foreign professionals. In 2010, there was a ratio of 1.43 doctors per 1000 inhabitants, increasing to 3.13 by 2024, with a reasonable projection for 2034 close to 6, in other words, one doctor for every 170 inhabitants, reaching the OECD curve, surpassing WHO recommendations, and continuing to rise non-linearly. By 2024, one in two doctors practicing in Chile has one or more medical specialties. The Public Health System reported that in 2023, approximately one-third of the total available registered professionals working hours hired represented medical specialists (61%). Specialist doctor rates by region, as of September 2023, are relatively homogeneous, with higher rates tending to be in the southern part of the country. There is underrepresentation in non-metropolitan regions of specialties such as infectious diseases, emergency medicine, adult intensive care, neonatology, hematology, and pediatric neurology. However, for most specialties, this asymmetry is not observed. Compared to other countries, Chile, with a rate of 28.4 between 2012-2020, ranks 57 out of 200 countries with available data, presenting a rate of 1.64 specialist doctors per 1000 inhabitants, while the OECD average was 2.35. This strongly suggests that Chile will likely end up with an excessive number of doctors overall but with room to grow in specialist doctors. It is possible to envision interactions and coordination that could benefit the country without exceeding a regulated system; however, professional training should be avoided to continue unregulated and subject only to free will based on marketing strategies and demand rules. National and international studies assessing healthcare challenges for the coming decades and the professional capacities required to address them at the level of general medicine, primary specialties, and derived specialties are urgently needed. Regarding clinical fields, conducting a relevant study to determine the total public and private sector training capacity that may be part of the training system for the necessary clinical competencies is essential. Forming a working group with relevant stakeholders with knowledge, concern, and involvement would be significant, e.g., the Academy of Medicine, ASOFAMECH, medical schools, Ministry of Health, Ministry of Education, and community representatives. From our higher education perspective, with a nationwide vision, universities should start a joint reflection on our role in this critical topic with a future-oriented view.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 8","pages":"909-926"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034945","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":"[Transforming the Management of People with Chronic Kidney Disease: The Necessary Inclusion of Kinesiologists in the Interdisciplinary Teams that Care for Them].","authors":"Hans Müller-Ortiz, Cristian Pedreros-Rosales, Andrea Araneda Gutiérrez, Patricia Sánchez Krause","doi":"10.4067/s0034-98872024000800935","DOIUrl":"https://doi.org/10.4067/s0034-98872024000800935","url":null,"abstract":"","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 8","pages":"935-936"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034946","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":"[Idiopathic Intracranial Hypertension: Clinical-Epidemiological Profile and Factors Associated with Visual Outcome].","authors":"Natalia Urquiola Cortés, Verónica Fernández Salgado, Christian Luco Franzoy, Cecilia Trigo Daroni, Nathaly Amaya Romero, Jorge Klagges Troncoso","doi":"10.4067/s0034-98872024001101120","DOIUrl":"10.4067/s0034-98872024001101120","url":null,"abstract":"<p><p>The prevalence of idiopathic intracranial hypertension (IIH) has been increasing along with the incidence of obesity in the population. There is little national statistical data on this pathology.</p><p><strong>Aim: </strong>To characterize cases of IIH clinically and epidemiologically and analyze factors associated with visual outcomes.</p><p><strong>Methods: </strong>Retrospective study. Review of clinical records of patients with IIH treated in a Chilean public hospital between 2010-2021. Statistical analysis of clinical, treatment, and visual outcome variables.</p><p><strong>Results: </strong>140 patients were included and 90.7% were women. The average age was 32 years and 92% were overweight/obese. The main presenting symptom was headache, followed by transient visual obscurations and diplopia. Visual acuity was normal in two-thirds, and 10.4% had severe visual impairment. Papilledema was present in 96.5%. In the visual field, the most frequent defect was an 85% increase in the blind spot. Treatment with acetazolamide was effective in 76.8% of cases, requiring high doses and prolonged use. Surgery was necessary in 24% of patients, with the installation of a lumboperitoneal shunt being the most common. In factors associated with visual outcome, greater papilledema and lack of response to medical treatment showed a statistically significant association with visual deterioration.</p><p><strong>Conclusions: </strong>Our study provides national data and confirms the classic profile of patients with IIH. Factors associated with visual impairment are the presence of severe papilledema and lack of response to medical treatment. Studies are required to determine the response to surgical treatment.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 11","pages":"1120-1129"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575092","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":"[Coronary Angiography in Clinical Practice: Update on Indications, Complications, and Contraindications].","authors":"Pabla Cataldo, Christian Dauvergne, Manuel Duarte, Patricio Julio, Manuel Méndez, Fernando Pineda, Polentzi Uriarte, Jorge Sandoval","doi":"10.4067/s0034-98872024000800889","DOIUrl":"10.4067/s0034-98872024000800889","url":null,"abstract":"<p><p>Coronary angiography (CA) is the gold standard for identifying the presence and extent of atherosclerotic coronary artery disease or dynamic stenosis of the arteries.</p><p><strong>Aim: </strong>Review of the literature and international clinical guidelines on the evidence of its indications in different clinical scenarios.</p><p><strong>Method: </strong>Qualitative study through a narrative review of the current indications of the technique, limitations, possible complications and contraindications.</p><p><strong>Results: </strong>Information on the different scenarios in which CA is requested is extensive, ranging from expert recommendations to evidence-based clinical guidelines that support its performance. Undoubtedly, technological advances have led to the understanding of coronary pathology with the contribution of complementary techniques that contribute not only to the diagnosis but also to its treatment. It is important to understand its potential complications in order not only to plan a procedure and avoid them, and not to subject patients to tests that will not contribute in their clinical context.</p><p><strong>Conclusions: </strong>Since the first CA, performed by Mason Sones in 1958, there has been an exponential growth in interventional cardiology, where CA has improved its technique generating more evidence in its indications.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 8","pages":"889-900"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034939","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":"[Psychotropic Drug and Chronic Medications in a Primary Care Center: Relation with COVID-19 Pandemic].","authors":"Arturo Roizblatt Scherzer, Eduardo Flores Casco, Nicole Grossman Kuperman","doi":"10.4067/s0034-98872024001101138","DOIUrl":"10.4067/s0034-98872024001101138","url":null,"abstract":"<p><p>The COVID-19 pandemic caused an overall global health crisis, generating an increase in mental health symptoms as well as a shift in health care for chronic conditions.</p><p><strong>Aim: </strong>To assess the modification of psychotropic and chronic prescriptions in a Primary Care Center (CESFAM) in the Metropolitan Region of Santiago, Chile, during the pre-pandemic, pandemic, and post-pandemic periods of COVID-19.</p><p><strong>Methodology: </strong>A cross-sectional observational study was conducted. All prescriptions were reviewed, and the percentage of prescriptions during May of each year and period was studied, considering the pre-pandemic, pandemic, and post-pandemic periods caused by the SARS-CoV-2 virus. The confidence interval for the mean percentage of drug prescriptions in the pre-pandemic years was constructed, and values from 2020 onwards were compared with that period. The distribution of drug prescriptions was analyzed, and the association between each period and type of drug was assessed using the chi-square test.</p><p><strong>Results: </strong>The SARS-CoV-2 pandemic in the Primary Care Center led to a statistically significant increase in the percentage of psychotropic drug prescriptions, with the following percentages per period: pre-pandemic (3.12%), pandemic (3.37%), and post-pandemic (3.89%). For chronic medications, compared to the pre-pandemic period (51.72%), there was an increase during the pandemic (60.29%) and then a decrease post-pandemic (55.17%).</p><p><strong>Conclusions: </strong>The monitoring of drug prescriptions concerning the pandemic in this study revealed modifications that may be of interest as a reliable indicator that could demonstrate an increase in psychiatric and chronic diseases. This could facilitate the development of public health strategies to take action and prevent similar future situations.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 11","pages":"1138-1147"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573792","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":"[Chronic Insomnia: A Public Health Problem].","authors":"Erika Quintanilla Dominguez, José Manríquez Urbina","doi":"10.4067/s0034-98872024000800937","DOIUrl":"https://doi.org/10.4067/s0034-98872024000800937","url":null,"abstract":"","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 8","pages":"937-938"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034938","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":"[Data Quality in the Chilean Health System: An Outstanding Debt with the Indigenous and Migrant Populations in Chile].","authors":"Carolina Acevedo De La Harpe, Nathalie Jaramillo-Brun","doi":"10.4067/s0034-98872024001101130","DOIUrl":"10.4067/s0034-98872024001101130","url":null,"abstract":"<p><p>Health equity is an objective that is strongly linked to the strength of health systems. In this regard, the data and evidence that the health structure has on the population is of vital importance.</p><p><strong>Aim: </strong>was to evaluate the quality of data on sexual and reproductive health of migrant and indigenous women in Chile. We approach this issue from a perspective that emphasizes the importance of the State and its institutions relying on their populations to implement more effective and efficient social policies.</p><p><strong>Methods: </strong>The Monthly Statistical Summaries (REM) prepared by the Department of Health Statistics and Information (DEIS) for the years 2012 to 2024 were reviewed.</p><p><strong>Results: </strong>Regarding coherence, the origin of the data is the same, however, the codes have changed over time, this is where not all the dimensions observed have the indigenous or migrant category. Regarding availability, there is no clear differentiation between cells with zeros or empty cases, which makes the interpretation and completeness of the data difficult.</p><p><strong>Conclusions: </strong>The findings show a phenomenon that we have called \"negative interdependence\" which generates bias with respect to the information collected by the health information system (DEIS-Chile) that perpetuates the health inequities of the observed populations and, above all, omits the subnational territorial context as a basis for the continuous improvement of health systems.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 11","pages":"1130-1137"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575088","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":"Encephalitis by Epstein Barr Virus in a Transplant Immunosuppressed Patient.","authors":"Esteban Teneb, Fernando Uherek, Ricardo Wenger, Alberto Fica, Belén Inostroza, Maritza Navarrete","doi":"10.4067/s0034-98872024000800931","DOIUrl":"10.4067/s0034-98872024000800931","url":null,"abstract":"<p><p>Encephalitis due to Epstein-Barr Virus (EBV) is a rare condition that primarily affects children and immunosuppressed patients. Diagnosing EBV encephalitis can be challenging due to its nonspecific clinical presentation and the lack of confirmatory tests. We present the case of a 66-year-old woman with a history of kidney transplantation who was admitted due to progressive subacute mental deterioration, preceded by vertigo and without fever. Physical examination revealed no cranial nerve abnormalities, focal neurological deficits, or meningeal signs. Cerebrospinal fluid (CSF) analysis showed a mild increase in protein and pleocytosis (13/µL) without hypoglycorrhachia. Brain magnetic resonance imaging (MRI) revealed multiple bi-hemispheric supratentorial hyperintensities associated with mild vasogenic edema, most prominent at the cortico-subcortical interface, hippocampal regions, and basal ganglia. An extensive search for microorganisms identified EBV by RT-PCR in the CSF (1,650 copies/mL). The patient initially received acyclovir without improvement but achieved rapid recovery after switching to ganciclovir. The patient was discharged, and outpatient follow-up visits demonstrated full recovery. This case supports the effectiveness of ganciclovir, as observed in previous reports. Overall, patients with EBV encephalitis generally have a benign course with complete recovery or mild sequelae.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 8","pages":"927-931"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034947","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":"[A Case of Recurrent Variceal Hemorrhage Secondary to Portosinusoidal Vascular Disease].","authors":"Nicolás Ortiz-López, Juan Pablo Roblero, Jaime Poniachik, Álvaro Urzúa, Laura Carreño","doi":"10.4067/s0034-98872024001101176","DOIUrl":"10.4067/s0034-98872024001101176","url":null,"abstract":"<p><p>Portal hypertension is a syndrome characterized by an elevation in pressure within the portal venous system, with severe consequences. Hepatic cirrhosis is its most common cause, but there are less frequent causes, including the recently described hepatic vascular disease, portosinusoidal vascular disease (PSVD), which affects portal venules and hepatic sinusoids. We present the case of a 68-year-old man with a history of portal hypertension and recurrent variceal bleeding. Despite medical treatment and endoscopic procedures, the hemorrhages persisted. A transjugular intrahepatic portosystemic shunt (TIPS) was performed to manage the condition. Hepatic elastography revealed unusually low liver stiffness for cirrhosis, prompting a liver biopsy. Histological findings supported the diagnosis of PSVD. Regarding treatment, there are no specific therapies for PSVD, and the focus is on managing complications associated with portal hypertension. PSVD is a rare entity that can be an underlying cause of non-cirrhotic portal hypertension. This case underscores the importance of awareness for early diagnosis and appropriate management. Ongoing research is crucial to gain a better understanding of this rare condition and enhance the quality of life for affected patients.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 11","pages":"1176-1180"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575086","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":"[Social Determinants of Combined Use of Alcohol and Non-prescription Drugs in Older Adults: A Population-based Study in Chile].","authors":"Yamil Tala, Camila Skewes, Miguel Ángel Fernández","doi":"10.4067/s0034-98872024000800867","DOIUrl":"10.4067/s0034-98872024000800867","url":null,"abstract":"<p><p>Alcohol consumption by older adults has been called the \"silent epidemic.\" An aging population and high levels of alcohol consumption increase the future challenge for epidemiology and public health. In addition, the misuse of prescription drugs is a growing public health problem associated with increased hospitalizations and health complications in older adults.</p><p><strong>Aim: </strong>To analyze the social determinants associated with problematic alcohol and prescription drug use in the older adult population in the country.</p><p><strong>Methods: </strong>Analysis of SENDA's population-based survey of drug and alcohol use in older adults from 2021. A multivariate statistical model was used to identify the factors that increase or decrease the probability of occurrence of the phenomenon.</p><p><strong>Results: </strong>The prevalence of alcohol and prescription drug use in older adults in Chile reached 12.8%. At the multivariate level, it is men, with less social support and without sentimental cohabitation, who have a higher probability of combining alcohol consumption with prescription drugs.</p><p><strong>Conclusions: </strong>The combination of alcohol and medicine without medical prescription is a potential public health problem, especially among older adults. This study represents a national effort to understand this phenomenon, identifying the most vulnerable groups with the highest prevalence of consumption to which public prevention policies should give special attention.</p>","PeriodicalId":101370,"journal":{"name":"Revista medica de Chile","volume":"152 8","pages":"867-874"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034944","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}