RESUMO
El objetivo de este trabajo fue determinar la relación entre el pronóstico visual según el Ocular Trauma Score (OTS) y la agudeza visual (AV) a los 6 meses de ocurrido el trauma ocular, en pacientes atendidos en la Unidad de Trauma Ocular del Hospital del Salvador, Santiago de Chile. Se hizo uso de un estudio descriptivo, longitudinal, retrospectivo. Se accedió a los registros clínicos de pacientes atendidos por trauma ocular grave entre el 1 de enero de 2014 al 15 de marzo 2015. 145 pacientes conformaron una muestra de 153 ojos. Se estableció la relación entre OTS obtenido y la AV a 6 meses del trauma mediante el coeficiente de correlación de Spearman. De los ojos estudiados, el grupo mayor N=68 (44,4%) calificó para OTS 3 y el menor N=16 (10,5%) para OTS 1. Se presentaron cinco categorías de visión, en un tiempo inicial la mayoría de los casos presentaron AV de luz, mala proyección-cuenta dedos (n=89). Tras seis meses dicha distribución se desplazó hacia la categoría 20/40 - 20/20 (n=68). Se encontró una fuerte asociación (r=0,711 p=0,000) entre el OTS calculado y la AV luego de seis meses de seguimiento. El OTS demostró poseer un gran valor predictivo y es una herramienta aplicable en nuestro medio, los datos obtenidos indican que existe un mejor pronóstico visual que los obtenidos en otro estudio. Cabe destacar que es la primera instancia en que se evalúa la aplicación del OTS en Chile.
This work aimed to determine the relationship between the visual prognosis according to the Ocular Trauma Score (OTS) and visual acuity (AV) 6 months after the ocular trauma in patients treated at the Eye Trauma Unit from the Hospital del Salvador, in Santiago, Chile. A descriptive, longitudinal and retrospective study was performed. We accessed registers of clinical patients attended for severe eye trauma from 1 January 2014 to 15 March 2015. 145 patients constitute a sample of 153 eyes. A connection was established between the OTS obtained and the AV 6 months after the trauma via the Spearman correlation coefficient. From the eyes studied, the greatest group N=68 (44.4%) qualified for OTS 3 and the smallest N=16 (10.5%) for OTS 1. Five eye categories were presented, in the beginning, most of the cases presented visual acuity with bad projection hand motion (n=89). After six months of distribution, it moved to the category 20/40 20/20 (n=68). A strong relation (r=0,711 p=0,000) was found between the estimated OTS and the AV after six months of tracking. The OTS proved to have great predictive valor and is an applicable tool in our area, the data obtained showed that there is a better visual prognosis than the obtained in other studies. It is worth noting that this is the first stage where the application of OTS is assessed in Chile.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Acuidade Visual/fisiologia , Índices de Gravidade do Trauma , Traumatismos Oculares/diagnóstico , Traumatismos Oculares/fisiopatologia , Prognóstico , Chile , Traumatismos Oculares/terapia , Valor Preditivo dos Testes , Estudos Retrospectivos , Seguimentos , Estudos Longitudinais , Emergências , Serviços de Saúde OcularRESUMO
The distal radius fracture is a fairly common clinical problem in elderly patients, treatment can be either surgical or conservative. We present a synthesis of evidence relating to compare the functional improvement of both treatment modalities, through a Systematic Review of randomized Clinical Trials. Objective: To determine whether there is scientific to endorse that functional improvement in the medium and long-term conservative versus surgical management in patients with fracture of the distal radius over 60 years. Search Strategy: Were included in Search Randomized Clinical Trials (RCTs), meta analysis (MT) and systematic Reviews (RS), the databases used were Medline, CINALH, Central (Cochrane), Lilacs and PEDro. Results: We selected three RCTs that met the eligibility criteria. Conclusions: There is limited evidence that surgical methods studied did not have better functional outcomes and long-term, compares with a closed reduction and cast. The SF-36 at 3-4 months, gives a DM of 3.01 (-1.6- 7.62), difference is not statistically significant (p = 0.54).
La fractura de radio distal es un problema clínico bastante frecuente en adultos mayores, el tratamiento puede ser de tipo quirúrgico o conservador. Realizaremos una síntesis de la evidencia, relativa a comparar la mejoría funcional de ambas modalidades terapéuticas, a través de una revisión sistemática de Ensayos Clínicos Aleatorizados. Objetivo: Determinar si existe evidencia científica que avale la mejoría funcional a mediano y largo plazo del manejo quirúrgico versus el conservador en pacientes con fractura del extremo distal del radio mayores de 60 años. Estrategia de Búsqueda: Se incluyeron en la búsqueda Ensayos Clínicos Aleatorizados (ECAs), Metaanálisis (MT) y Revisiones Sistemáticas (RS), las Bases de datos usadas fueron: Medline, CINALH, Central (Cochrane), Lilacs y PEDro. Resultados: Se seleccionaron 3 ECAs que cumplían con los criterios de elegibilidad. Conclusiones: Existe limitada evidencia que los métodos quirúrgicos estudiados no presentan mejores resultados funcionales a mediano y largo plazo, comparados con una reducción cerrada más yeso. El SF-36 al 3-4 mes, da una DM de 3,01 (-1,6 - 7,62), diferencia que no es estadísticamente significativa(p = 0,54).
Assuntos
Humanos , Pessoa de Meia-Idade , Fraturas do Rádio/terapia , Procedimentos Ortopédicos/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores Etários , Placas Ósseas , Moldes Cirúrgicos , Medicina Baseada em Evidências , Fixadores Externos , Fixação de Fratura/métodos , Fratura de Colles/terapia , Imobilização , Metanálise como Assunto , Recuperação de Função FisiológicaRESUMO
La Fenilquetonuria (PKU) se produces por la deficiencia de la enzima Fenilalanina Hidroxilasa, causando un aumento plasmático de fenilalanina (FA). El objetivo del presente estudio fue evaluar la ingesta de Selenio (Se), Zinc (Zn) y vitamina E en niños PKU menores de 13 años de edad, que estaban en dieta restringida en FA y recibiendo fórmula especial sin FA. Método: Se incluyeron 50 PKU entre los 0 y 13 años y en control en el INTA, Universidad de Chile. Se analizó ingesta de vitamina E, Se y Zn, se midió nivel de FA en plasma y se evaluó estado nutritional. Resultados: Las recomendaciones diarias de Se y Zn se cubren en un 100 por ciento con la dieta habitual de PKU. Pero al excluir la formula sin FA, la cobertura de ambos nutriente disminuye a 45 por ciento y 20 por ciento respectivamente. La ingesta de vitamina E se cubre en forma natural por el consumo de aceites vegetales y al incluir la vitamina de la fórmula sin FA, la cobertura se incrementaba 5 veces sobre su recomendación. El nivel de FA en la sangre fue en promedio de 5.4 mg/dL, considerado un buen control metabólico. El 64 por ciento tenía un estado nutritional normal, el 30 por ciento estaba sobrepeso u obeso y un 6 por ciento riesgo de desnutrición. Conclusiones: Se concluye que la dieta de niños PKU cubre las recomendaciones de los micronutrientes: Zn, Se y vitamina E. No obstante se debe enfatizar la importancia que tiene la fórmula sin FA para cumplir con las recomendaciones nutricionales, especialmente de micronutrientes.
Phenylketonuria (PKU) is caused by a deficiency of the enzyme Phenylalanine Hydroxylase, resulting in increased plasma Phenylalanine (Phe). The aim of this study was to assess the intake of Selenium (Se), Zinc (Zn) and vitamin E in PKU children, who were on a diet restricted in Phenylalanine (Phe) and receiving a special formula without Phe. Method: the study included 50 PKU children between 0 and 13 years controled at INTA, University of Chile. We analyzed intake of vitamin E, Se and Zn, measured Phe plasma levels and assessed nutritional status. Results: The daily recommendations of Se and Zn were 100 percent covered with the usual PKU diet. By excluding the formula without Phe, the coverage of both nutrients decreased to 45 percent and 20 percent respectively. The intake of vitamin E was covered by the consumption of vegetable oils and when the formula without Phe was included, the coverage was increased 5 times over the recommended levels. Blood Phe level remained on average at 5.4 mgldL, considered a good metabolic control. Conclusions: We conclude that the diet of PKU children covered the recommended levels of Zn, Se and vitamin E. However, it should be emphasized the importance of the formula without Phe to meet nutritional recommendations, particularly of micronutrients.
Assuntos
Humanos , Adolescente , Recém-Nascido , Lactente , Pré-Escolar , Criança , Fenilcetonúrias/dietoterapia , Ingestão de Energia/fisiologia , Selênio/administração & dosagem , Vitamina E/administração & dosagem , Zinco/administração & dosagem , Estatura , Peso Corporal , Estudos Transversais , Fenilcetonúrias/sangue , Avaliação Nutricional , Fenilalanina , Estudos Retrospectivos , Selênio/sangue , Vitamina E/sangue , Zinco/sangueRESUMO
El artículo afirma que es posible evaluar la estabilidad en rellenos sanitarios, analizando sus condiciones de equilibrio a partir de métodos geotécnicos tradicionales, aplicados a suelos
Assuntos
Chile , Aterros Sanitários , Deslizamentos de TerraRESUMO
El artículo afirma que es posible evaluar la estabilidad en rellenos sanitarios, analizando sus condiciones de equilibrio a partir de métodos geotécnicos tradicionales, aplicados a suelos
Assuntos
Aterros Sanitários , Chile , Deslizamentos de TerraRESUMO
BACKGROUND: Laparoscopic cholecystectomy is the treatment of choice for patients with symptomatic gallstones. The management of choledocholithiasis in these patients remains controversial. Endoscopic retrograde cholangiopancreatography (ERCP) with ductal stone clearance prior to laparoscopic cholecystectomy is one of the options. OBJECTIVE: To evaluate the results of ERCP prior to laparoscopic cholecystectomy in patients with suspected ductal stones. METHODS: We performed a retrospective study from patients who underwent ERCP prior to laparoscopic cholecystectomy in a four years period. RESULTS: ERCP was successful in 86 out of 88 patients (97.7%). Common bile duct (CBD) stones were found in 34 patients (39.5%). Sixty two of 86 patients had symptomatic gallstones with abnormal liver function test and/or ultrasound. CBD stones were found in 25 of the 62 symptomatic patients (40.3%). Twenty four patients had acute biliary pancreatitis. CBD stones were found in nine of these patients (37.5%). All patients with CBD stones underwent stone extraction after endoscopic sphincterotomy (ES). Sixteen other patients underwent ES for suspected obstruction at the ampulla. Stone extraction was successful in 100% of patients. There were six patients with complications (6.9%). Four patients had pancreatitis (4.6%), one patient hemorrhage (1.1%) and one patient cholangitis (1.1%). Analysis using logistic regression model showed that CBD stones on ultrasonography was the only variable significantly associated with choledocholithiasis (P < 0.001). CONCLUSIONS: Preoperative ERCP is useful in the management of CBD stones prior to laparoscopic cholecystectomy.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica , Cálculos Biliares/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Humanos , Testes de Função Hepática , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esfinterotomia EndoscópicaRESUMO
BACKGROUND: Clostridium difficile is the cause of 25-30% of cases of antibiotic-induced diarrhea. Pseudomembranous colitis is the most dramatic manifestation of C. difficile infection. METHODS: We report four cases of pseudomembranous colitis and review the literature. RESULTS: Three of the four patients, were over 80 years old and had other underlying illnesses. Before they developed colitis, all had received cephalosporins (cefuroxime, ceftriaxone, cefalexine) and one of them also clindamycin. All the patients had severe watery bowel movements, with mucus (one patient had also bloody stools), abdominal pain, nausea, vomit and fever. Blood tests disclosed leucocytosis with neutrophilia and increased band neutrophils in all patients. One patient had anasarca and hypo-albuminemia, suggestive of protein losing enteropathy. Sigmoidoscopy showed raised, yellow plaques covering the rectum, sigmoid and descendent colon mucosa. The response to oral metronidazole or vancomycin was good. The response to intravenous metronidazole was good in one patient and poor in another one. Two of our patients had relapses. The response of the relapses to oral metronidazole was good. One patient had two relapses eventually responding to oral metronidazole and Saccharomyces boulardii. CONCLUSIONS: Pseudomem-branous colitis has high morbility in debilitated elderly patients. Relapses are frequent in these patients. If other studies should confirm it, Saccharomyces boulardii could be useful in the prevention and treatment of relapses of this colitis.
Assuntos
Enterocolite Pseudomembranosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Enterocolite Pseudomembranosa/diagnóstico , Enterocolite Pseudomembranosa/tratamento farmacológico , Feminino , Humanos , MasculinoRESUMO
We present the experience during 1987-1991 years, about Female Genital Tuberculosis, at the University of Chile Clinical Hospital. We present 16 cases with histologic and bacteriologic demonstration; in two cases also positive cultures for myco bacterium tuberculosis. It is made emphasis about personal characteristics of patients physical examination findings, laboratories procedures and technics of diagnostic, treatment and posterior control of patients. We comments utility of new procedures as laparoscopy, gynecologic sonography and A.D.A. analysis of ascitis.
Assuntos
Doenças dos Anexos/diagnóstico , Peritonite Tuberculosa/diagnóstico , Tuberculose dos Genitais Femininos/diagnóstico , Doenças dos Anexos/terapia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Peritonite Tuberculosa/terapia , Estudos Retrospectivos , Tuberculose dos Genitais Femininos/terapiaRESUMO
Experience about urethral diverticulum in the female, is presented by the University of Chile Clinical Hospital's Services of Obstetrics-Gynecology and Urology, from 1954 to 1990 years. 34 cases were studied. This pathology was more frequent in patients in there forties and fifties. Diagnosis was made by clinics, endoscopy or urethrography. Treatment was surgical in 91.3%, using Te Linde's technic, with few complications; 85.5% of patients are free of disease.
Assuntos
Divertículo/diagnóstico , Doenças Uretrais/diagnóstico , Adolescente , Adulto , Idoso , Diagnóstico Diferencial , Divertículo/complicações , Divertículo/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Doenças Uretrais/complicações , Doenças Uretrais/cirurgiaAssuntos
Aleitamento Materno , Fertilidade , Lactação , Adolescente , Adulto , Chile , Feminino , Humanos , Lactente , Recém-Nascido , GravidezAssuntos
Doenças dos Cavalos/epidemiologia , Infecções por Orthomyxoviridae/veterinária , Animais , Chile , Surtos de Doenças/veterinária , Feminino , Doenças dos Cavalos/microbiologia , Cavalos , Vírus da Influenza A/isolamento & purificação , Masculino , Infecções por Orthomyxoviridae/epidemiologia , Infecções por Orthomyxoviridae/microbiologiaAssuntos
Divertículo/patologia , Doenças Uretrais/patologia , Adulto , Fatores Etários , Idoso , Diagnóstico Diferencial , Divertículo/diagnóstico , Divertículo/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Doenças Uretrais/diagnóstico , Doenças Uretrais/cirurgia , Infecções Urinárias/etiologiaRESUMO
PIP: 2139 women wearers of IUDs were examined for a period of 3 months-10 years. Of these 480, or 22.4%, received a genital damage from the device, mostly, i.e. 97%, because of infection, and/or because of serious menstrual disorders. However, only 10.2% of the 480 cases were considered clinically important, and surgical intervention was needed in only 1.5% of cases. 39 patients, i.e. 44% became pregnant with the device in situ. Results obtained with IUDs depend in great measure on the selection of acceptors, on the exact knowledge of contraindications, on the results of a thorough gynecological examination, and on a very precise technique of insertion.^ieng