vgaraujov/thesis-chile huggingface dataset:
[Systematic literature review on patient safety in medical departments]

UNLABELLED: Patient safety is an issue of interest. All scenarios of health care have a risk of adverse events (AE) and determination of its incidence has been reported in virtually all medical specialties. OBJECTIVE: To determine the incidence reported in the medical literature of adverse events in medical departments. DESIGN AND METHODS: An exhaustive search of biomedical databases using different strategies, search in high impact journals and a manual search of related articles. RESULTS: We reviewed 17,437 entries. After reading the abstracts and articles, and applying previously defined inclusion and exclusion criteria, we selected 10 articles that reported the incidence of adverse events in medical departments. Most studies corresponded to a historical cohort, had used an AE screening to identify high risk patients, and had used a structured review to check clinical records. None of them had as their ultimate objective to report on the impact of adverse events or characterize them. The incidence reported in medical departments ranged from 3.6% to 21.7%. The definitions of adverse events and forms of detection were similar; however the few differences put the comparability at risk. CONCLUSION: No studies were aimed at quantifying or characterising the adverse events in health care. None of them defined what constitutes a medical department, although the results reported are within the published values for health systems. Further research is needed in this area.
[Utilization of an emergency department by elderly people in a university hospital in Santiago de Chile]

Introducción Se ha reportado un incremento en las consultas de los adultos mayores (AM) a los servicios de urgencia (SU), pero en países en fases precoces de la transición demográfica y epidemiológica no se dispone de datos. Este trabajo describe las características de los mayores de 60 años (AM) que consultan al Servicio de Urgencia del Hospital Clínico Universitario de la Pontificia Universidad Católica de Chile (SU-PUC), en comparación con los menores de 60 años (AJ). Material y métodos Se recogieron retrospectivamente, a partir de los informes estadísticos mensuales del SU-PUC, datos de filiación, motivos de ingreso y rehospitalización. Se excluyeron consultas obstétricas, pediátricas e «ingresos programados». Se compararon las frecuencias mediante la chi cuadrado (significación: p < 0,05). Resultados Se registraron en un año un total de 37.660 consultas al SU-PUC (81% AJ; 19% AM; siendo mayores de 75 años un 8%) No se encontró diferencia estadística en hora de consulta (70% diurna), ni estacionalidad entre los grupos. Se hospitalizó al 19,6% de consultas (n = 7.414), detectándose diferencias en función de la edad (AM: 48,9% vs 12,9% AJ; p < 0,001), especialmente en mayores de 75 años (59%). La primera causa de hospitalización fue cardiopulmonar en AM (22%) y digestiva en AJ (31%). La rehospitalización fue del 10% en los AM y del 6% en AJ (p < 0,001). Conclusión La utilización de los SU por los AM y algunas características de su proceso asistencial (hospitalización) son similares a las encontradas en países en fases más avanzadas de la transición demográfica.
4D Flow MRI: A new diagnostic tool for congenital heart diseases

Purpose. To demonstrate the utility of 4D flow MR imaging for analyzing blood flow patterns and flow distribution in patients with congenital heart diseases. Methods: Six patients with congenital heart diseases were scanned using a standard cardiac MRI protocol, according to their condition. Additionally, 2D flow sequences of the great vessels, and a 4D flow sequence covering the entire heart were acquired. Flow patterns were visualized by using vector fields, streamlines and particle traces. Results: 4D flow technique depicted vortices and helical flow in the pulmonary artery of most patients, as well as in the aorta and superior vena cava of one patient with corrected aortic coarctation and a levoatrial cardinal vein. Conclusion: 4D flow MR imaging enables the identification of flow patterns difficult to detect with other diagnostic modalities. Comprehensive evaluation of flow patterns might help to understand the hemodynamic consequences of congenital heart diseases and their surgical procedures.
An introduction to systematic reviews and meta-analysis: a workshop report on promoting evidence based medical practice through capacity building in research synthesis

The increasing urgency for evidence based practice, especially in resource limited settings has inspired many initiatives to this effect. In Africa there is limited skill in research synthesis and the production of systematic reviews. The Centre for the Development of Best Practices in Health, together with the South African Cochrane Centre organised a workshop to train Cameroonian researchers on how to initiate and complete systematic reviews. Five facilitators and fifteen participants met over a period of four days. At the end of the workshop the participants expressed high levels of satisfaction and motivation to conduct systematic reviews, but expressed the need for additional support. Facilitators of future systematic review courses should address challenges related to internet access, adult education and realistic expectations from the participants.
Clinical and socio-demographic description of involuntary psychiatric inpatients admitted under the state of administrative hospitalization in Chile

Introduction: According to the "Operational framework for the admission of psychiatric inpatients and for the delivery of mental health services" in force since 2001, a person can be hospitalized at a psychiatric service without their agreement if their mental disorder poses a risk for their own safety or for the safety of other people. Aim: To describe the socio-demographic and clinical characteristics of psychiatric inpatients hospitalized under the "administrative hospitalization" rule (a specific type of involuntary hospitalization) at the psychiatric service of the Clinica San Carlos de Apoquindo between the years 2006 and 2008. Methods: Data was obtained from the patients clinical recordings. Results: Most of 32 patients were young women, active workers, with bipolar disorder and history of suicide behavior and poor medication compliance. Discussion: Our study is a first step to characterize the involuntary psychiatric inpatients population hospitalized under the procedures regulated by Chilean legislation established since less than ten years.
Cost-effectiveness of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Patients with chronic respiratory disease are heavy users of health care and social services resources worldwide. Although the major goals of pulmonary rehabilitation programs are to reduce levels of morbidity and to improve activity as well as participation in patients with chronic respiratory disease, their role in the management of these patients must also be validated by cost-effectiveness. Pulmonary rehabilitation's role in decreasing utilization of health care resources is an important potential benefi t. Pulmonary rehabilitation is an effective intervention in patients disabled by chronic respiratory disease; however, there are relatively few studies that evaluate its effect on health care utilization. An 18-session, 6-week outpatient pulmonary rehabilitation program decreased inpatient hospital days and decreased the number of home visits when compared with standard medical management. A comprehensive costeffectivenes analysis of the addition of this multidisciplinary pulmonary rehabilitation program to standard care for patients with chronic disabling respiratory disease concluded that the program was cost-effective and produced cost per quality-adjusted-life-years (QALY) ratios within the bounds considered to be cost-effective and therefore likely to result in financial benefits to the health care system. Patients with COPD who receive an education intervention with supervision and support based on disease-specific self management principles have decreased hospital admissions, decreased emergency department visits, and reduced number of unscheduled physician visits. This approach of care through self-management strategies is of interest because it does not require specialized resources and could be implemented within normal health care practice. In a before-after designed study, a community-based, 18-session, comprehensive pulmonary rehabilitation program was associated with an average reduction of total costs of US$344 per person per year. This was associated with decreased health service utilization, reduced direct costs, and improved health status of patients with COPD, regardless of disease severity. In summary, pulmonary rehabilitation programs in COPD patients reduces hospital stay and hospital readmissions especially after exacerbations. Pulmonary rehabilitation programs significantly reduce the use of healthcare resources and are cost-effective.
Effect of magnesium sulfate given for neuroprotection before pretermbirth: a randomized controlled trial

Antecedentes: El sulfato de magnesio prenatal puede reducir el riesgo de parálisis cerebral o muerte en infantes prematuros severos. Objetivo: Determinar la efectividad del sulfato de magnesio, administrado para neuroprotección a mujeres en riesgo de parto prematuro antes de las 30 semanas, para prevenir mortalidad pediátrica y parálisis cerebral. Método: Estudio controlado randomizado en 16 centros terciarios en Australia y Nueva Zelanda, con estratificación por centro y embarazo múltiple. Un total de 1.062 mujeres con fetos menores a 30 semanas de gestación, para quienes el parto fue planeado o esperado dentro de 24 horas, fueron enroladas entre febrero 1996 a septiembre 2000, con seguimiento de los niños sobrevivientes a 2 años de edad corregida. Intervenciones: Mujeres fueron aleatoriamente asignadas a recibir una dosis de carga de 8 mL (4g [16 mmol] de 0,5 g/mL) de solución de sulfato de magnesio o solución isotónica de cloruro de magnesio (0,9%) por 20 minutos seguido de una infusión de mantención de 2 mL/h por hasta 24 horas. Principales medidas de resultado: Tasas de mortalidad pediátrica total, parálisis cerebral y el resultado combinado de muerte o parálisis cerebral a la edad corregida de 2 años. Resultados: Los datos fueron analizados para 1.047 (99%) de los sobrevivientes a 2 años. Mortalidad pediátrica total (13,8% vs. 17,1%; RR: 0,83; 95% IC: 0,64-1,09), parálisis cerebral en sobrevivientes (6,8% vs 8,2%; RR: 0,83; 95% IC: 0,54-1,27) y muerte o parálisis cerebral combinados (19,8% vs 24,0%; RR: 0,83; 95% IC: 0,66-1,03) fueron menos frecuentes en infantes expuestos a sulfato de magnesio, pero ninguna de las diferencias fue estadísticamente significativa. Disfunción motora gruesa sustancial (3,4% vs 6,6%; RR: 0,51; 95% IC: 0,290,91) y muerte o disfunción motora gruesa sustancial combinados (17,0% vs 22,7%; RR: 0,75; 95% IC: 0,59-0,96) fueron significativamente reducidos en el grupo magnesio. Conclusiones: El sulfato de magnesio administrado a mujeres inmediatamente antes de un parto prematuro extremo puede mejorar importantes resultados pediátricos. No se observaron efectos adversos serios.
Elevated frequency of acute pancreatitis associated to biliary illness in chilean children

La pancreatitis aguda (PA) en niños presenta una morbimortalidad considerable. Las etiologías más frecuentes en este grupo etario son la PA secundaria a trauma, por enfermedades sistémicas y la PA idiopática, a diferencia de la población adulta en que predomina la litiasis biliar y el consumo de alcohol. En Chile, donde la patología biliar es altamente prevalente, existe escasa información clínica respecto de la PA en niños. Objetivo: Determinar las características clínicas de la pancreatitis aguda en un grupo de niños chilenos. Método: Estudio retrospectivo (1998-2008) de pacientes hospitalizados con PA. Se confirmó el diagnóstico por elevación de enzimas pancreáticas e imágenes; se obtuvieron los datos demográficos y se analizó: etiología, complicaciones y su resolución, necesidad de nutrición parenteral y uso de antibióticos. Resultados: Se identificaron 18 pacientes (8,3 ± 4 años). Etiología de la PA: litiasis y alteraciones anatómicas de la vía biliar (38,8%), idiopática (22,2%), drogas (22,2%), otras (16.8%). Dos pacientes presentaron colecciones peripancreáticas infectadas; igual número evolucionó con formación de pseudoquistes pancreáticos. Seis pacientes (33,3%) requirieron algún tipo de procedimiento quirúrgico como parte de su tratamiento. Dos tercios de los pacientes ingresaron a la Unidad de Pacientes Críticos. La mitad de los pacientes recibió nutrición parenteral y dos tercios antibióticos endovenosos. La mediana de hospitalización fue de 20 días (promedio 24,9 ± 14,3 días). No hubo mortalidad en la serie. Conclusiones: A diferencia de lo descrito en la literatura, la PA biliar fue la etiología más frecuente en esta serie. La patología biliar debe ser estudiada activamente en niños chilenos con PA.
Estimation of body fat in chilean children: Comparing subcutaneous fold equations amd doble photon densitometry

La estimación del grosor de pliegues subcutáneos (PS) es una manera simple de estimar composición corporal en niños, sin embargo, tiene limitaciones. La densitometría de doble fotón (DXA) es considerada como el nuevo estándar de referencia. Objetivo: Comparar la precisión de la estimación del porcentaje de masa grasa por PS con la obtenida por DXA en población infantil chilena. Pacientes y Método: Se estimó el porcentaje de masa grasa en 128 niños (70 mujeres y 58 hombres) sanos, eutróficos, entre 2 y 18 años, por diversas ecuaciones de PS y se comparó con DXA. La diferencia entre ambos mediciones fue evaluada mediante el método de Bland y Altman y el coeficiente de concordancia de Lin. Resultados: La mayoría de las ecuaciones de PS tuvieron un pobre nivel de concordancia con DXA. Sin embargo, existe una mejor concordancia entre lo calculado según PS y DXA tanto en niños pre-puberales con la fórmula específica de Westrate y Deurenberg y en niños de todas las edades, con la ecuación general de Westrate y Deurenberg (diferencia promedio de 2,96 ± 1,20% y 4,92 ± 0,98% e índice de concordancia de Lin de 0,50 ± 0,22 y 0,43 ± 0,88, respectivamente) Conclusiones: La estimación del porcentaje de masa grasa a partir de los PS, tiene una baja concordancia, sin embargo, mientras no se desarrollen ecuaciones con una precisión más alta se podrían utilizar las ecuaciones de Westrate y Deurenberg a todas las edades y la de Westrate y Deurenberg específica para la edad pre-puberal.
How has social status been measured in health research? A review of the international literature

Social status (SS) is a multidimensional variable that is used widely in health research. There is no single optimal method for estimating social status. Rather, in each case the measurement may vary depending on the research subject, the base theory considered, the population of interest, the event of interest and, in some cases, the available information. This literature review develops the following topics related to SS measurement, based on the international scientific sources available electronically: i) identification of the role of SS in the context of social epidemiology research, ii) description of the principal indicators and methodological approaches used to measure SS in health research, and iii) analysis of the distinct difficulties of SS measurement in specific populations such as ethnic groups, women, children, the elderly, and in rural vs. urban contexts. The review finally makes it possible to describe some of the implications of SS measurement in Latin American countries.
Hydroanencephalia in a newborn due to congenital toxoplasmosis

Se presenta el caso de un recién nacido de término con hidranencefalia por toxoplasmosis congénita con diagnóstico prenatal, el cual habría adquirido su infección en forma precoz durante el embarazo. Destaca madre con serología positiva para infección activa. Recién Nacido (RN) con IgM específica elevada. Resonancia Magnética fetal y del neonato compatible con hidranencefalia. RN con macrocefalia, catarata, reflejos arcaicos anormales, hipotonía, alteración del la termorregulación y LCR alterado. Frente a la gravedad y lo inusual del cuadro clínico y considerando la ausencia de un programa nacional de tamizaje se destaca la importancia de ofrecer a la madre embarazada la posibilidad de detección precoz y prevención de esta enfermedad frente a las severas complicaciones neurológicas de esta infección congénita.
Incidence and evolution of hyaline membrane in newborns under 35 weeks of gestational age according intrauterine growth

Introducción: Tradicionalmente se ha considerado que la restricción de crecimiento intrauterina produce maduración respiratoria, pero la información es diferente según si los estudios consideran el análisis por grupos de peso de nacimiento o edad gestacional. Objetivo: El objetivo de este análisis fue comparar la incidencia y evolución de membrana hialina, de los prematuros menores de 35 semanas de edad gestacional según fueran pequeños o no para edad gestacional. Pacientes y Método: Se analizaron dos bases de datos: 2 022 menores de 35 semanas hospitalizados en el Servicio para determinar incidencia de membrana hialina y 733 menores de 35 semanas tratados con surfactante con diagnóstico de membrana hialina para comparar evolución de ésta. Resultados: El análisis por grupos de edad gestacional muestra una incidencia de membrana hialina mayor, de 35,2%, en los pequeños para la edad gestacional, y de 29,1% en los no pequeños (p: 0,026). Si se analiza sólo menores de 1 500 gramos de peso de nacimiento, el grupo pequeño tiene una incidencia menor, de 47,5%, y los no pequeños de 60,7%. El análisis de regresión logística para alta con oxígeno de los que tuvieron membrana hialina, muestra asociación con menor puntaje z de peso de nacimiento, uso de corticoides y dependencia de oxígeno a las 36 semanas. Conclusiones: El recién nacido pretérmino pequeño para edad gestacional tiene mayor incidencia de membrana hialina y evoluciona con mayor dependencia de oxígeno al comparar por edad gestacional.
Induction of puberty in Turner's syndrome

Turner's Syndrome is the most frequent cause of female hypogonadism. Puberty must be pharmacologically induced in over 80% of these girls. Induction must be completed in a manner closest to physiology as possible. It is recommended that this induction be initiated at age 12 y.o. with natural estrogens (17 beta estradiol) in low dosage, equivalent to 1/10 a 1/8 of substitution dose, increasing stepwise and adding, after two years, a progestin to generate a menstruation. This revision shows various proposed schemes, as well as therapeutic alternatives available in Chile.
Inspiratory muscle training in patients with chronic obstructive pulmonary disease

Respiratory muscle weakness is observed in chronic obstructive pulmonary disease (COPD) patients and contributes to hypoxemia, hypercapnia, dyspnoea, nocturnal oxygen desaturation and reduced exercise performance. During exercise it has been shown that diaphragm work is increased in COPD and COPD patients use a larger proportion of the maximal inspiratory pressure (PImax) than healthy subjects. This pattern of breathing is closely related to the dyspnoea sensation during exercise and might potentially induce respiratory muscle fatigue. However, diaphragmatic fatigue was not demonstrated after exhaustive exercise. Studies in patients with COPD have shown natural adaptations of the diaphragm to greater oxidative capacity and resistance to fatigue. The above mentioned considerations gave conflicting arguments to the rationale of inspiratory muscle training (IMT) in COPD. Both IMT alone and IMT as adjunct to general exercise reconditioning significantly increased inspiratory muscle strength and endurance. A significant effect was found for dyspnoea at rest and during exercise. Improvedfunctional exercise capacity tended to be an additional effect of IMT alone and as an adjunct to general exercise reconditioning, but this trend did not reach statistical significance. No significant correlations were found for training effects with patient characteristics. However, subgroup analysis in IMTplus exercise training revealed that patients with inspiratory muscle weakness improved significantly more compared to patients without inspiratory muscle weakness. From this review it is concluded that inspiratory muscle training is an important addition to a pulmonary rehabilitation programme directed at chronic obstructive pulmonary disease patients with inspiratory muscle weakness. The effect on exercise performance is still to be determined. In summary, IMT improves inspiratory muscle strength and endurance, functional exercise capacity, dyspnoea and quality of life. Inspiratory muscle endurance training was shown to be less effective than respiratory muscle strength training.
Inter-hemispheric asymmetry of nigrostriatal dopaminergic lesion: A possible compensatory mechanism in Parkinson's disease

The onset of Parkinson’s disease (PD) is characterized by focal motor features in one body part, which are usually correlated with greater dopaminergic depletion in the contralateral posterior putamen. The role of dopamine (DA) hemispheric differences in the onset and progression of motor symptoms of PD, however, remains undefined. Previous studies have demonstrated that unilateral manipulations of one nigrostriatal system affect contralateral DA turnover, indicating a functional and compensatory inter-dependence of the two nigrostriatal systems. In preliminary data obtained by our group from asymmetric PD patients, a higher asymmetry index as measured by 6-[18F]fluoro-L-dopa (18 F-DOPA) positron emission tomography (PET) was associated with a higher threshold (i.e., greater dopaminergic loss) for the onset of motor symptoms in the less-affected side. To further elucidate the underlying basis for this, we carried out a complementary study in monkeys using PET to assess and correlate the degree of dopaminergic striatal depletion with motor activity. Control and 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-intoxicated monkeys with symmetrical lesions were characterized behaviorally and with 18F-DOPA PET. In parallel, an acute lesion was inflicted in the nigrostriatal projection unilaterally in one monkey, generating a 30% dopaminergic depletion in the ipsilateral striatum, which was not associated with any noticeable parkinsonian feature or deficit. The monkey remained asymptomatic for several months. Subsequently, this monkey received systemic MPTP, following which motor behavior and PET were repeatedly evaluated during progression of parkinsonian signs. The brains of all monkeys were processed using immunohistochemical methods. Our results suggest that the onset of motor signs is related to and influenced by the dopaminergic status of the less-affected, contralateral striatum. Although this work is still preliminary, the study agrees with our general hypothesis of hemispheric inter-dependence in the compensation of striatal DA deficit in PD.
Management of rectal cancer during pregnancy

Rectal cancer has low incidence in the pregnant women. Its diagnosis during pregnancy is usually delayed, since cancer symptoms are quite similar to normal symptoms of gestation. Delayed diagnosis confers worse prognosis, although pregnancy itself does not affect natural evolution of the disease. The perinatal outcome is not affected by the neoplasia, even in cases with multiple metastases, but may be affected by the treatment. The treatment of rectal cancer will depend of the stage of the neoplasia and gestational age. We review published data regarding rectal cancer associated with pregnancy and propose a management protocol.