RESUMO
People who suffer political violence (PV) are at risk of developing mental illness, chronic noncommunicable diseases, chronic pain, and decreased life expectancy. However, these indicators have been studied primarily in war veterans and refugees. The objective of this study was to estimate the prevalence of chronic musculoskeletal pain (CMP) and central sensitization-related symptoms (CSRS) in Chilean victims of PV during the 1973 to 1990 dictatorship. A cross-sectional observational multicenter study was conducted. Three hundred twenty-five people from six centers of a Ministry of Health of Chile program participated. The presence of CMP was determined by a history of pain ≥3 months, and CSRS was determined using the central sensitization inventory. About 69.23% of the sample had CMP (76.85% of females and 56.56% of males). About 60% of people with CMP showed a high level of CSRS severity (66.67% females and 44.93% males). Females presented significantly higher proportions of CMP (p < .001), and there was an association between CSRS severity and being female (p = .004). Chilean victims of PV during the 1973 to 1990 dictatorship presented a high prevalence of CMP and high-level CSRS severity. Both conditions affected females more than males. Future studies are needed to further delve into these variables' behavior and their influence on the quality of life in this population.
RESUMO
Introducción: el calcio es el electrolito más abundante del cuerpo humano y la hipercalcemia es el trastorno común causado normalmente por el hiperparatiroidismo primario o malignidad, su manejo depende de la presentación y causa subyacente. Además, una proporción de casos se presentan como una emergencia, lo que conlleva a una mortalidad significativa. Objetivo: mostrar un caso inusual de presentación clínica de hipercalcemia asociada a hiperparatiroidismo primario y, asimismo, dar una breve revisión acerca del enfoque y el manejo de esta patología. Presentación del caso: paciente femenina de 32 años, antecedente de adenoma paratiroideo no resecado y pancreatitis, asiste por tres días de dolor abdominal de tipo cólico y de moderada intensidad, acompañado de episodios eméticos de contenido alimentario, paraclínicos iniciales con hipercalcemia severa, electrocardiograma con bloqueo auriculoventricular grado I, gases arteriales con alcalosis respiratoria aguda e hiperlactatemia. También se le practicó un TAC de abdomen donde este apareció con tumores pardos. Se ingresó a la UCI para la administración de líquidos endovenosos, diuréticos de asa y cinacalcet, pero no presentó mejoría, por lo que se indicó terapia de hemodiálisis. Discusión y conclusión: la hipercalcemia es un hallazgo frecuente. El hiperparatiroidismo primario y la neoplasia maligna son las dos causas más frecuentes de aumento de los niveles de calcio sérico y, en conjunto, representan alrededor del 90 % de todos los casos, donde los valores en suero varían entre el calcio total (8,5 y 10,5 mg/dl) y el iónico (1,16-1,31). La concentración sérica de Ca 2+ está estrechamente relacionada por las acciones de la hormona paratiroidea y el calcitriol, donde el hiperparatiroidismo primario ocurre como resultado de adenomas, hiperplasias y carcinoma. Las manifestaciones clínicas y la severidad van a estar correlacionadas con el tiempo de duración de la enfermedad, los niveles de calcio y de PTH. Dentro del tratamiento, este será guiado por su causa, sin embargo, es posible clasificarlo en tratamiento urgente y no urgente. Además, el enfoque de la hipercalcemia aguda severa es un reto diagnóstico dadas las múltiples causas que pueden llevar a este trastorno hidroelectrolítico y la rápida instauración de tratamiento que se requiere cuando es detectada.
Background: Calcium is the most abundant electrolyte in the human body, hypercalcemia is a common disorder usually caused by primary hyperparathyroidism or malignancy. A proportion of cases presenting as an emergency, leading to significant mortality. The management of hypercalcemia depends on the presentation and underlying cause. Purpose: to present an unusual case of clinical presentation of hypercalcemia associated with primary hyperparathyroidism, as well as to give a brief review about the approach and management of this pathology. Case presentation: A 32-year-old female patient, with a history of unresected parathyroid adenoma and pancreatitis, attended for 3 days of abdominal pain, moderate intensity, accompanied by emetic episodes of food content, initial paraclinical findings showed severe hypercalcemia, electrocardiogram with block grade I atrioventricular, arterial gases with acute respiratory alkalosis and hyperlactatemia. CT of the abdomen with brown tumors. She was admitted to the ICU for administration of intravenous fluids, loop diuretics, and cinacalcet without showing any improvement, so hemodialysis therapy was indicated. Discussion and conclusion: hypercalcemia is a frequent finding. Primary hyperparathyroidism and malignancy are the two most common causes of elevated serum calcium levels, together accounting for about 90 % of all cases. Serum values vary between total calcium 8.5 and 10.5 mg/dl and ionic 1.16- 1.31. Serum Ca 2+ concentration is closely related by the actions of parathyroid hormone and calcitriol. Primary hyperparathyroidism occurs as a result of adenomas, hyperplasias, or carcinoma. The clinical manifestations and severity will be correlated with the duration of the disease, calcium and PTH levels. Within the treatment, this will be guided by its cause, however, it is possible to classify it into urgent and non-urgent treatment. The approach to severe acute hypercalcemia is a diagnostic challenge given the multiple causes that can lead to this hydroelectrolyte disorder and the rapid establishment of treatment that is required when it is detected.
RESUMO
Introducción: las reacciones hemolíticas tardías transfusionales ocurren después de 24 horas de practicadas, algunas durante las dos semanas siguientes a la transfusión o hasta en un período de 30 días. Las reacciones transfusionales inmunológicas pueden ser febriles, anafilácticas y hemolíticas. En este último nivel se presentan como reacción a antígenos de eritrocitos extraños en pacientes que fueron expuestos previamente a transfusiones y embarazo. Reporte de caso: a continuación revisaremos el caso de una paciente en el Hospital de San José de Bogotá quien presentó una reacción hemolítica tardía y se documentó la expresión de antígenos Duffy y antígenos E, secundarios a inmunización por trasfusiones anteriores.
Introducction: delayed hemolytic transfusion reactions (DHTR) happen 24 hours, two weeks or up to 30 days post transfusion. Immunologic transfusion reactions may be febrile, anaphylactic and hemolytic. Hemolysis occurs as a response to foreign red-blood cells antigens, in patients, previously exposed to transfusions and pregnancy. Case presentation: herein we review the case of a patient, admitted to Hospital de San José in Bogotá, who presented with a delayed hemolytic reaction, in whom the expression of Duffy and E antigens was documented, secondary to immunization related to previous blood transfusions.
Assuntos
HumanosRESUMO
Background: Studies on the long-term consequences of torture in survivors in Chile have only addressed the consequences for mental health, leaving aside the physical consequences. Aim: To report the causes of death in the universe of victims of the Chilean civic-military dictatorship recognized by the Reports of the National Commission for Political Prison and Torture (CNPPT) and the Advisory Commission for the qualification of Disappeared Detainees, Politically Executed individuals and Victims of Political Prison and Torture. Material and Methods: The causes of death, age at the time of death, sex, political context of death and opportunity of repair up to June 2016 are described in 38,254 victims of the Chilean civic-military dictatorship. Results: Of the universe of 38,254 victims, 9,152 (23.9%) died until June 2016. The median age at death was 68 years. The main causes of death were malignant tumors in 28%, cardiovascular diseases in 27%, respiratory diseases in 10%, digestive diseases in 9% and external causes in 8%. Conclusions: These results can inform prevention and treatment strategies for victims of the Chilean dictatorship.
Assuntos
Humanos , Transtornos de Estresse Pós-Traumáticos , Tortura , Sistemas Políticos , Prisões , Chile/epidemiologia , SobreviventesRESUMO
BACKGROUND: Studies on the long-term consequences of torture in survivors in Chile have only addressed the consequences for mental health, leaving aside the physical consequences. AIM: To report the causes of death in the universe of victims of the Chilean civic-military dictatorship recognized by the Reports of the National Commission for Political Prison and Torture (CNPPT) and the Advisory Commission for the qualification of Disappeared Detainees, Politically Executed individuals and Victims of Political Prison and Torture. MATERIAL AND METHODS: The causes of death, age at the time of death, sex, political context of death and opportunity of repair up to June 2016 are described in 38,254 victims of the Chilean civic-military dictatorship. RESULTS: Of the universe of 38,254 victims, 9,152 (23.9%) died until June 2016. The median age at death was 68 years. The main causes of death were malignant tumors in 28%, cardiovascular diseases in 27%, respiratory diseases in 10%, digestive diseases in 9% and external causes in 8%. CONCLUSIONS: These results can inform prevention and treatment strategies for victims of the Chilean dictatorship.
Assuntos
Transtornos de Estresse Pós-Traumáticos , Tortura , Chile/epidemiologia , Humanos , Sistemas Políticos , Prisões , SobreviventesRESUMO
BACKGROUND: It has been considered that the duration of first episode of psychosis is a critical period influencing the clini-cal and psychosocial evolution in people with diagnosis of schizophrenia. However, there is little knowledge about this issue in Low and Middle Income Countries. OBJECTIVE: To describe the clinical characteristics and contacts with health services of people with first episode of schizophrenia, prior to their diagnoses and initiation of treatment. Sources and methods. The sample included all persons with diagnosis of first episode of schizo-phrenia, in five psychiatric care centers, located in the North, Center and South of Chile. Diagnosis was confirmed with ICD-10 criteria and psychopathology symptoms were explored using PANSS. RESULTS: The sample was constituted by 48 patients (79.2% men, average age in 23.4 years). The symptom of depression was the first to appear (me-dian of 15 months, before diagnosis). Positive symptoms started in the previous year before diagnosis (delusions, median of 6 months). Positive symptoms triggered the first contact in 77.1% of the patients. Of these cases, 91.7% had medical care in this period (in Primary Health Care Centers and Mental Health Centers). The me-dian for previous contacts was 3.5, but the correct diagnosis was not done at that time. CONCLUSION: Most of the patients had medical contacts for their psychotic symptoms, but their diagnosis were not made within that period, delaying the start of treatment. There is a need to develop strategies to improve diagnosis capabilities in these centers.
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Serviços de Saúde Mental/estatística & dados numéricos , Esquizofrenia/patologia , Esquizofrenia/terapia , Adolescente , Adulto , Chile , Diagnóstico Precoce , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Psicopatologia , Transtornos Psicóticos/patologia , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/terapia , Saúde Pública , Esquizofrenia/fisiopatologia , Psicologia do Esquizofrênico , Fatores Socioeconômicos , Fatores de Tempo , Adulto JovemRESUMO
El estudio de los saberes para la salud y la enfermedad y de las prácticas médicas en la población de origen indígena plantea desafíos teóricos, sociales y políticos. Desde el punto de vista del análisis, la heterogeneidad cultural en la que se encuentra obliga a considerar los procesos de modernización, lo cual implica asumir una perspectiva histórica que no siempre consideran las investigaciones sobre la sociedad y cultura andina contemporánea. Este artículo pretende avanzar en este sentido. Planteamos que el peso de la escolaridad es gravitante en la diferenciación social y cultural y por lo tanto el nivel alcanzado incide en la comprensión de la naturaleza del cuerpo y su funcionamiento y en las prácticas para la salud. Los datos coinciden en gran parte con los informados por otros investigadores; a partir de estos, proponemos que es preciso ampliar el debate sobre la cuestión de la materialidad-inmaterialidad de las bases teóricas del pensamiento médico andino.
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Humanos , Povos Indígenas , Medicina Tradicional , Mudança Social , Chile , Terapias Complementares , Características Culturais , Sistemas de SaúdeRESUMO
BACKGROUND: Major depression, a frequent psychiatric disease, is associated with ischemic heart disease. It is usually subdiagnosed and subtreated. AIM: To study the prevalence of major depression among survivors of an acute myocardial infarction. PATIENTS AND METHODS: Retrospective study of 42 survivors of an acute myocardial infarction treated at a regional Chilean Hospital. The presence of major depression in the 6 months previous to the acute myocardial infarction, was investigated using the diagnostic instruments CIDI (Composite International Diagnostic Interview) and DIS (Diagnostic Interview Schedule), psychiatric diagnoses were based on DSMIII-R. The prevalence of depression was compared with that observed in a group of 156 healthy subjects participating in a psychiatric epidemiological study. RESULTS: Major depression was diagnosed in 12 male subjects with an acute myocardial infarction. The prevalence in the control group was significantly lower (15%, p < 0.049). Patients with depression were older and required longer hospital stay than patients without depression. CONCLUSIONS: Patients with acute myocardial infarction, had a significantly greater prevalence of major depression in the previous 6 months, than the general population. Thus, major depression could be an independent and modifiable coronary risk factor.
Assuntos
Transtorno Depressivo Maior/psicologia , Infarto do Miocárdio/psicologia , Adulto , Distribuição por Idade , Idoso , Chile/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Distribuição por SexoRESUMO
Se presentan los resultados de un estudio comunitario de trastornos psiquiátrico realizados en la población de 15 años y más de la provincia de Iquique, con lo que se completa la tercera y penúltima etapa del ya conocido Programa Nacional de Epidemiología Psiquiátrica. A una muestra probabilística bi-etápica de 350 adultos se les aplicó el CIDI 1.1 además de otros instrumentos. La prevalencia de vida y seis meses según criterios DSM-III-R para los trastornos estudiados se analizan por variables sociodemográficas género y edad. Destaca una prevalencia de vida de un 42.18 por ciento y de un 27.78 por ciento cuando se considera los seis meses previo al estudio. Se concluye sugiriendo que estamos presenciando un deterioro significativo de la salud mental en nuestro país y las medidas adecuadas son impostergables
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Estudos Transversais , Transtornos Mentais/epidemiologia , Chile/epidemiologia , Distribuição por Idade , Inquéritos Epidemiológicos , Fatores SocioeconômicosRESUMO
Se presentan los resultados obtenidos en tres estudios comunitarios de trastornos psiquiátricos realizado en 1990 y 1997 en Concepción, Santiago e Iquique. El análisis se centra en el abuso y dependencia de alcohol y drogas. Las prevalencias se analizan según variables sociodemográficas y su evolución a través del tiempo, junto con comparar los resultados con los estudios similares realizados en otros países. Se constata un sostenido y muy importante aumento del abuso y dependencia de sustancias psicoactivas junto con esbozar algunas posibles explicaciones