Violeta Díaz T

Evaluación geriátrica en la atención primaria

A good medical care program for the elderly requires a thorough assessment of the functional capacity and limitations of the consulting patients. Aim: To perform a geriatric assessment to elderly subjects consulting in a public outpatient clinic. Patients and methods: A cross sectional assessment of subjects over 60 years old, beneficiaries of the public health care system and consulting in 4 outpatient clinics of a poor community of Metropolitan Santiago. Evaluation included a complete medical history, the Katz score for activities of daily living (ADL), Lawton score for instrumental activities for daily living (IADL) and Folstein Mini Mental state examination. Results: During the study period 1,023 subjects, 73% female, aged 74±7 years, were assessed. Thirteen percent were illiterate, 78% elementary school, 8% had high school and 0.2% university education. Eighty eight percent lived with relatives, 79% did not participate in community groups and 7% smoked. The most common chronic disease detected was high blood pressure in 61%, followed by obesity in 32%, osteoarthritis in 22%, diabetes mellitus in 17%, depression in 11%, cardiac diseases in 8%, hypothyroidism in 3% and epilepsy in 1%. ADL score showed partial dependency in 11% and total dependency in 2%. IADL score showed partial dependency in 41% and total dependency in 4%. Mini Mental score was abnormal in 31% of subjects. Conclusions: High blood pressure, osteoarthritis, depression and cognitive impairment are the most common health problems in this sample of elderly subjects. ADL score showed a low rate of dependency (Rev Med Chile 2003; 131: 895-901)

Prevalencia de la ateromatosis carotídea en pacientes con enfermedad cerebro vascular oclusiva

Background: Hispanics have a greater incidence of stroke and prevalence of intracranial atherosclerosis than whites. Aim: To study the prevalence of extracranial atherosclerosis among patients admitted to a hospital with an ischemic stroke. Material and methods: A prospective study in stroke patients admitted to a Neurology ward in a University Hospital. All were subjected to a CT scan, carotid duplex-Doppler ultrasonographic examination with Doppler measurement of blood flow velocity, permeability and plaques. Cardiac emboli were searched with transthoracic and transesophagic echocardiography. Results: One hundred ten patients (39 women), aged 67.5±11.4 years old were studied. Stroke was atherothrombotic in 46 (41.8%), embolic in 30 (27.3%), lacunar in 27 (24.6%) and of other type in 7 (6.4%). Ninety two patients (84.4%) had high blood pressure, 38% had high cholesterol levels, 35% had a cardiac disease and 26% were smokers. Thirty five subjects (31.8%) had a normal carotid ultrasonography, 46 (41.8%) had mural plaques, 16 (14.5%) had multiple plaques without occlusion, 13 (11.8%) had a partial occlusion and 7 (6,4%) had a total occlusion. Logistic regression analysis disclosed no significant relationship between stroke types and carotid atherosclerosis. Age was the only significant predictor for carotid atherosclerosis. Conclusions: The prevalence of severe carotid atherosclerosis in this group of stroke patients was less than expected (Rev Med Chile 2001; 129: 161-5).

Evaluación de una unidad de tratamiento del ataque cerebral en un hospital universitario

During 2003, 425 stroke patientswere admitted to our hospital and 105 (age range 30-89 years, 58% female) were hospitalizedat the Stroke Unit. Eighty three percent had ischemic and 16% had hemorrhagic stroke. Themost common etiologies were thrombosis in 41%, embolism in 36%, lacunar in 13%, arterialdissection in 5% and transient ischemic attack in 3%. Fifty eight percent of patients had partialanterior ischemic stroke (PACI), 73% had hypertension and 29.5% diabetes. Only 18% arrivedto the Stroke Unit with less of 6 hours of evolution, 7% of patients were admitted within the 3hours after the onset of symptoms and 18%, from 3 to 6 hours. The mean lenght of stay in theStroke Unit was 6.6 days and at the hospital 9.9 days (p <0.01). The mean costs per patient atthe Stroke Unit and at the hospital were US

Neuropatía por disulfiram: Comunicación de tres casos clínicos

5.550 and US

Mortalidad por enfermedad de Parkinson en Chile

4.815, respectively (p =ns).

Demencia por déficit de vitamina B12: Caso clínico

Disulfiram is widely used for aversive treatment of alcoholism. Although it is well tolerated in most patients, one in 15,000 patients will develop peripheral neuropathy every year, which is frequently misdiagnosed as alcoholic neuropathy. Disulfiram neuropathy can be mild or severe, depending on diverse factors such as time of exposure and the dosage. Most patients will present with a motor-sensory neuropathy of the lower limbs, which tends to improve as disulfiram administration ceases, however some cases may remain with permanent sequelae. We report the clinical, laboratory and electrophysiological features of three patients who developed disulfiram neuropathy during treatment of alcoholism. Recovery was incomplete at 8 weeks after treatment cessation in all of them. No other findings justified the clinical features described in these patients. Considering the incidence of alcoholism and the wide use of disulfiram treatment in Chile, we suggest that disulfiram neuropathy is being underdiagnosed. We also stress the fact that disulfiram neuropathy could be avoided by using lower doses (Rev Med Chile 2002; 130: 1037-42).

Tendencia de la mortalidad por tumores cerebrales malignos en Chile: Análisis de tasas

BACKGROUND Parkinson disease (PD) is the second more common neurodegenerative disorder and determines a loss in quality of life, caregiver burden and increased mortality in those affected. AIM To determine the rates of mortality due to Parkinson disease in Chile. MATERIAL AND METHODS Data were collected from death certificates between 1997 and 2008. Mortality rates were calculated and the mortality trend was established along the study period, and analyzed by age, sex and geographic region of Chile. RESULTS There was a steady increase in mortality over the years, particularly since 2001 (r²= 0.85, p < 0.01). The increase in mortality rates was 0.25 per 100.000 habitants/year (r²: 0.89, p < 0.01). Mortality was always higher in men and in those older than 80 years. The highest rate (per 100,000 habitants) in Chile was observed in the region of Valparaiso (2.4) while the lowest was in Antofagasta (0.8) (t = 3.72, p < 0.05). CONCLUSIONS Mortality associated with PD has increased progressively, consistent with the expected increase in prevalence of the disease in the population.

Encefalomielitis aguda diseminada de presentación atípica: utilidad de la biopsia estereotáctica para su diagnóstico. Caso clínico

Cyanocobalamin (vitamin B12) deficiency can cause polyneuropathy, myelopathy, blindness, confusion, psychosis and dementia. Nonetheless, its deficiency as the sole cause of dementia is infrequent. We report a 59 years old man with a 6 months history of progressive loss of memory, disorientation, apathy, paranoid delusions, gait difficulties with falls, and urinary incontinence. He had suffered a similar episode 3 years before, with a complete remission. On examination there was frontal type dementia with Korsakoff syndrome, a decrease in propioception and ataxic gait. Cerebrospinal fluid examination showed a protein of 0.42 g/L. Brain computed tomography showed sequelae of a frontal left trauma. Brain single photon computed tomography (SPECT) was normal. Complete blood count showed a macrocytic anemia with a hematocrit 29% and a mean corpuscular volume of 117 µ3. Plasma vitamin B12 levels were undetectable, erythrocyte folate levels were 3.9 ng/ml and plasma folate was normal. The myelogram showed megaloblastosis and the gastric biopsy showed atrophic gastritis. Treatment with parenteral B12 vitamin and folic acid reverted the symptoms, with normalization of the neuropsychological tests and reintegration to work (Rev Med Chile 2003; 131: 915-9)

Migraña con aura: Una mirada molecular a un problema hereditario

Resumen es: Existe controversia en el aumento de la incidencia en las tasas de tumores primarios malignos de cerebro. Este incremento podria explicarse por el crecim...

Aplicaciones de la musicoterapia en la medicina

Thalium SPECT suggested a lymphoma. A stereotaxicbiopsy showed a subacute demyelinizing lesion, compatible with an acute disseminatedencephalomyelitis. The patient was treated with Methylprednisolone with resolution of symptoms. Sheremains in good condition after one year of follow-up (Rev Med Chile 2006; 134: 883-6).(