Revista Medica Herediana

Educación Médica: Lo que no siempre se enseña

Funcionalidad en el adulto mayor previa a su hospitalización a nivel nacional

Objetivo: Determinar las características de la funcionalidad del adulto mayor en las 2 semanas previas a su hospitalización en el Perú, así como su asociación con otros síndromes y problemas geriátricos. Materiales y métodos: En base a la información del estudio "Valoración Geriátrica Integral en adultos mayores hospitalizados a nivel nacional", que incluyó 400 pacientes de 60 años o más; se evaluó las características de la funcionalidad y se comparó los resultados de la funcionalidad con los principales síndromes y problemas geriátricos. Resultados: Se encontró una frecuencia de autonomía funcional de 53%, el bañarse y el vestirse fueron las Actividades Básicas de la Vida Diaria más comprometidas con 44,5% y 39% respectivamente. Se encontró relación significativa entre funcionalidad y edad, situación socioeconómica, caídas, incontinencia urinaria, mareos, desnutrición, déficit cognitivo y depresión Conclusiones: La frecuencia de dependencia funcional pre-hospitalización en la población adulta mayor es elevada. Se encontró que a mayor edad, presencia de problemas sociales, caídas, incontinencia urinaria, mareos, desnutrición, déficit cognitivo y depresión se asocia a deterioro funcional.(Rev Med Hered 2005;16:165-171).

Objective: To determine the characteristics of the functionality in the Peruvian elderly adult 2 weeks before their hospitalization, also the association of the functionality with geriatrics syndromes and problems. Material and methods: On base of the information of the study "Multidisciplinary Geriatric Assessment in Peruvian Hospitals", that included 400 patients elder than 60 years; the functionality characteristics were evaluated and the functionality results were compared with the principal geriatric syndromes and problems. Results: The frequency of functional autonomy was of 53%; bathing and dressing were the most compromised basic activities of the daily living in a 44.5% and 39% of the patients. There was a significant difference between functionality and age, economical situation, falls, urinary incontinence, dizziness, cognitive impairment and depression. Conclusions: The frequency of functional dependency in the pre-hospitalized elderly adult population is high; also more age, social problems, falls, urinary incontinence, dizziness, cognitive impairment and depression are associated with functional deterioration. (Rev Med Hered 2005;16:165-171).

La enfermedad periodontal como factor de riesgo de parto pretérmino y de bajo peso al nacer en el Hospital Nacional Cayetano Heredia 2002-2003.

Objetivo: Evaluar la relación entre parto pretérmino (PP) y de bajo peso (BP) al nacer (PPBP) y la enfermedad periodontal (EP) materna. Materiales y Métodos: Estudio tipo casos y controles de 156 madres, 53 casos (madres de bebés con PPBP) y 103 controles (bebés de madres nacidos con >37 semanas y más de 2 500g). Se interrogó a las madres y se revisó las historias clínicas, se registraron datos como: grado de instrucción, estado civil, hábitos de fumar, alcohol, drogas y otros factores de riesgo conocidos. Un solo examinador calibrado registró los indicadores periodontales: profundidad al sondaje, nivel de inserción clínica, sangrado al sondaje y presencia de placa. El análisis se hizo con técnicas de estratificación o regresión logística. Resultados: Los niños pretérminos con y sin bajo peso y a término con bajo peso tienen poco más del doble de probabilidad de tener madres con pérdida de nivel de inserción clínica OR 2,14 (IC 95% 1,24-3,68). Hay asociación de PPBP con la pérdida del nivel de inserción clínica, controlando por peso materno, número de controles prenatales y antecedentes de hijos con BP al nacer. Conclusión: La enfermedad periodontal es un factor de riesgo independiente y potencial de PPBP (Rev Med Hered 2005;16:172-177).

Objective: To evaluate the relationship between preterm delivery, low birth weight infants and maternal periodontal disease, controlling by other know risk factors. Material and methods: A case control study, the sample was 156 mothers, 53 cases (mothers of preterm with and without low birth weight and term with low birth weight) and 103 controls (mothers of babies with gestational age > 37 weeks and birth weight >2,500g.). Data was obtained directly examining and interviewing the mothers and reviewing clinical records. Probing depths, bleeding on probing, clinical attachment lost and plaque were registered and estimated. Results: The multivariate conditional logistic regression model adjusting for maternal weight, prenatal control and low birth weight history showed association between clinical attachment lost and preterm with and without low birth weight and term with low birth weight, ORa 2.14 (95% CI 1.24-3.68). Conclusion: The maternal periodontal disease constitutes a risk factor for preterm low birth weight. (Rev Med Hered 2005;16:172-177).

El trabajo a turnos como factor de riesgo para lumbago en un grupo de trabajadores peruanos.

Objetivo: Identificar la asociación entre trabajo a turnos y lumbago en un grupo de trabajadores mineros. Materiales y métodos: Estudio Caso Control realizado el año 2003 en un grupo de trabajadores mineros. Se revisaron las historias electrónicas de los trabajadores con lumbago, en quienes se obtuvo la edad, sexo, estado civil, grado de instrucción, tiempo de trabajo, índice masa corporal (IMC), trabajo a turnos (8 horas) y puesto de trabajo, éste último, se dividió en "white collar" (trabajo de oficina) y "blue collar"(trabajo no oficina). Se calculó el Odds Ratio para trabajo a turnos y puesto de trabajo versus lumbago. Resultados: De 1 240 trabajadores, 149 (72%) tuvieron lumbago sin ciática y 56 (28%) con ciática. No se encontró diferencias estadísticamente significativas para las variables demográficas descritas entre los grupos de estudio. Se encontró que los trabajadores de trabajo por turnos tuvieron un OR para lumbago sin ciática de 1,28 (IC de 0,89 - 1,82) y lumbago con ciática un OR de 2,12 (CI 1,4- 3,93). En relación al puesto de trabajo tipo blue collar se encontró que para lumbago sin ciática tuvo un OR de 1,63 (IC 1,05-2,51) y para lumbago con ciática se tiene OR de 1,48 (IC 0,76-2,9). Conclusión: Existe un riesgo mayor en trabajadores de turnos de trabajo para lumbago con ciática y mayor riesgo en trabajadores con puestos de trabajo tipo blue collar para lumbago sin ciática. (Rev Med Hered 2005;16:184-189).

Objective: To identify the association among shift work and low back pain in a group of mining workers. Material and Methods: A Case-Control Study was carried out in 2003 in mine´s workers from Perú. Workers with a diagnosis of low back pain were identified; factors analized include age, sex, marital status, education level, shift work (8 hours), length of employment at the company, Body Mass Index (BMI) and work place which was categorized as "white collar "(office work) and " blue collar " (non-office work). The Odds Ratio were evaluated for work shift and working place versus low back pain. Results: Population was 1 240 workers. 149(72%) had a diagnosis of low back pain without sciatica and 56(28%) with sciatica. No statistically significant differences were found in the demographic variables described between groups of study, which makes it possible to compare the populations in study. On the other hand, regarding shift work, an OR of 1.28 (CI of 0.89 - 1.82) for low back pain without sciatica was found and an OR of 2.12 (CI 1.4-3.93) for low back pain with sciatica was found. Regarding work place, blue collar work was found to have an OR of 1.63 (CI 1.05-2.51) for low back pain without sciatica and an OR of 1.48 (CI 0.76-2.9) for low back pain with sciatica was found. Conclusion: There is an increased risk for low back pain with sciatica in workers engaging in shift work and an increased risk for low back pain without sciatica in workers working in blue collar positions.(Rev Med Hered 2005;16:184-189).

Estilos de pensamiento en alumnos de Pre-Grado de Medicina

Objetivo: Describir los estilos de pensamiento de un grupo de estudiantes en el segundo y cuarto año de estudios del pregrado de medicina. Materiales y métodos: Estudio descriptivo, longitudinal y no experimental, en un grupo de 71 estudiantes. Resultados: Los estilos de pensamiento predominantes, en los años 2000 y 2002 respectivamente, fueron: función ejecutiva 53 (74,65%) y 58 (81,69%), forma monárquica 51 (71,83%) y oligárquica 49 (69,01%), nivel global 44 (61,97%) y local 41(57,75%), alcance interno 45 (63,38%) y 48 (67,61%), e inclinación liberal y conservadora 28 (39,44%) cada una y liberal 38 (53,52%). Conclusiones: Los hallazgos concuerdan parcialmente con los estilos de pensamiento del futuro profesional médico, función judicial, forma jerárquica, nivel global, alcance externo e inclinación liberal. (Rev Med Hered 2005;16:190-198).

Objective: To describe the thinking styles of a group of students in the second and fourth year of studies of pre grade of medicine. Material and Method: Not experimental, longitudinal, and descriptive study, in a group of 71 students. Results: The predominant thinking styles, in the 2000 and 2002 respectively, were: executive function 53(74.65%) and 58(81.69%), monarchical 51(71.83%) and oligarchy form 49(69.01%), global 44(61.97%) and local level 41(57.75%), internal reach 45(63.38%) and 48(67.61%), and conservative and liberal inclination 28(39.44%) each one and liberal 38(53.52%). Conclusions: Results agree partially with thinking styles of the future medical doctor, judicial function, hierarchical form, global level, external reach and liberal inclination. (Rev Med Hered 2005;16:190-198).

La historia médico - ocupacional como herramienta de diagnóstico

¿ Existe el cáncer localizado de próstata?

The natural history of prostate cancer is not well defined and this further complicates the therapeutic options for its treatment. Since 1980, radical prostatectomy was considered the first option in attempting to cure this type of cancer which represents a 25% of the cases of cancer in men, affecting 1/8 of the male population before age 75 and that reveals itself as the more frequent male cancer after age 50. Due to its effectiveness, radical prostatectomy should be performed when cancer is limited to the gland, not having surpassed the prostatic gland. The acquired experience shows that 20-40% of anatomical pieces extracted presented capsular invasion or positive margins, and that approximately 30-60% of the operated patients witness the progress of their disease within 5 years, despite surgery. This thought is possible due to the acquired experience with numerous patients that have been treated with radical prostatectomy. All the recent work done confirms that only cancer localized to the prostatic gland is susceptible of being cured by surgery and that only low risk cancers have a real possibility of being limited to the gland. In this group of patients with localized cancer, many are not of clinical importance. An important number of patients that have neoplasic cells in their prostate will die from other causes, without having necessarily suffered from the prostate. This paper highlights the limits of surgery and the actual lack of criteria to define a localized lesion within the gland and its aggressiveness, as well as the lack of alternative effective treatments in the case of an extra prostatic lesion. Finally, it is very important to try to make an early diagnosis of prostatic cancer, nevertheless, from the moment in which the diagnosis of cancer is given to the patient, the single word "cancer" sounds devastating and its announcement transforms the patients life, with an upcoming death sensation that could pose a psychological harm to the patient. Just to mention, for the urologist not to over estimate cancer and not to over treat it with interventions that may definitely alter the quality of life of the patient: radical prostatectomy causes urinary incontinence in 5-20% of patients and erectile disfunction in 40-70% of them. ¿ Does cancer localized to the prostate gland really exist? The question arises now between the cases of cancer that are diagnosed while they are not significative and the ones that have already surpassed the capsule. (Rev Med Hered 2005;16: 202-207).