Revista médica de Chile
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Constipation affects 2% to 27% of individuals. It is associated to irritable bowel syndrome in 59% of cases, to a pelvic floor dysfunction in 29% and to a low transit time in 13%. ⋯ An algorithm for the management of chronic idiopathic constipation, that includes a recommendation to increase fiber and liquid intake as an initial approach and an orientation to the use of different laxatives, is presented. The usefulness of biofeedback in patients with pelvic floor dysfunction and without organic cause of constipation, is also discussed.
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Revista médica de Chile · Sep 2007
Review[Do antidepressants really increase suicide rates in childhood and adolescence?].
The use of antidepressant in depressive illness results in a reduction of suicidal attempts and deaths due to suicide, conditions that are generally present in this disorder. Recently, the Federal Drug Administration (FDA) prohibited the use of antidepressants during childhood and adolescence. ⋯ It is not possible to ascribe a direct responsibility to antidepressants, because depression, by definition, has suicidal ideation. On the contrary, the reduction of suicidal rates supports the effectiveness of these medications.
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Revista médica de Chile · May 2007
Review[Cardiopulmonary resuscitation and do not resuscitate orders].
In medical practice, the different scenarios in which cardio respiratory resuscitation (CPR) may be applied must be taken into account. CPR is crucial in subjects that arrive in emergency rooms or suffer a cardiac arrest in public places or at their homes. It is also critical in hospitalized patients with potentially reversible diseases, who suffer cardiac arrest as an unexpected event during their evolution. ⋯ DNR orders must be renewed and reconsidered on a daily basis. It does not mean that other treatment should be discontinued and by no means should the patient be abandoned. DNR and previous directives, DNR and quality of life and DNR communication are also commented in the present article.
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Revista médica de Chile · Apr 2007
Review[Predictive value of history and physical examination for the diagnosis of community-acquired pneumonia in adults: a literature review].
Distinguishing pneumonia from other causes of respiratory illnesses, such as bronchitis, influenza and upper respiratory tract infections, has important therapeutic and prognostic implications. This decision is usually made by clinical assessment alone or by performing a chest x-ray. The reference standard for diagnosing pneumonia is chest radiography, but many physicians rely on history and physical examination to diagnose or exclude this disease. ⋯ Prediction rules have been recommended to guide the order of diagnostic tests, to maximize their clinical utility. Thus, some studies have shown that the absence of any vital sign abnormalities or any abnormalities on chest auscultation substantially reduces the likelihood of pneumonia to a point where further diagnostic evaluation may be unnecessary. This article reviews the literature on the appropriate use of the history and physical examination in diagnose community-acquired pneumonia.
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Revista médica de Chile · Aug 2006
Review[Recommendations for the nutritional assessment of critically ill patients].
Undernutrition affects 30 to 50% of hospitalized patients. The identification of patients with undernutrition or in risk to become undernourished is of utmost importance to prescribe a timely nutritional support. ⋯ Prognostic indexes and other parameters used for the assessment of nutritional risk are also discussed. Some tools are proposed for the diagnosis of hospital malnutrition.