Browsing by Author "Macchiavello, Stefano"

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    A study of hospital complaints and the role of the doctor-patient communication
    (SOC MEDICA SANTIAGO, 2011) Moore, Philippa; Vargas, Alex; Nunez, Salomon; Macchiavello, Stefano
    Background: Medical practice in Chile has changed dramatically over the last few years. Patients have raised their expectations and there is a growing number of complaints, and malpractice lawsuits. The doctor-patient relationship plays a fundamental role in patient satisfaction and has also been identified as an issue in most medical lawsuits. Aim: To analyze the importance of doctor-patient communication in the complaints received in a university hospital in Chile. Material and Methods: Review of all complaints received at the office for quality of care at a university hospital. Complaints classified in delay, manners and information categories were selected for further analysis. Results: Of a total of 8931 complaints registered between 2001 and 2008, 635 (19%) involved a doctor. Fifty one per cent of the latter, were related to the doctor-patient relationship. Of these, 146 cases (45%) were further classified as "Dysfunctional delivery of Information", 74 cases (23%) as "Not understanding the patient/family's perspective': 54 cases (17%) as "Discrediting the patient or family's views" and 49 cases (15%) as "Lack of communication': Conclusions: The percentage of complaints related to communication with the doctor is high, though lower than cited in other studies. The most common complaint is the dysfunctional delivery of information. (Rev Med Chile 2011; 139: 880-885).
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    Depressive symptoms are associated with higher morning plasma cortisol in primary care subjects
    (2018) Capponi, Valentina; Carrasco, Carmen; Macchiavello, Stefano; Undurraga, Juan; Campino Johnson, María del Carmen; Carvajal, Cristian; Gomez, Teresita; Weiss, Cristian; Aedo Campos, Igor Iván; Vecchiola Cárdenas, Andrea Paola; Allende, Fidel; Solari, Sandra; Fardella B., Carlos; Baudrand Biggs, René; Capponi, Valentina; Carrasco, Carmen; Macchiavello, Stefano; Undurraga, Juan; Campino Johnson, María del Carmen; Carvajal, Cristian; Gomez, Teresita; Weiss, Cristian; Aedo Campos, Igor Iván; Vecchiola, Andrea; Allende, Fidel; Solari, Sandra; Fardella B., Carlos; Baudrand Biggs, René
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    Overexpression of hepatic 5 alpha-reductase and 11 beta-hydroxysteroid dehydrogenase type 1 in visceral adipose tissue is associated with hyperinsulinemia in morbidly obese patients
    (W B SAUNDERS CO-ELSEVIER INC, 2011) Baudrand Biggs Rene Felipe; Domínguez Ruiz-tagle, José Miguel; Carvajal, Cristian A.; Riquelme, Arnoldo; Campino, Carmen; Macchiavello, Stefano; Bozinovic, Milan; Morales, Mauricio; Pizarro, Margarita; Solis, Nancy; Escalona, Alex; Boza, Camilo; Arrese, Marco; Fardella, Carlos E.
    11 beta-Hydroxysteroid dehydrogenase type 1 (11 beta-HSD1) converts cortisone to cortisol, mainly in the liver and visceral adipose tissue (VAT), and has been implicated in several metabolic disorders. The absence of systemic hypercortisolism in central obesity could be due to increased inactivation of cortisol to its tetrahydrometabolites by the hepatic enzymes 5 alpha-and 5 beta-reductases. Our aim was to assess the expression of the reductases in the liver and of 11 beta-HSD1 in the liver and VAT in morbidly obese patients and to analyze their association with clinical, anthropometric, and biochemical parameters. Hepatic and VAT samples were obtained during bariatric surgery. 5 alpha- and 5 beta-reductases, 11 beta-HSD1, and 18S expression was measured using real-time polymerase chain reaction. Anthropometric and biochemical variables were analyzed. Forty-one patients were recruited (age, 41.8 +/- 10.6 years; body mass index, 42.1 +/- 6.6 kg/m(2); 71% women). The expression of hepatic 5 alpha- and 5 beta-reductases was positively correlated (r = +0.53, P = .004), and their expression levels were correlated with hepatic 11 beta-HSD1 expression (r = +0.61, P < .001 for 5 alpha-reductase and r = +0.50, P < .001 for 5 beta-reductase). Hepatic 5 alpha-reductase was associated with insulin (r = +0.34, P = .015). Visceral adipose tissue 11 beta-HSD1 expression was associated with glucose (r = +0.37, P = .025) and insulin (r = +0.54, P = .002). Our results showed that 5 alpha-reductase and VAT 11 beta-HSD1 expressions were associated with insulinemia. These findings suggest that overexpression of 5 alpha-reductase, through a higher inactivation of cortisol in the liver, could have a protective role in preserving hepatic sensitivity to insulin. The overexpression of liver reductases in obesity could be an adaptive response to an increase in cortisol production by the liver and visceral 11 beta-HSD1 to avoid systemic hypercortisolism. (C) 2011 Elsevier Inc. All rights reserved.