Revista Hospital Clínico Universidad de Chile最新文献

{"title":"Consideraciones éticas, aspectos geriátricos y de cuidados paliativos relativos a la asistencia clínica en situación de crisis sanitaria. Hospital Clínico Universidad de Chile (marzo 2020)","authors":"Domingo Castillo S., R. Cornejo R, Nivia Estuardo A., Jaime Hidalgo F., Alejandra Palma B., S. Valenzuela P.","doi":"10.5354/2735-7996.2020.69903","DOIUrl":"https://doi.org/10.5354/2735-7996.2020.69903","url":null,"abstract":"Este documento es una guía general para técnicos y profesionales de la salud. Su contenido ha sido adecuado al contexto asistencial del Hospital Clínico Universidad de Chile (HCUCH) e incluye especificaciones atingentes a la pandemia Covid-19 que estamos viviendo a nivel mundial. Este documento no pretende ni debe ser considerado un sustituto a consultas al Comité de Ética Asistencial o a cualquier otra entidad o profesional que se requiera para entregar una atención óptima a los pacientes y familias que concurran a nuestra institución. El contenido de este documento podrá ser modificado en la medida en que el desarrollo de los acontecimientos sanitarios genere la necesidad de actualizar o complementar la información.Debemos enfatizar la necesidad de agotar todos los esfuerzos por maximizar las medidas de seguridad y minimizar el riesgo de Covid-19 de pacientes, familiares y funcionarios de la salud en todo momento.","PeriodicalId":287456,"journal":{"name":"Revista Hospital Clínico Universidad de Chile","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131552355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enfrentamiento a una masa cervical no tiroidea en Atención Primaria","authors":"T. González A., L. Fuenzalida M., P. Gac E., F. Rodríguez M., P. Cabané T., D. Rappoport W.","doi":"10.5354/2735-7996.2020.69840","DOIUrl":"https://doi.org/10.5354/2735-7996.2020.69840","url":null,"abstract":"The clinical approach to non-thyroid cervical masses in primary care has always been considered \u0000a diagnostic challenge. In the absence of specific diagnostic methods, the general practitioner \u0000must rely on clinic and general tests in order to achieve a suspected diagnosis and timely \u0000referral. On initial approach to cervical masses, one must first analyze each case according to \u0000patient age, associating an exhaustive anamnesis focused on the growth pattern and aggregate \u0000symptoms, along with a physical examination focused on signs of malignancy. Once completed, \u0000the etiology of the mass can be classified as probable congenital, inflammatory or tumoral \u0000origin. And also try to determine localization, temporality and discriminate between benign and \u0000malignant causes. Once the clinical interrogation has been completed, basic complementary \u0000tests and/or directed test according to suspicion can be requested. The foregoing allows the \u0000primary care physician a proper referral to specialist and/or initiation of appropriate treatment.","PeriodicalId":287456,"journal":{"name":"Revista Hospital Clínico Universidad de Chile","volume":"383 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132256958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caracterización clínica y angiográfica según sexo de pacientes con síndrome coronario agudo sin supradesnivel del segmento ST","authors":"H. Ugalde P., Pablo Romero A., Ignacio Cifuentes R.","doi":"10.5354/2735-7996.2020.69927","DOIUrl":"https://doi.org/10.5354/2735-7996.2020.69927","url":null,"abstract":"Ischemic Heart Disease is the leading cause of death and of potential years of life lost in Chile. The most frequent acute presentation of this group of pathologies is the Acute Coronary Syndrome (ACS) without ST segment elevation. According to the literature, there is a proportion of patients with non-ST elevated ACS in which coronary angiography reveals a mild coronary lesion or even shows no detectable lesion at all. This scenario is more common in women than in men. Compared with men, women with non-ST elevated ACS are older than men and more frequently have hypertension. Furthermore, women are less likely to have previous cardiac diseases, and are less common to present serum troponin rise at admission. In Chile, there are no previous studies about the differences between sexes in this disease. The objective of this study is to determine if there are major differences between sexes in aspects like clinical and angiographic findings in patients with non-ST elevated ACS. The study used a database of 1900 consecutive patients who were submitted for coronary angiography and had been previously diagnosticated with non-ST elevated ACS, between the years 2001-2017. Clinical assessment, laboratory and angiographic results were collected and analyzed to establish major differences considering p","PeriodicalId":287456,"journal":{"name":"Revista Hospital Clínico Universidad de Chile","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129712955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caracterización de indicadores de detección de glaucoma con los equipos OCT Spectralis y campímetro Humphrey II en pacientes altos miopes y altos miopes glaucomatosos del Hospital Clínico Universidad de Chile","authors":"Felipe Rojas B., Mauricio Aguilar V., Karl Meza M., Catalina Pinto C., Paula Verdugo H.","doi":"10.5354/2735-7996.2019.70044","DOIUrl":"https://doi.org/10.5354/2735-7996.2019.70044","url":null,"abstract":"Purpose: Characterize and describe glaucoma index parameters of the results of visual exams, \u0000Optical Coherence Tomography and Visual Field, in high myopic subjects with and without the \u0000pathology. Method: Cross sectional and observational study of 39 eyes, 15 high myopic with \u0000glaucoma y 24 high myopic without it. Visual Field (VF) were performed, where the global \u0000index between both groups were analyzed; Mean Deviation (MD), Model Standard Deviation \u0000(MSD) and Visual Field Index (VFI), beside Optical Coherence Tomography (OCT), in which the \u0000thickness of the ganglion cells layer (GCL) inside 3 central mm was compared. Results: The \u0000results were satisfactory, demonstrating different characteristics between the high myopic \u0000group with glaucoma and without it, both in VF and OCT exams. It was obtained in the VF \u0000analysis difference in average MD of -4,92 dB + 3,71 (p0,05) and VFI with Friedman Test 10,29 (p>0,05). The statistical OCT \u0000analysis, when comparing GCL, observed that the Temporary sector (T) had a statistically \u0000significant decrease (p","PeriodicalId":287456,"journal":{"name":"Revista Hospital Clínico Universidad de Chile","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127293367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infecciones profundas del cuello","authors":"Rodrigo Jiménez Y., D. Rappoport W., E. Ramírez, P. Gac E., F. Rodríguez M., P. Cabané T.","doi":"10.5354/2735-7996.2019.70052","DOIUrl":"https://doi.org/10.5354/2735-7996.2019.70052","url":null,"abstract":"Deep neck infections (DNIs) are special entities among infectious diseases for their versatility \u0000and potential for severe complications. Complex head and neck anatomy often makes early \u0000recognition of DNIs challenging, and a high index of suspicion is necessary to avoid any delay in \u0000treatment. The diagnosis is made by clinical history, physical examination findings and imaging \u0000studies. The treatment consists in securing the airway, intravenous antibiotics and surgical \u0000drainage, when needed. To make decisions the surgeon must understand the anatomy of \u0000the region, the etiology of infection, appropriate diagnostic tools, and medical and surgical \u0000management. This article provides a review of these pertinent topics.","PeriodicalId":287456,"journal":{"name":"Revista Hospital Clínico Universidad de Chile","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114879333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Síndrome de hiperémesis por cannabinoides: caso clínico","authors":"Daniela Benavides A., Daniela Valle S., Carlos Ibáñez P.","doi":"10.5354/2735-7996.2019.70048","DOIUrl":"https://doi.org/10.5354/2735-7996.2019.70048","url":null,"abstract":"Background. The cannabinoid hyperemesis syndrome (CHS) was first described in 2004. It is considered as a functional gastrointestinal syndrome characterized by the presence of nausea, severe and cyclic morning vomiting, epigastric abdominal pain, hot water bathing for symptom relief, in patients that use cannabis regularly and has a resolution of the syndrome after cessation of cannabis consumption. Clinical Case. Report of a 29 year old male, with daily consumption of cannabis, with history of intense epigastric abdominal pain and recurrent vomiting that partially responded to the use of antispasmodics. After 4 visits to the emergency department he was hospitalized for study and treatment. Laboratory and image exploration are carried out without positive results for organic disease. Therefore, a functional gastrointestinal syndrome is thought, and a cannabinoid hyperemesis syndrome was suspected. A psychiatric evaluation is carried out, diagnosing a cannabis use disorder. Discussion and conclusion. CHS is a syndrome that has been described recently and is not usually considered as a differential diagnosis for patients with hyperemesis. However, the current high prevalence of cannabis consumption, will probably lead to a more frequent presentation of the syndrome at different health providers. Therefore, it is important to diffuse and update the knowledge about this syndrome to recognize it and develop a timely treatment, avoiding medical complications from invasive exploratory methods and the use of unnecessary resources.","PeriodicalId":287456,"journal":{"name":"Revista Hospital Clínico Universidad de Chile","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127544166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"El corazón de la mujer","authors":"J. Arocha R.","doi":"10.5354/2735-7996.2019.70051","DOIUrl":"https://doi.org/10.5354/2735-7996.2019.70051","url":null,"abstract":"In the vast majority of cardiovascular diseases (CVDs), there are well-described differences \u0000between women and men in epidemiology, pathophysiology, clinical manifestations, effects of \u0000therapy, and outcomes. These differences arise on one hand from biological differences among \u0000women and men, which are called sex differences, due to differences in gene expression from \u0000the sex chromosomes and subsequent differences in sexual hormones leading to differences \u0000in gene expression and function in the CV system, In contrast, gender differences are unique \u0000to the human. They arise from sociocultural processes, such as different behaviours of women \u0000and men; exposure to specific influences of the environment; different forms of nutrition, \u0000lifestyle, or stress; or attitudes towards treatments and prevention. The scientific societies \u0000are at the forefront of implementing the knowledge in research and healthcare strategies with \u0000more proactive attitude for a feminine centered approaches may lead to a more specific and \u0000effective use of resources in CVD prevention and therapy in women.","PeriodicalId":287456,"journal":{"name":"Revista Hospital Clínico Universidad de Chile","volume":"83 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122631565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevención no farmacológica de las exacerbaciones en la EPOC: efecto antiinflamatorio de la actividad física","authors":"L. Mendoza i, Julia Guerrero P.","doi":"10.5354/2735-7996.2019.70050","DOIUrl":"https://doi.org/10.5354/2735-7996.2019.70050","url":null,"abstract":"The chronic obstructive pulmonary disease (COPD) is the chronic respiratory condition most prevalent in adults, caused mainly by smoking. Its burden is progressively increasing and, according to the World Health Organization, is one of the main causes of mortality and disability around the world. Patients with COPD present acute worsening of the disease, defined as acute exacerbations, which are the main cause of hospitalizations and deaths. Therefore, it is crucial to identify effective interventions focused in their prevention. Patients with COPD present dyspnoea and intolerance to exercise responsible for a progressive reduction in the level of physical activity, which is an independent risk factor for future exacerbations and mortality. On the other hand, it has been demonstrated that COPD patients with low level of physical activity present higher marker levels of systemic inflammation. Interventions able to increase the level of physical activity in COPD patients have demonstrated positive effects in quality of life and a few clinical trials suggest that improving physical activity is able to prevent exacerbations. We hypothesize that these effects could be explained by changes in systemic inflammation secondary to an increase of physical activity.","PeriodicalId":287456,"journal":{"name":"Revista Hospital Clínico Universidad de Chile","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125221298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manejo de la enfermedad tiroídea en el embarazo y puerperio","authors":"Paula Vergara U., Verónica Araya Q., Álvaro Sepúlveda-Martínez, Mauro Parra-Cordero","doi":"10.5354/2735-7996.2019.70053","DOIUrl":"https://doi.org/10.5354/2735-7996.2019.70053","url":null,"abstract":"1. Conocer los valores normales de TSH durante el embarazo y las últimas recomendaciones \u0000según sociedades internacionales. \u00002. Conocer el seguimiento y manejo de la enfermedad tiroídea durante el embarazo. \u00003. Conocer las modificaciones que se debe realizar al tratamiento de la enfermedad tiroídea \u0000previamente diagnosticada, al conocerse el estado de embarazo. \u00004. Conocer los fármacos recomendados para el manejo de la enfermedad tiroídea durante el \u0000embarazo y puerperio. \u00005. Conocer la utilidad de la pesquisa de anticuerpos antitiroídeos en el embarazo y a quién solicitarlos. \u00006. Conocer el seguimiento ecográfico adecuado del feto cuya madre está afectada por alguna \u0000patología tiroídea.","PeriodicalId":287456,"journal":{"name":"Revista Hospital Clínico Universidad de Chile","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124953911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Programa de autopsias virtuales o “virtuopsias” en el Hospital Clínico Universidad de Chile. Un importante eslabón para la generación de nuevo conocimiento y mejoramiento continuo.","authors":"Patricia Gómez M., María Elena Zúñiga G.","doi":"10.5354/2735-7996.2019.69995","DOIUrl":"https://doi.org/10.5354/2735-7996.2019.69995","url":null,"abstract":"Most of today´s medical knowledge of current advances in medicine are based on autopsy findings and patological studies conducted during the 19th century. At the end of the 60s, autopsies began to decline in many countries, for multivariate reasons. Nowadays, autopsies are almost no longer performed unless legal reasons are present. The so important and didactic Pathological Anatomy Meetings are not being held anymore either. These instances played a particularly important role, bringing together and gathering experts and apprentices from different medical areas and disciplines. Unfortunately they have been disappearing from hospitals. However, physicians still seem to need them, as many times there is urgent need to get reliable information about the etiology of thepatients’ symptoms and the ultimate causes that led him or her to death. The relevance of this information for generating new knowledge and proposing new diagnostic or therapeutic tools for continuous improvement, both in the field of healthcare and training is indisputable. Unfortunately, we still face situations in which a patient dies in the midst of many doubts regarding the ultimate cause of death. At the University of Chile Clinical Hospital, a so-called Adverse Event Meetings have been held every Thursday for several years. A lot of time is spent trying to elucidate what could have happened, in an attempt to detect errors that could have been corrected A team of doctors, midwives and nurses, analyze all the adverse events reported, step by step. In spite of this, there are situations where doubts still persist, once the meeting is over. Currents advances in imaging, immune-histochemistry, molecular and genetic study techniques can make possible today to obtain most important information without the need for a traditional autopsy. These technologies, appear then as a substitute for traditional autopsies, since the realization of some of these post-mortem studies would allow to elucidate many diagnostic doubts, improving diagnostic.","PeriodicalId":287456,"journal":{"name":"Revista Hospital Clínico Universidad de Chile","volume":"237 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129757783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}