Revista Medica Clinica Las Condes最新文献

{"title":"Síndrome de pinzamiento precordial: revisión de la literatura","authors":"Eduardo Segovia Vergara","doi":"10.1016/j.rmclc.2024.01.005","DOIUrl":"https://doi.org/10.1016/j.rmclc.2024.01.005","url":null,"abstract":"<div><h3>Introduction</h3><p>Chest pain is a common reason for consultation in clinical practice. Precordial catch syndrome seems to be one of the primary but less known causes.</p></div><div><h3>Methods</h3><p>A narrative review was conducted and expanded using the snowball method to find relevant articles.</p></div><div><h3>Results</h3><p>16 articles were found, only in English. Precordial catch syndrome is characterized by a brief stabbing pain, which worsens by breathing. No additional tests are required for diagnosis and the treatment focuses on patient education. Its etiology is not yet established.</p></div><div><h3>Conclusion</h3><p>Precordial catch syndrome is a common presentation of chest pain, especially in the young population. Future studies may be helpful in elucidating its incidence, etiology and risk factors, as well as raising awareness of a condition that is not well known in the medical community.</p></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"35 2","pages":"Pages 140-144"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S071686402400018X/pdfft?md5=ed0f59a57df9b85c9e6810583883be5b&pid=1-s2.0-S071686402400018X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140348219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arteritis macular: ¿una vasculitis benigna?","authors":"José González-Fernández ,&nbsp;Mar García-García ,&nbsp;Mariano Ara-Martín ,&nbsp;Lucía Prieto-Torres","doi":"10.1016/j.rmclc.2023.12.003","DOIUrl":"https://doi.org/10.1016/j.rmclc.2023.12.003","url":null,"abstract":"<div><p>Lymphocytic thrombophilic arteritis or macular arteritis presents as macular hyperpigmentation in the lower extremities and typically has a chronic indolent course. The diagnosis of this disease represents a challenge for the clinician. Histologically, it is characterized by a dense lymphocytic infiltrate around medium-sized vessels located in the reticular dermis and subcutaneous cellular tissue, together with a ring-shaped intraluminal deposit of fibrin.</p></div><div><h3>Objective</h3><p>Describe the clinical and histopathological characteristics of macular arteritis in order to obtain a correct diagnosis and apply appropriate treatment.</p></div><div><h3>Case report</h3><p>We present a 27-year-old female patient who came to the emergency room due to asymptomatic pigmented macules on the lower limbs of two months’ duration without any accompanying systemic symptoms.</p></div><div><h3>Results</h3><p>The skin biopsy described an inflammatory infiltrate where lymphocytes predominate around a medium-sized vessel at the dermo-hypodermis junction along with fibrinoid necrosis. After a clinical-pathological correlation, we issued the diagnosis of macular arteritis. An entity still under discussion, as there are authors who consider it part of the cutaneous polyarteritis nodosa spectrum and others who consider it a different pathology.</p></div><div><h3>Conclusion</h3><p>We present a young patient with macular arteritis. The infrequency of this entity gives importance to our case, expanding our knowledge regarding this vasculitis both in clinical and pathological terms.</p></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"35 1","pages":"Pages 60-63"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0716864024000075/pdfft?md5=f7088171b95d609d561538d0935323b5&pid=1-s2.0-S0716864024000075-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139700402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soportes actuales en falla hepática: cuando el trasplante se hace esperar","authors":"Leyla Nazal ,&nbsp;Rodolfo Valenzuela ,&nbsp;Andrés Ferre","doi":"10.1016/j.rmclc.2023.12.002","DOIUrl":"https://doi.org/10.1016/j.rmclc.2023.12.002","url":null,"abstract":"<div><p>Fulminant hepatic failure (FHF) and acute on chronic liver failure (ACLF) are entities with high morbidity and mortality, with liver transplantation being, in most cases, the only effective therapeutic alternative. The shortage of donors makes it necessary to have liver function support systems, which allow the patient to be kept in adequate conditions until transplantation or improvement. Despite greater knowledge of the pathophysiology of FHF, ACLF, as well as technological advances, we still do not have extracorporeal artificial liver support systems that allow complete replacement of liver function, acting mainly as palliative or symptomatic therapies while awaiting liver transplantation. The systems currently available combine different methods that purify toxins and molecules of different sizes and types, based on dialysis enriched with albumin. In recent years, promising new adsorption filters have been developed and conventional techniques, such as plasma exchange, are under reevaluation. There is still no consensus, however, regarding ideal therapy in different clinical scenarios. The objective of this article is to offer a state of the art view of available technologies and results in different clinical scenarios.</p></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"35 1","pages":"Pages 45-53"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S071686402400004X/pdfft?md5=feca872edb06587f76e5b332a2aeae8b&pid=1-s2.0-S071686402400004X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139700324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Terapias de reemplazo renal agudo en pacientes críticos","authors":"Verónica Fuentes A","doi":"10.1016/j.rmclc.2023.12.001","DOIUrl":"https://doi.org/10.1016/j.rmclc.2023.12.001","url":null,"abstract":"<div><p>Acute kidney injury (AKI) is defined as the abrupt deterioration of renal excretory function, often observed in critically ill patients. The incidence of AKI worldwide ranges between 20 and 200 cases per million population. Sepsis and septic shock contribute to 25-75% of AKI cases. Regardless of the cause, loss of fluid and electrolyte homeostasis and the accumulation of nitrogenous wastes lead to uremia, hyperkalemia, water and sodium retention, and metabolic acidosis. Renal replacement therapies (RRT) aim to mitigate these effects and prevent death associated with kidney failure. There are various modalities of RRT, including intermittent hemodialysis, continuous RRT, as well as different solute elimination techniques. There have been significant advances in membrane technologies and the addition of substances to improve biocompatibility, in addition to new anticoagulation strategies. The aim of this article is to review current RRT alternatives and comment on recommendations regarding their dosage and timing for starting and discontinuing therapy.</p></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"35 1","pages":"Pages 14-21"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0716864024000014/pdfft?md5=c8f1af2a8193065166a080e8f9f62221&pid=1-s2.0-S0716864024000014-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139700279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preservación pulmonar: trasplantes sin límite de tiempo ni distancia","authors":"P. Felipe Undurraga M ,&nbsp;Huáscar Rodríguez G ,&nbsp;Marliz Buck K ,&nbsp;Marcelo Cypel ,&nbsp;Javier Vega S","doi":"10.1016/j.rmclc.2024.01.002","DOIUrl":"https://doi.org/10.1016/j.rmclc.2024.01.002","url":null,"abstract":"<div><p>One of the great obstacles for organ transplantation is the time in which the ischemic organ can be preserved in a viable state before being implanted. With the use of the standard static cold preservation technique (4<!--> <!-->°C) preservation times are limited to 6-8<!--> <!-->hours, a time known as cold ischemia time. This begins from the moment the “cross-clamp” or complete cessation of circulation in the donor is performed until the organ is irrigated in the recipient.</p><p>Preclinical and clinical studies have recently been published demonstrating benefits of graft conservation at 10<!--> <!-->°C compared to standard storage, in addition to allowing ischemia times to be prolonged with the same safety standards for the recipient. These new lines of development aim to facilitate the logistics of lung transplantation, transforming it from an emergency surgery to a semi-elective surgical procedure, a change that has demonstrated benefits in surgical safety and even in implant survival results.</p></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"35 1","pages":"Pages 39-44"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0716864024000063/pdfft?md5=7c9d4f8ec7ca399c73c44e435a03511d&pid=1-s2.0-S0716864024000063-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139700289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caracterización de la autopercepción de los procesos de alimentación y deglución de adultos mayores pertenecientes a un Centro Comunitario de Salud Familiar (CECOSF)","authors":"Manuel Matías Ambiado-Lillo,&nbsp;Javiera Ignacia Castro Monardes,&nbsp;Yayslen Ayleen Chambe Silva,&nbsp;Ninoska Damaru Latin Saavedra,&nbsp;Sui-ly Alejandra Lobos Carlo","doi":"10.1016/j.rmclc.2024.01.001","DOIUrl":"https://doi.org/10.1016/j.rmclc.2024.01.001","url":null,"abstract":"<div><h3>Introduction</h3><p>Swallowing is an essential process in maintaining body homeostasis. With aging, changes occur in both central and peripheral structures, giving rise to presbyphagia, which involves morphological and functional alterations in the swallowing process. However, reports on the prevalence of swallowing difficulties in older adults are currently scarce.</p></div><div><h3>Objectives</h3><p>To determine the prevalence of swallowing difficulties due to aging, and how self-reported difficulties are related to safety, efficiency, competence, and comfort parameters.</p></div><div><h3>Method</h3><p>To this end, exploratory-descriptive research was carried out considering the self-perception assessment of 18 older adults from the city of Iquique, Chile.</p></div><div><h3>Results</h3><p>A prevalence of 27.78% was reported in terms of self-perceived swallowing difficulties.</p></div><div><h3>Conclusions</h3><p>Results inform the need for greater use of early screening instruments, such as self-report questionnaires.</p></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"35 1","pages":"Pages 54-59"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0716864024000051/pdfft?md5=e9f7a945bf9891c042d94495fc700402&pid=1-s2.0-S0716864024000051-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139700325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perfusión dirigida por objetivos: práctica actual en técnicas de circulación extracorpórea","authors":"Alejandra Gatica ,&nbsp;Carlos Muñoz-Valdivia ,&nbsp;Nicolette Van Sint Jan ,&nbsp;Sandra Ramos","doi":"10.1016/j.rmclc.2023.11.003","DOIUrl":"https://doi.org/10.1016/j.rmclc.2023.11.003","url":null,"abstract":"<div><p>Extracorporeal circulation (ECC) is an essential component of cardiac surgery since it allows life support to be maintained during the induced cardiac arrest necessary to perform cardiosurgical interventions. However, CPB presents adverse effects at a local and systemic level because its components produce alterations at the macro- and microcirculation levels, potentially leading to hypoperfusion. The goal-directed perfusion (GDP) technique seeks to personalize hemodynamic management according to predefined goals, thereby optimizing tissue oxygenation and perfusion during CPB. This implies constant monitoring of key parameters, to make real-time changes to perfusion strategies. Over the past 10 years, the benefits of using GDP have been explored and its superiority over the traditional approach visualized. The objective of this article is to describe GDP practice in monitoring during CPB. We will focus on the existing variables monitored under the GDP concept, applying and manipulating them to optimize tissue perfusion in real-time.</p></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"35 1","pages":"Pages 8-13"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0716864024000026/pdfft?md5=cd170c1a814ed9c7e318dcc5223097bd&pid=1-s2.0-S0716864024000026-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139699956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generalidades de fisiología de la oxigenación extracorpórea (ECMO): entendiendo desde la comparación","authors":"Nicolette van Sint Jan D ,&nbsp;Andrés Ferre ,&nbsp;Christian Fajardo J","doi":"10.1016/j.rmclc.2023.11.004","DOIUrl":"https://doi.org/10.1016/j.rmclc.2023.11.004","url":null,"abstract":"<div><p>Extracorporeal membrane oxygenation (ECMO) is used in patients with catastrophic respiratory and cardiac failure. In this article, the physiologic similarities and differences between normal and ECMO cardiopulmonary function are reviewed. The processes involved in gas transfer are described, as well as the factors that influence the efficiency of oxygenation and elimination of carbon dioxide. Emphasis is placed on the clinical relevance of the physiology of ECMO for critically ill patients.</p></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"35 1","pages":"Pages 30-38"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0716864024000038/pdfft?md5=6d24b22b684ad047d9e1d9e1cc952808&pid=1-s2.0-S0716864024000038-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139700280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Purificacion","authors":"","doi":"10.1016/j.rmclc.2024.01.004","DOIUrl":"https://doi.org/10.1016/j.rmclc.2024.01.004","url":null,"abstract":"","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"35 1","pages":"Page 64"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0716864024000099/pdfft?md5=499abeaceb35c32eefc9578a7ed8cd04&pid=1-s2.0-S0716864024000099-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139700403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eficacia de la terapia hemoadsortiva combinada con hemofiltración de alto volumen en el manejo del shock séptico refractario","authors":"Rodrigo Kemeny ,&nbsp;Andrés Giglio ,&nbsp;Andrés Ramos ,&nbsp;Antonio Arroyo ,&nbsp;César Pedreros ,&nbsp;Cristian Mondaca ,&nbsp;Verónica Fuentes ,&nbsp;Andrés Ferre ,&nbsp;Jorge Dreyse","doi":"10.1016/j.rmclc.2023.10.003","DOIUrl":"https://doi.org/10.1016/j.rmclc.2023.10.003","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;p&gt;Septic shock continues to be one of the main causes of mortality in intensive care units. Recently, hemoadsorption therapies have emerged as an additional tool to address this pathology, contributing to reestablishing the patient's immune homeostasis. However, there are still doubts about the effectiveness of these interventions and it is necessary to improve knowledge about their application in clinical practice.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;p&gt;Assess the impact of combined hemoadsorptive therapy and high-volume hemofiltration in the treatment of refractory septic shock in a non-concurrent patient cohort, analyzing clinical and laboratory parameters.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;A non-concurrent review of patients admitted to the intensive care unit with refractory septic shock who received hemoadsorptive associated with high-volume hemofiltration therapy over a period of five years (2016-2020) was conducted. Clinical variables, including age and gender, APACHE II and SOFA scores, vasopressor requirements, laboratory parameters, as well as in-hospital mortality and mortality at 30 and 90 days, were analyzed. Descriptive statistics were calculated, and pre- and post-therapy variables were compared using the Mann-Whitney test.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;The mean age of the cohort was 54.57 years and consisted of 14 patients. Hemoadsorptive therapy was associated with a reduction in vasopressor requirements, with a median initial requirement of noradrenaline of 0.7&lt;!--&gt; &lt;!--&gt;μg/kg/min (IQR 0.45-0.8875) that decreased to 0.12&lt;!--&gt; &lt;!--&gt;μg/kg/min (IQR 0-0.225) after therapy. The total normalized vasopressor requirement to noradrenaline at the start of therapy was 0.8125&lt;!--&gt; &lt;!--&gt;μg/kg/min (IQR 0.56-1.08), and after therapy, it was 0.175&lt;!--&gt; &lt;!--&gt;μg/kg/min (IQR 0.01-0.29). All patients received norepinephrine as the primary vasopressor agent. 71.4% had additional treatment with adrenaline, 28.6% with vasopressin, and only 7.1% were supplemented with dobutamine.&lt;/p&gt;&lt;p&gt;The median APACHE II scores pre- and post-therapy were 30.5 and 20.5, respectively, while the SOFA scores were 13.5 and 11.5. Mean lactate levels decreased by 60%, from 7.47&lt;!--&gt; &lt;!--&gt;mmol/l pre-therapy to 2.97 mmol/l post-therapy. Inflammatory parameters, such as C-reactive protein, mean procalcitonin levels decreased from 206&lt;!--&gt; &lt;!--&gt;mg/dl to 180&lt;!--&gt; &lt;!--&gt;mg/dl, mean level of procalcitonin decreased from 58 to 8.91&lt;!--&gt; &lt;!--&gt;ng/ml. Hospital mortality was 57%, increasing to 64% at 90-day follow-up.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;p&gt;In our non-concurrent cohort of 14 patients, hemoadsorptive therapy combined with high-volume hemofiltration demonstrated encouraging results in the treatment of refractory septic shock, significantly improving intermediate outcomes such as vasopressor requirements, lactate levels, and inflammatory parameters. However, our results in hard outcomes, such as mortality, were similar to those reported in cases of re","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"35 1","pages":"Pages 22-29"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0716864023000901/pdfft?md5=da64b4d08b954fc66bc2ee29ed178a74&pid=1-s2.0-S0716864023000901-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139700323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}