Pesquisa | SciELO

Background: Patients with a cardiovascular (CV) history may be at greater risk of becoming ill and die due to SARS-CoV-2. Aim: To assess the incidence of CV complications in COVID-19 patients, the type of complication, and their association with CV history. Material and Methods: The clinical course of 1,314 patients with COVID-19 admitted consecutively to critical care units of 10 Chilean hospitals was registered between April and August of 2020. Results: The median age of patients was 59 years and 66% were men. One hundred-four (8%) had a CV history, namely heart failure (HF) in 53 (4.1%), coronary heart disease in 50 (3.8 %), and atrial fibrillation in 36 (2.7 %). There were CV complications in 359 patients (27.3%). The most common were venous thrombosis in 10.7% and arrhythmias in 10.5%, HF in 7.2%, type 2 acute myocardial infarction in 4.2%, arterial thrombosis in 2.0% and acute coronary syndrome (ACS) in 1.6%. When adjusted by age, sex and risk factors, only HF (Odds ratio (OR) = 7.16; 95% confidence intervals (CI), 3.96-12.92) and ACS (OR = 5.44; 95% CI, 1.50-19.82) were significantly associated with CV history. There was no association with arrhythmias, type 2 acute myocardial infarction, arterial or venous thrombosis. Conclusions: Patients with a history of CV disease are at greater risk of suffering HF and ACS when hospitalized due to COVID-19. Arrhythmias, type 2 AMI, and arterial or venous thrombosis occur with the same frequency in patients with or without CV history, suggesting that these complications depend on inflammatory phenomena related to the infection.

Importancia de la ruta de señalización JAK/STAT en la sepsis
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Torres-Carpio, Daniel Alfonso

; Lanas-Mendoza, Enrique Santiago

; Rueda-Barragán, Fernando Enrique

; Vélez Páez, Pablo Andrés

; Torres Cabezas, Pedro René

; Jara González, Fernando Esteban

; Montalvo Villagómez, Mario Patricio

; Aguayo Moscoso, Santiago Xavier

; Vélez-Páez, Jorge Luis

Acta Médica Peruana

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Abr 2022, Volume 39 Nº 2 Páginas 151 - 165

Resumo: Es En | Texto: Es En | PDF: Es | PDF: En

RESUMEN El transductor de señal Janus-Kinasa y la vía de activación de la transcripción conocida como JAK/STAT es una ruta de señalización principal para la transducción de información en muchas citocinas inflamatorias implicadas durante la sepsis. Se ha demostrado que la vía JAK/STAT está fuertemente relacionada con el fallo multiorgánico, además que muchas citocinas pueden ejercer sus efectos biológicos a través de esta ruta. En los últimos años, se ha logrado un progreso significativo en la comprensión de las funciones de este complejo, sin embargo, su rol en la sepsis como objetivo terapéutico permanece en experimentación. En esta revisión se describen las funciones específicas de la vía JAK/STAT, su rol en la sepsis y presentamos un enfoque traslacional respecto a la perspectiva terapéutica para inhibir esta ruta de señalización durante la sepsis y su interacción con enfermedades inflamatorias como la COVID-19.

ABSTRACT The Janus-Kinase signal transducer and the transcription activation pathway known as JAK /STAT is a major signaling pathway for the transduction of information in many inflammatory cytokines involved during sepsis. The JAK /STAT pathway has been shown to be strongly related to multiorgan failure, and many cytokines can exert their biological effects through this pathway. In recent years, considerable progress has been made in understanding functions of this complex; however, its role in sepsis as a therapeutic target remains under experimentation. This review describes the specific functions of the JAK /STAT pathway, its role in sepsis, and presents a translational approach to the therapeutic perspective aiming to inhibit this signaling pathway during sepsis and its interaction with inflammatory diseases such as COVID-19.

https://doi.org/10.35663/amp.2022.392.2240

Latin American Consensus on management of residual cardiometabolic risk. A consensus paper prepared by the Latin American Academy for the Study of Lipids and Cardiometabolic Risk (ALALIP) endorsed by the Inter-American Society of Cardiology (IASC), the International Atherosclerosis Society (IAS), and the Pan-American College of Endothelium (PACE)
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Ponte-Negretti, Carlos I.

; Wyss, Fernando S.

; Piskorz, Daniel

; Santos, Raul D

; Villar, Raul

; Lorenzatti, Alberto

; López-Jaramillo, Patricio

; Toth, Peter P.

; Amaro, A. Juan J.

; Rodrigo, Alfonso K.

; Lanas, Fernando

; Urina-Triana, Miguel

; Lara, Jofre

; Valdés, T. Osiris

; Gomez-Mancebo, José R.

; Bryce, Alfonso

; Cobos S., Leonardo

; Puente-Barragan, Adriana

; Ullauri-Solórzano, Vladimir E.

; Medina-Palomino, Felix A.

; Lozada, Alfredo F.

; Duran, Maritza

; Berrospi, Percy

; Miranda, David

; Badimon, Juan J.

; González, J. José R.

; Libby, Peter

Archivos de cardiología de México

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Mar 2022, Volume 92 Nº 1 Páginas 99 - 112

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Abstract Background: Hypertension, hyperglycemia, dyslipidemia, overweight, obesity, and tobacco (smoking, chewing, and vaping), together with a pro-inflammatory and procoagulant state, are the main risk factors related to atherosclerotic cardiovascular disease. Objective and methods: A group of experts from the Americas, based on their clinical expertise in cardiology, cardiovascular prevention, and cardiometabolic (CM) diseases, joined together to develop these practical recommendations for the optimal evaluation and treatment of residual CM risk factors in Latin America, using a modified Delphi methodology (details in electronic TSI) to generate a comprehensive CM risk reduction guideline, and through personalized medicine and patient-centered decision, considering the cost-benefit ratio The process was well defined to avoid conflicts of interest that could bias the discussion and recommendations. Results: Residual risk reduction should consider therapeutic options adapted to specific patient needs, based on five treatment objectives: triglyceride-rich lipoproteins, inflammation, impaired glucose metabolism, high blood pressure, and prothrombotic status. Comprehensive control of all CM risk factors should be a priority to deal with this important public health problem and prevent premature deaths. The recommendations in this paper address the evidence-based treatment of CM risk and are intended for clinical application in Latin American countries.

Resumen Antecedentes: Un grupo de factores de riesgo cardiometabólicos (hipertensión, hiperglucemia, dislipidemia, sobrepeso, obesidad y tabaco (fumado, masticado, vaporizado), junto con un estado proinflamatorio y procoagulante, son los principales factores de riesgo relacionados con la enfermedad cardiovascular aterosclerótica. Objetivo y métodos: Basándose en su experiencia en cardiología, prevención cardiovascular y enfermedades cardiometabólicas, un grupo de expertos de las Américas se unió para desarrollar estas recomendaciones prácticas para la evaluación y tratamiento óptimos de los factores de riesgo cardiometabólicos residuales en América Latina, utilizando una metodología Delphi modificada con el objetivo de generar una guía integral de pautas para la reducción del riesgo cardiometabólico, mediante la medicina personalizada y la decisión centrada en el paciente teniendo en cuenta la relación costo-beneficio. El proceso fue bien definido para evitar conflictos de intereses que podrían sesgar la discusión y las recomendaciones. Resultados: La reducción del riesgo residual debe considerar opciones terapéuticas adaptadas a las necesidades específicas del paciente, basadas en 5 objetivos de tratamiento: lipoproteínas ricas en triglicéridos inflamación, metabolismo de la glucosa, presión arterial alta y estado protrombótico. El Control integral de todos los factores de riesgo cardiometabólicos debe ser una prioridad para hacer frente a este importante problema de salud pública y prevenir las muertes prematuras. Las recomendaciones de este documento abordan el tratamiento basado en evidencia del riesgo cardiometabólico y están destinadas a la aplicación clínica en los países de América Latina.

https://doi.org/10.24875/acm.21000005 55 downloads

Impacto del cambio climático en la salud
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Oyarzún G., Manuel

; Lanas Z., Fernando

; Wolff R., Marcelo

; Quezada L., Arnoldo

Revista médica de Chile

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Mai 2021, Volume 149 Nº 5 Páginas 738 - 746

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Climate changes evidenced by an increase in our planet's mean temperature, changes in rainfall, increased sea level and extreme weather conditions, favor air and soil contamination, ocean acidification, droughts, floods, heat waves and forest fires, which affect the health and wellbeing of exposed populations. These changes will exert negative effects on respiratory and cardiovascular systems, nutritional status, burden of infectious diseases, especially vector-borne infections, and human mental health. Moreover, environmental damages, such as loss of biodiversity, ecological collapse and deterioration of socioeconomic factors such as agricultural and fishery production, and the loss of habitable land, will impulse massive migrations. This article summarizes the impact that climate change is expected to have on respiratory, cardiovascular and infectious diseases and its repercussions on people of extreme ages. It is imperative to achieve the immediate commitment of worldwide national governments to control green-house gas emissions. The appropriate technology does exist, but political will is urgently needed to accomplish this goal.

https://doi.org/10.4067/s0034-98872021000500738 416 downloads

Ejercicio: una herramienta clave en la prevención cardiovascular. Consenso de la Sociedad Chilena de Cardiología y Cirugía Cardiovascular y de la Sociedad Chilena de Kinesiología en Cardiología y Cirugía Cardiovascular.
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Román, Claudia

; Fernández, Mauricio

; Acevedo, Mónica

; Alarcón, Gonzalo

; Araya, María Virginia

; Barquín, Inés

; Barrenechea, Javier

; Díaz, Héctor

; Lama, Denisse

; Lanas, Fernando

; López, Rosario

; Oliveros, María José

; Prat, Hernán

; Rouliez, Karen

; Santibáñez, Claudio

; Serón, Pamela

; Troncoso, Erika

; Varleta, Paola

Revista chilena de cardiología

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Ago 2019, Volume 38 Nº 2 Páginas 149 - 157

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Abstracts: This is a Document from de Chilean Society of Cardiology and Cardiovascular Surgery, along with the Chilean Society of Physical Therapy of Cardiology and Cardiovascular Surgery.

3819 downloads

Epidemiology and complications of facial fractures: a 5-year retrospective study
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Lanas, Guillermo

; Paredes, Fernando

; Vallejo, Kleber

; Lanas, Andrea

; Zindel-Deboni, María Cristina

Revista Facultad de Odontología Universidad de Antioquia

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Jun 2019, Volume 30 Nº 2 Páginas 191 - 201

Resumo: Es En | Texto: Es En | PDF: Es | PDF: En

RESUMEN Introducción: los estudios epidemiológicos regionales que involucren trauma facial son importantes para ayudar a desarrollar formas más eficientes de brindar cuidados en salud. El tiempo transcurrido desde que ocurre un traumatismo facial hasta su tratamiento definitivo puede afectar los resultados clínicos en términos de intervenciones, resolución y complicaciones. El objetivo del presente estudio consistió en verificar si existe una relación entre los diferentes tipos de fracturas, sus tratamientos y los intervalos de tiempo para su resolución clínica con la aparición de complicaciones. Métodos: se realizó un estudio retrospectivo con las historias clínicas del hospital Eugenio Espejo de Quito, verificando los datos epidemiológicos de la evolución clínica de pacientes con trauma facial entre el 2012 y 2016. Para ello se tomaron datos como edad, sexo, tipo de fractura, tiempo transcurrido hasta su tratamiento definitivo y aparición de complicaciones. Se descartaron las historias que no tuvieron todos los datos para este trabajo. Resultados: la mayoría de los casos ocurrió fuera de Quito (64%). Se observó que no existe relación entre hábitos nocivos, desplazamiento de fractura, tipo de abordaje o de fijación y presencia de comorbilidades con la aparición de complicaciones. El resultado de razones de probabilidad (intervalo de confianza) para las complicaciones fue de OR=0.301(0.170-0.536); por lo tanto, existe un 70% más de probabilidad de presentar alguna complicación si el tratamiento se realiza después de una semana de ocurrido el trauma. Conclusión: la reducción de las fracturas faciales antes de una semana puede disminuir la ocurrencia de complicaciones y secuelas.

ABSTRACT Introduction: regional epidemiological studies involving facial trauma are needed to develop more efficient ways of providing health care services. The time elapsed from the occurrence of facial trauma to its definitive treatment can affect clinical outcomes in terms of interventions, resolution, and complications. The aim of this study was to verify if there is a relationship between the different fracture types, their treatments or time intervals for clinical resolution and the onset of complications. Methods: a retrospective study was conducted by means of the clinical records of the Eugenio Espejo Hospital in Quito, verifying the epidemiological data on the clinical evolution of facial trauma patients between 2012 and 2016, and registering data such as age, gender, fracture type, time elapsed until its definitive treatment, and onset of complications. Clinical records lacking these data were excluded. Results: most cases occurred outside Quito (64%). There was no relationship between harmful habits, fracture displacement, type of access or fixation, or presence of comorbidities and the onset of complications. The odds ratio (95% confidence interval) for complications was OR = 0.301(0.170-0.536), so there is a 70% increased chance of developing some complications if treatment is performed one week after trauma occurs. Conclusion: reducing facial fractures before a week can decrease the onset of complications and sequelae.

https://doi.org/10.17533/udea.rfo.v30n2a6 377 downloads

Cambio del umbral diagnóstico de la hipertensión arterial en Latinoamérica
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Lanas-Zanetti, Fernando

Revista médica de Chile

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Mai 2019, Volume 147 Nº 5 Páginas 543 - 544

Resumo: Es | Texto: Es | PDF: Es

1949 downloads

External Validation of Cardiovascular Risk Scores in the Southern Cone of Latin America: Which Predicts Better?
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GULAYIN, PABLO E.

; DANAEI, GOODARZ

; GUTIEREZ, LAURA

; POGGIO, ROSANA

; PONZO, JAQUELINE

; LANAS, FERNANDO

; RUBINSTEIN, ADOLFO

; IRAZOLA, VILMA

Revista argentina de cardiología

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Fev 2018, Volume 86 Nº 1 Páginas 15 - 20

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

ABSTRACT: Background: Inaccurate estimates of demographic cardiovascular risk may lead to an inadequate management of preventive medical interventions such as the use of statins. Objectives: The aim of this study was to evaluate the external validity of cardiovascular risk equations in the general population of the Southern Cone of Latin America. Methods: Equations including variables evaluated in the CESCAS cohort study and that estimate overall cardiovascular mortality (CUORE, Framingham, Globorisk and Pooled Cohort Studies) were assessed. For each equation, an independent analysis was per-formed taking into account the cardiovascular events originally considered. Discrimination of each equation was evaluated through C-statistic and Harrell’s C-index. To assess calibration, a graph was built for each equation with the proportion of observed events vs. the proportion of estimated events by risk quintiles and the β slope of the resulting linear regression was calculated. Sensitivity and specificity were determined for the detection of people at high cardiovascular risk. results: The median follow-up time of the cohort at the time of the analysis was 2.2 years, with an interquartile range of 1.9 to 2.8 years. Sixty cardiovascular events were incorporated into the analysis. All C-statistic and Harrell’s-C index values were greater than 0.7. The value of the β slope farthest from 1 was that of the Pooled Cohort Studies score. Conclusions: Although the external validation parameters evaluated were similar, CUORE, Globorisk and the Framingham equa-tions showed the best global performance for cardiovascular risk estimation in our population.

RESUMEN: introducción: La estimación inexacta del riesgo cardiovascular poblacional puede llevar a un manejo inadecuado de las intervenciones médicas preventivas, como, por ejemplo, el uso de estatinas. Objetivo: Evaluar la validez externa de ecuaciones de predicción de riesgo cardiovascular en población general del Cono Sur de Latinoamérica. Material y métodos: Se evaluaron ecuaciones que incluyen variables evaluadas en el estudio CESCAS y que predicen tanto morbilidad como mortalidad cardiovascular global (CUORE, Framingham, Globorisk y Pooled Cohort Studies Equations). Para cada ecuación se realizó un análisis independiente en el que se tuvieron en cuenta los eventos cardiovasculares relevados. Se evaluó la discriminación de cada ecuación a través del cálculo del estadístico-C y el índice Harrell C. Para evaluar la calibración se graficó la proporción de riesgos observados vs. estimados por quintilos de riesgo para cada ecuación y se calculó la pendiente β de regresión lineal para las estimaciones. Se calculó sensibilidad y especificidad para la detección de personas con elevado riesgo cardiovascular. resultados: La mediana del tiempo de seguimiento de la cohorte al momento del análisis es de 2,2 años, con un rango intercuartilo de 1,9 a 2,8 años. Se incorporaron a los análisis 60 eventos cardiovasculares. Todos los valores de estadístico-C y del índice de Harrell fueron superiores a 0,7. El valor de la pendiente β más alejado de 1 fue el de Pooled Cohort Studies Euations. Conclusiones: Si bien los parámetros de validación externa evaluados fueron similares, CUORE, Globorisk y el índice de Framing-ham fueron las ecuaciones con mejores indicadores globales de predicción de riesgo cardiovascular.

383 downloads

Smoking and obesity in Chile's Third National Health Survey: light and shade
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Bachelet, Vivienne C.

; Lanas, Fernando

Revista Panamericana de Salud Pública

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2018, Volume 42 elocation e132

Resumo: Pt En Es | Texto: Pt En Es | PDF: Pt | PDF: En | PDF: Es

RESUMO O Ministério da Saúde do Chile divulgou recentemente as conclusões preliminares da Pesquisa Nacional de Saúde (PNS) 2016–2017. Foi conduzida uma pesquisa de delineamento transversal com uma estratégia de amostragem aleatória estratificada com múltiplos estágios, resultando em uma amostra final de 6.233 indivíduos com 15 anos de idade ou acima de representatividade nacional, regional e urbana/rural. Os resultados de pesquisa demonstram uma redução constante do tabagismo em relação às pesquisas nacionais anteriores (PNS 2003 e PNS 2009–2010), provavelmente decorrente das políticas de controle rigoroso do tabagismo promulgadas na última década. Porém, os resultados também indicam um aumento alarmante da obesidade nos 15 últimos anos. Políticas de regulamentação mais rigorosas devem ser necessárias para conter a epidemia de obesidade que assola o país, na mesma linha do que foi feito com o tabagismo. O ensinamento a ser tirado parece ser o seguinte: a pressão para que sejam adotadas políticas mais duras leva a bons resultados, como no caso do tabagismo, e medidas brandas não são suficientes diante da magnitude das epidemias em saúde enfrentadas atualmente pelo país, como o excesso de peso.

ABSTRACT The Chilean Ministry of Health recently disclosed the first results of the 2016–2017 National Health Survey (Encuesta Nacional de Salud, ENS). The survey was cross-sectional and used a multistage stratified random sampling strategy resulting in a final sample of 6 233 persons ≥ 15 years old, with national, regional, and urban/rural representativeness. The survey results show consistent reductions in tobacco consumption compared to previous national health surveys (ENS 2003 and ENS 2009–2010), most likely due to stringent tobacco control policies enacted in the last 10 years. However, the results also show that there were alarming increases in obesity in the last 15 years. Stronger regulatory policies may be needed to curb the obesity epidemic that besets Chile, along the lines of what was done with tobacco use. The lesson learned seems to be that pushing for stronger policy measures leads to good results, as seems to be the case for tobacco use, while weak measures may not be sufficient for the scale of the health epidemics Chile is now facing, such as excess weight.

RESUMEN El Ministerio de Salud chileno divulgó recientemente los primeros resultados de la Encuesta Nacional de Salud 2016–2017 (ENS). Se trataba de una encuesta transversal, en la cual se usó una estrategia de muestreo polietápico aleatorio y estratificado, cuyo resultado fue una muestra final de 6 233 personas ≥ 15 años, con representatividad nacional, regional y urbana o rural. Los resultados de la encuesta muestran reducciones constantes en el consumo de tabaco en comparación con encuestas nacionales de salud anteriores (la ENS 2003 y la ENS 2009–2010), muy probablemente debido a las políticas estrictas de control del tabaco sancionadas en los últimos 10 años. Sin embargo, los resultados también indican que la obesidad aumentó de forma alarmante en los últimos 15 años. Es posible que se necesiten políticas regulatorias más firmes para reducir la epidemia de obesidad que se registra en Chile, de manera similar a lo que se hizo con el consumo de tabaco. Pareciera que la enseñanza extraída es que impulsar medidas políticas más firmes conduce a buenos resultados, como parece ser el caso del consumo de tabaco, mientras que las medidas débiles pueden ser insuficientes para la escala de las epidemias en el ámbito de la salud a las que Chile se enfrenta ahora, como el sobrepeso.

https://doi.org/10.26633/rpsp.2018.132 24 downloads

10.

Guías para la monitorización ambulatoria de presión arterial de 24 horas. Documento de la Sociedad Chilena de Cardiología y Cirugía Cardiovascular
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Prat, Hernán

; Abufhele, Alejandro

; Alarcón, Gonzalo

; Barquín, Inés

; Escobar, Edgardo

; Fernández, Mauricio

; Lanas, Fernando

; Varleta, Paola

Revista chilena de cardiología

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Dez 2017, Volume 36 Nº 3 Páginas 264 - 274

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Abstracts: 24 hour blood pressure monitoring. Recommendations from the Chilean Society of Cardiology and Cardiovascular Surgery. The recommendations for blood pressure monitoring from the Chilean Society of Cardiology and Cardiovascular Surgery are analyzed. Emphasis is placed on indications for the procedure, according to different classes and causes of hypertension. Implications of different types of hypertension for prognosis and indications for adequate therapy are discussed.

34017 downloads

11.

Síndrome de Austrian, reporte de caso
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Salinas G., Alejandra

; Contreras R., Juan

; Lanas Z., Fernando

; Neira V., Víctor

; Soto, Mauricio

; Silva, Abelardo

; Bahamondes, Juan Carlos

; Díaz, Andrés

Revista médica de Chile

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Nov 2017, Volume 145 Nº 11 Páginas 1480 - 1484

Resumo: Es | Texto: Es | PDF: Es

Austrian syndrome is a triad characterized by pneumonia, meningitis and endocarditis, as a result of a Streptococcus pneumoniae bacteremia. We report a previously healthy 49 year-old male, who consulted at the emergency care unit with a history of one week of pleuritic pain, fever leading to an altered level of consciousness and seizures. A diagnosis of community-acquired pneumonia and meningitis was reached, isolating Streptococcus pneumoniae in the cerebrospinal fluid and blood cultures. Antibiotic treatment was started but the patient had an unsatisfactory response. During hospitalization a new heart murmur was found in the physical examination. An echocardiography was performed and a massive aortic valve insufficiency was found along with vegetations and a perforation of the same valve. The valve was replaced by a prosthetic one and the patient responded satisfactorily to the surgical and antibiotic treatment, without complications.

https://doi.org/10.4067/s0034-98872017001101480 1265 downloads

12.

Efectividad y seguridad del tratamiento anticoagulante con acenocumarol en fibrilación auricular no valvular
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Castro, Constanza

; Bustos, Luis

; Ocampo, Renato

; Molina, Elda

; Cabrero, Pía

; Vergara, René

; Lanas, Fernando

Revista médica de Chile

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Out 2017, Volume 145 Nº 10 Páginas 1243 - 1251

Resumo: Es | Texto: Es | PDF: Es

Background: Vitamin K antagonists significantly decrease the incidence of stroke but increase the risk of bleeding. Aim: To assess the effectiveness and risk of bleeding of vitamin K antagonists in non-valvular atrial fibrillation. Material and Methods: Retrospective cohort study of 524 patients, 236 women (45%) and 288 men (55%) with non-valvular atrial fibrillation (NVAF) admitted to the oral anticoagulation treatment (OAT) clinic at four public hospitals, between 2009 and 2012. They were followed until March 2013, measuring the quality of OAT, ischemic and bleeding events. Results: The mean follow-up was 26.1 months, with 1,154.7 person-years of follow-up accrued. The percentage of time in therapeutic range (TTR) was 35.2 ± 18%; this was deemed to represent the quality of OAT. The cumulative incidence of ischemic events, either stroke or systemic embolism, was 2.25/100 person-years, being greater in patients with previous embolism (Risk ratio 5.21, 95% confidence intervals 2.31– 11.73, p < 0.01). The cumulative incidence of major bleeding events-extracranial and intracraneal-was 4.08/100 person-years. The main site of extracranial major bleeding was the gastrointestinal tract (32%). Conclusions: In our clinical practice, the effectiveness of OAT with acenocoumarol in NVAF patients is similar to that published abroad. However, the incidence of bleeding complications is higher. The quality of the OAT measured by the TTR was lower than abroad.

2760 downloads

13.

Endocarditis marántica como presentación de cáncer de páncreas. Caso clínico
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Salinas G., Alejandra

; Bustamante H., Luis

; Lanas Z., Fernando

; Soto V., Alvaro

; García B., María Angélica

; Bartolotti H., Constanza

Revista médica de Chile

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Out 2017, Volume 145 Nº 10 Páginas 1353 - 1358

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Marantic or nonbacterial thrombotic endocarditis is characterized for the presence of vegetations formed by a meshwork of fibrin and other cellular material similar a blood clot, without the presence of microorganisms. It is often related with tumors and chronic inflammatory states. We report a 49 years old female with a history of weight loss and asthenia, presenting with multiple cerebrovascular attacks and fever. Blood cultures were negative and the fever did not subside with antibiotic treatment. Trans esophageal echocardiogram showed a mitral valve vegetation and thickening of the free edge of both leaflets. In search of the etiology of such a case, a primary pancreatic cancer with distant metastases was found. We cannot rule out the differential diagnosis with bacterial endocarditis with negative blood cultures, although the clinical context supports a non-infectious etiology.

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14.

Características basales, manejo de terapias antitrombóticas y pronóstico de pacientes chilenos con FA no valvular. Lecciones del Registro GARFIELD AF en Chile
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Corbalán, Ramón

; Conejeros, Carlos

; Rey, Carlos

; Stockins, Benjamín

; Eggers, Germán

; Astudillo, Carlos

; Lanas, Fernando

; Potthoff, Sergio

; Houzvic, César

; Montecinos, Humberto

; Charme, Gustavo

; Bugueño, Claudio

; Aguilar, Juan

; Arriagada, Germán

; Marín, Patricio

; Larico, Martín

Revista médica de Chile

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Ago 2017, Volume 145 Nº 8 Páginas 963 - 971

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with high rates of death, ischemic stroke and systemic embolism (SE). There is scarce information about clinical characteristics and use of anti-thrombotic therapies in Chilean patients with non-valvular AF. Aim: To describe the characteristics and 1-year outcomes of patients with recently diagnosed AF recruited in Chile into the prospective global GARFIELD-AF registry. Material and Methods: Between 2011-2016, we prospectively registered information of 971 patients recruited at 15 centers, 85% of them from the public system and 15% from the private sector. Demographics, clinical characteristics and use of antithrombotic therapies were recorded for all patients. Adverse clinical outcomes were analyzed in 711 patients with 1-year follow-up. Results: The mean age was 71.5 years (66-79), 50% were men. Mean CHAD2S2 Vasc and HAS BLED scores for stroke risk were 3.3 (2.0-4.0) and 1.5 (1.0-2.0) respectively. Oral anticoagulants were prescribed in 82% of patients. Seventy percent received Vitamin K antagonists, 10% novel direct anticoagulants or antiplatelet therapy and only 8% did not receive any antithrombotic therapy. Mean time in optimal therapeutic range (an international normalized ratio of 2 to 3), was achieved in only 40.7% (23.0-54.8) of patients receiving Vitamin K antagonists. One year rates of death, stroke/systemic embolism and bleeding were 4.75 (3.36-6.71), 2.40 (1.47-3.92) and 1.64% (0.91-2.97) per 100 person-years. Ischemic stroke occurred in 1.8% and hemorrhagic stroke in 0.8% of patients at 1-year of follow up. Conclusions: Although the use of vitamin K antagonists at baseline was high, the mean time in optimal therapeutic range was low. Mortality and stroke rates are higher than those reported in other contemporary registries.

https://doi.org/10.4067/s0034-98872017000800963 1564 downloads

15.

Estudio y manejo de nódulos tiroideos por médicos no especialistas. Consenso SOCHED
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Tala, Hernán

; Díaz, René E.

; Domínguez Ruiz-Tagle, José Miguel

; Sapunar Zenteno, Jorge

; Pineda, Pedro

; Arroyo Albala, Patricia

; Barberán, Marcela

; Cabané, Patricio

; Cruz Olivos, Francisco

; Gac, Patricio E.

; Glasinovic Pizarro, Andrea

; González, Hernán E.

; Grob, Francisca

; Hidalgo Valle, Maria Soledad

; Jaimovich, Rodrigo

; Lanas, Alejandra

; Liberman, Claudio

; Lobo Guiñez, Maite

; Madrid, Arturo

; Moreno Seguel, Marcela

; Mosso, Lorena

; Munizaga, Fernando C.

; Ortiz Parada, Eugenia

; Osorio Gonnet, Fernando

; Slater Morales, Jeannie

; Solar, Antonieta

; Stehr, Carlos

; Vásquez Rodríguez, Félix

; Véliz, Jesús

; Villaseca Najarian, Roberto

; Wohllk, Nelson

Revista médica de Chile

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Ago 2017, Volume 145 Nº 8 Páginas 1028 - 1037

Resumo: En Es | Texto: En Es | PDF: En | PDF: Es

The thyroid nodule is a frequent cause of primary care consultation. The prevalence of a palpable thyroid nodule is approximately 4-7%, increasing up to 67% by the incidental detection of nodules on ultrasound. The vast majority are benign and asymptomatic, staying stable over time. The clinical importance of studying a thyroid nodule is to exclude thyroid cancer, which occurs in 5 to 10% of the nodules. The Board of SOCHED (Chilean Society of Endocrinology and Diabetes) asked the Thyroid Study Group to develop a consensus regarding the diagnostic management of the thyroid nodule in Chile, aimed at non-specialist physicians and adapted to the national reality. To this end, a multidisciplinary group of 31 experts was established among university academics, active researchers with publications on the subject and prominent members of scientific societies of endocrinology, head and neck surgery, pathology and radiology. A total of 14 questions were developed with key aspects for the diagnosis and subsequent referral of patients with thyroid nodules, which were addressed by the participants. In those areas where the evidence was insufficient or the national reality had to be considered, the consensus opinion of the experts was used through the Delphi methodology. The consensus was approved by the SOCHED board for publication.

https://doi.org/10.4067/s0034-98872017000801028 28478 downloads

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