Revista Hospital Clínico Universidad de Chile

Editorial.

Héctor Ugalde P. — 2024-12-17

No abstract available

Covid persistente: una mirada actual

Lourdes González R. — 2024-12-17

Persistent Covid (PC) represents a post-infectious complication of SARS-CoV-2 infection, characterized by symptoms that persist for more than 12 weeks after the acute phase. These symptoms, which include chronic fatigue, respiratory distress, cognitive dysfunction, and other multisystem effects, significantly impact the quality of life of the affected individuals. The underlying pathophysiological mechanisms are complex and not yet fully understood, although studies have suggested a multifactorial origin. Proposed factors include viral persistence, immune dysfunction, autoimmunity, endothelial dysfunction, coagulation disturbances, and gut dysbiosis. The identification of these mechanisms could facilitate the development of diagnostic and therapeutic strategies, opening new perspectives for the effective management of persistent Covid. The diagnosis of PC is complex due to the diversity of symptoms and the lack of specific biomarkers. At present, therapeutic approaches focus primarily on symptomatic relief, but further research is required to fully elucidate the mechanisms underlying PC and to develop targeted interventions. This review synthesizes current evidence on the pathophysiological mechanisms of persistent Covid-19, highlighting recent advances and identifying key areas for future research.

Trastornos neuropsiquiátricos asociados al Covid persistente

Mario Díaz S. — 2024-12-17

Persistent COVID (PC) is the term used to describe a multisystemic and multifactorial entity, which follows acute SARS-CoV-2 infection. Symptoms must persist for three months or more to define this disorder. The clinical manifestations are variable and nonspecific, but have a great impact on the quality of life of patients. Neuropsychiatric symptoms are commonly reported in CP, mostly chronic fatigue, cognitive disorders, attention disorders, among others. The pathophysiological mechanisms are not fully known, but the most described are hypoxia related neuronal damage, microvascular lesions, a persistent proinflammatory state, activation of latent viral infections, and alteration of the blood-brain barrier. There are no specific complementary tests to confirm the diagnosis of CP. There is also no specific treatment to date and most therapies are aimed at relieving symptoms and improving quality of life. This article provides a comprehensive bibliographic review of the most common neuropsychiatric manifestations of CP, including its probable pathophysiological mechanisms and the therapies proposed to date.

Corazón resiliente: una aproximación a la afección cardiaca en Covid prolongado

Alfredo Parra-Lucares — 2024-12-17

The post-Covid-19 pandemic period has raised several questions regarding the new conditions associated with SARS-CoV-2 infection, one of which is the so-called long Covid. Among its characteristics, cardiac involvement stands out as a central element of this new pathology. From a pathophysiological perspective, there are different mechanisms through which this condition could be triggered, either directly due to the subacute inflammation of the initial hyperinflammatory disease, or indirectly, associated with the activation of autoimmune mechanisms. Clinical manifestations encompass a spectrum of symptoms and signs associated with major cardiological syndromes, such as palpitations, dyspnea, dizziness, or angina. Each of these symptoms reflects the involvement of different cardiac structures, grouped into manifestations of the conduction system, heart failure, cardiomyopathy, pericarditis, and acute or chronic coronary heart disease, respectively. To date, the existing literature on the diagnosis, treatment, and prognosis of these different conditions is limited, based on the identification of predictors derived mainly from retrospective observational studies. Similarly, recommendations are grounded in the extrapolation of previous knowledge in the field. We pose the question of whether prolonged Covid will be considered a new

Bienestar subjetivo en personas con Covid persistente

Monserrat Montenegro S. — 2024-12-17

Through this study, we seek to delve into the consequences that Long Covid had in the affective and emotional field of people with this condition, their knowledge about the changes that it entails, and how they perceive their daily lives regarding the repercussions they present. A qualitative, post-positivist, ethnographic research methodology will be used to achieve this. A sociodemographic file was implemented as a data collection technique, and in-depth interviews were conducted. A sociodemographic file was applied as a data collection technique, and in-depth interviews were conducted. According to the inclusion criteria, this study included six people chosen through the snowball technique. In terms of data analysis, interview transcripts were made, coded and categorized concerning the social representations shared by participants. This was followed by a second analysis using the outputs and inputs of Callista Roy’s nursing model. Ultimately, three main categories were obtained: the affective field, where feelings and emotions such as sadness, fear, and concern, among others, stand out; the cognitive field, including the patient’s knowledge about this syndrome, in which it becomes evident the little information available, and the representation field, that describes the significant changes it has meant for them in their daily lives.

Comparación de población urbana y rural con infarto transmural al miocardio en la provincia del Biobío, Región del Biobío, Chile

Manuel Mallol S. — 2024-12-17

One of the main causes of death in Chile and the world are cardiovascular diseases. Multiple strategies seek to reduce them, with local epidemiology becoming relevant for that. Objectives: To describe the demographic and clinical characteristics of rural and urban patients with ST-segment elevation myocardial infarction (IMEST) in the province of Biobío. Methods: A prospective registry was made of all patients admitted for IMEST between October 2019 and October 2020. Results: 100 records were obtained. 32% corresponded to rural population and 68% to urban population (p <0.001). The age in urban patients was lower than rural ones (58.9 vs 66.5 years, p<0.05). For both groups, the predominant sex was male. Smoking was higher in the urban population (51.4 vs 31.2%, p<0.05). LDL cholesterol was lower in the rural population (106 vs 122.7mg / dL, p<0.05). There was no difference in ischemia time, diabetes, HDL, reperfusion and mortality. Conclusions: A third of the study population were rural patients, with epidemiological profile different from the urban ones. That may be related to lifestyle habits that condition the above. Our study

¿En qué áreas podemos mejorar en artroplastia de rodilla en Hospital Clínico Universidad de Chile? Análisis por grupo relacionado a diagnóstico (GRD) 2018 a 2022

Maximiliano Barahona V. — 2024-12-17

Introduction: Knee arthroplasty (TKA) is crucial for treating severe osteoarthritis. The pandemic decreased the number of procedures, leading to significant waiting list. The Hospital Clínico de la Universidad de Chile (HCUCH) is a leader in these surgeries and seeks to optimize its efficiency. Material and Method: Ecological study. Data from Diagnosis Related Groups (DRG) and Ti-Cares from 2018 to 2022 were analyzed. Knee arthroplasty cases were included and hospital stay, use of intermediate beds, surgical time and operating room efficiency were analyzed through exploratory analysis and statistical models. Results: A total of 658 procedures were recorded. The mean age was 66 years and hospital stay was reduced from 4 to 3 days, with a more pronounced decrease after 2020. The use of intermediate beds was frequent (47.87%). Factors such as age, diabetes and comorbidities influenced this usage, with 2019 and 2021 being protective years. Conclusion: Improving management in HCUCH involves reducing hospital stay, optimizing the use of intermediate beds and increasing operating room efficiency. Strategies such as early discharge and use of technology can achieve greater efficiency in procedures, benefiting both patients and the public health system.

Test radiológico

Alejandra López P. — 2024-12-17

No abstract available

Resultado test radiológico

Alejandra López P. — 2024-12-17

No abstract available

Blaschkitis del adulto como fenómeno paraneoplásico. A propósito de un caso

Isabel Arratia S. — 2024-12-17

Blaschkitis is an inflammatory skin eruption that that can manifest following the lines of Blaschko. Clinically, it manifests as a recurrent papulovesicular inflammatory dermatitis with a linear distribution. The lesions may appear as narrow lines, though more frequently as broad bands, affecting the trunk either unilaterally or bilaterally. This condition is typically observed in middle-aged individuals. We present the case of an 81-year-old male with a one-year history of an inflammatory plaque in the abdominal region. Histopathological examination of the lesion revealed features consistent with a paraneoplastic syndrome.

Toxicidades gastrointestinales relacionadas a la inmunoterapia o inhibidores de puntos de control inmunitarios o del checkpoint

Luis Villanueva O. — 2024-12-17

Immune checkpoint inhibitors have revolutionized cancer therapy by enhancing the immune system’s ability to target tumor cells. However, these therapies can cause immune-related adverse events (irAEs), particularly in the gastrointestinal tract, leading to conditions like colitis and diarrhea. The incidence and severity of these irAEs vary depending on the type of inhibitor and patient-specific factors, with higher rates observed in combination therapies. The pathophysiology includes the underlying mechanisms of irAEs, histological findings, and animal models in colitis induced by immune checkpoint inhibitors (ICIs), as well as the influence of the gut microbiome. Early diagnosis and effective management, including corticosteroids and selective immunosuppressants, are crucial. Keywords: , , , ,

Rol de la alteración del eje microbiota-intestino-hígado en la enfermedad hepática esteatósica asociada a disfunción metabólica

Nicolás Ortiz-López — 2024-12-17

Metabolic dysfunction-associated steatotic liver disease (MASLD) is one of the leading causes of liver morbidity worldwide, including conditions such as hepatocellular carcinoma and the need for liver transplantation, with a particularly high prevalence in Latin America. The pathogenesis of MASLD is multifactorial, involving both genetic and environmental factors, including dysfunction of the gut-liver axis. The mechanisms involved in the progression of liver disease to cirrhosis are not yet fully understood. Recently, the intestinal microbiota has been recognized as playing a crucial role in disease progression by modulating systemic and hepatic inflammatory responses. In MASLD patients, microbial dysbiosis contributes to intestinal barrier dysfunction, increasing intestinal permeability and facilitating the translocation of microbial products to the liver, thereby exacerbating inflammation and hepatic damage. Additionally, alterations in bile acid levels and microbial metabolites further reinforce this pathological cycle. Therapeutic strategies aimed at restoring microbial balance—such as fecal microbiota transplantation, probiotics, prebiotics, and synbiotics—have shown promising results in modulating the microbiota-gut-liver axis and slowing MASLD progression. Further studies are needed to fully understand their impact on the pathophysiology of MASLD and to strengthen their integration into current therapeutic protocols for this disease.