Revista medica de Chile最新文献

SJS, SJS/TEN and TEN are severe and uncommon adverse drug reactions, representing different manifestations within a spectrum of the same disease characterized by denudation of the skin and mucous membranes. The literature reports outcomes with systemic corticosteroids, intravenous immunoglobulin, cyclosporine, TNF-alpha inhibitors, plasmapheresis, and Janus kinase inhibitors.

Aim: To provide an updated overview of the comprehensive management of SJS/TEN, aiming to increase survival, reduce sequelae, and improve quality of life.

Methods: A systematic search was conducted between September 2024 and April 2025 in indexed databases, selecting 55 articles and 3 relevant clinical guidelines.

Results: The diagnosis of SJS/TEN should be considered in the presence of fever, lymphopenia, atypical cutaneous lesions, and a positive Nikolsky sign. Immediate discontinuation of suspected drugs and prompt skin biopsy are essential. It is recommended to use mortality prediction scores such as SCORTEN, ABCD-10 and CRISTEN. Patients should be hospitalized in an intensive care unit or burn center under strict life support and isolation protocols. Management must be multidisciplinary and includes supportive measures such as fluid replacement, temperature control, nutritional support, analgesia, thromboprophylaxis, and infection prevention. Systemic therapy is always recommended and, depending on response and disease progression, may include glucorticosteroids, intravenous immunoglobulin, cyclosporine, TNF-alpha inhibitors, plasmapheresis, or, in exceptional cases, JAK inhibitors. Follow-up during the first year is suggested to monitor for potential cutaneous, mucosal, visual, and psychological sequelae.

Conclusions: This study provides practical and updated recommendations for early diagnosis, prioritization of life support measures, and selection of therapeutic alternatives, with the goal of improving patient survival and quality of life. Early initiation of systemic therapy is crucial to improve patient prognosis.

Patient diagnosed with glioblastoma multiforme undergoing adjuvant treatment with temozolomide, on the 4th day of the seventh adjuvant cycle, developed a widespread erythematous maculopapular rash on the abdomen, back, chest, and facial area. Due to the severity of the condition and the risk of experiencing a similar dermatological reaction, a desensitization protocol with temozolomide was decided to realize based on successful cases worldwide. The patient successfully completed the initially planned 12 treatment cycles, 5 of which involved the desensitization protocol, with only mild symptoms during the first desensitization cycle. Temozolomide desensitization is a successful and safe procedure that enables patients to continue their treatment.

Severe hypophosphatemia (plasma phosphate <1 mg/dL or <0.32 mmol/L) is a very common disorder in the hospital environment, it has multiple etiologies and traduces a body phosphate depletion. Due to the importance of phosphate for cellular function, severe hypophosphatemia implies a life-threatening condition; with alteration of neuromuscular, myocardial, respiratory, and erythrocyte function, among other complications. For its treatment it is necessary to supplement phosphate both orally and intravenously. The latter presents complications if not administered prudently. We present the case of an adult patient with rapidly progressive severe hypophosphatemia treated with intravenous sodium glycerophosphate, which evolved with important alterations of the internal environment (hyperphosphatemia, hypocalcemia, hypokalemia and hypernatremia). The etiologies of the disorder and a detailed analysis of phosphate correction are discussed; analyzing the necessary doses, adequate velocity of infusion, therapeutic objectives, existing formulations of intravenous phosphate and its most appropriate preparations.

The incidence of spinal schwannomas ranges from 0.3 to 0.4 cases per 100,000 people. They account for approximately 25% of intradural spinal cord tumors in adults. Most are solitary, encapsulated, and firm, composed predominantly of neoplastic Schwann cells. Microscopically, they are characterized by high cellularity and a relative lack of Antoni B pattern.

Case description: A 33-year-old male presented with axial low back pain, dysesthesia in the right L4 dermatome, and difficulty standing. Magnetic resonance imaging revealed a well-defined right paravertebral mass measuring 46×34×52 mm, extending into the right foraminal canal at the L4-L5 level.

Case discussion: Complete tumor resection was performed via an anterolateral retroperitoneal extraforaminal approach. The procedure was carried out jointly by a multidisciplinary team of neurosurgery and vascular surgery. The vascular surgeon ensured safe retroperitoneal exposure by identifying and carefully mobilizing major vascular structures, facilitating access to the tumor, while the neurosurgeon performed tumor dissection with preservation of neural structures. Histopathological analysis confirmed a schwannoma with positive staining for S100 and SOX10, and a Ki-67 index of 2%. The patient experienced local pain and transient dysesthesias, which gradually improved over the following days.

Conclusion: Successful management of schwannomas in atypical locations requires a multidisciplinary surgical approach. In this case, close collaboration between neurosurgery and vascular surgery was essential to achieve a complete and safe resection without intraoperative complications.

Chile's public health system is characterized by fragmentation, which hinders continuity of care. The referral and counter-referral (RCR) process plays a key role in ensuring coordination between levels of care, and several digitalization policies have been implemented to improve it.

Aim: To analyze the impact of three digitalization policies implemented in the RCR process of Chile's public health system on continuity of care.

Methods: A case series study was conducted on the following policies: the Healthcare Network Information System (SIDRA), Digital Hospital (HD), and Single Referral Channel (CUD). A documentary review of official documents and press releases was carried out. To characterize each policy, an adaptation of the pragmatic case study approach and a typology of public health digitalization policies were used. The Continuity of Care Questionnaire Between Levels of Care was applied to assess the impact of each policy on continuity of care.

Results: The policies analyzed reflect different digitalization models: digitization (SIDRA), digitalization (CUD), and digital transformation (HD). All three promoted the informational dimension of continuity of care. Regarding the longitudinal dimension, SIDRA's impact was marginal; HD improved continuity by expanding communication channels between care levels and covering the entire RCR cycle; and CUD went further by enhancing access to patients' medical records and automating communication between levels.

Conclusions: Digitalization policies in the RCR process have strengthened the informational dimension of continuity of care, but their impact on the longitudinal dimension remains heterogeneous. Advancing digitalization in health does not necessarily lead to proportional improvements in continuity of care.

Hodgkin's Lymphoma (HL) is a highly curable hematologic malignancy. Interim PET-CT plays a critical role in monitoring early treatment response and guiding therapeutic decisions. The Deauville Score (DS) is the standard qualitative tool for interpreting PET-CT, while semi-quantitative parameters such as Delta SUV (DSUV) and Tumor Liver ratio (TLr) may offer additional prognostic value.

Aim: To evaluate the clinical value of interim PET-CT in assessing treatment response in patients with HL treated with the ABVD regimen, and to compare the predictive performance of qualitative and semi-quantitative assessment methods.

Methods: A retrospective cohort study was conducted including 28 patients with histologically confirmed HL treated with ABVD at the Hospital de Clínicas "Dr. Manuel Quintela" and imaged at CUDIM between 2017 and 2023. PET-CT scans were analyzed at three time points: baseline, interim (after 2 cycles), and end-of-treatment. The Deauville Score was used to categorize interim PET-CT results (scores 1-3 as negative; 4-5 as positive). DSUV and TLr were also calculated to assess their prognostic value.

Results: Interim PET-CT using DS showed a strong negative predictive value (NPV) of 95%. DSUV demonstrated 100% sensitivity but lower specificity (64%) compared to DS. TLr achieved higher specificity (96%) than both DS and DSUV. Hematologic analysis showed increased red blood cell parameters and decreased white cell counts after 2 cycles, consistent with treatment-related effects. Concordance between DS and DSUV was moderate (Cohen's Kappa = 0.462).

Conclusions: The Deauville Score remains a robust primary tool for evaluating early treatment response in HL. Semi-quantitative parameters such as DSUV and TLr may provide complementary prognostic information. Further studies with larger cohorts are needed to validate their role in clinical decision-making.

Obstructive Sleep Apnea, (OSA), is a highly prevalent, underdiagnosed disorder, associated to increased perioperative complications. Overnight polysomnography is the diagnosis gold standard but is not always feasible. The STOP-BANG questionnaire is an OSA screening tool.

Aim: A retrospective study was performed to determine the STOP-BANG capability to identify moderate or severe OSA in obese patients scheduled for bariatric surgery.

Methods: 96 patients' Home Sleep Apnea Test results were used as a gold standard and their previous STOP-BANG scores as a covariable in a logistic regression model.

Results: The areas under the ROC curve at >3 and ≥5 cutoff points were 0,73 CI95% [0,63; 0,82] and 0,79 CI95% [0,67; 0,91], to allocate Moderate/Severe and Severe OSA respectively.

Conclusion: the STOP-BANG screening capacity was at most acceptable to identify Moderate or Severe OSA in bariatric patients. The best prediction was obtained to classify severe OSA.