Revista medica de Chile最新文献

Critical care echocardiography has become a central tool for advanced hemodynamic monitoring and management in critically ill patients. It is valuable in a wide range of clinical scenarios involving severe illness. This technique integrates real-time functional assessment of various components of the circulatory system with clinical and complementary data to enable personalized hemodynamic management. However, it must be performed and interpreted by a qualified and properly trained professional. In this review, we analyze the general principles of critical care echocardiography, its clinical applications, key elements to evaluate, recent advances, and relevant aspects of training and education.

Systemic lupus erythematosus (SLE) is a chronic multisystem inflammatory disease with a wide spectrum of clinical manifestations. Its association with autoimmune hepatitis is well documented; however, there is limited evidence linking it to hepatic overlap syndromes involving primary sclerosing cholangitis. Although cytopenias are a common hematologic manifestation of SLE, pancytopenia is less frequent and is associated with increased morbidity. Lupus enteritis is an uncommon gastrointestinal manifestation, typically presenting with nonspecific symptoms, which necessitates a high index of clinical suspicion for timely diagnosis. In this article, we present the clinical case of a patient with multiple coexisting autoimmune conditions consistent with SLE, who showed favorable clinical evolution following the initiation of immunosuppressive therapy.

Sleep quality and smartphone use are factors that could influence academic performance, since sleep deprivation decreases concentration and smartphone use is related to not planning work.

Aim: To evaluate the relationship between sleep quality and smartphone addiction with the grade point average (GPA) in medical students.

Methods: Analytical cross-sectional study. 181 medical students were included. Data were collected through an electronic survey. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI), smartphone addiction with the Smartphone Addiction Scale - Short Version (SAS-SV) and GPA based on the average of the last semester. Chi2, t-test and Wilcoxon tests were used to analyze the relationship between the variables.

Results: The students were 116 (64.09%) female and 65 (35.91%) male. The median age was 22 years (IQR 21-24). The ICSP results were 91 (50.28%) with poor sleep quality and 90 (49.72%) with good sleep quality. The SAS-SV results were 119 (65.75%) without smartphone addiction and 62 (34.25%) with smartphone addiction. The GPA was 3.96 (SD ±0.66). A significant difference was found between the GPA of the group of students without smartphone addiction and GPA of the group of students with smartphone addiction (p value 0.0007). A significant difference was also observed in the sleep efficiency of the group of students without smartphone addiction and the sleep efficiency of the group of students with smartphone addiction (p value 0.0425).

Conclusion: The GPA and sleep efficiency are lower in medical students with smartphone addiction.

Interstitial lung diseases are a heterogeneous group of disorders characterized by inflammation and/or fibrosis of the lung parenchyma, leading to a progressive loss of lung function. Idiopathic pulmonary fibrosis (IPF) is a representative model with a pathophysiology common to other types of pulmonary fibrosis.

Aim: This review presents the pathophysiological mechanisms and existing and developing antifibrotic therapies of IPF.

Method: Qualitative study through a narrative review of the pathophysiological phenomena of IPF and advances in antifibrotic therapy.

Results: The role of the alveolar epithelium, fibroblast/myofibroblast activity, cellular senescence and aging, immune system activity, oxidation-reduction mechanisms and genetic characteristics have been identified, which reveal the complex pathophysiology of this disease. Currently, there are only two therapies available to mitigate the effects of pulmonary fibrosis, Pirfenidone and Nintedanib, and the development and research of other antifibrotic drugs is still pending.

Conclusions: There are multiple pathophysiological phenomena in IPF. Understanding them is the basis for the development and evolution of antifibrotic therapies.

Mental health problems during university years are highly prevalent and often co-occur. Studying the factors associated with the co-occurrence of mental health problems could contribute to the development of preventive and therapeutic interventions.

Aim: To describe the co-occurrence of depressive symptoms, generalized anxiety symptoms, and problematic substance use among university students, and to analyze the relationship between sociodemographic factors and the presence of co-occurring mental health problems.

Method: A total of 1,470 university students (53.8% female; mean age 19.6) completed self-report questionnaires on depressive symptoms (PHQ-9), generalized anxiety symptoms (GAD-7), and substance use risk (ASSIST). Data were analyzed using bivariate hypothesis testing and logistic regression models.

Results: Among the students, 69.6% reported moderate to severe depressive symptoms, 46.9% moderate to severe generalized anxiety symptoms, and 52.5% substance use risk. A total of 58.6% screened positive for two or more mental health problems. High co-occurrence was observed (between 56.0% and 93.9%, p<0.05) among depressive symptoms, generalized anxiety symptoms, and problematic substance use risk. Female students, non-heterosexual individuals, those from low and middle socioeconomic backgrounds, and those simultaneously studying and working were more likely to experience co-occurring mental health problems (OR ≥1.08; p ≤0.024).

Conclusion: A high percentage of students scored above clinically relevant cut points for mental health, with high co-occurrence of depressive symptoms, generalized anxiety symptoms, and risky substance use. Various factors were significantly associated with the presence of co-occurring mental health problems. Based on these findings, it is recommended to consider the co-occurrence of mental health problems in the diagnosis, treatment, and prevention of mental health issues during university years.

Osteoporosis have been defined as the decrease in bone resistance that predisposes to fragility fractures. 50% of women over 50 years of age will suffer an osteoporotic fracture during their lifetime. Densitometry allows detecting mineral density and women with osteoporosis. The FRAX tool combines risk factors and permit calculating the high risk of major fracture than 10 years, the cutoff point in Chile being 3.2%.

Aim: To assess the ability of the FRAX tool to identify osteoporosis in menopausal women under 65 years of age.

Materials and methods: Retrospective study of patients aged 50 to 64 years treated in the climacteric program at Clínica Santa María between 2019 and 2022.

Results: A total of 264 women had bone densitometry (DXA) and FRAX assessment at baseline. The mean age was 57.4 years (SD ±4). A total of 53 patients had a calculated 10-year major osteoporotic fracture risk ≥3.2%. Bone densitometry with a T-score <-2.5 was found in 33 women. The sensitivity of FRAX to identify women with osteoporosis on DXA was 24.2%, detecting only 8 of the 33 women with T-score <-2.5.

Conclusion: Our results show that the FRAX alone fails to identify the majority of patients under 65 years of age at high risk of fracture who benefit of bone densitometry. More studies are needed to characterize menopausal women younger than 65 years with a T-score less than -2.5 in DO and a FRAX MOF risk less than 3.2%.