Couvelaire uterus is defined as the extravasation of blood in the myometrium and, sometimes, in the broad ligament, the adnexal structures and the peritoneum, because of placental abruption. The objective of the manuscript is to present the case of a primiparous woman who presented a Couvelaire uterus.
Clinical case
a 24-year-old primiparous woman with 33.5 weeks of pregnancy who presented preeclampsia with severity criteria, acute renal failure, stillbirth and disseminated intravascular coagulation. During the surgical procedure, 100% placental abruption was evidenced with an expansive infiltrating hematoma on the posterior and anterior side of the uterus and bilateral broad ligaments of approximately 1,500 cm3 (Couvelaire uterus).
Conclusions
This is an entity that has a low incidence; however, it usually presents a high morbidity and mortality burden for both the mother and the fetus.
{"title":"Útero de Couvelaire en paciente nulípara: reporte de caso","authors":"Sandra Yaneth Leguizamón-Martínez MD , Rhaiza Josefa Urbina-Labrador MD , Lorena García-Agudelo MD , Viviana C. Sánchez MD , Ledmar Jovanny Vargas-Rodríguez MD","doi":"10.1016/j.rmclc.2025.11.003","DOIUrl":"10.1016/j.rmclc.2025.11.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Couvelaire uterus is defined as the extravasation of blood in the myometrium and, sometimes, in the broad ligament, the adnexal structures and the peritoneum, because of placental abruption. The objective of the manuscript is to present the case of a primiparous woman who presented a Couvelaire uterus.</div></div><div><h3>Clinical case</h3><div>a 24-year-old primiparous woman with 33.5 weeks of pregnancy who presented preeclampsia with severity criteria, acute renal failure, stillbirth and disseminated intravascular coagulation. During the surgical procedure, 100% placental abruption was evidenced with an expansive infiltrating hematoma on the posterior and anterior side of the uterus and bilateral broad ligaments of approximately 1,500<!--> <!-->cm<sup>3</sup> (Couvelaire uterus).</div></div><div><h3>Conclusions</h3><div>This is an entity that has a low incidence; however, it usually presents a high morbidity and mortality burden for both the mother and the fetus.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 6","pages":"Pages 540-543"},"PeriodicalIF":0.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.rmclc.2025.12.006
{"title":"36 AÑOS CONSTRUYENDO UNA REVISTA AL SERVICIO DE LA SALUD","authors":"","doi":"10.1016/j.rmclc.2025.12.006","DOIUrl":"10.1016/j.rmclc.2025.12.006","url":null,"abstract":"","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 6","pages":"Pages 490-491"},"PeriodicalIF":0.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Empathy has cognitive and emotional dimensions that healthcare professionals need to develop. Empathy also influences the learning environment and student outcomes in simulation-based education. This study explored the empathy profiles of simulation instructors and analyzed how cognitive and affective dimensions correlate with demographic characteristics.
Methods
Quantitative, observational, cross-sectional study conducted with 36 novice simulation instructors. Empathy was evaluated using the Test of Cognitive and Affective Empathy, which assesses four dimensions of empathy: Perspective Adoption (PA), Emotional Understanding (EU), Empathic Distress (ED), and Empathic Joy (EJ). Statistical analysis was conducted using Kruskal-Wallis and Spearman's Rho tests in JASP (v0.19.1).
Results
Most participants were women (83.33%), aged 30–34 years (41.67%), and held a master's degree (80.56%). One-third of the participants (33%) scored =94th percentile on total empathy. PA and EJ scores were consistently high, while EU and ED showed greater variability. Gender differences were significant, with men scoring higher in total empathy, EU, and ED (p < 0.05). Structured training correlated with higher ED; lack of conference attendance correlated with higher EU. There were no associations between empathy scores and years of experience or academic qualifications.
Conclusions
Simulation instructors in this study exhibited high cognitive empathy, with variable levels of affective empathy. Empathy profiling can be an integral part of tailored instructor training that strikes a balance between emotional responsiveness and psychological safety. These results highlight the importance of including strategies to improve emotional resilience and promote effective educator-student interactions in simulation faculty development programs.
{"title":"Exploring empathy in simulation-based health education: instructor profiles and training implications","authors":"Soledad Armijo-Rivera MD, MSc , Scarlett Vicencio-Clarke MD, MSc , Nancy Riffo-Saldías MD, MSc , Hernán Caamaño , Pía Díaz , Francesca Caldo , Carla Pino","doi":"10.1016/j.rmclc.2025.10.010","DOIUrl":"10.1016/j.rmclc.2025.10.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Empathy has cognitive and emotional dimensions that healthcare professionals need to develop. Empathy also influences the learning environment and student outcomes in simulation-based education. This study explored the empathy profiles of simulation instructors and analyzed how cognitive and affective dimensions correlate with demographic characteristics.</div></div><div><h3>Methods</h3><div>Quantitative, observational, cross-sectional study conducted with 36 novice simulation instructors. Empathy was evaluated using the Test of Cognitive and Affective Empathy, which assesses four dimensions of empathy: Perspective Adoption (PA), Emotional Understanding (EU), Empathic Distress (ED), and Empathic Joy (EJ). Statistical analysis was conducted using Kruskal-Wallis and Spearman's Rho tests in JASP (v0.19.1).</div></div><div><h3>Results</h3><div>Most participants were women (83.33%), aged 30–34 years (41.67%), and held a master's degree (80.56%). One-third of the participants (33%) scored =94th percentile on total empathy. PA and EJ scores were consistently high, while EU and ED showed greater variability. Gender differences were significant, with men scoring higher in total empathy, EU, and ED (p<!--> <!--><<!--> <!-->0.05). Structured training correlated with higher ED; lack of conference attendance correlated with higher EU. There were no associations between empathy scores and years of experience or academic qualifications.</div></div><div><h3>Conclusions</h3><div>Simulation instructors in this study exhibited high cognitive empathy, with variable levels of affective empathy. Empathy profiling can be an integral part of tailored instructor training that strikes a balance between emotional responsiveness and psychological safety. These results highlight the importance of including strategies to improve emotional resilience and promote effective educator-student interactions in simulation faculty development programs.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 5","pages":"Pages 473-481"},"PeriodicalIF":0.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.rmclc.2025.10.007
Pedro Federico Cruz MD, Michael Peltzer MD, Juan Gac MD
Heart failure with reduced ejection fraction (HFrEF) remains a major cause of morbidity and mortality worldwide. Despite advances in pharmacological therapies, a subgroup of patients continues to be symptomatic and at high risk of sudden death. In this context, the implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) represent key tools to improve survival and quality of life. This article reviews the clinical evidence supporting their use, the current guideline-based indications, and the challenges in patient selection. Recent technological advances and the future of device-based therapy in heart failure are also discussed.
{"title":"Dispositivos en insuficiencia cardíaca: rol del desfibrilador automático implantable y la terapia de resincronización cardíaca","authors":"Pedro Federico Cruz MD, Michael Peltzer MD, Juan Gac MD","doi":"10.1016/j.rmclc.2025.10.007","DOIUrl":"10.1016/j.rmclc.2025.10.007","url":null,"abstract":"<div><div>Heart failure with reduced ejection fraction (HFrEF) remains a major cause of morbidity and mortality worldwide. Despite advances in pharmacological therapies, a subgroup of patients continues to be symptomatic and at high risk of sudden death. In this context, the implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) represent key tools to improve survival and quality of life. This article reviews the clinical evidence supporting their use, the current guideline-based indications, and the challenges in patient selection. Recent technological advances and the future of device-based therapy in heart failure are also discussed.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 5","pages":"Pages 401-405"},"PeriodicalIF":0.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.rmclc.2025.10.006
Gerardo Palma Carvajal MD
Heart failure with preserved ejection fraction (ICFEp) has become a highly prevalent entity with increasing clinical relevance, now surpassing heart failure with reduced ejection fraction (HFrEF) in frequency. This change is related to the aging population and a sustained increase in comorbidities such as hypertension, obesity, type 2 diabetes, and atrial fibrillation.
From a pathophysiological perspective, ICFEp is primarily associated with diastolic dysfunction, myocardial remodeling, and chronic inflammatory events, with a higher prevalence in women and older patients. Its clinical presentation is nonspecific and heterogeneous, which, together with the limited sensitivity of traditional biomarkers like NT-proBNP, makes its diagnosis challenging. To address this complexity, tools such as the HFA-PEFF and H2FPEF scores have been developed, which integrate clinical, echocardiographic, and biochemical parameters to standardize the diagnostic process.
ICFEp currently requires a rigorous diagnostic approach, precise phenotypic stratification, and individualized therapeutic strategies that address its clinical complexity. The objective of this review is to establish a practical guide for the diagnosis of HFpEF.
{"title":"Diagnóstico de insuficiencia cardíaca con fracción de eyección preservada","authors":"Gerardo Palma Carvajal MD","doi":"10.1016/j.rmclc.2025.10.006","DOIUrl":"10.1016/j.rmclc.2025.10.006","url":null,"abstract":"<div><div>Heart failure with preserved ejection fraction (ICFEp) has become a highly prevalent entity with increasing clinical relevance, now surpassing heart failure with reduced ejection fraction (HFrEF) in frequency. This change is related to the aging population and a sustained increase in comorbidities such as hypertension, obesity, type 2 diabetes, and atrial fibrillation.</div><div>From a pathophysiological perspective, ICFEp is primarily associated with diastolic dysfunction, myocardial remodeling, and chronic inflammatory events, with a higher prevalence in women and older patients. Its clinical presentation is nonspecific and heterogeneous, which, together with the limited sensitivity of traditional biomarkers like NT-proBNP, makes its diagnosis challenging. To address this complexity, tools such as the HFA-PEFF and H<sub>2</sub>FPEF scores have been developed, which integrate clinical, echocardiographic, and biochemical parameters to standardize the diagnostic process.</div><div>ICFEp currently requires a rigorous diagnostic approach, precise phenotypic stratification, and individualized therapeutic strategies that address its clinical complexity. The objective of this review is to establish a practical guide for the diagnosis of HFpEF.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 5","pages":"Pages 383-390"},"PeriodicalIF":0.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.rmclc.2025.10.003
Guido Antoniutti MD
Transthyretin amyloidosis is a multisystemic disease resulting from the deposit of amyloid fibrils derived from the transthyretin protein (TTR). When this deposit occurs in cardiac tissues, TTR amyloid cardiomyopathy (ATTR-CM) develops. This clinical entity was recognized over 170 years ago, with the initial description of amyloidosis by Virchow in 1854 and the definition of ATTR-CM in 1908. Significant progress has been made in the last two decades due to the development of novel diagnostic modalities and advancements in therapeutic alternatives. Molecules that interfere with the synthesis, folding, and deposition process of TTR have been investigated in patients with ATTR-CM and heart failure (HF). TTR stabilizer molecules (tafamidis and acoramidis) and TTR gene silencers (vutrisiran) have shown favorable outcomes in terms of quality of life and mortality in HF patients, representing currently available therapeutic options. Ongoing studies are evaluating drugs that target the same steps in the pathophysiological process of TTR, as well as innovative approaches such as gene editing and antibodies that promote the clearance of amyloid fibrils, which hold promise for further altering the disease course. The objective of this review is to describe ATTR-CM, with special attention to the current and future state of the diagnosis and specific treatment of the disease.información del artículo
{"title":"Historia, diagnóstico y tratamiento de la amiloidosis cardíaca por transtiretina: una revisión","authors":"Guido Antoniutti MD","doi":"10.1016/j.rmclc.2025.10.003","DOIUrl":"10.1016/j.rmclc.2025.10.003","url":null,"abstract":"<div><div>Transthyretin amyloidosis is a multisystemic disease resulting from the deposit of amyloid fibrils derived from the transthyretin protein (TTR). When this deposit occurs in cardiac tissues, TTR amyloid cardiomyopathy (ATTR-CM) develops. This clinical entity was recognized over 170 years ago, with the initial description of amyloidosis by Virchow in 1854 and the definition of ATTR-CM in 1908. Significant progress has been made in the last two decades due to the development of novel diagnostic modalities and advancements in therapeutic alternatives. Molecules that interfere with the synthesis, folding, and deposition process of TTR have been investigated in patients with ATTR-CM and heart failure (HF). TTR stabilizer molecules (tafamidis and acoramidis) and TTR gene silencers (vutrisiran) have shown favorable outcomes in terms of quality of life and mortality in HF patients, representing currently available therapeutic options. Ongoing studies are evaluating drugs that target the same steps in the pathophysiological process of TTR, as well as innovative approaches such as gene editing and antibodies that promote the clearance of amyloid fibrils, which hold promise for further altering the disease course. The objective of this review is to describe ATTR-CM, with special attention to the current and future state of the diagnosis and specific treatment of the disease.información del artículo</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 5","pages":"Pages 413-421"},"PeriodicalIF":0.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.rmclc.2025.10.002
Adrián Fernández MD , Elián Giordanino MD
Systolic dysfunction (SD) in hypertrophic cardiomyopathy (HCM) constitutes a rare yet clinically significant entity that is associated with increased morbidity and mortality. It is conventionally defined by a left ventricular ejection fraction (LVEF) below 50%, correlating with a worse prognosis. The pathophysiology of SD in HCM is multifactorial, involving microvascular dysfunction, myocardial fibrosis, and maladaptive ventricular remodeling. These processes lead to progressive contractile impairment and heart failure. The therapeutic approach must be individualized, including pharmacological strategies. For patients with advanced SD refractory to medical therapy, heart transplantation remains the definitive intervention. This review provides a comprehensive discussion of current therapeutic strategies, risk stratification approaches, and future perspectives in the management of systolic dysfunction in HCM.
{"title":"Manejo de la disfunción sistólica en pacientes con miocardiopatía hipertrófica: desafíos y perspectivas","authors":"Adrián Fernández MD , Elián Giordanino MD","doi":"10.1016/j.rmclc.2025.10.002","DOIUrl":"10.1016/j.rmclc.2025.10.002","url":null,"abstract":"<div><div>Systolic dysfunction (SD) in hypertrophic cardiomyopathy (HCM) constitutes a rare yet clinically significant entity that is associated with increased morbidity and mortality. It is conventionally defined by a left ventricular ejection fraction (LVEF) below 50%, correlating with a worse prognosis. The pathophysiology of SD in HCM is multifactorial, involving microvascular dysfunction, myocardial fibrosis, and maladaptive ventricular remodeling. These processes lead to progressive contractile impairment and heart failure. The therapeutic approach must be individualized, including pharmacological strategies. For patients with advanced SD refractory to medical therapy, heart transplantation remains the definitive intervention. This review provides a comprehensive discussion of current therapeutic strategies, risk stratification approaches, and future perspectives in the management of systolic dysfunction in HCM.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 5","pages":"Pages 406-412"},"PeriodicalIF":0.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Initial evaluation of heart failure is directed to ventricular function analysis, etiological investigation, prognostic factors evaluation and initial therapeutic decision. This article summarizes the role of non-invasive cardiac imaging (excluding echocardiogram) in every aspect. Utility of thoracic radiology, coronary computed tomography angiogram, cardiac magnetic resonance and nuclear medicine studies (spect myocardial perfusion and PET-CT) is analyzed, not only in the setting of ischemic cardiomyopathy but also in the rest of the etiological spectrum.
{"title":"Imágenes en insuficiencia cardíaca","authors":"Laura Grynberg MD, Paola Paolinelli MD, Francisca Furnaro MD, Patricia Bitar MD","doi":"10.1016/j.rmclc.2025.10.004","DOIUrl":"10.1016/j.rmclc.2025.10.004","url":null,"abstract":"<div><div>Initial evaluation of heart failure is directed to ventricular function analysis, etiological investigation, prognostic factors evaluation and initial therapeutic decision. This article summarizes the role of non-invasive cardiac imaging (excluding echocardiogram) in every aspect. Utility of thoracic radiology, coronary computed tomography angiogram, cardiac magnetic resonance and nuclear medicine studies (spect myocardial perfusion and PET-CT) is analyzed, not only in the setting of ischemic cardiomyopathy but also in the rest of the etiological spectrum.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 5","pages":"Pages 391-400"},"PeriodicalIF":0.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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