Revista Medica Clinica Las Condes最新文献

英文中文

Injuria cerebral precoz en la hemorragia subaracnoidea aneurismática: comprendiendo la ﬁsiopatología para optimizar el manejo intensivo 动脉瘤亚颈动脉出血的早期脑损伤：了解滤波器病理以优化强化治疗

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-05-01 DOI: 10.1016/j.rmclc.2025.06.009

Andrés Reccius-Meza MD

Early brain injury (EBI) following aneurysmal subarachnoid hemorrhage represents a critical phase of brain damage occurring within the first 72 hours after aneurysmal rupture. Traditionally underestimated in favor of delayed cerebral ischemia, EBI has emerged as a key determinant of both functional and vital prognosis in these patients.

EBI is characterized by a multifactorial cascade of events, including intracranial hypertension, global cerebral ischemia, disruption of the blood–brain barrier, cerebral edema, neurovascular inflammation, oxidative stress, and apoptosis, as well as alterations in cerebral blood flow autoregulation. Moreover, EBI is not confined to the brain: it triggers a systemic response that affects the cardiovascular system, lungs, immune system, and other peripheral organs, thereby amplifying secondary cerebral injury.

A comprehensive understanding of these mechanisms has driven the development of physiopathologically targeted therapeutic strategies aimed at preserving cerebral perfusion, oxygenation, and metabolism, controlling intracranial pressure, preventing epileptic seizures, and avoiding multiorgan failure. In this context, multimodal neuromonitoring has become an essential tool for tailoring real-time, individualized treatments.

动脉瘤性蛛网膜下腔出血后的早期脑损伤（EBI）是动脉瘤破裂后72小时内发生的脑损伤的关键阶段。传统上被低估的延迟性脑缺血，EBI已成为这些患者功能和生命预后的关键决定因素。EBI的特点是多因素级联事件，包括颅内高压、全脑缺血、血脑屏障破坏、脑水肿、神经血管炎症、氧化应激和细胞凋亡，以及脑血流自动调节的改变。此外，EBI并不局限于大脑：它会引发全身反应，影响心血管系统、肺、免疫系统和其他周围器官，从而放大继发性脑损伤。对这些机制的全面了解推动了生理病理靶向治疗策略的发展，旨在保持脑灌注、氧合和代谢，控制颅内压，预防癫痫发作，避免多器官功能衰竭。在这种情况下，多模态神经监测已成为定制实时、个性化治疗的必要工具。

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引用次数: 0

Duelo perinatal, salud mental y la importancia del acompañamiento psicológico 围产期丧亲、心理健康和心理支持的重要性

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-05-01 DOI: 10.1016/j.rmclc.2025.05.002

Francisca Cortés-Cataldo , Marcia Olhaberry-Huber , Catalina Sieverson-Raddatz , Macarena Romero-Jiménez , María Trinidad Tagle-Silva , Constanza Mena-Silva , Carolina Honorato-Miranda , Angélica Muñoz Anguita , Daniela Iribarren-Jaramillo

Grief is a normal, emotional and psychological adaptive response to a significant loss. Particularly, mourning the death of a child is considered one of the most stressful and devastating situations that a human being can experience. Perinatal grief is defined as the reaction after the death of a baby during pregnancy and up to the first month of life. Not receiving specialized care to cope with perinatal grief has been associated with an increased risk of developing mental health disorders. In the last decade there has been a significant increase in national and international initiatives that promote the validation of perinatal grief and its support. The objective of this article is to provide a review of the evidence regarding perinatal grief and its impact on mental health, considering its definition and approach throughout history and current proposals for its support and elaboration. Despite the advances in making visible the psychological impact of perinatal grief, greater systematization of experiences at the national level in different health care centers, both public and private, is still required.

悲伤是对重大损失的正常、情感和心理适应反应。特别是，哀悼一个孩子的死亡被认为是人类所能经历的最紧张和最具破坏性的情况之一。围产期悲伤被定义为怀孕期间婴儿死亡后直至生命第一个月的反应。没有接受专门护理来应对围产期悲伤与发展为精神健康障碍的风险增加有关。在过去十年中，促进确认围产期悲伤及其支持的国家和国际倡议显著增加。本文的目的是提供有关围产期悲伤及其对心理健康影响的证据，考虑其定义和方法在历史上和当前的建议支持和阐述。尽管在使围产期悲伤的心理影响可见方面取得了进展，但仍然需要在国家一级将不同的公共和私人保健中心的经验更系统化。

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引用次数: 0

“una sala de hospital durante la visita del médico jefe” 1889 “一个病房在首席医生的访问”1889年

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-05-01 DOI: 10.1016/j.rmclc.2025.06.011

引用次数: 0

Inteligencia artificial aplicada al cuidado del ataque cerebrovascular: una descripción del estado del arte y expectativas futuras 人工智能应用于脑卒中治疗：现状描述和未来预期

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-05-01 DOI: 10.1016/j.rmclc.2025.06.007

Esteban Basáez-Miranda MD

Stroke is the second leading cause of death and the first cause of disability in Chile. Given the epidemiological behavior of our country, it is projected that the number of stroke patients will continue to increase in the future, so it is essential to have new public health strategies to address this scenario of high healthcare burden. Artificial intelligence has thus become an extremely useful tool in the management of stroke in its different stages (detection, management, primary and secondary prevention, and rehabilitation). In a narrative way, the different modalities of artificial intelligence are described and, based on their foundations, applications are presented as shown in various clinical works according to the different phases of stroke. Finally, potentials and projections are explored, along with future perspectives and the associated ethical, technical, and public health policy challenges.

中风是智利第二大死亡原因和第一大残疾原因。鉴于我国的流行病学行为，预计未来中风患者的数量将继续增加，因此制定新的公共卫生战略来应对这种高医疗负担的情况至关重要。因此，人工智能已成为在不同阶段（检测、管理、一级和二级预防以及康复）管理中风的极其有用的工具。以叙述的方式，描述了人工智能的不同模式，并在其基础上，根据中风的不同阶段，在各种临床工作中展示了应用。最后，探讨了潜力和预测，以及未来的前景和相关的伦理、技术和公共卫生政策挑战。

引用次数: 0

Golpe de calor: claves para el reconocimiento y manejo precoz en tiempos de cambio climático 热浪：在气候变化时代早期认识和管理的关键

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-05-01 DOI: 10.1016/j.rmclc.2025.06.002

Eva Araya MD

Heat-related illness includes a continuum of syndromes, the most severe extreme of which is heatstroke. It usually occurs epidemically in relation to heat waves, especially affecting frail older adults, with high mortality. In the face of climate change, an increase in the frequency and intensity of heat waves is expected, and in this scenario it is essential to know the population at greatest risk together with the clinical manifestations of heat stroke, in order to initiate early treatment to reduce mortality.

与热有关的疾病包括一系列综合征，其中最严重的极端是中暑。它通常与热浪有关而流行，尤其影响体弱多病的老年人，死亡率高。面对气候变化，预计热浪的频率和强度将增加，在这种情况下，了解高危人群以及中暑的临床表现至关重要，以便及早进行治疗以降低死亡率。

引用次数: 0

Dermatomiositis clásica. Reporte de un caso Dermatomiositis经典。案例报告

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-03-01 DOI: 10.1016/j.rmclc.2025.03.006

Andry Devia-Pardo MD, Ayda Mongui-Fonseca MD, Lina Marroquín-Bravo MD, Teresita Pérez-Alonso MD

Introduction

Dermatomyositis is an inflammatory myopathy of variable course with different clinical manifestations, predominantly in the skin, which can present a chronic, progressive evolution with irreversible muscle damage and significant morbidity and mortality. The objective of this article is to describe the clinical case of a patient with classic dermatomyositis.

Clinical Case Presentation

A 59-year-old woman with a history of high blood pressure experienced muscle weakness in the shoulder and pelvic girdles in October 2022, with significant limitation of her daily activities. Various skin and muscle manifestations were found and motivated the execution of muscle and skin biopsies and electromyography. According to the findings on physical examination and the results of the other studies, the diagnosis of a classic adult dermatomyositis not associated with neoplastic processes was proposed. Treatment with hydroxychloroquine and immunosuppressants was initiated, with an adequate therapeutic response.

Conclusion

The accurate diagnosis of dermatomyositis requires the integration of the clinical picture, laboratory studies, histology and electromyography. This allows for the initiation of appropriate treatment in order to obtain, in most cases, a satisfactory clinical response.

皮肌炎是一种病程多变、临床表现各异的炎症性肌病，主要发生在皮肤，可呈现慢性、进行性发展，并伴有不可逆的肌肉损伤，发病率和死亡率均较高。本文的目的是描述一个典型皮肌炎患者的临床病例。临床病例介绍：一名59岁女性，既往有高血压病史，于2022年10月出现肩部和骨盆带肌无力，日常活动明显受限。发现了各种皮肤和肌肉表现，并促使肌肉和皮肤活检和肌电图的执行。根据体格检查的结果和其他研究的结果，建议诊断为典型的成人皮肌炎，与肿瘤进程无关。开始使用羟氯喹和免疫抑制剂治疗，有足够的治疗反应。结论皮肌炎的准确诊断需要临床表现、实验室检查、组织学和肌电图的综合检查。这允许开始适当的治疗，以获得，在大多数情况下，令人满意的临床反应。

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引用次数: 0

“¡Y LOS MÉDICOS... OTRA VEZ ASÍ!” 2021 “和医生……另一辆车在这里！2021”

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-03-01 DOI: 10.1016/j.rmclc.2025.04.007

引用次数: 0

Desafíos en hemorragia cerebral y cirrosis hepática. derivación ventricular bilateral como alternativa terapéutica 脑出血和肝硬化的挑战。双侧心室分流作为治疗替代

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-03-01 DOI: 10.1016/j.rmclc.2025.04.004

Antonio Arroyo MD , Andrés Ramos MD , Andrés Reccius MD

Objective

To describe the management of a patient with intraparenchymal hematoma, intraventricular hemorrhage (IVH) and coagulopathy secondary to liver cirrhosis; exploring bilateral ventricular shunt (bVSD) placement as a therapeutic option.

Case report

40-year-old man with liver cirrhosis and severe coagulopathy, found in coma and with multiple hemorrhagic brain lesions secondary to traumatic brain injury, as well as IVH and obstructive hydrocephalus. Despite the coagulopathy, an bVSD system was placed and used for ventricular lavage, achieving temporary control of intracranial pressure (ICP).

Results

Although temporary stabilization of ICP was achieved, the patient's evolution was unfavorable, basically influenced by the complex scenario of recurrent coagulopathy despite corrective measures, repeated obstruction of the DVEb, new hemorrhaging and the impossibility of performing other types of interventions. Finally, and as a consequence, limitation of therapeutic effort was performed.

Conclusions

DVEb placement may be a useful alternative to manage IVH in patients with severe coagulopathy, although long-term results still require further evaluation. This case illustrates the complexity of management in these patients and the need for further studies regarding this procedure.

目的探讨肝硬化并发肝实质内血肿、脑室内出血（IVH）和凝血功能障碍患者的治疗方法；探讨双侧心室分流（bVSD）放置作为治疗选择。病例报告40岁男性肝硬化和严重凝血功能障碍，发现昏迷和多发出血性脑病变继发于外伤性脑损伤，以及IVH和阻塞性脑积水。尽管存在凝血功能障碍，但仍放置bVSD系统并用于心室灌洗，暂时控制了颅内压（ICP）。结果虽然实现了ICP的暂时稳定，但患者的病情发展并不顺利，主要受纠正措施后凝血功能复发的复杂情况、DVEb反复阻塞、新出血以及无法进行其他类型干预的影响。最后，作为结果，限制了治疗的努力。结论sdveb放置可能是严重凝血功能障碍患者治疗IVH的有效选择，尽管长期效果仍需进一步评估。本病例说明了这些患者治疗的复杂性和进一步研究的必要性。

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引用次数: 0

Terapia con inhibidores de la vía m-TOR en recién nacidos con hiperinsulinismo congénito resistente a diásóxido y octreotida 使用m-TOR途径抑制剂治疗患有先天性二氧耐药高胰岛素症和奥曲肽的新生儿

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-03-01 DOI: 10.1016/j.rmclc.2025.04.005

Patricio Astudillo MD, MSc

Congenital hyperinsulinism (CHI) is a challenging and severe disease in children due to diffuse involvement of the pancreas. Its treatment is based on chronic therapy with diazoxide or octreotide, followed by partial pancreatectomy, which is often not curative.

It has been previously described that sirolimus (rapamycin), an mTOR pathway inhibitor (mammalian target of rapamycin), is effective in the off-label treatment of CHI in infants who are refractory to conventional therapies.

This report presents the case of a premature 33-week-old infant with a severe form of CHI and a negative mutation in the ABCC8 gene, who responded to rapamycin treatment, showing significant improvement in blood glucose regulation and quality of life. No serious adverse events were observed after 24 months of follow-up. This is the first report of a successful intervention in a pediatric patient in Chile, providing a promising basis for future studies comparing rapamycin with other treatments for the management of congenital hyperinsulinism. The objective of this work is to present a clinical case involving the off-label use of rapamycin in a patient with congenital hyperinsulinism, along with a review of the current literature.

先天性高胰岛素血症（CHI）是一种具有挑战性和严重的疾病，在儿童由于胰腺弥漫性累及。其治疗是基于慢性治疗与二氮卓或奥曲肽，随后部分胰腺切除术，这往往是不可治愈的。先前有报道称，西罗莫司（雷帕霉素）是一种mTOR途径抑制剂（雷帕霉素的哺乳动物靶点），在对常规治疗难治性迟发性脑炎的婴儿的说明书外治疗中有效。本报告报告了一例33周大的早产儿，患有严重的CHI和ABCC8基因的负突变，他对雷帕霉素治疗有反应，血糖调节和生活质量有显着改善。随访24个月，未见严重不良事件发生。这是智利首例成功干预儿童患者的报道，为今后比较雷帕霉素与其他治疗方法治疗先天性高胰岛素血症的研究提供了有希望的基础。这项工作的目的是提出一个涉及先天性高胰岛素血症患者使用雷帕霉素的临床病例，并对当前文献进行回顾。

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引用次数: 0

Síndrome de hipotensión intracraneal en paciente neurocrítico: reporte de caso 神经临界患者的颅内低血压综合征：病例报告

IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL

Revista Medica Clinica Las Condes

Pub Date : 2025-03-01 DOI: 10.1016/j.rmclc.2025.04.002

Antonio Arroyo MD , Andrés Reccius MD

Objective

to highlight the importance of recognizing intracranial hypotension syndrome (ICH), derived from the use of a spinal drainage (SD), in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Clinical Case

a 42-year-old female patient with no prior medical history was admitted to the emergency department due to a generalized tonic-clonic seizure. An initial diagnosis of aSAH was made using brain CT angiography, and an aneurysm was treated through endovascular therapy with coils. SD was placed for management, but the patient subsequently developed SIH, characterized by negative intracranial pressure (ICP) and orthostatic headache as her cardinal symptoms.

Discussion

SIH presents with both clinical and radiological features, with orthostatic headache and cerebellar tonsillar descent being among the most common findings. Various treatment options for SIH have been described in the literature. However, the epidural blood patch is one of the most effective alternatives when performed using the appropriate technique.

Conclusions

SD is an effective alternative with a low rate of side effects in the management of aSAH. However, it is crucial to be aware of the associated risks. Proper knowledge of the different clinical presentations and diagnostic approaches is essential for managing SIH.

目的强调在动脉瘤性蛛网膜下腔出血（aSAH）患者中识别由脊髓引流（SD）引起的颅内低血压综合征（ICH）的重要性。临床病例：一名42岁女性患者，无既往病史，因全身性强直阵挛性发作被送至急诊科。通过脑CT血管造影初步诊断aSAH，并通过血管内线圈治疗动脉瘤。患者接受SD治疗，但随后发展为SIH，以颅内压负（ICP）和直立性头痛为主要症状。sih表现出临床和影像学特征，直立性头痛和小脑扁桃体下降是最常见的表现。文献中描述了SIH的各种治疗方案。然而，当使用适当的技术时，硬膜外血贴是最有效的替代方法之一。结论ssd是治疗aSAH的有效选择，且不良反应发生率低。然而，意识到相关的风险是至关重要的。正确了解不同的临床表现和诊断方法对于治疗SIH至关重要。

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引用次数: 0

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