Revista Medica Clinica Las Condes最新文献

Actinomycosis is a chronic granulomatous bacterial infection caused by the Actinomyces species which frequently manifests as cervicofacial, thoracoabdominal or pelvic infections, the latter being the least frequent. There is a strong association between long term intrauterine device (IUD) use and the development of this infection.

It is characterized by the formation of slow-growing abscesses that can reach large dimensions, generating an insidious and non-specific clinical presentation.

Due to the above, the diagnosis is commonly late with a direct impact on the associated complications. Antibiotic treatment is usually prolonged and surgical interventions are sometimes required. We present the case of an IUD using patient who, after several months of symptoms, was hospitalized with the diagnosis of pelvic actinomycosis. The patient evolves favorably with abbreviated antibiotic treatments and outpatient clinical follow-up.

Appendiceal mucocele is a rare pathological entity, but potentially dangerous, it presents in different clinical forms. We present the case of a 47-year-old patient, with no particular history, who consulted for chronic pain in the right iliac fossa and whose abdominal-pelvic computed tomography showed a cystic mass in the appendix that evokes an appendiceal mucocele. The patient underwent an appendectomy. Histological analysis of this confirmed the diagnosis of appendiceal mucocele without malignant cells. Postoperative follow-up was easy.

Introduction

Deep brain stimulation (DBS) consists of the administration of electrical micropulses towards specific subcortical locations. Initially used as a treatment for motor disorders; It is also effective in neuropsychiatric pathologies, including aggressiveness refractory to conventional treatment. This study aims to review experiences with DBS for refractory aggressiveness and identify the most frequent stimulation parameters.

Methods

A review of databases Scopus, Cochrane, ScienceDirect and PubMed was carried out, identifying reports or case series in humans where DBS was used to manage refractory aggressive behavior and which contained stimulation parameters.

Results

17 papers with a total of 58 patients were included, according to the established criteria. The posteromedial hypothalamus was the most frequently used target. Most of the patients improved significantly after starting DBS. The predominant frequency range was between 180-185 Hz (75.8% of cases) and the predominant pulse width range was between 60-90 μs (84.4% of cases).

Conclusions

DBS of the posteromedial hypothalamus at high frequencies and relatively low pulse width seems to be effective for the treatment of refractory aggression; but the optimal setting for treatment is unknown. More studies are required on the physiological basis on which it operates, as well as larger cohorts of individuals for follow-up.

Background

Stigma is a disqualifying act where negative attitudes and labels towards an individual generate feelings of shame, guilt, and social exclusion. In mental health, there are three basic types of stigma: social stigma, self-stigma, and help-seeking stigma. In this review, we present the literature on self-stigma and help-seeking stigma in health personnel; placing special emphasis on existing interventions and projects to reduce stigma.

Methodology

Narrative review carried out in scientific databases between January 2005 and February 2022, including articles in English and Spanish.

Results

Only 38% of patients with mental health conditions seek professional care, with self-stigma and help-seeking stigma being important contributors to this phenomenon. These data sets include both health professions students and health professionals. Different interventions have been published in the last 10 years mainly based on education and contact with this population group. The results have shown small benefits in reducing stigma, but it is unclear if this lasts over time.

Discussion

Health professionals, including medical students, represent a population vulnerable to mental health conditions; which could be explained by their high academic, healthcare, and social burden. The interventions described so far manage to reduce certain types of stigma in mental health. Still, in the future, more focused approaches are needed to adapt the medical curriculum on this topic. In addition, the development of more standardized instruments that will permit objective measurement of the impact of these interventions is required.

Cataracts represents one of the main causes of moderate to severe reversible vision impairment in the world, being an important public health problem in Chile. The only solution is to remove the cataract and implant an intraocular lens (IOL). The main risk factor for cataracts is age, which will lead to a progressive increase in prevalence due to the increase in life expectancy. There are several modifiable risk factors that can be intervened such as diabetes, arterial hypertension, smoking, uncontrolled use of systemic or topical corticosteroids, among others. Although the diagnosis is clinical, we must always perform a detailed study to rule out problems in other ocular structures that may be contributing to poor vision. This study will also allow us to better choose the most appropriate IOL for the patient. We must know the patient's needs and expectations after the surgery, especially if we plan to use toric IOLs, extended depth of focus or multifocal IOLs, which provide more spectacle independence than regular monofocal lenses. This review will describe the preoperative preparation, the technology used in an ultrasonic phacoemulsification surgery and the postoperative follow-up of the patient. Cataract surgery is one of the safest and cost-effective surgeries in modern medicine. More than 90% of the eyes achieve best corrected visual acuity of 20/25, and with the greater precision incorporated in new technologies more than 80% of the patients are left with +/- 0,5 residual diopters, so that today we can offer personalized visual results according to specific patient needs.

Age related macular degeneration (AMD) is the most common cause of irreversible vision loss in people over 65 years of age. Its origin is multifactorial, involving aging as well as various genetic and environmental factors such as smoking, obesity and diet. It mainly affects the outer retina (retinal pigment epithelium and photoreceptors) in the macular area. It is classified into “non-neovascular” and “neovascular”.

The “non-neovascular” form is characterized by the presence of soft drusen, which can evolve towards progressive macular atrophy and a gradual loss of visual acuity. In the “neovascular” form, abnormal blood vessels develop, usually growing from the choroid, into the subretinal or subepithelial pigment space with exudation of fluid and blood with sudden loss of vision. This leads to fibrosis and irreversible damage to the outer retina.

This article analyzes the classification and current state of treatment of age-related macular degeneration.

Three-dimensional printing is emerging as a promising technology that permits us to personalize anatomical models, allowing us to visualize the anatomy of our patients in a much more concrete way than traditional radiological images. Likewise, it promotes pre-surgical planning and procedural simulation, improving outcomes and benefiting both health professionals and patients.

The clinical case of a pediatric patient with a metatarsal coalition who underwent a 3D model prior to surgery is presented.

Cataract surgery consists of removing the opaque natural lens and replacing its function with an intraocular lens (IOL). The first IOL successfully implanted in humans was done in 1949 with a polymethylmethacrylate (PMMA) IOL. New biocompatible materials such as hydrophilic acrylic, hydrophobic silicone, hydrophobic acrylic, among others, were developed, each with different advantages and disadvantages. Hydrophilic acrylic has a greater risk of posterior subcapsular opacity and dystrophic calcification, hydrophobic silicone opacifies in the presence of liquid silicone in the posterior segment, hydrophobic acrylic has more risk of glistening. The latter is the most widely used IOL in Chile due to its flexibility, low risk of dystrophic calcification and low risk of posterior subcapsular opacity. The greatest advances were made with new IOL designs. The traditional IOL is the monofocal IOL that later incorporates toricity. Multifocal diffractive bifocal and then trifocal IOLs appear giving spectacle independence but dysphotopsia. The Extended Depth of Focus (EDOF) technology allows exploring new optical properties, providing intermediate functional vision with minimal dysphotopsia. Today these characteristics are combined and we have a wide range of IOLs with different functionalities. This review aims to describe the performance of the different materials and designs, especially the most representative ones in our country. It also provides tools to define the most suitable IOL model for each patient and gives suggestions on formulas to calculate the spherocylindrical power in some special situations. Finally, a brief explanation of the future perspectives with the new accommodative IOLs under development.

Primary intraocular lymphoma is a high-grade malignant lymphoid neoplasm, a subtype of central nervous system (CNS) lymphomas. It is mostly a diffuse large B-cell lymphoma. Approximately 19% of cases debut simultaneously with CNS involvement. There are two variants: uveal lymphoma and vitreoretinal lymphoma, with the latter being the most frequent and aggressive. Its diagnosis presents a challenge, as it behaves like uveitis, which delays the diagnostic suspicion. Due to limitations in vitreous cytological study, a series of complementary tests exist to support the diagnosis: immunohistochemistry, flow cytometry, measurement of interleukins IL-6 and IL-10, among others. Several treatment alternatives have been established, but the focus is on intravitreal chemotherapy, which can be combined with systemic chemotherapy or radiotherapy. Despite advances in the diagnostic process, the prognosis remains poor. This review aims to characterize primary ocular lymphoma to enhance our understanding of this condition and enable early diagnostic suspicion.