Acidosis láctica en un paciente usuario de metformina / Metformin-associated lactic acidosis

Metformin is a hypoglycemic agent used as the first line for the treatment of non-insulin dependent Diabetes Mellitus. While it is a generally safe drug, it has an infrequent adverse reaction called lactic acidosis. We report a 49 year-old patient with non-insulin-requiring type 2diabetes who developed an acute kidney failure injury along with severe metabolic acidosis secondary to pneumonia during treatment.

La metformina es un agente hipoglucemiante que se ocupa de primera línea para el tratamiento de la Diabetes Mellitus no insulino dependiente. Si bien es un medicamento bien tolerado, tiene una reacción adversa bastante infrecuente que es la acidosis láctica. Reportamos el caso de una paciente de 49 años insulino no dependiente que desarrolló una injuria renal aguda junto con acidosis metabólica severa secundaria a una neumonía en tratamiento.

Manifestaciones neuropsiquiátricas del lupus eritematoso sistémico: revisión bibliográfica / Neuropsychiatric manifestations of systemic lupus erythematosus: bibliographic review

Neuropsychiatric syndromes in systemic lupus erythematosus (SLE) are one of the many clinical manifestations in which this pathology presents. They have a wide range of prevalence, from 37- 95% due to factors like absence of standardized definitions and non-nespecific clinical manifestations. Physiopathology is mediated by autoimmune mechanisms commonly differentiated in ischemic and inflammatory; there is a clear relationship between the pathologic pathway and the neuropsychiatric manifestation. Moreover, the blood-brain barrier plays a key role, since an alteration of the permeability allows the pass of autoantibodies to the cerebrospinal fluid. There are 19 neuropsychiatric syndromes described which include both diffuse and focal manifestations. The diagnosis must be of exclusion in sights of the more prevalent, severe and potentially deadly etiologies of the neuropsychiatric manifestations, being indispensable to conduct a full study of the patient. The therapyfocuses on symptomatic treatment for each manifestation. Immunotherapy and antithrombotic treatments should be prescripted depending on the underlying pathophysiological mechanism; however, to uncover the predominant pathological route remains a challenge. Future studies should be focused in a better understanding of the physiopathological routes in order to develop standardized diagnosis criteria and optimize an early treatment. This would have a major impact in the life of patients suffering from neuropsychiatric manifestations of SLE, whose late diagnosis is linked with greater organic damage and a poorer quality of life.

Caracterización clínica y epidemiológica de los pacientes con hepatitis alcohólica en el Hospital Regional de Talca: estudio retrospectivo de 5 años (2017-2022) / Clinical and epidemiological characterisation of patients with alcoholic hepatitis in the Regional Hospital of Talca - 5-year retrospective study (2017-2022)

Alcoholic Hepatitis (HA) represent to one of the pathological entities in the context of liver damage associated with excessive and prolonged alcohol consumption. Despite its high mortality, making the early diagnosis is still a challenge for physicians. The local information of this pathology is limited, so this work consists of conducting a retrospective study on the clinical and epidemiological characteristics of patients diagnosed with HA at the Regional Hospital of Talca (HRT); in order to make available to the treating doctors, the greatest amount of data contributing to decision-making for the benefit of patients. Methods: The clinical records of all patients discharged from the HRT with a diagnosis of HA during the period between January 2017 and August 2022 were reviewed. Background information such as: chief complaint, main symptoms, comorbidities, laboratory tests, treatment, evolution and survival, etc., was collected for analysis and to obtain the conclusions presented. Results: A total of 16 patients were studied; 93.75 % were male and 6.24 % female; with a mean age of 52. Of the patients, 87.5 % had a history of DHC. All had alcohol abuse for more than 5 years and 93.75% had active alcoholism. The most frequent laboratory findings included hyperbilirubinaemia (93.75 %), GOT/GPT ratio >2 (50 %) and leukocytosis (56.25 %). Of the total patients studied, 68.75% had a survival of more than 1 year after the event, while 12.5% died during hospitalisation.

Distrofia muscular de Duchenne, una causa infrecuente de miocardiopatía dilatada / Duchenne muscular dystrophy, a rare cause of dilated cardiomyopathy

Neuromuscular diseases represent a rare cause of dilated myocardiopathy, among them Duchenne muscular dystrophy is the most common. Transthoracic echocardiography and cardiac magnetic resonance imaging can assess cardiac involvement early. The case of a patient diagnosed with Duchenne muscular dystrophy who develops cardiac involvement during cardiology follow-up is presented below.

Manifestaciones Gastrointestinales de COVID-19: puesta al día y revisión de literatura / Gastrointestinal Manifestations of COVID-19: update and literature review

The Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a single-stranded RNA virus belonging to the beta coronavirus family, it is the cause of the COVID-19 disease and the pandemic that has revolutionized and challenged the medical research profession and health systems around the world. With the first coronavirus SARS-CoV, the important role of the angiotensin 2-converting enzyme (ACE2) in the pathophysiology of the disease caused by the virus was discovered, a discovery that would lay the foundations on which research on the new coronavirus is based. The virus is capable of producing disease with a wide spectrum of clinical presentation, from asymptomatic patients to patients with severe acute respiratory distress syndrome (ARDS) requiring admission to intensive care units (ICU). The most commonly described symptoms are fever, cough, myalgia, and dyspnea. However, and with advances in the knowledge of SARS-CoV-2 infection, it has been discovered that gastrointestinal (GI) symptoms are frequent and have been associated with severe disease. Viral RNA has been found in feces, urine, blood, and other fluids, which could mean that there are other routes of infection that have not been considered a threat by the medical community until now. In this article, an updated bibliographic review of this topic is presented, with articles selected from the PubMed platform.

Enfermedad relacionada con IgG4: reporte de un caso y revisión de la literatura / IgG4-related disease: a case report and literature review

Immunoglobulin G4 (IgG4-RD) -related disease is a regional or systemic fibroinflammatory disease of unknown etiology. It has a characteristic histopathological appearance of dense lymphoplasmacytic infiltrates with abundant IgG4 positive plasma cells, storiform fibrosis and obliterative phlebitis with the appearance of inflammatory swelling or swollen lesions. This entity frequently affects the pancreas, salivary glands, and lymph nodes, but it can compromise almost any structure in the human anatomy. This new disease entity includes a wide variety of diseases such as Mikulicz disease, autoimmune pancreatitis, Riedel's thyroiditis, interstitial nephritis, and retroperitoneal fibrosis. Glucocorticoid therapy can resolve clinical and pathologic abnormalities and impaired organ function. IgG4-RD was internationally recognized in 2011, and new evidence has accumulated on its pathogenesis, clinical characteristics, and treatment. However, much is still unknown about the behavior of IgG4 in vivo, the participation of this molecule in disease, and whether its role in IgG4-related disease is primary or secondary. The text below is based on a brief review of the most recent literature on this entity in relation to a clinical case.

Plasmaféresis, experiencia del Hospital Regional de Talca en pacientes con indicaciones nefrológicas / Plasmapheresis, experience of the Regional Hospital of Talca, in patients with nephrological indications

INTRODUCTION: Plasmapheresis is an extracorporeal procedure that allows the plasma to be separated from the figurative elements of the blood, removing specific elements involved in pathological processes. OBJECTIVE: To show the experience of the Regional Hospital of Talca (HRT) in the use of Plasmapheresis from 2017 to March 2019. METHODS: Corresponds to a retrospective study of all patients undergoing plasmapheresis from January 2017 to March 2019 (27 months). The clinical profile of this group of patients is analyzed, emphasizing in the nephrological etiologies and showing the clinical evolution of the diseases submitted to this procedure and aspects such as number of sessions, complications and associated therapies. RESULTS: In this period 14 patients have required plasmapheresis in our center, 9 cases for renal causes (64.2%) and 5 for non-renal causes (35.7%). A deceased was recorded during the acute stage of the disease (7.14%), in the context of a negative antineutrophil cytoplasmic antibody (ANCA) in patient with pulmonary-renal syndrome. 78% of those who needed plasmapheresis for renal etiologies are on hemodialysis at the end of the work. The clinical improvement experienced in the majority of the cases studied allows us to attribute a beneficial effect of plasmapheresis.