Rivaroxaban para el tratamiento de la trombocitopenia inducida por heparina: caso clínico / Treatment of heparin-induced thrombocytopenia with rivaroxaban: case report

Heparin-induced thrombocytopenia (HIT) is immune-mediated. It occurs more frequently with unfractionated heparin (UFH) than with low molecular weight heparins (LMWH). It is associated with thromboembolic rather than hemorrhagic events, as opposed to thrombocytopenia of other etiologies. The key in therapy is the cessation of heparin and the start of another anticoagulant. We report a 58 years old female with HIT secondary to the use of Enoxaparin who was successfully managed with Rivaroxaban. Our goal is to report a novel therapy and provide the evidence that supports its use.

[Treatment of heparin-induced thrombocytopenia with rivaroxaban. Case report]. / Rivaroxaban para el tratamiento de la trombocitopenia inducida por heparina. Caso clínico.

Heparin-induced thrombocytopenia (HIT) is immune-mediated. It occurs more frequently with unfractionated heparin (UFH) than with low molecular weight heparins (LMWH). It is associated with thromboembolic rather than hemorrhagic events, as opposed to thrombocytopenia of other etiologies. The key in therapy is the cessation of heparin and the start of another anticoagulant. We report a 58 years old female with HIT secondary to the use of Enoxaparin who was successfully managed with Rivaroxaban. Our goal is to report a novel therapy and provide the evidence that supports its use.

Latrodectismo. Caso clínico y revisión de la literatura / Latrodectism Case report and review of literature

El latrodectismo es un cuadro clínico causado por la mordedura de una araña del género Latrodectus spp., ampliamente distribuido en todo Chile continental. Generalmente las mordeduras se asocian a faenas agrícolas. El veneno del género Latrodectus contiene α-latrotoxina, una neurotoxina que actúa a nivel presináptico del sistema nervioso autónomo aumentando la liberación de acetilcolina. El cuadro clínico es inespecífico y hasta en un tercio de los casos ocurren síntomas sistémicos. El diagnóstico es clínico y depende del antecedente de la mordedura por una araña con un cuadro clínico compatible. El pronóstico es favorable: se reporta una letalidad entre 0 y 6 por ciento. El manejo es esencialmente sintomático, principalmente analgésico. Presentamos el caso de un hombre de 62 años, proveniente de Santa Cruz, VI región, trabajador en una plantación de trigo. Consultapor dolor torácico asociado a mialgias generalizadas y diaforesis. Por sospecha de latrodectismo, se administra neostigmina con buena respuesta clínica.(AU)

Latrodectism is a clinical entity caused by the bite of a spider of the genus Latrodectus spp. widely distributed throughout continental Chile. Generally, bites are associated with agricultural activities. The venom of spiders of the genus Latrodectus contains α-latrotoxin, a neurotoxin that acts at the presynaptic level of the autonomic nervous system, this way increases the release of acetylcholine. The clinical manifestations are non-specific and systemic symptoms occur in up to one-third of the cases. The diagnosis is clinical and depends on the history of being bitten by a spider with a compatible clinical presentation. The prognosis is favorable: a lethality between 0 and 6 percent has been reported. The clinical management is essentially symptomatic, mainly analgesic. We present the case of a 62-year-old man from Santa Cruz, VI region, working in a wheat farm. He attends the emergency service with chest pain associated with generalized myalgias and diaphoresis. On suspicion of latrodectism, neostigmine is administered with goodclinical response. (AU)

[Coverage of the gallbladder cancer prevention strategy in Chile: results from the 2009-2010 National Health Survey]. / Cobertura de la estrategia preventiva de cáncer de vesícula biliar en Chile: Resultados de la Encuesta Nacional de Salud 2009-2010.

BACKGROUND: In Chile, gallbladder cancer (GBC) is one of the most important causes of death and gallstone disease (GSD) is its main risk factor. Abdominal ultrasonography (AU) is used for the diagnosis of GSD and cholecystectomy is used to prevent it. AIM: To estimate GSD prevalence in the general population and to assess the diagnostic and therapeutic coverage of GSD as a preventive strategy for GBC in Chile. MATERIAL AND METHODS: A standardized digestive symptoms questionnaire of the 2009-2010 Chilean National Health Survey was answered by 5412 adults over 15 years old. Self-reports of AU, GBD and cholecystectomies were recorded. RESULTS: The prevalence of biliary-type pain was 7.1%. During the last five years, the prevalence of AU was 16%. GSD was reported in 20% of these tests and 84% of them were asymptomatic. The prevalence of AU was significantly lower in Araucanía region and among people with less than 12 years of education. Life cholecystectomy prevalence was 11% and reached 40% in people aged over 60 years. Women accounted for 75% of total cholecystectomies. Twenty-one percent of individuals who referred biliary-type pain, were studied with an AU. Only 60% of people with GSD confirmed by AU underwent a cholecystectomy. CONCLUSIONS: GSD affects at least 27% of the Chilean adult population. Important deficits and inequities in GSD diagnostic and therapeutic coverage were identified.

Cobertura de la estrategia preventiva de cáncer de vesícula biliar en Chile: Resultados de la Encuesta Nacional de Salud 2009-2010 / Coverage of the gallbladder cancer prevention strategy in Chile: results from the 2009-2010 National Health Survey

Background: In Chile, gallbladder cancer (GBC) is one of the most important causes of death and gallstone disease (GSD) is its main risk factor. Abdominal ultrasonography (AU) is used for the diagnosis of GSD and cholecystectomy is used to prevent it. Aim: To estimate GSD prevalence in the general population and to assess the diagnostic and therapeutic coverage of GSD as a preventive strategy for GBC in Chile. Material and Methods: A standardized digestive symptoms questionnaire of the 2009-2010 Chilean National Health Survey was answered by 5412 adults over 15 years old. Self-reports of AU, GBD and cholecystectomies were recorded. Results: The prevalence of biliary-type pain was 7.1%. During the last five years, the prevalence of AU was 16%. GSD was reported in 20% of these tests and 84% of them were asymptomatic. The prevalence of AU was significantly lower in Araucanía region and among people with less than 12 years of education. Life cholecystectomy prevalence was 11% and reached 40% in people aged over 60 years. Women accounted for 75% of total cholecystectomies. Twenty-one percent of individuals who referred biliary-type pain, were studied with an AU. Only 60% of people with GSD confirmed by AU underwent a cholecystectomy. Conclusions: GSD affects at least 27% of the Chilean adult population. Important deficits and inequities in GSD diagnostic and therapeutic coverage were identified.

Aceptación y adherencia de una pauta de preparación de colon el mismo díadel examen en población chilena / Patients’ acceptance and adherence to total or partial split dose bowel preparation for colonoscopy in chilean population

Colon preparation is more effective if it is partially or totally administered the same day of the colonoscopy. Objective: To know acceptance of a preparation guideline for the same day of the procedure and adherence to this guideline once it is implemented in a digestive endoscopy center. Methods: First, the importance of a preparation guideline for the same day was explained and adult patients and accompanying persons with preparation in the previous day were asked if they would be willing to prepare for the colonoscopy 4-5 h before the procedure. In the second stage, adult patients were surveyed who received instructions to prepare using polyethylene glycol solution (3 litres) the same day of the procedure. Results: 160 people were surveyed in phase one. 86 percent was willing to get up at 4 am to drink the solution, without statistical correlation with the other variables studied. 42.7 percent would prefer to split the doses and 39 percent would drink all the same day. 102 people were surveyed in phase two. 92 percent drank the preparation totally or partially the same day of the procedure (69 percent and 25 percent, respectively). 82 percent drank at least 80 percent of the dose. 51.5 percent described the preparation process as quite or very unpleasant. 45 percent would prefer colonoscopy preparation in the previous day. Conclusions: In our experience, most patients would accept preparation in the same day of the procedure and adhere to this, however, almost 50 percent would prefer to take it the previous day, in a future procedure.

La preparación de colon es más efectiva si es administrada parcial o totalmente el mismo día de la colonoscopia. Objetivo: Conocer la aceptación a una pauta de preparación al menos en parte el mismo día de la colonoscopia y adherencia a esta una vez implementada en un Centro de Endoscopia Digestiva. Métodos: Primero se explicó la importancia de una pauta de preparación el mismo día y se encuestó a pacientes adultos y acompañantes a estudio endoscópico con preparación exclusiva el día anterior si estarían dispuestos a realizar preparación para colonoscopia 4-5 h antes de la prueba. En la segunda fase se encuestó a pacientes adultos a los que se había indicado preparación con solución de polietilenglicol (3 litros) el mismo día del procedimiento. Resultados: En la fase 1 se encuestó a 160 personas. El 86 por ciento aceptaría levantarse a las 4 AM para tomar la preparación, sin relación estadística con las demás variables estudiadas. El 42,7 porciento preferirían tomar la dosis en forma repartida y 39 por ciento preferían beber todo el mismo día. En la fase 2 se encuestó a 102 personas. El 92 porciento tomó la preparación total o parcialmente el mismo día del examen (69 por ciento y 25 por ciento respectivamente). El 82 porciento tomó al menos 80 por ciento de la cantidad indicada. El 51,5 porciento calificó el proceso de la preparación como bastante o muy desagradable. El 45porciento preferiría en colonoscopias futuras la preparación el día anterior. Conclusiones: En nuestro medio, la mayoría de los pacientes aceptarían la pauta de preparación el mismo día de la prueba y adhieren a esta, aunque casi la mitad preferiría tomarla el día anterior en el futuro.