Bupropión: una alternativa farmacológica en cesación tabáquica / Bupropion: a pharmacological alternative in smoking cessation

Resumen Hay muchas razones para el uso de antidepresivos en cesación tabáquica: 1) la falta de nicotina puede producir síntomas depresivos o precipitar un episodio depresivo grave; 2) la nicotina puede tener efectos antidepresivos que mantienen la adicción; 3) algunos antidepresivos tienen una acción en vías neuronales o receptores implicados en la adicción a la nicotina; y 4) algunos pacientes no desean usar otras terapias o han fracasado con ellas. Bupropión es terapia de primera línea para la cesación del tabaco, con efectividad a largo plazo, los efectos adversos graves son escasos. La evidencia sugiere que bupropión es de eficacia similar a la terapia de reemplazo de nicotina (TRN) y menos eficaz que vareniclina, pero se necesita más estudios para confirmar esto. Bupropión es seguro en pacientes psiquiátricos compensados en un periodo de tres meses o más.

There are many reasons for the use of antidepressants in smoking cessation: 1) lack of nicotine can produce depressive symptoms or precipitate a severe depressive episode; 2) nicotine may have antidepressant effects that maintain addiction; 3) some antidepressants have an action on neural pathways or receptors involved in nicotine addiction; and 4) some patients do not want to use other therapies or they have failed with them. Bupropion is first-line therapy for smoking cessation, with long-term effectiveness, serious side effects are rare. The evidence suggests bupropion is similar in effectiveness to nicotine replacement therapy (NRT), and less effective than varenicline, but more studies are needed to confirm this. Bupropion is safe in psychiatric patients compensated over a period of three months or more.

Neumonías necrosantes graves con empiema asociado / Severe necrotizing pneumonias with secondary empyemas

Introducción: Las neumonías necrosantes (NN) con empiema son una enfermedad grave y un desafío multidisciplinario. El objetivo de este estudio es realizar una caracterización epidemiológica y, en forma secundaria, analizar su tratamiento y evolución. Presentación de casos: Se realizó un estudio retrospectivo de una serie de casos consecutivos con NN con empiema que se presentaron en el Hospital Padre Hurtado. Siete (77,8%) eran de sexo masculino. La mediana de edad fue de 53 (rango 21-73) años. El 44% presentaban comorbilidades (diabetes, HTA o enfermedades neurológicas). El 44% presentaban abuso de drogas y 3 estaban en un estado de desnutrición severa. Manejo y evolución: La mediana de tiempo de hospitalización fue de 41 (rango 16-129) días. En 4 pacientes el germen aislado fue un Enterococcus faecalis. Complicaciones torácicas ocurrieron en el 33,3% de los pacientes. Un paciente requirió una lobectomía, un paciente una fenestración y otro paciente falleció. Discusión: Las NN con empiemas son raras. Sin embargo, frente a la asociación de diabetes, desnutrición y abuso de drogas continuaremos viendo estos casos de difícil manejo con elevada morbimortalidad.

Introduction: Necrotizing pneumonia complicated with empyema is a life-threatening condition that challenges multidisciplinary teams. The aim of this study is to perform an epidemiological characterization of these patients, and secondly, analyse their treatment and outcomes. Case presentation: A retrospective analysis of a series of consecutive patients experiencing necrotizing pneumonia with empyema who presented at Hospital Padre Hurtado. Seven (77.8%) were male. The median age was 53 (range 21-73) years. 44% presented with comorbidities (diabetes, high blood pressure, and neurological diseases). 44% presented drug abuse consumption and three (33.3%) were in a state of severe malnutrition. Management and outcome: The median time of hospitalization was 41 (range 16-129) days. Thoracotomies were performed in eight (83.2%) of the patients. In four patients, the isolated bacteria's were Enterococcus faecalis. Thoracic complications occurred in three (33.3%) patients. One patient required a lobectomy, one patient a fenestration and one (11.1%) patient died. Discussion: Necrotizing pneumonias complicated with empyema are rare, however, if there is an association with drug abuse, diabetes and malnutrition, we will continue to see such challenging cases with high morbidity and mortality.

Consenso elaborado por la Sociedad Chilena de Endocrinología y Diabetes sobre resistencia a la insulina(RI) y síndrome metabólico (SM): aspectos clínicos y terapéuticos / Chilean society of endocrinology and diabetes consensus on clinical and therapeutic aspects of insulin resistance and metabolic syndrome

Background: The concept insulin resistance as the basis for a series of metabolic alterations and diseases was introduced by Gerald Reaven in 1988, when he described a cluster of alterations that named syndrome X. Aim: To review and discuss the present information about insulin resistance (IR) and metabolic syndrome (MS). Material and methods: The IR concept is defined,the affected metabolic ways, its consequences and relationship with different diseases are presented. The importance of central obesity with its metabolic, inflammatory and prothrombotic consequences playing a key role in cardiovascular risk, is discussed. The cluster of factors focused on cardiovascular disease and eventually diabetes is named MS. Several definitions of MS are analyzed and compared. A proposition is made about the definition to be used in the Chilean population. Differences between IR syndrome and MS are discussed. Diagnostic methods of IR and MS are presented, recommendations are made about their usefulness and reliability. Non pharmacological and pharmacological treatments of IR and MS are analyzed. Other related diseases, such as polycystic ovary syndrome, non alcoholic steatohepatitis and sleep apnea are discussed. Conclusions. Until further studies are made to define a local waist circumference cut-off associated with high risk, the ATPIII MS definition is preferred. A clinical approach is recommended for diagnosis. A search for all components of the MS is important. There is no evidence about the benefits of MS treatment on the prevention of cardiovascular diseases or diabetes. Evidence supports the use of lifestyle changes and some drugs, such as metformin on the prevention of diabetes in prediabetic states.

Neumonía adquirida en la comunidad: comunicación de 8 casos de neumonía grave por legionella pneumophila serogrupo 1 en Chile / Community acquired pneumonia: report of 8 cases of severe pneumonia caused by legionella pneumophila seroproup 1 in Chile

Legionella pneumophila is the second cause of severe community acquired pneumonia. In Chile, however, there are few reports of pneumonia caused by Legionella. We report eight patients (6 men, aged 42 to 72 years old) with community-acquired pneumonia caused by Legionella pneumophila serogroup 1, confirmed by the measurement of urinary antigen. Clinical presentation was characterized by fever or hypothermia (in one case), cough, dyspnea and neurological abnormalities in four patients. Cigarette smoking was the most frequently identified risk factor. All patients had at least one American Thoracic Society severity criteria. Complications observed were acute hypoxemic respiratory failure in seven patients, shock in four, renal failure in four and need for mechanical ventilation in three. No patient died