Recomendaciones de consenso respecto al soporte respiratorio no invasivo en el paciente adulto con insuficiencia respiratoria aguda secundaria a infección por SARS-CoV-2 / Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection

La enfermedad por coronavirus 2019 (COVID-19) es una infección del tracto respiratorio causada por un nuevo coronavirus emergente, que se reconoció por primera vez en Wuhan, China, en diciembre de 2019. Actualmente, la Organización Mundial de la Salud (OMS) ha definido la infección como pandemia y existe una situación de emergencia sanitaria y social para el manejo de esta nueva infección. Mientras que la mayoría de las personas con COVID-19 desarrollan solo una enfermedad leve o no complicada, aproximadamente el 14% desarrolla una enfermedad grave que requiere hospitalización y oxígeno, y el 5% puede requerir ingreso en una Unidad de Cuidados Intensivos (1). En casos severos, COVID-19 puede complicarse por el síndrome de dificultad respiratoria aguda (SDRA), sepsis y shock séptico y fracaso multiorgánico. Este documento de consenso se ha preparado sobre directrices basadas en evidencia desarrolladas por un panel multidisciplinario de profesionales médicos de cuatro sociedades científicas españolas (Sociedad Española de Medicina Intensiva y Unidades Coronarias [SEMICYUC], Sociedad Española de Neumología y Cirugía Torácica [SEPAR], Sociedad Española de Urgencias y Emergencias [SEMES], Sociedad Española de Anestesiología, Reanimación y Terapéutica delDolor [SEDAR]) con experiencia en el manejo clínico de pacientes con COVID-19 y otras infecciones virales, incluido el SARS, así como en sepsis y SDRA. El documento proporciona recomendaciones clínicas para el soporte respiratorio no invasivo (ventilación no invasiva, oxigenoterapia de alto flujo con cánula nasal) en cualquier paciente con presentación sospechada o confirmada de COVID-19 con insuficiencia respiratoria aguda. Esta guía de consenso debe servir como base para una atención optimizada y garantizar la mejor posibilidad de supervivencia, así como permitir una comparación fiable de las futuras intervenciones terapéuticas de investigación que formen parte de futuros estudios observacionales o de ensayos clínicos. Palabras clave: Ventilación mecánica no invasiva, terapia nasal de alto flujo, procedimientos generadores de aerosoles, control de infección. Esta guía de consenso debe servir como base para una atención optimizada y garantizar la mejor posibilidad de supervivencia, así como permitir una comparación fiable de las futuras intervenciones terapéuticas de investigación que formen parte de futuros estudios observacionales o de ensayos clínicos

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus , that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit (1). In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials

Dermatitis atópica del adulto: un desafío diagnóstico y terapéutico / Adult atopic dermatitis: a challenge diagnosis and therapy

Adult atopic dermatitis is a chronically recurring inflammatory dermatosis which presents in various forms. Some of these forms develop mostly in adults such as head and neck dermatitis and chronic hand eczema. Even though the diagnosis is clinical it frequently requires further investigations to exclude differential diagnosis. Once confirmed, it is crucial to classify its severity and exclude other comorbidities. Treatment includes general measures such as the use of emollients and soap substitutes which are applicable in all cases regardless of its severity. Other therapeutic options include topical corticosteroids, topical calcineurin inhibitors, phototherapy and immunosuppressants. Their use will depend on the degree of severity and specific characteristics of each individual. Newer biologics have proven to be a safe and effective alternative, and seem to be a promising option in cases of adult atopic dermatitis refractory to conventional treatments. (AU)

Prevalencia de incontinencia fecal en personas que acuden a policlínicos de un hospital universitario / Frequency of fecal incontinence in ambulatory patients

Abstract Background: Fecal incontinence (FI) affects quality of life and is a cause embarrassment, hampering the collection of data about the problem. It is more common in older people and it is important to know risk the factors and scope of the problem. Aim: Determine the prevalence and risk factors associated to FI in a population of patients consulting in a health center. Material and Methods: A self-applied questionnaire was answered by a randomly selected sample of 1136 ambulatory patients aged 50 ± 15years (59% females), excluding those who consulted in colorectal surgery and gynecology. Demographic variables, obstetric history, history of anorectal surgery, anorectal symptoms, involuntary urine loss, and the FI Wexner or Cleveland Clinic Fecal Incontinence scores were recorded. Results: Thirty one percent of respondents had some degree of FI. In multivariate analysis presence of anorectal pain, urinary incontinence and number of vaginal deliveries were significantly associated with FI. Conclusions: Prevalence of FI in this study is similar, though slightly higher, to data reported in national and international publications.

Resumen Introducción: La incontinencia fecal (IF) es una entidad que afecta la calidad de vida y produce vergüenza, esto hace difícil la obtención de datos fidedignos en cuanto a su prevalencia. Dado el aumento de la población mayor en nuestro país y su relación con la aparición de IF, es importante conocer los factores de riesgo y magnitud del problema, para así realizar prevención además de un diagnóstico y tratamiento precoz. Objetivo: Determinar la prevalencia y los factores asociados a IF en personas que acuden a un centro de salud por otra causa. Material y Método: Se realizó una encuesta auto aplicada en el Hospital Clínico de la Universidad de Chile, entre mayo y junio de 2012. La muestra se seleccionó en forma aleatoria incluyendo pacientes mayores de 20 años que acudieron a diversos policlínicos, excluyéndose los policlínicos de coloproctología y ginecología. Se registraron variables demográficas, antecedentes obstétricos, antecedentes quirúrgico sanorrectales, sintomatología anorrectal, pérdida involuntaria de orina, y la escala de incontinencia fecal de Wexner o CCFIS. Resultados: De un total de 1.136 individuos, 59,2% eran mujeres y la edad promedio fue de 50,53 ± 15,49 años. Un 31,07% presentaba algún grado de IF. En el análisis multivariado la presencia de dolor e incontinencia de orina, así como el número de partos presentaron una asociación significativa con la IF. Conclusión: Las cifras de prevalencia de IF en este estudio son algo mayores con respecto a datos nacionales e internacionales.

Actualización del síndrome de ovario poliquístico y su importancia en dermatología / Update of polycystic ovary syndrome and its importance in dermatology

El Síndrome de Ovario Poliquístico es un trastorno endocrino común que afecta a mujeres en edad reproductiva que puede causar problemas metabólicos y deterioro psicosocial importante. Las manifestaciones dermatológicas más frecuentes del hiperandrogenismo incluyen acné, hirsutismo y alopecia, cuyo reconocimiento es esencial para hacer un diagnóstico precoz. Las modalidades de tratamiento incluyen terapia hormonal con el objetivo de modular la producción de andrógenos y su acción, así como tratamientos no hormonales dirigidos a condiciones dermatológicas específicas.

Polycystic ovarian syndrome is a common endocrine disorder that affects women of reproductive age, which can cause metabolic, reproductive and psychosocial impairment. The most common skin manifestations of hyperandrogenism are acne, hirsutism and alopecia, whose recognition is essential for early diagnosis. There are several treatment modalities, including hormonal therapy in order to modulate androgen production and their effects, as well as other non hormonal treatments targeted to specific dermatologic conditions.

Actualización: uso de isotretinoína oral en rosácea / Update: use of oral isotretinoin in rosacea

La rosácea es una dermatosis facial inflamatoria crónica caracterizada por periodos intermitentes de exacerbación y remisión. La etiología es desconocida y factores genéticos y ambientales están involucrados en su desarrollo. El tratamiento tópico y sistémico controla la rosácea en forma parcial. La Isotretinoína oral es útil por sus propiedades antiinflamatorias,inmunomoduladoras y de reducción del flujo sanguíneo.

Rosacea is a chronic facial inflammatory dermatoses characterized by intermittent periods of clinical exacerbation and remission. The etiology is unkown. Genetic and external factors are involved in the pathogenesis. Topical and oral treatments partially control the disease. Oral Isotretinoin can be useful because of the antiinflammatory, inmumodulating actions and because it reduce the blood flow.

[Evolution of functional capacity of older people during hospital stay]. / Evolución de la capacidad funcional en adultos mayores hospitalizados en la unidad geriátrica de agudos del Hospital Clínico de la Universidad de Chile.

BACKGROUND: Up to 70% of hospitalized older people experience a deterioration of their functional capacity during the course of hospital stay. This change has a dismal effect of quality of life and prognosis. AIM: To assess the change in functional status of older people during the course of hospitalization in a geriatric unit. MATERIAL AND METHODS: Review of medical records of 83 patients with a mean age of 79 years (70% women), hospitalized in an acute geriatric unit of a clinical hospital, between 2007 and 2009. Functional capacity was assessed using Barthel and Lawthon scales in a basal period, on admission and on discharge. RESULTS: Mean hospital stay was nine days. Median scores of Barthel scale on the basal period, on admission and on discharge were 90, 50 and 80, respectively. The figures for Lawthon scale were 4,2 and 3 respectively. Seventy eight percent of patients lost functional capacity during hospital stay and 72% recovered their functional status on discharge. CONCLUSIONS: A great proportion of older people experience a loss of functional capacity during hospitalization. This deterioration can be reverted with an adequate geriatric management.

Evolución de la capacidad funcional en adultos mayores hospitalizados en la unidad geriátrica de agudos del Hospital Clínico de la Universidad de Chile / Evolution of functional capacity of older people during hospital stay

Background: Up to 70% of hospitalized older people experience a deterioration of their functional capacity during the course of hospital stay. This change has a dismal effect of quality oflife and prognosis. Aim: To assess the change in functional status of older people during the course of hospitalization in a geriatric unit. Material and Methods: Review of medical records of83 patients with a mean age of79years (70% women), hospitalized in an acute geriatric unit of a clinical hospital, between 2007 and 2009. Functional capacity was assessed using Barthel and Lawthon scales in a basal period, on admission and on discharge. Results: Mean hospital stay was nine days. Median scores of Barthel scale on the basal period, on admission and on discharge were 90, 50 and 80, respectively. The figures for Lawthon scale were 4,2 and 3 respectively. Seventy eight percent of patients lost functional capacity during hospital stay and 72% recovered their functional status on discharge. Conclusions: A great proportion of older people experience a loss of functional capacity during hospitalization. This deterioration can be reverted with an adequate geriatric management.

Cirugía menor en un centro de salud familiar y concordancia clínico patológica / Minor surgery in a family health center and clinicopathological concordance

INTRODUCCIÓN: Los servicios de Atención Primaria de Salud(APS) realizan Cirugía Menor(CM), evidenciándose beneficios como optimización de recursos y promoción de la actividad preventiva, diagnóstica y terapéutica. OBJETIVO: Describir la actividad de CM en un centro de APS y analizar la concordancia clínica-patológica de las lesiones...

INTRODUCTION: Primary Health Care (PHM) services perform minor surgery (MS), displaying benefits such as resource optimization and the promotion of preventive, diagnostic and therapeutic activities. OBJECTIVE: Describe the MS activity from a PHM center and analyse the clinicopathological concordance of the lesions…