Experiencia y factores perioperatorios que afectan a los resultados en isquemia mesentérica aguda. Resultados de un hospital terciario chileno / Experience and perioperative factors affecting results in acute mesenteric ischemia. Results of a Chilean tertiary hospital

Introducción y objetivo: la isquemia mesentérica es poco frecuente, pero tiene una alta mortalidad. Existen pocos reportes de esta patología en países subdesarrollados. Este estudio pretende describir los resultados de un centro universitario terciario chileno y los factores que afectan a su morbimortalidad. Material y métodos: análisis retrospectivo de los pacientes intervenidos de urgencia por isquemia mesentérica aguda entre 2016 y 2021 en el Hospital Clínico Universidad de Chile. Se excluyeron los pacientes manejados sin cirugía. Se analizaron factores perioperatorios, detalles operatorios, la mortalidad a 30 días y la estancia hospitalaria, entre otros. Resultados: se incluyeron 32 pacientes. La mediana de edad fue de 73,5 años (45-92). Las comorbilidades más frecuentes fueron hipertensión (62,5 %), diabetes mellitus (28,1 %) y enfermedad cardiovascular conocida: infarto agudo de miocardio, angina crónica, accidente cerebrovascular, isquemia aguda de extremidades y enfermedad arterial oclusiva periférica (34,4 %). El 40,6 % tenía causa arterial trombótica; el 18,8 %, arterial embólica; el 25 %, venosa, y el 15,6 %, no oclusiva (NOMI). El motivo de consulta más frecuente fue el dolor abdominal (84,4 %). En la primera intervención, el 81,3 % requirió resección intestinal. Se realizó una anastomosis en el 53,1 %. El 25 % de los pacientes fueron revascularizados, con un cirujano vascular en el equipo quirúrgico, en el 65,6 %. La mediana de estancia hospitalaria fue de 21 días (2-129). La mediana de tiempo a la cirugía fue de 10,75 horas (4,75-196)... (AU)

Introduction and objective: acute mesenteric ischemia has a low incidence but high mortality. The results of this disease are not well reported in developing countries. This study aims to describe the results of a Chilean tertiary university center and the factors that affect its morbidity and mortality. Material and methods: retrospective analysis of all patients undergoing emergency surgery for acute mesenteric ischemia between 2016 and 2021 at the hospital clínico universidad de chile. Patients managed without surgery were excluded. Demographic characteristics, perioperative factors, details of the first surgery, 30-day mortality, and hospital stay, among others, were analyzed. Results: 32 patients were included. The median age was 73.5 years (45-92). The most frequent comorbidities were arterial hypertension (62.5 %), diabetes mellitus (28.1 %) and known cardiovascular disease 34.4 % (acute myocardial infarction, chronic angina, cerebrovascular accident, acute limb ischemia, peripheral arterial occlusive disease). 40.6 % had a thrombotic arterial cause, 18.8 % embolic arterial, 25 % thrombotic venous and 15.6 % non-occlusive (NOMI). The most frequent reason for consultation was abdominal pain (84.4 %). In the first surgical intervention, 81.3 % required intestinal resection, with an anastomosis performed in 53.1 %. 25% were revascularized, with a vascular surgeon on the surgical team in 65.6 %. The median hospital stay was 21 (2-129) days. The median time from the emergency department to surgery was 10.75 hours (4.75-196). Mortality at 30 days was 40.6 %, with no differences between etiologies...(AU)

Estrategias para fomentar la higiene de manos en la atención ambulatoria / Interventions aimed to improve clinical handwashing in an outpatient setting

Introducción: se realizó un análisis de la evidencia disponible sobre intervenciones orientadas a mejorar la adherencia al lavado de manos, para generar recomendaciones para los centros de atención en salud ambulatoria.Materiales y métodos: se realizó una búsqueda en Pubmed, Embase y Epistemonikos, y en las referencias de guías sobre el tema, seleccionando aquellos estudios no observacionales en que se realizaran intervenciones para aumentar la adherencia al lavado de manos en atención en salud. Se clasificaron las estrategias descritas según tipo de intervención, y se evaluaron según su efectividad en mejorar la adherencia al lavado de manos y el seguimiento en el tiempo.Resultados: se seleccionaron 34 estudios experimentales prospectivos, que se clasificaron en 10 grupos según el tipo de intervención realizada, y se evaluaron según efectividad y seguimiento en una escala del I al VII. 24 de 34 estudios mostraron un aumento estadísticamente significativo de la adherencia al lavado de manos mayor al 15% desde el basal o en comparación al grupo control, correspondiendo en su mayoría a estrategias multimodales y de feedback. Discusión: las intervenciones más efectivas para mejorar la adherencia al lavado de manos fueron las que incluían abordajes multimodales y las que incluían feedback. Se hace urgente generar mayor evidencia sobre esta temática en el contexto de atención ambulatoria.

Introduction: To analyze the available evidence on interventions aimed at improving adherence to handwashing, to generate re-commendations for outpatient health care centers. Methods: A search was made in Pubmed, Embase and Epistemonikos, and in the references of guides on the subject, selecting those non-observational studies in which interventions were carried out to increase adherence to handwashing in health care. The strategies described were classified according to the type of intervention, and evaluated according to their effectiveness in improving adherence to handwashing, and its follow-up time afterward. Results: 34 prospective experimental studies were selected, which were classified into 10 groups according to the type of intervention performed, and were evaluated according to effectiveness and follow-up on a scale from I to VII. 24 of 34 studies showed a statistically significant increase in handwashing adherence greater than 15% from baseline or compared to the control group, corresponding mostly to multimodal and feedback strategies. Discussion: The most effective interventions to improve adherence to handwashing were those that included multimodal approaches and the ones that included feedback. It is urgent to generate more evidence on the subject in the context of ambulatory care.

Patterns of use and toxicity of new para-halogenated substituted cathinones: 4-CMC (clephedrone), 4-CEC (4-chloroethcatinone) and 4-BMC (brephedrone).

OBJECTIVE: This paper aims to present results of the analysis of clephedrone (4-CMC), 4-chloroethcathinone (4-CEC), and brephedrone (4-BMC) on recreational drug markets and a systematic review of all the available information concerning these substances. MATERIAL AND METHODS: Samples collected by the drug checking service of the Spanish harm reduction NGO-Energy Control were analyzed and systematic research was conducted. Between June 2014 and October 2016, 1,471 samples with at least one NPS were analyzed, 397 of which contained cathinones. RESULTS: Clephedrone was found in 29 samples, brephedrone in 8, and both were present in 2 samples. 4-Chloroethcathinone was detected in 5 samples. Eleven out of the 47 purchased samples (23.4%) were tested to contain the substance the user expected. Samples received were mainly sold as 3-MMC, MDMA, ketamine, and other cathinones. No literature on the effects or toxicity of these substances was found; the only information available was on internet fora. On many posts, users exhibit concerns about potential toxicity and side effects of using these substances. CONCLUSION: Since the emergence of these substances could prove to be the next step to the cat-and-mouse game existing between drug producers and legislation, further clinical and epidemiological research should be carried out in order to build evidence to support policy for public health issues.

Biogeography in Cellana (Patellogastropoda, Nacellidae) with Special Emphasis on the Relationships of Southern Hemisphere Oceanic Island Species.

Oceanic islands lacking connections to other land are extremely isolated from sources of potential colonists and have acquired their biota mainly through dispersal from geographically distant areas. Hence, isolated island biota constitutes interesting models to infer biogeographical mechanisms of dispersal, colonization, differentiation, and speciation. Limpets of the genus Cellana (Nacellidae: Patellogastropoda) show limited dispersal capacity but are broadly distributed across the Indo-Pacific including many endemic species in isolated oceanic islands. Here, we examined main distributional patterns and geographic boundaries among Cellana lineages with special emphasis in the relationships of Southern Hemisphere oceanic islands species. Phylogenetic reconstructions based on mtDNA (COI) recognized three main clades in Cellana including taxa from different provinces of the Indo-Pacific. Clear genetic discontinuities characterize the biogeography of Cellana and several lineages are associated to particular areas of the Indo-Pacific supporting the low dispersal capacity of the genus across recognized biogeographical barriers in the region. However, evolutionary relationships within Cellana suggest that long-distance dispersal processes have been common in the history of the genus and probably associated to the origin of the species in Hawaii and Juan Fernández Archipelago. Therefore, the presence of Cellana species in geographically distant Southern Hemisphere oceanic islands, such as the Juan Fernández Archipelago, suggests that long-distance dispersal mediated by rafting may have played an important role in the biogeography of the genus.

The hidden web and the fentanyl problem: Detection of ocfentanil as an adulterant in heroin.

BACKGROUND: The popularization of anonymous markets such as Silk Road is challenging current drug policy and may provide a new context for old issues, such as adulteration of heroin with fentanyl derivatives. The aims of this paper are to report the presence of ocfentanil, a novel, potent, non-controlled fentanyl analog, in samples sold as heroin in the hidden web, and to summarize the effects reported by users. METHODS: In 2015, four samples allegedly bought as heroin in cryptomarkets of the hidden web were sent to Energy Control for analysis. Energy Control is a Spanish harm reduction NGO that offers anonymous drug checking with the purpose of adapting counselling to the specific substances present in the drug and monitor the drug market. Identification was performed by GC/MS and LC/MS/MS. We contacted the submitters of the samples and performed an Internet search to retrieve additional information. RESULTS: One sample contained ocfentanil, caffeine and heroin. Three samples contained the aforementioned substances plus paracetamol. Two out of the four contacted users reported distinct short acting, opioid-like effects. No fora discussion could be found about the effects of ocfentanil, neither web pages nor individuals advertising the substance. CONCLUSION: We report the presence of a new substance detected in the hidden web as an adulterant of heroin, ocfentanil. It has short acting opioid-like effects, roughly the same potency as fentanyl, and can be injected, snorted or smoked. Severe side effects have been associated with its use, including one death. No discussion about this substance could be found in the Internet, which suggests this substance has not been sold as such. Available data about purities of drugs purchased in cryptomarkets suggest that adulteration is not a severe problem and this agrees with users' perceptions. However, this study suggests that adulteration is a real threat not only at the street level, but also for users that buy substances in cryptomarkets, and suggest the need for harm reduction initiatives in this setting.

Marine Biodiversity in Juan Fernández and Desventuradas Islands, Chile: Global Endemism Hotspots.

The Juan Fernández and Desventuradas islands are among the few oceanic islands belonging to Chile. They possess a unique mix of tropical, subtropical, and temperate marine species, and although close to continental South America, elements of the biota have greater affinities with the central and south Pacific owing to the Humboldt Current, which creates a strong biogeographic barrier between these islands and the continent. The Juan Fernández Archipelago has ~700 people, with the major industry being the fishery for the endemic lobster, Jasus frontalis. The Desventuradas Islands are uninhabited except for a small Chilean military garrison on San Félix Island. We compared the marine biodiversity of these islands across multiple taxonomic groups. At San Ambrosio Island (SA), in Desventuradas, the laminarian kelp (Eisenia cokeri), which is limited to Desventuradas in Chile, accounted for >50% of the benthic cover at wave exposed areas, while more sheltered sites were dominated by sea urchin barrens. The benthos at Robinson Crusoe Island (RC), in the Juan Fernández Archipelago, comprised a diverse mix of macroalgae and invertebrates, a number of which are endemic to the region. The biomass of commercially targeted fishes was >2 times higher in remote sites around RC compared to sheltered locations closest to port, and overall biomass was 35% higher around SA compared to RC, likely reflecting fishing effects around RC. The number of endemic fish species was extremely high at both islands, with 87.5% of the species surveyed at RC and 72% at SA consisting of regional endemics. Remarkably, endemics accounted for 99% of the numerical abundance of fishes surveyed at RC and 96% at SA, which is the highest assemblage-level endemism known for any individual marine ecosystem on earth. Our results highlight the uniqueness and global significance of these biodiversity hotspots exposed to very different fishing pressures.

Osteonecrosis disbárica de cabeza humeral en buzo pesquero tratado con artroplastia de superficie / Dysbaric osteonecrosis of humeral head in a diver treated with resurfacing arthroplasty

Describir osteonecrosis disbárica (ODB) en buzo pesquero y exponer la experiencia inédita de tratamiento con artroplastia de superficie (AS). Introducción ODB, forma de necrosis avascular secundaria a enfermedad por descompresión (EDC), cuyo tratamiento gold standard para estadios avanzados continúa siendo la artroplastia total (AT). Presentación de caso: Paciente de 49 años, buzo pesquero, antecedentes de EDC tratada el 2008 en cámara hiperbárica, con diagnóstico compatible con ODB de cabeza humeral derecha de 6 años de evolución; Constant score=29. Se realiza AS del hombro derecho, y luego de 18 meses de seguimiento se reporta una adecuada evolución clínica con remisión de la sintomatología; Constant score a 18 meses=72. Discusión: El uso de AT en el paciente joven es limitado, por lo que surge la necesidad de implementar nuevas técnicas quirúrgicas en este grupo de pacientes. Conclusión: La AS constituye una alternativa terapéutica en adultos jóvenes y activos con ODB...

Introduce and describe Dysbaric Osteonecrosis (DON) in a fishing diver patient, emphasising clinical features, use of imaging methods, and present a new experience of treatment with Resurfacing Arthroplasty (RA). Introduction: DON, a form of avascular necrosis secondary to Decompression Sickness (DCS). Total Arthroplasty (AT) remains the reference treatment for advanced stages. Case report: Male, 49 years old, fishing diver, with a history of DCS treated in a hyperbaric chamber (2008). Right humeral head DON Compatible with 6 years of onset. Constant Score=29. RA performed on right shoulder. Clinical remission of symptoms was observed after 18 months of follow-up. Constant Score at 18 months=72. Discussion: TA use in young patients is limited, so there is a need to implement new surgical techniques in this group of patients. Conclusion: RA is a therapeutic alternative in young and active subjects with DON...

Plastic debris in the open ocean.

There is a rising concern regarding the accumulation of floating plastic debris in the open ocean. However, the magnitude and the fate of this pollution are still open questions. Using data from the Malaspina 2010 circumnavigation, regional surveys, and previously published reports, we show a worldwide distribution of plastic on the surface of the open ocean, mostly accumulating in the convergence zones of each of the five subtropical gyres with comparable density. However, the global load of plastic on the open ocean surface was estimated to be on the order of tens of thousands of tons, far less than expected. Our observations of the size distribution of floating plastic debris point at important size-selective sinks removing millimeter-sized fragments of floating plastic on a large scale. This sink may involve a combination of fast nano-fragmentation of the microplastic into particles of microns or smaller, their transference to the ocean interior by food webs and ballasting processes, and processes yet to be discovered. Resolving the fate of the missing plastic debris is of fundamental importance to determine the nature and significance of the impacts of plastic pollution in the ocean.

Do subtoxic levels of chlorate influence the desiccation tolerance of Egeria densa?

Among the different factors hypothesized to be responsible for the virtual disappearance of Egeria densa, once a dominant aquatic macrophyte in a southern Chile wetland ecosystem, are the negative effects of certain chemical compounds (mainly chlorate) and harsh environmental conditions (desiccation caused by prolonged atmospheric exposure). The authors performed an integrated experiment in which E. densa plants were first exposed for four weeks inside a mesocosm system to levels of chlorate that existed in the wetland at the time of the plant's demise and then exposed to desiccation conditions that also resembled those that the system had experienced. Hence, the authors tested the hypothesis that E. densa plants exposed to sublethal levels of chlorate are more susceptible to the deleterious effect of desiccation compared with plants that had not been exposed to chlorate. This hypothesis was tested by means of quantifying physiologically related parameters in plants right after the four weeks under water and then after the desiccation period of 6 h. Their results rejected this hypothesis, because all plants, regardless of their history, are equally affected by desiccation.

Effect of prolonged exposition to pulp mill effluents on the invasive aquatic plant Egeria densa and other primary producers: a mesocosm approach.

The recent disappearance of the aquatic plant Egeria densa, a Brazilian native invasive species, from a wetland in southern Chile prompted several efforts to unveil the origin of this phenomenon. Because these changes occurred by the time a newly built pulp mill started its operations in the area, a reasonable doubt for a cause-effect relationship is plausible. We implemented a mesocosm approach to directly evaluate the effect of treated pulp mill effluents (PMEs) on several growth-related parameters of E. densa as well as other primary producers. We hypothesize that effluent, at a dilution similar to that detected in the zone of the wetland where the negative environmental impacts were evident, has a significant negative effect on this aquatic plant as well as on other primary producers inside a mesocosm system. After a prolonged (months) exposure to both 0% PME with pure river water and a 4 to 5% (v/v) dilution of treated PME, no effect on E. densa was measured. Furthermore, plants exposed to effluent exhibited a significantly greater general growth rate. Coincidently, chlorophyll a concentration in the water column and periphyton biomass also changed over time, but without any pattern attributable to the effluent. Values of the autotrophic index obtained from the periphyton growth pattern did not suggest enrichment of the system with organic matter. Our results only refer to the direct effect of mill effluents on several biotic responses, but they represent an important advance toward generation of the scientific knowledge necessary to understand how the ecosystem functions while receiving this and other unquantified sources of water.

Tractotomía espino-talámica percutánea por vía lateral: resultado en 218 pacientes / Percutaneous spinothalamic tractotomy by lateral way: results in 218 patients

Se presentan los elementos de la técnica de la tractotomía percutánea espinotalámica por vía lateral para el tratamiento del dolor intratable y los resultados obtenidos en 218 pacientes consecutivos operados por los autores en el Instituto de Neurocirugía Asenjo. Se resalta el renacer del interés en este tipo de cirugía debido a la obtención de resultados inferiores a los esperados por los procedimientos no quirúrgicos. La simplicidad del método permite la realización del procedimiento incluso en enfermos añosos y terminales

Hidrocéfalo normotensivo comunicante del adulto: correlación cisternográfico-terapéutica / Normal-pressure communicant hydrocephalus of adult: cisternorgraphic and therapeutic correlation

El hidrocéfalo del adulto se inserta con frecuencia en el diagnóstico diferencial de las demencias de diversa etiología. La precisión de este diagnóstico es de especial importancia dado el eventual buen resultado que tiene su tratamiento quirúrgico a través de la derivativa del LCR. El progreso de los procedimientos diagnósticos como ser TAC, RNM y FSC ha permitido una aproximación cada vez más exacta al estudio de estos pacientes. Sin embargo, creemos que la información que proporciona la radiocisternografía, especialmente en el hidrocéfalo comunicante, es de importancia fundamental para consolidar el diagnóstico. En este trabajo se expone el esquema en uso actualmente entre nosotros para el análisis de los pacientes con síndromes demenciales asociados a dilatación ventricular. Se señala la introducción en éste del estudio de FSC mediante SPECT. Una vez que se muestra como muy probable el diagnóstico de hidrocéfalo normotensivo comunicante, estos pacientes son sometidos a intervención derivativa del LCR. Se analiza aquí la correlación existente entre los hallazgos radiocisternográficos y los resultados del tratamiento quirúrgico en 83 pacientes, con observación de los casos de un año como mínimo. Se destaca que el grupo más beneficiado corresponde a pacientes con bloqueo de la circulación de LCR y con evolución de su enfermedad inferior a un año. La edad avanzada no parece como contraindicación, dado los resultados observados en pacientes mayores de 60 años. De todos modos, los resultados globales, que muestran una mejoría neta en el 44,6 por ciento de los enfermos, no difieren de aquellos comunicados por otros autores. Este hacho, que inclina al pesimismo, acentúa aún más la necesidad de afinar la tipificación preoperatoria. En efecto, los resultados buenos suben al 69,6 por ciento en el grupo de pacientes con bloqueo subaracnoideo epicortical total

Complicaciones hemorrágicas del sistema nervioso central en pacientes hemofílicos / Hemorrhagic complications of the control nervous system in hemophilic patients

Se revisan las complicaciones hemorrágicas en el SNC sufridas por pacientes hemofílicos y estudiados en el Instituto de Neurocirugía Santiago, entre 1970-85. Destacan la gravedad de estos cuadros en contraste con la ausencia de antecedentes traumáticos o bien relacionados con traumatismos leves o medianos. La población más afectada es la de menores de 12 años. No es infrecuente la repetición de estos episodios en el mismo paciente. Se revisa el cuadro clínico de presentación y los métodos auxiliares de diagnóstico usados, destacando el importante papel que cabe en la actualidad a la TAC. Se revisan los tratamientos médicos y quirúrgicos efectuados, haciéndose hincapié en la necesidad de precocidad en la iniciación de los primeros. Finalmente, se insiste en la importancia que tiene en la prevención de complicaciones, una adecuada educación de los parientes y de los responsables de estos pacientes, así como la oportuna y adecuada clasificación de la hemofilia que padecen, para facilitar la iniciación precoz del tratamiento

Aneurisma intrapetroso de la carótida interna: a propósito de un caso clínico / Intrapetrosal aneurysm of the internal carotid artery: apropos of a clinical case

Se presenta el caso de una niña de 10 años con una dilatación aneurismática fusiforme de toda la carótida interna intrapetrosa, que se manisfestó por dolor fronto-orbitario, tinnitus, parálisis del motor ocular externo, leve ptosis palpebral y sialorrea, estudiada mediante angiografía y TAC, tratada mediante la ligadura de la carótida interna en el cuello, con regresión completa de la sintomatología

Absceso temporal de probable origen en el seno cavernoso / Temporal abscess of probably originated in the cavernous sinus

Se presenta el caso de un paciente portador de un absceso temporal cuyo cuadro clínico se inicia con oftalmoplejia derecha. Se asiste a la positivización de la TAC y GEG, primariamente negativas, lo que permite un análisis y discusión de la secuencia evolutiva de los abscesos cerebrales. Se discute además la utilidad del tratamiento preoperatorio corticoidal asociado a antibióticos. Se plantea como probable puerta de entrada del germen, que en definitiva no fue identificado, el seno cavernoso, con compromiso selectivo probable de su pared externa. Se insiste en la necesidad de la repetición de los exámenes negativos por la posible evolución de una alteración en la barrera hematoencefálica

Hematoma espontáneo del cerebelo: clínica y terapéutica / Spontaneous cerebellar hematoma: clinical aspects and treatment

Se analizan 7 casos de hematoma cerebeloso espontáneo diagnosticados con TAC desde noviembre de 1982 a la fecha. Se señalan las características clínicas de esta patología y su incidencia. Se enfatiza la necesidad de sospechar el diagnóstico y de estudio precoz con TAC de todo paciente con historia de accidente vascular endefálico, sin descuidar la fosa posterior. Se destaca que sólo en casos con ubicación medial del hematoma y de un tamaño mayor que 3 cm hubo hidrocefalia secundaria, que necesitó derivativa de urgencia. Sólo en un paciente hubo la necesidad de evacuación quirúrgica del hematoma. Estos fueron siempre a la resolución total, independientemente del tamaño y de la ubicación. Se propone que frente a un paciente ya diagnosticado, la conducta debe ser expectante, especialmente frente a la aparición de hidrocefalia que deberá derivarse o ante la aparición de signos de comprensión troncal que determinará la evacuación del hematoma

Hidrocéfalo normotensivo comunicante del adulto: correlación cisternográfico terapéutica / Communicant normotensive hydrocephalus of the adult: cistermographic and therapeutic correlation

Se correlacionan las diferentes alteraciones radiocisternográficas encontradas en 17 pacientes estudiados por hidrocefalia comunicante normotensiva del adulto y el resultado obtenido con la intervención derivativa de líquido céfalo-raquídeo. Se destacan como hechos útiles en la predicción del resultado de la intervención derivativa, la existencia de bloqueo total de la circulación epicortical de líquido cefalorraquídeo y la mayor precocidad posible de la intervención respecto al comienzo de la enfermedad