Revista médica de Chile
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Revista médica de Chile · May 2014
Review[The GRADE system: a change in the way of assessing the quality of evidence and the strength of recommendations].
Individual clinicians and organizations making health care decisions should not only consider the magnitude of the benefits and harms of different courses of action (interventions), but also the confidence we can have in those estimates. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach offers a systematic and transparent way to summarize the evidence, to rate the confidence we can have in the effects of the interventions and to move from evidence to recommendations. ⋯ In this paper we describe the core concepts of the GRADE approach to rate the quality of the evidence and to grade the strength of recommendations. As clinicians, being familiar with such concepts may be helpful to make decisions informed by the best available evidence.
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Revista médica de Chile · May 2014
Case Reports[Tricuspid and pulmonary valve involvement in carcinoid syndrome. Report of two cases].
Carcinoid is a rare neuroendocrine tumor typically arising in the gastrointestinal tract that can cause heart valve involvement. We report two patients with carcinoid syndrome and tricuspid/pulmonary valve lesions. A 33-year-old male presenting with fatigue and weight loss: A tumor in the tail of the pancreas was found on an abdominal CAT scan. ⋯ A 35-year-old male with a carcinoid syndrome and cardiac failure: An echocardiogram showed a severe tricuspid stenosis and severe pulmonary regurgitation. The patient was subjected to a double surgical valve replacement. The pathology report of the excised valve showed a deforming fibrous and myxoid valvulopathy.
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Revista médica de Chile · May 2014
Case Reports[Pulmonary alveolar microlithiasis: Report of one case].
Pulmonary alveolar microlithiasis is an extremely rare disease characterized by intra-alveolar accumulation of calcified spherical particles (called microliths), due to a mutation of the gene encoding a membrane transport protein of the alveolar surface. Most patients are asymptomatic at diagnosis. The course of the disease is slowly progressive, with development of pulmonary fibrosis and respiratory failure. ⋯ We report a 39-year-old female presenting with progressive dyspnea. A chest X ray showed ground-glass opacities and a high resolution CT scan showed numerous calcified lung micronodules. A surgical lung biopsy confirmed the diagnosis of pulmonary alveolar microlithiasis.
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Appendicitis is a common cause of acute abdominal pain. It is caused by the obstruction of the cecal lumen and can evolve to perforation and peritonitis. This article reviews the initial description and history of appendicitis and describes the signs and symptoms used for diagnosis. In today's medicine, where technology plays an important role, the value of anamnesis and physical examination should be stressed as useful tools.
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Revista médica de Chile · May 2014
[Early determinants of acute kidney injury during experimental intra-abdominal sepsis].
Sepsis-induced acute kidney injury (AKI) is an early and frequent organ dysfunction, associated with increased mortality. ⋯ The reduction in renal blood flow and renal perfusion pressure were the main mechanisms associated with AKI, but were not associated with necrosis. Probably other mechanisms, such as microcirculatory vasoconstriction and inflammation also contributes to AKI development.