Revista médica de Chile
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Revista médica de Chile · Sep 2022
Review[Intravenous sodium bicarbonate. When, how and why to use it?].
Severe metabolic acidosis is defined by a pH < 7.2 with HCO3- < 8 mE- q/L in plasma. Its best treatment is to correct the underlying cause. However, acidemia produces multiple complications such as resistance to the action of catecholamines, pulmonary vasoconstriction, impaired cardiovascular function, hyperkalemia, immunological dysregulation, respiratory muscle fatigue, neurological impairment, cellular dysfunction, and finally, it contributes to multisystemic failure. ⋯ However, the calculations are only for reference. More important is to start intravenous NaHCO3 when needed, administer it judiciously, manage its side effects, and continue it to a safe goal. In this review we address all the necessary elements to consider in the administration of intravenous NaHCO3, highlighting why it is the best buffer for the management of severe metabolic acidosis.
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Revista médica de Chile · Sep 2022
Review[Challenges for training medical professionalism values in times of COVID-19 and social crisis].
The essence of professional education not only involves transmitting knowledge, but also values and attitudes for a practice that allows us to face changing global and national scenarios. Physicians are currently facing new challenges derived from the impacts of the pandemic as well as the social crisis. Increased workload, limited access to health systems, economic uncertainty, and increased public scrutiny hamper physicians to fulfill their responsibilities to patients and society. ⋯ Medical professionalism acts as a stabilizing and morally protective social force. Thus, it is critical to fathom essential values of professionalism that characterize medical practice today. Indeed, the explicit incorporation of these values in undergraduate and postgraduate programs will undoubtedly allow the training of better professionals for the practice of medicine. (Rev Med Chile 2022; 150: 1248-1255).
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Revista médica de Chile · Sep 2022
Case Reports[Late-onset hereditary transthyretin amyloidosis with polyneuropathy. Report of one case].
Hereditary transthyretin amyloidosis is a multisystemic autosomal dominant genetic disorder characterized by progressive distal sensory-motor polyneuropathy or restrictive cardiomyopathy, secondary to amyloid deposits. Its pathogenesis lies in the TTR gene mutation, and the Val50Met mutation is the most frequent. Patients have significant differences in the onset and severity of clinical presentation according to their country of origin. ⋯ During the etiological study of her polyneuropathy, an increased Kappa/Lambda index of 2.55 mg/L stood out. Therefore, light chain amyloidosis was suspected, and chemotherapy treatment was indicated without favorable response. After 10 years of progressive neurological and ophthalmological involvement, a genetic study confirmed the first case of late-onset hereditary transthyretin amyloidosis Val50Met with polyneuropathy in Chile.
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Gallbladder Cancer (GBC) prevalence varies among countries, associated with different geographical and genetic factors. The Mapuche ethnicity (Ethnia mostly located between the VIII and X Chilean regions) stands out in Chile due to its high GBC prevalence. ⋯ There was a low GBC prevalence rate in Northern Chile and among the Aymara population.
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Angiomyolipomas (AML) are mesenchymal tumors belonging to the group of perivascular epithelioid cell tumors, which, rarely, can display a malignant behavior. They are composed of adipose tissue, vessels, and muscle tissue in different proportions, and constitute a differential diagnosis for other focal liver lesions. ⋯ During ten years of imaging follow, the size and features of the lesion has not changed. The patient rejected a surgical excision.