Revista médica de Chile
-
Revista médica de Chile · Apr 2024
Review Case Reports[Acquired Epidermodysplasia Verruciformis in a Renal Transplant Patient: Case Report and Literature Review].
Acquired epidermodysplasia verruciformis is a rare condition, secondary to a state of acquired immunosuppression and is characterized by a susceptibility to infection by human papillomavirus of the beta genus, which carries an increased risk of developing non-melanoma skin cancer. We report the case of a 39-year-old woman receiving a kidney transplant, treated with prednisone and tacrolimus, who after starting immunosuppressive therapy developed papules and warty plaques in the inguinal region. A skin biopsy was performed that was consistent with epidermodysplasia verruciformis, so it was decided to adjust immunosuppressive therapy to everolimus, which achieved a reduction in lesions. There are only 13 other cases of acquired epidermodysplasia verruciformis in kidney transplant recipients; to our knowledge this is the first case reported in Chile.
-
Revista médica de Chile · Apr 2024
Review Case Reports[Transformation of Follicular Lymphoma into Composite Lymphoma: A Case Report and Literature Review].
Follicular lymphoma is a relatively indolent B-cell lymphoma composed of neoplastic centrocytes and centroblasts. The histologic transformation of follicular lymphoma is a well-described phenomenon with an average risk of 30% at ten years. The occurrence of Hodgkin lymphoma after follicular lymphoma, as well as composite lymphoma, is extremely rare. ⋯ A lymph node biopsy three years later revealed persistent follicular lymphoma, after which the patient received radiotherapy. The patient returned with progressively enlarging axillary lymph nodes five years later. A lymph node biopsy demonstrated a composite lymphoma that was consistent with follicular lymphoma and Hodgkin lymphoma.
-
Revista médica de Chile · Apr 2024
Review[Endocrinological Effects of Lithium: Pathophysiological Mechanisms and Clinical Implications].
Lithium carbonate has a narrow therapeutic range capable of producing various adverse effects; despite this fact, it is used as first-line therapy in patients with bipolar disorder (BD) thanks to its high effectiveness. Among its adverse events are several conditions at the endocrine level, such as hypothyroidism, hyperthyroidism, hypercalcemia, hyperparathyroidism, and nephrogenic diabetes insipidus. The adherence to current guidelines for monitoring those events is low. The objective of this review is to provide insight into the pathophysiological mechanisms of the endocrine effects of lithium and give recommendations based on the current literature for the monitoring and treatment of these conditions.
-
Revista médica de Chile · Apr 2024
Review[Decision-Making by Hospital Teams Regarding Access and Use of Life-Support Technology and End-of-Life Processes in Critically Ill Adult Patients: A Narrative Review].
Death processes have been progressively transferred to hospital spaces due to biomedicalization and the use of technologies, generating important challenges for healthcare systems. The COVID-19 pandemic exposed the lack of unified criteria and principles for a dignified death in the hospital. This study corresponds to a narrative review using Higgins & Green's methodological framework as a reference. ⋯ The evidence shows variability in decision-making associated with the clinical status of the patient, the criteria of the medical professional, added to structural elements of the health system and political-legal aspects. The literature recommends reflexive, dynamic, flexible, and individualized decision-making processes that consider the patient's preferences, clinical judgment, prognosis, and available resources. Communication, advance care planning, interdisciplinary discussions, external consultations, and the involvement of ethical committees are crucial throughout the process.
-
Revista médica de Chile · Apr 2024
Observational Study[Social Security Profile of Cardiovascular Surgical Treated Patients of a Public Hospital in the Macro-Northern Zone, Analysis of a Decade].
Cardiovascular pathology is the leading cause of death in Chile, with an inverse relationship between socioeconomic status and morbidity/ mortality. Currently, there is a lack of information regarding the Macro North Zone of Chile. Our aim is to describe the profile of patients undergoing interventions in a public hospital over a decade. ⋯ We found that patients are older and belong to lower-income tiers. Additionally, there is a migration towards tier A in recent years and an increase in interventions.