Revista Chilena de Estudiantes de Medicina

Rectal foreign bodies. An Updated review

Sat, 24 Oct 2020 00:00:00 +0000

Introduction: Rectal foreign bodies (REC) have increased in incidence in recent years, however, there are few epidemiological data to this date. Its management generally represents a challenge for surgeons due to the variability of clinical presentations. The goal of this review is to describe and analyze national and international publications on CER during the last decade. Materials and methods: A bibliographic review was carried out in Medline (PubMed) and Scholar Google databases, including publications from 2010 to 2021. Results: 29 results were obtained, eliminating those focused on extra-rectal foreign bodies and rectal lesions of other etiologies. There is a male predominance in CER cases, with a ratio of up to 28: 1 and a higher incidence between 20-40 years. 35.8% of the cases were secondary to sexual stimulation, 50.6% had no reported cause and 5.2% were due to third-party aggression. The cardinal symptoms are anal pain or constipation. Most CERs can be diagnosed by abdominal and pelvic radiographs (Rx), however, a negative Rx does not rule it out. Multiple extraction techniques are described, depending on the type of object and the risk or suspicion of complications; being the most frequent ones sphincter and / or anal mucosa lacerations, intestinal obstruction and perforation. Discussion: The bibliography regarding CER is currently scarce, however, its incidence is expected to increase; therefore, it is important that health care professionals take into consideration its diagnostic possibility and learn management options.

Characterization of adverse drug reactions (ADRs) in pediatric patients treated with systemic corticosteroids between January and December 2019: A preliminary report

Sat, 24 Oct 2020 00:00:00 +0000

INTRODUCTION: Corticosteroids are useful drugs in the treatment of multiple medical conditions, but with adverse drug reactions (ADRs) that can be serious. The pediatric population is even more vulnerable due to the difficulty of properly identifying this condition. OBJECTIVES: To describe the most frequent adverse reactions in patients who received short-term corticosteroids treatment (<14 days) in a pediatric hospital in Santiago de Chile. MATERIALS AND METHODS: Retrospective descriptive observational study based on existing data between January and December 2019 in the pharmacy dispatch registry. ADRs are described in terms of the sex of the patient, prescribed medication, compromised system, severity, causality and preventability as registered in the clinical records of each case. RESULTS: 29.9% of the patients (52/174) had a suspicion of ADR (95% CI 23.2% -37.3%). The drugs with the greatest association with ADRs were prednisone and hydrocortisone (51.6% and 41.6%, respectively). The most frequently compromised systems were the CNS and gastrointestinal system. No reactions classifiable as serious or preventable were reported. DISCUSSION: The characteristics of the population studied make it difficult to accurately estimate the incidence of ADRs, potentially existing an important underreporting. Documenting ADRs that occur long-term or are determined with specialist evaluation and/or specific laboratory tests is even more complex. Despite this, the high potential incidence justifies knowing the profile of ADRs to implement strategies that reduce their frequency and severity.

Gestación por sustitución o subrogada: La bioética aplicada al embarazo en parejas del mismo sexo

Sebastián A. Haro G., Derek U. Gützlaff I., Matías A. Jara V I. — Sat, 24 Oct 2020 00:00:00 +0000

Background: One of the factors with the greatest impact on a couple relationship is the desire to have children, framed in the traditional conception of the family, which has undergone economic, social, and legal changes for years. Highlighting in this framework the movements for homosexual rights, it is necessary to analyze the conflict of pregnancy in same-sex couples, due to its multiple implications both for homosexuals who decide to have children and for the ethical and moral debate of a population in transition to their acceptance Results: The methods available for achieving paternity in same-sex couples were described, focusing the analysis on surrogacy, leading to a comprehensive review of the issue from the point of view of bioethics and its legal status in international legislation Conclusions: It is impossible to give concrete answers to a topic as broad and conflictive as pregnancy in homoparental couples. However, it was possible to outline guidelines for the evaluation of similar issues to broaden the debate in this regard, offering an applied approach without falling into unchangeable principles that, in some way, punish those views that remain outside of them.

Caracterización de la Proporcionalidad Terapéutica desde una perspectiva Bioética: Una revisión bibliográfica

Sebastián A. Haro G., Derek U. Gützlaff I., Matías A. Jara V I. — Sat, 24 Oct 2020 00:00:00 +0000

INTRODUCTION: The vertiginous development in medical technique has brought the ethical aspects of treatments more frequently into discussion. Although it is evident that the potential severity of a pathological entity must be related to a therapeutic approach of corresponding intensity according to severity, it is not uncommon that, in an expert opinion, the treatment is not always proportional, and may be itself a cause of physical, psychological or social damage that does not justify its use to treat the disease. These situations need a deep reflection on its conception and implications. DISCUSSION: The key concept found in multiple definitions was "balance", the central axis when addressing the concept correctly. Regarding the criteria, clinical and economic perspectives must be integrated, as well as essentially human aspects, placing the patient at the center of any approach. CONCLUSIONS: There is no universal and systematized approach that unifies the lex artis to the subject in question. The humility in recognizing the limits of current medicine must go together with considerations of the different areas that as a whole define the treated patient, and the proportionality of his/her treatment. This new approach must also be an integral part of daily clinical care and not only limit its potential relevance in the field of palliative and end-of-life care.

Current management of gallbladder polyps in Chile

Sat, 24 Oct 2020 00:00:00 +0000

Introduction: Gallbladder polyps are a mucosal projection into the gallbladder lumen and an increasingly frequent diagnosis, due to radiologic advances. In Chile, the incidence of gallbladder cancer reaches 12,8 per 100.000 habitants. Materials and Methods: A review of 20 papers (national and international) was carried out on platforms like PubMed, UpToDate and google Scholar. Results: Mostly asymptomatic, a minority evolves to a malignant neoplasia. There is no consensus between the studies about all management criteria, being the most accepted one to an active treatment, a size ≥10mm. Other factors include association with primary sclerosing cholangitis (PSC) or cholelithiasis, sessile morphology, older age, and single polyps. Discussion: Given de incidence of incidental finding of polyps and the difficulty in differentiating potentially malignant polyps through images, associated with the high incidence of gallbladder cancer in Chile; active management with cholecystectomy is recommended for those measuring 10mm or more, associated with symptoms, cholelithiasis or PSC or growth in follow-up, age older than 50 years, sessile morphology, and Indian ethnicity. Due to the malignant potential of gallbladder polyps, their frequently asymptomatic presentation and the importance of gallbladder cancer in Chile, this review has the objective of making explicit the currently accepted risk factors and propose a management algorithm for gallbladder polyps in Chile.

Update on the treatment of acute and chronic anal fissure

Lucas González Johnson, Jasmín Peña Zacconi, Ignacia Santiago Hermosilla — Sat, 24 Oct 2020 00:00:00 +0000

INTRODUCTION: Anal fissure is one of the most common benign anorectal pathologies. These are classified as primary or secondary and acute or chronic. Anal fissures are the result of opposing forces that separate the anal mucosa beyond its normal capacity, generating ulcers or lacerations of the anal verge below the pectinate line, a highly sensitive area, and causing a vicious circle in which the internal anal sphincter is exposed It begins with repetitive spastic contractions that cause persistent ischemia and more difficult healing. Patients typically present with painful defecation, treatment is medical or surgical. The objective of this review is to present general and specific aspects in the current treatment of anal fissure, including the mainstay of general measures, medical treatment and surgical treatment.

Ocular trauma secondary to the use of tear gas during social protests in Chile

Sat, 24 Oct 2020 00:00:00 +0000

Introduction: Tear gas canisters (TGCs) are a crowd control tool in the context of protests, mainly generating temporary discomfort at the ocular, skin and respiratory level. There are few records of traumatic eye injuries due to TGCs. Objectives: The aim of this study was to describe a series of eye trauma (ET) secondary to TGCs who attended the Eye Trauma Unit of Hospital del Salvador between October 18 and November 30, 2019. Materials and Methods: Descriptive observational study. Demographic data, primary and secondary diagnoses, presence of severe ET, visual acuity (VA) upon admission, and need for surgery were analyzed. Results: 32 patients were included, 28 male (87,5%) and 4 female (12,5%), Average age was 32,3 years (range 16-51 years). Principal diagnosis was closed globe injury in 20 cases (62.5%), and open globe injury in 9 (28.1%). According to criteria of the Chilean “Explicit Health Guarantees”, 26 (81.3%) were classified as serious ET. 23 patients (71.9%) were admitted with some degree of visual deficit, highlighting 10 patients (31.3%), whose VA on admission was classified as blindness. 8 patients (25%) required surgery, the most frequent being surgical repair of open ET (50%), and evisceration of the intraocular content (37.5%) Discussion: TGCs are frequently used by law enforcement agencies to disperse demonstrations due to their ability to generate temporary disability. However, they can have serious health consequences, including permanent visual sequelae.