Aspectos cognitivos y legales en personas mayores: "Sano Juicio"

In Chile, 7.1% of people aged over 60 years have some type of cognitive disorder. The frequency of the latter increases to 13% in people between 75-79 years and 36.2% in people over 85 years. The concept of mild cognitive impairment (MCI) and dementia have evolved over time. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) uses the term minor and major neurocognitive disorder, replacing the DCL and dementia respectively. Major cognitive disorder impairs functional performance while minor disorders does not. There is an arbitrary discrimination against the elderly. A form of discrimination is the request made by some notaries of a medical certification of the cognitive function for older people willing to carry out a legal procedure. This request has the sole effect of pre-establishing evidence in favor of the notary and not protecting the testator or the vulnerable person. Assessing the ability of older people to care for themselves and their possessions has important implications for them and their families, since there is a serious risk of prejudice when someone is declared as disabled. Thus, considering the epidemiology of cognitive disorders in our country we propose a series of legal and medical discussion points aimed to protect autonomy and to protect individuals and their possessions when they have difficulties to control their decisions.

Rivaroxaban para el tratamiento de la trombocitopenia inducida por heparina: caso clínico / Treatment of heparin-induced thrombocytopenia with rivaroxaban: case report

Heparin-induced thrombocytopenia (HIT) is immune-mediated. It occurs more frequently with unfractionated heparin (UFH) than with low molecular weight heparins (LMWH). It is associated with thromboembolic rather than hemorrhagic events, as opposed to thrombocytopenia of other etiologies. The key in therapy is the cessation of heparin and the start of another anticoagulant. We report a 58 years old female with HIT secondary to the use of Enoxaparin who was successfully managed with Rivaroxaban. Our goal is to report a novel therapy and provide the evidence that supports its use.

Concordancia del Score de Gleason entre biopsia de próstata y la prostatectomía radical / Gleason Score correspondence berween prostate biopsy and radical prostatectomy

El score de Gleason (SG) es el sistema más utilizado en la etapificación del cáncer prostático (CP). La correlación entre el SG de la biopsia prostática por punción (BP) y el obtenido en la prostatectomía radical (PR) no es exacta. El objetivo de este estudio fue comparar el SG de la BP con el obtenido en la pieza quirúrgica de la PR en nuestro hospital. Creemos que existe un nivel moderado de concordancia entre ambas muestras. Se incluyeron los pacientes sometidos a PR entre 1993 y 2010 en el Hospital Militar de Santiago (HOSMIL). Se estableció como SG sobreestimado cuando el SG de la biopsia por punción era mayor al de la PR, y SG subestimado cuando el SG obtenido en la biopsia era menor al obtenido en la PR. Se utilizó la medida estadística Kappa (K) para determinar su nivel de concordancia. El estudio incluyó 534 pacientes. Se encontró una concordancia de 62 por ciento. La sobreestimación fue de 6,7 por ciento y la subestimación fue 31,2 por ciento. El valor del índice de concordancia Kappa (K) fue de 0,3186. Se encontró un índice de concordancia débil. Esto se podría explicar por la escasa muestra disponible en la biopsia, comparada con la pieza completa de la PR, entre otros factores. Se asemeja a resultados internacionales, que afirman que la subestimación es la situación más frecuente...

Gleason Score (SG) is the most frequently used system for prostate cancer (CP) staging. The correspondence between the SG of the prostate biopsy and the radical prostatectomy is not exact. The purpose of this study was to compare the SG of the biopsy with that obtained at radical surgery in our hospital. We relieve that there is a moderate level of correspondence between both specimens. We included all patients who underwent Radical Prostatectomy between 1993 and 2010 in the Hospital Militar de Santiago (HOSMIL). We defined overestimation when the SG in the biopsy was higher than in the Radical Prostatectomy; and underestimated when lower. The statistical measurement Kappa (K) was used for the analysis. 534 patients where studied. The correspondence was 62 percent. Overestimation was 6,7 percent and underestimation was 31.2 percent. Kappa (K) was 0.3186 and this is considered weak. This could be explained in part due to the small size of the tissue sample, when compared to the complete prostate after surgery. Our experience is similar to International reports, where underestimation is also frequent...