Dextrocardia como hallazgo incidental: revisión a partir de un caso / Dextrocardia as incidental finding: review from a case

INTRODUCTION: Dextrocardia is characterized by the positioning of the heart to the right of the thoracic cavity, usually with the apex oriented to the right and its inverse anatomy 1,2. It is a rare congenital pathology that can be associated with other congenital cardiac anomalies, as well as a change in position of all thoracoabdominal structures 1-4. Its diagnosis in adult life is usually incidental. We present the clinical case of a 64-year-old man with an electrocardiogram that showed deviation of the QRS complex axis to the extreme right and a physical examination compatible with dextrocardia, which was later confirmed with images. OBJECTIVES: To review the medical literature related to the diagnosis of dextrocardia through the presentation of a clinical case. METHODS: The clinical data of the case were collected by means of anamnesis, physical examination and specialized exams of the patient, as well as his clinical file. The literary review was made using the MEDLINE® search engine for scientific journals. RESULTS: Dextrocardia affects less than 1% of the general population according to the studies reviewed. Its importance lies in the association with other congenital pathologies such as cardiac and extracardiac structural malformations, which increases morbidity and mortality in this group of patients. It is imperative, when suspected, complete the study with images that allow confirming or ruling out other structural anomalies.

Dolor postoperatorio, analgesia y presencia de factores de riesgo para dolor crónico en pacientes hospitalizados de un hospital público de Santiago de Chile / Postoperative pain, analgesia and presence of risk factors for chronic postoperative pain in hospitalized patients of a public hospital of Santiago de Chile

INTRODUCCIÓN: el dolor postoperatorio es un importante problema de salud pública, con una elevada incidencia según publicaciones internacionales. el dolor crónico postoperatorio (DCPO) se desarrolla posterior a una cirugía y persiste por más de dos meses, excluyendo otras causas y problemas preexistentes. se han descrito factores de riesgo demográficos, psicosociales y médicos para el desarrollo de dolor crónico postoperatorio (DCPO), siendo el más importante el dolor postoperatorio agudo elevado. actualmente, en Chile se carece de datos locales sobre dolor postoperatorio agudo y crónico. OBJETIVO: evaluar la intensidad del dolor agudo en pacientes post-operados y las medidas analgésicas utilizadas, esto en el contexto de la identificación de los factores de riesgo para el desarrollo de DCPO en pacientes hospitalizados en el servicio de cirugía de un hospital de alta complejidad. MATERRIALES Y MÉTODOS: se realizó un estudio observacional descriptivo de corte transversal retrospectivo. La muestra incluyó a 100 pacientes post-operados seleccionados en forma aleatoria del área de cirugía del Hospital del Salvador entre los meses de septiembre y octubre de 2017. Se realizó una revisión de protocolos operatorios, evoluciones e indicaciones médicas y se registraron edad, sexo, dolor postoperatorio según la escala numérica del dolor (EN) y factores de riesgo de DCPO (cirugía con riesgo de daño nervioso, revisional, abierta, malla, complicaciones postoperatorias, dolor postoperatorio sobre 5, según EN), además del tiempo operatorio. Se realizó un registro electrónico en planilla de excel (Microsoft® Excel® 2011) pre-codificada y diseñada para este fin, resguardando la identidad de los participantes. Los datos obtenidos se expresaron como promedios (con desviación estándar) y medianas. RESULTADOS: se encontró una incidencia de 44% de dolor postoperatorio, con intensidad promedio de 4,4 ± 1,64 puntos entre los pacientes que presentaron dolor en algún grado. el 93% de los pacientes con dolor presentó dolor moderado a severo. en el 98% del total de pacientes se indicó terapia analgésica; de éstos, el 47,95% solo tuvo indicación de antiinflamatorios no esteroidales (AINEs), 39,79% AINEs y paracetamol, 7,14% solo paracetamol y 5,10% otras combinaciones. el 95% de los pacientes presentó uno o más factores de riesgo para DCPO, y el 11%, cuatro o más. DISCUSIÓN: el conocimiento de la incidencia e intensidad local de dolor postoperatorio es un primer paso para optimizar su manejo. la identificación de la población en riesgo de desarrollar DCPO podría permitir implementar a futuro medidas preventivas, que mejoren la calidad de vida de los pacientes postoperados

INTRODUCTION: postoperative pain is an important public health issue, with a high incidence reported in international literature. chronic postoperative pain (CPOP) is developed posterior to a surgical intervention and persists over two months, excluding other causes and preexisting problems. several risk factors for CPOP have been mentioned, including demographic, psicosocial and medical ones; the most relevant being high acute postoperative pain. nowadays, Chile lacks local data of acute and chronic postoperative pain. OBJECTIVES: assess the intensity of acute postoperative pain and the analgesia used, in the context of the identification of risk factors for CPOP in a surgery department of a high complexity hospital. MATERIALS AND METHODS: an observational descriptive tranversal restrospective study was used. the sample was constituted by 100 postsurgical patients selected randomly from the surgical department of the Hospital del Salvador between september and october 2017. a revision of surgical protocols and medical charts was made; age, sex, postsurgical pain according to numeric pain scale (NPS) and risk factors for CPOP (surgery with risk of nervous damage, second look, open, use of mesh, postsurgical complications, postsurgical pain above 5 according to NPS) were registered, besides surgical time. the record was made on an precoded excel sheet (Microsoft® Excel® 2011), designed for this purpose. the identity of the patients was kept anonymous. the data obtained was expressed as mean (with standard deviation) and median. RESULTS: an incidence of 44% of postsurgical pain was found, with mean intensity of 4.4 ± 1.64points between patients that presented any degree of pain.93% from the patients with pain presented moderate to severe pain. 98% from the total of patients had analgesia, from them 47.95% only had non-steroidal antiinflamatory drugs (NSAIDs), 39.79% NSAIDs and acetaminophen, 7.14% only acetaminophen and 5.10% other combinations. 95% of patients had one or more risk factors for CPOP, and 11% four or more of them. DISCUSSION: the knowledge of the incidence and intensity of postsurgical pain is the first step in order to optimize its manage. the identification of the population at risk to develop CPOP could allow the implementation of preventive measures that may improve the quality of life of postsurgical patients.