Medicina Espacial y Astronomía en Chile: Futuro esplendor / Advancing Space Medicine and Astronomy in Chile for Health on Earth

El cielo de Chile cuenta con las condiciones ideales para la astronomía a nivel mundial, lo que ha conllevado un desarrollo científico importante para el país en esta y otras áreas. En los próximos años varias misiones espaciales sucederán, siendo de importancia para su éxito la salud de los tripulantes. La medicina espacial se preocupa y estudia los cambios en la fisiología humana en el espacio, la que se ve alterada en su totalidad. Es fundamental el entendimiento de la patología en el ambiente espacial para el desarrollo de contramedidas para mitigar los diferentes riesgos, siendo uno de los principales la radiación espacial entre otros. El desarrollo de esta área de la medicina permitirá nuevos avances en la salud en la Tierra.

The sky of Chile has the ideal conditions for astronomy worldwide, which has led to crucial scientific development for the country in this and other areas. In the coming years, several space missions will occur, the crew members' health being essential for their success. Space medicine studies the changes in human physiology in space, which is entirely altered. It is essential to understand the pathology in the space environment to develop countermeasures to mitigate the different risks, one of the main ones being space radiation, among others. The development of this area of medicine will allow new advances in health on Earth.

MALA: Acidosis láctica asociado al uso de metformina, una revisión a propósito de casos clínicos / MALA: Lactic acidosis associated with the use of metformin, review of clinical cases

La metformina es el fármaco preferido en el manejo inicial de la diabetes mellitus tipo 2 (DMT2). Aunque se recomienda su uso ampliamente, se debe tener precaución al prescribirla a poblaciones susceptibles a condiciones de riesgo de hipoperfusión sistémica, ya que puede provocar acumulación en el organismo y alteraciones metabólicas que desemboquen en acidosis láctica asociada a metformina, una complicación grave que a menudo es subdiagnosticada. Con el propósito de promover un mejor conocimiento sobre este tema, la presente revisión se centra en el análisis de la clínica, fisiopatología, diagnóstico y manejo de la acidosis láctica asociada a metformina, prestando especial atención al manejo mediante terapias de reemplazo renal. El análisis se basará en la experiencia de una serie de casos de acidosis láctica asociada a metformina atendidos en un centro clínico hospitalario en Chile.

Metformin is the preferred medication for the initial management of type 2 diabetes mellitus (T2DM). Although its use is widely recommended, caution should be exercised when prescribing it to populations susceptible to systemic hypoperfusion conditions, as it can lead to accumulation in the body and metabolic disturbances that may result in metformin-associated lactic acidosis. This severe complication is often underdiagnosed. To promote a better understanding of this topic, the present review focuses on the analysis of the clinical, pathophysiological, diagnostic, and management aspects of metformin-associated lactic acidosis, with particular attention to management through renal replacement therapies. The analysis will be based on the experience of a series of cases of metformin-associated lactic acidosis treated at a hospital clinical center in Chile.

Trastorno grave del medio interno por fístula enterovesical, a propósito de un caso clínico / Severe metabolic disorder associated with an enterovesical fistula: report of one case

Enterovesical fistula (EVF) is a fistulous communication between the intestine and the bladder. It is uncommon and its classic clinical manifestations are the presence of pneumaturia, fecaluria, suprapubic pain and recurrent urinary infections. Surgical repair of EVF leads to rapid correction of both diarrhea and metabolic abnormalities. We report a 73-year-old diabetic woman with a neurogenic bladder secondary to a spine meningioma. She presented with diarrhea, vomiting, impaired consciousness and metabolic acidosis. She developed hypernatremia, hypokalemia, hypocalcemia, and hypophosphatemia, which were successfully corrected.

Nefropatía aguda por fosfatos secundaria al uso de laxantes con fosfato de sodio: caso clínico-patológico / Acute phosphate nephropathy secondary to the use of oral sodium phosphate laxatives: report of one case

Acute phosphate nephropathy (APN) is an acute renal failure secondary to the use of oral sodium phosphate (OSP) laxatives, with a high risk of progression to chronicity. We report a 60-year-old woman with mixed connective tissue disease whose serum creatinine increased up to 2.0 mg/dL in her regular control tests, without an evident causative factor. Kidney biopsy showed numerous intratubular calcium phosphate deposits, consistent with APN. She had a history of OSP laxative intake, and a sodium phosphate enema was used before a colonoscopy performed six months earlier. The temporal association between the use of OSP laxatives and acute kidney injury, should lead to the suspicion of APN. The urine sediment is generally normal or with mild to moderate proteinuria. The diagnosis is confirmed with a kidney biopsy. Until now, there is no specific treatment for APN, thus prevention is essential. In high-risk patients for developing APN, the administration of these laxatives should be avoided.

Monitoramento por radiotelemetria da área de uso de onça parda reintroduzida no entorno do Parque Estadual da Serra do Brigadeiro - MG, Brasil / Radiotelemetry monitoring of the home range of cougar reintroduced at the surroundings of the State Park of Serra do Brigadeiro - MG, Brazil

Um exemplar macho, subadulto de onça parda reintroduzido foi monitorado por técnica de radiotelemetria. O monitoramento foi de 110 dias, realizado de forma aleatória, com intervalos descontínuos. Os dados do acompanhamento sugerem que a área utilizada por este espécime seja de, aproximadamente, 26km². Esta configura o menor índice já descrito para a espécie, porém, deve-se ressaltar a importância deste monitoramento básico, visto a incipiência do comportamento de um felino de grande porte reintroduzido em habitat natural após período em cativeiro.

One subadult male specimen of a reintroduced mountain lion was monitored using the radio telemetry technique. The monitoring lasted 110 days, being randomly distributed. Data of the monitoring through radiotelemetry suggested that the home range of this specimen was of approximately 26km². This sets as the smallest home range described for this species. However, the importance of this basic monitoring should be emphasized, since information of the behavior of a large feline reintroduced in its natural habitat after a period in captivity is incipient.