Hepatotoxicidad grave inducida por sertralina / Sertraline-induced severe hepatotoxicity

We report the case of a 19-year-old patient, with a history of traumatic liver damage, but with a normal liver profile at her first discharge; 1 month after the event, with post-traumatic stress disorder, treatment with 25 mg of sertraline was started every day; one month later, she develops severe hepatotoxicity without a specific etiology. According to the Naranjo algorithm, it is attributed as a probable case of sertraline hepatotoxicity. Management is carried out with support measures and suspension of the medication, and the patient recovers until she is asymptomatic, currently has normal liver tests

Reportamos el caso de una paciente de 19 años, con antecedentes de daño hepático traumático, pero con un perfil hepático normal en su primer alta; después de 1 mes del evento, con trastorno de estrés postraumático se inició tratamiento con 25 mg diarios de sertralina; un mes después, desarrolla una hepatotoxicidad severa sin etiología determinada. De acuerdo con el algoritmo de Naranjo, se atribuye como caso probable de hepatotoxicidad por sertralina. El manejo se realiza con medidas de apoyo y suspensión del medicamento, y la paciente se recupera hasta que se encuentra asintomática, actualmente tiene pruebas hepáticas normales

Manejo incial del accidente cerebrovascular (ACV) isquémico agudo: los detalles hacen la diferencia / Initial management of acute ischemic stroke: details make the difference

The cerebrovascular disease, especially the ischemic stroke, is the second cause of death in our country. In Chile every year we have 14.000 new cases of ischemic stroke; this number is going up due to the progressive aging of our population. Every action we do during the six first ours of the evolution of the disease are critical for the final outcome. A proper treatments made of a group of unspecific actions that can really change the prognosis of the disease: Multidisciplinary approach, quick stabilization, unspecific neuroprotection, CT in the emergency room and hospitalization in a Stroke Unit, prevent and treat infections, early physical therapy, diagnosis of underlying disease and secondary prevention. The current law in Chile guarantee to every patient with an ischemic stroke the right to be hospitalized under the suspect of a stroke and to be followed up by a Neurologist, Psychologist, Physiatrists, kinesiologist, Speech and swelling therapist and a physical therapist. This law can only be fulfilled if every hospital in our country, or at least one per region, has its own Stroke Unit.

Evaluación de una unidad de tratamiento del ataque cerebral en un hospital universitario / Evaluation of a stroke unit at a university hospital in Chile

Background: Stroke is the second specific cause of death in Chile, with a mortality rate of 48.6 per 100.000 inhabitans. It accounts for 6 percent of all hospitalizations among adults. Aim: To study the type of patients hospitalized at a Stroke Unit in a general hospital and the costs and benefits of such unit. Material and methods: A descriptive and retrospective study using a patient registry, developed in Access® that included separate sections for ischemic and hemorrhagic stroke. Established diagnostic criteria were used. The mean costs per patient and complications were also calculated. Results: During 2003, 425 stroke patients were admitted to our hospital and 105 (age range 30-89 years, 58 percent female) were hospitalized at the Stroke Unit. Eighty three percent had ischemic and 16 percent had hemorrhagic stroke. The most common etiologies were thrombosis in 41 percent, embolism in 36 percent, lacunar in 13 percent, arterial dissection in 5 percent and transient ischemic attack in 3 percent. Fifty eight percent of patients had partial anterior ischemic stroke (PACI), 73 percent had hypertension and 29.5 percent diabetes. Only 18 percent arrived to the Stroke Unit with less of 6 hours of evolution, 7 percent of patients were admitted within the 3 hours after the onset of symptoms and 18 percent, from 3 to 6 hours. The mean lenght of stay in the Stroke Unit was 6.6 days and at the hospital 9.9 days (p <0.01). The mean costs per patient at the Stroke Unit and at the hospital were US$ 5.550 and US$ 4.815, respectively (p =ns). Conclusions: The Stroke Unit decreases hospital stay days without raising costs importantly. The inclusion criteria for stroke patients admitted to the Unit were adequate and the stroke registry allowed a good assessment of the Unit operation.