Registro de paro cardiorrespiratorio perioperatorio en un hospital universitario en el período 2006-2017 / Registry of perioperative cardiac arrests in a clinical hospital in the period 2006-2017

Background: Perioperative cardiac arrest (PCA) is a rare but important event in the operating room. Aim: To describe PCA events at a Clinical Hospital in Santiago, Chile. Material and Methods: Registry of PCA that occurred in the operating room (OR) and during procedures not carried out in the OR between September 2006 and November 2017. Precipitating events, type of anesthesia and results of resuscitation maneuvers were described. Results: Eighty events (five outside of the OR) during 170,431 surgical procedures were recorded, resulting in an incidence of 4.4 events per 10,000 interventions. Hypotension/hypoperfusion was the most frequently found preexisting condition (42.5%). The main cause was the presence of preoperative complications (57.5%). Nineteen cases (23.8%) were attributable to anesthesia, with an incidence of 1.11 per 10,000 anesthetic procedures. Survival rate at hospital discharge was 52.5%. The figure for PCA caused by anesthesia was 84.2%. Conclusions: The incidence of PCA and its survival is similar to that reported abroad. In general, PCA has a better prognosis than other types of cardiac arrest, especially if it has an anesthetic cause.

Correlación entre urticaria crónica y coagulación / Correlation between chronic urticaria and coagulation

Chronic urticaria (UC), defined as recurrence of wheals with or without angioedema for more than 6 weeks, is a quite common disease that may severely worsen the quality of life. Although the actual athophysiological mechanisms are still unknown, what we do know is that the main cells involved in their pathology are mast cells and eosinophils. The present article reviews recent findings showing an additional pathogenic mechanisms in UC patients: activation of the coagulation cascade resulting in thrombin production. Several investigators have demonstrated the activation of coagulation that is due to the involvement of eosinophils and a tissue factor pathway with generation of thrombin potentially contributing to an increased vascular permeability. CU patients often present with elevation of coagulation and fibrinolysis markers, such as prothrombin fragment F1+2 and D-dimer, which correlate with the disease severity. Preliminary data indicate that anticoagulant treatment with heparin and warfarin may be effective in reducing the symptoms of this disorder...

Importancia actual de la vitamina D: déficit prevalente y asociación a diversas patologías / Current importance of vitamin D

En los últimos años se ha detectado una epidemia mundial de bajos niveles de vitamina D en la población general, la que ha alertado sobre su correlación con diversas enfermedades. Hay muchas razones que pueden ser las causales de este importante problema, siendo la baja exposición a luz solar uno de los principales. Nuestra especialidad juega un rol central en promover una foto exposición más saludable o suplementando a pacientes de alto riesgo para lograr niveles adecuados de esta vitamina. En nuestra revisión analizamos brevemente las causas de bajos niveles de vitamina D, sus funciones y las recientes correlaciones de su déficit con varias condiciones, entre ellas; el cáncer de piel, atopia y enfermedades autoinmunes. Finalmente recomendamos búsqueda activa y suplementación cuando sea necesario.

In the last few years, a worldwide epidemic of low levels of vitamin D in general population has been discovered, raising an alert about its correlation with health problems. Many reasons may be responsible for this important problem, and insufficient exposure to sunlight may be the main one. Our specialty has a key role in promoting a healthy sun exposure or supplementing high risk patients, to keep adequate levels of this vitamin. In our review, we analyze briefly the causes for low levels of vitamin D, its functions and newly discovered correlations with diseases, including skin cancer, atopy and autoimmune conditions. Finally we recommend screening and supplementation, when necessary.

Cambios dermatológicos fisiológicos y patológicos del embarazo: estudio en 227 mujeres / Physiological and pathological cutaneous changes during pregnancy: study in 227 pregnant women

El embarazo predispone a diversos cambios cutáneos: cambios fisiológicos del embarazo, dermatosis y tumores cutáneos afectados por el embarazo, y dermatosis propias del embarazo. El objetivo de este estudio es describir los cambios cutáneos fisiológicos y patológicos del embarazo, así corno las modificaciones de éstos en los distintos trimestres de gestación. Se realizó un estudio prospectivo-descriptivo en 227 mujeres que concurrían a control obstétrico. Los cambios fisiológicos del embarazo se observaron en 174 (76,65 por ciento) embarazadas, siendo las estrías el cambio más frecuente (49,30 por ciento), seguidas de melasma (30,83 por ciento) y várices (24,22 por ciento). Los cambios fisiológicos del embarazo constituyen el diagnostico más frecuente en todos los trimestres (64,70 por ciento en el primero, 74,44 por ciento en el segundo y 82,52 por ciento en el tercer trimestre). Las patologías dermatológicas más frecuentes fueron dermatitis de contacto (11,89 por ciento) y acné (I 1,0 1 por ciento). Las dermatosis propias del embarazo se observaron en 9 (3,96 por ciento) embarazadas, siendo las más frecuentes el prurigo del embarazo y pápulas y placas urticarianas pruriginosas del embarazo (PPUPE), coda una de el las presente en un 1,76 por ciento de las embarazadas. Las mujeres embarazadas presentan diversos cambios cutáneos durante la gestación. Este trabajo constituye una aproximación a este problema a nivel nacional y evidencia el rol del dermatólogo en la salud materno-fetal.

Pregnancy predisposes to different cutaneous changes: physiological changes of pregnancy, dermatoses and cutaneous tumors aggravated by pregnancy, and specific dermatoses of pregnancy. The objective of this study is to describe physiological and pathological cutaneous changes during pregnancy as well as their modifications during different trimesters. It is a prospective-descriptive study, conducted on 227 pregnant women during obstetric control. Physiological cutaneous changes during pregnancy were observed in 174 women (76.65 percent), being stretch marks the most frequent (49.30 percent), followed by melasma (30.83 percent and varicose veins (24.22 percent). These physiological changes were the most common diagnoses in all trimesters (64.70 percent in the first; 74.44 percent in the second and 82.52 percent in the third). The most frequent cutaneous pathologies were contact dermatitis (11.89 percent) and acne (11.01 percent). Specific dermatoses of pregnancy were observed in 9 women (3.96 percent), being prurigo of pregnancy, and pruntic urticarial papules and plaques of pregnancy (PUPPP) the most common, each one present in 1.76 percent of our study group. Pregnant women present various cutaneous changes during pregnancy. This study is a national approximation to this problem, and evidence the important role of dermatologists in maternal-fetal care.