Deglución post extubación de pacientes críticos con y sin diagnóstico de COVID-19 durante la pandemia / Post extubation swallowing in critical patients with and without COVID-19 during the pandemic

Estudios previos han caracterizado la disfagia en pacientes críticos hospitalizados que requieren intubación y ventilación mecánica invasiva. A raíz de la pandemia COVID-19 es necesario conocer las características deglutorias de pacientes diagnosticados con la enfermedad para su manejo. El objetivo de este estudio es analizar las características deglutorias de pacientes críticos extubados con y sin diagnóstico de COVID-19. Se llevó a cabo un estudio de cohorte retrospectivo con una muestra a conveniencia de 43 sujetos mayores de 15 años, ingresados al Hospital San Juan de Dios (Santiago, Chile) entre el 01 de junio y el 31 de agosto de 2020, intubados con o sin diagnóstico de COVID-19. Del total de sujetos, 22 padecieron de COVID-19 quienes estuvieron significativamente más días intubados que aquellos sin la patología (p=0,002). Inmediatamente posterior a la extubación orotraqueal, más del 90% de la muestra presentó disfagia. No hubo diferencia significativa en el nivel FILS ni asociación significativa en el grado de severidad de la disfagia entre sujetos con y sin COVID-19. Tampoco hubo diferencia significativa en el nivel FILS entre los grupos a los 10 días post-extubación. El nivel FILS a los 10 días aumentó significativamente en aquellos sujetos con COVID-19 (p=0,016) y sin COVID-19 (p=0,004). En la muestra, el nivel FILS y grado de severidad de la disfagia de los pacientes con y sin COVID-19 no mostraron diferencias estadísticas, siendo alto el porcentaje de disfagia en ambos grupos, lo que se podría asociar a la intubación orotraqueal y al tubo orotraqueal. Es necesaria la incorporación del fonoaudiólogo dentro de los equipos de Unidades de Pacientes Críticos para el manejo de los pacientes con COVID-19 y disfagia. Además, se recomienda continuar con más estudios en el área.

Previous research have described the deglutition disorders in critical hospitalised patients who required intubation and mechanical ventilation. In the pandemic context, it is mandatory to study both level and grade of dysphagia in patients suffering from COVID-19. The aim of this study is to analyse the deglutition features of extubated critical patients with and without COVID-19. A retrospective cohort study was performed, considering a convenience sample of 43 patients from 15 years old hospitalised at 'Hospital San Juan de Dios' between June 1st and August 31th 2020, who were intubated, with and without the diagnosis of COVID-19. 22of out 43 patients were diagnosed with COVID-19 who were intubated for significantly more days in comparison with those without COVID-19 (p=.002). After the intratracheal extubation, 90% of the sample was diagnosed with dysphagia. There was no significant difference in the FILS score nor significant association in dysphagia severity between patients with and without COVID-19. After 10 days post extubation, there was no significant difference in the FILS score between both groups. The FILS score increased significantly in the COVID-19 (p=.016) and non-COVID-19 (p=.004) patients after 10 days post extubation. Post extubation, there are no statistical differences in the FILS score and dysphagia severity in critical ill patients with and without COVID-19, with a high percentage of dysphagia in both groups which could be associated with intratracheal intubation and endotracheal tubes. The incorporation of speech and language therapists in Critical Care Units is mandatory. Furthermore, it is recommended to perform extra research in the area.

Peripheral T-cell lymphoma not otherwise specified with oral manifestation: a case report / Linfoma periférico de células T no especificado con manifestación oral: reporte de caso

Peripheral T-Cell Lymphoma Not Otherwise Specified it is a rare type of Non-Hodgkin t-cells malignant tumor whose oral manifestations are difficult to diagnose. A case of a 48-year-old male with a hemi-maxillary lesion histological and immunohistochemically compatible with Peripheral T-Cell Lymphoma not otherwise specified is presented. A case of a 48-year-old male with a hemi-maxillary lesion histological and immunohistochemically compatible with Peripheral T-Cell Lymphoma not otherwise specified is presented. The patient treatment consisted of chemotherapy, but after the second cycle, died from immunosuppressive complications. Early stage diagnosis of oral lesions is imperative to avoid aggressive treatment and low overall survival rate of such pathologies.

Introducción: El linfoma periférico de células T no especificado es un tipo raro de tumor maligno no Hodgkin de células T cuyas manifestaciones orales son difíciles de diagnosticar. Se presenta el caso de un varón de 48 años con lesión hemimaxilar histológica e inmunohistoquímicamente compatible con linfoma periférico de células T no especificado. El tratamiento del paciente consistió en quimioterapia, pero después del segundo ciclo, falleció por complicaciones inmunosupresoras. El diagnóstico temprano de las lesiones orales es imperativo para evitar un tratamiento agresivo y la baja tasa de supervivencia.

Linfoma Extranodal de Células T/NK en Cavidad Oral. Reporte de un Caso en Chile / Extranodal Lymphoma of T / NK Cells in Oral Cavity. Case Report in Chile

RESUMEN: El linfoma extranodal de células T/NK es una neoplasia maligna agresiva que se caracteriza por una destrucción de estructuras de la línea media de la cara como paladar y fosa nasal. Presentamos el caso de un paciente de sexo masculino, 48 años de edad, consumidor de cocaína, que consulta en la Facultad de Odontología de la Universidad de Chile en Septiembre del 2015 por síntomas de disfagia, rinorrea y que presenta al examen clínico un tumor ulcerado que compromete paladar duro y blando, de un mes de evolución. Se confirma diagnóstico de linfoma de células T/NK con una batería de pruebas inmunohistoquímicas. Esta patología, aunque infrecuente, siempre debe ser considerada dentro los diagnósticos diferenciales en tumores ulcerados en esta localización.

ABSTRACT: Extranodal T / NK cell lymphoma is an aggressive malignant neoplasm characterized by destruction of midline structures of the face such as the palate and nasal fossa. We present the case of a male patient, 48 years old, cocaine user, who consults at the Faculty of Dentistry of the Universidad de Chile in September of 2015 due to symptoms of dysphagia, rhinorrhea and presenting to the clinical examination an ulcerated tumor which compromises hard and soft palate, a month of evolution. Diagnosis of T / NK cell lymphoma is confirmed with a battery of immunohistochemical tests. This pathology, although infrequent, should always be considered within the differential diagnoses in ulcerated tumors of this location.

Violencia policial y afrontamiento: crecimiento postraumático en pobladores de una comunidad aislada del sur de Chile / Police Violence and Coping: Posttraumatic Growth in a Community Isolated of Southern Chile

En Puerto Aysén, a inicios del año 2012, se realizaron manifestaciones sociales en pro del mejoramiento de la calidad de vida de sus habitantes que fueron duramente reprimidas por una inusitada fuerza policial enviada desde la capital, Santiago de Chile. El presente estudio evaluó la influencia de la participación social en las asambleas, las marchas y actividades de resistencia, la experiencia de compartir socialmente con otros, la severidad subjetiva del evento y diversas estrategias de afrontamiento, sobre el crecimiento postraumático, en 301 habitantes adultos de dicha localidad. Los resultados muestran que quienes participaron en manifestaciones y actividades de resistencia, compartieron su experiencia con otras personas, usaron estrategias de afrontamiento como la búsqueda de apoyo instrumental, afrontamiento activo, religiosidad y negación, entre otras, presentaron mayores niveles de crecimiento postraumático. A continuación, se presentan los datos y las implicancias de dichos hallazgos.

This study assessed the influence of social participation in assemblies, marches and resistance activities, social sharing experience with other; subjective severity of the event and coping strategies on posttraumatic growth in 301 adult residents Puerto Aysen, where at the beginning of 2012, were performed social manifestations to improve their quality of life and were harshly repressed by an unusual police force sent from the capital, Santiago de Chile. The results show that people who participated in manifestations and resistance activities, socially shared, used strategies of seeking instrumental support, active coping, religiosity and denial, among others, had higher levels of posttraumatic growth. Then we present the data and the implications of these findings.

Determinantes precoces en el desarrollo de injuria renal aguda durante la sepsis abdominal experimental / Early determinants of acute kidney injury during experimental intra-abdominal sepsis

Background: Sepsis-induced acute kidney injury (AKI) is an early and frequent organ dysfunction, associated with increased mortality. Aim: To evaluate the impact of macrohemodynamic and microcirculatory changes on renal function and histology during an experimental model of intra-abdominal sepsis. Material and Methods: In 18 anaesthetized pigs, catheters were installed to measure hemodynamic parameters in the carotid, right renal and pulmonary arteries. After baseline assessment and stabilization, animals were randomly divided to receive and intra-abdominal infusion of autologous feces or saline. Animals were observed for 18 hours thereafter. Results: In all septic animals, serum lactate levels increased, but only eight developed AKI (66%). These animals had higher creatinine and interleukin-6 levels, lower inulin and para-aminohippurate clearance (decreased glomerular filtration and renal plasma flow), and a negative lactate uptake. Septic animals with AKI had lower values of mean end arterial pressure, renal blood flow and kidney perfusion pressure, with an associated increase in kidney oxygen extraction. No tubular necrosis was observed in kidney histology. Conclusions: The reduction in renal blood flow and renal perfusion pressure were the main mechanisms associated with AKI, but were not associated with necrosis. Probably other mechanisms, such as microcirculatory vasoconstriction and inflammation also contributes to AKI development.