Estrategia fármaco-invasiva en el manejo del infarto agudo al miocardio con supradesnivel del ST / Pharmaco-invasive approach in the management of acute myocardial infarction. Analysis of 144 cases

BACKGROUND: In those patients who do not have timely access to primary angioplasty, the pharmaco-invasive approach, that is, the use of thrombolysis as a bridging measure prior to the coronary angiography, is a safe alternative. AIM: To describe the features of patients with an acute ST-elevation myocardial infarction (STEMI) treated with a pharmaco-invasive strategy. MATERIAL AND METHODS: Descriptive observational study of 144 patients with mean age of 46 years with STEMI who received a dose of thrombolytic prior to their referral for primary angioplasty at a public hospital between 2018 and 2021. RESULTS: There were no differences the clinical presentation according to the Killip score at admission between thrombolyzed and non-thrombolyzed patients (p = ns). Fifty-three percent of non-thrombolyzed patients were admitted with an occluded vessel (TIMI 0) compared with 27% of thrombolyzed patients (p < 0.001). The thrombolyzed group required significantly less use of thromboaspiration (3.5 and 8.4% respectively; p = 0.014). Despite this, 91 and 92% of non-thrombolyzed and thrombolyzed patients achieved a post-angioplasty TIMI 3 flow. Long-term survival was 91 and 86% in thrombolyzed and non-thrombolyzed patients, respectively (p = ns). CONCLUSIONS: The pharmaco-invasive strategy is a safe alternative when compared to primary angioplasty in centers that don't have timely access to Interventional Cardiology.

[Pharmaco-invasive approach in the management of acute myocardial infarction. Analysis of 144 cases]. / Estrategia fármaco-invasiva en el manejo del infarto agudo al miocardio con supradesnivel del ST.

BACKGROUND: In those patients who do not have timely access to primary angioplasty, the pharmaco-invasive approach, that is, the use of thrombolysis as a bridging measure prior to the coronary angiography, is a safe alternative. AIM: To describe the features of patients with an acute ST-elevation myocardial infarction (STEMI) treated with a pharmaco-invasive strategy. MATERIAL AND METHODS: Descriptive observational study of 144 patients with mean age of 46 years with STEMI who received a dose of thrombolytic prior to their referral for primary angioplasty at a public hospital between 2018 and 2021. RESULTS: There were no differences the clinical presentation according to the Killip score at admission between thrombolyzed and non-thrombolyzed patients (p = ns). Fifty-three percent of non-thrombolyzed patients were admitted with an occluded vessel (TIMI 0) compared with 27% of thrombolyzed patients (p < 0.001). The thrombolyzed group required significantly less use of thromboaspiration (3.5 and 8.4% respectively; p = 0.014). Despite this, 91 and 92% of non-thrombolyzed and thrombolyzed patients achieved a post-angioplasty TIMI 3 flow. Long-term survival was 91 and 86% in thrombolyzed and non-thrombolyzed patients, respectively (p = ns). CONCLUSIONS: The pharmaco-invasive strategy is a safe alternative when compared to primary angioplasty in centers that don't have timely access to Interventional Cardiology.

[Transfemoral transcatheter aortic valve implantation under conscious sedation. Experience in 15 patients]. / Implante de válvula aórtica percutánea con técnica de sedación consciente.

BACKGROUND: Transfemoral transcatheter aortic valve implantation (TAVI) is the standard of treatment for patients with symptomatic severe aortic stenosis (AE) and intermediate or high surgical risk. The use of conscious sedation (CS) could reduce complications and allow an early discharge of these patients. AIM: To report our experience with TAVI under conscious sedation. MATERIAL AND METHODS: Review of medical records of 15 patients aged 79 ± 6 years (53% women) undergoing a transfemoral TAVI implant under conscious sedation. RESULTS: The indications for the procedure were severe AE in 13 patients and biological prosthetic dysfunction in two. The mean Thoracic Surgeons predicted risk of mortality score was 7.3. The valves used were Edwards Sapien 3 in three patients, Medtronic Evolut in five, Boston Acurate Neo in four and Meril Myval in three. A successful implant was achieved in all cases and there were no hospital mortality or pacemaker requirements. One patient had a stroke, and one patient had a vascular access complication. Early discharge (< 72 h) was achieved in 80% of patients. CONCLUSIONS: TAVI under conscious sedation was a safe procedure and associated with a complication rate similar to previous reports, allowing for an early hospital discharge in most patients.

Implante de válvula aórtica percutánea con técnica de sedación consciente / Transfemoral transcatheter aortic valve implantation under conscious sedation: experience in 15 patients

Background: Transfemoral transcatheter aortic valve implantation (TAVI) is the standard of treatment for patients with symptomatic severe aortic stenosis (AE) and intermediate or high surgical risk. The use of conscious sedation (CS) could reduce complications and allow an early discharge of these patients. Aim: To report our experience with TAVI under conscious sedation. Material and Methods: Review of medical records of 15 patients aged 79 ± 6 years (53% women) undergoing a transfemoral TAVI implant under conscious sedation. Results: The indications for the procedure were severe AE in 13 patients and biological prosthetic dysfunction in two. The mean Thoracic Surgeons predicted risk of mortality score was 7.3. The valves used were Edwards Sapien 3 in three patients, Medtronic Evolut in five, Boston Acurate Neo in four and Meril Myval in three. A successful implant was achieved in all cases and there were no hospital mortality or pacemaker requirements. One patient had a stroke, and one patient had a vascular access complication. Early discharge (< 72 h) was achieved in 80% of patients. Conclusions: TAVI under conscious sedation was a safe procedure and associated with a complication rate similar to previous reports, allowing for an early hospital discharge in most patients.

Seguimiento del cáncer de cabeza y cuello tratado. Lo que el radiólogo debe conocer / Follow-up in head and neck cancer. What the radiologist must know

El manejo de los pacientes con cáncer de cabeza y cuello implica un tratamiento multidisciplinar con cirugía, radioterapia y quimioterapia. Las pruebas de imagen son cruciales en su seguimiento, sobre todo cuando la recurrencia tumoral no sea clínicamente evidente. Distinguir radiológicamente los cambios postratamiento de una recidiva tumoral constituye un reto debido a la alteración anatómica que suponen las técnicas quirúrgicas y sus reconstrucciones, al tratamiento radioterápico y a las pautas quimioterápicas. El diagnóstico diferencial debe incluir las posibles complicaciones derivadas de la radioterapia (necrosis mucosa, osteorradionecrosis, vasculopatía, radionecrosis cerebral) y de la cirugía (infecciones de la herida, necrosis del colgajo, fístulas, etc.). Un amplio conocimiento de los hallazgos esperables del tratamiento multimodal y sus complicaciones es esencial para un diagnóstico preciso de recurrencia tumoral. Por último, elegir la prueba de imagen adecuada y disponer de un estudio basal postratamiento es igualmente relevante para un control radiológico idóneo

The management of patients with head and neck cancer implies a multidisciplinary treatment with surgery, radiotherapy and chemotherapy. Imaging is crucial in their follow-up, especially when the tumor recurrence is not clinically evident. Radiologically distinguishing post-treatment changes from a tumor recurrence is a challenge due to the anatomical alteration due to surgical techniques and their reconstructions, radiotherapy treatment and chemotherapeutic guidelines. The differential diagnosis must include the possible complications derived from radiotherapy (mucosal necrosis, osteoradionecrosis, vasculopathy, cerebral radionecrosis) and surgery (wound infections, flap necrosis, fistulas,...). A wide knowledge of the expected findings of multimodal treatment and its complications is essential for an accurate diagnosis of tumor recurrence. Finally, choosing the appropriate image study and having a baseline post-treatment study is also relevant for a suitable radiological control

Follow-up in head and neck cancer. What the radiologist must know. / Seguimiento del cáncer de cabeza y cuello tratado. Lo que el radiólogo debe conocer.

The management of patients with head and neck cancer implies a multidisciplinary treatment with surgery, radiotherapy and chemotherapy. Imaging is crucial in their follow-up, especially when the tumor recurrence is not clinically evident. Radiologically distinguishing post-treatment changes from a tumor recurrence is a challenge due to the anatomical alteration due to surgical techniques and their reconstructions, radiotherapy treatment and chemotherapeutic guidelines. The differential diagnosis must include the possible complications derived from radiotherapy (mucosal necrosis, osteoradionecrosis, vasculopathy, cerebral radionecrosis) and surgery (wound infections, flap necrosis, fistulas,...). A wide knowledge of the expected findings of multimodal treatment and its complications is essential for an accurate diagnosis of tumor recurrence. Finally, choosing the appropriate image study and having a baseline post-treatment study is also relevant for a suitable radiological control.

Hydrogen Production by Formic Acid Decomposition over Ca Promoted Ni/SiO2 Catalysts: Effect of the Calcium Content.

Formic acid, a major product of biomass processing, is regarded as a potential liquid carrier for hydrogen storage and delivery. The catalytic dehydrogenation of FA to generate hydrogen using heterogeneous catalysts is of great interest. Ni based catalysts supported on silica were synthesized by incipient wet impregnation. The effect of doping with an alkaline earth metal (calcium) was studied, and the solids were tested in the formic acid decomposition reaction to produce hydrogen. The catalysts were characterized by X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), temperature-programmed reduction (TPR), Fourier transform infrared spectroscopy (FTIR), transmission electron microscopy (TEM), and programmed temperature surface reaction (TPSR). The catalyst doped with 19.3 wt.% of Ca showed 100% conversion of formic acid at 160 °C, with a 92% of selectivity to hydrogen. In addition, all the tested materials were promising for their application, since they showed catalytic behaviors (conversion and selectivity to hydrogen) comparable to those of noble metals reported in the literature.

Neuroimagen y ensayos clínicos con células madre en la esclerosis lateral amiotrófica: perspectivas de presente y futuro / Neuroimaging and clinical trials with stem cells in amyotrophic lateral sclerosis: present and future perspectives

La esclerosis lateral amiotrófica es una enfermedad neurodegenerativa rara con un curso rápido y fatal. La ausencia de tratamientos efectivos ha hecho surgir nuevas líneas de investigación, entre ellas las basadas en células madre. La inyección quirúrgica intramedular, que ha sido la principal vía de administración, ha demostrado ser segura en los ensayos de seguridad del procedimiento. Sin embargo, persisten desafíos como la mejor vía de administración o el modo de comprobar la supervivencia de las células y su interacción con la diana terapéutica. La misión de las técnicas de neuroimagen ha sido hasta ahora la detección de lesiones y complicaciones espinales y medulares, pero tienen potencial para sustituir al estudio anatomopatológico, analizando la relación de las células implantadas con la diana terapéutica, y como biomarcadores de la enfermedad, midiendo cambios morfológicos y funcionales postratamiento, lo que implicará más a los radiólogos en el manejo clínico de estos enfermos

Amyotrophic lateral sclerosis is a rare neurodegenerative disease with a rapid fatal course. The absence of effective treatments has led to new lines of research, some of which are based on stem cells. Surgical injection into the spinal cord, the most common route of administration of stem cells, has proven safe in trials to test the safety of the procedure. Nevertheless, challenges remain, such as determining the best route of administration or the way of checking the survival of the cells and their interaction with the therapeutic target. To date, the mission of neuroimaging techniques has been to detect lesions and complications in the spine and spinal cord, but neuroimaging also has the potential to supplant histologic study in analyzing the relations between the implanted cells and the therapeutic target, and as biomarkers of the disease, by measuring morphological and functional changes after treatment. These developments would increase the role of radiologists in the clinical management of patients with amyotrophic lateral sclerosis

Neuroimaging and clinical trials with stem cells in amyotrophic lateral sclerosis: present and future perspectives. / Neuroimagen y ensayos clínicos con células madre en la esclerosis lateral amiotrófica: perspectivas de presente y futuro.

Amyotrophic lateral sclerosis is a rare neurodegenerative disease with a rapid fatal course. The absence of effective treatments has led to new lines of research, some of which are based on stem cells. Surgical injection into the spinal cord, the most common route of administration of stem cells, has proven safe in trials to test the safety of the procedure. Nevertheless, challenges remain, such as determining the best route of administration or the way of checking the survival of the cells and their interaction with the therapeutic target. To date, the mission of neuroimaging techniques has been to detect lesions and complications in the spine and spinal cord, but neuroimaging also has the potential to supplant histologic study in analyzing the relations between the implanted cells and the therapeutic target, and as biomarkers of the disease, by measuring morphological and functional changes after treatment. These developments would increase the role of radiologists in the clinical management of patients with amyotrophic lateral sclerosis.

Behçet vascular: seguimiento a 3 años de paciente con presentación poli-aneurismática arterial complicada por múltiples roturas / Vascular Behcet's disease: a 3 year follow-up of a patient with multiple arterial aneurysms complicated by ruptures

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International experts' practice in the antibiotic therapy of infective endocarditis is not following the guidelines.

OBJECTIVE: The management of infective endocarditis (IE) may differ from international guidelines, even in reference centres. This is probably because most recommendations are not based on hard evidence, so the consensus obtained for the guidelines does not represent actual practices. For this reason, we aimed to evaluate this question in the particular field of antibiotic therapy. METHODS: Thirteen international centres specialized in the management of IE were selected, according to their reputation, clinical results, original research publications and quotations. They were asked to detail their actual practice in terms of IE antibiotic treatment in various bacteriological and clinical situations. They were also asked to declare their IE-related in-hospital mortality for the year 2015. RESULTS: The global compliance with guidelines concerning antibiotic therapy was 58%, revealing the differences between theoretical 'consensus', local recommendations and actual practice. Some conflicts of interest were also probably expressed. The adherence to guidelines was 100% when the protocol was simple, and decreased with the seriousness of the situation (Staphylococus spp. 54%-62%) or in blood-culture-negative endocarditis (0%-15%) that requires adaptation to clinical and epidemiological data. CONCLUSION: Worldwide experts in IE management, although the majority of them were involved and co-signed the guidelines, do not follow international consensus guidelines on the particular point of the use of antibiotics.

Fisiopatología del envejecimiento prematuro en los pacientes con infección por el VIH / No disponible

Tras 30 años de epidemia de la infección por el VIH muchos pacientes infectados han sobrevivido hasta edades más avanzadas tras la introducción del tratamiento antirretroviral de gran eficacia (TAR) en 1996. De 2000 a 2004, los CDC informaron que el número de adultos ≥ 50 años de edad que viven con infección por VIH y / o SIDA se duplicó. Además se espera que el número de personas mayores con VIH / SIDA aumente aún más durante la próxima década. Se estima que para el año 2020, más de la mitad de todos los individuos infectados por el VIH en los Estados Unidos sean mayores de 50 años. in embargo este aumento de la población VIH mayor de 50 años conlleva a una mayor prevalencia de determinadas comorbilidades relacionadas con la edad que en la población general aparecen en personas más mayores. Por tanto, el éxito que supone haber conseguido una mayor supervivencia no es tal si esto refleja un envejecimiento prematuro asociado a la infección por el VIH que está asociado principalmente a un proceso de inmunoactivación e inflamación crónica (AU)

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Perfil lipídico en mujeres embarazadas sanas de tres regiones de Chile / Lipid profile in healthy pregnant women in three regions of Chile

Antecedentes: Los lípidos plasmáticos maternos durante el embarazo pueden influir en el crecimiento fetal, particularmente en pacientes con diabetes gestacional; estos lípidos cambian su concentración plasmática materna a lo largo de la gestación. Objetivo: Calcular tablas y curvas de lípidos normales según edad gestacional en una población de embarazadas chilenas. Método: Se midió el colesterol total (CT), colesterol LDL (LDL-C) triglicéridos (TG), Colesterol-HDL (HDL-C), y ácidos grasos no esterificados (NEFA), en 94 embarazadas sanas y jóvenes (<33 años, edad media de 27,6 +/- 6,2 años), con peso pregestacional normal (Índice de Masa Corporal entre 20 y 24,9 Kg/m2 y medio de 23,3 +/- 2,0 Kg/m2). Las pacientes provenían de: Hospital Parroquial de San Bernardo, Santiago (n=55), Hospital de Talca (n=2); Hospital del Profesor, Santiago (n=18); Hospital Regional de Concepción (n=9) y Hospital Clínico de la Pontificia Universidad Católica de Chile (n=10). Resultados: Calculamos, para cada uno de los cuatro lípidos, las curvas de percentil 50, percentil 90 y percentil 10, en mg/dL y mmol/l. Los NEFA solo fueron expresados en mmol/l. Incluimos las funciones matemáticas de las curvas de regresión polinomial de los cuatro lípidos con el fin que sean fácilmente reproducibles en otros tamaños. Conclusiones: Calculamos las tablas y curvas de lípidos maternos normales a lo largo del embarazo, que sean aplicables a la población de embarazadas chilenas.

Background: In normal human pregnancy, maternal lipids can modify the rate of fetal growth, particularly in pregnancies with Gestational Diabetes Mellitus (GDM). These lipids change continuously their serum concentration in the mother along the pregnancy. Aim: To calculate tables and curves of normal serum lipids, according to gestational age, in healthy Chilean pregnant women. Methods: We measured total cholesterol (CT), LDL-cholesterol (LDL-C), triglycerides (TG), HDL-Cholesterol (HDL-C), and Non-Esterified Fatty Acids (NEFA) in 94 young and healthy pregnant women (< 33 years, mean age 27.6 +/- 6.2 years), with normal pregestational Body Mass Index (BMI, 20.0-24.9 Kg/m2 , mean value= 23.3 +/- 2.0 Kg/m2). The women of the study were patients of 5 hospitals: Hospital Parroquial de San Bernardo, Santiago (n=55), Hospital de Talca (n=2); Hospital del Profesor, Santiago (n=18); Hospital Regional de Concepción (n=9) and Hospital Clínico de la Pontificia Universidad Católica de Chile (n=10). Results: For each one of the lipids, we calculated curves of 50th, 90th and 10th percentiles, both in mg/dL and mmol/L (the NEFA were expressed only in mmol/L). The mathematical functions of the curves of polynomial regression of all lipids were included in the manuscript, in order to facilitate their reproduction. Conclusions: We calculated tables and curves of normal maternal serum lipids in relation to gestational, in order to make these available for use in the care of Chilean pregnant women.

Atopic dermatitis guideline. Position paper from the Latin American Society of Allergy, Asthma and Immunology.

As in other regions, the incidence of atopic dermatitis in Latin America has been increasing in recent years. Although there are several clinical guidelines, many of their recommendations cannot be universal since they depend on the characteristics of each region. Thus, we decided to create a consensus guideline on atopic dermatitis applicable in Latin America and other tropical regions, taking into account socio-economic, geographical, cultural and health care system characteristics. The Latin American Society of Allergy Asthma and Immunology (SLAAI) conducted a systematic search for articles related to the pathophysiology, diagnosis and treatment of dermatitis using various electronic resources such as Google, Pubmed, EMBASE (Ovid) and Cochrane data base. We have also looked for all published articles in Latin America on the subject using LILACS (Latin American and Caribbean Literature on Health Sciences) database. Each section was reviewed by at least two members of the committee, and the final version was subsequently approved by all of them, using the Delphi methodology for consensus building. Afterward, the final document was shared for external evaluation with physicians, specialists (allergists, dermatologists and pediatricians), patients and academic institutions such as universities and scientific societies related to the topic. All recommendations made by these groups were taken into account for the final drafting of the document. There are few original studies conducted in Latin America about dermatitis; however, we were able to create a practical guideline for Latin America taking into account the particularities of the region. Moreover, the integral management was highlighted including many of the recommendations from different participants in the health care of this disease (patients, families, primary care physicians and specialists). This practical guide presents a concise approach to the diagnosis and management of atopic dermatitis that can be helpful for medical staff, patients and their families in Latin America.

La incidencia de dermatitis atópica en Latinoamérica muestra un incremento constante, si bien existen muchas guías clínicas de dermatitis atópica, muchas de las recomendaciones no pueden ser válidas de manera universal debido a las particularidades de cada región. Por ello, nos propusimos crear una guía de consenso de dermatitis atópica válida para Latinoamérica y otras regiones tropicales, que tome en cuenta las características socioeconómicas, geográficas, culturales y de los sistemas de salud. La Sociedad Latinoamericana de Alergia, Asma e Inmunología (SLAAI) realizó una búsqueda sistemática de artículos relacionados con la fisiopatología, el diagnóstico y el tratamiento de la dermatitis atópica usando diversas fuentes electrónicas, como Google, Pubmed, EMBASE (Ovid) y Cochrane. También realizamos una búsqueda extensa de las publicaciones realizadas en Latinoamérica utilizando el buscador LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud). Cada sección fue revisada por al menos dos miembros del comité y luego una versión final fue aprobada por todos los participantes, utilizando la metodología Delphi para la construcción de consensos. Finalmente, el documento final fue compartido para la evaluación externa por médicos, otros especialistas (alergólogos, dermatólogos, pediatras), pacientes e instituciones académicas, como universidades y sociedades científicas relacionadas con el tema. Todas las recomendaciones dadas por estos grupos se tomaron en cuenta y se incluyeron en la versión final del documento. Existen pocos estudios realizados en Latinoamérica acerca de dermatitis; sin embargo, fue posible crear una guía que considera las particularidades de la región tropical. Además, destacó el tratamiento integral porque se consideraron muchas de las recomendaciones ofrecidas por los diferentes participantes en el tratamiento de esta enfermedad (pacientes, familiares, médicos de atención primaria, especialistas). atópica, muchas de las recomendaciones no pueden ser válidas de manera universal debido a las particularidades de cada región. Por ello, nos propusimos crear una guía de consenso de dermatitis atópica válida para Latinoamérica y otras regiones tropicales, que tome en cuenta las características socioeconómicas, geográficas, culturales y de los sistemas de salud. La Sociedad Latinoamericana de Alergia, Asma e Inmunología (SLAAI) realizó una búsqueda sistemática de artículos relacionados con la fisiopatología, el diagnóstico y el tratamiento de la dermatitis atópica usando diversas fuentes electrónicas, como Google, Pubmed, EMBASE (Ovid) y Cochrane. También realizamos una búsqueda extensa de las publicaciones realizadas en Latinoamérica utilizando el buscador LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud). Cada sección fue revisada por al menos dos miembros del comité y luego una versión final fue aprobada por todos los participantes, utilizando la metodología Delphi para la construcción de consensos. Finalmente, el documento final fue compartido para la evaluación externa por médicos, otros especialistas (alergólogos, dermatólogos, pediatras), pacientes e instituciones académicas, como universidades y sociedades científicas relacionadas con el tema. Todas las recomendaciones dadas por estos grupos se tomaron en cuenta y se incluyeron en la versión final del documento. Existen pocos estudios realizados en Latinoamérica acerca de dermatitis; sin embargo, fue posible crear una guía que considera las particularidades de la región tropical. Además, destacó el tratamiento integral porque se consideraron muchas de las recomendaciones ofrecidas por los diferentes participantes en el tratamiento de esta enfermedad (pacientes, familiares, médicos de atención primaria, especialistas).

Diagnóstico y tratamiento de un caso de endoprótesis de aorta torácica infectada / Diagnosis and treatment of a case of an infected thoracic aortic endoprosthesis

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Dolor abdominal súbito durante un viaje en avión: pienso en lo más frecuente, pero, ¿y si se trata de una entidad infrecuente? / Sudden abdominal pain during an airplane flight: what if the horse turns out to be a zebra?

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Mujer joven sin factores de riesgo cardiovascular, con clínica de claudicación intermitente / A young woman without cardiovascular risk factors with symptoms of intermittent claudication

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Valvuloplastía en estenosis mitral moderada a severa por sobre reemplazo valvular, según criterios de Wilkins: reporte de un caso / Valvuloplasty in moderate to severe mitral stenosis over valve replacement, according to Wilkins score: case report

INTRODUCCIÓN: La valvulopatía reumática es una entidad aún frecuente en Chile, siendo la válvula mitral la más afectada. Su principal motivo de consulta es disnea progresiva. Sin tratamiento tiene mal pronóstico debido al estrechamiento progresivo de dicha válvula. En la actualidad es posible tratarla mediante cirugía abierta y valvuloplastía mitral percutánea. En este caso se revisa y discute las indicaciones actualizadas de cada una, destaca al ecocardiograma para la selección de los pacientes, y analiza las ventajas y desventajas de las diferentes técnicas. PRESENTACIÓN DEL CASO: Mujer de 44 años, con estenosis mitral, disnea progresiva en Capacidad Funcional (CF) III de 3 años de evolución. Se realiza ecocardiografía transtorácica que demuestra estenosis mitral severa de etiología reumática y se decide cirugíade reemplazo valvular. En el ecocardiograma transtorácico para evaluación preoperatorio se concluye score de Wilkins de 5 puntos por lo que se sugiere realizar valvuloplastía mitral, resultando exitosa sin complicaciones y con aumento de área mitral a 1,9 cm2. DISCUSIÓN: Inicialmente se planteó cirugía de reemplazo valvular, pero al realizar el ecocardiograma preoperatorio se decide realizar valvuloplastía mitral por sobre cirugía debido al score de Wilkins. Éste score es la herramienta más utilizada para decidir entre estas dos técnicas, y según últimos estudios puede ser mejorado con la inclusión del parámetro de calcificación comisural evitando de esta manera sus principales complicaciones.

INTRODUCTION: Rheumatic valve disease is still common entity in Chile, being mitral valve the most affected. His main complaint is progressive dyspnea. Without treatment has a poor prognosis due to progressive narrowing of the valve. It is now possible to treat by an open surgery or percutaneous mitral valvuloplasty. In this case we review and discuss the indications, highlight the echocardiogram for patient selection, and discusses the advantages and disadvantages of the different techniques. CASE PRESENTATION: 44 years old woman with mitral stenosis, progressive dyspnea Functional Capacity (CF) III of 3 years duration. Transthoracic echocardiography was performed demonstrating severe mitral stenosis of rheumatic etiology and decides valve replacement surgery. In transthoracic echocardiography for preoperative evaluation concludes Wilkins score of 5 points so it is suggested mitral valvuloplasty proving successful and uncomplicated mitral area increased to 1.9 cm2. DISCUSSION: originally was raised valve replacement surgery and because of the preoperative echocardiogram is decided to perform mitral valvuloplasty instead of surgery because of Wilkins score. This score is the most used tool for deciding between these two techniques, and according to recent studies can be improved with the inclusion of commissural calcification parameter thus avoiding its major complications.

PP166. HELLP syndrome: Challenges for establishing diagnostic criteria.

INTRODUCTION: Preeclampsia is a public health problem which may manifest as pre-eclampsia (hypertension, proteinuria and/or edema) and eclampsia (convulsive crises and rarely coma in pregnant women with previous pre-eclampsia). But the pathology of hypertensive disease of pregnancy can present different clinical forms. Within that spectrum is HELLP syndrome: hemolysis (H), elevated liver enzymes (EL) and thrombocytopenia (LP). OBJECTIVES: To assess the diagnostic criteria in the literature adopted for HELLP syndrome. METHODS: A literature review on the Virtual Health Library with the keywords "HELLP syndrome" and "diagnosis" found 674 citations. Six hundred and thirty-four dismissed for failing to engage with the proposed question, and 43 articles remained. Twenty seven articles were excluded because of the language, unable in Latin America, letters, case report and articles published prior to 1999. Sixteen original articles were included. Eleven reviews, one prospective study, two cohorts, one retrospective cohort study and a cross. Studies were classified according to degree of recommendation and level of evidence. RESULTS: The term clinical and laboratory markers were varied and their cut-off levels differ among the authors. The appearance of eclampsia, pain in the upper abdomen, nausea and significant proteinuria and other maternal morbidities were more frequent in patients with HELLP syndrome. The levels of lactic dehydrogenase, AST, and uric acid were further elevated in women with HELLP syndrome guarding correlation with the prognosis of the case. There is no consensus for the interpretation of laboratory values that may represent the most widespread occurrence of parameters: hemolytic anemia, elevated liver enzymes and thrombocytopenia. Other morbidities may have clinical signs, symptoms and laboratory abnormalities that mimic the syndrome. CONCLUSION: There are many questions to establish standard diagnostic criteria for all patients with HELLP syndrome, necessitating studies consistent with significant population numbers to establish the main signs and symptoms and try to reach consensus on the best markers for the diagnosis and its proper indexes cutting.