Visión general de la reumatología en Chile / Overview of the rheumatology in Chile

El inicio de la Reumatología en nuestro país data del año 1873 con la primera publicación dedicada a la especialidad, pero no es hasta el año 1944 con la creación de la primera clínica en que la Reumatología nace formalmente. El segundo hito es la creación de la Sociedad Chilena de Reumatología en 1950, que desde esa fecha se ha preocupado de mantener actualizada a la comunidad científica y como apoyo constante a los pacientes. Desde el punto de vista de las patologías observadas son diferentes las frecuencias en complejos de atención primaria versus complejos de atención terciaria. En el año 2007 se incorpora el sistema Auge, que otorga a pacientes con algunas patologías reumatológicas garantías de atención y tratamiento, incluyendo biológicos en algunos casos. Se intenta en este artículo dar una revisión general a la historia y actualidad reumatológica chilena.

The start of Rheumatology in our country dates back to 1873 with the first publication devoted to the specialty, but not until 1944 with the creation of the first clinic in Rheumatology that the specialty formally born, the 2nd milestone was the creation of the Chilean Society of Rheumatology in 1950 which since then, has been concerned for keeping the scientific community update and give an ongoing support to patients. From the point of view of the observed diseases there are different frequencies when we compare the primary care vs. tertiary care health systems. In 2007 the AUGE system starts. This system gives to patients with specific rheumatologic diseases warranty of attention and treatment, including biologics therapies in some cases. We attempted in this paper give an overview of the history and current Chilean Rheumatology.

The effect of partial reinforcement on instrumental successive negative contrast in inbred Roman High- (RHA-I) and Low- (RLA-I) Avoidance rats.

Frustration is an emotional response that can be induced by the sudden devaluation of a reinforcer in the presence of greater reinforcement expectancies (e.g. instrumental successive negative contrast, iSNC). This emotional response seems to be similar to anxiety and can be attenuated by previous experiences of reward loss (e.g. partial reinforcement, PR, as opposed to continuous reinforcement, CR). In this study we used iSNC and PR procedures in order to compare the performance of two strains of rats psychogenetically selected on the basis of their emotional reactivity: the inbred Roman High- (RHA-I, low anxiety) and Low- (RLA-I, high anxiety) Avoidance rats. Animals were exposed to a straight alley, where they were changed from 12 pellets in the preshift phase (presented in 100% of trials-CR vs. 50% of trials-PR) to 2 pellets in the postshift phase, or exposed to 2 pellets throughout the training. The results indicated that the iSNC only appeared in RLA-I rats exposed to CR, as opposed to RLA-I animals exposed to PR and to RHA-I rats exposed to PR or CR. These data seem to support the implication of emotional responses in both iSNC and PR situations, and indicate that the behavioral reactivity to reward loss experiences is modulated by genetic variables.

[Severe lactic acidosis caused by propofol infusion: report of one case]. / Acidosis láctica severa asociada a infusión de propofol: Caso clínico.

Propofol infusion syndrome (PRIS) is a rare but potentially lethal complications. This disorder is triggered under unknown circumstances by a propofol infusion of more than 5 mg/kg/h for more than 48 h. PRIS is characterized by a multiorgan failure and rhabdomyolysis and is induced by a disturbance in mitochondrial long chain fatty acid oxidation. We report a 43 year-old woman who underwent brain surgery due to a vascular malformation. In the immediate postoperative period, she had an unexplained and severe lactic acidosis. During anaesthesia, she received a propofol infusion of 7 mg/kg/h that continued in the UCI at a rate of 3.5 mg/kg/h, for 8 hours more. The suspicion of PRIS motivated immediate discontinuation of propofol with rapid correction of lactic acidosis and full recovery of the patient.

Acidosis láctica severa asociada a infusión de propofol: Caso clínico / Severe lactic acidosis caused by propofol infusion: Report of one case

Propofol infusion syndrome (PRIS) is a rare but potentially lethal complications. This disorder is triggered under unknown circumstances by a propofol infusion of more than 5 mg/kg/h for more than 48 h. PRIS is characterized by a multiorgan failure and rhabdomyolysis and is induced by a disturbance in mitochondrial long chain fatty acid oxidation. We report a 43 year-old woman who underwent brain surgery due to a vascular malformation. In the immediate postoperative period, she had an unexplained and severe lactic acidosis. During anaesthesia, she received a propofol infusion of 7 mg/kg/h that continued in the UCI at a rate of 3.5 mg/kg/h, for 8 hours more. The suspicion of PRIS motivated immediate discontinuation of propofol with rapid correction of lactic acidosis and full recovery of the patient.

[Erroneous prescriptions of aciclovir and valaciclovir in herpes zoster treatment]. / Errores en la oportunidad y dosificación de aciclovir o valaciclovir en el tratamiento del herpes zoster.

Medical prescription errors are frequent in community settings and information exploring its magnitude during antiviral treatment of herpes zoster is scarce. A questionnaire was applied to 31 physicians working in hospital- or community-based settings in Santiago, Chile in order to characterize their dosing and timing preferences for aciclovir or valaciclovir prescriptions. Aciclovir was more often prescribed than valaciclovir (71.9 and 28.1%, respectively), but less than a third of prescription (27.3%) fulfilled the minimal aciclovir dosing and timing criteria for clinical efficacy (4 gr per day and <72 hours since rash initiation). The limited size of the simple prevented exploring factors linked to a misleading prescription. Appropriate knowledge on dosing and timing of aciclovir/valaciclovir therapy for herpes zoster was infrequent in a sample of physicians working in various clinical settings in Chile.

Errores en la oportunidad y dosificación de aciclovir o valaciclovir en el tratamiento del herpes zoster / Erroneous prescriptions of aciclovir and valaciclovir in herpes zoster treatment

Medical prescription errors are frequent in community settings and information exploring its magnitude during antiviral treatment of herpes zoster is scarce. A questionnaire was applied to 31 physicians working in hospital- or community-based settings in Santiago, Chile in order to characterize their dosing and timing preferences for aciclovir or valaciclovir prescriptions. Aciclovir was more often prescribed than valaciclovir (71.9 and 28.1 percent, respectively), but less than a third of prescription (27.3 percent) fulfilled the minimal aciclovir dosing and timing criteria for clinical efficacy (4 gr per day and < 72 hours since rash initiaton). The limited size of the simple prevented exploring factors linked to a misleading prescription. Appropriate knowledge on dosing and timing of aciclovir/valaciclovir therapy for herpes zoster was infrequent in a sample of physicians working in various clinical settings in Chile.

Los errores en la prescripción de medicamentos son frecuentes en escenarios ambulatorios y no hay información disponible sobre el uso de antivirales en el tratamiento del herpes zoster. Para conocer la dosis y oportunidad en la prescripción de aciclovir o valaciclovir se aplicó un cuestionario a 31 médicos que trabajan en hospitales o sitios de atención primaria en Santiago y que declararon haber atendido este tipo de pacientes. El compuesto aciclovir fue más indicado que valaciclovir (71,9 vs 28,1 por ciento) pero menos de un tercio de las prescripciones (27,3 por ciento) cumplieron simultáneamente con una dosis mínima (4 g/día) y ventanas de tiempo apropiadas de aciclovir (hasta 72 horas del rash). El reducido tamaño de la muestra impidió efectuar un análisis de los factores ligados a este fenómeno. El conocimiento apropiado sobre dosis y oportunidad de aciclovir o valaciclovir fue infrecuente en un grupo de médicos que declararon atender pacientes con herpes zoster en Santiago.