Revista médica de Chile
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Revista médica de Chile · Oct 2023
[Temporality and factors associated with the development of a cerebral infarction in patients with cervical artery dissection].
Cervical artery dissections (CAD) are the leading cause of ischemic stroke (CVA) in young people. The risk factors for stroke and the temporal relationship with CAD are not well characterized. Nor do we have a clinical-radiological classification that allows knowing the risk of stroke. ⋯ Stroke associated with CAD has a relatively low frequency. It is not related to the type of dissected artery. It mainly occurs not simultaneously with CAD and within the first week. The main associated factor for developing a stroke is arterial occlusion (Borgess type IB).1,8-9,3), male sex (p < 0.001; OR: 0.2; CI: 0.06-0.8) and oral contraceptives (p = 0.02; OR: 0.2; CI: 0.06-0.8).
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Revista médica de Chile · Oct 2023
Review[Siponimod (BAF312): General Characteristics and Clinical Implications of Pharmacogenomic Dosage in the Treatment of Active Secondary Progressive Multiple Sclerosis].
Siponimod is a selective immunosuppressive medication, developed as the first oral therapy for active secondary progressive multiple sclerosis. This medication acts by modulating the sphingosine 1 phosphate (S1P) receptor, as an antagonist of S1P1 and S1P5, thus preventing the egress of lymphocytes from lymph nodes and preventing inflammatory processes in the Central Nervous System that trigger demyelination. There is extensive scientific knowledge regarding the administration of the medication to patients, which will depend on their pharmacogenetic characteristics. ⋯ Additionally, before prescribing it, an electrocardiogram, assessments of antibody status, ophthalmic evaluation, varicella vaccination status, and peripheral lymphocyte count should be conducted, as the medication's effect is dose-dependent. Therefore, a titration process is carried out starting from 0.25mg up to 2 mg. The pharmacotherapeutic protocol of siponimod is a reliable reflection of the utility of pharmacogenetics in personalized medicine.
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Revista médica de Chile · Oct 2023
Review[Implantable automatic defibrillators and their deactivation, a necessary conversation. Literature review].
The use of implantable cardioverter-defibrillators (ICDs) has been on the rise. Patients using ICDs inevitably transit towards the end of life at some point, including some who develop terminal illnesses. In this context, it is relevant to discuss and evaluate the deactivation of these devices with the aim of addressing patients' comfort and avoiding shocks during the end-of-life phase. ⋯ Secondly, there is a significant lack of knowledge among patients, family members, and even doctors about the benefits of ICDs, as well as the deactivation process and ethics considerations, which leads them to believe that immediate death will occur, considering it as euthanasia or assisted suicide. Finally, the management of hospice patients or end-of-life ICDs users is poorly standardized, with low rates of deactivation, resulting in shocks in the last minutes of life, which can cause marked distress to patients and families. It is necessary to address these barriers and discuss these issues with patients to inform and educate them about the functioning of their devices, with the ultimate goal of enabling informed and shared decision-making for patient well-being.
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The Nobel Prize originated in 1895 when Alfred Nobel signed his will, leaving a large part of his wealth to the creation of the Nobel Foundation and the establishment of this prize, with the vision that people could help improve humanity through knowledge, science, and humanism. The Nobel Prize has been awarded in areas such as physics, physiology or medicine, chemistry, literature, peace, and economics. 943 people and 25 organizations have been awarded since 1901 to this day. The history and knowledge commemorated in the Nobel Prize have allowed an integral development in the understanding, diagnosis, therapy, and scientific progress in different types of cancer, laying the foundations and being the inspiration for thousands of scientists worldwide who work hard in the area of oncology. GLOBOCAN estimates indicated that there were approximately 19 million new cancer cases globally and almost 10 million cancer deaths in 2020 alone; hence, this study reviews and brings together the main scientific discoveries awarded with the Nobel Prize in the area of physiology or medicine and chemistry, which contributed to the knowledge, diagnosis and/or treatment of cancer from 1901 to 2021.