Revista médica de Chile
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Revista médica de Chile · Apr 2024
Review[Decision-Making by Hospital Teams Regarding Access and Use of Life-Support Technology and End-of-Life Processes in Critically Ill Adult Patients: A Narrative Review].
Death processes have been progressively transferred to hospital spaces due to biomedicalization and the use of technologies, generating important challenges for healthcare systems. The COVID-19 pandemic exposed the lack of unified criteria and principles for a dignified death in the hospital. This study corresponds to a narrative review using Higgins & Green's methodological framework as a reference. ⋯ The evidence shows variability in decision-making associated with the clinical status of the patient, the criteria of the medical professional, added to structural elements of the health system and political-legal aspects. The literature recommends reflexive, dynamic, flexible, and individualized decision-making processes that consider the patient's preferences, clinical judgment, prognosis, and available resources. Communication, advance care planning, interdisciplinary discussions, external consultations, and the involvement of ethical committees are crucial throughout the process.
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Revista médica de Chile · Apr 2024
Review Case Reports[Acquired Epidermodysplasia Verruciformis in a Renal Transplant Patient: Case Report and Literature Review].
Acquired epidermodysplasia verruciformis is a rare condition, secondary to a state of acquired immunosuppression and is characterized by a susceptibility to infection by human papillomavirus of the beta genus, which carries an increased risk of developing non-melanoma skin cancer. We report the case of a 39-year-old woman receiving a kidney transplant, treated with prednisone and tacrolimus, who after starting immunosuppressive therapy developed papules and warty plaques in the inguinal region. A skin biopsy was performed that was consistent with epidermodysplasia verruciformis, so it was decided to adjust immunosuppressive therapy to everolimus, which achieved a reduction in lesions. There are only 13 other cases of acquired epidermodysplasia verruciformis in kidney transplant recipients; to our knowledge this is the first case reported in Chile.
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Revista médica de Chile · Apr 2024
Case Reports[Transcatheter Aortic Valve Implantation in a Large Aortic Annulus: A Case Report].
In patients with symptomatic severe aortic stenosis (SAS), who are at high surgical risk and who require transcatheter aortic valve implantation (TAVI), anatomic factors can determine if patients are suitable for this technique. A very large aortic annulus is a technical challenge given the limited options of adequate valve sizes, and, in most of them, using them in this type of patient is an off-label indication. We present the case of a 59-year-old man with symptomatic ASOS with surgical risk secondary to chronic liver damage referred for TAVI with an aortic annulus greater than 900 mm2. A Myval #32 valve was implanted with overexpansion without complications and early discharge.
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Revista médica de Chile · Apr 2024
[Adaptive Behavior is Related to Body Adiposity and Functional Fitness in Older Women].
Older people present limited independent functioning and greater difficulties in their activities of daily living as they age. ⋯ The study found that, in women aged 65-84 years, AC tends to decrease with age, while body adiposity increases and functional fitness decreases. It is recommended to implement strategies that address these negative effects of aging, such as prevention and management of body adiposity, functional exercise programs, and promotion of a healthy lifestyle.
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Revista médica de Chile · Apr 2024
[Obstructive Sleep Apnea and Nocturnal Hypoxemia Increase the Cardiovascular Risk in Chilean].
Obstructive sleep apnea (OSA) and cardiovascular (CV) risk co-existence is frequent. However, the implications of novel metrics used in the diagnosis of OSA in patients with CV risk are scarce in the Hispanic/Latino population. ⋯ The RDI and CT90% showed a significant and incremental association with the CV risk of the cohort. However, predictive analyses of CV mortality using the RDI and CT90% were not significant.