Revista Hospital Clínico Universidad de Chile

Cambio de horario estacional y su impacto en la salud

Adrián Ocampo G. — Fri, 01 Mar 2024 00:00:00 +0000

Sobre la práctica del adelanto de hora y su impacto sobre la regulación cronométrica del ánimo

José M. Robert A. — Fri, 01 Mar 2024 00:00:00 +0000

Mood depends on variables regulated by circadian rhythms. Individuals predisposed to mood disorders are prone to disrupting the synchrony between these rhythms and our internal clock. Therefore, the artificial shift to daylight saving time should be particularly relevant in such cases. Recent evidence supports the impact of this practice on mental health. This article aims to analyze how changes in clock time affect mood stability, addressing an aspect still insufficiently recognized in routine clinical practice.

Efectos del cambio al horario de verano en la salud mental de los adolescentes: una revisión

Carlos González G., Claudio Torres Q. — Fri, 01 Mar 2024 00:00:00 +0000

The transition to Daylight Saving Time (DST) has been associated in the general population with various negative health effects, such as an increased risk of cardiovascular and cerebrovascular problems, along with symptoms of mental health issues. These effects are directly attributed to the sleep phase delay and, consequently, the deficit of sleep hours resulting from the measure. There is les evidence regarding the effect of DST on the child and adolescent population, although it is known that in these age groups, chronic sleep deprivation and disruption of chronobiological cycles play a role in the onset and course of various disorders, such as mood disorders, anxiety disorders, and neurodevelopmental disorders. The present work aims to review the existing evidence on the potential repercussions of DST on mental health in the adolescent population. First, a general model is presented regarding risk and protective factors for chronobiological cycles in adolescence. Subsequently, results from specific studies in adolescents are presented, covering both mental health and academic performance areas. Finally, the implications of these results are discussed.

Cambio de horario y riesgo cardiovascular

Alonso Quijada R. — Fri, 01 Mar 2024 00:00:00 +0000

The impact of light on our society is significant, influencing our central nervous system through natural light’s role in regulating circadian rhythms. Daylight Saving Time (DST) is often justified for energy savings, particularly in residential lighting. The central nervous system’s master biological clock, located in the hypothalamus, synchronizes peripheral clocks, including those in the cardiovascular system. Desynchronization between endogenous circadian systems and environmental cycles increases cardiovascular risk. The springtime DST change exacerbates social jet lag, leading to sleep debt, sympathetic activation, and increased proinflammatory cytokines. Studies show a temporary increase in myocardial infarction rates in the week following the springtime shift. From a health perspective, there’s growing evidence of negative effects on human metabolism and physiology due to changes in lighting schedules.

El estrés psicosocial en la esteatosis hepática asociada a disfunción metabólica (MASLD): sobreposición desfavorable

Fri, 01 Mar 2024 00:00:00 +0000

The metabolic dysfunction-associated steatotic liver disease (MASLD)(1) is considered the leading cause of liver disease worldwide. It is a complex pathology, which includes a spectrum of diseases ranging from steatosis to advanced forms of liver damage, such as cirrhosis. Its prevalence has increased in recent years, becoming a relevant public health problem. It is characterized by fat accumulation in hepatocytes, which induces lipotoxicity, oxidative stress, inflammation, and consequently, liver damage. The mechanisms involved in MASLD progression are not fully understood. Also, the factors that determine the heterogeneous susceptibility towards liver fibrosis among patients, remain unresolved. In recent years, chronic stress has been described as a relevant risk factor in the progression of MASLD. The presence of stress is associated with alterations in the gut-liver-brain axis, which promotes systemic low-grade inflammation that reinforces the liver damage progression. This review aims to discuss the evidence about the role of psychosocial stress in MASLD and its association with the pathogenic mechanisms involved in liver damage.

Neutrófilos en el perioperatorio ¿nuevo elemento para predecir y mejorar resultados quirúrgicos?

Felipe Maldonado C., Roberto González C., Mónica Cáceres Ll. — Fri, 01 Mar 2024 00:00:00 +0000

The immune response plays a crucial role in tissue repair. Currently, the cellular response is not taken into consideration in the categorization or management of patients. Neutrophils play a significant role in tissue repair and infection control. Targeting their function during the perioperative period could have therapeutic implications. Here, we provide a brief description of their potential significance in the perioperative period.

Terapia farmacológica en insuficiencia cardiaca fracción de eyección reducida: ¿cómo, cuánto, a quién?

Fri, 01 Mar 2024 00:00:00 +0000

Heart failure (HF) is a clinical syndrome characterized by a combination of symptoms and signs caused by structural and/or functional cardiac abnormalities, confirmed by elevated levels of natriuretic peptides and/or objective evidence of pulmonary or systemic congestion (1-2).Guidelines have been proposed to guide treatment based on the left ventricular ejection fraction (EF), dividing it into three categories: HF with preserved EF (EF > 50%), HF with mildly reduced EF (EF 40-49%), and HF with reduced EF (EF < 40%). Currently, certain drugs have demonstrated a reduction in mortality and morbidity. When combined, these drugs provide an even greater synergistic benefit. In 2021, the European Society of Cardiology (ESC) published an editorial regarding the best therapy for HFrEF. These drugs include Inhibitors of the Renin-Angiotensin- Aldosterone System (IERAA), Beta-Blockers (BB), Mineralocorticoid Receptor Antagonists (MRA), and Sodium-Glucose Cotransporter Inhibitors (iSGLT2), also known as the “four horsemen.” The initiation of these four combined drugs represents the optimal therapy for HFrEF. However, individual patient profiles should be considered to provide personalized, optimal therapy, taking into account potential side effects. This work aims to summarize the key points as outlined by the ESC regarding optimal therapy for HFrEF and how to choose it.

Base genética de las arritmias primarias hereditarias más frecuentes: síndrome de QT largo, el síndrome de brugada y taquicardia ventricular polimórfica catecolaminérgica

Danitza Campos J., Rosa Pardo V. — Fri, 01 Mar 2024 00:00:00 +0000

Inherited primary arrhythmias correspond to a group of genetic disorders, including long QT syndrome (LQTS), Brugada syndrome (BrS), and catecholaminergic polymorphic ventricular tachycardia (CPVT), among others. They are usually caused by pathogenic variants in genes related to ion channels, predisposing to arrhythmias and cardiac events. Inherited primary arrhythmias affect approximately 1 in 3,000 people and are an important cause of sudden cardiac death, mainly in young adults. Diagnosis is based on clinical history, particular electrocardiographic patterns, and detection of mutations. Given that mutation carriers are usually diagnosed after presenting a cardiac event and that the consequences of not identifying or treating them promptly can be fatal, genetic studies are very relevant to guide management, define prognosis, and detect asymptomatic individuals in the family, after performing cascade genetic studies, which allows early intervention in this risk group. This article reviews the genetic causes of LQTS, BrS, and CPVT, highlighting the relevance of genetic studies in patients with these arrhythmias.

Enfermedad de Wilson: de la clínica a la genética

Rafael Lobos U., Rosa Pardo V. — Fri, 01 Mar 2024 00:00:00 +0000

Wilson’s disease is a rare, autosomal recessive disorder caused by excess copper stored in the body. Mutations in the ATP7B gene are associated with Wilson’s Disease. It encodes the ATP7B protein responsible for maintaining normal levels of systemic copper. Intracellular copper overload leads to stress and subsequent oxidative damage to cellular proteins, lipids, DNA, RNA and mitochondria. Wilson’s disease has a wide clinical spectrum, mainly affecting the liver, nervous system, eye and mental health. The diagnosis requires clinical, biochemical, histological and genetic criteria. Treatment should be started early and if followed properly it can prevent clinical deterioration and improve life expectancy and quality of life. Treatment includes dietary measures, pharmacological treatments such as copper chelators and zinc salts, and in certain cases, liver transplantation. Some gene therapies are in the clinical trial phase and could become curative treatments for this disease.

Test radiológico

Fri, 01 Mar 2024 00:00:00 +0000

Metahemoglobinemia inducida por dapsona: reporte de un caso en el servicio de urgencia

Ignacio Carroza N., Camila Legua V. — Fri, 01 Mar 2024 00:00:00 +0000

Methemoglobinemia is a low prevalence but potentially severe condition in the Emergency Department. One of its leading causes is drug induction, dapsone being one of them. Dapsone is a synthetic sulfone with antimicrobial properties, often prescribed for prophylaxis against Pneumocystis jiroveci infection and other implications. This report presents the case of a 39-year-old male recently diagnosed with HIV on antiretroviral therapy along with prophylactic dapsone, who sought medical attention in the emergency room due to symptoms of cough, dyspnea, and fever. On admission, the patient exhibited a state of tachypnea and an oxygen saturation of 78% in room air, which is partially corrected with supplemental oxygen at an inspired oxygen fraction of 50%, achieving oxygen saturation of 90% by pulse oximetry. Chest X-ray revealed no abnormalities, and arterial blood gas analysis showed a partial pressure of oxygen of 380 mmHg with oxygen saturation of 100%. Given the disparity between pulse oximetry, arterial blood gas results, and the normal chest X-ray, a co-oximetry was conducted, revealing a methemoglobin level of 10.4% The patient was admitted to the ICU and continued receiving oxygen therapy. Dapsone was discontinued and the patient’s condition improved. without the need for methylene blue administration or alternative therapies.