Max Andresen H

Ética de las publicaciones en revistas médicas

Authors of clinical articles have similar motivations and rulesthan authors in other scientific fields. In addition, medical research must obey specific ethicalrules that apply to studies involving human subjects, including biological samples, tissues,cellular or sub cellular samples obtained from them. When submitting their reports forpublication, authors must declare that they have followed such ethical rules and also shoulddeclare any possible conflict of interest that may have arisen. External peer reviewers and theeditors should also conform to limitations by eventual conflicts of interest. Authors shouldrespect specific ethical norms that apply to the process of submitting, publishing andreproducing their manuscripts. In recent years, the editors of Revista Medica de Chile havebecome aware of five instances of misconduct committed by authors of articles submitted oralready published. Four correspond to redundant publications and one exhibits overtplagiarism in the text and syntax. Appropriate actions have been taken followingrecommendations published by the International Committee of Medical Journal Editors, theWorld Association of Medical Editors and other groups. The present article stresses that authorsand their sponsoring institutions must be aware of the importance of following ethical ruleswhen reporting scientific work (Rev Med Chile 2007; 135: 529-33).(

Perfil epidemiológico de la candidiasis invasora en unidades de pacientes críticos en un hospital universitario

La epidemiologia de candidiasis invasora (CI) ha cambiado, lo cual no ha sido suficientemente estudiado en Chile. Objetivo: Describir el perfil epidemiologico y microbiologico de CI en pacientes criticos. Metodos: Estudio observacional prospectivo entre octubre 2001 y agosto 2003, en pacientes criticos adultos con sospecha o confimnacion de CI. Resultados: 53 pacientes cumplieron criterios de CI. De ellos, 18 (33,9%) tuvieron candidemia, 22(41,5%) CI diseminada y 13(24,5%) CI local. Entre las candidemias, hubo 8 C. albicans (44,4%) y 10 Candida no albicans (55,6%), predominando C. tropicalis (27,7%). Un 88,8% de las candidemias fueron susceptibles a fluconazol. La mortalidad hospitalaria global fue 24,5%, significativamente menor en pacientes con candidemias vs CI diseminada (16,6 vs 31,8%, p = 0,02). Conclusiones: Se observo una mayor proporcion de Candida no albicans en candidemias de pacientes criticos. Sin embargo, la mayoria de estas cepas fue susceptible a fluconazol. La mortalidad global fue menor en candidemias.

Craniectomía descompresiva en una paciente con encefalitis herpética asociada a hipertensión intracraneana refractaria

Herpetic encephalitis is the most common cause of viral encephali-tis in our country. Pathological studies show progressive necrosis and edema in specific territo-ries of the brain. The mortality of herpetic encephalitis was reduced from 70% to 20% with theuse of intravenous aciclovir in the first three days of illness. However, almost 50% of patientsdevelop a neurological deficit. One of the most important causes of death in herpetic encephali-tis is the refractory intracranial hypertension. There are anecdotal reports of patients with re-fractory intracranial hypertension due to herpetic encephalitis that were treated with decom-pressive craniectomy with good results. We report a 21 years old female patient with herpeticencephalitis and refractory intracranial hypertension that was successfully treated with a de-compressive craniectomy (Rev Med Chile 2003; 131: 1434-8).(

Estrés oxidativo en el paciente crítico

Among critically ill patients, several physio-pathological processes such as global and local hypo-perfusion, hypoxia, endothelial injury and acidosis have been associated with the production and release of large amounts of reactive oxygen species (ROS) in a non regulated fashion. Although in physiologic conditions ROS influence intracellular processes and participate in the defense against infectious organism, in critically ill conditions they are associated with potential oxidative damage over cellular structures and with persistent activation of the inflammatory response. Mechanisms associated with oxidative damage are activation of the macrophage-monocyte system and neutrophils, ischemia-reperfusion events and intracellular ROS production. Endogenous compounds, mainly enzymes, and dietary components act as antioxidant. Several studies show that in critically ill patients increase levels of ROS or reduction of antioxidant levels are related to disease severity. In animal models of critical diseases, antioxidant therapy has shown to reduce mortality. Nevertheless, there are few studies in humans that only show improvements in hemodynamic variables, reduction in inflammatory mediators levels, decreases in oxidized compounds and that suggest a lower incidence of multiple organ failure (Rev Med Chile 2006; 134: 649-56). (Key words: Multiple organ failure; Oxidative stress; Reactive oxygen specias)

Prevalencia de sepsis grave en las Unidades de Cuidado Intensivo: Primer estudio nacional multicéntrico

4. SS was the admission diagnosis of 94 of the 283 patients (33%)and 38 patients presented SS after admission. On the survey day, 112 patients fulfilled SS criteria(40%). APACHE II and SOFA scores were significantly higher in SS patients than in non SS patients.Global case-fatality ratio at 28 days was 15.9% (45/283). Case-fatality ratio in patients with orwithout SS at the moment of the survey was 26.7% (30/112) and 8.7% (17/171), respectively p<0.05. Thirteen percent of patients who developed SS after admission, died. Case-fatality ratios forpatients with SS from Santiago and the other cities were similar, but APACHE II score wassignificantly higher in patients from Santiago. In SS patients, the independent predictors of mortalitywere SS as cause of hospital admission, APACHE II and SOFA scores. Ninety nine percent of SSpatients had a known sepsis focus (48% respiratory and 30% abdominal). Eighty five patients thatpresented SS after admission, had a respiratory focus.

Características de la enfermedad cerebrovascular en un Servicio de Cuidados Intermedios Neurológicos, en Chile. Análisis de 459 pacientes consecutivos

.La creacion de unidades de tratamiento delataque cerebrovascular (UTAC) y el advenimientode la trombolisis intravenosa han producido undramatico cambio en la terapeutica de la ECV.Distintos metaanalisis han mostrado que los pa-cientes hospitalizados en UTAC tienen menor mor-bimortalidad que los controles hospitalizados enservicios generales

Necrolisis epidérmica tóxica. Terapia en UCI con inmunoglobulinas intravenosas en un caso

We report a 27 years old homosexual male with AIDS that was admitted to the ICU dehydrated, with fever and severe malaise. He had irregular bullae, an extensive purpuric exanthema and a zone of epidermic detachment in the right arm. A toxic epidermal necrolysis was diagnosed and therapy with i.v. immunoglobulins was started. After four days of treatment, bullous lesions disappeared and the extension of exanthema decreased. Toxic epidermal necrolysis is a potentially fatal disease and the use of intravenous immunoglobulins for this condition has been reported as successful (Rev Med Chile 2000; 128: 1343-48).

Síndrome de respuesta inflamatoria sistémica severa: ¿es comparable a la sepsis severa?

Background: In 1992, a consensus conference defined the terms systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock. Since then, numerous reports have validated the prognostic usefulness of these operative definitions. Aim: To evaluate if sepsis severity criteria, as defined by the Consensus Conference, can be applied to noninfectious SIRS. Patients and methods: Five hundred eighteen patients admitted to 5 intensive care units (ICU) from 4 hospitals were prospectively evaluated during a 3 months period. Patients that met at least one severity criteria were included. SIRS etiology, organ dysfunction and evolution were recorded in each patient. Results: One hundred two patients were included: 79 with sepsis (group I) and 23 with noninfectious SIRS (group II). ICU and hospital mortality were comparable (43 and 48% in sepsis compared to 43 and 51% in non infectious SIRS). The most common sources of sepsis were pneumonia and peritonitis. Group II patients had a wide variety of diseases. ICU stay, APACHE score and number of organs with dysfunction were not different among groups. Only the incidence of renal dysfunction was higher in the septic group. Conclusions: The Consensus sepsis severity criteria can be applied to noninfectious SIRS, defining a population subset with similar high mortality and organ dysfunction incidence, although with greatly heterogeneous etiologies.

Hemicraniectomía descompresiva en dos pacientes con infarto maligno de la arteria cerebral media

Malignant middle cerebral territory infarction represents 5 to 10%of all brain infarctions. Its mortality is 80%, due to brain herniation and it is not reduced bymedical treatment. Decompressive hemicraniectomy reduces mortality to 12%, and thesubsequent quality of life of patients is acceptable. We report two male patients aged 61 and 54years, with a malignant middle cerebral territory infarction who were treated withdecompressive hemicraniectomy. After two years of follow up, both patients are self-sufficientand live at home with their families (Rev Med Chile 2005; 133: 447-52).(

Estudio de la cinética de citoquinas en sepsis grave y su relación con mortalidad y score de disfunción orgánica

BACKGROUND The Infectious Systemic Inflammatory Response syndrome and multiple organic dysfunction have common physiopathological mechanisms. Multiple organic dysfunction can be assessed using severity scores. AIM To relate cytokine kinetics with a multiple organic dysfunction score during sepsis. MATERIAL AND METHODS Tumor necrosis factor alpha (TNF alpha) and interleukin 6 (IL6) kinetics were studied in 25 patients with severe sepsis with less than 48 h of evolution and interleukin 1 beta (IL beta) kinetics was studied in 13 patients. Measurements were made at 0, 12, 24 and 48 hours after admission to the study, using an ELISA technique. These parameters were correlated with the Marshall multiple organic dysfunction score and survival. RESULTS Mean age of study subjects was 70 years, the APACHE II score was 16.9 +/- 6 and the Marshall score was 6.8 +/- 3.6. Sepsis was of pulmonary origin in 56% of patients and intra abdominal in 32%. Mortality was 36%. TNF alpha increased during the study period (24.1 pg/ml initially and 37.8 pg/ml at 24 hours, with a slight posterior reduction, p < 0.02). These levels had no association with mortality or organic dysfunction. IL6 remained elevated during the first hours and had a tendency to decrease thereafter. Decreased patients had higher values than survivors (306 pg/ml and 55.4 pg/ml respectively, p = 0.011). Its values were tightly correlated with Marshall score, with the number of failing organs, with the presence of shock and with probability of dying during hospitalization. IL1 beta remained low and was not associated with clinical parameters. CONCLUSIONS There is a tight correlation between the elevation of IL6 and the severity of the Systemic Inflammatory Response and mortality in these patients with sepsis.