Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720210004&lang=p vol. 149 num. 4 lang. p <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[Accuracy of artificial intelligence compared to trained medical technologists in diabetic retinopathy screening]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400493&lng=p&nrm=iso&tlng=p Background: The early detection of retinopathy among diabetics is of utmost importance. Aim: To estimate the diagnostic accuracy of two diabetic retinopathy (DR) screening strategies currently used in the Chilean public health system. Material and Methods: Cross-sectional observational study of 371 diabetic patients aged 61 ± 14 years (61% women) who underwent DR screening at a public Hospital between July 1 and August 31, 2019. The mydriatic retinal photographs of all participants were classified using artificial intelligence software (DART) and trained medical technologists, independently. The precision of both strategies was compared with the reference standard, namely the evaluation of the fundus by an ophthalmologist with a slit lamp. Participants with severe non-proliferative DR or worse were considered as positive cases. The ophthalmologist was blind to the results of the screening tests. Results: Twenty four percent of participants had DR, including 34 (9.2%) who had sight threatening DR in at least one eye. The sensitivity and specificity of DART were 100% (95% confidence intervals (CI): 90-100%) and 55,4% (95% CI: 50-61%), respectively. Medical technologists had a sensitivity of 97,1% (95% CI: 85-100%) and a specificity of 91,7% (95% CI: 88-94%). The only case missed by medical technologists was a patient with unilateral panphotocoagulated DR. Conclusions: Both strategies had a similar sensitivity to detect cases of sight-threatening DR. However, the specificity of DART was significantly lower compared to medical technologists, which would greatly increase the burden on the health system, a very important aspect to consider in a screening strategy. <![CDATA[Experience with endoscopic submucosal dissection for the treatment of early neoplasms of the digestive tract]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400501&lng=p&nrm=iso&tlng=p Background: Endoscopic submucosal dissection (ESD) allows en-bloc resection of early gastro-intestinal neoplasms (EGIN) with healing potential. Aim: To describe the results of patients treated with ESD for EGIN by our team. Patients and Methods: Descriptive study of patients with EGIN who underwent ESD with curative intention between January 2008 and March 2020. Results: One hundred thirty-two ESD were performed in 127 patients. 77% were gastric lesions, 14% colorectal, 8% esophageal and 1% duodenal. En-bloc resection was achieved in 98.4% of ESDs. Eighty eight percent of patients met curative standards. Overall, cancer-specific, and recurrence-free survival were 95%, 100% and 98% respectively. Conclusions: ESD allows en-bloc resections with curative potential in selected patients, but with a significant reduction in morbidity and mortality and less impact on quality of life. Our results suggest the feasibility to perform ESD in our country with results comparable to those reported in the literature. <![CDATA[Redefining the gold standard for aortic valve replacement: Minimally invasive with accelerated recovery]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400508&lng=p&nrm=iso&tlng=p Background: Despite being introduced 20 years ago minimally invasive aortic valve replacement is only performed routinely in a minority of patients world-wide. Aim: To report the operative outcome of minimally invasive aortic valve replacement done through a partial upper sternotomy. Patients and Methods: Retrospective analysis of data recorded prospectively of 450 consecutive patients with a median age of 66 years (59% males) who had a minimally invasive aortic replacement. Results: 79% of patients had aortic stenosis. Cross clamp/cardiopulmonary bypass times (median) were 56 and 68 minutes respectively. Conversion to full sternotomy was required in 2.6% of patients, reoperation for bleeding in 2.9%. 1.6% suffered a stroke and 19% postoperative atrial fibrillation. 0.9% required a permanent pacemaker. Postoperative mortality was 0.9%. Median postoperative hospital stay was six days. Conclusions: Minimally invasive aortic valve replacement can be performed with satisfactory results. <![CDATA[Long-term survival of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400514&lng=p&nrm=iso&tlng=p Background: Transcatheter aortic valve implantation (TAVI) is an effective and safe option for low, medium and high-risk patients with severe aortic stenosis (SAS). Aim: To analyze the clinical results and long-term survival of TAVI in our center. Material and Methods: Prospective analysis of 53 patients aged 73 ± 10 years with a Society of Thoracic Surgeons (STS) score of 7.3 ± 3.9%. Results: In 96% a transfemoral access was used and, in most patients, ProGlides™ as vascular closure device was used. General anesthesia and conscious sedation were used in 79 and 21% of cases, respectively. Fifty-three valves were implanted, 42 self-expandable (SEV) and 11 balloon-expandable (Edwards Sapiens). The implant was successful in 49 patients (92,4%). The transaortic gradient after TAVI was almost zero mmHg in all patients and one had a severe aortic regurgitation. Permanent pacemakers were needed in 17% of patients. Two patients had a pericardial effusion, and one had a major vascular complication. No strokes were recorded, and 30-day mortality was 3.7%. At long-term follow up (23.4 ± 21.6 months) the global survival was 85% and the rate of cardiovascular mortality was 5.9%. Conclusions: In this series of intermediate to high-risk patients, TAVI was associated with an excellent early and long-term survival. <![CDATA[Transfemoral transcatheter aortic valve implantation under conscious sedation. Experience in 15 patients]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400520&lng=p&nrm=iso&tlng=p Background: Transfemoral transcatheter aortic valve implantation (TAVI) is the standard of treatment for patients with symptomatic severe aortic stenosis (AE) and intermediate or high surgical risk. The use of conscious sedation (CS) could reduce complications and allow an early discharge of these patients. Aim: To report our experience with TAVI under conscious sedation. Material and Methods: Review of medical records of 15 patients aged 79 ± 6 years (53% women) undergoing a transfemoral TAVI implant under conscious sedation. Results: The indications for the procedure were severe AE in 13 patients and biological prosthetic dysfunction in two. The mean Thoracic Surgeons predicted risk of mortality score was 7.3. The valves used were Edwards Sapien 3 in three patients, Medtronic Evolut in five, Boston Acurate Neo in four and Meril Myval in three. A successful implant was achieved in all cases and there were no hospital mortality or pacemaker requirements. One patient had a stroke, and one patient had a vascular access complication. Early discharge (&lt; 72 h) was achieved in 80% of patients. Conclusions: TAVI under conscious sedation was a safe procedure and associated with a complication rate similar to previous reports, allowing for an early hospital discharge in most patients. <![CDATA[Neurology and COVID-19: Case Series of Neurological Complications in 96 patients Admitted at a University Hospital]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400527&lng=p&nrm=iso&tlng=p Background: There are multisystemic consequences secondary to SARS- CoV-2 infection. Aim: To characterize neurological complications in patients admitted due to SARS-CoV-2 infection. Methods: Review of medical records of patients aged over 15 years with COVID-19 evaluated by the neurology team between April and August 2020 at a university hospital. Severity of the infection, referral reasons, neurological diagnoses and laboratory results were registered. The diagnoses were defined by consensus among the members of the hospital neurology group. Cerebrovascular and inflammatory diseases of the central and peripheral nervous system were defined as “probably associated” or “possibly associated” to COVID-19. Results: Ninety-six patients had at least 1 new neu- rological complication. 74% were admitted due to pneumonia and 20% due to a neurological disease. The most common reasons for neurological referral were impaired consciousness (39%), focal neurological deficit (24%), headache (9%) and seizures (5%). The most relevant neurological diagnoses were delirium in 48 patients, stroke in 24, critical illness polyneuropathy and myopathy in 17, seizures in 14, brachial plexopathy in 3, compressive neuropathies in 5, encephalitis in 1, possible vasculitis in 1 and Guillain-Barré syndrome in 1. Stroke and epilepsy were associated with increased length of hospital stay, but without differences in mortality. Conclusions: The spectrum of neurological complications of COVID-19 is wide. There are clinical entities typical of critically ill patients and also diseases associated directly and indirectly with the SARS-CoV2 infection. <![CDATA[Socioeconomic determinants and gender gaps in depressive symptoms in Chile]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400533&lng=p&nrm=iso&tlng=p Background: There are marked differences associated with socio-economic factors in the prevalence of depressive symptoms (DS) in men and women. Aim: To estimate the association between socioeconomic status and DS in Chile and to estimate the gender gaps in this association. Material and Methods: The Patient Health Questionnaire-9 (PHQ-9) was applied as part of a socioeconomic survey carried out in a representative community sample (n = 2913). Using this information, we analyzed the influence of social status (education level, occupation, household income) and other psychosocial factors (gender, perceived social support, stressful life events) on DS. Results: The prevalence of DS was 23.2% in women and 13.4% in men. A socioeconomic gradient was found in the distribution of DS. This gradient was more pronounced for women than for men. Gender, social support and stressful life events were the most important predictors of severe DS, with an estimated risk twice as high among women and almost three times as high among those with low social support. Conclusions: There is a combined effect between socio-economic and gender inequalities on DS. This partially explains the greater vulnerability of poor women and the DS gap between men and women. <![CDATA[Prevalence and factors associated with partner violence among pregnant and puerperal women in Santiago, Chile]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400543&lng=p&nrm=iso&tlng=p Background: Violence against women (VAW) is a violation of women's fundamental rights and special attention must be paid during the gestational and postpartum period. Aim: To determine the prevalence of violence against women attending antenatal and postpartum controls in Primary Health Centers. Material and Method: The Woman Abuse Screening Tool (WAST) for early detection of VAW was applied to 279 pregnant and 102 puerperal women attending five public primary health centers in metropolitan Santiago. Results: The prevalence ofviolence against pregnant and puerperal women was 5.7 and 5.9%, respectively. In both groups, the factors associated with a greater risk of violence were being immigrants, a history of domestic violence, not having a supportive partner and alcohol consumption by the partner. Conclusions: Violence against these women is a multifactorial, complex and structural phenomenon, which involves the victim, the abuser and the entire social system. Primary health care level and health professionals can be key elements applying early detection strategies, timely referral mechanisms and bringing emotional support for victims. <![CDATA[Trend in stroke mortality in Chile from 1980 to 2015]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400554&lng=p&nrm=iso&tlng=p Background: Stroke is the third largest single cause of death in Chile, responsible for 7.3% of all deaths in 2019. Large declines in stroke mortality rates in most Latin American countries in recent decades have been reported. Aim: To analyze the trend in stroke mortality in Chile between 1980 and 2015. Material and Methods: We extracted data for age-standardized death rate (ASDR) stroke mortality per 100,000 inhabitants in Chile for the period 1980-2015from the WHO Mortality Database. Joinpoint regression analysis was used to analyze the trend and compute the average annual percent change (AAPC) by gender in Chile. Results: The ASDR from stroke decreased from 92.8 per 100,000 in 1980 to 34.4 per 100,000 in 2015. The AAPC was −2.8% (-3.5, −2.1), with two jointpoints, 2008 and 2012. By gender, the AAPC was −2.4% and −2.9% in men and women, respectively. Conclusions: Stroke mortality rate decreased significantly between 1980 and 2015 in Chile, mainly in women. <![CDATA[Challenges in the management of analgesia and sedation in critically ill patients with COVID-19 in Chile]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400559&lng=p&nrm=iso&tlng=p Approximately 5% of COVID-19 patients will have a severe disease requiring invasive or non-invasive mechanical ventilation. In this conditions, sedatives and analgesics are fundamental to promote tolerance, comfort and synchrony with the mechanical ventilator. High and unusual requirements for sedation, analgesics and neuromuscular blockers have been reported in these patients, contributing to prolonged exposure, a high rate of delirium and prolongation of mechanical ventilation. These factors, added to the progressive shortage of these drugs, a high demand for care and less capacity for personalized attention, have created an adverse scenario for their proper and rational use. This paper proposes different pharmacotherapeutic optimization strategies for a rational management of sedation, analgesia and neuromuscular block in critically ill patients with COVID-19, with the therapeutic alternatives available in Chile. <![CDATA[The role of intestinal microbiota in the development of non-alcoholic fatty liver disease]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400570&lng=p&nrm=iso&tlng=p Non-alcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of hepatic pathologies ranging from simple steatosis (SS) to hepatocellular carcinoma. Intestinal microbiota (IM) is composed of trillions of microorganisms existing in the gut. It has 150 times more genes than the host. Changes in the composition and function of the IM are associated with different diseases, including NAFLD. In this condition, IM could have a pathogenic role through different mechanisms such as energy salvaging from food, an inflammatory stimulus, a modulation of the innate immune system, regulation of bile acid turnover, alteration of choline metabolism and increasing endogenous ethanol levels. This review is an update on the role of the intestinal microbiota in NAFLD and the possible mechanisms involved. <![CDATA[Fecal occult blood test for colorectal cancer screening]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400580&lng=p&nrm=iso&tlng=p Screening programs for colorectal cancer (CRC) are standard in most developed countries because they reduce mortality and are cost-effective. Within them, colonoscopy allows to directly visualize the colon and remove neoplastic lesions. However, it is an expensive exam with low adherence in asymptomatic individuals. The fecal occult blood test (FOBT) is a low-cost and risk-free method for the user, which results in a high rate of adherence, explaining its use in most screening programs. This article analyzes the effectiveness of different fecal occult blood tests in screening programs. The main conclusions are that the sensitivity of the guaiac-based chemical test for the detection of colorectal cancer is lower than that observed with qualitative and quantitative immunological tests. Automated quantitative methods allow objective readings independent of the operator and the reaction reading time, necessary for the analysis of large numbers of samples. The participation rate with immunological FOBTs is higher than with chemical ones, which is why they are preferred by the different countries that have screening programs. The use of quantitative tests allows stratification of symptomatic and asymptomatic patients at higher risk, in the screening programs. <![CDATA[Advanced practice nursing as a proposal to improve access and coverage in oncology for Latin America]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400591&lng=p&nrm=iso&tlng=p PAHO/WHO proposes to implement the role of Advanced Practice Nurse (APN) in Latin America, to reduce gaps in coverage and access to health care. For this purpose, it is necessary to train nursing professionals with an expanded role, which allows them to collaborate in the diagnosis, treatment, and monitoring of people with specific diseases, under established protocols and clinical guidelines and within consolidated interdisciplinary health teams in a cost-effective way. One of the areas with the greatest coverage deficit in Latin America is adult oncology, with inequality in care opportunities for these patients. Part of the premature deaths attributable to this disease are due to the lack of access to timely diagnosis and treatment. As a contribution to the reduction of this gap, a training program of Advanced Nursing Practice was developed, addressing the most urgent needs in the field of oncology. The necessary competencies were defined to develop a professional-level master’s degree program, considering prevention, early detection, diagnosis, treatment, and monitoring of people with oncological diseases at different levels of care. A program of this kind is an opportunity to reduce the access gap and coverage of health care for people with cancer, improving their quality of life and their survival. <![CDATA[A posthumous tribute to Alejandro Goic, M.D. (1929-2021), Editor Emeritus]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400598&lng=p&nrm=iso&tlng=p Alejandro Goic, M.D., son of Croatian immigrants, graduated as M.D. in 1955, studying at the Catholic University of Chile Medical School. After a residency in internal medicine, he followed post graduate studies in psychosomatic medicine at the University of Oklahoma and in gastroenterology at Harvard University. Upon his return to Chile he had a brilliant career as clinician and medical educator, becoming a leader and advisor in medical education, clinical ethics and public health. Elected Dean of the University of Chile School of Medicine (1986-1994), he promoted important changes in undergraduate studies as well as in Magister and PhD programs in Biomedical Sciences. During the difficult years of the military government intervention in Chilean universities, he was one of the leaders of critical opposition. In parallel he was chief editor of Revista Médica de Chile (1976-1996), improving the editorial process according to the recommendations of ICMJE and WAME. In 1989 he was elected member of the Chilean Academy of Medicine and became its President (2000-2010). He was awarded honors and membership in prominent national and foreign institutions. In 2006 he received the National Prize in Medicine, the highest medical distinction in Chile. His wise thinking and enthusiasm gave origin to several books that have become classics in Medicine and Medical Education, permeating our institutions. <![CDATA[National health services system entrance contest for specialties in Chile. Quotas and scores obtained by applicants]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400602&lng=p&nrm=iso&tlng=p Among the several programs that allow access to medical specialization in Chile, the National Health Services System Entrance Contest (CONISS) is held annually for newly graduated physicians, which has a high number of applicants. The academic qualifications expressed as National Medical Qualification (CMN) are the main item of the scoring system. We reviewed the total scores and the CMN of the different medical specialization programs that exist in the country, which constitutes novel and relevant information for future medical graduates interested in applying to the program. In addition, the quotas of the different programs are reported, expressed as total, free, and used quotas. <![CDATA[Students’ perception about mistreatment in undergraduate medical training]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400617&lng=p&nrm=iso&tlng=p Background: Alarms about mistreatment in medical education have been raised for almost 30 years. Aim: To describe the frequency of abuse reports among medical students at a university in Chile, investigating their association with age, sex, and educational level. Material and Methods: The Mistreatment by Teachers Questionnaire was applied to 264 first to seventh year medical students (54% males). An exploratory factorial analysis of the instrument was performed, a descriptive analysis was made and its relationship with age, sex and level of training were evaluated. Results: Ninety eight percent of respondents reported having been mistreated at least once. Mistreatment was grouped into three factors with a confidence ranging between α = 0.79 and 0.93, namely demoralization, deregulated demands and physical aggression. The first two were associated with age and level of education. There were no differences by sex. Conclusions: Mistreatment is common in undergraduate medical education, as it has been found in other universities around the world. <![CDATA[Littoral cell angioma of the spleen. Report of one case]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400626&lng=p&nrm=iso&tlng=p Splenic vascular neoplasms are the most common form of spleen tumors. Among them, littoral cell angioma is rare and it is frequently an incidental finding in imaging studies. It has no specific clinical, laboratory or imaging findings. Splenectomy allows definitive diagnosis throughout a histopathological examination. We report a 52-year-old man presenting with asthenia and abdominal distension. Computed tomography with intravenous contrast showed multiple splenic hypodense masses and a prostatic enlargement. Presuming a lymphoma, a laparoscopic splenectomy was performed. Histopathologic examination diagnosed littoral cell angioma. During urological follow-up, a prostate adenocarcinoma was diagnosed. <![CDATA[Scrofuloderma, cutaneous and pulmonary tuberculosis associated with COVID-19. Report of one case]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400630&lng=p&nrm=iso&tlng=p Cutaneous tuberculosis represents 1-1.5% of extrapulmonary tuberculosis, including a variety of clinical conditions. Scrofuloderma and lupus vulgaris are the most common forms. We report a 49-year-old woman who sought medical attention through tele-dermatology concerning a cervical nodule associated with suppuration and cutaneous involvement. The diagnoses of scrofuloderma and pulmonary tuberculosis were confirmed, and during her evolution she presented a coinfection with SARS-CoV-2. The possible associations between tuberculosis and COVID-19 were reviewed. <![CDATA[Hematocele and hemoperitoneum as initial manifestation of hepatocellular carcinoma. Report of one case]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400635&lng=p&nrm=iso&tlng=p Hepatocellular carcinoma (HCC) rupture is a rare complication, with a higher prevalence in countries of Asia and Europe. Its clinical manifestations can be nonspecific, from abdominal pain and bloating to hemodynamic involvement. We report a 70-year-old male patient with a history of chronic liver disease, presenting with an enlargement and ecchymosis of the scrotum, associated with abdominal bloating. The initial abdominal ultrasound study showed increased liquid content in the scrotal sac and regional edema. A CT of the abdomen and pelvis showed a liver mass with characteristics of hepatocellular carcinoma, associated with extensive hemoperitoneum that drained into the scrotal sac. The patient was treated with embolization of the right hepatic artery and later with surgical resection of the tumor mass, with a good clinical evolution. <![CDATA[Acute kidney injury caused by rhabdomyolysis as a SARS-CoV-2 infection manifestation. Report of one case]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400641&lng=p&nrm=iso&tlng=p SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function. <![CDATA[Obesity and coronavirus: the two pandemics]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400648&lng=p&nrm=iso&tlng=p SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function. <![CDATA[What is the future of advanced human capital formation in Chile ? Current and post-COVID-19 scenarios]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400649&lng=p&nrm=iso&tlng=p SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function. <![CDATA[Psychological and behavioral aspects of the vaccination process]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400650&lng=p&nrm=iso&tlng=p SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function. <![CDATA[Ethical issues related to human embryos produced in the laboratory]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400652&lng=p&nrm=iso&tlng=p SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function. <![CDATA[Late radiotherapy toxicity: an old problem from the past or a current reality?]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400653&lng=p&nrm=iso&tlng=p SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function. <![CDATA[Biological therapy in inflammatory bowel disease pregnant patients: An expanded view on its use]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400655&lng=p&nrm=iso&tlng=p SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function. <![CDATA[On COVID-19, stress and teenagers’ brain]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872021000400656&lng=p&nrm=iso&tlng=p SARS-CoV-2 infection has a wide spectrum of clinical manifestations secondary to the impairment of different organs, including kidney. Rhabdomyolysis is produced by disintegration of striated muscle and the liberation of its contents to the extracellular fluid and bloodstream. This may produce hydro electrolytic disorders and acute kidney injury. We report a 35-year-old female with a history of SARS-CoV-2 infection who was hospitalized because of respiratory failure and developed renal failure. The etiologic study showed elevated total creatine kinase levels and a magnetic resonance imaging confirmed rhabdomyolysis. The patient required supportive treatment with vasoactive drugs, mechanic ventilation and kidney replacement therapy. She had a favorable evolution with resolution of respiratory failure and improvement of kidney function.