[Antimicrobial Susceptibility Patterns in Adult Patients Hospitalized for Community-Acquired Urinary Tract Infections in Two Tertiary Hospitals in Santiago, Chile].

Background: The constant increase of factors associated with the presence of resistant strains, makes empirical antibiotic selection a challenge in patients hospitalized for community-acquired urinary tract infection.

Aim: We characterized the bacteria and their antimicrobial susceptibility pattern in cultures obtained from adult patients that needed hospitalization for this disease in two tertiary hospitals in Santiago, Chile.

Methods: We conducted a prospective cross-sectional study in adults hospitalized for community-acquired urinary tract infection between 2017 and 2022.

a problem to face during internal medicine rotations: development and psychometric properties of the IMPRINT-15.

Clinical rotations are an essential part of Internal Medicine (IM) residency programmes, where curricular objectives are carried out. To our knowledge, there are no validated instruments to assess IM clinical rotations. Our objective was to develop an instrument for residents to assess the quality of clinical rotations in an IM residency programme, and to test the psychometric properties of the instrument.

Is it worth adding an inferior vena cava filter to anticoagulation in thromboembolic disease?

Some patients who have presented a thromboembolic event persist with a high risk of recurrence despite anticoagulant treatment. It has been suggested that adding an inferior vena cava filter may reduce this risk, but the clinical effects of this measure are not clear. To answer this question we searched in Epistemonikos database, which is maintained by screening multiple information sources.

[Evaluation of oral anticoagulation with rivaroxaban, in patients with new onset non valvular atrial fibrillation].

Background: Atrial fibrillation (AF) generates a hypercoagulable state with an increased thrombin generation and raised levels of thrombin-antithrombin complexes, which results in a high risk of stroke and thromboembolism.

Aim: To evaluate the anticoagulant effect of rivaroxaban by anti-Xa factor activity and its correlation with thrombin-antithrombin complexes, thrombin generation and prothrombin time in patients newly diagnosed with non-valvular AF.

Patients And Methods: Prospective study in patients with indication of anticoagulation.

Low molecular weight heparin in one or two doses for the initial treatment of venous thromboembolic disease?

The preferred dosification for low molecular weight heparins is in two doses for most patients with venous thromboembolic disease. A daily dose would make treatment simpler, less expensive and more comfortable while retaining a similar benefit and safety. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified two systematic reviews including five randomized trials.

[Development of MEDUC-PG14 survey to assess postgraduate teaching in medical specialties].

Background: Feedback is one of the most important tools to improve teaching in medical education.

Aim: To develop an instrument to assess the performance of clinical postgraduate teachers in medical specialties.

Material And Methods: A qualitative methodology consisting in interviews and focus-groups followed by a quantitative methodology to generate consensus, was employed.

Does aspirin reduce recurrence after completing anticoagulant treatment for an idiopathic thromboembolic event?

Idiopathic thromboembolic disease presents a high risk of recurrence. There is controversy about the effects of aspirin in reducing this risk after the completion of anticoagulant treatment. Searching in Epistemonikos database, which screens 30 databases, we identified four systematic reviews that together include two randomized trials.

[Correlation between aPTT and antifactor Xa to determine therapeutic ranges for unfractionated heparin].

Background: The therapeutic range (TR) of activated partial thromboplastin time (aPTT) for unfractionated heparin (UFH) dosing was established in the 1970 decade. Since then aPTT determination has changed. Current TR may be sub or supra-therapeutic depending on the reagents of the test, and therefore, responsible for complications of therapy.

[Treatment of diabetic ketoacidosis using 2009 American Diabetes Association guidelines].

Background: During 2009, new guidelines for the treatment of diabetic ketoacidosis were published by the American Diabetes Association.

Aim: To assess the impact of new treatment guidelines on the evolution of patients treated for diabetic ketoacidosis (KAD).

Patients And Methods: Anonymous data was obtained from computational medical records of patients treated for KAD at our institution two years before ("Traditional Protocol") and TWO years after ("ADA-2009 Protocol") the publication of the 2009 American Diabetes Association (ADA) KAD guidelines.

[The discharge process].

Discharge is one of the most important processes that hospitalized patients must endure. This process is complex, requires coordination among several professionals and transfers an overwhelming amount of information to patients. Often, it is limited to the writing of the discharge summary, with a primary emphasis on the drug list.

[Controversies in massive pulmonary embolism].

Massive pulmonary embolism (PE) is associated with high mortality. There is still a broad assortment of severity classifications for patients with PE, which affects the choice of therapies to use. The main clinical criteria for defining a PE as massive is systemic arterial hypotension, which depends on the extent of vascular obstruction and the previous cardiopulmonary status.

[Risk stratification of pulmonary thromboembolism].

The prognosis of pulmonary thromboembolism (PE) is related to the cardiopulmonary reserve of the patient and the magnitude of the embolus that impacts pulmonary circulation. The presence of hemodynamic instability (shock) stratifies a group of patients with high mortality, which should be treated with thrombolysis. Patients without shock but with right ventricular dysfunction can have a dismal evolution and should be managed aggressively.

[Basic cardiopulmonary resuscitation: knowledge, practical skills and effectiveness of maneuvers of general physicians].

Background: General physicians should be adequately trained to deliver effective resuscitation during ventricular fibrillation (VF).

Aim: To assess the degree of knowledge, skills and practical effectiveness in cardiopulmonary resuscitation (CPR) of Chilean general physicians.

Materials And Methods: Forty eight general physicians starting Anesthesiology or Internal Medicine residency programs were evaluated.

[New oral anticoagulant drugs].

Thromboembolic disease (TED) is the leading cause of morbidity and mortality worldwide. The hallmark of oral long-term anticoagulant therapy has been the use of vitamin K antagonists, whose anticoagulant effect is exerted inhibiting vitamin K epoxide reductase. Warfarin and acenocoumarol are the most commonly used.

[Strategies for the prophylaxis of thromboembolic disease among medical patients].

Thromboembolic disease is the main preventable cause of in-hospital death. Approximately 10% of nosocomial deaths are attributable to pulmonary embolism and in most cases, the diagnosis is not suspected before the autopsy. There are cost effective measures to decrease the incidence of thromboembolic disease.

[Competences on hypoglycemia management among healthcare professionals in a clinical hospital].

Background: A tight glycemic control of hospitalized patients increases the risk of hypoglycemia, whose management is not always optimal.

Aim: To assess the hypoglycemia management competences of a multidisciplinary team in a clinical hospital.

Material And Methods: An anonymous questionnaire about hypoglycemia management was answered by 11 staff physicians, 42 residents and 28 nurses of the department of medicine and critical care unit ofa university hospital.

[Cognitive impairment probably related to repeated episodes of hypoglycemia. Report of one case].

We report a 78 year-old diabetic woman, treated with gliburide and metformin, consulting in the emergency room for a non fuctuating impairment in consciousness. She had a history of similar episodes in the last two months. A brain CAT scan showed an old putamen lacunar infarction.

[Secondary adrenal insufficiency presenting as hyponatremia: report of one case].

Hyponatremia can be a marker of an underlying disease. We report a 52 years-old male with Diabetes Mellitus who consulted for an episode of nausea and vomiting lasting four days. His baseline serum sodium was 118 mEq/L.

[Hospital medicine].

Hospital medicine was created over 10 years ago aiming to provide an integral care to hospitalized patients. Hospital specialists are physicians mainly devoted to the global care of hospitalized patients. Their professional functions include patient care, teaching, clinical research and managing activities.

[Fever of unknown origin caused by multiple myeloma. Report of one case].

Fever of unknown origin (FUO) can be caused by tumors, especially those arising from the hematopoietic system. Multiple myeloma can also cause fever but it is not a common cause of fever of unknown origin. We report a 53 year-old man presenting with fever lasting eight weeks.

[Cat-scratch disease. Review of eight adult patients hospitalized for fever or adenopathy].

Background: Cat-scratch disease is common among children. Among adults the disease is less often considered in the differential diagnosis of enlarged lymph nodes and fever.

Aim: To report the clinical and laboratory features of eight patients with cat-scratch disease.