El botulismo del lactante es infrecuente en Chile. Esta grave toxemia causada por la ingesta de esporas de Clostridium botulinum se manifiesta como una parálisis flácida descendente, progresando desde una neuropatía craneana a insuficiencia ventilatoria.Objetivo: Reportar el caso de un paciente con insuficiencia ventilatoria ocasionada por esta enfermedad neuroparalítica.Caso Clínico: Lactante de 7 meses, quién consultó por dos días de evolución de dificultad para alimentarse. A su admisión a la Unidad de Cuidados Intensivos se evidenció parálisis de pares craneanos, midriasis arrefléctica bilateral y compromiso de conciencia. El estudio imagenológico no evidenció hallazgos patológicos. La muestra de deposiciones resultó (+) para Clostridium botulinum con aislamiento de toxina A. Se desestimó estudio electromiográfico. El paciente requirió uso de ventilación mecánica invasiva por 2 meses. Presentó recuperación motora restableciendo su normalidad luego de un año de evolución.Conclusión: El botulismo del lactante es un desafío diagnóstico dado su rareza, ante lo cual se debe tener un alto índice de sospecha.

La causa más frecuente de síndrome nefrítico en la población pediátrica es la glomerulonefritis aguda post-estreptocócica (GNAPE). Una complicación infrecuente es el síndrome de encefalopatía posterior reversible (posterior reversible encephalopathy syndrome, PRES), caracterizado por edema cerebral vasogénico subcortical y sintomatología neurológica variable. El desarrollo de anemia hemolítica autoinmune, es una presentación clínica atípica. Objetivo: Reportar la coexistencia de dos complicaciones extrarrenales inhabituales y graves de la GNAPE y discutir potenciales mecanismos involucrados en el desarrollo de estas.Caso Clínico: Paciente masculino de 4 años, con historia de 5 días de hematuria y edema, agregándose cefalea, náuseas y vómitos, ingresó en estatus convulsivo y crisis hipertensiva. Laboratorio mostró hipocomplementemia C3 y títulos elevados de Antiestreptolisina O, lo que se interpretó como GNAPE. Evolucionó con encefalopatía por lo que se sospechó PRES secundario a emergencia hipertensiva, lo que finalmente se confirmó mediante resonancia magnética de cerebro. Cursó además con anemia hemolítica autoinmune, con hemoglobina hasta 5 g/dL. Su tratamiento se basó en terapia antihipertensiva, medidas de neuro protección y tratamiento esteroidal. Egresó a los 31 días de hospitalización, asintomático a los 6 meses post alta. Conclusiones: Se debe tener un alto índice de sospecha de PRES ante la aparición de sintomatología neurológica inespecífica en el curso de la evolución de una GNAPE. La anemia existente en ocasiones puede ser de carácter autoinmune.

Infant botulism is rare in Chile. This severe toxemia caused by the ingestion of Clostridium botulinum spores manifests as a descending flaccid paralysis, progressing from cranial neuropathy to ventilatory insufficiency. Objective: To report the case of a patient with ventilatory insufficiency caused by this neuroparalytic disease. Clinical Case: 7-month-old infant, who consulted due to a two-day history of difficulty feeding. On admission to the Intensive Care Unit, cranial nerve palsies, areflexic bilateral mydriasis, and compromised state of consciousness were observed. The imaging study did not show pathological findings. The stool sample was (+) for Clostridium botulinum with isolation of toxin A. Electromyography was discarded. The patient required invasive mechanical ventilation for 2 months. The patient presented motor recovery after a year of evolution. Conclusion: Infant botulism is a diagnostic challenge given its rarity, therefore a high index of suspicion is required.

The most frequent cause of nephritic syndrome in the pediatric population is acute post-infectious glomerulonephritis (PIGN). A rare complication is posterior reversible encephalopathy syndrome (PRES), characterized by subcortical vasogenic cerebral edema associated with variable neurological symptoms. The development of autoimmune hemolytic anemia is an atypical clinical presentation. Objective: To report the coexistence of two unusual and serious extrarenal complications of PIGN and to discuss potential mechanisms involved in their development. Clinical Case: A 4-year-old male patient, with a 5-day history of hematuria and edema, headache, nausea, and vomiting. He was admitted in convulsive status and hypertensive crisis, laboratory showed C3 hypocomplementemia and high titers of Antistreptolysin O, which was interpreted as PIGN. Due to the presence of encephalopathy, PRES secondary to hypertensive emergency was suspected, which was confirmed by brain MRI. He also presented autoimmune hemolytic anemia, with hemoglobin up to 5 g/dL. The

Fever is a very common sign to observe in critically ill children during their intensive care unit stay. This should be understood as an evolutionary biological response, of normal adaptive character, from the host to the physiological stress. It is the result of a complex response to pyrogenic stimuli, resulting in the generation of cytokines and prostaglandins. The molecular mechanisms involved in the onset of fever are not yet fully specified, thus creating difficulties in the knowledge of the exact pathophysiological processes involved and, therefore, necessary to elaborate an adequate and specific therapeutic strategy. Experimental studies conclude that fever and inflammation are beneficial to the host. However, antipyretic therapy is commonly employed and human studies on the presence of fever and its treatment for the prognosis of critically ill septic patients are inconclusive. Up-to-date information on the physiology of human thermoregulation, the effect of temperature on febrile range over multiple biological processes involved in host defense, and thermoregulatory interventions in the septic patient are essential to know by the critical care physician.

La serendipia ha jugado un rol crucial en la historia de muy diversas areas de la ciencia, entre ellas, la medicina moderna. Esta corresponde a la facultad de realizar un descubrimiento, el cual se produce de manera accidental o casual, en combinación con la sagacidad del observador. Muchos de los más importantes y revolucionarios hallazgos en la ciencia médica, específicamente en la farmacología, involucraron eventos de carácter serendípicos. Se revisan brevemente algunos ejem- plos relacionados con la investigación farmacológica y el descubrimiento de fármacos, como fue la historia de las benzodiazepinas, hidrato de cloral, clonidina, warfarina, solución Ringer, ácido val- proico, barbitúricos, penicilina e insulina, en los que hubo sucesos relacionados con la serendipia. Todos estos medicamentos o sus derivados son de uso frecuente en la actualidad en las Unidades de Cuidados Intensivos.

El desarrollo de un síndrome nefrótico en concomitancia con una tiroiditis de Hashimoto es una asociación infrecuente en la edad pediátrica. Objetivo: Reportar una complicación infrecuente de la tiroiditis autoinmune, como es la aparición de un síndrome nefrótico. Caso Clínico: Paciente de 10 años que se presenta con síndrome nefrótico y bocio. Se pesquisa antecedente de tiroiditis autoinmune e hipotiroidismo no tratado. Se inicia terapia corticoidal y hormonal de sustitución (levotiroxina), logrando buena respuesta clínica y de laboratorio. Conclusión: La tiroiditis autoinmune impacta en la fisiología renal a través de mecanismos inmunológicos y no inmunológicos. Paralelamente, la repercusión renal puede afectar la función tiroidea. La importancia de la presente comunicación radica en reportar una complicación infrecuente de la tiroiditis autoinmune, como lo es la aparición de síndrome nefrótico.

Serendipity has played a crucial role in the history of many different areas of science, including modern medicine. This corresponds to the ability to make a discovery, which occurs accidentally or by chance, in combination with the sagacity of the observer. Many of the most important and revolutionary findings in medical science, specifically pharmacology, involved serendipitous events of a nature. Some examples related to drug discovery and pharmacological research are briefly reviewed, such as the history of benzodiazepines, chloral hydrate, clonidine, warfarin, Ringer's solution, valproic acid, barbiturates, penicillin and insulin, in which there were events related to serendipity. All these drugs or their derivatives are currently in frequent use in Intensive Care Units.

For centuries, numerous treatments were used, of the most varied origins and based on the most unlikely foundations designed to hasten recovery and improve the survival of patients with whooping cough. In 1906, when the bacterial origin of whooping cough was identified, the hope for a potential treatment arose, however, only decades later, humanity would face a significant change with the consolidation of an effective vaccination. This article provides a historical review from the use of some of the most frequent treatments devised between the 18th-20th centuries for the cure of whooping cough. Some of the therapies offered in Chile in the first half of the last century are emphasized and detailed.

The development of nephrotic syndrome in concomitance with Hashimoto's thyroiditis is an in frequent association in the pediatric age.OBJECTIVE:To report an infrequent complication of au toimmune thyroiditis, such as the appearance of nephrotic syndrome.CLINICAL CASE:A 10-year-old patient presenting with nephrotic syndrome and goiter. A history of autoimmune thyroiditis and un treated hypothyroidism was detected. Corticosteroid and hormone replacement therapy (levothyro- xine) is started, achieving a good clinical and laboratory response.CONCLUSION:Autoimmune thyroi ditis impacts renal physiology through immunological and non-immunological mechanisms. At the same time, renal repercussions can affect thyroid function. The importance of this communication lies in reporting an infrequent complication of autoimmune thyroiditis, such as the appearance of nephrotic syndrome.

Medical philately, with its diverse themes, is a faithful testimony of the historical events that have affected humanity. Likewise, it allows us to evidence its role as a diffuser of diverse prevention cam paigns carried out to control and eradicate serious infections, together with other achievements of health policy in the child population. Nowadays, the knowledge and collection of postage stamps is an increasingly unusual pastime. On the other hand, sometimes there is a marked historical ignoran ce and lack of appreciation of the effective actions for the control of infectious diseases, forgetting the enormous effect of these on the daily life of the current society. Through the visual testimony offe red by the postage stamps, we review the sanitary, educational, and therapeutic actions destined to control the infections in the pediatric patient, with emphasis on our country. In addition, we discuss the new populations at risk for the appearance of septic episodes. Even today, serious infections and sepsis represent an important public health problem.

La filatelia médica, con sus diversas temáticas, se configura como un fiel testimonio de los sucesos y hechos históricos que han afectado a la humanidad. Asímismo, permite evidenciar el rol difusor de diversas campañas de prevención realizadas para controlar y erradicar las infecciones graves, junto con otros logros de política sanitaria de gran impacto en la población infantil. En la actualidad, el conocimiento y colección de los sellos postales, es un pasatiempo cada vez más inusual. Por otra parte, en ocasiones, existe un marcado desconocimiento histórico y pérdida de la valoración de las medidas eficaces para el control de las enfermedades infecciosas, olvidando el enorme efecto de estas en la vida cotidiana de la sociedad de la época. Se revisa mediante el testimonio visual ofrecido por los sellos postales las medidas sanitarias, educacionales y terapéuticas destinadas al control de las infecciones en el paciente pediátrico, con énfasis en nuestro país. Además, se discuten las nuevas poblaciones de riesgo para la aparición de episodios sépticos. Aún en nuestros días las infecciones graves y la sepsis representan un grave problema de salud pública.

In our country, meningococcal disease has a low endemic and high lethality, with epidemic out breaks; some of them of historical character, like the one happened during the first half of the last century. The action of a group of doctors, pioneers in clinical, research and teaching aspects, together with the health personnel that constituted their team, immersed in a successful public health policy, allowed to consolidate the necessary care of the sick child of this serious pathology, as well as many others, thus enabling the development of a structured and scientific proposal, in the light of the knowledge available at that time. Therefore, after 80 years, it is important to review the various clini cal, pathophysiological and therapeutic aspects, in addition to the hospital and social context, of this successful history of the Chilean public health system.

Cada vez es más frecuente la atención médica en la Unidad de Cuidados Intensivos (UCI) de niños o adolescentes inmigrantes como también de aquellos nacidos en nuestro país con padres en tal condición. Esto ha ocasionado, en la actualidad, que el equipo de salud se deba enfrentar con problemas diagnósticos derivados del escaso conocimiento de condiciones genéticas propias de esta población y/o el desarrollo de diversas patologías infrecuentes en nuestro país, algunas resultantes de su condición sanitaria. En esta revisión se abordan diversos aspectos de la patología hematológica, infecciosa, parasitaria, respiratoria y cardiovascular, todos tópicos relevantes de conocer durante su estadía en la UCI. Es un deber del equipo de salud actualizarse sobre patologías de baja prevalencia en nuestro país, algunas de ellas muy poco conocidas hasta hace una década, pero que, actualmente, están cada vez más presentes en las UCI del sistema de salud público chileno.

Negative pressure pulmonary edema (NPPE) is a rare entity that can become life threatening. Its development in neonates is very rare, and its presentation as alveolar hemorrhage is uncommon. We report a case of a newborn 23 days old, previously healthy, who presented an episode of choking during breastfeeding. This progressed to acute respiratory failure due to diffuse alveolar hemorrhage. A few hours after admission, the newborn developed refractory hypoxemia, requiring high-frequency oscillatory ventilation and nitric oxide therapy for 24 hours. NPPE was postulated as a diagnosis of exclusion. The newborn recovered completely. NPPE should always be considered in a case with recent obstruction of the upper airway, even in unusual age groups. Sometimes it can manifest as alveolar hemorrhage.

Hypoalimentation is an important cause of hypernatremic dehydration in neonates; however, extreme values of plasma sodium make it necessary to investigate the differential diagnosis. We report the case of a 20-day-old newborn who was admitted with severe hypernatremic dehydration, with plasma sodium of 213 mEq/L and oliguric acute renal failure. The patient was treated with intravenous fluids for correction of dehydration and peritoneal dialysis for adequate sodium correction. During the etiological study, a 10-fold increase in the concentration of sodium in breast milk was detected. Peritoneal dialysis was an effective therapy in the management of the extreme hypernatremia with sodium correction within the recommended rate. At the 1-year follow-up appointment, the child had normal renal function, normal for age psychomotor development, and neurological physical was unremarkable. In conclusion, we report a case of an unusual extreme hypernatremia with discussion of the underlying pathophysiology and, more importantly, the effective treatment with a mixed approach with intravenous fluids and peritoneal dialysis.

It is increasingly common to provide medical care in the Intensive Care Unit (ICU) for immigrant children and adolescents as well as those born in Chile with parents in such condition. Currently, this has caused that the health team has to face diverse infrequent pathologies in our country and/or diagnostic problems derive from the poor knowledge of genetic conditions of this population, some resulting from their health conditions. This review addresses several aspects of hematological, infectious, parasitic, respiratory, and cardiovascular pathologies, all relevant topics to know during their stay in the ICU. It is a duty of the health team to be updated on pathologies of low prevalence in our country, some of them very little known until a decade ago, but which are currently increasingly present in the ICUs of the Chilean public health system.