Repositorio Institucional
Sistema de Bibliotecas Universidad Finis Terrae
El Repositorio Institucional de la Universidad FinisTerrae, es gestionado por el Sistema de Bibliotecas y tiene por objetivo permitir el acceso libre a la producción académica e institucional de la Universidad, aumentando la visibilidad de sus contenidos y garantizando su conservación.
Envíos recientes
Activity and Outcomes of a Multidisciplinary Sepsis Unit: Fifty Thousand Consultations over Thirteen Years
(MDPI, 2026-07-30) Borges-Sa, Marcio; Martin-Martinez, Elena; Aranda, Maria; Socias, Antonia; Tejada, Sofia; Garau, Margarita; Pérez de Amezaga, Luis; Mena, Joana; Giglio, Andres
Resumen: Background. Sepsis is a leading, time-dependent cause of in-hospital death, and guidelines now prioritize organized care such as code-sepsis protocols. Yet little is known about the long-term activity, organization and outcomes of permanent, hospital-scale programs. We characterized the activity of a hospital-wide multidisciplinary sepsis unit (MSU) over thirteen years and evaluated mortality trends. Methods. Retrospective cohort study using the registry of a hospital-wide MSU (2011-2023). The analysis unit was the sepsis event. Activity, referral pathways, interventions, follow-up and mortality were analyzed; temporal trends used multivariable logistic regression and standardized mortality ratios (SMR). Results. The unit attended 10,874 patients across 15,723 events and 50,925 consultations (median age 67; 59.3% men), referred mainly through the sepsis code (45.0%) and, increasingly, proactive early-warning detection (15.2%). An antibiotic change was recommended in 57.2% of events, and 89.8% of all suggested changes were implemented. Follow-up was sustained (median 3 visits; 61.8%). In-hospital mortality was 7.6%, and 11.8% in protocol-confirmed sepsis. Crude mortality did not fall, but severity rose (organ dysfunctions 1.67 to 2.72; septic shock 8 to 13%; both p < 0.001) with stable age; after adjustment the calendar-year effect disappeared (adjusted OR 1.00/year p = 0.70) and the SMR stayed near 1.0, including pandemic years. Age, ICU admission (OR 2.65) and organ-dysfunction count (OR 1.37) independently predicted death. Conclusions. Over thirteen years, this hospital-wide MSU delivered large-scale, multi-channel, longitudinal care to an increasingly severe population while maintaining stable risk-adjusted mortality, supporting the long-term feasibility of a model integrating early detection, multidisciplinary decision-making, antimicrobial stewardship and follow-up.
The PRECISE framework: a structured approach to antibiogram interpretation for antimicrobial optimization at the bedside
(Sociedad Española de Quimioterapia, 2026-08-31) Pérez-Oliva, Claudio; Giglio, Andrés; Marcio Borges-Sa
Resumen: Antimicrobial resistance claimed an estimated 4.95 million lives in 2019. When clinicians prescribe empiric therapy that follows guidelines, mortality drops by roughly a third; when they de-escalate on the basis of culture results, it drops by more than half. Yet the document that should drive both decisions, the antibiogram, is often read superficially or misinterpreted, particularly by physicians without infectious-disease training. Existing stewardship frameworks address prescribing principles, timing, or ecological impact, but none walks the clinician step by step through an individual susceptibility report and out the other side with a treatment plan. PRECISE is a seven-step mnemonic designed for that purpose. Each letter corresponds to a clinical action: Pathogen assessment, Resistance phenotype interpretation, Evaluate MIC, Curtail spectrum, Individualize PK/PD, Switch route, and Endpoint optimization. Three clinical vignettes (including one in which the steps deliberately collide) illustrate how the framework operates in practice.
Prospective economic evaluation of a predictive artificial intelligence model for sepsis: Effects on hospital costs and return on investment
(PLOS, 2026-08-31) Giglio, Andres; Macias-Fassio, Eric; Salas-Sosa, Santiago; Lopez, David; Pruenza, Cristina; Morales, Aythami; Borges-Sa, Marcio
Resumen: Early sepsis detection is essential for improving outcomes and reducing costs, but traditional rule-based systems have limited accuracy and real-world evidence for machine-learning alternatives remains scarce. In this context, BIAlert-Sepsis predicts sepsis risk within 24 hours using historical hospital data, and evaluating its implementation in a tertiary hospital setting provides an opportunity to quantify its clinical benefits and economic value. We conducted a retrospective quasi-experimental before–after study including all septic patients admitted from January 2011 to June 2024. The baseline period (Jan 2011 – Mar 2019) was compared with the AI implementation period (Apr 2019 – June 2024), excluding the COVID-19 interval. Outcomes were assessed using adjusted generalized linear models and interrupted time series regression. A hospital-perspective economic evaluation incorporated implementation and maintenance costs, and a 5-year model estimated net benefit and return on investment (ROI), supported by deterministic and probabilistic sensitivity analyses. A total of 8,039 patients were included (6,168 baseline period; 1,871 AI period). Demographic and clinical characteristics were comparable across periods. During the AI period, ICU admissions decreased from 34.4% to 30.4% (adjusted p = 0.001), accompanied by significant reductions of 0.35 ICU days and 0.59 ward days per patient. Mean admission costs declined from 26,517€ to 24,630€ (adjusted p = 0.005). After covariate adjustment, AI implementation was associated with a 26.1–31.1% reduction in mean admission costs across GLM models. Interrupted time series analysis identified a modest immediate cost level change after AI implementation and a larger sustained decline during the post-COVID period. The 5-year economic model projected a cumulative discounted net benefit of 3.55M€ and a 528% ROI. BIAlert-Sepsis was associated with favourable clinical outcomes and lower costs, with economic modelling suggesting early breakeven and positive financial returns
Dietary 1,3-diacylglycerols rich in γ-linolenic and stearidonic acids improve metabolic parameters and tissue lipid profiles in high-fat diet-induced obese mice
(Royal Society of Chemestry, 2026-08-03) Valenzuela, Rodrigo; Farias, Camila; Muñoz, Yasna; Alvear, Ignacio; Espinosa, Alejandra; Costa de Camargo, Adriano; López-Arana, Sandra; Rincón-Cervera, Miguel Ángel
Structured lipids (SLs) enriched in gamma-linolenic acid (GLA) and stearidonic acid (SDA) were synthesized as 1,3-diacylglycerols (1,3-DAGs) and evaluated in a high-fat diet (HFD)-induced obesity mouse model. Male C57BL/6J mice were fed control or HFD diets, with or without 2% SL supplementation, for 12 weeks. HFD feeding markedly increased the body weight, hepatic steatosis, insulin resistance, dyslipidemia, inflammation, and oxidative stress and altered hepatic gene expression. SL supplementation significantly attenuated weight gain without affecting the energy intake, reduced hepatic steatosis and adiposity, and improved glucose homeostasis. Serum triglycerides, total cholesterol, LDL-cholesterol, and transaminase activities were normalized, while pro-inflammatory cytokines (TNF-alpha, IL-1 beta, IL-6) and oxidative stress markers were reduced. The antioxidant capacity was restored, with normalization of SOD, CAT, GPX, and GR activities. At the transcriptional level, SLs reactivated PPAR-alpha signaling, enhanced CPT-I and ACOX expression, and suppressed lipogenic genes (SREBP-1c, ACC, FAS), thereby promoting fatty acid oxidation and attenuating lipogenesis. Desaturase activities (Delta 5D, Delta 6D) were modulated, improving n-6/n-3 ratios in liver and adipose tissue, with tissue-specific responses observed in the brain. Dietary GLA- and SDA-enriched 1,3-DAGs reprogrammed lipid metabolism, mitigated HFD-induced metabolic dysfunction, and enhanced PUFA profiles, exerting protective effects against obesity-related dyslipidemia, oxidative stress, and inflammation. These findings highlight their potential as functional lipids for nutritional strategies targeting obesity and metabolic disorders.
Consensus Conference Series on DysglycemiaBased Chronic Disease (DBCD) in Latin America: The Chilean Transculturalization
(Ubiquity Press, 2026-07-13) Nieto-Martinez, Ramfis; Grekin, Carlos; De Oliveira-Gomes, Diana; Gonzalez-Rivas, Juan P.; Lopez-Arana, Sandra; Mechanick, Jeffrey I.
Objective: The MEchanick Transculturalization Research and Innovation ConSortium/Bernard Lown Scholars in Cardiovascular Health Program Consensus Conference on Dysglycemia-Based Chronic Disease (DBCD) Transculturalization in Chile convened on November 20, 2023, in Santiago, Chile. The conference generated affirmed and emergent concepts, key strategies, and specific implementation tactics to improve type 2 diabetes (T2D) care in Chile. Findings: Important affirmed concepts included: (1) implementing a comprehensive approach to T2D management beyond glycemic control; (2) addressing unique challenges for early detection and treatment of T2D; and (3) applying expanded roles of telemedicine. Important emergent concepts included: (1) adopting transculturalized chronic care models such as DBCD; (2) recognizing prediabetes as a critical DBCD target to prevent T2D and T2D complications, especially cardiovascular disease; and (3) implementation of the DBCD model for individual and population health. Key strategies included: (1) validation of culturally adapted T2D risk assessment tools; (2) integration of social determinants of health (SDOH) and ethnocultural factors into DBCD care strategies/tactics; and (3) promotion of equity in healthcare access for all people comprising diverse populations. Finally, specific implementation tactics included: (1) focusing on patient-centered public policies; (2) ensuring access to effective treatments; and (3) using culturally relevant resources for education and prevention. When coordinated, these strategies and tactics mitigate DBCD progression, thereby enhancing healthcare outcomes. Conclusions and recommendations: Expert consensus emphasizes the need for a comprehensive approach to T2D management in Chile, leveraging transculturalized lifestyle medicine, validated risk assessment tools, SDOH, and patient-centered public policies. This process should begin with incorporating eHealth technologies, validation studies, and then translation into clinical practice guidelines. As this templated methodology is applied to other regions of the world, the resulting compendium of concepts, strategies, and tactics can foment a more effective preventive health culture and optimize DBCD care across the ethnocultural spectrum.