Examinando por Autor "Bruna Mejias, Alejandro"
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Ítem Anatomical variants of the origin of the coronary arteries: a systematic review and meta-analysis of prevalence(MDPI, 2024-06-24) Valenzuela Fuenzalida, Juan José; Becerra Rodriguez, Emelyn; Quivira Muñoz, Alonso; Baez Flores, Belén; Escalona Manzo , Catalina; Orellana-Donoso, Mathias; Nova Baeza, Pablo; Suazo Santibañez, Alejandra; Bruna Mejias, Alejandro; Sanchis Gimeno, Juan; Gutiérrez Espinoza, Héctor; Granite, GuiniverePurpose: The most common anomaly is an anomalous left coronary artery originating from the pulmonary artery. These variants can be different and depend on the location as well as how they present themselves in their anatomical distribution and their symptomatological relationship. For these reasons, this review aims to identify the variants of the coronary artery and how they are associated with different clinical conditions. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were researched until January 2024. Two authors independently performed the search, study selection, and data extraction. Methodological quality was evaluated using an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. Results: A total of 39 studies met the established selection criteria. In this study, 21 articles with a total of 578,868 subjects were included in the meta-analysis. The coronary artery origin variant was 1% (CI = 0.8-1.2%). For this third sample, the funnel plot graph showed an important asymmetry, with a p-value of 0.162, which is directly associated with this asymmetry. Conclusions: It is recommended that patients whose diagnosis was made incidentally and in the absence of symptoms undergo periodic controls to prevent future complications, including death. Finally, we believe that further studies could improve the anatomical, embryological, and physiological understanding of this variant in the heart.Ítem Anatomical variants of the renal veins and their relationship with morphofunctional alterations of the kidney: a systematic review and meta-analysis of prevalence(MDPI, 2024-04-21) Valenzuela Fuenzalida, Juan José; Vera Tapia, Karla; Urzúa Márquez, Camila; Yáñez Castillo, Javiera; Trujillo Riveros, Martín; Koscina, Zmilovan; Orellana-Donoso, Mathias; Suazo-Santibañez, Alejandra; Sanchis Gimeno, Juan; Bruna Mejias, Alejandro; Gutiérrez Espinoza, HéctorBackground: Variations in renal veins are quite common, and most people do not experience issues due to them. However, these variations are important for healthcare professionals, especially in surgical procedures and imaging studies, as precise knowledge of vascular anatomy is essential to avoid complications during medical interventions. The purpose of this study was to expose the frequency of anatomical variations in the renal vein (RV) and detail their relationship with the retroperitoneal and renal regions. Methods: A systematic search was conducted in the Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception until January 2024. Two authors independently carried out the search, study selection, and data extraction and assessed methodological quality using a quality assurance tool for anatomical studies (AQUA). Ultimately, consolidated prevalence was estimated using a random effects model. Results: In total, 91 studies meeting the eligibility criteria were identified. This study included 91 investigations with a total of 46,664 subjects; the meta-analysis encompassed 64 studies. The overall prevalence of multiple renal veins was 5%, with a confidence interval (CI) of 4% to 5%. The prevalence of the renal vein trajectory was 5%, with a CI of 4% to 5%. The prevalence of renal vein branching was 3%, with a CI of 0% to 6%. Lastly, the prevalence of unusual renal vein origin was 2%, with a CI of 1% to 4%. Conclusions: The analysis of these variants is crucial for both surgical clinical management and the treatment of patients with renal transplant and hemodialysis.Ítem Anatomy of vertebral artery hypoplasia and its relationship with clinical implications: a systematic review and meta-analysis of prevalence(Springer, 2024-05-19) Valenzuela Fuenzalida, Juan José; Rojas Navia, Constanza; Quirós Clavero, Amanda; Sanchis Gimeno, Juan; Rodriguez Luengo, Macarena; Nova Baeza, Pablo; Orellana-Donoso, Mathias; Becerra Farfán, Álvaro; Bruna Mejias, Alejandro; Sepúlveda Loyola, Walter; Iwanaga, JoePurpose: The vertebral artery (VA) is a vital branch of the subclavian artery, coursing through the transverse foramina of the cervical vertebrae, and playing a crucial role in irrigating the posterior region of the arterial cerebral circle, also known as the Polygon of Willis. Among the various possible alterations that can affect the VA, vertebral artery hypoplasia (HAV) emerges as a significant variant. This study aims to discern the anatomical features of HAV and its correlation with the clinical conditions of the posterior cerebral circulation. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were searched until January 2024. Two authors independently performed the search, study selection, and data extraction. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. Results: A total of 24 studies met the established selection criteria, with a total of 8847 subjects. In this study, 6 articles were included for the meta-analysis with a total of subjects. The average prevalence of VAH reported in each study was 11% (95% CI 10-12%); the studies had a heterogeneity of 41% based on the funnel plot and a low risk of bias. Conclusion: The prevalence of VAH is low, but in the presence of this condition, the changes are mainly in diameter rather than morphological. If it is present, some clinical safeguards must be taken to avoid complications such as stroke.Ítem Clinical implications of aberrant anatomy of the common hepatic duct in liver surgery: a systematic review and meta-analysis(Springer, 2024-09-27) Valenzuela Fuenzalida, Juan José; Avalos Díaz, Constanza; Droguett Utreras, Antonia; Guerra Loyola, Javier; Nova Baeza, Pablo; Orellana-Donoso, Mathias; Suazo Santibañez, Alejandra; Oyanedel Amaro, Gustavo; Sanchis Gimeno, Juan; Bruna Mejias, Alejandro; Gkionoul Nteli, ChatzioglouIntroduction: Knowledge of anatomical variants that affect the hepatic duct (HD) are of particular clinical relevance during hepatobiliary surgical procedures. More specifically, the aberrant anatomy of the common HD is the most common anatomical variation affecting the biliary tree. Below, we describe different classifications of anatomical variants that affect this canal. According to Huang's classification, variations are determined depending on the insertion of the right posterior hepatic duct (RPHD). Materials and methods: Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases were investigated until January 2024. The methodological quality was assessed with an anatomical studies assurance tool (AQUA). Pooled prevalence was estimated using a random effects model. For the subgroup analysis, Student's T-test was used. Results: The prevalence rate of aberrant hepatic duct (AHD) was 15% (confidence interval [CI] of 7-22%). The first subgroup had cadavers and images. For the cadavers, the prevalence was 15.83% (CI: 11.22-18.3%), while the images had a prevalence of 22.06% (CI: 18.12-25.33%). This subgroup analysis showed no statistically significant difference between these groups (p = 0.127). The second subgroup comprised the continents where the included studies were from. In this subgroup, no statistically significant differences were found (p = 0.613). Finally, regarding the right or left laterality of the HD variant, there were no statistically significant differences (p = 0.089). Conclusion: A AHD corresponds to a finding that can occur in a significant percentage of our society, which could be an accidental discovery during surgeries or present asymptomatically throughout life and be a cadaveric discovery later. We believe it is important for surgeons to have prior knowledge of the possible variants of HD to prevent possible complications during and after surgery.Ítem Hypoplastic and congenital absence of coronary arteries and Its correlation with clinical implications of cardiac circulation: a systematic review and meta-analysis(MDPI, 2024-04-18) Bruna Mejias, Alejandro; Del Villar Valdebenito, Javiera; Román, Camila; Alcaíno Adasme, Catalina; Sepulveda Loyola, Walter; Orellana-Donoso, Mathias; Nova Baeza, Pablo; Suazo Santibañez, Alejandra; Becerra Farfan, Alvaro; Sanchis Gimeno, Juan; Valenzuela Fuenzalida, Juan JoséBackground: Coronary arteries originate from the first portion of the aorta, emerging from the right and left aortic sinuses. They traverse through the subepicardium and coronary sulcus to supply the myocardium during diastolic function. The objective of this review was to understand how the hypoplasia and agenesis of the coronary arteries are associated with cardiac pathologies. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were researched until January 2024. An assurance tool for anatomical studies (AQUA) was used to evaluate methodological quality. The pooled prevalence was estimated using a random effects model. Results: A total of three studies met the established selection criteria for inclusion in this meta-analysis. The prevalence of coronary artery variants was 3% (CI = 2% to 8%), with a heterogeneity of 77%. The other studies were analyzed descriptively, along with their respective clinical considerations in the presence of the variant. Conclusions: Hypoplasia and the congenital absence of the coronary arteries are often incidental findings and understanding these variants is crucial to prevent misdiagnosis. Additionally, it is essential to exercise caution when considering surgical management for hearts with these variants.Ítem Partial agenesis of the pectoralis major and minor muscle: A cadaveric case report(Wolters Kluwer Health, Inc., 2024-09-13) Bruna Mejias, Alejandro; Orellana-Donoso, Mathias; Nova Baeza, Pablo; Suazo Santibañez, Alejandra; Oyanedel Amaro, Gustavo; Valenzuela Fuenzalida, Juan JoséRationale: The pectoralis major and minor muscles, located in the anterior chest wall, are crucial for upper limb movements. Patient concerns: Their nonsyndromic absence is rare but significant for surgical procedures involving the axillary and pectoral regions. Diagnoses: Ultrasound can confirm the diagnosis and delimit the extent of the muscular abnormality, detect abnormalities of the costal cartilages, among others. Interventions: This descriptive, cadaveric case report involves a formalin-fixed 57-year-old North American male, with no clinical or family history of similar conditions. The study was conducted at the Human Anatomy Laboratory of the School of Medicine of the universidad Finis Terrae in Santiago, Chile, in August 2022. Outcomes: We present a cadaveric case of bilateral partial agenesis of the pectoralis muscles discovered during routine dissection. The pectoralis major muscle exhibited only the clavicular portion, with the sternocostal and abdominal portions absent and replaced by a thin layer of connective tissue bilaterally. The pectoralis minor muscle showed partial muscle fibers only in the most distal and inferior portions bilaterally. Lessons: This case report is significant due to the rarity of this condition without accompanying anatomical variations. Understanding this variant is valuable for clinical situations involving the shoulder and thorax region, such as trauma to the proximal third of the humerus, clavicular region, suprascapular region, and anterior chest wall. It may complicate conservative and/or surgical treatments due to different functional and irrigation patterns in the area and is also important for educating future professionals.Ítem Prevalence and clinical consideration of anatomical variants of the splenic artery: a systematic review and meta-analysis(MDPI, 2023-03-09) Valenzuela-Fuenzalida, Juan José; Martínez-Hernández, Daniela; Pérez-Jiménez, Daniela; Nova Baeza, Pablo; Becerra-Farfan, Álvaro; Orellana-Donoso, Mathias; Bruna Mejias, Alejandro; Rodriguez Luengo, Macarena; Iwanaga, JoeBackground: The spleen is the largest secondary immune organ in the body. Knowledge regarding the normal splenic vascular anatomy and its anatomical variants is crucial in the medical practice of surgeons and radiologists and is useful for diagnostic evaluations and the guidance of various surgical procedures. Hence, in this research, we aim to characterize the behavior of the lineal or splenic artery in humans from an anatomoclinical point of view. Methods: A systematic search was carried out in electronic databases to compile the available literature on the research subject. Searches were undertaken in the following databases: Medline, Scielo, Wos, Cinahl, Scopus, and Google Scholar. The search terms were “Splenic artery”, “Splenic vascularization”, “Anatomical variations’’, “Splenic organ”, and “Clinical anatomy”. Results: From the 35 studies included in this review, clinical correlations of anatomical variations in the splenic artery with surgical procedures in the abdominal region were reported in 8 studies. These correlations are mainly associated with surgical procedures for the pancreas, liver, stomach, and bile ducts through imaging of the spleen. To verify our conclusions, the risk of bias of the anatomical studies was measured using the AQUA checklist. Conclusions: Recognition of the usual anatomy and anatomical variants of the splenic artery is crucial for both morphology professionals and clinicians addressing the abdominal region and its vascular components. In this review, we determined that the splenic artery could present a variation in its origin or entry into the splenic hilum, which could mean that in any abdominal intervention there may be complications if the splenic artery variation is overlooked. More anatomic clinical studies considering this variation in both diagnostic and surgical processes are suggested for further investigations.Ítem The association between anatomical variants of musculoskeletal structures and nerve compressions of the lower limb: a systematic review and meta-analysis(MDPI, 2024-03-26) Valenzuela Fuenzalida, Juan José; Inostroza Wegner, Alfredo; Osorio Muñoz, Francisca; Milos Brandenberg, Daniel; Santana Machuca, Andrés; Nova Baeza, Pablo; Orellana-Donoso, Mathias; Bruna Mejias, Alejandro; Iwanaga, Joe; Sanchis Gimeno, Juan; Gutierrez Espinoza, HéctorObjective: The aim of this study was to describe the main anatomical variants and morphofunctional alterations in the lower limb that compress surrounding nervous structures in the gluteal region, thigh region, and leg and foot region. Methods: We searched the Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception up to October 2023. An assurance tool for anatomical studies (AQUA) was used to evaluate methodological quality, and the Joanna Briggs Institute assessment tool for case reports was also used. Forest plots were generated to assess the prevalence of variants of the gluteal region, thigh, and leg. Results: According to the forest plot of the gluteal region, the prevalence was 0.18 (0.14–0.23), with a heterogeneity of 93.52%. For the thigh region, the forest plot presented a prevalence of 0.10 (0.03–0.17) and a heterogeneity of 91.18%. The forest plot of the leg region was based on seven studies, which presented a prevalence of 0.01 (0.01–0.01) and a heterogeneity of 96.18%. Conclusions: This review and meta-analysis showed that, in studies that analyzed nerve compressions, the prevalence was low in the thigh and leg regions, while in the gluteal region, it was slightly higher. This is mainly due to the PM region and its different variants. We believe that it is important to analyze all the variant regions defined in this study and that surgeons treating the lower limb should be attentive to these possible scenarios so that they can anticipate possible surgical situations and thus avoid surgical complications.Ítem Use of ketamine in patients with multifactorial neuropathic pain: a systematic review and meta-analysis(MDPI, 2024-09-03) Bruna Mejias, Alejandro; Baeza, Vicente; Gamboa, Javiera; Baez Flores, Belén; San Martin, Jessica; Astorga, Constanza; Leyton, Javiera; Nova Baeza, Pablo; Orellana-Donoso, Mathias; Suazo Santibañez, Alejandra; Becerra Farfán, Álvaro; Oyanedel Amaro, Gustavo; Valenzuela Fuenzalida, Juan JoséNeuropathic pain (NP) is a heterogeneous group of conditions characterized by the experience of a number of sensory disturbances including pain, burning sensations, paroxysms of stabbing pain, dysesthesias, allodynia, and hyperalgesia. The above-mentioned sensations may occur in a specific dermatome area or other delimited region of the body. The objective of this review was to analyze the evidence for ketamine in multifactorial neuropathic pain. The research group systematically searched the databases MEDLINE (via PubMed), EMBASE, SCOPUS, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature (Cinahl), and the Web of Science. The findings of this review show that different forms of low doses of ketamine (LDK) do not present statistically significant changes for any of the scales included. In this study, the total symptom score [standardized mean difference (SMD) = -3.59, confidence interval (CI) = -4.16 to -3.02, and p < 0.00001], neuropathy impairment score (SMD = -1.42, CI = -3.68 to 0.84, and p = 0.22), and neuropathy symptom checklist (SMD = -0.09, CI = -0.15 to -0.02, and p = 0.01) were taken into account. For finality compared to the use of a placebo, the findings suggest that LDK does not exhibit significant differences in terms of pain reduction and functionality. Moreover, no specific dosages are identified to support the use of LDK in the reduction in NP.