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Aprendizajes sobre la vulneración a la infancia durante la pandemia COVID-19: enfermedad, evidencia y políticas públicas
(Sociedad Chilena de Pediatría, 2024-11-01) Díaz, Franco
La pandemia de COVID-19 ha tenido repercusiones significativas en niños, niñas y adolescentes (NNA), tanto por los efectos directos del virus como por las medidas de salud pública aplicadas. Presentamos un análisis de los aciertos y errores en la respuesta gerontocéntrica a la pandemia, que invisibilizó a los NNA del panorama global, de su salud y ciclo vital. Contraponiéndose con la discreta incidencia de COVID-19 pediátrico, múltiples guías se desarrollaron precipitadamente para terapia, afectando el enfrentamiento de otras enfermedades, por ejemplo, el soporte respiratorio no-invasivo y terapia inhalada. Las medidas de confinamiento y cierre de colegios tuvieron un impacto mínimo en la propagación del virus, desmitificando el rol de supercontagiantes, pero su mantención prolongada se basó en decisiones no respaldadas por evidencia, resultando en una importante pérdida educativa y trastornos psicosociales. La crisis de salud mental en NNA se ha agudizado, con un aumento rápido de depresión y trastornos alimentarios, especialmente en grupos socioeconómicamente vulnerables. Otros ámbitos de salud fueron alterados, como la interrupción de servicios sanitarios preventivos, chequeos rutinarios y vacunaciones, diagnósticos de enfermedades como cáncer y terapias de rehabi-litación. Además, se analiza críticamente la narrativa de los mandatos de uso de mascarillas y vacunas en NNA. En conclusión, reflexionamos sobre los aciertos y errores durante la pandemia en puntos críticos de la salud de NNA, con el fin de aprender y optimizar nuestra respuesta a situaciones futuras. Es imperativo adoptar medidas urgentes para identificar y mejorar en estas áreas, cuyos catastróficos efectos recién comenzamos a entender en NNA, y futuros adultos.
Critical asthma in infancy and toddlers: how can we mechanically discriminate from critical bronchiolitis?
(Wiley, 2024-11-06) Cruces, Pablo; Alcántar, Valentina; Caviedes, Paola; Díaz, Franco
Asthma in infancy and toddlers has been increasingly recognized, referring to recurrent episodes of wheezing, also in mechanically ventilated children [1]. We analyzed the working pressures of the respiratory system under static conditions in a cohort of infants and toddlers with a discharge diagnosis of critical asthma. Also, we compare them with critical bronchiolitis cohort and anesthetized children without respiratory disease (normal physiology). Finally, we aimed to identify consistent thresholds in lung mechanics to discriminate between these conditions.
Reply to letter to the editor regarding “Wound drain in lumbar arthrodesis for degenerative disease: an experimental, multicenter, randomized controlled trial”
(Elsevier, 2024) Molina, Marcelo
We would like to thank Dr Alexander Hammer and Dr. Klaus John Schnake for their interest and perceptive insights concerning our study. In your letter, you raise interesting points of view that we will address in this response.
Low-grade cartilaginous vertebral tumor: a rare cause of spinal cord compression
(Gavin Publishers, 2023-12-19) Molina, Marcelo; Ceballos, Oscar; Pereira, Mariana
Introduction: Osteochondroma is the most common benign primary neoplasm, representing up to 36% of benign bone tumors. Its location in the spine is rare, occurring in 4% to 7% of primary tumors in this location, and of these, around one-third present myelopathy secondary to spinal cord compression. Despite its low prevalence described in the literature, in recent years there has been an increase in reported cases. Objectives: To present a rare low-grade cartilaginous tumor with intracanal extension as an etiology of spinal cord compression syndrome with myelopathy. Treatment options were discussed. Material and Method: Informed consent was approved by the patient. Clinical information and images were obtained from the electronic file. A review of the literature was done for its analysis and discussion. Results: 52-year-old man, no medical history. He consulted for a 2-month history of progressive loss of strength on the left lower extremity (LLE). On physical examination, it presents hypoesthesia and 3/5 strength from L2 to S1 myotomes in the LLE. Neurological evaluation, spine CT, and MRI were done. Images show a T7 vertebral body tumor with a large extruded calcified mass occupying 80% of the canal at T6T7 with severe compression of the spinal cord. Surgical management was decided by performing posterior arthrodesis from T4 to T10 with posterolateral tumor resection and spinal cord decompression. The patient woke up with paraplegia after surgery. There was a gradual and significant improvement in the patient’s condition over the first four weeks. After a 6-month of following an intensive rehabilitation program, the patient progressed favorably, pain-free, with normal sensitivity, full recovery to 5/5 strength, walking independently, and some degree of spasticity. At 2 years follow up the patient has only mild gait disturbance secondary to spasticity. Discussion: A case of solitary osteochondroma as a cause of progressive compressive myelopathy was presented. Surgical options are evaluated depending on the location of the tumor, presence of mechanical pain, radiographic spinal alignment, vertebral collapse, posterolateral involvement, and neurological compromise of the spine. Most of the similar published reports show that this clinical picture is more frequent in the context of multiple hereditary exostoses and 132 new cases have been published from 2004 to 2016, which shows a 2.4-fold increase since 2003, of which, 27.2% presented with myelopathic symptoms. Conclusion: Osteochondroma is a rare spine tumor that can produce radicular or myelopathic symptoms. Surgery is recommended in spinal cord compression cases. Surgical options are evaluated depending on the location, morbidity, and complications.
Survey on spinal injections for lumbar degenerative stenosis among spine surgeons in Latin America
(Fortune Journals, 2023-11-09) Molina, Marcelo; Torres, Ramon; Yurac, Ratko; Pantoja, Samuel; Gonzales, Lucio
Introduction: Epidural and facet joint injections are usually used as part of the treatment algorithm for low back and radicular pain. Current clinical practice in Latin America is not well described in the literature. Objectives: Evaluate the indications and techniques of spinal injections (SI) in patients with degenerative lumbar spinal stenosis (DLSS) among spine surgeons in Latin America. Study Design: Cross-sectional, international survey, narrative literature review. Methods: An online survey was sent to spine surgeons and members of the AOSpine Latin America. Data included surgeon geographic information, specialty, time in professional activity, SI indications, and techniques in different scenarios of pain and stenosis localization. Results: A total of 446 surgeons, 291 (65%) orthopedic surgeons, and 155 (35%) neurosurgeons replied to the survey. 92% of spine surgeons indicated a spinal steroid injection to treat DLSS. Most spinal surgeons (54%) would simultaneously perform both peridural and intraarticular lumbar facet (combined) steroid injections in patients with low back pain and radicular pain. Foraminal injection is a preferred technique for patients with central and foraminal stenosis. There are no significant differences in most of the answers between orthopedic surgeons and neurosurgeons. Almost 80% of respondents expect a good result from the injection. However, 86% of surgeons believe injection effects last less than 6 months, and only 12% think surgery will not be necessary in the future. Only 15% of spine surgeons irrespective of specialty adhere to a guideline on spine injections for DLSS. Conclusion: This study provides a global perspective on how Latin American spine surgeons treat patients with DLSS concerning the use of spinal steroid injections. We observed that more than 90% of respondents use this procedure to treat DLSS. There are almost no differences between orthopedic spine surgeons and neurosurgeons when performing SI. A foraminal injection is preferred for lateral recess and foraminal stenosis. Most of the respondents expect to achieve positive results with the procedure, but they believe that its effect will last for less than 6 months and possible need for surgery.
Posterior hemivertebrectomy for correction of congenital kyphosis in adulthood: case report and literature review
(Gavin Publishers, 2023-12-19) Molina, Marcelo; Pereira, Mariana; Khek, Pablo; Ballesteros, José Vicente
Congenital kyphosis is an infrequent cause of kyphosis with a potential severe progressive deformity and neurological damage. There are few reports in the literature about congenital kyphosis focusing on adults. Case presentation: 24-year-old male with progressive dorsal pain, paresthesias, and numbness in his legs. Physical examination demonstrated a rigid kyphotic deformity with tenderness on the apex, neurologically intact. The diagnosis was a T10 butterfly posterior hemivertebra with segmental kyphosis of 48 degrees. The patient was treated surgically with a single posterior procedure, performing a complete T10 hemivertebrectomy and instrumented fixation from T8 to T12. The postoperative assessment demonstrated a segmental kyphosis of 14 degrees with 34º of correction, without surgical complications, and good functional results during 4 years of follow-up. Conclusion: Posterior-only hemivertebra resection is an effective procedure for treating congenital kyphosis, providing an excellent correction of the deformity with a good functional outcome. Intraoperative imaging tools, such as CT scans and navigation systems, can aid in performing the surgery and improve outcomes.
RECOSAN tumors study: analysis of patients with spine surgery due to oncologic pathology
(Fortune Journals, 2024-11-01) Molina, Marcelo; Ceballos, Oscar; Pereira, Mariana; Lobos, Daniel; Yurac, Ratko; Otto, Juan Pablo; Barahona, Maximiliano
Introduction: Primary bone tumors of the spine are rare and account for 2.8 to 13% of all bone tumors. On the other hand, the spine is a frequent location for metastatic disease. As local control of the primary tumor pathology continues to improve, survival rates improve, and, by extension, the chance of metastasis increases. Breast, lung, and prostate cancer are the main causes of spinal metastases. The RECOSAN (Santiago Spine Surgery Registry) project is the first multicenter, prospective, and national registry of spinal surgeries in Chile. Purpose: The objective was to describe the epidemiological, diagnostic, surgical information, complications, and biopsy results of patients operated on for tumor pathology in the RECOSAN registry. Materials and methods: The RedCap database of the RECOSAN project’s was used to obtain information on patients who underwent spinal surgery due to tumor pathology in five Chilean hospitals. Information on the biopsies of these patients was requested from the respective hospitals and clinics where they were admitted. Demographic data, surgical history, and results of biopsies performed were collected. Results: Out of 1225 patients admitted to the registry, 82 correspond to spinal surgeries due to tumor pathology. Biopsy reports were obtained from 63 patients who underwent surgical biopsy plus tumor resection and instrumentation. 52% of the patients were male, and the mean age was 57 years. 44% of the biopsies were in the dorsal spine and 40% in the lumbar spine. Of the total number of biopsies performed, 84.1% resulted in tumor lesions. Of these, 66% corresponded to metastases and 34% to primary tumors. The most frequent histological diagnoses were breast carcinoma (20.8%), prostate carcinoma (11.3%) and plasma cell neoplasia (9.4%). The percentage of intraoperative complications of the instrumented patients was 18%, and the percentage of reoperation was 4.7%. There was agreement between the preoperative and final diagnoses based on the biopsy of 66% of the cases, reaching a moderate concordance (Kappa=0.42). Conclusion: Vertebral biopsy is an essential procedure for histological diagnosis in both primary and metastatic tumor lesions. This is the first national multicenter registry in Chile for patients undergoing surgery for tumors. It covers epidemiological data, clinical information, surgical techniques, biopsy results, as well as intraoperative and postoperative complications. In this series, the most frequent histological diagnoses coincide with those reported in the literature. The concordance between the preoperative diagnosis and the biopsy is moderate, which supports the importance of obtaining a biopsy for the treatment of spinal tumor pathology.
Radiological classification for degenerative lumbar spine disease: a literature review of the main systems
(Fortune Journals, 2023-12-29) Molina, Marcelo; Vial, Sebastián
Study Design: Systematic review Objectives: Performed a systematic review of available lumbar spinal degenerative disease classifications. Methods: We performed a systematic literature review search for papers that proposed or described radiological classification systems for degenerative lumbar spine disease, such as lumbar disc herniation, facet joint arthritis, spondylolisthesis, and lumbar stenosis. The literature was performed in MEDLINE and EMBASE, limited to English articles published from 1980 to the present. The reliability tests of the reviewed articles were assessed with the “Intraclass Correlation Coefficients” (ICC) and “Cohen's Kappa coefficient” (k). Results: We found 1873 articles. A total of 64 articles were reviewed, identifying 31 radiological classification systems. We found 7 classifications for degenerative disc disease, 7 for disc herniation, 7 for facet joint osteoarthritis, 8 for degenerative spinal stenosis, and 2 for degenerative spondylolisthesis. Of the 31 systems found, 24 had interrater agreement studies. The clinical orientation of the classification was analyzed when appropriate. Discussion: Reliability studies play a crucial role in evaluating a classification system as they enable reproducibility among evaluators, thereby fortifying the system. Classifications should not only be endorsed based on their validation and reliability studies, but it is also crucial to assess their feasibility for practical implementation in clinical settings. Conclusions: A classification system should have a reliability with Kappa or ICC over 0.60 to be recommended. It should provide a clinical orientation to make therapeutic decisions and form part of a guideline. Continued research on classification development is essential to improve systems, enhancing their clinical utility and bolstering their reliability
Analysis of predictors for spinal fusion in degenerative lumbar stenosis in Chile based on diagnosis-related groups
(Gavin Publishers, 2024-01-03) Molina, Marcelo; Salvo, Lorena; Arriola, Constanza; Rioseco, Bernardita
Introduction: Degenerative Lumbar spinal stenosis (DLSS) is the most common cause of spine surgery for patients above 55 years. Surgery options include decompression alone or with spinal fusion. The DRG system uses classification algorithms that categorize patients into groups with similar clinical and resource consumption characteristics, using ICD-10 nomenclature for diagnoses and ICD-9-CM for procedures. Objective: Identify clinical and epidemiological variables of DLSS surgery patients based on Chile’s DRG system data and define factors associated with arthrodesis as a complement to decompression. Study Design: Retrospective observational study. Methods: This study used the national DRG database to analyze factors predicting the need for fusion in patients with DLSS. Data from 31 public hospitals in Chile were analyzed for patients discharged between 2020 and 2022. Variables considered included age, gender, presence of other spinal pathologies, and attending physician specialty. For the descriptive analysis of qualitative variables, frequencies and percentages were used.The study used univariate and multivariate logistic regression analysis. A statistical significance level of less than 0.05 was considered. Results: We analyzed 1024 patients with lumbar spinal stenosis and found that 54.6% were female and 45.4% were male (p= 0.0034). The majority of the patients (57.4%) were aged between 60 and 79 years. 75% of orthopedic surgeons opted for decompression plus arthrodesis, while neurosurgeons preferred decompression alone in 73% of cases. The most significant predictors for decompression with fusion were the physician’s specialty in orthopedic surgery, female sex, and the presence of other spinal pathologies such as scoliosis, herniated disc, and spondylolisthesis. Patients treated by an Orthopedic Surgeon had an 8.2 times greater probability of undergoing decompression plus arthrodesis as compared to those treated by a Neurosurgeon. Additionally, the presence of spondylolisthesis increased the probability of decompression with fusion by 6.2 times, and the presence of scoliosis increased it by 6.6 times. Neurosurgeons opted for decompression alone in 89.7% of the cases with DLSS stenosis and herniated disc, while only 48.9% of orthopedic surgeons opted for the same option (p=0.0000). Conclusion: Our study based on DRG records from public hospitals in Chile has identified certain factors linked to a higher frequency of spinal arthrodesis. These factors include the surgery being performed by orthopedic surgeons, patients aged between 40 and 60 years old, the presence of degenerative spondylolisthesis and degenerative scoliosis, and the absence of a herniated disc.
Percepción de estudiantes de Medicina sobre curso híbrido de Traumatología y Ortopedia post pandemia COVID-19: estudio transversal en Chile
(Clínica Las Condes, 2024-05-14) Ruiz Riquelme, Pablo; Cáceres Hernández, Andrea; Konig López, Bernardita; Quintana Guiñez, Felipe; Castro Cruz, Magdalena
Introducción: La pandemia del COVID-19 tuvo como consecuencia un aumento en la educación a distancia en estudiantes de pregrado de medicina. Si bien hay reportes de estas experiencias, aún falta investigación acerca de la percepción de estos nuevos métodos de aprendizaje. La Universidad Finis Terrae implementó su curso de traumatología de pregrado con modalidad online en el año 2021 y con modalidad híbrida en el año 2022. Objetivo: El objetivo es determinar la percepción de los estudiantes de quinto año de medicina del curso híbrido de “Traumatología y Ortopedia 2022”. Metodología: Se realizó una encuesta de satisfacción estudiantil que evaluó las siguientes dimensiones: concepto y experiencia previa con clases a distancia; percepción de aprendizaje de modalidad a distancia y práctica presencial; limitaciones de la educación a distancia; y valoración sobre mantener metodología de enseñanza. Resultados: Todos los estudiantes (92/92) respondieron la encuesta. El grupo estuvo constituido por un 53% de mujeres y 47% de hombres, con una mediana de edad de 24 [22-37] años. La mayoría de los estudiantes refirió que el curso cumplió sus expectativas y tuvieron buena adquisición de conocimiento teórico, aunque tenían inseguridad en la aplicación del examen físico. Se reconocieron ventajas y desventajas de esta modalidad y se plantearon formas de mejora. Conclusión: Este estudio concluye la percepción favorable del estudiantado sobre la adecuada adquisición de conocimientos teóricos, las ventajas de la modalidad híbrida y la valoración positiva. Sin embargo, se sugiere mejorar la adquisición de conocimientos del examen físico y el tiempo asignado para el desarrollo del curso de Traumatología y Ortopedia.
Renal cell carcinoma in a patient with crossed and fused renal ectopy: a case report
(Elsevier, 2024-02-22) Bassa-Moyano, Joan Cristóbal; Fernández Wenzel, Juanita; Almonacid Grunert, Jorge; Aroca Siré, Pablo; Muñoz Fuentes, Cristian
Crossed-fused renal ectopia (CFRE) is a rare congenital disease in which one of the kidneys with its ureter crosses the midline and fuses with the contralateral kidney. The association of this malformation with the presence of primary renal cell carcinoma (RCC) is even more anecdotal; there are only a few cases reported in the literature. We describe the case of a 62 year-old man with CFRE associated with renal cell carcinoma, which was successfully removed by retroperitoneoscopy, after careful preoperative study of blood supply and anatomical features.
Intragastric administration of short chain fatty acids greatly reduces voluntary ethanol intake in rats
(Springer Nature, 2024-11-26) Quintanilla, Maria Elena; Santapau, Daniela; Diaz, Eugenio; Valenzuela Martinez, Ignacio; Medina, Nicolas; Landskron, Glauben; Dominguez, Antonia; Morales, Paola; Ramírez, David; Hermoso, Marcela; Olivares, Belén; Berríos-Cárcamo, Pablo; Ezquer, Marcelo; Herrera-Marschitz, Mario; Israel, Yedy; Ezquer, Fernando
Alcohol use disorder (AUD) represents a public health crisis with few FDA-approved medications for its treatment. Growing evidence supports the key role of the bidirectional communication between the gut microbiota and the central nervous system (CNS) during the initiation and progression of alcohol use disorder. Among the different protective molecules that could mediate this communication, short chain fatty acids (SCFAs) have emerged as attractive candidates, since these gut microbiota-derived molecules have multi-target effects that could normalize several of the functional and structural parameters altered by chronic alcohol abuse. The present study, conducted in male alcohol-preferring UChB rats, shows that the initiation of voluntary ethanol intake was inhibited in 85% by the intragastric administration of a combination of SCFAs (acetate, propionate and butyrate) given before ethanol exposure, while SCFAs administration after two months of ethanol intake induced a 90% reduction in its consumption. These SCFAs therapeutic effects were associated with (1) a significant reduction of ethanol-induced intestinal inflammation and damage; (2) reduction of plasma lipopolysaccharide levels and hepatic inflammation; (3) reduction of ethanol-induced astrocyte and microglia activation; and (4) attenuation of the ethanol-induced gene expression changes within the nucleus accumbens. Finally, we determined that among the different SCFAs evaluated, butyrate was the most potent, reducing chronic ethanol intake in a dose–response manner. These findings support a key role of SCFAs, and especially butyrate, in regulating AUD, providing a simple, inexpensive, and safe approach as a preventive and intervention-based strategy to address this devastating disease.
A nomogram for relapse/death and contemplating adjuvant therapy for parathyroid carcinoma
(Elsevier, 2023-08) Silva-Figueroa, Angélica
The staging systems proposed to date for PC have not been adequately validated. Recent multivariate have been carried out in large national and international databases to search for prognostic factors for survival and relapse in PC. Advanced age, male gender, high PTH and calcium levels at diagnosis, tumor size >30 mm, angioinvasion, presence of distant metastases, and specific tumor microenvironmental factors, such as parafibromin staining and tumor-infiltrating lymphocytes, have been strongly correlated with decreased OS and CSS, and with increased risk of local and distant recurrence. Because of their prognostic significance, these host and tumor factors should be included in any PC staging system. However, there is a need to promote collaborative PC registry plans to collate data on the above prognostic factors as well as new ways in a standardized global registry. Such a resource could be used to stratify patients with PC and identify those at high risk for relapse and death who may benefit from strict surveillance or adjuvant therapeutic care. PC is an indolent cancer with a high recurrence rate of 3 to 5 years after the first surgical intervention. Progression can remain dormant for decades until patients present with distant metastases. Such heterogeneity and neoplastic latency make OS an ambitious endpoint to achieve, and pursuing OS contradicts the actual needs of patients with this endocrine neoplasm. More relevant endpoints focus on achieving normal blood biochemistry to improve quality of life and intervening to lengthen recurrence/metastasis event-related-free survival. Surgery remains the standard treatment because traditional therapies, such as EBRT and chemotherapy, do not benefit patients with advanced unresectable or metastatic PC, new options are emerging for patients with PC. Genomic and phenotypic profiling can continue to inform personalized therapeutic strategies to expand the clinical options available to patients with PC.
Health screening of middle-aged women: what factors impact longevity?
(The North American Menopause Society, 2022-08) Blumel, Juan E.; Aedo, Sócrates; Murray, Nigel P.; Vallejo, María S.
Objective The aim of this study was to measure the impact of different risk factors in middle-aged women on longevity evaluated after three decades of an initial health screening. Methods Women who received an annual check-up between 1990 and 1993 were recruited. Anamnesis and physical examination were recorded. Blood samples for the measurement of glycemia and lipids were taken. Data are reported as of December 2021. Results A total of 1,158 women aged 40 to 60 were studied. At 30.9 years of follow-up, the Kaplan-Meier overall survival was 75.6% (95% confidence interval, 72.6-78.3). The main causes of the 260 deaths observed were the following: cancer (n = 88; 33.8%), cardiovascular disease (n = 55; 21.2%), and infectious disease (n = 41; 15.8%). The following hazard ratios were found with the flexible parametric survival model: personal history of fracture (hazard ratio, 2.55; 95% confidence interval, 1.29-5.02; P = 0.007), type 2 diabetes mellitus (2.14; 1.18-3.88; P = 0.012), personal history of heart disease (1.85; 1.09-3.13; P = 0.022), chronic arterial hypertension (1.65; 1.25-2.17; P < 0.001), postmenopausal status (1.60; 1.13-2.26; P = 0.008), unskilled jobs (1.56; 1.17-2.07; P = 0.002), cigarette smoking (1.51; 1.17-1.94; P = 0.002), age (1.06; 1.03-1.09; P < 0.001), body mass index (1.04; 1.01-1.07; P = 0.004), multiparous (0.72; 0.56-0.93; P = 0.012), and active sexual intercourse (0.68; 0.52-0.87; P = 0.003). Lipid disorders did not reach statistical significance as a risk factor. Conclusions In this cohort, it was observed that most of the classic risk factors for mortality were present. However, a history of fracture appears in middle-aged women as a strong predictor of mortality, surpassing diabetes and arterial hypertension. Multiparity, on the other hand, was a protective factor.
Physiological and clinical effects of trunk inclination adjustment in patients with respiratory failure: a scoping review and narrative synthesis
(BMC, 2024-07-09) Benites, Martín Hernán; Zapata‑Canivilo, Marcelo; Poblete, Fabian; Labbe, Francisco; Battiato, Romina; Ferre, Andrés; Dreyse, Jorge; Bugedo, Guillermo; Bruhn, Alejandro; Costa, Eduardo L. V.; Retamal, Jaime
Background Adjusting trunk inclination from a semirecumbent position to a supinefat position or vice versa in patients with respiratory failure signifcantly afects numerous aspects of respiratory physiology including respiratory mechanics, oxygenation, endexpiratory lung volume, and ventilatory efciency. Despite these observed efects, the current clinical evidence regarding this positioning manoeuvre is limited. This study undertakes a scoping review of patients with respiratory failure undergoing mechanical ventilation to assess the efect of trunk inclination on physiological lung parameters. Methods The PubMed, Cochrane, and Scopus databases were systematically searched from 2003 to 2023. Interventions: Changes in trunk inclination. Measurements: Four domains were evaluated in this study: 1) respiratory mechanics, 2) ventilation distribution, 3) oxygenation, and 4) ventilatory efciency. Results After searching the three databases and removing duplicates, 220 studies were screened. Of these, 37 were assessed in detail, and 13 were included in the fnal analysis, comprising 274 patients. All selected studies were experimental, and assessed respiratory mechanics, ventilation distribution, oxygenation, and ventilatory efciency, primarily within 60 min post postural change. Conclusion In patients with acute respiratory failure, transitioning from a supine to a semirecumbent position leads to decreased respiratory system compliance and increased airway driving pressure. Additionally, CARDS patients experienced an improvement in ventilatory efciency, which resulted in lower PaCO2 levels. Improvements in oxygenation were observed in a few patients and only in those who exhibited an increase in EELV upon moving to a semi recumbent position. Therefore, the trunk inclination angle must be accurately reported in patients with respiratory failure under mechanical ventilation
Systematic review and meta-analysis of right subclavian artery variants and their correlation with cervical-thoracic clinical conditions
(Wolkers Kluwer Health, 2024-12-13) Valenzuela Fuenzalida, Juan José; Orellana-Donoso, Mathias; Perez-Jiménez, Daniela; Farfán Cabello, Emilo; Gold Semmler, Marjorie; Becerra Farfan, Álvaro; Román, Camila; Nova Baeza, Pablo
Background: A high incidence of anatomical variations in the origin of the branches of the aortic arch has been reported, Nowadays, this variation is considered the most frequent in the aortic arch, its prevalence being estimated between 0.5% and 2.5% of the population. To understand its origin, knowledge of embryonic development is necessary. Methods: We searched the MEDLINE, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, and Latin-American literature and caribean of health sciences databases with dates ranging from their inception to June 2023. Study selection, data extraction, and methodological quality were assessed with the guaranteed tool for anatomical studies (Anatomical Quality Assurance). Finally, the pooled prevalence was estimated using a random effects model. Results: Thirty-nine studies were found that met the eligibility criteria. Twenty studies with a total of 41,178 subjects were included in the analysis. The overall prevalence of an ARSA variant was 1% (95% confidence interval = 1%–2%), the clinical findings found are that if ARSA is symptomatic it could produce changes in the hemodynamic function of the thoracocervical region in addition to other associated symptomatic complications in surrounding structures. Conclusions: ARSA can cause several types of alterations in the cervical or thoracic region, resulting in various clinical complications, such as lusory dysphagia. Hence, knowing this variant is extremely important for surgeons, especially those who treat the cervico-thoracic region. The low prevalence of ARSA means that many professionals are completely unaware of its existence and possible course and origin. Therefore, this study provides detailed knowledge of ARSA so that professionals can make better diagnoses and treatment of ARSA.
Neuronas espejo y sistemas neuronales asociados al aprendizaje clínico: una revisión de la literatura
(Federación Latinoamericana de Simulación Clínica y Seguridad del Paciente, 2023) Orquera, Paulo; Valenzuela, Juan José; Orellana-Donoso, Mathias; Gold, Marjorie; Abascal, Nancy
Introducción: se ha sugerido que las neuronas espejo (MN, por sus siglas en inglés) desempeñan un papel fundamental en los procesos sociales de orden superior, incluido el aprendizaje motor, la comprensión de la acción, el aprendizaje por imitación, la toma de perspectiva, la comprensión de las emociones faciales y la empatía. Sin embargo, aún no existen estudios que evalúen y demuestren un papel importante de las MN en el aprendizaje por imitación en instancias como la simulación clínica para estudiantes universitarios de carreras de ciencias de la salud. Objetivo: describir cómo algunos mecanismos neuronales pueden contribuir al aprendizaje basado en la imitación y discutir su papel en la simulación clínica. Material y métodos: se realizó una búsqueda sistemática en bases de datos electrónicas, con el fin de recopilar la literatura disponible sobre el tema. Resultados: se incluyeron 22 artículos después de aplicar los criterios de inclusión y exclusión. Siete de ellos abordaron el proceso de aprendizaje a través de neuronas espejo, siete lo hicieron a través de la imitación y dos más trataron el aprendizaje sensoriomotor a través de MN. Conclusiones: aunque parece que el sistema de las MN tiene implicaciones que podrían subyacer al aprendizaje basado en simulación clínica, se necesitan más estudios primarios con alto rigor metodológico y experimentos para medir la actividad del sistema de las MN en el aprendizaje basado en simulación clínica y su papel para establecer conclusiones más concretas.
Pannexin-1 expression in tumor cells correlates with colon cancer progression and survival
(Elsevier, 2024) Fierro Arenas, Aaron; Landskron, Glauben; Camhi-Vainroj, Ilan; Basterrechea, Benjamin; Parada Venegas, Daniela; Lobos Gonzalez, Lorena; Dubois Camacho, Karen; Araneda, Catalina; Romero, Camila; Dominguez, Antonia; Vasquez, Gonzalo; Lopez K, Francisco; Alvarez, Karin; Gonzalez, Carlos M; Hager Ribeiro, Carolina; Balboa, Elisa; Eugenin, Eliseo; Hermoso, Marcela A; De la Fuente, Marjorie
Aims: Pannexin-1 (PANX1) is a hemichannel that releases ATP upon opening, initiating inflammation, cell proliferation, and migration. However, the role of PANX1 channels in colon cancer remains poorly understood, thus constituting the focus of this study. Main methods: PANX1 mRNA expression was analyzed using multiple cancer databases. PANX1 protein expression and distribution were evaluated by immunohistochemistry on primary tumor tissue and non-tumor colonic mucosa from colon cancer patients. PANX1 inhibitors (probenecid or 10Panx) were used to assess colon cancer cell lines viability. To study the role of PANX1 in vivo, a subcutaneous xenograft model using HCT116 cells was performed in BALB/c NOD/SCID immunodeficient mice to evaluate tumor growth under PANX1 inhibition using probenecid. Key findings: PANX1 mRNA was upregulated in colon cancer tissue compared to non-tumor colonic mucosa. Elevated PANX1 mRNA expression in tumors correlated with worse disease-free survival. PANX1 protein abundance was increased on tumor cells compared to epithelial cells in paired samples, in a cancer stagedependent manner. In vitro and in vivo experiments indicated that blocking PANX1 reduced cell viability and tumor growth. Significance: PANX1 can be used as a biomarker of colon cancer progression and blocking PANX1 channel opening could be used as a potential therapeutic strategy against this disease.
Exploring the lutein therapeutic potential in steatotic liver disease: mechanistic insights and future directions
(Frontiers Media S.A., 2024) Balboa, Elisa; Saud, Faride; Parra Ruiz, Claudia; De la Fuente, Marjorie; Landskron, Glauben; Zanlungo, Silvana
The global prevalence of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is increasing, now affecting 25%–30% of the population worldwide. MASLD, characterized by hepatic steatosis, results from an imbalance in lipid metabolism, leading to oxidative stress, lipoperoxidation, and inflammation. The activation of autophagy, particularly lipophagy, alleviates hepatic steatosis by regulating intracellular lipid levels. Lutein, a carotenoid with antioxidant and anti-inflammatory properties, protects against liver damage, and individuals who consume high amounts of lutein have a lower risk of developing MASLD. Evidence suggests that lutein could modulate autophagy-related signaling pathways, such as the transcription factor EB (TFEB). TFEB plays a crucial role in regulating lipid homeostasis by linking autophagy to energy metabolism at the transcriptional level, making TFEB a potential target against MASLD. STARD3, a transmembrane protein that binds and transports cholesterol and sphingosine from lysosomes to the endoplasmic reticulum and mitochondria, has been shown to transport and bind lutein with high affinity. This protein may play a crucial role in the uptake and transport of lutein in the liver, contributing to the decrease in hepatic steatosis and the regulation of oxidative stress and inflammation. This review summarizes current knowledge on the role of lutein in lipophagy, the pathways it is involved in, its relationship with STARD3, and its potential as a pharmacological strategy to treat hepatic steatosis.
Tratamiento de sobrecrecimiento bacteriano en el intestino delgado en pacientes chilenos con síndrome de intestino irritable: un estudio prospectivo y comparativo
(Elsevier, 2024-11-12) von Muhlenbrock, Christian; Landskron, Glauben; Madrid-Silva, Ana Maria
Introducción y objetivos: Los pacientes con trastornos del eje intestino-cerebro, como el síndrome de intestino irritable (SII), a menudo muestran sobrecrecimiento bacteriano en el intestino delgado (SBID). Su tratamiento incluye rifaximina RF), ciprofloxacino (CF), neomicina, sulfametoxazol-trimetoprima y metronidazol (MZ). La RF es un antibiótico no absorbible, que se ha observado que tiene pocos efectos secundarios. Nuestro objetivo fue evaluar la respuesta sintomática y la erradicación del SBID en pacientes con SII, utilizando 3 regímenes antibióticos. Métodos: Se realizó un estudio doble ciego, aleatorizado y prospectivo con pacientes con SII mayores de 18 años, utilizando el cuestionario de Roma IV y la prueba de aliento con lactulosa. Los pacientes diagnosticados con SBID fueron asignados aleatoriamente para recibir tratamiento con antibiótico. El grupo A recibió tratamiento con RF, el grupo B con CF y el grupo C con MZ, cada uno durante 10 días. La respuesta al tratamiento fue evaluada en función de la tasa de erradicación del SBID 15 días después de completar la terapia, utilizando pruebas de aliento con hidrógeno y metano con lactulosa. Los síntomas autorreportados fueron registrados en una escala de Likert de 10 puntos, antes, durante y después del tratamiento. Resultados: Se incluyó a 97 pacientes con SII y SBID, de los cuales el 81% completó el tratamiento. El 59% de los pacientes tratados con RF logró la erradicación del SBID, frente al 53% y 79% de los pacientes tratados con CR y MZ, respectivamente. En el grupo de metronidazol los niveles de metano disminuyeron más que en los otros 2 grupos. Sin embargo, la mayor disminución en dolor abdominal e inflamación fue observada en el grupo de RF, con un menor porcentaje de eventos adversos. Conclusiones: Los pacientes con SII y SBID se benefician de la terapia con antibióticos. El MZ mostró la mejor tasa de erradicación de SBID, pero la RF mostró una mejoría sintomática más importante y una menor tasa de eventos adversos.

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