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Ítem Unfused transverse foramen of the atlas vertebra in the Neandertal lineage fossils(Wiley, 2025-11-07) Gómez-Olivencia, Asier; Arlegi, Mikel; Valenzuela-Fuenzalida, Juan José; Orellana-Donoso, Mathias; Arsuaga, Juan Luis; Sanchis-Gimeno, JuanIn anatomically modern humans, the atlas can display an unfused transverse foramen (UTF) but currently the presence of UTF in the Neandertal lineage is uncertain due to a scarcity of prevalence studies and no exhaustive record of its presence throughout the entire hominin fossil record. In this context, this study aimed to assess the UTF prevalence in Neandertal lineage fossils. In the Neandertal lineage fossil record, UTF was identified in three atlases: a Middle Pleistocene Preneandertal fossil (VC3) from Sima de los Huesos, and the Neandertal specimens Kebara 2 and Krapina 98. These results suggest that UTF may have been present in the hominin lineage since, at least, the Middle Pleistocene. An UTF could have been present in other, older hominin lineages but this remains unclear due to the generally poor preservation of atlases outside the Neandertal lineage fossil record. However, the existence of UTFs in the Neandertal lineage warrants further investigation into the evolutionary and developmental factors underlying this vertebral morphological variation.Ítem Prevalence of radial artery variants and their relationship with clinical considerations of the antebrachial region: Systematic revier and meta-analysis(MDPI, 2025-11-24) Sanchis Gimeno, Juan; Loaiza-Giraldo, Jessica Paola; Alruiz, Yael; Vergara, Maximiliano; Maria Fernanda Navia; Roman, Camila; Suazo Santibañez, Alejandra; Nova Baeza, Pablo; Orellana-Donoso, Mathias; Oyanedel Amaro, Gustavo; Rodriguez Luengo, Macarena; Bruna Mejias, Alejandro; Valenzuela Fuenzalida, Juan José; León Rojas, José; Granite, GuinevereBackground: The radial artery (RA) is one of the terminal branches of the brachial artery, extending along the lateral forearm, crossing the anatomical snuffbox, and contributing to the palmar arches. Anatomical variations in the RA are of great clinical relevance due to their implications in procedures such as transradial catheterization, arterial cannulation, and bypass grafting. These variants may alter the course, branching pattern, or origin of the vessel, potentially increasing procedural complexity and the risk of iatrogenic injury. In critically ill patients and in surgical or interventional settings, accurate identification of RA anatomy is essential. The objective of this study was to systematically identify and describe RA variants reported in the scientific literature and to analyze their clinical relevance. Methods: A systematic search was conducted across six electronic databases: Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Latin American and Caribbean Literature in Health Sciences (LILACS), covering publications up to July 2025. Eligible studies included anatomical, radiological, and surgical investigations reporting RA variants. Study quality was evaluated using the Assessment of Quality in Anatomical Studies (AQUA) tool. Quantitative synthesis was performed using a random-effects model to estimate the pooled prevalence of RA variants and subgroup differences. Twenty-three studies met the inclusion criteria, and eleven were included in the meta-analysis, encompassing a total of 6320 participants. Results: Radial artery variants were categorized into three main types: variations in origin, course, and branching pattern. The pooled global prevalence of RA variants was 12% (95% CI: 6-18%), with substantial heterogeneity (I2 = 97.7%). Higher prevalence was found in imaging-based studies (14%) compared with donor-based studies (12%). Sex-based subgroup analysis revealed a higher prevalence in females (18%; CI: 9-28%) compared with males (3%; CI: 3-4%), with moderate heterogeneity (I2 = 61.3%). Regionally, European populations demonstrated a higher prevalence (20%) than Asian populations (11%), both showing high heterogeneity (I2 > 98%). Notably, only one study from the Americas and none from Africa or Oceania were identified, representing a major geographical limitation in the available data. The findings of this study highlight the considerable variability in RA anatomy across populations. Such variations hold significant clinical importance, particularly in the context of transradial interventions, arterial cannulation, and reconstructive procedures where vascular integrity is critical. The high degree of heterogeneity observed may reflect differences in population genetics, sample size, and imaging or dissection methodologies. The limited representation of certain regions underscores the need for further anatomical and radiological studies to obtain a more comprehensive understanding of global RA variability. Preoperative or pre-procedural imaging using Doppler ultrasonography or computed tomography angiography is recommended to identify anomalous patterns and minimize iatrogenic complications. Conclusions: Radial artery variants are frequent and diverse. Their recognition is fundamental for the safety and success of invasive and surgical procedures in the upper limb. A standardized approach to vascular evaluation, particularly through preoperative imaging, is essential to improve procedural outcomes and reduce the risk of arterial injury in clinical practice.Ítem Sexual dimorphism in the Atlas Vertebra of normal and overweight patients with its possible surgical implications(Elsevier, 2025-10-04) Nilgün Tuncel, Çini; Orellana-Donoso, Mathias; Granite, Guinevere; Nova Baeza, Pablo; Mata-Escolano, Federico; Blanco-Perez, Esther; Valenzuela Fuenzalida, Juan José; Piagkou. Maria; Triantafyllou, George; Konschake, Marko; Sanchis-Gimeno, Juan A.Background: We aimed to detect the sexual dimorphism in the width and external anteroposterior length (EAPL) values of the atlas vertebra, and to detect significant correlations between the width and EAPL with height, weight, and body mass index (BMI) in normal weight and in overweighted patients. Methods: The width and EAPL were measured in 63 (32 female, 31 male) normal weight individuals and in 61 (30 female, 31 male) overweighted individuals who underwent a cervical spine computed tomography scan. Data was first compared between all female patients and male patients, and secondly was compared between normal and overweight individuals. Spearman's correlation analysis was used to evaluate correlations between width and EAPL with height, weight, and BMI. Results: Atlas width and EAPL were significantly higher in normal and overweight males (P < 0.001). No correlations were found between height, weight, and BMI and the width and EAPL in normal and overweight individuals. The only significant correlation found was between width and EAPL in both normal and overweight individuals (P < 0.001). Conclusions: There is sexual dimorphism in atlas width and EAPL, with male patients presenting significantly higher values, but there are no correlations between height, weight, and BMI and the width and EAPL in both normal and overweight individuals. In addition, being overweight does not affect the correlation between width and EAPL.Ítem Comment on: Is “pre-sepsis” the new sepsis? A narrative review(Public Library of Science, 0006-03-26) Giglio, Andrés; Aranda, mario; Macias, Eric; Borges, MarcioEl presente comentario al editor presenta la experiencia clínica con BiAlert Sepsis AI en un hospital, aportando evidencia al concepto de pre-sepsis propuesto por Gerard et al.. Los datos muestran que la mayoría de los pacientes detectados por la IA son infectados sin disfunción orgánica temprana y permiten definir cuatro trayectorias clínicas dentro de la pre-sepsis: pacientes en riesgo que no desarrollan sepsis, evolución abortada, sepsis subumbral y pre-sepsis progresiva con desarrollo de sepsis en 24–48 horas. Estas trayectorias evidencian que la sepsis debe entenderse como un continuo más que como un punto de corte binario y respaldan la necesidad de enfoques diagnósticos y terapéuticos basados en trayectorias para intervenir precozmente en esta ventana crítica.Ítem From ICU to Hospital-Wide: Implementing a Recycling Programme in a Latin American Tertiary Care Hospital(Wiley, 2026-02-13) Olive, Fernanda; Sanhueza, M. Bernardita; Giglio, Andrés; Ferre, AndrésBackground: Healthcare systems contribute approximately 4.4% of global greenhouse gas emissions, with intensive care units (ICUs) generating disproportionately high waste volumes. While professional organisations have published sustainability guidelines, limited documentation exists from middle-income settings, particularly in Latin America where resource constraints present unique implementation challenges. Aim: To analyse the implementation process and outcomes of a nurse-led hospital-wide recycling programme initiated in the intensive care unit of a Latin American tertiary-care hospital. Study Design: Single-case study following Yin's methodology examining programme implementation from 2019 to 2023. Data collection included institutional documentation review, quantitative analysis of recycling volumes and direct observations of operational practices across multiple hospital departments. Results: The programme established recycling protocols while maintaining infection control standards. Total recycled materials increased from 44 994 kg in 2019 (3% of total waste) to a peak of 102 579 kg in 2021, with subsequent decline to 48 279 kg in 2023. Despite this decline, recycling rates remained above baseline (4.7%–5.8% vs. 0.2% pre-implementation). Material distribution showed organic waste (59.1%) and paper/cardboard (36.4%) as primary components. Key implementation challenges included space constraints, staff engagement variability and absence of standardised frameworks, addressed through protocol adaptation, education programmes and waste collection optimisation. Conclusions: This case study suggests that implementing comprehensive recycling programmes in middle-income healthcare settings may be feasible despite resource limitations when protocols are adapted to local contexts and clinical leadership is leveraged. Relevance to Clinical Practice: This study describes how ICU nurses can lead institutional sustainability initiatives in resource-constrained settings. The findings provide practical insights for developing environmental policies in Latin American healthcare systems, highlighting the importance of early protocol formalisation and realistic expectations about programme sustainability.Ítem Hospital-wide sepsis detection: A machine learning model based on prospectively expert-validated cohort(MDPI, 2026-01-21) Borges-Sa, Marcio; Giglio, Andrés; Aranda, Maria; Socias, Antonia; del Castillo, Alberto; Pruenza, Cristina; Hernández, Gonzalo; Cerdá, Sofía; Socias, Lorenzo; Estrada, Victor; de la Rica, Roberto; Martin, Elisa; Martin-Loeches, IgnacioBackground/Objectives: Sepsis detection remains challenging due to clinical heterogeneity and limitations of traditional scoring systems. This study developed and validated a hospital-wide machine learning model for sepsis detection using retrospectively developed data from prospectively expert-validated cases, aiming to improve diagnostic accuracy beyond conventional approaches. Methods: This retrospective cohort study analysed 218,715 hospital episodes (2014–2018) at a tertiary care centre. Sepsis cases (n = 11,864, 5.42%) were prospectively validated in real-time by a Multidisciplinary Sepsis Unit using modified Sepsis-2 criteria with organ dysfunction. The model integrated structured data (26.95%) and unstructured clinical notes (73.04%) extracted via natural language processing from 2829 variables, selecting 230 relevant predictors. Thirty models including random forests, support vector machines, neural networks, and gradient boosting were developed and evaluated. The dataset was randomly split (5/7 training, 2/7 testing) with preserved patient-level independence. Results: The BiAlert Sepsis model (random forest + Sepsis-2 ensemble) achieved an AUC-ROC of 0.95, sensitivity of 0.93, and specificity of 0.84, significantly outperforming traditional approaches. Compared to the best rule-based method (Sepsis-2 + qSOFA, AUC-ROC 0.90), BiAlert reduced false positives by 39.6% (13.10% vs. 21.70%, p < 0.01). Novel predictors included eosinopenia and hypoalbuminemia, while traditional variables (MAP, GCS, platelets) showed minimal univariate association. The model received European Medicines Agency approval as a medical device in June 2024. Conclusions: This hospital-wide machine learning model, trained on prospectively expert-validated cases and integrating extensive NLP-derived features, demonstrates superior sepsis detection performance compared to conventional scoring systems. External validation and prospective clinical impact studies are needed before widespread implementation.Ítem De la variabilidad terapéutica al cuidado seguro: la necesidad de protocolización en la cetoacidosis diabética pediátrica(Sociedad Chilena de Pediatría, 2025-12-01) Díaz, FrancoLa cetoacidosis diabética (CAD) pediátrica persiste como emergencia metabólica clave, con avances en tratamiento, pero riesgos neurocognitivos persistentes, especialmente en América Latina (40-60% de debuts en CAD). El editorial analiza la implementación de una guía de práctica clínica (GPC) en un hospital pediátrico, logrando >90% de adherencia, reducción de intervenciones riesgosas y manejo más seguro, pese a mayor tiempo de resolución (10,5 a 14 h). Se urge protocolización regional para minimizar variabilidad, recurrencias y secuelas a largo plazo.Ítem Respiratory effects of trunk inclination in obese and non-obese patients mechanically ventilated for ARDS(BMC, 2025) Benites, Martín Hernán; Bihari, Shailesh; Battiato, Romina; Bruhn, Alejandro; Bugedo, Guillermo; Costa, Eduardo L. V.; Dellamonica, Jean; Guérin, Claude; Langer, Thomas; Marini, John J.; Marrazo, Francesco; Mezidi, Mehdi; Selickman, John; Wiersema, Ubbo F.; Retamal, JaimeBackground Adjusting trunk inclination in patients with acute respiratory distress syndrome directly affects physiological variables such as respiratory mechanics and PaCO2 levels. These effects may vary according to the body mass index (BMI) due to differences in lung and chest wall mechanics, highlighting the need for further investigation to clarify the clinical relevance of body position across patient subgroups. Methods A secondary analysis compared the physiological effects of increasing trunk inclination angles between mechanically ventilated patients with obesity (BMI ≥ 30 kg/m2) and those without obesity (BMI < 30 kg/m2). Results Data from 159 patients collected across seven individual studies were analyzed. The following physiological changes were observed in response to increased trunk inclination: Sixty-five patients with obesity presented a greater decrease in respiratory system compliance (-7.5 [-10; -5] mL/cmH2O; p < 0.001) compared to ninety-four patients without obesity (-3.5 [-7; -0.08] mL/cmH2O; p = 0.045). Lung compliance decreased in obese patients (-7.8 [-12.4; -3.3] mL/cmH2O; p < 0.001), whereas no significant changes were observed in patients without obesity (-5.9 [-14.2; 2.3] mL/cmH2O; p = 0.160). Chest wall compliance decreased by -42.9 [-63.2; -22.6] mL/cmH2O (p < 0.001) in obese patients and by -47.7 [-95.3; -0.15] mL/cmH2O in non-obese patients (p = 0.049). PaCO2 increased in obese patients by 4.6 [1.4; 7.8] mmHg (p = 0.004) but not in patients without obesity (2.5 [-0.6; 5.6] (p = 0.113). No significant differences were observed in PaO2/FIO2 between phases.Ítem Las fisuras del sistema en la publicación académica en pediatría: una crítica al acceso abierto y sus consecuencias(Sociedad Chilena de Pediatría, 2025-10-21) Díaz, Franco; Gómez-Lund, Oscar; Riderelli, Jocelyn; Monteverde-Fernández, Nicolás; González-Dambrauskas, Sebastián; Jabornisky, Roberto; Jaramillo-Bustamante, Juan Camilo; Caporal, PaulaEn las últimas dos décadas, la publicación académica ha experimentado transformaciones profundas con la digitalización y el acceso a internet. En forma concomitante, el movimiento de Acceso Abierto ha desempeñado un papel fundamental en la mejora de la accesibilidad al conocimiento científico mediante la eliminación de pagos y otras barreras restrictivas. Si bien esta democratización de la información ha generado beneficios sustanciales, también ha introducido desafíos complejos, convirtiendo las publicaciones médicas en una industria lucrativa que pone a prueba los límites éticos de las prácticas comerciales y, en última instancia, la integridad de la investigación. La concentración de poder en unas pocas grandes editoriales dentro de un mercado sesgado e inelástico, la proliferación de editoriales con fines de lucro y la creciente carga financiera, trasladada a los autores, son factores críticos que contribuyen a la crisis actual de la academia. El objetivo de este manuscrito es examinar los principales hitos en la evolución de la publicación académica, analizar su panorama actual y discutir los desafíos fundamentales que enfrenta la industria en la era del Acceso Abierto, particularmente desde la perspectiva de investigadores en pediatría en América Latina. Over the past two decades, academic publishing has undergone substantial transformation, largely driven by digitalization and increased global Internet access. In parallel, the Open Access (OA) movement has played a critical role in advancing equitable access to scientific knowledge by eliminating paywalls and licensing restrictions. While these developments have yielded considerable benefits–particularly in enhancing the dissemination and democratization of research– they have also generated complex ethical and structural challenges. Notably, the consolidation of publishing power among a few major editorial houses, the emergence of profit-driven publication models, and the shifting of publication costs onto authors, have contributed to a growing crisis in academic medicine. These trends have raised concerns regarding transparency, editorial independence, and the overall integrity of the scientific record. This manuscript aims to delineate the historical and structural evolution of academic publishing, assess its current landscape, and critically examine the key challenges facing the field in the context of Open Access. Particular attention is given to the implications for pediatric researchers in Latin America, who are disproportionately affected by these systemic barriers.Ítem Diez recomendaciones clave para fortalecer los cuidados intensivos pediátricos: una revisión narrativa desde América Latina(Sociedad y Fundación Española de Cuidados Intensivos Pediátricos, 2025-10-01) Gómez-Lund, Oscar; Donoso-Fuentes, Alejandro; López-Barón, Eliana; Ruge-Joya, Erika Johana; Díaz, Franco; Alzate-Hernández, Hulizay Paola; Morantes-Flórez, Jennifer Giseth; Jaramillo-Bustamante, Juan Camilo; Higuera-Álvarez, Lorena Alejandra; Sarmiento-Guzmán, María Piedad; Aguilar-Zamora, Nadia Sofía Alejandra; Vásquez-Hoyos, Pablo; Torres-González, Pamela; Zárate-Castañon, Patricia; Jabornisky, Roberto; Roa-Giraldo, Juan DavidEsta revisión narrativa presenta diez recomendaciones clave para fortalecer la práctica de las unidades de cuidados intensivos pediátricos (UCIP) en el entorno clínico actual. Estas reflexiones surgieron de la experiencia compartida de intensivistas pediátricos latinoamericanos y se sustentan en la literatura relevante. Abordan desafíos comunes como el reconocimiento y el manejo tempranos del deterioro clínico, el equilibrio entre la reanimación con líquidos y el uso temprano de vasopresores, la detección temprana de la falla de la ventilación no invasiva (VNI) y la promoción de la nutrición enteral. Otros temas incluyen el uso racional de antibióticos, las prácticas éticas de restricción y la integración de las familias como participantes activos en la atención. La revisión también destaca la importancia de tomar decisiones oportunas sobre la extubación, un mejor uso de los recursos y el equilibrio entre el juicio clínico y las herramientas objetivas. Aunque estas recomendaciones surgieron en América Latina, consideramos que son de aplicación universal. This narrative review presents ten key recommendations aimed at strengthening pediatric intensive care unit (PICU) practice in today’s clinical environment. These reflections emerged from the shared experience of Latin American pediatric intensivists and are supported by relevant literature. They address common challenges such as early recognition and management of clinical deterioration, balancing fluid resuscitation with early vasopressor use, early detection of non-invasive ventilation (NIV) failure, and promoting enteral nutrition. Additional topics include rational antibiotic use, ethical restraint practices, and the integration of families as active participants in care. The review also highlights the value of timely extubation decisions, better resource use, and the balancing clinical judgment with objective tools. Although developed from the perspective of Latin American clinicians, we consider these recommendations to have universal applicability.Ítem National epidemiological analysis of lupus in Chile: a registry-based study from 2013 to 2024(Sage Publications, 2025-10) Vergara, Karen; Ramirez, Paulina; Handrujovicz, Ivana; Giglio, AndrésBackgroundSystemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical manifestations and regional variations in epidemiology. Despite its clinical significance, robust epidemiological data from Latin America, particularly Chile, remain limited. This study aims to provide the first comprehensive epidemiological assessment of SLE in Chile using population-adjusted denominators and rigorous statistical methods.MethodsWe analyzed data from Chile's Specific Health Guarantees Program (GES) from July 2013 to August 2024, covering 95% of the insured population. Population denominators were obtained from Chile's National Institute of Statistics stratified by age and sex. Incidence rates were calculated using annual new case reports from 2014 to 2023, while prevalence and mortality were estimated through 2024. All analyses included 95% confidence intervals using Poisson distribution methods. Rate ratios were calculated using Poisson regression models with population offset terms. Sensitivity analyses modeled different assumptions regarding program discharge mortality proportions.ResultsThe median annual SLE incidence in Chile was 7.1 per 100,000 beneficiaries (IQR 6.3-7.7) using population-adjusted denominators. Prevalence increased from 26.7 per 100,000 in 2013 to 91.3 per 100,000 in 2024. The male-to-female incidence ratio was 1:10.61 (Rate Ratio: 0.093, 95% CI: 0.088-0.098). Mortality analysis using program discharges as a proxy revealed an overall rate of 11.9 per 1000 SLE patients (IQR 7.2-18.8), with significantly higher rates in males compared to females (Rate Ratio: 1.756, 95% CI: 1.546-1.987). Age-stratified analysis demonstrated progressive mortality increases, with patients ≥60 years showing rates of 87.4 per 1000 in males and 49.0 per 1000 in females. Sensitivity analyses modeling different assumptions about discharge mortality (70%-100% fatal) yielded mortality estimates ranging from 8.2 to 11.9 per 1000 SLE patients.ConclusionsThis study provides a comprehensive epidemiological assessment of SLE in Chile using population-adjusted denominators and statistical confidence intervals. Our findings demonstrate SLE incidence rates higher than North American estimates, significant sex disparities in both incidence and mortality, and age-related mortality progression. The sensitivity analysis addresses limitations in mortality estimation through administrative data. These findings contribute essential epidemiological parameters for healthcare planning and underscore the need for enhanced surveillance systems for autoimmune diseases in Latin America.Ítem Association of Ventilatory Ratio with Acute Cor Pulmonale and Mortality in COVID-19 ARDS: A Cohort Study(Sage Publications, 2025-09-08) Benites, Martín Hernán; Battiato, Romina; Mercado, Pablo; Pairumani, Ronald; Medel, Juan Nicolás; Petruska, Edward; Ugalde, Diego; Morales, Felipe; Eisen, Daniela; Araya, Carla; Montoya, Jorge; Retamal, Jaime; Kattan, Eduardo; Basoalto, Roque; Bugedo, Guillermo; Valenzuela, Emilio DanielPurpose: An elevated ventilatory ratio (VR) and acute cor pulmonale (ACP) are associated with mortality in ARDS patients. The primary aim of this study was to assess the association between VR and ACP in patients with COVID-19-related ARDS (CARDS). The secondary objectives were to analyze the association between VR and ICU mortality, describe VR temporal behavior in survivors and non-survivors, and evaluate the association between VR and pulmonary embolism. Materials and Methods: We studied a cohort of patients with C-ARDS. The VR was calculated using a validated formula. Echocardiography was used to diagnose ACP, and CT pulmonary angiography was performed to identify PE. To evaluate the associations between VR and ACP, mortality, and PE, a generalized logistic regression model was used. Results: Of the 140 subjects, 60 (43%) had a VR < 2, while 80 (57%) had a VR ≥ 2. Patients with a VR ≥2 had a higher risk of developing ACP than those with a VR <2 (Odds Ratio (OR), 3.77; 95% CI: 1.30 - 8.72). The ICU mortality rate was 29%. Of the 40 patients who died, 30 (75%) had a VR ≥ 2. Mortality was significantly associated with VR ≥ 2 and driving pressure ≥ 15 cm H2O. In non-survivor patients with a VR < 2 at ICU admission, a significant increase in VR was observed over the 7-day observation period. No significant association was observed between PE and VR (p = .118). Conclusion: Elevated VR was associated with ACP in patients with C-ARDS. VR ≥ 2 combined with driving pressure ≥ 15 cm H2O significantly improved the ability to identify patients at risk for ACP. Additionally, at ICU admission, elevated VR values and initially low values that increased over the first week were associated with higher ICU mortalityÍtem Desafíos en hemorragia cerebral y cirrosis hepática. Derivación ventricular bilateral como alternativa terapéutica(Clínica Las Condes, 2025) Arroyo, Antonio; Ramos, Andrés; Reccius, AndrésObjetivo: Describir el manejo de un paciente con hematoma intraparenquimatoso, hemorragia intraventricular (HIV) y coagulopatía secundaria a cirrosis hepática, explorando la colocación de derivación ventricular bilateral (DVEb) como una opción terapéutica. Caso clínico: Hombre de 40 años con cirrosis hepática y coagulopatía severa, encontrado en coma y con múltiples lesiones cerebrales hemorrágicas secundarias a lesión cerebral traumática, asociado a HIV e hidrocefalia obstructiva. A pesar de la coagulopatía, se colocó un sistema de DVEb, el cual se utilizó para lavado ventricular, logrando control temporal de la presión intracraneal (PIC). Resultados: Aunque se logró estabilización temporal de la PIC, la evolución del paciente fue desfavorable, básicamente influenciado por el escenario complejo de coagulopatía recurrente pese a las medidas correctivas, obstrucción repetida del DVEb, nuevo foco hemorrágico y la imposibilidad de realizar otro tipo de intervenciones. Finalmente, y consecuencia de ello, se realizó adecuación del esfuerzo terapéutico. Conclusiones: La colocación de DVEb puede ser una alternativa útil para manejar la HIV en pacientes con coagulopatía severa, aunque los resultados a largo plazo aún requieren mayor evaluación. Este caso ilustra la complejidad del manejo en estos pacientes y la necesidad de más estudios sobre esta intervención.Ítem Síndrome vasopléjico inducido por protamina: la importancia del ECLS con ECMO y protocolo CALS en casos complejos(Clínica Las Condes, 2025) Arroyo, Antonio; Zamorano, Anibal; Silva, Diego; Gacitúa, Tomás; Portilla, Mario; Salazar, Pablo; Zamorano, JavieraObjetivo: Describir un caso de paro cardíaco (PC) asociado a síndrome vasopléjico inducido por protamina (SVIP), manejado con el protocolo de Soporte Vital Avanzado en Cirugía Cardíaca (CALS, por sus siglas en inglés) y soporte vital extracorpóreo (ECLS, por sus siglas en inglés) con oxigenación por membrana extracorpórea (ECMO, por sus siglas en inglés). Caso clínico: Paciente masculino de 51 años con valvulopatías múltiples, sometido a reemplazo valvular mitral y anuloplastia tricuspídea. En el postoperatorio inmediato, aún en pabellón, desarrolló hipotensión severa inducida por protamina, seguida de PC en asistolia. Fue manejado con masaje directo, reconexión a circulación extracorpórea (CEC) e infusión de inopresores, logrando retorno a circulación espontánea (RCE) a los 15 minutos. Se estabilizó hemodinámicamente y se procedió al cierre de esternotomía y desconexión de CEC. En la Unidad de Cuidados Intensivos Coronarios sufrió un nuevo PC en asistolia, sin respuesta a maniobras avanzadas de reanimación. Se realizó re-esternotomía y ECLS con ECMO venofemoral-arteriofemoral (VF × AF), logrando RCE. Durante la intervención, se evidenció una ruptura de la pared ventricular izquierda secundaria al masaje directo, la cual fue reparada exitosamente. Permaneció 12 días en ECMO y evolucionó sin secuelas neurológicas. Discusión: El SVIP fue el desencadenante del cuadro, agravado por el estado de shock refractario multifactorial. La implementación del ECLS con ECMO y un equipo multidisciplinario entrenado fueron clave para la supervivencia del paciente. Conclusiones: El ECLS con ECMO, utilizado antes de 30 minutos, junto con el protocolo CALS, mejora la supervivencia y previene secuelas neurológicas en los casos con síndrome vasopléjico inducido por protamina.Ítem Síndrome de hipotensión intracraneal en paciente neurocrítico: reporte de caso(Clínica Las Condes, 2025) Arroyo, Antonio; Reccius, AndrésObjetivo: importancia del reconocimiento del síndrome de hipotensión intracraneal (SHI), derivado del uso de drenaje espinal (DE) en los pacientes con hemorragia subaracnoidea aneurismática (HSAa). Caso clínico: paciente femenina de 42 años sin antecedentes previos. Ingresa al servicio de urgencias por cuadro de crisis tónico clónica generalizada. Se realiza diagnóstico inicial de HSAa con angioTC de cerebro y se excluye aneurisma mediante terapia endovascular con coils. Se instala DE para manejo, evolucionando con SHI, caracterizado por presión intracraneal (PIC) negativa y cefalea ortostática como síntomas cardinales. Discusión: el SHI presenta características clínicas y radiológicas, siendo la cefalea ortostática y el descenso de las amigdalas cerebelosas las mas frecuentes. Si bien existen diversos tratamientos para el SHI descritos en la literatura, el parche hemático epidural representa una de las alternativas mas efectivas cuando se utiliza la técnica adecuada. Conclusiones: el DE representa una alternativa efectiva y con baja tasa de efectos secundarios en el manejo de la HSAa; no obstante, es vital conocer los riesgos derivados de su uso. El SHI requiere conocimiento amplio de las diferentes presentaciones clínicas y la orientación diagnóstica.Ítem The Effect of Diabetes Mellitus on Central Corneal Thickness Values: A Systematic Review and Meta-Analysis(MDPI, 2025-09-06) Uzunoglu, Arda; Valenzuela Fuenzalida, Juan José; Morales-Calderón, Karin; Aguilar-Aguirre, Isidora; Bruna-Mejías, Alejandro; Nova-Baeza, Pablo; Orellana-Donoso, Mathias; Oyanedel-Amaro, Gustavo; Suazo Santibañez, Alejandra; Sanchis-Gimeno, Juan A.; León Rojas, Jose E.; Granite, GuinevereDiabetes mellitus (DM) is a chronic metabolic disorder that can induce systemic and ocular complications. Among the latter, an increase in central corneal thickness (CCT) has been reported, potentially affecting endothelial function and increasing the risk of ocular disease. This study aimed to determine the impact of DM on CCT and to assess its correlation with diabetes duration and glycosylated hemoglobin (HbA1c) levels. A systematic literature search was conducted in Web of Science (1980–2025) following a PICO-based strategy. Observational studies evaluating CCT in diabetic patients were included. Data were analyzed using a random-effects model. Statistical heterogeneity was assessed with χ2 test, p values, and I2 index. Publication bias was evaluated using Begg’s funnel plot and Egger’s regression test. Twenty-nine studies were included in the meta-analysis. Diabetic patients showed significantly higher CCT values compared to controls, particularly in those with long-standing DM (p < 0.001) and poor glycemic control (HbA1c, p < 0.001). Egger’s regression suggested an association between increasing CCT, disease duration, and HbA1c levels, while funnel plot asymmetry indicated potential publication bias. CCT appears to increase in patients with long-term DM and inadequate glycemic control. These findings highlight the relevance of CCT assessment as a potential indicator of corneal changes in diabetic patients.Ítem Effectiveness of Vitamin D Supplementation on Biochemical, Clinical, and Inflammatory Parameters in Patients with Different Types of Diabetes: A Systematic Review and Meta-Analysis(MDPI, 2025-09-18) Bruna-Mejías, Alejandro; Valdivia-Arroyo, Rocío; Becerra-Rodríguez, Emelyn Sofía; Clasing-Cárdenas, Ignacio; Castaño-Gallego, Yesica Tatiana; Granite, Guinevere; Orellana-Donoso, Mathias; Oyanedel-Amaro, Gustavo; Nova-Baeza, Pablo; Cifuentes-Suazo, Gloria; Suazo Santibañez, Alejandra; Sanchis-Gimeno, Juan; Gutiérrez Espinoza, Héctor; Valenzuela Fuenzalida, Juan JoséBackground and Aims: Numerous clinical and observational studies have examined the role of vitamin D in glycemic control and metabolic regulation among diabetic patients, but findings remain inconsistent. This meta-analysis aimed to assess the effects of vitamin D supplementation on glycosylated hemoglobin (HbA1c%), HOMA-IR, HOMA-β, LDL cholesterol, total cholesterol, triglycerides, fasting insulin, fasting plasma glucose, C-reactive protein, and the likelihood of reversion to normoglycemia in prediabetic individuals. Methods: A comprehensive search of multiple databases was performed using keywords including “diabetes mellitus,” “type 2 diabetes,” “vitamin D supplementation,” and “VD supplementation.” Twenty studies met the inclusion criteria. Results: Vitamin D supplementation was associated with significant improvements across several parameters, including HOMA-β (SMD = 0.71; 95% CI: 0.63–0.80; p < 0.00001), HDL cholesterol (SMD = 0.07; 95% CI: 0.05–0.09; p < 0.00001), and others (SMD = −0.40; 95% CI: −0.45 to −0.34; p < 0.00001). Conclusions: Vitamin D supplementation appears to provide beneficial effects on glycemic, lipid, and inflammatory markers in patients with diabetes and prediabetes. Specifically, supplementation significantly reduced HbA1c%, HOMA-IR, LDL cholesterol, total cholesterol, triglycerides, fasting insulin, fasting glucose, and C-reactive protein while increasing the rate of normoglycemia among prediabetic individuals. Further research is needed to strengthen the evidence base regarding vitamin D’s role in diabetes management.Ítem Unilateral Lung Agenesis: A Systematic Review of Prevalence, Anatomical Variants, and Clinical Implications(MDPI, 2025-09-08) Orellana-Donoso, Mathias; Barrenechea-Salvador, Mariano; Caro-Navarro, Joaquín; Cervela-Díaz, Matías; Chacón-Ortiz, Cristian; Claudet-Córdoba, Nicolás; Sanchis-Gimeno, Juan; Nova-Baeza, Pablo; Valenzuela Fuenzalida, Juan José; Suazo Santibañez, Alejandra; Valdes-Orrego, Iván; Cifuentes-Suazo, Gloria; Leon-Rojas, Jose E.Unilateral lung agenesis (ULA) is a rare congenital anomaly characterized by the complete absence of one lung, often accompanied by cardiovascular, skeletal, or gastrointestinal malformations. Despite its clinical significance, evidence of prevalence, anatomical variants, and outcomes remain fragmented. This systematic review aimed to synthesize existing data on ULA’s prevalence, anatomical classifications, diagnostic approaches, and clinical implications. Methods: Following PRISMA 2020 guidelines, five databases (MEDLINE, Web of Science, CINAHL, Scopus, and EMBASE) were searched from inception to January 2024. Inclusion criteria encompassed case reports, case series, and observational studies on ULA in humans. Risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist. Narrative synthesis was performed due to methodological heterogeneity. Results: Thirty-two studies (137 participants) were included. Right-sided ULA predominated (58%), with poorer prognoses due to mediastinal distortion. Cardiovascular anomalies (40%) were the most common comorbidity. Diagnostic modalities included chest radiography (85%), CT (70%), and bronchoscopy (25%). Schneider-Boyden scale was used to classify the included studies. Risk of bias assessment revealed 65% of studies as low risk, 28% as moderate, and 7% as high risk. Conclusions: ULA necessitates multidisciplinary management, particularly in cases with associated anomalies. Left-sided ULA correlates with better outcomes, emphasizing the role of early imaging. Limitations include reliance on case reports and inconsistent reporting of anatomical variants. Future research should adopt standardized classifications and longitudinal designs to improve evidence quality.Ítem Internal carotid artery agenesis: a systematic review of prevalence, basal brain circulation variations, and associated pathologies(Springer Nature, 2025-07-05) Orellana-Donoso, Mathias; Sanchis-Gimeno, Juan; Afandi-Rebolledo, Sary; Nova-Baeza, Pablo; García-Mena, Paloma; Suazo Santibañez, Alejandro; Peñailillo-Ibarra, Rocío; Valdés-Orrego, Iván; Valenzuela Fuenzalida, Juan JoséThe internal carotid artery (ICA) is a crucial vessel, and its congenital absence, known as ICA agenesis, is a rare vascular anomaly. This systematic review aimed to provide a comprehensive overview of the available evidence on this condition. We systematically searched multiple databases from inception until January 2024. Two authors independently screened titles and abstracts, and a third reviewer was involved if consensus could not be reached. Data extraction and quality assessment were performed using validated the AQUA tool and the JBI critical appraisal checklist tool. A total of 138 (7.8%) articles out of 1,778 met the inclusion criteria, reporting 2040 subjects from which 176 presented (8.6%) ICA agenesis. Most of the studies were case reports (96%), and the included studies originated from various countries, with the United States (17.39%), Japan (14.49%), Turkey (10.87%), and India (10.14%) contributing the most. Left-sided agenesis was the most common (67.39%), followed by right-sided (42.03%) and bilateral (22.46%) agenesis. The most reported clinical manifestations were Horner’s syndrome, increased risk of intracranial aneurysms, and pituitary gland abnormalities. ICA agenesis is a rare vascular anomaly with a left-sided predominance. While some patients may develop associated clinical conditions, many remain asymptomatic due to the development of robust collateral circulation. Comprehensive preoperative evaluation and awareness of these anatomical variations are crucial to guide surgical planning and minimize the risk of complications. PROSPERO registration number: CRD42024592673.Ítem A Systematic Review with a Meta-Analysis of the Morphological Variants of the Corpus Callosum: Related Neurocognitive Clinical Implications(Elsevier, 2025) Valenzuela Fuenzalida, Juan José; Orellana-Hidalgo, Sebastián; Baeza-Garrido, Vicente; Trujillo-Riveros, Martin; Aguilar-Aguirre, Isidora; Nova-Baeza, Pablo; Orellana-Donoso, Mathias; Cifuentes-Suazo, Gloria; Bruna Mejías, Alejandro; Casanova-Martinez, Daniel; Sanchis-Gimeno, Juan; Piagkou, Maria; Triantafyllou, George; Konschake, MarkoBackground: Corpus callosum agenesis (CCA) occurs in approximately 1 in every 4000 births and is identified in 3–5% of individuals evaluated through neuroimaging for neurodevelopmental disorders. The combined prevalence of CCA and hypoplasia is estimated to range from 1.8 to 10 in every 10,000 births. Methods: The online databases Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, and Latin American and Caribbean Literature in Health Sciences were searched until May 2025. Two authors independently conducted the search, selected the studies, and extracted the data. The methodological quality of the studies was assessed using the Anatomical Quality Assessment tool. A random effects model was used to estimate the pooled prevalence. Results: A total of 46 studies met the established selection criteria. In this analysis, 15 articles were included in the meta-analysis, which involved a total of 5,118,037 subjects. The overall prevalence of CCA was 18% (confidence interval = 10%–25%). The subgroup analysis revealed a significant difference in the prevalence of CCA among the Asian continent compared to the other four continents (P-value 0.001). Conclusions: Early diagnosis of CCA during the fetal stage can enable specialists to implement more effective treatments and reduce the likelihood of neurofunctional impairments. Furthermore, understanding the morphological characteristics of CCA can assist in making an early and accurate diagnosis, minimizing the need for differential diagnoses that could interfere with the functioning of the interhemispheric connection system and brain functional connections.