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Antidiabetic potential of extracts from Cylindropuntia imbricata (Haw.) F.M. Knuth, Opuntia engelmannii Salm-Dyck ex Engelm., Ibervillea sonorae (S. Wats.) Greene and Theobroma cacao L.
(Universidad Nacional Autónoma de México; Facultad de Estudios Superiores Zaragoza., 2024-07-30) De la Sota- Esparza, Gastaldo Emmanuel; Alvarado-Vásquez, Marco Antonio; Rivas-Morales, Catalina; Rocha-Estrada, Alejandra; Chavez-Reyes, Arturo; Ortíz-Martínez, David Mizael
Diabetes mellitus is a disease that affects more than 537 million people in the world without decreasing. When diabetes becomes complicated, it damages several organs until it causes death. The drugs in use to counteract the disease produce side effects; a circumstance that has led to research on plants with anti-diabetic properties. The objective of this study was to evaluate the antidiabetic potential of extracts obtained by maceration of the following parts of the plant: Cylindropuntia imbricata (Cactaceae) cladode and seed, Opuntia engelmannii (Cactaceae) cladode and seed, Ibervillea sonorae (Cucurbitaceae) root and Theobroma cacao (Malvaceae) seed mixed with solvents of different polarity (hexane, ethyl acetate, dichloromethane and methanol). A total of 24 extracts were obtained and subjected to the following analyses: 1) phytochemical screening to determine their composition, 2) toxicity in B16F10 cells using the alamar blue test, 3) antioxidant capacity through DPPH inhibition, and 4) in vitro evaluation to determine their antihyperglycemic capacity (inhibition of alpha-glucosidase). The results obtained from methanolic extracts with O. engelmannii and T. cacao seeds, as well as ethyl acetate extracts with T. cacao and C. imbricata seeds showed antioxidant and antihyperglycemic activity. No toxicity in B16F10 cells, and antidiabetic potential in vitro. La diabetes mellitus es una enfermedad que no decrece y afecta a más de 537 millones de personas en el mundo. La diabetes al complicarse daña varios órganos hasta causar la muerte. Los fármacos en uso para contrarrestar la enfermedad producen efectos secundarios; circunstancia que ha propiciado la investigación en plantas con propiedades antidiabéticas. El objetivo de este estudio fue evaluar el potencial antidiabético de los extractos obtenidos por maceración de las siguientes partes de la planta: del cladodio y semilla de Cylindropuntia imbricata (Cactaceae), del cladodio y semilla de Opuntia engelmannii (Cactaceae), de la raíz de Ibervillea sonorae (Cucurbitaceae) y de la semilla de Theobroma cacao (Malvaceae) mezcladas con solventes de diferente polaridad (hexano, acetato de etilo, diclorometano y metanol). Se obtuvieron un total de 24 extractos sometidos a los análisis: 1) de cribado fitoquímico para determinar su composición, 2) de toxicidad en células B16F10 mediante la prueba de azul alamar, 3) de capacidad antioxidante a través de la inhibición de DPPH, y 4) de evaluación in vitro para conocer su capacidad antihiperglucémica (inhibición de la alfa glucosidasa). Los resultados obtenidos, de los extractos metanólicos con las semillas de O. engelmannii y T. cacao, así como los de acetato de etilo con las semillas de T. cacao y C. imbricata mostraron una actividad antioxidante y antihiperglucémica. Sin toxicidad en las células B16F10, y con potencial antidiabético in vitro.
Therapeutic antisense oligonucleotides in oncology: from bench to bedside
(MDPI, 2024-08-23) Cakan, Elif; Lara, Olivia D.; Szymanowska, Anna; Bayraktar, Emine; Chavez-Reyes, Arturo; Lopez-Berestein, Gabriel; Amero, Paola; Rodriguez-Aguayo, Cristian
Advancements in our comprehension of tumor biology and chemoresistance have spurred the development of treatments that precisely target specific molecules within the body. Despite the expanding landscape of therapeutic options, there persists a demand for innovative approaches to address unmet clinical needs. RNA therapeutics have emerged as a promising frontier in this realm, offering novel avenues for intervention such as RNA interference and the utilization of antisense oligonucleotides (ASOs). ASOs represent a versatile class of therapeutics capable of selectively targeting messenger RNAs (mRNAs) and silencing disease-associated proteins, thereby disrupting pathogenic processes at the molecular level. Recent advancements in chemical modification and carrier molecule design have significantly enhanced the stability, biodistribution, and intracellular uptake of ASOs, thereby bolstering their therapeutic potential. While ASO therapy holds promise across various disease domains, including oncology, coronary angioplasty, neurological disorders, viral, and parasitic diseases, our review manuscript focuses specifically on the application of ASOs in targeted cancer therapies. Through a comprehensive examination of the latest research findings and clinical developments, we delve into the intricacies of ASO-based approaches to cancer treatment, shedding light on their mechanisms of action, therapeutic efficacy, and prospects.
Respiratory system compliance accurately assesses the “Baby Lung” in Pediatric Acute Respiratory Distress Syndrome
(The American Thoracis Society, 2024-04-01) Cruces, Pablo; Reveco, Sonia; Caviedes, Paola; Díaz, Franco
The concept of the “baby lung” has gained widespread recognition in acute respiratory distress syndrome (ARDS) and has significantly influenced the principles of protective mechanical ventilation (MV) (1). This concept is rooted in tomographic studies performed in adult patients with ARDS, which revealed the presence of a smaller, normally aerated lung compartment at the end of expiration and normal specific lung elastance. There is a strong correlation between end-expiratory lung volume (EELV) and respiratory system.
Noninvasive continuous positive airway pressure is a lung- and diaphragm-protective approach in self-inflicted lung injury
(The American Thoracis Society, 2024-04-15) Cruces, Pablo; Erranz, Benjamín; Pérez, Agustín; Reveco, Sonia; González, Carlos; Retamal, Jaime; Poblete, Daniela; Hurtado, Daniel E.; Díaz, Franco
Strenuous spontaneous effort can promote lung and diaphragmatic injury in acute lung injury (ALI), phenomena known as “patient self-inflicted lung injury” (P-SILI) and load-induced diaphragmatic injury, respectively (1–3). Although continuous positive airway pressure (CPAP) can relieve hypoxemia and work of breathing (4), it is controversial if it prevents lung and diaphragmatic injury (5, 6). We aimed to investigate the effects of noninvasive CPAP on lung and diaphragmatic injury in an ALI model compared with unassisted animals.
Letter: Development of a Randomized Trial Comparing ICP-Monitor-Based Management of Severe Pediatric Traumatic Brain Injury to Management Based on Imaging and Clinical Examination Without ICP Monitoring-Study Protocol
(Wolters Kluwer Health, Inc., 2024) Nielsen, Katie; Caporal, Paula; Díaz, Franco; González-Dambrauskas, Sebastián; Vásquez-Hoyos, Pablo; Domínguez-Rojas, Jesús
Pediatric traumatic brain injury is a major public health concern, particularly in resource-limited settings where this entity has higher incidence and mortality than developed nations. Despite the disproportionate burden of pediatric traumatic brain injury in low- and middle-income countries (LMICs), the current Brain Trauma Foundation guidelines are largely based on low-quality evidence generated in high-income countries (HICs).1 Adherence to guidelines is challenging in LMICs because of economic constraints, equipment availability, and human resources,2 which may explain disparities in outcomes. We applaud Chesnut et al3 for publishing a randomized controlled trial (RCT) protocol to test the hypothesis of whether intracranial pressure (ICP) monitoring improves outcomes in pediatric severe TBI (psTBI). The RCT will compare outcomes for children receiving ICP-based vs clinical examination and imaging-based management. Their main objective is to generate class I evidence regarding the impact of ICP-driven management in psTBI on long-term outcomes.
Ventilatory load reduction by combined mild hypothermia and ultraprotective mechanical ventilation strategy in severe COVID-19-related acute respiratory distress syndrome: A physiological study.
(The Emergency Medicine Association of Turkey, 2024-04) Cruces, Pablo; Moreno, Diego; Reveco, Sonia; Ramírez, Yenny; Díaz, Franco
We report the feasibility of a combined approach of very low low tidal volume (VT) and mild therapeutic hypothermia (MTH) to decrease the ventilatory load in a severe COVID-19-related acute respiratory distress syndrome (ARDS) cohort. Inclusion criteria was patients ≥18 years old, severe COVID 19 related ARDS, driving pressure ∆P >15 cmH2 O despite low-VT strategy, and extracorporea therapies not available. MTH was induced with a surface cooling device aiming at 34°C. MTH was maintained for 72 h, followed by rewarming of 1°C per day. Data were shown in median (interquartile range, 25%–75%). Mixed effects analysis and Dunnett’s test were used for comparisons. Seven patients were reported. Ventilatory load decreased during the first 24 h, minute ventilation (VE) decreased from 173 (170–192) to 152 (137–170) mL/kg/min (P = 0.007), and mechanical power (MP) decreased from 37 (31–40) to 29 (26–34) J/min (P = 0.03). At the end of the MTH period, the VT, P, and plateau pressure remained consistently close to 3.9 mL/kg predicted body weight, 12 and 26 cmH2 O, respectively. A combined strategy of MTH and ultraprotective mechanical ventilation (MV) decreased VE and MP in severe COVID-19-related ARDS. The decreasing of ventilatory load may allow maintaining MV within safety thresholds.
Prevalence of bacterial codetection and outcomes for infants intubated for respiratory infections
(Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2024-07-01) Karsies, Todd; Shein, Steven L.; Diaz, Franco; Vasquez-Hoyos, Pablo; Alexander, Robin; Pon, Steven; González-Dambrauskas, Sebastián
OBJECTIVES: To determine the prevalence of respiratory bacterial codetection in children younger than 2 years intubated for acute lower respiratory tract infection (LRTI), primarily viral bronchiolitis, and identify the association of codetection with mechanical ventilation duration. MEASUREMENTS AND MAIN RESULTS: Of the 472 analyzed patients (median age 4.5 mo), 55% had a positive respiratory culture and 29% (n = 138) had codetection. 90% received early antibiotics starting at a median of 0.36 hours after respiratory culture. Median (interquartile range) IMV duration was 151 hours (88, 226), and there were 28 deaths (5.3%). Codetection was more common with younger age, a positive respiratory syncytial virus test, and an admission diagnosis of bronchiolitis; it was less common with an admission diagnosis of pneumonia, with admission to a low-/middle-income site, and in those receiving vasopressors. When adjusted for confounders, codetection was not associated with longer IMV duration (adjusted relative risk 0.854 [95% CI 0.684–1.065]). We could not exclude the possibility that codetection might be associated with a 30-hour shorter IMV duration compared with no codetection, although the CI includes the null value. CONCLUSIONS: Bacterial codetection was present in almost a third of children younger than 2 years requiring intubation and ICU admission for LRTI, but this was not associated with prolonged IMV. Further large studies are needed to evaluate if codetection is associated with shorter IMV duration.
Noninvasive ventilation for Pediatric Acute Respiratory Distress Syndrome: experience from the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study
(The Society of Critical Care Medicine; The World Federation of Pediatric Intensive and Critical Care Societies, 2023) Díaz, Franco; Emeriaud, Guillaume; Pons-Òdena, Marti; Bhalla, Anoopindar K.; Shein, Steven L.; Killien, Elizabeth Y.; Modesto i Alapont, Vicent; Rowan, Courtney; Baudin, Florent; Lin, John C.; Grégoire, Gabrielle; Napolitano, Natalie; Mayordomo-Colunga, Juan; Cruces, Pablo; Medina, Alberto; Smith, Lincoln; Khemani, Robinder G.
Objectives: The worldwide practice and impact of noninvasive ventilation (NIV) in pediatric acute respiratory distress syndrome (PARDS) is unknown. We sought to describe NIV use and associated clinical outcomes in PARDS. Design: Planned ancillary study to the 2016/2017 prospective Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study. Setting: One hundred five international PICUs. Patients: Patients with newly diagnosed PARDS admitted during 10 study weeks. Interventions: None. Measurements and main results: Children were categorized by their respiratory support at PARDS diagnosis into NIV or invasive mechanical ventilation (IMV) groups. Of 708 subjects with PARDS, 160 patients (23%) received NIV at PARDS diagnosis (NIV group). NIV failure rate (defined as tracheal intubation or death) was 84 of 160 patients (53%). Higher nonrespiratory pediatric logistic organ dysfunction (PELOD-2) score, Pa o2 /F io2 was less than 100 at PARDS diagnosis, immunosuppression, and male sex were independently associated with NIV failure. NIV failure was 100% among patients with nonrespiratory PELOD-2 score greater than 2, Pa o2 /F io2 less than 100, and immunosuppression all present. Among patients with Pa o2 /F io2 greater than 100, children in the NIV group had shorter total duration of NIV and IMV, than the IMV at initial diagnosis group. We failed to identify associations between NIV use and PICU survival in a multivariable Cox regression analysis (hazard ratio 1.04 [95% CI, 0.61-1.80]) or mortality in a propensity score matched analysis ( p = 0.369). Conclusions: Use of NIV at PARDS diagnosis was associated with shorter exposure to IMV in children with mild to moderate hypoxemia. Even though risk of NIV failure was high in some children, we failed to identify greater hazard of mortality in these patients
Morphological differences between patient self-inflicted and ventilator-induced lung injury: an experimental study
(American Thoracic Society, 2023-03) Díaz, Franco
The role of supraphysiological airway pressure and VT in lung damage during mechanical ventilation (MV) has been studied in-depth, the phenomenon called ventilator-induced lung injury (VILI). Following the same principles, strenuous pontaneous breathing can also be harmful, and the concept of patient self-inflicted lung injury (P-SILI) is proposed (1). However, establishing P-SILI as a pathological entity in acute patients is challenging. There are few P-SILI models focusing on the respiratory effort during MV, showing histological damage in animals with intense respiratory effort (2–4). On the contrary, data regarding strong unassisted spontaneous breathing without MV is lacking. Therefore, we aimed to compare the histopathological findings in animals with acute lung injury (ALI) treated without ventilatory support, injurious MV, and protective MV.
Capnometry after an inspiratory breath hold, PLATCO2, as a surrogate for PaCO2 in mild to moderate Pediatric Acute Respiratory Distress Syndrome: A feasibility study
(Wiley Periodicals, 2023-07-10) Cruces, Pablo; Moreno, Diego; Reveco, Sonia; Améstica, Marjorie; Araneda, Patricio; Ramirez, Yennys; Vásquez-Hoyos, Pablo; Díaz, Franco
Objective: Accurate and reliable noninvasive methods to estimate gas exchange are necessary to guide clinical decisions to avoid frequent blood samples in children with pediatric acute respiratory distress syndrome (PARDS). We aimed to investigate the correlation and agreement between end‐tidal PCO2 measured immediately after a 3‐s inspiratory‐hold (PLATCO2) by capnometry and PaCO2 measured by arterial blood gases (ABG) in PARDS. Measurements and Main Results: All patients were in volume‐controlled ventilation mode. The regular end‐tidal P P CO ETCO ( ) 2 2 (without the inspiratory hold) was registered immediately after the ABG sample. An inspiratory‐hold of 3 s was performed for lung mechanics measurements, recording PETCO2 in the breath following the inspiratory‐hold. (PLATCO2). End‐tidal alveolar dead space fraction (AVDSf) was calculated as [( – )/ PP P aCO ETCO aCO ] 2 2 2 and its surrogate (S)AVDSf as [( CO – )/ CO PLAT 2 ETCO PLAT 2 P ] 2 . Measurements of PaCO2 were considered the gold standard. We performed concordance correlation coefficient (ρc), Spearman's correlation (rho), and Bland–Altmann's analysis (mean difference ± SD [limits of agreement, LoA]). Eleven patients were included, with a median (interquartile range) age of 5 (2–11) months. Tidal volume was 5.8 (5.7–6.3) mL/kg, PEEP 8 (6–8), driving pressure 10 (8–11), and plateau pressure 17 (17–19) cm H2O. Forty‐one paired measurements were analyzed. PaCO2 was higher than PETCO2 (52 mmHg [48–54] vs. 42 mmHg [38–45], p < 0.01), and there were no significant differences with PLATCO2 (50 mmHg [46–55], p > 0.99). The concordance correlation coefficient and Spearman's correlation between PaCO2 and PLATCO2 were robust (ρc = 0.80 [95% confidence interval [CI]: 0.67–0.90]; and rho = 0.80, p < 0.001.), and for PETCO2 were weak and strong (ρc = 0.27 [95% CI: 0.15–0.38]; and rho = 0.63, p < 0.01). The bias between PLATCO2 and PaCO2 was −0.4 ± 3.5 mmHg (LoA −7.2 to 6.4), and between PETCO2 and PaCO2 was −8.5 ± 4.1 mmHg (LoA −16.6 to −0.5). The correlation between AVDSf and (S)AVDSf was moderate (rho = 0.55, p < 0.01), and the mean difference was −0.5 ± 5.6% (LoA −11.5 to 10.5) Conclusion: This pilot study showed the feasibility of measuring end‐tidal CO2 after a 3‐s end‐inspiratory breath hole in pediatric patients undergoing controlled ventilation for ARDS. Encouraging preliminary results warrant further study of this technique.
La extubación durante la noche no se asocia con su fracaso en pacientes pediátricos de Unidad de Cuidados Intensivos: Estudio de cohorte retrospectivo
(Sociedad Chilena de Pediatría, 2023-04-17) Ibarra V., Maybreet; Andrades E., Francisca; Satta S., María; Díaz, Franco; Donoso F., Alejandro
Poco es conocido sobre la hora del día y carácter de éste (hábil/no hábil) en que se efectúa la extubación, y si durante la noche esta es segura. Objetivo: describir la frecuencia de extubación nocturna (EN) y en día no hábil (ENH). Adicionalmente determinar la asociación entre éstas y resultados clínicos. Pacientes y Método: Estudio de cohorte retrospectivo de pacientes menores de 18 años quienes recibieron ventilación mecánica (VM) invasiva y se efectuó un intento extubación en una Unidad de Paciente Crítico Pediátrico (UPCP) médico quirúrgica de alta complejidad entre el 01/01/2018 al 31/12/2021. Exposición primaria: EN, la cual fue definida como la realizada entre 20:01 - 8:00 horas. Se evaluó su asociación con fracaso de extubación (FE), duración de VM invasiva y tiempo de esta- día en la UPCP. Resultados: 146 pacientes fueron incluidos (58,9% hombres, edad 1,14 (0,25 - 5,5) años). En el 17,8% se efectuó EN. La extubación nocturna no se asoció con FE como tampoco el día de extubación. El FE fue 3,8% en EN y 5% en la extubación diurna (ED) (p = 0,80). La duración de la VM invasiva fue menor en EN que ED (48 (24-73,5) vs. 72 (48-96) h, p = 0,02). Conclusiones: La EN no se asoció con FE. Los pacientes con EN tuvieron menor duración de VM invasiva, y ésta última se asoció con FE. La retirada de la VM invasiva debe ser considerada en la primera oportunidad y estar determinada por factores clínicos, más que por la hora del día.
Plateau pressure and driving pressure in volume- and pressure- controlled ventilation: comparison of frictional and viscoelastic resistive components in Pediatric Acute Respiratory Distress Syndrome
(Society of Critical Care Medicine and The World Federation of Pediatric Intensive and Critical Care Societies, 2023-09) Cruces, Pablo; Moreno, Diego; Reveco, Sonia; Ramirez, Yennys; Díaz, Franco
Objectives: To examine frictional, viscoelastic, and elastic resistive components, as well threshold pressures, during volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) in pediatric patients with acute respiratory distress syndrome (ARDS). Measurements and main results: All patients were in VCV mode during measurement of pulmonary mechanics, including: the first pressure drop (P1) upon reaching zero flow during the inspiratory hold, peak inspiratory pressure (PIP), plateau pressure (P PLAT ), and total positive end-expiratory pressure (tPEEP). We calculated the components of the working pressure, as defined by the following: frictional resistive = PIP-P1; viscoelastic resistive = P1-P PLAT ; purely elastic = driving pressure (ΔP) = P PLAT -tPEEP; and threshold = intrinsic PEEP. The procedures and calculations were repeated on PCV, keeping the same tidal volume and inspiratory time. Measurements in VCV were considered the gold standard. We performed Spearman correlation and Bland-Altman analysis. The median (interquartile range [IQR]) for patient age was 5 months (2-17 mo). Tidal volume was 5.7 mL/kg (5.3-6.1 mL/kg), PIP cm H 2 O 26 (23-27 cm H 2 O), P1 23 cm H 2 O (21-26 cm H 2 O), P PLAT 19 cm H 2 O (17-22 cm H 2 O), tPEEP 9 cm H 2 O (8-9 cm H 2 O), and ΔP 11 cm H 2 O (9-13 cm H 2 O) in VCV mode at baseline. There was a robust correlation (rho > 0.8) and agreement between frictional resistive, elastic, and threshold components of working pressure in both modes but not for the viscoelastic resistive component. The purely frictional resistive component was negligible. Median peak inspiratory flow with decelerating-flow was 21 (IQR, 15-26) and squared-shaped flow was 7 L/min (IQR, 6-10 L/min) ( p < 0.001). Conclusions: P PLAT , ΔP, and tPEEP can guide clinical decisions independent of the ventilatory mode. The modest purely frictional resistive component emphasizes the relevance of maintaining the same safety limits, regardless of the selected ventilatory mode. Therefore, peak inspiratory flow should be studied as a mechanism of ventilator-induced lung injury in pediatric ARDS
Factores asociados a ventilación mecánica prolongada en niños con fallo respiratorio de causa pulmonar: estudio de cohortes del registro de LARed Network
(Elsevier, 2023-06-15) Barajas-Romero, Juan Sebastían; Vásquez-Hoyos, Pablo; Pardo, Rosalba; Jaramillo-Bustamante, Juan Camilo; Grigolli, Regina; Monteverde-Fernández, Nicolas; Gonzalez-Dambrauskas, Sebastián; Jabornisky, Roberto; Cruces, Pablo; Wegner, Adriana; Díaz, Franco; Pietroboni, Pietro
Objectives: To identify factors associated with prolonged mechanical ventilation (pMV) in pediatric patients in pediatric intensive care units (PICUs). Design: Secondary analysis of a prospective cohort. Setting: PICUs in centers that are part of the LARed Network between April 2017 and January 2022. Participants: Pediatric patients on mechanical ventilation (IMV) due to respiratory causes. We defined IMV time greater than the 75th percentile of the global cohort. Main variables of interest: Demographic data, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality. Results: 1698 children with MV of 8±7 days were included, and pIMV was defined as 9 days. Factors related to admission were age under 6 months (OR 1.61, 95% CI 1.17-2.22), bronchopulmonary dysplasia (OR 3.71, 95% CI 1.87-7.36), and fungal infections (OR 6.66, 95% CI 1.87-23.74), while patients with asthma had a lower risk of pIMV (OR 0.30, 95% CI 0.12-0.78). Regarding evolution and length of stay in the PICU, it was related to ventilation-associated pneumonia (OR 4.27, 95% CI 1.79-10.20), need for tracheostomy (OR 2.91, 95% CI 1.89-4.48), transfusions (OR 2.94, 95% CI 2.18-3.96), neuromuscular blockade (OR 2.08, 95% CI 1.48-2.93), high-frequency ventilation (OR 2.91, 95% CI 1.89-4.48), and longer PICU stay (OR 1.13, 95% CI 1.10-1.16). In addition, mean airway pressure greater than 13cmH2O was associated with pIMV (OR 1.57, 95% CI 1.12-2.21). Conclusions: Factors related to IMV duration greater than 9 days in pediatric patients in PICUs were identified in terms of admission, evolution, and length of stay
Reply to Pérez
(American Thoracic Society, 2023) Cruces, Pablo; Erranz, Benjamín; Díaz, Franco
Reply to Pérez. Patient self-inflicted and ventilator-induced lung injury: two sides of the same coin?
Results of prophylactic simple fasciocutaneous advancement in the initial management of acute ankle fractures with high risk of operative wound complication
(Elsevier, 2023-09-04) Becerra, Eduardo; Castro, Magdalena; Ruiz Riquelme, Pablo
Ankle fracture is the third most prevalent fracture in older adults. Wound dehiscence is the most frequent complication. Our objective is to determine the operative wound complication rate in patients with unstable ankle fracture in whom a prophylactic simple fasciocutaneous advancement was used. Prophylactic fasciocutaneous advancement at the beginning of traumatological surgery is technically simple, reproducible, cheap and with low complications.
Incidence and clinical implications of anatomical variations in the pancreas and Its ductal system: A systematic review and meta-analysis
(MDPI, 2023-08-09) Orellana-Donoso, Mathias; Milos Brandenberg, Daniel; Benavente-Urtubia, Andoni; Guerra-Loyola, Javier; Bruna-Mejías, Alejandro; Nova-Baeza, Pablo; Becerra-Farfan, Álvaro; Sepúlveda-Loyola, Walter; Luque-Bernal, Ricardo Miguel; Valenzuela-Fuenzalida, Juan José
Objetivo: Esta revisión sistemática analiza las variantes anatómicas en el páncreas y su sistema ductal para informar sobre su asociación con patologías pancreáticas. Métodos: Realizamos una búsqueda en las bases de datos MEDLINE, Scopus, Web of Science, Google Scholar, CINAHL y LILACS desde su inicio hasta julio de 2023. La calidad metodológica se evaluó con la herramienta Anatomical Quality Assessment (AQUA). Finalmente, la prevalencia agrupada se estimó mediante un modelo de efectos aleatorios. Resultados: Se encontraron 55 estudios que cumplieron con los criterios de elegibilidad. La prevalencia general de páncreas divisum (PD) fue del 18% (IC del 95% = 15-21%). La prevalencia de EP asociada con pancreatitis fue del 30% (IC 95% = 1-61%). Conclusiones: Una variante anatómica del páncreas como la EP puede ser la causa de la obstrucción de la vía biliar, dando lugar a diversas complicaciones clínicas, como la pancreatitis. De ahí que conocer esta variante sea de suma importancia para los cirujanos, especialmente para quienes tratan la región gastroduodenal.
Anatomical variations and abnormalities of the maxillary region and clinical implications: A systematic review and metaanalysis
(Wolters Kluwer Health, 2023-07-05) Valenzuela-Fuenzalida, Juan José; Baez-Flores, Belén; Ávila-Sepúlveda, Roberto; Moya-Medina, Claudia; Pérez-Jiménez, Rubén; López, Esteban; Sánchis, Juan; Orellana-Donoso, Mathias; Leyton-Silva, Javiera; Rodríguez, Macarena-Cecilia; Iwanaga, Joe
Objetivo: El objetivo de esta revisión es investigar y analizar las variaciones anatómicas presentes en el seno maxilar (SM), a través de la examinación de la prevalencia de estas variaciones, así como la correspondiente prevalencia de patologías clínicamente significativas y complicaciones asociadas a ellas. Métodos: El proceso de búsqueda se realizó en las siguientes bases de datos; MEDLINE, SCIELO, WOS, CINHAL, SCOPUS y GOOGLE SCHOLAR, utilizando como términos de búsqueda; “Hueso maxilar”, “Seno maxilar”, “Seno paranasal”, “Variaciones anatómicas”, “Sinusitis” y “Anatomía clínica”. Resultados: Se incluyeron un total de 26 artículos y 12969 muestras, de las cuales se registró el sexo de 12,594 sujetos, dando un total de 5802 hombres y 6792 mujeres. Las variantes reportadas por los incluidos fueron células de Haller, Concha Bullosa, Número de septos, Seno hipoplásico, Agger Nasi, Engrosamiento de la mucosa MS, Desviación del tabique nasal, Ostium accesorio y Células de Onodi. Entre los mencionados, los que presentaron mayor número de estudios (entre 8 y 10 estudios incluidos) fueron: las Células de Haller, la Concha Bullosa y el Número de septos, donde la prevalencia fue de 0,30, 0,36, 0,39 respectivamente. Estas variaciones pueden provocar sinusitis, provocar algunos tipos de tumores o afectar estructuras vecinas que podrían verse comprometidas por esta variación. Conclusión: Como resultado, es ciertamente complejo distinguir la presencia de variaciones anatómicas de anomalías patológicas. Por tanto, el conocimiento de las diferentes variaciones y sus relaciones clínicas podría ser un activo útil para los médicos dedicados a esta región.
Systematic review and meta-snalysis: recurrent laryngeal nerve variants and their implication in surgery and neck pathologies, using the Anatomical Quality Assurance (AQUA) checklist
(MDPI, 2023-04-24) Valenzuela-Fuenzalida, Juan José; Baeza-Garrido, Vicente; Navia-Ramírez, María Fernanda; Cariseo-Ávila, Carolina; Bruna-Mejías, Alejandro; Becerra-Farfan, Álvaro; Lopez, Esteban; Orellana-Donoso, Mathias; Loyola-Sepulveda, Walter
The recurrent laryngeal nerve (RLN) is the structure responsible for sensory and motor innervation of the larynx, and it has been shown that its lesion due to a lack of surgical rigor led to alterations such as respiratory obstruction due to vocal cords paralysis and permanent phonation impairment. The objectives of this review were to know the variants of the RLN and its clinical relevance in the neck region. Methods: This review considered specific scientific articles that were written in Spanish or English and published between 1960 and 2022. A systematic search was carried out in the electronic databases MEDLINE, WOS, CINAHL, SCOPUS, SCIELO, and Latin American and Caribbean Center for Information on Health Sciences to compile the available literature on the subject to be treated and was enrolled in PROSPERO. The included articles were studies that had a sample of RLN dissections or imaging, intervention group to look for RLN variants, or the comparison of the non-recurrent laryngeal nerve (NRLN) variants, and finally, its clinical correlations. Review articles and letters to the editor were excluded. All included articles were evaluated through quality assessment and risk of bias analysis using the methodological quality assurance tool for anatomical studies (AQUA). The extracted data in the meta-analysis were interpreted to calculate the prevalence of the RLN variants and their comparison and the relationship between the RLN and NRLN. The heterogeneity degree between included studies was assessed. Results: The included studies that showed variants of the RLN included in this review were 41, a total of 29,218. For the statistical analysis of the prevalence of the RLN variant, a forest plot was performed with 15 studies that met the condition of having a prevalence of less than 100%. As a result, the prevalence was shown to be 12% (95% CI, SD 0.11 to 0.14). Limitations that were present in this review were the publication bias of the included studies, the probability of not having carried out the most sensitive and specific search, and finally, the authors’ personal inclinations in selecting the articles. Discussion: This meta-analysis can be considered based on an update of the prevalence of RLN variants, in addition to considering that the results show some clinical correlations such as intra-surgical complications and with some pathologies and aspects function of the vocal cords, which could be a guideline in management prior to surgery or of interest for the diagnostic.
Trastornos de conducta alimentaria grave en adolescentes durante la pandemia COVID-19: un llamado a la acción
(Sociedad Chilena de Pediatría, 2022-06) Díaz, Franco; Pilicita, Lorena; Godoy, Luisana; Donoso, Alejandro
Las investigaciones sobre las repercusiones de la pandemia COVID-19 en los adolescentes con TCA es escasa, no obstante, estos son uno de los desórdenes psiquiátricos de más difícil tratamiento, aún en condiciones de normalidad. Durante el primer año de la pandemia hubo un reporte de un incremento hasta en un 30%, de las admisiones hospitalarias por AN, con un predominio en adolescentes mujeres. Estos datos incipientes muestran solo la punta del iceberg, siendo los problemas de salud mental una de las principales secuelas de la pandemia COVID-19.
Relationship between national changes in mobility due to non-pharmaceutical interventions and emergency department visits due to pediatric acute respiratory infections during the COVID-19 pandemic
(Yale University; Cold Spring Harbor Laboratory (CSHL), 2022-01) Díaz, Franco; Carvajal, Cristóbal; Gatica, Sebastián; Vásquez-Hoyos, Pablo; Jabornisky, Roberto; Von Moltke, Richard; Jaramillo-Bustamante, Juan Camilo; Pizarro, Federico; Cruces, Pablo
Background Strong social distancing measures were quickly implemented in Chile during the SARS-CoV-2 outbreak. One of the aims of non-pharmaceutical interventions (NPI) mandates was to decrease overcrowding, thus is usually measured as mobility changes. Methods we gather data from national health statistics for pediatric emergency (PED) visits for acute respiratory infection (ARI) in children younger than 15. We defined a historical cohort, including data from 2016 to 2019, and compared them with 2020 and 2021 pandemic years. Also, Chile’s national mobility reports from the online google database were downloaded. We tested the correlation between changes in mobility and relative reduction in PED-ARI by Spearman’s Rank Test. Results Historical data showed a mean of 46863 ± 3071 PED-ARI weekly visits with a high seasonal variation, with two peaks in weeks 20 and 28 and weeks 32 to 36. This transient drop was temporally associated with the mid-winter 2-week holiday of schools. The usual PED visits peaks did not occur in 2020 and 2021. Mobility declined from week 9, reaching lower than historical data from week 12 and a minimum of 43% in week 15 of 2020 . The correlation between mobility and PED-ARI visits showed a strong monotonic relationship (quadratic) with a Spearman’s rho of 0.80 (95% CI 0.75 to 0.86) . Conclusion NPI resulting in a decrease in mobility should be considered a robust public health measure to relieve the winter’s collapse of the national health system, decreasing morbimortality in children due to PED-ARI.

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