Artículos de Revistas

URI permanente para esta colección

https://repositorio.uft.cl/handle/20.500.12254/2464

Examinar

Mostrando 1 - 20 de 133

Desafíos en hemorragia cerebral y cirrosis hepática. Derivación ventricular bilateral como alternativa terapéutica
(Clínica Las Condes, 2025) Arroyo, Antonio; Ramos, Andrés; Reccius, Andrés
Objetivo: 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.
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, Javiera
Objetivo: 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.
Síndrome de hipotensión intracraneal en paciente neurocrítico: reporte de caso
(Clínica Las Condes, 2025) Arroyo, Antonio; Reccius, Andrés
Objetivo: 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.
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, Guinevere
Diabetes 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.
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 José
Background 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.
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.
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 José
The 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.
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, Marko
Background: 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.
A Systematic Review of Anatomical Variations of the Inferior Thyroid Artery: Clinical and Surgical Considerations
(MDPI, 2025-07-23) Bruna-Mejías, Alejandro; Pérez-Farías, Carla; Prieto-Heredia, Tamara; Vergara-Vargas, Fernando; Martínez-Cid, Josefina; Sanchis-Gimeno, Juan; Afandi-Rebolledo, Sary; Valdés-Orrego, Iván; Nova-Baeza, Pablo; Suazo Santibañez, Alejandra; Valenzuela Fuenzalida, Juan José; Orellana-Donoso, Mathias
The inferior thyroid artery (ITA) is an essential component of the thyroid gland’s vasculature, with significant clinical and surgical implications due to its anatomical variability. This systematic review aimed to describe the prevalence of ITA anatomical variants and their association with clinical conditions or surgical implications. Methods: A comprehensive search was conducted in MEDLINE, Web of Science, Google Scholar, CINAHL, Scopus, and EMBASE on 20 November 2025. Eligibility criteria included studies reporting on the presence of ITA variants and their correlation with pathologies. Two authors independently screened the literature, extracted data, and assessed methodological quality using the AQUA and JBI tools. Results: Of the 2647 articles identified, 19 studies involving 1118 subjects/cadavers were included. Variations in ITA origin, absence, and additional arteries were reported, with the most common variant being direct origin from the subclavian artery. Clinically, these variations were associated with increased risk of intraoperative hemorrhage, potential nerve damage, and challenges in preoperative planning, particularly during thyroidectomy and other neck procedures. Conclusions: Understanding the anatomical diversity of the ITA is crucial for reducing surgical risks and improving patient outcomes. The review highlighted the need for more standardized research protocols and comprehensive data reporting to enhance the quality of evidence in this domain. Preoperative imaging and thorough anatomical assessments tailored to individual patient profiles, considering ethnic and gender-related differences, are essential for safe surgical interventions in the thyroid region.
Anatomical variants of the vertebral artery and their relationship with craniocervical disorders and surgical considerations: a systematic review and meta‐analysis
(Springer Nature, 2025-05-29) Valenzuela Fuenzalida, Juan José; Villar‐Valdebenito, Javiera del; Aburto, Lorenzo; Berríos, Fernanda; Nazar Izquierdo, Diego; Rodriguez‐ Luengo, Macarena; Czerniachowska, Maja; Nova Baeza, Pablo; Orellana-Donoso, Mathias; Suazo Santibañez, Alejandra; Bruna‐Mejías, Alejandro; Oyanedel‐Amaro, Gustavo; Smith, Heather F.; Sanchis‐Gimeno, Juan
The vertebral artery (VA) supplies almost one-third of the blood flow to the brain, contributing mainly to its posterior circulation. This article provides a comprehensive overview of the different anatomical variations related to the origin, course, and termination of the VA and associated clinical implications. Data were compiled from numerous published studies accessed from the databases Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Literature in Health Sciences (LILACS) as of January 2024. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model, and differences in VA variant rates were assessed. VA variants were identified that could be separated into three categories: variation in origin, course, and terminal branches. A total of 16 studies met the established selection criteria for the current meta-analysis. VA variations were reported at an overall prevalence of 11% (CI: 7%–15%) and a heterogeneity of 77%. Statistically significantly higher rates were revealed in the following subgroups of the sample: imaging examinations versus cadavers (p = 0.032); right side of the body versus left (p = 0.034); and bilaterally versus unilaterally (p = 0.019). Concerns listed in included studies primarily focused on the possibility of iatrogenic damage during surgical procedures. A few studies also indicated higher rates of VA variants in patients who reported symptoms of recurrent headaches, vertigo, dizziness, and/or syncope. The presence of VA variants is high and can occur in various regions. However, the most important clinical consideration is that individuals with this variant must be constantly monitored since their posterior cerebral circulation could be affected. To avoid iatrogenic damage to the VA, clinicians should employ medical imaging to evaluate its course and branches prior to surgical interventions in the region.
Comparison of the Mediterranean Diet and Other Therapeutic Strategies in Metabolic Syndrome: A Systematic Review and Meta-Analysis
(MDPI, 2025-06-19) Bruna-Mejías, Alejandro; San Martin, Jessica; Arciniegas-Diaz, Danna; Meneses-Caroca, Trinidad; Salamanca-Cerda, Amelia; Beas-Gambi, Antonia; Loaiza-Giraldo, Jessica Paola; Ortiz-Ahumada, Cynthia; Nova-Baeza, Pablo; Oyanedel-Amaro, Gustavo; Orellana-Donoso, Mathias; Suazo Santibañez, Alejandra; Sanchis-Gimeno, Juan; Valenzuela Fuenzalida, Juan José
The Mediterranean diet (MD) is one of the healthiest diets, high in fiber, antioxidants, and unsaturated fats. MD improves lipid profiles, reduces inflammation, controls blood pressure, decreases insulin resistance, and enhances the sensitivity to this hormone, lowering the risks of Metabolic syndrome (MS). MS is characterized by central obesity, hypertension, insulin resistance, and dyslipidemia, increasing the risk of cardiovascular disease and type II diabetes. The objective of this study was to know the effectiveness of the MD versus other treatments in patients with MS. A systematic search across multiple databases, Medline, Embase, Web of Science, Scopus, Google Scholar, and Cinahl, was conducted using keywords such as “Mediterranean diet”, “Mediterranean food”, “eat mediterranean”, “Metabolic syndrome”, and “x syndrome”. A total of 12 studies met the inclusion criteria. Mediterranean diet at different doses versus other diets or other treatments showed significant improvements in clinical parameters, including BMI (mean difference of −0.83 95% CI: −0.93 to −0.74; p < 0.00001),waist circumference (mean difference = −1.81, CI = −2.63 to −0.99, p < 0.00001) triglycerides (mean difference = −22.38, CI = −32.86 to −11.90, p < 0.00001), Glucose (mean difference = −4.28, CI = −7.64 to −0.93, p = 0.005) and, HOMA IR (mean difference = −0.72, CI = −0.78 to −0.65, p < 0.00001), and Insulin resistance (mean difference = −2.98, CI = −3.27 to −2.69, p < 0.00001), all of which improved, Although there were more outcomes, these are the most important changes for patients with metabolic syndrome. MD improves metabolic and cardiovascular health, but study heterogeneity limits the results’ generalizability. Because of that, further research is needed to standardize approaches and explore their mechanisms. MD should be part of an optimized strategy that includes education and physical activity. The strength of the evidence was very low according to the GRADE approach. Further research is needed to support the efficacy of the Mediterranean diet in patients with MS.
Clinical Characteristics of Neuropathic Pain and Its Relationship with Cancer in Different Corporal Areas—A Systematic Review
(MDPI, 2025-01-06) Danés-López, Fernanda; Diaz-Palominos, Cristóbal; Ortiz Domínguez, Anggie; Silva Rodriguez, Alanna; Astorga, Constanza; Martínez-Hernández, Daniela; Valenzuela Fuenzalida, Juan José; Sanchis-Gimeno, Juan; Nova-Baeza, Pablo; Suazo Santibañez, Alejandra; Oyanedel-Amaro, Gustavo; Orellana-Donoso, Mathias; Gutiérrez Espinoza, Héctor
Neuropathic pain (NP) and cancer are caused by nerve damage due to cancer or treatments such as chemotherapy, radiotherapy, and surgery, with a prevalence that can reach up to 40%. Causes of neuropathic cancer pain (NCP) include direct nerve invasion or compression by the tumor, as well as neural toxicity associated with treatments. This type of pain is classified into several categories, such as plexopathy, radiculopathy, and peripheral neuropathies. Methods: Medline, Web of Science, Google Scholar, CINAHL, and LILACS databases were searched until October 2024. Two authors independently performed the search, study selection, and data extraction. Methodological quality was analyzed using the Robins-I tool. Results: The main findings of this review indicate that, depending on the cancer type, neuropathic pain will exhibit different characteristics, as well as identifying which types of cancer have a higher probability of presenting neuropathic pain. Additionally, there is a direct relationship whereby the more advanced the cancer, the greater the likelihood of experiencing neuropathic pain. Finally, although chemotherapy is employed as a cancer treatment, this therapy is quite invasive, and one of its adverse effects is that treated patients have a higher probability of developing neuropathic pain. Conclusions: Neuropathic pain is a condition that adversely affects patients with cancer. A detailed understanding of the relationships and triggers that produce this condition is present in only a small percentage of patients with cancer and is necessary to provide better treatment and gain a more comprehensive understanding of the characteristics of neuropathic pain. The objective of this study is to describe the relationship between different types of cancer or various treatments and the presence of NP.
The Gastric Vein Variants: An Evidence-Based Systematic Review of Prevalence and Clinical Considerations
(MDPI, 2025-05-22) Bruna-Mejías, Alejandro; Salgado-Torres, Cristian; Cáceres-Gálvez, Constanza; Rodriguez-Osorio, Benjamin; Orellana-Donoso, Mathias; Nova-Baeza, Pablo; Suazo Santibañez, Alejandra; Oyanedel-Amaro, Gustavo; Sanchis-Gimeno, Juan; Piagkou, Maria; Triantafyllou, George; Konschake, Marko; Valenzuela Fuenzalida, Juan José
The objective of the present systematic study was to analyze and characterize the gastric vein (GV) variations to understand their significance within clinical contexts, particularly in gastric and liver surgeries and managing conditions associated with the portal vein system. Methods: We conducted a systematic review, examining various databases, including Medline, Scopus, Web of Science, Google Scholar, CINAHL, and EMBASE, up to April 2025. Two independent authors conducted the literature search, selected pertinent studies, and extracted relevant data. The methodological quality of the studies was evaluated utilizing the Assessment Tool for Anatomical Studies (AQUA). The pooled prevalence was estimated through the application of a random effects model. Results: Among the 279 articles reviewed, 11 studies were ultimately incorporated into the systematic analysis, encompassing 47,993 subjects. The pooled prevalence of GV variants was determined to be 8.32%, revealing considerable heterogeneity (I2 = 98.92%). A subgroup analysis showed a greater prevalence of GV variants in diagnostic imaging studies than in cadaveric studies, with a higher frequency observed in males than in females. Conclusions: The morphological variability of the GVs holds clinical significance, as it may significantly impact the management of abdominal disorders, particularly during surgical and endovascular interventions. This study emphasizes the necessity of thorough preoperative evaluations to identify these variations, thereby minimizing surgical complications and enhancing therapeutic outcomes for patients suffering from gastric and portal vein system disorders. Integrating advanced imaging techniques into clinical practice may facilitate improved surgical and therapeutic planning.
A Systematic Review and Meta-Analysis on the Prevalence of Variants in the Pancreaticobiliary Duct Junction and Its Association with Cancer
(MDPI, 2025-04-25) Valenzuela Fuenzalida, Juan José; Beas-Gambi, Antonia; Matta-Leiva, Josefa; Martínez-Hernández, Daniela; Milos, Daniel; Orellana-Donoso, Mathias; Suazo Santibañez, Alejandra; Bruna-Mejías, Alejandro; Sebastian Riveros, Andres; Becerra-Farfán, Alvaro; Sanchis-Gimeno, Juan; Gutierrez-Espinoza, Héctor; Bastidas-Caldes, Carlos
The objective of this study was to describe the anatomical variants of the pancreaticobiliary junction and how its position or structural change could be associated with hepatic, duodenal, and pancreatic clinical complications. Methods: We searched MEDLINE, Scopus, Web of Science (WOS), Google Scholar, CINAHL, and EMBASE databases from their inception up to September 2024. Results: Two authors independently performed the search, study selection, data extraction, and assessed the methodological quality with an assurance tool for anatomical studies (AQUA). Finally, the pooled prevalence was estimated using a random effects model. A total of 59 studies with a total of 22,752 participants were included in this review. The overall prevalence of the anomalous pancreaticobiliary junction (APBJ) variant was 12% (95% CI = 6% to 18%). The prevalence of cancer associated with variants of APBJ was 29% (95% CI = 23% to 34%). Conclusions: In the present anatomical systematic review and meta-analysis, we found that a longer common channel correlated with a higher prevalence of bile duct or gallbladder malignancy, due to the backward flow of bile which occurs as a result of the position and distance of the bile ducts, as well as pancreatic failing. Hence, APBJs are of great interest for gastroduodenal surgeons.
The adverse effects and use of bevacizumab in patients with glioblastoma: a systematic review and meta-analysis
(MDPI, 2025-05-25) Bruna-Mejías, Alejandro; Silva-Bravo, Vicente; Moyano Valarezo, Laura; Delgado-Retamal, María Fernanda; Nazar-Izquierdo, Diego; Aguilar-Aguirre, Isidora; Nova-Baeza, Pablo; Orellana-Donoso, Mathias; Suazo Santibañez, Alejandra; Gutiérrez-Espinoza, Héctor; Sanchis Gimeno, Juan; Bastidas-Caldes, Carlos; Valenzuela Fuenzalida, Juan José
A glioblastoma (GBM) is a type of tumor originating from the glial brain cells, the astrocytes, and thus belongs to the astrocytoma group. Bevacizumab (BV) is a treatment for GBM. BV is the active ingredient in the drugs Avastin®, Alymsys®, Mvasi® and ZiraBev®. It is currently approved as second-line treatment for GBM recurrence in combination with radiotherapy, and as first-line treatment for other cancers, including advanced colorectal cancer, metastatic breast cancer and advanced non-small-cell lung cancer. The objective of this systematic review was to analyze the scientific evidence from the science-based literature on the therapeutic effect and adverse effects of the drug BV in patients with GBM or GBM multiforme. Methods: We systematically searched electronic databases for the literature search, including the MEDLINE (via PubMed), SCOPUS, Google Scholar, the Cumulative Index to Nursing and Allied Health Literature and Web of Science databases, covering records from their earliest data to December 2024. Randomized or controlled clinical trials that were published in English or Spanish were included. The following keywords were used in different combinations: “Bevacizumab therapy”, “Bevacizumab pharmaceutical”, “Glioblastoma”, “Glioma” and “multiform glioblastoma”. Results: The use of Bevacizumab has been extensively studied in the scientific literature, with beneficial effects in symptom control. However, the adverse effects of BV vary across different types of carcinomas, which is why it has already been established that these adverse effects must be taken into consideration. In our meta-analysis of adverse effects, we found 14 adverse effects and estimated their prevalence, with an average of 19% (CI: 4 to 44%). The most significant vascular adverse effect was thromboembolism, which led to a greater number of complications for patients with GBM. Finally, the most common adverse effects were nausea, vomiting, fatigue and hypertension. Conclusions: While the beneficial properties of this pharmacological therapy have been observed, its adverse effect profile requires constant evaluation, as it includes vascular, blood and symptomatic adverse effects, which must be analyzed on a case-by-case basis and with great attention, especially in the case of more serious complications such as thromboembolic events.
Anatomical variants in pancreatic irrigation and their clinical considerations for the pancreatic approach and surrounding structures: a systematic review with meta-analysis
(MDPI, 2025-02-19) Valenzuela Fuenzalida, Juan José; Núñez-Castro, Camila Ignacia; Morán-Durán, Valeria Belén; Nova-Baeza, Pablo; Orellana-Donoso, Mathias; Suazo Santibañez, Alejandra; Becerra-Farfan, Alvaro; Oyanedel-Amaro, Gustavo; Bruna-Mejías, Alejandro; Granite, Guinevere; Casanova-Martinez, Daniel; Sanchis-Gimeno, Juan
Background and Objectives: The pancreas receives blood through a complex network of multiple branches, primarily originating from the celiac trunk (CeT) and the superior mesenteric artery (SMA). This blood supply is structured into three main arterial groups, each serving different regions of the pancreas to effectively support its endocrine and exocrine functions. Materials and Methods: The databases Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Latin American and the Caribbean Literature in Health Sciences (LILACS) were searched until January 2025. Methodological quality was evaluated using an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. Results: A total of sixteen studies met the established selection criteria in this study for meta-analysis. Pancreatic irrigation variants presented a prevalence of 11.2% (CI: 7–14%) and a heterogeneity of 88.2%. The other studies were analyzed by subgroups, showing statistically significant differences in the following subgroups: (1) sample type—a larger sample of images analyzed in the included studies (p = 0.312), which did not show statistically significant differences; (2) geographical region (p = 0.041), which showed a greater presence in the Asian population studied, and this was statistically significant; and (3) sex (male or female) (p = 0.12), where there were no statistically significant differences. Conclusions: The discovery of variations in pancreatic irrigation is common due to the numerous blood vessels involved in supplying this vital organ. Understanding different vascular patterns (such as those from the splenic and mesenteric arteries) is crucial for surgical interventions on the pancreas. For transplant patients, a thorough vascular analysis of both the donor and recipient is essential. Variations can impact blood flow and compatibility, potentially leading to transplant rejection if not addressed. To enhance outcomes, it is recommended to develop more accurate imaging tools for pre-surgical analysis, necessitating ongoing research in this area.
Hacia un sistema de salud sustentable en Chile: el papel de los hospitales verdes
(Clínica Las Condes, 2025-08-12) Olive, Fernanda; Sanhueza, María Bernardita
El sector salud desempeña un papel crucial en la protección de la población, pero su impacto ambiental es innegable. La atención sanitaria global es responsable del 4,4% de las emisiones de gases de efecto invernadero. En Chile, la gestión sostenible de residuos hospitalarios es deficiente, con solo un 2% de los desechos reciclados. Las Unidades de Cuidados Intensivos (UCI) presentan una huella ambiental alta, generando tres veces más CO2 por cama que otras áreas hospitalarias. El objetivo de este artículo es analizar el impacto ambiental del sistema de salud en Chile y destacar el rol estratégico de los hospitales, especialmente de sus equipos clínicos, en la transición hacia modelos de atención más sostenibles. En este contexto, se hace necesario que el sistema de salud chileno viva una transición a un eje más verde, abordando problemáticas como la generación de residuos, uso excesivo de elementos plásticos y generación de emisiones de CO2. Los equipos de salud juegan un rol clave al liderar iniciativas de sostenibilidad, capacitación y promoción de mejores prácticas, existiendo varios casos de éxito que demuestran la viabilidad y beneficios asociados. Existe la necesidad de cambios regulatorios y compromisos institucionales para alinear la atención sanitaria con los objetivos globales de sostenibilidad ambiental, garantizando un futuro más saludable para las personas y el planeta.
Cost-effectiveness of dabigatran for thromboembolic events prevention in atrial fibrillation patients in Chile
(BMC, 2025) Abbot, Tomas; Armijo, Nicolás; Rojas Orellana, Luis; Giglio, Andrés; Balmaceda, Carlos; Espinoza, Manuel
Background Atrial fibrillation (AF) is the most common sustained arrhythmia in adults, associated with significant morbidity, mortality, and economic burden due to thromboembolic events. In Chile, acenocoumarol is the most widely used anticoagulant, while access to direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, and apixaban remains limited for AF patients. Among DOACs, dabigatran is the only one with an approved specific reversal agent (idarucizumab) available in the Chilean public system. Evaluating the cost-effectiveness of these alternatives is critical for informing resource allocation. Aims To evaluate the cost-effectiveness of dabigatran compared to acenocoumarol, rivaroxaban and apixaban, for thromboembolic events prevention in atrial fibrillation (AF) patients, from the Chilean public health payer perspective. Methods A Markov cohort model was used to represent the natural history of AF in terms of ischemic and hemorrhagic complications. Direct costs were obtained from local official sources and converted to US dollars (1 USD = 710.9 CLP at 2022). Data about major events and utilities were obtained from the literature. We applied an undifferentiated discount rate of 3% for costs and outcomes over a lifetime time horizon. Uncertainty was characterized through deterministic and probabilistic sensitivity analysis. We also examined the use of idarucizumab and prothrombin-complexes-concentrate (PCC) as reversal agents in an emergency setting as an additional scenario-analysis. Results Dabigatran was the most (cost-)effective among all alternatives (8.53 QALYs). Considering the Chilean costeffectiveness threshold of USD 17,200 (1 GDP per capita), dabigatran was cost-effective (USD 11,042 per QALY gained), while both rivaroxaban and apixaban were dominated by dabigatran. Regarding the second-order uncertainty, at the suggested threshold, dabigatran exhibit the highest probability of being cost-effective (approximately 60%). In the reversal agent scenario, dabigatran plus idarucizumab was also found to be cost-effective in the Chilean context. Conclusion Dabigatran is cost-effective and dominates both rivaroxaban and apixaban at current publicly available prices in Chile. In addition, we expect dabigatran-idarucizumab is also expected to be cost-effective for Chilean health system when is compared against acenocoumarol-PCC as reversal agents.
Evaluating in situ Simulation in Critical Care: Insights from Healthcare Professionals
(Dove Medical Press, DovePress, 2025-08-27) Giglio, Andrés; Ferre Contreras, Andrés; Garcia, Javiera
Carta al editor relacionado al artículo de Sung TC y Hsu HC que lleva por nombre: Improving Critical Care Teamwork: Simulation-Based Interprofessional Training for Enhanced Communication and Safety.
Decoding sepsis: a 16-year retrospective analysis of activation patterns, mortality predictors, and outcomes from a hospital-wide sepsis protocol
(MDPI, 2025-08-14) Borges-Sa, Marcio; Giglio, Andrés; Aranda, Maria; Socias, Antonia; Castillo, Alberto del; Mena, Joana; Franco, Sara; Ortega, María; Nieto, Yasmina; Estrada, Victor; Rica, Roberto de la
Background: Sepsis remains a leading cause of mortality in hospitalized patients. We evaluated characteristics and outcomes of patients identified through a comprehensive hospital-wide sepsis protocol over a 16-year period. Methods: This retrospective cohort study analyzed hospital-wide sepsis protocol activations at a tertiary care hospital in Spain from 2006 to 2022. The protocol required at least two SIRS criteria plus evidence of organ dysfunction in patients over 14 years old. We analyzed demographics, activation criteria, hospital location, mortality predictors using univariate and multivariate analyses, including propensity score modeling, and resource utilization trends. Results: A total of 10,919 patients with 14,546 protocol activations were identified. The median age was 69 years (IQR: 56–78), with 60.9% male patients. Protocol activations occurred in the emergency department (54%), ICU (34.2%), and inpatient wards (11.8%). The most common SIRS criteria were tachycardia (75.6%), tachypnea (50.4%), and fever (48.5%). Prevalent organ dysfunctions included hypotension (53%), hypoxemia (50.1%), oliguria (28.9%), and altered mental status (22%). Overall in-hospital mortality showed a significant linear downward trend from 26.5% in the first year to 13.6% in later years (p < 0.01). Propensity score analysis confirmed independent mortality predictors included hyperlactatemia (aOR 2.21), altered consciousness (aOR 2.09), hypotension (aOR 1.87), and leukopenia (aOR 1.79). ICU admission rate decreased from 58% to 24% over the study period. Conclusions: This 16-year analysis shows that comprehensive hospital-wide sepsis protocols achieve sustained mortality reduction with improved resource utilization efficiency. These findings support implementing comprehensive sepsis protocols as an effective strategy for improving sepsis outcomes.

Examinar

Envíos recientes