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Response to Letter to the Editor: Reliable pain and function outcomes after high tibial osteotomy for medial osteoarthritis in the grey area between osteotomy and unicompartmental replacement
(Wiley, 2026) Pineda, Tomás
Los autores aclaran que su estudio sobre osteotomía tibial alta (HTO) se centra en el alivio del dolor y la mejora funcional en pacientes con osteoartritis de zona gris (AKUMA), no en el retorno al deporte. Reconocen limitaciones del estudio y destacan la relevancia de factores psicológicos, manteniendo que sus resultados ofrecen orientación clínica válida.
Reliable pain and function outcomes but limited sport performance after high tibial osteotomy for medial knee osteoarthritis in the grey zone between osteotomy and unicompartmental replacement
(Wiley, 2026) Pineda, Tomás; Pierecchi, Antoine; Jacquet, Christophe; Gaggero, Nicolás; Kley, Kristian; Ollivier, Matthieu
Purpose: To evaluate mid-term outcomes of high tibial osteotomy (HTO) in patients with medial knee osteoarthritis presenting borderline indication between osteotomy and unicompartmental knee arthroplasty (UKA) and to identify clinical and radiographic factors associated with success in pain, function and sport. Methods: Retrospective multicentre cohort of consecutive HTOs performed between 2005 and 2015 with ≥2 years of follow-up, including patients classified within the grey zone according to the AKUMA framework. Preoperative and postoperative long-leg radiographs were obtained to measure hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA) and joint line convergence angle (JLCA). Primary outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Tegner and modified Weiss (mW) scores; secondary outcomes included satisfaction, sports relevance, symptom-free return to sport and forgotten-knee. Success thresholds were WOMAC ≥ 80, Tegner ≥5 and mW ≥6. Univariate analyses compared successes versus non-successes, and multivariable logistic regression was performed for WOMAC. Results: Eighty-four patients were analysed with a mean follow-up 8.0 ± 3.2 (2.0-14.3) years. Success rates were 72.0% for WOMAC, 6.8% for Tegner and 7.5% for mW. Postoperative MPTA was higher in WOMAC successes than in non-successes. In multivariable analysis, Ahlbäck Grade 3 lowered the odds of achieving WOMAC ≥ 80 (odds ratio [OR]: 0.20, 95% confidence interval [CI]: 0.04-0.94). Tegner success was associated with greater LDFA and with rating sport as very important. mW success was associated with lower preoperative MPTA, lower LDFA, higher tibial extra-articular deformity (TEAD) and very high sport priority. Higher Ahlbäck and Kellgren-Lawrence (KL) grades were linked to worse satisfaction; the forgotten-knee endpoint showed no significant associations. Conclusion: In medial OA knees within the AKUMA grey zone, HTO provides reliable pain relief and functional improvement, while sport success remains limited. Osteoarthritis burden reduces the probability of high pain and function-related scores, while sport-oriented outcomes depend more on coronal alignment features and the patient's sport priority.
Rectus femoris tendon: An emerging option in ACL reconstruction
(Wiley, 2026) Pineda, Tomás
Over the past decades, the search for the 'ideal' graft in anterior cruciate ligament (ACL) reconstruction has remained one of orthopaedic surgery's most enduring pursuits. Each generation of surgeons has witnessed new grafts and techniques emerge - only for most to find their rightful place somewhere between innovation and pragmatism. The sheer number of available options - bone-patellar tendon-bone, hamstring autografts, quadriceps tendon, peroneus longus and the many forms of allografts - is itself a reminder that no single graft is perfect. Each carries its own strengths and limitations, underscoring that no option fully satisfies the balance between biomechanical performance, donor-site morbidity, graft survival and functional recovery. This ongoing search for improvement keeps the door open for exploring new alternatives. In this context, a new and unexpected contender has quietly entered the scene.
The rectus femoris tendon demonstrates comparable ultimate stress to the patellar tendon: A paired biomechanical study
(Wiley, 2025) Pineda, Tomás; Sewpaul, Yash; Morin, Vincent; Jacquet, Christophe; Horteur, Clement; Ollivier, Matthieu
Purpose: The objective of this study was to compare the ultimate tissue strength of the rectus femoris (RF) and patellar tendons using paired soft‐tissue grafts obtained from fresh organ donors, simulating clinical graft preparation. Methods: Fourteen paired RF and patellar tendon (PT) grafts were harvested from seven organ donors and tested within 12 h postmortem. The RF was folded and mounted as a double‐stranded graft to simulate its clinical use. All grafts underwent uniaxial tensile testing using a standardised protocol. Primary outcomes included ultimate stress (MPa), load to failure (N) and elongation at failure (%). Data distribution was assessed with the Shapiro–Wilk test, and paired t‐tests or Wilcoxon signed‐rank tests were applied accordingly. A post hoc power analysis was conducted to determine the minimum detectable difference in stress with the given sample size. Results: Ultimate stress did not diﬀer significantly between RF and PT grafts (46.4 ± 10.5 MPa vs. 52.9 ± 9.7 MPa, p = 0.184). RF grafts showed significantly lower load to failure (885.9 ± 52.3 N vs. 1278.7 ± 207.5 N, p < 0.001) and greater elongation (1.2 ± 0.2% vs. 0.2 ± 0.1%, p < 0.001). Conclusion: This study found that the double‐stranded RF tendon exhibits ultimate tissue strength comparable to the patellar tendon, despite diﬀerences in load to failure and elongation. These results highlight the RF as a biomechanically viable graft option that merits further investigation. Given its consistent dimensions and soft‐tissue‐only harvest, the RF tendon represents a reproducible and potentially less invasive alternative for knee ligament reconstruction.
Physiological dissociation between ventilatory ratio and ventilatory efficiency in patients with ARDS
(Springer Nature, 2026-03-19) Benites, Martín Hernán; Suarez-Sipmann, Fernando; Santos, Arnoldo; Retamal, Jaime
Background: The ventilatory ratio (VR) is frequently used as a surrogate marker of ventilatory efficiency in patients with ARDS. However, its ability to reflect changes in alveolar ventilation (V̇Talv/VT) when respiratory mechanics are modified remains unknown. This study aimed to evaluate the relationship between VR and V̇Talv/VT during sequential changes in respiratory mechanics=, tidal volume (VT), and minute ventilation (V̇E) in patients with ARDS. Methods: This was a secondary analysis of a quasi-experimental, repeated-measures study conducted in a single-center adult ICU. Twenty-two patients with ARDS were evaluated across three sequential 60 min controlled periods, during which trunk inclination was adjusted to induce changes in VT. At the end of each period, VR was calculated, and V̇Talv/VT was measured using volumetric capnography. A total of 66 paired measurements were analyzed in this study. Results: By design, VT increased from Time 1 to Time 2 by + 62 mL and decreased from Time 2 to Time 3 by − 68 mL. These changes in VT were associated with the following: VR was not significantly different between Time 1 and Time 2 [− 0.23 (95% CI: − 0.44 to − 0.02; p = 0.071)] or between Time 2 and Time 3 [+ 0.17 (95% CI: − 0.04 to + 0.38; p = 0.086)]. The alveolar ventilation ratio (V̇Talv/VT) increased significantly from Time 1 to Time 2 by + 0.080 (95% CI: + 0.039 to + 0.121; p < 0.001), and decreased from Time 2 to Time 3 by − 0.060 (95% CI: − 0.101 to − 0.019; p < 0.001). Association between VR and V̇Talv/VT: no significant relationship was found (β = − 0.056, marginal R2 = 0.052, conditional R2 = 0.205, p = 0.111). Conclusions In this cohort of patients with ARDS, VR did not correlate with V̇Talv/VT following controlled modifications of respiratory mechanics. These findings suggest that VR may not reliably represent ventilatory efficiency under changing ventilatory conditions, and its use as a surrogate variable should be approached with caution.
Editorial: Insuficiencia Cardíaca
(Elsevier, 2025-09-01) Giordanino, Elian
La insuficiencia cardíaca constituye una de las principales causas de hospitalización en adultos mayores y afecta a más de 65 millones de personas en el mundo. Los avances recientes en diagnóstico, terapéutica y comprensión fisiopatológica han transformado su manejo clínico, aunque también lo han vuelto más complejo. Este número especial aborda la insuficiencia cardíaca desde múltiples perspectivas, incluyendo el diagnóstico de la fracción de eyección preservada, el uso apropiado de técnicas de imagen y las indicaciones actuales de dispositivos de asistencia. Asimismo, se revisan los progresos en el abordaje de miocardiopatías como la hipertrófica y la amiloidosis, así como el creciente desafío que representan los pacientes adultos con cardiopatías congénitas. Se incluyen también análisis actualizados sobre patologías de etiología diversa, como la insuficiencia tricuspídea y la pericarditis constrictiva, junto con una revisión del manejo crítico del shock cardiogénico y de los dispositivos de asistencia circulatoria mecánica. La edición ofrece una visión integral y actualizada de los retos clínicos que plantea la insuficiencia cardíaca en la práctica cardiológica contemporánea.
Manejo de la disfunción sistólica en pacientes con miocardiopatía hipertrófica: desafíos y perspectivas
(Elsevier, 2025-09-01) Fernández, Adrián; Giordanino, Elián
La disfunción sistólica (DS) en la miocardiopatía hipertrófica (MCH) constituye una entidad rara pero clínicamente significativa, asociada con un aumento de la morbilidad y la mortalidad. Se define convencionalmente por una fracción de eyección del ventrículo izquierdo (FEVI) inferior al 50%, lo que se correlaciona con un peor pronóstico. La fisiopatología de la DS en la MCH es multifactorial e involucra disfunción microvascular, fibrosis miocárdica y remodelado ventricular adverso. Estos procesos conducen a un deterioro progresivo de la contractilidad y a insuficiencia cardíaca. El enfoque terapéutico debe ser individualizado e incluir estrategias farmacológicas. En pacientes con DS avanzada refractaria al tratamiento médico, el trasplante cardíaco sigue siendo la intervención definitiva. Esta revisión ofrece un análisis exhaustivo de las estrategias terapéuticas actuales, los enfoques de estratificación del riesgo y las perspectivas futuras en el manejo de la disfunción sistólica en la MCH.
Hipertensión pulmonar y enfermedad del tejido conectivo, una grave presentación
(Elsevier, 2025-01-01) Marrugo, Neguith; Giordanino, Elián; Palma, Gerardo; Venegas, Juan Carlos
Introducción: La hipertensión arterial pulmonar (HAP) es una condición rara con presión arterial pulmonar elevada (>20 mmHg) y resistencia vascular aumentada. Afecta entre 5 y 15 adultos por millón, y provoca disnea, dolor torácico, y riesgo de insuficiencia cardíaca derecha y muerte. A continuación, se describe un caso de presentación grave de hipertensión arterial pulmonar cuyo diagnóstico se establece luego de un paro cardíaco recuperado. Caso clínico: Hombre de 48 años que consulta por edemas, presíncope y disnea progresiva de 6 meses de evolución. Sufre paro cardiorrespiratorio por actividad eléctrica sin pulso y luego asistolia, requiriendo reanimación, noradrenalina y ventilación mecánica. El ecocardiograma muestra hipertensión pulmonar severa (presión sistólica arteria pulmonar 59 mmHg) con función ventricular izquierda conservada y dilatación severa del ventrículo derecho. La angiotomografía descarta tromboembolismo pulmonar. Se instaura tratamiento con dobutamina y balance negativo, con mejoría hemodinámica. El cateterismo cardíaco derecho confirma hipertensión pulmonar precapilar. Se inician sildenafil, óxido nítrico y posteriormente, ambrisentán. Los estudios reumatológicos revelan artritis reumatoide con sobreposición Sjögren como probable etiología de la hipertensión arterial pulmonar. El paciente mejora con tratamiento dirigido a su hipertensión pulmonar y prednisona, lográndose suspender ventilación mecánica y darse de alta, manteniéndose estable al mes de seguimiento. Discusión: La HAP asociada a enfermedades del tejido conectivo, como el síndrome de Sjögren y la artritis reumatoide, es poco prevalente. Los tratamientos incluyen antagonistas de los receptores de endotelina, inhibidores de fosfodiesterasa-5, prostanoides y combinaciones de fármacos. El tratamiento inmunológico adecuado de las enfermedades reumatológicas subyacentes puede mejorarla. En el presente caso clínico, el manejo integral, incluyendo vasodilatadores pulmonares y control de la precarga, fue clave para la recuperación del paciente.
Consenso Argentino de diagnóstico y tratamoiento de la miocardiopatía hipertrófica año 2025
(Sociedad Argentina de Cardiolgía, 2026) Fernández, Adrián; Atamañuk, Nicolás A.; Baratta, Sergio; Costabel, Juan Pablo; Dumont, Carlos A.; Guerchicoff, Marianna; de Arenaza, Diego Pérez; Giordanino, Elián
1.1 Utilidad de los consensosLos consensos constituyen guías de práctica elaboradas por equipos multidisciplinarios que sintetizan el estado actual del conocimiento y ofrecen recomendaciones claras y aplicables para orientar la toma de decisiones clínicas en contextos reales. Su función es brindar un marco de referencia común, actualizado y coherente, que promueva la calidad asistencial, la seguridad del paciente y la homogeneidad de criterios en la evaluación diagnóstica, el seguimiento y el tratamiento de la miocardiopatía hipertrófica (MCH). No sustituyen el juicio clínico ni las preferencias del paciente; la conducta final debe considerar la resentación individual, los antecedentes personales y familiares, las comorbilidades, el entorno sociolaboral y los recursos disponibles, con una ponderación explícita del balance riesgo beneficio y del impacto sobre la calidad de vida. Este enfoque se enmarca en la evolución de las normativas y declaraciones de expertos que han guiado el manejo de la MCH en las últimas dos décadas y que sirven de base a este documento. (1-7) 1.2 Propósito y organización de este consenso En las últimas décadas se publicaron documentos clave sobre MCH impulsados por distintas sociedades científicas, entre ellos el consenso conjunto ACC/ESC de 2003, los Consensos Argentinos de la Sociedad Argentina de Cardiología (SAC) de 2009 y 2017, las guías ACCF/AHA de 2011 y las guías europeas ESC de 2014, que constituyeron una base valiosa para la práctica clínica y el asesoramiento familiar en MCH (1-4). A esta serie se suman las Guías ESC 2023 sobre miocardiopatías y las Guías AHA/ACC/AMSSM/HRS/PACES/SCMR 2024 de MCH, que actualizan definiciones, diagnóstico, estratificación de riesgo y manejo. (6,7) La coexistencia de recomendaciones divergentes en aspectos críticos, como la indicación de cardiodesfibrilador implantable (CDI) en prevención primaria de muerte súbita cardíaca (MSC), motivó a la SAC a promover una actualización que recogiera la mejor evidencia disponible y aportara una posición contextualizada al sistema sanitario argentino. (6,7) Con ese propósito, este documento fue desarrollado por 55 especialistas organizados en comisiones temáticas, sometido a revisión metodológica y editorial, evaluado por un comité de seis expertos nacionales y seis referentes internacionales, y aprobado por el Área de Normas y Consensos de la SAC; su presentación fue acordada con el Comité Científico del Congreso SAC y su publicación aprobada por el Comité Editor de la Revista Argentina de Cardiología. Mantiene el esquema de clases de recomendación y niveles de evidencia utilizado previamente y aspira a ofrecer una herramienta práctica para cardiólogos clínicos, especialistas en imágenes, electrofisiólogos, cirujanos, pediatras y equipos interdisciplinarios, promoviendo la toma de decisiones compartida con pacientes y familias en línea con las mejores prácticas internacionales.
Actualización sobre el manejo inicial de fracturas expuestas para médicos generales y especialistas. Revisión panorámica de la literatura
(Revista Médica de Chile, 2026-03-04) Frey Moreno, Catalina; Ramirez Arenas, Joaquín; Ruiz Riquelme, Pablo
Las fracturas expuestas representan una carga significativa para la salud pública debido al riesgo de infección, secuelas y mortalidad. El manejo inicial es crucial para evitar o reducir estas complicacio-nes. Objetivo: Describir las opciones actuales de manejo inicial de fracturas expuestas en el servicio de urgencias por el médico general y especialista. Metodología: Revisión panorámica del manejo de fractura expuesta realizada entre octubre y noviembre 2024, utili-zando términos MESH en PubMed y SCIELO en inglés y español. Se incluyeron artículos de los últimos 5 años (2019-2024) abordando los pilares del manejo en urgencias: antibioticoterapia, manejo del dolor, inmovilización y desbridamiento. Resultados: De 2.883 artícu-los obtenidos en PubMed y SCIELO, 30 estudios fueron incluidos. Se mantienen los pilares de tratamiento para disminuir complicaciones: antibioticoterapia, manejo del dolor, inmovilización, desbridamiento y cierre de la herida. Discusión: La antibioticoterapia debe ser precoz, idealmente antes de 60 minutos, aseo quirúrgico antes de 24 horas de la lesión según las características de la fractura, cierre precoz de la herida. También, manejo del dolor asociado a reducción e inmovi-lización y/o fijación. Además, considerar el uso de antibioticoterapia local y continua o cierre-asistido-por-vacío (VAC) por especialistas. Es importante la creación de protocolos específicos para el sistema de salud chileno. Conclusiones: El médico general debe conocer los tiempos de administración antibiótica y desbridación, optimizar el manejo del dolor farmacológicamente, inmovilizar la fractura e indicar la profilaxis antitetánica. El especialista debe procurar un aseo quirúrgico y cierre de la herida precoz, considerando asociar antibiótico local o VAC para favorecer el pronóstico del paciente. El manejo actualizado y protocolizado de esta patología es relevante para prevenir su morbimortalidad.
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, Juan
In 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.
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, Guinevere
Background: 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.
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.
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, Marcio
El 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.
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, Andrés
Background: 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.
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, Ignacio
Background/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.
De la variabilidad terapéutica al cuidado seguro: la necesidad de protocolización en la cetoacidosis diabética pediátrica
(Sociedad Chilena de Pediatría, 2025-12-01) Díaz, Franco
La 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.
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, Jaime
Background 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.
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, Paula
En 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.
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 David
Esta 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.

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