FM - Artículos de Revista

Examinar

Mostrando 1 - 20 de 503

Relación neutrófilo a linfocito, recuento linfocitario e índices de actividad inflamatoria como factores pronóstico en infecciones por SARS-CoV-2: Un estudio de cohorte prospectiva
(Sociedad de Anestesiologia de Chile, 2022) Martínez, Felipe; Boisier, Dominique; Vergara, Constanza; Vidal, Jaime
Introduction: Patients with COVID-19 can develop respiratory failure requiring treatment with invasive mechanical ventilation (IMV) and death. It is important to have clinical predictors of these outcomes. Objetives: To establish the diagnostic accuracy of neutrophil to lymphocyte ratios (NLr) in predicting the need of IMV and survival amongst patients with COVID-19 and to compare this accuracy with other laboratory tests. Methodology: Prospective cohort study of hospitalized patients with a SArS-CoV-2 infection confirmed by rT-PCr. Clinical, demographic and laboratory predictors were assessed, including LDH, C-reactive protein, absolute lymphocyte counts, serum ferritin and NLr. Statistical analyses were undertaken using receiver-operator characteristics (rOC) curves, which were in turn compared using the method described by Hanley and McNeal. Results: One hundred and twelve patients were studied, most were male (60.7%) with a mean age of 63.4 ± 18.3 years. Twenty-two patients required IMV during their stay and 28 died. The NLr showed a good diagnostic accuracy in detecting patients that would require IMV (AUC 0.70, 95% CI 0.57-0.86) or died during the hospitalization (AUC 0.83, 95%CI 0.75-0.91). A cutoff point of 5.5 or higher had an 80.8% sensitivity and 73.1% specificity in detecting patients that died during their stay. Conclusions. NLr showed favorable diagnostic properties in detecting patients with COVID-19 at risk of adverse outcomes. Its wide availability and low cost are desirable features that might facilitate its implementation in routine clinical practice. © 2022 Sociedad de Anestesiologia de Chile. All rights reserved.
Epigenetic regulators controlling osteogenic lineage commitment and bone formation
(Elsevier Inc., 2024) Dashti, Parisa; Lewallen, Eric A.; Gordon, Jonathan A.R.; Montecino, Martin A.; Davie, James R.; Davie J.R.; Stein, Gary S.; van Leeuwen, Johannes P.T.M.; van der Eerden, Bram C.J.; van Wijnen, Andre J.
Bone formation and homeostasis are controlled by environmental factors and endocrine regulatory cues that initiate intracellular signaling pathways capable of modulating gene expression in the nucleus. Bone-related gene expression is controlled by nucleosome-based chromatin architecture that limits the accessibility of lineagespecific gene regulatory DNA sequences and sequence-specific transcription factors. From a developmental perspective, bone-specific gene expression must be suppressed during the early stages of embryogenesis to prevent the premature mineralization of skeletal elements during fetal growth in utero. Hence, bone formation is initially inhibited by gene suppressive epigenetic regulators, while other epigenetic regulators actively support osteoblast differentiation. Prominent epigenetic regulators that stimulate or attenuate osteogenesis include lysine methyl transferases (e.g., EZH2, SMYD2, SUV420H2), lysine deacetylases (e.g., HDAC1, HDAC3, HDAC4, HDAC7, SIRT1, SIRT3), arginine methyl transferases (e.g., PRMT1, PRMT4/CARM1, PRMT5), dioxygenases (e.g., TET2), bromodomain proteins (e.g., BRD2, BRD4) and chromodomain proteins (e.g., CBX1, CBX2, CBX5). Thisnarrative review provides a broad overview of the covalent modifications of DNA and histone proteins that involve hundreds of enzymes that add, read, or delete these epigenetic modifications that are relevant for selfrenewal and differentiation of mesenchymal stem cells, skeletal stem cells and osteoblasts during osteogenesis
Mascarillas para oxigenoterapia de alto flujo: ¿Son realmente Venturi?
(Sociedad de Anestesiologia de Chile, 2022) Fajardo Campoverdi, Aurio; Adasme Jeria, Rodrigo; Maturana Quinones, Michael; Roncalli Rocha, Angelo; Cristancho Gomez, William
Oxygen therapy is the mainstay for the treatment of hypoxia. The use of devices capable of satisfying the necessary flow demanded by the patient also offers stable and predictable oxygen concentrations, which is why they are currently considered a reliable and safe therapeutic tool. The physical mechanism for the operation of these devices is based on a modification of Bernoulli's principle. The supply of a constant flow of oxygen, when its pressure drops, increases its velocity and consequently allows the incorporation of ambient air into the system. However, in order to be granted the Venturi designation, structural requirements in geometrical, physical and thermodynamic terms must be met. The ISO standard specifies a Venturi tube by three fundamental parts: a contraction zone (inlet of a continuous flow of a gas), a constriction zone (smaller in radius than the contraction zone, so as to increase the fluid velocity) and a diffusion zone (outlet of a gas mixture with ambient air). In conclusion, the designation of Venturi to high-flow oxygen therapy masks is at least questionable. © 2022 Sociedad de Anestesiologia de Chile. All rights reserved.
Dynamic changes of hepatic vein Doppler velocities predict preload responsiveness in mechanically ventilated critically ill patients
(Intensive Care Medicine Experimental, Volume 12, Issue 1 December 2024 Article number 46, 2024-12) Bruna, Mario; Alfaro, Sebastian; Muñoz, Felipe; Cisternas, Liliana; Gonzalez, Cecilia; Conlledo, Rodrigo; Ulloa-Morrison, Rodrigo; Huilcaman, Marcos; Retamal, Jaime; Castro, Ricardo; Rola, Philippe; Wong, Adrian
Background: Assessment of dynamic parameters to guide fluid administration is one of the mainstays of current resuscitation strategies. Each test has its own limitations, but passive leg raising (PLR) has emerged as one of the most versatile preload responsiveness tests. However, it requires real-time cardiac output (CO) measurement either through advanced monitoring devices, which are not routinely available, or echocardiography, which is not always feasible. Analysis of the hepatic vein Doppler waveform change, a simpler ultrasound-based assessment, during a dynamic test such as PLR could be useful in predicting preload responsiveness. The objective of this study was to assess the diagnostic accuracy of hepatic vein Doppler S and D-wave velocities during PLR as a predictor of preload responsiveness. Methods: Prospective observational study conducted in two medical–surgical ICUs in Chile. Patients in circulatory failure and connected to controlled mechanical ventilation were included from August to December 2023. A baseline ultrasound assessment of cardiac function was performed. Then, simultaneously, ultrasound measurements of hepatic vein Doppler S and D waves and cardiac output by continuous pulse contour analysis device were performed during a PLR maneuver. Results: Thirty-seven patients were analyzed. 63% of the patients were preload responsive defined by a 10% increase in CO after passive leg raising. A 20% increase in the maximum S wave velocity after PLR showed the best diagnostic accuracy with a sensitivity of 69.6% (49.1–84.4) and specificity of 92.8 (68.5–99.6) to detect preload responsiveness, with an area under curve of receiving operator characteristic (AUC–ROC) of 0.82 ± 0.07 (p = 0.001 vs. AUC–ROC of 0.5). D-wave velocities showed worse diagnostic accuracy. Conclusions: Hepatic vein Doppler assessment emerges as a novel complementary technique with adequate predictive capacity to identify preload responsiveness in patients in mechanical ventilation and circulatory failure. This technique could become valuable in scenarios of basic hemodynamic monitoring and when echocardiography is not feasible. Future studies should confirm these results. © The Author(s) 2024.
La reparación aislada presenta mayor altura patelar postoperatoria según el índice de Insall-Salvati en comparación con la aumentación biológica en roturas agudas del tendón rotuliano
(Ediciones Doyma, S.L., 2024-10) R. Olivieri; J.T. Munoz; J.I. Laso; J. Ugarte; N. Franulic; P. Innocenti
Antecedentes y objetivo: Las roturas del tendón rotuliano (RTR) son lesiones infrecuentes pero altamente incapacitantes. El tratamiento quirúrgico es el estándar. La altura patelar (AP) postoperatoria es utilizada para determinar el éxito de la intervención, existiendo varios índices descritos en la literatura. El objetivo del estudio fue determinar si existen diferencias en la AP según el índice Insall-Salvati en el postoperatorio inmediato y a los 4 meses, entre 2 grupos de pacientes operados de RTR aguda: el primero, resuelto con técnicas de reparación aislada (RATR), y el segundo, en el que se agregó aumento biológico con auto o aloinjerto a la reparación (ABTR). Nuestra hipótesis fue que el grupo ABTR tuvo una menor AP en el postoperatorio inmediato y a los 4 meses. Materiales y métodos: Todos los pacientes con RTR aguda intervenidos en nuestro centro entre 2016 y 2022 fueron revisados retrospectivamente. Se excluyeron pacientes con re-rotura del tendón operado y con aumentación no biológica. La AP según el índice de Insall-Salvati fue medida en las radiografías tomadas al día siguiente de la cirugía y a los 4 meses de evolución por 3 ortopedistas con subespecialidad en cirugía de rodilla, de forma independiente. Un cuarto evaluador, ciego, analizó los resultados de las mediciones, determinando el promedio de AP y el índice de correlación intraclase de acuerdo absoluto para la media entre los 3 evaluadores. El resultado primario fue la diferencia de AP entre ambos grupos al día siguiente de la cirugía y a los 4 meses. El secundario fue la diferencia de AP entre la medición postoperatoria inmediata y a los 4 meses en ambos grupos.
Perception of the Virtualization of the Subject of Normal Human Anatomy and Embriology in a Pandemic
(Universidad de la Frontera, 2023-06) Rodríguez Luengo, Macarena; Águila Camacho, José; Pallauta Torres, Luis; Pérez Cárdenas, Nury; Luengo Mai, Diego; Niklander Ebensperger, Sven
As a result of the pandemic and the restrictions regarding in person attendance, different learning methodologies had to be explored and implemented to virtualize the contents in the Anatomy subject. The objective of this study was to evaluate the perception of teachers and students regarding the methodologies used in the virtualization of this subject. An observational-descriptive study with a quantitative approach was carried out. The study population was a convenience sample made up of 57 students and 4 teachers of the Normal Human Anatomy and Embryology subject of the Dentistry degree, Universidad Andrés Bello, Viña del Mar campus during 2021. These participants answered a validated questionnaire that included closed questions with a 5-level Likert scale, considering learning dimensions, motivation and performance, and qualifying questions to find out the perception of the strategies and resources used. Students positively perceive all digital resources, highlighting the Normal Human Anatomy Manual, with learning being the best evaluated dimension. The best perceived active strategy in terms of the 3 dimensions corresponds to the case method. In contrast, the inverted classes were perceived negatively in all dimensions. In relation to teachers, the best perceived digital resource was videos and capsules, highlighting the motivation dimension. The best evaluated active strategies were the case method and inverted classes. Despite having a positive perception regarding virtualization, there is no agreement between the best evaluated active strategies and digital resources among teachers and students. © 2023, Universidad de la Frontera. All rights reserved.
Rendimiento y seguridad de las colonoscopías de screening en dos grupos etarios de pacientes de la tercera edad
(Sociedad de Cirujanos de Chile, 2022) Olivares M., Sebastián; Campaña V., Gonzalo; Muñoz P., Nelson; Readi V., Alejandro; Marín V., Pamela; Campaña W., Nicolás
Aim: To compare diagnostic yield of significant findings rate and safety of screening colonoscopies in two groups of elderly patients. Materials and Method: A retrospective analysis was performed on patients who underwent screening colonoscopies at INDISA Clinic, from November 2017 to March 2019. Exclusion criteria were those with “alarm” symptoms according to Rome IV criteria, emergencies and therapeutic colonoscopies were excluded. Comparison groups were patients between 70-79 years old (Grupo I), and those over 80 years old (Grupo II). The primary outcome was the diagnostic yield of screening colonoscopy, defined as its capacity to identify adenomas, high-grade dysplasia, and colo-rectal cancer. Secondary outcomes were morbidity and mortality of the procedure. Statistical analysis was descriptive and inferential. Results: A total of 125 patients met our inclusion criteria; Grupo I: 70 and Grupo II 55 patients. Significant findings were observed in 27.1% in Grupo I and 30.9% in Grupo II (p = 0.675). No differences in bowel prep quality or procedure-related complications were observed between both groups. Discussion and Conclusion: Screening colonoscopies for colorectal cancer are well tolerated in patients over 80 years of age, with equivalent diagnostic rates compared with the younger patient group. Given the increasing life expectancy worldwide, it is recommended to continue checking for colorectal cancer with screening colonoscopies in octogenarians, particularly healthy ones. © 2022, Sociedad de Cirujanos de Chile. All rights reserved.
Hiperparatiroidismo recurrente y persistente. Parte 1. Serie de casos y diagrama de flujo de razonamiento clínico
(Sociedad de Cirujanos de Chile, 2024-06) Cabané Toledo, Patricio; Palta, Rodrigo Miranda; Espinoza, Patricio Gac; Llanos, Claudio Correa; Moreno, Francisco Rodriguez; Mery, Lucas Fuenzalida
Introducción: En la cirugía del Hiperparatiroidismo Primario (HPTP), hasta un 5% de los pacientes pueden presentar persistencia o recurrencia de su enfermedad. Las causas de cada una de estas situaciones dependen de múltiples factores relacionados con la enfermedad misma, localización preoperatoria, el tipo decirugía elegida y realizada, exámenes intraoperatorios y la experiencia del cirujano. Metodología: Revisión de fichas clínicas. Se describen 14 casos de persistencia y recurrencia. Resultados: Descripción de casos clínicos. Conclusión: Se discute la literatura y desarrolla un diagrama de enfrentamiento para guiar el estudio,posibles causas y manejo terapéutico.
Estudio comparativo en pacientes sometidos a cirugía colorrectal con preparación mecánica exclusiva y preparación mecánica con antibióticos orales
(Sociedad de Cirujanos de Chile, 2022) Olivares M., Sebastián; Campaña V., Gonzalo; Readi V., Alejandro; Rodríguez G., Marcelo
Aim: To evaluate postoperative complications and clinical evolution in patients undergoing colectomies and anastomosis with two preoperative strategies, mechanical bowel preparation alone (MBP) and mechanical bowel preparation with oral antibiotics (MBP+OA). Materials and Method: Retrospective study, with defined inclusion and exclusion criteria. Variables studied: preoperative demographic characteris-tics, surgical intervention, anastomotic location, anastomotic leakage (AL), surgical site infection (SSI), postoperative intestinal transit, Clostridium difficile (CD) infection and hospital stay. Statistical analysis, bivariate and multivariate models were performed. Results: 216 patients studied, 149 were MBP group and 67 MBP+OA group. The group MBP had higher rates of AL (7.38% vs. 0%, p = 0.011). For left-sided colectomies, AL rate in both groups had a higher difference in the middle rectum, with no cases in the MBP+OA group (0% vs. 50%, p = 0.019). For right colectomies, the AL rates were similar in both groups. SSI was higher in MBP group (4.7% vs. 0%, p = 0.037). The bowel transit recovery was faster for MBP+OA group, determining less hospital stay (3.98 days vs. 6.39 days, p = 0.001). The group MBP+OA had a higher rate of CD colitis, 4.48% (p = 0.008). Discussion and Conclusion: These results suggest that preoperative oral antibiotic with mechanical bowel preparation could help to prevent anastomotic leaks in left-sided colectomies, also avoid surgical site infection, favoring the recovery of postoperative bowel transit, reducing hospital stay. The association to CD should be examined in larger studies. © 2022, Sociedad de Cirujanos de Chile. All rights reserved.
Hiperparatiroidismo recurrente y persistente. Parte 2: análisis de diagrama de flujo de razonamiento clínico y revisión de la literatura
(Sociedad de Cirujanos de Chile, 2024-06) Cabané Toledo, Patricio; Gac Espinoza, Patricio; Correa Llanos, Claudio; Jimenez Durán, Felipe; Rodríguez Moreno, Francisco; Fuenzalida Mery, Lucas
El manejo habitual del HPTPha experimentado varias modificaciones en el tiempo encuanto a tecnologías de localización y tipos de cirugía. En general, tiene un alto éxito terapéutico. Sin embargo, hay un porcentaje de casos que presentan persistencia o recurrencia y pueden ser muy difíciles de enfrentar. Metodología: En este artículo mostramos un esquema de enfrentamiento basado en la literatura y en los casos clínicos enfrentados por los autores, que permiten abordar desde la causa probable y los estudio de relocalización, hasta el manejo terapéutico y sus posibles evoluciones. Además, se analiza cada una de las situaciones descritas en la Parte 1 de este artículo con una revisión actualizada de la literatura. Conclusión: El estudio protocolizado y en equipo multidisciplinario es vital para abordar adecuadamente los casos de pacientes con HPTP persistente y recurrente. Con este esquema de pensamiento proponemos una forma de enfrentar el problema
Effect of Cannabis sativa L. extracts, phytocannabinoids and their acetylated derivates on the SHSY-5Y neuroblastoma cells’ viability and caspases 3/7 activation
(Biological Research, Volume 57, Issue 1 December 2024 Article number 33, 2024-12) Tapia-Tapia, Elizabeth; Aránguiz, Pablo; Diaz, Rodrigo; Espinoza, Luis; Weinstein-Oppenheimer, Caroline R; Cuellar, Mauricio
Background: There is a need for novel treatments for neuroblastoma, despite the emergence of new biological and immune treatments, since refractory pediatric neuroblastoma is still a medical challenge. Phyto cannabinoids and their hemisynthetic derivatives have shown evidence supporting their anticancer potential. The aim of this research was to examine Phytocannabinoids or hemisynthetic cannabinoids, which reduce the SHSY-5Y, neuroblastoma cell line’s viability. Methods: Hexane and acetyl acetate extracts were produced starting with Cannabis sativa L. as raw material, then, 9-tetrahidrocannabinol, its acid counterpart and CBN were isolated. In addition, acetylated derivatives of THC and CBN were synthesized. The identification and purity of the chemicals was determined by High Performance Liquid Chromatography and 1H y 13C Magnetic Nuclear Resonance. Then, the capacity to affect the viability of SHSY-5Y, a neuroblastoma cell line, was examined using the resazurin method. Finally, to gain insight into the mechanism of action of the extracts, phytocannabinoids and acetylated derivatives on the examined cells, a caspase 3/7 determination was performed on cells exposed to these compounds. Results: The structure and purity of the isolated compounds was demonstrated. The extracts, the phytocannabinoids and their acetylated counterparts inhibited the viability of the SHSY 5Y cells, being CBN the most potent of all the tested molecules with an inhibitory concentration of 50 percent of 9.5 µM. Conclusion: Each of the evaluated molecules exhibited the capacity to activate caspases 3/7, indicating that at least in part, the cytotoxicity of the tested phytocannabinoids and their hemi-synthetic derivatives is mediated by apoptosis. © The Author(s) 2024.
Causal Learning: Monitoring Business Processes Based on Causal Structures
(Multidisciplinary Digital Publishing Institute (MDPI), 2024-10) Montoya, Fernando; Astudillo, Hernán; Díaz, Daniela; Berríos, Esteban
Conventional methods for process monitoring often fail to capture the causal relationships that drive outcomes, making hard to distinguish causal anomalies from mere correlations in activity flows. Hence, there is a need for approaches that allow causal interpretation of atypical scenarios (anomalies), allowing to identify the influence of operational variables on these anomalies. This article introduces (CaProM), an innovative technique based on causality techniques, applied during the planning phase in business process environments. The technique combines two causal perspectives: anomaly attribution and distribution change attribution. It has three stages: (1) process events are collected and recorded, identifying flow instances; (2) causal learning of process activities, building a directed acyclic graphs (DAGs) represent dependencies among variables; and (3) use of DAGs to monitor the process, detecting anomalies and critical nodes. The technique was validated with a industry dataset from the banking sector, comprising 562 activity flow plans. The study monitored causal structures during the planning and execution stages, and allowed to identify the main factor behind a major deviation from planned values. This work contributes to business process monitoring by introducing a causal approach that enhances both the interpretability and explainability of anomalies. The technique allows to understand which specific variables have caused an atypical scenario, providing a clear view of the causal relationships within processes and ensuring greater accuracy in decision-making. This causal analysis employs cross-sectional data, avoiding the need to average multiple time instances and reducing potential biases, and unlike time series methods, it preserves the relationships among variables.
Psychiatric and Psychosocial Characteristics of a Cohort of Spanish Individuals Attending Genetic Counseling Due to Risk for Genetically Conditioned Dementia
(IOS Press BV, 2022) Sobregrau, Pau; Peri, Josep M.; Sánchez Del Valle, Raquel; Molinuevo, Jose L.; Barra, Bernardo; Pintor, Luís
Background: Predictive genetic tests are presently effective over several medical conditions, increasing the demand among patients and healthy individuals. Considering the psychological burden suspected familial dementia may carry on individuals, assessing personality, coping strategies, and mental health could aid clinicians in findings the appropriate time for delivering genetic test results and predict compliance regarding genetic counseling and expectations towards the genetic condition depending on the outcome. Objective: To describe the psychiatric, psychological, and coping characteristics of a sample of Spanish individuals at risk of familial dementia before genetic test results were given. Methods: We included 54 first degree relatives of patients diagnosed with Alzheimer's disease, lobar frontotemporal degeneration, or prion diseases. The NEO-FFI-R, COPE, and HADS tests evaluated personality, coping strategies, and psychological distress, respectively. Results: Anxiety and depression were below the cut-off point for mild severity. Conscientiousness and Agreeableness were the most preponderant personality factors, while Neuroticism was the least. Positive reinterpretation and Acceptance were the most frequent coping strategies, and Denial and Alcohol and drug use were the least used. Ongoing medical pathologies increased depression, while psychiatric disorders worsened psychological distress. Conclusion: Contrary to our expectations, PICOGEN candidates showed psychological distress and personality traits within normative ranges, and the use of problem-focused coping strategies prevailed over avoidance coping strategies. Nevertheless, clinicians should pay particular attention to individuals attending genetic counseling who are women, aged, and present an ongoing psychiatric disorder and psychiatric history at inclusion to ensure their mental health and adherence throughout the process. © 2022 - The authors. Published by IOS Press.
Transfer of T6SSSPI-19from Salmonella Gallinarum to Salmonella Typhimurium Lacking T6SSSPI-6Complements its Colonization Defect in Mice
(Sciendo, 2023-06) Pezoa, David; Blondel, Carlos J.; Amaya, Fernando A.; Santiviago, Carlos A.
Salmonella genus harbors five Type VI Secretion System (T6SS) gene clusters. The T6SS encoded in SPI-6 (T6SSSPI-6) contributes to Salmonella Typhimurium colonization of chickens and mice, while the T6SS encoded in SPI-19 (T6SSSPI-19) of Salmonella Gallinarum contributes to chicken colonization. Interestingly, the T6SSSPI-19 of Salmonella Gallinarum complemented the defect in chicken colonization of a Salmonella Typhimurium strain that lacks the T6SSSPI-6, suggesting that both T6SSs are interchangeable. Here we show that the transfer of Salmonella Gallinarum T6SSSPI-19 complemented the defect in mice colonization of a Salmonella Typhimurium ΔT6SSSPI-6 strain, indicating that both T6SSs are functionally redundant during host colonization. © 2023 David Pezoa et al., published by Sciendo.
Pharmacotherapy and clinical outcomes of hospitalized COVID-19 patients in Chile during the first wave of pandemic
(Sociedad Medica de Santiago, 2023-05) Muñoz, Daniel; Cano, Catalina; Amador, Jorge; Vergara, Sandra; Ruiz, Guido; Vera, Claudia; Concha, Francisco; Morales, José; Fuentes, Yudith; Jara, Johana; López, Miguel; Martínez, José; Valenzuela, Valeria; Díaz, Claudia; Vásquez, Néstor; Torres, Sandra; Figueroa, Camila; Rocha, Daniela; Troncoso, Carla; Fuentes, Tatiana; Hernández, Rubén; Soto, Felipe; Klahn, Patricia; Sandoval, Rosa; Álvarez, Osvaldo; Bustamante, Beatriz; Castillo, Marcela; Mercado, Beatriz; Orellana, Cristian; Soto, Ricardo; Mollo, Julio; Espinoza, Sandra
Background: The largest growth in cases of COVID-19 worldwide during 2020 was in the Americas, and Chile was one of the most affected countries. Aim: To describe, characterize, and evaluate the use of drugs as treatment for COVID-19 in hospitalized patients in Chile during the first wave of the pandemic. Methods: We performed a multicenter, observational study that included 442 patients with confirmed SARS-CoV-2 infection admitted in Chilean hospitals between March 21 and September 22, 2020. The analysis included demographics, comorbidities, specific drug therapy, and outcomes over a 28-day follow-up period. Results: The median age of patients was 68 years (IQR 55-73), and 38.9% were women. The most common comorbidities were hypertension (57.7%) and diabetes (36.9%). Fifty-seven (12.9%) patients died. Hypertension (HR 2.99; CI 95% 1.43-6.26) and age ≥ 65 (2.14; CI 95% 1.10- 4.17) were the main predictors of mortality. Primary drugs were azithromycin (58.8%) and corticosteroids (51.1%). In this sample, azithromycin was a protective factor regarding mortality (HR 0.53; CI 95% 0.31-0.90), increasing clinical improvement and avoiding progression. Conclusions: The patterns of use of drugs to treat COVID-19 in Chile during the first wave of the pandemic were very dynamic and followed the international, evidence-based guidelines. The low mortality rate indicates that the clinical management of hospitalized patients was adequate. © 2023 Sociedad Medica de Santiago. All rights reserved.
Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation: a narrative review and proposed treatment algorithm
(British Editorial Society of Bone and Joint Surgery, 2024-03) Cirillo, Juan Ignacio; Ricciardi, Guillermo A.; Lemos, Facundo Lisandro Alvarez; Guiroy, Alfredo; Yurac, Ratko; Schnake, Klaus
Isolated cervical spine facet fractures are often overlooked. The primary imaging modality for diagnosing these injuries is a computed tomography scan. Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation remains controversial. The available evidence regarding treatment options for these fractures is of low quality. Risk factors associated with the failure of nonoperative treatment are: comminution of the articular mass or facet joint, acute radiculopathy, high body mass index, listhesis exceeding 2 mm, fragmental diastasis, acute disc injury, and bilateral fractures or fractures that adversely affect 40% of the intact lateral mass height or have an absolute height of 1 cm.
Estrategias y recomendaciones para enfrentar la enfermedad por virus respiratorio sincicial el año 2024
(Sociedad Chilena de Pediatria, 2024-01) Paris, Enrique; Daza, Paula; Tapia, Lorena; Díaz, Juan Pablo; Romero, Pablo Cruces; Castillo, Andrés; González, Cecilia; Endeiza, María Luz; Jofré, Leonor; Castro, Fabiola; Zamorano, Alejandra; Rodríguez, Jaime
Durante el invierno de 2023, Chile enfrentó una compleja situación relacionada con al virus respiratorio sincicial (VRS). Después de experimentar una disminución en la circulación del VRS durante los años de la pandemia de SARS-CoV-2, se observó un brote tardío en la primavera de 2022 y un inicio anticipado del brote en 2023, con un aumento significativo en el número de casos graves. La poca efectividad en la planificación estratégica y comunicación de riesgo contribuyeron a la complejidad de la situación. Para evitar lo anterior el próximo invierno, se sugieren medidas como vigilancia activa, unificación de definiciones para infecciones respiratorias agudas, identificación de variantes del VRS, educación pública sobre contagios y preparación anticipada respecto a camas hospitalarias y personal de salud. Se destaca la importancia de la inmunización y colaboración intersectorial para adquirir nuevas alternativas preventivas como también la necesidad de una comunicación temprana sobre la importancia de la inmunización e identificación de grupos de alto riesgo, mejora en capacitaciones del personal médico y planificación estratégica del Ministerio de Salud buscando un enfoque proactivo y colaborativo para abordar la compleja situación del VRS en futuros inviernos. El Comité Asesor en Vacunas y Estrategias de Inmunización de Chile ya realizó un análisis y recomendación sobre una nueva alternativa de prevención. Este grupo de trabajo apoyará cualquier decisión del Ministerio de Salud en políticas públicas que intenten un cambio en el paradigma del control de esta enfermedad por la salud de los niños/as de nuestro país.
Experiencia en cirugía colorrectal resectiva laparoscópica en pacientes mayores de 75 años
(Sociedad de Cirujanos de Chile, 2024) García Prado, Diego; Arche Prats, Jorge; Olivares Medina, Sebastián; Rodríguez González, Marcelo; Readi Vallejos, Alejandro; Campaña Villegas, Gonzalo
Objetivo: Describir la experiencia en cirugía colorrectal resectiva laparoscópica en mayores de 75 años durante los años 2004 a 2019 en Clínica INDISA. Material y Método: Estudio transversal de las cirugías electivas por vía laparoscópica en mayores de 75 a ños, en los que se realizó anastomosis colorrectal, basado en el registro clínico electrónico. Resultados: Un total de 48 cirugías completamente laparoscópicas, la mayoría por cáncer colorrectal (CCR) (89,6%), mostraron indicadores de calidad óptima en la cosecha ganglionar en el 73,2%. Con una mediana de estadía de 6 días y una mortalidad a 30 días de 2,1% (un caso), comparable a las series internacionales. Discusión: El abordaje laparoscópico en pacientes ancianos tiene beneficios por sobre la vía abierta y presenta morbimortalidad aceptable. El balance intraoperatorio entre riesgo/seguridad quirúrgica y pronóstico oncológico es un factor a tener en cuenta en la toma de decisiones, junto con las patologías inherentes al grupo etario y la reserva funcional de cada paciente en particular. Conclusión: Se trata de la primera serie nacional de pacientes sobre 75 años sometidos a cirugía colorrectal resectiva electiva vía laparoscópica. Es factible y seguro en estos pacientes realizar cirugía mínimamente invasiva con morbimortalidad aceptable. La edad por sí sola no representa una contraindicación para la cirugía colorrectal laparoscópica. Es necesario contar con estudios de mayor volumen para conocer mejor la realidad nacional y los resultados a largo plazo.
Tumor glómico de la vía aérea y resección carinal, a propósito de un caso
(Sociedad de Cirujanos de Chile, 2024) Arche Prats, Jorge; Rodríguez Duque, Patricio; García Prado, Diego
Describir caso infrecuente de tumor glómico pulmonar que compromete tráquea y bronquio principal derecho con síntomas respiratorios. Los tumores glómicos (GT) de la tráquea son una enfermedad infrecuente, se originan a partir de células musculares lisas modificadas. Los pacientes presentan síntomas inespecíficos como tos, disnea o hemoptisis. Se han reportado tratamientos quirúrgicos, incluyendo toracotomía y resección por fibrobroncoscopia. No hay duda de que la cirugía es el tratamiento de elección, sin embargo, pocos estudios han evaluado el tratamiento ideal para los (GT) traqueales. Caso Clínico:Describimos un caso de (GT) originado en la vía aérea, mujer de 62 años que presentó tos y expectoración durante 7 días, había sido diagnosticada de tumor endotraqueal por tomografía computada. La resección tumoral se intentó mediante broncoscopía, pero presentó bordes positivos, por lo que se realizó resección traqueal quirúrgica y anastomosis. La paciente logró buenos resultados y no se observó recurrencia en un seguimiento de 10 meses. Este es el tercer informe de (GT) originado en vía aérea (tráquea y bronquio principal derecho).
Diverticular Disease: analysis of deaths according to sex, age group and regions in Chile
(Sociedad de Cirujanos de Chile, 2022) Meneses C., Luis; Aldunate G., Paula; Meneses P., Javier; Acuña M., Catalina; Millanao C., Gabriel; Schatte V., Dominique
Aim: To describe deaths from diverticular bowel disease in the period 2016-2020 in Chile according to sex, age group and region. Material and Method: Descriptive study. 406 deaths due to diverticular disease were described according to sex, age group and region between the years 2016-2020, performing a statistical analysis with the IBM SPSS Statistics ® software that included a Binomial Test for analysis of deaths according to “sex” and the Kruskal Wallis Test for the study of significance between the variables “sex” and “age group”. A 99% confidence interval (p < 0.01) was used. Results: A mortality rate of 0.46/100,000 inhabitants was obtained for the period. The female sex was predominant in a ratio close to 3:1 (p < 0.01). Deaths increased with age and the age group with the higher number of deaths was 80-89. A relationship between sex and age group was demonstrated (p < 0.01). The regions with the highest observed mortality rate were Magallanes, Valparaíso and Maule. Discussion: The mortality rate is similar to that reported worldwide. Women die at a higher rate than men, as described in other studies. The higher mortality rate observed in some regions of the country could be associated with the high prevalence of risk factors for the disease. Conclusion: Deaths from diverticular disease decreased since 2018, in conjunction with showing that women present a significantly higher number of deaths than men and that there were differences by region. © 2022, Sociedad de Cirujanos de Chile. All rights reserved.

Examinar

Envíos recientes