Artículos Medicina y Ciencias de la Salud

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A Novel Technique for Medial Patellofemoral Ligament Reconstruction Using Vertical Patellar Tunnels and Use of a Single Implant. Technical Note
(2023) Edwards, Diego; Casas-Cordero, Juan Pablo; Alonso, Julián; Cerda, Daniel; Cornejo, Francisco; Zelaya, Gerardo
Validation of real-time PCR as a diagnostic tool in aspergillosis associated with COVID-19 in patients hospitalized at Clínica Dávila at Santiago, Chile, during the years 2020 and 2021
(2023) Fellay, Simone; Pino, Roberto; Hardy, Megan; Tapia, Cecilia
Introducción: Desde el inicio de la pandemia por COVID-19 se han registrado casos de infecciones de aspergilosis pulmonar asociada a esta infección, la cual tiene características diferentes a la aspergilosis pulmonar clásica y, por lo tanto, han significado un desafío diagnóstico. Objetivo: Validar una reacción de polimerasa en cadena (RPC) en tiempo real (sigla en inglés RT-PCR) comercial, como herramienta diagnóstica alternativa a la técnica de galactomanano (GM) en el diagnóstico de aspergilosis pulmonar asociada a COVID-19 (sigla en inglés CAPA). Pacientes y Método: Se analizaron resultados de RT-PCR de Aspergillus spp y GM en lavado bronco-alveolar (LBA) de 72 pacientes, hospitalizados por COVID-19 de Clínica Dávila entre los años 2020 y 2021. De estos pacientes, 33 presentaron CAPA. Resultados: La RT-PCR de Aspergillus y GM presentaron una correlación positiva (r = 0,6351, valor p < 0,0001). La técnica de RT-PCR presentó una sensibilidad (S), especificidad (E), valor predictor positivo (VPP) y valor predictor negativo (VPN) de 100, 44, 66 y 100%, respectivamente, mientras que en GM fueron de 64, 89, 84 y 73%, respectivamente para LBA. Al utilizar ambas técnicas en combinación se obtuvo una S, E, VPP y VPN de 100, 82, 88 y 100%, respectivamente. Conclusión: Este estudio concluyó que usar una técnica de RT-PCR de Aspergillus y GM en conjunto en LBA mejoraron los parámetros de desempeño de ambas técnicas usadas de manera individual para diagnosticar CAPA. Se requieren más estudios para evaluar el desempeño de técnicas combinadas en otros tipos de aspergilosis. Background: Since the beginning of the COVID-19 pandemic, there have been cases of pulmonary aspergillosis infections associated with this infection, which has different characteristics from classical pulmonary aspergillosis and therefore, have been diagnostic challenges. Aim: To validate a commercial real-time PCR (RT-PCR) method as an alternative diagnostic tool to the galactomannan (GM) technique in the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA). Methods: Results of RT-PCR of Aspergillus spp and GM in broncho-alveolar lavage (BAL) of 72 patients hospitalized for COVID-19 at Clínica Dávila between 2020 and 2021 were analyzed. Of these patients, 33 presented CAPA. Results: The RT-PCR for Aspergillus and GM showed a positive correlation (r = 0.6351, p-value < 0.0001). The RT-PCR for Aspergillus technique presented a sensitivity (S), specificity (S), positive predictive value (PPV) and negative predictive value (NPV) of 100, 44, 66 and 100% respectively, while the GM technique presented 64, 89, 84 and 73%, respectively for BAL. Using both techniques in combination a S, E, PPV and NPV of 100, 82, 88 and 100% were obtained respectively. Conclusion: This study concluded that using RT-PCR and GM techniques in combination in BAL improved the performance parameters of both techniques from those used individually to diagnose CAPA. Further studies are required to evaluate the performance of combined techniques in other aspergillosis focus.
Vaginal surgical repair of vesico-vaginal fistulas: a successful experience [Reparación quirúrgica por vía vaginal de fístulas vesicovaginales: una experiencia exitosa]
(2023) Santis, Fernanda; Mergudich, Tania; Santis, Fernanda; Bonavia, Nicolás; Maluenda, Andrea; Arévalo, Diego
Objetivo: Se presenta una serie de casos de reparación por vía vaginal de fístula vesicovaginal (FVV) de nuestro centro. Material y métodos: Estudio observacional descriptivo. Se evaluaron todas las pacientes con reparación quirúrgica de FVV en el Centro de Innovación de Piso Pélvico del Hospital Sótero del Río entre 2016 y 2022. Resultados: Se reportaron 16 casos, de los cuales el 81,3% fueron secundarios a cirugía ginecológica. En todos se realizó la reparación por vía vaginal, con cierre por planos. En el 94% (15/16) se logró una reparación exitosa en un primer intento. El tiempo de seguimiento poscirugía fue de 10 meses (rango: 3-29). No hubo casos de recidiva en el seguimiento. Una paciente presentó fístula de novo, la cual se reparó de manera exitosa en un segundo intento por vía vaginal. Se reportaron satisfechas con la cirugía 15 pacientes, con mejoría significativa de su calidad de vida. Una paciente reportó sentirse igual (6,3%), pero sus síntomas se debían a síndrome de vejiga hiperactiva que la paciente no lograba diferenciar de los síntomas previos a la cirugía. Conclusión: Las FVV en los países desarrollados son secundarias a cirugía ginecológica benigna. La cirugía por vía vagi-nal en nuestra serie demostró una alta tasa de éxito, con mejora significativa en la calidad de vida de las pacientes Objetive: We present a case series of vesico-vaginal fistulas (VVF) vaginal repair in our center. Material and methods: Des-criptive observational study. All patients with surgical repair of VVF at the Centro de Innovación en Piso Pélvico of Hospital Sótero del Río were evaluated between September 2016 and September 2022. Results: 16 cases were reported. 81.3% were secondary to gynecological surgery. In all cases, a vaginal repair was performed, with a layered closure. 94% (15/16) had no contrast extravasation at the time of examination, confirming fistula closure. The follow-up time was 10 months (range: 3-29). There were no cases of recurrence during follow-up. 1 patient presented de novo fistula which was successfully repaired in a second attempt vaginally. 15/16 patients reported being satisfied with the surgery, with significant improvement in quality of life. 1 patient reported feeling the same (6.3%), but her symptoms were due to overactive bladder syndrome that the patient could not differentiate from the symptoms prior to surgery. Conlusion: VFV in developed countries are mainly secondary to benign gynecological surgery. Vaginal surgery in our series achieved a significant improvement in the quality of life of patients.
Updates to the modern diagnosis of GERD: Lyon consensus 2.0
(2023) Gyawali, Prakash; Yadlapati, Rena; Fass, Ronnie; Katzka, David; Pandolfino, John; Savarino, Edoardo; Sifrim, Daniel; Spechler, Stuart; Zerbib, Frank; Fox, Mark; Bhatia, Shobna; De Bortoli, Nicola; Kyung Cho, Yu; Cisternas, Daniel; Chen, Chien-Lin; Cock, Charles; Hani, Albis; Remes, Jose; Xiao, Yinglian; Vaezi, Michael; Roman, Sabine
The Lyon Consensus provides conclusive criteria for and against the diagnosis of gastro-oesophageal reflux disease (GERD), and adjunctive metrics that consolidate or refute GERD diagnosis when primary criteria are borderline or inconclusive. An international core and working group was assembled to evaluate research since publication of the original Lyon Consensus, and to vote on statements collaboratively developed to update criteria. The Lyon Consensus 2.0 provides a modern definition of actionable GERD, where evidence from oesophageal testing supports revising, escalating or personalising GERD management for the symptomatic patient. Symptoms that have a high versus low likelihood of relationship to reflux episodes are described. Unproven versus proven GERD define diagnostic strategies and testing options. Patients with no prior GERD evidence (unproven GERD) are studied using prolonged wireless pH monitoring or catheter-based pH or pH-monitoring off antisecretory medication, while patients with conclusive GERD evidence (proven GERD) and persisting symptoms are evaluated using pH-impedance monitoring while on optimised antisecretory therapy. The major changes from the original Lyon Consensus criteria include establishment of Los Angeles grade B oesophagitis as conclusive GERD evidence, description of metrics and thresholds to be used with prolonged wireless pH monitoring, and inclusion of parameters useful in diagnosis of refractory GERD when testing is performed on antisecretory therapy in proven GERD. Criteria that have not performed well in the diagnosis of actionable GERD have been retired. Personalisation of investigation and management to each patient's unique presentation will optimise GERD diagnosis and management.
Tumor-like presentation of herpetic cervicitis: A case report
(2023) Boldrini, Pablo; Vallejos, Gabriel; Ballesteros, Polentze; Valenzuela, Gonzalo; Roncone, Enrique
The case of a 20-year-old immunocompetent woman with necrotizing cervicitis of the cervix caused by a primary infection with herpes simplex virus type 2 is presented, along with its respective evolution in images. Cervical cancer was included in the differential diagnoses, but biopsies ruled out malignancy and laboratory tests demonstrated the viral etiology of the cervical inflammation. After initiating specific treatment, the cervical lesions completely healed within 3 weeks. This case highlights the need to consider herpes simplex infection in the differential diagnosis of cervical inflammation and tumor formation. Additionally, it provides images that can aid in diagnosis and allow for the observation of its clinical evolution.
Transgenerational transmission of reproductive and metabolic dysfunction in the male progeny of polycystic ovary syndrome
(2023) Risal, Sanjiv; Li, Congru; Luo, Qing; Fornes, Romina; Lu, Haojiang; Eriksson, Gustaw; Manti, Maria; Ohlsson, Claes; Lindgren, Eva; Crisosto, Nicólas; Maliqueo, Manuel; Echiburú, Barbara; Recabarren, Sergio; Sir Petermann, Teresa; Benrick, Anna; Brusselaers, Nele; Qiao, Jie; Deng, Qiaolin; Stener-Victorin, Elisabet
The transgenerational maternal effects of polycystic ovary syndrome (PCOS) in female progeny are being revealed. As there is evidence that a male equivalent of PCOS may exists, we ask whether sons born to mothers with PCOS (PCOS-sons) transmit reproductive and metabolic phenotypes to their male progeny. Here, in a register-based cohort and a clinical case-control study, we find that PCOS-sons are more often obese and dyslipidemic. Our prenatal androgenized PCOS-like mouse model with or without diet-induced obesity confirmed that reproductive and metabolic dysfunctions in first-generation (F1) male offspring are passed down to F3. Sequencing of F1-F3 sperm reveals distinct differentially expressed (DE) small non-coding RNAs (sncRNAs) across generations in each lineage. Notably, common targets between transgenerational DEsncRNAs in mouse sperm and in PCOS-sons serum indicate similar effects of maternal hyperandrogenism, strengthening the translational relevance and highlighting a previously underappreciated risk of transmission of reproductive and metabolic dysfunction via the male germline.
The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis
(2023) Jiang, Zhilin; Davies, Benjamin; Zipser, Carl; Margetis, Konstantinos; Martin, Allan; Matsoukas, Stavros; Zipser, Freschta; Kheram, Najmeh; Boraschi, Andrea; Zakin, Elina; Righteous, Oke; Fehlings, Michael; Wilson, Jamie; Yurac, Ratko; Cook, Chad; Milligan, Jamie; Tabrah, Julia; Widdop, Shirley; Wood, Lianne; Roberts, Elizabeth; Rujeedawa, Tanzil; Tetreault, Lindsay; AO Spine RECODE-DCM Diagnostic Criteria Incubator
Study design: Delayed diagnosis of degenerative cervical myelopathy (DCM) is likely due to a combination of its subtle symptoms, incomplete neurological assessments by clinicians and a lack of public and professional awareness. Diagnostic criteria for DCM will likely facilitate earlier referral for definitive management. Objectives: This systematic review aims to determine (i) the diagnostic accuracy of various clinical signs and (ii) the association between clinical signs and disease severity in DCM? Methods: A search was performed to identify studies on adult patients that evaluated the diagnostic accuracy of a clinical sign used for diagnosing DCM. Studies were also included if they assessed the association between the presence of a clinical sign and disease severity. The QUADAS-2 tool was used to evaluate the risk of bias of individual studies. Results: This review identified eleven studies that used a control group to evaluate the diagnostic accuracy of various signs. An additional 61 articles reported on the frequency of clinical signs in a cohort of DCM patients. The most sensitive clinical tests for diagnosing DCM were the Tromner and hyperreflexia, whereas the most specific tests were the Babinski, Tromner, clonus and inverted supinator sign. Five studies evaluated the association between the presence of various clinical signs and disease severity. There was no definite association between Hoffmann sign, Babinski sign or hyperreflexia and disease severity. Conclusion: The presence of clinical signs suggesting spinal cord compression should encourage health care professionals to pursue further investigation, such as neuroimaging to either confirm or refute a diagnosis of DCM.
The impacts of social determinants of health and cardiometabolic factors on cognitive and functional aging in Colombian underserved populations
(2023) Santamaria, Hernando; Moguilner, Sebastian; Rodriguez, Odir; Botero, Felipe; Pina, Stefanie; O’Donovan, Gary; Albala, Cecilia; Matallana, Diana; Schulte, Michael; Slachevsky Conchol, Andrea; Yokoyama, Jennifer; Possin, Katherine; Ndhlovu, Lishomwa; Al‑Rousan, Tala; Corley, Michael; Kosik, Kenneth; Muniz, Graciela; Miranda, J. Jaime; Ibanez, Agustin
Global initiatives call for further understanding of the impact of inequity on aging across underserved populations. Previous research in low- and middle-income countries (LMICs) presents limitations in assessing combined sources of inequity and outcomes (i.e., cognition and functionality). In this study, we assessed how social determinants of health (SDH), cardiometabolic factors (CMFs), and other medical/social factors predict cognition and functionality in an aging Colombian population. We ran a cross-sectional study that combined theory- (structural equation models) and data-driven (machine learning) approaches in a population-based study (N = 23,694; M = 69.8 years) to assess the best predictors of cognition and functionality. We found that a combination of SDH and CMF accurately predicted cognition and functionality, although SDH was the stronger predictor. Cognition was predicted with the highest accuracy by SDH, followed by demographics, CMF, and other factors. A combination of SDH, age, CMF, and additional physical/psychological factors were the best predictors of functional status. Results highlight the role of inequity in predicting brain health and advancing solutions to reduce the cognitive and functional decline in LMICs.
The Global Otolaryngology-Head and Neck Surgery Workforce
(2023) Petrucci, Beatriz; Okerosi, Samuel; Patterson, Rolvix; Hobday, Sara; Salano, Valerie; Waterworth, Christopher; Brody, Robert; Sprow, Holly; Alkire, Blake; Fagan, Johannes; Ovnat Tamir, Sharon; Der, Carolina; Bhutta, Mahmood; Maina, Ivy; Pang, Jonathan; Daudu, Davina; Mukuzi, Allan; Srinivasan, Tarika; Pietrobon, Carolina; Hao, Sheng-Po; Nakku, Doreen; Seguya, Amina; Din, Taseer; Djoutsop Mbougo, Olga; Mokoh, Lilian; Jashek-Ahmed, Farizeh; Law, Tyler; Holt, Elizabeth; Haider, Ali; Zemene, Yilkal; Ibekwe, Titus; Raphiou, Oumar; Alvarado, Jaqueline; Mulwafu, Wakisa; Fenton, John; Agius, Adrian; Doležal, Pavel; Amani, Édouard; Mojica, Karen; Silva, Ricardo
Importance: A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed. Objective: To establish comprehensive workforce metrics for global otolaryngology-head and neck surgery (OHNS) with updated data from more countries/territories. Design, setting, and participants: A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians. Main outcome: The OHNS workforce per capita, stratified by income and region. Results: Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world's population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally. Conclusion and relevance: This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.
The Frequency of Symptoms in Patients With a Diagnosis of Degenerative Cervical Myelopathy: Results of a Scoping Review
(2023) Jiang, Zhilin; Davies, Benjamin; Zipser, Carl; Margetis, Konstantinos; Martin, Allan; Matsoukas, Stavros; Zipser-Mohammadzada, Freschta; Kheram, Najmeh; Boraschi, Andrea; Zakin, Elina; Righteous, Oke; Fehlings, Michael; Wilson, Jamie; Yurac, Ratko; E Cook, Chad; Milligan, Jamie; Tabrah, Julia; Widdop, Shirley; Wood, Lianne; Roberts, Elizabeth; Rujeedawa, Tanzil; Tetreault, Lindsay; AO Spine RECODE-DCM Diagnostic Criteria Incubator
Study design: Delayed diagnosis of degenerative cervical myelopathy (DCM) is associated with reduced quality of life and greater disability. Developing diagnostic criteria for DCM has been identified as a top research priority. Objectives: This scoping review aims to address the following questions: What is the diagnostic accuracy and frequency of clinical symptoms in patients with DCM? Methods: A scoping review was conducted using a database of all primary DCM studies published between 2005 and 2020. Studies were included if they (i) assessed the diagnostic accuracy of a symptom using an appropriate control group or (ii) reported the frequency of a symptom in a cohort of DCM patients. Results: This review identified three studies that discussed the diagnostic accuracy of various symptoms and included a control group. An additional 58 reported on the frequency of symptoms in a cohort of patients with DCM. The most frequent and sensitive symptoms in DCM include unspecified paresthesias (86%), hand numbness (82%) and hand paresthesias (79%). Neck and/or shoulder pain was present in 51% of patients with DCM, whereas a minority had back (19%) or lower extremity pain (10%). Bladder dysfunction was uncommon (38%) although more frequent than bowel (23%) and sexual impairment (4%). Gait impairment is also commonly seen in patients with DCM (72%). Conclusion: Patients with DCM present with many different symptoms, most commonly sensorimotor impairment of the upper extremities, pain, bladder dysfunction and gait disturbance. If patients present with a combination of these symptoms, further neuroimaging is indicated to confirm the diagnosis of DCM.
The first genome-wide association study in the Argentinian and Chilean populations identifies shared genetics with Europeans in Alzheimer's disease
(2024) Dalmasso, Maria; De Rojas, Itziar; Olivar, Natividad; Muchnik, Carolina; Angel, Bárbara; Gloger, Sergio; Sanchez, Mariana; Chacón, María; Aránguiz, Rafael; Orellana, Paulina; Cuesta, Carolina; Galeano, Pablo; Campanelli, Lorenzo; Novack, Gisela; Martinez, Luis; Medel, Nancy; Lisso, Julieta; Sevillano, Zulma; Irureta, Nicolás; Castaño, Eduardo; Montrreal, Laura; Thoenes, Michaela; Hanses, Claudia; Heilmann-Heimbach, Stefanie; Kairiyama, Claudia; Mintz, Inés; Villella, Ivana; Rueda, Fabiana; Romero, Amanda; Wukitsevits, Nancy; Quiroga, Ivana; Gona, Cristian; Lamber, Jean-Charles; Solis, Patricia; Politis, Daniel; Mangone, Carlos; Gonzalez, Christian; Boada, Mercè; Tàrraga, Lluís; Slachevsky Conchol, Andrea
Introduction: Genome-wide association studies (GWAS) are fundamental for identifying loci associated with diseases. However, they require replication in other ethnicities. Methods: We performed GWAS on sporadic Alzheimer's disease (AD) including 539 patients and 854 controls from Argentina and Chile. We combined our results with those from the European Alzheimer and Dementia Biobank (EADB) in a meta-analysis and tested their genetic risk score (GRS) performance in this admixed population. Results: We detected apolipoprotein E ε4 as the single genome-wide significant signal (odds ratio = 2.93 [2.37-3.63], P = 2.6 × 10-23 ). The meta-analysis with EADB summary statistics revealed four new loci reaching GWAS significance. Functional annotations of these loci implicated endosome/lysosomal function. Finally, the AD-GRS presented a similar performance in these populations, despite the score diminished when the Native American ancestry rose. Discussion: We report the first GWAS on AD in a population from South America. It shows shared genetics modulating AD risk between the European and these admixed populations. Highlights: This is the first genome-wide association study on Alzheimer's disease (AD) in a population sample from Argentina and Chile. Trans-ethnic meta-analysis reveals four new loci involving lysosomal function in AD. This is the first independent replication for TREM2L, IGH-gene-cluster, and ADAM17 loci. A genetic risk score (GRS) developed in Europeans performed well in this population. The higher the Native American ancestry the lower the GRS values
The BrainLat project, a multimodal neuroimaging dataset of neurodegeneration from underrepresented backgrounds
(2023) Prado, Pavel; Medel, Vicente; Gonzalez, Raul; Sainz, Agustín; Vidal , Victor; Santamaría, Hernando; Moguilner, Sebastian; Mejia, Jhony; Slachevsky Conchol, Andrea; Behrens, Maria; Aguillon, David; Lopera, Francisco; Parra, Mario; Matallana,Diana; Maito, Marcelo; Garcia, Adolfo; Custodio, Nilton; Ávila, Alberto; Piña, Stefanie; Birba, Agustina; Fittipaldi, Sol; Legaz, Agustina; Ibañez, Agustín
The Latin American Brain Health Institute (BrainLat) has released a unique multimodal neuroimaging dataset of 780 participants from Latin American. The dataset includes 530 patients with neurodegenerative diseases such as Alzheimer's disease (AD), behavioral variant frontotemporal dementia (bvFTD), multiple sclerosis (MS), Parkinson's disease (PD), and 250 healthy controls (HCs). This dataset (62.7 ± 9.5 years, age range 21-89 years) was collected through a multicentric effort across five Latin American countries to address the need for affordable, scalable, and available biomarkers in regions with larger inequities. The BrainLat is the first regional collection of clinical and cognitive assessments, anatomical magnetic resonance imaging (MRI), resting-state functional MRI (fMRI), diffusion-weighted MRI (DWI), and high density resting-state electroencephalography (EEG) in dementia patients. In addition, it includes demographic information about harmonized recruitment and assessment protocols. The dataset is publicly available to encourage further research and development of tools and health applications for neurodegeneration based on multimodal neuroimaging, promoting the assessment of regional variability and inclusion of underrepresented participants in research.
Los inicios de la enseñanza de pediatría en Chile y la fundación de hospitales de niños
(2023) Schonhaut , Luisa; Chávez, Pablo; Vargas, Nelson
El objetivo del presente manuscrito es revisar antecedentes históricos previos a la creación de la Socie-dad Chilena de Pediatría (SOCHIPE) en el año 1922, con el propósito de reflexionar sobre su impacto en la profesionalización de la pediatría nacional, especialmente en la salud y sobrevida de los niños. Se revisaron documentos de la Junta de Beneficencia, libros y estudios especializados de la época. Hasta principios del siglo XX, el país ostentaba una de las tasas de mortalidad infantil más elevadas del mundo, y contaba con precarias instalaciones para enfrentarlas. En aquellos años, el único esta-blecimiento cerrado para la atención de infantes era la Casa de Huérfanos, que estaba al cuidado de religiosas con apoyo de médicos; es ahí donde se desarrollaron los primeros cursos teórico-prácticos de la especialidad. Presionados por la alta mortalidad infantil y las mortíferas epidemias, la Junta de Beneficencia vio la urgencia de mejorar las condiciones higiénicas y crear instalaciones para el cui-dado de los niños. El manuscrito aborda el surgimiento de espacios encargados del resguardo de la salud de los menores de cinco años, desde la creación de la cátedra de pediatría y del primer hospital de niños, el Hospital Roberto del Río, lo que marcó el inicio de las políticas de salud pública infantiles. ¿Qué se sabe del tema que trata este estudio?Durante el siglo XX, las políticas de salud pública en Chile origi-naron una rápida transición epidemiológica y demográfica, lo que impactó en las condiciones de vida y la salud de los infantes. Entre los hitos destacados se encuentra la fundación de la Sociedad Chile-na de Pediatría en el año 1922.¿Qué aporta este estudio a lo ya conocido?A través de revisión de documentos de la Junta de Beneficencia y publicaciones especializadas se aporta nueva evidencia sobre las ca-racterísticas de la mortalidad infantil y las consecuencias que tuvo la creación de la cátedra de enfermedades de la niñez y el hospital de niños en los siglos XIX y principios del XX. The objective of this manuscript is to review the historical background before the creation of the Chilean Society of Pediatrics (SOCHIPE) in 1922 and reflect on its impact on the professionalization of national pediatrics, especially on children’s health and survival. For this purpose, we review docu-ments from the Charity Board, books, and specialized studies. Until the beginning of the 20th cen-tury, the country had one of the highest infant mortality rates in the world and precarious facilities to deal with it. In those years, the only closed establishment for infant care was the House of Orphans, which was cared for by nuns with doctors’ support; they developed the first theoretical-practical courses of the specialty. Pressured by high infant mortality and deadly epidemics, the Charity board cared about the urgency of improving hygienic conditions and creating childcare facilities. The ma-nuscript addresses the emergence of spaces responsible for safeguarding the health of children under five years of age since the creation of the chair of pediatrics and the first children’s hospital, the Ro-berto del Río Hospital, which set the beginning of the policies for children’s public health.
Targeting earlier diagnosis: What symptoms come first in Degenerative Cervical Myelopathy?
(2023) Munro, Colin; Yurac, Ratko; Carl, Zipser; Fehlings, Michael; Rodrigues, Ricardo; Milligan, James; Margetis , Konstantinos; Kotter, Mark; Davies, Benjamin
Background: Degenerative cervical myelopathy (DCM) is a common and disabling condition. Early effective treatment is limited by late diagnosis. Conventional descriptions of DCM focus on motor and sensory limb disability, however, recent work suggests the true impact is much broader. This study aimed to characterise the symptomatic presentation of DCM from the perspective of people with DCM and determine whether any of the reported symptoms, or groups of symptoms, were associated with early diagnosis. Methods: An internet survey was developed, using an established list of patient-reported effects. Participants (N = 171) were recruited from an online community of people with DCM. Respondents selected their current symptoms and primary presenting symptom. The relationship of symptoms and their relationship to time to diagnosis were explored. This included symptoms not commonly measured today, termed 'non-conventional' symptoms. Results: All listed symptoms were experienced by >10% of respondents, with poor balance being the most commonly reported (84.2%). Non-conventional symptoms accounted for 39.7% of symptomatic burden. 55.4% of the symptoms were reported as an initial symptom, with neck pain the most common (13.5%). Non-conventional symptoms accounted for 11.1% of initial symptoms. 79.5% of the respondents were diagnosed late (>6 months). Heavy legs was the only initial symptom associated with early diagnosis. Conclusions: A comprehensive description of the self-reported effects of DCM has been established, including the prevalence of symptoms at disease presentation. The experience of DCM is broader than suggested by conventional descriptions and further exploration of non-conventional symptoms may support earlier diagnosis.
Surgical timing prevails as the main factor over morphologic characteristics in the reduction by ligamentotaxis of thoracolumbar burst fractures
(2023) Cirillo, Juan; Farias, Ignacio; Cristóbal Del Pino; Gimbernat, Marcos; Urzúa, Alejandro; Tapia, Carlos; Zamorano, Juan
Background: thoracolumbar burst fractures are associated with spinal canal occupation. The indirect decompression of the spinal canal and reduction of the fragment can be achieved with the distraction of the middle column and ligamentotaxis. Nevertheless, the factors that influence the effectiveness of this procedure and its temporality are controversial. Methods: The aim of this observational, cross-sectional study was to evaluate the effectiveness of indirect reduction by ligamentotaxis in thoracolumbar burst fractures according to the fracture's radiologic characteristics and the procedure's temporality. Patients diagnosed with a thoracolumbar burst fracture between 2010 and 2021 were submitted to indirect reduction by distraction and ligamentotaxis. A retrospective analysis of radiologic characteristics and temporality of the procedure was performed with an independent sample t-test or Pearson's correlation coefficient, as required. Results: A total of 58 patients were included in the analysis. Postoperatively, ligamentotaxis significantly improved all radiologic parameters (canal occupation, endplates distance, and vertebra height). Still, none of the radiological characteristics of the fracture (width, height, position, sagittal angle) were associated with the postoperative change in canal occupation. The endplates distance and the temporality of ligamentotaxis significantly predicted the reduction of the fracture. Conclusion: Fragment reduction effectiveness is more significant when performed as early as possible and adequate distraction is achieved using the internal fixator system. The radiologic characteristics of the fractured fragment do not determine its reduction capacity.
Barreras para una alimentación saludable: un análisis cualitativo de las semánticas emergentes en las comunidades escolares de Ciudad Sur
(2024) Flores, Andrea; Díaz, Carlos; Palacios, José; Pinheiro, Anna; Pizarro, Tito; Rodríguez, Lorena; Sáez, Luis
Objetivo: Identificar las percepciones de padres, madres y apoderados, profesionales de establecimientos educacionales, funcionarios municipales, y feriantes pertenecientes a la zona sur de Santiago de Chile, respecto a las barreras y limitaciones de la puesta en práctica de una alimentación saludable en el ambiente alimentario escolar. Método: Se realizaron seis grupos focales agrupando a 50 actores claves vinculados a los establecimientos educacionales de Ciudad Sur utilizando una muestra no probabilística. Se aplicó un análisis de contenido mediante la técnica de codificación temática buscando relevar los universos semánticos emergentes. Resultados: Se identificaron nueve barreras, o semánticas, que caracterizan limitantes a la realización de la alimentación saludable en los entornos escolares desde la perspectiva de los participantes: la familia, kioscos escolares, la salida de los establecimientos escolares, gusto, determinantes socioeconómicos, política pública, falta de conocimiento, publicidad y disponibilidad de productos sin sellos. Conclusiones: Las limitaciones asociadas al ambiente alimentario doméstico tienen una representación significativamente alta (47,9%) y contienen un carácter de responsabilización individual en su enunciación. Esta cultura explicativa es opuesta a la evidencia científica y académica respecto al funcionamiento de la conducta alimentaria, y a la centralidad de los ambientes alimentarios respecto a la facilitación u obstaculización del consumo de alimentos saludables o adecuados.
"HLA-C: evolution, epigenetics, and pathological implications in the major histocompatibility complex"
(2023) Velastegui, Erick; Vera, Edwin; Vanden Berghe, Wim; Muñoz, Mindy
HLA-C, a gene located within the major histocompatibility complex, has emerged as a prominent target in biomedical research due to its involvement in various diseases, including cancer and autoimmune disorders; even though its recent addition to the MHC, the interaction between HLA-C and KIR is crucial for immune responses, particularly in viral infections. This review provides an overview of the structure, origin, function, and pathological implications of HLA-C in the major histocompatibility complex. In the last decade, we systematically reviewed original publications from Pubmed, ScienceDirect, Scopus, and Google Scholar. Our findings reveal that genetic variations in HLA-C can determine susceptibility or resistance to certain diseases. However, the first four exons of HLA-C are particularly susceptible to epigenetic modifications, which can lead to gene silencing and alterations in immune function. These alterations can manifest in diseases such as alopecia areata and psoriasis and can also impact susceptibility to cancer and the effectiveness of cancer treatments. By comprehending the intricate interplay between genetic and epigenetic factors that regulate HLA-C expression, researchers may develop novel strategies for preventing and treating diseases associated with HLA-C dysregulation.
Lateral hinge fracture in medial opening wedge high tibial osteotomy: a narrative review
(2023) Franulic, Nicolás; Muñoz, José; Figueroa, Francisco; Innocenti, Piero; Gaggero, Nicolás
Lateral hinge fractures (LHF) are one of the most common complications of medial opening wedge high tibial osteotomy (MOWHTO), and are the leading cause of construct instability displacement, non-union, and varus recurrence after this procedure. To date, Takeuchi's classification is the most popular classification to describe this complication, and it can help surgeons to make intra and postoperative decisions. Opening medial gap width is the most recognized factor related to LHF occurrence. Recognizing the implications of LHF in patients' clinical and radiographic results has led many authors to propose surgical tips and the use of osteosynthesis materials such as K-wires and screws for its prevention, which should be considered when identifying risk factors for LHF during preoperative planning. The evidence for determining the optimal management of LHF is scarce and mostly supported by experts' opinions and recommendations; therefore, studies are still needed to identify the most appropriate behavior when dealing with such a complication.
Knockdown of Antisense Noncoding Mitochondrial RNA Reduces Tumorigenicity of Patient-Derived Clear Cell Renal Carcinoma Cells in an Orthotopic Xenograft Mouse Model
(2024) Araya, Mariela; Sepúlveda, Francisca; Villegas, Jaime; Alarcón, Luis; Burzio, Luis; Burzio, Verónica; Borgna, Vincenzo
Clear cell renal cell carcinoma (ccRCC) is the most prevalent form of renal cancer and its treatment is hindered by a resistance to targeted therapies, immunotherapies and combinations of both. We have reported that the knockdown of the antisense noncoding mitochondrial RNAs (ASncmtRNAs) with chemically modified antisense oligonucleotides induces proliferative arrest and apoptotic death in tumor cells from many human and mouse cancer types. These studies have been mostly performed in vitro and in vivo on commercially available cancer cell lines and have shown that in mouse models tumor growth is stunted by the treatment. The present work was performed on cells derived from primary and metastatic ccRCC tumors. We established primary cultures from primary and metastatic ccRCC tumors, which were subjected to knockdown of ASncmtRNAs in vitro and in vivo in an orthotopic xenograft model in NOD/SCID mice. We found that these primary ccRCC cells are affected in the same way as tumor cell lines and in the orthotopic model tumor growth was significantly reduced by the treatment. This study on patient-derived ccRCC tumor cells represents a model closer to actual patient ccRCC tumors and shows that knockdown of ASncmtRNAs poses a potential treatment option for these patients.
EV-miRNA-Mediated Intercellular Communication in the Breast Tumor Microenvironment
(2023) Sepúlveda, Francisca; Mayorga, Cristina; Guzmán, Kevin; Durán, Eduardo; Lobos, Lorena
Cancer research has prioritized the study of the tumor microenvironment (TME) as a crucial area of investigation. Understanding the communication between tumor cells and the various cell types within the TME has become a focal point. Bidirectional communication processes between these cells support cellular transformation, as well as the survival, invasion, and metastatic dissemination of tumor cells. Extracellular vesicles are lipid bilayer structures secreted by cells that emerge as important mediators of this cell-to-cell communication. EVs transfer their molecular cargo, including proteins and nucleic acids, and particularly microRNAs, which play critical roles in intercellular communication. Tumor-derived EVs, for example, can promote angiogenesis and enhance endothelial permeability by delivering specific miRNAs. Moreover, adipocytes, a significant component of the breast stroma, exhibit high EV secretory activity, which can then modulate metabolic processes, promoting the growth, proliferation, and migration of tumor cells. Comprehensive studies investigating the involvement of EVs and their miRNA cargo in the TME, as well as their underlying mechanisms driving tumoral capacities, are necessary for a deeper understanding of these complex interactions. Such knowledge holds promise for the development of novel diagnostic and therapeutic strategies in cancer treatment.

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