Artículos Medicina y Ciencias de la Salud

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Determinants of COVID-19 and non-COVID-19 vaccine confidence in lowand middle-income countries: A systematic review of qualitative evidence and thematic synthesis
(2025) Blukacz, Alice; Obach, Alexandra; Vasquez, Paola; Campaña, Carla; Huerta, Catalina; Bernal, Yanara; Cabieses, Báltica
Background: The COVID-19 pandemic has shown the immediate risk for global and public health posed by vaccination inequities worldwide. The regions most affected are low- and middle-income countries (LMICs). In addition to systemic challenges, vaccine hesitancy driven by low vaccine confidence has been identified as a threat to vaccine uptake. The aim of this systematic review of qualitative literature is to explore the determinants of COVID-19 and non-COVID-19 vaccine confidence in LMICs. Methods: A systematic review was conducted following the PRISMA and ENTREQ guidelines. The electronic databases Cinahl, Embase, Pubmed, Scopus and Web of Science were searched for qualitative studies focusing on the topic of interest in LMICs published between 2013 and 2023. The quality of the studies was assessed using the Joanna Briggs Institute's Checklist for Qualitative Research. A thematic synthesis was conducted. The study was registered on the Open Science Framework platform. Findings: 66 studies were included in the review. Three main determinants of vaccine confidence were identified: (1) General perceptions of the safety and efficacy of vaccines; (2) Information and experience; (3) Trust in healthcare providers, institutions, and systems. General perceptions of vaccine safety and efficacy were similar between COVID-19 and non-COVID-19 vaccines, and doubts regarding vaccine safety were neither new nor exclusive to the COVID-19 vaccine, indicating a persisting challenge. Furthermore, low vaccine confidence was partly determined by broader dynamics of mistrust towards Western countries and institutions, which was reflected for both vaccine groups. While conspiracy theories have been persisting determinants of low confidence, low COVID-19 vaccine confidence was partly determined by what was perceived as a lack of specific information. Conclusion: Persistent challenges to vaccine confidence were identified, rooted in colonial legacies and global health inequities, as well as limited intercultural approaches to building trust with regards to vaccines.
Prevalence of Cow’s Milk Allergy in Infants from an Urban, Low-Income Population in Chile: A Cohort Study
(2025) Cruchet, Sylvia; Arancibia, María Eugenia; Maturana, Andrés; Marchant, Pamela; Rodríguez, Lorena; Lucero, Yalda
Background. Cow’s milk allergy (CMA) is one of the most common food allergies in infancy, with prevalence estimates of 0.5–7.5% in high-income countries. Data from low- and middle-income regions remain limited, and the predominant immune mechanism (IgE or non-IgE mediated) may vary across populations. Objective. We aimed to determine the prevalence and clinical characteristics of CMA in infants from an urban, low-income Chilean population. Methods. A prospective cohort study was conducted at Padre Hurtado Hospital in Santiago, Chile. Healthy term newborns were recruited and followed for up to 12 months. Sociodemographic, perinatal data and parental atopy were recorded. Parents were contacted monthly to screen for CMA symptoms. Infants with ≥two symptoms underwent clinical evaluation, a 4-week cow’s milk protein exclusion diet, and an open oral food challenge (OFC). Diagnosis followed international consensus guidelines. Results. Of 552 enrolled infants (48% male), 27 were diagnosed with CMA, yielding a prevalence of 4.9% (95% CI 3.1–7.0%). All cases exhibited non-IgE-mediated symptoms, including vomiting, dermatitis, colic, and perianal erythema. CMA was diagnosed before 6 months of age in 74% of cases. At 12 months, 40% had developed oral tolerance. Sociodemographic and perinatal characteristics were similar between groups, but some self-reported parental atopic traits were more frequent in CMA cases. Conclusions. CMA prevalence in this Chilean cohort was comparable to that reported in high-income countries, with a predominance of non-IgE-mediated forms. These findings support the need for standardized diagnostic protocols, including OFC, in diverse populations. Future studies should explore long-term outcomes and risk factors in non-IgE-mediated CMA.
Enfoque clínico del paciente con síndrome de Stevens-Johnson y necrólisis epidérmica tóxica. Parte I: Epidemiología, Diagnóstico y Factores Pronósticos
(2025) Lobos, Nelson; Valenzuela, Fernando; Molgó, Montserrat; López, Valeska; Palisson, Francis
El síndrome de Stevens-Johnson (SSJ) y la necrolisis epidérmica tóxica (NET) son manifestaciones cutáneas graves de reacciones adversas a medicamentos. Esta primera revisión es una puesta al día en los aspectos epidemiológicos, fisiopatológicos, manifestaciones clínicas, diagnósticos y pronósticos de estos cuadros. Objetivo: Establecer un enfoque clínico actualizado en torno a SSJ/NET. Métodos: Se realizó una búsqueda en bases de datos indexadas (PubMed, SciElo, LILACS), seleccionando 68 artículos y 2 guías clínicas del Ministerio de Salud de Chile (MINSAL), desde marzo hasta octubre de 2024. Resultados:SSJ/NET afecta a individuos genéticamente susceptibles con respuestas inmunitarias inapropiadas, provocadas por fármacos o factores no farmacológicos, resultando en apoptosis de queratinocitos y alta mortalidad. Se proponen tres hipótesis sobre la activación de linfocitos T: hapteno/prohapteno, interacción p-i y modelo del péptido alterado. Los mediadores clave incluyen FasL, perforinas, granzimas y granulisina. Factores genéticos, como alelos HLA y variantes del CYP450, influyen en la susceptibilidad. El diagnóstico se basa en evaluación clínica e histopatológica. La biopsia es crucial para la confirmación, aunque el inicio del tratamiento no debe retrasarse si hay alta sospecha. Los hallazgos típicos son ampollas subepidérmicas, necrosis epidérmica y queratinocitos apoptóticos. Herramientas como los algoritmos de causalidad y biomarcadores pueden ayudar a identificar SSJ/TEN tempranamente, aunque estos últimos necesitan más investigación. Conclusiones: Diagnosticar SSJ/NET es desafiante debido a su presentación clínica variable y similitudes con diagnósticos diferenciales. La biopsia es importante, pero los hallazgos histopatológicos no siempre distinguen entre formas de SSJ/NET. Las herramientas de causalidad y biomarcadores tienen potencial, pero se requiere más validación. Nuestras recomendaciones son educar al paciente con riesgo, si hay alta sospecha, el tratamiento debe iniciarse sin esperar confirmación definitiva. Por otra parte, esta revisión inicial permite fundamentar las recomendaciones establecidas en la segunda parte de la revisión.
The Latin American Society for Immunodeficiencies Registry
(2024) Seminario, Gisela; Gonzalez, Maria; Sanchez, Carolina; Sevciovic, Anete; Rodrigues, Gesmar; Regairaz, Lorena; Alvares, Aristoteles; LASID Registry Group; Aldave, Juan; Poli Harlowe, María Cecilia; King, Alejandra; Rodrigues, Fatima; Leiva, Lily; Franco, Jose; Espinosa, Francisco; Sorensen, Ricardo; Tavares, Beatriz; Bezrodnik, Liliana; Condino, Antonio
Purpose - The Latin American Society of Immunodeficiencies (LASID) Registry was established in 2009 to collect data on Inborn Errors of Immunity (IEI) patients in the region. Although several reports have been published regarding LASID data, this is the first report of the entire dataset. Methods - The European Society of Immunodeficiencies (ESID) donated the online platform in 2008. Data was collected from participating centers from Apr 13, 2009, to Dec 31, 2022, and included demographic, clinical, and follow-up information. Results - A total of 9307 patients were included in the database. At the end of the study period, 8,805 patients were alive or lost to follow-up, and 502 were deceased. The most common type of IEI was predominantly antibody deficiency (PAD, 60.35%), and selective IgA deficiency was the most frequent diagnosis (1627 patients, 17.48%), followed by Common Variable Immune Deficiency (CVID, 1191 patients). Most patients (78.16%) were ≤ 18 years old at inclusion, and the median age at diagnosis was 4.77 years. The median time to diagnosis was 5.04 years. Antibiotics were prescribed in 32.3% of visits, followed by immunoglobulins (29.49% ). Hematopoietic stem cell transplantation was performed in 5.03% of patients. Omenn syndrome was the most common disease in deceased patients, with a mortality rate of 52.63%. Conclusion - This study contributes to our understanding of IEIs in Latin America and highlights the importance of early diagnosis, appropriate treatments, and improved data collection to optimize patient outcome.
A Systematic Review of Current Terminology for Conditions Preceding Degenerative Cervical Myelopathy: Evidence Synthesis to Inform an AO Spine Expert Opinion Statement
(2025) Agrawal, Vinisha; Farhan Ali, Mohammed; Yasin, Froher; Ashraf, Daniyal; Brannigan, Jamie F. M.; Yurac, Ratko; Kumar, Vishal; Murphy, Rory; Tessitore, Enrico; Molliqaj, Granit; Dejaegher, Joost; Zamorano, Juan José; Wynne-Jones, Guy; Tripathi, Manjul; Anderson, David B.; Arbatin, Jose Joefrey F.; Kato, So; Romelean Jayapalan, Ronie; Dea, Nicolas; Harrop, James S.; Wilson, Jefferson; Kwon, Brian K.; Martin, Allan R.; Bednarik, Josef; Kotter, Mark R.; Davies, Benjamin M.; Mowforth, Oliver D.; Nouri. Aria
Study Design: Systematic review. Objectives: The pre-symptomatic state of Degenerative Cervical Myelopathy (DCM), wherein degenerative changes and spinal cord compression are seen without clinical findings, is poorly understood and inconsistently categorised. Clear identification may elucidate the temporality of DCM development. Therefore, a systematic assessment was undertaken of current terminology for pre-DCM states, with the objective of standardising definitions and informing an AO Spine expert position statement. Methods: Medline and Embase were searched for all studies on asymptomatic spinal compression or clinical findings preceding DCM, returning 3585 studies. After screening, 96 studies were included in the final analysis. The terminology used for pre-DCM states and their definitions were extracted, along with their frequencies or speciality/country of author in the literature. Results: Multiple terms were used to represent pre-DCM stages, including “asymptomatic” (86 studies), “non-myelopathic” (26 studies), “without myelopathy” (15 studies), “pre-symptomatic” (9 studies) and “sub-clinical” (7 studies). “asymptomatic” was associated with the greatest inconsistency. Some defined this as patients with radiological signs of spinal degeneration with/without spinal cord compression but no clinical signs of myelopathy, whereas others used the term synonymously with healthy controls. This inconsistency is particularly challenging in clinical studies in which DCM patients are compared to those with pre- DCM states and/or healthy volunteers. Conclusion: There is substantial inconsistency in the terms used to describe pre-DCM states. There is no clear relationship between the terms used and the country or speciality of the main author. Standardised definitions for these disease states should be agreed and used in future studies.
Concordance of Helicobacter pylori Detection Methods in Symptomatic Children and Adolescents
(2025) Cabrera, Camila; Campusano, Yanira; Torres, Joaquín; Ivulic, Dinka; Galvez, Valeria; Tapia, Diego; Rodríguez, Vicente; Lagomarcino, Anne; Gallardo, Alejandra; Alliende, Francisco; Toledo, Marcela; Román, Gabriela; Jaime, Francisca; González, Mónica; Marchant, Pamela; Rojas, Marianela; Juanet, Juan Ignacio; Villanueva, Mónica; Ossa, Juan Cristóbal; Del Canto, Felipe; Viver, Tomeu; O’Ryan, Miguel; Lucero, Yalda
Background: Helicobacter pylori is the most prevalent chronic bacterial infection globally, acquired mostly during childhood. It is associated with chronic gastritis, peptic ulcer disease, and gastric cancer. Due to challenges in culturing H. pylori, diagnostic reference standards often rely on combining ≥2 non-culture, biopsy-based methods. Histology with Giemsa staining is widely used in clinical settings due to its low cost and reliable performance. Methods: This study evaluated the concordance between histology with Giemsa staining as the reference standard and other diagnostic methods, including the rapid urease test (RUT), ureA RT-PCR, 16S sequencing, and anti-H. pylori serum IgG. Positive percent of agreement (PPA), negative percent of agreement (NPA) and concordance kappa index were calculated. Results: A total of 120 patients (41 positive and 79 negative by Giemsa staining) were analyzed. Among the methods tested, RT-PCR for ureA showed the best performance (PPA = 94.7%, NPA = 98.6%, kappa = 0.939), while RUT underperformed compared with expectations (PPA = 65.9%, NPA = 97.5%, kappa = 0.681). Serology had the lowest performance (PPA = 53.7%, NPA = 96.1%, kappa = 0.548). Conclusions: The combination of histology with Giemsa staining and ureA RT-PCR achieved the highest detection rate and strongest agreement.
Risk factors and outcomes of pediatric non-invasive respiratory support failure in Latin America
(2024) Escobar, Diana; Barajasz, Juan; Peralta, Juan; Jaramillo, Juan; Monteverde, Nicolas; Serra, Jesus; Caporal, Paula; Menta, Soledad; Lasso, Ruben; Zemanate, Eliana; Martínez, Javier; Herrera, Hernan; Martínez, Luis; Castro, Francisca; Carvajal, Cristobal; Decía, Monica; Jabornisky, Roberto; Diaz, Franco; Gonzalez, Sebastian; Vasquez, Pablo; On behalf of LARed Network
Background: Noninvasive respiratory support (NRS) is standard in pediatric intensive care units (PICUs) for respiratory diseases, but its failure can lead to complications requiring invasive mechanical ventilation (IMV). This study aimed to identify risk factors for NRS failure in children with acute respiratory failure (ARF) in PICUs, and compare complications and outcomes between IMV-only and NRS failure patients. Methods: We conducted a cohort study using data from the LARed Network prospective registry (April 2017-November 2022), in children under 18 years admitted to PICUs for ARF. Cases were divided into subgroups: those managed with IMV only, those who experienced NRS failure requiring IMV, those who received NRS successfully, and those who did not require NRS or IMV. Exclusions included patients with home respiratory support prior to admission, patients without PICU discharge at the cutoff date of the analysis and those with incomplete data. Multivariate mixed models analyzed NRS failure risk factors, and complications between the IMV-only and NRS failure groups, using centers as a random effect. Results: A total of 7374 children met the inclusion criteria, with 6208 in the NRS group and 1166 in the IMV-only group. The NRS success rate was 85.3 %. Risk factors for NRS failure included age (median of 4.6 months, interquartile range of 2.1-14.2 months), history of prematurity (adjusted odds ratio [aOR]=1.53, 95 % confidence interval [CI]: 1.20 to 1.95) or malnutrition (aOR=1.85, 95 % CI: 1.18 to 2.91), suspected bacterial infection (aOR=5.12, 95 % CI: 4.05to 6.49), FiO2 >30 % (aOR=1.52, 95 % CI: 1.18 to 1.97), severe hypoxemia with SpO2/FiO2 ≤150 (aOR=1.85, 95 % CI: 1.48 to 2.30), tachypnea (aOR=1.42, 95 % CI: 1.18 to 1.72), tachycardia (aOR=1.77, 95 % CI: 1.47 to 2.12), and lung consolidations (aOR=1.45, 95 % CI: 1.14 to 1.85) or interstitial infiltrates (aOR=1.29, 95 % CI: 1.05 to 1.58) on chest X-ray. There were no significant differences in morbidity, mortality, duration of IMV, or PICU length of stay between patients who received IMV only and those who experienced NRS failure. However, patients who experienced NRS failure were more likely to develop withdrawal symptoms related to sedative or opioid discontinuation and/or delirium (aOR=2.57, 95 % CI: 1.85 to 2.57). Conclusion: This study identified key risk factors for predicting NRS failure in children with acute ARF in PICUs, including younger age, prematurity, malnutrition, suspected bacterial infection, FiO2 >30 %, severe hypoxemia (SpO2/FiO2 ≤150), tachypnea, tachycardia, and radiological findings such as lung consolidation and interstitial infiltrates. Compared to patients managed with IMV from the start, those who experienced NRS failure were more likely to develop withdrawal symptoms and/or delirium, although clinical outcomes such as mortality, IMV duration, and PICU length of stay were similar in both groups.
Recommendations for Implementing the INTERACT3 Care Bundle for Intracerebral Hemorrhage in Latin America: Results of a Delphi Method
(2025) Allende, María; Munoz Venturelli, Paula; Gonzalez, Francisca; Bascur, Francisca; Anderson, Craig; Ouyang, Menglu; Cabieses, Báltica; Obach, Alexandra; Cano, Vanessa; Arauzg, Antonio
Introduction: The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT3) showed that the implementation of a care bundle improves outcomes after acute intracerebral hemorrhage (ICH). We aimed to establish consensus-based recommendations for the broader integration of the care bundle across Latin American countries (LAC). Methods: A 3-phase Delphi study allowed a panel of 32 healthcare workers from 14 LAC to sequentially rank statements relevant to 7 domains (training, resources/infrastructure, patient education, blood pressure, temperature, glycemic control, and anticoagulation reversal). The pre-defined consensus threshold was 75%. Results: A total of 43 statements reached consensus by the third round, with 12 new statements emerging through rounds. The highest-ranked statements in each domain emphasized critical aspects, but successful implementation requires appropriate resourcing. Key priorities were continuous training of all healthcare workers in ICH management, establishing protocols aligned with available resources, and collaborative interdisciplinary care supported by institutional networks. Statements related to anticoagulation reversal had the highest priority. Conclusions: Consensus statements are provided to facilitate integration of the INTERACT3 care bundle to reduce disparities in ICH outcomes in LAC.
Implementation of Low-Intensity Thrombolysis Monitoring Care in Routine Practice: Process Evaluation of the Optimal Post rtPA-IV Monitoring in Acute Ischemic Stroke Study in the USA
(2025) Ouyang, Menglu; González, Francisca; Montalbano, Michelle; Pruski, April; Jan, Stephen; Wang, Xia; Johnson, Brenda; Summers, Debbie; Khatri, Pooja; Malavera, Alejandra; Faigleg, Roland; Munoz Venturelli, Paula; Urrutia, Francisca; Day, Diana; Robinson, Thompson; Durham, Alice; Ebraimo, Ahtasam; Song, Lili; Su, Yi; Zaidi, Wan Asyraf Wan; Lindley, Richard; Delcour, Candice; Cruz, Victor; Anderson, Craig; Liu, Hueiming
Introduction: The ongoing OPTIMISTmain study, an international, multicenter, stepped-wedge cluster randomized trial, aims to determine effectiveness and safety of low-intensity versus standard monitoring in thrombolysis-treated patients with mild-to-moderate acute ischemic stroke (AIS). An embedded process evaluation explored integration and impact of the intervention on care processes at participating US sites. Methods: A mixed-methods approach with quantitative and qualitative data was collected between September 2021 and November 2022. Implementer surveys were undertaken at pre- and post-intervention phases to understand the perceptions of low-intensity monitoring strategy. A sample of stroke care nurses were invited to participate in semi-structured interviews at an early stage of post-intervention. Qualitative data were analyzed deductively using the normalization process theory; quantitative data were tabulated. Results: Interviews with 21 nurses at 8 hospitals have shown low-intensity monitoring was well accepted as there were less time constraints and reduced workload for each patient. There were initial safety concerns over missing deteriorating patients and difficulties in changing established routines. Proper training, education, and communication, and changing the habits and culture of care, were key elements to successfully adopting the new monitoring care into routine practice. Similar results were found in the post-intervention survey (42 nurses from 13 hospitals). Nurses reported time being freed up to provide patient education (56%), daily living care (50%), early mobilization (26%), mood/cognition assessment (44%), and other aspects (i.e., communication, family support). Conclusions: Low-intensity monitoring for patients with mild-to-moderate AIS, facilitated by appropriate education and organizational support, appears feasible and acceptable at US hospitals.
Membrane Lipids Augment Cell Envelope Stress Signaling via the MadRS System to Defend Against Antimicrobial Peptides and Antibiotics in Enterococcus faecalis
(2025) Miller, William; Nguyen, April; Singh, Kavindra; Rizvi, Samie; Khan, Ayesha; Erickson, Sam; Egge, Stephanie; Cruz, Melissa; Dinh, An; Diaz, Lorena; Thornton, Philip; Zhang, Rutan; Xu, Libin; Garsin, Danielle; Shamoo, Yousif; Arias, Cesar
Enterococci have evolved resistance mechanisms to protect their cell envelopes against bacteriocins and host cationic antimicrobial peptides (CAMPs) produced in the gastrointestinal environment. Activation of the membrane stress response has also been tied to resistance to the lipopeptide antibiotic daptomycin. However, the actual effectors mediating resistance have not been elucidated. Here, we show that the MadRS (formerly YxdJK) membrane antimicrobial peptide defense system controls a network of genes, including a previously uncharacterized 3-gene operon (madEFG) that protects the Enterococcus faecalis cell envelope from antimicrobial peptides. Constitutive activation of the system confers protection against CAMPs and daptomycin in the absence of a functional LiaFSR system and leads to persistence of cardiac microlesions in vivo. Moreover, changes in the lipid cell membrane environment alter CAMP susceptibility and expression of the MadRS system. Thus, we provide a framework supporting a multilayered envelope defense mechanism for resistance and survival coupled to virulence.
Patient centered outcomes in stroke: utility-weighted modified Rankin Scale results in a community-based study
(2025) Delfino, Carlos; Cavada, Gabriel; Hoffmeister, Lorena; Lavados, Pablo
Background and aims: The transformation of modified Rankin Scale (mRS) scores based on the corresponding utilities of health-related quality of life questionnaires can facilitate the capture of Patient-Centered Outcomes (PCO) in stroke. We aimed to derive utility-weighted modified Rankin Scale (UW-mRS) values by mapping mRS functional status to EQ-5D-3L scores in a population-based cohort of stroke patients. Methods: The UW-mRS was obtained by analyzing the EQ5-D-3 L and mRS scores at 180 days after any stroke in the ÑANDU study, a large prospective community-based study in Chile. The mRS prediction was estimated using a linear regression adjusted by the EQ-5D-3L value. Generalized linear and binary logistic regression models were constructed to determine influencing factors of the UW-mRS, using STATA software (version 18.0). Results: We included 773 patients presenting with any stroke during 2015–2016: 48% were female, with a mean age of 71 years (SD 13.8), and 85% had an acute ischemic stroke (AIS). 82% of patients had a low socioeconomic status, 50% had less than 12 years of formal education, and only 32% lived in urban areas. UW-mRS values for mRS categories 0–6 at 180 days were 0.913, 0.694, 0.425, 0.249, −0.102, −0.347 and 0, respectively. Multivariable analysis identified age > 70 years (Coefficient β [β] -0.038 [Standard error SE 0.018], p = 0.032), prior mRS score 3–5 (β −0.556 [SE 0.197], p < 0.001), ischemic stroke (β −0.066 [SE 0.025], p = 0.010), and National Institutes of Health Stroke Scale (NIHSS) at admission>5 (β −0.015 [SE 0.002], p < 0.001) as significant predictors of worse UW-mRS scores (R2 = 70%) in the overall group. Sex-disaggregated analysis showed that age > 70 years was a significant predictor in males (β −0.069 [SE 0.024], p = 0.006), while presenting an AIS had a greater impact on female’s worse UW-mRS score (β −0.087 [SE 0.033], p = 0.010). Conclusion: These results present UW-mRS values derived from a population-based stroke study. Key determinants of health-related quality of life in post-stroke patients included age, prior disability, and stroke severity. Sex-disaggregated analysis revealed age being significant for males and AIS for females. Incorporating PCO as UW-mRS in stroke research can provide a more nuanced understanding of the impact of stroke on survivors, offering valuable insights for clinical decision-making and rehabilitation strategies across diverse healthcare contexts.
Personas mayores y cuidadores: experiencias con tecnologías digitales en salud en tres regiones de Chile
(2025) Hirmas Adauy, Macarena; Olea, Andrea; Sgombich, Ximena; Castillo-Laborde, Carla; Matute, María Isabel; Abusleme, Teresa; Jofré, Daniel; Slachevsky Chonchol, Andrea; Massad, Cristián
Este artículo da cuenta de las experiencias y expectativas de personas mayores, cuidadores y familiares con respecto al uso de tecnologías digitales para el cuidado de la salud en Chile, asumiendo como perspectiva de análisis la Teoría de Usos y Gratificaciones. Para la realización del estudio se utilizó un enfoque cualitativo con 9 grupos focales y 16 entrevistas individuales. Llevado a cabo entre marzo y noviembre de 2022, la investigación abordó aspectos como competencia digital, accesibilidad y usos. Los resultados indican que las personas mayores tienen una relación tardía con la tecnología, con barreras como miedo a la obsolescencia y falta de habilidades digitales. La tecnología es percibida como útil para las tareas cotidianas y la asistenciasanitaria, aunque existen preocupaciones acerca del fraude y el mal uso de información personal, lo que amplía la brecha digital. La alfabetización digital en personas mayores es sobre todo adquirida a través del apoyo familiar y de procesos de formación informales. La salud digital es vista como multifacética, beneficiando la gestión administrativa y el acceso a la información médica, aunque se requieren estrategias más efectivas de inclusión digital para mejorar la autonomía y lab integración de las personas mayores en el entorno digital.
Advances in Label-Free Detection of Non-Muscle Invasive Bladder Cancer: A Critical Review
(2025) Vera, Gabriela; Cerda, Javier; Fernández Arancibia, Mario; Sánchez, Miguel; Rojas, Pablo
Non-muscle invasive bladder cancer (NMIBC) accounts for about 75% of new bladder cancer diagnoses. Early detection improves survival, yet routine white-light cystoscopy is invasive, costly, and can miss up to 45% of flat or small lesions. These shortcomings have prompted development of label-free diagnostic tools that read the intrinsic optical, electrical, or mechanical signatures of urinary biomarkers without added labels. This review examines recent engineering advances in such platforms for NMIBC detection, focusing on analytical performance, readiness for clinical translation, and remaining barriers to adoption. We compare each technology with conventional cytology using key metrics such as limit of detection, diagnostic accuracy, analysis time, cohort size, and stage of clinical development. Surface-enhanced Raman spectroscopy and interferometric flow cytometry offer femtomolar sensitivity and more than 98% accuracy within minutes, while compact electrochemical sensors targeting NMP22, Galectin-1, and microRNAs reach sub-picogram levels on disposable chips. Standardized sample handling, multicenter validation, and robust cost-effectiveness data are now essential for these tools to advance point-of-care NMIBC surveillance.
Transolecranon fracture dislocation and transolecranon basal coronoid fracture dislocation; results of standardized treatment in a retrospective cohort
(2025) De la Paz, Joaquín; Lecaros, Juan José; Calvo, Andrés; Ariztia, Antonio; Aravena, Cristian; Reinares, Felipe
Background: Our understanding of transolecranon fracture dislocation (TOFD) has evolved to include associate ligament, coronoid, and radial head lesions impacting stability, rather than solely bone stability. Similarly, the understanding of coronoid fracture patterns has progressed. O’Driscoll et al state that basal subtype 2 coronoid fractures correspond to a TOFD, with a fracture passing through the base of the coronoid. In the literature, there is no clear differentiation between basal coronoid TOFD (BC-TOFD) and pure-TOFD outcomes. The main objective of this study is to evaluate the functional results and complications of TOFD using a standardized surgical technique. The secondary objectives are to describe the associated injuries and to compare the results between pure-TOFD and BC-TOFD. Methods: This retrospective study included all patients with a TOFD treated with a standardized surgical procedure and rehabilitation protocol between 2013 and 2018 in a single trauma level 1 center. The surgical procedure mainly consisted of fixing the olecranon with a plate, using the same screws for coronoid fixation and coronoid plate if necessary. Radial head management involved either arthroplasty or screw fixation, with ligament repair performed as needed. Demographic data and the associated bone and ligament injuries were reviewed. The clinical outcomes (range of motion, Mayo Elbow Performance Score (MEPS), and Broberg and Morrey (B&M) scores) were evaluated at the final follow-up, after a minimum of 2 years. Complications and reoperations were assessed. Results: 24 patients were included, and 75.0% were men. The average follow-up was 57.9 ± 22.0 months. The mean age was 42.0 ± 15.1 years. 18 (75.0%) were BC-TOFD and 6 (25.0%) were pure-TOFD. Ligament injuries requiring repair and radial head fracture were present in 8 (33.3%) and 11 (45.8%), respectively. The average range of motion were flexion 119.0 ± 17.6, extension deficit 20.4 ± 12.6 , pronation 68.9 ± 20.4 , and supination 63.1 ± 27.4 . MEPS and B&M mean scores were 82.3 ± 16.5 and 82.0 ± 16.1, respectively. The reoperation rate was 33.3%. No significant differences were found between pure-TOFD and BC-TOFD. A significant distribution difference was found in MEPS (P ¼ .001), B&M (P ¼ .002), range of flexion (P ¼ .011), and extension deficit (P ¼ .005) between patients who had reintervention and those who did not. Conclusion: A standardized protocol for TOFD allows good to excellent functional results. There are no significant differences between pure-TOFD and BC-TOFD. One-third underwent reintervention. Patients with reintervention presented worse outcomes.
Stroke and cervical artery dissection and/or aneurysm: 2019-2021 Chilean hospital-based national registry
(2025) Allende, Maria; Munoz Venturelli, Paula; Mazzon, Enrico; Brunser, Alejandro; Delgado, Iris; Rebolledo Jaramillo, Boris
Background: Cervical artery dissection is one of the main causes of stroke in young adults, yet the characteristics of patients have been mainly described in Caucasian populations. We aimed to identify patients' characteristics associated with stroke among cervical artery dissection patients in Chile. Methods: We conducted a retrospective analysis of a national hospital-based database in Chile between 2019 and 2021. Patients with cervical artery dissection or aneurysm (CeDA) were identified using ICD-10 codes I72.0 (carotid artery) and I72.6 (vertebral artery); stroke events were classified using codes I60-I64. We performed multivariable logistic regression to evaluate the association between patients' characteristics and stroke occurrence. We further performed Poisson regression to assess the impact of the coronavirus pandemic on CeDA admissions. Results: Of 2,647,398 hospital discharges, we identified 597 CeDA patients (mean [SD] age 57 [15] years; female 384, 64 %). Stroke occurred in 233 (37 %) patients, with ischaemic stroke accounting for 71 % of these events. In the multivariable analysis, stroke occurrence was associated with vertebral artery involvement (OR 2.89; 95 %CI 1.76-4.77), atrial fibrillation (2.25; 1.03-4.90), hypertension (1.85; 1.25-2.74), male sex (1.80; 1.24-2.62) and current smoking (1.78; 1.13-2.80). Hospital admissions for CeDA declined in 2020 (rate ratio [RR] 0.69; 95 %CI 0.57-0.85) and 2021 (0.76; 0.63-0.92), compared with 2019. Conclusions: In this Chilean hospital-based database, stroke occurrence among CeDA patients was linked to male sex, vertebral artery involvement, hypertension, current smoking, and atrial fibrillation. Further research is needed to understand the underlying mechanisms and its association with patient prognosis.
Estado nutricional y uso de plataformas de compra y venta de alimentos en línea en estudiantes universitarios
(2025) Araneda, Jacqueline; Concha, Lisett; Muñoz, Jennifer; Quintiliano, Daiana; Navarro, Esteban; Pinheiro, Anna Christina
Introducción: La compra y venta de alimentos en línea ha experimentado un aumento significativo en todo el mundo, propiciado por un mayor acceso a las tecnologías y dispositivos electrónicos. Objetivo: evaluar la asociación entre la exposición a servicios de compra y venta de alimentos en línea y el estado nutricional de los universitarios. Material y métodos: Participaron 587 estudiantes de Universidad del Bío- Bío, Chile. Se aplicó un cuestionario online que incluía preguntas sobre el uso de aplicaciones de delivery y las influencias del entorno en la compra de alimentos. Se realizó un estudio de clúster y se desarrollaron modelos de regresión logística. Resultados: Se obtuvieron 3 clústers de exposición a plataformas de entrega de comida a domicilio, mediante un análisis de conglomerados (MCA K-means): expuestos a estímulos tradicionales (n=198), poco expuestos (n=196) y altamente expuestos (n=193). Quienes están altamente expuestos a plataformas digitales de comida a domicilio, tienen mayor probabilidad de tener malnutri- ción por exceso (OR=1,53; p = 0,048). Comprar comida vegetariana, vegana o sin gluten es un factor protector de la malnutrición por exceso (OR= 0,65; p = 0,049). Conclusión: Existe relación significativa entre la utilización de servicios de compra y venta de alimentos en línea y el estado nutricional de estudiantes universitarios. Los resultados sugieren que el acceso y uso de estas plataformas podría influir en los patrones alimentarios y, en conse- cuencia, en el estado nutricional de esta población.
Evaluating employees’ perceptions of non-monetary incentives in workplace-based weight loss programs
(2025) Oliveira-Barbosa, Adriana Aparecida de; Pinheiro-Fernandes, Anna Christina; Quintiliano Scarpelli, Daiana; Marques de Oliveira, María Rita; Belmar Prieto, Julieta; Masferrer Riquelme, Dominique
This study investigated Chilean employees expectations, perceptions of acceptability, and beliefs about the potential effectiveness of non-monetary incentives in workplace weight loss programs. Eighty-six employees with overweight and sedentary occupations from six Chilean companies partici- pated in 16 focus groups as part of a descriptive qualitative study. The content analysis, grounded in Self-Determination Theory, revealed eight catego- ries grouped into three overarching themes: 1) Beliefs and challenges regarding healthy habits and body weight. 2) Workplace structure, environment, and culture. 3) The use of non-monetary incentives to promote healthy behaviors at work. While participants appreciated the non-monetary incentives, these were not enough to overcome the psychological, emotional, and structural barriers to adopting healthier lifestyles. Non-monetary incentives that provided additional spare time, particularly for family, were the most appreciated by participants; nevertheless, organizational constraints restrict the use of these incentives in workplace weight loss initiatives. In conclusion, although non-monetary incentives were identified as a strategy to promote healthier lifestyles, their success is dependent on implementing structural and cultural modifications in the work environment. A comprehensive strat- egy that considers both individual and organizational factors is needed to promote sustainable healthy habits.
Systemic illness with eosinophilia and urticaria-like rash caused by prolonge d b e dbug exposure
(2025) Weitzel, Ian; Palma, Valeria; Silva, Macarena; Castro, Alex; Weitzel, Thomas
Bedbugs are blood-feeding nocturnal ectoparasites, which are well-adapted to human habitats. In recent decades, bedbug infestation has been an emerging health problem worldwide, affecting all socio-economic population strata. The clinical presentations of bedbug exposure are variable, ranging from simple pruriginous bite lesions to severe cutaneous and systemic manifestations. Diagnosis is challenging and depends on awareness, clinical experience, and a thorough medical history. In our case, cutaneous lesions were accompanied by severe systemic symptoms and hypereosinophilia, leading to prolonged illness and hospitalization. The differential diagnosis of such presentations should include bedbug exposure, to avoid long-lasting disease, unnecessary diagnostic procedures, and the associated psychological burden for the patient.
Uso de la información del envase de alimentos en Chile: análisis nacional con enfoque en responsables de niñas y niños menores de 5 años
(2025) Orellana, Romina; Soto, Carla; Quintiliano-Scarpelli, Daiana; Pemjean, Isabel; Corvalan, Camila; Zancheta, Camila
Objetivos: Describir el uso de información del envase para selección de alimentos por personas adultas en Chile y verificar su asociación con varia- bles sociodemográficas y con ser responsable de niños/as. Métodos: Estudio transversal basado en datos secundarios de la Encuesta Nacional de Salud (ENS) 2016-2017. Fueron incluidas las personas mayores de 18 años e identificadas las responsables de niños/as de entre 7 meses y 5 años. Se analizó el uso de ingredientes, información nutricional, sellos de advertencia, mensajes saludables, marca y precio en la decisión de compra de alimentos (SÍ: siempre, casi siempre, algunas veces; NO: rara vez, nunca). Las asociaciones fueron verificadas con modelos de regresión logística, ajustados por variables sociodemográficas. Resultados: Las informaciones más utilizadas fueron el precio (71,3%) y la marca (62,2%), seguidas de los sellos de advertencia (55,4%). La tabla nutricional fue la menos utilizada (43,3%). El uso frecuente de las informaciones del envase se relacionó con el sexo femenino, mayor educación y renta y con residencia en zona urbana. El 11,2% de los/as participantes eran responsables de niños/as, mayo- ritariamente mujeres (85,2%). No se observaron diferencias en el uso de las informaciones del envase entre las personas responsables de niños/as. Conclusiones: Tras la implementación de la ley, los sellos de advertencia se convirtieron en una fuente importante de información para la compra. Aunque la legislación se enfoca en la protección de menores de 14 años, no se encontró uso diferencial del envase por responsables de niños/as, lo que puede relacionarse con factores intrafamiliares y sociales que influyen en esas decisiones.
Advantages of the upper eyelid approach with lateral canthotomy in the resolution of complex fronto-orbito-zygomatic fractures: bibliographic review of conventional approaches and a case report
(2025) Tapia, Pedro; Díaz, Fernanda; Zeballos, Jessica; Díaz, Sofía; Jollán, Florencia; Ossandón-Zúñiga, Benjamín
This study presents a modified upper eyelid approach incorporating a lateral canthotomy to improve surgical access in complex fronto-orbital fractures. A 69-year-old male patient with no comorbidities was admitted to the regional hospital of Rancagua with a left fronto-orbital-zygomatic fracture. Surgery was performed under general anesthesia using an upper eyelid incision combined with a lateral canthotomy to enhance exposure of the fracture site. Reduction and osteosynthesis of the lateral orbital wall and part of the frontal bone were successfully achieved without complications. The modified approach provided wide and direct access to the affected areas, particularly beneficial in cases with comminuted fractures requiring the placement of multiple osteosynthesis elements. The lateral canthotomy significantly expanded the surgical field, facilitating accurate reconstruction. Additionally, the eyelid incision, placed along the natural palpebral crease, offered excellent aesthetic results with a nearly imperceptible scar. This technique proves to be a valuable option for the management of complex fronto-orbital injuries, combining effective exposure with favorable cosmetic outcomes. It is especially useful in extended fractures where optimal visualization is critical for successful repair. The upper eyelid approach with lateral canthotomy thus stands out as a reliable and aesthetically conscious alternative for orbital fracture surgery.

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