Repositorio Institucional
Nuestra plataforma Reúne, conserva y difunde la producción intelectual en formato digital de estudiantes, académicos e investigadores de la Universidad del Desarrollo. Es una plataforma web colaborativa diseñada y administrada por el Sistema de Bibliotecas, en el que participan las unidades académicas como proveedoras de contenido, ejerciendo el rol de editor en su respectiva “comunidad” Leer Más...
¿Qué estás buscando?
Recent Submissions
Ángulo de Convergencia de la Línea Articular después de la Artroplastia Total de Rodilla: Comparación entre Alineación Mecánica y Alineación Paciente Específica con Cirugía Asistida por Robot
(2025) Figueroa, David; Gonzalez, Waldo; Isla, Jorge; Figueroa, Francisco; Figueroa, Loreto; Rodrigo Guiloff; Guiloff, Rodrigo
Introducción
Como un método para mejorar la satisfacción del paciente después de la artroplastia total de rodilla (ATR), se han realizado diferentes estrategias de alineación para restaurar las superficies femorales y tibiales a su estado preartrítico.
Debido a este cambio de paradigma, la orientación de la línea articular de la rodilla (JLO), un componente esencial de la cinemática de la rodilla, ha despertado recientemente interés como parámetro clínico.
Este estudio tuvo como objetivo evaluar la JLO de la rodilla, medida por el ángulo de convergencia de la línea articular (JLCA), después de la ATR en dos estrategias de alineación diferentes mientras se utiliza cirugía asistida por robots.
Nuestra hipótesis fue que una estrategia de alineación específica para el paciente conduciría a más valores de JLCA considerados normales (0–2°).
Métodos
Se realizó una revisión retrospectiva de datos de 98 pacientes (100 rodillas) que se sometieron a ATR asistida por robots.
El Grupo I consistió en 50 rodillas que se sometieron a ATR utilizando una estrategia de alineación mecánica, y el Grupo II consistió en 50 rodillas que se sometieron a ATR utilizando una estrategia de alineación específica para el paciente.
El JLCA fue medido por dos observadores diferentes en radiografías preoperatorias y postoperatorias.
Se realizó un análisis estadístico utilizando la prueba t de Student, la prueba de chi-cuadrado y la regresión lineal para análisis multivariable.
Resultados
No hubo diferencias demográficas estadísticamente significativas entre ambos grupos en cuanto a edad, género, lado, índice de masa corporal, clasificación de Kellgren-Lawrence, rango de movimiento preoperatorio y medición del ángulo de cadera-rodilla-tobillo (HKA).
La edad promedio fue de 69 años y el 61,2 % de todos los pacientes eran mujeres.
En el Grupo I, el JLCA promedio preoperatorio fue de 2,34° (1,49 DE), y el JLCA promedio postoperatorio fue de 0,35° (0,27 DE).
En el Grupo II, el JLCA promedio preoperatorio fue de 2,43° (1,72 DE), y el JLCA promedio postoperatorio fue de 0,29° (0,24 DE).
En el Grupo I, la diferencia media entre el JLCA preoperatorio y postoperatorio fue de 2,34 (1,48 DE), y en el Grupo II la diferencia media entre el JLCA preoperatorio y postoperatorio fue de 2,43 (1,72 DE).
No hubo una diferencia estadísticamente significativa entre ambos grupos en cuanto a la mejora del JLCA (p = 0,285).
Conclusiones
El JLCA mejoró en el postoperatorio en ambas estrategias de alineación, mecánica y específica del paciente, después de la ATR asistida por robots, sin diferencias significativas entre las estrategias.
Introduction
Different alignment strategies have been used to restore the femoral and tibial surfaces to their pre-arthritic state after total knee arthroplasty (TKA), improving patient satisfaction.
Due to this paradigm change, the knee joint line orientation (JLO), an essential component of knee kinematics, has recently garnered interest as a clinical parameter.
This study aimed to evaluate the JLO measured by the joint line convergence angle (JLCA) after TKA using two different alignment strategies and robotic-assisted surgery.
We hypothesized that a patient-specific alignment strategy would lead to more JLCA values considered normal (0–2°).
Methods
A retrospective review of data from 98 patients (100 knees) who underwent robotic-assisted TKA was performed.
Group I consisted of 50 knees that underwent TKA using a mechanical alignment strategy, and Group II consisted of 50 knees that underwent TKA using a patient-specific alignment strategy.
The JLCA was measured by two different observers in pre-operative and post-operative radiographs.
Statistical analysis was performed using the T-Student test, chi-square test, and linear regression for multivariate analysis.
Results
There were no statistically significant demographic differences between both groups regarding age, gender, side, body mass index, Kellgren-Lawrence classification, pre-operative range of motion, and hip-knee-ankle (HKA) angle measurement.
The mean age was 69 years and 61.2% of all patients were females.
In Group I, the average pre-operative JLCA was 2.34° (1.49 SD), and the average post-operative JLCA was 0.35° (0.27 SD).
In Group II, the average pre-operative JLCA was 2.43° (1.72 SD), and the average post-operative JLCA was 0.29° (0.24 SD).
In Group I, the mean difference between the pre- and post-operative JLCA was 2.34 (1.48 SD), and in Group II, the mean difference between the pre- and post-operative JLCA was 2.43 (1.72 SD).
There was no statistically significant difference between both groups regarding JLCA improvement (p = 0.285).
Conclusions
The JLCA improved post-operatively in both mechanical and patient-specific alignment strategies after robotic-assisted TKA, without significant differences between strategies.
Functional Outcomes of Patients With Proximal Humerus Fractures Treated With Primary Versus Salvage Reverse Shoulder Arthroplasty: A Cohort Study of 41 Patients
(2025) Ariztía, Antonio; Calvo, Andrés; Alba, Vicente; Paccot, Daniel; Bernal, Nazira; Aravena, Cristian; Reinares, Felipe
Introduction Reverse shoulder arthroplasty (RSA) is an option for patients with complex fractures of the proximal humerus and a salvage option for osteosynthesis failure, fracture sequelae, and hemiarthroplasty (HA) revision. The objective of this study was to compare the functional outcomes of primary RSA for proximal humerus fractures (PHFs) with those of salvage RSA for the failed treatment of PHFs. We hypothesized that patients undergoing primary RSA would experience significantly less pain and better functional outcomes than those receiving RSA as a salvage procedure. Methods This was a retrospective cohort study of patients with PHFs who underwent RSA initially or as a salvage procedure due to failure of conservative treatment, osteosynthesis, or HA. The demographic characteristics of the patients and the radiological features of the initial fracture were considered. Functional outcomes were assessed in terms of range of motion (ROM), the Constant-Murley score (CMS), the subjective shoulder value (SSV), and pain (visual analog scale (VAS)). For the comparative statistical analysis, the t-test and Mann-Whitney U test were used. Results Ninety patients underwent RSA, but only 41 patients were included. There were 23 patients in the primary RSA group and 18 in the salvage RSA group, with an average follow-up of 15 months (12-80 months). The primary RSA group experienced significantly less pain (VAS: 0.5±0.13 vs. 1.8±0.40) (p=0.002) and had a better CMS functional index score (73.2±1.6 vs. 65±3.01) (p=0.01) at the end of the follow-up period. No differences in ROM (active anterior elevation and external or internal rotation) or SSV were observed between the two groups. Conclusions In this series of patients, ROM was similar among the patients who underwent primary RSA and those who underwent salvage RSA; however, those who underwent primary RSA had better but not clinically relevant CMS and significantly less pain.
Indicaciones y planificación de la revisión en dos tiempos de la cirugía del ligamento cruzado anterior: revisión narrativa
(2025) Rodríguez Calvo, Rafael; González, Waldo; Figueroa, David; Calvo Mena, Rafael; Monge, Sebastián; Yáñez, Claudio
Resumen:
El aumento en las cirugías de reconstrucción del ligamento cruzado anterior (RLCA) ha generado un incremento proporcional en las revisiones quirúrgicas. Estadísticas canadienses estiman aproximadamente 13 000 revisiones anuales, mientras que en EE. UU. se reporta una incidencia entre el 4.1 y el 13.3 % de todas las RLCA. El éxito de una cirugía de revisión depende de un enfoque sistemático que permita identificar la causa de la falla, como una rerotura o inestabilidad persistente, y planificar el procedimiento definitivo. Si bien la mayoría de estas revisiones se realizan en un solo tiempo, entre el 8 y el 9 % requieren un abordaje en dos tiempos. Esta decisión depende de factores como la calidad ósea, el tamaño y la posición de los túneles, el método de fijación previo
y la presencia de lesiones asociadas. La principal indicación para una revisión en dos tiempos es la osteólisis con túneles mayores a 14 mm o el riesgo
de convergencia entre los túneles primarios y de revisión. En este artículo se presenta una revisión narrativa sobre las indicaciones y la planificación quirúrgica de las revisiones del LCA en dos tiempos. En conclusión, existe evidencia limitada, y en general de corto plazo, sobre los resultados de la reconstrucción
del LCA en revisiones de dos etapas. A pesar de estas suelen realizarse en casos más complejos, los resultados reportados mostraron resultados clínicos comparables.
Abstract:
The increase in anterior cruciate ligament reconstruction (ACLR) surgeries has led to a proportional rise in revision procedures. Canadian statistics estimate approximately 13 000 annual revisions, while in the United States, the reported incidence ranges from 4.1% to 13.3% of all ACLRs. The success of a revision surgery depends on a systematic approach that identifies the cause of failure, such as rerupture or persistent instability, and allows for the planning of the definitive procedure. While most of these revisions are performed in a single stage, 8% to 9% require a two-stage approach. This decision depends on factors
such as bone quality, tunnel size and position, previous fixation methods, and the presence of associated injuries. The primary indication for a two-stage revision is osteolysis with tunnels larger than 14 mm or the risk of convergence between primary and revision tunnels. This article presents a narrative review analyzing the indications and surgical planning for two-stage ACL revision procedures.
Formación en humanidades médicas en las escuelas de medicina de Chile
(2025) Vukusic, Antonio; Castillo, Marcela
Profesionalismo y cuidado en la época pospandémica: algunas reflexiones para pensar en la formación de los profesionales de la salud
(2025) Benaglio, Carla
El comportamiento profesional, o profesionalismo, se centra en la interacción con el paciente y en el entorno laboral. Se refiere a un código de conducta y a valores como el altruismo, la humanización y la comprensión cultural. Este concepto abarca un conjunto de habilidades, conocimientos y conductas destinadas a proteger, respetar y asistir a las personas en condiciones vulnerables de la mejor manera posible. La capacidad de cuidar a los demás es una competencia
fundamental para los profesionales de la salud, y su valor esencial se articula en el respeto, la empatía, la honestidad y la ética en el cuidado. La literatura indica que el profesionalismo no se mantiene estable a lo largo del tiempo; por el contrario, sufre una notable “erosión” que depende de diversos factores, tanto personales como profesionales, afectando así la capacidad de brindar una atención de calidad. El bienestar del profesional de la salud influye significativamente en su comportamiento, lo cual, a su vez, repercute en la posibilidad de cometer errores o de no colaborar de manera efectiva con el equipo. El período caracterizado por la pandemia de COVID-19 ha aumentado notablemente los niveles de estrés y burnout entre los profesionales de la salud, quienes se han visto expuestos a la incertidumbre, a altas tasas de mortalidad y a un distrés moral debido a las difíciles decisiones que han tenido que tomar. Este ha sido un período
particularmente doloroso, durante el cual ellos también han demostrado ser muy vulnerables. En este contexto, las instituciones sanitarias y educativas enfrentan hoy el gran desafío de priorizar el bienestar de los estudiantes y de los profesionales de la salud. Las actividades formativas basadas en las humanidades médicas y la medicina narrativa pueden contribuir, significativamente, a este bienestar, facilitando, a su vez, una reflexión enriquecedora sobre la práctica profesional y la capacidad de cuidar a los demás.
Professional behavior, or professionalism, focuses primarily on interaction with the patient and in the work environment. It refers to a code of conduct and values such as altruism, humanization, and cultural understanding. This concept encompasses a set of skills, knowledge and behaviours aimed at protecting, respecting and assisting people in vulnerable conditions in the best possible way. The ability to care for others is fundamental to professionalism, and
its essential value is articulated in respect, empathy, honesty, and ethics in care. The literature indicates that professionalism does not remain stable over time; on the contrary, it suffers a notable “erosion” that depends on various factors, both personal and professional, thus affecting the ability to provide quality care. The well-being of the health professional significantly influences their behavior, which, in turn, has an impact on the possibility of making mistakes or not collaborating effectively with the team. The period characterized by the COVID-19 pandemic has significantly increased the levels of stress and burnout among health professionals, who have been exposed to uncertainty, high mortality rates and moral distress due to the difficult decisions they have had to make. This has been a particularly painful period, during which they too have shown themselves to be very vulnerable. In this context, health and educational institutions confront the significant challenge of prioritizing the well-being of students and health professionals. Training activities grounded on medical humanities and narrative medicine can significantly enhance this well-being, facilitating enriching reflections on professional practice and the capacity to care for others.
The Prevalence of Multimorbidity Among Genitourinary Cancer Patients in Chile: A Retrospective Population-Based Study
(2025) Eltit, Ignacio; Juri, Diego; Delgado, Iris; Cáceres, Camila; Rojas, Ignacio; Fernández Arancibia, Mario
Introduction and Objectives: Multimorbidity, defined as the coexistence of two or more chronic conditions, poses significant challenges in healthcare by affecting patient outcomes and increasing costs. This study aimed to evaluate multimorbidity’s impact on patients with genitourinary cancer (GUC) in Chile, focusing on prevalent comorbidities, their combinations, and their association with hospitalization severity. Materials and Methods: A retrospective, population-based study was conducted using data from the Fondo Nacional de Salud (FONASA) in Chile, including patients with bladder, prostate, kidney, and testicular cancer between 2019 and 2021. Diagnosis-related group (DRG) data were used to analyze comorbidity prevalence, hospitalization type (elective vs. emergency), severity (moderate/major vs. minor/none), length of stay, and associated costs. Results: Among 4,028,597 hospital events, 11.6% were related to GUC, involving 18,792 patients. Multimorbidity was present in 67.3% of patients, with hypertension and diabetes being the most common comorbidities. These patients accounted for 69.1% of total GUC care costs. Hospital mortality was higher in multimorbid patients (7.5% vs. 3.7%; p < 0.001), who also had longer stays (mean 8 vs. 5 days). Most patients were admitted electively (60.3%), while 39.7% were admitted through the emergency room. Patients with multimorbidity had higher rates of moderate/major severity hospitalizations compared to those without (56.1% vs. 32.5%; p < 0.001). Conclusions: In Chile, multimorbidity among GUC patients is linked to increased costs, longer hospital stays, higher mortality, and greater hospitalization severity. Comprehensive care strategies are needed to improve outcomes and reduce healthcare system burdens.
El futuro es hoy: Integrando la inteligencia artificial en la práctica médica
(2025) Errázuriz, Pedro
La inteligencia artificial (IA) está transformando rápidamente la práctica clínica, ofreciendo diversas aplicaciones en múltiples ámbitos de la atención médica. Las tecnologías impulsadas por IA, como el aprendizaje automático, el procesamiento del lenguaje natural y la visión computacional, facilitan tareas como el triaje
de pacientes, programación de citas, síntesis de antecedentes médicos, apoyo diagnóstico y análisis predictivos para condiciones críticas como la sepsis. Además, la IA permite generar contenidos educativos, programas de rehabilitación y mejorar la adherencia terapéutica mediante herramientas personalizadas de monitoreo. A pesar de estos prometedores avances, su implementación exige abordar desafíos éticos relacionados con la confidencialidad de los datos, amplificación de sesgos, transparencia y responsabilidad. Para aprovechar plenamente el potencial clínico de la IA, es fun- damental capacitar adecuadamente a los profesionales de la salud, asegurar la participación informada de los pacientes e integrar responsablemente estas tecnologías en la práctica médica cotidiana.
Artificial intelligence (AI) is rapidly transforming clinical practice, offering diverse applications across healthcare settings. AI-driven technologies, including machine learning, natural language processing, and computer vision, enable tasks such as patient triage, appointment scheduling, medical history summarization,
diagnostic support, and predictive analytics for critical conditions like sepsis. Furthermore, AI facilitates educational content generation, rehabilitation programs, and enhances patient adherence through personalized monitoring tools. Despite these promising capabilities, its adoption requires addressing ethical challenges related to data confidentiality, bias amplification, transparency, and accountability. To fully leverage AI’s clinical potential, healthcare professionals must receive adequate training, ensure informed patient engagement, and contribute actively to the responsible integration of these technologies into everyday medical practice.
Eficacia del dispositivo de avance mandibular en el manejo de la apnea obstructiva del sueño: una revisión narrativa de sus implicaciones clínicas y terapéuticas
(2025) Vallés, Valentina; Palacios, Silvana; Chavarría, Martín; Estrada, Felipe
El dispositivo de avance mandibular (DAM) representa una alternativa terapéutica innovadora para el tratamiento de la apnea obstructiva del sueño (AOS), una condición respiratoria discapacitante con importantes implicaciones para la calidad de vida y la salud general. Esta revisión narrativa se llevó a cabo mediante una búsqueda exhaustiva en las bases de datos PubMed y Scopus, utilizando palabras clave relacionadas con el DAM y la AOS. Se seleccionaron artículos publicados en los últimos 10 años, los cuales fueron analizados críticamente con el objetivo de sintetizar la evidencia disponible sobre el uso clínico de este dispositivo.En este trabajo se aborda demanera detallada el diseño del DAM como un factor clave para predecir el éxito del tratamiento, su mecanismo de acción, sus características principales, así como las indicaciones y contraindicaciones absolutas para su uso. Los hallazgos de esta revisión buscan contribuir a una mejor comprensión del papel del DAM en el manejo de la AOS, proporcionando una perspectiva basada en la evidencia que permita optimizar su aplicación clínic.
The mandibular advancement device (MAD) represents an innovative therapeutic alternative for the treatment of obstructive sleep apnea (OSA), a disabling respiratory condition with significant implications in the quality of life and general health. This narrative review was conducted through an exhaustive search of the PubMed and Scopus databases, using keywords related to MAD and OSA. Articles published within the last 10 years were selected and critically analyzed with the aim of synthesizing the available evidence on the clinical use of this device.This work addresses in detail the design of the MAD as a key factor for predicting treatment success, its mechanism of action, its main characteristics, as well as the absolute indications and contraindications for its use. The findings of this review seek to contribute to a better understanding of the role of MAD in OSA management, providing an evidence-based perspective that allows for optimizing its clinical application.
Effect of weightlifting shoes on stability during barbell squat in high intensity cross training athletes
(2025) Poletto, Giorgio; Borsatto, Eduardo; De campos, Daiani; Campo, Eduardo; Álvarez, Joel; De Brito, Heiliane
Efectividad y beneficios del ejercicio físico en pacientes con fibromialgia: una revisión bibliográfica
(2025) Gomez, Nathalia; Smith Raúl; Levenier, Michelle
Introduction: Fibromyalgia is a chronic condition characterized by widespread pain, non-restorative sleep, fatigue, and cognitive dysfunction, which significantly affects patients’ quality of life. Material or Patients and Methods: This literature review analyzes the efficacy and benefits of physical exercise in the management of fibromyalgia, including aerobic exercises, strengthening, flexibility, aquatic activities, and specific practices like Tai Chi, yoga, and Pilates. The search was conducted in the scientific databases PubMed, Scopus, and Google Scholar. Priority was given to the inclusion of randomized clinical trials, systematic reviews, and meta-analyses. Results: Evidence demonstrates that physical exercise can reduce pain, improve functional capacity and quality of life, and decrease fatigue and stiffness. At the molecular level, physical exercise modulates inflammatory markers and neurotransmitters, contributing to the reduction of central sensitization and improving cognitive function and sleep quality. However, the response to exercise varies among patients due to the heterogeneity of the condition. Conclusion: It is crucial to design individualized and progressive exercise programs to maximize benefits and minimize the risk of exacerbating symptoms. Interdisciplinary collaboration and the integration of strategies to improve adherence are essential for developing safe and effective exercise programs that enhance the quality of life for patients with fibromyalgia.
Experiencias en la incorporación de humanidades médicas a lo largo de la carrera de medicina
(2025) Benaglio, Carla
Experiencia de consultoría ético-clínica en una institución chilena
(2025) Portales, Bernardita
Los Servicios de Consultoría Ético-clínica se han desarrollado como complemento a los Comités de Ética Asistencial. En este manuscrito se hace referencia a la Conferencia presentada en el XIV Seminario de Bioética de la Academia Chilena de Medicina, en que se expuso sobre la experiencia del Servicio de Consultoría Ético-clínica de Clínica Alemana de Santiago, implementado el año 2008. Se señalan algunos resultados en base a un trabajo de tesis realizado en que se describe el proceso y la forma de trabajo de este servicio, y se hace referencia también a una publicación que trata sobre una encuesta realizada a médicos intensivistas de adultos de dicha institución en que se pregunta sobre la percepción del aporte de este tipo de interconsultas. Finalmente, se menciona la participación actual de los consultores ético-clínicos en el programa de Planificación Anticipada de Cuidados y Voluntades Anticipadas en Clínica Alemana de Santiago. Se concluye en la relevancia de desarrollar estos Servicios de Consultoría ético-clínica, así como la importancia de llevar a cabo evaluaciones periódicas de los procesos, formas y modelos de trabajo junto con estar atentos a nuevos desafíos o necesidades que puedan surgir.
Clinical Ethics Consult Services have been developed as a complement to Health care Ethics Committees. This manuscript refers to the conference presented at the XIV Bioethics Seminar of Bioethics of Chilean Academy of Medicine. The experience of the Clinical Ethics Consult Service of “Clínica Alemana de Santiago”, implemented in 2008, was presented. Some results are pointed out based on a tesis work that describes the process and the way of working of this service, and reference is also madeto a publication that deals with a survey carried out on adult intensive care physicians of that institution, in which the perception of the contribution of this typeo finter consultations is asked. Finally, the current participation of clinical ethics consul-tants in the Advance Care Planning and Advance Directives Program at “Clínica Alemana de Santiago” is mentioned. It is concluded that these clinical ethics consult services are relevant,
as well as the importance of carrying out periodic evaluations of the processes, forms and work models, along with being attentive to new challenges or needs that mayarise.
Educación en genética y genómica en medicina ¿por qué, qué y cómo?
(2025) Repetto, Gabriela
La Genética y la Genómica tienen un rol importante como determinantes de salud y enfermedad. Este siglo ha visto grandes avances tecnológicos, como la secuenciación masiva del genoma, que han llevado a una mejor comprensión de mecanismos, factores de riesgo, prevención y terapias. Sin embargo, la implementación de estos desarrollos en la práctica clínica y en los sistemas de salud es muy heterogénea en el mundo. Esto ha generado un aumento de brechas globales. El reciente reporte del Consejo Científico de la Organización Mundial de la Salud, titulado “Acelerando el acceso a la genómica para salud. global” hace un llamado a los Estados Miembros a avanzar en dicha implementación de manera equitativa. Un aspecto clave para este propósito es la formación y educación de los profesionales de salud. Este articulo resume propuestas y resultados internacionales, así como un análisis de situación de las carreras de Medicina en Chile, algunas experiencias locales y un llamado a la colaboración nacional e internacional en el tema, en beneficio de la salud individual y poblacional.
Genetics and Genomics play an important role as determinants of health and disease. This century has seen significant technological advances, such as massive genome sequencing, which have led to a better understanding of mechanisms, risk factors, prevention, and therapies. However, the implementation of these developments in clinical practice and health systems is very heterogeneous worldwide, resulting in increasing global gaps. The recent report by the World Health Organization’s Scientific Council, titled “Accelerating Access to Genomics for Global Health,” calls on Member States to advance this implementation equitably. A key aspect for this purpose is the training and education of health professionals. This article summarizes international proposals and results, as well as an analysis of the situation of medical careers in Chile, some local experiences, and a call for national and international collaboration on this issue, benefiting individual and population health.
Diagnosis of langerhans cell histiocytosis based on maxillofacial manifestations in an adult: case report
(2025) Humeres, Carlos; Rojas, Alexandra; Flores, María José; Cicali, Sebastian; Venegas, José; Estrada, Felipe; Monsalves, Nicolás
Background: Langerhans cell histiocytosis (LCH) is a rare clonal disease that most commonly affects the pediatric population. In adults, its diagnosis is challenging due to its low prevalence and nonspecific clinical manifestations. The maxillofacial region may be the first site affected, making the dentist a key figure in early detection. Materials and Methods: We present the case of a 38-year-old male patient who consulted due to tooth mobility and difficulty chewing. Radiographic examination revealed osteolytic lesions in the mandible. The diagnosis was confirmed by biopsy with immunohistochemical positivity for CD1a, CD68, and S100. The patient was referred to the hematology-oncology team, where a systemic workup was completed. Treatment included chemotherapy with vinblastine, prednisone, and mercaptopurine, along with endocrine management and radiotherapy. Results and Discussion: The patient showed a favorable outcome, with no recurrence after four years of follow-up. The mandible was the most commonly affected site, with symptoms including pain, tooth mobility, and radiolucent lesions. Diagnosis was confirmed by immunohistochemistry in all cases. Treatment modalities varied and included surgery, radiotherapy, and chemotherapy. Discussion: This case highlights the role of dentists in identifying rare systemic diseases. Tooth mobility without evident periodontal disease may be the first sign of LCH. The literature supports a multidisciplinary approach and the need to consider LCH in the differential diagnosis of maxillofacial lesions. Conclusions: LCH can initially present in the maxillofacial region. Early recognition enables timely intervention, improving prognosis and reducing the risk of systemic complications.
Demographic and Manometric Variables Can Independently Predict Gastroesophageal Reflux Disease: The AGES-D Score
(2025) Reyes, Diego; Muñoz, Ana; Candia, Roberto; Rey, Paula; Chahuan, Javier; Gran, Ignacio; Remes-Troche, José; Cisternas, Daniel; Monrroy, Hugo
Objective: Conclusive diagnosis of gastroesophageal reflux disease (GERD) can be challenging. When reflux monitoring is inconclusive, high-resolution esophageal manometry (HRM) may provide additional relevant information. We aimed to identify demographic and manometric parameters associated with GERD and to propose a diagnostic score.
Methods: Adult patients with GERD symptoms who underwent reflux monitoring and HRM were considered for inclusion. The gold standard for GERD diagnosis was acid exposure time (AET); patients with AET>6% and AET<4% were included. Univariate and multivariate analyses were performed. A diagnostic score was developed using parameters independently associated with GERD. Generation and validation cohorts were randomly selected in a 2:1 ratio. Diagnostic accuracy was assessed using the area under the receiver operating characteristic curve (AUC ROC).
Results: A total of 391 patients met the inclusion criteria; 167 had GERD (AET>6%) and 224 did not have GERD (AET<4%). In the multivariate analysis, age, male sex, and the distance between the lower esophageal sphincter and the crural diaphragm (LES-CD) were directly associated with GERD, while esophagogastric junction contractile integral (EGJ-CI) and distal contractile integral (DCI) were inversely associated with GERD (p values: 0.03, <0.01, <0.01, 0.01, and 0.01, respectively). The AUC ROC of a diagnostic score based on these parameters was 0.76 and 0.82 in the generation and validation cohorts, respectively.
Conclusions: In this observational study, age, male sex, LES-CD distance, EGJ-CI, and DCI (AGES-D) were independently associated with GERD. A novel score incorporating these parameters could be useful in the assessment of inconclusive cases.
Delayed Sacral Insufficiency Fracture Following Oncologic Resection of a Chondrosarcoma: Emphasizing the Role of Biomechanical Risk Assessment
(2025) Valencia, Manuel; Silva, Álvaro; Zuniga, Joaquín; Marré, Andrea
Introduction: Sacral chondrosarcoma is a primary malignant bone tumor for which en bloc resection remains the standard treatment. Given its location and role within the pelvic ring continuity, it poses a surgical and reconstructive challenge. Even with successful oncologic resection, the lack of a comprehensive preoperative biomechanical analysis may contribute to late-onset complications requiring reinterventions and impair the patient's quality of life.
Case report: The case describes a 41-year-old woman with no previous diagnosis of osteoporosis or prior fractures who underwent en bloc resection of a sacral chondrosarcoma at the S1-S2 level, without initial complications. Six months post-operatively, the patient returned with pain and gait impairment. An insufficiency fracture at the S1 vertebral body and residual sacral wing was identified, without signs of tumor recurrence or associated fluid collection. It was managed with posterior lumbopelvic fixation, with a favorable outcome and recovery in a 5-year follow-up.
Conclusion: This case underlines the importance of the biomechanical integrity of the pelvic ring. It raises the need for assessment of the biomechanical risk within the oncologic surgical planning, despite the absence of classical bone fragility factors. Thus, structural destabilization of the pelvis must consider corrective or preventive strategies to prevent complications. A comprehensive analysis of these factors allows for improved functionality and patients quality of life.
Cinetosis en niños: Actualización de fisiopatología, diagnóstico, manejo y prevención
(2025) Troc, Constanza; Iribarren, Javier; Contreras, Daniela; Breinbauer, Hayo; Cordano, Valentina; Ramos, Phoebe
Resumen
La cinetosis es considerada como un vértigo fisiológico que ocurre como respuesta normal ante una percepción inusual de movimiento. Afecta principalmente a niños, entre 2 a 12 años. La etiología aún es desconocida. Los síntomas pueden afectar la calidad de vida diaria y el desarrollo de los niños y de sus familias, por lo que es importante conocer sobre esta condición para su adecuada prevención y manejo. Este artículo busca proveer una actualización de las bases fisiopatológicas, presentación clínica, diagnóstico y manejo de la cinetosis en población pediátrica. Se realizó una búsqueda en PubMed y Cochrane data base. Se incluyeron 55 estudios. Se encontró que la teoría del conflicto sensorial es la más ampliamente aceptada para explicar la cinetosis. Los síntomas más comunes son mareos, vértigo, cefalea, y náuseas, entre otros. El diagnóstico es clínico. El manejo incluye medidas generales, tratamiento farmacológico principalmente con antihistamínicos, rehabilitación vestibular y tratamiento de comorbilidades como migraña. En conclusión, susceptibilidad se relaciona con factores genéticos, edad, antecedentes de migraña y trastornos vestibulares. Teorías como el conflicto sensorial y vertical subjetivo ofrecen marcos explicativos. Medidas conductuales y modificaciones ambientales pueden ser efectivas para prevenir la cinetosis. Finalmente, se destaca la falta de información específica sobre cinetosis pediátrica, subrayando la necesidad de futuras investigaciones.
Abstract
Motion sickness is a syndrome considered a physiological vertigo, as it occurs as a normal response to an unusual perception of movement. It frequently affects children, mainly between the ages of 2 and 12. Although its prevalence is uncertain, the symptoms deeply impact children’s quality of life and development. Clinicians need to be aware of this condition for its proper prevention and management. This article aims to provide an update on motion sickness physiopathology, clinical presentation, diagnosis, and management in pediatric population. A literature review was conducted in PubMed and Cochrane databases. Fifty-five studies were included. It was found that sensory conflict theory is the most widely accepted explanation for motion sickness. The most common symptoms are dizziness, vertigo, headache and nausea, among others. The diagnosis is clinical. A fundamental aspect of management is prevention through general measures, supported by medications such as antihistamines and ondansetron, though the role of these drugs in this population remains unclear. Additionally, vestibular rehabilitation and migraine treatment are important for patients with these comorbidities. In conclusion, susceptibility is related to genetic factors, age, history of migraines, and vestibular disorders. Theories such as sensory conflict and subjective vertical offer explanatory frameworks. Behavioral measures and environmental modifications can be effective in preventing motion sickness. Finally, there is a notable lack of specific information on pediatric motion sickness, highlighting the need for future research.
Características clínicas, tratamientos y su impacto en la calidad de vida y productividad laboral en pacientes chilenos con espondiloartritis: Un estudio basado en encuestas web
(2025) Ibáñez, Sebastián; Díaz, Pamela; Zúniga, Leana
RESUMEN
Objetivo: Describir las características clínicas, los tratamientos utilizados y el impacto de la espondiloartritis (EspA) en la calidad de vida y la productividad laboral de los pacientes en Chile. Métodos: Estudio transversal basado en una encuesta web autoadminis- trada dirigida a pacientes con diagnóstico de EspA. Se utilizaron instrumentos validados como BASDAI, BASFI, ASAS-HI, WPAI y FiRST. Se compararon los resultados entre usuarios y no usuarios de terapias biológicas o inhibidores de JAK. Resultados: Se incluyeron 346 pacientes, con una mediana de edad de 43 años; el 70,8% eran mujeres. El retraso diagnóstico tuvo una mediana de 4 años. El 41,9% reportó ser HLA-B27 positivo. El diagnóstico más frecuente fue EspA axial radiográfica (71,1%). En cuanto a tratamientos, el 76,3% usaba AINE, 44,8% FAME, 33,5% terapias biológicas o JAKi y 30,9% opiáceos. El 78% presentó un BASDAI > 4 y el 27,8% un ASAS-HI > 12. El impacto en la productividad laboral fue significativo: el presentismo y la pérdida total de productividad alcanzaron medianas de 50%, mientras que el impacto en actividades generales fue del 60%. Los usuarios de biológicos o JAKi mostraron menor actividad de la enfermedad (BASDAI 5,1 vs 6,2; p = 0,0004), mejor capacidad funcional (BASFI 4,4 vs 5,6; p = 0,0206), menor nivel de afectación subjetiva y menor pérdida de productividad laboral (46,3% vs 50%; p = 0,0151), en comparación con los no usuarios. Conclusión: Los resultados una alta carga de enfermedad en los pacientes con EspA en Chile, asociada a un uso limitado de terapias avanzadas y a barreras en el acceso al tratamiento. Se destaca la necesidad de estrategias diagnósticas y terapéuticas más efectivas y accesibles, así como una mejor comprensión del impacto de la enfermedad en la vida laboral y social de los pacientes.
ABSTRACT
Objective: To describe the clinical characteristics, treatments used, and the impact of spondyloarthritis (SpA) on the quality of life and work productivity of patients in Chile. Methods: A cross-sectional study based on a self-administered web survey targeting patients with a diagnosis of SpA. Validated instruments such as BASDAI, BASFI, ASAS-HI, WPAI, and FiRST were used. Results were compared between users and non-users of biological therapies or JAK inhibitors. Results: A total of 346 patients were included, with a median age of 43 years; 70.8% were women. The median diagnostic delay was 4 years. A total of 41.9% reported being HLA-B27 positive. The most frequent diagnosis was radiographic axial SpA (71.1%). Regarding treatments, 76.3% used NSAIDs, 44.8% synthetic DMARDs, 33.5% biological or JAK inhibitor therapies, and 30.9% opioids. High disease activity (BASDAI > 4) was found in 78% of patients, and 27.8% had an ASAS-HI > 12. The WPAI indicated a substantial work impact: median presenteeism and total work productivity loss were both 50%, and impairment in general activities reached 60%. Users of biologics or JAK inhibitors had lower disease activity (BASDAI 5.1 vs 6.2; p = 0.0004), better functional capacity (BASFI 4.4 vs 5.6; p = 0.0206), lower subjective disease impact, and reduced productivity loss (46.3% vs 50%; p = 0.0151) compared to non-users. Conclusion: The findings reveal a high disease burden among Chilean patients with SpA, associated with limited use of advanced therapies and barriers to treatment access. These results underscore the need for more effective and accessible diagnostic and therapeutic strategies, and greater awareness of the social and occupational impact of the disease.
Consultoría ético clínica: su razón y sus roles
(2025) Beca, Juan
Abstract
Clinical Ethics Consultation emerged from the experience of Clinical Ethics Committees (CEC), as a way of getting over their limitations. CEC meets once or twice per month, analyzes cases in a more theoretical mode, ignoring contextual features. Consultation brings Bioethics closer to health professionals, patients and their relatives, but there is no universal methodology for its work. Consultants need special training and are members of CEC. All cases are discussed in CEC meetings more in their theoretical than their practical perspective. From our experience of more than 15 years in ethical consultation we define four roles of Clinical Ethics Consultation: 1) Deliberation of clinical and bioethical issues altogether with patient’s values and preferences; 2) Bring Bioethics closer to clinics, contextual features and patient’s life; 3) Support for patients, relatives or surrogates their participation in decision making; and 4) Analysis of paradigmatic cases in CEC for their study and eventual normative proposals.
Resumen La consultoría ético-clínica surge después de la experiencia de los Comités de Ética Asistencial (CEA) y como un complemento que permite superar dificultades y limitaciones. Los CEA se reúnen, generalmente, una o dos veces al mes, analizan los casos de una manera más teórica y distante del paciente. Para acercar la Bioética a la cama del enfermo se ha desarrollado la consultoría, sin llegar aún a un sistema único de trabajo. Profesionales clínicos, miembros del CEA, se capacitan para asesorar en decisiones ético-clínicas complejas, deliberando sobre los problemas con los tratantes y con el paciente y sus familiares o representantes. Los casos se presentan después al CEA para su análisis más conceptual del tema de cada caso. Se presentan, en base a la experiencia de más de 15 años, 4 roles de la consultoría ético-clínica como una forma eficaz de apoyo a los profesionales y una ayuda a pacientes y familiares. Los roles son: 1) Deliberar incorporando lo clínico, lo bioético y los valores o preferencias del paciente; 2) Acercar la Bioética al contexto, a lo clínico y a la vida de cada paciente; 3) Apoyar a pacientes, familiares y subrogantes en su participación en la toma de decisiones; y 4) Analizar en el Comité de Ética los casos paradigmáticos para su estudio y posibles propuestas normativas.
Biomarkers in Systemic Sclerosis
(2025) Karsulovic, Claudio; Hojman, Lia
Systemic sclerosis (SSc) is a complex autoimmune disease characterized by vasculopathy, immune dysregulation, and progressive fibrosis affecting the skin and internal organs. Pulmonary complications, including interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH), are major contributors to morbidity and mortality, while skin fibrosis remains a hallmark of disease heterogeneity. Despite advances in understanding SSc pathogenesis, early diagnosis and timely therapeutic intervention remain challenging due to the rapid progression of inflammation and the narrow window before irreversible fibrosis occurs. The identification of reliable biomarkers is crucial for improving diagnosis, monitoring disease activity, and guiding treatment decisions in SSc. While autoantibodies are well-established diagnostic tools, this review focused on non-autoantibody biomarkers, including soluble proteins, cytokines, chemokines, epigenetic modifiers, and oxidative stress indicators. These biomarkers reflect diverse pathogenic mechanisms such as endothelial injury, fibroblast activation, immune signaling, and extracellular matrix remodeling. By examining the available evidence across both clinical and preclinical studies, this review provides an updated overview of molecular markers involved in inflammation and fibrosis in SSc. Understanding their biological significance and therapeutic potential may improve risk stratification, guide targeted interventions, and ultimately contribute to the development of precision medicine strategies in systemic sclerosis.