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Tumor testicular de células de la granulosa juvenil en el período neonatal: diagnóstico y manejo a propósito de dos casos clínicos
(2026) Bozzo, Florencia; De la Cuadra, Julieta; Dulanto, Elena
Introducción: El tumor testicular de células de la granulosa juvenil es una neoplasia poco frecuente del estroma de los cordones sexuales, que representa menos del 5% de los tumores testiculares pediátricos. Se caracteriza por un curso clínico benigno y una presentación habitual como masa escrotal indolora en recién nacidos o lactantes. Objetivo: Describir dos casos clínicos de tumor testicular de células de la granulosa juvenil en lactantes, destacando sus características clínicas, hallazgos imagenológicos, confirmación anatomopatológica y manejo terapéutico con énfasis en su diagnóstico diferencial. Metodología: Reporte de dos casos clínicos siguiendo directrices CARE, con análisis clínico, imagenológico e histopatológico, luego de solicitar firma de consentimiento informado a ambos tutores legales. Desarrollo: Se describen dos lactantes con lesiones testiculares sólidoquísticas heterogéneas al estudio ecográfico. Uno presentó marcadores tumorales en rango normal y el otro, elevación de alfafetoproteína. Ambos fueron manejados mediante orquiectomía radical, con buena evolución posterior. El análisis histopatológico e inmunohistoquímico confirmó el diagnóstico de tumor testicular de células de la granulosa juvenil. Discusión: El tumor testicular de células de la granulosa juvenil debe considerarse dentro del diagnóstico diferencial de masas testiculares en lactantes, especialmente frente al tumor de saco vitelino. La edad y la interpretación contextual de los hallazgos clínicos e histopatológicos son fundamentales para el diagnóstico. Aunque la orquiectomía radical sigue siendo el tratamiento estándar, existen enfoques conservadores y terapias emergentes en casos seleccionados. Este reporte refuerza la importancia de su reconocimiento y adecuada correlación clínico-patológica.
Introduction: Juvenile granulosa cell tumor of the testis is a rare neoplasm of the sex cord–stromal tissue, representing less than 5% of pediatric testicular tumors. It is characterized by a benign clinical course and typically presents as a painless scrotal mass in newborns or infants. Objective: To describe two clinical cases of juvenile granulosa cell tumor of the testis in infants, highlighting their clinical features, imaging findings, histopathological confirmation, and therapeutic management, with emphasis on differential diagnosis. Methodology: Report of two clinical cases following CARE guidelines, including clinical, imaging, and histopathological analysis, after obtaining informed consent from both legal guardians. Development: Two infants with heterogeneous solid-cystic testicular
lesions identified on ultrasound are described. One had tumor markers within the normal range, while the other showed elevated alpha-fetoprotein levels. Both were managed with radical orchiectomy and had favorable outcomes. Histopathological and immunohistochemical analysis confirmed the diagnosis of juvenile granulosa cell tumor of the testis. Discussion: Juvenile granulosa cell tumor of the testis should be considered in the differential diagnosis of testicular masses in infants, especially in comparison with yolk sac tumor. Age and contextual interpretation of clinical and histopathological findings are essential for diagnosis. Although radical orchiectomy remains the standard treatment, conservative approaches and emerging therapies exist in selected cases. This report reinforces the importance of its recognition and proper clinicopathological correlation.
Empatía y conducta prosocial: Una reflexión desde la neurociencia cognitiva
(2025) Ceric Garrido, Francisco; Tejada, Maria del Carmen
En el ámbito de la neurociencia social contemporánea, la percepción de la naturaleza humana abarca un amplio espectro que va desde el egoísmo hasta la bondad innata. Desde esta perspectiva, se introduce la exploración de la conducta prosocial, la cual se fundamenta en la comprensión de cómo los individuos pueden manifestar comportamientos altruistas o colaborativos a lo largo de un continuo que oscila entre la búsqueda de beneficios propios y el deseo innato de ayudar a los demás. La interrelación entre la conducta prosocial y la empatía se convierte en un punto clave de estudio, ya que ambas dimensiones están intrínsecamente conectadas en la forma en que los individuos interactúan y se relacionan en sociedad. Comprender cómo estas dos facetas se entrelazan permite apreciar mejor la complejidad de la naturaleza humana y su influencia en la dinámica social.
Coexistencia entre necrosis avascular de las cabezas femoral y humeral: Una revisión narrativa exploratoria con características sistemáticas
(2026) Celis, Felipe; Prieto, Isidora; Beltrán, Álvaro; Requena, Jesús; Celis, Pablo
Introducción: La necrosis avascular es una condición caracterizada por muerte de células óseas secundaria a la interrupción del flujo sanguíneo. Afecta principalmente la cabeza femoral y, en menor medida, la humeral, sin embargo, existe escasa evidencia sobre la coexistencia entre ambas localizaciones. Objetivo: Explorar la evidencia disponible y describir patrones clínicos, factores de riesgo y estrategias diagnósticas. Metodología: Se realizó una revisión narrativa exploratoria siguiendo las directrices de la extensión PRISMA-ScR para revisiones sistemáticas. Se buscaron artículos publicados en PubMed de los últimos ocho años mediante términos relacionados con necrosis avascular de las cabezas femoral y humeral. Se incluyeron estudios observacionales y reportes de caso para análisis cualitativo. Resultado: Se incluyeron nueve artículos (seis reportes de caso y tres estudios observacionales). La literatura revisada describió una coexistencia de necrosis avascular de las cabezas femoral y humeral, siendo la cadera el sitio inicial más común. El uso crónico de corticosteroides fue el factor de riesgo predominantemente documentado para ambas localizaciones. La resonancia magnética fue el método diagnóstico descrito de mayor utilidad. Discusión: Los hallazgos sugieren mantener sospecha de compromiso humeral en pacientes con necrosis avascular de cabeza femoral con factores de riesgo sistémicos. Sin embargo, la heterogeneidad de los datos y el carácter retrospectivo de los estudios limitan la interpretación de los resultados. Conclusión: Esta revisión documenta la coexistencia entre necrosis avascular de cabeza femoral y humeral en presencia de factores de riesgo. Se requieren estudios prospectivos con mayor poder estadístico para caracterizar esta relación y orientar estrategias diagnósticas y terapéuticas.
Promoviendo el aprendizaje autorregulado en educación superior: Perspectivas desde la planificación, la enseñanza y la evaluación
(2025) Bruna, Daniela; Sánchez-Oñate, Alejandro Antonio
El propósito de este estudio fue evaluar el impacto de un programa de entrenamiento de docentes universitarios en estrategias de promoción de autorregulación del aprendizaje. Aun cuando la literatura señala diversas estrategias para promoverla, no hay claridad sobre las actividades concretas que realizan los docentes en aula. A través de un enfoque cualitativo, basado en la teoría fundamentada, se implementó un estudio mediante entrevistas semiestructuradas a 35 docentes (71.4% mujeres), con una edad media de 41.8 años, de una universidad privada del sur de Chile. Los resultados destacan prácticas de planificación y evaluación que promueven la autorregulación del aprendizaje, las dificultades observadas y la percepción del impacto de estas. Se concluye que el acompañamiento docente en la educación superior es clave para fomentar la autorregulación del aprendizaje y cuáles son las principales barreras para implementar esta práctica, aportando información relevante para el desarrollo de estas competencias.
Evaluación del bienestar subjetivo en estudiantes de educación media rural en Chile: Propiedades psicométricas de dos escalas
(2025) Sánchez-Oñate, Alejandro Antonio; Céspedes Cárdenas, Paz; Reyes Reyes, Fernando Teddy; Vergara-Barra, Pablo
Esta investigación se enfocó en evaluar las propiedades psicométricas del Índice de Bienestar Personal para Escolares (PWI-SC) y la Escala Breve de Bienestar Subjetivo en la Escuela para Adolescentes (BASWBSS) en escolares de enseñanza media de zonas rurales de Chile. La literatura sobre bienestar subjetivo en escolares muestra altas puntuaciones de bienestar en estudiantes urbanos, pero se carece de evidencia en estudiantes rurales. El estudio se realizó con 320 escolares (M = 16.5 años; DT = 1.24) de liceos públicos rurales en la Región del Biobío, Chile. Tanto el PWI-SC como la BASWBSS demostraron ser adecuadas para su uso en contextos rurales, con resultados de validez y confiabilidad similares a estudios con estudiantes urbanos. La validación de estas escalas para aplicarlas en contextos rurales es crucial para comprender y promover el bienestar en entornos escolares rurales. Los resultados contribuyen al campo de la medición del bienestar subjetivo en estudiantes chilenos de estas zonas. Los hallazgos tienen implicaciones tanto para la investigación como para la promoción del bienestar en escuelas rurales, destacando la importancia de considerar el contexto al desarrollar y aplicar instrumentos de medición.
Resilience as a predictor of empathy in Colombian nursing students
(2025) Hernández-Alvarez, Guiomar; López-Sáleme, Rossana; Escobar-Velásquez, Katty; Gamarra-Moncayo, José Rolando; Reyes Reyes, Fernando Teddy; Reyes-Reyes, Alejandro; Díaz-Narváez, Víctor
Objective: This study aims to determine whether individual resilience can predict empathic behavior in undergraduate nursing students and how resilience influences empathy (positively or negatively).
Methods: Descriptive, cross-sectional, and correlational study. The population consisted of 516 students from all academic semesters duly enrolled in the 2023 academic cycle in the Faculty of Nursing, Universidad Cartagena de Indias, Colombia. A convenience sample of 330 students was selected, with a predominance of women compared to men. To assess empathy, the Jefferson Scale of Empathy for Health Professionals was used, which has three dimensions (Compassionate Care, Perspective-Taking, and “Walking in the Patient’s Shoes”), and resilience was measured using the Trait Resilience Scale composed of three dimensions (Engineering, Ecology, and Adaptation). Empathy and resilience data were subjected to psychometric analysis to verify compliance with the theoretical model and the presence of the dimensions of each construct in the data. Descriptive statistics of each scale are presented. The prediction of resilience on empathy was performed using Structural Equation Models (SEM).
Results: There is an overall positive relationship between resilience as a predictor of empathy; the goodnessof-fit indicators of the implemented SEM model prove to be adequate; however, not all dimensions of the resilience variable prove to be adequate predictors when associated with the empathy dimensions, the ecological dimension of resilience positively predicts the perspective-taking dimension of empathy. In contrast, the adaptation dimension negatively predicts the compassionate care dimension of empathy, with no statistically significant relationship in the engineering dimension.
Conclusion: Individual resilience is a variable that can predict empathetic behavior in nursing students from the studied Faculty of Nursing.
Design and validation of the multidimensional school social climate inventory for adolescents (MSSCI-A) in Chile
(2025) Bravo-Sanzana, Mónica; Terán-Mendoza, Oscar; Miranda, Rafael; Oriol, Xavier; Varela, Jorge; Mieres-Chacaltana, Manuel
In Latin America, there is a critical need for validated instruments that capture the multidimensionality of school social climate from an ecological perspective. To fill this gap, this study developed and validated the Multidimensional School Social Climate Inventory for Adolescents (MSSCI-A). Using a non-experimental, cross-sectional design, data were collected from 8949 students across 16 Chilean regions, randomly divided for exploratory and confirmatory analyses. Content validity was ensured through expert judgment with Aiken’s V, while item variability was tested in a pilot study. Dimensionality was examined through Exploratory Factor Analysis (EFA) and Exploratory Graph Analysis (EGA), which identified 10 coherent and parsimonious dimensions. These combined expected domains such as Emotional Safety, Collaboration, and Belonging with hybrid factors that reflect how students experience interdependent aspects of school life. The Organizational Structure factor, however, did not meet minimum psychometric standards and was therefore removed. The final model was tested with Confirmatory Factor Analysis (CFA), while
internal consistency and convergent validity were supported through Cronbach’s alpha, McDonald’s omega, and AVE. Findings show that the MSSCI-A demonstrates strong psychometric properties. Overall, it constitutes one of the few validated, multidimensional, and culturally grounded tools in Latin America, with applications in research, educational practice, and policymaking.
Assessing psychological well-being among adolescents: A new multidimensional instrument for Chilean school students
(2025) Bravo-Sanzana, Mónica; Terán-Mendoza, Oscar; Miranda, Rafael; Oriol, Xavier; Varela, Jorge; Mieres-Chacaltana, Manuel
Adolescent psychological well-being is a key component of social and educational sustainability. Strengthening well-being during the school years supports healthy development, academic engagement, and resilience to contemporary challenges. Within the framework of the United Nations 2030 Agenda for Sustainable Development, fostering mental health and equity in education contributes to more inclusive, cohesive, and peaceful communities. This study aimed to develop and validate the Psychological Well-Being Scale for Adolescents in a Chilean school population. Drawing on Ryff’s multidimensional model, the scale included 32 items and was administered to 8638 high school students from all
sixteen regions of Chile. Exploratory Factor Analysis identified a seven-factor structure in which self-acceptance was divided into two dimensions: one associated with self-esteem and achievement, and another with self-appreciation and body image. Confirmatory Factor Analysis demonstrated that the seven-factor model achieved the best fit. The scale showed high internal consistency, adequate convergent validity, and measurement invariance. The Psychological Well-Being Scale for Adolescents is a psychometrically sound and culturally adapted instrument validated with Chilean adolescents in school contexts. Current evidence supports its use for research and applied assessment within Chilean educational settings.
Cross-national risk factors for childbirth-related PTSD: Findings from the INTERSECT study
(2025) Handelzalts, Jonathan E.; Ayers, Susan; Webb, Rebecca; Constantinou, Georgina; Lucas, Grace; Grollman, Christopher; Ohayon, Shay; Awad Sirhan, Natalia; Baird, Kathleen; Baldisserotto, Márcia; Batool, Ramish; Batool, Shahida; Caparros-Gonzalez, Rafael A.; Chorwe-Sungani, Genesis; Christoforou, Andri; Coo, Soledad; Costa, Raquel; Dikmen-Yildiz, Pelin; Ďuríčeková, Barbora; Dušová, Bohdana; Enea, Violeta; Garthus-Niegel, Susan; Grundström, Hanna; Gureje, Oye; Hadjigeorgiou, Eleni; Marie Haga, Silje; Horsch, Antje; Ionio, Chiara; Jarašiūnaitė-Fedosejeva, Gabija; Jomeen, Julie; Kazmierczak, Maria; Lalor, Joan; Milosavljevic, Maja; Nagle, Ursula; Nakić Radoš, Sandra; Nieminen, Katri; Damilola Oladeji, Bibilola; Osório, Flavia; Pawlicka, Paulina; Peled, Yoav
Background: Childbirth-related post-traumatic stress disorder (CB-PTSD) is an underrecognized condition with consequences for mothers and infants. This study aimed to determine risk factors for CB-PTSD symptoms across countries within a stress-diathesis framework, focusing on antenatal, birth-related, and postpartum predictors.
Methods: The INTERSECT cross-sectional survey (April 2021-January 2024) included 11,302 women at 6-12 weeks postpartum. The study was carried out across maternity services in 31 countries. Outcomes were CB-PTSD diagnosis, symptom severity, and perceived traumatic birth, assessed with the City Birth Trauma Scale. Multiple risk factors were assessed, including preexisting vulnerability, pregnancy, birth, and infant related factors. All models were adjusted for country-level variation as a random effect.
Results: Models explained substantial variance across all outcomes (conditional R2 = 0.53-0.58). Negative birth experience was the strongest predictor (e.g. odds ratio [OR] = 0.82, 95% confidence interval [CI] = 0.80-0.84 for diagnosis). Ongoing maternal complications predicted both CB-PTSD diagnosis and symptoms (e.g. OR = 1.61, 95% CI = 1.41-1.84), and major infant complications were associated with CB-PTSD diagnosis (OR = 1.63, 95% CI = 1.29-2.07). Reports of perceived danger to self or infant (criterion A) were linked to higher CB-PTSD symptoms and traumatic birth ratings (e.g., β =0.25, 95% CI = 0.21-0.29). Other predictors reached significance but showed small effects.
Conclusions: Findings support a stress-diathesis framework, showing that while pre-existing vulnerabilities contribute, birth-related stressors exert the strongest influence. Trauma-informed maternity care should prioritize these factors, with attention to women's appraisals of birth.
Synergy between resilience and empathy in health sciences students: A cross-sectional study
(2025) Díaz-Narváez, Víctor P.; Alonso Palacio, Luz Marina; Borja González, Juana; Rod, J. E.; De las Salas, Roxana; Alonso Cabrera, Jesús; Salcedo Salgado, Juan; Rodríguez Sanjuán, Alexander; Ríos García, Ana Liliana; Cano Barrios, Allison Elena; De la Cruz-Rocha, Edwin Rafael; Caro, Sara; Serrano Mariño, Dolores Vanessa; Ferreira Medina, Yanina; Hernández Bustos, Oscar E.; Espitia Nieto, Sandra; Hoyos De Los Ríos, Olga Lucia; Gamarra-Moncayo, José; Vilca, Lindsey W.; Reyes Reyes, Fernando Teddy; Reyes-Reyes, Alejandro; Cisneros, Ricardo; Velasco, Katherine; Carmona-Meza, Zenen
Background. Empathy is considered a key factor in patient satisfaction, treatment adherence, clinical outcomes, and professional fulfillment. Consequently, training health sciences students in empathy has become a priority in universities worldwide. However, empathy-focused interventions have not achieved the desired success due to the complex nature of empathy. Both internal and external factors shape and influence empathy. Resilience has been proposed as one such factor, but the association between these two concepts is poorly understood. This study aims to evaluate the association between different dimensions of resilience and empathy in health science students.
Methods. A Cross-sectional analysis evaluated the levels of empathy and resilience in 993 Medical, Nursing, and Dentistry students at Universidad del Norte using the Jefferson Scale of Empathy-Health Professions Students (JSE-HPS) and the Ecological, Engineering, Adaptation (EEA) Resilience Scale. Data were examined through univariate and multivariate normality analyses and descriptive statistics. To evaluate the theoretical structure of empathy and resilience, a confirmatory factor analysis (CFA) was performed on the three-dimensional models of each construct. Reliability was established using the Omega coefficient. Finally, structural equation modeling (SEM) with a robust maximum likelihood estimator was applied to analyze the association between resilience and empathy.
Results. The normal distribution assumptions were largely met for empathy scale data, its respective dimensions, and individual items. The theoretical model was well-supported for both constructs, and the data suggested acceptable reliability. SEM analysis revealed that the association between empathy and resilience dimensions vary. Ecological resilience was positively correlated with all empathy dimensions while engineering and adaptative resilience were negatively correlated with all three dimensions of empathy.
Conclusions. There is no universal effect of resilience on empathy. Designers of empathy-focused educational interventions and researchers should consider the potential differential effects of different dimensions of resilience on different aspects of empathy. In particular, focusing on ecological resilience may create the conditions for achieved empathy to be expressed, while strategies to mitigate the potential negative impact of adaptive resilience on empathy should be further explored.
Sedentary Behavior, Physical Activity, and Health of Workers in Chile According to the National Health Survey-2017
(2025) Leppe Zamora, Jaime; Leppe Zamora, Marco; Roa-Alcaino, Sonia; Sarmiento, Olga Lucía
Background/Objectives: Sedentary behavior (SB) and physical activity (PA) are key determinants of health in occupational settings. This study aimed to analyze the levels of SB, PA, and their associations with health outcomes among Chilean workers using data from the National Health Survey-2017. Methods: A secondary analysis of 2042 workers aged ≥18 years was conducted. Occupations were classified using ISCO-08, and SB/PA were assessed using the Global Physical Activity Questionnaire (GPAQ). Health outcomes included musculoskeletal symptoms, hypertension, diabetes mellitus, metabolic syndrome, and cardiovascular risk. Results: Of the participants, 49.8% were women, and the mean age was 45 years (±13.7). The median SB was 120 min/day, with 32.6% accumulating ≥4 h/day. “Managers” exhibited the highest SB (median: 270 min/day). The median total PA was 123 min/day, and “Skilled agricultural, forestry, and fishery workers” reported the highest PA (median: 330 min/day). The SB (≥4 h/day) was significantly associated with musculoskeletal symptoms (OR: 1.61, 95% CI: 1.21–2.14) and hypertension (OR: 1.53, 95% CI: 1.07–2.18). PA showed no significant protective effect. Conclusions: SB and PA vary significantly across occupational groups. SB is associated with musculoskeletal symptoms. Health promotion programs should be tailored to specific occupational groups.
Percutaneous or surgical revascularization in patients with severe left main coronary artery disease in Latin America: A GRADE clinical practice guideline
(2025) Lamelas, Pablo; Pompeu, Michel; Izcovich, Ariel; Bottaro, Federico; Tisi Baña, Matias; Sosa Liprandi, María Inés; Lanas, Fernando; Vilca Mejia, Omar Asdrúbal; Zuñiga Luna, Mauricio; Aubanel, Patricia; Munera, Ana; Contreras Reyes, Juan; Bagur, Rodrigo; Whitlock, Richard; Garcia Garcia, Héctor; Mamas Mamas; Cohen, Mauricio G.; Ricalde, Alejandro; Abizaid, Alexandre; Mendiz, Oscar; Araya, Mario; Costa, Ricardo; Santaera, Omar; Hidalgo, Pedro; Caldonazo, Tulio; Baranchuk, Adrian; Ragusa, Martin Alberto; SOLACI; SIAC
Background
Severe left main coronary artery disease (LMD) poses a major treatment challenge in Latin America, where both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are used.
Methods
This guideline was developed de novo using the GRADE approach. A multidisciplinary panel reviewed evidence from a systematic review of randomized trials comparing PCI and CABG, incorporating a comprehensive literature search of patient values and preferences and outcome utilities. Thresholds were assigned for each clinical outcome, from small to large effect.
Results
Five randomized trials enrolling 4612 patients were included. At 30 days, PCI resulted in a large reduction in major bleeding and a small reduction in strokes. At 5 years, PCI was associated with a small to moderate increase of spontaneous myocardial infarction and a moderate to large increase in repeat revascularization. No important differences in short- or long-term mortality were observed between PCI and CABG. The overall certainty of evidence was rated low. There was a notable variability in patient values and a close call on the balance of effects.
Conclusions
For patients in Latin America with severe left main coronary artery disease, the guideline panel suggests either PCI or CABG. This is a conditional recommendation, based on low certainty in the evidence (⨁⨁◯◯). It applies when both procedures are clinically and anatomically appropriate and can be performed at centers meeting acceptable standards. The decision should be made through a shared decision-making process involving the patient and the multidisciplinary care team.
Revisión sistemática sobre modelos de habilidades socioemocionales en educación superior
(2025) Bruna, Daniela; Sánchez-Oñate, Alejandro Antonio; Cobo-Rendón, Rubia
El objetivo de este estudio fue caracterizar el abordaje de las habilidades socioemocionales (HSE) en la educación superior universitaria, basándose en modelos teóricos utilizados en la investigación empírica entre 2013 y 2023. La metodología empleada es una revisión sistemática siguiendo las directrices PRISMA, analizando estudios en inglés, español y portugués, y excluyendo investigaciones centradas en salud mental y postgrado. Se identifican 28 artículos que cumplen los criterios de inclusión, abarcando modelos teóricos como la inteligencia emocional, la teoría de la autodeterminación, el modelo CASEL, el modelo de Bar-On y la teoría de las inteligencias múltiples. Los resultados destacan la importancia de integrar HSE en los programas educativos universitarios para mejorar el bienestar y el rendimiento académico de los estudiantes. Se concluye que el desarrollo de programas personalizados, la formación del personal docente y la evaluación continua son claves para la implementación efectiva de estas habilidades en la educación superior.
Espiritualidad de profesionales de la salud en unidades de pacientes críticos en Chile durante el COVID-19
(2025) Guerra Guerrero, Verónica; Correa Schnake, Marcelo; Poblete Troncoso, Margarita; Páez, Andrea; Daneck Muñoz, María Carolina
La pandemia tuvo consecuencias multidimensionales. Los profesionales de la salud fueron afectados debido a situaciones estresantes y traumáticas a lo largo del tiempo. El objetivo es analizar la espiritualidad como uno de los temas principales derivados de las experiencias vividas por un grupo de profesionales de la salud en unidades de pacientes críticos durante la pandemia. Se trata de un estudio con enfoque fenomenológico hermenéutico, con entrevistas en profundidad a 30 profesionales de la salud en Chile. El análisis de datos fue de tipo temático y se mantuvo los resguardos éticos correspondientes. Se encontró que la espiritualidad se relaciona con la reflexión y creencias espirituales del equipo de salud, y que la espiritualidad se redescubre a partir de la experiencia profesional y personal deshumanizadora a la que conduce la pandemia.
Characteristics and temporality of the ventilatory techniques in the management of acute respiratory distress syndrome: A scoping review
(2025) Battalian, Théo; Escudero Romero, Raúl; Barzaga Molina, Arianne
Introduction: Acute Respiratory Distress Syndrome (ARDS) is a critical condition characterised by acute respiratory failure due to increased alveolar-capillary membrane permeability. This leads to non-cardiogenic pulmonary oedema, hypoxemia, and impaired respiratory compliance, significantly impacting patients’ survival and quality of life. The management of ARDS involves various ventilatory and non-ventilatory therapies. Understanding the optimal timing and application of these therapies is crucial for improving patient outcomes.
Aim of the study: This scoping review aims to identify and synthesise the ventilatory techniques used in managing ARDS, focusing on their temporality and the interplay between different therapies. The study seeks to synthesize the available evidence and summarize current management strategies, highlighting areas for further research and improvement in ARDS care.
Material and Methods: A systematic search of PubMed, EBSCO, and ScienceDirect databases was conducted, following the Joanna Briggs Institute guidelines (2015), for articles published between 2013 and 2023. Studies involving adult patients (18 years or older) diagnosed with ARDS and receiving ventilatory support in the ICU were included.
Exclusion criteria included other acute respiratory pathologies, clinically extreme obese patients, and patients with tracheostomy.
Results: 437 articles were identified through the database search, of which 23 met the inclusion criteria and were included in the final review. Most articles were published between 2015-2019 (43.5%), originated from the USA (34.78%), and employed observational study designs (73.91%). The included studies reported on patients aged between 23 and 79 years, with intrapulmonary causes being the most common aetiology for ARDS. Various ventilatory strategies were identified, including conventional oxygen therapy, high-flow nasal cannula (HFNC), non-invasive ventilation (NIV), invasive ventilation (IMV), and combined approaches. Temporality was reported in 35% of the articles, but none of them as their primary focus.
Conclusions: The review highlights the diversity of ventilatory techniques employed in ARDS management and the importance of individualizing treatment strategies based on patient response and disease severity. The temporality of these interventions remains a crucial aspect, requiring further investigation to establish clearer guidelines for optimizing the timing and sequence of ventilatory support in ARDS. The findings underscore the need for future research
to focus on patient-centred outcomes and the long-term implications of ARDS management, including quality of life and functional status.
Chronic dizziness in older adults: Disrupted sensorimotor EEG beta oscillations during postural instability
(2025) Ellmers, Toby J.; Ibitoye, Richard; Castro, Patricia; Kal, Elmar C.; Kaski, Diego; Bronstein, Adolfo M.
Objective: Chronic dizziness is common in older adults, yet frequently occurs without a clear cause (‘idiopathic dizziness’). Patients experience subjective unsteadiness with minimal objective imbalance, potentially related to small vessel disease. Here we examine the hypothesis that this syndrome is associated with disrupted cortical processing of postural instability.
Methods: EEG and postural sway were recorded in 33 older adults with chronic, idiopathic dizziness (Age, Mean = 77.3 years, SD = 6.4, 61 % female) and 25 matched controls (Age, Mean = 76.9 years, SD = 6.0, 56 % female).
EEG was time-locked to spontaneous instances of postural instability and analysed via time–frequency decomposition.
Results: Significant between-group differences in EEG were observed during the early phase of postural instability (p < 0.05, cluster-corrected). Whilst controls exhibited broadband increase in EEG power across sensorimotor areas, dizzy patients displayed suppressed beta activity (19–24 Hz). Contrary to predictions, these differences did not relate to small vessel disease markers (rs < 0.05, ps > 0.720) but to fear of falling (r = -0.44, p = 0.001).
Conclusions: Previous work implies that suppressing cortical beta enhances the relay of sensory information. We therefore propose that the modulation in beta EEG observed in patients reflects an anxious, top-down strategy to ncrease sensitivity to instability, which paradoxically causes persistent feelings of subjective imbalance.
Significance: These results identify associations between idiopathic dizziness and disrupted sensorimotor beta activation during postural instability. Cortical beta during imbalance may be a possible biomarker of chronic, idiopathic dizziness in older adults and/or fear of falling.
Culturally adapted meta-debriefing: a mixed-methods study of reflective practice in Spanish-speaking simulation faculty development in Chile
(2025) Armijo-Rivera, Soledad; Vergara, Karen; Vicencio, Scarlett; Foss, Brynjar; Maldonado, Marcia
Background: Simulation-based education has expanded across Latin America, creating demand for contextually relevant faculty development. Meta-debriefing, defined as a facilitated conversation following a debriefing, can strengthen debriefer performance. However, its implementation and effectiveness in Spanish-speaking settings remain underexplored. The CORE model (context, observation, reflection, and enhanced practice) provides structural guidance, but its adaptation to regional cultures has not been studied.
Methods: We conducted a concurrent mixed-methods study of one experienced meta-debriefer interacting and facilitating 15 remote meta-debriefing sessions with interprofessional novice debriefers. Quantitative data were derived from audio-recorded sessions using DASH, SET-M, a CORE-aligned checklist, and a meta-debriefing pillars tool. Qualitative data consisted of written observer reports, analyzed using inductive content analysis, and triangulated across sources.
Results: Quantitative analysis revealed high adherence to the CORE model and consistent demonstration of the four meta-debriefing pillars. Peer-assessed DASH scores ranged from 6.8 to 7.0, while SET-M items were consistently marked as achieved. Qualitatively, the meta-debriefer demonstrated behaviors aligned with psychologically safe, context-dependent, theoretically grounded, and formative facilitation. The meta-debriefer used cultural metaphors (e.g., "boli," "cazuelas," and a prisoner's song) to clarify structure and normalize reflection. Five reflection strategies emerged as central to generating debriefer insight: (1) Structured reorientation, (2) constructivist linkage to clinical identity, (3) metaphorical framing, (4) strategic questioning (e.g., advocacy & inquiry, circular inquiry), and (5) emotional normalization.
Conclusion: This study demonstrates how meta-debriefing, when implemented through culturally sensitive and structured approaches like CORE, supports transformative learning among simulation debriefers. Meta-debriefer's relational style, use of shared narratives, and context-sensitive scaffolding activated learner-centered reflection. As meta-debriefing models gain traction in Latin America and beyond, this study highlights the value of culturally responsive faculty development strategies that integrate local language, values, and pedagogical traditions into simulation-based education.
Indicators of psychiatric institutionalization in Southeast Asia between 1990 and 2024
(2025) Mundt, Adrian; Arafat, S. M. Yasir; Dorji, Chencho; Desousa, Avinash; Chadda, Rakesh; Gowda, Guru; Orus, Cristian; Kesavan, Muralidharan; Ibrahim, Athifa; Luitel, Nagendra; Gambheera, Harischandra; Kittirattanapaiboon, Phunnapa; Priebe, Stefan; Rozas, Enzo
Background: This study aimed to assess indicators of psychiatric institutionalization and their changes over time across the Southeast Asia Region (SEAR).
Methods: We collected numbers of psychiatric beds, specialized forensic psychiatric beds, beds in residential facilities for people living with chronic mental illness and prison populations in the 11 SEAR member states between 1990 and 2024 using primary and secondary data sources. We calculated median rates per 100,000 population, as well as percent changes of the median rates between the first and last available data points. We also compared findings in SEAR with OECD countries.
Findings: Psychiatric bed numbers and prison population were available from 10 countries. Bed prevalence increased in seven countries, but decreased in three. The median psychiatric bed prevalence was 1.5 at the first and 2.9 per 100,000 population at the last data point (+94%). The prison population increased in nine countries, with the median rate changing from 60 to 123 (+106%). Data on specialized forensic psychiatric beds were available from seven countries, with a range of 0.0-0.5 beds at the last data point. Based on data from five countries, the median prevalence of beds in residential facilities increased from 1.3 to 2.3. Psychiatric bed prevalence was on average about 5% of that in the OECD, while prison population rates were similar to those in OECD countries.
Interpretation: Psychiatric bed provision in the SEAR is among the lowest worldwide. In contrast, incarceration rates are similar to those in high-income regions. Most countries have increased the prevalence of psychiatric beds over the past three decades, but they remain scarce, and further investments need consideration.
Funding: Agencia Nacional de Investigación y Desarrollo (ANID), Chile.
Efficacy of platelet-rich-fibrin for the treatment of alveolar osteitis: a systematic review and meta-analysis
(2025) Ávila-Oliver, Camila; Veloso, Valentina; Laissle, Germán; Rojas, Ana María; Verdugo-Paiva, Francisca; Ramos-Rojas, José
Background: This systematic review aims to provide an updated summary of the available evidence on the role of platelet-rich fibrin (PRF) in the treatment of alveolar osteitis.
Material and Methods: Searches were conducted in several electronic databases, including PubMed, EBSCO, Cochrane Central Register of Controlled Trials (CENTRAL) LILACS and ClinicalTrials.gov. No date or language restrictions were applied. Two reviewers independently evaluated eligible studies according to predefined criteria and extracted data using a standardized form. Meta-analyses were performed to estimate results and the certainty of evidence, using the GRADE approach, was assessed.
Results: The search strategy yielded 1.706 references. Finally, 4 randomized trials were included and assessed quantitatively. Overall, the risk of bias was low for 75% of the domains reviewed across studies. The studies included a total of 179 patients, where the intervention group received PRF, and the control group received several treatment alternatives, including iodoform gauze, zinc oxide eugenol, and saline solution. Results showed that the use of PRF may decrease pain severity measured on day 3 (MD -1.66, CI 95%, -4.11 to 0.78) and on day 7 (MD -1.57, CI 95%, -4.00 to 0.88), and improves alveolar socket healing (SMD 2.25; 95% CI 1.70 to 2.80; p<0.00001; I2=12%).
Conclusions: The results of this study demonstrate that PRF improves alveolar healing, reduces analgesic use in patients, and likely increases overall clinical efficacy, making it a valuable alternative in the treatment of alveolar osteitis. Despite these findings, this review also showed a great degree of uncertainty on the impact of PRF on pain severity associated with alveolar osteitis. Although these results are promising, further randomized clinical trials with standardized methodologies must be performed to validate these findings.
Dyspnea in pregnancy. Can POCUS be the game changer?
(2025) Ghiringhellia, Juan; Arzola, Cristian; Zasso, Fabricio
Dyspnea is a common symptom during pregnancy, but it can present a diagnostic challenge. While it may often be attributed to physiological changes it may also signal serious underlying conditions such as asthma crisis, infection, pulmonary edema (PEd), pulmonary embolism, and amniotic fluid embolism.
Point-of-care ultrasound (POCUS) is a swift and effective bedside modality for assessing acute or critical medical conditions. It can be used as an alternative or alongside traditional formal ultrasound conducted by a radiology-cardiology service. This review explores the role of POCUS in the parturient experiencing shortness of breath, highlighting the potential value of maternal cardiopulmonary POCUS in obstetric anesthesia, facilitating timely treatment and providing immediate differential diagnosis in potentially unstable patients. As an example, a case is discussed involving a sudden onset of PEd and loss of consciousness in a 48-year-old patient who underwent a category-1 cesarean section under general anesthesia. POCUS identified severely decreased global systolic function and confirmed pulmonary edema through the presence of B-Kerley lines, providing a swift guidance for intraoperative inotropic support and fluid management while excluding other causes of pathological dyspnea in pregnancy.