Browsing by Author "Hidalgo, Valeria"
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Publication Aloe vera peel-derived nanovesicles display anti-inflammatory properties and prevent myofibroblast differentiation(2024) Ramírez, Orlando; Pomareda, Florencia; Olivares, Belén; Huang, Ya-Lin; Zavala, Gabriela; Carrasco, Javiera; Álvarez, Simón; Leiva, Camila; Hidalgo, Valeria; Romo, Pablo; Sánchez, Matías; Vargas, Ayleen; Martínez, Jessica; Aguayo, Sebastian; Schuh, ChristinaBackground: Aloe vera (AV) is a medicinal plant, most known for its beneficial effects on a variety of skin conditions. Its known active compounds include carbohydrates and flavonoids such as quercetin and kaempferol, among others. In the past decade, plant nanovesicles (NVs) have gained considerable interest as interkingdom communicators, presenting an opportunity for clinical standardization of natural products. In this study, we aimed to assess the potential of AVpNVs for the treatment of burn wounds. Methods: AVpNVs were isolated and characterized regarding vesicle yield (nanoparticle tracking analysis) and structure (transmission electron microscopy and atomic force microscopy), as well as their protein content with proteomics. We assessed key characteristics for treating burn wounds in vitro, such as the anti-inflammatory potential in LPS-stimulated macrophages and keratinocytes, and the effect of AVpNVs on myofibroblast differentiation and contraction. Key findings: AVpNVs presented a homogenous NV population, vesicular shape, and NV-associated protein markers. AVpNVs significantly decreased the secretion of pro-inflammatory cytokines TNFα, IL-1β, and IL-6. Furthermore, AVpNVs inhibited myofibroblast differentiation and significantly decreased their contractile potential in collagen matrices. Observed effects were linked to proteins identified in the isolates through proteomics analysis. Conclusion: AVpNVs displayed characteristics as an inflammatory modulator, while simultaneously diminishing myofibroblast differentiation and contraction. Novel strategies for burn wound treatment seek to decrease scarring on a cellular and molecular level in the early stages of wound healing, which makes AVpNVs a promising candidate for future plant-vesicle-based treatments.Item Evaluación preoperatoria en anestesia: Revisión de la Guía 2017 de la Sociedad de Anestesiología de Chile(2026) Acuña, María; Alarcón, Asunción; Hidalgo, Valeria; Norero, SofíaIntroducción: Las guías de evaluación preanestésica estandarizan el manejo perioperatorio para disminuir la morbimortalidad. En 2017, la Sociedad de Anestesiología de Chile (SACh) publicó sus recomendaciones nacionales. Sin embargo, la constante evolución de la evidencia científica exige analizar su vigencia frente a las nuevas publicaciones internacionales. Objetivo: Describir los pilares de la guía SACh 2017 (momento de evaluación, historia clínica, examen físico y exámenes complementarios) y analizar los aportes de la literatura actualizada en la planificación anestésica. Metodología: Revisión narrativa desarrollada en tres etapas: categorización de los ejes temáticos de la guía SACh 2017, análisis de su bibliografía de respaldo y búsqueda bibliográfica en bases de datos indexadas publicadas en el período 2018–2026. Resultado: La evaluación se sustenta en anamnesis detallada, examen físico dirigido y exámenes complementarios selectivos. Se destaca la importancia de realizar la valoración con antelación suficiente para permitir la optimización de patologías y hábitos. El examen físico debe ser centrado en el área cardiopulmonar, y agregar otra en caso de síntomas. La indicación de pruebas de laboratorio e imágenes no debe realizarse de manera rutinaria, sino basarse estrictamente en las comorbilidades del paciente y la invasividad del procedimiento, garantizando así la costo-efectividad del sistema de salud. La nueva evidencia introduce actualizaciones críticas, como la telemedicina, protocolos de suspensión de agonistas GLP-1 y SGLT2, y nuevos biomarcadores. Conclusión: La evaluación preoperatoria es un acto médico crítico y personalizado. Los fundamentos centrales de la guía SACh 2017 continúan vigentes; no obstante, es indispensable integrar los nuevos consensos. Introduction: Preoperative evaluation guidelines standardize perioperative management to reduce morbidity and mortality. In 2017, the Chilean Society of Anesthesiology (SACh) published its national recommendations. However, the continuous evolution of scientific evidence requires an analysis of their current validity in light of recent international publications. Objective: To describe the core pillars of the 2017 SACh guidelines (timing of evaluation, medical history, physical examination, and complementary tests) and to analyze the contributions of updated literature to anesthetic planning. Methodology: A narrative review conducted in three stages: categorization of the main thematic axes of the 2017 SACh guidelines, analysis of its supporting literature, and a literature search in indexed databases published between 2018 and 2026. Result: Preoperative evaluation relies on a detailed medical history, a targeted physical examination, and selective complementary testing. Early evaluation is essential to allow time for the optimization of medical conditions and lifestyle habits. The physical examination should focus on the cardiopulmonary system, adding other systems if symptoms are present. Laboratory tests and imaging should not be requested routinely; instead, they must be strictly based on patient comorbidities and procedural invasiveness to ensure healthcare system cost- effectiveness. Recent evidence introduces critical updates, such as telemedicine, discontinuation protocols for GLP-1 receptor agonists and SGLT2 inhibitors, and new biomarkers. Conclusion: Preoperative evaluation is a critical and personalized medical act. While the core principles of the 2017 SACh guidelines remain valid, integrating these new consensus guidelines is essential.Item Fisiopatología de las quemaduras graves: fundamentos para el manejo precoz y anticipatorio del médico general(2026) Saintard, Marianne; Hidalgo, Valeria; Arancibia, Ignacio; Alarcón, Asunción; Paredes, JoaquínIntroducción: Las quemaduras constituyen un problema de salud pública por el impacto de su elevada morbimortalidad a nivel global. Son una patología compleja que genera daño tisular progresivo, comprometiendo la homeostasis hemodinámica y metabólica. Objetivo: Describir los mecanismos fisiopatológicos locales y sistémicos de las quemaduras graves para orientar el manejo inicial por el médico general y facilitar una anticipación estratégica de las complicaciones agudas y crónicas. Metodología: Revisión bibliográfica en las bases de datos PubMed y SciELO utilizando términos MeSH “Burns/physiopathology”, “Oxidative Stress” e “Inflammation”. Se seleccionaron artículos en inglés y español de los últimos 10 años, priorizando revisiones sistemáticas y guías clínicas internacionales. Resultado: Localmente, las quemaduras generan daño concéntrico (zonas de Jackson). La liberación masiva de patrones moleculares asociados a daño (DAMPs) y patógenos (PAMPs) desencadena una respuesta inflamatoria, estrés oxidativo y desprendimiento del glicocálix endotelial, lo que incrementa la permeabilidad capilar, favoreciendo el edema intersticial, shock hipovolémico y falla multiorgánica. Adicionalmente, inducen estrés hipermetabólico persistente con hiperglicemia y catabolismo proteico. Discusión: Rescatar la zona de estasia es el principal objetivo terapéutico en urgencias, requiriendo reanimación hídrica controlada y coberturas húmedas para evitar la pérdida tisular irreversible. La fluidoterapia debe guiarse por objetivos de perfusión para mitigar el riesgo de fluid creep (sobrecarga de volumen) y complicaciones fatales como el distrés respiratorio agudo y el síndrome compartimental. Conclusión: Comprender estos fenómenos fisiopatológicos a nivel celular y sistémico fundamenta terapias precoces dirigidas por objetivos para limitar la progresión lesional y las complicaciones orgánicas graves. Este manejo anticipatorio es esencial para estabilizar al paciente en fase aguda y atenuar secuelas metabólicas, funcionales y psiquiátricas a largo plazo. Introduction: Burns constitute a public health problem due to the impact of their high global morbidity and mortality. They are complex pathologies that generate progressive tissue damage, compromising hemodynamic and metabolic homeostasis. Objective: To describe the local and systemic pathophysiological mechanisms of severe burns to guide initial clinical management by general practitioners and facilitate strategic anticipation of acute and chronic complications. Methodology: Literature review in PubMed and SciELO databases using MeSH terms “Burns/physiopathology”, “Oxidative Stress”, and “Inflammation”. Articles in English and Spanish from the last 10 years were selected, prioritizing systematic reviews and international clinical guidelines. Result: Locally, burns generate concentric damage (Jackson's zones). Massive release of damage-associated (DAMPs) and pathogen-associated (PAMPs) molecular patterns triggers an inflammatory response, oxidative stress, and endothelial glycocalyx shedding, increasing capillary permeability, favoring interstitial edema, hypovolemic shock, and multiorgan failure. Additionally, they induce persistent hypermetabolic stress with hyperglycemia and protein catabolism. Discussion: Rescuing the zone of stasis is the main therapeutic objective in emergency care, requiring controlled fluid resuscitation and wet dressings to prevent irreversible tissue loss. Fluid therapy must be goal-directed to mitigate the risk of fluid creep (volume overload) and fatal complications such as acute respiratory distress syndrome and compartment syndrome. Conclusion: Understanding these cellular and systemic pathophysiological phenomena provides the rationale for early goal-directed therapies to limit injury progression and severe organ complications. This anticipatory management is essential to stabilize acute patients and mitigate long-term metabolic, functional, and psychiatric sequelae.