Artículos Medicina y Ciencias de la Salud

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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.
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.
Food additives in Latin America: a descriptive analysis of the packaged food supply in five countries
(2025) Zancheta, Camila; Grilo, Mariana; Ayala, Salvador; Duran, Ana; Canella, Daniela; Mora, Mercedes; Ulloa, Victoria; Tolentino, Lizbeth; Reyes, Marcela; Corvalan, Camila
Background: Latin America is distinguished by diverse regulatory frameworks and evolving dietary patterns, including the weakening of traditional diets and the increasing consumption of ultra-processed foods (UPFs). Predominantly produced by transnational corporations, UPFs rely heavily on food additives to achieve desirable sensory properties (e.g., flavor, color), ensure food safety, and extend shelf life. Over the past decade, research has increasingly shown that higher consumption of UPFs is associated with poor health outcomes, and food additives have emerged as a potential mechanism underlying this association. However, few studies have systematically analyzed the presence of food additives in the food supply. This study aimed to assess the distribution and patterns of food additives in packaged foods from five Latin American countries. Methods: Data were obtained from packaged foods and beverages sold in supermarkets in Brazil (2017; n = 9,673), Mexico (2017; n = 15,846), Chile (2018; n = 13,913), Colombia (2018; n = 8,282), and Ecuador (2019; n = 2,083). We used the list of ingredients to search for food additives described in the Codex Alimentarius. We assessed the prevalence of specific food additives, categorized their functional classes, and applied exploratory factor analysis to identify patterns of food additive use, overall and in each country. Results: Food additives were present in over 75% of the studied products, ranging from 76.1% in Colombia to 84.0% in Ecuador. Food categories with the highest prevalence of additives (> 90%) included confectionery, dairy products, bakery items, and meat products. Most products contained two or more additives (64.3%); nearly 10% contained ten or more. We observed consistent results on the most used additives (i.e., flavorings, citric acid, phosphates, and lecithin) and patterns of food additives used across countries, although differences were observed in the use of specific additives, particularly low-calorie sweeteners and colorings. Conclusion: Food additives are widely used in the packaged food supply of Latin American countries, and variations in the use of specific food additives likely reflect differences in regulatory frameworks, industry practices, and consumer preferences across countries. Given the increasing concern about the potential health effects of food additives, there is an urgent need to strengthen monitoring efforts and further investigate population-level exposures and associated health outcomes.
Rol de la inteligencia artificial en la reducción de biopsias innecesarias en lesiones mamarias BI-RADS 4 en imágenes
(2026) Astudillo, Magdalena; Baraqui, Florencia; Saieg , María; Florencia Bozzo; Roman, Martin
Introducción: El cáncer de mama es la neoplasia más frecuente en mujeres y una de las principales causas de mortalidad femenina. Su diagnóstico se realiza mediante mamografía, ecografía y resonancia magnética, sin embargo, estas técnicas presentan especificidad limitada, conduciendo a procedimientos invasivos innecesarios en una proporción significativa de casos. En este contexto, la inteligencia artificial emerge como herramienta complementaria a la interpretación radiológica. Objetivo: Analizar la evidencia científica actual acerca del rol de la IA en la radiología mamaria y su impacto en la reducción de biopsias innecesarias en lesiones BI-RADS 4. Metodología: Se realizó una búsqueda sistemática en PubMed, Google Scholar, ScienceDirect, RSNA y MDPI, utilizando descriptores MeSH relacionados con cáncer de mama, radiología mamaria, IA y deep learning, con límite de 10 años (2015-2025). De 134 artículos identificados, se seleccionaron 21 para análisis final. Desarrollo: Los estudios revisados demuestran que los modelos de aprendizaje profundo mejoran el rendimiento diagnóstico en las tres modalidades principales. En mamografía, estos algoritmos identifican una proporción significativa de lesiones BI-RADS 4 como potencialmente benignas manteniendo alta sensibilidad, con potencial para reducir biopsias innecesarias. En ecografía y resonancia magnética, la integración de radiómica e inteligencia artificial mejora la especificidad diagnóstica en la diferenciación de lesiones benignas y malignas respecto a la evaluación visual convencional. Conclusión: La IA tiene amplio potencial para optimizar la interpretación de imágenes mamarias, contribuyendo a reducir biopsias innecesarias en lesiones BI-RADS 4 y a un diagnóstico más preciso y eficiente. Introduction: Breast cancer is the most common malignancy in women worldwide and a leading cause of female mortality. Diagnosis relies on imaging modalities—primarily mammography, ultrasound, and MRI—which present limited specificity, leading to unnecessary invasive procedures in a significant proportion of cases. In this context, artificial intelligence emerges as a complementary tool to radiological interpretation. Objective: To analyze the current scientific evidence on the application of AI in breast radiology and its impact on the reduction of unnecessary biopsie in BI-RADS 4 lesions. Methodology: A systematic search was conducted in PubMed, Google Scholar, ScienceDirect, RSNA and MDPI using MeSH descriptors related to breast cancer, breast imaging, AI and deep learning, restricted to the last 10 years (2015-2025). Of 134 articles identified, 21 were selected for final analysis. Discussion: The reviewed studies demonstrate that deep learning models improve diagnostic performance across the three main imaging modalities. In mammography, these algorithms identify a significant proportion of BI-RADS 4 lesions as potentially benign while maintaining high sensitivity, with potential to reduce unnecessary biopsies. In ultrasound and MRI, the integration of radiomics and artificial intelligence significantly improves diagnostic specificity in differentiating benign from malignant lesions compared to conventional visual assessment. Conclusion: AI has broad potential to optimize breast image interpretation, contributing to reducing unnecessary biopsies in BI-RADS 4 lesions and enabling more accurate and efficient diagnosis.
Early high‑sensitivity troponin elevation and short‑term mortality in sepsis: a systematic review with meta‑analysis
(2025) Gajardo, Abraham I. J.; Ferrière‑Steinert, Santiago; Valenzuela Jiménez, Joaquín; Heskia Araya, Sebastián; Kouyoumdjian Carvajal, Thomas; Ramos-Rojas, José; Medel, Juan Nicolás
Background Serum cardiac troponin (cTn) elevation is a well-established phenomenon in sepsis. However, the clinical significance of this phenomenon with high-sensitivity (hs) assays and the current sepsis definition needs to be settled. Research Question What is the association between early serum cTn levels measured by hs-assays and the risk of short-term mortality in septic patients? Study Design and Methods We conducted a systematic review using a comprehensive PubMed, Scopus, and Embase search. Studies were eligible if they reported association data on early hs-cTn and mortality in an adult sample with sepsis that met the Sepsis-3 definition. For the synthesis of the effect of hs-cTn on mortality, we applied random effect models on the pooled unadjusted and adjusted odds ratio (OR and aOR, respectively) of elevated vs. normal hs-cTn serum values, and on the crude standardized mean difference (SMD) of hs-cTn between survivors and non-survivors. Results In total, 6242 patients from 17 studies were included, with short-term mortality rates ranging from 16.9% to 53.8%. Using a crude analysis, non-survivor patients showed higher hs-cTn than survivors (SMD of 0.87, 95%CI: 0.41–1.33). Elevated hs-cTn was associated with increased mortality (OR = 1.78, 95% CI: 1.41–2.25). However, this prognostic effect was absent in studies that adjusted for different confounders (aOR = 1.06, 95% CI: 0.99–1.14). Discussion and Conclusions Non-survivors of sepsis exhibited significantly elevated hs-cTn levels. While elevated hs-cTn levels are associated with an increased risk of mortality, they are not independently associated with this outcome in sepsis.
Using the OSCE to assess medical students’ communication and clinical reasoning during five years of restricted clinical practice
(2025) Armijo-Rivera, Soledad; Zamorano Saavedra, Catalina; Vicencio-Clarke, Scarlett; Behrens Pérez, Claudia; Pérez-Villalobos, Cristhian
Background Objective and Structured Clinical Examination (OSCE) is a widely used evaluation method for health profession students. In Chile, physicians OSCEs have incorporated clinical reasoning and patient-centered communication assessment since 2015. The overall impact of the COVID-19 pandemic on undergraduate medical clinical practice remains unknown, in particular whether this context disproportionately affected lower-income regions, as was the case analysed in this study. Aim This research compares the OSCE patient-centered communication and clinical reasoning results among five cohorts of intermediate-level medical students with restricted clinical practice in Chile. Methods We designed an observational study analyzing five cohorts of fourth-year medical students with different clinical practice opportunities, with 3rd to 4th-year progression analysis in two cohorts. Adaptations to compensate lack of clinical practice hours include high-fidelity simulation and theoretical discussion of clinical cases, as well as formative OSCE at third-year level in two cohorts. Communication in OSCE was assessed using the Communication Assessment Tool (CAT) and Clinical Reasoning (CR) with a register form (that includes a global score, History Taking, Differential Diagnosis, and Therapeutic Plan subscores). Descriptive statistics and central tendency measurements were applied to analyze CAT and CR scores, along with Kruskal-Wallis tests and Wilcoxon’s test for paired sample analysis. Findings The 2018 cohort shows the lowest results in both variables although it was the cohort with more clinical practice opportunities. The higher CAT result was in the 2021 cohort, while the 2022 cohort exhibited a significantly higher CR score (p < 0.05). There is a linear tendency to grow over the years for both measures. The 2023 cohort shows significant improvement between third-year and fourth-year OSCEs in all items of CAT and a detriment in CR, while the 2022 cohort shows a significant increment in CR and four items of CAT (p < 0.05). Conclusion The students with fewer hours of clinical practice showed similar CR and communication results to the prepandemic group, probably because of the adaptations implemented. Simulation was an effective alternative.
Advancing the assessment of clinical competence in Latin America: a scoping review of OSCE implementation and challenges in resource-limited settings
(2025) Armijo-Rivera, Soledad; Fuenzalida-Muñoz, Brenda; Bozzo-Navarrete, Sergio; Kunakov, Natasha; Sanhueza, Jacqueline; Cornejo, Carla; Vicencio-Clarke, Scarlett; Miranda-Hurtado, Cesar; Elbers-Arce, Alexandra; Shibao-Miyasato, Hector; Soublette, Alix; Sandoval, Ana María; Cicibel Casas-Bueno, Fresia; Delgado, Ximena
Background Objective Structured Clinical Examination (OSCE) is important to assess clinical competencies in health professions. However, in Latin America, a region with limited resources, the implementation and quality of OSCEs remain underexplored despite their increasing use. This study analyses how the OSCE has been applied and how its quality has evolved in Latin America. Methods A scoping review methodology was used, including a search across PubMed, Scopus, WOS, LILACS and Scielo, including studies on the implementation of OSCE in Latin America, written in English, French, Portuguese, or Spanish. Their quality was assessed using the AMEE guidelines 81 and 49 criteria and MMERSQI. Data were extracted regarding OSCE structure, evaluator training, validity, reliability, and the use of simulated patients. Results 365 articles were obtained, of which 69 met the inclusion criteria. The first report on OSCE implementation in the region dates back to 2000. Three countries accounted for 84.06% of the reports (Chile, Mexico, Brazil). 68.12% was applied in undergraduate programs. In this group, the implementation was mainly in Medicine (69.57%), with lesser use in physiotherapy (7.95%) and nursing (2.9%). The number of stations and duration of each varied, with 18-station circuits being the most common. Evidence of validity and reliability of the OSCE was reported in 26.09%, feedback to students in 33,33%, and simulated patient training in 37.68% of the reports. A notable trend in the quinquennial analysis is the increased use of high-fidelity simulations and the shift towards remote OSCEs during the pandemic. The inclusion of inactive stations, inadequate training for simulated patients, and the absence of evidence supporting instrument validation are recurrently reported challenges in OSCE studies. The overall methodological quality has improved, as evidenced by OSCE Committee and Blueprint in nearly 50% of the studies and rising MMERSQI scores, especially in recent years.
Ancient genomes reveal a deep history of Treponema pallidum in the Americas
(2025) Barquera, Rodrigo; Sitter, T. Lesley; Kirkpatrick, Casey L.; Ramirez, Darío A.; Kocher, Arthur; Spyrou, Maria A.; Couoh, Lourdes R.; Talavera-González, Jorge A.; Castro, Mario; Hunnius, Tanya von; Guevara, Evelyn K.; Hamilton, W. Derek; Roberts, Patrick; Scott, Erin; Fabra, Mariana; Da Peña, Gabriela V.; Pacheco, Aryel; Rodriguez, Mónica; Aspillaga, Eugenio; Tiliakou, Anthi; Nelson, Elizabeth A.; Giffin, Karen L.,; Bianco, Raffaela A.; Rohrlach, Adam B.; García Martínez, María de los Angeles; Ballesteros Solís, Fabiola A.; Sajantila, Antti; Saunders, Shelley R.; Nores, Rodrigo; Herbig, Alexander; Krause, Johannes; Bos, Kirsten I.
Human treponemal infections are caused by a family of closely related Treponema pallidum that give rise to the diseases yaws, bejel, pinta and, most notably, syphilis1. Debates on a common origin for these pathogens and the history of syphilis itself have weighed evidence for the ‘Columbian hypothesis’2, which argues for an American origin, against that for the ‘pre-Columbian hypothesis’3, which argues for the presence of the disease in Eurasia in the Medieval period and possibly earlier. Although molecular data has provided a genetic basis for distinction of the typed subspecies4, deep evolution of the complex has remained unresolved owing to limitations in the conclusions that can be drawn from the sparse palaeogenomic data that are currently available. Here we explore this evolutionary history through analyses of five pre- and peri-contact ancient treponemal genomes from the Americas that represent ancient relatives of the T. pallidum subsp. pallidum (syphilis), T. pallidum subsp. pertenue (yaws) and T. pallidum subsp. endemicum (bejel) lineages. Our data indicate unexplored diversity and an emergence of T. pallidum that post-dates human occupation in the Americas. Together, these results support an American origin for all T. pallidum characterized at the genomic level, both modern and ancient.
Reinforced falsetto to increase the glottic closure in patients diagnosed with unilateral vocal fold paralysis: A preliminary study
(2025) Orellana Marambio, Patricio; Rosales, Felipe Gonzalo; Monichi, Giovanna
There is favourable evidence in speech therapy for the rehabilitation of vocal fold paralysis. Nonetheless, contemporaneous studies that apply reinforced falsetto were not found. The aim of this study is to determine the results of speech therapy using reinforced falsetto for complete glottic closure in patients diagnosed with unilateral vocal fold paralysis, who were treated at the Laboratory of Voice at the ‘Universidad del Desarrollo’ in Chile between 2015 and 2023. A descriptive, observational and retrospective study was performed on 10 adult participants. Before therapy, grade of dysphonia was severe in 90% of the participants, whilst moderate in the remaining 10%. Incomplete glottic closure was observed in 100% of the participants. After the therapy, grade of dysphonia was diagnosed as being mild in 60% of the cases, and normal in the remaining 40% of participants. All the participants recovered their glottic closure. Significant differences were observed pre-intervention and post-intervention in: fundamental frequency; sound intensity; harmonics; maximum phonation time; glottic closure; and dysphonia severity. In conclusion, the reinforced falsetto technique was favourable for the glottic closure in the sample of participants studied. Further, there was clinical improvement in all the analysed acoustic and laryngoscopic variables. Speech therapy using reinforced falsetto could therefore be useful for the rehabilitation of unilateral vocal fold paralysis. It is suggested that extra research is performed, including a representative sample, in order to generalise the results and make them applicable to the general population.
Biofunctional Polyvinyl Alcohol/Xanthan Gum/Gelatin Hydrogel Dressings Loaded with Curcumin: Antibacterial Properties and Cell Viability
(2025) Rivera, María; Cament, Alejandro; Ahumada, Manuel; Corrales, Teresa; García, Verónica; Pablos, Jesús; Osorio, Javiera; Ramos, Giselle; Vargas, Leslie; Marcelo Ezquer; Ezquer, Marcelo; Ortiz, J. Andrés
This study explores the development of biocompatible hydrogel dressings incorporating curcumin as an alternative antibacterial agent. In this context, hydrogels were prepared using polyvinyl alcohol, xanthan gum, gelatin, and curcumin as a therapeutic component. FTIR spectroscopy confirmed the successful incorporation of curcumin into the hydrogel matrix, while release profiles demonstrated sustained release. Mechanical testing indicated that xanthan gum reduced elongation and strength in hydrogels, while the combination of xanthan gum and gelatin increased stiffness without loss of elasticity. Curcumin had no major effect on the tensile and rheological properties, preserving the structural integrity of the hydrogels. The hydrogels demonstrated antibacterial activity against Pseudomonas aeruginosa and Staphylococcus aureus ATCC strains, as well as multidrug methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates. Biocompatibility was confirmed through viability assays with immortalized human keratinocytes (HaCaT) and adult human dermal fibroblasts (HDFa), showing no acute cytotoxic effects after 48 h of exposure. Their effective action against clinically relevant bacteria and high cytocompatibility position these hydrogels as promising candidates for infection management and antibiotic resistance mitigation in wound care applications.
Persistence and recurrence after removal of idiopathic epiretinal membrane
(2025) Reichel, Felix F.; Labbe, Eduardo; Gelisken, Faik; Seitz, Immanuel P.; Hagazy, Sherif; Dimopoulos, Spyridon
OBJECTIVES: To analyse the incidence of persistence and recurrence after the peeling of idiopathic epiretinal membrane (ERM) and to describe its clinical features. METHODS: This retrospective study included 666 eyes (645 patients) that underwent macular surgery for ERM removal. Optical coherence tomographic (OCT) images taken within three months after surgery and at the following visits, clinical parameters and surgery related factors were analysed to investigate the incidence and associated factors of ERM persistence and recurrence. Postoperative ERM types were categorised depending on the size ( < 100 μm, ≥100 μm) and the location (foveal, parafoveal, outside the parafovea) RESULTS: The mean follow-up time was 29.4 months. ERM persistence (examination within 3 months) was found in 29.6% of all eyes. Only 1.9% of the eyes presented foveal ERM persistence. Foveal recurrence, defined as reappearance or growth of persistent ERM covering the fovea, was found in 8.2%. In 84.4% of eyes with foveal ERM recurrence, postoperative persistence of ERM of varying severity were identified. None of the pre-operative or surgery related factors were found significantly associated with ERM recurrence. Persistent ERM within the parafovea was the most significant risk factor for foveal ERM recurrence. CONCLUSION: Recurrence of ERM is generally preceded by the persistence of ERM fragments found in the early postoperative period. Growth of ERM persistence from the parafoveal region was often the origin of foveal ERM recurrence. Insufficient peeling seems to be the most significant predisposing factor for foveal ERM recurrence.
Post-COVID-19 symptoms in a community sample: Exploratory study in two Chilean cities, 2023–2024
(2025) Molina, Xaviera; Awad, Camila; Ramírez-Santana, Muriel; Rubilar, Paola; pablaza, Mauricio; Nunez-Franz, Loreto
Background: SARS-CoV-2 infection affects health, well-being, and the economy, especially considering the persistence of symptoms following an acute episode. This study aims to (1) estimate the frequency of symptoms following SARS-CoV-2 infections, (2) characterize symptoms compatible with post-COVID-19 conditions, and (3) explore risk factors for persistent symptoms among individuals from two Chilean cities diagnosed with COVID-19 at least once. Methods: This cross-sectional exploratory study involved a convenience sample of individuals who participated in a prior seroprevalence study in Chile. Participants were recruited by phone between November 2023 and January 2024, and self-reported persistent COVID-19 symptoms using the modified Yorkshire Rehabilitation Scale, which assessed symptom severity and functional disability across three dimensions. Bivariate analysis explores the association between sociodemographic and health variables and reported symptoms using the Mann-Whitney-Wilcoxon and Kruskal-Wallis tests. Two Negative binomial models (Model 1: clinical factors and Model 2: clinical plus sociodemographic factors) evaluated factors associated with the severity of post-COVID-19 symptoms. Results: Of the 144 participants successfully contacted, 83 met the inclusion criteria. A total of 80.7 % reported symptoms consistent with post-COVID-19. The most frequently reported symptoms were sleep disturbances (59.7 %), anxiety (59.7 %), and memory problems (58.2 %). Only three participants had received a formal post-COVID diagnosis, and none were receiving care through Chile’s universal post-COVID program. Symptom severity was significantly higher in women (p = 0.04), individuals with two or more COVID-19 episodes (p = 0.04), and those with comorbidities (p = 0.02). Negative binomial regression analysis indicated that multiple COVID-19 episodes were associated with greater symptom severity. Conclusions: A high percentage of participants experienced post-COVID-19 symptoms. Despite the high symptom burden, access to formal diagnosis and care was minimal, highlighting the need to strengthen diagnostic and management protocols within the Chilean healthcare system.
Arsenic Exposure During Pregnancy and Childhood: Factors Explaining Changes over a Decade
(2025) Rubilar, Paola; Hirmas, Macarena; Apablaza, Mauricio; Awad, Camila; Molina, Xaviera; Muñoz, María Pía; Delgado, Iris; Zanetta-Colombo, Nicolás C.; Castillo-Laborde, Carla; Matute, María Isabel; Retamal, Mauricio; Olea, Andrea; Pino, Paulina; González, Claudia; Carvajal, Cristóbal; Iglesias, Verónica
Arsenic chronic exposure, particularly in its inorganic form, represents a significant public health concern. This study was conducted in Arica, the northernmost city in the country, whose inhabitants have been exposed to inorganic arsenic both naturally through drinking water and anthropogenically due to a toxic waste disposal site. We explored changes in inorganic arsenic levels in a cohort of pregnant women and their children over a decade, identifying exposure trends and their determinants. We used data on arsenic exposure through maternal urine samples during pregnancy, collected by the Health Authority between 2013 and 2016 (measurement 1), and followed up with assessments of their children in 2023 (measurement 2). Temporal changes in inorganic arsenic concentration were analyzed using the Wilcoxon Signed-Rank test, and a mixed linear regression model was employed to determine which factors contributed to urinary inorganic arsenic levels. We did not observe significant differences in mean arsenic concentrations between the two-time points (p = 0.4026). The mixed linear regression model revealed that children consuming bottled water had 8.3% lower urinary inorganic arsenic concentrations than those drinking tap water (95% CI: −15.36 to −0.54%). Additionally, children from ethnic groups had 8.64% higher inorganic arsenic concentrations (95% CI: 0.49 to 17.5%), while those with caregivers with higher education showed a 13.67% reduction (95% CI: −25.06 to −0.56%). Despite mitigation efforts, these findings underscore the ongoing risk of inorganic arsenic exposure among vulnerable populations. They further emphasize the importance of addressing natural arsenic contamination in water and implementing targeted interventions to reduce disparities associated with socioeconomic and demographic factors.
Clustering of Oral Health‐Related Behaviors and TheirAssociation With Sociodemographic Factors inAdolescents Living in England, Wales, and NorthernIreland
(2025) Ávila, Camila; Venturelli, Renato; Ladevig, Dominga; Georgios, Tsakos; Richard, Watt
Objectives This study investigated the clustering patterns of oral health-related behaviors and their relationship with sociodemographic factors in a national sample of 12- and 15-year-olds from England, Wales, and Northern Ireland. Material and Methods Data from the Child Dental Health Survey (CDHS) 2013 were analyzed. Five individual behaviors were considered: smoking, alcohol use, tooth brushing frequency, sugar intake, and dental attendance. Explanatory variables included sex, age, and eligibility for free school meal (FSM) (as a marker of socioeconomic deprivation). Clustering patterns were assessed using counted clusters, pairwise correlation, and observed/expected ratio analysis. Logistic regression models were performed to assess the associations between behavioral clusters and sociodemographic factors. Results The study included 4932 young people, with 51.5% aged 15 years, 50.6% male, and 17.4% eligible for FSM. Statistical differences were found in individual behaviors: Males were more likely to report lower tooth brushing frequency (28.1% vs. 13.6% for females), while 15-year-olds were more likely to engage in smoking (28.0% vs. 6.0%) and alcohol consumption (73.5% vs. 29.2%) compared to 12-year-olds. FSM-eligible adolescents were more likely to engage in all risk behaviors, except for alcohol consumption. Seven significant behavioral clusters were identified through O/E analysis, each involving combinations of two or three risk behaviors. In the regression analysis, age was strongly associated with these clusters. For example, 15-year-olds had significantly higher odds (OR: 7.04; 95% CI: 4.85–10.22) of exhibiting the cluster involving smoking and alcohol use compared to 12-year-olds. Sex and FSM eligibility also showed significant, though weaker, associations with five of the identified behavioral patterns. Conclusions Detrimental oral health behavioral clusters were more commonly observed among males, 15-year-olds, and adolescents from less advantaged backgrounds.

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