Artículos Medicina y Ciencias de la Salud

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Heterogeneous cardiovascular responses to acute mean arterial pressure augmentation in septic shock: the role of ventriculo-arterial coupling and venous return
(2026) Valenzuela, Emilio; Mercado, Pablo; Medel, Juan; Oviedo, Vanessa; Gabrielli, Luigi; Slama, Michel; Bakker, Jan; Castro, Ricardo; Retamal, Jaime
Background: In patients with septic shock, vasopressor-induced mean arterial pressure (MAP) augmentation is commonly used to restore tissue perfusion; however, patients may exhibit divergent cardiovascular responses despite achieving similar arterial pressure targets. We hypothesized that this heterogeneity reflects the differences in ventricular adaptation to increases in arterial load and venous return determinants. Methods: We conducted a prospective physiological observational study in mechanically ventilated adults with septic shock who underwent transient MAP augmentation from approximately 65 to 85 mmHg after the initial hemodynamic resuscitation. MAP was increased by norepinephrine dose escalation or by adding vasopressin according to clinical judgment. Comprehensive transthoracic echocardiography was performed immediately before and after MAP augmentation. Patients were classified a priori according to the relative changes in cardiac output (CO): flow recruitment (> 15% increase), stable flow (- 15% to + 15%), or flow deterioration (> 15% decrease). Changes in effective arterial elastance (Ea), end-systolic elastance (Ees), VA coupling (Ea/Ees), stroke volume, left ventricular ejection fraction (LVEF), analogue mean systemic filling pressure (Pmsa), and derived venous return variables were analyzed. Results: Thirty-two patients were included. Despite comparable increases in MAP, the cardiovascular responses were heterogeneous: 10 patients (31%) exhibited flow recruitment, 17 (53%) maintained a stable flow, and 5 (16%) developed flow deterioration. Patients with flow deterioration showed a greater increase in Ea without a proportional increase in Ees, resulting in worsening VA coupling (ΔEa/Ees + 0.22 IQR [0.01-0.81]), whereas VA coupling remained stable or improved in patients with preserved or increased flow (p = 0.035). Flow deterioration was also associated with reduced LVEF and changes in the derived venous return indices, which may have contributed to the observed reduction in forward flow. Changes in VA coupling correlated with changes in IVCT (ρ = 0.788, p < 0.0001), MPI (ρ = 0.599, p < 0.0003), stroke volume (ρ =-0.418, p = 0.017), and LVEF (ρ=-0.431, p = 0.0139). Conclusions: Acute MAP augmentation elicits heterogeneous cardiovascular responses in patients with septic shock despite similar increases in arterial pressure. Flow deterioration is characterized by worsening VA coupling, reduced stroke volume, and impaired systolic adaptation, potentially modulated by changes in the derived venous return indices.
Combined Approach with Ultrasound and Pressure-Volume Loops to Manage Mechanical Ventilation in Acute Hypoxemic Respiratory Failure
(2026) Aguilera, Javiera; Adrião, Diana; Mercado, Pablo; Slama, Michel; De Vita, Nello; Vaschetto, Rosanna; Pozzi, Marco; Bouhemad, Belaïd; Mongodi, Silvia; Mojoli, Francesco
Acute hypoxemic respiratory failure (AHRF), particularly acute respiratory distress syndrome (ARDS), is characterized by marked heterogeneity in lung morphology and mechanics, requiring individualized mechanical ventilation strategies that balance adequate gas exchange with the prevention of ventilator-induced lung injury (VILI). Lung ultrasound (LUS) has become a cornerstone of critical care imaging, allowing differential diagnosis, quantitative assessment of lung aeration, phenotyping of ARDS morphology, and monitoring of disease evolution and complications. However, imaging alone does not provide direct guidance for optimizing ventilator settings. Some modern ventilators enable the rapid bedside acquisition of tidal pressure-volume (PV) loops, allowing tidal hysteresis to be measured and thereby providing complementary physiological information by identifying cyclic opening and closing of lung units and signs of overdistension. Emerging evidence supports the use of tidal hysteresis thresholds to identify insufficient positive end-expiratory pressure (PEEP) associated with tidal recruitment/derecruitment and to guide individualized PEEP titration during decremental PEEP trials. This review discusses the rationale and practical implementation of an integrated approach combining critical care ultrasound and PV loops throughout the management of mechanically ventilated patients with AHRF. We describe how ultrasound can support diagnosis, phenotyping, monitoring of lung aeration, and detection of ventilation-related complications, while PV loops provide a practical physiological framework for optimizing ventilator settings. This approach may provide a comprehensive, non-invasive, and repeatable bedside assessment of lung morphology, aeration, and respiratory mechanics, potentially facilitating personalized mechanical ventilation strategies aimed at reducing the risk of VILI and optimizing patient management.
Association of Ventilatory Ratio with Acute Cor Pulmonale and Mortality in COVID-19 ARDS: A Cohort Study
(2026) Benites, Martín; Battiato, Romina; Mercado, Pablo; Pairumani, Ronald; Medel, Juan; Petruska, Edward; Ugalde, Diego; Morales, Felipe; Eisen, Daniela; Araya, Carla; Montoya, Jorge; Retamal, Jaime; Kattan, Eduardo; Basoalto, Roque; Bugedo, Guillermo; Valenzuela, Emilio
PurposeAn elevated ventilatory ratio (VR) and acute cor pulmonale (ACP) are associated with mortality in ARDS patients. The primary aim of this study was to assess the association between VR and ACP in patients with COVID-19-related ARDS (C-ARDS). The secondary objectives were to analyze the association between VR and ICU mortality, describe VR temporal behavior in survivors and non-survivors, and evaluate the association between VR and pulmonary embolism.Materials and MethodsWe studied a cohort of patients with C-ARDS. The VR was calculated using a validated formula. Echocardiography was used to diagnose ACP, and CT pulmonary angiography was performed to identify PE. To evaluate the associations between VR and ACP, mortality, and PE, a generalized logistic regression model was used.ResultsOf the 140 subjects, 60 (43%) had a VR < 2, while 80 (57%) had a VR ≥ 2. Patients with a VR ≥2 had a higher risk of developing ACP than those with a VR <2 (Odds Ratio (OR), 3.77; 95% CI: 1.30 - 8.72). The ICU mortality rate was 29%. Of the 40 patients who died, 30 (75%) had a VR ≥ 2. Mortality was significantly associated with VR ≥ 2 and driving pressure ≥ 15 cm H2O. In non-survivor patients with a VR < 2 at ICU admission, a significant increase in VR was observed over the 7-day observation period. No significant association was observed between PE and VR (p = .118).ConclusionElevated VR was associated with ACP in patients with C-ARDS. VR ≥ 2 combined with driving pressure ≥ 15 cm H2O significantly improved the ability to identify patients at risk for ACP. Additionally, at ICU admission, elevated VR values and initially low values that increased over the first week were associated with higher ICU mortality.
Latin America Cutaneous Oncology Management (LACOM) I: The Role of Skin Care in Oncology Patients and Survivors
(2025) Alcalá, Daniel; Acosta, Ana; Andreani, Sebastian; Andriessen, Anneke; Cárdenas, Hebert; Moreno, Marcela; Motola, Daniel; Riganti, Julia; Ollague, José; Lacouture, Mario; Toquica, Alejandra
Background: Cancer-treatment-related cutaneous adverse events (cAEs) are common and may severely impact quality of life (QoL) and decrease treatment outcomes. The Latin American Cutaneous Oncology Management (LACOM) project provides clinical insights into cancer-treatment-related cAEs, offering tools for preventing and managing cAEs. Methods: LACOM I focuses on integrating education, prophylactic measures, and skincare in cancer treatment to improve treatment adherence, outcomes, and patients' and survivors' QoL. Results: The LACOM panel provides evidence and opinion-based best practice recommendations for oncology skincare programs to support all stakeholders in the Latin American healthcare setting (Argentina, Chili, Colombia, Ecuador, Panama, Peru, and Mexico) working with oncology patients throughout the entire continuum of care to achieve optimal outcomes, improving cancer patients and survivors' QoL. Oncology skincare programs comprise hygiene, moisturization, and sun protection with products that should be safe and help to minimize cAEs and improve skin conditions. Conclusions: Integrating education, general measures, and skincare programs into cancer treatment should encourage the adoption of a proactive role of skincare from the beginning of treatment and ongoing, supporting optimal outcomes and improving cancer patients' and survivors' QoL. J Drugs Dermatol. 2025;24(3):262-268. doi:10.36849/JDD.8565.
Socioeconomic inequalities in Chile during the COVID-19 pandemic: A regional analysis of income poverty
(2025) Delgado, Iris; Dahal, Sushma; Matute, María Isabel; Rubilar, Paola; Mamelund, Svenn-Erik; Chowell, Gerardo
The COVID-19 pandemic caused an unprecedented economic crisis, intensifying poverty levels in Latin America, particularly in Chile. This study examines the short- and long-term socioeconomic impacts of COVID-19 on income poverty in Chile, focusing on regional disparities, rurality, ethnicity, educational attainment, and immigration. Using data from the Chile National Socioeconomic Characterization Survey (CASEN) for 2017, 2020, and 2022, we analyzed poverty trends across the pre-pandemic, pandemic, and post-pandemic periods. We employed spatial clustering techniques with Local Moran's I to detect poverty hotspots and applied logistic regression models to identify key sociodemographic factors associated with these hotspots. Our results reveal stark regional disparities, with disproportionately higher poverty rates among rural populations, Indigenous communities, and individuals with lower education levels or immigrant backgrounds. The proportion of individuals in poverty hotspots rose from 6.8% in 2017 to 8.6% in 2020, before slightly declining to 7.7% in 2022. Although emergency monetary subsidies helped reduce overall poverty from 10.8% in 2020 to 6.5% in 2022, these measures were insufficient to address deep-rooted structural inequalities. Our findings underscore the urgent need for targeted, long-term policies that go beyond temporary financial assistance and tackle systemic disparities linked to rurality, ethnicity, education, and immigration. Such measures are essential for achieving sustainable poverty reduction and fostering inclusive economic growth in Chile.
Nuevas Osteotomías Estructurales del Mentón Mediante Técnica Coronal y Modificación de Genioplastia de Avance Telescópica: A Propósito de Dos Casos Clínicos
(2025) Solé-Ventura, Pedro; Tapia-Contreras, Pedro; Matus-Miranda, Gustavo; Díaz-Abarza, Sofía; Mordoh-Cucurella, Sebastián
El mentón es clave en la armonía facial; su corrección tridimensional mediante genioplastia permite abordar deformidades faciales y funcionales con técnicas personalizadas. El objetivo de este estudio fue presentar dos técnicas quirúrgicas innovadoras de osteotomías estructurales del mentón: una técnica coronal para reducción multivectorial y una modificación de la genioplastia telescópica para avance controlado, a propósito de dos casos clínicos. Paciente sexo masculino de 22 años, dolicocefálico clase I, sometido a osteotomía y genioplastia coronal. Segundo paciente de sexo femenino de 28 años, con biotipo braquifacial y promentonismo severo, sometida a cirugía ortognática bimaxilar, seguida de genioplastia telescópica modificada. Se describieron y ejecutaron las dos técnicas, empleando sierra reciprocante y piezoeléctrico, con abordaje intraoral y fijación intermaxilar. Ambas técnicas permitieron mejorar la simetría y proyección del mentón, respetando el surco mentolabial y sin comprometer la vía aérea ni la arquitectura facial.
Podcasts educativos: una herramienta innovadora en la educación de enfermería
(2025) Guerra Sánchez, Fabiola Alejandra; Contreras Gutiérrez, Jorge Eduardo; Núñez Núñez, Alejandro Patricio; Reeves Valentino, Sergio Alejandro; Pérez Acuña, Claudia Verónica
Introducción: En una sociedad en constante cambio, la educación debe adaptarse para satisfacer las necesidades de los estudiantes. Recursos innovadores tecnológicos, enseñanza híbrida y otros recursos desempeñan un rol relevante en esta adaptación. Para maximizar su impacto, es esencial examinarlos desde diversas perspectivas. Objetivo: Evaluar la satisfacción con podcasts educativos complementarios utilizados en una asignatura de sexto semestre de la carrera de enfermería en una universidad privada en Chile. Métodos: Estudio de tipo cuantitativo, descriptivo, inferencial, de corte transversal, con un muestreo no probabilístico y por conveniencia, que consideró como criterio de inclusión la disponibilidad y disposición de los sujetos a participar. La muestra estuvo constituida por 79 estudiantes de un universo de 113. Los datos fueron obtenidos usando el “Cuestionario de satisfacción del estudiante con podcasts educativos”. El estudio contó con la aprobación del Comité de ética institucional y se resguardaron todos los criterios éticos. Resultados: La puntuación global obtenida tras la aplicación del “Cuestionario de satisfacción del estudiante con podcasts educativos” mostró altos índices de satisfacción con la herramienta en general. Los valores de estadística descriptiva por cada ítem evidenciaron resultados positivos en relación con el nivel de satisfacción. Conclusiones: Los podcasts educativos de tipo complementario presentan altos niveles de satisfacción en la población estudiada, lo que resulta coherente con la literatura. Queda el desafío de estudiar los efectos de los podcasts educativos en los niveles superiores del modelo de Kirkpatrick.
Management of Cervicofacial Necrotizing Fasciitis of Peritonsillar Origin: A Case Report
(2025) Tapia Contreras, Pedro; Matus-Miranda, Gustavo; Zeballos-Cofré, Jessica; Carvajal-Guzmán, Melissa; Jollán, Florencia; Díaz-Abarza, Sofía
Necrotizing fasciitis (NF) is a rare, rapidly progressing, and severe infection of subcutaneous tissues and muscle fascia that can be fatal. It causes rapid tissue necrosis through pathogen-induced vasoconstriction and thrombosis. While commonly found in the torso, abdomen, and limbs, it rarely affects the head and neck. Effective treatment includes early diagnosis, surgery, antibiotics, and hyperbaric oxygen therapy, though mortality remains high. A 40-year-old man with a history of uncontrolled diabetes mellitus (DM) presented with increased volume, erythema, and cramps in the cervical and upper thoracic area. The main diagnosis was NF, requiring surgical debridement of the affected tissue. Despite therapeutic efforts, the patient succumbed to sepsis and multiple organ failure. NF is a life-threatening infection with a very low incidence but a high mortality rate. Cervical NF often arises from odontogenic infections and is associated with systemic factors like diabetes and obesity. Early diagnosis is challenging, but Computed tomography (CT) and the Laboratory risk indicator score for necrotizing fasciitis (LRINEC) score are essential. Effective treatment includes surgical debridement, broad-spectrum antibiotics, and hyperbaric oxygen therapy. NF remains a critical condition with high mortality, underscoring the need for early recognition and aggressive treatment strategies to improve patient outcomes.
Surgically Treated Maxillofacial Fractures in Dr. Franco Ravera Zunino Hospital in Chile: a Retrospective Study of 5 Years Experience
(2025) Tapia Contreras, Pedro; Matus-Miranda, Gustavo; Molinare-Severino, Pablo; Zeballos-Cofré, Jessica; Moreno-Zárate, José; Matamoros-Rojo, Cristian; Sepúlveda-Quezada, Ricardo; Jollán, Florencia; Díaz-Abarza, Sofía
Maxillofacial trauma is one of the fields of surgical activity in our specialty and constitutes a relevant problem in highly complex hospitals, the presence of our specialists being essential within an interdisciplinary team for the resolution of this type of pathology. An adequate management and early treatment is essential from the moment the patient is admitted, without leaving aside the sequelae and the subsequent rehabilitation work for the work and daily reinsertion of the patients. The purpose of this work is to present the experience of the Maxillofacial Surgery team of the Rancagua Hospital in the surgical resolution of 320 maxillofacial fractures with a retrospective review of 5 years. A study was carried out with analysis of the surgical protocols of patients operated on for maxillofacial trauma, in the central pavilion, under general anesthesia, in a period of 5 years. The variables analyzed were diagnosis, age, sex, compromised facial third, type of fracture, approaches used, and type of rigid internal fixation. 368 surgical procedures were performed. The average age of the operated patients was 36 years, with a predominance of the male sex (80.4 %), the middle third was the most affected (49.1 %) followed by fractures of the lower third of the face (35.5 %). It is necessary to develop epidemiological investigations of these pathologies in order to obtain demographic conclusions and contribute to unifying diagnostic and treatment criteria, thus establishing efficient prevention and treatment policies in relation to each service and as a whole at the public health level.
Influencia vertical del contacto prematuro en la determinación de la relación oclusal de modelos articulados
(2025) Deck-Glaves, Bárbara; Belkner-Cinquemani, Mark; Casamitjana-Schiappacasse, Francisca; Buchi-Velázquez, Agustina; Herrera-Muñoz, Alisson
El estudio de la oclusión ha sido un tema de gran interés durante años y conocer los problemas relacionados es esencial para la ortodoncia. Objetivo: Este estudio busca cuantificar el efecto vertical y sagital interoclusal producido por un aumento de contacto prematuro de 0.5mm y 1mm en modelos de estudio y analizado según biotipo facial y clase esqueletal. Materiales y métodos: Fueron estudiados 30 modelos de pacientes, los cuales fueron montados en relación céntrica en articulador semiajustable. Se hicieron incrementos verticales sobre la superficie completa del contacto prematuro, mediante bloques de resina y fueron escaneados en oclusión, para luego compararlos en sentido vertical y sagital en software Blender. Resultados: Existe diferencia significativa en los cambios producidos tanto a nivel vertical como sagital. El mayor cambio observado fue en sentido sagital anterior en biotipo dolicofacial. No se encontró diferencia significativa al analizar el total de la muestra según biotipo facial ni clase esqueletal. Conclusión: Un aumento selectivo de la dimensión vertical del contacto prematuro, sí influye en la relación vertical y sagital interoclusal.
Recomendaciones chilenas para poligrafía respiratoria en pediatría. Sociedad Chilena de Neumología Pediátrica, Sociedad Chilena de Enfermedades Respiratorias y Sociedad Chilena de Medicina del Sueño
(2025) Zenteno Araos, Daniel; Brockmann Veloso, Pablo; Abara Elías, Selim; Bertrán Salinas, Katalina; Oyarzún Aguirre, Ignacio; Nayar Escobar, Stefhanie; Astudillo Maggio, Claudia; Campos Olmedo, Carolina; Escobar Adaros, Pía; Navarro Riquelme, Juan Andrés; Moya-Isammitt, Ana; Torres-Puebla, Gerardo; Moscoso Altamira, Gonzalo; Farbinger Pérez, Franz; Alarcón Grandón, Ricardo; Hernández Gómez, Alejandra
Los Trastornos Respiratorios del Sueño (TRS) son muy prevalentes y se encuentran subdiagnosticados en la población pediátrica. La prueba de referencia para el diagnóstico y su categorización es la polisomnografia (PSG), cuyo acceso es limitado en nuestro medio. Por esto, la poligrafia (PG) es una alternativa más accesible y versátil, que contribuye a disminuir la brecha diagnóstica de los TRS a nivel local. En estas recomendaciones, los autores, miembros de la Sociedad Chilena de Neumología Pediátrica (SOCHINEP), Sociedad Chilena de Enfermedades Respiratorias (SER-Chile) y la Sociedad Chilena de Medicina del Sueño (SOCHIMES) se plantearon como objetivo establecer directrices para el uso de PG en pediatría. Se profundiza sobre aspectos técnicos, aspectos prácticos e interpretación; incluyendo comentarios específicos sobre poblaciones especiales como menores de 3 meses, hospitalizados en unidades críticas, pacientes con enfermedades neuromusculares, obesidad, malformaciones craneo-faciales y ventilados crónicos. De esta forma, se establecen recomendaciones aplicables para todo Chile en el uso de la PG como una herramienta confiable y estandarizada en diferentes escenarios clínicos en pediatría.
Interpretable machine learning model for characterizing magnetic susceptibility-based biomarkers in first episode psychosis
(2025) Franco, Pamela; Montalba, Cristian; Caulier, Raúl; Milovic, Carlos; González, Alfonso; Ramirez, Juan; Undurraga, Juan; Salas, Rodrigo; Crossley, Nicolás; Tejos, Cristian; Uribe, Sergio
Background and purpose: Several studies have shown changes in neurochemicals within the deep-brain nuclei of patients with psychosis. These alterations indicate a dysfunction in dopamine within subcortical regions affected by fluctuations in iron concentrations. Quantitative Susceptibility Mapping (QSM) is a method employed to measure iron concentration, offering a potential means to identify dopamine dysfunction in these subcortical areas. This study employed a random forest algorithm to predict susceptibility features of the First-Episode Psychosis (FEP) and the response to antipsychotics using Shapley Additionality Explanation (SHAP) values. Methods: 3D multi-echo Gradient Echo (GRE) and T1-weighted GRE were obtained in 61 healthy-volunteers (HV) and 76 FEP patients (32 % Treatment-Resistant Schizophrenia (TRS) and 68 % treatment-Responsive Schizophrenia (RS)) using a 3T Philips Ingenia MRI scanner. QSM and R2* were reconstructed and averaged in twenty-two segmented regions of interest. We used a Sequential Forward Selection as a feature selection algorithm and a Random Forest as a model to predict FEP patients and their response to antipsychotics. We further applied the SHAP framework to identify informative features and their interpretations. Finally, multiple correlation patterns from magnetic susceptibility parameters were extracted using hierarchical clustering. Results: Our approach accurately classifies HV and FEP patients with 76.48 ± 10.73 % accuracy (using four features) and TRS vs RS patients with 76.43 ± 12.57 % accuracy (using four features), using 10-fold stratified cross-validation. The SHAP analyses indicated the top four nonlinear relationships between the selected features. Hierarchical clustering revealed two groups of correlated features for each study. Conclusions: Early prediction of treatment response enables tailored strategies for FEP patients with treatment resistance, ensuring timely and effective interventions.
Mechanical Instability After Civilian Thoracolumbar Gunshot Injuries: A Systematic Review to Support Classification Development
(2025) Ricciardi, Guillermo; Cirillo, Ignacio; Cabrera, Juan; Alvarenga, Otávio; Neves, Emiliano; Carazzo, Charles; Dittmar, Michael; Guiroy, Alfredo; Yurac, Ratko; Schroeder, Gregory
Study DesignSystematic Review.ObjectivesIdentify risk factors for mechanical instability in thoracolumbar gunshot wounds to develop a new classification system.MethodsA systematic review following PRISMA 2020 guidelines was conducted across multiple databases from January 1, 1990, to September 12, 2024 (PROSPERO: CRD42023458804).ResultsOf 2400 records, 33 studies (3195 patients) met inclusion criteria, mostly retrospective and single-center, with varying definitions of instability. Direct comparison was limited due to clinical heterogeneity. Only 12 studies defined mechanical instability, mainly using the Denis three-column theory. Instability was reported in less than 10% of cases, except for one higher-rate outlier. The main markers included vertebral body comminution and potential ligamentous injury. Management was mainly conservative, with a low fixation rate (1.5-9.7%). Imaging relied on CT and static X-rays, with some studies advocating for dynamic radiographs.ConclusionThere is a lack of standardized definitions for mechanical instability in civilian thoracolumbar gunshot injuries. Four recurrent unstable patterns were detected, with vertebral body comminution as the most consistent marker. The need for a standardized classification system and further prospective studies is evident.
Intervenciones psicoeducativas que facilitan la adaptación del box dental y la aplicación de odontología preventiva de niños y adolescentes con Trastorno del Espectro Autista
(2025) Señor Zapata, María Fernanda; Narváez, Carmen Gloria; Hernández Reeve, María Alejandra
Actualmente Trastorno del Espectro Autista (TEA) no se define como un solo trastorno, sino un conjunto de estos. Estos individuos tienen un desarrollo atípico: alteraciones en las funciones cerebrales ejecutivas como en la interacción social, comunicación verbal-no verbal y la conducta, actividades e intereses. El especialista en odontología pediátrica debe entender el trasfondo de las características de los individuos con este trastorno y conocer las herramientas existentes para proveer una atención odontológica de calidad adaptada a las necesidades de ellos. El objetivo de este estudio fue identificar las estrategias psicoeducativas facilitadoras de la adaptación del box dental y la aplicación de odontología preventiva en niños y adolescentes con TEA. Se realizó una revisión sistemática narrativa con una búsqueda en la base de datos Pubmed, Cochrane Library, Web of Science y Wiley, de artículos relacionados publicados entre los años 2015 y 2023. De un total preliminar, después de realizado los filtros correspondientes, se llegó a un total de 19 artículos seleccionados para esta revisión. Estas intervenciones incluyen Pedagogia Visual, pictogramas, imágenes, tecnología como tablets e imágenes digitales, historias visuales, SADE, PECS y terapia Sensorial. El tratamiento con cualquiera de las técnicas facilitadoras antes mencionadas son tratamientos largos que necesitan múltiples sesiones tanto en el box odontológico como en la instrucción de técnica de cepillado para lograr el éxito. Destaca la necesidad del trabajo intersectorial entre salud y educación, especialmente en el campo de la odontología preventiva, para lograr una atención menos costosa, ya sea para el Estado o para los propios cuidadores, evitando procedimientos riesgosos de elevado costo como es la atención bajo anestesia general.
Community-Based Rehabilitation and Patient-Centered Outcomes in Survivors of Critical COVID-19 Attending an Intensive Care Recovery Clinic
(2025) González, Felipe; Haezebrouck , Evan; Fresenko, Lindsey; Sevin, Carla; Slone, Stacey; Montgomery, Ashley; Kalema, Anna; Ginoza, Lori; Martinez, Clarisa; Martinez, Clarisa; Biehl, Michelle; Kelley, Soibhan; Johnson, Joshua; Mar, Matthew; Mayer, Kirby
Objective: To examine the occurrence of physical and cognitive impairments among survivors of critical coronavirus disease of 2019 (COVID-19) who attend an intensive care unit (ICU) recovery clinic and describe their utilization of community-based rehabilitation (physical and occupational therapy). Design: Retrospective, observational cohort study and multisite practice analysis. Setting: ICU recovery clinics at 4 academic medical centers. Participants: Adults (median age 56 [interquartile range, {IQR}, 47-64] years, 60% female) surviving acute respiratory failure caused by COVID-19 who required advanced respiratory support. Main outcome measures: Six-minute walk test (6MWT) and Montreal Cognitive Assessment (MoCA). Results: Patients attended the ICU recovery clinic (n=163) in a median of 43 (IQR, 30-60) days after discharge. Ninety-four patients (58%) participated in at least 1 community-based rehabilitation session, 52 (32%) never participated, and 17 (10%) did not have data available. Patients walked a median [IQR] of 282 [150-390] meters on the 6MWT, and the median Short Physical Performance Battery (SPPB) score was 8 [4-11] with 63% of patients classified as physically frail (score ≤9/12). The median MoCA score was 26 [22-27], with 37% at least mild cognitive impairment (score of ≤26). Among patients who were driving before ICU admission, 44% had not returned to driving after hospitalization, and an additional 21% reported driving with new limitations. Patients who participated in at least 1 community-based rehabilitation session had longer ICU lengths of stay as well as worse performance on the 6MWT and SPPB at discharge compared with individuals not receiving postdischarge rehabilitation (P<.001). Conclusions: Survivors of acute respiratory failure caused by critical COVID-19 who attended an ICU recovery clinic are at high risk of physical and/or cognitive impairments. Two-thirds of survivors participated in physical or occupational therapy at home or an outpatient center after hospital discharge. Patients with longer lengths of stay and more physical impairments at discharge are more likely to participate in community-based rehabilitation interventions.
Therapeutic Alternatives of Buccal Mucosa Grafting in Extraoral Reconstructions: a Case of Fournier's Gangrene
(2025) Tapia Contreras, Pedro; Sarzosa Enrriquez, Marcelo; Matus-Miranda, Gustavo; Pizzi Lazo, Pablo; Díaz-Abarza, Sofía; Jollán, Florencia
Buccal mucosal grafts are versatile in medical practice, documented minimally despite potential in otolaryngology, ophthalmology, dermatology, plastic surgery and urology. They offer advantages such as being hairless, easily obtained, and infection-resistant, with a thin, highly vascularized epithelial layer aiding absorption and reducing contracture risk. Complications from oral donor sites, like pain and sensory changes, are known, relevant in conditions such as Fournier's gangrene, necessitating urgent surgical intervention and often reconstruction. We present a case report of a 45-year-old male with Fournier's gangrene treated jointly by urology and maxillofacial surgery. Buccal mucosal grafts were harvested from the inner cheek mucosa for simultaneous urethral reconstruction. The procedure preserved the parotid duct, obtaining a graft comprising mucosal, submucosal, and glandular tissues, applied to the urethral defect with bovine dermis coverage. Postoperative recovery was uneventful, with successful catheter removal in 2 weeks and complete donor site healing in 6 months. Buccal mucosal grafts prove effective in complex reconstruction, offering structural integrity and minimal morbidity. Despite challenges like graft contraction and limited tissue availability in severe cases, buccal mucosal grafts are favored for reliability and patient satisfaction in reconstructive needs, notably urethral reconstruction. The evidence shows a high success rate in most of the uses of buccal mucosal grafts, so it is recommended as an effective and safe graft for extraoral reconstructions, particularly urethral reconstruction, where the Maxillofacial Surgeon is part of the interdisciplinary team. Awareness of potential complications and procedural limitations ensures optimal outcomes and patient care.
MPOX como imitador clínico de molusco contagioso
(2025) Navea, Oscar; Pérez-Wilson, Jaime; Calderón, Daniela; Navea, María Belén
Paciente masculino de 34 años consultó por lesiones genitales de 2 días de evolución luego de un contacto sexual 8 días antes. El examen físico reveló tres pápulas blanquecinas y umbilicadas en glande, prepucio y pubis; y una úlcera en prepucio. Las pruebas iniciales resultaron negativas, pero una prueba de PCR confirmó infección por MPOX. El MPOX es una enfermedad zoonótica, con alza de contagios desde el 2016 y un brote declarado emergencia de salud pública en 2022. La transmisión principal ocurre a través de contacto directo con secreciones o lesiones, afectando principalmente a hombres que tienen sexo con hombres. Destacamos la posibilidad de confusión diagnóstica con el molusco contagioso, especialmente en etapas iniciales. En Chile, se han reportado 1.441 casos confirmados de MPOX, siendo este uno de los pocos casos reportados en la literatura con presentación inicial de lesiones molusco-contagioso-like en el área genital
Muscle Dysfunction and Physical Recovery After Critical Illness
(2025) Mart, Matthew F.; Gordon, Joshua I.; González-Seguel, Felipe; Mayer, Kirby P.; Brummel, Nathan
During critical illness, patients experience significant and rapid onsets of muscle wasting and dysfunction with loss of strength, mass, and power. These deficits often persist long after the ICU, leading to impairments in physical function including reduced exercise capacity and increased frailty and disability. While there are numerous studies describing the epidemiology of impaired muscle and physical function in the ICU, there are significantly fewer data investigating mechanisms of prolonged and persistent impairments in ICU survivors. Additionally, while several potential clinical risk factors associated with poor physical recovery have been identified, there remains a dearth of interventions that have effectively improved outcomes long-term among survivors. In this article, we aim to provide a thorough, evidence-based review of the current state of knowledge regarding muscle dysfunction and physical function after critical illness with a focus on post-ICU and post-hospitalization phase of recovery.
Longitudinal changes in striatocortical connectivity in first-episode psychosis associated with the emergence of treatment resistance
(2025) Tepper, Angeles; Vásquez, Javiera; Díaz, Camila; Ramirez, Juan; Aguirre, Juan; Barbagelata, Daniella; Aceituno, David; Undurraga, Juan; Nachar, Ruben; Mena, Cristian; McCutcheon, Robert; McGuire, Philip; Gonzalez, Alfonso; Crossley, Nicolas
Treatment resistance affects up to one in four individuals with psychosis in the first few years of illness. However, there is limited information about the brain changes associated with treatment resistance, restricting our ability to develop effective prognostic biomarkers or new treatments. Using resting-state functional MRI, we examined striatocortical connectivity in 87 patients who presented a non-affective first-episode of psychosis and 118 healthy controls, with follow-up imaging on more than half of the participants in the next 6 years, totaling 361 images. Crucially, we identified 30 patients who presented treatment-resistant psychosis in this follow-up period. Thus, we examined baseline (at first episode) and longitudinal striatocortical differences within psychosis subgroups (treatment-responsive and treatment-resistant psychosis), and between patients subgroups and healthy controls. Compared to healthy controls, participants with treatment-responsive psychosis presented baseline differences in functional connectivity of ventral striatal systems, without changes over time; whereas patients with treatment-resistant psychosis showed both baseline and longitudinal differences in ventral striatal systems, compared to healthy controls. Treatment-responsive and treatment-resistant psychosis groups differed in longitudinal changes in connectivity between ventral striatal and temporal cortical regions. This is one of the circuits which has been previously related to symptom improvements in patients with first-episode of psychosis. No baseline differences were observed between the two psychosis groups. Overall, treatment-resistant psychosis is characterized by longitudinal changes in striatal systems in early psychosis, which might be used as the basis of future prognostic biomarkers.
White matter hyperintensities and their impact in brain structure and function in alzheimer's disease and behavioral variant frontotemporal dementia across Latin America and the United States: a cross-sectional study
(2025) Altschuler, Florencia; Canziani, Verónica; Fraile, Matías; Gonzalez, Raul; Hernández, Hernán; Baez, Sandra; Migeot, Joaquín; Fittipaldi, Sol; Maito, Marcelo; Legaz, Agustina; Godoy, Maria; Moguilner, Sebastián; Cruzat, Josephine; Coronel, Carlos; Tagliazucchi, Enzo; Santamaria, Hernando; Reyes, Pablo; Matallana, Diana; Avila, José; Slachevsky Chonchol, Andrea; Behrens, María; Custodio, Nilton; Cardona, Juan; Brusco, Luis; Bruno, Martin; Sosa, Ana; Pina, Stefanie; Takada, Leonel; Franca, Elisa de Paula; Possin, Katherine; De Oliveira, Maira; Hu, Kun; Lawlor, Brian; Yokoyama, Jennifer; Miller, Bruce; Lopera, Francisco; Martin, Adolfo; Medel, Vicente; Ibañez, Agustin; Gonzalez, Cecilia
Background: White matter hyperintensities (WMHs) are a core manifestation of normal and pathological aging and are potentially linked to geographical differences in social and physical exposomes. Previous studies have not examined the impact of WMHs burden on neurodegeneration and cognition in healthy controls (HCs) and patients with Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD) across geographic regions. This study addressed this gap by assessing the impact of WMHs burden on participants with and without dementia from Latin America (LA) and the United States (US). Methods: The study comprised 994 participants, including HCs (n = 402), AD (n = 359), and bvFTD subjects (n = 233) from LA and the US. WMHs and their association with grey matter (GM) atrophy, assessed through GM volume and cortical thickness, were evaluated and compared among groups (HCs, AD, and bvFTD) in LA and the US using a voxel-wise brain imaging approach (p < 0.05 family-wise error-corrected for multiple comparisons, minimum cluster size = 50 voxels). Multiple regressions analysis were employed to examine geographic differences in WMHs burden, WMHs-GM associations, and the effect of WMHs on cognitive performance, as assessed by the Mini-Mental State examination. Results: In the LA cohort only, higher WMHs load was associated with greater GM atrophy across all groups (HCs, AD, bvFTD), with a specific neurodegenerative pattern involving orbitofrontal, cingulate, and temporal areas. HCs from LA showed a greater WMHs load than their US counterparts, and this effect was dependent on GM atrophy. Finally, WMHs burden negatively impacted cognitive performance in dementia subjects, with a greater effect observed in bvFTD subjects from the US. Conclusion: WMHs have a more pronounced impact on neurodegeneration across the LA cohort, with a worse impact on HCs, which also show higher WMHs burden than their US counterparts. This could increase the risk of developing dementia. Moreover, WMHs burden differentially impacts cognition, with a greater negative effect observed in bvFTD subjects from the US. These findings highlight geographic variations in WMHs-related conditions, offering valuable insights for tailored future research.

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