Artículos Medicina y Ciencias de la Salud

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Comparando la percepción de ambientes alimentarios entre barrios de distinto nivel socioeconómico en Santiago, Chile: un estudio transversal
(2024) Egaña, Daniel; Gálvez, Patricia; Rodríguez, Lorena; Villegas, Rodrigo; Castillo, Bárbara; Molina, Paulina
En las últimas décadas, se ha relevado la importancia de actuar en factores contextuales de la obesidad, entre ellos, los ambientes alimentarios. Recientemente, en Chile se validó la Encuesta de Medida del Entorno Nutricional Percibido, NEMS-P-Ch. Sin embargo, no existen investigaciones que hayan evaluado la percepción del grado de obesogenicidad/saludable de estos ambientes y se desconoce si difieren entre hogares de distinto nivel socioeconómico (NSE). El objetivo de este estudio es comparar la percepción sobre los ambientes alimentarios entre hogares de barrios de alto y bajo NSE de Santiago, Chile. Estudio transversal, mediante muestreo aleatorio sistemático de hogares. Se aplicó NEMS-P-Ch a 256 hogares (128 de cada comuna). Su aplicación entrega un puntaje global y puntajes asociados a la percepción de cada ambiente. Personas de la comuna de alto NSE presentan mayor ingreso familiar mensual, mayor proporción de personas con educación superior completa y menor número de habitantes en el hogar, respecto a la comuna de bajo NSE. Al comparar el puntaje global, participantes de la comuna de NSE alto perciben el entorno alimentario más salu dable que habitantes de menor NSE y hay diferencias significativas en tres de cuatro ambientes evaluados (doméstico, abastecimiento y vía pública). Mientras la mayoría de los ambientes se perciben como pantanos alimentarios, el ambiente doméstico se percibe más saludable en ambas comunas, asimilable a la idea de oasis alimentario. Estos resultados deberían movilizar acciones nacionales y locales para mejorar la disponibilidad y acceso a alimentos saludables, especialmente en barrios de menor NSE, que perciben sus ambientes alimentarios más obesogénicos.
Torsión lingular espontánea como causa rara de dolor torácico de manejo quirúrgico: Reporte de un caso
(2024) Berrios C., Nicolás; Ortega S., José; Paz A., Sebastián
Objetivo: Describir un caso extremadamente raro de torsión pulmonar espontánea en una paciente sin antecedentes de trauma o cirugía torácica, y discutir su importancia clínica. Materiales y Métodos: Se analizó el caso de una paciente femenina de 56 años que presentó dolor torácico súbito. Para el diagnós tico, se emplearon métodos como el examen físico, la tomografía computarizada y la videotoracoscopia (VTC). Resultados: La VTC reveló un infarto del segmento lingular inferior por torsión pulmonar, llevan do a la realización de una resección segmentaria de la língula sin complicaciones. Discusión: La torsión pulmonar espontánea es rara y generalmente se asocia con condiciones subyacentes como neumotórax, atelectasias, infecciones, derrame pleural, defectos congénitos o tumores. Este caso es inusual al carecer de dichos antecedentes, aunque se detectó una infección viral concomitante. Dada la gravedad de las po tenciales complicaciones mortales, resulta crucial un diagnóstico y tratamiento oportunos. Conclusión: Se presenta un caso inusual de torsión pulmonar espontánea. A pesar de su rareza, es vital considerarlo en el diagnóstico diferencial de dolor torácico agudo.
Factors associated with loneliness in Latin-American family care partners during the COVID-19 pandemic
(2024) Leon, Tomas; Tapia-Munoz, Thamara; Slachevsky Chonchol, Andrea; Costa Beber, Bárbara; Aguzzoli, Fernando; Nubia, Carla; Vilar-Compte, Mireya; Gaitan-Rossi, Pablo; Olavarria, Loreto; Castro, Loreto; Pinto, Alejandra; Guajardo, Tania; Grycuk, Emilia; Chen, Yaohua; Iracema Leroi, Iracema; Lawlor, Brian; Duran-Aniotz, Claudia; O’ Sullivan, Roger; Miranda-Castillo, Claudia; International Working Group
Background: COVID-19-related restrictions led to an increase in overall loneliness and social isolation. Before the pandemic, care partners reported higher levels of loneliness and higher loneliness prevalence compared to non-care partners. Because of the spread and severity of the infections, and the access to support spread, we expect a different impact of the COVID-19 pandemic on LATAM care partners. Objectives: To describe the loneliness levels of LATAM caregivers and to identify socioeconomic and health factors associated. Design: An international online cross-sectional survey for care partners, embedded within the ‘Coping with Loneliness and Isolation during COVID-19’ (CLIC) Study conducted between June 2020– and November 2020. Setting: We analysed data from 246 family care partners living in Latin American countries (46% Mexico, 26% Chile,18% Brazil, and 10% from Argentina, Peru, Venezuela, Panama, Guatemala y Costa Rica). Measurements: We assessed loneliness using the 6-items of De Jong Gierveld loneliness Scale. We described the levels of overall, emotional, and social loneliness pre and during Covid, and reported the distribution of care partners who improved, worsened or maintained their levels of loneliness. Moreover, we used longitudinal multiple linear regression models with bootstraps errors of 1,000 iterations to identify factors associated with the levels of overall, emotional, and social loneliness during the pandemic. Results: Participants were mostly women, 50 years and older, in a partnership, highly educated and with finances meeting their needs, with good to excellent physical and mental health. Among the total of care partners, 55% perceived higher overall loneliness, 56% higher emotional loneliness, and 21% higher social loneliness during the pandemic in comparison with pre-COVID-19 levels. Perceived mental health was associated with the overall, emotional, and social loneliness. Conclusions: Regardless of their living and health situation, during the pandemic, loneliness increased in all groups of care partners. These should be taken in consideration when planning public health approaches for crises such as pandemics or other large-scale disruptive events.
Histiocitosis de Erdheim Chester como desafío diagnóstico ante un cuadro sistémico: reporte de un caso
(2024) García, Dominga; Flores, Yorman; Vergara, Maximiliano; Labarca, Cristian
Las histiocitosis están dadas por células mieloides patogénicas y pueden clasificarse en Langerhans (LCH) y no LCH. En este último grupo se encuentra la enfermedad de Erdheim-Chester (ECD) que se caracteriza por el compromiso multiorgánico, hallazgos imagenológicos frecuentes y estudio histológico confirmatorio. Se presenta un caso con compromiso multiorgánico y confirmación histológica. Caso Clínico: Hombre, 50 años, con cuadro de 18 meses de debilidad muscular proximal simétrica asociada a parámetros inflamatorios elevados, y 6 meses de molestias visuales y exoftalmos. Por imágenes se objetivan masa retro-orbitaria inespecífica y masa fibrótica retroperitoneal con infiltración perivascular, miocárdico, perirrenal y suprarrenal e hipermetabolismo óseo. Se inicia manejo con corticoides sistémicos y se solicita estudio con biopsia de masa retroperitoneal con histiocitos espumosos, positivos para CD68, negativos para CD1a y con estudio positivo para mutación BRAFV600. Se inicia manejo con Vemurafenib con respuesta favorable. Discusión: Existen menos de 500 casos de ECD reportados en la literatura. Su patogenia aún no está clara, pero se han descrito cohortes que evidencian su compromiso multiorgánico, incluyendo compromiso óseo, neurológico, orbitario, retroperitoneal, renal, pulmonar, endocrinológico y cutáneo, entre otros. Existen alteraciones imagenológicas e histológicas típicas que conforman sus criterios diagnósticos, concordantes con los descritos en este paciente. El tratamiento de primera línea es con IFN-alfa que ha demostrado mejorar sobrevida, pero asociado a efectos adversos Como segunda línea se ha propuesto Vemurafenib en casos con mutación BRAFV600 positiva, corticoides, entre otros inmunosupresores, pero se requieren más estudios.
Morphine self-administration is inhibited by the antioxidant N‐acetylcysteine and the anti-inflammatory ibudilast; an effect enhanced by their co-administration
(2024) Quintanilla, María Elena; Morales, Paola; Santapau, Daniela; Gallardo, Javiera; Rebolledo, Rocío; Riveras, Gabriel; Acuña, Tirso; Herrera-Marschitz, Mario; Israel, Yedy; Ezquer, Fernando
Background The treatment of opioid addiction mainly involves the medical administration of methadone or other opioids, aimed at gradually reducing dependence and, consequently, the need for illicit opioid procurement. Thus, initiating opioid maintenance therapy with a lower level of dependence would be advantageous. There is compelling evidence indicating that opioids induce brain oxidative stress and associated glial activation, resulting in the dysregulation of glutamatergic homeostasis, which perpetuates drug intake. The present study aimed to determine whether inhibiting oxidative stress and/or neuroinflammation reduces morphine self-administration in an animal model of opioid dependence. Methods Morphine dependence, assessed as voluntary morphine self-administration, was evaluated in Wistar-derived UChB rats. Following an extended period of morphine self-administration, animals were administered either the antioxidant N-acetylcysteine (NAC; 40 mg/kg/day), the anti-inflammatory ibudilast (7.5 mg/kg/day) or the combination of both agents. Oxidative stress and neuroinflammation were evaluated in the hippocampus, a region involved in drug recall that feeds into the nucleus accumbens, where the levels of the glutamate transporters GLT-1 and xCT were further assessed. Results Daily administration of either NAC or ibudilast led to a mild reduction in voluntary morphine intake, while the co-administration of both therapeutic agents resulted in a marked inhibition (-57%) of morphine self-administration. The administration of NAC or ibudilast markedly reduced both the oxidative stress induced by chronic morphine intake and the activation of microglia and astrocytes in the hippocampus. However, only the combined administration of NAC + ibudilast was able to restore the normal levels of the glutamate transporter GLT-1 in the nucleus accumbens. Conclusion Separate or joint administration of an antioxidant and anti-inflammatory agent reduced voluntary opioid intake, which could have translational value for the treatment of opioid use disorders, particularly in settings where the continued maintenance of oral opioids is a therapeutic option.
Biobanks and data interoperability in Latin America: engendering high-quality evidence for the global research ecosystem
(2024) Valdés Meza, Erick; Lecaros Urzúa, Juan Alberto
Currently, each biobank in Latin America operates with its own set of standards for database creation and management, resulting in a lack of regional and international interoperability. Furthermore, regulations concerning data protection, curation, and the transfer of biological samples and associated data vary significantly from country to country, by complicating efforts to create a unified data-sharing platform. To address these challenges, Latin America should promote the development of an integrated regional network of biobanks to generate high-quality evidence within the global research ecosystem. This initiative will combine regulatory science—focused on interoperability standards across semantic, technical, legal, and organizational dimensions—and meta-science, which assesses the quality of scientific practice. Evidence indicates that harmonized standards in biobanks lead to higher-quality, more reliable data, thereby facilitating the reproducibility of scientific studies. This paper aims to identify and address existing regulatory, policy, and infrastructure gaps in Latin America to establish harmonized interoperability criteria essential for reproducing biomedical studies. Additionally, it seeks to propose minimum standards for regulating biobank networks, which will promote the development of medical products on a global scale, thereby engendering high quality evidence for the global research ecosystem and enhancing Latin America’s integration into it.
Herramientas Virtuales para Aumentar la Precisión en el Entrenamiento de Alumnos de Endodoncia
(2024) Queyrie, Gaby; Alonzo, Karime
RESUMEN: La simulación háptica ha sido propuesta como una herramienta metodológica válida para que los estudiantes de Odontología adquieran habilidades psicomotoras necesarias para su práctica clínica en seres humanos. La evidencia científica disponible presenta estudios cualitativos de percepción tanto de estudiantes como profesores con una favorable acogida. La evidencia cuantitativa, utiliza distintos tipos de simuladores y métodos para calcular el rendimiento de los estudiantes, o la mejora en la adquisición de habilidades. El objetivo de este estudio fue comparar el nivel de precisión para realizar una cavidad de acceso endodóntico en un premolar inferior en el simulador háptico VirtEasy Classic Full Inmersion (VirtEasy Dental V2 in VR) por alumnos de 3er año de la asignatura de endodoncia al inicio y término del programa de endodoncia de la carrera de odontología UDD 2023. Mientras que la hipótesis planteada fue que la precisión de los estudiantes del curso de endodoncia de la carrera de Odontología UDD 2023 mejora con la práctica en el simulador virtual háptico. Los resultados arrojaron una mejora en la precisión de un 31,6 % al finalizar el periodo de entrenamiento y realizando la misma cavidad de acceso. Esta información es relevante para que otras universidades o grupos docentes, consideren la simulación háptica en sus programas de estudio como un método que ayuda y favorece el desarrollo de la motricidad fina y la seguridad del paciente. ABSTRACT Haptic simulation has been proposed as a valid methodological tool for dental students in order to acquire the necessary psychomotor skills that are needed for their clinical practice on humans. Available scientific evidence presents qualitative studies of the perception from both students and teachers with a favorable reception. Quantitative evidence utilizes different types of simulators and methods to calculate student performance and improvements in skill acquisition. The aim of this study was to compare the level of accuracy in performing an endodontic access cavity on a lower premolar using the VirtEasy Classic Full Immersion haptic simulator (VirtEasy Dental V2 in VR) by third-year endodontic students at both the beginning and end of Universidad del Desarrollo’s (UDD) dentistry endodontic program of year 2023. The proposed hypothesis was that the accuracy of students in the 2023 UDD dentistry endodontic course would effectively improve with practice on the virtual haptic simulator. The results showed an improvement in accuracy of 31.6 % at the end of the training period while performing the same access cavity. This information could be relevant for other universities or teaching groups as they might consider haptic simulation in their study programs as a method that aids and promotes the development of fine motor skills and patient safety.
Efectividad de la terapia con pentoxifilina y tocoferol en pacientes con osteorradionecrosis maxilar: Resumen Estructurado de la Evidencia
(2024) Montalva, Patricia; Agüero, Ignacio; Puente, Benjamín; Souper, Rafael; Villanueva, Julio; Dallaserra, Matías
Introdución Esta investigación tiene como objetivo evaluar y determinar la efectividad de la terapia con pentoxifilina y tocoferol (PENTO) como tratamiento conservador no quirúrgico para la resolución de la osteorradionecrosis maxilar y/o mandibular (ORN). Métodos: Se realizó una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, que se mantiene mediante la revisión de múltiples fuentes de información, como MEDLINE, EMBASE y Cochrane, entre otras. Se extrajeron los datos de las revisiones identificadas, se analizaron los estudios primarios y se elaboró una tabla de resumen de hallazgos mediante el método GRADE. Resultados y conclusiones: Se identificaron cuatro revisiones sistemáticas que, en conjunto, incluyeron 12 estudios primarios, de los cuales dos fueron ensayos clínicos no aleatorizados y 10 estudios observacionales. No se sabe con certeza si la terapia con PENTO mejora o conduce a la resolución de la ORN sin necesidad de intervención quirúrgica, si mejora o alivia el dolor, si es una intervención segura y bien tolerada, y si reduce la necesidad de secuestrectomía o cirugía local, debido a la muy baja certeza de la evidencia existente. Introduction: This research aims to evaluate and determine the effectiveness of pentoxifylline and tocopherol therapy (PENTO) as a conservative non-surgical treatment for the resolution of maxillary and/or mandibular osteoradionecrosis (ORN). Methods: A search was conducted in Epistemonikos, the largest database of systematic reviews in health, maintained through the screening of multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. Data were extracted from the identified reviews, analyzed from the primary studies, and a summary of findings table was prepared using the GRADE method. Results and conclusions: Four systematic reviews were identified, which together included 12 primary studies, of which two were non-randomized clinical trials and 10 were observational studies. It is uncertain whether PENTO therapy improves or leads to the resolution of ORN without the need for surgical intervention, improves or relieves pain, is a safe and well-tolerated intervention, and reduces the need for sequestrectomy or local surgery, due to the very low certainty of the existing evidence.
Insuficiencia cardíaca mejorada por causa reversible: razones para no suspender el tratamiento
(2024) Nouel, Ana; Sepúlveda, Luis; Appiani, Franco
La insuficiencia cardíaca (IC) con fracción de eyección mejorada (FEVIm) se refiere a un subgrupo de pacientes con IC con fracción de eyección reducida (FEVIr), que una vez implementado el tratamiento adecuado (bloqueo neurohumoral, dispositivos, retiro de noxa u otro según corresponda) pueden evolucionar con mejoría de la función ventricular. Las poblaciones estudiadas con FEVIm son heterogéneas, incluyendo una amplia gama tales como la miocardiopatía dilatada (MCD) idiopática, familiar, isquémica y un subgrupo de causas históricamente conocidas como “reversibles”, que clínicamente se cree que tienen mayor potencial de recuperación al retiro de la noxa y podrían tener una eventual suspensión de la terapia médica óptima (TMO). En esta revisión se destacarán varios aspectos que ayudan a comprender el porqué, incluso en estas causas reversibles, al constatar una FEVIm no debería suspenderse el TMO. Es difícil determinar si en realidad es seguro el retiro, ya que desconocemos precisamente qué impulsa la recuperación ventricular. Una recaída de la FEVI, no sólo podría demorar una segunda recuperación, sino que también afectaría sobrevida del paciente. Heart failure (HF) with total or partial normalization of ejection fraction (LVEF) is a subgroup of patients with HF who, after implementing the appropriate treatment (neurohumoral block, devices, noxa withdrawal or others as appropriate) can evolve with improvement in LVEF. This group of patients, include a wide range of HF causes, including idiopathic, familial, and ischemic dilated cardiomyopathy (DCM). Also, included is a subgroup of causes which are clinically believed to have greater potential for recovery upon withdrawal of noxa and eventual consideration of discontinuation of optimal medical therapy may be considered. In this review, several aspects are highlighted that help to understand why even in these reversible causes, when HF of LVEF is confirmed, optimal medical treatment should be continued since it is quite difficult to predict whether withdrawal will be truly safe.
Análisis de las ventajas y desventajas en la Técnica Box para reconstrucción vertical de los maxilares atróficos, reporte de 4 casos
(2024) Tapia, Pedro; Arrúe, Pablo; Guerrero, Maria; Vargas, Javier
La reabsorción ósea vertical de los maxilares se ha transformado en un problema al momento de planificar la rehabilitación mediante implantes. Actualmente el uso de implantes de corta longitud provee de resultados aceptables a largo plazo, principalmente en defectos leves o medianos. El problema surge cuando existen defectos óseos verticales severos. Si bien el Gold estándar para las reconstrucciones mediante injertos son los bloques autólogos y la forma más predecible de ganancia ósea vertical es la distracción osteogénica, hoy en día aparecen alternativas terapéuticas, como la técnica box, que combinan elementos aloplásticos reabsorbibles con injertos de hueso homólogo. El propósito de este trabajo es presentar la experiencia de 4 casos clínicos que nos permiten evidenciar ventajas y desventajas del uso de las técnica box para reconstrucción de maxilares atróficos. Vertical bone resorption of the jaws has become a problem when planning reconstruction and rehabilitation using implants. Currently, it has been shown that the use of shortlength implants provides acceptable long-term results, mainly in light or medium defects. The problem arises in cases with severe bone defects. Autologous blocks are the gold standard for graft reconstructions and distraction osteogenesis is the most predictable form of vertical bone gain. However many therapeutic alternatives exist today, such as the box technique, which combine resorbable alloplastic elements with homologous bone grafts. The aim of this work is to present the experience of 4 clinical cases that allow us to demonstrate the advantages and disadvantages of the use of box techniques for the reconstruction of atrophic jaws.
Data Resource Profile: EULAT Eradicate GBC: the European-Latin American Research Consortium towards Eradication of Preventable Gallbladder Cancer
(2025) Scherer, Dominique; Barahona, Carol; Mengoa, Claudio; Montenegro, Paola; Losada, Hector; Lineth, Ana; Rojas, Armando; Vera, Allan; Spencer, Loreto; Ortega, Alejandro; Vargas, Karina; Roa, Juan; Inklemona, Cristina; Colombo, Alicia; Kirsten, Romy; Zollner, Linda; Marcelain, Katherine; Rounge, Trine; Langseth, Hilde; Lewis, Sarah; Arroyo, Gerardo; Armisen, Ricardo; Nervi, Bruno; Muller, Bettina; Fernandez, Piga; Kumar, Rajiv; Salinas, Pamela; Kelly, Rachel; Jenab, Mazda; Bermejo, Justo
Comprehensive Analysis of Genetic Contributions to Alzheimer’s Disease and Frontotemporal Dementia in Admixed Latin American Populations
(2024) Acosta, Juliana; Pina, Stefanie; Cochran, Nicholas; Taylor, Jared; Warly, Caroline; Matallana, Diana; Tadao, Leonel; Bruno, Martin; Levine, Alexandra; George, Dawwod; Lopera, Francisco; Slachevsky Chonchol, Andrea; Behrens, María; Ávila, José; Zapata, Lina; Brusco, Luis; Custodio, Nilton; Ramos, Teresita; Bruna, Bárbara; Ponce, Daniela; Gelvez, Nancy; Lopez, Greizy; Gomez, Luisa; Buitrago, Carlos; Reyes, Pablo; Durón, Dafne; Pantazis, Caroline; Maito, Marcelo; Javandel, Shireen; Godoy, Maria; Bistue, Maria; Vitale, Dan; Nalls, Mike; Singleton, Andrew; Miller, Bruce; Ibáñez, Agustín; Kosik, Kenneth; Yokoyama, Jennifer; Montesinos, Rosa; França, Elisa de Paula; Multi-Partner Consortium to Expand Dementia Research in Latin America (ReDLat)
Background: Most research initiatives have emerged from high-income countries (HIC), leaving a gap in understanding the disease’s genetic basis in diverse populations like those in Latin American countries (LAC). ReDLat tackles this gap, focusing on LAC’s unique genetics and socioeconomic factors to identify specific Alzheimer’s Disease (AD) and Frontotemporal Dementia (FTD) risk factors in Mexico, Colombia, Peru, Chile, Argentina, and Brazil. Method: We employed a comprehensive genetic analysis approach, integrating Whole Genome Sequencing (WGS), Exome Sequencing, and SNP arrays to understand the cohort’s unique genetic architecture.We conducted ancestry analysis and searched for disease-causing variants with mendelian inheritance, genome-wide association studies (GWAS), rare variant enrichment, and evaluation of Polygenic Risk Scores (PRS). Results: We recruited and genotyped an initial cohort of 1046 participants with AD, 423 with FTD, and 855 healthy controls (HC) between 2020 and 2023. Analysis is ongoing, and we expect to sequence ∼600 additional samples in the coming months. Ancestry analysis revealed tri-continental admixture, except for Brazil, which showed an additional Asian component (Figure 1). Top candidate gene rare variant enrichment associations (SKAT p < 0.05) were TREM2 for FTD and ABCA7 and ABCA1 for AD. GWAS identified a robust association with the APOE locus on chromosome 19 in AD vs. HC.. We tested an AD PRS developed in European populations by Bellenguez et al (2020). on our cohort using 83 single-nucleotide polymorphisms.. The PRS modestly distinguishes between all patients and HC (p = 2.4 × 10ˆ-12), AD vs. HC (p = 2.2 × 10ˆ-12), and even FTD vs. HC (p = 4.3 × 10ˆ-5), albeit with modest separation between groups, as expected for its application in a genetically admixed population. Conclusion: Our findings represent a pivotal step in understanding the genetic landscape of AD and FTD in admixed populations. They underscore the importance of including diverse populations in genetic research, paving the way for future studies. These findings have the potential to inform more personalized approaches to the diagnosis and treatment of neurodegenerative diseases in diverse global populations, as well as identify novel targets for therapeutic development
Functional Capacity in Activities of Daily Living in the Alzheimer’s Disease Continuum
(2024) Henriquez, Fernando; Domínguez, Carmen; Grandi, Fabrissio; Gonzalez, Cecilia; Riquelme, Patricio; Lillo, Patricia; Martínez, David; Thumala, Daniela; Henriquez, Rodrigo; Aboitiz, Francisco; Slachevsky Chonchol, Andrea
Background The most common and prevalent dementia worldwide is Alzheimer’s disease (AD). AD is a continuum composed of Subjective Cognitive Impairment (SCD), Mild Cognitive Impairment (MCI), and Alzheimer’s Disease dementia (ADD) stage. One of the main clinical variables in patients with dementia is performance in functional capacity since its alterations are associated with poor prognosis and disease progression. Functional capacity is measured through activities of daily living (ADL), which are divided into three domains: i) Basic (BADL), ii) Instrumental (IADL), and iii) Advanced (AADL). The study aimed to characterize the performance of the different stages of the AD continuum in the ADL domains and their association with cognitive abilities. Method A cross-sectional study of subjects at different stages of the AD continuum was conducted: Healthy Controls (CTR) (n = 17), SCD (n = 77), MCI (n = 30), and ADD (n = 23), who were matched for age, sex, and education. ADLs were estimated using The Technology-Activities of Daily Living Questionnaire (T-ADLQ), which assesses the three domains and a total score. T-ADLQ performance was compared across groups and correlated with cognitive ability instruments (ACE-III and IFS). Result The results showed that patients with ADD performed worse on the BADL, IADL, and total ADLs compared to the other three groups. There were no significant differences between the CTR, SCD, and MCI on the BADL, IADL, and total ADLs. However, the AADL, in addition to differentiating the ADD patients from the other three groups, also showed differences between CTR and MCI subjects and between SCD and MCI subjects (Table 1 and Figure 1). The correlation study showed that AADL correlated significantly with global cognitive and executive function assessment (Figure 2). Conclusion AADL shows progressive functional impairment at different stages of the AD continuum, which is further associated with global cognitive and executive function performances. As one progresses to a more advanced stage of the disease continuum, the performance of ADLs, especially AADLs, worsens, which could indicate a marker of disease progression, allowing for better patient follow-up.
Neuroderechos, neurotecnologías e infancia
(2024) Vega, Sebastián; Heresi, Carolina; Manterola, Carla; Espoz, Pablo
El desarrollo de nuevas tecnologías que impactan la conducta de las personas, y en particular de la población pediátrica, plantea nuevos desafíos éticos y regulatorios. El parlamento chileno inició la discusión de proyectos de ley sobre neuroderechos que buscan proteger la integridad de las personas frente a nuevas situaciones planteadas por el desarrollo tecnológico. Las propuestas contienen elementos que deben ser abordados en forma transdisciplinaria, de manera de poder dar cuenta no solo de las amenazas futuras, sino también de las actuales, con una mirada desde la protección del desarrollo de los niños, niñas y adolescentes. We are facing new ethical and regulatory challenges posed by the development of new technologies that impact human behavior, especially in the pediatric population. The Chilean parliament began discussing bills on neuro-rights in order to protect the integrity of individuals in the new era of tech-nological development. The proposals contain elements that must be addressed in a transdisciplinary manner, to account not only for future threats but also for the current ones, focusing on the protec-tion of the development of children and adolescents.
Manejo del dolor agudo y crónico en pacientes ancianos
(2024) Morena, Josefina; Lacassie, Martín; Vega, Eduardo; Cárdenas, Antonia; Pedemonte, Cristóbal; Elgueta, María
El artículo aborda los desafíos del manejo del dolor en pacientes quirúrgicos de edad avanzada debido al envejecimiento creciente de la población mundial. La población de personas mayores enfrenta una mayor prevalencia de patologías quirúrgicas y condiciones de dolor crónico, lo que convierte el control del dolor en una preocupación importante para los anestesiólogos. La neurofisiología de la percepción del dolor cambia con la edad, afectando los sistemas nerviosos periférico y central. Las alteraciones neuroquímicas y la disminución de los niveles de neurotransmisores afectan la nocicepción y la modulación del dolor, lo que puede conducir a problemas de dolor crónico en pacientes ancianos. Los cambios fisiológicos propios del envejecimiento también afectan la farmacocinética y la farmacodinamia de los analgésicos, por lo que requieren una cuidadosa consideración al seleccionar fármacos adecuados. El artículo sugiere diversas opciones farmacológicas para el tratamiento del dolor en pacientes ancianos. Sin embargo, es fundamental el manejo multimodal que involucra medidas no farmacológicas. Los autores concluyen que tratar el dolor en pacientes ancianos requiere una comprensión integral de los cambios fisiológicos relacionados con el envejecimiento. The article addresses the challenges of pain management in elderly surgical patients due to the increasing aging population worldwide. The elderly population faces a higher prevalence of surgical pathologies and chronic pain conditions, making pain control a significant concern for anesthesiologists. The neurophysiology of pain perception changes with age, affecting both the peripheral and central nervous systems. Neurochemical alterations and reduced neurotransmitter levels impact nociception and pain modulation, potentially leading to chronic pain issues in elderly patients. The physiological changes that come with aging also affect the pharmacokinetics and pharmacodynamics of drugs used for pain management. These changes require careful consideration when selecting appropriate analgesics. This article suggests various pharmacological options for pain management in elderly patients. However, it emphasizes the importance of a multimodal approach to pain management, considering non-pharmacological interventions as well. The authors conclude that treating pain in elderly patients requires a comprehensive understanding of the physiological changes related to aging and individual comorbidities. More research is needed to improve pain management strategies for this growing population.
Interacción de Tratamiento Ortodóncico, Fonoaudiológico y Kinesiológico. Reporte de caso
(2024) Quiroz, Francisca; Argandoña, Romina; Briones, Vivian; Santelices, Pilar
Se describe el caso clínico de una paciente de 8 años de edad, sexo femenino que presenta respiración oral, anomalía dentomaxilar, interposición lingual en deglución, fonación, lengua descendida en reposo y adaptaciones musculoesqueléticas por lo que requiere tratamiento de Ortodoncia, Fonoaudiología y Kinesiología. El presente reporte de caso describe la interacción de las especialidades requeridas para el manejo adecuado de la paciente y expone un flujograma sugerido para abordar casos similares. The following is a clinical case of an eight-year-old female patient who presents oral respiration, dentomaxilar anomaly, tongue interposition during swallowing and phonation, lowered tongue at rest and musculoskeletal adaptations, hence requires orthodontics, speech and physical therapy. This case report describes the interaction of the specialties necessary for the proper management of the patient and presents a suggested flow chart to address similar cases.
Efectividad de Plasma Rico en Fibrina en Lesiones de Osteonecrosis de los Maxilares Asociada a Medicamentos: Resumen Estructurado de Evidencia (FRISBEE)
(2024) Muñoz, Vicente; Agüero, Ignacio; Puente, Benjamín; Soupe, Rafael; Villanueva, Julio; Dallaserra, Matías
Introducción: Este trabajo de investigación tiene como objetivo evaluar y determinar la efectividad del uso de plasma rico en fibrina (PRF) como tratamiento para las lesiones de osteonecrosis de los maxilares asociadas a medicamentos (MRONJ). Métodos: Se realizó una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Se identificaron siete revisiones sistemáticas que en conjunto incluyeron 14 estudios primarios, de los cuales, solamente uno corresponde a un ensayo clínico aleatorizado, y el resto a estudios observacionales. No es seguro establecer con claridad si el uso de PRF mejora o contribuye a la resolución de lesiones de osteonecrosis de los maxilares asociados a medicamentos, debido a que el nivel de certeza de la evidencia es muy bajo. Introduction: This research aims to evaluate and determine the effectiveness of using platelet-rich fibrin (PRF) as a treatment for medication-related osteonecrosis of the jaws (MRONJ). Methods: A search was conducted in Epistemonikos, the largest database of systematic reviews in health, maintained through the screening of multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. Data were extracted from the identified reviews, analyzed from the primary studies, and a summary of findings table was prepared using the GRADE method Results and conclusions: Seven systematic reviews were identified, which together included 14 primary studies, of which only one was a randomized clinical trial, and the rest were observational studies. It is unclear whether the use of PRF improves or contributes to the resolution of medication-related osteonecrosis of the jaws due to the very low certainty of the evidence.
Evaluating novel in silico tools for accurate pathogenicity classification in epilepsy-associated genetic missense variants
(2024) Montanucci, Ludovica; Brünger, Tobias; Boßelmann, Christian; Ivaniuk, Alina; Pérez Palma, Eduardo; Lhatoo, Samden; Leu, Costin; Lal, Dennis
Objective: Determining the pathogenicity of missense variants in clinical genetic tests for individuals with epilepsy is crucial for guiding personalized treatment. However, achieving a definitive pathogenic classification remains challenging, with most missense variants still classified as variants of uncertain significance (VUS) and with the availability of many computational tools which may provide conflicting predictions. Here, we aim to evaluate the performance of state-of-the-art computational tools in pathogenicity prediction of missense variants in epilepsy-associated genes. This will assist in selecting the most appropriate tool and critically assess their use in clinical setting. Methods: We assessed the performance of nine in silico pathogenicity prediction tools for missense variants in epilepsy-associated genes on three carefully curated data sets. The first two data sets comprise missense variants in epilepsy associated genes that have been uploaded to ClinVar in the last year and were, therefore, not part of the training set of any of the nine considered tools. These two data sets are based on two different lists of epilepsy-associated genes and comprise ~700 and ~ 250 missense variants, respectively. The third data set includes ~400 missense variants within epilepsy-associated genes for which the functional effects have been determined experimentally and are therefore used here to infer pathogenicity. These three data sets represent the best available approximation to blind and independent test sets. Results: Among the nine assessed tools, AlphaMissense (area under the curve [AUC]: .93, .88, and .95) and REVEL (AUC: .93, .88, and .93) showed the best classification performance, also outperforming other tools in the number of classified variants. Significance: We show which recently developed prediction tools achieve higher performance in epilepsy-associated genes and should be integrated, therefore, into the American College of Medical Genetics and Genomics/Association of Molecular Pathology (AGMC/AMP) variant classification process. Periodic reevaluation of genetic test results with newly developed or updated tools should be incorporated into standard clinical practice to improve diagnostic yield and better inform precision medicine.
Disparities Affecting Organ Donation Rates in Chile
(2024) Pérez, Pablo; Muñoz, Delia; González, María; Vera, Magdalena; Muñoz, Ana
Organ transplantation represents a life-saving procedure for patients with end-stage organ failure. The demand for organ and tissue donation has increased substantially, and waiting times have increased considerably. Clearly, low numbers of organ donors represent a critical public health concern.
Cáncer de vesícula: ¿Es momento de modificar el GES?
(2024) Samaniego, Camila; De Aretxabala, Xabier; Castillo, Felipe; Paredes, Álvaro; González, María
Chile presenta en la actualidad una de las más altas tasas de mortalidad por cáncer de vesícula en el mundo. En 2006 el Ministerio de Salud Chileno incluyó la colelitiasis (pacientes 35-49 años) y el tratamiento con colecistectomía dentro del programa de Garantías Explícitas de Salud (GES). Objetivo: Evaluar los resultados del programa GES "Colecistectomía preventiva del cáncer de vesícula biliar" con la intención de proponer cambios en el programa. Método: Estudio retrospectivo de datos oficiales obtenidos de fuentes abiertas y mediante solicitud por transparencia desde el Ministerio de Salud e Instituto Nacional de Estadísticas. Resultados: Desde su inicio el año 2006, se han efectuado un total de 284.139 notificaciones de pacientes portadores de colelitiasis pertenecientes al rango etario entre 35 y 49 años. Lo anterior puede correlacionarse al número de colecistectomías practicadas como parte del programa. De estos, 229.546 fueron a pacientes mujeres. Durante los últimos 20 años, la mortalidad ajustada de la enfermedad ha mostrado una caída desde 15.16 muertes/100.000 habitantes hasta 6.72/100.000 habitantes el año 2021. La disminución en la tasa de mortalidad comenzó antes de la implementación del programa. A lo largo del país, se observan áreas claramente identificadas como de alta incidencia, especialmente en la zona centro sur. Mientras se identifican otras de baja incidencia en el norte". En cuanto a notificaciones GES existen regiones con alta notificación que no siempre se correlacionan con la incidencia. Existiendo áreas de alta incidencia y baja notificación. Conclusión: La disminución en la mortalidad del cáncer de vesícula en Chile, requiere que el programa de colecistectomía preventiva del cáncer de vesícula biliar sea modificado. Los recursos existentes debieran focalizarse en pacientes portadores de colelitiasis de áreas de alta incidencia además de portadores de factores de riesgo. Chile currently has one of the highest mortality rates from gallbladder cancer in the world. In 2006, the Chilean Ministry of Health included cholelithiasis (patients aged 35-49) and treatment with cholecystectomy within the Explicit Health Guarantees (GES) program. Aim: To evaluate the results of the GES Preventive Cholecystectomy Program for Gallbladder Cancer as to consider the need to propose changes to the model. Methods: retrospective analysis of official data from the Chile Ministry of Health and National Statistics Institute. Results: Since the program's inception in 2006, 284.139 notifications have been issued to patients aged between 35 and 49 with gallstones. Notifications can be correlated with the number of cholecystectomies performed under the program. Gallbladder cancer standardized mortality has shown a decrease over the last two decades, even before the program was implemented. High and low incidences are observed throughout the country. Regarding notifications, there are areas with a high incidence that are not always correlated with the areas with high notifications. Conclusion: The decrease in the standardized mortality of GBC in Chile requires modifying the present GES Preventive Cholecystectomy program for Gallbladder Cancer. Resources should be oriented to patients living in high-incidence areas with known risk factors.

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