Artículos Medicina y Ciencias de la Salud

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Radiotherapy-induced vitiligo in a patient with breast cancer, a case report
(2024) Villanueva, Francisco; Jara, Natalia; Darlic, Valentina
Vitiligo is a disease characterised by the autoimmune destruction of melanocytes, manifesting as depigmentation of the skin. We present the case of a female patient with a history of breast cancer who developed vitiligo in the area of the treatment field 12 months after the end of radiotherapy. It has been reported in the literature that vitiligo can occur in patients with a history of vitiligo after radiotherapy, attributable to the Koebner phenomenon, where some treatments can induce new vitiligo lesions in the patient.
Deep‐frying impact on food and oil chemical composition: Strategies to reduce oil absorption in the final product
(2024) Valle, Consuelo; Echeverría, Francisca; Chávez, Vilma; Valenzuela, Rodrigo; Bustamante, Andrés
During frying, oils can deteriorate due to autoxidation and hydrolytic alterations, processes influenced by the oil's fatty acid composition (FAC) and antioxidant content. However, there are different techniques to improve fried food quality and reduce oil absorption. This review aims to assess existing literature on the interactions between frying methods, oil selection, and the chemical composition of foods. To achieve this goal, the article examines the impact of oil FAC, antioxidants, pretreatments, and alternative frying technologies. A literature search was conducted from 2016 to 2023. The keywords used were (AND/OR) frying, fried foods, oil, oil absorption, and fatty acids. Oils rich in monounsaturated fatty acids and antioxidants, such as olive oil, are recommended for their nutritional benefits and improved oil stability. The water content and structure of the food also play a significant role in oil absorption. Pretreatments to diminish food moisture content contribute to a lower oil absorption in the fried food while mitigating excessive accumulation of lipid oxidation products. Proper selection of frying oils, incorporation of antioxidants, and the use of pretreatments could help prevent chemical changes and minimize oil absorption during frying. These measures contribute to maintaining the nutritional quality and safety of fried foods while also enhancing their overall sensory appeal.
Predictability and functional impact of lateral acromioplasty using preoperative 2D planning on the correction of the critical shoulder angle (CSA) in patients with rotator cuff repair
(2024) Toro, Felipe; De la Paz, Joaquín; De la Maza, Francisca; Ruiz, Francisco; Moraga, Claudio; Mardones, Paula
Background: Rotator cuff tears are highly prevalent, and their association with critical shoulder angle (CSA) has been reported. There is controversy regarding whether the morphology of the acromion influences its incidence, as well as whether acromioplasty would impact the results of a rotator cuff repair. Lateral acromioplasty does not play a decompressive role; rather, it aims to correct the deltoid vector. According to some publications, this would achieve less loading on the repaired rotator cuff, a lower retear rate, and better function. CSA correction with lateral acromioplasty can be planned with radiography (2-dimensional [2D]), but its predictability has not been fully studied. The primary objective of this study is to evaluate the predictability of 2D planning with radiography in CSA correction in patients with rotator cuff repair. The secondary objective is to analyze the association between the correction of the CSA and the functional outcomes. Methods: This single-center, prospective, observational, analytical study included candidates for arthroscopic repair of a rotator cuff tear with a CSA > 35°. Lateral acromioplasty was performed as planned with preoperative radiography (2D) to achieve a CSA of 35°. The degrees to be corrected were calculated. CSA was recalculated with a postoperative radiography; and the error in the planned grades to be corrected was calculated. At the end of follow-up, Visual Analog Scale, Subjective Shoulder Value (SSV), and Quick-Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) scores were evaluated. Results: Forty one cases were included, 43.9% were men, and the mean age was 55.5 ± 8.6 years. The mean preoperative and postoperative CSA were 39.6° ± 1.9° and 35.7° ± 2.3°, respectively; 41.5% achieved a postoperative CSA ≤ 35°. The mean CSA planned correction error was 45.7 ± 28.8%. At the end of the follow-up, 33 (78.6%) had a functional evaluation, with an average follow-up of 41 ± 6.8 months. The mean Visual Analog Scale, Quick-DASH, and SSV were 0.9 ± 1.6, 5.3 ± 7.5, and 92.7 ± 10.6, respectively. There was a significant difference in Quick-DASH (P = .01) and SSV (P = .02) according to whether a postoperative CSA ≤ 35° was achieved. Conclusion: In lateral acromioplasty, planning of CSA correction with radiography (2D) is imprecise. Reaching a CSA ≤ 35° positively influences functional results.
Effects of school closure on lifestyle behaviours and health outcomes in children during the COVID-19 pandemic in Chile: A time-matched analysis
(2024) Suárez, Mónica; Fernández, Rodrigo; Quintiliano Scarpelli Dourado, Daiana; Pinheiro Fernandes, Anna Christina; Pizarro, Tito
Background: The COVID-19 pandemic led to school closures, potentially impairing children's behaviours and health. We aimed to explore the effects of school closure on lifestyle behaviours (dietary habits, physical activity) and health outcomes (adiposity, fitness, self-esteem, self-concept) in children. Methods: We measured 247 children before school closure (October-November 2019) and after school reopening (October-November 2021) (COVID-19 group). To distinguish the changes due to school closure from changes due to growth, we included 655 age-matched children with cross-sectional measurements in October-November 2019 (control group). The response of this group (i.e., differences between children with 2 years of difference) was considered the expected response to growth. Two-way ANOVA was used to test age-by-group interactions, indicating an effect of school closure. Results: In 7-to-9-year-old children, the COVID-19 group had larger-than-expected decreases in physical activity (by 0.4 points), resulting in higher physical inactivity prevalence (by 19 percent points) at 9 years. This was accompanied by larger-than-expected increases in fat percentage (by 6.1 percent point). In 8-to-10-year-old children, the COVID-19 group had higher physical inactivity prevalence at 10 years (by 20 percent points). This was accompanied by larger-than-expected increases in fat percentage (by 8.3 percent points), z-score BMI (by 0.90 units), and waist circumference (by 6.1 cm). In 9-to-11-year-old children, the COVID-19 group had larger-than-expected decreases in physical activity (by 0.3 points) and increases in self-concept (by 0.2 points). The response in dietary habits, fitness, or self-esteem was not different between groups. Conclusion: Overall, school closure negatively impacted physical activity and adiposity, particularly in the youngest children.
Criteria and Indicators for Centers of Clinical Excellence in Stroke Recovery and Rehabilitation: A Global Consensus Facilitated by ISRRA
(2024) Stockley, Rachel; Walker, Marion; Murphy, Margit; Abd Aziz, Noor Azah; Amooba, Philemon; Churliov, Leonid; Farrin, Amanda; Fini, Natalie; Ghaziani, Emma; Godecke, Erin; Gutierrez, Tania; Jia, Jie; Kandasamy, Thoshenthri; Lindsay, Patrice; Solomon, John; Thijs, Vincent; Tindall, Tierney; Tippett, Donna; Watkins, Caroline; Lynch, Elizabeth
Background: The aim of the International Stroke Recovery and Rehabilitation Alliance is to create a world where worldwide collaboration brings major breakthroughs for the millions of people living with stroke. A key pillar of this work is to define globally relevant criteria for centers that aspire to deliver excellent clinical rehabilitation and generate exceptional outcomes for patients. Objectives: This paper presents consensus work conducted with an international group of expert stroke recovery and rehabilitation researchers, clinicians, and people living with stroke to identify and define criteria and measurable indicators for Centers of Clinical Excellence (CoCE) in stroke recovery and rehabilitation. These were intentionally developed to be ambitious and internationally relevant, regardless of a country's development or income status, to drive global improvement in stroke services. Methods: Criteria and specific measurable indicators for CoCE were collaboratively developed by an international panel of stroke recovery and rehabilitation experts from 10 countries and consumer groups from 5 countries. Results: The criteria and associated indicators, ranked in order of importance, focused upon (i) optimal outcome, (ii) research culture, (iii) working collaboratively with people living with stroke, (iv) knowledge exchange, (v) leadership, (vi) education, and (vii) advocacy. Work is currently underway to user-test the criteria and indicators in 14 rehabilitation centers in 10 different countries. Conclusions: We anticipate that use of the criteria and indicators could support individual organizations to further develop their services and, more widely, provide a mechanism by which clinical excellence can be articulated and shared to generate global improvements in stroke care.
Linfangioma Oral en Paciente con Síndrome Koolen de Vries: Presentación de Caso y Revisión de Literatura
(2024) Stierling, María; Ramírez, Diego; Sebastián Lazo
Los linfangiomas son tumores benignos hamartomatosos de los vasos linfáticos, originadas de un secuestro del saco linfático y agrandados por un inadecuado drenaje a la falta de comunicación con los canales linfáticos centrales o a la secreción excesiva de células de revestimiento. La incidencia de estos tumores en el sistema linfático es baja con una frecuencia de 1,2 a 2,8/1.000 en niños, sin predilección por sexo. En el territorio maxilofacial se pueden distinguir tres tipos de linfangioma: linfangioma simple, linfangioma cavernoso e higroma quístico o linfangioma quístico. Clínicamente estas lesiones se presentan como masas de tejido blando indoloras y de crecimiento lento. Su aspecto clínico depende de la extensión de la lesión. Diversos métodos de tratamiento para el linfangioma han sido reportados en la literatura, siendo la escisión quirúrgica la indicada, principalmente cuando estructuras vitales no están involucradas en la lesión. En este artículo se presenta un caso de una paciente femenina de 13 años con un aumento de volumen en el bermellón del labio superior, con antecedente de síndrome Koolen De Vries, a la cual se le realizó la exéresis de la lesión. Lymphangiomas are benign hamartomatous tumors of the lymphatic vessels, originating from a sequestration of the lymphatic sac and enlarged by inadequate drainage, lack of communication with the central lymphatic channels or excessive secretion of lining cells. The incidence of these tumors in the lymphatic system is low, with a frequency of 1.2 to 2.8/1000 in children, with no predilection for sex. Three types of lymphangioma can be distinguished in the maxillofacial territory: simple lymphangioma, cavernous lymphangioma, and cystic hygroma or cystic lymphangioma. Clinically, these lesions present as painless, slow-growing soft tissue masses. Their clinical appearance depends on the extent of the lesion. Various treatment methods for lymphangioma have been reported in the literature, with surgical excision being indicated mainly when vital structures are not involved in the lesion. This article presents a case of a 13-year-old female patient with an increase in volume in the vermilion of the upper lip, with a history of Koolen De Vries syndrome, in which the excision of the lesion was performed.
Oxidative Stress in Polycystic Ovary Syndrome: Impact of Combined Oral Contraceptives
(2024) Santander, Nicolás; Figueroa, Esteban; González, Alejandro; Maliqueo, Manuel; Echiburú, Bárbara; Crisosto, Nicolás; Salas, Francisca
Polycystic Ovary Syndrome (PCOS) is a complex hormonal disorder that is associated with heightened metabolic risks. While oxidative stress (OS) is known to play a role in PCOS, the precise nature of the relationship between PCOS and increased OS remains not entirely understood. Combined oral contraceptives (COCs) are the first-line treatment to regulate menstrual cycles and androgen levels, but their impact on oxidative stress requires further study. We conducted a transcriptomic analysis using RNAseq and assessed the levels of various oxidative stress (OS) markers in serum samples from women with PCOS and controls and whether they were using combined oral contraceptives (COCs), including enzymatic activities, FRAP, and 8-isoprostane (8-iso). A total of 359 genes were differentially expressed in women with PCOS compared to control women. Genes differentially expressed were enriched in functions related to inflammation and, interestingly, oxidative stress response. In controls, 8-iso levels were increased in women using COCs, whereas in women with PCOS, 8-iso levels were reduced in those using oral contraceptives (191.1 ± 97 vs. 26.4 ± 21 pg/mL, p: <0.0001). Correlation analyses showed a trend for a negative correlation between 8-iso and Ferriman score in women with PCOS consuming COCs (r = -0.86, p = 0.06) and a negative correlation between GSH and hyperandrogenism in women with PCOS (r = -0.89, p = 0.01). These results reveal the presence of lipid peroxidation in women with PCOS, which was modified by the use of COCs, providing new insights into the pathophysiology of PCOS in the Chilean population.
Formación del cardiólogo en Chile y contribuciones desde la Sociedad Chilena de Cardiología y Cirugía Cardiovascular
(2024) Rossel, Víctor; Gajardo, Jorge; Miranda, Rodrigo; Nauhm, Yalile; Larrea, Ricardo; Greig, Douglas; Fernández, Flor; Bittner, Alex; Aguayo, Rubén; Varleta, Paola; Sanhueza, Gonzalo; Bugueño, Claudio; Quiñiñir, Luis; Llancaqueo, Marcelo; Pedemonte, Oneglio; Julio, Patricio; Sepúlveda, Luis; Oyonarte, Miguel; Sociedad Chilena de Cardiología y Cirugía Cardiovascular
La Sociedad Chilena de Cardiología y Cirugía Cardiovascular (SOCHICAR) es una entidad científica cuya misión es mejorar la salud cardiovascular del país y entre sus objetivos principales está el debatir los problemas de la especialidad y realizar diferentes actividades que tiendan a fomentar su progreso. Para cumplir con ellos se realizan diversas actividades de educación dirigidas a profesionales de la salud, entre los cuales se encuentran los médicos en programas de formación de cardiología. La formación de especialistas en Chile es responsabilidad de las Universidades, quienes diseñan la malla curricular y planifican las distintas actividades del programa de acuerdo con el perfil de egreso. La SOCHICAR busca integrar a estas nuevas generaciones de cardiólogos, implementando una serie de actividades dirigidas a ellos que contribuyan en su período de formación. Nos pareció relevante entregar nuestra posición como Sociedad Científica en importantes aspectos relacionados con este proceso: el perfil de egreso del cardiólogo clínico, las competencias necesarias para su desempeño en el país, la identificación de áreas deficitarias en su etapa formativa y las contribuciones desde la Sociedad a este proceso dependiente de las universidades. Se convocó a cardiólogos de SOCHICAR, en distintas etapas de desarrollo profesional, diferentes áreas geográficas y ámbitos de desempeño y funciones, en total, 15 cardiólogos (as), distribuidos en tres grupos de trabajo. Esta declaración de posición de la SOCHICAR puede ser de utilidad y una fuente de información importante a considerar por autoridades, entidades acreditadoras, centros formadores y la Sociedad Chilena de Cardiología. The Chilean Society of Cardiology and Cardiovascular Surgery (SOCHICAR) is a scientific society whose mission is to improve the nation's cardiovascular health. Its primary goals include discussing issues affecting the specialty and engaging in various activities that support its advancement. To achieve these goals, numerous educational initiatives are undertaken for health professionals, including physicians in cardiology training programs. Training specialists in Chile is the responsibility of the universities, which design the curriculum and plan the program according to the graduate profile. SOCHICAR seeks to integrate these new generations of cardiologists, setting up tasks that contribute to their training. It seemed relevant to us to state our position as a Scientific Society in importants aspects related to this process: the graduate profile of the clinical cardiologist, the necessary competencies for their performance nationally, the identification of deficient areas in their training period, and the Society's contributions to this university-dependent process. A total of 15 cardiologists from SOCHICAR, at different stages of professional development, various geographic areas, and areas of performance and functions, were invited to participate in three working groups. This SOCHICAR position statement may be useful and an important source of information to be considered by authorities, accrediting entities, training centers, and the Chilean Society of Cardiology.
Obesogenicity perception of food environments in adults: A cross-sectional study in urban areas of Santiago, Chile
(2024) Rodríguez, Lorena; Egaña, Daniel; Molina, Paulina; Villegas, Rodrigo; Castillo, Barbara; Gálvez, Patricia
INTRODUCTION In Chile, there is a high prevalence of obesity, and most people have an inadequate quality of food. Food environments can constitute barriers that prevent healthy food choices and lead to overweight and obesity, as well as diet-related non-communicable diseases. There are international instruments that allow the characterization of food environments. In Chile, there are no studies on the perception of food environments. This study aimed to characterize the perception of obesogenicity of food environments in the urban Chilean population using an instrument previously validated in Chile. METHODS This is a cross-sectional study with probabilistic sampling. The "Perceived Nutrition Environment Measures Survey", based on the Chilean model of food environments, was applied to 256 participants from two urban communities of the Metropolitan Region. Scores were calculated for the instrument items, which allowed calculating scores by environments included in the Chilean model of Food Environments. Negative scores were related to a higher obesogenic level. RESULTS The results show that the domestic food environment is perceived as less obesogenic (median of 15.8 points), with more than 90% of households having fruits, vegetables, and legumes, even though the supply food environment was negative (median-0.19 points). However, about 50% of households had ultra-processed foods. The street food environment was perceived as the most obesogenic (median -1.91 points), with more than 60% of the participants indicating difficulty finding healthy options. CONCLUSIONS According to the level of obesogenicity of the environments studied, it is necessary to have public policies that improve them and ensure the availability and physical and economic access to healthy food, particularly in the food supply and public road environments
Long-term quality of life in patients with bariatric surgery evaluated with BAROS
(2024) Palacio Agüero, Ana; Díaz-Torrente, Ximena; Zancheta, Camila; Reyes, Alejandra; Cosentino, Marcela; Almada, María José
Quality of life (QoL) significantly improves in the short term after bariatric surgery (BS). However, evidence on the long-term QoL of patients with BS is limited. Aim: To analyze the long-term QoL of patients who underwent Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). Methods: We evaluated 257 patients from three private clinics in Santiago, Chile, with ~10-y since surgery. The Bariatric Analysis and Reporting Outcome System (BAROS) was used. Results: Median values for the BAROS score indicated good results of treatment:4.3 (2.3-6.0) and 4.1 (2.1-6.4) for RYGB and SG patients, respectively. The Moorehead-Ardelt Quality of Life (MAQoL) score was higher in patients with SG compared to RYGB (1.5 vs. 1.3, p = 0.047). A moderate, positive, and significant correlation was observed between the percentage excess weight loss and MAQoL score (rho= 0.48, p<0.001). Conclusions: Patients undergoing BS showed a good QoL even in the long term (~10 y).
Gaps in biomedical research in frontotemporal dementia: A call for diversity and disparities focused research
(2024) Nuytemans, Karen; Franzen, Sanne; Broce, Iris J.; Caramelli, Paulo; Ellajosyula, Ratnavalli; Finger, Elizabeth; Gupta, Veer; Gupta, Vivek; Illán-Gala, Ignacio; Loi, Samantha M.; Morhardt, Darby; Pijnenburg, Yolande; Rascovsky, Katya; Williams, Monique M.; Yokoyama, Jennifer S.; Acosta-Uribe, Juliana; Akinyemi, Rufus; Alladi, Suvarna; Ayele, Biniyam A.; Ayhan, Yavuz; Bourdage, Renelle; Castro-Suarez, Sheila; Cruz de Souza, Leonardo; Dacks, Penny; Boer, Sterre C. M. de; Leon, Jessica de; Dodge, Shana; Grasso, Stephanie; Ghoshal, Nupur; Kamath, Vidyulata; Kumfor, Fiona; Matias-Guiu, Jordi A.; Narme, Pauline; Nielsen, T. Rune; Okhuevbie, Daniel; Piña-Escudero, Stefanie; Ruiz-Garcia, Ramiro; Ryan, Brigid; Scarioni, Marta; Slachevsky Chonchol, Andrea; Suarez-Gonzalez, Aida; Lead Tee, Boon; Tsoy , Elena; Ulugut, Hulya; Chiadi U Onyike, Chiadi U.; Babulal, Ganesh M.; ISTAART Frontotemporal Dementia and Related Disorders PIA; ISTAART Diversity and Disparities PIA
Frontotemporal dementia (FTD) is one of the leading causes of young-onset dementia before age 65, typically manifesting as abnormal behavior (in behavioral variant FTD) or language impairment (in primary progressive aphasia). Although FTD affects all populations across the globe, knowledge regarding the pathophysiology and genetics derives primarily from studies conducted in North America and Western Europe. Globally, biomedical research for FTD is hindered by variable access to diagnosis, discussed in this group's earlier article, and by reduced access to expertise, funding, and infrastructure. This perspective paper was produced by two professional interest areas of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) and discusses the field's current status on the cross-cultural aspects of basic and translational research in FTD (including that focused on epidemiology, genetics, biomarkers, and treatment). It subsequently provides a summary of gaps and needs to address the disparities and advance global FTD biomedical research.
Food insecurity and sociodemographic factors in Latin America during the COVID-19 pandemic
(2024) Novoa-Sanzana, Stephanie; Moya-Osorio, José; Morejón Terán, Yadira; Ríos-Castillo, Israel; Becerra Granados, Luis Miguel; Prada Gómez, Gloria; Ramos de Ixtacuy, Mónica; Fernández Condori, Roxana Carla; Nessier, María Celeste; Guerrero Gómez, Ana; González-Céspedes, Laura; Nava-González, Edna J.; Pérez Ocampo, Luisa; Castillo-Albarracín, Adriana Nathaly; Durán-Agüero, Samuel
Objective. To understand the association of food insecurity with sociodemographic factors in a sample population in Latin America during the COVID-19 pandemic. Methods. This was a multicenter cross-sectional study conducted in 10 countries in Latin America using an online survey through various digital platforms from October 14, 2020 to February 15, 2021. Statistical analysis of data was performed by applying descriptive statistics, chi-square test, and logistic regression analysis. Results. Of a total of 6 357 surveys, 58.2% of respondents experienced food security, 29.3% were slightly food insecure, 9.2% were moderately food insecure, and 3.3% were severely food insecure. Concerning the association food insecurity and sociodemographic variables, there is a significant association in the variables studied, including area of residence, education level, occupation, number of persons in the household, house hold with children younger than 10 years of age, and socioeconomic level. Conclusions. These findings indicate that sociodemographic factors associated with food insecurity during the COVID-19 pandemic in Latin America were rural residence; complete and incomplete basic and secondary schooling; occupation (homemaker, unemployed, and self-employed); low, medium-low, and medium socioeconomic level; household with more than four persons; and household with children younger than 10 years of age.
International Society on Thrombosis and Haemostasis clinical practice guideline for treatment of congenital hemophilia A and B based on the Grading of Recommendations Assessment, Development, and Evaluation methodology
(2024) Rezende, Suely; Neumann, Ignacio; Angchaisuksiri, Pantep; Awodu, Omolade; Boban, Ana; Cuker, Adam; Curtin, Julie; Fijnvandraat, Karin; Gouw, Samantha; Gualtierotti, Roberta; Makris, Michael; Nahuelhual, Paula; O'Connell, Niamh; Saxena, Renu; Shima, Midori; Wu, Runhui; Rosendaal, Frits
Background: Hemophilia is a rare congenital bleeding disorder that results from complete or partial deficiency of blood coagulation factor (F)VIII (hemophilia A) or FIX (hemophilia B) due to pathogenic variants in their coding genes. Hemophilia requires complex management. To date, there is no evidence-based clinical practice guideline on hemophilia treatment based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Objectives: This evidence-based clinical practice guideline from the International Society on Thrombosis and Haemostasis aims to provide an overview of evidence and support patients, caregivers, hematologists, pediatricians, other clinicians, researchers, and stakeholders in treatment decisions about congenital hemophilia A and B. Methods: The International Society on Thrombosis and Haemostasis formed a multidisciplinary guideline panel of physicians and patients with global representation, balanced to minimize potential bias from conflicts of interest. The panel prioritized a set of clinical questions and outcomes according to their importance for clinicians and patients. A methodological team supported the guideline development process, including searching for evidence and performing systematic reviews. The GRADE approach was used, including GRADE Evidence to Decision frameworks. The recommendations were subject to public comment. Results: The panel selected 13 questions, of which 11 addressed the treatment of hemophilia A and 2 the treatment of hemophilia B. Specifically, the panel addressed questions on prophylactic and episodic treatment with FVIII concentrates, bypassing agents, and nonfactor therapy (emicizumab) for hemophilia A (with and without inhibitors) as well as immune tolerance induction for hemophilia A. For hemophilia B, the panel addressed questions on prophylactic and episodic treatment of bleeding events with FIX concentrates. Agreement was reached for all 13 recommendations, of which 7 (54%) were based on evidence from randomized clinical trials, 3 (23%) on observational studies, and 3 (23%) on indirect comparisons. Conclusion: Strong recommendations were issued for prophylactic over episodic treatment for severe and moderately severe hemophilia A and B. Only conditional recommendations were issued for the remaining questions. Future research should focus on direct treatment comparisons and the treatment of hemophilia B with and without inhibitors. Future updates of this guideline will provide an updated evidence synthesis on the current questions and focus on new FVIII and FIX concentrates, novel nonfactor therapies, and gene therapy for severe and nonsevere hemophilia A and B.
Effectiveness and safety of the tetravalent TAK-003 dengue vaccine: a systematic review
(2024) Bengolea, AgustIn; Scigliano, Clara; Ramos, Jose; Rada, Gabriel; Catalano, Hugo; Izcovich, Ariel
In Argentina, the dengue virus has experienced an increase in recent years. This study aims to conduct a systematic review to evaluate the effectiveness and safety of the TAK-003 tetravalent dengue vaccine in this context. A systematic review of randomized controlled trials comparing the effectiveness and safety of the vaccine with placebo in the general population was conducted. The search was carried out in Epistemonikos, and two researchers independently assessed the studies. Risk of bias was evaluated using the Cochrane Rob 2 tool. A meta-analysis of the results was performed, and the certainty of evidence was assessed using the GRADE methodology. We concluded, with high certainty of evidence, that the tetravalent dengue vaccine reduces severe infections (RR 0.17, 95% CI 0.12 to 0.24) and infections by the dengue virus (RR 0.40, 95% CI 0.36 to 0.45) in a population ≤17 years. The vaccine may not increase the risk of serious adverse events, although it is important to note the low certainty of evidence (RR 1.04, 95% CI: 0.69-1.55). The use of the tetravalent dengue vaccine decreases the risk of severe and non-severe dengue infections in this population. However, there is low certainty of evidence regarding the vaccine's safety. The decision to vaccinate should consider the magnitude of benefits relative to the risk of infection.
Quadruple therapies show a higher eradication rate compared to standard triple therapy for Helicobacter pylori infection within the LEGACy consortium. A multicenter observational study in European and Latin American countries
(2024) Medel-Jara, Patricio; Reyes Placencia, Diego; Fuentes-López, Eduardo; Corsi, Oscar; Latorre, Gonzalo; Antón, Rosario; Jiménez, Elena; Miralles-Marco, Ana; Caballero, Carmelo; Boggino, Hugo; Cantero, Daniel; Barros, Rita; Santos-Antunes, João; Díez, Marc; Quiñones, Luis A.; Riquelme, Erick; Rollan, Antonio; Cerpa, Leslie C.; Valdés, Ivania; Nyssen, Olga P.; Moreira, Leticia; Gisbert, Javier P.; Camargo, M. Constanza; Ortiz-Olvera, Nayeli; Leon‐Takahashi, Alberto, M.; Ruiz-Garcia, Erika; Fernández-Figueroa, Edith A.; Garrido, Marcelo; Owen, Gareth I.; Cervantes, Andrés; Fleita, Tania; Riquelme, Arnoldo
Introduction: Gastric cancer (GC) is one of the most lethal malignancies worldwide.Helicobacter pylori is the primary cause of GC; therefore, its eradication reduces therisk of developing this neoplasia. There is extensive evidence regarding quadrupletherapy with relevance to the European population. However, in Latin America, dataare scarce. Furthermore, there is limited information about the eradication ratesachieved by antibiotic schemes in European and Latin American populations.Objective: To compare the effectiveness of standard triple therapy (STT), quadrupleconcomitant therapy (QCT), and bismuth quadruple therapy (QBT) in six centers inEurope and Latin America.Methods: A retrospective study was carried out based on the LEGACy registry from2017 to 2022. Data from adult patients recruited in Portugal, Spain, Chile, Mexico,and Paraguay with confirmed H. pylori infection who received eradication therapyand confirmatory tests at least 1 month apart were included. Treatment success by each scheme was compared using a mixed multilevel Poisson regression, adjustingfor patient sex and age, together with country‐specific variables, including preva-lence of H. pylori antibiotic resistance (clarithromycin, metronidazole, and amoxi-cillin), and CYP2C19 polymorphisms.Results: 772 patients were incorporated (64.64% females; mean age of 52.93 years).The total H. pylori eradication rates were 75.20% (255/339) with STT, 88.70% (159/178) with QCT, and 91.30% (191/209) with QBT. Both quadruple therapies (QCT‐QBT) showed significantly higher eradication rates compared with STT, with anadjusted incidence risk ratio (IRR) of 1.25 (p: <0.05); and 1.24 (p: <0.05), respectively.The antibiotic‐resistance prevalence by country, but not the prevalence of CYP2C19polymorphism, showed a statistically significant impact on eradication success.Conclusions: Both QCT and QBT are superior to STT for H. pylori eradication whenadjusted for country‐specific antibiotic resistance and CYP2C19 polymorphism in asample of individuals residing in five countries within two continents.
Sagittal Discrepancies of Intraoperative Results between 2D and 3D Planning in Orthognathic Surgery: A Series of 44 Cases
(2024) Tapia C., Pedro; Díaz S., Fernanda; Sole V., Pedro; Matus-Miranda, Gustavo; Mordoh C., Sebastián; Becerra M., Carlos; Marín O., Paula
Pre-surgical planning in orthognathic surgery is a process of vital importance for obtaining satisfactory results for both the clinician and the patient. There are different planning methods, among which 3D software is one of the most important. These allow precise observation of the movements of bone and soft tissue structures, which until recently could not be predicted. Despite its advantages, many specialists continue to plan using the 2D method. The aim of this paper is to present the discrepancies between 2D and 3D preoperative planning and the intraoperative results of 44 patients undergoing bimaxillary orthognathic surgery and, together with this, to expose the variables that possibly influence the occurrence of these differences.
Management of chronic pleural tuberculosis and non-tuberculous empyema in the 21st century
(2024) Perez Moreno, Pablo; Bello, Angelica
This review addresses complexities in managing pleural tuberculosis (TB) and non-TB empyema. Historically, TB, often termed “the mother of thoracic surgery”, has witnessed a dramatic transformation from invasive surgical interventions to the dominance of medical therapy with the advent of effective anti- TB agents in the mid-20th century. This shift marked a pivotal moment in the treatment landscape, with medical therapy taking precedence and surgical methods reserved for diagnostic purposes or complications. In contrast, the history of non-TB empyema, dating back to Aristotle, evolved from open drainage and open surgery to minimally invasive surgery and fibrinolytic therapy. The review delves into the nuances of these conditions, exploring their clinical manifestations and the state-of-the-art management strategies that have emerged over time. Advancements in imaging modalities, such as computed tomography (CT), complemented by diagnostic laboratory techniques like the GeneXpert MTB/RIF assay, have revolutionized the diagnosis of TB, enhancing accuracy and expediting the process. The review also highlights the distinct clinical presentations of pleural TB and non-TB empyema, underscoring the challenges and intricacies in their management. It thoroughly explores the historical evolution, current diagnostic approaches, and advanced management strategies for these conditions, offering valuable insights for the learner.
Síndrome de Ovario Poliquístico y Salud Mental en Adolescentes
(2024) Matte, María Rosario; Del Río, Juan Pablo; Fernández, Olga; Crisosto, Nicolás
El Síndrome de Ovario Poliquístico (SOP) es el desorden endocrino-metabólico más frecuente en las adolescentes. Se asocia a complicaciones metabólicas, cardiovasculares y reproductivas. Hallazgos recientes sugieren también una asociación con patología psiquiátrica, tanto en las pacientes afectadas como en su descendencia. En la presente actualización, se realizó una síntesis de la literatura reciente relativa a la salud mental en mujeres y adolescentes con SOP. Se realizó una búsqueda sistematizada en PubMed, Epistemonikos y Scielo de los artículos publicados en los últimos 5 años. Se confirmó que existe un aumento significativo del riesgo de presentar trastornos por ansiedad, depresión, tras tornos alimenticios, trastorno obsesivo compulsivo, trastorno afectivo bipolar y psicosis en mujeres con SOP. Además, presentan riesgo de trastornos del neurodesarrollo, tales como trastorno del espectro autista y trastorno por déficit atencional e hiperactividad, tanto en ellas como en su descendencia. La hiperinsulinemia y el hiperandrogenismo podrían explicar parte de estas asociaciones, afectando la maduración del sistema nervioso central, especialmente durante la vida intrauterina y la adolescencia. El distrés derivado de las características fenotípicas físicas de la enfermedad también podría impactar la salud mental de las pacientes. Aún no se cuenta con suficientes estudios que expliquen el origen de esta correlación, ni tampoco con ensayos clínicos que aborden la salud mental de forma específica en estas pacientes. La evidencia actual sugiere la necesidad de evaluar activamente la salud mental de estas pacientes y coordinar a los distintos equipos de salud que intervengan en el manejo de la patología.
Evaluating the Cost Burden of Alopecia Areata Treatment: A Comprehensive Review for Dermatologists
(2024) Patel, Palak; Coello, Angelica; Larrondo Gálvez, Jorge Felipe; McMichael, Amy
Alopecia areata (AA) is managed with prolonged medical treatments and cosmetic therapies, whose cost can be burdensome. We sought to identify the costs of AA treatment and consolidate the available data for the practicing dermatologist by performing a PubMed search of articles indexed for MEDLINE. Ten studies including approximately 16,000 patients with AA across a range of Oxford Centre for Evidence-Based Medicine Levels of Evidence were included. Studies showed that despite the limited efficacy of many AA therapies, patients incurred substantial expenses to manage their AA.
Daily compliance of the ABCDEF liberation bundle for patients in the intensive care unit: A retrospective descriptive study
(2024) Muñoz, Felipe; Leppe Zamora, Jaime; González Seguel, Felipe; Castro-Avila, Ana Cristina
Introduction Implementing the ABCDEF bundle has demonstrated improved outcomes in patients with critical illness. This study aims to describe the daily compliance of the ABCDEF bundle in a Chilean intensive care unit. Methods Retrospective observational study of electronic clinical records of nursing, physiotherapy, and medical professionals who cared for patients over 18 years of age, admitted to an intensive care unit for at least 24 hours, with or without mechanical ventilation. Daily bundle compliance was determined by considering the daily records for each element: Assess pain (element A), both spontaneous awakening trials (element B1) and spontaneous breathing trials (element B2), choice of sedation (element C), delirium assessment (element D), early mobilization (element E), and family engagement (element F). Results 4165 registered bundle elements were obtained from nursing (47%), physiotherapy (44%), and physicians (7%), including 1134 patient/days (from 133 patients). Elements E and C showed 67 and 40% compliance, while D, A, and B2 showed 24, 14 and 11%, respectively. For B1 and F, 0% compliance was achieved. Compliance was higher in patients without mechanical ventilation for A and E, while it was similar for D. Conclusions Early mobilization had the highest compliance, while spontaneous awakening trials and family engagement had absolute non-compliance. Future studies should explore the reasons for the different degrees of compliance per bundle element in clinical practice.

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