Artículos Medicina y Ciencias de la Salud

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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.
Electrospun Polyvinyl Alcohol/Sodium Alginate Nanocomposite Dressings Loaded with ZnO and Bioglass: Characterization, Antibacterial Activity, and Cytocompatibility
(2025) Ortiz, Andrés; Sepúlveda, Francesca; Flores, Siomara; Saavedra, Marcela; Sáez, Suhelen; Jiménez, Thomas; Murgas, Paola; Troncoso, Scarlett; Sanhueza, Camila; Ulloa, María; Porte, Lorena; Ahumada, Manuel; Corrales, Teresa; Palza, Humberto; Zapata, Paula
Chronic wounds pose a great challenge due to their slow healing and susceptibility to infections, hence the need for innovative alternatives to conventional antibiotics, as increasing bacterial resistance limits the efficacy of current treatments. This paper addresses the development of novel electrospun membranes based on polyvinyl alcohol (PVA) and sodium alginate, incorporating therapeutic ZnO and bioglass (54SiO2:40CaO:6P2O5) nanoparticles. While nanocomposites presented smaller fiber diameters than pure polymers, ternary nanocomposites displayed higher values, e.g., in porous areas, values were in the ca. 80-240 nm range and 0.06-0.60 μm2, respectively. The Young's modulus of the PVA/SA membrane, initially 15.9 ± 2.0 MPa, decreased by 65% with 10 wt.% ZnO NPs, whereas 10 wt.% BG NPs increased it by 100%. The membranes demonstrated efficacy against Gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) isolated from a human wound secretion, as well as two ATCC strains: Staphylococcus aureus and Staphylococcus epidermidis. A cell viability assay conducted with HaCaT cells demonstrated nearly complete survival following 72 h of membrane exposure. Their combined Gram-positive antibacterial activity and cytocompatibility support their potential application as biofunctional dressings for the management of chronic and hospital-acquired topical infections, while also contributing to the global effort to combat antibiotic resistance.
Ultrasound of the tongue as an uncommon site: a focus on technique and early diagnosis of lingual pathologies
(2025) Campos, Óscar; Aris, Ricardo; Whittle, Carolina; Niedmann, Juan
Tongue ultrasound, although less conventional in radiology, offers high-resolution images without ionizing radiation, allowing for accurate evaluation of superficial lesions. This article aims to increase awareness of its usefulness and promote its adoption in clinical practice. Characteristic findings of a variety of lesions are highlighted through clinical cases evaluated at our institution. This technique emerges as a safe and inexpensive alternative for the diagnosis and monitoring of lingual pathologies, being a promising tool for early detection and effective management of these conditions. La ecografía de la lengua, aunque menos convencional en radiología, ofrece imágenes de alta resolución sin radiación ionizante, lo que permite una evaluación precisa de lesiones superficiales. Este artículo tiene como objetivo aumentar el conocimiento sobre su utilidad y promover su adopción en la práctica clínica. Se destacan los hallazgos característicos de una variedad de lesiones a través de casos clínicos evaluados en nuestra institución. Esta técnica emerge como una alternativa segura y económica para el diagnóstico y el seguimiento de patologías linguales, siendo una herramienta prometedora para una detección precoz y un manejo efectivo de estas condiciones.
Driving research on successful aging and neuroprotection in Latin America: Insights from the inaugural symposium on brain resilience and healthy longevity
(2025) Quiroz, Yakeel; Aguillón, David; Arboleda, Joseph; Bocanegra, Yamile; Cardona, Gloria; Corrada, Maria; Diez, Ibai; Garcia, Elkin; Kosik, Kenneth; Martinez, Lusiana; Pineda, David; Posada, Rafael; Roman, Norbel; Sepulveda, Diego; Slachevsky Chonchol, Andrea; Soto, Marcio; Tabilo, Evelyn; Vasquez, Daniel; Villegas, Andrés
Introduction: Global life expectancy has steadily increased in recent decades, resulting in a significant rise in the number of individuals aged 80 years and older. This trend is also evident in Latin America, where life expectancy is improving, though at varying rates across countries and regions. Methods: Partnering with the Neurosciences Group of Antioquia (GNA), we launched a Colombian study on resilience in families with autosomal dominant Alzheimer's disease and the oldest-old population. Over the past 2 years, the project has expanded to include participants from Peru, Chile, and Costa Rica. Results: This research led to the first symposium on Brain Resilience and Healthy Longevity, held in Medellín, Colombia, in August 2024. Discussion: The article summarizes key discussions from the symposium, highlighting the most promising opportunities for brain resilience and prevention research in the region and offering recommendations for future research to promote healthy aging and dementia-free communities. Highlights: Uncovering the genetic and physiological drivers of cognitive resilience, neurodegeneration resistance, and healthy longevity is essential for maintaining brain function as we age. "Superagers" and cognitively resilient individuals from Latin American families with Alzheimer's disease offer valuable insights into brain protection mechanisms. Studying the interplay of socio-environmental and genetic factors in the oldest-old is key to understanding healthy longevity and improving dementia prevention. The inaugural Brain Resilience and Healthy Longevity Symposium highlights the need for global collaboration to uncover factors that drive cognitive resilience and healthy aging in Latin America, advancing dementia prevention.
Critical Review of the Methodological Shortcoming of Ambulatory Blood Pressure Monitoring and Cognitive Function Studies
(2025) Haghayegh, Shahab; Hermida, Ramon; Smolensky, Michael; Jimenez, Mili; Duran, Claudia; Slachevsky Chonchol, Andrea; Behrens, Maria Isabel; Aguillon, David; Santamaria, Hernando; García, Adolfo; Matallana, Diana; Ibáñez, Agustín; Hu, Kun
Growing evidence suggests that abnormal diurnal blood pressure rhythms may be associated with many adverse health outcomes, including increased risk of cognitive impairment and dementia. This study evaluates methodological aspects of research on bidirectional associations between ambulatory blood pressure monitoring (ABPM) patterns and cognitive function. By examining the 28 recent studies included in a recent systematic review on the association between ABPM patterns with cognitive function and risk of dementia, our review revealed several significant limitations in study design, sample characteristics, ABPM protocol, cognitive assessment, and data analysis. The major concerns include a lack of diversity in study populations with underrepresentation of Blacks and Latinos, a predominant focus on Alzheimer's disease or all-cause dementia without distinguishing other dementia subtypes, different and not standardized measures of cognition or dementia, prevalent use of 24 h monitoring without considering the adaption effect, inconsistent definitions of dipping status, and ignorance of individual differences in timings of daily activities such as bed and awakening times. In addition, confounding variables such as class, dose, and timing of antihypertensive medication are inadequately controlled or considered. Further, longitudinal studies were scarce examining the bidirectional relationship between ABPM patterns and cognitive decline over time. Collectively, these deficiencies undermine the reliability and generalizability of current findings. Addressing these methodological challenges is crucial for a more comprehensive understanding of diurnal blood pressure rhythms in diverse populations and for developing an evidence-based guideline for ambulatory monitoring and control of blood pressure across the sleep-wake cycle to prevent cognitive decline and dementia.
AO Spine Clinical Practice Recommendations: Reducing the Surgical Footprint of Surgery for Spinal Metastases
(2026) Silva, Alvaro; Chen, Hanbo; Disch, Alexander; Kam, Jeremy; O'Toole, John; Dea, Nicolas; Gasbarrini, Alessandro; Laufer, Ilya; Netzer, Cordula; Reynolds, Jeremy; D Rhines, Laurence; Sahgal, Arjun; Verlaan, Jorrit-Jan; Fisher, Charles; Barzilai, Ori
Study DesignLiterature review with clinical recommendations.ObjectiveSpinal metastases represent a late complication of cancer and a major factor in decreased quality of life. The role of surgery for specific indications for spinal metastases is well established. Given the significant morbidity associated with spine surgery in this frail population, efforts are ongoing to decrease the surgical footprint. The objective of this study is to provide the readers with a concise curation of the latest spine literature on reducing the surgical footprint for spine metastases and clinical recommendations for how the practicing clinician should interpret and make use of this evidence.MethodsThe latest spine literature in the topic of reducing the surgical footprint for spine metastases was reviewed and clinical recommendations were formulated. The recommendations are dichotomously graded into strong and conditional based on the integration of scientific methodology and content expert opinion. This opinion considers experience and practical issues such as risks, burdens, costs, patient values, and circumstances.ResultsFour high impact studies were selected for review. The findings suggest that surgery plays a key role in improving patients' quality of life, but incidence of adverse events remains high and hence methods to decrease surgical morbidity are necessary. The integration of radiation into the treatment algorithm allows for less extensive surgical procedures and SBRT should be strongly considered after surgery for spine metastases in appropriate patient populations. Implementation of enhanced recovery after surgery (ERAS) protocols reduce perioperative morbidity for both open and minimally invasive surgeries and should be considered on an institutional level. Utilization of minimally invasive surgical stabilization should be considered as it results in fewer post operative complications, lower infection rates, less blood loss during surgery, and a shorter hospital stay compared to open stabilization of unstable pathology thoracolumbar fractures.ConclusionsThe role and benefits of surgery for metastatic spine disease are well established, yet surgery carries significant risk for adverse events which may negatively affect overall cancer care. Methods for reducing the surgical footprint include incorporation of stereotactic radiation allowing less extensive surgery, implementation of ERAS protocols and utilization of minimally invasive surgical strategies.
Impact of burnout on turnover, medical errors, medical leave and a cross-sectional study of contributing factors among Chilean physicians
(2025) Villalón López, Francisco; Mundt, Adrian P.; Hirmas, Alejandro; Rivera, Rita M.; Guiloff, Rodrigo
Background During the COVID-19 pandemic, many physicians experienced burnout, underscoring the need to identify factors associated with this condition to develop effective prevention and treatment strategies. Objective To examine the relationship between physician burnout and individual factors, medical errors, medical leave and the work environment. Design A cross-sectional online survey conducted from November 2020 to December 2020. Participants Physicians registered with the Medical College of Chile. Setting Registered physicians working in Chile across primary, secondary and tertiary levels of healthcare. Primary outcomes Burnout was assessed using the Maslach Burnout Inventory for Human Services. Secondary outcomes Self-reported medical errors, medical leave and turnover. Independent variables Sociodemographic characteristics, personality factors, psychological well-being, mindfulness factors, self-compassion and work environment factors. Descriptive statistics, linear and logistic regressions and regression analyses with cross-validation using least absolute shrinkage and selection operator (LASSO) tests were applied. Results Of the 23 481 registered physicians, 795 (3.4%) completed the survey. The sample included 64.1% women, with a mean age of 37.7 years (SD=11.3). The prevalence of burnout syndrome was 20.4% based on strict criteria and 68.9% based on lax criteria. Burnout scores predicted days of medical leave (ß=0.086, p<0.01), turnover (ß=0.012, p<0.05) and perceived medical errors (ß=0.009, p<0.001). In contrast, burnout was inversely correlated with age (ß=−0.125, p<0.001), agreeableness as a personality trait (ß=−0.107, p<0.001), psychological well-being (ß=−0.248, p<0.001) and the mindfulness factor awareness (ß=−0.145, p<0.001). In the work environment, time pressure (ß=0.167, p<0.001) was positively associated with burnout among others. Conclusion Younger physicians may be prioritised for individual-level interventions, while addressing time pressure at the organisational level could help prevent burnout. However, longitudinal studies are needed to clarify the directionality of relationships with psychological factors.
The challenges of establishing centers for the surgical management of epilepsy in low- and middle-income countries
(2025) Vidaurre, Jorge; Pérez, Juan; Campos, Manuel; Weisleder, Pedro
Epilepsy affects over 50 million individuals globally, with more than 80 % residing in resource-limited countries. While the majority of patients achieve seizure control with antiseizure medications, approximately one-third are diagnosed with drug-resistant epilepsy (DRE). For these individuals, epilepsy surgery represents a potentially effective therapeutic option. Expert consensus from the Surgical Therapies Commission of the International League Against Epilepsy (ILAE) recommends prompt referral for surgical evaluation upon diagnosis of DRE. Nevertheless, despite substantial supporting evidence, such referrals are frequently delayed-particularly in low- and middle-income countries (LMICs). This article examines the barriers to timely surgical evaluation and explores strategies to facilitate the development of epilepsy surgery programs in resource-constrained settings.

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