Artículos Medicina y Ciencias de la Salud

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Uso de rúbricas para la evaluación de textos académicos: un desafío en la enseñanza de enfermería
(2023) Riquelme, Giselle; Pérez, Claudia; Aedo, Vivian
Introducción: Tanto la enseñanza de la escritura como la forma en que se evalúa constituyen un desafío importante en educación superior. La utilización de estrategias evaluativas permite remediar las carencias en habilidades de escritura, al ser no solo un recurso de evaluación exhaustivo y didáctico, sino que también, una guía para el desarrollo del texto en sí mismo. Objetivo: Desarrollar metodologías evaluativas para mejorar los aspectos de forma y contenido en la escritura de textos académicos en Enfermería. Metodología: el proyecto contó de tres fases que contemplaron la construcción de dos instrumentos (fase 1), su aplicación en un texto académico y respectivos ajustes (fase 2), y la evaluación de dicha aplicación (fase 3). Resultados: se obtuvieron dos rúbricas de tipo analíticas conformadas por los ítems de FORMA (aspectos de escritura) y CONTENIDO (aspectos de investigación), las que fueron aplicadas tres veces al texto para evaluar su progreso, observándose mejoras en la calificación global, en coherencia y cohesión en FORMA, y marco teórico, resultados y metodología, en CONTENIDO. Discusión: el uso de rúbricas analíticas son una herramienta muy útil a la hora de evaluar textos académicos. Son instrumentos sumamente completos pues miran el proceso como un todo, actuando no solo como una instancia evaluativa, sino que también formadora para el estudiantado, a la vez que se configuran como una guía para el desarrollo de la escritura. Introduction: Both the teaching of writing and the way it is evaluated constitute major challenges in higher education. The use of evaluative strategies can help remediate deficiencies in writing skills by being not only an exhaustive and didactic evaluation resource, but also a guide for the development of the text itself. OBJECTIVE: Develop evaluative methodologies to improve aspects of form and content in the writing of academic texts in Nursing. METHODOLOGY: The project had three phases that considered the construction of two instruments (phase 1), their application in an academic text (thesis report) and respective adjustments (phase 2), and, finally, the evaluation of said application. RESULTS: Two analytical headings were obtained (quantitative methodology and qualitative methodology), consisting of the items of FORM (writing aspects) and CONTENT (research aspects), respectively, which were applied three times to the text to evaluate its progress. Improvements were observed in the overall rating, in the areas of coherence and cohesion in FORM, and in the theoretical framework, results, and methodology in CONTENT. DISCUSSION: Analytical rubrics are a very useful tool when evaluating academic texts. They are extremely comprehensive instruments because they look at the process as a whole, serving not only as an evaluative tool, but also as a training opportunity for students, providing a guide for the development of academic writing skills.
Virtual reality: acquisition of skills in physical examination of nursing students
(2024) Contreras, Jorge; Pérez, Claudia; Aedo, Vivian; Leyton, Katherine
The Nursing Process (NP) is a fundamental tool for providing quality patient care. It has 5 stages, the first being the assessment, which is considered the most relevant since it supports the NP in the information obtained. In this stage, inspection, palpation, percussion, and auscultation techniques are used in the physical examination as tools in the assessment process. Virtual reality could be a beneficial intervention to train nursing students in acquiring their inspection and auscultation skills in the cardiac, respiratory, and digestive systems. The objective of this study was to evaluate the didactic strategy with the use of virtual reality in the acquisition of physical examination skills in the cardiac, respiratory, and digestive systems in nursing students. Methodology: a quantitative study of the quasi-experimental design of one group with pre and post-intervention evaluation was carried out. Results: the results in the pre-test related to the median was 5.5, varying positively with an increase in the post-test to 6.3, obtaining that the application of a didactic strategy with virtual reality significantly improves/enhances the processes of acquisition of physical exploration skills in nursing students. Discussion: the results obtained in our research demonstrate that the use of a realistic and low-cost simulator for cardiac, respiratory, and digestive exploration improves the acquisition of skills and stimulates learning in the student, in addition to facilitating the deliberate practice of the procedure before performing it on a real patient. The incorporation of virtual reality in the acquisition of physical examination skills in the cardiac, respiratory, and digestive systems is an instrument that can be added to the nursing curriculum as a new didactic strategy.
¿Cambió la pandemia la imagen de las enfermeras españolas? Identidad enfermera y voz como fuentes informativas
(2024) González, Hildegart; Gómez, Beatriz; Errasti, Begoña; Choperena, Ana; Díaz, Isabel; Alfaro, Amaranta; Pérez, Claudia
Introducción: Los medios de comunicación son claves en la configuración de la imagen social de las enfermeras. La difusión de una imagen de enfermería incoherente con su identidad profesional tiene consecuencias adversas para las enfermeras, para el conjunto del sistema sanitario y para la sociedad. Objetivo: Comparar la imagen de las enfermeras y su papel como fuentes informativas en 2019-2020 tomando como marco para el análisis la identidad profesional consensuada por ISPIN. Estudiar si durante pandemia por COVID-19 la imagen de las enfermeras en los medios fue más completa y si se les dio un mayor protagonismo como fuentes informativas. Material y Método: Análisis cuantitativo mediante instrumento que evalúa la coherencia entre la imagen publicada y la identidad profesional enfermera definida por ISPIN en las 468 noticias publicadas en El País y El Mundo en 2019-2020, que incluían la palabra enfermera/s, enfermeros/s o enfermería. Resultados: La presencia mediática de las enfermeras aumentó en 2020. Las temáticas principales en las que se las mencionó durante los dos años estuvieron relacionadas con cuestiones problemáticas del ejercicio de la profesión. El número de informaciones publicadas en las que se describe su trabajo diario aumentó en 2020. El rol más difundido fue el asistencial, pero la visibilidad de su función como gestoras creció durante la pandemia. Los estereotipos para representarlas se redujeron y la presencia de hombres enfermeros fue mayor. Conclusión: Aunque se incrementó la presencia de las enfermeras y de sus asociaciones como fuentes informativas, no fueron fuentes principales en la mayoría de las noticias. Introduction: The media plays a crucial role in shaping nurses' social image. Disseminating a nursing image inconsistent with their professional identity has adverse consequences for nurses, the healthcare system, and society. Objective: To compare nurses' image and role as information sources in 2019 and 2020, the professional identity framework agreed upon by ISPIN will be used for analysis. To study whether the image of nurses in the media during the COVID-19 pandemic was more comprehensive and whether they were given a more significant role as information sources. Material and Method: Quantitative analysis using an instrument that evaluates the coherence between the published image and the professional nurse identity defined by ISPIN in 468 news articles published in El País and El Mundo in 2019 and 2020, which included the words nurse(s) or nursing. Results: The media presence of nurses increased in 2020. The main topics in which they were mentioned during the two years were related to problematic issues within the profession. The number of reports describing their daily work increased in 2020. The most widely publicized role remained caregiving, but their visibility as managers grew during the pandemic. Stereotypes used to represent them decreased, and the presence of male nurses was more significant. Conclusion: Although the presence of nurses and their associations as information sources increased, they were not the primary sources in most of the news articles.
Analizar los rasgos definitorios de un currículo de formación de profesionales de la salud basados en interculturalidad de una facultad de medicina: analizado desde la fenomenografía
(2025) Pérez, Claudia; Medina, José
Introducción la integración de la competencia intercultural en el currículo de profesionales de la salud es un elemento crucial para abordar las diversas necesidades de atención en salud de sociedades cada vez más multiculturales. El manuscrito analiza los rasgos definitorios de un currículo de formación de profesionales de la salud basados en la interculturalidad, destacando la necesidad de integrar la perspectiva intercultural en el currículo de educación para las carreras de la salud. Método estudio cualitativo con enfoque fenomenográfico. Se realizaron 27 entrevistas a estudiantes, docentes y autoridades de una facultad de medicina, elegidas por muestreo opinático. El análisis de los datos se realizó a partir de los 7 pasos para el análisis fenomenográfico descrito por Dahlgren y Fallsberg. Resultados el análisis permitió distinguir que los rasgos definitorios están conformados por 3 categorías: a) Competencia intercultural en el currículo, b) Metodologías de enseñanza-aprendizaje para la competencia intercultural y c) Desafíos para la implementación de la competencia intercultural. Conclusión la importancia de integrar la competencia intercultural en la formación de profesionales de la salud, a través de módulos específicos, enfoques transversales, interdisciplinarias y competencias genéricas es fundamental. La implementación de metodologías de enseñanza experienciales y prácticas, así como la adaptación de las estructuras institucionales, son esenciales para superar los desafíos que presenta la enseñanza de esta. Al adoptar una visión integral y proactiva en la formación de los estudiantes, las instituciones pueden ayudar a preparar a los futuros profesionales de la salud para un mundo cada vez más diverso, promoviendo una atención más inclusiva y culturalmente competente. Introduction The integration of intercultural competence into the curriculum of health professionals is a crucial element in addressing the diverse health care needs of increasingly multicultural societies. The manuscript analyzes the defining features of a training curriculum for health professionals based on interculturality, highlighting the need for intercultural integration in the education curriculum for health careers. Method Qualitative study with a phenomenographic approach. Twenty-seven interviews were carried out with students, teachers and authorities of a medical school, chosen by opinion sampling. Data analysis was carried out using the 7 steps for phenomenographic analysis described by Dahlgren and Fallsberg. Results The analysis allowed us to distinguish that the defining traits are made up of 3 categories: a) Intercultural competence in the curriculum, b)Teaching-learning methodologies for intercultural competence and c) Challenges for the implementation of intercultural competence. Conclusion The importance of integrating intercultural competence in the training of health professionals, through specific modules, transversal, interdisciplinary approaches and generic competences is fundamental. The implementation of experiential and practical teaching methodologies, as well as the adaptation of institutional structures, are essential to overcome the challenges presented by teaching of this. By taking a comprehensive and proactive view in training students, institutions can help prepare future health professionals for an increasingly diverse world, promoting more inclusive and culturally competent care.
Diet quality of Chilean schoolchildren: How is it linked to adherence to dietary guidelines?
(2025) Pinheiro Fernandes, Anna Christina; Araneda, Jacqueline; Quintiliano Scarpelli Dourado, Daiana; Pizarro, Tito; Marques, Maria
Introduction: In Chile, the prevalence of overweight among schoolchildren over the age of 5 is approximately 50%, one of the highest in the Americas region. This is largely influenced by the presence of inadequate food environments, characterized by limited access to healthy foods and a high availability of highly processed foods (HPF). This study analyzes food consumption in Chilean schoolchildren and the association of this with the Chilean Dietary Guidelines Based on Foods (DGBF) and the HPF consumption. Material and methods: The sample (1,094 schoolchildren) was obtained from the baseline of the FONDEF IT18I0016 project, in Santiago-Chile. Anthropometry and socioeconomic data were measured. Dietary intake was assessed using a validated semi-quantitative frequency survey featuring images of food groups aligned with DGBF, as well as HPF. All data were collected by trained professional nutritionists. Associations between dependent and independent variables, and potential confounding factors were calculated using logistic regression models with stepwise backward/forward. A p < 0.05 was accepted as significant, using Stata 16.0. Results: Most of the students (54.1%) were with malnutrition by excess and 20.0% exhibited abdominal obesity. Twenty percent of the students met the recommended intake for DGBF (fruits, vegetables, fish, milk and dairy products, legumes, water) and less than 5% did not consume any HPF. Consuming some sub-groups of HPF in moderate quantities (either no consumption or occasional consumption) increases the likelihood of meeting DGBF: candies and sweets (OR: 0.72; p = 0.04), pies with or without filling (OR: 0.63; p = 0.01), and salted snacks (OR: 0.67; p = 0.02). Conclusion: Our results contribute to reaffirm the need to enhance healthy food consumption among schoolchildren and to discourage the intake of HPF, particularly focusing on specific sub-groups of HPF that may increase the risk of displacing the consumption of food groups recommended by the DGBF.
Ambiente alimentario alrededor de establecimientos educacionales municipalizados de la ciudad de Chillán
(2024) Araneda, Jacqueline; Toledo, Álvaro; Inzunza, Constanza; Córdova, Carolina; Pinheiro Fernandes, Anna Christina
Introducción: Los ambientes alimentarios externos a los establecimientos educacionales influyen en la alimentación y el estado nutricional de los niños. Objetivo: Determinar el tipo del ambiente alimentario que rodea establecimientos educacionales municipalizados de la ciudad de Chillán. Materiales y método: Se realizó un estudio descriptivo de corte transversal con una muestra de cuatro establecimientos educacionales municipali-zados y 139 puntos de venta de alimentos. Se utilizaron pautas de observación para medir ambientes alimentarios a 400 metros a partir del punto central de cada escuela. Las pautas evaluaron los puntos de venta de alimentos, según disponibilidad, variedad y publicidad de alimentos. Resultados:El 50% de los puntos de venta de alimentos que rodean a los establecimientos educacionales son categorizados como no saludables. Solo un 9% es considerado un punto de venta saludable. Conclusiones: Se observó una alta densidad de puntos de venta de alimentos no saludables alrededor de las escuelas estudiadas, propiciando un ambiente obesogénico. Es imperativo establecer políticas públicas para mejorar el ambiente alimentario escolar. Food environments outside educational establishments influence children’s diet and nutritional status. Objective: To determine the type of food environment that surrounds the municipal educational establishments of the city of Chillán. Material and method: A cross-sectional descriptive study was conducted involving a sample of four municipal educational establishments and 139 food establishments. Observation guidelines were used to measure food environments 400 meters from the center point of each school, evaluating food outlets based on food avai-lability, variety, and advertising. Results: 50% of food outlets surrounding educational establishments were categorized as unhealthy. Only 9% were considered a healthy selling point. Conclusions: A high density of unhealthy food outlets was observed around the schools studied, fostering an obesogenic environment. It is imperative to establish public policies to improve the school food environment.
A Simple Machine Learning-Based Quantitative Structure-Activity Relationship Model for Predicting pIC50 Inhibition Values of FLT3 Tyrosine Kinase
(2025) Alcázar, Jackson; Sánchez, Ignacio; Merino, Cristian; Monasterio, Bruno; Sajuria, Gaspar; Miranda, Diego; Díaz, Felipe; Campodónico, Paola
Background/Objectives: Acute myeloid leukemia (AML) presents significant therapeutic challenges, particularly in cases driven by mutations in the FLT3 tyrosine kinase. This study aimed to develop a robust and user-friendly machine learning-based quantitative structure-activity relationship (QSAR) model to predict the inhibitory potency (pIC50 values) of FLT3 inhibitors, addressing the limitations of previous models in dataset size, diversity, and predictive accuracy. Methods: Using a dataset which was 14 times larger than those employed in prior studies (1350 compounds with 1269 molecular descriptors), we trained a random forest regressor, chosen due to its superior predictive performance and resistance to overfitting. Rigorous internal validation via leave-one-out and 10-fold cross-validation yielded Q2 values of 0.926 and 0.922, respectively, while external validation on 270 independent compounds resulted in an R2 value of 0.941 with a standard deviation of 0.237. Results: Key molecular descriptors influencing the inhibitor potency were identified, thereby improving the interpretability of structural requirements. Additionally, a user-friendly computational tool was developed to enable rapid prediction of pIC50 values and facilitate ligand-based virtual screening, leading to the identification of promising FLT3 inhibitors. Conclusions: These results represent a significant advancement in the field of FLT3 inhibitor discovery, offering a reliable, practical, and efficient approach for early-stage drug development, potentially accelerating the creation of targeted therapies for AML.
Propiedades del Test de Aprendizaje y Desarrollo Infantil “TADI”, en el contexto de las políticas de validación de escalas para niños y niñas menores de 6 años en Chile y Latinoamérica
(2024) Schonhaut , Luisa; Edwards, Marta; Pardo, Marcela; Valdés, Antonia
En Latinoamérica se han construido distintas escalas para la evaluación del Desarrollo Infantil Temprano (DIT), la mayoría de aplicación directa. En Chile, en los años 70-80 se crearon la Escala de Evaluación del Desarrollo Psicomotor (EEDP) y el Test de Desarrollo Psicomotor (TEPSI), utilizadas hasta la actualidad en distintos países hispanoparlantes, sin que hayan sido actualizadas ni revalidadas. En respuesta a la necesidad de contar con un nuevo instrumento construido en Chile para la evaluación del DIT a gran escala, entre los años 2009 y 2012 se construyó y estandarizó el Test de Aprendizaje y Desarrollo Infantil (TADI). Este fue actualizado y robustecido entre 2018 y 2023 como TADI-2. Objetivo: Describir los principales requerimientos metodológicos considerados en la cons trucción de un instrumento de medición en salud y, en ese contexto, analizar la validez del TADI-2. Desarrollo: Destaca el riguroso proceso de validación del TADI-2, cumpliendo con los estándares de selección de contenido, estandarización, confiabilidad, validez en distintos entornos socioculturales y étnicos, bajo costo, fácil aplicación y uso abierto. La sensibilidad para el puntaje global en los niños/as de 4 y 5 años fue muy buena y, en los menores, moderada. Conclusiones: La evidencia recabada muestra que el TADI-2 puede ser implementado para el tamizaje del DIT a través de aplicación directa, de los niños/as menores de 6 años de Chile y resto del continente. Se recomienda continuar estudiando el instrumento en muestras más amplias para conocer la consistencia de los resultados en estudios complementarios y poblacionales.
Preventive behaviors for COVID-19 in Chile: Lessons from a population follow-up for 2021 and 2022
(2024) Rubilar, Paola; Núñez-Franz, Loreto; Apablaza, Mauricio; Ramírez-Santana, Muriel; Molina, Xaviera; Canales, Luis
INTRODUCTION The rapid emergence of COVID-19 urged policy responses worldwide, focusing on vaccination and mobility restrictions. Chile represents a unique scenario for analyzing personal preventive measures amid intensive communication and vaccination campaigns. This study aims to explore changes in population adherence to non-pharmacological preventive measures during the pandemic and the factors that explain this adherence each year. METHODS 386 individuals who participated in two population-based studies (2021 and 2022) were considered. An interview was conducted to measure adherence to self-care practices, and case and contact tracing by the health authorities. The Wilcoxon signedrank test was performed to measure change between 2021 and 2022, bivariate analysis, and a linear regression model for each year were performed. RESULTS Mask-wearing in public places was the most commonly used measure (95.9% in 2021, 89.9% in 2022). Follow-up of cases and cases contacts by the health authority had high coverage in 2021 (94.3% and 83% respectively). A greater decrease was observed in contact tracing in 2022 totaling 33.3%. An increase in the score of adherence to preventive practices was observed in 2022 (p < 0.00). The regression model showed in 2021 that women were more likely to adopt preventive behaviors (95% confidence interval: 0.27 to 1.13) and the overweight/obese had higher adherence compared to normal body mass index (95% confidence interval: 0.06 to 0.98). In 2022 being a young adult (30 to 49 years) predicted the adoption of behavioral precautions (95% confidence interval: 0.00 to 1.32). CONCLUSIONS Adherence to preventive measures increased even with high vaccination coverage, likely due to the epidemiological situation with the Omicron variant circulating in 2022.
Intravenous Thrombolysis in Patients 90 Years or Older with Moderate to Severe Acute Ischemic Stroke Increases Ambulation at Discharge and Is Safe: A Prospective Cohort Study from a Single Center in Santiago, Chile
(2024) González-Brevis, Pablo; Lavados, Pablo; Aguirre, André I.; Brunser, Alejandro; Olavarría, Verónica V.
Introduction: The WorldHealthOrganizationpredictsthat the globalpopulationaged60yearsandolderwilldouble by 2050, leading to a significant rise in the public health impact of acute ischemic stroke (AIS). Existing stroke guidelines do not specify an upper age limit for the administration of intravenous thrombolysis (IVT), although some suggest a relative exclusion criterion in patients aged ≥80 in the 3–4.5-h window. Many physicians avoid treating these patients with IVT, argumenting high risk and little benefit. Our aim was to investigate the efficacy and safety of IVT treatment in patients with nonminor AIS aged ≥90, admitted to our institution. The primary efficacy endpoint was the ability to walk at discharge (mRS 0–3), and the primary safety endpoints were death and symptomatic intracranial hemorrhagic transformation (sIHT) at discharge. Methods: Patients with AIS aged ≥90 admitted to our center from January 2003 to December 2022 were included. They were selected if had an NIHSS ≥5, were previously ambulatory (prestroke mRS score 3 or less), and arrived within 6 h from symptom onset. Those treated or not with IVT were compared with univariate analysis. Results: The mean age was 93.2 (2.4) years, and 51 (73.9%) were female. The admission mRSandNIHSSwere1(IQR0–2) and 14 (IQR 7–22), respectively. Thrombolyzed patients had a shorter time from symptom onset to door and lower glycemia on admission. IVT was associated with a higher proportion of patients achieving mRS 0–3atdischarge (p = 0.03) and at 90 days (p = 0.04). There were no dif ferences between groups in the risk of death (p = 0.55) or sIHT (p = 0.38). Conclusion: In this small sample, ambulatory patients aged ≥90 with moderate or severe AIS treated with IVT had increased odds of being able to walk independently at discharge than those not treated, without safety concerns.
Food addiction in patients on weight loss treatment.
(2024) Palacio Agüero, Ana; Cuello, Catalina; Díaz-Torrente, Ximena
Background: Food addiction (FA) is defined as hedonic eating behavior involving the consumption of highly palatable foods (i.e., ultra processed foods in quantities beyond homeostatic energy requirements). FA is present in a subset of patients with overweight or obesity and could contribute to the response to weight loss treatments. Aim: Determine FA in individuals that fulfil the criteria of FA as measured by the YFAS 2.0, and its association with anthropometric and body composition variables in a clinical sample of patients undergoing weight loss treatment. Also, to determine the most prevalent FA criteria. Methods: An observational, analytical, and cross-sectional study was conducted. Sampling was non-probabilistic, convenience based. A total of 158 participants were recruited from two clinical centers (private and public) focused on managing non-communicable chronic diseases. The Chilean version of YFAS 2.0 was administrated through the online REDCap platform. Anthropometric measurements were measured, and body mass index (BMI) was calculated. Results: The mean age was 47.8 (SD 14.9) and BMI 28.7 (SD 5.3) kg/m2. There were 12.7% patients who screened positive on the YFAS 2.0 Chilean version (3.2% for mild, 2.5% for moderate and 7.0% for severe), the mean symptom count was 2.2 (SD 2.6), with withdrawal being the most prevalent criterion (33.5%). FA patients had significantly higher body weight compared to non-FA subjects (p = 0.045). We observed a slight and significant correlation between FA symptom count and body weight (p = 0.020), waist circumference (p = 0.005), and BMI (p = 0.023). Conclusion: This is the first study in Chile that showed that FA was present in patients undergoing weight loss treatment and was associated with anthropometric measurements. In addition, it showed that withdrawal was the most prevalent criterion. Future studies should investigate whether the presence of FA and the withdrawal criterion could contribute to suboptimal clinical response to weight loss treatment.
Diet quality of Chilean schoolchildren: How is it linked to adherence to dietary guidelines?
(2025) Pinheiro Fernandes, Anna Christina; Araneda Flores, Jacqueline; Quintiliano Scarpelli Dourado, Daiana; Pizarro Quevedo, Tito; Marques de Oliveira, María Rita
Introduction In Chile, the prevalence of overweight among schoolchildren over the age of 5 is approximately 50%, one of the highest in the Americas region. This is largely influenced by the presence of inadequate food environments, characterized by limited access to healthy foods and a high availability of highly processed foods (HPF). This study analyzes food consumption in Chilean schoolchildren and the association of this with the Chilean Dietary Guidelines Based on Foods (DGBF) and the HPF consumption. Material and methods The sample (1,094 schoolchildren) was obtained from the baseline of the FONDEF IT18I0016 project, in Santiago-Chile. Anthropometry and socioeconomic data were measured. Dietary intake was assessed using a validated semi-quantitative frequency survey featuring images of food groups aligned with DGBF, as well as HPF. All data were collected by trained professional nutritionists. Associations between dependent and independent variables, and potential confounding factors were calculated using logistic regression models with stepwise backward/forward. A p < 0.05 was accepted as significant, using Stata 16.0. Results Most of the students (54.1%) were with malnutrition by excess and 20.0% exhibited abdominal obesity. Twenty percent of the students met the recommended intake for DGBF (fruits, vegetables, fish, milk and dairy products, legumes, water) and less than 5% did not consume any HPF. Consuming some sub-groups of HPF in moderate quantities (either no consumption or occasional consumption) increases the likelihood of meeting DGBF: candies and sweets (OR: 0.72; p = 0.04), pies with or without filling (OR: 0.63; p = 0.01), and salted snacks (OR: 0.67; p = 0.02).
Comparación de la Técnica de Socket Shield y el Protocolo Convencional de Implante Inmediato para la Rehabilitación de Dientes Anteriores: Análisis Crítico de una Revisión Sistemática
(2024) Valenzuela, Daniela; Jofré J., Jorge; Asenjo-Lobos, Claudia
The Socket Shield Technique (SST), a procedure utilized in dental implantology, entails retaining a section of the natural tooth root (the socket shield) in place when an adjacent tooth is extracted, and an implant is placed in the same area. While the technique presents certain advantages, numerous investigations into SST lack of well-designed prospective randomized clinical trials at long term, compromising the credibility and reliability of their findings. The objective of this study was to critically appraise and grade the level of evidence of a systematic review that compare the SST with the conventional immediate implant protocol (CIIP) for anterior tooth rehabilitation. A recent systematic review was appraised to assess the quality and consistency of the study findings. This assessment utilized the Strength of Recommendation Taxonomy (SORT) to facilitate the application of research results to clinical practice decision-making. The assessment of the quality and reliability of the systematic review and meta-analysis revealed that the evidence obtained from the study was graded with a strength of recommendation B and a level of evidence 2. SST seems to be a feasible procedure. However, there is insufficient evidence to recommend this technique as an alternative to CIIP in daily practice. Evidence from long-term studies with proper methodology and an adequate sample size is needed to support socket shield technique as an alternative treatment to the conventional immediate implant protocol.
Validation of the transcranial Doppler rescue criteria for mechanical thrombectomy
(2024) Khan, Adnan; Saqqur, Maher; Shuaib, Ashfaq; Khan, Khurshid; Sharma, Vijay; Brunser, Alejandro; Eggers, Jürgen; Mikulik, Robert; Katsanos, Aristeidis; Sergentanis, Theodore; Vadikolias, Konstantinos; Rubiera, Marta; Bavarsad, Reza; Thang, Huy; Martínez, Patricia; Safouris, Apostolos; Heliopoulos, Ioannis; Salam, Abdul; Derksen, Carol; Voumvourakis, Konstantinos; Psaltopoulou, Theodora; Alexandrov, Anne; Alexandrov, Andrei; Tsivgoulis, Georgios; CLOTBUST-PRO Investigators
Background and purpose: Transcranial Doppler (TCD) identifies acute stroke patients with arterial occlusion where treatment may not effectively open the blocked vessel. This study aimed to examine the clinical utility and prognostic value of TCD flow findings in patients enrolled in a multicenter prospective study (CLOTBUST-PRO). Methods: Patients enrolled with intracranial occlusion on computed tomography angiography (CTA) who underwent urgent TCD evaluation before intravenous thrombolysis was included in this analysis. TCD findings were assessed using the mean flow velocity (MFV) ratio, comparing the reciprocal ratios of the middle cerebral artery (MCA) depths bilaterally (affected MCA-to-contralateral MCA MFV [aMCA/cMCA MFV ratio]). Results: A total of 222 patients with intracranial occlusion on CTA were included in the study (mean age: 64 ± 14 years, 62% men). Eighty-eight patients had M1 MCA occlusions; baseline mean National Institutes of Health Stroke Scale (NIHSS) score was 16, and a 24-hour mean NIHSS score was 10 points. An aMCA/cMCA MFV ratio of <.6 had a sensitivity of 99%, specificity of 16%, positive predictive value (PV) of 60%, and negative PV of 94% for identifying large vessel occlusion (LVO) including M1 MCA, terminal internal carotid artery, or tandem ICA/MCA. Thrombolysis in Brain Ischemia scale, with (grade ≥1) compared to without flow (grade 0), showed a sensitivity of 17.1%, specificity of 86.9%, positive PV of 62%, and negative PV of 46% for identifying LVO. Conclusions: TCD is a valuable modality for evaluating arterial circulation in acute ischemic stroke patients, demonstrating significant potential as a screening tool for intravenous/intra-arterial lysis protocols.
Global Perceptions and Utilization of Clinical Neurophysiology in Movement Disorders
(2024) Kassavetis, Panagiotis; Chen, Robert; Ganos, Christos; Hallett, Mark; Hamada, Masashi; Latorre, Anna; Pal, Pramod; Schwingenschuh, Petra; Vial Undurraga, Felipe; Tijssen, Marina; Merchant, Shabbir
Background: Clinical neurophysiology (CNP) involves the use of neurophysiological techniques to make an accurate clinical diagnosis, to quantify the severity, and to measure the treatment response. Despite several studies showing CNP to be a useful diagnostic tool in Movement Disorders (MD), its more widespread utilization in clinical practice has been limited. Objectives: To better understand the current availability, global perceptions, and challenges for implementation of diagnostic CNP in the clinical practice of MD. Methods: The International Parkinson and Movement Disorders Society (IPMDS) formed a Task Force on CNP. The Task Force distributed an online survey via email to all the members of the IPMDS between August 5 and 30, 2021. Descriptive statistics were used for analysis of the survey results. Some results are presented by IPMDS geographical sections namely PanAmerican (PAS), European (ES), African (AFR), Asian and Oceanian (AOS). Results: Four hundred and ninety-one IPMDS members (52% males), from 196 countries, responded. The majority of responders from the AFR (65%) and PAS (63%) sections had no formal training in diagnostic CNP (40% for AOS and 37% for ES). The most commonly used techniques are electroencephalography (EEG) (72%) followed by surface EMG (71%). The majority of responders think that CNP is somewhat valuable or very valuable in the assessment of MD. All the sections identified "lack of training" as one of the biggest challenges for diagnostic CNP studies in MD. Conclusions: CNP is perceived to be a useful diagnostic tool in MD. Several challenges were identified that prevent widespread utilization of CNP in MD.
Pivotal Role of mTOR in Non-Skin Manifestations of Psoriasis
(2024) Joo, Ka; Karsulovic, Claudio; Sore, Milisa; Hojman, Lia
Psoriasis is a chronic inflammatory condition affecting 2% of the Western population. It includes diverse manifestations influenced by genetic predisposition, environmental factors, and immune status. The sustained activation of mTOR is a key element in psoriasis pathogenesis, leading to an uncontrolled proliferation of cytokines. Furthermore, mTOR activation has been linked with the transition from psoriasis to non-skin manifestations such as psoriatic arthritis and cardiovascular events. While therapies targeting pro-inflammatory cytokines have shown efficacy, additional pathways may offer therapeutic potential. The PI3K/Akt/mTOR pathway, known for its role in cell growth, proliferation, and metabolism, has emerged as a potential therapeutic target in psoriasis. This review explores the relevance of mTOR in psoriasis pathophysiology, focusing on its involvement in cutaneous and atheromatous plaque proliferation, psoriatic arthritis, and cardiovascular disease. The activation of mTOR promotes keratinocyte and synovial cell proliferation, contributing to plaque formation and joint inflammation. Moreover, mTOR activation may exacerbate the cardiovascular risk by promoting pro-inflammatory cytokine production and dysregulation lipid and glucose metabolism. The inhibition of mTOR has shown promise in preclinical studies, reducing skin inflammation and plaque proliferation. Furthermore, mTOR inhibition may mitigate cardiovascular risk by modulating cholesterol metabolism and attenuating atherosclerosis progression. Understanding the role of mTOR in psoriasis, psoriatic arthritis, and cardiovascular disease provides insight into the potential treatment avenues and sheds light on the complex interplay of the immune and metabolic pathways in these conditions.
Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Optimizing Management and Minimizing Risk of Osteoporotic Vertebral Fractures - Perspectives of the AO Spine KF Trauma and Infection Group Key Opinion Leaders
(2024) Joaquim, Andrei; Bigdon, Sebastian; Bransford, Richard; Chhabra, Harvinder; Yurac, Ratko; Kumar, Vishal; El-Sharkawi, Mohammad; Benneker, Lorin; Karamian, Brian; Canseco, Jose; Scherer, Julian; Hassan, Ahmed; Schroeder, Gregory; Öner, Cumhur; Rajasekaran, Shanmuganathan; Vialle, Emiliano; Kanna, Rishi; Vaccaro, Alexander; Tee, Jin; Camino, Gaston; Fisher, Charles; Dvorak, Marcel; Schnake, Klaus; AO Spine Knowledge Forum Trauma & Infection
Study design: Literature review with clinical recommendations. Objective: To highlight important studies about osteoporotic spinal fractures (OF) that may be integrated into clinical practice based on the assessment of the AO Spine KF Trauma and Infection group key opinion leaders. Methods: 4 important studies about OF that may affect current clinical practice of spinal surgeons were selected and reviewed with the aim of providing clinical recommendations to streamline the journey of research into clinical practice. Recommendations were graded as strong or conditional following the GRADE methodology. Results: 4 studies were selected. Article 1: a validation of the Osteoporotic Fracture (OF)-score to treat OF fractures. Conditional recommendation to incorporate the OF score in the management of fractures to improve clinical results. Article 2: a randomized multicenter study comparing romosozumab/alendronate vs alendronate to decrease the incidence of new vertebral fractures. Strong recommendation that the group receiving romosozumab/alendronate had a decreased risk of new OF when compared with the alendronate only group only. Article 3: a systematic literature review of spinal orthoses in the management of. Conditional recommendation to prescribe a spinal orthosis to decrease pain and improve quality of life. Article 4: post-traumatic deformity after OF. A conditional recommendation that middle column injury and pre-injury use of steroids may lead to high risk of post-traumatic deformity after OF. Conclusions: Management of patients with OF is still complex and challenging. This review provides some recommendations that may help surgeons to better manage these patients and improve their clinical practice.
Early Mobilization Dose Reporting in Randomized Clinical Trials With Patients Who Were Mechanically Ventilated: A Scoping Review
(2024) González Seguel, Felipe; Letelier, Renato
Objective: The aim of this scoping review was to investigate the mobilization dose reporting in the randomized clinical trials (RCTs) of patients receiving mechanical ventilation in the intensive care unit. Methods: In this scoping review, RCTs published from inception to December 2022 were searched in relevant electronic databases. Trials that involved adults receiving mechanical ventilation (>48 hours) and any early mobilization modality were analyzed. Two independent authors screened, selected, and extracted data. The mobilization doses of the intervention groups (IGs) and the comparator groups (CGs) were assessed as the proportion of reported items/total applicable from the main items of the Consensus on Exercise Reporting Template (CERT). Results: Twenty-three RCTs comprising 2707 patients (1358 from IG and 1349 from CG) were included, involving studies on neuromuscular electrical stimulation (n = 7), progressive mobility (n = 6), leg cycling (n = 3), tilt table (n = 1), and multicomponent (n = 6) mobilization. The pooled reporting of CERT items was 68% (86% for IG and 50% for CG). The most reported CERT items were type of exercise (100%) and weekly frequency (100%) for IG, whereas the least reported were intensity (4%) and individualization (22%) for CG. Regardless of the group, individualization, progression, and intensity of mobilization were the least reported items. Eight IGs (35%) reported all CERT items, whereas no CGs reported all of them. Conclusions: Deficits in mobilization dose reporting of intensive care unit RCTs were identified, especially for exercise intensity in adults receiving mechanical ventilation. One-third of IG reported all exercise dosing items, whereas no CG reported all of them. Future studies should investigate the details of optimal dosage reporting, particularly for CG. Impact: The lack of dose reporting may partially explain the inconsistency in the meta-analysis results of early mobilization trials, thus limiting the interpretation for clinical practice in the intensive care unit.
Educational disparities in brain health and dementia across Latin America and the United States
(2024) Gonzalez, Raul; Legaz, Agustina; Moguilner, Sebastián; Cruzat, Josephine; Hernández, Hernán; Baez, Sandra; Cocchi, Rafael; Coronel, Carlos; Medel,Vicente; Tagliazuchi, Enzo; Migeot, Joaquín; Ochoa, Carolina; Maito, Marcelo; Reyes, Pablo; Santamaria, Hernando; Godoy, Maria; Javande, Shireen; García, Adolfo; Matallana, Diana; Avila, José; Slachevsky Chonchol, Andrea; Behrens, María; Custodio, Nilton; Cardona, Juan; Brusco, Ignacio; Bruno, Martín; Sosa, Ana; Pina, Stefanie; Takada, Leonel; França, Elisa; Valcour, Victor; Possin, Katherine; De Oliveira, Maira; Lopera, Francisco; Lawlor, Brian; Hu, Kun; Miller, Bruce; Yokoyama, Jennifer; Gonzalez, Cecilia; Ibañez, Agustin
Background: Education influences brain health and dementia. However, its impact across regions, specifically Latin America (LA) and the United States (US), is unknown. Methods: A total of 1412 participants comprising controls, patients with Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD) from LA and the US were included. We studied the association of education with brain volume and functional connectivity while controlling for imaging quality and variability, age, sex, total intracranial volume (TIV), and recording type. Results: Education influenced brain measures, explaining 24%-98% of the geographical differences. The educational disparities between LA and the US were associated with gray matter volume and connectivity variations, especially in LA and AD patients. Education emerged as a critical factor in classifying aging and dementia across regions. Discussion: The results underscore the impact of education on brain structure and function in LA, highlighting the importance of incorporating educational factors into diagnosing, care, and prevention, and emphasizing the need for global diversity in research. Highlights: Lower education was linked to reduced brain volume and connectivity in healthy controls (HCs), Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD). Latin American cohorts have lower educational levels compared to the those in the United States. Educational disparities majorly drive brain health differences between regions. Educational differences were significant in both conditions, but more in AD than FTLD. Education stands as a critical factor in classifying aging and dementia across regions.
Availability and barriers to access post-stroke rehabilitation in Latin America
(2024) Gonzalez, Alejandro; Rosales, Julieta; De Souza, Ana; Corredor, Angel; Barboza, Miguel; NAVIA, VICTOR; Brunet, Florencia; Lagos, Javier; Novarro, Nelson; Ortega, Diego; Villarroel, Victor; Abanto, Carlos; Barrientos, Jose; Saltos, Filadelfo; Papavasileiou, Vasileios; Todd, Oliver; Gongora, Fernando; ALATAC collaborators
Objectives: To describe the availability and barriers to access post-stroke rehabilitation services in Latin America. Materials and methods: We conducted a multi-national survey in Latin American countries. The survey consisted of three sections: (1) the national state of post-stroke rehabilitation; (2) the local state of post-stroke rehabilitation; and (3) the coverage and financing of post-stroke services. Stroke leaders from the surveyed countries were involved in developing and disseminating the survey. Results: 261 responses were collected from 17 countries. The mean age of respondents was 42.4 ± 10.1 years, and 139 (54.5 %) of the respondents were male. National clinical guidelines for post-stroke rehabilitation were reported by 67 (25.7 %) of the respondents. However, there were discrepancies between respondents within the same country. Stroke units, physiotherapy, occupational therapy, speech therapy, and neuropsychological therapy services were less common in public than private settings. The main barriers for inpatient and outpatient services included limited rehabilitation facilities, coverage, and rehabilitation personnel. The main source of financing for the inpatient and outpatient services was the national health insurance, followed by out-of-pocket payments. Private and out-of-pocket costs were more frequently reported in outpatient services. Conclusions: Post-stroke rehabilitation services in Latin American countries are restricted due to a lack of coverage by the public health system and private insurers, human resources, and financial aid. Public settings offer fewer post-stroke rehabilitation services compared to private settings. Developing consensus guidelines, increasing coverage, and using innovative approaches to deliver post-stroke rehabilitation is paramount to increase access without posing a financial burden.

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