Examinando por Autor "Bruna-Mejías, Alejandro"
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Ítem A Systematic Review of Anatomical Variations of the Inferior Thyroid Artery: Clinical and Surgical Considerations(MDPI, 2025-07-23) Bruna-Mejías, AlejandroThe inferior thyroid artery (ITA) is an essential component of the thyroid gland’s vasculature, with significant clinical and surgical implications due to its anatomical variability. This systematic review aimed to describe the prevalence of ITA anatomical variants and their association with clinical conditions or surgical implications. Methods: A comprehensive search was conducted in MEDLINE, Web of Science, Google Scholar, CINAHL, Scopus, and EMBASE on 20 November 2025. Eligibility criteria included studies reporting on the presence of ITA variants and their correlation with pathologies. Two authors independently screened the literature, extracted data, and assessed methodological quality using the AQUA and JBI tools. Results: Of the 2647 articles identified, 19 studies involving 1118 subjects/cadavers were included. Variations in ITA origin, absence, and additional arteries were reported, with the most common variant being direct origin from the subclavian artery. Clinically, these variations were associated with increased risk of intraoperative hemorrhage, potential nerve damage, and challenges in preoperative planning, particularly during thyroidectomy and other neck procedures. Conclusions: Understanding the anatomical diversity of the ITA is crucial for reducing surgical risks and improving patient outcomes. The review highlighted the need for more standardized research protocols and comprehensive data reporting to enhance the quality of evidence in this domain. Preoperative imaging and thorough anatomical assessments tailored to individual patient profiles, considering ethnic and gender-related differences, are essential for safe surgical interventions in the thyroid region.Ítem Comparison of the Mediterranean Diet and Other Therapeutic Strategies in Metabolic Syndrome: A Systematic Review and Meta-Analysis(MDPI, 2025-06-19) Bruna-Mejías, AlejandroThe Mediterranean diet (MD) is one of the healthiest diets, high in fiber, antioxidants, and unsaturated fats. MD improves lipid profiles, reduces inflammation, controls blood pressure, decreases insulin resistance, and enhances the sensitivity to this hormone, lowering the risks of Metabolic syndrome (MS). MS is characterized by central obesity, hypertension, insulin resistance, and dyslipidemia, increasing the risk of cardiovascular disease and type II diabetes. The objective of this study was to know the effectiveness of the MD versus other treatments in patients with MS. A systematic search across multiple databases, Medline, Embase, Web of Science, Scopus, Google Scholar, and Cinahl, was conducted using keywords such as “Mediterranean diet”, “Mediterranean food”, “eat mediterranean”, “Metabolic syndrome”, and “x syndrome”. A total of 12 studies met the inclusion criteria. Mediterranean diet at different doses versus other diets or other treatments showed significant improvements in clinical parameters, including BMI (mean difference of −0.83 95% CI: −0.93 to −0.74; p < 0.00001),waist circumference (mean difference = −1.81, CI = −2.63 to −0.99, p < 0.00001) triglycerides (mean difference = −22.38, CI = −32.86 to −11.90, p < 0.00001), Glucose (mean difference = −4.28, CI = −7.64 to −0.93, p = 0.005) and, HOMA IR (mean difference = −0.72, CI = −0.78 to −0.65, p < 0.00001), and Insulin resistance (mean difference = −2.98, CI = −3.27 to −2.69, p < 0.00001), all of which improved, Although there were more outcomes, these are the most important changes for patients with metabolic syndrome. MD improves metabolic and cardiovascular health, but study heterogeneity limits the results’ generalizability. Because of that, further research is needed to standardize approaches and explore their mechanisms. MD should be part of an optimized strategy that includes education and physical activity. The strength of the evidence was very low according to the GRADE approach. Further research is needed to support the efficacy of the Mediterranean diet in patients with MS.Ítem Effectiveness of Vitamin D Supplementation on Biochemical, Clinical, and Inflammatory Parameters in Patients with Different Types of Diabetes: A Systematic Review and Meta-Analysis(MDPI, 2025-09-18) Bruna-Mejías, AlejandroBackground and Aims: Numerous clinical and observational studies have examined the role of vitamin D in glycemic control and metabolic regulation among diabetic patients, but findings remain inconsistent. This meta-analysis aimed to assess the effects of vitamin D supplementation on glycosylated hemoglobin (HbA1c%), HOMA-IR, HOMA-β, LDL cholesterol, total cholesterol, triglycerides, fasting insulin, fasting plasma glucose, C-reactive protein, and the likelihood of reversion to normoglycemia in prediabetic individuals. Methods: A comprehensive search of multiple databases was performed using keywords including “diabetes mellitus,” “type 2 diabetes,” “vitamin D supplementation,” and “VD supplementation.” Twenty studies met the inclusion criteria. Results: Vitamin D supplementation was associated with significant improvements across several parameters, including HOMA-β (SMD = 0.71; 95% CI: 0.63–0.80; p < 0.00001), HDL cholesterol (SMD = 0.07; 95% CI: 0.05–0.09; p < 0.00001), and others (SMD = −0.40; 95% CI: −0.45 to −0.34; p < 0.00001). Conclusions: Vitamin D supplementation appears to provide beneficial effects on glycemic, lipid, and inflammatory markers in patients with diabetes and prediabetes. Specifically, supplementation significantly reduced HbA1c%, HOMA-IR, LDL cholesterol, total cholesterol, triglycerides, fasting insulin, fasting glucose, and C-reactive protein while increasing the rate of normoglycemia among prediabetic individuals. Further research is needed to strengthen the evidence base regarding vitamin D’s role in diabetes management.Ítem Hypoplastic and congenital absence of coronary arteries and Its correlation with clinical implications of cardiac circulation: a systematic review and meta-analysis(MDPI, 2024-04-18) Bruna-Mejías, AlejandroBackground: Coronary arteries originate from the first portion of the aorta, emerging from the right and left aortic sinuses. They traverse through the subepicardium and coronary sulcus to supply the myocardium during diastolic function. The objective of this review was to understand how the hypoplasia and agenesis of the coronary arteries are associated with cardiac pathologies. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were researched until January 2024. An assurance tool for anatomical studies (AQUA) was used to evaluate methodological quality. The pooled prevalence was estimated using a random effects model. Results: A total of three studies met the established selection criteria for inclusion in this meta-analysis. The prevalence of coronary artery variants was 3% (CI = 2% to 8%), with a heterogeneity of 77%. The other studies were analyzed descriptively, along with their respective clinical considerations in the presence of the variant. Conclusions: Hypoplasia and the congenital absence of the coronary arteries are often incidental findings and understanding these variants is crucial to prevent misdiagnosis. Additionally, it is essential to exercise caution when considering surgical management for hearts with these variants.Ítem Morphological Characteristics of the Double Mental Foramen and Its Relevance in Clinical Practice: An Observational Study(MDPI, 2024-04-25) Bruna-Mejías, AlejandroThe mental foramen (MF) is an opening found bilaterally on the anterolateral aspect of the mandible; it can be round or oval and have different diameters. One of the anatomical variants of the jaw is the presence of an accessory mental foramen (AMF). These are usually smaller than the MF and can be located above, below, or to the sides of the main MF. The objective of this study was to recognize the presence of AMF in dry jaws of the Chilean population and collect information about its clinical relevance reported in the literature. In this descriptive observational study, we have collected dried jaws obtained from three higher education institutions in Santiago de Chile, from the Department of Morphology of the Andrés Bello University, the Normal Human Anatomy Unit of the University of Santiago, and the Human Anatomy pavilion from the Faculty of Medicine of the Finis Terrae University. The samples for this research were obtained by convenience, and the observation of the jaws was carried out in the human anatomy laboratories of each institution by three evaluators independently, and a fourth evaluator was included to validate that each evaluation was correct. The sample for this research came from 260 dry jaws, showing the following findings from the total jaws studied, and to classify as an accessory MF, it will be examined and measured so that it complies with what is declared in the literature as the presence of AMF, which is between 0.74 mm. and 0.89 mm. There were 17 studies included with a sample that fluctuated between 1 and 4000, with a cumulative total of 7946 and an average number of jaws analyzed from the studies of 467.4, showing statistically significant differences between the means with the sample analyzed in this study; p = 0.095. For the cumulative prevalence of the presence of AMF, this was 3.07 in this study, and in the compared studies, the average of AMF was 8.01%, which did not present a statistically significant difference; p = 0.158. Regarding the presence of variants of unilateral AMF, this occurred in five jaws, which is equivalent to 1.84% in the sample of this study, while in previous studies, it was 7.5%, being higher on the left side than on the right. The presence of AMF is a variant with high prevalence if we compare it with other variants of the jaw. Knowledge of the anatomy and position of the AMF is crucial to analyze different scenarios in the face of surgical procedures or conservative treatments of the lower anterior dental region.Ítem Partial agenesis of the pectoralis major and minor muscle: A cadaveric case report(Wolters Kluwer Health, Inc., 2024-09-13) Bruna-Mejías, AlejandroRationale: The pectoralis major and minor muscles, located in the anterior chest wall, are crucial for upper limb movements. Patient concerns: Their nonsyndromic absence is rare but significant for surgical procedures involving the axillary and pectoral regions. Diagnoses: Ultrasound can confirm the diagnosis and delimit the extent of the muscular abnormality, detect abnormalities of the costal cartilages, among others. Interventions: This descriptive, cadaveric case report involves a formalin-fixed 57-year-old North American male, with no clinical or family history of similar conditions. The study was conducted at the Human Anatomy Laboratory of the School of Medicine of the universidad Finis Terrae in Santiago, Chile, in August 2022. Outcomes: We present a cadaveric case of bilateral partial agenesis of the pectoralis muscles discovered during routine dissection. The pectoralis major muscle exhibited only the clavicular portion, with the sternocostal and abdominal portions absent and replaced by a thin layer of connective tissue bilaterally. The pectoralis minor muscle showed partial muscle fibers only in the most distal and inferior portions bilaterally. Lessons: This case report is significant due to the rarity of this condition without accompanying anatomical variations. Understanding this variant is valuable for clinical situations involving the shoulder and thorax region, such as trauma to the proximal third of the humerus, clavicular region, suprascapular region, and anterior chest wall. It may complicate conservative and/or surgical treatments due to different functional and irrigation patterns in the area and is also important for educating future professionals.Ítem The adverse effects and use of bevacizumab in patients with glioblastoma: a systematic review and meta-analysis(MDPI, 2025-05-25) Bruna-Mejías, AlejandroA glioblastoma (GBM) is a type of tumor originating from the glial brain cells, the astrocytes, and thus belongs to the astrocytoma group. Bevacizumab (BV) is a treatment for GBM. BV is the active ingredient in the drugs Avastin®, Alymsys®, Mvasi® and ZiraBev®. It is currently approved as second-line treatment for GBM recurrence in combination with radiotherapy, and as first-line treatment for other cancers, including advanced colorectal cancer, metastatic breast cancer and advanced non-small-cell lung cancer. The objective of this systematic review was to analyze the scientific evidence from the science-based literature on the therapeutic effect and adverse effects of the drug BV in patients with GBM or GBM multiforme. Methods: We systematically searched electronic databases for the literature search, including the MEDLINE (via PubMed), SCOPUS, Google Scholar, the Cumulative Index to Nursing and Allied Health Literature and Web of Science databases, covering records from their earliest data to December 2024. Randomized or controlled clinical trials that were published in English or Spanish were included. The following keywords were used in different combinations: “Bevacizumab therapy”, “Bevacizumab pharmaceutical”, “Glioblastoma”, “Glioma” and “multiform glioblastoma”. Results: The use of Bevacizumab has been extensively studied in the scientific literature, with beneficial effects in symptom control. However, the adverse effects of BV vary across different types of carcinomas, which is why it has already been established that these adverse effects must be taken into consideration. In our meta-analysis of adverse effects, we found 14 adverse effects and estimated their prevalence, with an average of 19% (CI: 4 to 44%). The most significant vascular adverse effect was thromboembolism, which led to a greater number of complications for patients with GBM. Finally, the most common adverse effects were nausea, vomiting, fatigue and hypertension. Conclusions: While the beneficial properties of this pharmacological therapy have been observed, its adverse effect profile requires constant evaluation, as it includes vascular, blood and symptomatic adverse effects, which must be analyzed on a case-by-case basis and with great attention, especially in the case of more serious complications such as thromboembolic events.Ítem The Gastric Vein Variants: An Evidence-Based Systematic Review of Prevalence and Clinical Considerations(MDPI, 2025-05-22) Bruna-Mejías, AlejandroThe objective of the present systematic study was to analyze and characterize the gastric vein (GV) variations to understand their significance within clinical contexts, particularly in gastric and liver surgeries and managing conditions associated with the portal vein system. Methods: We conducted a systematic review, examining various databases, including Medline, Scopus, Web of Science, Google Scholar, CINAHL, and EMBASE, up to April 2025. Two independent authors conducted the literature search, selected pertinent studies, and extracted relevant data. The methodological quality of the studies was evaluated utilizing the Assessment Tool for Anatomical Studies (AQUA). The pooled prevalence was estimated through the application of a random effects model. Results: Among the 279 articles reviewed, 11 studies were ultimately incorporated into the systematic analysis, encompassing 47,993 subjects. The pooled prevalence of GV variants was determined to be 8.32%, revealing considerable heterogeneity (I2 = 98.92%). A subgroup analysis showed a greater prevalence of GV variants in diagnostic imaging studies than in cadaveric studies, with a higher frequency observed in males than in females. Conclusions: The morphological variability of the GVs holds clinical significance, as it may significantly impact the management of abdominal disorders, particularly during surgical and endovascular interventions. This study emphasizes the necessity of thorough preoperative evaluations to identify these variations, thereby minimizing surgical complications and enhancing therapeutic outcomes for patients suffering from gastric and portal vein system disorders. Integrating advanced imaging techniques into clinical practice may facilitate improved surgical and therapeutic planning.Ítem Use of ketamine in patients with multifactorial neuropathic pain: a systematic review and meta-analysis(MDPI, 2024-09-03) Bruna-Mejías, AlejandroNeuropathic pain (NP) is a heterogeneous group of conditions characterized by the experience of a number of sensory disturbances including pain, burning sensations, paroxysms of stabbing pain, dysesthesias, allodynia, and hyperalgesia. The above-mentioned sensations may occur in a specific dermatome area or other delimited region of the body. The objective of this review was to analyze the evidence for ketamine in multifactorial neuropathic pain. The research group systematically searched the databases MEDLINE (via PubMed), EMBASE, SCOPUS, the Cochrane Central Register of Controlled Trials, the Cumulative Index to Nursing and Allied Health Literature (Cinahl), and the Web of Science. The findings of this review show that different forms of low doses of ketamine (LDK) do not present statistically significant changes for any of the scales included. In this study, the total symptom score [standardized mean difference (SMD) = -3.59, confidence interval (CI) = -4.16 to -3.02, and p < 0.00001], neuropathy impairment score (SMD = -1.42, CI = -3.68 to 0.84, and p = 0.22), and neuropathy symptom checklist (SMD = -0.09, CI = -0.15 to -0.02, and p = 0.01) were taken into account. For finality compared to the use of a placebo, the findings suggest that LDK does not exhibit significant differences in terms of pain reduction and functionality. Moreover, no specific dosages are identified to support the use of LDK in the reduction in NP.