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A nomogram for relapse/death and contemplating adjuvant therapy for parathyroid carcinoma
(Elsevier, 2023-08) Silva-Figueroa, Angélica
The staging systems proposed to date for PC have not been adequately validated. Recent multivariate have been carried out in large national and international databases to search for prognostic factors for survival and relapse in PC. Advanced age, male gender, high PTH and calcium levels at diagnosis, tumor size >30 mm, angioinvasion, presence of distant metastases, and specific tumor microenvironmental factors, such as parafibromin staining and tumor-infiltrating lymphocytes, have been strongly correlated with decreased OS and CSS, and with increased risk of local and distant recurrence. Because of their prognostic significance, these host and tumor factors should be included in any PC staging system. However, there is a need to promote collaborative PC registry plans to collate data on the above prognostic factors as well as new ways in a standardized global registry. Such a resource could be used to stratify patients with PC and identify those at high risk for relapse and death who may benefit from strict surveillance or adjuvant therapeutic care. PC is an indolent cancer with a high recurrence rate of 3 to 5 years after the first surgical intervention. Progression can remain dormant for decades until patients present with distant metastases. Such heterogeneity and neoplastic latency make OS an ambitious endpoint to achieve, and pursuing OS contradicts the actual needs of patients with this endocrine neoplasm. More relevant endpoints focus on achieving normal blood biochemistry to improve quality of life and intervening to lengthen recurrence/metastasis event-related-free survival. Surgery remains the standard treatment because traditional therapies, such as EBRT and chemotherapy, do not benefit patients with advanced unresectable or metastatic PC, new options are emerging for patients with PC. Genomic and phenotypic profiling can continue to inform personalized therapeutic strategies to expand the clinical options available to patients with PC.
A Systematic Review of Anatomical Variations of the Inferior Thyroid Artery: Clinical and Surgical Considerations
(MDPI, 2025-07-23) Bruna-Mejías, Alejandro
The 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.
Actualización sobre el manejo inicial de fracturas expuestas para médicos generales y especialistas. Revisión panorámica de la literatura
(Revista Médica de Chile, 2026-03-04) Frey Moreno, Catalina
Las fracturas expuestas representan una carga significativa para la salud pública debido al riesgo de infección, secuelas y mortalidad. El manejo inicial es crucial para evitar o reducir estas complicacio-nes. Objetivo: Describir las opciones actuales de manejo inicial de fracturas expuestas en el servicio de urgencias por el médico general y especialista. Metodología: Revisión panorámica del manejo de fractura expuesta realizada entre octubre y noviembre 2024, utili-zando términos MESH en PubMed y SCIELO en inglés y español. Se incluyeron artículos de los últimos 5 años (2019-2024) abordando los pilares del manejo en urgencias: antibioticoterapia, manejo del dolor, inmovilización y desbridamiento. Resultados: De 2.883 artícu-los obtenidos en PubMed y SCIELO, 30 estudios fueron incluidos. Se mantienen los pilares de tratamiento para disminuir complicaciones: antibioticoterapia, manejo del dolor, inmovilización, desbridamiento y cierre de la herida. Discusión: La antibioticoterapia debe ser precoz, idealmente antes de 60 minutos, aseo quirúrgico antes de 24 horas de la lesión según las características de la fractura, cierre precoz de la herida. También, manejo del dolor asociado a reducción e inmovi-lización y/o fijación. Además, considerar el uso de antibioticoterapia local y continua o cierre-asistido-por-vacío (VAC) por especialistas. Es importante la creación de protocolos específicos para el sistema de salud chileno. Conclusiones: El médico general debe conocer los tiempos de administración antibiótica y desbridación, optimizar el manejo del dolor farmacológicamente, inmovilizar la fractura e indicar la profilaxis antitetánica. El especialista debe procurar un aseo quirúrgico y cierre de la herida precoz, considerando asociar antibiótico local o VAC para favorecer el pronóstico del paciente. El manejo actualizado y protocolizado de esta patología es relevante para prevenir su morbimortalidad.
The Akin osteotomy without fixation in open hallux abducto-valgo correction surgery: A single center retrospective analysis of 286 cases
(Elsevier, 2023-01-06) Testa, Enrique Adrián
Between 2011 and 2018, 222 patients, 286 feet (147 left, 139 right) met the inclusion criteria. We found an average difference between pre-op and post-op at 3 months of distal articular set angle (DASA) of 7.0 degrees and average interphalangeal joint obliquity angle (IPOA) of 12.0 degrees (p < 0.001). All cases achieved fusion but in 5.9 % (17/289 cases) of cases, we observed delayed consolidation. The average union time in these cases was 22.1 weeks. Hyperextension of the distal fragment (mal union in plantar flexion) was observed in 7 cases (2.4 %). None of the 7 cases required correction. Out of 286 surgeries, 8 (2.7 %) required reoperation, but only one case for a hypocorrection required Akin's re osteotomy. Regarding the inter- and intra-observer correlations, good and excellent reliability are observed for all parameters under consideration. Conclusion The absence of internal fixation would appear not to impair osteotomy healing and complication rates compared with techniques with fixation would not appear to be worse. The results are encouraging; nevertheless, we believe that further studies need to be performed in order to confirm the data.
Análisis de la epidemia estacional por virus respiratorios y virus respiratorio sincicial (VRS) del año 2023 comparado con cohorte prepandemia (2015-2019) en Chile
(Sociedad Chilena de Pediatría, 2025) Díaz, Franco
Durante la pandemia de COVID-19, las infecciones respiratorias pediátricas disminuyeron drásticamente a nivel mundial. Sin embargo, en el otoño-invierno de 2023, estas enfermedades resurgieron de manera inusual, causando estrés en el sistema de salud. Comparando los datos del 2023 con los del quinquenio prepandemia del Departamento de Estadísticas e Información de Salud (DEIS) de Chile, observamos que la magnitud y frecuencia de las enfermedades respiratorias pediátricas fueron similares. No obstante, el estrés en el sistema de salud se debió al inicio temprano de la demanda, la sincronicidad de grupos etarios, la heterogeneidad geográfica y la capacidad de respuesta global y local. En la Región Metropolitana (RM), los casos no aumentaron en número, pero se presentaron 4 semanas antes. En las regiones central, centro-sur y sur, los casos aparecieron más temprano y durante un periodo más corto, resultando en un pico de hasta 4 veces más en hospitalizaciones y consultas de urgencia. La eficacia de las políticas públicas, como los cambios en programas educacionales y la inmunización contra el virus respiratorio sincicial (VRS), requiere un análisis objetivo y multisectorial. Es necesario ajustar las políticas para evitar la sobrerrepresentación de la RM y fomentar la colaboración público-privada para perfeccionar la información de la carga del VRS, y así mejorar los estándares de atención, tratamientos y su disponibilidad a lo largo de Chile.
Analysis of predictors for spinal fusion in degenerative lumbar stenosis in Chile based on diagnosis-related groups
(Gavin Publishers, 2024-01-03) Molina, Marcelo
Introduction: Degenerative Lumbar spinal stenosis (DLSS) is the most common cause of spine surgery for patients above 55 years. Surgery options include decompression alone or with spinal fusion. The DRG system uses classification algorithms that categorize patients into groups with similar clinical and resource consumption characteristics, using ICD-10 nomenclature for diagnoses and ICD-9-CM for procedures. Objective: Identify clinical and epidemiological variables of DLSS surgery patients based on Chile’s DRG system data and define factors associated with arthrodesis as a complement to decompression. Study Design: Retrospective observational study. Methods: This study used the national DRG database to analyze factors predicting the need for fusion in patients with DLSS. Data from 31 public hospitals in Chile were analyzed for patients discharged between 2020 and 2022. Variables considered included age, gender, presence of other spinal pathologies, and attending physician specialty. For the descriptive analysis of qualitative variables, frequencies and percentages were used.The study used univariate and multivariate logistic regression analysis. A statistical significance level of less than 0.05 was considered. Results: We analyzed 1024 patients with lumbar spinal stenosis and found that 54.6% were female and 45.4% were male (p= 0.0034). The majority of the patients (57.4%) were aged between 60 and 79 years. 75% of orthopedic surgeons opted for decompression plus arthrodesis, while neurosurgeons preferred decompression alone in 73% of cases. The most significant predictors for decompression with fusion were the physician’s specialty in orthopedic surgery, female sex, and the presence of other spinal pathologies such as scoliosis, herniated disc, and spondylolisthesis. Patients treated by an Orthopedic Surgeon had an 8.2 times greater probability of undergoing decompression plus arthrodesis as compared to those treated by a Neurosurgeon. Additionally, the presence of spondylolisthesis increased the probability of decompression with fusion by 6.2 times, and the presence of scoliosis increased it by 6.6 times. Neurosurgeons opted for decompression alone in 89.7% of the cases with DLSS stenosis and herniated disc, while only 48.9% of orthopedic surgeons opted for the same option (p=0.0000). Conclusion: Our study based on DRG records from public hospitals in Chile has identified certain factors linked to a higher frequency of spinal arthrodesis. These factors include the surgery being performed by orthopedic surgeons, patients aged between 40 and 60 years old, the presence of degenerative spondylolisthesis and degenerative scoliosis, and the absence of a herniated disc.
Anatomical variants in pancreatic irrigation and their clinical considerations for the pancreatic approach and surrounding structures: a systematic review with meta-analysis
(MDPI, 2025-02-19) Valenzuela Fuenzalida, Juan José
Background and Objectives: The pancreas receives blood through a complex network of multiple branches, primarily originating from the celiac trunk (CeT) and the superior mesenteric artery (SMA). This blood supply is structured into three main arterial groups, each serving different regions of the pancreas to effectively support its endocrine and exocrine functions. Materials and Methods: The databases Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Latin American and the Caribbean Literature in Health Sciences (LILACS) were searched until January 2025. Methodological quality was evaluated using an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. Results: A total of sixteen studies met the established selection criteria in this study for meta-analysis. Pancreatic irrigation variants presented a prevalence of 11.2% (CI: 7–14%) and a heterogeneity of 88.2%. The other studies were analyzed by subgroups, showing statistically significant differences in the following subgroups: (1) sample type—a larger sample of images analyzed in the included studies (p = 0.312), which did not show statistically significant differences; (2) geographical region (p = 0.041), which showed a greater presence in the Asian population studied, and this was statistically significant; and (3) sex (male or female) (p = 0.12), where there were no statistically significant differences. Conclusions: The discovery of variations in pancreatic irrigation is common due to the numerous blood vessels involved in supplying this vital organ. Understanding different vascular patterns (such as those from the splenic and mesenteric arteries) is crucial for surgical interventions on the pancreas. For transplant patients, a thorough vascular analysis of both the donor and recipient is essential. Variations can impact blood flow and compatibility, potentially leading to transplant rejection if not addressed. To enhance outcomes, it is recommended to develop more accurate imaging tools for pre-surgical analysis, necessitating ongoing research in this area.
Anatomical variants of the vertebral artery and their relationship with craniocervical disorders and surgical considerations: a systematic review and meta‐analysis
(Springer Nature, 2025-05-29) Valenzuela Fuenzalida, Juan José
The vertebral artery (VA) supplies almost one-third of the blood flow to the brain, contributing mainly to its posterior circulation. This article provides a comprehensive overview of the different anatomical variations related to the origin, course, and termination of the VA and associated clinical implications. Data were compiled from numerous published studies accessed from the databases Medline, Scopus, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Literature in Health Sciences (LILACS) as of January 2024. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model, and differences in VA variant rates were assessed. VA variants were identified that could be separated into three categories: variation in origin, course, and terminal branches. A total of 16 studies met the established selection criteria for the current meta-analysis. VA variations were reported at an overall prevalence of 11% (CI: 7%–15%) and a heterogeneity of 77%. Statistically significantly higher rates were revealed in the following subgroups of the sample: imaging examinations versus cadavers (p = 0.032); right side of the body versus left (p = 0.034); and bilaterally versus unilaterally (p = 0.019). Concerns listed in included studies primarily focused on the possibility of iatrogenic damage during surgical procedures. A few studies also indicated higher rates of VA variants in patients who reported symptoms of recurrent headaches, vertigo, dizziness, and/or syncope. The presence of VA variants is high and can occur in various regions. However, the most important clinical consideration is that individuals with this variant must be constantly monitored since their posterior cerebral circulation could be affected. To avoid iatrogenic damage to the VA, clinicians should employ medical imaging to evaluate its course and branches prior to surgical interventions in the region.
Anatomical variations and abnormalities of the maxillary region and clinical implications: A systematic review and metaanalysis
(Wolters Kluwer Health, 2023-07-05) Valenzuela Fuenzalida, Juan José
Objetivo: El objetivo de esta revisión es investigar y analizar las variaciones anatómicas presentes en el seno maxilar (SM), a través de la examinación de la prevalencia de estas variaciones, así como la correspondiente prevalencia de patologías clínicamente significativas y complicaciones asociadas a ellas. Métodos: El proceso de búsqueda se realizó en las siguientes bases de datos; MEDLINE, SCIELO, WOS, CINHAL, SCOPUS y GOOGLE SCHOLAR, utilizando como términos de búsqueda; “Hueso maxilar”, “Seno maxilar”, “Seno paranasal”, “Variaciones anatómicas”, “Sinusitis” y “Anatomía clínica”. Resultados: Se incluyeron un total de 26 artículos y 12969 muestras, de las cuales se registró el sexo de 12,594 sujetos, dando un total de 5802 hombres y 6792 mujeres. Las variantes reportadas por los incluidos fueron células de Haller, Concha Bullosa, Número de septos, Seno hipoplásico, Agger Nasi, Engrosamiento de la mucosa MS, Desviación del tabique nasal, Ostium accesorio y Células de Onodi. Entre los mencionados, los que presentaron mayor número de estudios (entre 8 y 10 estudios incluidos) fueron: las Células de Haller, la Concha Bullosa y el Número de septos, donde la prevalencia fue de 0,30, 0,36, 0,39 respectivamente. Estas variaciones pueden provocar sinusitis, provocar algunos tipos de tumores o afectar estructuras vecinas que podrían verse comprometidas por esta variación. Conclusión: Como resultado, es ciertamente complejo distinguir la presencia de variaciones anatómicas de anomalías patológicas. Por tanto, el conocimiento de las diferentes variaciones y sus relaciones clínicas podría ser un activo útil para los médicos dedicados a esta región.
Anatomical variations of the mandibular canal and their clinical implications in dental practice: a literature review
(Springer Nature, 2021-02-25) Valenzuela Fuenzalida, Juan José
Introduction The anatomical variations of the mandibular canal have been described according to the number of additional branches it presents, bifid and trifid. Within the bifids we can also find subtypes of variations such as the retromolar man- dibular canal. These anatomical variations can have important clinical implications for the work of dental professionals. Methods A systematic search of the literature was carried out in different databases that met the following criteria: articles published between 2000 and 2020, and articles that established a clinical correlation with variations in the mandibular canal. Results After applying inclusion and exclusion criteria, 32 articles were obtained, in which the variations of the mandibular canal were identified, their prevalence and incidence, which was very varied between the different articles, it was also found that the CBCT was the main technique to identify the anatomical variations of the mandibular canal. Lastly, the anatomical variations of the mandibular canal have a direct clinical correlation with pre-surgical, intra-surgical and postsurgical com- plications in pathologies that require surgical intervention. Conclusions The anatomical variations of the mandibular canal have a high incidence, so knowing them is of vital impor- tance both for clinicians and anatomy professors who provide morphological training. We believe that research should focus on describing and diagnosing the causes of these anatomical variations. That said, there is also a continuous challenge for all health professionals to learn about the different anatomical variations that the human body presents and how these can affect clinical practice.
Anatomy of vertebral artery hypoplasia and its relationship with clinical implications: a systematic review and meta-analysis of prevalence
(Springer, 2024-05-19) Valenzuela Fuenzalida, Juan José
Purpose: The vertebral artery (VA) is a vital branch of the subclavian artery, coursing through the transverse foramina of the cervical vertebrae, and playing a crucial role in irrigating the posterior region of the arterial cerebral circle, also known as the Polygon of Willis. Among the various possible alterations that can affect the VA, vertebral artery hypoplasia (HAV) emerges as a significant variant. This study aims to discern the anatomical features of HAV and its correlation with the clinical conditions of the posterior cerebral circulation. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were searched until January 2024. Two authors independently performed the search, study selection, and data extraction. Methodological quality was evaluated with an assurance tool for anatomical studies (AQUA). Pooled prevalence was estimated using a random effects model. Results: A total of 24 studies met the established selection criteria, with a total of 8847 subjects. In this study, 6 articles were included for the meta-analysis with a total of subjects. The average prevalence of VAH reported in each study was 11% (95% CI 10-12%); the studies had a heterogeneity of 41% based on the funnel plot and a low risk of bias. Conclusion: The prevalence of VAH is low, but in the presence of this condition, the changes are mainly in diameter rather than morphological. If it is present, some clinical safeguards must be taken to avoid complications such as stroke.
Anterior tibial translation versus rotational instability in ACL reconstruction: Defining the problem before choosing the procedure
(Wiley, 2026) Pineda, Tomás
The expanding use of lateral extra‐articular procedures (LEAPs) and tibial deflexion osteotomy (TDO)—also referred to as slope‐reducing anterior closing wedge high tibial osteotomy—in anterior cruciate ligament (ACL) reconstruction reflects meaningful progress in our understanding of mechanisms of graft failure. However, as their use expands, an important distinction just be maintained: they do not address the same problem.
Antidiabetic potential of extracts from Cylindropuntia imbricata (Haw.) F.M. Knuth, Opuntia engelmannii Salm-Dyck ex Engelm., Ibervillea sonorae (S. Wats.) Greene and Theobroma cacao L.
(Universidad Nacional Autónoma de México; Facultad de Estudios Superiores Zaragoza., 2024-07-30) De la Sota-Esparza, Gastaldo Emmanuel
Diabetes mellitus is a disease that affects more than 537 million people in the world without decreasing. When diabetes becomes complicated, it damages several organs until it causes death. The drugs in use to counteract the disease produce side effects; a circumstance that has led to research on plants with anti-diabetic properties. The objective of this study was to evaluate the antidiabetic potential of extracts obtained by maceration of the following parts of the plant: Cylindropuntia imbricata (Cactaceae) cladode and seed, Opuntia engelmannii (Cactaceae) cladode and seed, Ibervillea sonorae (Cucurbitaceae) root and Theobroma cacao (Malvaceae) seed mixed with solvents of different polarity (hexane, ethyl acetate, dichloromethane and methanol). A total of 24 extracts were obtained and subjected to the following analyses: 1) phytochemical screening to determine their composition, 2) toxicity in B16F10 cells using the alamar blue test, 3) antioxidant capacity through DPPH inhibition, and 4) in vitro evaluation to determine their antihyperglycemic capacity (inhibition of alpha-glucosidase). The results obtained from methanolic extracts with O. engelmannii and T. cacao seeds, as well as ethyl acetate extracts with T. cacao and C. imbricata seeds showed antioxidant and antihyperglycemic activity. No toxicity in B16F10 cells, and antidiabetic potential in vitro. La diabetes mellitus es una enfermedad que no decrece y afecta a más de 537 millones de personas en el mundo. La diabetes al complicarse daña varios órganos hasta causar la muerte. Los fármacos en uso para contrarrestar la enfermedad producen efectos secundarios; circunstancia que ha propiciado la investigación en plantas con propiedades antidiabéticas. El objetivo de este estudio fue evaluar el potencial antidiabético de los extractos obtenidos por maceración de las siguientes partes de la planta: del cladodio y semilla de Cylindropuntia imbricata (Cactaceae), del cladodio y semilla de Opuntia engelmannii (Cactaceae), de la raíz de Ibervillea sonorae (Cucurbitaceae) y de la semilla de Theobroma cacao (Malvaceae) mezcladas con solventes de diferente polaridad (hexano, acetato de etilo, diclorometano y metanol). Se obtuvieron un total de 24 extractos sometidos a los análisis: 1) de cribado fitoquímico para determinar su composición, 2) de toxicidad en células B16F10 mediante la prueba de azul alamar, 3) de capacidad antioxidante a través de la inhibición de DPPH, y 4) de evaluación in vitro para conocer su capacidad antihiperglucémica (inhibición de la alfa glucosidasa). Los resultados obtenidos, de los extractos metanólicos con las semillas de O. engelmannii y T. cacao, así como los de acetato de etilo con las semillas de T. cacao y C. imbricata mostraron una actividad antioxidante y antihiperglucémica. Sin toxicidad en las células B16F10, y con potencial antidiabético in vitro.
Aprendizajes sobre la vulneración a la infancia durante la pandemia COVID-19: enfermedad, evidencia y políticas públicas
(Sociedad Chilena de Pediatría, 2024-11-01) Díaz, Franco
La pandemia de COVID-19 ha tenido repercusiones significativas en niños, niñas y adolescentes (NNA), tanto por los efectos directos del virus como por las medidas de salud pública aplicadas. Presentamos un análisis de los aciertos y errores en la respuesta gerontocéntrica a la pandemia, que invisibilizó a los NNA del panorama global, de su salud y ciclo vital. Contraponiéndose con la discreta incidencia de COVID-19 pediátrico, múltiples guías se desarrollaron precipitadamente para terapia, afectando el enfrentamiento de otras enfermedades, por ejemplo, el soporte respiratorio no-invasivo y terapia inhalada. Las medidas de confinamiento y cierre de colegios tuvieron un impacto mínimo en la propagación del virus, desmitificando el rol de supercontagiantes, pero su mantención prolongada se basó en decisiones no respaldadas por evidencia, resultando en una importante pérdida educativa y trastornos psicosociales. La crisis de salud mental en NNA se ha agudizado, con un aumento rápido de depresión y trastornos alimentarios, especialmente en grupos socioeconómicamente vulnerables. Otros ámbitos de salud fueron alterados, como la interrupción de servicios sanitarios preventivos, chequeos rutinarios y vacunaciones, diagnósticos de enfermedades como cáncer y terapias de rehabi-litación. Además, se analiza críticamente la narrativa de los mandatos de uso de mascarillas y vacunas en NNA. En conclusión, reflexionamos sobre los aciertos y errores durante la pandemia en puntos críticos de la salud de NNA, con el fin de aprender y optimizar nuestra respuesta a situaciones futuras. Es imperativo adoptar medidas urgentes para identificar y mejorar en estas áreas, cuyos catastróficos efectos recién comenzamos a entender en NNA, y futuros adultos.
Asociación del nivel socioeconómico y educacional en los egresos por cáncer de mama en Chile durante los años 2001 al 2016
(Asociación Nacional Científica de Estudiantes de Medicina de Chile (ANACEM), 2021) Morales Rojas, Catalina Javiera
Introducción El cáncer de mama constituye la primera causa de muerte en los cánceres en Chile según Globocan 2018. Dentro de los factores que explican esta alta mortalidad encontramos una baja tasa de detección y de realización de mamografías en los niveles socioeconómicos altos. Es por esto que comprender las causas de defunción y los factores que afectan en la mortalidad y letalidad por cáncer de mama en los últimos 17 años nos permitirá enfocar las políticas públicas de los próximos 50 años. Los objetivos generales de este trabajo fueron caracterizar los egresos hospitalarios en los pacientes por cáncer de mama según la edad, el sexo, la previsión, el nivel socioeconómico y educacional en Chile durante los años 2001 al 2016 y calcular la mortalidad y letalidad específica en estas mismas variables durante los años 2001 a 2016. El objetivo específico es asociar las variables socioeconómicas y educacionales, estimando los Odd’s ratios de las variables en los egresos hospitalarios por cáncer de mama en Chile durante los años 2001 al 2016. Materiales y Métodos: Estudio de cohorte longitudinal retrospectivo en 81,072 egresos hospitalarios y 20,220 defunciones obtenidas de la página DEIS MINSAL, años 2001 - 2016. Para el análisis univariado se efectuó una regresión de ajuste de tasas Praisweinstein según edad y sexo según modelo OMS de ajuste de tasas. Para las variables de tipo discreta se describieron mediante porcentajes y tasas y para las variables de tipo continua se utilizó mediana y desviación estándar. Se efectuó un test de smirnovkolmolgorov para determinar el tipo de distribución y de normalidad de las muestras. Para las variables de tipo dicotómica se utilizó un modelo de regresión logística binaria para describir estas variables y determinar la posible asociación entre el nivel socioeconómico y educacional de las pacientes diagnosticadas por cáncer de mama. Resultados: Murieron 1,88 veces más personas de nivel socioeconómico alto con un IC entre 1,83- 1,94 con respecto a la población de nivel socioeconómico bajo. En cambio, las personas con un mayor nivel educacional murieron 0,5 veces menos según la regresión realizada respecto al bajo nivel educacional con un IC entre 0,47- 0,52, pero a menor nivel educacional aumentó 20 veces la mortalidad, constituyendo una causa inversa. Respecto al sexo las mujeres murieron 2,08 veces más que los hombres. Para el nivel socioeconómico alto en relación al bajo un OR [1.88 (1.83 a 1,94)], p<0,0001], para el nivel educacional alto en relación al bajo fue a favor del mayor nivel educacional con OR [0,5 (0,47 - 0,52)] y en cuanto a la comparación de sexos un OR [1,04 (1,03-2,17), p=0,039]. Es decir, la diferencia entre mortalidad que hubo fue significativa para todos los intervalos tanto para sexo, nivel educacional como para nivel socioeconómico. Se encontró una constante de 0,013 de mortalidad basal, es decir, todos tienen 1,3% de riesgo de morir por cáncer de mama independiente del nivel socioeconómico, educacional y del sexo. Conclusión: Existen diferencias estadísticamente significativas respecto a la mortalidad entre los niveles socioeconómicos altos y bajos y también en nivel educacional, sin embargo, al realizar los métodos de regresión se obtuvo una mayor mortalidad y mayor riesgo de morir por cáncer de mama en los niveles socioeconómicos más altos asociados a, probablemente, la menor cantidad de tamizajes y realización de mamografías en este estrato. A partir del año 2008 se observó un incremento a los niveles originales observados al inicio del segundo milenio incrementando las diferencias existentes en los índices de desigualdad tanto por nivel educacional como por nivel socioeconómico incrementando en 20 veces respecto al nivel educacional, y 1.88 respecto al nivel socioeconómico.
Association between posterior tibial slope and graft survival in high-risk anterior cruciate ligament reconstruction with lateral extra-articular tenodesis
(SAGE Publications, 2026) Pineda, Tomás
Background: Posterior tibial slope (PTS) is a well-established anatomic risk factor for anterior cruciate ligament (ACL) graft failure.Lateral extra-articular tenodesis (LET) is increasingly used as an adjunctive procedure in high-risk patients to reduce rerupture rates; however, how its protective effect varies across the continuum of slope values remains insufficiently characterized. Purpose: To determine how PTS modifies the protective effect of LET in high-risk patients and to evaluate the influence of PTS on graft failure across different risk profiles. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective cohort of 585 patients who underwent primary ACL reconstruction (ACLR) with hamstring tendon autografts between 2014 and 2017 was analyzed at a minimum follow-up of 6 years. Patients were nonrandomly allocated according to predefined clinical risk criteria into a low-risk group (isolated ACLR) and a high-risk group (ACLR 1 LET). A graft rerupture was defined clinically and confirmed by imaging. Multivariable logistic regression was used to assess the association between PTS and graft failure. Restricted cubic spline regression was also used to explore nonlinear relationships and identify slope ranges associated with low and high failure probabilities. Results: PTS independently predicted a graft rerupture in both groups, with a stronger effect in the high-risk group (adjusted odds ratio, 1.63; P = .005) compared with the low-risk group (adjusted odds ratio, 1.21; P = .029). The relationship between PTS and graft failure was nonlinear. In the high-risk group, the lowest failure probabilities were observed within a PTS range of 5 to 9, below which the risk of failure plateaued. In contrast, PTS values exceeding 11 to 12 were associated with high failure probabilities in both groups. Conclusion: PTS was independently associated with graft failure in both groups. Although LET was associated with lower failure probabilities within a moderate slope range, increasing PTS values were linked to a progressively higher risk of reruptures in both groups. The association between a steeper slope and failure observed in the ACLR with LET group suggests that an elevated PTS may attenuate the relative protective effect of LET.
Association between types of abdominopelvic cancer in patients with situs inversus total: Systematic review
(Wolters Kluwer Health, Inc., 2024-02-23) Brandenberg, Daniel Milos
Background: Situs inversus is a rare congenital anatomical variant that involves a group of anomalies regarding the arrangement of intrathoracic and intraabdominal organs. Being able to find in the abdominal region the liver, gallbladder, inferior vena cava, and head of the pancreas and ascending colon on the left side of the abdomen, while on the right side there is the spleen, the stomach, the body of the pancreas, the ligament of Treitz, descending colon among others. In this same way, the thoracic organs, lungs and heart, are changed in their position in a mirror translocation. Methods: We systematically searched MEDLINE, Web of Science, Google Scholar, CINAHL, Scopus, and LILACS; the search strategy included a combination of the following terms: "Situs inversus," "Situs inversus totalis," "Cancer," "Neoplasm," "Abdominopelvic regions," and "clinical anatomy." Results: Within the 41 included studies, 46 patients with situs inversus who had cancer, in addition to being found in this organ and in these regions, we also found as a result that the majority of the studies in the research were in stage II; finally, no one study could assert the direct relationship between the situs inversus totalis and the cancer. Conclusion: If our hallmarks could make us think that more exhaustive follow-up of the stomach and other organs should be carried out in these patients, there could also be other predisposing factors for cancer, which is why more studies are suggested to give future diagnostic and treatment guidelines treatment.
Association of Ventilatory Ratio with Acute Cor Pulmonale and Mortality in COVID-19 ARDS: A Cohort Study
(Sage Publications, 2025-09-08) Benites, Martín Hernán
Purpose: An elevated ventilatory ratio (VR) and acute cor pulmonale (ACP) are associated with mortality in ARDS patients. The primary aim of this study was to assess the association between VR and ACP in patients with COVID-19-related ARDS (CARDS). The secondary objectives were to analyze the association between VR and ICU mortality, describe VR temporal behavior in survivors and non-survivors, and evaluate the association between VR and pulmonary embolism. Materials and Methods: We studied a cohort of patients with C-ARDS. The VR was calculated using a validated formula. Echocardiography was used to diagnose ACP, and CT pulmonary angiography was performed to identify PE. To evaluate the associations between VR and ACP, mortality, and PE, a generalized logistic regression model was used. Results: Of the 140 subjects, 60 (43%) had a VR < 2, while 80 (57%) had a VR ≥ 2. Patients with a VR ≥2 had a higher risk of developing ACP than those with a VR <2 (Odds Ratio (OR), 3.77; 95% CI: 1.30 - 8.72). The ICU mortality rate was 29%. Of the 40 patients who died, 30 (75%) had a VR ≥ 2. Mortality was significantly associated with VR ≥ 2 and driving pressure ≥ 15 cm H2O. In non-survivor patients with a VR < 2 at ICU admission, a significant increase in VR was observed over the 7-day observation period. No significant association was observed between PE and VR (p = .118). Conclusion: Elevated VR was associated with ACP in patients with C-ARDS. VR ≥ 2 combined with driving pressure ≥ 15 cm H2O significantly improved the ability to identify patients at risk for ACP. Additionally, at ICU admission, elevated VR values and initially low values that increased over the first week were associated with higher ICU mortality
Atypical presentation of COVID-19: chronic bilateral testicular pain with lower extremity peripheral polyneuropathy, case report
(Elsevier, 2022-01) Salazar, Aníbal
In context of COVID-19 pandemic, there has been different presentations of the infection. The relationship of testicular pain with COVID-19 has not been extensively studied. We present a 31 years old male, with SARS-COV-2 infection, repeatedly consulting for intermittent bilateral testicular pain. Two months later he reported acute loss sensibility and pain in extremities, being diagnosed with axonal fine fiber polyneuropathy. Although the presence of SARS-COV-2 in testis remains controversial, there is a potential orchiepididymitis risk due to viral binding to ACE2 receptor in testicle, and also could induce systemic vasculitis as another possible cause of orchitis.
Balancing lung recruitment and venous congestion in ARDS: rethinking the systemic effects of PEEP
(Springer Nature, 2026-06-22) Benites, Martín Hernán
La presión positiva al final de la espiración (PEEP) mejora la oxigenación y la estabilidad alveolar en el síndrome de distrés respiratorio agudo (SDRA), pero los ensayos clínicos no han logrado traducir este beneficio fisiológico en una mejora consistente de la supervivencia. Los autores proponen que esta discordancia se explica por un efecto sistémico poco caracterizado de la PEEP: la congestión venosa. Según el marco de Guyton, la PEEP altera simultáneamente la resistencia vascular pulmonar y la transmisión de presión pleural, afectando el retorno venoso y elevando la presión venosa central, con repercusiones renales, hepáticas, esplácnicas y cerebrales. El artículo describe tres fenotipos mecánicos pulmonares (baja distensibilidad con pobre reclutabilidad, alta distensibilidad con transmisión pleural preferencial, y buena reclutabilidad alveolar) que determinan respuestas hemodinámicas distintas ante un mismo nivel de PEEP, incluyendo casos donde el reclutamiento alveolar efectivo puede preservar el retorno venoso al descargar el ventrículo derecho. Los autores concluyen que la titulación de PEEP debería replantearse como una decisión sistémica y no puramente respiratoria, integrando signos clínicos de congestión venosa (diuresis, presión venosa central, hallazgos ecográficos tipo VExUS) junto con la oxigenación, hacia un enfoque individualizado guiado por la fisiología pulmonar y circulatoria conjunta.

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Examinando Artículos de Revistas por Materia "07 - Protección y mejora de la salud humana"

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