Colecciones Institucionales

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Colorectal cancer in Chile: process discovery and enhancement using process mining and simulation
(2024) Álvarez Abusleme, Tomás Joaquín; Vera Andreo, Jorge Rafael; Pontificia Universidad Católica de Chile. Escuela de Ingeniería
Colorectal cancer (CRC) is a significant health issue globally, with particular prevalence in Chile. This thesis is structured into two distinct phases: the first aims to discover and analyze the CRC care process within the Southern Metropolitan Public Healthcare System (SMPHS) of Chile, while the second focuses on delivering a feasible improvement strategy for CRC care in this region. The discovery phase utilized Process Mining, an innovative approach enabling quick identification of common pathways and performance indicators within a system. This study utilized real-world data from the SMPHS to swiftly analyze and evaluate the CRC care process. Spanning from 2017 to 2023, the dataset encompassed 2048 and 2524 patient cases. Through collaboration with the Management and Networks Department of the SMPHS, key dynamics and challenges in diagnosis and treatment were uncovered and are detailed in this study. The improvement phase presents a microsimulation model designed to simulate the implementation of a CRC screening strategy. This strategy involves conducting random fecal immunochemical tests for the population aged between 50 and 75. Positive test results lead to a colonoscopy procedure, aimed at promoting early detection of CRC. All demographic and medical data used in the model was obtained from respected sources to ensure the validity of the model. The results suggest that as population adherence rates to the screening program increase, there is a consistent reduction in late-stage cancer cases; however, overall costs also rise.
Consenso sobre riesgo de complicaciones infecciosas en pacientes usuarios de medicamentos biológicos seleccionados. Primera parte
(2019) Cerón Araya, Inés María; Gambra, Pilar; Vizcaya Altamirano, María Cecilia; Ferrés Garrido, Marcela Viviana; Bidart, Teresa; López Quizhpi, Tania Lorena; Acuña, M. Paz; Álvarez, Ana M.; Zubieta, Marcela; Rabello, Marcela; Iruretagoyena Bruce, Mirentxu Inés; Rabagliati Borie, Ricardo Miguel
The use of biological therapies has meant a great improvement in the management of several conditions like autoimmune, neoplastic or others diseases. Although its use has implied significant improvements in the prognosis of these diseases, it is not exempt from complications: infectious diseases as one of them. The objective of this consensus was to evaluate, from an infectious viewpoint, the safeness of the most frequently used biological therapies and give recommendations for the prevention of infections in patients treated with these drugs. These recommendations were based on the highest quality evidence available for the selected biologics. The consensus counts of two manuscripts. This first part details the risks of developing infectious complications depending on the type of biological used for a certain pathology. This evaluation included a broad search in MEDLINE and Epistemonikos of systematic reviews and meta-analyzes of controlled clinical trials and case- control examining post-treatment infections with anti-TNF alpha, anti-CD20, anti-CD52, CTLA4-Ig and anti-integrins. The research was complemented by a review of: multicentre cohorts of biological users, the MMWR of the CDC, Atlanta, U.S.A., and national registers and scientific societies in which infectious complications derived from the use of biological therapies were mentioned.
Effects of hypotensive anesthesia compared to normotensive anesthesia in orthognathic surgeryEfectos de la anestesia hipotensora comparada con la anestesia normotensora en cirugía ortognática
(2024) Dallaserra Albertini, Matías; Vargas Buratovic Juan Pablo; Campolo González, Andrés Francisco; Ríos Espósito, Nicolás; Nazar Jara, Claudio; Valladares Pérez, Salvador Rubén; Ortuño Borroto, Duniel
Introduction: Orthognathic surgery is widely accepted for correcting dentofacial deformities. Due to the rich blood supply in the head and neck region, considerable bleeding can occur from the incised soft tissues and bone during orthognathic surgery. Hypotensive anesthesia is a method used in surgical practice by which blood pressure is decreased predictably and deliberately to reduce blood loss and improve surgical field. However, there is still uncertainty regarding its effectiveness and safety in orthognathic surgery. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis, and generated a summary of findings table using the GRADE approach. Results and Conclusions: We identified three systematic reviews, including 11 studies overall, which are randomized trials. We concluded that hypotensive anesthesia may reduce intraoperative blood loss and may improve the quality of surgical field, however, the certainty of the evidence has been assessed as low. On the other hand, orthognathic surgery with HA may make little or no difference in surgical time (low certainty evidence). Finally, no studies were found that reported adverse effects or mortality.Introducción: La cirugía ortognática se encuentra ampliamente aceptada para la corrección de anomalías dentofaciales. Debido al importante suministro de sangre en la región de cabeza y cuello, puede ocurrir una considerable pérdida de sangre proveniente de los tejidos duros y blandos intervenidos durante una cirugía ortognática. La anestesia hipotensiva es un método utilizado en la práctica quirúrgica mediante el cual se disminuye de manera predecible y deliberada la presión sanguínea con el fin de reducir la pérdida hemática y mejorar el campo quirúrgico. Sin embargo, aún existe incertidumbre respecto a su efectividad y seguridad en cirugía ortognática. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y Conclusiones: Identificamos tres revisiones sistemáticas, que en conjunto incluyeron 11 estudios primarios, todos ensayos aleatorizados. Concluimos que la anestesia hipotensiva podría reducir la pérdida de sangre intraoperatoria y mejorar la calidad del campo quirúrgico, pero la certeza de la evidencia es baja. Por otro lado, el uso de anestesia hipotensiva podria podría resultar en poca o nula diferencia en el tiempo quirúrgico (certeza de la evidencia baja). Finalmente, no se encontraron estudios que reportaran efectos adversos o mortalidad.
Prevalencia del Consumo de Alcohol en Adolescentes en Tres Momentos de la Pandemia y su Relación con el Malestar Emocional
(2024) Heras, Arretz Santiago de las; Repetto Lisboa, Paula Beatriz; Verges Gómez, Alvaro Javier; Pontificia Universidad Católica de Chile. Escuela de Psicología
El consumo de alcohol en adolescentes chilenos es un importante problema de salud. Aunque el consumo de alcohol ha disminuido en los últimos años, sigue siendo una preocupación en el contexto nacional. Por esa razón, se han implementado medidas de salud pública que buscan restringir el acceso al alcohol las que han sido efectivas. Dada la relevancia que tiene limitar el acceso, es probable que este se haya visto afectado durante la pandemia de COVID-19, las cuarentenas y otras restricciones de movilidad. Sin embargo, estudios previos realizados durante este período reportaron cambios inconsistentes en los patrones de consumo. Pero dado que la mayoría de estos estudios fueron realizados con adultos, no está claro qué ocurrió con el consumo en adolescentes. Esto es particularmente relevante dado el aumento de la molestia psicológica, reportada durante la pandemia, que corresponde a un reconocido factor de riesgo para el consumo de alcohol en esta población. En consecuencia, este estudio evaluó el consumo de alcohol de adolescentes en el contexto pandémico, en tres momentos con restricciones diferentes, y la influencia de la molestia psicológica en este. Se utilizó una submuestra de 914 adolescentes del Estudio Chileno de Crecimiento y Obesidad (ECO), quienes fueron evaluados en tres momentos de la pandemia, con y sin confinamiento. Los resultados indican variaciones en el consumo y su asociación con síntomas de ansiedad, en todas las mediciones y con síntomas depresivos en las dos últimas mediciones. Las restricciones sanitarias se asociaron con una disminución en el consumo. Además, se detectó un aumento en el consumo durante periodos con menores restricciones, como las vacaciones, cuando los adolescentes pudieron socializar más, facilitando así el acceso al alcohol.
Rol de la microbiota intestinal en el desarrollo del hígado graso no alcohólico
(Sociedad Médica de Santiago, 2021) Tumani Karmy, María Fernanda; Tapia, Gladys; Aguirre, Carolina; Obregón, Ana María; Pettinelli, Paulina
Non-alcoholic fatty liver disease (NAFLD) encompasses a wide spectrum of hepatic pathologies ranging from simple steatosis (SS) to hepatocellular carcinoma. Intestinal microbiota (IM) is composed of trillions of microorganisms existing in the gut. It has 150 times more genes than the host. Changes in the composition and function of the IM are associated with different diseases, including NAFLD. In this condition, IM could have a pathogenic role through different mechanisms such as energy salvaging from food, an inflammatory stimulus, a modulation of the innate immune system, regulation of bile acid turnover, alteration of choline metabolism and increasing endogenous ethanol levels. This review is an update on the role of the intestinal microbiota in NAFLD and the possible mechanisms involved.
Simulating A Subcondylar Mandibular Fracture With Intraoral Open Reduction and Internal Fixation: A Novel Education Tool for Residents
(Sage Publications INC, 2022) Rojas, Francisco; Tapia, Sebastián; Campolo González, Andrés Francisco; Vargas Díaz, Alex Patricio; Ramírez Skinner, Hernan Eduardo; Benítez, Benito K.; Teuber Lobos, Cristian Andrés
Study Design Face and content validation of a surgical simulation model. Objective Open reduction and internal fixation in displaced subcondylar mandibular fractures is standard care. This requires an extraoral (eg: retromandibular, transparotideal) or intraoral approach. An intraoral approach requires further training since specialized instrumentation such as the 90° screwdriver system and endoscopes might be needed. Currently, no simulation models are available for training residents in intraoral reduction and fixation of subcondylar mandibular fractures. Therefore, we present a validated simulation model for intraoral treatment of subcondylar mandibular fractures. Methods Based on a computer tomography data set, we designed and printed a 3D model of a mandible with a unilateral subcondylar fracture. To simulate intraoral work depth, it was positioned inside a dental phantom. We tested the model by a group of experts (n = 8), simulating intraoral reduction and fixation of a unilateral subcondylar fracture, using a 90° screwdriver system, a 1.0 subcondylar plate (lambda), and 5-6 mm screws. We assessed Face and Content validity by survey. Results We provided an open-source printable fracture model. Printing costs were approximately US $10. Experts “Agreed” the model resembling the real scenario and its use for training intraoral reduction and fixation of subcondylar mandibular fractures.
Sphingolipid profiling as a biomarker of type 2 diabetes risk: evidence from the MIDUS and PREDIMED studies
(Springer Nature, 2024) Berkowitz Fiebich Loni; Razquin, Cristina; Salazar Vilches, Cristian Javier; Biancardi Roman, Fiorella Carinna; Estruch, Ramón; Ros, Emilio; Fitó, Montserrat; Corella, Dolores; Coe, Christopher L.; Ryff, Carol D.; Ruiz-Canela, Miguel; Salas-Salvado, Jordi; Wang, Daniel; Hu, Frank B.; Deik, Amy; Martínez-González, Miguel A.; Rigotti Rivera, Attilio Gianpietro
Background Type 2 diabetes (T2D) has become a worldwide pandemic. While ceramides may serve as intermediary between obesity-related lipotoxicity and T2D, the relationship with simple glycosphingolipids remains uncertain. The aim of this study was to characterize the associations between blood glycosphingolipid and ceramide species with T2D and to identify a circulating sphingolipid profile that could serve as novel biomarker for T2D risk. Methods Cross-sectional relationship between sphingolipid levels, insulin resistance, and T2D prevalence were evaluated in 2,072 American adults from MIDUS cohort. Prospectively, the association between sphingolipid species and the incidence of T2D was analyzed using a case-cohort design nested within the PREDIMED trial (250 cases and a random sample of 692 participants, with 3.8 years of median follow-up). Circulating levels of sphingolipid species in both populations were measured using LC/MS. Hazard ratios were estimated with weighted Cox regression models using Barlow weights. Results In American adults, only CER18:0 and CER22:0 were linked to insulin resistance and a higher prevalence of T2D. Conversely, three lactosylceramides (LCER 14:0, 16:0, and 24:1) showed a strong inverse relationship with both insulin resistance and T2D. These findings led to development of two sphingolipid scores. In the prospective analysis, these scores consistently predicted a reduced risk of T2D incidence in PREDIMED (HR: 0.64, 95% CI 0.44 to 0.94 and 0.58, 0.40 to 0.85 respectively) between extreme quartiles, with 5-year absolute risk differences of 9.6% (95% CI: 0.3–20.5%) and 11.4% (1.0–21.6%). They were validated in the same trial with samples obtained after 1 year of follow-up. Conclusions Our findings support the potential usefulness of circulating sphingolipid profiles as novel biomarkers for T2D risk. Moreover, this study opens the door for future research on the predictive value and possible protective roles of lactosylceramides in T2D. Graphical abstract
Surgical treatment of paediatric fractures of the mandibular condyle: a systematic review of the literature
(Churchill Livingstone, 2024) Ríos Espósito, Nicolas Felipe; Neira Cisternas, Isidora Valesca; Campolo González, Andrés Francisco
This study aims to review surgical treatment in paediatric condylar fractures and describe different types of techniques performed, along with the results obtained from them. A retrospective review was conducted from records of paediatric patients (from one to 17 years old) who sustained fractures of the mandibular condyle and underwent surgical treatment from 2003 to 2023. The number of patients, age, location, and type of fracture, clinical and imaging examinations, treatment methods, intraoperative/postoperative complications, removal of osteosynthesis material, follow up and outcomes were recorded and analysed. A total of 68 patients with 79 fractures were identified. The most common fracture pattern was condylar neck fracture (61.1%). Of the 68 patients who underwent surgical treatment, one had a complication of minimal temporal paraesthesia and another patient had near-complete resorption of the condyle. A total of 55 patients (81%) reported normal dental occlusion, mouth opening (>35 mm), lateral excursions (7–8 mm), TMJ function, no pain, no deviation of the midline or the jaw, and no ankylosis. Thirteen patients (19%) developed an unsatisfactory result, nine patients (13%) had a jaw deviation on mouth opening, four patients (6%) had mandibular retrusion, and seven patients (10%) had signs of TMJ dysfunction. A total of 59 patients (87%) reported bone completely healed with no signs of bone abnormality; seven patients (10%) had shortening of the condylar neck and/or ramus. Surgical treatment can lead to good or excellent results for severely dislocated and displaced condylar fractures in children and can reduce the unsatisfactory results resulting from closed treatment.
Use of autologous platelet derivatives for secondary alveoloplasty in patients with cleft lip and palate: a systematic review and meta-analysis
(Churchill Livingstone, 2024) Campolo González, Andrés Francisco; Heider Contreras, Claudia Andrea; Verdugo Paiva, M. F.; Bravo Jeria, R.; Morovic, C. G.; Rada, G.
This study aimed to evaluate the effectiveness of autologous platelet derivatives (APD), specifically platelet-rich plasma (PRP) or platelet-rich fibrin (PRF), combined with autogenous iliac crest bone grafts in secondary alveoloplasty for patients with cleft lip and palate. Electronic databases, relevant journals, and reference lists of included studies were searched until July 2022. Best-evidence synthesis was performed to draw conclusions. After the search strategies, 12 randomized controlled trials were included that provided data on six outcomes: newly formed bone, mean bone loss in height and width, bone density, functionality, and postoperative complications. Two authors independently assessed the risk of bias, and the certainty of evidence was assessed using the GRADE approach. The pooled results suggest that there is uncertainty as to whether the combination of APDs with autogenous iliac crest bone grafts improves the percentage of newly formed bone, as the certainty of the evidence was assessed as very low. It may slightly improve the functionality of patients (with low certainty of the evidence) and probably slightly reduces the incidence of postoperative complications (with moderate certainty of evidence). Further randomized clinical trials with standardized methodologies are required to validate these findings.

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