Ricardo Cartes-Velásquez

Introducción: El adenocarcinoma de intestino delgado (AID) es una neoplasia infrecuente, cuya presentación clínica inespecífica dificulta el diagnóstico precoz.Caso clínico: Presentamos el caso de una mujer de 60 años con dolor abdominal, vómitos y pérdida de peso, en quien el estudio imagenológico reveló un cuerpo extraño en la tercera porción del duodeno. La endoscopía digestiva alta mostró una semilla de fruta impactada, la cual fue extraída exitosamente, y permitió identificar un tumor estenosante en yeyuno proximal. Se realizó resección quirúrgica del segmento comprometido con anastomosis duodeno-yeyunal. El estudio histopatológico confirmó un adenocarcinoma moderadamente diferenciado tipo Borrmann III, con invasión serosa y compromiso ganglionar (pT4 N2 Mx).Discusión: Este caso destaca una forma de presentación atípica del AID con morfología anular estenosante y la detección incidental de un cuerpo extraño, combinación escasamente descrita en la literatura. Se discuten las implicancias diagnósticas y terapéuticas de este hallazgo, enfatizando la importancia de considerar esta entidad en el diagnóstico diferencial de obstrucción intestinal de causa no clara.

Objective: To determine the attitudes towards blind and deaf persons and experience-related factors in a sample of Chilean dental students. Material and Methods: This cross-sectional study involved dental students from one Chilean university. Data were collected through a survey, including sex, course, acquaintance with disabilities, training on disability, and healthcare delivery to people with disabilities (PwD), and attitudes were measured using the Chilean validated Multidimensional Attitudes Scale (MAS). Data analysis involved descriptive statistics, internal consistency, and comparative analyses. Results: 311 dental students completed the survey. The Cronbach's alpha coefficients indicated good internal consistency (>0.7) for the MAS scales and their dimensions. Attitudes towards deaf and blind individuals were generally positive (3.5 points) across most groups. Students with cognitive disability connections scored higher (>0.5 points) than those with sensory disabilities. Conclusion: Chilean dental students' attitudes towards blind and deaf individuals showed an overall positive inclination, except in the calm dimension.

Background: A systematic exercise programme using low-cost virtual reality devices can help maintain and improve postural control in older adults. This study aimed to evaluate the effectiveness of two different exergame programme modalities: telerehabilitation (TR) and face-to-face (FF). Methods: A randomised controlled trial was conducted with 16 participants aged 65 to 75. Both groups completed an 18-session exergame intervention over six weeks, with the TR group (exposure) receiving remote sessions and the FF group having in-person (control) sessions with a physiotherapist. Assessments were carried out at baseline, at weeks 2, 4, and 6, with two follow-ups at weeks 8 and 10. Centre of Pressure (CoP) measures in tasks: eyes open (EO), eyes closed (EC), medial-lateral (ML) weight-shifting exergame and anterior–posterior (AP) weight-shifting exergame, and clinical tests were used to evaluate postural control. Results: TR and FF significantly reduced the CoP_Sway-area during EC (TR: p < 0.01; FF: p = 0.01) at 6 weeks and only FF demonstrated a significant reduction during EO (p < 0.01). Post hoc analysis revealed that TR maintained a significant reduction in the secondary outcomes of the CoP at 8 and 10 weeks, while FF did not sustain these effects over time. Between-group comparisons revealed a greater effect of TR in CoP_Sway-area, and secondary outcomes during the AP weight-shifting task (p < 0.01) at 6 weeks, whereas the FF had a greater effect in secondary CoP outcomes during the ML weight-shifting task (p < 0.01) at 6 weeks. Conclusion: Both six-week exergame programmes were equally effective at improving postural control. Given the observed specific effects of TR and FF delivery, physiotherapists can consider either modality to suit individual needs and access, or as a complementary approach to maintain and improve postural control in older adults.

Multimorbidity has emerged as a pressing public health concern on a global scale, primarily driven by population aging and the epidemiological transition, which has resulted in an increased prevalence of chronic non-communicable diseases. Objective: The objective of the study was to investigate the functioning profile of individuals with multimorbidity in Chile, focusing on capacity and performance, and to explore the association between multimorbidity and compromised functioning. Methods: Data from the II ENDISC, a cross-sectional population study conducted in Chile in 2015, were analyzed. The sample comprised 12,265 randomly selected individuals aged 17 and above, who were interviewed using the Model Disability Survey. Generalized linear models (GLMs) were employed to assess the impact of multimorbidity on capacity and performance. Results: The results revealed that individuals with multimorbidity presented worse capacity scores (38.31 vs. 19.72) and performance scores (44.51 vs. 27.28) compared to those without multimorbidity. Furthermore, adjusted risk through GLM shows that individuals with multimorbidity had a higher risk of experiencing worse capacity (1.39) and performance (1.29) scores. Gender, self-rated health, age, employment status, and education level were identified as factors associated with varying degrees of impact on functioning. Conclusions: These findings underscore the importance of addressing multimorbidity and its associated factors in healthcare planning and intervention strategies, particularly for socioeconomically vulnerable populations, to enhance well-being and functioning among individuals with multimorbidity.

Introduction and Hypothesis Urinary incontinence (UI) affects various aspects of women’s lives, limiting activity and social participation. Despite its impact, data from Latin American populations remain scarce. This study aimed to examine the prevalence of UI among Chilean women and its association with capacity and performance, as well as related factors. Methods This is a secondary analysis of the 2022 III Estudio Nacional de la Discapacidad en Chile (III ENDISC), a population-based household survey. The analysis included 17,314 women aged 18 or older. UI was identified via self-report: “Do you experience urinary incontinence?”. Capacity and performance were assessed using the Model Disability Survey (MDS), performance represents the ability to carry out tasks in one’s usual environment, and capacity would be related to the execution of tasks in standardized environments, with scores from 0 to 100 (higher scores = worse functioning). Means and 95% confidence intervals (CI) were calculated, and generalized linear models estimated associations using arithmetic mean ratios (AMRs). Results The overall self-reported UI prevalence was 3.4% (95% CI 3.13–3.81; n = 621), considering 16 regions of Chile, ranging from 0.8% to 52.7%, the highest being in the metropolitan region of Santiago. Higher UI rates were observed in women over 65, with lower education, worse self-perceived health, and those not working. Unadjusted models showed women with UI had a 62% higher risk for reduced capacity and 114% higher for reduced performance. However, after adjustment for age, health perception, and comorbidities, UI was no longer statistically significant. Conclusions Although women with UI showed worse functioning, this health condition was not an independent predictor after multivariable adjustment, the disability being influenced by other factors such as age and health conditions. These findings underscore the importance of addressing UI and its associated comorbidities in public health strategies.

Background: Chronic pain is a prevalent condition that disproportionately affects women, significantly impairing their functioning. Understanding its prevalence and impact is essential for designing effective interventions. This study aimed to determine the prevalence of chronic pain among women and assess its effects on functioning.Methods: This cross‐sectional analysis utilised data from the National Study on Disability (ENDISC‐2022) in Chile, focusing on women aged 18 years and older. Chronic pain was assessed through self‐reported data, and functioning was evaluated using performance indicators derived from the Model Disability Survey (MDS). Generalised Linear Models (GLM) were applied to examine associations with sociodemographic and psychosocial variables, and stratified analyses compared women with and without chronic pain.Results: Among the 30,010 participants in the ENDISC study, 14.8% reported chronic pain, with 67.1% of those affected being women. Women experiencing chronic pain exhibited significantly poorer performance scores across all evaluated domains compared to their counterparts without pain. The GLM regression analysis revealed that women with chronic pain had a significantly higher risk of worse functioning scores compared to those without chronic pain.Conclusions: Sociodemographic factors such as age, education level, and employment status further influenced outcomes, underscoring the vulnerability of women with chronic pain. Chronic pain is a significant and pervasive issue among women in Chile, markedly impairing their functioning and well‐being. Gender‐sensitive approaches and policies are crucial to reducing the burden of chronic pain and improving the quality of life for affected women, particularly those in vulnerable sociodemographic groups.Significance: The findings highlight the need for targeted interventions that address the multifaceted nature of chronic pain, including its physical, psychological, and social dimensions in women with pain and a more sensitive look at the difficulties encountered by this population, such as work issues.

Background/Objectives: Population health problems are among the world’s main concerns. However, mortality and morbidity alone do not fully encompass the health experience of populations. International efforts are underway to verify health experiences using functioning as the third health indicator. The aim of the study was to compare the functioning profile of the Chilean population with mortality and morbidity rates due to neurological, circulatory, respiratory, and musculoskeletal diseases at the regional level. Methods: An ecological study was conducted with the secondary dataset II Estudio Nacional de la Discapacidad (ENDISC) and mortality and hospitalization rates from the Departamento de Estadísticas e Información en Salud. The II-ENDISC was a national household survey, based on the Model Disability Survey, carried out in 2015. Results: The correlation of functioning with morbidity and mortality rates was determined by Spearman’s correlation. The correlation values of the mortality and morbidity coefficients with the performance and disability data were not relevant and significant (p < 0.35; p > 0.05). This suggests a lack of a linear relationship between these indicators at the regional level. Conclusions: The analysis of the Chilean population revealed that performance values, as an expression of functioning, do not correlate with morbidity or mortality rates. This discrepancy underscores the limitations of relying solely on traditional health indicators to capture the complexity of population health. Our findings support the conceptual value of functioning as a complementary and distinct health indicator, rather than a proxy for morbidity or mortality.

Vancomycin, a cornerstone antibiotic against severe Gram-positive infections, is increasingly challenged by resistance in Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin Enterococcus spp. (VRE), necessitating the development of novel therapeutic strategies. This review examines how structural modifications to vancomycin can enhance its antibacterial activity and explores the critical role of computational approaches in designing the next generation of analogs. By analyzing the existing literature, we highlight how strategic alterations, such as the introduction of lipophilic side chains, substitutions on the sugar moieties, and modifications to the aglycone core, have yielded derivatives with improved antibacterial potency. Notably, certain analogs (e.g., Vanc-83, Dipi-Van-Zn) have demonstrated expanded activity against Gram-negative bacteria and exhibited enhanced pharmacokinetic profiles, including prolonged half-lives and improved tissue penetration, crucial for effective treatment. Semisynthetic glycopeptides like telavancin, dalbavancin, and oritavancin exemplify successful translation of structural modifications, offering sustained plasma concentrations and simplified dosing regimens that improve patient compliance. Complementing these experimental efforts, computational methods, including molecular docking and molecular dynamics simulations, provide valuable insights into drug–target interactions, guiding the rational design of more effective analogs. Furthermore, physiologically based pharmacokinetic modeling aids in predicting the in vivo behavior and optimizing the pharmacokinetic properties of these novel compounds. This review highlights a critical path forward in the fight against multidrug-resistant infections. By meticulously examining the previously carried out structural refinement of vancomycin, guided by computational predictions and validated through rigorous experimental testing, we underscore its immense potential.

Sr. Editor: La evidencia sobre el flujo de pacientes y los tiempos de ciclos en los entornos hospitalarios es compleja, abarcando diversas estrategias e intervenciones destinadas a mejorar la eficiencia y reducir retrasos que impacten principalmente en la saturación de las unidades de emergencia (UE). Una revisión sistemática mostró que las intervenciones más efectivas fueron aquellas que abordaron el sistema completo: mejorar el acceso a camas, reorganizar flujos internos y acelerar decisiones clínicas, logrando reducciones significativas en tiempos de espera, estancia y tasas de abandono de las UE [1]. Algunas de las barreras claves para optimizar el flujo de pacientes son la demora en iniciar el proceso de alta y las demoras en la salida efectiva del paciente, las cuales se han asociado principalmente a una planificación operativa deficiente, falta de estandarización en los procedimientos y escasez de personal clínico. Estas demoras se ven agravadas por una coordinación interdepartamental limitada y por decisiones clínicas inconsistentes derivadas de la ausencia de criterios compartidos y protocolos unificados [2]. El tiempo de ciclado del paciente hospitalizado es un indicador propuesto en la literatura para abordar este aspecto específico [3] Otros factores a considerar tienen relación con abordar los flujos de la demanda programada. Las tablas quirúrgicas de cirugías electivas pueden adecuarse para suavizar los picos de intensidad, habitualmente concentrados en días lunes y martes, y con eso, impactar favorablemente los cuellos de botella previsibles, lo cual permite incluso aumentar la oferta quirúrgica y mantener oportunidad de acceso en escenarios de alta demanda mundial, como lo fue la pandemia por COVID-19 [4]. Asimismo, la interacción entre demanda desde urgencia y demanda programada afecta también, tanto el acceso a camas críticas como la demora en la habilitación de estas cuando el paciente ya está en condiciones de egresar [5]. En Chile, la Subsecretaría de Redes Asistenciales ha promovido la eficiencia del flujo mediante un modelo de acciones que involucra a todos los actores organizacionales relacionados a las camas hospitalarias [6]. Asimismo, está en desarrollo una compra pública de innovación destinada a construir soluciones que permitan acelerar el tiempo de ciclado del paciente hospitalizado [7]. Con todo, los focos futuros debiesen estar puestos en la implementación generalizada de estas prácticas y el abordaje de la demanda programada de camas de hospitalización. Los sistemas de salud actuales, altamente demandados y con interacciones complejas entre sus constituyentes, requieren que tengamos una mirada sistémica de transformación, cuyo centro prioritario al día de hoy deben ser los flujos de atención, de tal manera que podamos ofrecer oportunidades de acceso a todas las personas que lo requieran.