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Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital
No full textObjective: To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications.
Methods: A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022.
Results: Advanced or basic trial phases were performed on 35 patients, 33 (94%) of which were successful and opted to move on Implantable Pulse Generator (GG) implantation. The average follow-up time after definitive implantation was 82 months (SD 59). Of the 33 patients undergoing, 27 (81%)reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%) with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I.
Conclusion: SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it.Versión Aceptad
Ceftazidime/avibactam resistance is associated with PER-3-producing ST309 lineage in Chilean clinical isolates of non-carbapenemase producing Pseudomonas aeruginosa
No full textIntroduction: Ceftazidime/avibactam (CZA) is indicated against multidrug-resistant Pseudomonas aeruginosa, particularly those that are carbapenem resistant. CZA resistance in P. aeruginosa producing PER, a class A extended-spectrum β-lactamase, has been well documented in vitro. However, data regarding clinical isolates are scarce. Our aim was to analyze the contribution of PER to CZA resistance in non-carbapenemase-producing P. aeruginosa clinical isolates that were ceftazidime and/or carbapenem non-susceptible.
Methods: Antimicrobial susceptibility was determined through agar dilution and broth microdilution, while bla PER gene was screened through PCR. All PER-positive isolates and five PER-negative isolates were analyzed through Whole Genome Sequencing. The mutational resistome associated to CZA resistance was determined through sequence analysis of genes coding for PBPs 1b, 3 and 4, MexAB-OprM regulators MexZ, MexR, NalC and NalD, AmpC regulators AmpD and AmpR, and OprD porin. Loss of bla PER-3 gene was induced in a PER-positive isolate by successive passages at 43°C without antibiotics.
Results: Twenty-six of 287 isolates studied (9.1%) were CZA-resistant. Thirteen of 26 CZA-resistant isolates (50%) carried bla PER. One isolate carried bla PER but was CZA-susceptible. PER-producing isolates had significantly higher MICs for CZA, amikacin, gentamicin, ceftazidime, meropenem and ciprofloxacin than non-PER-producing isolates. All PER-producing isolates were ST309 and their bla PER-3 gene was associated to ISCR1, an insertion sequence known to mobilize adjacent DNA. PER-negative isolates were classified as ST41, ST235 (two isolates), ST395 and ST253. PER-negative isolates carried genes for narrow-spectrum β-lactamases and the mutational resistome showed that all isolates had one major alteration in at least one of the genes analyzed. Loss of bla PER-3 gene restored susceptibility to CZA, ceftolozane/tazobactam and other β-lactamsin the in vitro evolved isolate.
Discussion: PER-3-producing ST309 P. aeruginosa is a successful multidrug-resistant clone with blaPER-3 gene implicated in resistance to CZA and other β-lactams.Versión Publicad
Caracterización del perfil epidemiológico, patológico, radiológico y de manejo de los pacientes con tumores estromales del tubo digestivo. Experiencia chilena de cinco años
No full textIntroducción y objetivos
Los tumores del estroma gastrointestinal (GIST) son las neoplasias mesenquimáticas más frecuentes del tubo digestivo y su expresión y manejo dependen de su agresividad. Nuestro objetivo es caracterizar los GIST diagnosticados en nuestro centro, a partir de variables epidemiológicas, anatomopatológicas, imagenológicas y de manejo.
Material y métodos
Estudio observacional de cohorte retrospectiva en pacientes adultos con diagnóstico de GIST mediante imágenes y biopsia entre los años 2017 y 2022 en nuestro centro, caracterizando datos epidemiológicos, imagenológicos, de anatomía patológica y terapéuticos.
Resultados
Se incluyeron 33 pacientes, promedio de edad 59 años. La mayoría fue un hallazgo incidental (54.5%) y de los sintomáticos, lo más frecuente fue hemorragia digestiva (24%). La ubicación más frecuente fue el estómago (19/33 casos) y su forma de presentación exofítica fue la más habitual (48.5%). Imagenológicamente, su impregnación fue mayormente heterogénea y progresiva y 54% presentaron alguna característica intrínseca, siendo la necrosis/áreas quísticas lo más frecuente, sin casos de invasión local ni diseminación a distancia. Histológicamente la variante fusada fue la más frecuente (78.8%) y la mayoría presentaron menos de cinco mitosis por campo mayor. En nuestro recinto, 30 casos fueron tratados, siendo la cirugía la forma de resolución más frecuente (29/30). No se registraron muertos a causa de GIST en nuestra serie.
Conclusiones
Nuestra serie tiene características epidemiológicas e imagenológicas similares a la literatura, diferenciándose por un diagnóstico precoz y baja agresividad de los casos.
Introduction and aims
Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal neoplastic tumors of the gastrointestinal tract and their expression and management is dependent on their aggressivity. Our aim was to characterize the GISTs diagnosed at our center, analyzing the epidemiologic, anatomopathologic, imaging study, and management variables.
Material and methods
A retrospective, observational cohort study was conducted on adult patients diagnosed with GIST through imaging studies and biopsy, within the time frame of 2017 and 2022 at our center, characterizing the epidemiologic, imaging study, anatomopathologic, and therapeutic data.
Results
Thirty-three patients with a mean age of 59 years were included. The majority of cases were incidental findings (54.5%), and of the symptomatic cases, the most frequent presentation was gastrointestinal bleeding (24%). The most common location was the stomach (19/33 cases), and the most frequent presentation was exophytic (48.5%). In the imaging studies, impregnation was mainly heterogeneous and progressive and 54% had an intrinsic characteristic, with necrosis/cystic areas the most frequent feature. There were no cases of local invasion or distant metastasis. Histologically, the spindle cell type was the most frequent (78.8%) and the majority had fewer than 5 mitoses per high power field. Thirty cases were treated at our center and surgery was the most frequent form of resolution (29/30). No deaths caused by GIST were registered in our case series.
Conclusions
The epidemiologic and imaging study characteristics in our case series were similar to those reported in the literature, but our results were different, with respect to early diagnosis and the low aggressivity of the cases.Versión Publicad
SARS-CoV-2 infectivity and antigenic evasion: spotlight on isolated Omicron sub-lineages
No full textSince the SARS-CoV-2 outbreak in 2019, a diversity of viral genomic variants has emerged and spread globally due to increased transmissibility, pathogenicity, and immune evasion. By the first trimester of 2023 in Chile, as in most countries, BQ and XBB were the predominant circulating sub-lineages of Omicron. The molecular and antigenic characteristics of these variants have been mainly determined using non-authentic spike pseudoviruses, which is often described as a limitation. Additionally, few comparative studies using isolates from recent Omicron sub-lineages have been conducted. In this study, we isolated SARS-CoV-2 variants from clinical samples, including the ancestral B.1.1, Delta, Omicron BA.1, and sub-lineages of BA.2 and BA.5. We assessed their infectivity through cell culture infections and their antibody evasion using neutralization assays. We observed variations in viral plaque size, cell morphology, and cytotoxicity upon infection in Vero E6-TMPRSS2 cells for each variant compared to the ancestral B.1.1 virus. BA.2-derived sub-variants, such as XBB.1.5, showed attenuated viral replication, while BA.5-derived variants, such as BQ.1.1, exhibited replication rates similar to the ancestral SARS-CoV-2 virus. Similar trends were observed in intestinal Caco-2 cells, except for Delta. Antibody neutralization experiments using sera from individuals infected during the first COVID-19 wave (FWI) showed a consistent but moderate reduction in neutralization against Omicron sub-lineages. Interestingly, despite being less prevalent, BQ.1.1 showed a 6.1-fold greater escape from neutralization than XBB.1.5. Neutralization patterns were similar when tested against sera from individuals vaccinated with 3xBNT162b2 (PPP) or Coronavac-Coronavac-BNT162b2 (CCP) schedules. However, CCP sera showed 2.3-fold higher neutralization against XBB.1.5 than FWI and PPP sera. This study provides new insights into the differences between BA.2 and BA.5-derived variants, leading to their eventual outcompetition. Our analysis offers important evidence regarding the balance between infectivity and antigenic escape that drives the evolution of second-generation SARS-CoV-2 variants in the population.Versión Publicad
Genetic and epigenetic landscape of early-onset oral squamous cell carcinoma: Insights of genomic underserved and underrepresented populations
No full textOral squamous cell carcinoma (OSCC) has a poor prognosis and the treatment employed generates significant physical deformity in patients. In recent years, an increase in the incidence of cases of OSCC has been observed in adult patients up to 45 years old in several genetic underrepresented and underserved countries. The increase in OSCC cases in young people is very relevant because it shows that OSCC does not make exceptions and hereditarily must play an important role. This fact has not been associated with an evident biological basis, and a large majority of these patients do not present the classic principal risk factors association. OSCC is the result of accumulation of genetic and epigenetic alterations and this information is still fragmented in the literature, mainly in the young group. Conducting studies with a comprehensive analysis of genetic and epigenetic data is crucial, to provide greater understanding of the underlying biology of OSCC, because this information can be decisive to determine targets for therapeutic treatment. We review the main germline and somatic aspects of genetic and genomic variation in OSCC considering the absence of genomic data from developing countries such as Chile and the rest of Hispano-America.Versión Aceptad
Fortalecer la socialización de los protocolos de convivencia escolar, en la comunidad educativa de un colegio del servicio local de educación pública (SLEP) Andalien Sur, de la comuna de Concepción
Get PDFTrabajo de grado presentado a la Facultad de Psicología de la Universidad del Desarrollo para optar al Grado de Magíster en Psicología EducacionalEl presente proyecto se centra en analizar los retos de fomentar un entorno escolar seguro y saludable en un establecimiento educacional de enseñanza media. Se resalta la importancia del clima escolar y se identifica la falta de validación de los protocolos como un impedimento para el óptimo desarrollo de un entorno educativo más seguro y respetuoso. El proyecto busca implementar una intervención para mejorar la socialización y validación de los protocolos en dicho establecimiento.
Se identificaron obstáculos significativos durante el proceso diagnóstico, tales como la baja asistencia estudiantil a las actividades planificadas y la falta de conocimiento sobre los protocolos de convivencia escolar.
La intervención fue diseñada a partir de los hallazgos del proceso diagnóstico, enfocándose en actividades de sensibilización, difusión y participación activa de los diversos miembros de la comunidad educativa. A pesar de enfrentar dificultades como la planificación de fechas y la baja participación estudiantil y de apoderados, se observaron resultados favorables. Se registró un aumento significativo en la validación de los protocolos de convivencia escolar por parte de estudiantes, funcionarios y apoderados.
Este incremento se debe a una mayor comprensión de los protocolos y a una mayor participación activa en su ejecución.
Este proyecto evidencia el efecto beneficioso de la intervención en la percepción y validación de los protocolos de convivencia escolar. Pese a las dificultades de la implementación, se lograron avances significativos en la promoción de un entorno educativo más seguro, respetuoso, y la relevancia de abordar de manera activa el clima escolar y fomentar una cultura de colaboración y participación en la comunidad educativa.
Finalmente, se espera reforzar la intervención y ampliar su alcance, involucrando a más actores de la comunidad educativa y desarrollando estrategias más efectivas de sensibilización y difusión. Se recomienda estudiar integrar los resultados de la intervención en políticas públicas más amplias, para fomentar un cambio sistémico en el abordaje de la convivencia escolar en los establecimientos educacionales a nivel nacional
Contextualizing indigenous venturing: emerging insights for context-based indigenous entrepreneurship research
Get PDFThesis submitted to the Faculty of Business Economics at Universidad del Desarrollo for the academic degree of Doctor in Business Economics.We have a limited understanding of entrepreneurship beyond Western developed contexts. Commonly, mainstream entrepreneurship research relies on assumptions which do not always hold across different segments of the population, such as Indigenous peoples , a still marginalized and under researched segment of society. D espite its relevance for emancipation , economic independence, and sustainable development among Indigenous communities worldwide, Indigenous entrepreneurship remains largely understudied in our field . Therefore , in this doctoral thesis composed of two research articles, I examine some underexplored aspects of Indigenous venturing, focusing on the cultural backgrounds and contextual specificities in which Indigenous entrepreneurship takes place . In doing so, I seek to stress the need for more inclusive research, urging a reconsideration of some of our common knowledge and taken for granted entrepreneurial perspectives.
In the first article of this dissertation , I explore the interface between Indigenous entrepreneurship and place, considering both the 'material' and 'socially constructed' dimensions of place. Specifically, I examine Latin American Indigenous individuals from different ethnicities, engaging in venturing across urban, remote, and rural locations. My findings put into perspective the key influence of place in Indigenous venturing , ranging from deeply embedded and relational ventures in remote settings to Western influenced business approaches within urban areas . Overall, I contribute with an empirical typology that provides a more detailed understanding of the context laden and highly idiosyncratic nature of Indigenous entrepreneurship, focusing on the emergence, orientation, main outcomes, and constraints among Indigenous ventures from different places and groups of people Building on embeddedness theory, in the second chapter of this dissertation I seek to gain new insights into the embedding process among Indigenous entrepreneurs migrating from their native settlements into urban environments . M y findings reveal that migrant Indigenous entrepreneurs engage in distinct ive prosocial and sustainable ventures, bringing their context laden traditions, beliefs, and values to the urban realm through their businesses.
Based on this evidence , I showcas e the pivotal role that their home contexts play in the ir agentic embedding wi thin host contexts . I also contribut e to a multi contextual understanding of embeddedness, considering both distal and proximal contexts at a time
Implementación de Flipped Learning en Microbiología y Parasitología, mediante la creación de recursos audiovisuales que expliquen las técnicas de análisis usadas en prácticos de laboratorio
No full textProyectos de Innovación y Fortalecimiento de la Docencia 2023-2. Línea Innovación en el aulaRecursos audiovisuales para apoyar el proceso de aprendizaje de carácter práctico y aplicado de la asignatura Microbiología y Parasitología de los Alimentos de la carrera de Nutrición y Dietétic
Diagnosis of knee cartilage injuries—an international Delphi consensus statement
No full textIntroduction
Articular cartilage injuries of the knee are a complex and challenging clinical pathology.
Objectives
The purpose of this study was to establish consensus statements via a Delphi process on the diagnosis of knee cartilage injuries.
Methods
A consensus process on knee cartilage injuries utilizing a modified Delphi technique was conducted. Seventy-nine surgeons across 17 countries participated in these consensus statements. Eleven questions were generated on the diagnosis of knee cartilage injuries, with 3 rounds of questionnaires and final voting occurring. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was defined as 100% agreement with a proposed statement.
Results
Of the 11 total questions and consensus statements regarding the diagnosis of knee cartilage injuries developed from 3 rounds of voting, 0 achieved unanimous consensus, 8 achieved strong consensus, and 3 achieved consensus.
Conclusions
The majority of the statements regarding diagnosis achieved strong consensus, which related to aspects of the physical exam and history, imaging and documentation, and assessment of concomitant injury or bony malalignment that aid in surgical decision-making. The statements that did not achieve strong consensus were determining when a lesion is symptomatic, documentation of imaging, and when a diagnostic arthroscopy is indicated.Versión Aceptad
Comparing Socket Shield Technique and Conventional Immediate Implant Protocol for Anterior Tooth Rehabilitation: A Critical Analysis of a Systematic Review.
Get PDFThe Socket Shield Technique (SST), a procedure utilized in dental implantology, entails retaining a section of the natural tooth root (the socket shield) in place when an adjacent tooth is extracted, and an implant is placed in the same area. While the technique presents certain advantages, numerous investigations into SST lack of well-designed prospective randomized clinical trials at long term, compromising the credibility and reliability of their findings. The objective
of this study was to critically appraise and grade the level of evidence of a systematic review that compare the SST with the conventional immediate implant protocol (CIIP) for anterior tooth rehabilitation. A recent systematic review was appraised to assess the quality and consistency of the study findings. This assessment utilized the Strength of Recommendation Taxonomy (SORT) to facilitate the application of research results to clinical practice decision-making. The assessment of the quality and reliability of the systematic review and meta-analysis revealed that the evidence obtained from the study was graded
with a strength of recommendation B and a level of evidence 2. SST seems to be a feasible procedure. However, there is insufficient evidence to recommend this technique as an alternative to CIIP in daily practice. Evidence from long-term studies with proper methodology and an adequate sample size is needed to support socket shield technique as an alternative treatment to the conventional immediate implant protocol.Versión publicad