Medwave最新文献

{"title":"Effects of hypotensive anesthesia compared to normotensive anesthesia in orthognathic surgery.","authors":"Matias Dallaserra-Albertini, Juan Pablo Vargas-Buratovic, Andrés Campolo-González, Nicolas Ríos-Espósito, Claudio Nazar-Jara, Salvador Valladares-Pérez, Duniel Ortuño-Borroto","doi":"10.5867/medwave.2024.09.2803","DOIUrl":"10.5867/medwave.2024.09.2803","url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results and conclusions: </strong>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.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"24 9","pages":"e3029"},"PeriodicalIF":1.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lithium mining: How can science address a new exposure scenario in workers that has not been previously studied?","authors":"Muriel Ramírez-Santana, Sandra Cortés Arancibia, Vivienne C Bachelet","doi":"10.5867/medwave.2024.09.3029","DOIUrl":"https://doi.org/10.5867/medwave.2024.09.3029","url":null,"abstract":"","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"24 9","pages":"e3029"},"PeriodicalIF":1.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142503961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symic smallpox: From warning to practice.","authors":"Muriel Ramírez-Santana","doi":"10.5867/medwave.2024.09.3008","DOIUrl":"10.5867/medwave.2024.09.3008","url":null,"abstract":"","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"24 9","pages":"e3008"},"PeriodicalIF":1.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast cancer diagnosis and staging in Chile: A non-randomized survey-based study to assess frequency and delays.","authors":"Carla Campaña, Oyarte Marcela, Báltica Cabieses, Alexandra Obach","doi":"10.5867/medwave.2024.09.2801","DOIUrl":"https://doi.org/10.5867/medwave.2024.09.2801","url":null,"abstract":"<p><strong>Introduction: </strong>Breast cancer progression involves physiological mechanisms such as metastasis. Delays in diagnosis and treatment increase the risk of mortality and are associated with barriers to healthcare access. In Chile, breast cancer is highly prevalent, and early diagnosis has improved, although disparities in the disease evolution persist. This study characterized diagnostic and staging tests, waiting times, and sociodemographic profiles to identify delays and inequities in care.</p><p><strong>Methods: </strong>Survey study. Using a non-probabilistic sample, a questionnaire was applied in an encrypted platform with prior informed consent. The instrument collected data on requested tests, associated times, staging, and sociodemographic characteristics. These variables were analyzed using descriptive statistics, tests of association, confidence intervals, and comparison tests using bootstrapping.</p><p><strong>Results: </strong>A sample of 263 persons was obtained. The most requested tests were biopsy (99.62%) and blood tests (80.23%). The median number of tests requested was six (Q1:4, Q3:8), with a mean of 5.87 (standard deviation: 2.24). No significant differences were observed in the percentage of persons from whom the total number of examinations were requested according to the studied variables. The day-hour-result intervals ranged from 1 to 365 days. The median day-hour-result of the biopsy was 15 days (Q1:10, Q3:30). People between 40 and 49 years old, non-residents of the capital city, belonging to income quintile I, with high school education, from the public health system, with late-stage diagnosis had higher median day-hour-result in biopsy. There was no significant difference in the number of requested tests according to staging (I and II, or III and IV).</p><p><strong>Conclusions: </strong>Biopsy in Chile is the test of choice for diagnostic confirmation in breast cancer. Other tests are requested regardless of the diagnosis stage, contrary to the recommendations of clinical guidelines. Cancer prognosis is crucial, especially in countries with greater inequalities.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"24 9","pages":"e2801"},"PeriodicalIF":1.2,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical exercise in Chilean breast cancer survivors: Qualitative study of barriers, facilitators and preferences.","authors":"Francia Martínez, Constanza Segura Rios, Orellana María Paz, Francisco Acevedo, Benjamin Wallbaum, César Sánchez, Luis Vergara, Karol Ramirez-Parada, Tomás Merino Lara","doi":"10.5867/medwave.2024.09.2963","DOIUrl":"https://doi.org/10.5867/medwave.2024.09.2963","url":null,"abstract":"<p><strong>Introduction: </strong>Breast cancer survivors often experience pre and post-treatment physical and psychological symptoms, negatively affecting their quality of life. Regular physical exercise is associated with better quality of life and lower recurrence of cancer, and therefore all oncological patients are recommended to practice it in a regular basis. Despite this, breast cancer survivors have low adherence to physical exercise. The purpose of this study is to identify barriers, facilitators and preferences of Chilean breast cancer survivors to practice physical exercise.</p><p><strong>Methods: </strong>Phenomenological qualitative study of 12 in-depth interviews with adjuvant radiation therapy concluded at least three months ago.</p><p><strong>Results: </strong>Breast cancer survivors ignored the benefits of physical exercise during and after treatment. The barriers were physical symptoms, psychological barriers, sociocultural barriers, health system barriers, disinformation and sedentary lifestyle. Facilitators were coping with physical symoptoms, psychological issues, having information and active lifestyle. The preferences were painless and familiar exercises. Preferred exercise was walking.</p><p><strong>Conclusions: </strong>Breast cancer survivors may adhere to physical exercise despite barriers when certain facilitators are present, which may be promoted by the health team when reporting the benefits of the physical exercise, prescribing personalized, safe and painless physical exercise and educating both patient and her family about the role of the physical exercise in cancer recovering process.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"24 9","pages":"e2963"},"PeriodicalIF":1.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with gingival recession prevalence in undergraduate students of the Faculty of Dentistry of the Universidad de los Andes in the year 2022.","authors":"Bruno Cavieres, Eduardo Cuellar, Mauricio Nally, Andreas Anwandter, Duniel Ortuño","doi":"10.5867/medwave.2024.08.2784","DOIUrl":"https://doi.org/10.5867/medwave.2024.08.2784","url":null,"abstract":"<p><strong>Objective: </strong>To determine the prevalence of gingival recessions in students of the faculty of odontology at Universidad de Los Andes and the factor associated with its presence.</p><p><strong>Methods: </strong>In this cross-sectional study, a randomized stratified sampling was used to select the students. The sample included 311 undergraduate students evaluated between March and December 2022. The year spectrum was from 17 to 29 years old. Two calibrated examiners intra e interoperator completed a clinical evaluation with a periodontal probe, where the purpose was to diagnose gingival recessions and identify if there were any related factors such as smoking, braces, bruxism, marginal insertion frenulum, fine phenotype, and malposition. The total prevalence was described with each trust interval of 95%. The association between categorical variables was analyzed with the chi-square test, and the t-student test of the Mann-Whitney test analyzed the difference between continuous variables and recession prevalence.</p><p><strong>Results: </strong>93,56% of the students presented at least one gingival recession. The highest prevalence related to teeth occurred in pieces 1.6, 3.4, 2.6, and 4.1, and the most severe were 3.3, 4.3, and 1.3. The most associated factor related to recessions was orthodontics, with a prevalence of 75,2%. Bruxism showed a positive association with the number of recessions, with a prevalence of 60,7%.</p><p><strong>Conclusions: </strong>Buccal gingival recessions were very prevalent in undergraduate students at the dental school of Universidad de los Andes during 2022, and they were strongly associated with the history of orthodontics.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"24 8","pages":"e2784"},"PeriodicalIF":1.2,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fulvestrant en la práctica clínica: análisis de efectividad en pacientes uruguayas con cáncer de mama HR+/HER2.","authors":"Natalia Camejo, Dahiana Amarillo, Cecilia Castillo, Sofía Badía Alza, Camila Baliño, Miguel Banchieri, Juan Fagundez, Santiago Ghiga, Marcos Lorier, Isabel Alonso, Gabriel David Krygier Waltier","doi":"10.5867/medwave.2024.08.2923","DOIUrl":"https://doi.org/10.5867/medwave.2024.08.2923","url":null,"abstract":"<p><strong>Introduction: </strong>Fulvestrant demonstrated benefits in overall survival and progression-free survival in patients with advanced breast cancer, who are hormone receptor-positive and human epidermal growth factor receptor 2 negative. The characteristics, evolution, and survival of patients with hormone receptor-positive, HER2-negative breast cancer treated with fulvestrant were evaluated according to the national treatment coverage protocols of the National Resources Fund, with the aim of understanding the efficacy of fulvestrant in patients treated in usual clinical practice and comparing our results with those from pivotal studies.</p><p><strong>Methods: </strong>A database from the National Resources Fund covering the period from 2009 to 2022 was used. Survival curves were assessed using the Kaplan-Meier method, and differences were analyzed using the Log-Rank test.</p><p><strong>Results: </strong>A total of 1085 patients with an average age of 63,66 years were included. Following a follow-up of 14 months, the median overall survival was 16 months, and the median progression-free survival was 6 months. The presence of liver and bone metastases was associated with a shorter overall survival. Patients from the public sector and those with a better performance status experienced longer overall survival.</p><p><strong>Conclusions: </strong>Our findings provide a valuable perspective for treatment management in a context of limited resources. Overall survival and progression-free survival were somewhat lower than those reported in pivotal clinical trials. The presence of liver and bone metastases was associated with worse prognosis and survival; additionally, patients with worse performance status had shorter overall survival. These findings underscore the need for personalized therapies, opening new lines of future research.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"24 8","pages":"e2923"},"PeriodicalIF":1.2,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142349987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor: Institutional factors and the teaching staff have an impact on the research of university medical students.","authors":"Brian Johan Bustos-Viviescas, Carlos Enrique García Yerena, Amalia Villamizar Navarro","doi":"10.5867/medwave.2024.08.3001","DOIUrl":"10.5867/medwave.2024.08.3001","url":null,"abstract":"","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"24 8","pages":"e3001"},"PeriodicalIF":1.2,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142291202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor on \"Education on pain disciplines in physical therapy in Chile: In need of change\".","authors":"José Alfredo Órdenes Mora, Laiza Moura Almeida-Terassi, Manuel Ahumada Wartemberg, Felipe J J Reis","doi":"10.5867/medwave.2024.08.2999","DOIUrl":"10.5867/medwave.2024.08.2999","url":null,"abstract":"","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"24 8","pages":"e2999"},"PeriodicalIF":1.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142291201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrophysiology lab efficiency using cryoballoon for pulmonary vein isolation in Latin America: A sub-analysis of the Cryo Global Registry Study.","authors":"Armando Pérez-Silva, Rodrigo Isa-Param, Juan F Agudelo-Uribe, Alex Pacheco-Bouthillier, Reece Holbrook, Daniela Paredes-Fernández, Kayla Jones, Juan Tellez, Thomas R Holmes, Alicia Sale, Nicolás Martinenghi","doi":"10.5867/medwave.2024.08.2918","DOIUrl":"10.5867/medwave.2024.08.2918","url":null,"abstract":"<p><strong>Objective: </strong>Cryoballoon ablation for pulmonary vein isolation is a time-efficient procedure that can alleviate stress on electrophysiology lab resources. This analysis modeled the impact of cryoballoon ablation on electrophysiology lab operation using data from Latin America.</p><p><strong>Methods: </strong>Data from centers in Argentina, Mexico, Colombia, and Chile of the were used as inputs for an electrophysiology lab efficiency simulation model. The model used the assumption that either two (today's electrophysiology lab operations) or three (including electrophysiology lab operational changes) cryoballoon ablation procedures could be performed per day. The endpoints were the percentage of days that resulted in 1) overtime and 2) time left for an extra non-ablation electrophysiology procedure.</p><p><strong>Results: </strong>Data from a total of 232 procedures from six Latin American centers were included in the analysis. The average electrophysiology lab occupancy time for all procedures in Latin America was 132 ± 62 minutes. In the Current Scenario (two procedures per day), 7.4% of simulated days resulted in overtime, and 81.4% had enough time for an extra electrophysiology procedure. In the Enhanced Productivity Scenario (three procedures per day), 16.4% of days used overtime, while 67.4% allowed time for an extra non-ablation electrophysiology procedure.</p><p><strong>Conclusions: </strong>Using real-world, Latin American-specific data, we found that with operational changes, three ablation procedures could feasibly be performed daily, leaving time for an extra electrophysiology procedure on more than half of days. Thus, use of cryoballoon ablation is an effective tool to enhance electrophysiology lab efficiency in resource-constrained regions such as Latin America.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"24 8","pages":"e2918"},"PeriodicalIF":1.2,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}