Medwave最新文献

{"title":"Contextual factors and use of heuristics in the care of critically ill patients by intensivists during the COVID-19 pandemic: a quasi-experimental vignette study in Chile.","authors":"Fabiola Jaramillo-Castell, Sergio Minué-Lorenzo, Demetrio Carmona-Derqui, Manuel Correa, Carmen Fernández-Aguilar, José Martín-Martín","doi":"10.5867/medwave.2026.01.3162","DOIUrl":"https://doi.org/10.5867/medwave.2026.01.3162","url":null,"abstract":"<p><strong>Background: </strong>Clinical decision-making in intensive care units during the COVID-19 pandemic has been poorly studied. The aims of this study are to assess the variability of intensivists' decision-making in Chile, analyze the association between clinical decision-making and certain contextual factors (time, pandemic wave, patient age, available clinical information), and estimate the frequency of heuristic use (statu quo, representativeness, and availability) in clinical decision-making.</p><p><strong>Methods: </strong>Quasi-experimental, cross-sectional, qualitative-quantitative study using an online questionnaire of clinical vignettes on the care of critically ill patients during the pandemic. Fifty-one intensivists participated, choosing between two alternatives per case, one of which involved using a heuristic. Frequencies were calculated to estimate variability. Intra-individual changes after manipulating contextual variables were evaluated using the McNemar test (mid-P) or binomial tests.</p><p><strong>Results: </strong>There is wide variability in the decision-making process: only 4 out of 16 cases exceeded 82% agreement. Contextual factors had a heterogeneous influence. No differences were observed regarding the time of day when the decision was made. The pandemic wave influenced 2 of the 4 vignettes. Regarding patient age, it was observed that the decision to withdraw treatment in the absence of a response within 30 days is more likely in older patients, but this is not a determining factor for admission to intensive care units. On the other hand, the clinical decision is modified according to the availability of clinical information. The use of availability heuristic (greater in the first wave) and statu quo heuristic is observed in three of the four vignettes studied, but not representativeness heuristic.</p><p><strong>Conclusions: </strong>The participating intensivists showed high variability and sensitivity to specific contextual factors. The use of statu quo and availability heuristics was observed under certain conditions. This analysis could help improve decision-making during health crises.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 1","pages":"e3162"},"PeriodicalIF":0.8,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147307668","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":"Global non-alcoholic fatty liver disease: analysis of the Global Burden of Disease Study (1990 to 2021).","authors":"Yong Liao, Yongli Song, Sanjin Zeng, Yongli Li, Chenggui Xu, Yinan Chen, Minjie Yin, Anhua Shi","doi":"10.5867/medwave.2026.01.3127","DOIUrl":"https://doi.org/10.5867/medwave.2026.01.3127","url":null,"abstract":"<p><p>Recent meta-analyses highlight the rising global incidence of non-alcoholic fatty liver disease, now the fastest-growing cause of liver-related mortality and a leading driver of end-stage liver disease. Previous estimates needed updated assessments of its epidemiological burden. Using Global Burden of Disease 2021 data, we analyzed age-standardized prevalence, incidence, and disability-adjusted life years for non-alcoholic fatty liver disease across 204 countries /regions from 1990 to 2021. Trends in disease burden were evaluated by sex, age, region, and Socio-Demographic Index. Between 1990 and 2021, non-alcoholic fatty liver disease incidence increased by 31.5% (466 to 613 cases/100 000 population), with new cases rising 94.5% (24.86 to 48.35 million). Prevalence surged 52% (10.58% to 16.07%), affecting 1.268 billion individuals (+124.8%). Disability-adjusted life years increased 46.7% (31.67 to 46.47 years/100 000 population), totaling 3.667 million (+117.2%). Middle-aged adults (30 to 60 years) accounted for 55% of cases, with female prevalence peaking at 35 to 44 years. Women ≥65 years had higher prevalence (18.2% vs 15.5% in men) and bore 30% of disability-adjusted life years. Men aged 15-60 had 40% higher prevalence due to smoking and high-fat diets. The Middle East, China, and Southeast Asia contributed over half of global cases, while high-income regions reported the highest disability-adjusted life years rates due to metabolic risks and aging. Hyperglycemia accounted for 38% of global disability-adjusted life years, and smoking contributed 28% in low/middle-income regions, declining from 22% to 15% in high Socio-Demographic Index nations. Targeted interventions such as metabolic risk reduction via diabetes control and diet in high-SDI nations, tobacco control and low-fat diets in low/middle-income regions, smoking & obesity counseling for men aged 15 to 60, menopause metabolic monitoring for women ≥65 are needed. Integrating non-alcoholic fatty liver disease into chronic disease programs, prioritizing exercise/diet strategies, and tailoring policies to regional Socio-Demographic Index are key to easing its burden.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 1","pages":"e3127"},"PeriodicalIF":0.8,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147290571","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":"Frequency of mesenteric panniculitis in an oncologic population: A multicenter comparative study with a control group.","authors":"David Ladrón de Guevara H, Emily Godoy L, Felipe Zumaeta V, Sofía Carrasco O, Melanie Dávila R, Gonzalo Briceño M, Yussef Cura C","doi":"10.5867/medwave.2026.01.3153","DOIUrl":"10.5867/medwave.2026.01.3153","url":null,"abstract":"<p><strong>Introduction: </strong>Mesenteric panniculitis is a rare benign entity that affects the mesentery, often detected incidentally in an imaging examination. Its association with cancer is a controversial topic. The objective of the study was to determine the frequency of this condition in a known oncological population and compare it with that of a control population.</p><p><strong>Methods: </strong>Cross-sectional, retrospective study, comparative with a control group. Patients referred for PET/CT (Positron Emission Tomography/Computed Tomography) staging for recently diagnosed cancer, who had not been treated and had no history of other previous cancer, were selected. This oncological group was separated according to type of cancer. The control group included patients referred for multiple traumatic injuries to undergo computed tomography that included the abdomen and pelvis. Control patients with a history of cancer were excluded. In both cases, the images were reviewed in search of mesenteric panniculitis.</p><p><strong>Results: </strong>Of the oncological group (1911 patients), 5.2% presented mesenteric panniculitis. The types of cancer with the highest frequency of mesenteric panniculitis were non-Hodgkin lymphoma (16.1%) and prostate cancer (12.8%), followed by multiple myeloma (6.9%), urothelial carcinoma (6.2%), cancer of the head and neck (5.3%) and pancreatic cancer (5.2%). Hodgkin lymphoma and cancers exclusive to women (breast, cervix, uterus, ovary) presented a low frequency of mesenteric panniculitis, similar to the control population. The frequency of mesenteric panniculitis in the control population (1056 individual) was 0.6%. The Odds Ratio of the oncological population vs. control for mesenteric panniculitis exposure was 9.6 (95% CI4.2249 to 22.1015, p < 0,0001).</p><p><strong>Conclusions: </strong>The frequency of mesenteric panniculitis depends on the type of cancer, and it is high in non-Hodgkin lymphoma and prostate cancer, but low and similar to that of the control population in other neoplasms.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 1","pages":"e3153"},"PeriodicalIF":0.8,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989957","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":"Neurofibromatosis Type 1 in Ecuador: genotype-phenotype correlations from a case series.","authors":"Elius Paz-Cruz, Patricia Guevara-Ramirez, Arianne Llamos Paneque, Emily Onofre, Christian Rivas Iglesias, Santiago Cadena-Ullauri, Rafael Tamayo-Trujillo, Viviana A Ruiz-Pozo, Daniel Simancas-Racines, Ana Karina Zambrano","doi":"10.5867/medwave.2026.01.3155","DOIUrl":"10.5867/medwave.2026.01.3155","url":null,"abstract":"<p><strong>Introduction: </strong>Neurofibromatosis type 1 (NF1) is a multisystemic genetic disorder caused by pathogenic variants in the gene, characterized by variable clinical manifestations such as pigmentary abnormalities, neurofibromas, skeletal dysplasia, and tumor predisposition. However, genotype-phenotype correlations remain insufficiently explored, particularly in underrepresented populations.</p><p><strong>Methods: </strong>Three unrelated Ecuadorian pediatric patients with a presumptive diagnosis of NF1 underwent detailed clinical evaluation, next-generation sequencing (NGS), using the TruSight Cancer panel, and ancestry analysis based on 46 ancestry-informative insertion-deletion (InDel) markers. Variants were classified according to ACMG/AMP guidelines using the Franklin and Variant Interpreter platforms, which incorporate in silico prediction tools to assess variant pathogenicity.</p><p><strong>Results: </strong>Three distinct pathogenic variants were identified: one nonsense (p.Arg1534Ter) and two missense (p.Gln20His, p.Asp1644Asn). Clinical findings included early-onset orbital plexiform neurofibroma, multiple café-au-lait macules, axillary/inguinal freckling, radial bone dysplasia, cutaneous neurofibromas, and prepubertal gynecomastia. All patients exhibited predominantly Native American ancestry. analyses predicted a pathogenic classification of all variants. Early pigmentary signs, present in all cases, served as key diagnostic indicators.</p><p><strong>Conclusions: </strong>This case series expands the mutational and phenotypic spectrum of NF1 in a pediatric Ecuadorian cohort. Findings underscore the diagnostic value of early pigmentary signs and highlight less commonly reported manifestations such as radial bone dysplasia and prepubertal gynecomastia. Integrating molecular diagnostics with early clinical evaluation may enable earlier and more precise diagnosis, guiding personalized management strategies. Further studies should investigate genotype-phenotype correlations and the influence of ancestry on NF1 expression.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 1","pages":"e3155"},"PeriodicalIF":0.8,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985119","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":"Identification and susceptibility profile of microorganisms isolated directly from urine in a cross-sectional study using matrix-assisted laser desorption/ionization time-of-flight and Phoenix M50.","authors":"Juan Araya Orellana, Jazmín Basoalto León, Romina Napoletani Ramírez, Tomás Arán-Sekul","doi":"10.5867/medwave.2026.01.3049","DOIUrl":"https://doi.org/10.5867/medwave.2026.01.3049","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluates the efficacy of matrix-assisted laser desorption ionization-time of flight technology and the Phoenix™ M50 system for bacterial identification and antimicrobial susceptibility testing from bacterial concentrate obtained from urine samples, reducing diagnostic time to 24 hours compared to the traditional 72 hours in a public hospital in Antofagasta, Chile.</p><p><strong>Methods: </strong>Through differential centrifugation, a bacterial concentrate is obtained directly from urine, allowing the preparation of a McFarland standard for identification and susceptibility studies. We compared the identification and minimal inhibitory concentration results obtained from the bacterial concentrate with those obtained from the strain isolated in culture.</p><p><strong>Results: </strong>380 samples were analyzed after exclusions. Direct identification showed 93.4% sensitivity and 73.8% specificity, with moderate agreement (κ=0.604) versus culture. had 98.5% concordance. For antimicrobial susceptibility test, Phoenix M50 performed well with , meeting Cumitech 31A standards for 13 out of 19 antibiotics. In contrast, only 8 of 19 antibiotics met the criteria for .</p><p><strong>Conclusions: </strong>The antimicrobial susceptibility method varies depending on the species-antibiotic combination; therefore, specific studies for each species are crucial. Despite these challenges, the direct method offers significant advantages in diagnostic speed and emphasize its potential for improving clinical decision-making, though further validation and protocol refinement are needed, particularly for Gram-positive pathogens.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"26 1","pages":"e3049"},"PeriodicalIF":0.8,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145945064","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":"Health inequalities in post-COVID-19 Chile: Health system coverage and effective access by sex and migrant status.","authors":"Marilaura Nuñez, Iris Delgado, María Isabel Matute, Báltica Cabieses, Muñoz Venturelli Paula","doi":"10.5867/medwave.2025.11.3114","DOIUrl":"https://doi.org/10.5867/medwave.2025.11.3114","url":null,"abstract":"<p><strong>Introduction: </strong>In 2022, after the COVID-19 pandemic, approximately 93% of the countries in the Region of the Americas continued to report interruptions in essential health services, with worse outcomes in vulnerable social groups. The present study aims to describe barriers to access to health care in Chile, disaggregated by sex and international migrant status.</p><p><strong>Methods: </strong>Cross-sectional study, analyzing the results of the CASEN 2022 survey of persons ≥18 years of age. We calculated ascription, effective access and health barriers by international migrant status and sex. Multiple logistic regression models were performed adjusting for age, rurality, educational level, occupation, and income quintile. The model was expressed as an adjusted Odds Ratio (ORadj) with a 95% confidence interval in STATA v.18.5.</p><p><strong>Results: </strong>For the year 2022 in Chile, a total of 14,767,688 people were represented in this study, with a mean age of 45.4 years (SD: 17.8), 51.2% were women and 9.27% were migrants. Regarding health insurance, 3.11% of the population was not affiliated with the health system, with men (ORadj: 0.6; 95% CI: 0.54-0.68) and immigrants (ORadj: 10.3; 8.78-12.15) being the most affected groups. In terms of effective access, 17.4% had health needs, with a predominance of the female sex (ORadj: 1.3; 95% CI: 1.21-1.32). However, of those who had needs and expressed them, 39.2% expressed unmet needs, with a higher probability of showing it in women (ORadj: 1.2; 95% CI: 1.10-1.27).</p><p><strong>Conclusions: </strong>In Chile, health system coverage remains a challenge for men and the migrant population. We observe with concern high percentages of unmet health needs, particularly among women. The intersection of sex and international migration reveals a dual vulnerability in access to health care that warrants further study.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"25 11","pages":"e1314"},"PeriodicalIF":0.8,"publicationDate":"2025-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145857148","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":"Correction to: Development, content validity, and reliability of a questionnaire to measure perceived workplace discrimination in the Chilean mining sector: A validation study.","authors":"Editors Medwave","doi":"10.5867/medwave.2025.11.8708","DOIUrl":"https://doi.org/10.5867/medwave.2025.11.8708","url":null,"abstract":"","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"25 11","pages":"e8708"},"PeriodicalIF":0.8,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145820138","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":"Clinical and wound-related predictors for prolonged hospital stay in diabetes-related foot infections in a resource-limited setting: A retrospective cohort study.","authors":"Eddy Lopez-Huamanrayme, Angelica Caycho-Jara, Kevin Roque-Quico, Fidel Flores, Carlos Tamayo, Jhanira Alferez-Condori, Claudia Cordova-Huancas","doi":"10.5867/medwave.2025.11.3135","DOIUrl":"https://doi.org/10.5867/medwave.2025.11.3135","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetes-related foot infections are a common cause of hospitalization and are associated with prolonged hospital stays, higher healthcare costs, and poor outcomes. However, information on clinical risk factors for prolonged hospital stay in resource-limited settings is scarce. The aim of this study was to identify clinical factors associated with prolonged hospital stay in patients hospitalized for diabetes-related foot infection.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients admitted with diabetes-related foot infection at Hospital Nacional Alberto Sabogal Sologuren part of the Peruvian Social Security system, between 2020 and 2021. Clinical characteristics, wound features, and treatment types were collected from electronic medical records. Prolonged hospital stay was defined as more than 10 days according to national guidelines. Associations with prolonged hospital stay were assessed using Poisson regression with robust variance.</p><p><strong>Results: </strong>A total of 228 patients were included (76.3% male; median age: 66 years). The most frequent comorbidities were atherosclerotic cardiovascular disease (56.6%), arterial hypertension (54.8%), and chronic kidney disease (42%). Overall, 50.5% of patients were treated with bedside wound debridement; 25.4% underwent minor amputation; and 24.1% received surgical management (major amputation or operating-room debridement). Prolonged hospital stay occurred in 49.6% of patients. Independent risk factors included wound length >5 cm (adjusted relative risk: 1.63; 95% confidence interval: 1.17 to 2.26), surgical management (1.63; 1.40 to 2.97), minor amputation (1.63; 1.22 to 2.63), and a history of atherosclerotic cardiovascular disease (1.63; 1.08 to 1.84).</p><p><strong>Conclusions: </strong>Nearly half of patients with diabetes-related foot infection experienced prolonged hospital stay. Larger wound size, surgical treatment, minor amputation, and atherosclerotic cardiovascular disease were associated with prolonged hospitalization. Identifying these factors may guide clinical decisions to reduce hospital stays in resource-limited health systems.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"25 11","pages":"e3135"},"PeriodicalIF":0.8,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145810732","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":"Correction to: Biases and mistakes in the Official College of Physicians of Barcelona (COMB) document on digital health.","authors":"Editors Medwave","doi":"10.5867/medwave.2025.11.8707","DOIUrl":"10.5867/medwave.2025.11.8707","url":null,"abstract":"","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"25 11","pages":"e8707"},"PeriodicalIF":0.8,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145768525","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":"Biases and mistakes in the Official College of Physicians of Barcelona (COMB) document on digital health.","authors":"Xavier Bosch-Capblanch","doi":"10.5867/medwave.2025.11.3156","DOIUrl":"10.5867/medwave.2025.11.3156","url":null,"abstract":"","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"25 11","pages":"e3156"},"PeriodicalIF":0.8,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145743247","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}