Medwave最新文献

{"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":"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}

{"title":"Surgeons' and payers' perceptions of barriers to accessing bariatric and metabolic surgery in Argentina: An exploratory qualitative study.","authors":"Paulina Siciliani, Mariana Glancszpigel, Daniela Paredes","doi":"10.5867/medwave.2025.11.3154","DOIUrl":"https://doi.org/10.5867/medwave.2025.11.3154","url":null,"abstract":"<p><strong>Introduction: </strong>Bariatric and metabolic surgery is a safe and effective method for treating clinically severe obesity. In Argentina, Law 26 396 and its amendments establish the regulatory framework for its coverage. However, administrative, regulatory, and financial barriers limit effective access to it, with gaps remaining in its scope and understanding. This study aimed to explore surgeons' and health insurance providers' perceptions of the implementation of bariatric and metabolic surgery in Argentina, within the framework of Law 26 396, and to identify the barriers that impede effective, timely access.</p><p><strong>Methods: </strong>We conducted an exploratory qualitative study comprising 16 in-depth virtual interviews with eight surgeons specializing in bariatric and metabolic surgery and eight health insurance officers of the Argentine healthcare system, conducted between November and December 2024. The sampling was intentional. The interviews were recorded, transcribed, and coded. A thematic and recursive analysis was conducted, enabling us to identify emerging categories.</p><p><strong>Results: </strong>We identified multiple barriers and challenges to the effective implementation of bariatric and metabolic surgery in Argentina, including geographic inequalities, heterogeneity in surgical module agreements, administrative and bureaucratic restrictions related to variability in the interpretation of the law and its requirements, high costs, and the imposition of quotas that delay timely access, among others.</p><p><strong>Conclusions: </strong>The implementation of bariatric and metabolic surgery presents structural and functional challenges that affect equitable and timely access. Although Law 26 396 and its subsequent regulations established a regulatory framework for its coverage, tensions among healthcare system actors and regional disparities have resulted in heterogeneous implementation. Administrative and financial barriers persist, affecting its effective and timely practice. We highlight the need to strengthen coordination between physicians and health insurance providers, promoting opportunities for dialogue that optimize authorization and funding processes.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"25 11","pages":"e3154"},"PeriodicalIF":0.8,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145715040","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":"Emergency contraception in Chile: Analysis of public policy according to Walt and Gilson.","authors":"María Angélica Saldías Fernández, Denisse Parra-Giordano","doi":"10.5867/medwave.2025.10.3139","DOIUrl":"https://doi.org/10.5867/medwave.2025.10.3139","url":null,"abstract":"<p><p>This study aims to analyze Chile's policy governing access to the emergency contraceptive pill from the perspective of Walt and Gilson's policy triangle. Its purpose is to generate evidence on relevant actors, implementation, activities, and decisions taken. Through a retrospective case study with a qualitative-analytical approach, supported by a literature review, official reports available online, and analysis of relevant documents, an empirical analysis was conducted using a qualitative-descriptive synthesis matrix based on the Policy Triangle. The analysis followed a historical structure organized into four time periods that characterized the political process surrounding the emergency contraceptive pill in Chile. The main results highlight the participation of numerous sociopolitical actors in formulating the public policy to secure access to the emergency contraceptive pill, within a context of persistent ideological tensions. These dynamics were expressed in arguments that at different moments strengthened or weakened the policy process. Although issues were progressively resolved and the policy remains a work in progress, the process contributed to strengthening the reproductive rights of Chilean women. In conclusion, Walt and Gilson's policy triangle, as an interpretive tool, offers concrete opportunities to analyze public policy in health, confirming the importance of interaction among health authorities, politicians, academic groups, and civil society organizations in matters related to health in general and respect for the sexual and reproductive rights of women with the introduction of emergency contraception.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"25 10","pages":"e3139"},"PeriodicalIF":0.8,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145635796","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":"Laparoscopic Heller myotomy with fundoplication in type II esophageal achalasia: A case report.","authors":"Karla Cumbe-Guerrero, Jennifer Quito Peralta, Braulio Alvarez Loja, Carlos Martínez-Santander, Fernanda Cumbe Guerrero","doi":"10.5867/medwave.2025.10.3082","DOIUrl":"https://doi.org/10.5867/medwave.2025.10.3082","url":null,"abstract":"","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"25 10","pages":"e3082"},"PeriodicalIF":0.8,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604901","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":"Artificial intelligence for skin lesion classification and diagnosis in dermatology: A narrative review.","authors":"Paula Andrea Ramos Chaparro, Erwin Hernando Hernández Rincón, Nicolas Melo Sierra, Gabriela Alejandra Osorio Betancourt, Diana Marcela Díaz Quijano, Samuel David Barbosa Ardila, Mariam Rolón Cadena, Alejandro Rueda Rodríguez","doi":"10.5867/medwave.2025.10.3120","DOIUrl":"https://doi.org/10.5867/medwave.2025.10.3120","url":null,"abstract":"<p><strong>Introduction: </strong>Artificial intelligence (AI) is increasingly present in dermatology, demonstrating accuracy levels comparable to, or even superior to, those of dermatologists in diagnosing skin lesions from clinical and dermoscopic images. This review provides an overview of AI's role in the automated classification and monitoring of skin lesions.</p><p><strong>Objective: </strong>To explore and map the existing literature on the use and benefits of AI in dermatology.</p><p><strong>Methods: </strong>This narrative review focused on exploring the use and benefits of AI in dermatology, utilizing MeSH/DeCS terms such as \"Dermatology,\" \"Artificial Intelligence,\" \"Diagnosis,\" and \"Computer Aided Diagnosis.\" Three databases (PubMed, Lillacs, and Scopus) from 2008 to 2024. We excluded articles that did not focus on dermatology, lacked the topic of Artificial Intelligence, or presented theoretical designs without practical application or evidence, resulting in a final selection of forty-four articles.</p><p><strong>Results: </strong>The results strongly support AI's effectiveness, displaying its precision in diagnosis, comparable to or exceeding that of human dermatologists across diverse tasks. The evolution of AI in dermatology implies a substantial transformation in care, extending its applications from skin cancer to various dermatological pathologies. While emphasizing the vital collaboration between AI and healthcare professionals, a critical gap remains in the real-world clinical validation of AI. Ethical considerations, especially in automated decision-making, need careful attention.</p><p><strong>Conclusions: </strong>This narrative review highlights the crucial role of AI in dermatology, emphasizing its potential to enhance diagnostic accuracy for skin lesions.</p>","PeriodicalId":18597,"journal":{"name":"Medwave","volume":"25 10","pages":"e3120"},"PeriodicalIF":0.8,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564744","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}