Revista Medica Clinica Las Condes最新文献

{"title":"Educación y atención de enfermería en personas con epilepsia","authors":"Katherinne Moreno Durán RN","doi":"10.1016/j.rmclc.2026.01.003","DOIUrl":"10.1016/j.rmclc.2026.01.003","url":null,"abstract":"<div><div>Epilepsy, which affects approximatel 50 million people worldwide, is a complex neurological disorder with significant social, psychological, and medical implications. Despite advances in diagnosis and treatment, public understanding and acceptance remain limited, perpetuating myths and stigma. Comprehensive education for patients, families, healthcare professionals, and the community is essential to improve quality of life, promote effective self-care and reduce stigma.</div><div>Patients and families benefit from tailored education about epilepsy management, treatment adherence, seizure management, psychosocial issues and comorbidities. Community education is critical for dispelling misconceptions and fostering inclusion, especially in educational settings where school staff often lack adequate knowledge. Training for healthcare teams should be interdisciplinary, leveraging technological tools for flexible and accessible learning.</div><div>Epilepsy Specialist Nurses (ESN) play a vital role by providing expert guidance, emotional support, treatment coordination, and education, acting as a key link between patients and healthcare services. Digital tools and seizure action plans further enhance self-management.</div><div>The aim of this article is to provide an up-to-date guide on epilepsy education, to the key audiences, review the available educational resources and analyze the role of ESNs in the care and support of people with epilepsy and their families. Addressing challenges, such as improving health literacy, expanding community awareness, and supporting ESN roles, will help close gaps in care and enable people with epilepsy to lead fuller, more integrated lives.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 1","pages":"Pages 93-100"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147549956","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":"Inteligencia artificial en diagnóstico displasia cortical focal: desentrañando la caja negra del diagnóstico en resonancia magnética","authors":"Marcelo Gálvez Moya MD ,&nbsp;Evelyng Faure Lobos MD","doi":"10.1016/j.rmclc.2026.02.004","DOIUrl":"10.1016/j.rmclc.2026.02.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Focal cortical dysplasia (FCD) is one of the main causes of drug-resistant epilepsy. Its detection on magnetic resonance imaging (MRI) remains challenging due to subtle structural abnormalities. Artificial intelligence (AI) has emerged as a complementary tool for neuroradiologists, capable of identifying morphological and signal patterns imperceptible to the human eye.</div></div><div><h3>Objective</h3><div>To review, from a radiologist's perspective, what artificial intelligence “sees” in focal cortical dysplasia and how it quantifies findings on structural MRI, describing morphometric parameters, interpretability tools, performance, limitations, and clinical applications in epilepsy imaging protocols and surgical planning.</div></div><div><h3>Methods</h3><div>We reviewed recent publications, open datasets, and multicenter projects (MELD, multicenter DL validation, pediatric cohorts) focused on FCD detection using machine learning and deep learning algorithms applied to structural MRI (T1, FLAIR). We described the main performance metrics, interpretability techniques, and morphological features explored.</div></div><div><h3>Results</h3><div>AI algorithms achieve a sensitivity comparable to that of expert neuroradiologists (73-81%), with higher performance when both evaluations are combined (up to 87%).</div><div>Models identify classical findings (cortical thickening, blurring of the gray-white matter junction, FLAIR hyperintensity) and quantify morphometric alterations (cortical thickness, H and K curvatures). Interpretability tools such as Grad-CAM and saliency maps help to “open the black box” of prediction. False positives remain, especially in multicenter cohorts.</div></div><div><h3>Conclusions</h3><div>AI complements visual MRI analysis, transforming it into a semiquantitative and reproducible process. Its integration into epilepsy protocols could improve FCD detection, optimize surgical planning, and contribute to the integrated diagnosis proposed by the ILAE 2022.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 1","pages":"Pages 48-56"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147549959","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":"Genética en epilepsia: puesta al día","authors":"Carolina Álvarez MD ,&nbsp;Viviana Venegas MD ,&nbsp;Eduardo Pérez","doi":"10.1016/j.rmclc.2026.02.002","DOIUrl":"10.1016/j.rmclc.2026.02.002","url":null,"abstract":"<div><div>Epilepsy is a common neurological disorder with high disability and mortality, in which genetics plays a central role in etiology and management. In pediatric patients, up to 80% of cases are estimated to have a genetic origin, ranging from common variants conferring risk in generalized epilepsies to rare, highly penetrant variants causing developmental and epileptic encephalopathies (DEE). Advances in next-generation sequencing and bioinformatics have identified over 900 genes, enabling etiological diagnoses, genetic counseling, and access to precision therapies. Genetic testing strategies—including panels, whole-exome sequencing, whole-genome sequencing, and blended genome–exome approaches—differ in yield and cost, while emerging methods (long-read sequencing, RNA-seq, BGE) enhance diagnostic resolution. Understanding functional mechanisms (gain or loss of function) informs therapeutic decisions and prevents the use of aggravating drugs, improving prognosis and quality of life. This review discusses the layered genetic architecture of epilepsy, its clinical implications, and the challenges of implementing genomic medicine in Latin American settings.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 1","pages":"Pages 17-29"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147549951","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":"Tratamiento del síndrome de espasmos epilépticos infantiles","authors":"Christina Briscoe MD, EdM ,&nbsp;Karina Rosso MD ,&nbsp;Maria A. Planchart Ferretto MD ,&nbsp;Julianne Sison ,&nbsp;Candice Marti MD ,&nbsp;Stephanie Donatelli MD ,&nbsp;Chellamani Harini MD","doi":"10.1016/j.rmclc.2026.02.008","DOIUrl":"10.1016/j.rmclc.2026.02.008","url":null,"abstract":"<div><div>Infantile epileptic spasms syndrome (IESS) is the most common developmental and epileptic encephalopathy of infancy. Its management differs substantially from other infantile epilepsies. Timely treatment is critical, as even short delays in initiating therapy are associated with poorer developmental outcomes. The primary therapeutic goal is complete electroclinical remission, defined as cessation of with electrographic remission, typically assessed around day 14 of treatment. Hormonal therapy with ACTH or high-dose prednisolone and vigabatrin remain the standard of care, achieving remission in 60-70% of patients, although 30-40% remain refractory. In tuberous sclerosis complex, vigabatrin is first-line, while in other etiologies hormonal therapy is often preferred initially, with vigabatrin as second-line. Barriers to care include variable access to pediatric neurologists, EEG capacity, and medication availability. In refractory cases, epilepsy surgery can provide long-term seizure freedom in a substantial proportion of patients with operable lesions, while callosotomy may be beneficial in select nonlesional cases. The ketogenic diet is another option, producing remission in a minority but frequently reducing spasm burden. Ongoing controversies include whether to use hormonal and vigabatrin therapy in combination versus sequentially, and the optimal timing of surgical referral. Standardized treatment pathways and equitable access are essential to improve outcomes. Despite progress, many patients remain drug-resistant, underscoring the urgent need for innovation to expand effective and safe treatment options for IESS.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 1","pages":"Pages 38-47"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147549957","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":"Efectividad del análisis de causa raíz de eventos centinela combinado con el Protocolo de Londres como herramienta de mejoramiento institucional","authors":"Astolfo León Franco Herrera MD ,&nbsp;Katherine Vásquez Rincón MSc ,&nbsp;Stephany Lerma Rodríguez RN ,&nbsp;Jessica Milena Galeano Vargas RN ,&nbsp;Diana Carolina González Aragón MSc ,&nbsp;Alejandro de la Torre Sanclemente MD, MSc","doi":"10.1016/j.rmclc.2026.02.007","DOIUrl":"10.1016/j.rmclc.2026.02.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Root cause analysis (RCA) combined with the London Protocol is widely used to investigate sentinel events and guide improvement actions, yet its real-world effectiveness in preventing recurrences remains debated.</div></div><div><h3>Methods</h3><div>Institutional retrospective study (Jan/2021–Dec/2024) including all sentinel events analyzed with RCA<!--> <!-->+<!--> <!-->London Protocol by a trained team. Timelines were reconstructed, gaps versus standards (JCI, policies, CPGs/protocols) were mapped, root causes identified, and 5W1H<!--> <!-->+<!--> <!-->F (follow-up) action plans developed. Analyst time per case and on-time implementation of corrective actions were recorded.</div></div><div><h3>Results</h3><div>We analyzed 229 sentinel events, identifying 365 root causes and 850 improvement actions; 595/850 (70%) were implemented on time. Pooled root-cause distribution was: poor adherence to CPGs/protocols (29.3%), delayed recognition/management of clinical deterioration (20.8%), communication failures (16.4%), surgery/interventional procedures issues (14.2%), LASA/high-risk medication errors (9.1%), and others (10.2%). Average analyst time per case decreased from ∼25<!--> <!-->h (2021–2022) to ∼19<!--> <!-->h (2023–2024). Annual patterns of recurrence persisted across categories.</div></div><div><h3>Conclusions</h3><div>RCA<!--> <!-->+<!--> <!-->London Protocol systematically identifies failures and informs action; however, impact is limited when recommendations are predominantly weak and implementation/follow-up are suboptimal. Structural interventions, resourcing, and sustained verification of risk control are needed to translate learning into fewer recurrences.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 1","pages":"Pages 118-124"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147549894","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":"“El milagro de San Ignacio de Loyola”","authors":"","doi":"10.1016/j.rmclc.2026.03.002","DOIUrl":"10.1016/j.rmclc.2026.03.002","url":null,"abstract":"","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 1","pages":"Page 125"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147549895","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":"Comorbilidades psiquiátricas en epilepsia","authors":"Vania Krauskopf MD ,&nbsp;Viviana Herskovic MD","doi":"10.1016/j.rmclc.2026.01.002","DOIUrl":"10.1016/j.rmclc.2026.01.002","url":null,"abstract":"<div><div>There is a strong relationship between epilepsy and psychopathology, recognized from ancient times. It has been extensively studied in children and in adults. This relationship is complex, because epilepsy may present simultaneously with mental health disorders, it may cause them or intensify them, and antiepileptic treatment may cause or worsen psychiatric symptoms. On the other hand, psychiatric disorders may impact the prognosis of epilepsy, may interfere with adherence to treatment and may affect quality of life. It is thus important to prevent, screen for and treat psychiatric comorbidity in patients with epilepsy.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 1","pages":"Pages 84-92"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147549955","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":"Monitoreo electroencefalgráfico continuo en neonatos","authors":"Francesca Solari MD","doi":"10.1016/j.rmclc.2026.02.003","DOIUrl":"10.1016/j.rmclc.2026.02.003","url":null,"abstract":"<div><div>Continuous electroencephalographic (cEEG) monitoring in newborns is a fundamental tool in the management of critically ill newborns with probable brain damage. This technique provides early diagnosis of the newborn's condition, allowing for timely intervention and therapies that will influence the newborn's future prognosis and neurodevelopment. It is the gold standard technique for detecting neonatal seizures and for the differential diagnosis of other non-epileptic events. Its limitation is the high initial cost, but when used correctly, it improves the prognosis of sick newborns and ultimately results in lower long-term costs. Centralized and remote interpretation of cEEG and automated seizure detection are potential future applications of this neurodiagnostic tool.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"37 1","pages":"Pages 30-37"},"PeriodicalIF":0.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147549952","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":"Mucormicosis en cirugía maxilofacial. Una revisión de la literatura","authors":"Víctor Herrera-Barraza DDS ,&nbsp;Felipe Donoso-Rebolledo DDS, MEd ,&nbsp;Javiera Morales-Romero DDS ,&nbsp;Nicolás Ferrer-Valdivia DDS, MEd, OMR","doi":"10.1016/j.rmclc.2025.12.002","DOIUrl":"10.1016/j.rmclc.2025.12.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Mucormycosis is a low-prevalence fungal infection with high mortality, primarily affecting immunocompromised patients, such as diabetics and COVID-19 patients. In the maxillofacial region, it presents with facial pain, swelling, and ulcers, making early diagnosis and timely treatment crucial. The objective of this study is to perform a structured literature review on the implications of mucormycosis in maxillofacial surgery, focusing on its epidemiology, diagnostic approaches, and treatment strategies.</div></div><div><h3>Materials and Methods</h3><div>A narrative literature review was conducted using the keywords “Mucormycosis” AND “Maxillofacial Surgery” across the databases PubMed, SciELO, Scopus, ScienceDirect, and Google Scholar. Relevant articles published in the last 10 years, from January 2015 to March 2025, were included, focusing on the epidemiology, diagnosis, and treatment of mucormycosis in maxillofacial surgery.</div></div><div><h3>Results</h3><div>Rhino-orbito-cerebral mucormycosis (ROCM) is the most common form in maxillofacial surgery, particularly in patients with diabetes, those treated with immunosuppressive corticosteroids, and those affected by COVID-19. Diagnosis involves clinical history, imaging, and histopathological analysis, complemented by pharmacological and surgical treatments.</div></div><div><h3>Conclusion</h3><div>Mucormycosis is a complex and challenging condition in maxillofacial surgery, with high mortality. A multidisciplinary approach combining early diagnosis, surgical treatment, and appropriate antifungal therapy is essential to improve survival and reduce the sequelae of the infection.</div></div>","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 6","pages":"Pages 521-528"},"PeriodicalIF":0.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766110","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":"“Star Travel”","authors":"","doi":"10.1016/j.rmclc.2025.12.007","DOIUrl":"10.1016/j.rmclc.2025.12.007","url":null,"abstract":"","PeriodicalId":31544,"journal":{"name":"Revista Medica Clinica Las Condes","volume":"36 6","pages":"Page 558"},"PeriodicalIF":0.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766116","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}