Colegio Médico de Chile

• Median nerve variants within the carpal tunnel have a pooled prevalence of 12%. • Bifid median nerve is the most frequently reported morphological variant. • No consistent association was found between anatomical variants and carpal tunnel syndrome. • Coexisting vascular or muscular anomalies may influence surgical complexity. • Preoperative imaging may aid anatomical identification, although clinical benefit remains uncertain. Anatomical variants of the median nerve (MN) within the carpal tunnel are clinically relevant due to their potential impact on the development, diagnosis, and surgical management of carpal tunnel syndrome (CTS). Reported prevalence estimates vary considerably across populations and study designs. To systematically review the literature and estimate the pooled prevalence of morphological variants of the median nerve within the carpal tunnel, and to assess their laterality, geographic distribution, and reported clinical implications. A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. MEDLINE, Scopus, Web of Science, CINAHL, and LILACS were searched from inception to November 2024. Google Scholar was used for supplementary screening of gray literature. Observational studies reporting the prevalence of MN variants identified through imaging, surgical exploration, or anatomical dissection were included. Methodological quality was assessed using the Anatomical Quality Assessment (AQUA) tool. Pooled prevalence estimates were calculated using a random-effects model (DerSimonian–Laird) with Freeman–Tukey double arcsine transformation. Sixty-three studies met eligibility criteria for qualitative synthesis, and 19 studies (n = 9,045 subjects) were included in the primary meta-analysis. The pooled prevalence of MN variants within the carpal tunnel was 12% (95% CI: 9–15%), with substantial heterogeneity (I² = 87%). Subgroup analysis showed similar prevalence in imaging-based studies (12%, 95% CI: 9–15%; I² = 87.8%). No clear laterality predominance was observed (right: 46%, 95% CI: 40–52%; I² = 0.0%; left: 53%, 95% CI: 48–59%; I² = 0.0%), whereas bilateral presentation demonstrated greater variability (21%, 95% CI: 6–36%; I² = 90.6%). Geographic subgroup analysis showed pooled prevalence estimates of 22% in Asia (95% CI: 13–31%; I² = 92.6%), 20% in Europe (95% CI: 14–27%; I² = 79.2%), and 18% in America (95% CI: 16–20%; I² = 19.4%). Morphological variants of the median nerve within the carpal tunnel are relatively common anatomical findings. Current evidence does not support their role as independent risk factors for CTS; however, their coexistence with vascular or muscular anomalies may influence local anatomical relationships and surgical complexity. Preoperative imaging may facilitate anatomical identification and surgical planning, although its impact on clinical outcomes and intraoperative complications remains uncertain and requires further prospective investigation.

Oral health literacy (OHL) influences older adults' capacity to obtain, process and apply oral health information for self-care and decision-making. Evidence on OHL in community-dwelling older adults in Chile remains scarce. This study explored the factors shaping OHL among Chilean community-dwelling older adults. A qualitative exploratory study was conducted using the Grounded Theory approach. Older adults (≥ 65 years) were purposively sampled from three municipalities in Santiago, Chile, representing different levels of social vulnerability. Thirteen in-depth, face-to-face, semi-structured interviews were conducted. The interviews were audio-recorded, transcribed verbatim and analysed iteratively using constant comparison and open, axial and selective coding, categorising the answers to identify emerging topics until reaching saturation. Data triangulation included interviews, field observations and document reviews. Findings emerged into two overarching dimensions shaping OHL across the life course: upstream and downstream factors. Upstream factors included contextual factors, provider-related factors and system-related factors. Downstream factors encompassed individual and behavioural aspects that influenced access to dental care and attention. OHL in older adults is shaped by cumulative life-course experiences across structural, social and individual domains. Addressing OHL requires integrated public policies, professional training in patient-centred communication and community-based strategies targeting social determinants to promote equitable oral health in older age.

BackgroundFunctional impairment (FI) in activities of daily living (ADL) is a critical criterion for diagnosing dementia that could be categorized into its three dimensions: basic (BADL), instrumental (IADL) and advanced activities (aADL). While FI has been well studied in Alzheimer's disease (AD), this characterization has been underexplored in frontotemporal dementia (FTD) and even more in Latin American countries, where genetic and exposome diversity defines variability in its clinical presentation.MethodWe evaluated 547 individuals from RedLat consortium for dementia research in Latin America (262 controls, 236 AD and 49 FTD) from 5 Latin American countries (Argentina, Brazil, Chile, Colombia and Mexico). We performed descriptive statistics for sociodemographic variables. Functional performance was evaluated through the Tecnology‐Activities of Daily Living (T‐ADLQ) global score and subscores for BADL, IADL, and aADL. Kruskal‐Wallis and Dunn post‐hoc tests were performed to compare T‐ADLQ scores between the three groups.ResultAD participants showed poor global cognitive performance compared to FTD, and FTD presented higher scores in NPI than AD. In total, basic, instrumental, and advanced T‐ADLQ scores, FTD showed higher scores than AD participants, which means poor functional performance in FTD participants; however, these differences only showed significance in the basic domain.ConclusionIn Latin American individuals, FTD showed poorer functional performance than AD patients, statistically significant in the basic domain. Further research would be oriented toward exploring the relationship between this functional performance and cognitive and clinical symptoms to determine the functional profile in FTD, compared with AD.

La autonomía permite a las personas tomar decisiones en su vida cotidiana y en su relación con los demás. Para que esta virtud pueda ser desarrollada debe ser enseñada tempranamente y de manera explícita durante la formación escolar por medio de experiencias reales y contextualizadas que las doten de sentido. Este proceso adquiere mayor relevancia en poblaciones con discapacidad visual en las cuales el autogobierno y determinación son conceptos prioritarios a desarrollar para aumentar su inclusión. El presente estudio midió el efecto de un programa piloto de educación musical en el desarrollo de la autonomía de un grupo de estudiantes con discapacidad visual de Santiago de Chile. El programa comprendía ocho sesiones en las que se conjugaron el ejercicio y práctica musical con la contextualización y formación explícita de la autonomía como virtud. La evaluación del programa fue de carácter no experimental y mixto. Los resultados evidencian que los estudiantes participantes mostraron un aumento estadísticamente significativo de su autonomía (p<0.05). Además, los estudiantes y sus familias/tutores destacaron el potencial del programa como catalizador para el trabajo de la autonomía dentro y fuera del colegio. En base a lo anterior se sugiere explorar nuevas sinergias entre la educación musical y la formación moral haciendo especial acento en aquellas poblaciones que presenten algún tipo de discapacidad.

Introduction: The Allurion® gastric balloon (AGB) is an innovative option for treating overweight individuals and those with grade I obesity, or as a bridging treatment for bariatric surgery, or for patients who do not desire surgical intervention. This study aimed to evaluate the efficacy and safety of the AGB in a multicentric cohort. Materials and Methods: A retrospective analysis of consecutive cases treated with AGB (≥18 years old with body mass index [BMI] ≥27) was performed in eight centers in three countries in Latin America (Argentina, Chile, and Perú), between September 2021 and September 2022, with a 12-month follow-up. Results: In total, 402 patients were included (median BMI of 32.81 kg/m2). Mean total weight loss percentage was 8.3%, 11.6%, and 14.9% at 3, 6, and 12 months, respectively, with a follow-up of 93.03%, 75.37%, and 40.54%. The adverse event rate was 1.24% (n = 5). During the first 7 days, 34.58% (n = 139) experienced concomitant symptoms, and 1.99% (n = 8) asked for endoscopic balloon extraction because of intolerance. The complication rate was 6.46% (n = 26). Readmission index was 4.97% (n = 20), and reintervention was 2.23% (n = 9). Balloon elimination was experienced by 5.7% of patients in the first 14 days, 29.10% (n = 117) before the third month, and 62.68% (n = 252) after the 16th week. Early deflation rate was 2.73% (n = 11). Digestive track elimination was perceived by 26.61%. Conclusions: AGB is a safe and effective option for the treatment of overweight and obesity in Latin America. Lifestyle changes and continuous support with a multidisciplinary team are essential to achieving good mid- to long-term outcomes.

E l presente reportaje recoge una entrevista a la que los

IntroductionCutaneous squamous cell carcinoma (SCC) accounts for 20% of all skin cancers and its incidence continues to increase globally. It represents 75% of non-melanoma skin cancer (NMSC) mortality. Risk factors include ultraviolet radiation (UVR) exposure, advanced age, chemical exposure, fair skin types, and immunosuppression. While most human papillomavirus (HPV) infections are associated with the development of warts, a subgroup is potentially implicated in the development of cutaneous SCC. The prevalence of alpha, beta, and gamma-HPV in Chilean patients with hand SCCs has not been previously addressed. The objective of this study was to evaluate the presence of HPV and genotyping in hand SCC from Chilean patients.Materials and methodsAn observational, cross-sectional, descriptive study was conducted. Alpha (α), beta (β) and gamma (γ)-HPV detection was performed by conventional polymerase chain reaction (PCR) in paraffin-embedded tissue samples from 52 patients diagnosed with hand SCC from Santiago, Chile. HPV genotyping was carried out via direct amplicon sequencing by Sanger method.ResultsThe most frequent carcinoma site was the dorsum of the hands (52.5%). α-HPV was not detected in these specimens, whereas β-HPV and γ-HPV were detected in 25% of the analyzed samples. The most frequent genotypes found were β-HPV 100 (38%) and γ-HPV 178 (15%). Additionally, γ-HPV 101, 162, HPV-mSK_016, HPV-mSK_083, HPV-mSK_213 and HPV-mSK249nr genotypes were detected, none of which had been previously described in cutaneous SCC.Conclusionβ-HPV and γ-HPV are detectable in 25% of hand SCCs from Chilean patients. It is important to conduct prospective studies to better elucidate the role of these viruses in the development of this disease.

Se presentan los resultados de las excavaciones y análisis de artefactos, ecofactos y arte rupestre del sitio Infieles-1, Puna de Atacama, Chile. Este sitio se emplaza adyacente a un paredón de ignimbrita con diversas manifestaciones rupestres. El análisis de estas pinturas y grabado, junto a la excavación realizada permitió identificar tres ocupaciones alfareras. La primera se relaciona con portadores de cerámica Condorhuasi-Río Diablo del Formativo del Noroeste de Argentina, unida a manifestaciones que poseen referentes en la modalidad estilística Punta del Pueblo de Antofagasta de la Sierra (500-1000 d.C.), coherente con el fechado radiocarbónico (AMS) obtenido en Infieles-1. A continuación, y hacia fines de este lapso, se identificaron posibles motivos Ánimas y, por último, un tercer momento asociado probablemente al Período Intermedio Tardío/Período Tardío, a partir de manifestaciones culturales del norte y centro de la región de Atacama. Asimismo, se describe sucintamente el arte rupestre histórico del sitio, analizando sus definiciones e implicancias culturales. En síntesis, se caracterizan y discuten, desde una perspectiva internodal y de tráfico regional e interregional, las ocupaciones temporales y diacrónicas del sitio por parte de grupos locales, responsables del arte rupestre en Infieles durante la época alfarera, y que manifiestan acentuadas interrelaciones culturales con espacios trasandinos.

El objetivo de esta investigación fue develar la naturaleza de las preguntas formuladas en clases de ciencias, en los primeros años de escolaridad. Se evidenció un predominio de interrogantes dirigidas a promover habilidades de pensamiento científico (HPC), relacionadas con la observación y la exploración. Con un enfoque cualitativo, a través de un estudio de caso instrumental, se registró el trabajo en aula de dos docentes de diferentes niveles: una de educación parvularia y otra de educación básica. La estrategia involucró un análisis del contenido de la información recolectada a través de la observación participante. Los resultados indican que se favorecen la observación y formulación de hipótesis, buscando las ideas de los niños mediante preguntas directas, desaprovechando y restringiendo la posibilidad de complejizarlas. Se concluye que los docentes deben capacitarse en el diseño de interrogantes significativas que permitan a los niños aprendizajes valiosos para comprender los fenómenos que les rodean. Palabras clave: primera infancia; enseñanza; ciencias naturales; habilidades; docente. Abstract The objective of this research was to reveal the nature of the questions asked in science classes, in the first years of schooling. A predominance of questions aimed at promoting scientific skills thinking (SST), related to observation and exploration, was evidenced. With a qualitative approach, through an instrumental case study, the work in the classroom of two teachers of different levels was recorded: one from kindergarten and the other from basic education. The strategy involved an analysis of the content of the information collected through participant observation. The results indicate that observation and hypothesis formulation are favored, seeking children's ideas through direct questions, wasting and restricting the possibility of making them more complex. It is concluded that teachers should be trained in the design of significant questions that allow children valuable learning to understand the phenomena that surround them. Keywords: early childhood; teaching; natural sciences; skills; teacher.

Electroacupuncture, which is the most widely used alternative medicine treatment, has been gradually recognized for its effectiveness; however, its mechanism of action is not fully understood. The NLR family pyrin domain containing 3 (NLRP3) inflammasome is a thoroughly studied inflammasome that is closely associated with Alzheimer’s disease, spinal cord injury, and other diseases and plays an important role in the diagnosis and treatment of human immune system diseases. In recent years, some scholars have found that the NLRP3 inflammasome is a part of the mechanism of action of electroacupuncture, which has attracted further attention. In the current review, using “electroacupuncture” and “NLRP3 inflammasome” as keywords and based on the existing randomized controlled trials or clinical trials, we summarize the mechanisms of electroacupuncture targeting NLRP3 inflammasome in the treatment of different diseases and discuss how to optimize the electroacupuncture protocol to obtain thorough mechanisms of NLRP3 inflammasome in electroacupuncture and improve the level of evidence.