Hospital Las Higueras

Children and adolescents who identify as transgender report mental health-associated conditions and limited or low family support. This research aims to describe the mental health state and family support of transgender users between 7 and 18 years old treated by the Gender-Affirming Pediatric Care Team at Las Higueras Hospital from December 2018 to May 2023. This research is a cross-sectional analytical study of the entire transgender population (between 7 and 18 years old) treated by gender-affirming pediatric care specialists between 2018 and 2023 (N = 72). There has been a progressive increase in the number of users from this population, mostly pubescent children and adolescents, with a higher prevalence of suicide ideation (74%), depressive disorders (68%), anxiety disorders (65%), and autism spectrum disorder (40%). Most of them had the support of their families, and when they did not have this support, the likelihood of attempting suicide was 1.52 times higher. Health professionals must intervene in the mental health of this population group and support their families, as parental support is a protective factor for mental health.

Extracorporeal hemoadsorption is a promising therapeutic strategy for neurological complications associated with chronic kidney disease and acute kidney injury. Neurological disorders—including cognitive impairment, Parkinson disease, and dementia—are more prevalent in individuals with renal dysfunction due to shared inflammatory pathways and the accumulation of protein-bound uremic toxins (PBUTs), such as advanced glycation end products (AGEs), indoxyl sulfate, and p-Cresol. PBUTs exacerbate neurological conditions by promoting neuroinflammation and neurodegeneration. They are inadequately removed via conventional dialysis, necessitating alternative solutions. Hemoadsorption has shown potential in reducing systemic inflammation and eliminating PBUTs, offering neuroprotective and disease-modifying effects. Preclinical studies have demonstrated significant reductions in AGEs, indoxyl sulfate, and amyloid-beta peptides in models of Alzheimer’s disease (AD) and other conditions, improving outcomes. In clinical trials involving inflammatory disorders such as Guillain-Barré syndrome, hemoadsorption reduced cytokines—including tumor necrosis factor alpha, interleukin-17 (IL-17), and IL-22—correlating with enhanced recovery and reduced ventilation requirements. While evidence supports its efficacy, further research is needed to standardize protocols, evaluate long-term outcomes, and explore its potential in broader populations. Hemoadsorption could transform the management of individuals with renal and neurological disorders, improving disease outcomes and quality of life.

Hodgkin lymphoma (HL) is classified as the first malignancy to be cured by a combination of chemotherapy and radiotherapy. However, the life expectancy of HL survivors is hampered by the occurrence of late adverse events, including second malignant neoplasms (SMNs) and cardiovascular diseases (CVDs). We investigated the causes of death in a cohort of 1,435 patients over age 15 years treated at 18 different public cancer centers in Chile. After a median follow-up of 19 years (0-37), the 5-year overall survival improved from 64% in the cohort 1985-1994 to 81% in the cohort 2009-2014 (P < .001). HL was the main cause of death in the first 10 years after treatment, whereas SMN and CVD risk peaked 10-15 years and remained raised for 30 years or longer. Cumulative incidence of deaths (CIDs) due to SMNs resulted significantly higher in patients treated with cyclophosphamide, vincristine, procarbazine, prednisone (MOPP)/MOPP-like regimens over doxorubicin, bleomycin, vinblastine, dacarbazine. CIDs due to CVDs increased from 0.4 to 4.1 at 5 and 20 years, respectively. HL survivors continue to have a reduced life expectancy due to an increased risk of dying of SMNs and/or CVDs, although it was lower among patients treated in the most recent calendar period studied (2002-2014).

Cancer care guidelines have been developed in many subspecialities, usually in advanced health systems. However, there are notable global disparities in healthcare access, which can impact sarcoma care. Unfortunately, there is a lack of global data on this subject. Our aim was to describe access to sarcoma care based on a comprehensive global survey among orthopaedic oncologists, and assess for global as well as regional differences. A 25-question survey was emailed to the attendees of the 2024 Birmingham Orthopaedic Oncology Meeting and included questions about the respondents' training and practice, access to sarcoma centres, and specific items for sarcoma diagnosis and treatment. For data analysis and comparison, countries were grouped geographically and per the World Bank's income classification. A total of 192 specialists from 47 countries completed the survey (67%). Overall, 40% declared that most patients in their country were treated in a specialized sarcoma centre. Declared access to specific diagnostic technology ranged from 69% (translocation studies) to 86% (various immunohistochemistry). Only 31% stated having access to proton therapy and 82% to all possible reconstruction methods. Compromise of ideal surgical management because of prior treatments and financial constraints was declared to have happened regularly in 40% and 17% of practices, respectively. Regions with better-developed healthcare systems had improved access to all aspects surveyed. Similar results were observed when comparing high-income countries against low- to middle-income countries. Our study highlights substantial global and regional disparities in access to sarcoma services, which could potentially impact clinical outcomes. Further studies are needed to clarify this reality.

Technological advances and interprofessional teamwork have significantly improved survival rates of critically ill patients. However, this progress has also introduced new challenges, such as intensive care unit-acquired weakness, which can contribute to postintensive care syndrome. Both conditions are associated with increased morbidity and mortality, prolonged length of hospital stay, higher social and health care costs, and reduced quality of life for patients and their families. Timely physical therapy plays a crucial role in mitigating intensive care unit-acquired weakness and postintensive care syndrome. Key recommendations for the effective rehabilitation of patients in the intensive care unit include education and training, communication and collaboration, patient screening, planning of activities, distribution of functions focused on teamwork, patient cooperation, safety assessments, patient positioning, functional mobilization, and documentation of outcomes. This narrative review aims to update the current understanding of the influence of physical therapy and critical care teamwork on intensive care unit patients and to provide evidence-based recommendations for promoting early mobilization in the intensive care unit setting.

Testicular torsion (TT) is a critical condition caused by spermatic cord twisting, which can result in irreversible testicular damage without timely intervention. In Chile, centralised healthcare and significant geographic barriers can delay treatment for TT, which potentially worsens outcomes. This study evaluates the impact of referral status on orchiectomy rates among paediatric TT cases treated at two hospitals in Southern Chile. A cross-sectional analysis was conducted on TT cases in patients under 15 years. These patients were treated at Hospital Guillermo Grant Benavente and Hospital Las Higueras between January 2018 and January 2024. Data on demographics, symptom duration, referral status and treatment timelines were analysed using Wilcoxon rank-sum and Pearson's Chi-squared tests, with significance set at p < 0.05. Among 144 patients, 71% were referred from other facilities. Orchiectomy was performed in 44 cases, with a median symptom duration of 48 h, which was significantly longer than that of non-orchiectomy cases (5 h, p < 0.001). Referred patients showed a higher crude orchiectomy rate (35% vs. 20%; p = 0.064). However, in the multivariable analysis with adjusted age, hospital and symptom onset time, referral emerged as an independent predictor of orchiectomy (odds ratio (OR) = 3.68; 95% confidence interval (CI): 1.15-13.1; p = 0.035). Referral delays in TT management correlate with increased orchiectomy rates. Enhancing specialist access and referral protocols is crucial to reducing treatment delays and improving outcomes in regions with dispersed healthcare services.

We read with interest the recent article by Hohn et al., addressing the efficacy of the hemoadsorption technique in managing cytokine elevation following cardiac surgery, with a particular focus on renal outcomes and the evolving role of extracorporeal blood purification.The REC-CAS study on CytoSorb and the SIRAKI02 randomized trial on oXiris membranes represent pivotal contributions to this field.Yet, they also share limitations that must be carefully considered [1,2].