Hospital Regional Rancagua

Endoscopic intranasal tooth removal is an underreported alternative in the literature. However, it is gaining increasing popularity because, in trained professionals, it is a reliable, safe, and minimally invasive technique, which can translate into lower postoperative morbidity and a decreased risk of infection. We report the case of a 46- year-old female patient who presented with a displaced root remnant into the nasal cavity as a complication following the extraction of her upper right third molar. The transnasal endoscopic approach was successfully performed. This procedure offers significant advantages, such as faster recovery, less discomfort for the patient, a lower risk of bleeding, and improved visualization of the anatomy.

Myasthenia gravis (MG) is a rare, chronic, and progressive autoimmune disorder that can lead to significant disability in its advanced stages. This retrospective observational study aimed to estimate the prevalence of MG in the O’Higgins Region of Chile and provide a comprehensive characterization of patients’ clinical profiles, including medical history, diagnostic findings, and therapeutic responses. A female predominance (n=47, 66.2%) was observed, and most patients showed abnormalities in electrophysiological studies. In nearly all cases, diagnosis was established through autoantibody testing, with acetylcholine receptor antibodies being the most frequently identified. The most frequent comorbidities included mood disorders, hypertension, and thyroid dysfunction. Most patients received cholinesterase inhibitors; corticosteroids were used in 74.6% of cases, and one-third were treated with conventional immunosuppressants. A smaller group received biological therapies such as rituximab or other newer agents, ravulizumab. Despite the range of available treatments, approximately 20% of patients exhibited a refractory disease course. MG is a disease with a multifaceted impact on patients' personal, social, and occupational lives. The findings of this study may support the development of targeted health policies aimed at improving comprehensive care for MG patients in Chile.

Necrotizing Fasciitis (NF) is a severe and aggressive disease with rapid progression associated with systemic diseases, its presentation is rare in the head and neck region. We present the case of a 69-year-old patient who consulted urgently for a 3-day history characterized by right molar pain with subsequent increase in right facial volume and periorbital cellulitis, with uncontrolled diabetes mellitus. The condition showed a cyclical evolution influenced by existing comorbidities, with the patient undergoing both surgical and medical treatment with a multidisciplinary team. Additionally, we carried out a review of the literature on FN. The patient's survival outcomes were favorable; However, the consequences were disabling both aesthetically and functionally. The literature review revealed the rarity of such cases and the peculiarities of the presented case compared to those reported in the literature so far. An early diagnosis based on its clinical manifestations and complementary studies can lead to correct management of the disease.

Background The thoracic ultrasound (TUS) is a monitoring tool that has gained worldwide popularity in various scenarios, offering the opportunity for dynamic, bedside evaluations. Recent studies indicate that the use of TUS enables the diagnosis of pathologies resulting from blunt chest trauma (BCT), yielding favorable outcomes. This study aimed to compare the utility of TUS versus chest radiography (CXR) in diagnosing pulmonary pathologies resulting from closed-chest traumas. Methodology A prospective cross-sectional study was conducted with a sample of 58 patients diagnosed with BCT who sought emergency care at the "Dr. Luis Razetti" University Hospital in Barcelona, Venezuela, from November 2023 to January 2024. Results Of the patients, 75.9% (n = 44) were male, with an average age of 37.8 years (standard deviation = 18.4 years). Injuries were reported in 8.6% (n = 5) of the patients, including 60% (n = 3) pneumothorax and 40% (n = 2) hemothorax. Ultrasound results coincided with CXR in 94.8% (n = 55) of the cases, with a Cohen's kappa coefficient of 0.9 (95% confidence interval (CI) = 0.642-1.0). TUS demonstrated higher sensitivity than CXR (100% vs. 60%) for detecting hemothorax and pneumothorax in patients with BCT, with an area under the receiver operating characteristic curve of 0.991 (95% CI = 0.968-1.013). Conclusions BCT predominantly occurred in young males, resulting primarily in pneumothorax and hemothorax lesions, detectable with higher sensitivity through TUS compared to CXR. The use of TUS should be considered an essential component of the initial assessment for individuals with BCT.

Antecedentes: El Shock Cardiogénico (SC) y las Angioplastías de Alto Riesgo (AAR) están asociadas con altas tasas de mortalidad. El uso del dispositivo Impella CP podría reducir el riesgo de muerte en estos escenarios. En Chile no existen reportes evaluando el uso del dispositivo Impella CP.

ABSTRACT Wet muck is a problem in underground mines due to the consequences it brings to the safety of workers, equipment, mining infrastructure, drawpoints, production drifts, and productive sectors, which can generate a loss in reserves. This paper describes a mathematical model to estimate wet muck entry for long-term planning applications at El Teniente. Three basins of El Teniente were included in the study of wet muck control: North, Centre, and South. Each basin includes mines with different characteristics in each exploitation sector. Consequently, models were built for each of the basins to represent its distinct reality. The models have been embedded in machine-learning software that estimates hazards associated with the extraction process for underground mines. To create the models, several variables – each associated with historical extraction – were investigated, including the extraction ratio and the height of draw, amount of water entering the cave, season of the year, presence of mud in neighbouring drawpoints, sectors closed due to wet muck above, and changes in surface or depressions. This study also includes granular flow variables and lithologies. In addition, fragmentation was included and estimated with a granular flow simulator, and the information was validated and calibrated with data from the El Teniente mine. Results indicate that our classification models can reproduce the wet muck phenomenon with an acceptable precision between 69% and 75% and an average tonnage error per drawpoint of 6%−15%. The approach detailed here to create models could be applied to other mine sites if the necessary data are available.

In rainy areas, sweet cherries are cultivated under plastic covers, preventing the cracking of the fruit but decreasing the firmness and acidity of the cherries. We evaluated the impact of plastic cover and pre-harvest K foliar application on quality parameters, antioxidant properties, and phenolic and organic acid compositions in fruits of sweet cherry cv. Regina of Southern Chile. Our results showed that K+ increased firmness, total soluble content, size, fruit weight, and titratable acidity at harvest, independent of the cover factor. The positive impacts of foliar K fertilization on anthocyanins, flavonoids, and phenolic acids could explain the higher antioxidant capacity of fruits. Our study revealed that the additional K doses applied increased malic acid, the main organic acid in cherry fruits, but only in fruits from uncovered trees. In covered trees, the effect was reversed. Citric acid was higher in fruit from covered trees. Our results indicated that tartaric acid also increased with the application of higher K doses; however, this acid was detectable only in uncovered tree fruit. Interestingly, all organic acids were lower in fruits produced in the lower canopy than those detected in fruits harvested from the upper canopy. This showed the positive impact of canopy light exposure on maintaining suitable acidity levels in sweet cherry fruits.

The flipped classroom is an active method where information in delivered before class and the time allocated for it is dedicated to achieving more complex learning objectives. Diverse resources are used in each phase of the methodology. However, Web 2.0 or "Social Web" tools allow greater personal and remote interaction. To describe the perception about flipped classroom methodology implemented using web 2.0 tools in 48 medical students from the University Mayor. The students were invited to view four video-classes available on Edpuzzl. During the activity, questions about the topic were inserted to promote understanding, research, and teamwork, then the topic was discussed using Case-Based Learning through the Quizizz program. A survey composed of 12 closed items and an open question was applied to analyze the perceptions of students. Data were analyzed using the SPSS and Atlas-Ti programs. A high satisfaction rate was observed about the way in which the content, discussion and communication of the information was presented. The methodology encouraged the development of generic competences, but it was not always positively perceived. The flipped classroom methodology developed with Edpuzzle was very well evaluated by students. This teaching method may be particularly useful in the epidemiological context of COVID-19 and other situations which require distant learning.

Abstract Background: Home mechanical ventilation (HMV) is a viable and effective strategy for patients with chronic respiratory failure (CRF) of different causes. The Chilean Ministry of Health started in 2006 a program for HMV in Children and in 2008 it began a program for HMV in adults. All belonged to the state health insurance.Methods: Prospective cohort of adult patients with CRF in 10 regions of Chile admitted to the national HMV program, their demographic, clinical and functional characteristics, mode of admission, time in the program and survival.Results: A total of 1,105 patients were included. Median age was 59 years (44-58, IQR1-IQR3). Women were 58.1%. The body mass index was 34.9 (26-46) kg/m2, and 942 (85.4%) belonged to low-income socioeconomic groups. The baseline score on the Severe Respiratory Insufficiency questionnaire (SRI) was 47 (35-62.1) points, 98.5% lived in urban areas, 76.2% initiated HMV in the stable chronic mode, 23.8% in the acute mode and 99 patients were transferred from the children's program. There were 1047 patients on noninvasive ventilation and 58 on invasive ventilation through tracheostomy. Baseline PaCO2 was 58.2 (52-65) mmHg. Device usage time was 7.3 h/d (5.8-8.8), the time in HMV was 21.6 (12.2-49.5) months. The diagnostic groups were COPD, 35%; obesity hypoventilation syndrome (OHS), 23.9%; neuromuscular disease (NMD) 16.3%; non-cystic fibrosis bronchiectasis or tuberculosis (non-CF BC or TBC) 8.3%; Scoliosis, 5.9%; and Amyotrophic Lateral Sclerosis (ALS) 5.24%. The lowest 1- and 3-year survival rates were observed in the ALS group, i.e., 67% and 26%, respectively, and the lowest 9-year survival was observed in the non-CF BC or TB and COPD, 27% and 30.9%, respectively. The best survival rates at 9 years were 57.7%, 57.2% and 50.9% for patients with OHS, Scoliosis and NMD, respectively.Conclusion: The most common diagnoses were COPD and OHS. Patients were hypercapnic and had poor quality of life at program admission. The best survival was observed in patients with OHS, Scoliosis and NMD.