Hospital Regional de Talca

BackgroundUnintentional pesticide poisoning is a global health concern, disproportionately affecting agricultural workers in developing countries due to inadequate regulations and limited access to protective equipment. While questionnaires offer a cost-effective alternative for assessing organophosphate (OP) pesticide exposure compared to urinary (e.g., Dialkyl Phosphates, DAPs) or blood biomarkers (e.g., acetylcholinesterase, AChE, and butyrylcholinesterase, BChE), these tools require validation against gold-standard methods. This study validated a questionnaire assessing occupational OP exposure among Chilean agricultural workers in the Maule region, contrasting its performance against DAP levels and AChE and BChE inhibition.MethodsA longitudinal study was conducted with 51 agricultural workers. Urinary DAPs, measured via liquid chromatography–tandem mass spectrometry, AChE, and BChE activities, determined by Ellman’s method, were measured before (T0) and during (T1) the spray season. The questionnaire was administered at T1. Sensitivity, specificity, predictive values, and Receiver Operating Characteristic (ROC) curve analyses were performed to assess the accuracy.ResultsUrinary DAP levels and AChE inhibition increased in T1 (from 6.54 ± 4.66 to 12.39 ± 9.88 μg/g creatinine, p = 0.004, and from 2.26E-3±6.53E-4 to 1.44E-3±2.73E-4 mmol/min-1*mgProt-1, p < 0.001, respectively), with AChE inhibition (30.99%) exceeding Chilean regulatory threshold. The questionnaire score correlated with AChE inhibition (p = 0.0063) but not with BChE inhibition or DAP levels. Sensitivity was 64%, and specificity improved from 56% to 71% when using a 20% AChE inhibition threshold instead of a 30%.ConclusionAgricultural workers in the Maule region are exposed to OP pesticides. The questionnaire shows potential as a screening tool for occupational exposure. These findings highlight the need to reassess the Chilean regulatory limits and refine the tool to enhance risk assessment and intervention planning.

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).

Background There is limited evidence on the symptoms of peripheral neuropathy in chemotherapy patients, particularly in the Maule Region of Chile. Aim To characterize symptoms of chemotherapy-induced peripheral neuropathy (CIPN) among patients undergoing chemotherapy for various types of cancer at a Public Hospital in the Maule Region of Chile. The secondary objective was to assess sex-related differences in peripheral neuropathy symptoms and to examine the association between age and neurotoxicity symptoms. Methods Adult patients undergoing chemotherapy were remotely assessed, and their sociodemographic and clinical data were collected. CIPN was evaluated using the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group–Neurotoxicity questionnaire (FACT-GOG-NTX) questionnaire. Descriptive analyses were performed, along with the Mann–Whitney test for gender differences and Spearman’s Rho for correlations with age were used. Results Of the 122 patients (mean age 58), 74.6% were women, 32.8% had breast cancer, and 22.1% were at stage III. Pain was reported by 32% of patients. Former smokers made up 39%, and 47.5% were occasional alcohol drinkers. Women had lower social/family well-being (SWB) and functional well-being (FWB) than men ( p &lt; 0.05), with no other significant differences. In women, higher age correlated with lower SWB and emotional well-being (EWB) (Rho = −0.31 and −0.30, respectively) and greater neurotoxicity symptoms (Rho = 0.22). Conclusion CIPN affects adult women, particularly those employed, with outcomes linked to pain and stage III cancer, often involving tobacco and alcohol use. Women report lower well-being scores than men. Hematologic and multiple myeloma patients had the lowest FACT-GOG-NTX scores. Symptoms primarily impact sensory and motor function, emphasizing the need for early neurotoxicity assessment and treatment.

ResumenEl objetivo de esta investigacin es analizar la responsabilidad social profesional (RSP) de titulados en ciencias administrativas, econmicas y contables en Chile.Se aplica un instrumento a una muestra no probabilstica compuesta por 137 profesionales.La metodologa es de carcter exploratorio y se aplica un instrumento validado.Se realiza un anlisis factorial exploratorio y se examinan diferencias estadsticamente significativas.Los resultados demuestran diferencias segn: sexo, voluntariado y organizacin social.Las universidades deben implementar polticas educativas que incluyan los valores de la responsabilidad social en consistencia con los perfiles profesionales en coherencia con las necesidades de las empresas modernas.En conclusin, los resultados de esta investigacin deben ser usados por instituciones de educacin superior (IES) de acuerdo a las caractersticas de la disciplina profesional y la singularidad de los requerimientos de los grupos de inters que habitan sus territorios de influencia.

RESUMENEl propósito de este trabajo es profundizar en los aspectos éticos que experimenta el equipo de salud cuando reciben la indicación de limitar el esfuerzo terapéutico o la orden de no reanimar. Desde un paradigma interpretativo, cualitativo y con un enfoque de análisis de contenido, se realizó un proceso basado en tres fases: preanálisis en el que se identificaron las categorías, la proyección del análisis y el análisis inductivo. Durante 2023, se realizaron entrevistas en el entorno clínico de un hospital de alta complejidad en Chile a 56 miembros de equipos de salud de unidades críticas y urgencias, de las que emergieron cuatro categorías: a) riesgo de vulnerar los derechos de los pacientes al utilizar la orden de no reanimar, y limitación del esfuerzo terapéutico; b) brecha en la interpretación del marco legal que aborda la atención y cuidado de pacientes al final de la vida, o con enfermedades terminales por parte del equipo de salud; c) conflictos éticos de la atención al final de la vida; y d) el cuidado eficiente o el cuidado holístico en pacientes con enfermedad terminal. Existen brechas importantes en la formación en bioética y aspectos del buen morir en los equipos de salud que se enfrentan a la orden de limitar el esfuerzo terapéutico y no reanimar. Se sugiere capacitar al personal, y trabajar una guía de consenso para abordar los aspectos éticos del buen morir.

Type 2 diabetes mellitus is a metabolic condition where vascular inflammation and oxidative stress contribute to disease progression and associated complications. Although statins are recommended for managing dyslipidemia in diabetes, additional therapies are often required to achieve target lipid levels. This meta-analysis aimed to evaluate the efficacy of rosuvastatin monotherapy versus combination therapy with ezetimibe in patients with type 2 diabetes. A systematic literature search was conducted across multiple databases until April 2024, identifying six randomized controlled trials meeting the inclusion criteria. The meta-analysis revealed that the rosuvastatin plus ezetimibe combination resulted in significantly greater reductions in total cholesterol (mean difference, or MD: 19.49; 95% CI: 13.99 to 24.99), triglycerides (MD: 13.44; 95% CI: 2.04 to 24.85), and low-density lipoprotein cholesterol(MD: -17.68; 95% CI: 12.85 to 22.51) compared to rosuvastatin monotherapy. Conversely, rosuvastatin monotherapy achieved a greater reduction in HbA1c levels (MD: -0.11; 95% CI: -0.17 to -0.04). Subgroup analysis demonstrated that using the same dose of rosuvastatin in both groups led to more significant improvements in lipid parameters with lower heterogeneity. The findings suggest that the rosuvastatin-ezetimibe combination may be a more effective lipid-lowering strategy for patients with type 2 diabetes, though larger studies are needed to assess long-term safety and optimal dosing. Additionally, while rosuvastatin monotherapy provided modest HbA1c reductions, the clinical relevance remains uncertain, and potential risks with high-dose statins should be considered.