Hospital la Serena

La colelitiasis se encuentra entre los trastornos patológicos más frecuentes que enfrenta la humanidad. En los últimos años, la prevalencia de cálculos biliares de colesterol ha mostrado una tendencia ascendente significativa, principalmente en los países del Este, debido a los cambios en el estilo de vida y a los cambios demográficos. La investigación actual ha suscitado debate sobre la compleja patogénesis de los cálculos biliares y el posible papel del esfínter de Oddi en esta afección. Las presiones dentro de la vía biliar dependen de varios factores, incluyendo la función normal del esfínter de Oddi, el diámetro ductal, el contenido ductal y la regulación hormonal. La disfunción del esfínter de Oddi puede provocar el reflujo de enzimas pancreáticas hacia el tracto biliar, lo que provoca inflamación de la mucosa, cambios moleculares, colelitiasis, dilatación de la vía biliar común y en algunos casos, cáncer de vesícula biliar. Las presiones elevadas dentro de la vía biliar también pueden activar mecanismos moleculares que inducen la formación de cálculos de colesterol. Este conocimiento desafía paradigmas anteriores y abre nuevas vías de investigación para comprender mejor la fisiopatología del tracto biliar y encontrar formas de modificarlo y prevenir enfermedades graves.

ABSTRACTBackgroundInotuzumab Ozogamicin (InO) has shown efficacy in relapsed/refractory acute lymphoblastic leukemia (R/R ALL), but evidence from Latin America is scarce. We evaluated the outcomes of Chilean patients treated with InO in public and private health centers.MethodsWe retrospectively analyzed 35 patients with R/R ALL (median age 33 years; 54% male). Twenty percent had BCR::ABL‐positive ALL, 78% expressed CD22, and 91% expressed CD19. Response rates, measurable residual disease (MRD), survival outcomes, and treatment‐related toxicities were assessed. Multivariate analyses explored prognostic factors.ResultsComplete remission or remission with incomplete recovery (CR/CRi) was achieved in 74% of patients. Among those evaluated, 82% reached MRD < 0.01%. Patients undergoing allogeneic hematopoietic stem cell transplantation (Allo‐HSCT) after InO had superior overall survival (OS) compared with those who did not (24.2 vs. 5.2 months). Median progression‐free survival (PFS) was 6.9 months and median OS was 8.8 months. Sinusoidal obstruction syndrome occurred in 14% of patients but was generally mild. Multivariate analysis identified comorbidities and high blast counts as adverse prognostic factors, whereas MRD negativity and subsequent Allo‐HSCT were associated with improved outcomes.ConclusionsInO demonstrated high remission and MRD negativity rates in Chilean patients with R/R ALL, with OS and PFS comparable to existing research. Although SOS incidence was higher, it was generally mild. Achieving MRD negativity and proceeding to Allo‐HSCT provided the greatest survival benefit. Study limitations include short follow‐up and limited data.

Background/Objectives: Celiac disease (CD) alters nutrient absorption and body composition, especially during childhood. Although adherence to a gluten-free diet (GFD) promotes mucosal recovery, its impact on cellular functionality and metabolic balance remains underexplored. This study aims to evaluate the utility of bioelectrical impedance vector analysis (BIVA) in assessing nutritional status, inflammatory improvement, and body composition changes in pediatric patients with CD following a GFD. Methods: Seventy-nine children aged 5-14 years were studied. Three groups were analyzed: (1) 25 children with newly diagnosed CD, evaluated at diagnosis and after 12 months of GFD (prospective cohort); (2) 25 CD patients on a GFD for over 24 months (cross-sectional); and (3) 29 healthy controls. Body composition (fat mass (FM), fat-free mass (FFM), body cell mass (BCM), phase angle (PhA), and Na+/K+ ratio) was measured. GFD adherence was assessed and a dietary assessment was also performed. Results: After 12 months on a GFD, newly diagnosed CD patients showed significant increases in FM (from 8.2 to 10.1 kg, p = 0.001), FFM (p = 0.001), and BCM (p = 0.0001), along with a significant decrease in the Na+/K+ ratio (p = 0.015). Compared to healthy controls, CD children on GFD for more than 24 months had higher FM (12.2 vs. 8.8 kg, p = 0.013) and lower Na+/K+ ratios (p = 0.006). PhA increased slightly over time but did not reach statistical significance. Conclusions: Our study suggests that the adherence to a GFD leads to improved body composition and cellular homeostasis in children with CD, as reflected by increases in BCM and reductions in Na+/K+ ratio, making it a promising biomarker for monitoring inflammation and cellular recovery.

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).

Introducción: la infección por SARS COV2 tiene una prevalencia de 7.6% en la población pediátrica colombiana; sin embargo, de estos pacientes solo un 0.03 a un 0.4% ingresan a unidad de cuidados intensivos presentando factores que podrían contribuir al desarrollo de una falla multiorgánica. Objetivo: determinar los factores riesgo asociados a la presencia de falla multiorgánica en paciente pediátricos con diagnóstico de infección por SARS-COV2. Métodos: se estudiaron todos los niños de 1 mes a 18 años de edad hospitalizados entre marzo de 2020 y enero de 2022 en el Hospital Infantil Napoleón Franco Pareja, Cartagena, Colombia, con diagnóstico confirmado de infección por SARS-COV-2. Se investigó la asociación entre las variables demográficas, bioquímicas o imagenológicas con desenlaces como síndrome de distrés respiratorio agudo, shock séptico, inflamación multisistémica asociada a Covid-19, lesión renal aguda y daño miocárdico. Resultados: fueron incluidos 43 pacientes, el 60.5% fue diagnosticado como Síndrome de Inflamación Multisistémica relacionada a Covid-19, de los cuales un alto porcentaje requirió admisión a Cuidados Intensivos Pediátricos por el riesgo de complicaciones. El 11.6% de los pacientes tenía inmunosupresión que se asoció a enfermedad grave (18.6%) y crítica (25.6%). Se encontró una asociación estadísticamente significativa entre el desarrollo de falla multiorgánica (14%), y la, presencia de comorbilidades (p= 0.00416), severidad de la enfermedad (p= 0.0113) y fracción de eyección disminuida (p=0.0278). Conclusión: los pacientes pediátricos con infección por SARS COV 2 confirmada (Covid-19) presentan de manera infrecuente falla multiorgánica. Se encontró asociación entre el desarrollo de falla multiorgánica con la elevación de LDH, lesión miocárdica instaurada durante la infección y la presencia de comorbilidades, especialmente aquellas que involucran inmunodeficiencias primarias

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.