Clínica Alemana de Santiago ["The German Hospital of Santiago"] is a Chilean private health care facility. It is located in the eastern sector of Santiago de Chile with two facilities: one on Avenida Vitacura (in the Vitacura neighborhood) and the other in La Dehesa. The German Hospital is affiliated with the German-Chilean Beneficence Corporation which was created in 2000 to replace the Beneficent Society of the German Hospital, created on 5 July 1905.
In a large multicenter real-world cohort, we aimed to evaluate outcomes of FLAG-Ida salvage therapy for relapsed/refractory (R/R) acute myeloid leukemia (AML) and validated the SALFLAGE prognostic score. We analyzed 1079 adults with R/R AML treated across 112 PETHEMA institutions over 26 years (1998-2024), including patients with primary refractory disease (36.9%) and first relapse episode (63.1%), with a median age of 52 years. Complete remission composite (CRc) was achieved 56.8%, including complete remission (CR) in 51.0%, CR with incomplete recovery in 4.0%, and morphological-free-state in 1.8%, enabling 35.2% of patients and 62% of responders to proceed to allogeneic transplantation without morphological disease. With median follow-up of 50.9 months, median overall survival (OS) was 10.2 months, with 5-year OS rate of 21.6%. Prior allogeneic transplantation (HR 0.54; p < 0.001) and relapse-free interval ≥ 1 year (HR 0.75; p = 0.024) independently predicted improved OS, whereas modified high-risk cytogenetics including t(8; 21) (HR 3.58; p < 0.001), FLT3-ITD mutation at primary diagnosis (HR 1.61; p < 0.001), and age ≥ 60 (HR 1.43; p < 0.001) conferred inferior OS. Validation of the SALFLAGE score demonstrated moderate discrimination (C-index 0.67), with 5-year survival of 38.4%, 27.2%, and 12.7% across risk categories (p < 0.001). Outcomes improved over periods (1998-2005 vs. 2006-2016 vs. 2017-2024): 30-day mortality was 6.9% vs. 9.3% vs. 5.0%, respectively (p = 0.030), and median OS was 7.8 versus 9.4 versus 11.1 months, respectively (p = 0.16). We confirm FLAG-Ida as a reference salvage regimen in fit R/R AML and validate the SALFLAGE score in this setting.
Background: The diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) relies on sensitive serological detection of MOG-IgG. Fixed cell-based assays (CBAs) may yield low-positive or borderline results that complicate early clinical decision-making, whereas live CBAs—recommended as the reference method—preserve native antigen conformation and offer higher analytical sensitivity. Importantly, low-positive titres should not be confused with true seronegativity, as they may nevertheless be clinically meaningful. Case Presentation: A 14-year-old previously healthy male presented with left optic neuritis and perineuritis following an upper respiratory infection. Initial MOG-IgG testing on a fixed CBA was low-positive (1:10). He partially responded to intravenous methylprednisolone and required intravenous immunoglobulin (IVIG) for complete resolution. Over three years, he experienced sequential, steroid-dependent bilateral optic neuritis with perineuritis, relapsing on every steroid taper. Rituximab and subsequently mycophenolate mofetil failed to induce remission. Repeat testing with a live CBA at a reference laboratory yielded a high-positive MOG-IgG titre of 1:1000, confirming MOGAD. Tocilizumab (8 mg/kg every 4 weeks) was initiated and allowed complete corticosteroid withdrawal. At age 18, the patient remained asymptomatic, with an Expanded Disability Status Scale score of 0, best-corrected visual acuity of 20/20 in both eyes, and stable peripapillary retinal nerve fibre layer thickness on spectral-domain optical coherence tomography. Conclusions: In paediatric patients with recurrent optic neuritis with perineural involvement and borderline fixed-CBA results, confirmatory testing with a live CBA at a reference laboratory should be considered to avoid diagnostic delay and therapeutic misdirection. In refractory, steroid-dependent cases, IL-6 receptor blockade may represent a reasonable therapeutic option, in line with emerging evidence.
LITERATURE REVIEW:Breaking combines dance and acrobatics, making it a physically demanding discipline. Limited evidence suggests muscular imbalances in isometric shoulder strength and jump performance. To date, research has primarily focused on male participants and has not included isokinetic dynamometry assessments. OBJECTIVE:To analyze the isokinetic strength of the shoulder internal and external rotators and the knee flexors and extensors in female breakers, and to explore their association with training habits. METHODS:A retrospective cross-sectional analysis was conducted on eight women with over 5 years of breaking experience. Concentric isokinetic strength tests were performed for shoulder rotators (at 90°/s and 240°/s) and knee flexors and extensors (at 60°/s and 180°/s). Peak torque, Inter-Limb Asymmetry Index (IAI), hamstring-to-quadriceps (H:Q) ratio, and external-to-internal shoulder rotation (ER:IR) ratio were calculated. Spearman's rank correlation coefficient (ρ) assessed relationships between training habits and isokinetic strength measures. RESULTS:In the shoulder test at 90°/s, the median IAI for internal rotator peak torque was 14.0% (7.7-17.0). The ER:IR ratio showed median values of 38.0% (36.7-44.0) in the right arm and 32.5% (29.2-42.7) in the left. A positive correlation was found between ER:IR ratio and weekly resistance training hours (ρ = .709; P = .049). In the knee test at 60°/s, a positive correlation was observed between extensor torque IAI and weekly breaking hours (ρ = .70; P = .049). At 180°/s, flexor torque IAI was positively correlated with years of breaking practice (ρ = .929; P < .001). CONCLUSION:Female breakers exhibit shoulder and knee muscle imbalances associated with training duration and volume. These findings support the relevance of targeted strength assessments and preventive strategies in this population.
BACKGROUND:National data on clinical pharmacy implementation can inform health policy, resource allocation, workforce planning, and academic development. In Chile, such data are limited, particularly for therapeutic drug monitoring (TDM). The objective of this study was to characterize the clinical pharmacy workforce in Chilean hospitals and describe the implementation of core clinical activities, with an emphasis on TDM. METHODS:A national cross-sectional survey was conducted among pharmacists performing clinical functions in Chilean hospitals, using the 2024 registry of the Clinical Pharmacy Division of the Chilean Society of Intensive Care Medicine as the sampling frame. Descriptive analyses were performed; workforce capacity was expressed as full-time equivalents (FTEs) and regional density per 10 000 inhabitants. RESULTS:Of 220 invited pharmacists, 181 responded (82.3%), representing 83 institutions across 15 of 16 administrative regions. Median age was 35 years (interquartile range [IQR] 31-39); 28.2% were registered Clinical Pharmacy Specialists, and 77.1% worked in public hospitals. The highest density was in the Metropolitan Region (0.12 FTE/10000 inhabitants), followed by Tarapacá and Antofagasta (0.09 each). Deployment was most frequent in Infectious Diseases (36.5%) and intensive care units (34.8%). Pharmacotherapy follow-up and medication therapy review were each reported by 94.5%, adverse drug reaction reporting by 87.3%, and involvement in TDM by 85.1%. Teaching and research were reported by 44.8% and 30.4%, respectively, but 95.5% reported no formally protected time. TDM was available in 81.9% of centers, most commonly for vancomycin (80.7%), valproic acid (63.9%), amikacin (60.2%), and phenytoin (57.8%); pharmacokinetic software to support dose individualization was used in 61.4% of centers. CONCLUSION:Clinical pharmacy services in Chile are broadly integrated into hospital care-particularly in infectious diseases, critical care, and TDM-while gaps persist in formal credentialing, regional workforce distribution, and institutional structures supporting academic activities.
