Organ shortage remains a major limitation in liver transplantation, particularly in regions with low donation rates. Marginal grafts, such as those with severe steatosis, are frequently discarded due to the high risk of primary graft dysfunction. Normothermic machine perfusion (NMP) has emerged as a strategy to enable functional assessment and expand the donor pool. Case presentation: We report the case of a 60-year-old donor liver with 70% macrovesicular steatosis and prolonged cold ischemia time (11 hours), initially considered unsuitable for transplantation. A sequential dynamic preservation strategy was implemented, consisting of dual hypothermic oxygenated perfusion (D-HOPE) followed by normothermic ex vivo machine perfusion using the Liver Assist® platform. After 2 hours of NMP, viability criteria were met, including lactate clearance (0.5 mmol/L), adequate bile production (16 mL), and favorable perfusate and bile pH values. The graft was successfully transplanted into a 58-year-old recipient with metabolic dysfunction-associated liver disease and hepatocellular carcinoma. Postoperative evolution was favorable, without graft-related complications. At one-year follow-up, both graft and patient survival were preserved. Conclusion: This case illustrates that normothermic ex vivo machine perfusion, within a dynamic preservation strategy, can enable the safe utilization of liver grafts initially deemed unsuitable. Its implementation may expand organ availability, optimize clinical decision-making, and improve outcomes, particularly in settings with a limited donor supply.
Acute coronary syndrome (ACS) in adults aged 75 years and older poses a clinical challenge due to the high prevalence of comorbidities and the frequent exclusion of this population from clinical trials. In Chile, evidence regarding the characteristics and outcomes of this group is limited. AIM:To describe the clinical and sociodemographic characteristics of patients aged ≥75 years with ACS undergoing coronary angiography at Dr. Hernán Henríquez Aravena Hospital (HHAH) between 2022 and 2023, and to evaluate the association of these variables with clinical outcomes. METHODS:Observational cross-sectional study including patients aged ≥75 years admitted to the Hemodynamics Unit of HHAH between January 2022 and December 2023. Clinical and sociodemographic variables were collected. Outcomes included 30-day and one-year mortality, prolonged hospitalization, and post-event left ventricular ejection fraction (LVEF). Descriptive and comparative analyses were performed. RESULTS:300 patients were included. The mean age was 80.9 years; 63.7% were male, and 40.7% resided in rural areas. Hypertension and dyslipidemia were the most prevalent comorbidities, and multimorbidity reached 94.3%. The most frequent ACS subtype was non-ST-segment elevation myocardial infarction (NSTEMI). Atypical symptoms were present in 53.6% of patients, and 40.6% sought medical care more than 12 hours after symptom onset. Percutaneous coronary intervention was performed in 75.7% of cases. Mortality was 12.7% at 30 days and 31.3% at one year. Reduced post-event LVEF was associated with higher mortality. CONCLUSIONS:This cohort showed a high burden of multimorbidity, delayed presentation, and substantial one-year mortality. The observed association between post-event LVEF and mortality should be interpreted with caution, given the methodological limitations of the study.
Transgender individuals are becoming increasingly visible and have specific healthcare needs. There is very limited information regarding the metabolic effects of gender-affirming hormone therapy, particularly in Latin American populations. AIM:To evaluate the endocrine and metabolic effects of gender-affirming hormone therapies (GAHT) in transgender individuals in Chile, as well as their safety and achievement of treatment targets. METHODS:This ambispective observational cohort study assessed endocrine and metabolic laboratory parameters in transgender individuals over 18 years of age receiving masculinizing or feminizing GAHT over 24 months. RESULTS:124 individuals met the inclusion criteria (58 transfeminine [TF], mean age 25 years, and 66 transmasculine [TM], mean age 22 years). TF participants had a mean height of 170 cm, weight of 72.9 kg, and BMI of 25 kg/m2; TM participants had a mean height of 161 cm, weight of 71.5 kg, and BMI of 28 kg/m2. Among TF participants, 38% were living with HIV, and 31% were receiving PrEP. Regarding anthropometric and laboratory changes during follow-up, TF individuals showed significant increases in weight (1.5 kg, p= 0.035) and estradiol (42 pg/mL, p= 0.001), and a decrease in testosterone (78 ng/dL, p= 0.014). TM individuals showed significant increases in weight (2 kg, p= 0.02), testosterone (359 ng/dL, p= 0.03), LDL cholesterol (7.4 mg/dL, p= 0.004), and hematocrit (5.8%, p= 0.02), as well as decreases in estradiol (31 pg/mL, p= 0.002), LH (9.2 uIU/mL, p= 0.02), prolactin (3.8, p= 0.009), and HDL cholesterol (7.3 mg/dL, p= 0.026). No changes were observed in blood pressure, and no thrombotic events occurred. Hyperprolactinemia was observed in 48% of TF and 34% of TM participants, with spontaneous resolution in 83% of cases. Polycythemia occurred only in TM individuals (39%), and 5% required a phlebotomy. No participants reported regret or discontinuation related to gender identity. CONCLUSION:In our population, GAHT was safe, with no treatment discontinuations due to adverse effects. Transmasculine individuals showed greater variation in the measured parameters.
AIM:To estimate the prevalence of self-reported visual, hearing, and dental impairments in Chilean older adults with type 2 diabetes mellitus (T2DM), assess the association between T2DM and these conditions, and explore their common predictors. METHODS:Cross-sectional study conducted between 2017 and 2019 with 358 community-dwelling individuals aged 65 and older in six Chilean cities. Sociodemographic, clinical, and lifestyle variables were collected through structured interviews. Logistic regression models were used to examine associations and identify predictors. RESULTS:Individuals with T2DM reported significantly higher prevalence of visual (81%), hearing (32%), and dental (68%) impairments compared to those without T2DM (p<0.001). T2DM was significantly associated with all three impairments: visual (OR= 5.8), hearing (OR= 3.4), and dental (OR= 4.8). Duration of T2DM ≥11 years and presence of dyslipidemia were common predictors. CONCLUSIONS:These findings highlight the need to integrate sensory and dental health screening and management in primary care for older adults with T2DM in Latin America, especially in underserved community settings.
Takayasu arteritis is a rare large-vessel vasculitis that often presents with asymmetric or absent pulses, vascular bruits, intermittent claudication, and cerebrovascular symptoms in over 50% of cases. Surgical intervention becomes essential in patients with severe, refractory disease. We report the case of a 30-year-old female presenting with upper limb claudication and decreased visual acuity in the right eye. Physical examination revealed bilateral carotid and subclavian bruits, significant blood pressure discrepancy between upper and lower limbs, and episodes of limb shaking. Vascular imaging demonstrated extensive involvement of the brachiocephalic trunk, common carotid, and vertebral arteries, with marked arterial wall thickening and gadolinium enhancement. Despite high-dose corticosteroids and tocilizumab therapy, the patient showed a poor clinical response. A successful aortobicarotid bypass was performed. This case underscores the importance of surgical revascularization in medically refractory Takayasu arteritis, offering symptom relief and improved quality of life.
The provisions of the Sustainable Development Goals and the World Health Organization indicate that progress must be made toward equity to improve people's lives. In Chile, the achievement of intercultural competence in professional training in health sciences is still pending. The Tuning project indicates that professional training should be oriented toward a competency-based model to ensure a graduate profile that is relevant to the context. AIM:To validate a specific competency and sub-competencies in interculturality for Health Sciences degree programs. METHODS:Descriptive quantitative study, Gwet's AC1 was used to assess inter-rater agreement for the validation of a specific competency and three sub-competencies in interculturality. In the first phase, 10 academics from the field of education and 10 from the field of health from different universities were invited. The second phase involved expert judges with PhD degrees related to the research topic to assess the final agreement. Participants were required to sign an informed consent form before completing the questionnaire. RESULTS:Eight education evaluators and six health evaluators participated in the first phase. A total Gwet AC1 of 0.87 was obtained for education and 0.90 for health. The most discordant results were for the specific competency and sub-competency 1. The suggestions were incorporated and sent to five expert judges from different fields related to the research topic, with which perfect agreement was obtained (Gwet AC1= 1). CONCLUSIONS:The validation of a specific competency and sub-competencies in interculturality was achieved in two phases, with complete agreement among the expert judges in the second phase. It is made available to those who manage the Health Sciences curriculum so that they can incorporate it into their study plans.
Sexual victimization of children and adolescents is a critical public health concern. AIM:The prevalence of different forms of sexual victimization and their sociodemographic correlates were estimated in a nationally representative sample of school-aged children in Chile. METHODS:Data from 13,132 students aged 12 to 18 years were analyzed, drawn from the 2nd National Polyvictimization Survey (2023/2024). An adapted version of the Juvenile Victimization Questionnaire was used. Descriptive analyses and logistic regressions were performed. RESULTS:Lifetime sexual victimization was reported by 28.6% of adolescents, and 17% reported victimization within the past 12 months. The most common forms were verbal sexual harassment and exhibitionism, mostly perpetrated by male adolescents. Being female, identifying as another gender, having a disability, being older, and attending public schools were associated with increased risk. CONCLUSIONS:The findings underscore the need to strengthen prevention policies with an emphasis on gender and disability.
Acute myocardial infarction and ischemic stroke are the leading causes of morbidity and mortality among older adults and represent a growing challenge in Chile due to population ageing. Analyzing their social determinants may help guide equitable public action. AIM:To analyze the social determinants that influence cardiovascular diseases in adults aged 60 years and older. METHODS:A quantitative study was conducted using secondary data from CASEN 2022, focusing on adults aged 60 years and older. The dependent variable was dichotomous; a probit model was applied, and marginal effects were estimated from the results. RESULTS:The findings show that older men, Chilean nationals, those with a low educational level, those aged between 60 and 80 years, those with physical and mental difficulties, those living alone, those without social participation, those living in urban areas, and those with low-income levels have a higher probability of presenting cardiovascular diseases. CONCLUSIONS:Older adults with greater social vulnerability are at higher risk of presenting cardiovascular diseases. This may reflect the impact of health inequities in the older population.
