vgaraujov/thesis-chile huggingface dataset:
Efficacy and safety of chest physiotherapy in adult patients with community-acquired pneumonia

La neumonía adquirida en la comunidad es la principal causa de muerte de origen infeccioso en la población infantil y adulta de nuestro país. La fisioterapia respiratoria (FR) ha sido ampliamente utilizada como tratamiento adyuvante en pacientes adultos con neumonía comunitaria, sin que se haya demostrado aún su eficacia clínica. En teoría, estas técnicas podrían ayudar a mantener abiertas las vías aéreas, facilitar la eliminación de secreciones bronquiales y mejorar el intercambio de gases en pacientes con neumonía. Revisamos los estudios publicados que han examinado la eficacia y seguridad de la FR en pacientes adultos con neumonía adquirida en la comunidad. Resultados: Seis ensayos clínicos controlados han evaluado cuatro modalidades de fisioterapia respiratoria en pacientes hospitalizados por neumonía comunitaria: a) La fisioterapia torácica convencional (vibración, percusión y drenaje postural); b) La manipulación osteopática (incluyendo la inhibición paraespinal, elevación costal y la liberación diafragmática o miofascial); c) El ciclo activo de técnicas de respiración (incluyendo el control de la respiración activa, ejercicios de expansión torácica y técnicas de espiración forzada); y d) La respiración con presión espiratoria positiva. Ninguna de estas técnicas ha logrado reducir en forma significativa la mortalidad hospitalaria o ha modificado la tasa de curación. Algunos estudios sugieren que la manipulación osteopática y la respiración con presión espiratoria positiva pueden acortar la estadía hospitalaria (2,0 y 1,4 días, respectivamente). Además, la respiración con presión espiratoria positiva puede reducir la duración de la fiebre en 0,7 días, y la manipulación osteopática puede acortar el uso de antibióticos en 1,93 días. No se han reportado eventos adversos serios. En resumen, la evidencia disponible es limitada y sugiere que la fisioterapia respiratoria no debería ser recomendada como tratamiento adyuvante de rutina en pacientes adultos con neumonía comunitaria no complicada.
Efficacy and safety of tension-free vaginal tape compared with transobturator tape among obese women with stress urinary incontinence: a retrospective cohort study

Objective To determine the efficacy and safety of tension-free vaginal tape (TVT) compared with transobturator tape (TOT) in obese women with stress urinary incontinence (SUI). Methods We performed a retrospective chart review of patients who underwent insertion of TVT or TOT for stress urinary incontinence between January 2003 and October 2009. Women were excluded if they had had previous surgery for SUI or had a diagnosis of intrinsic sphincter deficiency. Results One hundred eighty obese women (BMI >30 kg/m2) with SUI and with follow-up for at least one year were identified (90 had TVT and 90 had TOT). The rates of success on the objective criteria were 91% for the TVT group and 88% for the TOT group (P = 0.46) and 87% versus 80% (P = 0.23) on subjective assessment. Conclusion Our retrospective cohort study demonstrated similar rates of cure for obese women with SUI who underwent insertion of TVT and TOT.
Ex Vivo and In Vivo Models for Endoscopic Submucosal Dissection Training

Endoscopic submucosal dissection is a technically challenging but highly effective technique for the treatment of well selected early neoplasms in the digestive tract. Although it is frequently performed in East Asian countries, the Western world has not adopted this technique yet, probably due in part to the difficulty to learn it. Ex vivo and in vivo animal models are invaluable tools to overcome at least the beginning of the learning curve, although the initial step is the acquisition of basic knowledge about early diagnosis of neoplasias, and observing real procedures in expert centers. The practical issues, advantages, and disadvantages of the ex vivo and in vivo models are discussed.
Gestures, vocalizations, and memory in language origins

This article discusses the possible homologies between the human language networks and comparable auditory projection systems in the macaque brain, in an attempt to reconcile two existing views on language evolution: one that emphasizes hand control and gestures, and the other that emphasizes auditory–vocal mechanisms. The capacity for language is based on relatively well defined neural substrates whose rudiments have been traced in the non-human primate brain. At its core, this circuit constitutes an auditory–vocal sensorimotor circuit with two main components, a “ventral pathway” connecting anterior auditory regions with anterior ventrolateral prefrontal areas, and a “dorsal pathway” connecting auditory areas with parietal areas and with posterior ventrolateral prefrontal areas via the arcuate fasciculus and the superior longitudinal fasciculus. In humans, the dorsal circuit is especially important for phonological processing and phonological working memory, capacities that are critical for language acquisition and for complex syntax processing. In the macaque, the homolog of the dorsal circuit overlaps with an inferior parietal–premotor network for hand and gesture selection that is under voluntary control, while vocalizations are largely fixed and involuntary. The recruitment of the dorsal component for vocalization behavior in the human lineage, together with a direct cortical control of the subcortical vocalizing system, are proposed to represent a fundamental innovation in human evolution, generating an inflection point that permitted the explosion of vocal language and human communication. In this context, vocal communication and gesturing have a common history in primate communication.
Guidelines for the management of twin pregnancy complicated with intrauterine single fetal demise

El embarazo múltiple está asociado a un aumento en la mortalidad y morbilidad perinatal, comparado con el embarazo único. Una complicación grave que afecta al embarazo gemelar es la muerte fetal in útero de un gemelo, situación que implica un riesgo de morbilidad/mortalidad para el feto sobreviviente y la embarazada. En base a la mejor evidencia disponible sugerimos una pauta de manejo que permita optimizar el resultado perinatal del gemelo sobreviviente y de la embarazada.
Hospital costs associated with delirium in older medical patients

INTRODUCTION: Delirium is a common and serious complication in older patients, associated with increased, potentially preventable, morbidity and mortality. The aim of this study was to evaluate the associated costs of delirium during hospitalization in a university affiliated hospital in Chile. MATERIALS AND METHODS: Prospective cohort study of consecutive patients 65 years and older, admitted to a medical ward. A psychogeriatric team assessed patients during the first and every 48h until discharge using the Confusion Assessment Method (CAM-S), length of hospital stay, pharmacy and total hospitalization costs were analyzed. Statistical analysis was performed using bivariate and multivariate analysis according to delirium diagnosis. RESULTS: Data from 454 patients was analyzed, 160 of them in a delirium cohort (35.2%) and 294 in a non-delirium cohort (64.8%). The delirium cohort had a longer hospital stay (DATA) and higher mortality (7.0% versus 1.7%). The median of total costs of delirium during hospital stay was 38.7% higher than the non-delirium cohort (P<.001). Total costs were significantly higher in the delirium cohort after adjustment of covariables (P=.01). CONCLUSIONS: This study confirms that delirium is associated with significantly greater costs. Considering that effective delirium prevention is possible, the knowledge of associated costs can help health care providers to justify prevention strategies and finally give better care for older patients.
Internet abuse and dependence: The epidemic and its controversy

Introducción: Junto con la aparición de internet, ha ido cobrando interés problemas de salud emergentes asociados al uso de las nuevas tecnologías. La discusión no sólo se ha dado en los medios de comunicación, sino también a nivel académico. Inicialmente asociado al reporte de casos de "adicción a internet", para luego llegar al punto de incluso considerar su incorporación al futuro DSM-V, ya sea homologando el fenómeno a la adicción a substancias, o como un fenómeno emparentado con los trastornos por control de impulsos. Método: Se realizó una revisión sistemática de la literatura publicada sobre el tema utilizando los términos MESH afines: "Internet", "Behavior, Addictive", "Impulse Control Disorders" e "Impulsive Behavior" que se hubieran indexado desde el 2006 a marzo de 2012. Resultados: La prevalencia del abuso y dependencia a internet ha sido difícil de esclarecer por falta de consenso en los criterios diagnósticos. Tal como en otras entidades psiquiátricas podrían existir predisponentes genéticos y psicológicos así como asociación con comorbilidades tales como trastornos del ánimo, trastornos ansiosos, síndrome de déficit atencional e hiperactividad, abuso de alcohol y trastornos alimentarios. Pareciera haber correlato neurobiológico, demostrado en neuroimágenes, con las conocidas adicciones químicas. En cuanto al tratamiento, al no haber instrumentos para medir la respuesta, aún no existe evidencia de eficacia terapéutica. Conclusión: Para esclarecer muchas de estas dudas aún no resueltas hace falta terminología específica e instrumentos validados para diagnosticar y seguir a estos pacientes, para de esta manera describir sus factores de riesgo, curso natural y alternativas de tratamiento.
Labhardts colpoperineocleisis: A safe and effective alternative for the treatment of genital prolapse in patients without sexual activity

Introducción: El prolapso genital impacta negativamente la calidad de vida y autoimagen de la mujer. Rutinariamente indicamos la colpoperineocleisis de Labhardt a pacientes de edad avanzada y sin actividad sexual. Objetivo:Evaluar los resultados con esta técnica e identificar posibles factores de riesgo que predigan la falla. Métodos: Análisis retrospectivo de pacientes tratadas con la técnica entre los años 2008-2010. Se realizó análisis univariado y multivariado para identificar factores de riesgo asociados a la falla y se construyeron curvas libre de falla anatómica a fin de evaluar la durabilidad. Resultados: 68 pacientes cumplieron los criterios de inclusión. La edad promedio fue 71,9±5,7 años; 95,6% fueron clasificadas en etapa III o IV según POP-Q. El tiempo operatorio fue de 54 ± 20 minutos. Seguimiento promedio de 21 meses; la tasa de recidiva anatómica fue de 14,7%. La tasa de incontinencia de orina de esfuerzo (IOE) de novo fue de 5,9%. El análisis univariado identificó como factor predictor de recidiva el flujo vaginal posoperatorio; en análisis multivariado de Cox, esa condición mantuvo significancia estadística (OR 6,3). Se identificó como factor de riesgo el no acatamiento de la técnica quirúrgica (OR 7,2). Conclusión: La colpoperineocleisis de Labhardt es una técnica segura, con baja tasa de complicaciones, una tasa de recurrencia aceptable y baja tasa de IOE de novo. Pilar del éxito es evitar la infección y respetar la técnica quirúrgica. Es necesario estudios comparativos con otras técnicas oclusivas, como también evaluar el rol de la infección como causa de falla de la técnica.
Lymphoma-like lesion of the cervix with monoclonal immunoglobulin heavy chain gene rearrangement in PCR analysis. A case report

Resumen La lesión del cérvix es una proliferación linfoide benigna que simula un linfoma B difuso de células grandes, por ello es causa de potencial error diagnóstico. Presentamos el caso de una mujer de 24 años con PAP atípico y conización subsecuente, identificándose una proliferación linfoide atípica. El infiltrado linfoide era polimórfico, con numerosas células grandes entremezcladas, sin necrosis ni esclerosis. El epitelio presentó displasia epitelial moderada. Las células grandes fueron inmunorreactivas para CD20, sin expresión de cadenas ligeras de inmunoglobulinas. La hibridación in situ para el virus de Epstein-Barr resultó positiva en escasas células grandes aisladas. Mediante técnica de PCR, para amplificación de la región FR3 de la cadena pesada de la IgH, se observaron 2 bandas monoclonales. Hasta el último seguimiento (24 meses), no se encontró evidencia de enfermedad sistémica/progresión.
Maternal supplementation with docosahexaenoic acid (DHA) lacks clinically significant benefit

Aims: To evaluate maternal and fetal benefits of prenatal supplementation with docosahexaenoic acid (DHA). Method: Systematic review of clinical randomized controlled trials. Results: Prenatal DHA supplementation increased DHA levels on maternal blood, breast milk or neonatal cells. Maternal supplementation with DHA neither reduced mother's depressive symptoms nor improved the neurological and visual performance of the children. Although it was observed a reduction in risk of cognitive delay between infants of women supplemented with DHA (RR 0.4; IC95 % 0.22-0.78) and a better performance in the mental processing at the age of 4, the 7 years follow-up showed absence of significant differences in the intellectual level. The secondary analysis of two studies showed that the supplementation with DHA reduced the risk of premature birth <34 weeks (RR 0.49; IC95% 0.25-0.94; p=0.03), neonatal ICU hospitalizations (RR 0.57; IC95% 0.34-0.97; p=0.04), birth weight <2500 g (RR 0.65; IC95% 0.44-0.96; p=0.03) and intrauterine growth restriction in nulliparous patients (RR 0.5; IC95% 0.3-1.0; p=0.03). Nevertheless, prevention of premature birth was not reproduced in a specifically designed study. Conclusions: Studies report an increased mother and neonatal content of DHA in response to prenatal supplementation with this polyunsaturated long chain fatty acid. Nevertheless, at date the absence of relevant clinical effects do not permit to support or to reject maternal dietary supplementation with DHA during pregnancy.
Molecular Mechanisms Underlying the Link between Nuclear Receptor Function and Cholesterol Gallstone Formation

Cholesterol gallstone disease is highly prevalent in western countries, particularly in women and some specific ethnic groups. The formation of water-insoluble cholesterol crystals is due to a misbalance between the three major lipids present in the bile: cholesterol, bile salts, and phospholipids. Many proteins implicated in biliary lipid secretion in the liver are regulated by several transcription factors, including nuclear receptors LXR and FXR. Human and murine genetic, physiological, pathophysiological, and pharmacological evidence is consistent with the relevance of these nuclear receptors in gallstone formation. In addition, there is emerging data that also suggests a role for estrogen receptor ESR1 in abnormal cholesterol metabolism leading to gallstone disease. A better comprehension of the role of nuclear receptor function in gallstone formation may help to design new and more effective therapeutic strategies for this highly prevalent disease condition.
Oral propranolol for treating infantile hemangiomas: a case series of 57 patients

Abstract Introduction and objectives Infantile hemangiomas (IH) are a frequent vascular tumor. In recent years, propranolol has emerged as an alternative in the treatment of IH. The objective of the present study was to evaluate the effectiveness of propranolol for the treatment of IH. Materials and methods Patients with IH requiring treatment were included. Cardiologic evaluation was made to every patient and electrocardiogram (ECG) and echocardiogram were done. Oral propranolol was started in an ambulatory way at a dose of 2 mg/kg daily divided in two doses. At ten days all the patients were evaluated with a 24-h rhythm holter. Evaluation of effectiveness: In clinical controls and by images IH were formally analyzed, without blindness. Response was categorized as complete response (CR), partial response (PR) and no response (NR). Adverse events: Adverse events were registered in a special category of the formulary. Results 57 patients were included. Mean age was 9.7 months. There were 80.8% females. Mean duration of treatment was 7.3 months (1–24 months). Efficacy: 50.6% had CR, 49.3% had PR. There were a 7% of adverse events. No differences in response rate exist according to age or location. No rhythm holter was altered at ten-day control. Conclusion Our study highlights the possibility of starting propranolol in an ambulatory way, establishes a dose of 2 mg/kg/day and confirms the security profile of the drug. We consider propranolol as a first line treatment for IH.
Overestimation of abortion in Colombia and other Latin American countries

Recently, the Guttmacher Institute estimated a number of 400,400 clandestine abortions for Colombia. Because of the strong implications that such brief could have in different areas of interest, a full revision of the methodology of estimation was performed. The methodology used by the Guttmacher Institute was as follows: first, the authors estimated the losses from spontaneous and induced abortions from the opinion of 289 subjects who work in an equal number of Colombian health institutions through the opinion survey entitled "Health Facilities Survey". Subsequently, an expansive multiplier (x3, x4, x5, etc.) was applied to the numbers obtained by this survey that also emerges from a subjective opinion of another 102 respondents of the "Health Professional Survey" selected by convenience. There is no objective data based on real vital events, the whole estimate is based on imagining/numbers underlying mere opinions. Even as public opinion survey, the sampling technique introduced serious selection bias in the gathering of information. Valid epidemiological methods using standardized rates, choosing the paradigmatic cases of Chile and Spain as standard populations, it was observed that Guttmacher Institute methodology overestimates more than 9 times the complications due to induced abortion in hospital discharges and more than 18 times the total number of induced abortions. In other Latin American countries where the same methodology was applied including Argentina, Brazil, Chile, Mexico, Peru, Guatemala, and Dominican Republic, the number of induced abortions was also largely overestimated. These results call for caution with this type of reports that alarm public opinion.
Persistent sepsis-induced hypotension without hyperlactatemia: A distinct clinical and physiological profile within the spectrum of septic shock

Introduction. A subgroup of septic shock patients will never develop hyperlactatemia despite being subjected to a massive circulatory stress. Maintenance of normal lactate levels during septic shock is of great clinical and physiological interest. Our aim was to describe the clinical, hemodynamic, perfusion, and microcirculatory profiles associated to the absence of hyperlactatemia during septic shock resuscitation. Methods. We conducted an observational study in septic shock patients undergoing resuscitation. Serial clinical, hemodynamic, and perfusion parameters were registered. A single sublingual microcirculatory assessment was performed in a subgroup. Patients evolving with versus without hyperlactatemia were compared. Results. 124 septic shock patients were included. Patients without hyperlactatemia exhibited lower severity scores and mortality. They also presented higher platelet counts and required less intensive treatment. Microcirculation was assessed in 45 patients. Patients without hyperlactatemia presented higher PPV and MFI values. Lactate was correlated to several microcirculatory parameters. No difference in systemic flow parameters was observed. Conclusion. Persistent sepsis-induced hypotension without hyperlactatemia is associated with less organ dysfunctions and a very low mortality risk. Patients without hyperlactatemia exhibit less coagulation and microcirculatory derangements despite comparable macrohemodynamics. Our study supports the notion that persistent sepsis-induced hypotension without hyperlactatemia exhibits a distinctive clinical and physiological profile.
Recurring parachordoma in the hand of a child. A case report and review of the literature

El paracordoma es una neoplasia infrecuente de partes blandas que forma parte del espectro tumor mixto/mioepitelioma. Descrito en la década de 1950, se han comunicado 64 casos, 10 de los cuales corresponden a niños. El rango etario es amplio, con una media en la cuarta década. El paracordoma es morfológicamente similar al cordoma, pero su localización es extraaxial, preferentemente en la porción proximal de las extremidades, y posee un patrón inmunohistoquímico característico. Esta neoplasia es de crecimiento lento y localmente agresivo, pero se han informado casos con metástasis. Se presenta un niño de 8 años con un paracordoma de un año de evolución en la mano izquierda, que recidivó a los 6 meses de la cirugía inicial.
Role of laparoscopy in unexplained infertility. Experience of the Clinical Hospital of the Pontifical Catholic University of Chile

The present study aims to explore the effectiveness of laparoscopic surgery on women presenting with infertility, of unidentified aetiology according to the standard infertility investigation, and recurrent failed In Vitro Fertilization (IVF) attempts. Identifying and correcting possible underlying pathologies by laparoscopy may subsequently enable natural conception in an effort to address infertility and avoid IVF overuse. One-hundred and seven (107) women with unidentified aetiology of infertility and recurrent failed IVF attempts met the inclusion criteria. Laparoscopic surgery was performed as the endpoint of the patients' diagnostic journey, aiming to identify a possible underlying factor as the cause of infertility. Sixty-two (62) out of 107 patients (57.94%) that underwent laparoscopy were diagnosed with endometriosis, 25 out of the 107 patients (23.3%) were diagnosed with periadnixal and pelvic adhesions, and 20 cases (18.69%) presented with no pathology and remained unexplained. Following identification and correction of endometriosis and pelvic adhesions, patients were invited to conceive naturally. For the patients that laparoscopic investigation failed to reveal any pathology they were categorized as unexplained infertility and were subjected to a single IVF cycle. Natural conception success rate within the first postoperative year was the primary outcome. Within the first postoperative year, 30 out of 62 patients (48.38%) diagnosed with endometriosis following laparoscopic investigation achieved a natural conception, and 28 out of them (93.4%) reported live-births. Additionally, 11 out of 25 patients (44%) diagnosed with periadnixal and pelvic adhesions achieved natural conception within the first operative year. Regarding the group of unexplained infertility patients, only four out of the 20 patients (20%) achieved clinical pregnancy in the first post-operative IVF cycle. In conclusion, laparoscopy appears to be a promising approach, addressing infertility, providing significant diagnostic findings, while avoiding IVF overuse regarding patients of unidentified infertility presenting with recurrent failed IVF attempts.