University of the Andes (Chile)

Fracture-related infection (FRI) after tibial plateau open reduction and fixation is a common complication that leads to catastrophic sequelae and substantial economic costs, making prevention paramount. To facilitate an appropriate approach, it is useful to classify risk factors based on patient-related factors, injury-related factors, and management-related factors. Patient-related factors like smoking have a great amount of evidence establishing their relation with FRI. Diabetes and obesity might be associated, but evidence is somewhat conflicting. Nevertheless, smoking cessation and a multidisciplinary approach for these pathologies are essential to prevent FRI. Injury-related factors like high-energy fractures and acute compartment syndrome have compelling evidence relating them to FRI and must be acknowledged as inherent factors. While the exposure of the fracture has been associated with infection, open fractures are yet to be confirmed as directly related to FRI in tibial plateau fractures. Likewise, early antibiotic prophylaxis and surgical debridement are mandatory. As for management-related factors, increased surgical time emerges as a strong predictor for FRI. Evidence regarding the number of surgical approaches and plates shows a trend toward an increase in FRI prevalence. With respect to external fixator installation and removal, pin-plate overlapping is yet to be confirmed or ruled out as risk factors.

This study aimed to reflect on the spiritual care of nursing in palliative care from the conceptual perspective of Martin Heidegger. The approximation between Heidegger’s philosophical aspects and palliative nursing practice, with a clinical view of spiritual care, promotes reflections on human existence and finitude. Being in palliative care can generate anguish, loss of meaning of life and connection with the world. The relationship of care between nurse and patient, which is established through language, favors comprehensive, intentional and humanized care, and is revealed as this relationship of care deepens. In this relational process, bonds begin to be established between nurse and patient, which can lead to authentic spiritual care. Approaching health from the spiritual dimension is a challenge, as it forces healthcare professionals to come into contact with existential issues of patients, families and themselves. Thus, reflection based on Heidegger’s philosophical aspects allows us to become aware of the facticity of death. DESCRIPTORS Nursing; Nursing Care; Palliative Care; Philosophy; Spirituality

Background and Objectives There is limited evidence on knowledge of related health among healthcare personnel who care for older adults. The objective of this study was to investigate the knowledge and experience of oral health care among family members and medical staff responsible for older adults with varying degrees of cognitive impairment and Alzheimer's disease. Materials and Methods This qualitative study explored the experiences and knowledge of 30 family members and medical staff through in‐depth, semi‐structured interviews. The interviews were recorded using both audio and video formats: digital platforms were used for immediate family members, while formal caregivers were interviewed in person. Researchers transcribed and analysed the recordings, categorising the answers to identify emerging topics until reaching saturation. Results The core emerging themes among the direct family members were: (1) Lack of knowledge about oral health; (2) Oral hygiene role for the patients; (3) Consequences of a poor oral care; and (4) Recommendations for a better oral health care. For the formal caregivers the emerging themes were: (1) Lack of knowledge and experiences about oral health; (2) Deficient oral hygiene of residents; (3) Impact on quality of life; and (4) Suggestions for improving oral health. Conclusion Despite recognising the significance of oral health, direct family members and formal caregivers of older adults with cognitive impairment or dementia still need additional tools to effectively carry out necessary hygiene techniques and care.

This Element analyzes the incorporation of new information and communication technologies (ICTs) by different parties in Latin America to organize volunteers and mobilize supporters during elections. It assesses ICT-related changes in how parties recruit prospective candidates, collect information about citizens' preferences, and mobilize for elections and how these changes have reduced the power of the rank and file within party organizations. Party leaders have an incentive to incorporate new ICTs to increase electoral efficacy and reduce the role of rank-and-file members in performing essential party functions. However, the result of the incorporation of technology depends on leaders' capacity to control the process within the party. Based on case studies of ICT incorporation by various Latin American parties and electoral campaigns, the authors posit that the incorporation of technology will consolidate a power dynamic that predates the adoption of ICTs to fulfill organizational functions.

Dynamic policy games feature a wide range of equilibria. This paper provides a methodology for obtaining robust predictions. We focus on a model of sovereign debt, although our methodology applies to other settings, such as models of monetary policy or capital taxation. Our main result is a characterization of distributions over outcomes that are consistent with a subgame perfect equilibrium conditional on the observed history. We illustrate our main result by computing—conditional on an observed history—bounds across all equilibria on the maximum probability of a crisis: means, variances, and covariances over debt prices.

Study Design systematic review. Objective To evaluate risk factors associated with failure of non-operative management of isolated unilateral facet fractures of the subaxial cervical spine in neurologically intact patients. Methods A systematic review of the PubMed, Embase, LILACS, and Cochrane Library databases was conducted in order to determine risk factors associated with failure of non-operative management in isolated unilateral facet fractures of the subaxial cervical spine without facet and/or vertebral displacement, in neurologically intact patients. Our research was in line with the PRISMA Statement and registered on PROSPERO (CRD42023405699). Results A total of 1639 studies were identified through a database search on May 5, 2023. In total, 7 studies from the databases were included, along with 1 study found through a manual citation search. The evidence showed high clinical heterogeneity, a serious risk of bias according to the ROBINS-I tool, and a predominance of retrospective cohort studies. In comparison to less complex facet fractures, lateral floating mass fractures were found to have 5.41 times higher odds of failure of non-operative management (OR = 5.41; 95% CI = 1.32, 22.19). We calculated the potential association between lower absolute fracture height and non-operative treatment success [Fracture height (percentage) Mean Difference = −17.51 (−28.22, −6.79 95% CI); Absolute height Mean Difference: −0.46 (−0.60, −0.31 95% CI)]. Other risk factors were not included in the meta-analysis due to lack of data. The level of certainty was rated as “very low”. Conclusions Lateral floating mass cervical facet fractures and larger fracture fragment size (measured either in absolute terms or as a percentage) are significant risk factors for failure of non-operative treatment.

Periodontal diseases are closely related to non-communicable diseases, and their prevention depends on their link with healthy lifestyle programs. The purpose of this consensus was to summarize and propose preventive strategies at the community, individual, and research levels in Latin America and the Caribbean. A critical review and search strategy was carried out in Pubmed, LILACS, and SCIELO on three topics: a) Social determinants, risk factors, and behavioral changes related to PD throughout the lives of individuals; b) Impact of mechanical and chemical control of plaque for the prevention of gingivitis; c) Impact on prevention of systemic diseases. Relative to public health policies, no consensus was reported in the region. In some countries, periodontal educational strategies, mainly for pregnant women and for other chronic diseases have been implemented, but their impact on primary and secondary prevention has hardly been evaluated. In recent years, a positive aspect has been the implementation of some public policies, including clinical practice guidelines and care pathways. Based on the latest consensus, multicenter educational research and technological strategies were found in the region, but their effectiveness needs to be evaluated in clinical studies. A barrier to the implementation of preventive strategies has to do with the human factor. Therefore, the training of periodontists to be experts in communication strategies, technologies that allow the empowerment of patients for taking care of their periodontal health are required . Moreover, it is necessary to train professionals from other areas of health, who are more aware of the importance of oral health as a healthy lifestyle.

Background Oral diseases are a significant global public health challenge. Current evidence indicates that several chronic conditions are individually associated with tooth loss. People are living with more than one chronic condition, known as multimorbidity (MM). Considering the common risk factors for oral and chronic diseases, this study aimed to evaluate the association between MM and tooth loss in the Chilean population. Methods Cross-sectional study with secondary data from the latest Chilean National Health Survey (ENS 2016-17). The number of remaining teeth was classified into four groups: functional dentition (≥ 20 remaining teeth), moderate tooth loss (10 to 19), severe tooth loss (1 to 9), and edentulism (0). MM was defined based on the number of chronic conditions as a binary variable (MM≥ 2) and as a 4-level categorical variable (MMG0−G3), G0: none, G1: 1, G2: 2–4, and G3: ≥5 conditions. Stratified analysis by age group (< 65, ≥ 65 years) was performed. Mean and SD were calculated for crude and adjusted remaining teeth. Significance level was set to 0.05. Prevalence ratios were estimated with Poisson regression models with robust variance, crude and adjusted for sex, age, geographic area, and educational level. Logistic regressions models were fitted to calculate odds ratios as a sensitivity analysis. Results Of 4,151 adults aged 17–98, 54.9% had MM and the prevalence of moderate, severe tooth loss and edentulism was 25.4%, 6.9% and 4.8% respectively. Adults aged ≥ 65 years with MM≥ 2 were 1.66 [1.04–2.66] times more likely to have severe tooth loss than those without MM. Adults aged < 65 years with MMG3 were 1.76 [1.12–2.77] times more likely to have moderate tooth loss and 2.55 [1.02–6.36] times more likely to have severe tooth loss than those without MM. Conclusions In this study, we found statistically significant associations between the number of chronic conditions and moderate/severe tooth loss in both analyzed age groups. These findings highlight the need to provide oral health care for adults with multimorbidity using a person-centred model and to seek strategies to prioritize health care.

Uncontrolled regeneration leads to neoplastic transformation1, 2–3. The intestinal epithelium requires precise regulation during continuous homeostatic and damage-induced tissue renewal to prevent neoplastic transformation, suggesting that pathways unlinking tumour growth from regenerative processes must exist. Here, by mining RNA-sequencing datasets from two intestinal damage models4,5 and using pharmacological, transcriptomics and genetic tools, we identified liver X receptor (LXR) pathway activation as a tissue adaptation to damage that reciprocally regulates intestinal regeneration and tumorigenesis. Using single-cell RNA sequencing, intestinal organoids, and gain- and loss-of-function experiments, we demonstrate that LXR activation in intestinal epithelial cells induces amphiregulin (Areg), enhancing regenerative responses. This response is coordinated by the LXR-ligand-producing enzyme CYP27A1, which was upregulated in damaged intestinal crypt niches. Deletion of Cyp27a1 impaired intestinal regeneration, which was rescued by exogenous LXR agonists. Notably, in tumour models, Cyp27a1 deficiency led to increased tumour growth, whereas LXR activation elicited anti-tumour responses dependent on adaptive immunity. Consistently, human colorectal cancer specimens exhibited reduced levels of CYP27A1, LXR target genes, and B and CD8 T cell gene signatures. We therefore identify an epithelial adaptation mechanism to damage, whereby LXR functions as a rheostat, promoting tissue repair while limiting tumorigenesis.

This study investigates how varying concentrations of hydroxyapatite (OHAp) and the addition of gelatin influence the ionic crosslinking time of alginate-based bioinks, as well as the shear stress experienced by neonatal human dermal fibroblasts (HDFn) during extrusion. These factors are crucial for validating bioinks and developing viable 3D bioprinted models. Four bioink formulations were created with a 50/50 ratio of alginate to gelatin, incorporating different calcium phosphate concentrations (0%, 1%, 5%, and 10%). The bioink compositions were confirmed via Fourier Transform Infrared (FT-IR) spectroscopy, and rheological analyses evaluated their pseudoplastic behavior, printability limits, and crosslinking times. The results indicated a notable increase in the consistency index (k) from 0.32 for the 0% OHAp formulation to 0.48 for the 10% OHAp formulation, suggesting improved viscoelastic properties. The elastic modulus recovery after crosslinking rose significantly from 245 Pa to 455 Pa. HDFn experienced a shear stress of up to 1.5436 Pa at the tip during extrusion with the HDFn-ALG5-GEL5-OHAp10 bioinks, calculated at a shear rate as low as 2 s−1. Viability assays confirmed over 70% cell viability 24 h post-extrusion and 92% viability after 7 days for the 10% OHAp formulation, highlighting the potential of hydroxyapatite-enhanced bioinks in tissue engineering applications.

Background Patellar tendon ruptures are infrequent but disabling injuries. Surgical treatment is the gold standard to obtain good outcomes, and numerous techniques have been described. Biomechanical studies report better results when augmented techniques are used. However, there is a lack of consensus regarding the best standard technique. Purpose/Hypothesis The purpose of this study was to assess a cohort of patients with acute patellar tendon rupture that was surgically treated and to compare the clinical outcomes of 2 groups: isolated repair and biological augmentation techniques with autograft or allograft. It was hypothesized that the biological augmentation group would have better clinical outcomes than the isolated repair group. Study Design Cohort study; Level of evidence, 3. Methods All patients with acute patellar tendon rupture surgically treated in our center between 2016 and 2022 were retrospectively reviewed. Patient and rupture characteristics, surgical technique, clinical outcomes, and complications were recorded. The primary outcome was rerupture rate, and secondary outcomes were infection rate, stiffness >15° of knee flexion deficit, and extensor mechanism lag >5°. Results The study included 34 patients with 36 operated knees (2 patients with bilateral rupture). The mean age was 44.9 years. Isolated repair was performed in 20 knees (55.6%), and 16 knees underwent repair and biological augmentation with autograft or allograft. Both groups were comparable in terms of their demographic characteristics. A statistically significant association was found between the type of surgery and tendon rerupture. Of the patients in the isolated repair group, 5 of 20 (25%) experienced a failure, whereas in the biological augmentation group, no reruptures were recorded ( P = .031). However, no statistically significant associations were found between the type of surgery and other complications, such as the development of stiffness ( P = .54), residual extension lag >5° ( P = .87), or the development of infection ( P = .25). Conclusion In this cohort of patients, biological augmentation reduced the rate of surgical failure for acute patellar tendon rupture without being associated with a higher risk of complications such as stiffness, residual extension lag, or the development of infection.

Background Multiple studies have demonstrated the association between Quality of Life (QoL) and the prevalence of caries, periodontitis, and tooth loss. However, the role of the position and location of tooth loss in impacting QoL remains unclear. Aim Evaluate the effect of tooth loss, including anterior losses, on Health Related Quality of Life (HRQoL) and Oral Health Related Quality of Life (OHRQoL) in Chileans aged 15 years and older who participated in the ENS 2016–2017. Methods A total of 5473 individuals participated in this study. HRQoL was measured using the EQ-5D questionnaire, while OHRQoL was assessed through a general question (GQ/ENS) and five specific questions (SQ/ENS). An analysis of variance test was performed to determine how difference or variation in number(s) of teeth in study participants affected their HRQoL Odds ratios with corresponding 95% confidence intervals were calculated using multinomial logistic regression to determine how, and to what degree, anterior tooth loss was associated both with HRQOL and OHRQOL in the study sample. Results The number of remaining teeth was significantly higher in the 'No problems' group across all EQ-5D dimensions, except Anxiety/Depression. The largest difference was in Self-care, where ‘No problems’ had a mean of 20.18 teeth compared to 6.43 in the ‘Problematic’ group. Anxiety/Depression showed higher odds of ‘Some problems’ with upper anterior tooth loss, while 'Usual Activities' showed higher odds of ‘problematic’ with lower anterior tooth loss. In OHRQoL, participants with an ‘Excellent’ perception had a mean of 24.32 teeth, and both upper and lower anterior tooth loss increased the odds of poor oral health self-perception. Conclusions Tooth loss significantly impacts both HRQoL and OHRQoL, with more remaining teeth associated with better outcomes, while anterior tooth loss is linked to worse self-perceived oral health.

Aim To characterize the gingival crevicular fluid (GCF) and plasma extracellular vesicles (EVs) and explore their proteomic cargo in healthy pregnant women compared to those with gestational diabetes mellitus (GDM) and periodontitis. Methods One‐hundred and four pregnant women were recruited at 24–30 gestation weeks. GDM was diagnosed by an oral glucose tolerance test. GCF and plasma samples were obtained to isolate EVs and characterized by nanoparticle tracking, immunoassays, electron microscopy and mass spectrometry. Results Of the recruits,17.3% women were healthy, 50% had periodontitis and 32.7% had both GDM and periodontitis. Probing depth, clinical attachment loss and bleeding on probing were more severe in GDM and periodontitis pregnancies ( p < 0.0001). Additionally, this group showed an increase concentration of total, small and large GCF‐EVs ( p = 0.0015, p = 0.0011 and p = 0.0008, respectively), with decreased expression of CD9, CD81 and CD81/CD63 ratio ( p = 0.0461, p = 0.0164 and p = 0.0005, respectively). No differences were observed in plasmatic EVs concentration or markers expression. Proteomic analysis of GCF‐EVs showed peptides of both host and bacterial origin. Gene ontology analysis revealed that proteins of GCF‐EVs participate in immune inflammatory responses, glucose metabolism and insulin response mechanisms. Conclusion GCF‐EVs were increased in both GDM and periodontitis, and their proteomic cargo suggest their involvement in immune inflammatory response, glucose metabolism and insulin pathways during pregnancy.

Resumen Este artículo analiza la procedencia de la acción de disolución por causa grave, prevista para la sociedad anónima cerrada, en la sociedad por acciones chilena. Se indaga si debe admitirse un medio de tutela previsto para proteger al accionista minoritario frente a la imprevisión del conflicto, cuando se eligió un tipo social como el de la sociedad por acciones, diseñado con el objetivo de fomentar la inversión en capital de riesgo y, por lo tanto, teniendo en mente contratantes sofisticados y previsores. Se utiliza el método dogmático, con referencia a literatura sobre contratación incompleta, en busca de un criterio que determine si acaso, y de qué modo, la elección del tipo restringe la disolución judicial; y para aplicar ese criterio al caso particular de los conflictos suscitados en torno al administrador único de la sociedad por acciones. Se concluye que, entre partes sofisticadas, la disolución judicial debe limitarse a situaciones excepcionales, mientras que, entre partes no sofisticadas, esta se encuentra disponible en los mismos casos en que lo estaría en una sociedad anónima, siempre que se demuestren motivos que justifiquen la elección de la sociedad por acciones por contratantes inexpertos.

Objectives While COVID-19 continues to challenge the world, meteorological variables are thought to impact COVID-19 transmission. Previous studies showed evidence of negative associations between high temperature and absolute humidity on COVID-19 transmission. Our research aims to fill the knowledge gap on the modifying effect of vaccination rates and strains on the weather-COVID-19 association. Methods Our study included COVID-19 data from 439 cities in 22 countries spanning 3 February 2020 – 31 August 2022 and meteorological variables (temperature, relative humidity, absolute humidity, solar radiation, and precipitation). We used a two-stage time-series design to assess the association between meteorological factors and COVID-19 incidence. For the exposure modeling, we used distributed lag nonlinear models with a lag of up to 14 days. Finally, we pooled the estimates using a random effect meta-analytic model and tested vaccination rates and dominant strains as possible effect modifiers. Results Our results showed an association between temperature and absolute humidity on COVID-19 transmission. At 5 °C, the relative risk of COVID-19 incidence is 1.22-fold higher compared to a reference level at 17 °C. Correlated with temperature, we observed an inverse association for absolute humidity. We observed a tendency of increased risk on days without precipitation, but no association for relative humidity and solar radiation. No interaction between vaccination rates or strains on the weather-COVID-19 association was observed. Conclusions This study strengthens previous evidence of a relationship of temperature and absolute humidity with COVID-19 incidence. Furthermore, no evidence was found that vaccinations and strains significantly modify the relationship between environmental factors and COVID-19 transmission.

This article analyzes the concept of leveling as a political and social phenomenon in the mass society of the nineteenth century by Alexis de Tocqueville and Søren Kierkegaard. The use of this concept in the works of both authors is explained and, subsequently, a comparative analysis is carried out to find the common aspects and the differences that exist between the two. This analysis allows us how to understand the complexity of the phenomenon of leveling and of democratic equality, considering their effects on individuals and their social ties in the mass society. Keywords: Tocqueville; Kierkegaard; Leveling; Equality; Democracy; Mass society

Understanding gel structures and behavior is a prerequisite for attaining the desired food application characteristics. The mixing temperature is crucial when incorporating thermolabile active compounds into gels. This study evaluated the effect of mixing temperature on the physical and chemical properties of a bigel system prepared using a carnauba wax/canola oil oleogel and Arabic gum hydrogels. The results showed that bigels prepared at lower temperatures (30 and 40 °C) resulted in a solid-like state under crystallization temperature, resulting in matrices with larger hydrogel droplets, softer texture, and lower adhesiveness, spreadability, and solvent binding capacity. In contrast, bigels prepared at higher temperatures (50 and 60 °C), around crystallization temperature but with no solid state, resulted in matrices with smaller hydrogel droplets and higher firmness, adhesiveness, and spreadability. These bigels had a higher apparent viscosity, especially at lower shear rates, and solid-like behavior in the linear viscosity range. During the bigel preparation process, adjusting the mixture temperature had no effect on the samples’ oxidative stability, FTIR spectra, or thermal properties. The results highlighted the importance of hydrogel droplet size on the microstructure of the formed bigels, and smaller droplets could act as effective fillers to reinforce the matrix without making chemical changes.

Fracture of surgical instruments in dental practice is not usually reported in the literature. Management involves searching for and retrieving the fragment to avoid issues such as infection, swallowing, or aspiration. Although foreign bodies may not cause symptoms for years, some can cause chronic pain. The authors describe herein the unusual case of an unintentionally retained broken elevator blade left for 8 years before being found during an orthodontic evaluation. Panoramic radiography revealed a foreign body in the alveolar bone of the right mandibular third molar that was causing mild chronic pain. The patient was unaware whether routine radiographic examination had revealed its presence. Cone-beam computer tomography was performed to identify the position of the blade fragment, and surgery was performed to retrieve it. The mild chronic pain disappeared after removal. It is advisable to use high-quality surgical instruments and to perform routine checkups before and after surgery.