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Arsenic Exposure During Pregnancy and Childhood: Factors Explaining Changes over a Decade
(MDPI AG, 2025-03-16)
RUBILAR RAMIREZ, PAOLA ANDREA
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HIRMAS ADAUY, MACARENA SOLEDAD
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APABLAZA SALINAS, MAURICIO IVÁN
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Camila Awad
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Xaviera Molina
Arsenic chronic exposure, particularly in its inorganic form, represents a significant public health concern. This study was conducted in Arica, the northernmost city in the country, whose inhabitants have been exposed to inorganic arsenic both naturally through drinking water and anthropogenically due to a toxic waste disposal site. We explored changes in inorganic arsenic levels in a cohort of pregnant women and their children over a decade, identifying exposure trends and their determinants. We used data on arsenic exposure through maternal urine samples during pregnancy, collected by the Health Authority between 2013 and 2016 (measurement 1), and followed up with assessments of their children in 2023 (measurement 2). Temporal changes in inorganic arsenic concentration were analyzed using the Wilcoxon Signed-Rank test, and a mixed linear regression model was employed to determine which factors contributed to urinary inorganic arsenic levels. We did not observe significant differences in mean arsenic concentrations between the two-time points (p = 0.4026). The mixed linear regression model revealed that children consuming bottled water had 8.3% lower urinary inorganic arsenic concentrations than those drinking tap water (95% CI: −15.36 to −0.54%). Additionally, children from ethnic groups had 8.64% higher inorganic arsenic concentrations (95% CI: 0.49 to 17.5%), while those with caregivers with higher education showed a 13.67% reduction (95% CI: −25.06 to −0.56%). Despite mitigation efforts, these findings underscore the ongoing risk of inorganic arsenic exposure among vulnerable populations. They further emphasize the importance of addressing natural arsenic contamination in water and implementing targeted interventions to reduce disparities associated with socioeconomic and demographic factors.</jats:p>
Scopus© Citations 1 6
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Patient centered outcomes in stroke: utility-weighted modified Rankin Scale results in a community-based study
(Frontiers Media SA, 2025-03-21)
Carlos Delfino
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Gabriel Cavada
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HOFFMEISTER ARCE, LORENA
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LAVADOS GERMAIN, PABLO MANUEL
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MUÑOZ VENTURELLI, PAULA ANDREA
Background and aims</jats:title><jats:p>The transformation of modified Rankin Scale (mRS) scores based on the corresponding utilities of health-related quality of life questionnaires can facilitate the capture of Patient-Centered Outcomes (PCO) in stroke. We aimed to derive utility-weighted modified Rankin Scale (UW-mRS) values by mapping mRS functional status to EQ-5D-3L scores in a population-based cohort of stroke patients.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The UW-mRS was obtained by analyzing the EQ5-D-3 L and mRS scores at 180 days after any stroke in the ÑANDU study, a large prospective community-based study in Chile. The mRS prediction was estimated using a linear regression adjusted by the EQ-5D-3L value. Generalized linear and binary logistic regression models were constructed to determine influencing factors of the UW-mRS, using STATA software (version 18.0).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We included 773 patients presenting with any stroke during 2015–2016: 48% were female, with a mean age of 71 years (SD 13.8), and 85% had an acute ischemic stroke (AIS). 82% of patients had a low socioeconomic status, 50% had less than 12 years of formal education, and only 32% lived in urban areas. UW-mRS values for mRS categories 0–6 at 180 days were 0.913, 0.694, 0.425, 0.249, −0.102, −0.347 and 0, respectively. Multivariable analysis identified age &gt; 70 years (Coefficient <jats:italic>β</jats:italic> [β] -0.038 [Standard error SE 0.018], <jats:italic>p</jats:italic> = 0.032), prior mRS score 3–5 (<jats:italic>β</jats:italic> −0.556 [SE 0.197], <jats:italic>p</jats:italic> &lt; 0.001), ischemic stroke (β −0.066 [SE 0.025], <jats:italic>p</jats:italic> = 0.010), and National Institutes of Health Stroke Scale (NIHSS) at admission&gt;5 (<jats:italic>β</jats:italic> −0.015 [SE 0.002], <jats:italic>p</jats:italic> &lt; 0.001) as significant predictors of worse UW-mRS scores (R<jats:sup>2</jats:sup> = 70%) in the overall group. Sex-disaggregated analysis showed that age &gt; 70 years was a significant predictor in males (β −0.069 [SE 0.024], <jats:italic>p</jats:italic> = 0.006), while presenting an AIS had a greater impact on female’s worse UW-mRS score (β −0.087 [SE 0.033], <jats:italic>p</jats:italic> = 0.010).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>These results present UW-mRS values derived from a population-based stroke study. Key determinants of health-related quality of life in post-stroke patients included age, prior disability, and stroke severity. Sex-disaggregated analysis revealed age being significant for males and AIS for females. Incorporating PCO as UW-mRS in stroke research can provide a more nuanced understanding of the impact of stroke on survivors, offering valuable insights for clinical decision-making and rehabilitation strategies across diverse healthcare contexts.<
Scopus© Citations 1 6
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The Presence of Associated Injuries in Pediatric Radial Neck Fractures: A Systematic Review of the Literature and Meta-Analysis of Pooled Individual Patient Data
(MDPI AG, 2025-02-27)
Lisette C. Langenberg
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Joyce L. Benner
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Nazira Bernal Bader
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Christiaan J. A. van Bergen
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Joost W. Colaris
<jats:p>Background: Pediatric radial neck fractures (pRNFs) can occur in isolation or in association with concomitant injuries. It is unknown whether the presence of associated injuries should influence the choice of treatment. The aim of this study is to assess the incidence of associated injuries in pRNF and their correlation with fracture angulation (Judet grade) or the patient’s age (under or over ten years of age). Methods: A systematic literature review was performed following PRISMA-IPD guidelines, including case series on pRNF with a minimum of five cases of children until 16 years of age. The quality assessment included a risk of bias analysis and evaluation using the MINORS criteria. Individual patient data on age, Judet classification and associated injuries were extracted from the included studies and pooled for the meta-analysis. The correlation between the presence of associated injury and the patient’s age or Judet classification was depicted in two forest plots. Results: A total of 20 articles published sufficient individual patient data (n = 371) on associated injuries. All but one were retrospective case series. Fifteen articles had MINORS scores of 8 or higher. The incidence of associated injuries was 33% (123 of 371 cases). Almost half of the associated injuries included an olecranon fracture (61/123). There was no correlation between Judet classification (p = 0.243) and incidence nor between patient age and the incidence of associated injuries (p = 0.694). Conclusions: Surgeons should be aware of potential associated injuries in over a third of pRNF cases, regardless of the patient’s age or fracture angulation. Deduction of the trauma mechanism may be a more useful tool for assessing the potential presence of associated injuries than the most frequently used fracture classification or the patient’s age. More research is needed regarding the requirements for enhanced diagnostic imaging, specific treatment or follow-up adaptations in children with pRNFs and associated injuries.</jats:p>
4Scopus© Citations 1
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Prevalence, Causal Classification, and Prognosis of Patent Foramen Ovale in Young Patients With Embolic Strokes of Undetermined Source
(Ovid Technologies (Wolters Kluwer Health), 2025-05-06)
Abhilekh Srivastava
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Kate Tsiplova
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Amanda Taylor
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Aleksandra Pikula
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Jennifer Mandzia
1
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Therapeutic trajectories of families with rare diseases in Chile from the perspectives of patients, carers, and healthcare workers: a qualitative study
(Springer Science and Business Media LLC, 2025-02-25)
CABIESES VALDES, BALTICA BEATRIZ
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OBACH KING, ALEXANDRA ALICE
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Antonia Roberts
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REPETTO LISBOA, MARIA GABRIELA
Background Rare diseases are conditions that have a low prevalence in the population and a high disease burden and are often chronic and progressive. International evidence concerning the experience of people and families living with rare diseases is scarce, leading to late and erroneous diagnoses, as well as non-specific treatments. This study explored the therapeutic trajectories of people and families living with rare diseases within Chile’s public and private healthcare systems from the perspective of patients, caregivers, and medical teams, including the initial symptoms, first consultation, testing, diagnosis, treatment, and follow-up. Methods A qualitative exploratory study was conducted through multiple case studies. Sixty participants were interviewed in person and/or virtually: patients (n = 16), caregivers (n = 22), healthcare workers (n = 20), and two patient organisation leaders. The material was analysed using thematic analysis. The project was approved by the Scientific Ethics Committee of Facultad de Medicina Clínica Alemana, Universidad del Desarrollo. Results After similar initial symptoms and first consultation, three main types of trajectories were identified: (i) the path taken by those who reach a diagnosis for a disease that has specific treatment available; (ii) the journey of those who reach a diagnosis for their health condition, but their disease does not have a specific treatment available; and (iii) the trajectory of those who have not reached a diagnosis and receive symptomatic treatments for symptoms. Conclusions The therapeutic trajectories of patients with rare symptoms are similar in terms of initial symptoms and first consultation. However, their paths diverge at the diagnostic stage, with diverse experiences related to these journeys, largely based on having a diagnosis and whether there is a specific treatment. Rare conditions in Chile requires further attention and urgent action that considers those who live with them and their families.
1
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Return-to-sport tests: Do they reduce risk of re-rupture after anterior cruciate ligament reconstruction?
(Elsevier BV, 2025-04)
FIGUEROA POBLETE, DAVID HUMBERTO
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Waldo Gonzalez Duque
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Daniela Landea Caroca
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Camila Tapia Castillo
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Daniela Erskine Ventura
Scopus© Citations 1 1
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TGFβ links EBV to multisystem inflammatory syndrome in children
(Springer Science and Business Media LLC, 2025-03-12)
Carl Christoph Goetzke
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Mona Massoud
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Stefan Frischbutter
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Gabriela Maria Guerra
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Marta Ferreira-Gomes
<jats:title>Abstract</jats:title> <jats:p>In a subset of children and adolescents, SARS-CoV-2 infection induces a severe acute hyperinflammatory shock<jats:sup>1</jats:sup> termed multisystem inflammatory syndrome in children (MIS-C) at four to eight weeks after infection. MIS-C is characterized by a specific T cell expansion<jats:sup>2</jats:sup> and systemic hyperinflammation<jats:sup>3</jats:sup>. The pathogenesis of MIS-C remains largely unknown. Here we show that acute MIS-C is characterized by impaired reactivation of virus-reactive memory T cells, which depends on increased serum levels of the cytokine TGFβ resembling those that occur during severe COVID-19 (refs. <jats:sup>4,5</jats:sup>). This functional impairment in T cell reactivity is accompanied by the presence of TGFβ-response signatures in T cells, B cells and monocytes along with reduced antigen-presentation capabilities of monocytes, and can be reversed by blocking TGFβ. Furthermore, T cell receptor repertoires of patients with MIS-C exhibit expansion of T cells expressing TCRVβ21.3, resembling Epstein–Barr virus (EBV)-reactive T cell clones capable of eliminating EBV-infected B cells. Additionally, serum TGFβ in patients with MIS-C can trigger EBV reactivation, which is reversible with TGFβ blockade. Clinically, the TGFβ-induced defect in T cell reactivity correlates with a higher EBV seroprevalence in patients with MIS-C compared with age-matched controls, along with the occurrence of EBV reactivation. Our findings establish a connection between SARS-CoV-2 infection and COVID-19 sequelae in children, in which impaired T cell cytotoxicity triggered by TGFβ overproduction leads to EBV reactivation and subsequent hyperinflammation.</jats:p>
Scopus© Citations 4 2
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Efficacy of platelet-rich-fibrin for the treatment of alveolar osteitis: a systematic review and meta-analysis
(Medicina Oral, S.L., 2025)
C. Ávila-Oliver
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V. Veloso
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G. Laissle
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AM. Rojas
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F. Verdugo-Paiva
2
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New Dermoscopy Pattern in Nevus‐Associated Melanomas
(Wiley, 2025-04-19)
Nelson Lobos‐Guede
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Dan Hartmann
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Valentina Darlic
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Cristina Carrera
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Llucia Alos
Melanomas can appear de novo or in association with a pre‐existing nevus. The association of melanomas with pre‐existing nevi and its role as a melanoma precursor is a controversial issue. Dermoscopy can increase melanoma's diagnostic accuracy and help us suspect nevus‐associated melanomas (NAM). Differentiating NAMs clinically and dermoscopically can be challenging. There are few published studies so far describing dermoscopic features of NAM that have differentiated from <jats:italic>de novo</jats:italic> melanomas, such as multi‐component pattern, multifocal pigmentation, atypical pigment network, regression structures, negative pigment network, irregular globules, and streaks. Here, we report four acquired compound NAMs showing a starburst pattern (SP) within the lesion. No publications have reported NAMs with melanoma components in the form of SP arising within the center of the lesion. Therefore, when faced with a compound or intradermal nevus with incipient central reticulated pigmentation, especially if there is no history of trauma or previous surgery, we must pay alert to the possibility of an early development of melanoma.
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Early high-sensitivity troponin elevation and short-term mortality in sepsis: a systematic review with meta-analysis
(Springer Science and Business Media LLC, 2025-02-14)
Abraham I. J. Gajardo
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Santiago Ferrière-Steinert
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Joaquín Valenzuela Jiménez
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Sebastián Heskia Araya
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Thomas Kouyoumdjian Carvajal
Abstract Background Serum cardiac troponin (cTn) elevation is a well-established phenomenon in sepsis. However, the clinical signifcance of this phenomenon with high-sensitivity (hs) assays and the current sepsis defnition needs to be settled. Research Question What is the association between early serum cTn levels measured by hs-assays and the risk of short-term mortality in septic patients? Study Design and Methods We conducted a systematic review using a comprehensive PubMed, Scopus, and Embase search. Studies were eligible if they reported association data on early hs-cTn and mortality in an adult sample with sepsis that met the Sepsis-3 defnition. For the synthesis of the efect of hs-cTn on mortality, we applied random efect models on the pooled unadjusted and adjusted odds ratio (OR and aOR, respectively) of elevated vs. normal hs-cTn serum values, and on the crude standardized mean diference (SMD) of hs-cTn between survivors and non-survivors. Results In total, 6242 patients from 17 studies were included, with short-term mortality rates ranging from 16.9% to 53.8%. Using a crude analysis, non-survivor patients showed higher hs-cTn than survivors (SMD of 0.87, 95%CI: 0.41–1.33). Elevated hs-cTn was associated with increased mortality (OR=1.78, 95% CI: 1.41–2.25). However, this prognostic efect was absent in studies that adjusted for diferent confounders (aOR=1.06, 95% CI: 0.99–1.14). Discussion and Conclusions Non-survivors of sepsis exhibited signifcantly elevated hs-cTn levels. While elevated hs-cTn levels are associated with an increased risk of mortality, they are not independently associated with this outcome in sepsis
1Scopus© Citations 19

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