Revista Confluencia is an electronic publication whose purpose is to disseminate scientific knowledge in the field of health. Its objective is the publication of unpublished articles in spanish in the field of health, whose elaboration emanates from the scientific production of students in the context of courses, workshops, clinical experiences, assistantships (among others), which can be presented in sections such as research (qualitative and quantitative), literature reviews, clinical cases, intervention programmes or projects, reflections and letters to the editor. From 2023, Revista Confluencia includes the publication of student articles with optional co-authorship by academics, researchers, health professionals, authorities and public health managers. It is very important for us to ensure that students continue to be the protagonists of the journal, so the participation of professors or clinical tutors who participate in the publication will be open to their inclusion as last authors. From the year 2024 Revista Confluencia takes on the challenge of continuous publication, which will reduce the time it takes to submit and publish articles.
Juvenile testicular granulosa cell tumor in the neonatal period: Diagnosis and management of two clinical cases
Introduction: Juvenile granulosa cell tumor of the testis is a rare neoplasm of the sex cord–stromal tissue, representing less than 5% of pediatric testicular tumors. It is characterized by a benign clinical course and typically presents as a painless scrotal mass in newborns or infants. Objective: To describe two clinical cases of juvenile granulosa cell tumor of the testis in infants, highlighting their clinical features, imaging findings, histopathological confirmation, and therapeutic management, with emphasis on differential diagnosis. Methodology: Report of two clinical cases following CARE guidelines, including clinical, imaging, and histopathological analysis, after obtaining informed consent from both legal guardians. Development: Two infants with heterogeneous solid-cystic testicular lesions identified on ultrasound are described. One had tumor markers within the normal range, while the other showed elevated alpha-fetoprotein levels. Both were managed with radical orchiectomy and had favorable outcomes. Histopathological and immunohistochemical analysis confirmed the diagnosis of juvenile granulosa cell tumor of the testis. Discussion: Juvenile granulosa cell tumor of the testis should be considered in the differential diagnosis of testicular masses in infants, especially in comparison with yolk sac tumor. Age and contextual interpretation of clinical and histopathological findings are essential for diagnosis. Although radical orchiectomy remains the standard treatment, conservative approaches and emerging therapies exist in selected cases. This report reinforces the importance of its recognition and proper clinicopathological correlation.
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Kerion Celsi in pediatrics: Case report and diagnostic considerations
Introduction: Kerion Celsi is a severe inflammatory form of tinea capitis, presenting with painful plaques, suppuration, and localized alopecia, often mimicking bacterial scalp infections. Objective: To describe the clinical course of a school-aged child with kerion Celsi treated with topical terbinafine. Methodology: A descriptive pediatric case report with serial photographic follow-up over six weeks is presented, for which informed consent was obtained from the legal guardian. Result: A previously healthy 5-year-old boy developed a progressive inflammatory scalp lesion with erythema, scaling, crusting, and localized alopecia. Topical terbinafine was administered for six weeks, leading to gradual improvement and clinical resolution, leaving mild residual alopecia. Discussion: Kerion reflects an intense hypersensitivity reaction to dermatophytes. Early recognition is essential to prevent misdiagnosis, unnecessary intravenous antibiotic use, and long-term complications such as scarring alopecia. Conclusion: This report highlights the importance of considering kerion as part of the differential diagnosis of inflammatory scalp lesions, particularly in children, either through the use of dermatoscopy or on clinical suspicion in cases of suppurative lesions that do not respond to antibiotics, with the aim of preventing complications such as permanent scarring alopecia.
Knowledge of palliative care among medical interns in Chilean universities: A necessary diagnosis
Introduction: Palliative care is essential in current medical education. Objective: To determine the knowledge of medical interns in Chilean universities regarding palliative care. Methodology: A convergent parallel, descriptive, cross-sectional, and multicenter design was used. A validated questionnaire was administered to assess conceptual, clinical, and legal dimensions. The study was approved by an ethics committee and the participants signed informed consent. Result: Responses from 346 interns were analyzed. Eighty-seven percent consider palliative care to be essential in medical care. There are gaps in specific knowledge: a significant percentage associates palliative care with end-of-life care, or there are doubts regarding the use of morphine and addiction (11%). 93% agree that palliative care should not be delayed. Discussion: Although there is a positive attitude and adequate general conceptual knowledge. There are myths and gaps in technical knowledge that suggest the need to strengthen palliative care competencies. Conclusion: Medical interns in Chile demonstrate a positive attitude and a solid conceptual foundation in palliative care. There is a need to strengthen both curricular and continuing education to ensure timely, comprehensive care that complies with current legislation.
Epidemiological update on the hospital discharge rate for pilonidal cysts in Chile, 2019-2024
Introduction: Pilonidal cyst is a chronic and recurrent inflammatory condition whose prevalence has increased worldwide. Its recent national epidemiology remains unknown. Objectives: To determine the hospital discharge rate for pilonidal cyst during the period 2019-2024 in Chile. Methodology: Quantitative, observational and descriptive study of the hospital discharge rate for pilonidal cyst between 2019-2024 in Chile, according to sex, age group and length of hospital stay, with data from Department of Health Statistics and Information and the National Institute of Statistics. Rates and measures of central tendency were calculated using Microsoft Excel. Ethics committee approval was not required. Result: A total of 10.712 hospital discharges were recorded during the study period yielding a hospital discharge rate of 9,66 per 100.000 inhabitants. A predominance of male rate (12,35) and of the 20-29 year age group (28,97) was observed. The overall mean length of hospital stay was 1,70 days, being higher in women (1,84). Discussion: The hospital discharge rate was lower than that reported in international studies, and its decrease may be associated with health measures implemented during the COVID-19 pandemic and postponement of elective surgeries. The predominance in men and young populations is consistent with the literature. The length of hospital stay is similar to that reported in other studies, and its higher value in women may be related to sex-related clinical differences. Conclusion: This study provides an epidemiological approximation of the healthcare burden of pilonidal cyst in Chile, highlighting the need for future research on factors associated with its clinical management.
Preoperative evaluation in anesthesia: A review of the 2017 Guidelines of the Chilean Society of Anesthesiology
Introduction: Preoperative evaluation guidelines standardize perioperative management to reduce morbidity and mortality. In 2017, the Chilean Society of Anesthesiology (SACh) published its national recommendations. However, the continuous evolution of scientific evidence requires an analysis of their current validity in light of recent international publications. Objective: To describe the core pillars of the 2017 SACh guidelines (timing of evaluation, medical history, physical examination, and complementary tests) and to analyze the contributions of updated literature to anesthetic planning. Methodology: A narrative review conducted in three stages: categorization of the main thematic axes of the 2017 SACh guidelines, analysis of its supporting literature, and a literature search in indexed databases published between 2018 and 2026. Result: Preoperative evaluation relies on a detailed medical history, a targeted physical examination, and selective complementary testing. Early evaluation is essential to allow time for the optimization of medical conditions and lifestyle habits. The physical examination should focus on the cardiopulmonary system, adding other systems if symptoms are present. Laboratory tests and imaging should not be requested routinely; instead, they must be strictly based on patient comorbidities and procedural invasiveness to ensure healthcare system cost-effectiveness. Recent evidence introduces critical updates, such as telemedicine, discontinuation protocols for GLP-1 receptor agonists and SGLT2 inhibitors, and new biomarkers. Conclusion: Preoperative evaluation is a critical and personalized medical act. While the core principles of the 2017 SACh guidelines remain valid, integrating these new consensus guidelines is essential.
Level of knowledge and perception about healthy sexuality in self-sufficient older adults: A descriptive study in Chillán, Chile.
Introduction: The concerns of age-related changes, leaving aside some factors associated with health, this study aims to the level of knowledge about healthy sexuality in self-reliant seniors attending the More Self-sufficient Senior program at four Family Health Centers in the City of Chillán, 2024. Methodology: A quantitative, observational descriptive study was conducted. The population consists of 779 elderly persons over 60 years enrolled in the program. A non-probabilistic sample is calculated for convenience with a reliability of 85% and a standard error of 5%. 155 responses were collected. For the data collection, a closed response instrument was built, based on objective and updated literature review, which was submitted to validation using the expert judgment methodology, consisting of 26 questions. The data collection was carried out in person. The study has the permission of the Scientific Ethics Committee of the Hospital Herminda Martin de Chillán, which granted the study authorization CEC-HCHM N°806636/2024. Result: Of the total respondents, 81% of older people have no knowledge about healthy sexuality, 94% have a negative perception about healthy sexuality, 13% cannot speak freely about their sexuality because it bothers their family environment and 46% of older people surveyed feel judged for having an active sex life. Conclusions: The study revealed a low level of knowledge about healthy sexuality among older adults, suggesting the need to strengthen sexual education regarding protective and risk factors that allow individuals to develop in all aspects of life.
Tuberculous constrictive pericarditis of rapid progression and fatal
Objective: To describe a case of fulminant tuberculosis constrictive pericarditis, highlighting its clinical, microbiological, imaging, and histopathological findings. Methodology: Observational, descriptive and retrospective study, consisting of a case report. The information was obtained from sources such as clinical records, laboratory tests, microbiological and imaging studies, among others. The antecedents were ordered chronologically and analyzed descriptively. A signed informed consent form was obtained. Development: A 28-year-old man with a history of harmful alcohol use and polysubstance use, as well as a chronic cervical abscess retrospectively considered suggestive of scrofula, presented with progressive ascites, peripheral edema, weight loss, night sweats, and dyspnea. Computed tomography revealed pericardial effusion, bilateral pleural effusions, and hepatic congestion. He was initially treated for presumed viral pericarditis but subsequently developed pulmonary thromboembolism, refractory shock, and acute respiratory failure requiring invasive mechanical ventilation and vasoactive support. Echocardiography demonstrated constrictive physiology and marked pericardial thickening. During thoracotomy, a loculated pericardial collection containing hemorrhagic and purulent material was identified. PCR testing of pericardial fluid was positive for Mycobacterium tuberculosis, and pericardial biopsy showed granulomatous inflammation. Despite surgical drainage and initiation of antituberculous therapy, the patient died. Discussion: The nonspecific clinical presentation and limited microbiological yield of pericardial specimens may delay the diagnosis of tuberculosis pericarditis. Constitutional symptoms, pericardial effusion, and evidence of extrapulmonary involvement should prompt early consideration of tuberculosis. Conclusion: Early integration of clinical, imaging, microbiological, and histopathological findings is essential for timely diagnosis and treatment. Nevertheless, advanced tuberculosis pericardial disease may follow a rapidly progressive and fatal course.
Coexistence between avascular necrosis of the femoral and humeral heads: An exploratory narrative review with systematic features
Introduction: Avascular necrosis is a condition characterized by bone cell death secondary to interruption of blood supply. It primarily affects the femoral head and, to a lesser extent, the humeral head; however, evidence on the coexistence between both locations remains limited. Objective: This study aims to explore available evidence and describe clinical patterns, risk factors, and diagnostic strategies. Methodology: An exploratory narrative review was conducted following the PRISMA-ScR guidelines for systematic reviews. Articles published in PubMed over the last eight years were searched using terms related to avascular necrosis of the femoral and humeral heads. Observational studies and case reports were included for qualitative analysis. Result: Nine articles were included (six case reports and three observational studies). The reviewed literature described a coexistence of femoral and humeral head avascular necrosis, with the hip being the most common initial site. Chronic corticosteroid use was the predominantly documented risk factor for both locations. Magnetic resonance imaging was the diagnostic method reported as most useful. Discussion: The findings suggest maintaining clinical suspicion for humeral involvement in patients with femoral head avascular necrosis presenting systemic risk factors. However, data heterogeneity and the retrospective nature of the included studies limit the interpretation of results. Conclusion: This review documents the coexistence of femoral and humeral head avascular necrosis in the presence of risk factors. Prospective studies with greater statistical power are required to characterize this relationship and guide diagnostic and therapeutic strategies.
Mortality due to necrotizing enterocolitis of the newborn in Chile: Descriptive analysis 2016-2024
Introduction: Necrotizing enterocolitis in newborns is a severe gastrointestinal disease that mainly affects preterm infants with low birth weight and is associated with high morbidity and mortality. In Chile, there are limited updated epidemiological data on deaths due to this condition. Objective: To describe the mortality rate from necrotizing enterocolitis in newborns as the underlying cause in Chile during 2016-2024. Methods: An observational, descriptive, cross-sectional study. The study utilised data on deaths from necrotising enterocolitis in newborns recorded by the Department of Health Statistics and Information, along with population data from the National Institute of Statistics for the period 2016-2024. Data processing was carried out in Microsoft Excel. Result: A total of 396 deaths from this cause were recorded between 2016-2024, with a mortality rate of 22,34 per 100.000 live births. The annual mortality rate was irregular and higher among males. Regionally, high rates were noted in Aysén and La Araucanía, and low mortality rates in Atacama, Arica and Parinacota. 97,73% of deaths occurred in hospitals. Discussion: Interannual variations may be explained by statistical instability associated with small numbers. Higher male mortality and regional variation may be related to biological factors and neonatal risk, such as low birth weight. Conclusion: Necrotising enterocolitis in newborns remains a relevant cause of mortality in Chile, with differences by sex and region, and with hospital as the predominant place of death. Strategies are needed to prevent prematurity and to enhance regional care capacity through increased availability of subspecialists and specialized centers.
Mortality and hospital discharge rates for lip, oral cavity, and oropharyngeal cancer in Chile, 2002–2023
Introduction: Lip, oral cavity, and pharynx cancer represents a significant public health problem worldwide. In Chile, national epidemiological information is limited, and there are no specific clinical guidelines for its comprehensive management. Objective: To describe the epidemiological situation of cancer of the lip, oral cavity, and pharynx in Chile by analyzing mortality and hospital discharges according to time, place, age, and sex. Methods: A descriptive ecological study was conducted using secondary data from the Department of Health Statistics and Information (DEIS) of the Chilean Ministry of Health. Deaths occurring between 2002 and 2023 and hospital discharges between 2002 and 2021 corresponding to ICD-10 codes C00–C14 were analyzed. Crude rates, age-adjusted rates, and standardized mortality ratios were calculated, assessing their temporal, regional, and demographic variation. Result: In 2023, 304 deaths were recorded, with a crude mortality rate of 1,5 per 100.000 inhabitants. Crude mortality showed an upward trend, whereas the age-adjusted mortality rate decreased by 22,8% over the study period. Mortality was higher among men and increased significantly with age. Relevant regional differences were observed. Hospital discharges increased by 14,5% since 2002, predominating among men and older adults. Conclusion: In Chile, age-adjusted mortality from cancer of the oral cavity and pharynx has declined, while hospital discharges have increased. These findings highlight the need to strengthen prevention strategies, early detection, and the development of specific public health policies at the national level.
José Miguel Domingo Gastón de Toro Ballesteros
Spiritual accompaniment in palliative care from a comprehensive care perspective: A narrative review
Introduction: Spiritual care is an essential component of palliative care, as it supports the existential and spiritual well-being of patients with serious illnesses. However, its effective implementation remains a challenge in many health systems. Objective: To explore spiritual care, its meaning, and its relationship with comprehensive person-centered care according to scientific literature. Methodology: A narrative review of scientific literature was conducted using databases such as PubMed/MEDLINE, Scopus, Scielo and Redalyc. Language filters (English, Spanish and Portuguese) and publications from the last ten years were applied. DeCS/MESH, terms including spirituality, palliative care, comprehensive health care, religion and medicine were combined using boolean operators (AND and OR). Exclusion criteria included religious interventions unrelated to palliative care and articles lacking analytical development. No definitive number of articles was established due to the narrative nature of the review. Development: Spirituality is a dynamic and multifaceted dimension that becomes particularly relevant in palliative care by promoting meaning-making, coping and adaptation in the context of advanced illness. Spiritual care is grounded in genuine presence, active listening, and respect; however, its integration into clinical practice is affected by conceptual, professional, and organizational divergences. Conclusion: The implementation of spirituality in healthcare requires overcoming these existing barriers through interdisciplinary models that incorporate spiritual care as a core competency of comprehensive and humanized end-of-life care.
Hospital discharges for cystic fibrosis in patients aged 0-19 years in Chile: A descriptive study, 2021-2024
Introduction: Cystic fibrosis is a multisystem genetic disease that primarily affects respiratory and digestive systems. In Chile, evidence on hospital discharges due to cystic fibrosis in the pediatric population is limited. Objective: To describe the hospital discharge rate for cystic fibrosis in patients aged 0-19 years in Chile between 2021-2024. Methodology: Observational, descriptive, retrospective longitudinal study based on secondary records from the Department of Health Statistics and Information. Hospital discharges with a primary diagnosis code E84 “Cystic fibrosis” (International Classification of Diseases, Tenth Revision), were included. The denominator for rate calculation was obtained from the 2024 Census of the National Institute of Statistics. The analysis examined absolute frequencies and the hospital discharge rate per 100.000 inhabitants, as well as the weighted average length of hospital stay. Result: A total of 1.114 hospital discharges were analyzed. The overall hospital discharge rate was 6,2 cases per 100.000 inhabitants; the highest rate was recorded in 2022 (6,8) and the lowest in 2024 (5,1). The hospital discharge rate was higher among women (6,9) and in the 10-to-14-year age group (7,4). The average length of hospital stay was 15,4 days, higher among men. Discussion: Cystic fibrosis maintains a relevant hospital burden in pediatric and adolescent populations, with descriptive differences according to sex and age group, as well as prolonged hospital stays that reflect the complexity of inpatient management. Conclusion: Strengthening multidisciplinary outpatient follow-up, especially during adolescence, and generating national evidence to evaluate the impact of new diagnostic and therapeutic strategies are needed.
Hospital discharge rate of patients with aortic valve stenosis during the period 2021-2024 in Chile
Introduction: Aortic valve stenosis is the most common valvular heart disease, associated with high morbidity and mortality. Given the aging population and limited national epidemiological data, there is a need to analyze hospital discharges. Objective: To establish the hospital discharge rate for aortic valve stenosis in Chile during 2021-2024. Methodology: Quantitative, observational, descriptive, cross-sectional study. Hospital discharge rate for aortic valve stenosis were analyzed by sex, age, and average length of hospital stay, including all discharges with an ICD-10 I35.0 diagnosis nationwide. Data came from the Department of Health Statistics and Information and the National Institute of Statistics and were analyzed with descriptive statistics in Microsoft Excel. Result: 8.147 cases were recorded, with an hospital discharge rate of 11,02 per 100.000 inhabitants and an upward trend, with predominance in men (12,98/100.000) and in those over 80 (71,67/100.000). Average length of stay was 11,12 days: 11,42 for men and 10,72 for women. Discussion: The hospital discharge rate increase is consistent with population aging; sex differences may reflect variations in progression or access to diagnosis; the shorter stay since 2022 suggests health-system recovery after the pandemic. Conclusion: The growing hospital burden of aortic valve stenosis in Chile highlights the need for healthcare planning, emphasizing clinical factors and gender gaps.
Descriptive analysis of mortality from bronchus and lung cancer in Chile: An epidemiological overview of 20 years (2002-2022)
Introduction: Bronchus and lung cancer is a malignant neoplasm originating from the bronchial epithelium or pulmonary parenchyma. Objective: To establish the mortality rate from bronchus and lung cancer in Chile between 2002 and 2022. Methods: A cross-sectional, observational, descriptive, and retrospective study was conducted. Deaths from bronchus and lung cancer (ICD-10 code C34) recorded in Chile from 2002 to 2022 were analyzed, based on official data from the Department of Statistics and Health Information. The variables considered were: cause of death, sex, age, and region. Mortality rate were calculated using population projections from the National Institute of Statistics. Result: A total of 59.720 deaths from lung cancer were recorded, with an average mortality rate of 15,39 per 100.000 inhabitants. Mortality was higher in men (19,02) than in women (11,79). The highest mortality rate was observed in older adults (65 years of age or older), reaching 78,67 per 100.000. Regionally, Antofagasta had the highest mortality rate (26,45), while Ñuble and La Araucanía had the lowest. Discussion: The increasing mortality trend reflects the persistence of tobacco use, population aging, and regional environmental exposures. The low five-year survival rate and delayed diagnosis emphasize the urgent need to implement early detection programs. Conclusion: This study highlights a high and rising burden of lung cancer mortality in Chile. Integrated public health policies are needed to improve prevention, early diagnosis, and timely access to treatment.
Jean Watson's humanized care: A literature review
Introduction: The increasing dehumanization of health care has negatively impacted the nurse-patient relationship, affecting the quality of care, therapeutic communication, and professional well-being. Objective: This literature review aims to analyze the impact of Jean Watson’s Human Caring Theory on nurse-patient care, focusing on three dimensions: communication, patient satisfaction, and the emotional well-being of the professional. Methodology: A systematic search was conducted in databases such as PubMed, SciELO, CINAHL, Medline, and Google Scholar, using MeSH terms and filters by recency, language, and article type. From a total of 671 initial articles, 21 were selected that met quality and relevance criteria. Result: The findings show that Watson’s Theory significantly enhances therapeutic connection through caritas processes, promotes human-centered care, and strengthens nursing vocation. Discussion: Structural barriers were identified, such as work overload, limited training in soft skills, and weak institutionalization of humanized approaches. Conclusion: It is concluded that Watson’s Theory represents an effective strategy to address the depersonalization of care and humanize clinical environments.
Epidemiological analysis of hospitalizations for knee dislocations vs. Sprains: A descriptive study of temporal trends (2021-2024) in Chile
Introduction: Knee dislocations and ligament sprains constitute a spectrum of traumatic injuries that vary in severity, mechanism of injury and hospital burden. Although most are managed on an outpatient basis, hospital discharge data enables us to characterize the use of resources and the epidemiological patterns of these injuries. Objective: To describe the epidemiological characteristics and temporal trends of hospital discharges for knee dislocations and ligament sprains in Chile between 2021 and 2024. Methods: An observational, descriptive and retrospective study based on aggregated hospital discharge records (2021–2024). Diagnoses were categorized as dislocations and sprains. Frequencies, proportions and weighted averages of hospital stay were calculated. Comparisons by sex were carried out using the Chi-squared test and Odds Ratios (OR) with 95% CI. Result: A total of 32.636 hospital discharges related to knee injuries were identified; 1.102 (3,4%) corresponded to dislocations and 11.062 (33,9%) to sprains. Hospital discharges for sprains increased from 1.727 to 3.339, whereas those for dislocations increased from 253 to 289. The proportion of dislocations was higher among women (p < 0,001; OR = 2,78; 95% CI: 2,45-3,15). The mean length of hospital stay was longer for dislocations (4,64 days) than for sprains (1,31 days). Discussion: Sprains were more frequent; however, dislocations were associated with a greater healthcare burden, reflected by longer hospital stays. Conclusion: Between 2021 and 2024, hospital discharges for knee sprains were more frequent than those for knee dislocations. However, dislocations were associated with a longer length of hospital stay.
Role of artificial intelligence in reducing unnecessary biopsies in breast lesions BI-RADS 4 in images
Introduction: Breast cancer is the most common malignancy in women worldwide and a leading cause of female mortality. Diagnosis relies on imaging modalities—primarily mammography, ultrasound, and MRI—which present limited specificity, leading to unnecessary invasive procedures in a significant proportion of cases. In this context, artificial intelligence emerges as a complementary tool to radiological interpretation. Objective: To analyze the current scientific evidence on the application of AI in breast radiology and its impact on the reduction of unnecessary biopsies in BI-RADS 4 lesions. Methodology: A systematic search was conducted in PubMed, Google Scholar, ScienceDirect, RSNA and MDPI using MeSH descriptors related to breast cancer, breast imaging, AI and deep learning, restricted to the last 10 years (2015-2025). Of 134 articles identified, 21 were selected for final analysis. Discussion: The reviewed studies demonstrate that deep learning models improve diagnostic performance across the three main imaging modalities. In mammography, these algorithms identify a significant proportion of BI-RADS 4 lesions as potentially benign while maintaining high sensitivity, with potential to reduce unnecessary biopsies. In ultrasound and MRI, the integration of radiomics and artificial intelligence significantly improves diagnostic specificity in differentiating benign from malignant lesions compared to conventional visual assessment. Conclusion: AI has broad potential to optimize breast image interpretation, contributing to reducing unnecessary biopsies in BI-RADS 4 lesions and enabling more accurate and efficient diagnosis.
Children's views on their participation in vaccine clinical trials
Introduction: Since the start of the COVID-19 pandemic, efforts have been made to develop vaccines tailored to the needs of children and adolescents, a group from whom it is important to gather information regarding their participation in clinical trials. Objective: To determine the opinion of children and adolescents aged 7 to 11 and 12 to 17 years regarding their participation in clinical trials for vaccine development, considering the recent inclusion of this demographic in trials in Chile. Methodology: A quantitative descriptive, cross-sectional study using a questionnaire administered to 427 children and adolescents from two schools in the Metropolitan Region. The instrument assessed opinions, concerns, motivations, and willingness to participate in clinical trials. Result: 53,6% of the 7-11 age group and 55,4% of the 12-17 age group agreed with the participation of minors in clinical trials. Additionally, 45% and 42,4%, respectively, indicated their willingness to participate. The primary motivation was the desire to aid in vaccine development, although moderate concerns were evident, particularly regarding potential long-term effects. Discussion: The results reflect a predominantly positive attitude towards pediatric clinical research, with age-group differences in comprehension and argumentation. A clear awareness of justice, altruism, and appreciation for informed consent was observed. Conclusion: Including the voices of children and adolescents in the design of clinical research is essential to ensure respect, understanding, and truly meaningful participation.
Health knowledge, Attitudes and Practice
Review of cardiovascular disease prevention strategies in Chile: Acute myocardial infarction and stroke
Introduction: Cardiovascular diseases, primarily acute myocardial infarction and stroke, are the leading cause of death worldwide, generating a significant health, social, and economic burden. Objective: To review the primary, secondary, and tertiary prevention strategies for acute myocardial infarction and stroke implemented in Chile and to analyze their concordance with the main international cardiovascular prevention guidelines. Methods: A narrative review was conducted, which included grey literature, primary studies, reviews, clinical guidelines and regulatory documents—both national and international—as well as indexed scientific literature. Results: Chile has implemented integrated primary, secondary, and tertiary prevention strategies for acute myocardial infarction and stroke, mainly within the framework of the Explicit Health Guarantees system, showing overall concordance with the main international cardiovascular prevention guidelines. Discussion: Although national strategies are generally consistent with international recommendations, gaps persist between clinical recommendations and their implementation. These gaps affect risk factor control in primary prevention, timely access to diagnosis and treatment in secondary prevention, and follow-up, rehabilitation, and management of sequelae in tertiary prevention, ultimately impacting long-term outcomes in acute myocardial infarction and stroke. Conclusions: Chile has a solid regulatory framework for cardiovascular prevention that is consistent with the main international guidelines; however, implementation gaps remain. Strengthening equity, continuity of care, and the updating of clinical guidelines is necessary.
Geriatric dermatology in contemporary clinical practice: An analytical review of an emerging and underrepresented field in the scientific literature
Introduction: Population aging has steadily increased the proportion of individuals aged 65 and over, generating a significant impact on healthcare systems. In this context, the skin plays a central role in the comprehensive clinical assessment of older adults, as dermatological diseases are highly prevalent and are associated with impaired quality of life, frailty, hospitalizations, and increased morbidity and mortality. Geriatric dermatology thus emerges as an area of growing clinical and academic relevance, yet it remains underrepresented in the literature. Objective: To analyze and synthesize the published scientific evidence on geriatric dermatology, addressing the pathophysiological changes of cutaneous aging, the most prevalent dermatoses in older adults, and the main clinical and therapeutic considerations in this population. Methodology: A narrative literature review was conducted following PRISMA guidelines, using PubMed/MEDLINE. The search employed the MeSH terms “Dermatology” AND “Geriatrics,” including publications from the last five years and studies involving populations aged 65 and over. Development: Evidence shows that more than 70-80% of older adults present with at least one active dermatosis, most commonly xerosis, inflammatory dermatoses, cutaneous infections, chronic venous insufficiency, pressure injuries, and skin neoplasms. The physiological changes associated with aging modify both clinical presentation and therapeutic response, increasing the risk of adverse effects. Conclusion: This review underscores the need to develop specific clinical guidelines, promote the inclusion of older adults in dermatologic research, and advance care models adapted to the rapid growth of this population.
Public health interventions for the prevention and early detection of oral cavity and oropharyngeal cancer at the national and international levels: A literature review
Introduction: Oral cavity cancer represents a relevant public health problem in Chile due to its high morbidity and mortality, which is highly associated with diagnosis at advanced stages, despite being a largely preventable disease. Objective: This study analyzes the available evidence on public health interventions at the level of prevention, early detection, diagnosis, and management of oral cavity cancer, both international and national literature. Methodology: A bibliographic review of the scientific literature was conducted, including indexed publications and grey literature, prioritizing reviews, meta-analyses, and official documents from the last 10 years. Result: At the international level, the evidence supports the control of alcohol and tobacco consumption, together with vaccination against Human Papillomavirus, as the main pillars of primary prevention; while visual oral examination remains the method of choice for screening in high-risk populations due to its high cost-effectiveness and feasibility. In contrast, although in Chile there are regulatory policies and campaigns aimed at the main risk factors, there are no early detection programs nor standardized national clinical guidelines. Discussion: In agreement with previous Chilean reviews, this gap in management still persists, leading to delayed diagnoses, inequities in access to care, and poorer clinical outcomes. Conclusions: The implementation of systematic early detection strategies and the development of national clinical guidelines based on updated evidence represents a priority need to strengthen the response of the Chilean health system to oral cavity cancer.
Results of an educational intervention focused on the early detection of breast cancer in patients of the CRS of the Padre Hurtado Hospital
Introduction: This paper presents an educational intervention carried out at Padre Hurtado Hospital to address the population’s knowledge gap regarding breast cancer prevention and early detection. Interviews and clinical experiences revealed misconceptions, low understanding of risk factors, and limited knowledge about breast self-examination, which—together with the high prevalence of this condition—justified the intervention. Objective: To provide clear information about breast cancer, correct misconceptions, raise awareness about early detection and body self-awareness, and develop practical skills for performing breast self-examination. Methodology: The intervention was planned in accordance with the User-Centered Design Model and Jane Vella’s Adult Learning Model. Twenty-five users of various ages participated. Activities included brainstorming sessions, an educational roulette, anatomical models, guided self-examination practice, and infographics. The technique was evaluated using a checklist, and the final impact was assessed through written reflections. Result: Participation reached 100%. A total of 92% of participants correctly performed the breast self-examination, and 88% acquired new knowledge. Improved understanding of warning signs, risk factors, and the elimination of misconceptions was also observed. Discussion: Visual, practical, and spoken educational strategies proved effective in promoting meaningful learning, especially among groups with limited access to comprehensible health information. Conclusion: The intervention met all proposed objectives and highlights the importance of the educational role of nursing in fostering community self-care and early detection of breast cancer.
The emerging role of artificial intelligence in dermatology: Clinical applications and challenges, a bibliographic review of recent evidence
Introduction: Dermatology is a field strongly grounded in the visual and dermatoscopic assessment of cutaneous lesions, where clinical experience and specialist judgment are essential for accurate decision-making. In recent years, artificial intelligence has emerged as a tool with high potential to support diagnosis, severity assessment, and longitudinal monitoring of skin diseases, making a systematic and updated analysis of its usefulness, scope, and real impact in dermatological practice necessary. Objective: To critically analyze the current role of artificial intelligence in dermatology, describing its main clinical applications, benefits, limitations, and challenges, with emphasis on image-based diagnosis, severity assessment, multimodal models, artificial intelligence-assisted dermatopathology, medical education, and equity in access to dermatologic care. Methodology: A narrative literature review was conducted using PubMed/MEDLINE, applying exclusively the MeSH terms “Artificial Intelligence” and “Dermatology.” A total of 132 articles were selected after applying inclusion and exclusion criteria and a screening process based on PRISMA recommendations. Discussion: Recent evidence shows that artificial intelligence can achieve highly accurate diagnostic performance, enhance objective severity assessment, and optimize the longitudinal monitoring of skin diseases. However, challenges remain related to bias, clinical validation, explainability, and professional adoption. Conclusion: AI does not replace expert clinical evaluation, but it may serve as a valuable complement when integrated responsibly, ethically, and in an appropriate clinical context.
Klebsiella oxytoca as an unusual agent of mixed diffuse otitis externa: Case report and literature review
Introduction: Diffuse otitis externa is an acute inflammation of the external auditory canal, most commonly caused by Pseudomonas aeruginosa and Staphylococcus aureus. The involvement of other gram-negative bacilli is exceptional and poorly documented. Objective: This report aims to contribute evidence through the description of a case of diffuse otitis externa in which Klebsiella oxytoca was isolated, a bacterium not previously described as a causal agent of human otic infections, and to highlight the clinical relevance of considering unusual pathogens in cases with atypical clinical courses. Methodology: We present the case of a 43-year-old man with clinical features of mixed otitis externa, whose culture showed growth of Klebsiella oxytoca and Aspergillus niger. The patient was evaluated clinically and by otomicroscopy, with microbiological sampling and follow-up after targeted topical treatment. Result: The patient evolved favorably under topical antifungal and antibacterial therapy. Discussion: Klebsiella oxytoca is an opportunistic gram-negative bacillus whose role in otitis has only been reported in animal models and in a single human case of malignant otitis externa in 1992, with no subsequent reports in the literature. In this case, clindamycin-induced dysbiosis and local immunosuppression due to topical corticosteroids likely favored its occurrence. Conclusion: This report documents a case of diffuse otitis externa associated with Klebsiella oxytoca and Aspergillus niger, highlighting the importance of considering unusual pathogens and performing cultures with antibiograms in cases of atypical evolution, reinforcing the need for a clinical approach based on critical thinking and diagnostic reassessment when facing non-standard presentations.
Obsessive-compulsive disorder: A literature review of the main things to know and its relationship with other diseases
Introduction: Obsessive-compulsive disorder is a psychiatric disorder characterized by obsessions and compulsions that range from mild to very severe depending on the patient's functional impairment. This condition has multiple comorbidities, which underscores the importance of a proper diagnosis and a comprehensive view of the patient. Objective: To review the diagnosis, pathophysiology, and current therapeutic options for obsessive-compulsive disorder, along with comorbidities and a comprehensive view of the patient. Methodology: A systematic search was carried out mainly in Pubmed where the term Mesh "Obsessive-Compulsive Disorder" was used associated with epidemiology, etiology, pathophysiology, rehabilitation and therapy, added to gray literature and bibliography from other platforms. Development: The article details the concept of obsessive-compulsive disorder, its diagnosis in the DSM-5, the dimensions affected, and the assessment of symptom severity using the Yale-Brown Obsessive-Compulsive Scale. It also describes the use of high-dose selective serotonin reuptake inhibitors and cognitive behavioural therapy as the preferred treatment options, alongside a review of other available options. The comorbidity of obsessive-compulsive disorder is described, along with the need to treat patients using a broader approach. Conclusion: Obsessive-compulsive disorder is a psychiatric disorder with significant prevalence in the Chilean population. Also, the evidence suggests that obsessive-compulsive disorder responses favourably to combined treatment strategies. Given its high comorbidity with other disorders, a comprehensive assessment of the patient is vitally important.
The role of midwifery in education and prevention of pelvic floor dysfunction in primary care: An area of pending attention in adolescence
One in three adolescent girls experiences urinary incontinence without realizing it's related to their pelvic floor. They tend to normalize the symptoms and, consequently, downplay their importance despite the impact they have on their lives. This document reveals a worrying gap in pelvic health education, which focuses almost exclusively on pregnant women, postpartum women, and older women, leaving adolescents marginalized. Midwives in Primary Health Care can change this reality by becoming key agents, thanks to their training and close relationship with the adolescent population. Their work allows them to break down taboos, educate on basic anatomy, promote preventative habits, and detect early signs that may affect the pelvic floor. Incorporating a preventative approach in adolescence helps prevent future pelvic floor dysfunction, improves quality of life, and reduces healthcare costs.
Analysis of hospital discharges for hypospadias in Chile from 2021 to 2024
Introduction: Hypospadias is one of the most common congenital urogenital malformations and affects urinary, sexual, and reproductive function. Globally, it is estimated to affect 1 in every 200 to 300 live births. Objective: Descriptively analyse the hospital discharge rate for hypospadias during the period 2021 to 2024 in Chile. Methodology: An observational, descriptive, cross-sectional, and ecological study was conducted using data from the Chilean Department of Health Statistics and Information and the National Institute of Statistics (2021-2024), using the ICD-10 code Q54. Hospital discharge rates per 100,000 inhabitants, average length of hospital stay, and distribution by diagnosis and age were calculated. Result: A total of 1.561 hospital discharges were recorded. The overall rate was 17,01 per 100.000 inhabitants, highest in 2024 (19,39). The 0-4-year group had the highest rate (51,29) and the longest average stay occurred in the 10-14-year group (3,81 days). The most frequent diagnosis was “unspecified hypospadias” (41,9%). Discussion: It is suggested that the COVID-19 pandemic reduced elective hospitalizations in 2021. The greater care burden in children under 4 years is consistent with the recommended surgical age. The high number of nonspecific diagnoses reflects inefficiencies in coding, highlighting the need for improvement. Conclusion: Improving specific hospital records with individualised codes is essential for the quality of healthcare, as it allows for the proper classification of pathologies, improves the accuracy of clinical records, and facilitates medical and administrative decision-making.
When diagnosis is not enough: A call for ethics in care
This essay addresses dental bioethics as the inescapable foundation of professional practice, moving beyond mere technical competence. The aim is to analyze the structural tension in contemporary dentistry when the focus is on procedural diagnosis, overshadowing the patient's subjective experience. Through a critical review of bioethical principles and recent literature, incorporating concepts of professionalization and epistemic burdens. It is argued that humanized care requires an ethical-deliberative dialogue that harmonizes evidence with the individual's biography. The counterargument regarding the "priority of the epistemic" is introduced, suggesting that moral obligations depend on prior knowledge. A model is proposed where the dentist-patient relationship is an expert moral encounter. Bioethics, understood as the "heart" of the profession, guarantees co-responsible and respectful decisions, requiring specialized training that transcends voluntarism.
Limitations and exceptions to medical confidentiality in Chile
Medical confidentiality is a fundamental ethical duty in clinical practice, aimed at protecting patients' autonomy, privacy, and trust. However, in Chile, this principle is not absolute and includes exceptions when it conflicts with public health, the protection of minors, or serious risk to third parties, as established in Law No.20.584 and other applicable regulations. This article analyzes the bioethical conflict that arises between the duty of confidentiality and the obligation to prevent harm, examining. The criteria that justify limiting medical confidentiality from a perspective of proportionality. The analysis is based on the principles of autonomy, beneficence, non-maleficence, and justice, proposing a reasoned balance between respect for patients' rights and collective well-being. It concludes that medical confidentiality should be protected as a general rule but justifiably limited in exceptional situations.
Nail disorders as clinical markers of systemic disease: A literature review
Introduction: Physical examination remains essential in clinical practice and, within it, nail assessment is often overlooked despite its semiological value. Various nail abnormalities may represent early or persistent manifestations of systemic cardiovascular, hematologic, endocrine, autoimmune, infectious, or renal diseases, underscoring the importance of integrating nail evaluation systematically into patient assessment. Objective: To critically analyze recent evidence on nail disorders as clinical markers of systemic disease, describing their associations, diagnostic implications, and utility in medical practice. Methodology: A narrative review was conducted using PubMed/MEDLINE and MeSH terms specific to nail disorders and systemic diseases. The search identified 945 records; after applying filters for the last five years, full-text access, and inclusion/exclusion criteria, 56 articles were selected, of which 19 were used for this report. The selection process followed PRISMA recommendations. Discussion: Nail findings reflect inflammatory, vascular, metabolic, or immunological alterations. Several signs with high clinical value are highlighted, including digital clubbing, splinter hemorrhages, koilonychia, leukonychia, Beau’s lines, onychomadesis, and nail changes associated with chronic kidney disease, connective tissue disorders, or nail psoriasis. The topography, distribution, and number of affected nails help guide clinicians toward specific systemic etiologies and support comprehensive diagnostic evaluation. Conclusion: Nail abnormalities represent valuable semiological tools that remain underutilized in everyday clinical practice. Their timely recognition facilitates early detection of systemic diseases, strengthens diagnostic decision-making, and contributes meaningfully to the clinical training of students and healthcare professionals.