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BACKGROUND: The purpose of this study was to assess the prevalence of coma among patients in critical care units in Chile. We also aimed to provide insight into the demographic characteristics, etiologies, and complications associated with coma. METHODS: A single day cross-sectional study was conducted through a national survey of public and private hospitals with critical and intensive cardiac care units across Chile. Data were collected using an online questionnaire that contained questions regarding critically ill patients' information, demographic characteristics, etiology and duration of coma, medical complications, and support requirements. RESULTS: A total of 84% of all health facilities answered, accounting for a total of 2,708 patients. The overall coma prevalence was 2.9%. The median age of the comatose patients was 61 years (interquartile range 50-72) and 66.2% were male. The median coma duration was five days (interquartile range 2-9). Cerebral hemorrhage was the most common etiology, followed by severe hypoxic-ischemic encephalopathy, acute ischemic stroke, and traumatic brain injury. A total of 48.1% of coma patients experienced acute and ongoing treatment complications, with pneumonia being the most common complication, and 97.4% required support during comatose management. CONCLUSIONS: This study provides an overview of the prevalence of coma in Chilean critical and cardiac care units. Coma is a common condition. Comatose patients frequently experience medical complications during their hospitalization.

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To ensure neuronal survival after severe traumatic brain injury, oxygen supply is essential. Cerebral tissue oxygenation represents the balance between oxygen supply and consumption, largely reflecting the adequacy of cerebral perfusion. Multiple physiological parameters determine the oxygen delivered to the brain, including blood pressure, hemoglobin level, systemic oxygenation, microcirculation and many factors are involved in the delivery of oxygen to its final recipient, through the respiratory chain. Brain tissue hypoxia occurs when the supply of oxygen is not adequate or when for some reasons it cannot be used at the cellular level. The causes of hypoxia are variable and can be analyzed pathophysiologically following "the oxygen route." The current trend is precision medicine, individualized and therapeutically directed to the pathophysiology of specific brain damage; however, this requires the availability of multimodal monitoring. For this purpose, we developed the acronym "THE MANTLE," a bundle of therapeutical interventions, which covers and protects the brain, optimizing the components of the oxygen transport system from ambient air to the mitochondria.

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RESUMEN Introducción: Actualmente la salud es concebida como un derecho fundamental y para garantizarlo se debe propender por una adecuada formación de los profesionales de la salud. El internado rotatorio es la última etapa y la más importante del pregrado en Medicina. Objetivo: Explorar los factores desde la perspectiva de estudiantes y docentes, que influyen en el desarrollo de competencias en la rotación de Ortopedia y Traumatología durante el internado médico. Métodos: Estudio cualitativo con enfoque en teoría fundamentada. Para la recolección de datos se realizó un cuestionario semiestructurado a una muestra aleatoria de 14 participantes, 7 estudiantes y 7 docentes, que cumplían los criterios de inclusión. El análisis se basó en la codificación y categorización de los datos que posteriormente fueron sometidos a un proceso de triangulación para lograr la teorización final. Resultados: Los factores que favorecen el desarrollo de competencias están relacionados con la motivación intrínseca del estudiante, la flexibilidad y disponibilidad de recursos académicos, las características del programa de la rotación y el ambiente de práctica. Se identificaron como factores limitantes aquellos asociados a una formación deficiente en ciencias básicas médicas, la priorización del componente asistencial sobre el académico, la disponibilidad limitada de espacios y recursos de aprendizaje y los métodos de enseñanza tradicionales. Conclusiones: Es de vital importancia la identificación de los factores que favorecen y limitan el desarrollo de las competencias de los estudiantes de medicina en su última etapa de formación en ortopedia.

ABSTRACT Introduction: Few areas of orthopedic surgery have had such important technical changes in recent decades as in corrective spinal surgery. Fundamental changes have come with the new spinal instrumentation systems, which have been substantially modified and improved to facilitate three-dimensional correction of the deformity and provide secure spinal fixation, correction and stability. Objective: To evaluate the results achieved with the spinal instrumentation systems used in the correction of thoracolumbar kyphosis due to ankylosing spondylitis. Methods: A descriptive, retrospective and longitudinal study was carried out on 16 patients with thoracolumbar kyphosis due to ankylosing spondylitis operated on with the pedicle subtraction osteotomy technique and instrumented with Luque-type pedicle and sublaminar systems, in the Orthopedics service at Hermanos Ameijeiras Surgical Clinical Hospital, from March 2001 to March 2021. Results: All the patients were male, white skin color and average age of 39 years. More than 80% correction was achieved in the sagittal profile and an average of 34.3° per osteotomy, without major neurological complications. Good functional results were obtained, with high degree of patient satisfaction and improvement in their quality of life. Conclusions: The use of both spinal instrumentation systems is effective in maintaining the correction of thoracolumbar kyphosis due to ankylosing spondylitis.

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Introducción Las fracturas de clavícula son muy comunes, representan el 2.6% de todas las fracturas en la población adulta y el 35% de todas las lesiones del hombro. El objetivo de este estudio es determinar cuál es la mejor técnica quirúrgica entre los métodos tipo placa superior versus placa antero-inferior para el tratamiento de fracturas del tercio medio de clavícula. Materiales y métodos Se realizó un estudio de tipo cohorte longitudinal bajo criterios de inclusión, con seguimiento de 9 meses. Se midieron distintos desenlaces de la técnica quirúrgica y fueron utilizados los cuestionarios Dash y Constant Score para evaluar el grado de satisfacción y el resultado funcional, respectivamente. Este estudio cuenta con la aprobación del comité de ética institucional. Resultados Se seleccionaron 96 pacientes (44 sometidos a placa antero-inferior y 52 a placa superior). Los desenlaces medidos se comportan como factor protector para el método de placa antero-inferior: sangrado intraoperatorio (RR 0.60), tiempo quirúrgico (RR 0.52), de consolidación (RR 0.55), irritación del material (RR 0.12) y retiro del material (RR 0.25). Las diferencias respecto a resultados funcionales y grado de satisfacción también fueron estadísticamente significativas. Discusión En concordancia con la literatura, el método de placa antero-inferior demostró ser más seguro y recomendado que el de placa superior, pues mejora el tiempo de unión, reduce la tasa de retardo de la consolidación, el volumen de pérdida de sanguínea intra-operatoria y el tiempo quirúrgico, con mejor resultado funcional y grado de satisfacción en los pacientes.

Background Clavicle fractures are frequent injuries of the shoulder, with an overall incidence of 2.6% of all fractures among the adult population and 35% of all shoulder injuries. This study aims to determine whether dorsal plating or anterior/inferior plating is a better surgical technique for treating middle-third clavicle fractures. Methods A cohort study using inclusion criteria and involving a nine-month follow-up period was carried out. Different surgical technique outcomes were measured; Dash and Constant Score questionnaires, respectively, were used to assess the degree of satisfaction and functional outcome of patients. This study has the approval of the hospital's Ethics Committee. Results 96 patients were selected; 44 underwent anterior-inferior plating and 52 superior plating. The following measured variables are revealed as protective factors for anterior-inferior plating: operative blood loss volume (RR 0.60), operative time (RR 0.52), union rate (RR 0.55), irritation due to material (RR 0.12), and request for material extraction (RR 0.25). Differences regarding functional outcomes and patient satisfaction degrees were also statistically significant. Discussion According to literature, anterior-inferior proved to be safer than dorsal plating method and thus advisable, due to it reduces union time, retarded union rates, operative blood loss volume, and operative time; which results in better functional outcomes and greater patient satisfaction.

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Two H2-based membrane biofilm reactor (H2-MBfR) systems, differing in membrane type, were tested for sulfate reduction from a real mining-process water having low alkalinity and high concentrations of dissolved sulfate and calcium. Maximum sulfate reductions were 99%, with an optimum pH range between 8 and 8.5, which minimized any toxic effect of unionized hydrogen sulfide (H2S) on sulfate-reducing bacteria (SRB) and calcite scaling on the fibers and in the biofilm. Although several strategies for control of pH and gas back-diffusion were applied, it was not possible to sustain a high degree of sulfate reduction over the long-term. The most likely cause was precipitation of calcite inside the biofilm and on the surface of fibers, which was shown by scanning electron microscopy coupled with energy dispersive spectroscopy (SEM-EDS) analysis. Another possible cause was a decline in pH, leading to inhibition by H2S. A H2/CO2 mixture in the gas supply was able to temporarily recover the effectiveness of the reactors and stabilize the pH. Biomolecular analysis showed that the biofilm was comprised of 15-20% SRB, but a great variety of autotrophic and heterotrophic genera, including sulfur-oxidizing bacteria, were present. Results also suggest that the MBfR system can be optimized by improving H2 mass transfer using fibers of higher gas permeability and by feeding a H2/CO2 mixture that is automatically adjusted for pH control.

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