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Introduction: Surgical waiting lists for conditions not covered by the Explicit Health Guarantees represent unmet needs and structural gaps within the Chilean public health system. The field of orthopedics and traumatology accounts for a high volume of pending procedures, with total knee arthroplasty being the most frequently delayed. The coexistence of deferrable pathologies not formally recorded, combined with the low efficiency in the use of operating rooms, aggravates this problem. This study aims to characterize the surgical waiting list for conditions not covered by the Explicit Health Guarantees in Chile between 2022 and 2024, with a focus on orthopedics and traumatology. Additionally, we identify the most delayed procedures, the most affected health services, and the current capacity for resolution.

Methods: A descriptive observational study based on official data requested from the Ministry of Health through transparency and public records, including the Department of Health Statistics and Information and the National Health Fund. Surgical procedures awaiting treatment were analyzed by specialty, region, establishment, sex, and age for the period from 2022 to 2024.

Results: Orthopedics and traumatology were the specialties with the highest number of pending procedures (22 to 24% of the total). Knee arthroplasty consistently ranked first, with over 20 000 cases annually. The O'Higgins Health Service had the highest burden. In 2022, the rate of arthroplasties performed on patients covered by the National Health Fund was four times lower than on patients covered by Social Security Health Institutions. No region achieved a surgical volume sufficient to reduce the waiting list significantly.

Conclusions: The problem of waiting lists in orthopedics is mainly due to organizational shortcomings. Creating the role of trauma emergency ward, optimizing the use of wards, and creating outpatient surgical units are short- and medium-term measures to reverse this trend.

Introduction: Small-scale and artisanal mining are historical activities in Chile that are deeply rooted in the region and economically significant. However, their workers face high levels of exposure to occupational hazards in informal conditions, with no adapted tools for occupational health surveillance. The available instruments are designed for formal companies and do not consider the operational context of artisanal miners.

Objective: To adapt and validate the content of a battery of questionnaires designed to identify working conditions affecting artisanal and small-scale mining workers in Chile.

Methods: An instrumental study was conducted in four phases: document review of national and international protocols; participatory risk identification with union leaders; development of thematic questionnaires; content validation through the judgment of 25 experts in occupational health, mining, psychometrics, and statistics. One hundred and fifty-five items were evaluated according to criteria of clarity, relevance, sufficiency, and coherence, using Aiken's V coefficient (threshold ≥ 0.80).

Results: 87% of the items met the threshold in all four criteria. Aiken's scores ranged from 0.77 to 0.98. The diesel exposure module obtained the highest scores, while the working conditions module showed less clarity (0.77), justifying the modification or elimination of 41% of its items. A new questionnaire on exposure to chemical agents was created by integrating modules. As a result of the adjustment process, the final battery consisted of six thematic questionnaires.

Conclusions: This is the first questionnaire set with favorable content validity to assess working conditions in Chilean artisanal mining, a sector with high labor informality. It represents an initial validation step. Further studies should evaluate reliability, construct validity, and field applicability.

Introduction: Hip and knee osteoarthritis are common causes of disability, with high social and economic impact. Total hip and knee arthroplasties are cost-effective interventions that significantly improve quality of life. However, timely access to these surgeries in the Chilean public healthcare system remains limited. Since 2019, the Diagnosis-Related Groups (DRG) system has enabled the financing of hospital surgical procedures by adjusting payments according to case complexity. The objective of our study was to describe the hospital volume, clinical profile of patients, and financing situation of arthroplasties performed between 2019 and 2023 in public hospitals operating under the Diagnosis-Related Groups system.

Methods: Observational, cross-sectional, and retrospective study. All procedures coded as primary total hip arthroplasty or total knee arthroplasty recorded in the Diagnosis-Related Groups database of the National Health Fund (FONASA) between January 2019 and September 2023 were analyzed. Clinical, demographic, geographic, and economic variables were extracted. Comorbidities were identified using the International Classification of Diseases, 10th revision (ICD-10).

Results: A total of 29 409 primary and 1993 revision arthroplasties were performed. Surgical volume decreased in 2020 and recovered progressively. Hospital productivity varied across regions. One-third of the total hip arthroplasties were performed in patients under 65 years old. The most frequent comorbidities were hypertension (43.4%) and diabetes (16.6%). The average reimbursement for revision surgeries was similar to that of primary procedures.

Conclusions: We identified regional inequities in access to total hip and knee replacements. We also found possible underreporting of comorbidities and underfunding of revisions, which highlights the need for specific adjustments to the Diagnosis-Related Groups system. In the future, it will be necessary to improve the quality of coding, expand financial coverage for patients excluded from the Explicit Health Guarantees, and incorporate technological adjustments that adequately reflect the costs of revisions, to move toward equitable and sustainable access to these surgeries.

This report describes the rare case of a patient with autoimmune hemolytic anemia due to cryoagglutinins secondary to Mycoplasma pneumoniae infection, coexisting with pernicious anemia. A 56-year-old man presented with a ten-day history of cough and mucocutaneous pallor. Laboratory studies revealed megaloblastic anemia with low vitamin B12 levels, positive antibodies against intrinsic factor and parietal cells, as well as hemolysis parameters and a positive direct Coombs test for complement (C3d) with cryoagglutinins active at low temperatures. M. pneumoniae infection was confirmed by indirect immunofluorescence for IgM and IgG. Intramuscular B complex supplementation and doxycycline were administered for 14 days, improving hemoglobin and other hematological parameters within four weeks. This case highlights the diagnostic complexity in patients with rare hemolytic anemias in the context of atypical infections and underscores the importance of a multidisciplinary approach for their diagnosis and appropriate treatment. The coexistence of cryoagglutinin-mediated autoimmune hemolytic anemia and pernicious anemia poses diagnostic and therapeutic challenges that are relevant to clinical practice.

Introduction: The COVID-19 pandemic had a major impact on emergency services, including stroke care. Changes in the administration times of brain reperfusion therapies for stroke have been little explored in Chile. The aim of this study was to analyze the impact that the pandemic had on critical stroke treatment times, the number of patients treated, clinical severity, and the presence of major vessel occlusion.

Methods: We performed a retrospective analysis of patients undergoing encephalic reperfusion therapy in a hospital in Valparaíso, Chile. Two groups of patients treated one year before (pre-pandemic group) and one year after (pandemic group) the start of health restrictions were compared.

Results: 104 patients were included, with a mean age of 67.4 ± 13 years and a clinical severity of 13.5 ± 6.5 in the NIHSS. 91.5% received thrombolytic therapy. No significant intergroup differences were found in the metrics of treatment time, number of patients treated, clinical severity, or presence of major vessel occlusion. Although there was a non-significant trend towards delayed institutional therapeutic times, a significant correlation was found suggesting that the shorter the time from symptom onset to door, the shorter the time to access therapy (r = 0.84).

Conclusions: There were no significant differences in the therapeutic times of stroke in the period prior to the COVID-19 pandemic and the pandemic period, showing similarities to the experience reported in Chile and highlighting the adaptation of the health system during the health crisis. Studies with more complex epidemiological designs analyzing larger samples of patients will allow us to complement these results.

Introduction: Efficient and effective cancer management is a priority for the Chilean healthcare system. In recent years, significant progress has been made through public policies integrating management at different levels (micro, meso, and macro). However, gaps between the population's needs, service availability, and effective demand may impact health outcomes.

Objective: To describe the national effective demand for prioritized cancer services within the Chilean public healthcare system.

Methods: A descriptive comparative analysis was conducted using data from the public sector Health Guarantees Management Information System between 2018 and 2022. The rates of new cases granted health guarantees by intervention type and the analysis of delayed guarantees were performed.

Results: A total of 3.8 million new cases of explicit health guarantees and 3.9 million fulfilled opportunity guarantees were included. The rates of primary treatment opportunity guarantee by tracer intervention declined in 2020 and 2021, while delayed guarantees showed an increasing trend throughout the entire period. Effective demand varied across cancer types. Breast cancer, preventive cholecystectomy, and gastric cancer exhibited the largest sex-based differences in new cases and primary treatment. Delayed guarantees were similar between sexes, except for breast cancer.

Conclusions: This study provides valuable insights into the demand for cancer services in Chile and the performance of the public healthcare system concerning sex and cancer type, highlighting the impact of the COVID-19 pandemic. The findings emphasize the need to strengthen the public system's response capacity to reduce gaps and improve equity in oncological care.

Introduction: Telerehabilitation has been proposed as an innovative, safe, and effective method of intervention to prevent or improve frailty. This rehabilitation modality facilitates access to opportunities and reduces gaps in healthcare. The advantages and challenges of implementing synchronous telerehabilitation programs in older people should be explored.

Objective: This protocol describes the methodology to analyze the effects of a multicomponent physical exercise program in synchronous telerehabilitation modality compared to a multicomponent physical exercise program in face-to-face modality in terms of quality of life of frail older people.

Methods: A systematic review will be performed in the following databases: Medline/PubMed, Scopus, Web of Science, CINAHL, Central, PeDRO, Lilacs, and Epistemonikos. To identify randomized clinical trials that meet the proposed eligibility criteria. The primary outcomes are quality of life and functionality, and the secondary outcomes are strength, balance, and cardiorespiratory capacity. In addition, the risk of bias will be assessed using the ROB-2 tool, and the certainty of the evidence will be assessed using the GRADE system. A meta-analysis will be performed if the procedures used to determine the results of the study are homogeneous; mean differences with a 95% confidence interval will be calculated. Otherwise, standardized mean differences will be used to determine the effect sizes.

Expected: results The main findings of this review and meta-analysis will contribute to clarifying the effectiveness of physical therapy applied in a synchronous remote modality. It will also identify the variables on which it has a positive effect.

Prospero registration: CRD42024605527.

This study presents a case of a 25-year-old Native American woman from Otavalo, Ecuador, diagnosed with sea-blue histiocytosis and myelodysplastic syndrome. Bone marrow aspiration revealed sea-blue histiocytes, and next-generation sequencing identified a likely pathogenic stop-gain mutation in the SAMD9 gene, associated with myelodysplastic syndrome. Additionally, variants of uncertain significance were found in the ALB and SRI genes. Ancestral analysis showed a predominantly Native American composition, suggesting a potential genetic predisposition specific to Andean communities. The report underscores the importance of understanding genetic and ancestral backgrounds in diagnosing and managing hematological disorders.

Introduction: In Chile, the number of migrants affected by tuberculosis has experienced a significant increase from 7.1% in 2014 to 29.7% in 2023, ranking as the first group at risk. The objective was to estimate the time to diagnosis of tuberculosis from arrival in Chile in a series of migrants undergoing treatment between January 2021 and March 2022.

Methods: We analyzed a cohort of migrants over 18 years of age with a diagnosis of tuberculosis treated in the communes of Recoleta and Independencia. Those who agreed to participate and signed the informed consent form were included. Cases with non-tuberculous mycobacteria and residents outside the Metropolitan Region were excluded. Sociodemographic, clinical, and arrival dates, as well as symptoms and diagnoses, were recorded. Proportional hazards models in STATA v.18 were used to analyze times according to independent variables. A p value < 0.05 was considered significant.

Results: The median time to diagnosis was 93.5 months, varying by subgroup. The recent migration subgroup without Chilean documentation had a hazard ratio of 13.1, which indicates that, at any time after arrival, these individuals have a 13-fold increased risk of tuberculosis diagnosis compared to the reference subgroup (traditional migration with Chilean identity documents). This hazard ratio is reduced by 2.4 times when these types of migrants have documentation from Chile (95% confidence interval: 1.2 to 4.5).

Conclusions: There is a wide range of time from arrival in Chile to the diagnosis of tuberculosis. Factors such as the type of migration and the type of identity document have an impact on the development of this disease. It is necessary to expedite the legal administrative process for migrants and implement timely screening policies, along with follow-up and improved access to healthcare, to reduce exposure and risk of tuberculosis.