Browsing by Author "Acuna, Maria Paz"

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    Characteristics of HIV-associated cryptococcal meningitis in a tertiary Chilean hospital: An observational retrospective study
    (2024) Elicer, Isabel; Eugenin, Laura; Acuna, Maria Paz; Uslar, Wilhelm; Fernandez, Ana; Lasso, Martin
    Background: Central nervous system opportunistic infections can be the first presentation of an HIV infection. Our aim is to describe clinical and laboratory characteristics of HIV-associated Cryptococcal Meningitis (CM), inhospital outcomes and analyze associations of these parameters with adverse outcomes. Methods: Observational study of local cohort of HIV-associated cryptococcal meningitis in a high complexity tertiary urban hospital in Santiago, Chile. Descriptive analysis through chart review of all episodes of HIV-associated CM in adults, from 1995 to 2019. Inclusion criteria were confirmed CM with cerebrospinal fluid culture or India ink in the appropriate clinical context and HIV diagnosis. We selected relevant variables that have been described as predictors of adverse outcomes in the literature and explore associations in our cohort. Results: There were 37 HIV associated CM cases, occurring from 2000 to 2019. Majority were men (86 %) with a median age of 35 years. CM was the first HIV manifestation in 32 %. Opening pressure was measured in 10 % of patients at admission. Most CSF parameters were mildly altered, and two patients presented with completely normal CSF findings. Most patients -94,4 %- suffered adverse events secondary to antifungal therapy. Despite of recommendations against their use, steroids were frequently prescribed. Mortality was 18,9 %, and was associated with older age, and more days of headache prior to admission. Conclusions: CM clinical presentation and CSF characteristics are variable at presentation, which can lead to delayed diagnosis. Inappropriate use of corticosteroids, antifungal toxicity and suboptimal management of elevated intracranial pressure are key aspects to improve.
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    Combining remote sensing and field data to assess recovery of the Chilean Mediterranean vegetation after fire: Effect of time elapsed and burn severity
    (2022) Smith-Ramirez, Cecilia; Castillo-Mandujano, Jessica; Becerra, Pablo; Sandoval, Nicole; Fuentes, Rodrigo; Allende, Rosario; Acuna, Maria Paz
    It has been debated if Chilean sclerophyllous vegetation can recover after fire of different severity and short and long term. We evaluated the resiliency of this vegetation type after single-occurrence fires of different severities that occurred 30, 20 and 10 years in Central Chile before the study. Two approaches were followed: satellite image analysis and vegetation sampling. Wildfires that occurred between 1985 and 2015 were identified based on Landsat images. We selected 30 sites burned by a single fire in either 1985, 1995 or 2005, and that was not converted to another land use by 2015, then determined the percentage cover by vegetation type. We recorded or estimated the independent variables of burn severity, slope, altitude, pre-fire vegetation type and latitude of the sites. Composition, richness, and abundance of adult and regeneration of woody vegetation and herbaceous cover were sampled. Generalized linear models were used to evaluate the effect of the independent variables and the time elapsed since the fire on vegetation recovery. The proportion of dense vegetation forest cover was significantly higher with more time elapsed since the fire, while semi-dense forest/shrubland and open shrubland vegetation cover returned to pre-fire levels more quickly. The richness and abundance of regenerated woody species was significantly greater with more time elapsed since the fire. However, no relationship was found between species richness and abundance of adult woody species and time elapsed post-fire. We found that vegetative recovery over time was not related to burn severity. Forested and mixed forest/shrubland cover is reached 10-20 years after the fire, if no further intervention occurs. Richness and species abundance was similar to that of unburned sites after 20 or more years post-fire. This study provided evidence that forest vegetation in the Chilean Mediterranean ecosystem is resilient to fires of at least low and medium intensities.