Browsing by Author "Astudillo, Patricio"

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    Association between depressive symptoms in mothers and metabolic control in adolescents with type 1 diabetes
    (SOC CHILENA PEDIATRIA, 2020) von Borries, Denise; Astudillo, Patricio; Perez, Viviana; Garcia F, Hernan; Rumie, Karime; Garcia B, Hernan
    Poor metabolic control in patients with Type 1 Diabetes Mellitus (T1DM) is associated with short- and long-term complications. Adolescents with T1DM present poorer metabolic control than patients of other age groups. Few studies have shown an association between mothers with depressive symptoms and the metabolic control of their adolescent children. Objective: To evaluate the association between maternal depressive symptoms and metabolic control of their adolescents with T1DM. Subjects and Method: Cross-sectional observational study carried out with adolescents aged between 10 and 18 years, with T1DM diagnosis of at least 1 year ago and their mothers. The Beck Depression Inventory-II and the SALUFAM questionnaire were applied, and sociodemographic data were collected. Glycosylated hemoglobin from capillary blood was used as a marker of metabolic control. Results: 86 couples (mother-adolescent children) were studied. The average age of the adolescents was 14.04 years and the average evolution time of T1DM was 5.95 years. 27.325.6% of mothers had depressive symptoms, which was associated with worse metabolic control of their children (HbA1c of 7.66% and 8.91%, p-value <0.001). 17.9% of adolescents had depressive symptoms, which was not associated with maternal depressive symptoms or worse metabolic control. Maternal depressive symptoms were also associated with lower maternal and paternal educational levels, high number of children in the family, presence of other siblings with chronic illnesses, and high health vulnerability (SALUFAM). Conclusions: The mother's depressive symptoms can be associated with worst metabolic control in T1MD adolescents. It is fundamental a multidisciplinary family approach to get better metabolic controls in T1DM adolescents.
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    Evaluation of antimicrobial consumption in a Neonatology Unit: a team work to promote the rational use of antibiotics
    (SOC CHILENA INFECTOLOGIA, 2017) Jimenez, Elisa; Valls, Nicolas; Astudillo, Patricio; Valls, Cristian; Cavada, Gabriel; Sandoval, Alejandra; Alegria, Angelica; Ortega, Gabriela; Nunez, Daniela; Mena, Patricia
    Background: Antibiotics (ATB) are drugs widely used in hospitalized newborns. The indiscriminate use of ATBs promote the rise of resistant bacteria to the most commonly indicated antimicrobials. In addition, ATB prescription presents associations to morbidity, such as bronchopulmonary dysplasia, necrotizing enterocolitis, late sepsis and even death. All of the above leads to an increase in health care costs. Aim: To record and to evaluate trends of antibiotic use over time in hospitalized NB in the Neonatology Unit at Dr. Sotero del Rio Hospital, in order to objectify the changes in the usual practice of the ATM indication. A secondary objective was to assess its impact on antimicrobial resistance. Methods: Cohort, observational, prospective unicenter study which included all hospitalized patients between January 2011 and December 2014. Birth weight, hospitalization days, ATB indication and days of ATB use were recorded for each patient. The use of ATB was quantified by means of different rates; days of indication of one or more ATBs for global consumption (RUA), total sum of days of use (TSUA) and for the most frequently used ATBs. Each calculated rate for 100 days hospitalized. In addition, the antimicrobial susceptibility of the most frequently isolated bacteria in our service: coagulase-negative Staphylococcus (SCN) and Gram-negative bacilli (BGN) were recorded continuously. Results: The 34.7% of the hospitalized patients received some type of antimicrobial agent. ATBs were 32.3% of medicines used. The most widely used was ampicillin (with 20.2% of the total) and cefadroxyl (with 11.6%). The RUA did not change during the study time, but STUA decreased by 10.7% between 2011 and 2014 with p < 0.05. When subgroup analyzes were divided by weight ranges, in the < 750 g group, the use of vancomycin decreased in use by 9.9% and an increase of 18.8% for metronidazole was observed. On the other hand, there was an increase in the use of the piperacillin-tazobactam regimen in the range > 1,500 g. When evaluating antimicrobial susceptibility, there was a decrease in susceptibility for oxacillin in SCN between 2011 and 2014 from 27% to 10.3% respectively. In addition, for Gram negative there was a decrease from 76.9% to 40.5% in susceptibility to third generation cephalosporins, mainly due to Klebsiella pneumoniae, which became the predominantly isolated BGN with an increase of 6.7% to 50% between 2011 and 2014, respectively. For K. pneumoniae the loss of susceptibility to third generation cephalosporins decreased from 77% to 22%. Finally, amikacin showed an activity over 85% in all BGNs between 2011 and 2014. Conclusions: It is advisable to plan and to maintain a continuous record of ATB consumption, as well as therapy and prophylaxis, being categorized by ATB type and range of newborn weight. It is of considerable importance to analyze and to evaluate the susceptibility of microorganisms. It is essential that an interdisciplinary team prepare this recording, and to continuously provide feedback to professionals who maintain the functioning of neonatal care units.
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    Facilitators and barriers perceptions to early referral to pediatric palliative care perceived
    (2023) Ceballos-Yanez, Diego; Astudillo, Patricio; Eugenin-Soto, Maria Ignacia
    The perception of facilitators and barriers to referral to pediatric palliative care (PPC) is a widely studied phenomenon, with scarce information in Latin America. Objective: to adapt a survey on the perception of facilitators and barriers to PPC referral and evaluation. Subjects and Method: elec-tronic survey with cultural adaptation with translation-retrotranslation in pediatricians and pediatric subspecialists of 3 tertiary centers in Santiago. The survey consisted of 4 sections and 51 questions, corresponding to sociodemographic data (including self-perception of spirituality and religiosity), training and clinical practice of the respondent in PPC, and facilitators and barriers to referral to PPC. Results: 146 pediatricians were invited and 78 surveys were obtained (response rate: 53.4%). The median age was 42 years and 11.5 years of professional practice. The majority corresponded to pediatricians without subspecialty training (n = 34; 43.6%). Twenty-three (29.5%) of the partici-pants received PPC training, which was perceived as insufficient in 17 (74%) cases; there were also no differences in PPC training when comparing pediatricians with or without subspecialty training. Ninety-five percent of the respondents agreed with the perceived benefit of early referral to PPC for patients with life-threatening pathologies, regardless of their diagnosis, although only 47.7% stated that they had made a referral to a PPC team. The emotional relationship with the patients and their families was perceived as a barrier by pediatricians in those subspecialists susceptible to PPC com-pared with those who were not (20% vs. 50%; p = 0.03). Conclusion: A significant deficit in PPC training was detected. There were no differences in facilitators and barriers between pediatricians and subspecialties susceptible to PPC. Specialties not accustomed to PPC-susceptible patients may be affected by emotional factors in their decisions.
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    Micronutrients intake in patients with refractory epilepsy with ketogenic diet treatment
    (2024) Velandia, Silvia; Astudillo, Patricio; Acevedo, Keryma; Le Roy, Catalina
    The Ketogenic Diet (KD) is a non-pharmacological strategy for drug-resistant epilepsy (DRE) and inborn errors of metabolism (Glut-1 deficiency) management. KD is characterized by being restrictive, affecting micronutrient intake. There are different modalities of KD in which food intake and nutritional deficiencies vary. Objective: To determine the micronutrient intake in different KD modalities. Patients and Method: Observational, cross-sectional study with patients diagnosed with DRE and Glut-1 deficiency. The dietary intake of 21 micronutrients was evaluated, and analyzed according to KD modality [Classic, Modified Atkins Diet (MAD)], use of special formula, and adequacy of recommended dietary intake (RDI) according to age and sex, defining < 75% as deficient. Results: 19 patients were evaluated, median age 62 months (IQR: 20.5-79), 12/19 (63.2%) male, 13/19 (68.4%) eutrophic, 5/19 (26.3%) gastrostomy users, 10 (52.6%) MAD modality, use of special formula 7/19 (36.8%). Micronutrient deficiencies were found in 16/21 (76.2%) in the classic diet and 9/16 (42.9%) in the MAD. The intake of vitamin D, B2, B12, sodium, phosphorus, zinc, and selenium was significantly lower in the classic diet than in DMA, the median intake adequacy of vitamins A, C, D, E, and K was > 100%. The use of special formula manages to complete the requirements in MAD. Conclusions: The micronutrient intake in the different KD modalities is low for most of them, being the MAD with formula the one that presented a more adequate micronutrient intake. These results should be considered in nutritional follow-up and supplementation planning.
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    Micronutrients intake in patients with refractory epilepsy with ketogenic diet treatment
    (2024) Velandia, Silvia; Astudillo, Patricio; Acevedo, Keryma; Le Roy, Catalina
    The Ketogenic Diet (KD) is a non-pharmacological strategy for drug-resistant epilepsy (DRE) and inborn errors of metabolism (Glut-1 deficiency) management. KD is characterized by being restrictive, affecting micronutrient intake. There are different modalities of KD in which food intake and nutritional deficiencies vary. Objective: To determine the micronutrient intake in different KD modalities. Patients and Method: Observational, cross-sectional study with patients diagnosed with DRE and Glut-1 deficiency. The dietary intake of 21 micronutrients was evaluated, and analyzed according to KD modality [Classic, Modified Atkins Diet (MAD)], use of special formula, and adequacy of recommended dietary intake (RDI) according to age and sex, defining < 75% as deficient. Results: 19 patients were evaluated, median age 62 months (IQR: 20.5-79), 12/19 (63.2%) male, 13/19 (68.4%) eutrophic, 5/19 (26.3%) gastrostomy users, 10 (52.6%) MAD modality, use of special formula 7/19 (36.8%). Micronutrient deficiencies were found in 16/21 (76.2%) in the classic diet and 9/16 (42.9%) in the MAD. The intake of vitamin D, B2, B12, sodium, phosphorus, zinc, and selenium was significantly lower in the classic diet than in DMA, the median intake adequacy of vitamins A, C, D, E, and K was > 100%. The use of special formula manages to complete the requirements in MAD. Conclusions: The micronutrient intake in the different KD modalities is low for most of them, being the MAD with formula the one that presented a more adequate micronutrient intake. These results should be considered in nutritional follow-up and supplementation planning.
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    Prophylactic fluconazole protocol in very low birth weight infants: invasive candidiasis prevention in a Latin American neonatal intensive care unit
    (2023) Valenzuela-Stutman, Daniela; Romero, Andrea Maccioni; Astudillo, Patricio
    ObjectiveTo evaluate the effect of prophylactic fluconazole for very low birth weight infants (VLBWI) in a neonatal intensive care unit (NICU) with a 7.8% incidence of invasive candidiasis (IC).Study designInterventional pre-post cohort study comparing 2 years with and without fluconazole prophylaxis protocol (2016-2018 = 228 infants and 2019-2021 = 125 infants). Fluconazole was administered to all extremely low birth weight infants (ELBWI) and infants with BW 1001-1500 g with risk factors or positive carrier cultures. Liver function tests were performed weekly.ResultsThe incidence of IC decreased from 7.8% to 2.4% (OR:0.3, p = 0.05) with the use of prophylactic fluconazole for VLBWI and in ELBWI decreased from 16,7% to 3,7% (OR:0.1, p = 0.04). No significant differences were seen in mortality.ConclusionsFluconazole is a safe, effective, and feasible strategy to prevent IC in a Latin American country.