Browsing by Author "Cortinez Fernandez, Luis Ignacio"

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    Population pharmacokinetics of amikacin in suspected cases of neonatal sepsis
    (Wiley, 2023) Severino Cuevas, Nicolás Felipe; Urzúa Baquedano, Maria Soledad; Ibacache Figueroa, Mauricio Enrique; Paulos Arenas, Claudio; Cortinez Fernandez, Luis Ignacio; Toso Milos, Alberto Antonio; Leguizamon Marino, Liliana Marcela; Inojosa Mackenzie, Fernanda; Maccioni Romero, Andrea Ana; Meza Cañas, Sebastián Jaime; Garcia, Andres; Ramirez, Marcelo; Von Mentlen Gutierrez, Catalina Paz; Ceballos Jorquera Javiera Nicol; Paredes Galvez, Noemi Saray
    Aims:This study aimed to characterize the population pharmacokinetic parameters of intravenously administered amikacin in newborns and assess the effect of sepsis in amikacin exposure. Methods: Newborns aged >= 3 days who received at least 1 dose of amikacin during their hospitalization period were eligible for the study. Amikacin was administered intravenously during a 60-min infusion period. Three venous blood samples were taken from each patient during the first 48 h. Population pharmacokinetic parameter estimates were obtained using a population approach with the programme NONMEM. ResultsData from 329 drug assay samples were obtained from 116 newborn patients (postmenstrual age [PMA] 38.3, range 32-42.4 weeks; weight 2.8, range 1.6-3.8 kg). Measured amikacin concentrations ranged from 0.8 to 56.4 mg/L. A 2-compartment model with linear elimination produced a good fit of the data. Estimated parameters for a typical subject (2.8 kg, 38.3 weeks) were clearance (Cl = 0.16 L/h), intercompartmental clearance (Q = 0.15 L/h), volume of distribution of the central compartment (Vc = 0.98 L) and peripheral volume of distribution (Vp = 1.23 L). Total bodyweight, PMA and the presence of sepsis positively influenced Cl. Plasma creatinine concentration and circulatory instability (shock) negatively influenced Cl. ConclusionOur main results confirm previous findings showing that weight, PMA and renal function are relevant factors influencing newborn amikacin pharmacokinetics. In addition, current results showed that pathophysiological states of critically ill neonates, such as sepsis and shock, were associated with opposite effects in amikacin clearance and should be considered in dose adjustments.
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    Prehabilitation for Chilean frail elderly people - pre-surgical conditioning protocol - to reduce the length of stay: randomized control trial
    (2024) Contreras Ibacache, Víctor; Elgueta Le-beuffe, María Francisca; Balde Sepulveda, Detlef Peter Mario; Astaburuaga Jorquera, Paula Daniela; Carrasco, Marcela; Pedemonte Trewhela, Juan Cristobal; Nicoletti Santoni, Maria Natalia; Medina Díaz, René; Figueroa, Constanza; Alamos Ramirez, Mirelly De Los Angeles; Cuzmar Benítez, Valeria; Vargas Moreno, Benjamin Ignacio; Barraza Mendizabal, Benjamin Juan Pablo; Retamal, Claudio; Cortinez Fernandez, Luis Ignacio; Franco, Sebastián; Agurto, Raul; Vivanco, Catherin
    Background: Frail elderly patients have a higher risk of postoperative morbidity and mortality. Prehabilitation is a potential intervention for optimizing postoperative outcomes in frail patients. We studied the impact of a prehabilitation program on length of stay (LOS) in frail elderly patients undergoing elective surgery.Methods: An RCT study was conducted. Frail patients scheduled for elective surgery were randomized to receive either pre-surgical conditioning protocol (PCP) or standard preoperative care. PCP included nursing, anesthetic, and geriatric assessment, nutritional intervention, and physical training for 4-weeks preoperatively. A nurse followed both groups until discharge criteria were met. The primary outcome was postoperative LOS. Secondary outcomes were nutritional status, preoperative frailty status (frailty phenotype-FP) after PCP, and postoperative complications up to three months categorized according to the Clavien-Dindo Classification. Means and medians between the control and intervention groups were compared, with statistical significance set at α=5%.Results: Thirty-four patients were to intervention and Thirty-seven to the control group. In the intervention group, adherence to prehabilitation was 90%. The median LOS after surgery was three days in both groups, without finding statistically significant differences between groups (P=0.754), although there was a trend towards lower LOS in the urologic surgery subgroup. We found a significant reduction in frailty status after PCP (FPpre=2.4±0.5 and FPpost=1.7±0.5, P<0.001). Nutritional status significantly improved in frail patients after prehabilitation (MNAbasal=9.0±2.5 and MNApost=10.6±2.6), P=0.028. The intervention group had less severe postoperative complications, which were not statistically significant.Conclusions: The PCP conducted both in-person and online, for older frail patients undergoing elective colorectal and urological surgery was not associated with shorter LOS. However, frailty status significantly improved after completing PCP.
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    Trasplante hepático: Evolución, curva de aprendizaje y resultados después de los primeros 300 casos
    (2019) Quezada González, José Luis; Cancino, Alejandra; Arrese Jimenez, Marco Antonio; Wolff, Rodrigo; Benitez Gajardo, Carlos Esteban; Pattillo Silva, Juan Carlos; Gana Ansaldo, Juan Cristobal; Concha Pinto, Mario Rodrigo; Cortinez Fernandez, Luis Ignacio; Vera Alarcón, María Magdalena; Miranda, Paula; Rubilar, Francisco; Troncoso, Andrés; Briceno Valenzuela, Eduardo Andres; Dib Marambio, Martin Javier; Jarufe Cassis, Nicolas Patricio; Martínez, Jorge; Guerra Castro, Juan Francisco
    Liver transplantation (LT) is an option for people with liverfailure who cannot be cured with other therapies and for some people with liver cancer. Aim: To describe, and analyze the first 300 LT clinical results, andto establish our learning curve. Material and Methods: Retrospective cohortstudy with data obtained from a prospectively collected LT Program database.We included all LT performed at a single center from March 1994 to September2017. The database gathered demographics, diagnosis, indications for LT, surgicalaspects and postoperative courses. We constructed a cumulative summation testfor learning curve (LC-CUSUM) using 30-day post-LT mortality. Mortality at 30days, and actuarial 1-, and 5-year survival rate were analyzed. Results: A total of281 patients aged 54 (0-71) years (129 women) underwent 300 LT. Ten percentof patients were younger than 18 years old. The first, second and third indicationsfor LT were non-alcoholic steatohepatitis, chronic autoimmune hepatitis andalcoholic liver cirrhosis, respectively. Acute liver failure was the LT indication in51 cases (17%). The overall complication rate was 71%. Infectious and biliarycomplications were the most common of them (47 and 31% respectively). TheLC-CUSUM curve shows that the first 30 patients corresponded to the learningcurve. The peri-operative mortality was 8%. Actuarial 1 and 5-year survival rateswere 82 and 71.4%, respectively. Conclusions: Outcome improvement of a LTprogram depends on the accumulation of experience after the first 30 transplantsand the peri-operative mortality directly impacted long-term survival.