Browsing by Author "Graf, Jeronimo"

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    Extracorporeal Membrane Oxygenation for COVID-19-associated Severe Acute Respiratory Distress Syndrome in Chile A Nationwide Incidence and Cohort Study
    (2021) Diaz, Rodrigo A.; Graf, Jeronimo; Zambrano, Jose M.; Ruiz, Carolina; Espinoza, Juan A.; Bravo, Sebastian, I; Salazar, Pablo A.; Bahamondes, Juan C.; Castillo, Luis B.; Gajardo, Abraham I. J.; Kursbaum, Andres; Ferreira, Leonila L.; Valenzuela, Josefa; Castillo, Roberto E.; Perez-Araos, Rodrigo A.; Bravo, Marcela; Aquevedo, Andres F.; Gonzalez, Mauricio G.; Pereira, Rodrigo; Ortega, Leandro; Santis, Cesar; Fernandez, Paula A.; Cortes, Vilma; Cornejo, Rodrigo A.
    Rationale: The role of and needs for extracorporeal membrane oxygenation (ECMO) at a population level during the coronavirus disease (COVID-19) pandemic have not been completely established.
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    Platelet Count in Patients with Mild Disease at Admission is Associated with Progression to Severe Hantavirus Cardiopulmonary Syndrome
    (2019) Lopez, Rene; Vial, Cecilia; Graf, Jeronimo; Calvo, Mario; Ferres, Marcela; Mertz, Gregory; Cuiza, Analia; Agueero, Begonia; Aguilera, Dante; Araya, Diego; Pailamilla, Ignacia; Paratori, Flavia; Torres-Torres, Victor; Vial, Pablo A.; Abarca, Juan; Miguel Noriega, Luis; Valdivieso, Francisca; Delgado, Iris; Martinez, Constanza; Carlos Chamorro, Juan; Hernandez, Jury; Pino, Marcelo; Vega, Ivonne; Otarola, Irisol; Ortega, Carlos; Daube, Elizabeth; Castillo, Constanza; Mardones, Jovita; Sanhueza, Ligia; Inostroza, Jaime; Donoso, Solange; Navarrete, Maritza; Araneda, Andres; Aguilera, Teresa; Osorio, Carola; Yobanolo, Veronica; Scholz, Luis; Riquelme, Raul; Riquelme, Mauricio; Munoz, Miriam
    Background: Hantavirus cardiopulmonary syndrome (HCPS) has a mortality up to 35-40% and its treatment is mainly supportive. A variable to predict progression from mild to severe disease is unavailable. This study was performed in patients with documented infection by Andes orthohantavirus, and the aim was to find a simple variable to predict progression to moderate/severe HCPS in patients with mild disease at admission. Methods: We performed a retrospective analysis of 175 patients between 2001 and 2018. Patients were categorized into mild, moderate, and severe disease according to organ failure and advanced support need at hospital admission (e.g., mechanical ventilation, vasopressors). Progression to moderate/severe disease was defined accordingly. Clinical and laboratory variables associated with progression were explored. Results: Forty patients with mild disease were identified; 14 of them progressed to moderate/severe disease. Only platelet count was different between those who progressed versus those that did not (37 (34-58) vs. 83 (64-177) K/mm(3), p < 0.001). A ROC curve analysis showed an AUC = 0.889 (0.78-1.0) p < 0.001, with a platelet count greater than 115K /mm(3) ruling out progression to moderate/severe disease. Conclusions: In patients with mild disease at presentation, platelet count could help to define priority of evacuation to tertiary care centers.
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    Proteinuria in Hantavirus Cardiopulmonary Syndrome: A Frequent Finding Linked To Mortality
    (2021) Lopez, Rene; Espinoza, Mauricio; Graf, Jeronimo; Mertz, Gregory; Ferres, Marcela; Calvo, Mario; Vial, Cecilia; Vial, Pablo A.
    Objectives: To determine the relative frequency and prognosis value of proteinuria in hantavirus cardiopulmonary syndrome (HCPS) due to Andes virus. Methods: This observational analytical study prospectively obtained data from patients admitted to 12 health centers in nine Chilean cities between 2001 and 2018. Only patients with confirmed Andes virus HCPS and laboratory characterization that included qualitative proteinuria determination at admission were considered. Results: The database involved 175 patients, 95 of them had a measurement of urine protein at the time of hospital admission. They were mainly male (71%) and the median age was 35 [22-47] years. Median duration of the febrile prodromal time was 5 [4-7] days. Hospital length of stay and hospital mortality rate were 10 [7-14] days and 21.1%, respectively. Seventy-three patients (77%) were identified with proteinuria at admission, which was associated with increased mortality rate (26% versus 5%, p = 0.036) and the relative risk was 1.3 [1.1-1.6], p = 0.002. Conclusions: Proteinuria is a frequent finding in patients with HCPS, which is associated with a higher mortality rate. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )
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    Viral shedding and viraemia of Andes virus during acute hantavirus infection: a prospective study
    (2024) Ferres, Marcela; Martinez-Valdebenito, Constanza; Henriquez, Carolina; Marco, Claudia; Angulo, Jenniffer; Barrera, Aldo; Palma, Carlos; Pinto, Gonzalo Barriga; Cuiza, Analia; Ferreira, Leonila; Rioseco, Maria Luisa; Calvo, Mario; Fritz, Ricardo; Bravo, Sebastian; Bruhn, Alejandro; Graf, Jeronimo; Llancaqueo, Alvaro; Rivera, Gonzalo; Cerda, Carolina; Tischler, Nicole; Valdivieso, Francisca; Vial, Pablo; Mertz, Gregory; Vial, Cecilia; Le Corre, Nicole
    Background Andes virus (ANDV) is a zoonotic Orthohantavirus leading to hantavirus cardiopulmonary syndrome. Although most transmissions occur through environmental exposure to rodent faeces and urine, rare person -toperson transmission has been documented, mainly for close contacts. This study investigates the presence and infectivity of ANDV in body fluids from confirmed cases and the duration of viraemia. Methods In this prospective study, 131 participants with confirmed ANDV infection were enrolled in Chile in a prospective study between 2008 and 2022. Clinical samples (buffy coat, plasma, gingival crevicular fluid [GCF], saliva, nasopharyngeal swabs [NPS], and urine) were collected weekly for 3 weeks together with clinical and epidemiological data. Samples were categorised as acute or convalescent (up to and after 16 days following onset of symptoms). Infectivity of positive fluids was assessed after the culture of samples on Vero E6 cells and use of flow cytometry assays to determine the production of ANDV nucleoprotein. Findings ANDV RNA was detected in 100% of buffy coats during acute phase, declining to 95% by day 17, and to 93% between days 23-29. ANDV RNA in GCF and saliva decreased from 30% and 12%, respectively, during the acute phase, to 12% and 11% during the convalescent phase. Successful infectivity assays of RT-qPCR-positive fluids, including GCF, saliva, NPS, and urine, were observed in 18 (42%) of 43 samples obtained during the acute phase of infection. After re -culture, the capacity to infect Vero E6 cells was maintained in 16 (89%) of 18 samples. Severity was associated with the presence of ANDV RNA in one or more fluids besides blood (odds ratio 258 [95% CI 142-518]). Interpretation ANDV infection is a systemic and viraemic infection, that affects various organs. The presence of infectious particles in body fluids contributes to our understanding of potential mechanisms for person -to -person transmission, supporting the development of preventive strategies. Detection of ANDV RNA in additional fluids at hospital admission is a predictor of disease severity. Funding National Institutes of Health and Agencia de Investigaci & oacute;n y Desarrollo. Copyright (c) 2024 Elsevier Ltd. All rights reserved.