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805 Complications of Gastrointestinal Endoscopy in 85,391 Procedures
(Mosby-Elsevier, 2012) Espino Espino, Alberto Antonio; García Astorquiza, Ximena Andrea; Mac Namara, Macarena; Richter Roca, Hugo Michael; Pimentel Muller, Fernando; Biel Morales, Francisco Javier; Robles García, Camila Fernanda; Callejas, Matías F.; Sharp Pittet, Allan Carlos; Donoso, Andrés; Candia Balboa, Roberto Andrés; González Donoso, Robinson; Jarufe Cassis, Nicolás; Arrese, Marco; Álvarez Lobos, Manuel; Padilla Pérez, Oslando
Background: Complications are inherent to GI endoscopy (GIE) and do not necessarily imply endoscopist's negligence. They may occur even using highest standards of practice. Objectives: To analyze the frequency and severity of complications occurring within 30 days after of the GIE at a single university hospital in Chile. Methods: We reviewed the records about patients who underwent GIE from January 2001 through May 2011. Results: A total of 85,391 GIE were evaluated. Procedures: 46,928 (55%) esophagogastroduodenoscopy (EGD); 27,993 (32.8%) diagnostic colonoscopies; 1427 (1.7%) polypectomies; and other procedures (hemostasis, variceal band ligation (VBL), foreign-body removal, dilation, stents, PEG, ERCP, EUS and double balloon endoscopy) 9043 (10.5%). A total of 299 complications were associated with GIE (59 % female, mean age 63 years, range 5 - 99). The overall complications rate was 0.35% (cardiopulmonary (CP) 0.1%, bleeding 0.07%, perforation 0.06%, infection 0.04%, pancreatitis 0.03% and other). The overall complication rate was higher in therapeutic procedures (TP) vs diagnostic procedures (DP) (2.7% v/s 0.16%, p<0.0001). The percentage of severe complications was higher in TP vs DP (52.3% vs 28.4%, p<0.0001). The overall complication rate for EGD was 0.14% (CP 0.07%, perforation 0.017%, bleeding 0.019%); diagnostic colonoscopy, 0.27% (CP 0.1%, perforation 0.06%, bleeding 0.02%); and polypectomy, 1.8% (CP 0.14%, perforation 0.28%, bleeding 0.98%). A total of 15 deaths occurred (overall rate 0.018%, 83% in TP). The overall mortality rate was higher in TP vs DP (0.2% v/s 0.003%, p<0.0001). The mortality rate for PEG was 0.7%; VBL 0.4%; ERCP 0.2%; diagnostic colonoscopy 0.004%; EGD 0.004%; and polypectomy 0%. Conclusions: GIE is associated with complications and mortality. The severity and risk of complications are higher in therapeutic procedures. These risks should be clearly explained to patients and their family before the procedure.
A nomogram for predicting serious complications in patients with solid tumors and apparently stable febrile neutropenia: prospective data on 781 consecutive episodes from the FINITE study
(2014) Ghanem, Ismael; Rebollo, Maite Antonio; Garrido, Marcelo; Martínez, Jerónimo; Font, Carme; Ramchandani, Avinash; Biosca, Merce; Beato, Carmen; Martínez de Castro, Eva; Castanon, Eduardo; Virizuela Echaburu, Juan; Espinosa, Javier; Sevillano, Elena; Aragon Manrique, Isabel; Cardona, Merce; Mondejar, Rebeca; Baron, Francisco; Acevedo Claros, Francisco Nicolás; Jiménez-Fonseca, Paula; Carmona Bayonas, Alberto
Background: An accurate estimate of the likelihood of serious complications in patients with otherwise apparently stable febrile neutropenia (FN) may assist in decision-making regarding individualized therapy. Our group has developed a prognostic score for predicting complications in patients with solid tumors and apparently stable episodes called CISNE (Clinical Index for Stable Febrile Neutropenia). The purpose of this study is to present a nomogram based on the previously mentioned index in a broader dataset of patients. Methods: FINITE is a prospective and multicenter study which aims to investigate prognostic factors and outcomes of FN episodes with clinical stability at first assessment, defined as events without acute organ dysfunction, vital signs abnormalities or major infections. We performed a nomogram based on the CISNE score which includes the following prognostic variables: ECOG PS≥2, chronic obstructive pulmonary disease, cardiovascular disease, mucositis NCI grade ≥2, monocytes <200/mm3 and stress-induced hyperglycemia. A calibration plot was used to analyze the accuracy of this multivariate nomogram. Results: From October 2012 to December 2013, 781 patients with apparently stable FN were recruited in 21 Spanish hospitals. The rate of infection-related complications and death was 15.6% (95% confidence interval [CI], 12.9-18.6%) and 1.7% (95% CI, 0.98%-3.01%). A nomogram was designed according to the CISNE score. The area under the ROC curve was 0.836 (95% CI, 0.808-0.861). The observed and predicted probabilities also matched closely. Conclusions: Our group has developed a user-friendly nomogram for predicting complications in patients with apparently stable FN. This nomogram may be particularly useful to prevent premature discharges of cancer patients starting inpatient management.
A randomized controlled trial of mindfulness-based stress reduction (MBSR) in health workers (E-Poster Presentations)
(Cambridge Univ. Press, 2020) Errazuriz Concha, Antonia; Figueroa Cabello, Rodrigo Andrés
Abstract PS6-37: Clinical stage is the only predictor of survival in breast cancer patients with a complete pathological response
(2021) Acevedo, Francisco; Walbaum, Benjamin; Merino, Tomas; Petric, Militza; Sanchez, Cesar
INTRODUCTION In breast cancer (BC) patients, achieving a complete pathological response (pCR) after neoadjuvant chemotherapy (NCT) is associated with better prognosis. Despite this, some of these patients will experience recurrences of the disease and will eventually die of BC. We identified clinical factors that can affect recurrence and survival in BC patients who achieve pCR.METHODSRetrospective analysis of a Chilean BC database including patients treated in public and private hospitals in Santiago, Chile from 2010 to 2019. pCR was defined as the absence of residual invasive disease in the breast and in the axillary lymph nodes (ypT0/is N0) at the completion of the NCT. Invasive Disease-Free Survival (IDFS), Distant Disease-Free Survival (DDFS) and BC-specific survival (BCS) was measured from the time of diagnosis to the event or lost to follow-up. We performed Cox regression analysis to identify factors associated with prognosis.RESULTSFrom 855 patients who received NCT, 195 (22.8%) achieved pCR and were included in this study. Clinical characteristics are shown in table 1. 76 (37.9%) patients had hormone receptor positive (HR+) and 113 (57.4%) had Human epidermal growth factor 2 (HER2) positive tumors. 88.7% were treated with a regimen that included anthracyclines and taxanes. With a median follow-up of 36 months, three-year IDFS, DDFS and BCS and their 95% confidence intervals were 90.9% (84.7 - 94.6), 91.8% (86.0 - 95.3) and 93.8% (87.8 - 97.5); respectively. The stage at diagnosis was the only predictor associated with IDFS (Hazard ratio (HR) = 5.6; p = 0.02), DDFS (HR = 4.1, p = 0.07), and BCS (HR = 8.3, p = 0.04). Body mass index (BMI), age, hospital, HR or HER2 status, lymph node involvement, or the presence of an in-situ component, were not associated with prognosis in the multivariate analysis.CONCLUSIONThe clinical stage at diagnosis was the only predictor of survival in patients who achieved pCR after NCT. Short follow-up and few events may have affected these results. This data is consistent with previously published work. Table 1. Tumor and patient characteristicsMedian age49 (24 – 78)HospitalPublic57.4%Private43.6%BMIMedian27.2 (18.5 – 44.7)Overweight38.0%Obese31.9%Receptor StatusRH+/HER2-16.4%RH+/HER2+21.5%RH-/HER2+35.9%RH-/HER2-26.2%Clinical StageI2.1%II47.4%III50.5%Lymph Node +69.7%ypT0/N078.1%ChemotherapyAnthracycline5.1%Taxane6.2%Anthracycline-Taxane88.7% Citation Format: Francisco Acevedo, Benjamin Walbaum, Tomas Merino, Militza Petric, Cesar Sanchez. Clinical stage is the only predictor of survival in breast cancer patients with a complete pathological response [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-37.
Adrenal dysregulation in children who were born extremely premature - a pilot study
(2016) Carmen Campino; Alejandro Martinez-Aguayo; Rene Baudrand; Cristian Carvajal; Hernan Garcia; Marlene Aglony; Rodrigo Bancalari; Lorena Garcia; Carolina Loureiro; Andrea Vecchiola; Alejandra Tapia; Carolina Valdivia; Cristobal Fuentes; Carlos Lagos; Sandra Solari; Fidel Allende; Alexis Kalergis; Carlos Fardella
Advancements in MELD Score and Its Impact on Hepatology
(Thieme Medical Publishers, Inc., 2024) Hudson, David; Valentin Cortez, Francisco Javier; Hurtado Díaz de León, Ivonne; Malhi, Gurpreet; Rivas, Angélica; Afzaal, Tamoor; Rad, Mahsa Rahmany; Díaz Piga, Luis Antonio; Khan, Mohammad Qasim; Arab Verdugo, Juan Pablo
There continues to be an ongoing need for fair and equitable organ allocation. The Model for End-Stage Liver Disease (MELD) score has evolved as a calculated framework to evaluate and allocate patients for liver transplantation objectively. The original MELD score has undergone multiple modifications as it is continuously scrutinized for its accuracy in objectively representing the clinical context of patients with liver disease. Several refinements and iterations of the score have been developed, including the widely accepted MELD-Na score. In addition, the most recent updated iteration, MELD 3.0, has been created. The MELD 3.0 calculator incorporates new variables such as patient sex and serum albumin levels and assigns new weights for serum sodium, bilirubin, international normalized ratio, and creatinine levels. It is anticipated that the use of MELD 3.0 scores will reduce overall waitlist mortality and enhance access for female liver transplant candidates. However, despite the emergence of the MELD score as one of the most objective measures for fair organ allocation, various countries and healthcare systems employ alternative methods for stratification and organ allocation. This review article will highlight the origins of the MELD score, its iterations, the current MELD 3.0, and future directions for managing liver transplantation organ allocation.
Andes viral RNA load in chilean patients with Hantavirus Cardiopulmonary Syndrome
(2008) Pablo, Vial A.; Mertz, G. J.; Ferrés, Marcela; Galeno, H.; Belmar, E.; Aldunate, R.; Castillo, C.; Noriega, L. M.; Tapia, M.; Donoso, S.; Ortega, C.; Navarro, E.; Arriagada, J. J.; Scholtz, L. A.; Ferrer, Pablo; Godoy, P.; Ibanez, R.; Hjelle, B.
Attenuated Salmonella typhimurium encoding the HpaA antigen of Helicobacter pylori elicit a Th1 and Th2 immune response
(2007) Serrano Honeyman, Carolina Andrea; Olmos, Marco; Bruce, Elsa; Martinez, Patricio; Torres, Javiera; Venegas, Alejandro; Harris Diez, Paul Richard
Brain affordances: an approach to design for performers with locked-in syndrome
(2016) Aparicio Alonso, Andrés
Can Cushioned Shoes with Anatomical Insole Correct theImpact in Runners with Recurring Shin Splint?
(2015) De La Fuente Cancino Carlos Ignacio; Henríquez, Ramírez, Hugo; Ramírez-Campillo, Rodrigo; Delgado Bravo Mauricio Antonio; Chamorro Lange, Claudio Hernán; Ruidiaz, Sebastián; Campos Jara, Christian Alex; Carcuro, Giovanni
Characterization of Drug Use Patterns Using Process Mining and Temporal Abstraction Digital Phenotyping
(2019) Rojas, Eric; Capurro Nario, Daniel Alejandro
Understanding and identifying executed patterns, activitiesand processes for patients of different characteristics provides medicalexperts a deep understanding of which tasks are critical in the providedcare, and may help identify ways to improve them. However, extractingthese events and data for patients with complex clinical phenotypes isnot a trivial task. This paper provides an approach to identifying specificpatient cohorts based on complex digital phenotypes as a starting pointto apply process mining tools and techniques and identify patterns orprocess models. Using temporal abstraction-based digital phenotypingand pattern matching, we identified a cohort of patients with sepsis fromthe MIMIC II database, and then apply process mining techniques todiscover medication use patterns. In the case study we present, the useof temporal abstraction digital phenotyping helped us discover a relevantpatient cohort, aiding in the extraction of the data required to generatedrug use patterns for medications of different types such as vasopressors,vasodilators and systemic antibacterial antibiotics. For sepsis patients,combining the use of temporal abstraction digital phenotyping and process mining tools and techniques, was proven to help extract accuratecohorts of patients for health care process mining.
Characterization of exposures in preschoolers reported to a Chilean Poison Control Center in 2020
(TAYLOR & FRANCIS LTD, 2023) Sateler Villanueva, Antonia; Bettini Silva, Marli Francesca; Silva Peña, Lorena Alejandra; Medel Jara, Patricio Andres; Iturra Montecinos, Pablo Andres; Figueroa Silva, Francisco Julio Antonio; Irarrazabal Vargas, Lisette Paola; Rios Bustamante, Juan Carlos
Clusters of Autoimmune Diseases in Children and the Role of PTPN22 C1858T Gene Polymorphism in Pediatric Polyautoimmunity
(2014) Borzutzky Schachter, Arturo; Seiltgens, Cristián; Iruretagoyena B., Mirentxu; Cristi, Francisca; Ponce, María Jesús ; Melendez, Patricia; Martínez Aguayo, Alejandro; Hodgson Bunster, María Isabel; Talesnik Guendelman, Eduardo; Riera Cassorla, Francisca Paz; Méndez, Cecilia; Harris D., Paul R.; García Bruce, Hernán; Gana Ansaldo, Juan Cristóbal; Godoy, Claudia; Cattani Ortega, Andreína
Background/Purpose:Autoimmune diseases (AIDs) have familial aggregation and frequently share a common genetic background, but few studies have evaluated autoimmune clusters in children with AIDs and their families. Children with more than one AID (pediatric polyautoimmunity) may have a stronger genetic component than children with a single AID. The objectives of this study were to identify clusters of AIDs in children and their first-degree relatives and to evaluate the association of PTPN22 C1858T gene polymorphism with pediatric polyautoimmunity.Methods:A cross-sectional study was performed in subjects with an AID of pediatric onset (<18 years)recruited at Pediatric Rheumatology, Endocrinology and Gastroenterology Clinics at the Health Network of the Pontificia Universidad Católica de Chile School of Medicine. Clusters of AIDs were identified by K-means cluster analysis. The PTPN22 C1858T gene polymorphism was determined by RT-PCR in subjects with pediatric polyautoimmunity and in subjects with three common AIDs: juvenile idiopathic arthritis (JIA), autoimmune thyroid disease (AITD), and type I diabetes (T1D).Results:191 subjects with pediatric AIDs were included, of which 45 (24%) had polyautoimmunity. Mean age was 12.1 years (range 1–19) and 68% were female. Most frequent AIDs were JIA (36%), AITD (25%), T1D (19%), uveitis (8%), celiac disease (6%), and vitiligo (6%). 59% of subjects with pediatric autoimmunity had first-degree relatives with an AID. Five clusters of AID were identified in families of children with autoimmunity (Table 1). Among the 45 subjects with pediatric polyautoimmunity, four clusters of AIDs were identified (Table 2). Genomic DNA from 128 subjects was evaluated for PTPN22 C1858T gene polymorphism revealing common homozygosity (C/C) in 85.2%, heterozygosity (C/T) in 13.3%, and rare homozygosity (T/T) in 1.6 %, in equilibrium with Hardy Weinberg equation (P = 0.4). 26% of polyautoimmune subjects had the T allele in contrast with 11% of monoautoimmune subjects (P = 0.04). No significant difference was found in the age of onset of autoimmunity between mono and polyautoimmune subjects (P = 0.44) or between subjects with C/C genotype vs. C/T and T/T genotypes (P = 0.81).
Comparison of the effectiveness of peripheral nerve blockers made with neurostimulator versus ultrasound: Systematic review and meta-analysis
(2008) Cabrera Viera, Francisca; Torres Perez, David; Altermatt Couratier, Fernando René
COMPARISON OF TWO PREGNANCY NUTRITIONAL EVALUATION STANDARDS IN ADOLESCENT CHILEAN PREGNANT WOMEN
(2017) Villalobos Restovic, Andrea; Mardones, Francisco; Rosso R., Pedro Pablo; Farías Jofré, Marcelo; Villarroel del Pino, Luis A.; Bacallao, Jorge; Rojas, Ivan
COMPARISON OF TWO PREGNANCY NUTRITIONAL EVALUATION STANDARDS USING NATIONAL DATA FROM URUGUAY
(2017) Mardones, Francisco; Gonzalez, Nely; Bove, Maria Isabel; Rosso R., Pedro Pablo; Villarroel del Pino, Luis A.; Bacallao, Jorge; Farías Jofré, Marcelo
Docohexaenoic acid improves the reduced umbilical vein relaxation observed in the offspring of pregnancies with maternal obesity
(2017) Farías Jofré, Marcelo Enrique; Villalobos Labra, Roberto Esteban; Solari Gajardo, Sandra; Aguirre Polanco, Carolina; Samith Catalán, Bárbara Patricia; Rojas Vidal, María José
Background and objectives: Maternal obesity (MO) is associated with increased risk of long term metabolic risk in the offspring (REF), probably involving mechanisms such as early programming of insulin resistance in fetal and neonatal tissues. On the other hand, exposure to the polyunsaturated acid Docohexaenoic acid (DHA) has been related with increased insulin response in multiple cell types. The aims of our study were to evaluate the in vitro effect of DHA on vascular response of umbilical vein to insulin, and the role of the intracellular inhibitory phosphorylation of the insulin receptor substrate-1. Methods: Umbilical cords from normal and MO pregnant woman attending to obstetrics service at the Clinical Hospital of Pontificia Universidad Catolica de Chile were obtained after informed consent. Isolated rings of umbilical vein were used to evaluate vasodilatation capacity by wire-myography, in absence or presence of insulin (10-10 to 10-6 uM, 0-20 min) and DHA (100 uM, 12 h). Primary cultures of human umbilical vein endothelial cells (HUVEC) were used to evaluated phosphorylated and total protein levels of IRS-1 in cells exposed or not to insulin (1 nM, 30 min), in absence or presence of DHA (100 uM, 12 h). 308 Ann Nutr Metab 2017;71(suppl 2):1–1433 Oral Abstracts Results: Insulin produces a significant vasodilation (20%) in umbilical vein rings from normal pregnancies, an effect that was absent in MO-derived umbilical rings. This vasodilator effect of insulin was recovered in umbilical vein rings from MO pregnancies pre-incubated with DHA. In addition, HUVEC from MO pregnancies showed increased levels of IRS-1 phosphorylated in serine307, compared with normal cells, a difference that was reduced by DHA, even in presence of insulin. Conclusions: In vitro addition of DHA recovers the reduced vascular response to insulin in umbilical vein from MO pregnancies, involving a reduction of the inhibitory phosphorylation of IRS in serine307.
Dynamics of metals in street dust after a mudslide: Case of mining city in Chile
(2019) Vega Contreras, Alejandra Soledad; Arce, Guillermo; Carkovic Aguilera, Athena B.; Moya, Pablo; Coquery, Marina; Pastén González, Pablo Arturo; CEDEUS (Chile)
EP072 Rebound pain with ambulatory perineural catheter for rotator cuff repair
(2024) De La Cuadra Fontaine, Juan Carlos; Miranda Hiriart, Pablo; Morrison Corrales, Christopher Joseph; Altermatt Couratier, Fernando René
Background and Aims The appearance of sudden intense pain, after a peripheral nerve block ceases, is kown as Rebound Pain (RP). The reported frequency is described as between 40-60%. To reduce its occurrence, the use of adjuvants and the use of perineural catheter have been described. Dexamethasone, both perineural and also intravenously, reduces the incidence of RP. The risk decreases to approximately 10-20%. The methodology of studies using continuous technique has not allowed us to further clarify the benefit of their use. Our objective was to measure the incidence of RP in patients undergoing shoulder rotator cuff surgery with the use of home perineural catheters in our postoperative ambulatory REDCAP registry.Methods The study has ethics committee approval. A review of REDCAP was carried out from January 1, 2020 to December 31, 2023, extracting data from patients with a diagnosis of rotator cuff tear. Pain >7 on a scale of 0-10 was considered rebound pain.Results 495 patients were identified. 58 were lost to post-discharge follow-up (11.7%). Among the remaining 437 patients, 81 (18.5%) reported pain >7 at least once. On first postoperative day, 26 (5.7%). On 2nd postoperative day, 33 patients (7,8%) At the end of the infusion, 5,8% of patients reported rebound pain according to the work definition.
Evaluation of direct immunofluorescent assay (DFA) and rapid antigen test (RAT) for diagnosis of new pandemic influenza A H1N1 2009 (FLU AH1N1) during first wave in Santiago, Chile
(ELSEVIER SCI LTD, 2010) Vizcaya, C.; Ferres, M.; Perret Pérez, Cecilia; Martinez, C.; Godoy, P.; Contreras, A. M.; Ferrer, P.; Azocar, T.
Background: Since May 17th 2009 (epidemiological week 20th), the new strain of influenza A H1N1 was detected in respiratory samples of symptomatic patients in Santiago, Chile. The circulation of the virus lasted 11 weeks, with a peak between weeks 25-27th. The objective of our study was to evaluate the performance of influenza tests for diagnosis of FLU AH1N1. Methods: Nasopharyngeal swabs were taken from in and outpatients with influenza like illness (ILI), between June 1st and July 19th of 2009 (weeks 23-29th) and the results of DFA and RAT were compared using RT-PCR FLU AH1N1 (Light mix Kit Influenza A virus M2 and Light Mix Kit FLU A swine H1Ò of TIB MOLBIOL) as gold standard. We analyzed sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of DFA (D3 Ultra 8 DFA Respiratory & Identification Kit ä de Diagnostic Hybrid) and RAT (QuickVeuÒ of Biomerieux). Results were compared by age group and over three different periods of the outbreak: increasing, peak and decreasing. Results: 510 patients had RT-PCR for FLU AH1N1 with simultaneous DFA, 385 with RAT and 48 with both tests. Average age with DFA was 25,8 years (1 month-108 years, 53% females) and with RAT 32,9 years (2 months-108 years, 51% females), (p <0,0001). Comparing periods of the outbreak, DFA sensitivity was 58%, 77% and 81% in ascending, peak and descending period, respectively (p <0,001) and specificity was 90%, 83% and 91% respectively (p>0,05). Evaluating RAT, sensitivity was 41%, 61% and 67% (p<0,001) and specificity was 87%, 96% y 92% (p> 0,05) in different periods.

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