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Porcentaje de éxito de erradicación de Helicobacter pylori con tratamiento antibiótico empírico en pacientes pediátricos de un Hospital Terciario
(2023)
Sofía Darritchon Lama
;
Diego Díaz García
;
Marcela Toledo Cumplido
;
LUCERO ALVAREZ, YALDA CECILIA
<jats:p>La infección por Helicobacter pylori es una condición frecuente, que a largo plazo se asocia con desarrollo de enfermedad ulceropéptica y eventualmente cáncer gástrico, que se podrían prevenir con un tratamiento oportuno. Lo óptimo sería lograr un éxito de erradicación mayor al 90%, pero los tratamientos empíricos recomendados no logran esas tasas en condiciones reales.Objetivo: Determinar el porcentaje de éxito del tratamiento empírico de erradicación de primera línea contra H. pylori en pacientes pediátricos atendidos en un hospital terciario.Pacientes y Método: Estudio descriptivo retrospectivo en pacientes con infección por H. pylori detectado en biopsias gástricas y que hubieran recibido tratamiento antibiótico de primera línea durante el periodo 2017-2021. Se consideró erradicación exitosa el resultado negativo de test de antígeno en deposiciones o nuevas biopsias luego de ≥ 1 mes de finalizado el tratamiento.Resultados: Se identificaron 82 pacientes con infección por H. pylori, de los cuales 53 recibieron tratamiento de erradicación. De éstos, 26 (49%) fueron controlados con test de erradicación luego del tratamiento y en ellos el porcentaje de éxito fue de solo 38% (10/26).Conclusiones: La tasa de erradicación con los esquemas empíricos utilizados fue menor a la esperada, lo que evidencia el desafío de buscar estrategias más efectivas de tratamiento incluyendo el estudio de susceptibilidad a antimicrobianos. La adherencia de los pacientes al protocolo de seguimiento también fue baja, lo que deberá reforzarse en el futuro para poder realizar un manejo clínico más adecuado. </jats:p>
Scopus© Citations 4 2
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Percepción de la simulación en obstetricia y ginecología en el pregrado y posgrado de una universidad privada chilena
(2023)
Elisa Díaz-Reiher
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María del M. Mora-Mourguiart
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Valentina Fuentes Lomb
;
Victoria Sepúlveda-Camhi
;
Rodrigo Latorre-Riquelme
7
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Granuloma annulare on ultrasound: a diagnosis to consider in pediatric skin lesions
(2023)
WHITTLE PINTO, CAROLINA
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N. Rossel
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L. Pérez-Marrero
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X. Chaparro
Scopus© Citations 1 3
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Isolation of Ciprofloxacin and Ceftazidime-Resistant Enterobacterales From Vegetables and River Water Is Strongly Associated With the Season and the Sample Type
(2021)
Constanza Díaz-Gavidia
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Carla Barría
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RIVAS JIMENEZ, LINA MARIA
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Patricia García
;
Francisca P. Alvarez
<jats:p>The dissemination of antibiotic-resistant bacteria (ARB) from water used for crop irrigation to vegetables is poorly studied. During a year, five farmer markets in a city in Central Chile were visited, and 478 vegetable samples (parsleys, corianders, celeries, lettuces, chards, and beets) were collected. Simultaneously, 32 water samples were collected from two rivers which are used to irrigate the vegetables produced in the area. Resistant Enterobacterales were isolated and identified. Colistin resistance gene <jats:italic>mcr-1</jats:italic> and extended spectrum β-lactamases (ESBL) were molecularly detected. The association of environmental factors was evaluated, with the outcomes being the presence of Enterobacterales resistant to four antibiotic families and the presence of multidrug resistance (MDR) phenotypes. Parsley, coriander, and celery showed the highest prevalence of resistant Enterobacterales (41.9% for ciprofloxacin and 18.5% for ceftazidime). A total of 155 isolates were obtained, including <jats:italic>Escherichia coli</jats:italic> (<jats:italic>n</jats:italic>=109), <jats:italic>Citrobacter</jats:italic> sp. (<jats:italic>n</jats:italic>=20), <jats:italic>Enterobacter cloacae</jats:italic> complex (<jats:italic>n</jats:italic>=8), <jats:italic>Klebsiella pneumoniae</jats:italic> (<jats:italic>n</jats:italic>=8), and <jats:italic>Klebsiella aerogenes</jats:italic> (<jats:italic>n</jats:italic>=1). Resistance to ampicillin (63.2%) and ciprofloxacin (74.2%) was most frequently found; 34.5% of the isolates showed resistance to third-generation cephalosporins, and the MDR phenotype represented 51.6% of the isolates. In two <jats:italic>E. coli</jats:italic> isolates (1.29%), the gene <jats:italic>mcr-1</jats:italic> was found and ESBL genes were found in 23/62 isolates (37%), with <jats:italic>bla</jats:italic><jats:sub>CTX-M</jats:sub> being the most frequently found in 20 isolates (32%). Resistant Enterobacterales isolated during the rainy season were less likely to be MDR as compared to the dry season. Understanding environmental associations represent the first step toward an improved understanding of the public health impact of ARB in vegetables and water.</jats:p>
1Scopus© Citations 28
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Deficiencia de vitamina D y de hierro en niños y adolescentes con parálisis cerebral
(2021)
C. Le Roy
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S. Barja
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C. Sepúlveda
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M.L. Guzmán
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M. Olivarez
14Scopus© Citations 16
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Support and follow-up needs of patients discharged from intensive care after severe COVID-19: a mixed-methods study of the views of UK general practitioners and intensive care staff during the pandemic’s first wave
(2021)
CASTRO AVILA, ANA CRISTINA
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Laura Jefferson
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Veronica Dale
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Karen Bloor
<jats:sec><jats:title>Objectives</jats:title><jats:p>To identify follow-up services planned for patients with COVID-19 discharged from intensive care unit (ICU) and to explore the views of ICU staff and general practitioners (GPs) regarding these patients’ future needs and care coordination.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>This is a sequential mixed-methods study using online surveys and semistructured interviews. Interview data were inductively coded and thematically analysed. Survey data were descriptively analysed.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>GP surgeries and acute National Health Service Trusts in the UK.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>GPs and clinicians leading care for patients discharged from ICU.</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcomes</jats:title><jats:p>Usual follow-up practice after ICU discharge, changes in follow-up during the pandemic, and GP awareness of follow-up and support needs of patients discharged from ICU.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We obtained 170 survey responses and conducted 23 interviews. Over 60% of GPs were unaware of the follow-up services generally provided by their local hospitals and whether or not these were functioning during the pandemic. Eighty per cent of ICUs reported some form of follow-up services, with 25% of these suspending provision during the peak of the pandemic and over half modifying their provision (usually to provide the service remotely). Common themes relating to barriers to provision of follow-up were funding complexities, remit and expertise, and communication between ICU and community services. Discharge documentation was described as poor and lacking key information. Both groups mentioned difficulties accessing services in the community and lack of clarity about who was responsible for referrals and follow-up.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The pandemic has highlighted long-standing issues of continuity of care and complex funding streams for post-ICU follow-up care. The large cohort of ICU patients admitted due to COVID-19 highlights the need for improved follow-up services and communication between specialists and GPs, not only for patients with COVID-19, but for all those discharged from ICU.</jats:p></jats:sec>
1Scopus© Citations 26 1
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Margin Reanalysis With 3-Dimensional Micrographic Surgery Technique of Conventional Excision Specimens With Negative Margin Readings
(2020)
Julio Magliano
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NAVARRETE CABELLO, JORGE ANDRES
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Verónica Lezue
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Alicia González
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Miguel Martínez
10Scopus© Citations 1
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Campylobacter spp. Prevalence in Santiago, Chile: A Study Based on Molecular Detection in Clinical Stool Samples from 2014 to 2019
(2023)
PORTE TORRE, LORENA ISABEL
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Caricia Pérez
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Mario Barbé
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Carmen Varela
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Valeska Vollrath
<jats:p>Campylobacter spp. is an emerging cause of infectious diarrhea worldwide. In South American countries such as Chile, its prevalence is underestimated due to inadequate detection methods. Gastrointestinal multiplex PCR panels (GMP) permit rapid and sensitive detection of bacterial pathogens and provide important epidemiological information. This study aimed to analyze Campylobacter epidemiology using the results of molecular methods and to compare molecular detection results to those of culture methods. We performed a retrospective, descriptive analysis of Campylobacter spp. detected in clinical stool samples between 2014–2019 by GMP and culture. Within 16,582 specimens examined by GMP, Campylobacter was the most prevalent enteropathogenic bacteria (8.5%), followed by Salmonella spp. (3.9%), Shigella spp./enteroinvasive Escherichia coli (EIEC) (1.9%), and Yersinia enterocolitica (0.8%). The highest Campylobacter prevalence occurred in 2014/2015. Campylobacteriosis affected more males (57.2%) and adults from 19–65 years (47.9%) and showed a bimodal seasonality with summer and winter peaks. In 11,251 routine stool cultures, Campylobacter spp. was detected in 4.6%, mostly C. jejuni (89.6%). Among 4533 samples tested by GMP and culture in parallel, GMP showed a superior sensitivity (99.1% versus 50%, respectively). The study suggests that Campylobacter spp. is the most frequent bacterial enteropathogen in Chile.</jats:p>
1Scopus© Citations 6 1
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The genomic landscape across 474 surgically accessible epileptogenic human brain lesions
(2022)
Javier A López-Rivera
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Costin Leu
;
Marie Macnee
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Jean Khoury
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Lucas Hoffmann
<jats:title>Abstract</jats:title> <jats:p>Understanding the exact molecular mechanisms involved in the aetiology of epileptogenic pathologies with or without tumour activity is essential for improving treatment of drug-resistant focal epilepsy. Here, we characterize the landscape of somatic genetic variants in resected brain specimens from 474 individuals with drug-resistant focal epilepsy using deep whole-exome sequencing (&gt;350×) and whole-genome genotyping. Across the exome, we observe a greater number of somatic single-nucleotide variants in low-grade epilepsy-associated tumours (7.92 ± 5.65 single-nucleotide variants) than in brain tissue from malformations of cortical development (6.11 ± 4 single-nucleotide variants) or hippocampal sclerosis (5.1 ± 3.04 single-nucleotide variants). Tumour tissues also had the largest number of likely pathogenic variant carrying cells. low-grade epilepsy-associated tumours had the highest proportion of samples with one or more somatic copy-number variants (24.7%), followed by malformations of cortical development (5.4%) and hippocampal sclerosis (4.1%). Recurring somatic whole chromosome duplications affecting Chromosome 7 (16.8%), chromosome 5 (10.9%), and chromosome 20 (9.9%) were observed among low-grade epilepsy-associated tumours. For germline variant-associated malformations of cortical development genes such as TSC2, DEPDC5 and PTEN, germline single-nucleotide variants were frequently identified within large loss of heterozygosity regions, supporting the recently proposed ‘second hit’ disease mechanism in these genes. We detect somatic variants in 12 established lesional epilepsy genes and demonstrate exome-wide statistical support for three of these in the aetiology of low-grade epilepsy-associated tumours (e.g. BRAF) and malformations of cortical development (e.g. SLC35A2 and MTOR). We also identify novel significant associations for PTPN11 with low-grade epilepsy-associated tumours and NRAS Q61 mutated protein with a complex malformation of cortical development characterized by polymicrogyria and nodular heterotopia. The variants identified in NRAS are known from cancer studies to lead to hyperactivation of NRAS, which can be targeted pharmacologically. We identify large recurrent 1q21–q44 duplication including AKT3 in association with focal cortical dysplasia type 2a with hyaline astrocytic inclusions, another rare and possibly under-recognized brain lesion. The clinical-genetic analyses showed that the numbers of somatic single-nucleotide variant across the exome and the fraction of affected cells were positively correlated with the age at seizure onset and surgery in individuals with low-grade epilepsy-associated tumours. In summary, our comprehensive genetic screen sheds light on the genome-scale landscape of genetic variants in epileptic brain lesions, informs the design of gene panels for clinical diagnostic screening and guides future directions for clinical implementation of epilepsy surgery genetics.</jats:p>
Scopus© Citations 25 6 1
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Relationship between job satisfaction, burnout syndrome and depressive symptoms in physicians: a cross-sectional study based on the employment demand–control model using structural equation modelling
(2022)
David Villarreal-Zegarra
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Wilder Iván Lázaro-Illatopa
;
Ronald Castillo-Blanco
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CABIESES VALDES, BALTICA BEATRIZ
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Alice Blukacz
<jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate the relationship between job satisfaction, burnout syndrome (BS) and depressive symptoms (DS) based on the job demand–control framework model on a nationally representative sample of physicians working in the Peruvian Health System.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>We carried out a secondary data analysis of the National Survey of Satisfaction of Users in Health 2016 in Peru.</jats:p></jats:sec><jats:sec><jats:title>Primary and secondary outcome measures</jats:title><jats:p>Our study assessed the development of the predictive model and had two parts: (1) to evaluate the association among the variables based on the job demand–control framework, and (2) to assess the proposed model acceptability using the structural equation modelling approach to estimate goodness-of-fit indices (GOFIs).</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>We excluded physicians older than 65 years, who did not report income levels or who had missing data related to the workplace. Thus, we analysed 2100 participants.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The prevalence of DS was 3.3%. Physicians’ work-related illnesses had more probability to result in DS (prevalence ratio=2.23). DS was moderately related to BS dimensions (r>0.50); nevertheless, the relationships between DS and the three job satisfaction scales were weak (r<0.30). The first predictive model based on the variables, DS, BS and job satisfaction, had low GOFIs (comparative fit index (CFI)=0.883; root mean square error of approximation (RMSEA)=0.125). In a second evaluation, we used models with correlated errors obtaining optimal GOFIs (CFI=0.974; RMSEA=0.060).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Our study identified a stable model to explain the relationship between job satisfaction, BS and DS among physicians. The results are consistent with the job demand–control framework. They could be applied to decision-making in occupational contexts in Latin American low/middle-income countries.</jats:p></jats:sec>
Scopus© Citations 14 3

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