Browsing by Author "Florea, Andrei"
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Item First wave of SARS-CoV-2 in Santiago Chile: Seroprevalence, asymptomatic infection and infection fatality rate(2022) Vial, Pablo; González, Claudia; Apablaza, Mauricio; Vial, Cecilia; Lavín, M. Estela; Araos, Rafael; Rubilar, Paola; Icaza, Gloria; Florea, Andrei; Pérez, Claudia; Concha, Paula; Bastías, Diego; Errázuriz, María Paz; Pérez, Ruth; Guzmán, Francisco; Olea, Andrea; Guzmán, Eugenio; Correa, Juan; Munita, José; Aguilera, XimenaBackground: The first wave of SARS-CoV-2 infection in Chile occurred during the cold season reaching a peak by the end of June 2020, with 80 % of the cases concentrated in its capital, Santiago. The main objective of this study was to estimate the attack rate during this first wave of SARS-CoV-2 in a large, densely populated city with more than seven million inhabitants. Since the number of confirmed cases provides biased information due to individuals’ potential self-selection, mostly related to asymptomatic patients and testing access, we measured antibodies against SARS-CoV-2 to assess infection prevalence during the first wave in the city, as well as estimate asymptomatic cases, and infection fatality ratio. To our knowledge this is one of the few population-based cross- sectional serosurvey during the first wave in a highly affected emerging country. The challenges of pandemic response in urban settings in a capital city like Santiago, with heterogeneous subpopulations and high mobility through public transportation, highlight the necessity of more accurate information regarding the first waves of new emerging diseases. Methods: From April 24 to June 21, 2020, 1326 individuals were sampled from a long-standing panel of household representatives of Santiago. Immunochromatographic assays were used to detect IgM and IgG anti-body isotypes. Results: Seroprevalence reached 6.79 % (95 %CI 5.58 %− 8.26 %) in the first 107 days of the pandemic, without significant differences among sex and age groups; this figure indicates an attack rate 2.8 times higher than the one calculated with registered cases. It also changes the fatality rate estimates, from a 2.33 % case fatality rate reported by MOH to an estimated crude 1.00 % (CI95 % 0.97–1.03) infection fatality rate (adjusted for test performance 1.66 % [CI95 % 1.61–1.71]). Most seropositive were symptomatic (81,1 %). Conclusions: Despite the high number of cases registered, mortality rates, and the stress produced over the health system, the vast majority of the people remained susceptible to potential new epidemic waves. We contribute to the understanding of the initial spread of emerging epidemic threats. Consequently, our results provide better information to design early strategies that counterattack new health challenges in urban contexts.Publication Perspectivas actuales del rol de la anestesia en los trastornos del sueño postoperatorio(2022) Florea,Diana; Allen, María C.; Herrera, Karime; Florea, AndreiLos trastornos del sueño posoperatorio pueden causar efectos graves, que afectan los resultados quirúrgicos y se atribuyen al estrés quirúrgico, al dolor, a los fármacos y a factores ambientales propios de las unidades de paciente crítico. Principalmente se observa disminución de las etapas de sueño profundo y REM en los primeros dos días postoperatorios con importante rebote del REM entre el día dos y cinco, período en el cual también se observan la mayoría de las complicaciones posquirúrgicas. El rol de la anestesia en la aparición de los trastornos del sueño es menor y depende del tipo de anestesia empleado. La anestesia general induce desincronización del ritmo circadiano y se relaciona a mayor incidencia de trastornos del sueño posoperatorio que la anestesia regional. La magnitud y el tipo de alteraciones depende de los diferentes tipos de anestésicos, del mecanismo de acción a nivel de sistema nervioso central, de la dosis empleada y del momento del día en el cual se administra, además de condiciones propias del paciente como edad o comorbilidad. Existe gran interés en comprender mejor la relación entre la anestesia y el ritmo circadiano ya que eso puede tener importante impacto en la recuperación postoperatoria de los pacientes.Item Seroprevalence, spatial distribution, and social determinants of SARS-CoV-2 in three urban centers of Chile(2022) Vial, Pablo; González, Claudia; Icaza, Gloria; Ramirez‐Santana, Muriel; Quezada‐Gaete, Rubén; Núñez‐Franz, Loreto; Apablaza, Mauricio; Vial, Cecilia; Rubilar, Paola; Correa, Juan; Pérez, Claudia; Florea, Andrei; Guzmán, Eugenio; Lavín, María Estela; Concha, Paula; Nájera, Manuel; Aguilera, XimenaBackground: Seroprevalence studies provide an accurate measure of SARS-CoV-2 spread and the presence of asymptomatic cases. They also provide information on the uneven impact of the pandemic, pointing out vulnerable groups to prioritize which is particularly relevant in unequal societies. However, due to their high cost, they provide limited evidence of spatial spread of the pandemic specially in unequal societies. Our objective was to estimate the prevalence of SARS-CoV-2 antibodies in Chile and model its spatial risk distribution. Methods: During Oct–Nov 2020, we conducted a population-based serosurvey in Santiago, Talca, and Coquimbo–La Serena (2493 individuals). We explored the individual association between positive results and socio-economic and health-related variables by logistic regression for complex surveys. Then, using an Empirical Bayesian Kriging model, we estimated the infection risk spatial distribution using individual and census information, and compared these results with ofcial records. Results: Seroprevalence was 10.4% (95% CI 7.8–13.7%), ranging from 2% (Talca) to 11% (Santiago), almost three times the number ofcially reported. Approximately 36% of these were asymptomatic, reaching 82% below 15 years old. Seroprevalence was associated with the city of residence, previous COVID-19 diagnosis, contact with confrmed cases (especially at household), and foreign nationality. The spatial model accurately interpolated the distribution of disease risk within the cities fnding signifcant diferences in the predicted probabilities of SARS-CoV-2 infection by census zone (IQR 2.5–15.0%), related to population density and education. Conclusions: Our results underscore the transmission heterogeneity of SARS-CoV-2 within and across three urban centers of Chile. Socio-economic factors and the outcomes of this seroprevalence study enable us to identify priority areas for intervention. Our methodological approach and results can help guide the design of interdisciplinary strate‐ gies for urban contexts, not only for SARS-CoV-2 but also for other communicable diseases.