Browsing by Author "Fuster, Felipe"
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Item CD4/CD8 ratio as a predictor of the response to HBV vaccination in HIV-positive patients: A prospective cohort study(Elsevier Ltd., 2016) Fuster, Francisco; José, Vargas; Jensen, Daniela; Sarmiento, Valeska; Acuña, Pedro; Peirano, Felipe; Fuster, Felipe; Arab, Juan; Martínez, Felipe; Core-HIV Study GroupBACKGROUND: Hepatitis B virus (HBV) and human immunodeficiency virus (HIV) share transmission mechanisms and thus coinfection is frequent. Active immunization against HBV is essential in HIV patients. Reports using standard and reinforced HBV vaccination schedules vary widely in seroconversion rates depending on the characteristics of the included patients. Regional data concerning HBV vaccination in HIV patients are scarce. We aim to determine the serological response to HBV vaccination using standard schedule in HIV-positive patients and to evaluate characteristics that predict seroconversion. MATERIALS AND METHODS: We performed a single centre prospective study of HBV vaccination with standard schedule in HIV-positive patients. Adults with negative markers of HBV infection were included between November 2012 and December 2014. Anti-HBs titres were measured 4-8 weeks after completion of vaccination schedule. Clinical, laboratory values and HIV characteristics were analyzed to determine their association with seroconversion and adherence to the HBV vaccination schedule. RESULTS: The study included 245 HIV-positive patients, 68.9% were male and the mean age was 42.1 years. A total of 80.7% of the patients had undetectable HIV viral loads, 86.1% had CD4 counts >200, and 94.7% were on HAART. The response to vaccination was positive in 62% (95% CI, 56-68%) and mean anti-HBs titres of 646 IU/ml. 85.5% of the responders had anti-HBs titres >100 IU/ml. An age less than 45 years, no tobacco use and a CD4/CD8 ratio >0.4 were associated with seroconversion in multivariate analysis. The seroconversion rates were 86% in the subgroup of patients who met these criteria. A total of 97.9% of the study population completed the vaccination schedule. CONCLUSION: The CD4/CD8 ratio was the primary factor associated with positive serological conversion in the multivariate analysis. The seroconversion rates were higher in a selected group of patients who were particularly suitable for the use of the standard HBV vaccination schedule.Item Cierre de bolsillo subpectoral para la reconstrucción mamaria: descripción de una nueva técnica quirúrgica mediante el uso de celulosa oxidada regenerada NU-KNIT(Sociedad de Cirujanos de Chile, 2017) Gantz, Jose; Villalón, Javier; Salazar, Victor; Cadiz, Fernando; Pradenas, Sebastian; Romagnoli, Militza; Allamand, Juan; Vial, Gustavo; Santos, Maria; Fuster, Felipe; Fischer, Diego; Castillo, Martin; Rivera, MatiasIntroduction: The use of breast expander, prior to the final prosthetic reconstruction, is not exempt from complications. They not only relate to the presence of peri-operative radiation therapy, or patient-related issues; but also related to the muscle integrate coverage of the breast expander. Material and methods: Retrospective review of patients undergoing deferred breast reconstruction using a modification of the technique of sub muscular pocket closing with oxidized regenerated cellulose NU-KNITTM for the breast expander. Between January 1, 2014 and December 31, 2015 one plastic surgeon (J.V.), from the Breast Pathology Unit at Clínica Alemana de Santiago, performed reconstruction surgeries with this technique in 31 patients. In the present article, the technique modification, demographic data, histological data and the complications which arose during the expansion phase of the same, will be described. Results: 40 breast reconstructions were performed in 31 patients. 11 seromas (27.5% of total expanders), 2 sufferings of skin flap wound dehiscence (5% expanders) and 1 wound infection (2.5% of expanders) were presented. Two patients required surgical debridement due to surgical dehiscence and infection. One patient required explantation of the expander (2.5% of total expanders). Discussion: The modification of the surgical technique represents a safe and reproducible alternative to achieve a complete closure of the muscular pocket and thus a complete coverage of the expander, consequently; avoiding some of the secondary complications drawn from an insufficient coverage of the expander.Item Cierre de bolsillo subpectoral para la reconstrucción mamaria: descripción de una nueva técnica quirúrgica mediante el uso de celulosa oxidada regenerada NU-KNIT®(Sociedad de Cirujanos de Chile, 2017) Gantz, José; Villalón, Javier; Salazar, Víctor; Cadiz, Fernando; Pradenas, Sebastián; Romagnoli, Militza; Allamand, Juan; Vial, Gustavo; Santos, María; Fuster, Felipe; Fischer, Diego; Castillo, Martin; Rivera, MatiasIntroduction: The use of breast expander, prior to the final prosthetic reconstruction, is not exempt from complications. They not only relate to the presence of peri-operative radiation therapy, or patient-related issues; but also related to the muscle integrate coverage of the breast expander. Material and methods: Retrospective review of patients undergoing deferred breast reconstruction using a modification of the technique of sub muscular pocket closing with oxidized regenerated cellulose NU-KNITTM for the breast expander. Between January 1, 2014 and December 31, 2015 one plastic surgeon (J.V.), from the Breast Pathology Unit at Clínica Alemana de Santiago, performed reconstruction surgeries with this technique in 31 patients. In the present article, the technique modification, demographic data, histological data and the complications which arose during the expansion phase of the same, will be described. Results: 40 breast reconstructions were performed in 31 patients. 11 seromas (27.5% of total expanders), 2 sufferings of skin flap wound dehiscence (5% expanders) and 1 wound infection (2.5% of expanders) were presented. Two patients required surgical debridement due to surgical dehiscence and infection. One patient required explantation of the expander (2.5% of total expanders). Discussion: The modification of the surgical technique represents a safe and reproducible alternative to achieve a complete closure of the muscular pocket and thus a complete coverage of the expander, consequently; avoiding some of the secondary complications drawn from an insufficient coverage of the expander.Item Presence of anti-HBc is associated to high rates of HBV resolved infection and low threshold for Occult HBV Infection in HIV patients with negative HBsAg in Chile.(Wiley Periodicals, Inc., 2016) Vargas, José; Jensen, Daniela; Sarmiento, Valeska; Peirano, Felipe; Acuña, Pedro; Fuster, Felipe; Soto, Sabrina; Ahumada, Rodrigo; Huilcaman, Marco; Bruna, Mario; Jensen, Werner; Fuster, FranciscoHBV-HIV coinfection is prevalent. Frequently, anti-HBc is the only serological marker of HBV, which can be indicative of HBV resolved infection, when found together with anti-HBs reactivity; or present as "isolated anti-HBc," related to HBV occult infection with presence of detectable DNA HBV, more prevalent in HIV-positive individuals. Regional data about this condition are scarce. Anti-HBc rapid test has been used as screening, but its performance has not been described in HIV-positive patients. The aim of this study was determine prevalence of anti-HBc in HIV-positive patients, serological pattern of HBV resolved infection and isolated anti-HBc, evaluating presence of HBV occult infection. Assess anti-HBc rapid test compared to ECLIA. Methods included measurement of anti-HBc and anti-HBs in HIV-positive patients with negative HBsAg. Serum HBV DNA quantification and HBV booster vaccination to "isolated anti-HBc" individuals. Detection of anti-HBc by rapid test and ECLIA. In 192 patients, prevalence of anti-HBc was 42.7% (82/192); associated to male gender, drug use, men-sex-men, positive-VDRL, and longer time HIV diagnosis. 34.4% (66/192) had presence of anti-HBs, mean titers of 637 ui/ml. Isolated anti-HBc in 8.3% (16/192), associated to detectable HIV viral load and no-use of HAART; in them, HBV DNA was undetectable, and 60% responded to HBV vaccination booster. Anti-HBc rapid test showed low sensibility (32.9%) compared to ECLIA. These results show that prevalence of anti-HBc in HIV-positive individuals is high, in most cases accompanied with anti-HBs as HBV resolved infection. Low prevalence of "isolated anti-HBc," with undetectable HBV DNA, and most had anamnestic response to HBV vaccination; suggest low possibility of occult HBV infection. Anti-HBc rapid test cannot be recommended as screening method for anti-HBc.