Browsing by Author "Riquelme, Raúl"

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    A non-randomized multicentre trial of human immune plasma for treatment of hantavirus cardiopulmonary syndrome caused by Andes virus
    (International Medical Press, 2015) Vial, Pablo; Valdivieso, Francisca; Calvo, Mario; Rioseco, María; Riquelme, Raúl; Araneda, Andrés; Tomicic, Vinko; Graf, Jerónimo; Paredes, Laura; Fiorenzano, Matías; Bidart, Teresa; Cuiza, Analía; Marco, Claudia; Hjelle, Brian; Ye, Chunyan; Hanfelt-Goade, Daniel; Vial, Cecilia; Rivera, Juan; Mertz, Gregory; Hantavirus Study Group in Chile; Delgado, Iris
    BACKGROUND: In Chile, Andes virus (ANDV) is the sole aetiological agent of hantavirus cardiopulmonary syndrome (HCPS) with mean annual incidence of 55 cases, 32% case fatality rate (CFR) and no specific treatment. Neutralizing antibody (NAb) titres at hospital admission correlate inversely with HCPS severity. We designed an open trial to explore safety and efficacy and evaluate pharmacokinetics of immune plasma as a treatment strategy for this disease. METHODS: We performed plasmapheresis on donors at least 6 months after HCPS and measured NAb titres through a focus-reduction neutralization test. Subjects admitted to 10 study sites with suspected/confirmed HCPS were eligible for treatment with immune plasma by intravenous infusion at an ANDV NAb dose of 5,000 U/kg. HCPS was confirmed through immunoglobulin M serology or reverse transcriptase-PCR. The main outcome was mortality within 30 days. RESULTS: From 2008-2012, we enrolled and treated 32 cases and confirmed HCPS in 29. CFR of hantavirus plasma-treated cases was 4/29 (14%); CFR of non-treated cases in the same period in Chile was 63/199 (32%; P=0.049, OR=0.35, CI=0.12, 0.99); CFR of non-treated cases at the same study sites between 2005-2012 was 18/66 (27%; (P=0.15, OR=0.43, CI=0.14, 1.34) and CFR in a previous methylprednisolone treatment study was 20/60 (33%; P=0.052, OR=0.32, CI=0.10, 1.00). We detected no serious adverse events associated to plasma infusion. Plasma NAb titres reached in recipients were variable and viral load remained stable. CONCLUSIONS: Human ANDV immune plasma infusion appears safe for HCPS. We observed a decrease in CFR in treated cases with borderline significance that will require further studies for confirmation.
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    Evaluación Naturalística del Efecto de Terapias Psicoanalíticamente Orientadas y Terapias Cognitivas en un Hospital General Público en Santiago de Chile1
    (2010) Florenzano, Ramón; Leiva, Pamela; Riquelme, Raúl; Möller, Francisca; Calderón, Ana
    En Chile existen pocos estudios comparativos sobre la efectividad y eficiencia de las psicoterapias psicoanalíticas, por lo que aquí revisamos resultados de la aplicación rutinaria del OQ 45.2 de Lambert et. al. en un servicio de psiquiatría pública en Santiago. Encontramos descensos de puntajes globales y de las subescalas desde el pre-test (M1) hasta los post-test precoz (M2) y tardío (M3). Este descenso fue mayor en la Unidad de Trastornos de Personalidad UTP (n=37), de orientación psicoanalítica, que en la de Terapia Cognitiva (n=37). Si bien en ambas hubo cambio clínicamente significativo en la primera el descenso fue mayor. El principal problema en ambos grupos fue la adherencia. En esta comparación encontramos buena efectividad y eficiencia de terapias psicoanalíticas en un servicio público en Chile.
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    Factores de riesgo socio-demográficos del síndrome cardiopulmonar por hantavirus
    (2019) Vial, Cecilia; Valdivieso, Francisca; Cuiza, Analía; Delgado, Iris; Ribeiro, Grazielle; Llop, Elena; Ferrés, Marcela; Repetto, Gabriela; Riquelme, Raúl; Rioseco, María Luisa; Calvo, Mario; Mertz, Gregory; Vial, Pablo
    Background: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. Aim: To evaluate sociodemographic factors as risk factors in severity of HCPS. Patients and Methods: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. Results: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. Conclusion: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.

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