Browsing by Author "Valenzuela, Omar"

Now showing 1 - 9 of 9
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    Artritis psoriásica: La elección del fármaco antirreumático biológico en la Ley Ricarte Soto
    (2020) Ibáñez, Sebastián; Valenzuela, Francisca; Valenzuela, Omar
    The financial coverage granted by law in Chile for patients with psoriatic arthritis who require biological treatment is of paramount importance and a great advance. However physicians must be knowledgeable about the advantages and limitations of this therapy. The challenge of clinicians is to choose the drug with the greater odds of achieving therapeutic success, with less adverse events and lower costs for our health system. This article aims to help doctors to select the best biological treatment for a specific patient, trying to optimize its effectiveness, minimizing adverse effects, always looking for an efficient use of resources.
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    Evaluación de presencia y severidad de periodontitis en pacientes chilenos con artritis reumatoide atendidos en el Hospital Padre Hurtado
    (2015) Ibáñez, Sebastián; Ferreira, Cristina; Contreras, Andrés; Valenzuela, Omar; Giadalah, Nicolás; Jara, Vicente; Jaime, Francisca; Jarpa, Elena
    Background: Periodontitis may have a triggering and aggravating role of various medical conditions, including rheumatoid arthritis. Aim: To evaluate the periodontal status in Chilean patients with rheumatoid arthritis (RA), treated in a public hospital. Patients and Methods: A trained professional conducted a periodontal examination in 40 patients with RA aged 23 to 73 years (85% women). When present, the severity of periodontitis and its relationship with gender, smoking, age, corticosteroids dose and AR activity were assessed. AR activity was evaluated using the Disease Activity Score Calculator for Rheumatoid Arthritis (DAS 28). Results: Thirty five of the 40 patients had periodontitis and in 13, it was severe. Men, smokers, and older patients had more severe stages. Patients using higher doses of corticosteroids had lower severity of periodontitis. No relationship between the severity of periodontitis and AR activity was found. Conclusions: Periodontitis is common and severe in patients with RA, and is influenced by gender, age, smoking and corticosteroid dose.
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    Evaluación reumatológica del paciente con enfermedad pulmonar intersticial
    (2019) Wolff C., Verónica; Valenzuela, Omar
    Las Enfermedades del Tejido Conectivo (ETC) comprenden un grupo heterogéneo de patologías multisistémicas de origen autoinmune. La Enfermedad pulmonar intersticial (EPI) asociada a ETC (EPI-ETC) es frecuente y empeora el pronóstico de la ETC. Las EPI-ETC representan aproximadamente 15-30% del total las EPI y se presentan con las mismas formas histopatológicas y radiológicas descritas para las EPI idiopáticas. Esto pone en evidencia la importancia de incorporar en forma rutinaria a reumatología en el comité multidisciplinario para el diagnóstico y manejo de las EPI
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    First Report of Tocilizumab Use in a Cohort of Latin American Patients Hospitalized for Severe COVID-19 Pneumonia
    (2020) Valenzuela, Omar; Ibáñez, Sebastián; Poli, Cecilia; Roessler, Patricia; Aylwin, Mabel; Roizen, Gigia; Iruretagoyena, Mirentxu; Agar, Vivianne; Donoso, Javiera; Fierro, Margarita; Montes, José Miguel
    Introduction/objectives: An interleukin-6 inhibition strategy could be effective in selected COVID-19 patients. The objective is to present our experience of tocilizumab use in patients with severe COVID-19. Methods: Observational retrospective cohort study. Hospitalized patients were evaluated by our multidisciplinary team for eventual use of tocilizumab. Patients with progressive ventilatory impairment and evidence of a hyperinflammatory state despite usual treatment received tocilizumab 8 mg/kg intravenous (maximum dose 800 mg), in addition to standard treatment. The use and time of use of mechanical ventilation (MV), the change of the Alveolar-arterial (A-a) gradient, of the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and of inflammation laboratory parameters after 72 h of tocilizumab use was evaluated. Results: 29 patients received tocilizumab. 93.1% were men, 37.9% were obese, and 34.5% had hypertension. Of the 20 patients who were not on MV when receiving tocilizumab, 11 required non-invasive MV, for an average of 5 days, and one of them required intubation. A-a gradient, PaO2/FiO2, and inflammation parameters improved significantly. A better lymphocyte count, which improved significantly after tocilizumab use, was significantly associated with less use of MV. Five patients presented positive culture samples after tocilizumab, three being of clinical significance. A lower lymphocyte count was associated with having a positive culture. No other significant adverse events were seen. Conclusion: Our study suggests the utility and shows the safety of tocilizumab use in COVID-19 patients who have respiratory failure and evidence of hyperinflammation. Lymphocyte improvement was a predictor of good response.
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    First Report of Tocilizumab Use in a Cohort of Latin American Patients Hospitalized for Severe COVID-19 Pneumonia
    (2020) Valenzuela, Omar; Ibáñez, Sebastián; Poli, Cecilia; Roessler, Patricia; Aylwin, Mabel; Roizen, Gigia; Iruretagoyena, Mirentxu; Agar, Vivianne; Donoso, Javiera; Fierro, Margarita; Montes, José
    Introduction/objectives: An interleukin-6 inhibition strategy could be effective in selected COVID-19 patients. The objective is to present our experience of tocilizumab use in patients with severe COVID-19. Methods: Observational retrospective cohort study. Hospitalized patients were evaluated by our multidisciplinary team for eventual use of tocilizumab. Patients with progressive ventilatory impairment and evidence of a hyperinflammatory state despite usual treatment received tocilizumab 8 mg/kg intravenous (maximum dose 800 mg), in addition to standard treatment. The use and time of use of mechanical ventilation (MV), the change of the Alveolar-arterial (A-a) gradient, of the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and of inflammation laboratory parameters after 72 h of tocilizumab use was evaluated. Results: 29 patients received tocilizumab. 93.1% were men, 37.9% were obese, and 34.5% had hypertension. Of the 20 patients who were not on MV when receiving tocilizumab, 11 required non-invasive MV, for an average of 5 days, and one of them required intubation. A-a gradient, PaO2/FiO2, and inflammation parameters improved significantly. A better lymphocyte count, which improved significantly after tocilizumab use, was significantly associated with less use of MV. Five patients presented positive culture samples after tocilizumab, three being of clinical significance. A lower lymphocyte count was associated with having a positive culture. No other significant adverse events were seen. Conclusion: Our study suggests the utility and shows the safety of tocilizumab use in COVID-19 patients who have respiratory failure and evidence of hyperinflammation. Lymphocyte improvement was a predictor of good response.
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    Hydroxychloroquine and chloroquine in COVID-19: should they be used as standard therapy?
    (2020) Ibáñez, Sebastián; Martínez, Oriela; Valenzuela, Francisca; Silva, Francisco; Valenzuela, Omar
    The pandemic of the new coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has urged the nations to an unprecedented world-wide reaction, including an accelerated exploration of therapeutic options. In the absence of a vaccine and specifically designed antivirals, the medical community has proposed the use of various previously available medications in order to reduce the number of patients requiring prolonged hospitalizations, oxygen therapy, and mechanical ventilation and to decrease mortality from coronavirus disease 2019 (COVID-19). Hydroxychloroquine and chloroquine are among the proposed drugs and are the most widely used so far, despite the lack of robust evidence on their usefulness. The objective of this article is to review and discuss the possible role of these drugs in the therapy of COVID-19.
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    Neumomediastino y necrosis cutánea en asociación a dermatomiositis: presentación de un caso clínico y revisión de la literatura
    (Sociedad Médica de Santiago, 2015) Gallardo, Natalia; Valenzuela, Omar; Ibáñez, Sebastián
    We report a 37 years old male with a dermatomyositis treated with oral cyclophosphamide. He was admitted to the hospital due to a zone of skin necrosis with purulent exudate, located in the second left toe. A complete blood count showed a leukocyte count of 2,600 cells/mm3. A Chest CAT scan showed a pneumomediastinum with emphysema of adjacent soft tissue. Cyclophosphamide was discontinued and leukocyte count improved. The affected toe was amputated and a chest CAT scan showed a partial resolution of the pneumomediastinum. We discuss and review the pathogenesis, clinical presentation and management of pneumomediastinum and cutaneous necrosis in association with dermatomyositis.
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    Patients with axial spondyloarthritis report significant differences between men and women and high impact of the disease: Large websurvey analysis
    (2020) Ibáñez, Sebastián; Valenzuela, Omar; Bentumb, Rianne E. van; Horst-Bruinsma, Irene E. van der
    Objective: In axial spondyloarthritis (axSpA), mounting evidence shows female patients to experience a higherdisease burden. Thesedifferences appear to beparticularly large inSouthAmerica. One explanation could be inequity in treatment access between men and women. The objective was to evaluate gender differences in disease burden and work participation, and the potential influence of treatment, in Latin American patients. Methods: A cross sectional online survey among axSpA patients, collecting disease characteristics, treatment, disease burden (BASDAI, BASFI, ASAS Health Index) and work participation (WPAI). Associations between gender and disease burden or work participation were assessed through regression analyses, correcting for treatment. Results: AxSpA was reported by 472 participants (63% women) and disease activity (BASDAI ≥ 4: 83%), ASASHI (≥ moderately impaired: 91%) and work disability (absenteeism: 41%; presenteeism 82%) were high. Biological use was very low (20%), while 34% used opiates. Females had significantly higher BASDAI, ASAS HI, work absenteeism and presenteeism, although were less likely to receive biologics (26% versus 16%, P < 0.01). Gender differences disappeared after correction for treatment. Conclusions: This web survey in Latin American axSpA patients shows a high disease burden and work impairment. The use of biologics is low, while the use of opiates was alarmingly high. Women used significantly less biologics despite reporting a worse disease state and work disability, which could be due to treatment inequity
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    Use of Corticosteroids in COVID-19: Should It Be Considered as a Standard-of-Care Therapy?
    (2020) Roessler, Patricia; Roizen, Gigia; Valenzuela, Omar; Ibáñez, Sebastián
    By the end of 2019, a novel coronavirus was identified as the cause of several cases of pneumonia in Wuhan, China. Its appearance was rapidly evident throughout the world. In February 2020, the World Health Organization (WHO) designated the disease as coronavirus disease 2019 (COVID-19). The virus that causes COVID-19 is named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and it has been responsible of more than 1,200,000 deaths in the world to date.1,2 Until a vaccine or other effective treatment is available, the pandemic has created the urgent need to repurpose different therapeutic tools to stop the disease. In this context, corticosteroids (CSs) emerge as a highly available and known therapeutic alternative worldwide. Corticosteroids had been used in the setting of previous severe coronavirus infection, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) with controversial results. SARS-CoV-2, SARS-CoV, and MERS-CoV share many genetic features, and SARS-CoV-2 is highly homologous to SARS-CoV.3 We will discuss the mechanism of action of CSs, and we will critically review the current literature to analyze the arguments against and in favor of using this therapy in COVID-19

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