Artículos Medicina y Ciencias de la Salud

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  • Publication
    Multiple clonal transmissions of clinically relevant extended-spectrum beta-lactamase–producing Escherichia coli among livestock, dogs, and wildlife in Chile
    (2023) Hayer, Juliette; Salgado, Marília; Opazo, Andrés; González, Paulina; Piñeiro, Ana; Munita, Jose M.; Rivas Jiménez, Lina María; Benavides, Julio
    Objectives: Extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-E. coli) are a main cause of human deaths associated with antimicrobial resistance (AMR). Despite hundreds of reports of the faecal carriage of ESBL-E. coli in domestic and wild animals, the dynamics of its circulation remains poorly understood. Methods: We used whole genome sequencing of 19 ESBL-E. coli previously isolated in the same local setting from dogs, livestock, and a wild rodent in Central Chile to assess potential cross-species transmission of ESBL-E. coli. Results: Isolates harboured a large number of AMR (n = 95) and virulence (n = 45) genes, plasmids replicons (n = 24), and E. coli sequence types including top extraintestinal pathogenic E. coli ST410, ST58, ST88, and ST617. Almost identical clones (<50 single nucleotide polymorphisms difference, same antibiotic and heavy metal resistance genes, virulence genes, and plasmids) were found in faeces of dogs, cattle, or sheep from the same farm, and in a dog and a wild rodent living in proximity. Conclusions: To our knowledge, this is the first report of multiple clonal cross-species transmission of ESBL-E. coli in domestic and potentially wild animals of Latin America. Our results suggest that relatively rare spread of AMR across animal species can still occur by both clonal and plasmid dissemination. Our study highlights the need for establishing preventive measures to limit the circulation of these bacteria among animals in agricultural settings, particularly given the highly pathogenic profile of several E. coli strains detected in these animals.
  • Publication
    Evaluation of short- and long-term bond strength of zirconia after different surface treatments
    (2023) Pinto-Pardo, Nicolás; Ledezma Araya, Priscilla; Deischler, Matías; Aguilera, Leonardo; Readi, Pablo
    Objective: The aim of the study was to evaluate the short and long-term effects of different surface treatments on the bond strengths of zirconia. Material and Methods: 225 blocks of sintered zirconia samples (4 x 4 x 3 mm) were divided into five groups and subjected to different surface treatments: control group (without surface treatment), alumina group (sandblasting [25-µm-aluminum-oxide]), alumina+Ambar Universal-APS (AU) group, CoJet group (silica-coated [30-μm silica-modified aluminum particles]), and CoJet+AU group. Subsequently, zirconia samples were cemented against resin samples (total dimensions: 8x8x6mm) and assigned to three storage conditions: dry, humid (artificial saliva at 37°C for 30-days) or thermocycling [100.000-cycles] (n=15 per group). The microtensile bond strength (µTBS) was determined using a universal testing machine. The failure modes were observed and analyzed using a stereomicroscope. Normality tests, descriptive statistics, and two-way ANOVA, followed by post-hoc comparisons, were performed to evaluate the effect of surface treatments and storage conditions on µTBS (α=0.05). Results: μTBS was influenced by surface treatment in the short and long-term (P<0.0001). The highest values were found in CoJet+AU in dry (33.51 ±2.48 MPa), humid (32.87 ±2.68 MPa) and thermocycling (21.37 ±1.68 MPa) storage conditions compared with others. Interestingly, no significant differences in μTBS were found among alum +AU and CoJet alone under any of the three storage conditions. Adhesive failure increased in all groups after thermocycling, but CoJet+AU had the lowest values of adhesive failure compared with others. Conclusion: The combination of CoJet and Ambar universal as a surface treatment for zirconia specimens provides significantly higher short and long-term bond strengths of adhesive cementation
  • Publication
    Intervenciones cognitivas a través de realidad virtual en personas con Deterioro Cognitivo Leve: Una Revisión Sistemática
    (2023) Roa E., Pablo; Nazar C., Gabriela; Sáez D., Fabiola
    Introduction: The possibility of Mild Cognitive Impairment (MCI) reversal has generated numerous studies in search of treatment, including cognitive stimulation through virtual reality (VR). Despite its use, there is still no evidence about the modalities and effects in people with MCI. Aim: To systematize the characteristics of the studies that have used cognitive interventions with VR cognitive in people with MCI, describe their effects and to establish recommendations for future research based on the limitations reported. Methods: systematic review of studies published between 2010 and 2020, in the Web of Science, Scopus and Pubmed databases. Results: 14 studies were identified with programs that mostly used immersive VR, with the “supermarket” as the most frequent virtual scenario. In seven studies only one cognitive function was involved, with memory and executive functions being the most intervened. The assessment instruments focused on cognitive measures, with little assessment of neuropsychiatric and quality of life variables. Thirteen studies reported improvements on the general cognitive level or by specific domain. Conclusions: The use of immersive and non-immersive VR has had positive results in the general or domain-specific cognitive performance of people with MCI, however, due to the incipient and limited evidence of its use in people with this pathology, it is not possible to determine the sustainability of these results and the generalization of these interventions regarding daily living activities. Interventions with real environments and post-intervention follow-up are recommended.
  • Publication
    Enjuagues bucales con carbohidratos y su uso en deportistas. Resumen de revisiones sistemáticas
    (2023) Fuentes-Barría, Héctor; Aguilera-Eguía, Raúl; González-Wong, Catalina
    Objetivo; Analizar los efectos del enjuague bucal con carbohidratos en deportistas. Material y Métodos; Se realizó una búsqueda en la revista Retos, además de Medline / PubMed, Web of Science, Springer, Scopus, Europe PMC, SPOLIT, SPORTDiscus, SciELO, Epistemonikos y Trip database. Las búsquedas se realizaron entre los años 2018 y 2022 utilizando la estrategia “carbohydrate AND mouth rinse AND sports”, seleccionándose solo revisiones sistemáticas con metaanálisis. Resultados; Se identificaron 318 registros de los cuales luego de aplicar los criterios de elegibilidad se analizaron tres, cuyos resultados mostraron posibles mejoras sobre la potencia media de salida (Diferencia media estandarizada (DME) = 0,25, IC 95%; 0,04 a 0,46), rendimiento deportivo (DME = 0,15, IC 95%; 0,04 a 0,27) y la resistencia muscular hasta el fallo (Diferencia media (DM) = 1,24, IC 95%; 0,70 a 1,77), mientras que el tiempo contrarreloj (DME = -0,13, IC 95; -0,36 a 0,10) y la fuerza máxima muscular (DM = 0,25, IC 95%; -1,81 a 2,32) no muestran mejoras significativas. Conclusión; La suministración de un protocolo de enjuagues bucales con carbohidratos en forma constante puede constituir una ayuda ergogénica. Sin embargo, estos efectos aún son controvertidos.
  • Publication
    Can We Extend the Indications for Multilevel Surgery to Non-Ambulatory Children with Neuromuscular Diseases? A Safety and Efficacy Study
    (2023) Galán-Olleros, María; Martínez-Caballero, Ignacio; Chorbadjian Alonso, Gonzalo; Rosa M. Egea-Gámez, Rosa M.; Sánchez-López, David; Ramírez-Barragán, Ana; Fraga-Collarte, Manuel; Lerma-Lara, Sergio
    A retrospective study that aims to analyze the safety and efficacy of single-event multilevel surgery (SEMLS) involving bifocal femoral osteotomy (BFO) performed in nine non-ambulatory children with neuromuscular diseases (NMD), with a median age of 12.86 years, to resolve both hip subluxation and ipsilateral knee flexion contracture that impaired standing, and to evaluate patient and caregiver satisfaction. Results: Median surgical time was 4 h 15 min (2 h 35 min–5 h 50 min). Hip flexion deformity improved by a median of 30 (15–35), while median improvement in knee flexion deformity was 30 (20–50). Only two patients could use a standing frame prior to surgery, although with increasing difficulty, while all children could use it following SEMLS. Mean follow-up was 27.47 months (24.33–46.9). Significant blood loss requiring transfusion was the only complication recorded (8/9). All caregivers reported slight, moderate, or significant improvement in all domains of the questionnaire, and all would undergo the procedure again and recommend it to others, as nearly all (8/9) were very satisfied. Conclusion: The findings of this study suggest that SEMLS including BFOs in non-ambulatory children with NMD can correct hip, knee, and foot deformities and simultaneously realign lower limbs to restore functional standing and wheelchair transfer. The functional results, safety, and degree of satisfaction achieved justify offering this strategy to families
  • Publication
    Percepción de preparación de los internos y egresados de Medicina para enfrentar la muerte de un paciente
    (2023) Lavín, Pedro; Rodríguez, Dominga; Beca, Juan Pablo
    Historically, death has been socially accepted, but for the last decades it has been hidden in hospitals, transforming physicians into “death specialists”. Thus, medical graduates should feel prepared to assume this responsibility accompanying the patient and their family through the process. With this in consideration, the present work explores students' and graduates' perceptions of preparation to face a patient's death (SPEM) in a Chilean Medical school and identifies SPEM-associated characteristics. An observational study was performed using a digital form sent by email to interns and 2018 and 2019 graduates of the Facultad de Medicina CAS-UDD, in which they were asked about their SPEM and possible SPEM-related variables. The results showed that 63% and 31% of interns and graduates reported feeling inadequately prepared or unprepared to address a patient's death, respectively. During the first two years of their profession, 71% of graduates faced a patient's death. There was a significant correlation between the SPEM and death-facing training. Considering these results and the previous evidence of the positive impact that classes and courses have on SPEM, it is suggested that an obligatory course should be added to improve SPEM in medical.
  • Publication
    Responsabilidad civil médica en telemedicina: una propuesta de principios para una lex artis telemédica
    (2023) Lecaros Urzúa, Juan Alberto; López, Gonzalo
    El presente artículo analiza la responsabilidad civil médica atribuible a los profesionales de la salud que intervienen en el proceso de atención a distancia. Con este objeto, se propone un conjunto de principios de los cuales se derivan deberes de cuidado en la telemedicina exigibles a los profesionales de salud y a los prestadores. A partir de los principios de analogía con y complementariedad de la atención presencial, se desarrollan tres categorías de principios especiales para la atención a distancia: principios habilitantes, principios operativos y principios de protección al paciente. Bajo este esquema de principios se especifican deberes de cuidado, distinguiendo aquellos que responden a los riesgos causados por la distancia física de aquellos que surgen de los cambios organizacionales necesarios para este tipo de atención. La aplicación de estos deberes se analiza en tres escenarios de telemedicina: la teleconsulta, la teleinterconsulta y la teleconsultoría. Esta estructura de principios y deberes en la prestación de salud a distancia permite delimitar los alcances de la lex artis para cada escenario específico y, al mismo tiempo, elaborar estrategias regulatorias considerando criterios de necesidad, racionalidad y suficiencia, según los contenidos específicos que caracterizan cada escenario de atención de salud a distancia. El present article analitza la responsabilitat civil mèdica atribuïble als professionals de la salut que intervenen en el procés d'atenció a distància. Amb aquest objecte, es proposa un conjunt de principis dels quals es deriven deures de cura en la telemedicina exigibles als professionals de salut i als prestadors. A partir dels principis d'analogia amb i complementarietat de l'atenció presencial, es desenvolupen tres categories de principis especials per a l'atenció a distància: principis habilitants, principis operatius i principis de protecció al pacient. Sota aquest esquema de principis s'especifiquen deures de cura, distingint aquells que responen als riscos causats per la distància física d'aquells que sorgeixen dels canvis organitzacionals necessaris per a aquesta mena d'atenció. L'aplicació d'aquests deures s'analitza en tres escenaris de telemedicina: la teleconsulta, la teleinterconsulta i la teleconsultoría. Aquesta estructura de principis i deures en la prestació de salut a distància permet delimitar els abastos de la lex artis per a cada escenari específic i, al mateix temps, elaborar estratègies reguladores considerant criteris de necessitat, racionalitat i suficiència, segons els continguts específics que caracteritzen cada escenari d'atenció de salut a distància.
  • Publication
    Bundled care to optimize outcome after intracerebral hemorrhage: action for effective implementation
    (2023) Ouyang, Menglu; Anderson, Craig S.
    Patients who experience acute intracerebral hemorrhage (ICH) are not managed with urgency or level of coordinated care as those with acute ischemic stroke. This is largely due to the lack of any proven treatment for ICH, which has led to therapeutic nihilism and a low threshold for the withdrawal of active care in these patients. The third Intensive Care Bundle with Blood Pres sure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3) is a landmark study which used a novel, quality improvement, implementation design across 122 hospitals in 10 countries, to show that the early intervention of bundled care with time- and target-based metrics, can substantially improve outcomes for patients who suffer ICH. We advocate the widespread adoption of an early bundle of care focused on urgent time-based metrics for the control of elevated blood pressure and other abnormal physiological parameters, and the emergency reversal of anticoagulation, for patients with ICH. Such coordinated interdisciplinary stroke care will optimise the chances of patients all over the world surviving free of major disability after suffering an ICH.
  • Publication
    Application of the Team Emergency Assessment Measure Scale in undergraduate medical students and interprofessional clinical teams: validity evidence of a Spanish version applied in Chile
    (2023) Armijo-Rivera, Soledad; Ferrada-Rivera, Sandra; Aliaga-Toledo, Marcela; Pérez, Leonardo A.
    Background: Teamwork is one of the competencies necessary for physicians to work effectively in health systems and is a competency that can be developed with simulation in professionals and medicine students. The Team Emergency Assessment Measurement (TEAM) was created to evaluate the non-technical performance of team members during resuscitation events in real teams. The TEAM scale includes items to assess leadership, teamwork, situational awareness, and task management. An objective evaluation tool in Spanish is valuable for training health professionals at all undergraduate and continuing education levels. This study aimed to generate evidence of the validity of the Team Emergency Assessment Measure (TEAM) in Spanish to measure the performance of medical students and adult, pediatric, and obstetric emergency clinical teams in simulated emergencies as a self-assessment tool. Methods: To develop the Spanish version of the instrument, a forward and backward translation process was followed by independent translators, native and fluent in English and Spanish, and a review by a panel of Chilean experts comprising three trained simulation instructors to verify semantics and cultural equivalence. High-fidelity simulations with debriefing were conducted with 5th-year medical students, in which students and instructors applied the Spanish version of the TEAM scale. In the second stage, adult, pediatric, and obstetric emergency management simulations were conducted using the TEAM scale for real clinical teams as a self-assessment tool. Findings: By applying the overall TEAM scale to medicine students and clinical teams, Cronbach's alpha was 0.921. For medical students' self-assessment, we obtained Cronbach's alpha of 0.869. No significant differences were found between the overall scores and the scores by dimensions evaluated by instructors and students (p > 0.05). In the case of clinical team training, Cronbach's alpha was 0.755 for adult emergency teams, 0.797 for pediatric emergency teams, and 0.853 for obstetric emergency teams. Conclusion: The validated instrument is adequate for evaluating teamwork in medical student simulations by instructors and peers and for self-assessment in adult, pediatric, and obstetric emergency clinical teams.
  • Publication
    Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline
    (2023) Busse, Jason; Casassus, Rodrigo; Carrasco, Alonso; Durham, Justin; Mock, David; Zakrzewska, Joanna; Palmer, Carolyn; Samer, Caroline; Coen, Matteo; Guevremont, Bruno; Hoppe, Thomas; Guyatt, Gordon; Crandon, Holly; Yao, Liang; Sadeghirad, Behnam; Vandvik, Per; Siemieniuk, Reed; Lytvyn, Lyuba; Hunskaar, Birk; Agoritsas, Thomas
    Clinical question: What is the comparative effectiveness of available therapies for chronic pain associated with temporomandibular disorders (TMD)? Current practice: TMD are the second most common musculoskeletal chronic pain disorder after low back pain, affecting 6-9% of adults globally. TMD are associated with pain affecting the jaw and associated structures and may present with headaches, earache, clicking, popping, or crackling sounds in the temporomandibular joint, and impaired mandibular function. Current clinical practice guidelines are largely consensus-based and provide inconsistent recommendations. Recommendations: For patients living with chronic pain (≥3 months) associated with TMD, and compared with placebo or sham procedures, the guideline panel issued: (1) strong recommendations in favour of cognitive behavioural therapy (CBT) with or without biofeedback or relaxation therapy, therapist-assisted mobilisation, manual trigger point therapy, supervised postural exercise, supervised jaw exercise and stretching with or without manual trigger point therapy, and usual care (such as home exercises, stretching, reassurance, and education); (2) conditional recommendations in favour of manipulation, supervised jaw exercise with mobilisation, CBT with non-steroidal anti-inflammatory drugs (NSAIDS), manipulation with postural exercise, and acupuncture; (3) conditional recommendations against reversible occlusal splints (alone or in combination with other interventions), arthrocentesis (alone or in combination with other interventions), cartilage supplement with or without hyaluronic acid injection, low level laser therapy (alone or in combination with other interventions), transcutaneous electrical nerve stimulation, gabapentin, botulinum toxin injection, hyaluronic acid injection, relaxation therapy, trigger point injection, acetaminophen (with or without muscle relaxants or NSAIDS), topical capsaicin, biofeedback, corticosteroid injection (with or without NSAIDS), benzodiazepines, and β blockers; and (4) strong recommendations against irreversible oral splints, discectomy, and NSAIDS with opioids. How this guideline was created: An international guideline development panel including patients, clinicians with content expertise, and methodologists produced these recommendations in adherence with standards for trustworthy guidelines using the GRADE approach. The MAGIC Evidence Ecosystem Foundation (MAGIC) provided methodological support. The panel approached the formulation of recommendations from the perspective of patients, rather than a population or health system perspective. The evidence: Recommendations are informed by a linked systematic review and network meta-analysis summarising the current body of evidence for benefits and harms of conservative, pharmacologic, and invasive interventions for chronic pain secondary to TMD. Understanding the recommendation: These recommendations apply to patients living with chronic pain (≥3 months duration) associated with TMD as a group of conditions, and do not apply to the management of acute TMD pain. When considering management options, clinicians and patients should first consider strongly recommended interventions, then those conditionally recommended in favour, then conditionally against. In doing so, shared decision making is essential to ensure patients make choices that reflect their values and preference, availability of interventions, and what they may have already tried. Further research is warranted and may alter recommendations in the future
  • Publication
    Humoral immunity against SARS-CoV-2 evoked by heterologous vaccination groups using the CoronaVac (Sinovac) and BNT162b2 (Pfizer/BioNTech) vaccines in Chile
    (2023) Díaz, Diego; Díaz, Pablo; Barra, Gisselle; Puentes, Rodrigo; Arata, Loredana; Grossolli, Jonnathan; Riveros, Boris; Ardiles, Luis; Santelises, Julio; Vasquez, Valeria; Escobar, Daniel; Soto,Daniel; Canales, Cecilia; Díaz, Janepsy; Lamperti, Liliana; Castillo, Daniela; Urra, Mychel; Zuñiga, Felipe; Ormazabal, Valeska; Nova, Estefanía; Benítez, Rosana; Rivera, Alejandra; Claudia, Cortes; Valenzuela, María; García, Heriberto; Vasquez, Abel
    Introduction: Severe acute respiratory syndrome virus 2 (SARS-CoV-2) has caused over million deaths worldwide, with more than 61,000 deaths in Chile. The Chilean government has implemented a vaccination program against SARS-CoV-2, with over 17.7 million people receiving a complete vaccination scheme. The final target is 18 million individuals. The most common vaccines used in Chile are CoronaVac (Sinovac) and BNT162b2 (Pfizer-Biotech). Given the global need for vaccine boosters to combat the impact of emerging virus variants, studying the immune response to SARS-CoV-2 is crucial. In this study, we characterize the humoral immune response in inoculated volunteers from Chile who received vaccination schemes consisting of two doses of CoronaVac [CoronaVac (2x)], two doses of CoronaVac plus one dose of BNT162b2 [CoronaVac (2x) + BNT162b2 (1x)], and three doses of BNT162b2 [BNT162b2 (3x)]. Methods: We recruited 469 participants from Clínica Dávila in Santiago and the Health Center Víctor Manuel Fernández in the city of Concepción, Chile. Additionally, we included participants who had recovered from COVID-19 but were not vaccinated (RCN). We analyzed antibodies, including anti-N, anti-S1-RBD, and neutralizing antibodies against SARS-CoV-2. Results: We found that antibodies against the SARS-CoV-2 nucleoprotein were significantly higher in the CoronaVac (2x) and RCN groups compared to the CoronaVac (2x) + BNT162b2 (1x) or BNT162b2 (3x) groups. However, the CoronaVac (2x) + BNT162b2 (1x) and BNT162b2 (3x) groups exhibited a higher concentration of S1-RBD antibodies than the CoronaVac (2x) group and RCN group. There were no significant differences in S1-RBD antibody titers between the CoronaVac (2x) + BNT162b2 (1x) and BNT162b2 (3x) groups. Finally, the group immunized with BNT162b2 (3x) had higher levels of neutralizing antibodies compared to the RCN group, as well as the CoronaVac (2x) and CoronaVac (2x) + BNT162b2 (1x) groups. Discussion: These findings suggest that vaccination induces the secretion of antibodies against SARS-CoV-2, and a booster dose of BNT162b2 is necessary to generate a protective immune response. In the current state of the pandemic, these data support the Ministry of Health of the Government of Chile's decision to promote heterologous vaccination as they indicate that a significant portion of the Chilean population has neutralizing antibodies against SARS-CoV-2.
  • Publication
    Head-to-head comparison of CAMPYAIR aerobic culture medium versus standard microaerophilic culture for Campylobacter isolation from clinical samples
    (2023) Levican, Arturo; Varela, Carmen; Porte, Lorena; Weitzel, Thomas; Briceño, Isabel; Guerra, Francisco; Mena, Benjamín; Hinton Jr, Arthur
    Campylobacter spp. are considered the most frequent cause of acute gastroenteritis worldwide. However, outside high-income countries, its burden is poorly understood. Limited published data suggest that Campylobacter prevalence in low- and middle-income countries is high, but their reservoirs and age distribution are different. Culturing Campylobacter is expensive due to laboratory equipment and supplies needed to grow the bacterium (e.g., selective culture media, microaerophilic atmosphere, and a 42°C incubator). These requirements limit the diagnostic capacity of clinical laboratories in many resource-poor regions, leading to significant underdiagnosis and underreporting of isolation of the pathogen. CAMPYAIR, a newly developed selective differential medium, permits Campylobacter isolation without the need for microaerophilic incubation. The medium is supplemented with antibiotics to allow Campylobacter isolation in complex matrices such as human feces. The present study aims to evaluate the ability of the medium to recover Campylobacter from routine clinical samples. A total of 191 human stool samples were used to compare the ability of CAMPYAIR (aerobic incubation) and a commercial Campylobacter medium (CASA, microaerophilic incubation) to recover Campylobacter. All Campylobacter isolates were then identified by MALDI-TOF MS. CAMPYAIR showed sensitivity and specificity values of 87.5% (95% CI 47.4%-99.7%) and 100% (95% CI 98%-100%), respectively. The positive predictive value of CAMPYAIR was 100% and its negative predictive value was 99.5% (95% CI 96.7%-99.9%); Kappa Cohen coefficient was 0.93 (95% CI 0.79-1.0). The high diagnostic performance and low technical requirements of the CAMPYAIR medium could permit Campylobacter culture in countries with limited resources.
  • Publication
    Global epidemiology and clinical outcomes of carbapenem-resistant Pseudomonas aeruginosa and associated carbapenemases (POP): a prospective cohort study
    (2023) Reyes, Jinnethe; Komarow, Lauren; Chen, Liang; Ge, Lizhao; Hanson, Blake; Cober, Eric; Herc, Erica; Alenazi, Thamer; Kaye, Keith; Garcia, Julia; Li, Lanjuan; Kanj, Souha; Liu, Zhengyin; Oñate, Jose; Salata, Robert; Marimuthu, Kalisvar; Gao, Hainv; Zong, Zhiyong; Valderrama, Sandra; Yu, Yunsong; Tambyah, Paul; Weston, Gregory; Salcedo, Soraya; Abbo, Lillian; Xie, Qing; Ordoñez, Karen; Wang, Minggui; Stryjewski, Martin; Munita, Jose M.; Paterson, David; Evans, Scott; Hill, Carol; Baum, Keri; Bonomo, Robert; Kreiswirth, Barry; Virginia, Maria; Pate, Robin; Arias, Cesar; Chambers, Henry; Fowler,Vance; Doi, Yohei; Van Duin, David; Satlin, Michael; Antibacterial Resistance Leadership Group and Multi-Drug Resistant Organism Network Investigators
    Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a global threat, but the distribution and clinical significance of carbapenemases are unclear. The aim of this study was to define characteristics and outcomes of CRPA infections and the global frequency and clinical impact of carbapenemases harboured by CRPA. Methods: We conducted an observational, prospective cohort study of CRPA isolated from bloodstream, respiratory, urine, or wound cultures of patients at 44 hospitals (10 countries) between Dec 1, 2018, and Nov 30, 2019. Clinical data were abstracted from health records and CRPA isolates were whole-genome sequenced. The primary outcome was 30-day mortality from the day the index culture was collected. We compared outcomes of patients with CRPA infections by infection type and across geographic regions and performed an inverse probability weighted analysis to assess the association between carbapenemase production and 30-day mortality. Findings: We enrolled 972 patients (USA n=527, China n=171, south and central America n=127, Middle East n=91, Australia and Singapore n=56), of whom 581 (60%) had CRPA infections. 30-day mortality differed by infection type (bloodstream 21 [30%] of 69, respiratory 69 [19%] of 358, wound nine [14%] of 66, urine six [7%] of 88; p=0·0012) and geographical region (Middle East 15 [29%] of 52, south and central America 20 [27%] of 73, USA 60 [19%] of 308, Australia and Singapore three [11%] of 28, China seven [6%] of 120; p=0·0002). Prevalence of carbapenemase genes among CRPA isolates also varied by region (south and central America 88 [69%] of 127, Australia and Singapore 32 [57%] of 56, China 54 [32%] of 171, Middle East 27 [30%] of 91, USA ten [2%] of 527; p<0·0001). KPC-2 (n=103 [49%]) and VIM-2 (n=75 [36%]) were the most common carbapenemases in 211 carbapenemase-producing isolates. After excluding USA patients, because few US isolates had carbapenemases, patients with carbapenemase-producing CRPA infections had higher 30-day mortality than those with non-carbapenemase-producing CRPA infections in both unadjusted (26 [22%] of 120 vs 19 [12%] of 153; difference 9%, 95% CI 3-16) and adjusted (difference 7%, 95% CI 1-14) analyses.Interpretation: The emergence of different carbapenemases among CRPA isolates in different geographical regions and the increased mortality associated with carbapenemase-producing CRPA infections highlight the therapeutic challenges posed by these organisms. Funding: National Institutes of Health.
  • Publication
    Navigating economic turmoil: Chilean businesses during COVID-19 lockdowns and vaccine rollouts
    (2024) Pertuze, Julio A.; Montégu, José Pablo; González, Cecilia; Araos Bralic, Rafael Ignacio; Daza, Paula
    Objectives: This study evaluates the effects of COVID-19 lockdowns, differentiated by their stringency, on the sales of Chilean businesses across various size categories and industries throughout 2020 and 2021. It also explores the role of the vaccination campaign and the implementation of the Mobility Pass in mitigating the negative economic effects of stringent containment measures. Methods: The study uses administrative data from the Chilean Internal Revenue Service (SII), examining sales across different business sizes and industries, from March 2020 to December 2021. Through an econometric analysis, we estimate the effects of lockdowns on business sales during two distinct periods: initial reliance on dynamic non-pharmaceutical interventions (NPIs) pre-vaccine, and a subsequent stage characterized by high vaccine uptake and reduced NPI stringency. Results: Lockdowns significantly reduced sales across all business sizes and most industries during the first period, with microenterprises and certain service sectors experiencing the highest decline. The national vaccination campaign and the introduction of the Mobility Pass in the second period appears to have mitigated the negative effects of lockdowns, primarily benefiting micro and small firms. Conclusions: The study highlights the trade-offs between health and economic outcomes during the pandemic, stressing the importance to alleviate mobility restrictions post-vaccine rollout to ease the economic strain on businesses. The findings call for targeted support measures for MSMEs and vulnerable industries affected by NPIs.
  • Publication
    Factors influencing neutralizing antibody response to the original SARS-CoV-2 virus and the Omicron variant in a high vaccination coverage country, a population-based study
    (2023) Hormazabal, Juan; Nuñez-Franz, Loreto; Rubilar, Paola; Apablaza, Mauricio; Vial Cox, María Cecilia; Cortes Salinas, Lina Jimena; González, Natalia; Vial, Pablo; Said, Macarena; Gonzalez Wiedmaier, Claudia; Olivares, Kathya; Aguilera, Ximena; Ramírez-Santana, Muriel
    The study compared immunity to the original SARS-CoV-2 virus (Wuhan) and the Omicron variant using neutralizing antibodies (NAbs), that provide a good approximation of protective immunity. The results might help determine immunization strategies. Design and methods: Unlike previous studies, we analyzed NAbs in a random sample of 110 IgG positive sera from individuals who participated in a population-based seroprevalence transversal study, carried out in May 2022 in two Chilean cities, a country with high vaccination coverage. Results: Our findings indicate that 98.2% of individuals had NAbs against Wuhan, 65.5% against Omicron, and 32.7% tested positive for Wuhan but not Omicron. Factors influencing protective immunity included a prior natural infection and the number of vaccines received. NAbs titers against the original virus were high, demonstrating vaccine effectiveness in the population. However, the level of antibodies decreased when measuring NAbs against Omicron, particularly among older individuals, indicating a decline in vaccine protection. Previous COVID-19 episodes acted as a natural booster, increasing NAbs titers against both virus strains. Conclusions: Protective immunity against the original Wuhan SARS-CoV-2 virus is reduced when compared to Omicron variant. Updating vaccine to target emerging variants and continued monitoring of effectiveness at the population level are necessary.
  • Publication
    Fast and easy synthesis of silver, copper, and bimetallic nanoparticles on cellulose paper assisted by ultrasound
    (2023) Araya-Hermosilla, Rodrigo; Martinez Arenas, Jessica Isabel; Zúñiga Loyola, César; Ramírez, Sara; Salazar, Sebastián; Henry, Charles S.; Lavín, Roberto; Silva, Nataly
    This work focuses on a systematic method to produce Ag, Cu, and Ag/Cu metallic nanoparticles (MNPs) in situ assisted with ultrasound on cellulose paper. By tuning the concentration of AgNO3 and CuSO4 salt precursors and ultrasound time, combined with a fixed concentration of ascorbic acid (AA) as a reducing agent, it was possible to control the size, morphology, and polydispersity of the resulting MNPs on cellulose papers. Notably, high yield and low polydispersity of MNPs and bimetallic nanoparticles are achieved by increasing the sonication time on paper samples pre-treated with salt precursors before reduction with AA. Moreover, mechanical analysis on paper samples presenting well-dispersed and distributed MNPs showed slightly decreasing values of Young's modulus compared to neat papers. The strain at break is substantially improved in papers containing solely Ag or Cu MNPs. The latter suggests that the elastic/plastic transition and deformation of papers are tuned by cellulose and MNPs interfacial interaction, as indicated by mechanical analysis. The proposed method provides insights into each factor affecting the sonochemistry in situ synthesis of MNPs on cellulose papers. In addition, it offers a straightforward alternative to scale up the production of MNPs on paper, ensuring an eco-friendly method.
  • Publication
    Revisión de protocolos clínicos para el manejo del cuff en pacientes adultos con vía aérea artificial en hospitales públicos chilenos
    (2023) ROSALES, FELIPE; Marín Garrido, Fabiola; Monichi, Giovanna; Miranda Llanos, Francisca
    En Chile no existe una guía clara del Ministerio de Salud al respecto el manejo de las presiones del cuff en pacientes adultos con vía aérea artificial. En este contexto, diversas instituciones de salud, tanto públicas como privadas, han desarrollado sus propios protocolos para el manejo de pacientes adultos con vía aérea artificial. Estos protocolos presentan variaciones en las presiones del cuff utilizadas, lo que puede generar riesgos para los pacientes. Más aun, se ha observado que los profesionales de la salud aplican presiones peligrosas en el manejo de estos pacientes. El objetivo de este estudio fue describir las técnicas y las presiones utilizadas en los protocolos de instituciones hospitalarias de salud pública en Chile para el manejo de la presión del cuff en pacientes adultos con vía aérea artificial. Para ello, se llevó a cabo una revisión de protocolos vigentes de estas instituciones. Los resultados muestran que la mayoría de los protocolos mencionan el uso de una técnica objetiva, aunque no especifican necesariamente el instrumento a utilizar. La presión mínima promedio en los protocolos revisados es de 28,44 cmH2O, mientras que la presión máxima promedio es de 36,12 cmH2O. Solo el 23,80% de los protocolos cumplen con los valores recomendados actualizados. En conclusión, la mayoría de los protocolos mencionados utilizan una técnica objetiva. De ellos, el 68,75% sugieren presiones del cuff por sobre los valores seguros, lo que podría afectar la atención de los pacientes durante su hospitalización. Se requiere una actualización de los protocolos y la elaboración de directrices ministeriales claras al respecto.
  • Publication
    Gathering the Stakeholder’s Perspective: Experiences and Opportunities in Rare Genetic Disease Research
    (2023) White, Lauren; Crowley, Blaine; Finucane, Brenda; McClellan, Emily; Donoghue, Sarah; Garcia, Sixto; Repetto, Gabriela; Fischer, Matthias; Jacquemont, Sebastien; Gur, Raquel; Maillard, Anne; Donald, Kirsten; Bassett, Anne; Swillen, Ann; McDonald, Donna
    Background: Research participant feedback is rarely collected; therefore, investigators have limited understanding regarding stakeholders’ (affected individuals/caregivers) motivation to participate. Members of the Genes to Mental Health Network (G2MH) surveyed stakeholders affected by copy number variants (CNVs) regarding perceived incentives for study participation, opinions concerning research priorities, and the necessity for future funding. Respondents were also asked about feelings of preparedness, research burden, and satisfaction with research study participation. Methods: Modified validated surveys were used to assess stakeholders´ views across three domains: (1) Research Study Enrollment, Retainment, Withdrawal, and Future Participation; (2) Overall Research Experience, Burden, and Preparedness; (3) Research Priorities and Obstacles. Top box score analyses were performed. Results: A total of 704 stakeholders´ responded from 29 countries representing 55 CNVs. The top reasons for initial participation in the research included reasons related to education and altruism. The top reasons for leaving a research study included treatment risks and side effects. The importance of sharing research findings and laboratory results with stakeholders was underscored by participants. Most stakeholders reported positive research experiences. Conclusions: This study provides important insight into how individuals and families affected with a rare CNV feel toward research participation and their overall experience in rare disease research. There are clear targets for areas of improvement for study teams, although manystakeholders reported positive research experiences. Key findings from this international survey may help advance collaborative research and improve the experience of participants, investigators, and other stakeholders moving forward.
  • Publication
    Gallbladder Cancer Risk and Indigenous South American Mapuche Ancestry: Instrumental Variable Analysis Using Ancestry-Informative Markers
    (2023) Zollner, Linda; Boekstegers, Felix; Barahona, Carol; Scherer, Dominique; Marcelain, Katherine; Gárate, Valentina; Waldenberger, Melanie; Morales, Erik; Rojas, Armando; Munoz, César; Retamales, Javier; De Toro, Gonzalo; Vera, Allan; Barajas, Olga; Rivera, María; Cortés, Analía; Loader, Denisse; Saavedra, Javiera; Gutiérrez, Lorena; Ortega, Alejandro; Bertrán, Maria; Bartolotti, Leonardo; Gabler, Fernando; Campos, Mónica; Alvarado, Juan; Moisán, Fabricio; Spencer, Loreto; Nervi, Bruno; Carvajal-Hausdorf, Daniel; Losada, Héctor; Almau, Mauricio; Fernández, Plinio; Olloquequi, Jordi; Carter, Alice; Miquel, Juan; Bustos, Bernabe; Fuentes, Macarena; Gonzalez, Rolando; Bortolini, Maria; Acuña, Victor; Gallo, Carla; Ruiz, Andres; Rothhammer, Francisco; Bermejo, Justo
    A strong association between the proportion of indigenous South American Mapuche ancestry and the risk of gallbladder cancer (GBC) has been reported in observational studies. Chileans show the highest incidence of GBC worldwide, and the Mapuche are the largest indigenous people in Chile. We set out to assess the confounding-free effect of the individual proportion of Mapuche ancestry on GBC risk and to investigate the mediating effects of gallstone disease and body mass index (BMI) on this association. Genetic markers of Mapuche ancestry were selected based on the informativeness for assignment measure, and then used as instrumental variables in two-sample Mendelian randomization analyses and complementary sensitivity analyses. Results suggested a putatively causal effect of Mapuche ancestry on GBC risk (inverse variance-weighted (IVW) risk increase of 0.8% per 1% increase in Mapuche ancestry proportion, 95% CI 0.4% to 1.2%, p = 6.7 × 10-5) and also on gallstone disease (3.6% IVW risk increase, 95% CI 3.1% to 4.0%), pointing to a mediating effect of gallstones on the association between Mapuche ancestry and GBC. In contrast, the proportion of Mapuche ancestry showed a negative effect on BMI (IVW estimate -0.006 kg/m2, 95% CI -0.009 to -0.003). The results presented here may have significant implications for GBC prevention and are important for future admixture mapping studies. Given that the association between the individual proportion of Mapuche ancestry and GBC risk previously noted in observational studies appears to be free of confounding, primary and secondary prevention strategies that consider genetic ancestry could be particularly efficient.
  • Publication
    Exposure of 4- year to 24- year olds to tobacco imagery on prime- time Chilean television
    (2023) Peruga, Armando; Oscar Urrejola; Delgado, Iris; Matute, María Isabel; Castillo-Laborde, Carla; Molina, Xaviera; Hirmas Adauy, Macarena; Olea, Andrea; González, Claudia; Aguilera, Ximena; Sargent, James
    Introduction: The extent of the population's exposure to tobacco imagery across all genres of regular TV programming and the contribution of each of these genres is unknown, except for UK broadcast channels. The objective of this study is to estimate the exposure of young people to tobacco imagery on Chilean prime-time television and the programme source contributing to such exposure. Methods: Programmes aired during 3 weeks in 2019 from the 15 highest audience channels in Chile were content-analysed for the occurrence of tobacco categorised as actual use, implied use, tobacco paraphernalia, tobacco brand appearances and whether they violated Chilean smoke-free law for each 1 min interval (92 639). The exposure of young people to tobacco content was estimated using media viewership figures. Results: Young people received 29, 11 and 4 million tobacco impressions of any type, explicit use and smoke-free violation, respectively, at a rate of 21.8, 8.0 and 2.1 thousand impressions per hour of TV viewing. The main sources of exposure to tobacco impressions were feature films and animated productions, which were almost entirely non-Chilean. Finally, young people were exposed to tobacco brand impressions primarily through films, effectively circumventing the advertising ban in Chile. Discussion: Television programming is a source of significant youth exposure to tobacco imagery, including branding impressions. To conform to the WHO FCTC, Chile should prohibit tobacco branding in any TV programme and require strong anti-tobacco advertisements prior to any TV programme portraying tobacco.