[Screening of hepatitis B in high risk Chilean and immigrant pregnant women: Management of mother to child transmission]. / Cribado de virus de hepatitis B en mujeres embarazadas: inmigrantes, y chilenas con conductas de riesgo. Manejo del binomio madre-hijo: Plan piloto.

BACKGROUND: Chile is a low-endemic HBV country, but countries with the highest migratory flow to Chile have an intermediate-high endemicity. In order to avoid vertical transmission of HBV, immunoprophylaxis (IP) in the newborn (NB) is a key factor. AIM: To identify HBsAg prevalence in pregnant immigrants and Chilean pregnant women with risk behaviors (RB) and to asses IP use in the NB. MATERIAL AND METHODS: Prospective HBsAg screening cohort of immigrant and Chilean pregnant women with RB, between July 1, 2017 and June 30, 2018 in CABL. IP of all NB of reactive HBsAg mothers was assessed. RESULTS: 1,415 HBsAg samples, 1,265 immigrants and 150 Chileans with RB. 37 reactive HBsAg. Two false positive. HBsAg prevalence in immigrant pregnant women was 2.7% and 0.66% in Chileans with RB (p < 0.05). 91.1% came from Haiti, with a prevalence of 3.5% in our region. All NB (36) received IP with a median of administration of 3:02 h. CONCLUSIONS: The prevalence in immigrant pregnant women was higher than that reported in the general population and in Chilean women with RB. We proposed the need for universal screening in pregnancy, especially in pregnant women from countries with intermediate-high endemicity.

Cribado de virus de hepatitis B en mujeres embarazadas: inmigrantes, y chilenas con conductas de riesgo. Manejo del binomio madre-hijo: Plan piloto / Screening of hepatitis B in high risk Chilean and immigrant pregnant women: management of mother to child transmission

Resumen Introducción: Chile es un país de baja endemia de virus de hepatitis B (VHB), pero los países de mayor flujo migratorio hacia Chile tienen una endemia intermediaalta. La inmunoprofilaxis (IP) en el recién nacido (RN) es fundamental para evitar la transmisión vertical de VHB. Objetivos: Determinar la prevalencia de HBsAg en mujeres embarazadas: inmigrantes, y chilenas con conductas de riesgo (CR), y evaluar el cumplimiento de la indicación de IP a los RN de madre con HBsAg reactivo. Material y Métodos: Cohorte prospectiva de cribado de HBsAg a mujeres embarazadas inmigrantes, y chilenas con CR, entre julio 2017 y junio 2018 en CABL. Los RN de madre con HBsAg reactivo se les administró IP adecuada (antes de 12 h de vida). Resultados: Se realizó un total de 1.415 HBsAg: 1.265 a inmigrantes y 150 a chilenas con CR. Se obtuvieron 37 pacientes con HBsAg reactivos. Dos falsos positivos. La prevalencia HBsAg en inmigrantes fue 2,7% y 0,66% en chilenas con CR (p < 0,05). El 91,1% provenía de Haití, con una prevalencia de 3,5% en nuestra área. Todos los RN (36) recibieron IP. La mediana de administración de IP fue 3:02 h. Conclusiones: La prevalencia de VHB en mujeres gestantes inmigrantes fue superior a lo reportado en la población general y en mujeres chilenas con CR. Planteamos la necesidad de implementar el cribado universal en el embarazo, y en especial, en mujeres embarazadas provenientes de países con endemia intermedia-alta.

Background: Chile is a low-endemic HBV country, but countries with the highest migratory flow to Chile have an intermediate-high endemicity. In order to avoid vertical transmission of HBV, immunoprophylaxis (IP) in the newborn (NB) is a key factor. Aim: To identify HBsAg prevalence in pregnant immigrants and Chilean pregnant women with risk behaviors (RB) and to asses IP use in the NB. Material and Methods: Prospective HBsAg screening cohort of immigrant and Chilean pregnant women with RB, between July 1, 2017 and June 30, 2018 in CABL. IP of all NB of reactive HBsAg mothers was assessed. Results: 1,415 HBsAg samples, 1,265 immigrants and 150 Chileans with RB. 37 reactive HBsAg. Two false positive. HBsAg prevalence in immigrant pregnant women was 2.7% and 0.66% in Chileans with RB (p < 0.05). 91.1% came from Haiti, with a prevalence of 3.5% in our region. All NB (36) received IP with a median of administration of 3:02 h. Conclusions: The prevalence in immigrant pregnant women was higher than that reported in the general population and in Chilean women with RB. We proposed the need for universal screening in pregnancy, especially in pregnant women from countries with intermediate-high endemicity.

[Plasmapheresis in neurological diseases. Experience in 140 procedures in 47 patients]. / Plasmaféresis indicada por enfermedad neurológica. Experiencia de 140 procedimientos en 47 pacientes.

BACKGROUND: Plasmapheresis can be useful in myasthenia gravis, Guillain Barré syndrome and chronic demyelinating inflammatory polyradiculoneuritis. AIM: To report our experience with plasmapheresis in patients with neurological diseases. MATERIAL AND METHODS: Retrospective review of plasmapheresis procedures done between 1995 and 2001, in a public hospital. Indications criteria, clinical results and technical yield were analyzed. RESULTS: One hundred fifty nine procedures were reviewed. One hundred forty (88%) were indicated for neurological diseases (44% for Guillain Barré syndrome and 29% for myasthenia gravis). Clinical improvement or eventual complications were avoided in 70% of patients with Guillain Barré syndrome and 100% of patients with myasthenia gravis. Hypotension in 10% and paresthesias in 7% were observed. All complications were successfully controlled with crystalloid or fresh plasma infusions or citrate management. In 11 cases, the procedure was interrupted due to obstruction of the venous access, that was peripheral in eight of these. The most common difficulties of the procedure were delay in performing it in 50% of patients and insufficient exchange volumes in 30%. CONCLUSIONS: Plasmapheresis was safe and useful in patients with myasthenia gravis and Guillain Barré syndrome. The drawbacks of the procedure are its costs and requirement of special equipment.

[Immunophenotyping of peripheral blood lymphocytes from Chilean chronic chagasic patients by flow cytometry]. / Inmunofenotipificación de linfocitos en sangre periférica de pacientes chagásicos crónicos chilenos mediante citometría de flujo.

BACKGROUND: Cellular immune mechanisms of the resistance to infection by T cruzi as well as the pathogenesis of Chagas disease are still controversial. AIM: To quantify and analyse the peripheral blood immune cells from chagasic and non chagasic patients by flow cytometry. PATIENTS AND METHODS: Peripheral blood samples were taken from 21 individuals seropositive for Chagas disease, under no specific treatment. Control samples from 21 healthy blood donors were also obtained. To quantify immune cells populations by flow cytometry, antibodies against CD3, CD4, CD8, CD16/56, CD45/14, CD19 and HLA-DR markers were used. RESULTS: The percentage of CD8+ cells was low and the CD4+/CD8+ ratio was high in chagasic patients, compared to their non infected counterparts. No statistically significant differences in the number of CD4+, NK, B, CD4+HLADR+ and CD8+HLADR+ cells, were observed within the two groups. CONCLUSIONS: These results show that Chilean chronic chagasic patients have lower percentage of CD8+ cells and higher CD4+/CD8+ ratio than non infected individuals.

Enfermedad de Chagas en hemofílicos / Chagas disease in haemophilic patients

Se efectuó examen serológico mediante RHAI y RIFI para Enfermedad de Chagas a 35 pacientes hemofílicos bajo control en el Banco de Sangre del Hospital Barros Luco Trudeau, de Santiago, comparando los resultados con los obtenidos con igual estudio en 748 donantes de sangre del mismo banco. Entre los hemofílicos la frecuencia de seropositivos fue de 45,7% (16 casos), mientras que en los donantes sólo hubo 1,9% de positivos (14 casos). De los 16 hemofílicos seropositivos 12 (75%) habían recibido más de 1.000 unidades transfusionales. La correlación de los resultados serológicos positivos a T. cruzi entre los hemofílicos y los donantes permite establecer con coeficiente de riesgo relativo estimado (RRE) de infección chagásica transfusional de 44,15 veces mayor en los hemofílicos que entre personas no transfundidas. Tanto la cifra general de infección chagásica en hemofílicos como el RRE de infección por Enfermedad de Chagas en estos pacientes es mayor que en otros estudios similares efectuados en el país