Time in therapeutic range and risk of preeclampsia in chronic hypertensive pregnant women.

Pregnancy Hypertensive Disorders (PHD), particularly Preeclampsia (PE), are significant contributors to maternal-fetal morbidity and mortality, with chronic arterial hypertension (CH) being a major risk factor. The prevalence of CH has risen alongside obesity and advanced maternal age. While antihypertensive treatment mitigates adverse pregnancy outcomes, the duration of effective blood pressure (BP) control, termed Time in Therapeutic Range (TTR), has not been extensively studied in pregnant women. TTR, reflecting the proportion of time BP remains within target ranges, predicts long-term cardiovascular and renal events in the general population but remains unexplored in pregnancy. This study investigates the association between TTR, assessed through office BP (OBP) and ambulatory BP monitoring (ABPM), and PE development in pregnant women with CH. In a retrospective longitudinal study, data from 166 pregnant women with HA referred to our hospital analyzed. BP was measured using OBP and ABPM from 10 weeks of gestation, with TTR calculated as the percentage of visits where BP remained within target ranges. The study defined four TTR control groups: 0%, 33%, 50-66%, and 100%. Results showed that 28% of the participants developed PE, with a higher incidence correlating with lower TTR in ABPM. TTR in ABPM was a significant predictor of PE risk, with the best-controlled group (100% TTR) demonstrating a 92% reduced risk compared to those with 0% TTR. The agreement between OBP and ABPM TTR was low, emphasizing the importance of ABPM for accurate BP monitoring in pregnancy. This study indicates that integrating ABPM for TTR assessment in high-risk pregnancies has the potential to reduce maternal and fetal complications.

[Consequence of hypertensive disorders during pregnancy (THE) on women's cardiovascular health]. / Consecuencia de los trastornos hipertensivos durante el embarazo (THE) sobre la salud cardiovascular de la mujer.

Patients with hypertensive disorders of pregnancy (HDP) are at increased risk of maternal-fetal complications and represent the third leading cause of maternal mortality. To date, it is known that women experiencing this condition during pregnancy have a higher future risk of cardiovascular events (CVD). Our objective was to report the incidence of new-onset hypertension in the postpartum period. We conducted a cohort study in high-risk pregnant patients who underwent ambulatory blood pressure monitoring (ABPM) between weeks 20-30. Patients were categorized as normotensive (NT) or gestational hypertensive (GH), excluding those with chronic hypertension, and were followed until the end of pregnancy with a postpartum assessment after 3months. Patients with HDP (39%) had a higher incidence of preeclampsia and newborns with low birth weight and preterm birth. A total of 177 pregnant women were analyzed for the primary outcome. Among those with GH, 33.3% vs 17.2% of NT (P=.014) reported new-onset hypertension. The odds ratio for developing new-onset hypertension was 2.3 (95%CI: 1.20-4.77), for those with GH. In conclusion, pregnant patients with GH assessed by ABPM between 20-30weeks are at higher risk of developing new-onset hypertension in the postpartum period, emphasizing the need for closer monitoring and control to prevent future cardiovascular complications.

[Prevalence, knowledge and control of arterial hypertension in vulnerable neighborhoods of Argentina: A Cross-sectional Study]. / Estudio de prevalencia, conocimiento y control de la hipertensión arterial en barrios vulnerables de Argentina.

INTRODUCTION: Hypertension (HTN) represents the primary individual risk factor, contributing significantly to the global burden of cardiovascular diseases (CVD). In our country, epidemiological research has highlighted substantial variations in the prevalence of these risk factors across different populations. However, there is a lack of epidemiological studies assessing exclusive cardiovascular risk factors within vulnerable neighborhoods characterized by extremely limited economic resources, sociocultural challenges, and inadequate healthcare access. METHODS: A multicenter cross-sectional observational study was conducted among individuals residing in economically deprived and marginalized communities, including informal settlements and underprivileged neighborhoods. Simple random sampling of households was employed. Blood pressure measurements, anthropometric assessments, and epidemiological, economic, and sociocultural questionnaires were administered. Results encompass prevalence rates, awareness levels, and blood pressure control across diverse regions. Logistic regression was utilized to identify independent variables influencing primary outcomes. RESULTS: A total of 989 participants were analyzed. The overall prevalence of hypertension was 48.2%. About 82% had a body mass index (BMI) >25. Approximately 45.3% had less than 6 years of formal education. Independent association was established between education levels below 6 years and higher hypertension prevalence. Among hypertensive individuals, 44% were unaware of their condition, with only 17.2% achieving control, correlated with having health insurance and a higher educational background. Merely 24% were receiving combined therapy. CONCLUSION: The prevalence of hypertension within vulnerable neighborhoods is alarmingly high, surpassing rates in other social strata. Knowledge, treatment, and control levels of hypertension are suboptimal, comparable to other populations. Inadequate use of combination therapy was observed. This study underscores the urgent need for targeted interventions addressing cardiovascular risk factors in poor areas to mitigate the burden of CVD.

Prognostic performance of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio for mortality in patients with acute stroke.

OBJECTIVE: To evaluate the prognostic performance of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) for mortality in patients with acute stroke treated at a Peruvian hospital. DESIGN: Retrospective cohort study. SETTING: Tertiary care hospital. PATIENTS: Patients aged ≥18 years with a diagnosis of acute stroke and admitted to the hospital from May 2019 to June 2021. INTERVENTIONS: None. MAIN VARIABLES OF INTERESTS: Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mortality. RESULTS: A total of 165 patients were included. The mean age was 66.1±14.2 years, and 59.4% were male. Only NLR had a performance superior to 0.7 (AUC: 0.75; 95%CI: 0.65-0.85), and its elevated levels were associated with an increased risk of mortality (aRR: 3.66; 95%CI: 1.77-8.85) after adjusting for confounders. CONCLUSION: The neutrophil-to-lymphocyte ratio has an acceptable prognostic performance for mortality in patients with acute stroke. Its use may be considered to stratify patients' risk and to consider timely alternative care and management.

Massive enlargement of gastric pouch as a complication of gastrojejunal anastomotic stenosis following one anastomosis laparoscopic gastric bypass: A case report.

INTRODUCTION AND IMPORTANCE: By 2030 it is predicted that 1 in 5 women and 1 in 7 men will be living with obesity. The only long-term effective strategy for achieving significant weight loss over time is surgical treatment. One Anastomosis Gastric Bypass (OAGB) has been proposed as an effective therapeutic option. Stenosis of Gastro-Jejunal Anastomosis (GJA) is one of the most common long-term complications and its cause recognized as multifactorial. CASE PRESENTATION: We present the case of a patient with a history of progressive postoperative oral intolerance after OAGB with 60 kg weight loss (BMI 20.7 kg/m2). Severe stenosis of the GJA and massive dilation of the gastric remnant was documented, treated multiple times with endoscopic balloon dilation. He was referred to our unit due to persistent symptoms. Revision surgery to a Gastric Bypass was programmed, ultimately performed via an open approach with resection of 80 % of the gastric remnant. CLINICAL DISCUSSION: Endoscopic dilatation and surgical revision are the two primary treatment options for GJA stricture. In refractory cases to pneumatic dilation, laparoscopic revision surgery is indicated, however an open approach is frequently required, as surgeries are technically demanding due to distorted anatomy in this population. CONCLUSION: Operations to correct chronic complications are tailored to the patient's anatomy as well as the symptoms or pathologies they are intended to correct. Whilst revision surgeries are associated with an increased risk of conversion, complications and longer hospital stay, they can be performed safely in experienced centers.

Prediabetes is more than a pre-disease: additional evidences supporting the importance of its early diagnosis and appropriate treatment.

AIM: To identify Prediabetes (PreD) as early and serious diabetes step using clinical-biochemical characteristics in the population of the Primary Prevention Diabetes Buenos Aires (PPDBA) study. METHODS: PPDBA Study evaluated benefits of adopting healthy lifestyles to prevent T2D. It recruited people 45-75 years of age with PreD (impaired fasting glycaemia [IFG], impaired glucose tolerance [IGT] or both, American Diabetes Association criteria), using an opportunistic approach. They completed a FINDRISC questionnaire, and those with a score ≥13 points were invited to participate. When they accepted, we performed an oral glucose tolerance test (OGTT) with a complete lipid profile and HbA1c while physicians completed a clinical history. We recruited 367 persons, and depending on OGTT results, the sample was divided into normals (NGT), PreD, or with diabetes (last one was excluded in our analysis). Data were statistically analyzed using parametric and nonparametric tests and logistic regression to identify parameters associated with PreD. RESULTS: From the recruited (n = 367) 47.7% have NGT, 48.5% PreD and 3.8% unknown T2D (excluded). People with PreD were significantly older, with a higher percentage of overweight/obesity, BMI, and larger waist circumference than NGT. They also showed significantly higher fasting and 2 h post glucose load, HbA1c, and triglyceride levels. No significant differences were recorded in the blood pressure, lipid profile though both groups had abnormally high LDL-c values. They also had a larger percentage of TG/HDL-c ratios (insulin resistance indicator) (55% vs. 37.5%). Logistic regression analysis showed that PreD was significant associated with age, waist circumference, and triglyceride above target values. CONCLUSION: Our findings showed that clinical and biochemical parameters were significantly different between people with PreD and those with NGT. This evidence supports the concept that PreD is a serious dysfunction, which should be early diagnosed and treated properly to prevent its transition to T2D and its complications.

[Isolated nocturnal hypertension in individuals with human immunodeficiency virus]. / Hipertensión nocturna aislada en individuos con el virus de la inmunodeficiencia humana.

INTRODUCTION: Isolated nocturnal hypertension is associated with a greater number of cardiovascular events and target organ damage due to arterial hypertension. It has been observed that patients in the general population with this entity do not have high blood pressure figures in the office; and it is necessary to perform an outpatient measurement to unmask it. The prevalence in special populations is not fully described. The objective of the following study is to describe the prevalence of isolated nocturnal hypertension in a population living with the human immunodeficiency virus and to observe its relationship with the categories of office blood pressure and the phenotypes of the 24-hour ambulatory blood pressure measurement. METHODOLOGY: A retrospective cohort was carried out in a population with human immunodeficiency virus in a public hospital in Spain, clinical epidemiological characteristics, office blood pressure measurements and 24-hour ambulatory blood pressure measurement (ABPM) were recorded. An analysis was performed based on the different ABPM blood pressure phenotypes, as well as based on the different office blood pressure categories, the risks for isolated nocturnal hypertension were calculated. RESULTS: One hundred and sixteen individuals, without antihypertensive medication or history of established cardiovascular disease, were included in the analysis. A prevalence of nocturnal hypertension of 23.3% was described. It was not possible to demonstrate significant differences between phenotypes by ABPM of any variable specific to HIV. There were no adjusted risk differences between the different categories of office normotensives. CONCLUSIONS: Isolated nocturnal hypertension is more frequent in patients with HIV and office blood pressure values in normotensive patients are not sufficient to predict isolated nocturnal hypertension.

Plasma levels of efavirenz and frequency of the CYP2B6 516G>T polymorphism in people living with HIV-1 in Mexico.

Efavirenz (EFV) is a widely used antiretroviral, due to its safety, efficacy, and low cost. However, plasma concentrations have been related with an increased risk of virological failure and the appearance of serious adverse reactions. EFV is metabolized by Cytochrome P450, the main isoenzyme involved is CYP2B6 and the most relevant genetic polymorphisms found in several populations has been the CYP2B6 516G> T. The aim of this study was to identify the frequency of the CYP2B6 516G>T polymorphism and its effect on the plasma concentration of efavirenz (EFV) in a group of people living with HIV (PLWH) and undergoing EFV treatment in Morelos, Mexico. Ninety-six PLWH undergoing EFV treatment, at a daily dose of 600 mg orally in combination with other antiretrovirals (ARVs), were included in this study. The CYP2B6 516G>T polymorphism was detected using PCR-RFLP. The plasma concentrations of EFV were evaluated by high-resolution liquid chromatography coupled to a mass-mass detector, using a protein precipitation method. The median plasma EFV concentration was 4.6 µg/mL (IQR = 4.64) and 64.6% of the subjects had concentrations above the therapeutic range. The CYP2B6 516G>T genotype findings were as follows: 46.9% of the population presented the wild-type genotype (GG), while 45.8 % and 7.3 % showed the heterozygote (GT) and the polymorphic homozygote (TT) genotype, respectively. The homozygote G had the lowest plasma concentrations of EFV (median = 4.1 µg/mL and IQR = 1.7 µg/mL), followed by those with the GT genotype (median = 5.1 µg/mL and IQR = 3.0 µg/mL). Participants with the homozygous T genotype had the highest EFV concentrations (median = 9.7 µg/mL and IQR = 5.8 µg/mL). In conclusion, the CYP2B6 516G>T polymorphism was associated with plasma levels of EFV in PLWH undergoing ARV treatment. EFV plasma concentrations at 600mg doses were outside the therapeutic range in most subjects.

Primer registro de trauma en Chile: análisis de 2 años en un hospital público / First trauma registry in Chile: 2 years analysis in a public hospital

Resumen Introducción: El trauma representa un verdadero reto para los sistemas sanitarios por ser un gran problema de salud pública. En Chile se desconoce el manejo del paciente politraumatizado. Objetivo: Describir los resultados del primer registro de trauma (RT) en línea, en los pacientes que se atienden en el Hospital Dr. Sótero del Río durante los primeros dos años de la implementación. Materiales y Método: Se recoge información prospectiva en un registro en red, sobre pacientes víctimas de trauma, ingresados al Hospital Dr. Sótero del Río durante dos años. Estas variables involucran todo el proceso de atención clínica desde el ingreso al alta o fallecimiento. Resultados: En dos años, se registran 3.515 ingresos de pacientes víctima de trauma. Entre estos, el 81,3% son hombres. El 27% sufre trauma penetrante y 59% cerrado. Destacan más lesiones por arma de fuego que por arma blanca. El 18,4% de los pacientes ingresados tiene un el Injury Severity Score (ISS) mayor a 15 puntos. 34 pacientes ingresan en paro cardiorrespiratorio y 7,3 % lo hace hipotenso. Se realizan 1.856 tomografías y el 54,4% requiere cirugía de urgencia. Ingresan 692 traumas torácicos, 654 abdominales, 1.550 de extremidades, 687 lesiones en cráneo y 190 traumas cervicales. Se activa el protocolo de transfusión masiva en el 3,1% de los ingresos. El 8,3% utiliza la unidad de paciente crítico y la mortalidad es de 2,9%, teniendo como primera causa el trauma encéfalocraneano y segunda el shock hemorrágico. Conclusiones: Nuestro hospital tiene una gran incidencia de trauma. La implementación de un RT permite conocer la dimensión y evaluar el proceso asistencial en torno al paciente víctima de trauma. Es necesario dirigir recursos e implementar capacitación en los centros de alto volumen de trauma, además, de continuar con la extensión de la herramienta como estrategia de monitorización multicéntrica.

Introduction: Trauma represents a real challenge for health systems because is a major public health problem. In Chile, the management of polytrauma patients is unknown. Aim: Describe the results of the first online trauma registry; in patients treated at the Dr. Sótero del Río Hospital during the first two years of implementation. Materials and Method: Prospective information is collected in a network registry, about trauma victims, admitted to Dr. Sótero del Río Hospital for two years. These variables involve the entire clinical care process from admission to discharge or death. Results: 3.515 admissions of trauma victims are registered in two years. Among these, 81.3% are men. 27% suffered penetrating trauma and 59% closed. They emphasize larger injuries by firearm than by bladed weapon. 18.4% of admitted patients have ISS greater than 15 points. 34 patients enter cardio-respiratory arrest and 7.3% make it hypotensive. 1,856 CT scans are performed and 54.4% require emergency surgery. They admitted 692 thoracic trauma, 654 abdominal, 1550 limb, 687 skull injuries and 190 cervical trauma. The massive transfusion protocol is activated at 3.1% of the admissions. 8.3% use the critical patient unit and mortality is 2.9%, with cranial brain trauma as the first cause and hemorrhagic shock as a second cause. Conclusions: Our hospital has a high incidence of trauma. The RT implementation allows us to know the dimension and assess the care process about the trauma patient. It is necessary to direct resources and implement training in high-volume trauma centers, as well as continuing with the extension of the tool as a multi-center monitoring strategy.

Update on Dietary Compliance, Nutritional Status, and Neuropsychological Functioning in the Chilean Phenylketonuria cohort

Abstract Since 1992, Chile has had a Newborn Screening Program for Phenylketonuria (PKU), which currently has an incidence of 1:18,916 newborns. The objective of the current study was to describe the 2020 follow up of the Chilean PKU cohort. The variables analyzed were: nutritional status, dietary compliance and neuropsychological functioning. We conducted a descriptive cross-sectional statistical analysis. The 271 subjects with PKU had an average age of diagnosis of 17±8 days and a phenylalanine (Phe) level of 1122±546 umol/L. Approximately 80% of protein requirement came from a protein substitute. For those <18 years of age, 80% had good dietary compliance with Phe level between 120-360 umol/L and those >18 years had a median of 522 umol/L (95%CI 468 - 636). Forty-four percent of the active PKU cohort had overweight/obesity. Eighty-five percent of the cohort >4 years of age had a normal intelligence quotient (IQ) (score 80-120). We observed a negative correlation (p <0.001; 95% CI: - 0.5, -0.2) between IQ score and Phe level. The Chilean protocol and protein substitute subsidy for life, together with the follow-up and continuous education carried out by the clinical team has encouraged compliance.

Anisakis physeteris y Pseudoterranova decipiens en el pez Mugil Curema comercializado en Tumaco, Colombia / Anisakis physeteris and Pseudoterranova decipiens in the Mugil curema fish caught in Tumaco, Colombia

RESUMEN Objetivo. Identificar nematodos de la familia Anisakidae en el pez de consumo Mugil curema. Materiales y métodos. Para este estudio, se recolectaron 16 peces Lisa (M. curema) del puerto de Tumaco, una ciudad en la costa colombiana del Pacífico. La identificación morfológica de las larvas se realizó mediante taxonomía clásica y se calculó el porcentaje de infestación de larvas. Para la identificación molecular, se realizó una PCR múltiple con cebadores para las especies Anisakis physeteris, Pseudoterranova decipiens, Anisakis simplex sensu stricto, Contracaecum osculatum, Hysterothylacium aduncum y Anisakis pegreffii. Resultados. La revisión taxonómica permitió la identificación de larvas de tipo II del género Anisakis y larvas del género Pseudoterranova. Las larvas se aislaron principalmente del intestino, donde se encontró que el 94% de los peces estaban parasitados por nematodos anisakidos. La PCR multiplex permitió la identificación de la especie A. physeteris (Larva tipo II) y P. decipiens. Conclusiones. Este estudio es el primer reporte de nematodo Anisakidae en Tumaco, Colombia. Estos resultados proporcionan una justificación convincente para un estudio adicional sobre la familia Anisakidae en Colombia, como un problema de salud pública.

ABSTRACT Objective: Identification nematodes Anisakidae family in Mugil curema fish. Materials and methods: For this study, 16 Lisa fish (Mugil curema) were obtained from the port of Tumaco, a city on the Colombian Pacific coast. Morphological identification of larvae was made by classical taxonomy and the percentage of larval infestation was calculated. For molecular identification, a multiplex PCR was carried out with primers for six species, Anisakis physeteris, Pseudoterranova decipiens, Anisakis simplex sensu stricto, Contracaecum osculatum, Hysterothylacium aduncum and Anisakis pegreffii. Results: The taxonomic revision enabled the identification of type II larvae of the genus Anisakis and larvae of the genus Pseudoterranova. The larvae were isolated mainly from the intestine, where it was found that 94% of the fish were parasitized by anisakid nematodes. The multiplex PCR enabled the identification of the species A. physeteris (Larva type II), and P. decipiens. Conclusions: This study is the first report of nematode Anisakidae on Tumaco, Colombia. These results provide a compelling justification for further study into the Anisakidae family in Colombia, as a public health problem.

[COVID-19 and its relationship with hypertension and cardiovascular disease]. / COVID-19, hipertensión y enfermedad cardiovascular.

The association between hypertension, diabetes, cardio and cerebrovascular disease and severe and fatal COVID-19, described in different countries, is remarkable. Myocardial damage and myocardial dysfunction are postulated as a possible causal nexus. Frequent findings of elevated troponin levels and electrocardiographic anomalies support this concept. On the other hand, hypotheses in favour and against a deleterious effect of angiotensin converting enzyme inhibitors and angiotensin receptor blockers, a usual treatment for cardiovascular disease, have been raised. There is currently no solid evidence and thus properly designed studies on this subject are urgently needed. In this context, patients with cardiovascular disease should especially avoid being exposed to the virus, should not self-medicate and rapidly seek medical advice should they show symptoms of infection.

Sobrevida a 10 años de pacientes egresados luego de cirugía por endocarditis infecciosa en un hospital público / Hospital mortality and long-term survival of 103 patients with infective endocarditis requiring surgery

Background Infective endocarditis (IE) is a serious disease with high mortality, especially among the most severe cases undergoing surgery. Aim To analyze the clinical features, perioperative mortality and long-term survival of patients with infective endocarditis requiring surgery. Material and Methods Review of medical records of patients who underwent heart valve surgery for active infective endocarditis in a public hospital between 1995 and 2008. Demographic characteristics and comorbidities were described. Perioperative and 10 year survival were analyzed retrieving death certificates from the Chilean Identification Service. Results Data from 103 patients aged 46 ± 14 years (74% males) was analyzed. Thirty five percent of patients had an underlying predisposing heart condition such as congenital heart disease in 18.5% and prosthetic valves in 10%. The most common location was the aortic valve and the most common surgical procedure was heart valve replacement with a mechanical prosthetic valve in 87% of the cases. Pathogen identification in blood cultures was achieved in 48% of the cases. The most common causative microorganisms were S. aureus in 12%, coagulase-negative Staphylococcus in 11%, S. viridans in 10% and Enterococcus in 7%. Hospital mortality was 20.4% and ten-year survival was 65%. Conclusions Patients with severe IE requiring surgical treatment still have high perioperative and late mortality.

Soil lead pollution modifies the structure of arbuscular mycorrhizal fungal communities.

The impact of lead (Pb) pollution on native communities of arbuscular mycorrhizal fungi (AMF) was assessed in soil samples from the surroundings of an abandoned Pb smelting factory. To consider the influence of host identity, bulk soil surrounding plant roots soil samples of predominant plant species (Sorghum halepense, Bidens pilosa, and Tagetes minuta) growing in Pb-polluted soils and in an uncontaminated site were selected. Molecular diversity was assessed by sequencing the 18S rDNA region with primers specific to AMF (AMV4.5NF/AMDGR) using Illumina MiSeq. A total of 115 virtual taxa (VT) of AMF were identified in this survey. Plant species did not affect AMF diversity patterns. However, soil Pb content was negatively correlated with VT richness per sample. Paraglomeraceae and Glomeraceae were the predominant families while Acaulosporaceae, Ambisporaceae, Archaeosporaceae, Claroideoglomeraceae, Diversisporaceae, and Gigasporaceae were less abundant. Acaulosporaceae and Glomeraceae were negatively affected by soil Pb, but Paraglomeraceae relative abundance increased under increasing soil Pb content. Overall, 26 indicator taxa were identified; four of them were previously reported in Pb-polluted soils (VT060; VT222; VT004; VT380); and five corresponded to cultured spores of Scutellospora castaneae (VT041), Diversispora spp. and Tricispora nevadensis (VT060), Diversispora epigaea (VT061), Glomus proliferum (VT099), and Gl. indicum (VT222). Even though AMF were present in Pb-polluted soils, community structure was strongly altered via the differential responses of taxonomic groups of AMF to Pb pollution. These taxon-specific differences in tolerance to soil Pb content should be considered for future phytoremediation strategies based on the selection and utilization of native Glomeromycota.

The BeWo cell line derived from a human placental choriocarcinoma is permissive for respiratory syncytial virus infection.

The respiratory syncytial virus (RSV) is the main pathogen associated with upper respiratory tract infections during early childhood. Vertical transmission of this virus has been suggested in humans, based on observations recorded during animal studies that revealed an association of RSV with persistent structural and functional changes in the developing lungs of the offspring. However, human placentas have not yet been evaluated for susceptibility to RSV infection. In this study, we examined the capacity of RSV to infect a human trophoblast model, the BeWo cell line. Our results suggest that BeWo cells are susceptible to RSV infection since they allow RNA viral replication, viral protein translation, leading to the production of infectious RSV particles. In this report, we demonstrate that a human placenta model system, consisting of BeWo cells, is permissive to RSV infection. Thus, the BeWo cell line may represent a useful model for studies that aim to characterize the events of a possible RSV infection at the human maternal-fetal interface.

[Hospital mortality and long-term survival of 103 patients with infective endocarditis requiring surgery]. / Sobrevida a 10 años de pacientes egresados luego de cirugía por endocarditis infecciosa en un hospital público.

Background Infective endocarditis (IE) is a serious disease with high mortality, especially among the most severe cases undergoing surgery. Aim To analyze the clinical features, perioperative mortality and long-term survival of patients with infective endocarditis requiring surgery. Material and Methods Review of medical records of patients who underwent heart valve surgery for active infective endocarditis in a public hospital between 1995 and 2008. Demographic characteristics and comorbidities were described. Perioperative and 10 year survival were analyzed retrieving death certificates from the Chilean Identification Service. Results Data from 103 patients aged 46 ± 14 years (74% males) was analyzed. Thirty five percent of patients had an underlying predisposing heart condition such as congenital heart disease in 18.5% and prosthetic valves in 10%. The most common location was the aortic valve and the most common surgical procedure was heart valve replacement with a mechanical prosthetic valve in 87% of the cases. Pathogen identification in blood cultures was achieved in 48% of the cases. The most common causative microorganisms were S. aureus in 12%, coagulase-negative Staphylococcus in 11%, S. viridans in 10% and Enterococcus in 7%. Hospital mortality was 20.4% and ten-year survival was 65%. Conclusions Patients with severe IE requiring surgical treatment still have high perioperative and late mortality.

Experiencia de unidad de dolor agudo perioperatorio del hospital Gustavo Fricke, enero - abril 2019 / Areview of the perioperative pain management unit, Gustavo Fricke Hospital, january - april 2019

Introducción: Se puede definir dolor como una experiencia sensorial o emocional desagradable asociada a un daño real o potencial en un tejido. El dolor agudo postoperatorio mal controlado aumenta la morbimortalidad al impactar sobre múltiples sistemas. Para abordar este problema se han creado unidades encargadas de manejar el dolor perioperatorio, conformadas por equipos multidisciplinarios. Objetivos: El objetivo general de esta revisión es presentar el funcionamiento y la experiencia a la fecha de la Unidad del Dolor Agudo Perioperatorio (UDAP) del Hospital Gustavo Fricke (HGF) a los distintos servicios. Desarrollo: La Unidad del Dolor Agudo Perioperatorio (UDAP) del HGF se gesta dentro de la unidad de anestesia y pabellones quirúrgicos en enero del año 2018.Son cerca de 30 pacientes mensuales los que se incluyen en la unidad, los que en promedio están 2 días con algún tipo de analgesia avanzada. Estos pacientes han sido sometidos a cirugías de distintas especialidades, siendo la cirugía digestiva la más frecuente, seguido de la ginecológica y traumatológica. Conclusión: La UDAP del HGF es una iniciativa que nace buscando garantizarla evaluación y seguimiento adecuado de los pacientes sometidos a intervenciones quirúrgicas. La experiencia a la fecha ha sido satisfactoria, no obstante, existen aspectos a mejorar y que constituyen los desafíos a mediano y largo plazo de la unidad.

Introduction: Pain may be defined as an unpleasant sensory or emotional experience associated with real or potential tissue damage. Poorly managed acute post-operatory pain affects multiple systems and increases mortality and morbidity. To address this issue, pain management units have been created for the management of perioperative pain by multidisciplinary teams. Objectives: The general objective of this review is to describe the functioning and experience to date of the Acute Perioperative Pain Unit (UDAP) in Gustavo Fricke Hospital (HGF). Development: Gustavo Fricke Hospital´s Acute Perioperative Pain Unit has been administered by the operating theatre and anaesthesia unit since January 2018. Around 30 patients are seen per month. They receive step 3 pain relief and the average length of stay is 2 days. The patients undergo surgeries from the various specialties, gastrointestinal surgery being the most frequent, followed by gynecological and traumatological. Conclusion: The Gustavo Fricke Hospital Acute Perioperative Pain Unit arose from the need to guarantee adequate evaluation and follow-up of surgical patients. To date the experience has been satisfactory, however some aspects could be improved and these constitute medium and long term challenges for the unit.

Experiencia de unidad de dolor agudo perioperatorio del hospital Gustavo Fricke, enero - abril 2019 / A review of the perioperative pain management unit, Gustavo Fricke Hospital, january - april 2019

Introducción: Se puede definir dolor como una experiencia sensorial o emocional desagradable asociada a un daño real o potencial en un tejido. El dolor agudo postoperatorio mal controlado aumenta la morbimortalidad al impactar sobre múltiples sistemas. Para abordar este problema se han creado unidades encargadas de manejar el dolor perioperatorio, conformadas por equipos multidisciplinarios. Objetivos: El objetivo general de esta revisión es presentar el funcionamiento y la experiencia a la fecha de la Unidad del Dolor Agudo Perioperatorio (UDAP) del Hospital Gustavo Fricke (HGF) a los distintos servicios. Desarrollo: La Unidad del Dolor Agudo Perioperatorio (UDAP) del HGF se gesta dentro de la unidad de anestesia y pabellones quirúrgicos en enero del año 2018. Son cerca de 30 pacientes mensuales los que se incluyen en la unidad, los que en promedio están 2 días con algún tipo de analgesia avanzada. Estos pacientes han sido sometidos a cirugías de distintas especialidades, siendo la cirugía digestiva la más frecuente, seguido de la ginecológica y traumatológica. Conclusión: La UDAP del HGF es una iniciativa que nace buscando garantizar la evaluación y seguimiento adecuado de los pacientes sometidos a intervenciones quirúrgicas. La experiencia a la fecha ha sido satisfactoria, no obstante, existen aspectos a mejorar y que constituyen los desafíos a mediano y largo plazo de la unidad.

Introduction: Pain may be defined as an unpleasant sensory or emotional experience associated with real or potential tissue damage. Poorly managed acute post-operatory pain affects multiple systems and increases mortality and morbidity. To address this issue, pain management units have been created for the management of perioperative pain by multidisciplinary teams. Objectives: The general objective of this review is to describe the functioning and experience to date of the Acute Perioperative Pain Unit (UDAP) in Gustavo Fricke Hospital (HGF). Development: Gustavo Fricke Hospital´s Acute Perioperative Pain Unit has been administered by the operating theatre and anaesthesia unit since January 2018. Around 30 patients are seen per month. They receive step 3 pain relief and the average length of stay is 2 days. The patients undergo surgeries from the various specialties, gastrointestinal surgery being the most frequent, followed by gynecological and traumatological. Conclusion: The Gustavo Fricke Hospital Acute Perioperative Pain Unit arose from the need to guarantee adequate evaluation and follow-up of surgical patients. To date the experience has been satisfactory, however some aspects could be improved and these constitute medium and long term challenges for the unit.