ABSTRACT
OBJECTIVE: The aim of this study was to assess the risk factors associated with 30-day hospital readmissions after a cholecystectomy. METHODS: We conducted a case-control study, with data obtained from UC-Christus from Santiago, Chile. All patients who underwent a cholecystectomy between January 2015 and December 2019 were included in the study. We identified all patients readmitted after a cholecystectomy and compared them with a randomized control group. Univariate and multivariate analyses were conducted to identify risk factors. RESULTS: Of the 4866 cholecystectomies performed between 2015 and 2019, 79 patients presented 30-day hospital readmission after the surgical procedure (1.6%). We identified as risk factors for readmission in the univariate analysis the presence of a solid tumor at the moment of cholecystectomy (OR = 7.58), high pre-operative direct bilirubin (OR = 2.52), high pre-operative alkaline phosphatase (OR = 3.25), emergency admission (OR = 2.04), choledocholithiasis on admission (OR = 4.34), additional surgical procedure during the cholecystectomy (OR = 4.12), and post-operative complications. In the multivariate analysis, the performance of an additional surgical procedure during cholecystectomy was statistically significant (OR = 4.24). CONCLUSION: Performing an additional surgical procedure during cholecystectomy was identified as a risk factor associated with 30-day hospital readmission.
OBJETIVO: El objetivo de este estudio fue evaluar los factores de riesgo asociados al reingreso hospitalario en los primeros 30 días post colecistectomía. MÉTODOS: Estudio de casos-controles con datos obtenidos del Hospital Clínico de la UC-Christus, Santiago, Chile. Se incluyeron las colecistectomías realizadas entre los años 2015-2019. Se consideraron como casos aquellos pacientes que reingresaron en los 30 primeros días posterior a una colecistectomía. Se realizó un análisis univariado y multivariado de diferentes posibles factores de riesgo. RESULTADOS: De un total de 4866 colecistectomías, 79 pacientes presentaron reingreso hospitalario. Los resultados estadísticamente significativos en el análisis univariado fueron; tumor sólido al momento de la colecistectomía (OR = 7.58) bilirrubina directa preoperatoria alterada (OR = 2.52), fosfatasa alcalina preoperatoria alterada (OR = 3.25), ingreso de urgencia (OR = 2.04), coledocolitiasis al ingreso (OR = 4.34) realización de otros procedimientos (OR = 4.12) y complicaciones postoperatorias. En el análisis multivariado sólo la realización de otro procedimiento durante la colecistectomía fue estadísticamente significativa (OR = 4.24). CONCLUSIÓN: La realización de otros procedimientos durante la colecistectomía es un factor de riesgo de reingreso hospitalario en los 30 días posteriores a la colecistectomía.
Subject(s)
Cholecystectomy, Laparoscopic , Humans , Case-Control Studies , Cholecystectomy/adverse effects , Cholecystectomy, Laparoscopic/adverse effects , Patient Readmission , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies , Risk FactorsABSTRACT
INTRODUCCIÓN: La introducción progresiva de vacunas contra SARS-CoV-2 a partir de 2021, priorizando grupos de mayor edad, podría implicar un cambio en el perfil de pacientes hospitalizados por COVID-19 en el tiempo. OBJETIVO: Comparar las características y evolución de pacientes adultos hospitalizados por COVID-19 en un período anterior en 2020 (PER1) y otro posterior al inicio de la vacunación masiva contra SARS-CoV-2 (PER2). PACIENTES Y MÉTODOS: Se registró edad, género, comorbilidades, complicaciones y evolución de los pacientes hospitalizados por COVID-19 en una clínica privada, en Santiago, Chile. Se calculó el puntaje de gravedad y riesgo nutricional. RESULTADOS: En PER2, los pacientes fueron de menor edad, pero con comorbilidades similares al PER1, excepto por mayor malnutrición por exceso. Los pacientes del PER2 no vacunados requirieron más ventilación mecánica (38,9 vs. 14,3%, p = 0,03) y evolucionaron más gravemente (puntaje 6) que aquellos adecuadamente inmunizados (puntaje 5, p = 0,048). Las variables que más predijeron mortalidad fueron edad > 60 años (OR 28.995) y presencia de riesgo nutricional (OR 5.246). DISCUSIÓN: El cambio en el perfil y evolución de los pacientes hospitalizados con COVID-19 está asociado con la secuencia de priorización de vacunas contra SARS-CoV-2, cuyo efecto redujo las hospitalizaciones y gravedad de COVID-19 en adultos mayores.
BACKGROUND: During the COVID-19 pandemic, the early prioritization of SARS-CoV-2 vaccines for older adults may have affected the characteristics of hospitalized COVID-19 patients over time. AIM: To compare the clinical characteristics and outcomes of adult patients admitted for COVID-19 before (PER1) and after (PER2) the initiation of mass vaccination for SARS-CoV-2. METHODS: Data on age, gender, comorbidities, complications, and outcomes of adult patients hospitalized for COVID-19 in a private clinic of Santiago, Chile, were collected. Scores for COVID-19 severity and nutritional risk were calculated. RESULTS: In PER2, patients were younger but had similar comorbidities, except for a higher prevalence of overweight and obesity compared to PER1. Unvaccinated COVID-19 patients in PER2 required more invasive ventilatory support (38.9% vs. 14.3%, p = 0.03) and had a higher severity score (six) than vaccinated patients (five, p = 0.048). The variables that best predicted mortality were age > 60 years (OR 28,995) and the presence of nutritional risk (OR 5,246). DISCUSSION: Changes in the profile and outcomes of hospitalized patients during the COVID-19 pandemic are associated with the prioritization of SARS-CoV-2 vaccines and their protective effect in reducing hospitalizations and disease severity in older adults.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , COVID-19 Vaccines/administration & dosage , COVID-19/mortality , COVID-19/prevention & control , Severity of Illness Index , Comorbidity , Clinical Evolution , Nutritional Status , Vaccination/statistics & numerical data , Risk Assessment , COVID-19/epidemiology , Hospitalization/statistics & numerical dataABSTRACT
La infección por SARS-CoV-2 podría gatillar la ocurrencia de numerosas patologías, algunas de ellas de tipo endocrinológico. Se presenta una revisión narrativa sobre la asociación entre COVID-19 y tiroiditis subaguda, en la que se describen aspectos epidemiológicos, fisiopatológicos, manifestaciones clínicas y de laboratorio, tratamiento y pronóstico. La prevalencia de alguna disfunción tiroidea en pacientes COVID-19 fluctúa entre 13 y 64%, específicamente en relación con tiroiditis subaguda se describe un cambio en la prevalencia de 0,5% a 10% entre los años 2019 y 2020. La tiroiditis subaguda se produce por la unión del virus SARS-CoV-2 con la enzima convertidora de angiotensina 2 (ACE-2) ampliamente expresada en la glándula tiroides, generando manifestaciones clínicas tipo tirotoxicosis, aunque la presentación de la tiroiditis subaguda asociada a COVID-19 puede ser atípica. Los elementos centrales del tratamiento son similares a los empleados ante cualquier tiroiditis subaguda. Se concluye la necesidad de considerar esta entidad en el diagnóstico diferencial de pacientes actual o previamente infectados por SARS-CoV-2 que presenten síndrome febril, elevación de parámetros inflamatorios o taquicardia persistente, sin etiología precisada.
SARS-CoV-2 infection can trigger the occurrence of numerous pathologies, some of them endocrinological. The present narrative review works on the association between COVID-19 and subacute thyroiditis, which describes epidemiological and pathophysiological aspects, clinical and laboratory manifestations, treatment, and prognosis. The prevalence of thyroid dysfunction in COVID-19 patients fluctuates between 13 and 64%, explicitly concerning subacute thyroiditis; it has been described as a change in prevalence from 0.5% to 10% between 2019 and 2020. The binding of the SARS-CoV-2 virus with the angiotensin-converting enzyme 2 receptor (ACE-2) widely expressed in the thyroid gland causes subacute thyroiditis, generating thyrotoxicosis-like clinical manifestations. However, the presentation of subacute thyroiditis associated with COVID-19 may be atypical. The central elements of the treatment are similar to those used in any subacute thyroiditis. We conclude that this entity must be considered in differential diagnoses of patients currently or previously infected with SARS-CoV-2 that present a febrile syndrome, elevated inflammatory parameters, or persistent tachycardia without a specified aetiology.
ABSTRACT
Background: Hospitalization and deaths due to cardiovascular diseases (CVD), have a peak in frequency during winter. Aim: To assess the existence of seasonal variation in deaths due to acute myocardial infarction (AMI) in Chile. Material and Methods: Analysis of death report databases available at the website of the Chilean Ministry of Health. The seasonality of deaths due to AMI (codes ICD-10 I21, I22, I23) occuring in Chile between 2001-2016 were analyzed using a geometric model assuming a sinusoidal cyclic pattern. Results: During the period 2001-2016, a total of 94,788 deaths due to AMI were registered, corresponding to 93,349 corrected deaths. Of the latter, 29.2% occurred in winter, 24.9% in spring, 24.0% in autumn and 21.8% in summer. The geometric model showed a marked sinusoidal pattern for the aggregated data. The peak-to-low ratio of deaths was 1.41 (95% CI 1.38-1.44). The peak of deaths occurred during July in 14 out of 16 years analyzed. Conclusions: In Chile, deaths due to AMI have a marked seasonal pattern, characterized by a higher number of deaths in winter and a lower number in summer.
Subject(s)
Humans , Myocardial Infarction , Seasons , Chile/epidemiology , HospitalizationABSTRACT
INTRODUCCIÓN: La etiología de la enfermedad de Kawasaki (EK) es desconocida, planteándose que infecciones virales la gatillan en pacientes susceptibles. OBJETIVO: Estudiar la asociación temporal entre la circulación de virus respiratorios y hospitalizaciones por EK en la Región Metropolitana (RM), Chile, entre 2010-2017. METODOLOGÍA: Estudio ecológico retrospectivo de casos de EK en pacientes bajo 18 años de edad, en base a egresos hospitalarios. La circulación de virus se analizó mediante el reporte de la red de vigilancia metropolitana. Se utilizaron promedios móviles para EK (PMEK) y virus respiratorios (PMVR). RESULTADOS: Se registraron 14.902 casos de infecciones virales respiratorias entre 2010-2017. Se observó correlación directa entre PMVR-virus respiratorio sincicial (VRS) de un mes y año y PMEK del mes subsiguiente (coeficiente de correlación (ρ) = +0,441; p < 0,001), y una asociación similar para PMVR-influenza A (FLU A) (ρ = +0,362; p < 0,001). PMVR-influenza B (FLU B) y PMVR-metapneumovirus (MPV) presentan correlaciones directas con PMEK (ρ = +0,443; p < 0,001 y ρ = +0,412; p < 0,001, respectivamente), siendo contemporáneo en mes y año con EK para FLU B, mientras que MPV presenta un desfase de un mes entre PMVR y PMEK. CONCLUSIÓN: Existe correlación temporal directa entre la circulación de VRS, FLU A, FLU B y MPV con EK en niños de la RM, Chile.
BACKGROUND: The etiology of Kawasaki disease (KD) is unknown. It is believed that viral infections could trigger the disease in susceptible patients. AIM: To study the temporal association between the circulation of respiratory viruses and KD hospitalizations in the Metropolitan Region (MR), Chile, between 2010-2017. METHODS: Ecologic study consisting of a review of KD cases in children under 18 years of age based on hospital discharges. The circulation of respiratory viruses was analyzed using the report of the metropolitan surveillance network. Moving averages for KD (MAKD) and respiratory viruses (MARV) were used. RESULTS: 14,902 cases of respiratory virus infections were recorded between 2010-2017. A direct correlation was found between MARV-respiratory syncytial virus (RSV) of one month and year and MAKD of the subsequent month (correlation coefficient (ρ) = +0.441; p < 0.001). A similar association was found for MARV-influenza A (FLU A) (ρ = + 0.362; p < 0.001). MARV-influenza B (FLU B) and MARV-metapneumovirus (MPV) had direct correlations with MAKD (ρ = +0.443; p < 0.001 and ρ = +0.412; p < 0.001, respectively), being FLU B contemporary in month and year with KD, and MPV presenting a one-month lag. CONCLUSION: There is a direct temporal correlation between RSV, FLU A, FLU B and MPV circulation and KD in children from RM, Chile.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Respiratory Tract Infections/epidemiology , Viruses , Respiratory Syncytial Virus Infections/epidemiology , Influenza, Human/epidemiology , Mucocutaneous Lymph Node Syndrome/epidemiology , Chile/epidemiology , Retrospective Studies , Respiratory Syncytial Virus, Human , Respiratory Syncytial Virus Infections/complications , Influenza, Human/complications , HospitalizationABSTRACT
Resumen El COVID-19 es un problema de salud pública mundial por su carácter epidémico que, a la fecha, carece de tratamiento farmacológico. Sin embargo, ya se cuenta con algunas vacunas autorizadas para uso en emergencia, aunque la duración de su protección, su capacidad para interrumpir la transmisión viral y su eficacia frente a variantes emergentes de SARS-CoV-2 se encuentran en estudio. La campaña de vacunación contra SARS-CoV-2 de Chile requirió de diseño y planificación, como toda campaña. Parte de estos fue la priorización de grupos objetivo de vacunar, necesaria debido a que el mundo se vería enfrentado a un suministro limitado de vacunas COVID-19. En distintos momentos del año 2020, el CAVEI emitió recomendaciones sobre priorización de grupos de población a vacunar contra SARS-CoV-2, respondiendo a diferentes necesidades y según la evidencia disponible en cada instancia. Éstas se consolidan en la Tabla 1 de este informe. Resumidamente, en fase 1 se recomendó vacunar al personal de salud, residencias de larga estadía y personal crítico del Estado. En fase 2, a personas mayores de 65 años y población con comorbilidades. En fase 3, a personas que cumplen labores esenciales y, finalmente, a la población general.
Abstract COVID-19 is a global public health issue due to its epidemic nature that, to date, lacks pharmacological treatment. However, some COVID-19 vaccines have been authorized for emergency use, although the duration of their protection, their ability to interrupt viral transmission, and their efficacy against emerging variants of SARS-CoV-2 are being studied. Chile's SARS-CoV-2 vaccination campaign required design and planning, like any other campaign. This process included the prioritization of risk groups for vaccination given the limited supply of COVID-19 vaccines globally. Throughout 2020, CAVEI issued recommendations on the prioritization of population groups to be vaccinated against SARS-CoV-2 in response to different needs and in accordance with available evidence. These recommendations are consolidated in Table 1 in this report. In summary, it was recommended that healthcare workers, people in long-term residences and essential State personnel be vaccinated in phase 1. In phase 2, persons over 65 years of age and people with comorbidities. In phase 3, essential tasks workers and, lastly, the general population.
Subject(s)
Humans , COVID-19 Vaccines , COVID-19/prevention & control , Mass Vaccination , Advisory Committees , SARS-CoV-2Subject(s)
Chickenpox Vaccine , Chickenpox , Immunization Schedule , Immunization , Immunization ProgramsABSTRACT
OBJETIVO: Determinar si las personas mayores tienen mayor tasa de sufrir siniestros de tránsito, de fallecer o de lesionarse en estos, en comparación con personas adultas en Chile entre los años 2008 y 2017. MÉTODO: Se utilizaron las bases de datos de la Comisión Nacional de Seguridad de Tránsito de los últimos 10 años y los datos de habitantes según las proyecciones realizadas por el Instituto Nacional de Estadística. Se calcularon las medidas de efecto e intervalos de confianza del 95%. RESULTADOS: Las personas mayores en Chile tuvieron 0,5 veces la tasa de sufrir un siniestro de tránsito; 0,6 veces la tasa de lesionar y 1,3 veces la tasa de fallecer en un siniestro de tránsito que presentan las personas adultas. Antofagasta y Arica fueron las regiones con menor y mayor ocurrencia de fallecimientos de personas mayores. Las principales causas de siniestro fueron la imprudencia del conductor y peatón, las que a su vez presentaron 1,6 y 2,6 veces la tasa de fallecimiento en personas adultas. De los principales tipos de siniestros, sólo en los atropellos las personas mayores tuvieron mayor ocurrencia de muerte (razón de tasas 2,4). CONCLUSIONES: Confirma la mayor vulnerabilidad a fallecer en un siniestro de tránsito de las personas mayores. Se aprecian grandes diferencias a través de las diversas regiones del país. Las futuras investigaciones deben abordar las características de los usuarios, las estrategias que podrían ayudar a estos a tener una mejor interacción y promover la salud con foco en la seguridad vial en las personas mayores.
OBJECTIVE: To determine if older adults in Chile have higher rates of traffic incidents, resulting in death or injury when compared to younger adults between 2008 and 2017. METHODS: The databases of the National Traffic Safety Commission of the last ten years and the data of inhabitants according to the projections made by the National Statistics Institute were used. Effect measures and 95% confidence intervals were calculated. RESULTS: The elderly in Chile had 0.5 times the rate of suffering a traffic accident, 0.6 times the rate of injury, and 1.3 times the rate of dying in a traffic accident when compared against non-elderly adults. Antofagasta and Arica were the regions with the lowest and highest occurrence of death for older adults, respectively. The leading causes of traffic accidents were the imprudence of the driver and pedestrian, which presented 1.6 and 2.6 times the death rate when compared against non-elderly adults. Of the main types of traffic accidents, only when the pedestrian was hit by a vehicle, the elderly had a higher occurrence of death (rate ratio 2.4). CONCLUSIONS: Older adults presented a greater vulnerability to death by traffic accidents. Substantial differences are seen across different regions. Future research should address the characteristics of the users, the strategies that could help them to have better interaction, and promote health with a focus on road safety for older people.
Subject(s)
Humans , Adolescent , Adult , Middle Aged , Aged , Young Adult , Automobile Driving/statistics & numerical data , Accidents, Traffic/statistics & numerical data , Pedestrians/statistics & numerical data , Chile/epidemiology , Registries , Databases, Factual , Age FactorsSubject(s)
Humans , Mass Vaccination/trends , Patient Compliance/statistics & numerical data , Vaccination Coverage/trends , Socioeconomic Factors , Time Factors , Chile , Mass Vaccination/statistics & numerical data , Risk Factors , Vaccination Coverage/statistics & numerical data , Vaccination Refusal/trends , Vaccination Refusal/statistics & numerical dataABSTRACT
Resumen Introduccion: Las infecciones asociadas a atencion de salud (IAAS) aumentan la morbilidad y mortalidad. Durante 2014, en Hospital Clinico Red de Salud UC Christus (RS-UCCH) se estimo que 15% de las infecciones virales respiratorias fueron adquiridas durante la atencion de salud, siendo mas frecuente el virus influenza. Objetivos: Caracterizacion clinico-epidemiologica de IAAS por influenza en pacientes hospitalizados en unidades de pacientes criticos (UPC) y cuidados especiales. Material y Metodos: Estudio descriptivo. Se incluyeron pacientes en UPC y cuidados especiales con IAAS influenza entre 2014 y 2017 en RS-UCCH. IAAS por influenza se definio como: inicio de sintomas y/o RPC-TR positiva para virus influenza ≥ 48 h de ingreso hospitalario, sin sintomatologia respiratoria o estudio negativo previo. Resultados: Se identificaron 22 pacientes, edad mediana 74 anos. La influenza fue adquirida en promedio al dia 13; el 77% fue por influenza A y el 27% presento coinfeccion respiratoria. Trece (59%) estaban hospitalizados en UPC, dos (15%) por problemas pulmonares. El 86% tenia co-morbilidad y el 50% descompensacion de ella. No estaba vacunado 59%; la letalidad observada fue 18%. Conclusiones: IAAS por influenza ocurrio en pacientes cronicos, de mayor edad y no vacunados. Es primordial educar en prevencion de IAAS y mantener altas coberturas de vacunacion.
Background: Healthcare-associated infections (HAIs) increase morbidity and mortality. During 2014, at the Hospital Clinico Red de Salud UC Christus (RS-UCCH) it was estimated that 15% of respiratory viral infections were acquired during hospitalization and influenza A was more frequent. Aims: Clinical and epidemiological characterization of HAIs due to influenza virus in patients hospitalized in critical care units (CCU) and special care. Methods: Descriptive study. We included patients hospitalized in CCU and special care with hospital acquired influenza during 2014-2017. HAI due to influenza was defined as: symptom onset and/or positive influenza PCR after ≥ 48 hours of hospital admission, without previous respiratory symptoms or previous negative influenza test study. Results: 22 patients were identified, median age was 74 years. Influenza was acquired average on day 13. Influenza A was detected in 77% and 27% had respiratory co-infection. Thirteen (59%) were hospitalized in CCU, only 2 (15%) due to lung problems. Comorbidity was present in 86% and decompensation in 50%. Only 41% received influenza vaccine. The associated lethality was 18%. Conclusions: HAI due to influenza occurred in chronic, older and unvaccinated patients. Education about HAIs and continuous high vaccination coverage must be reinforced.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Cross Infection/epidemiology , Influenza, Human/epidemiology , Intensive Care Units/statistics & numerical data , Influenza Vaccines , Comorbidity , Chile/epidemiology , Cross Infection/diagnosis , Cross Infection/prevention & control , Age Factors , Critical Care , Influenza, Human/diagnosis , Influenza, Human/prevention & control , Hospitalization/statistics & numerical dataABSTRACT
INTRODUCCIÓN: La comunicación gestual, entendida como el uso de gestos no verbales antes de la aparición de la palabra, es una fortaleza en niños con síndrome de Down (SD). OBJETIVO: Describir conductas de desarrollo comunicativo en niños con SD, previo y posterior a capacitaciones en comunicación gestual, basadas en talleres de "Señas, palabras y juegos" del programa Baby Signs®. SUJETOS Y MÉTODO: Estudio prospectivo de niños con SD entre 18 y 22 meses de edad cognitiva, a los cuales se les realizó capacitaciones en comunicación gestual según la metodología Baby Signs, evaluando habilidades comunicativas a través del inventario McArthur adaptado para niños con SD (Inventario de desarrollo comunicativo, CDI-SD), analizando los puntajes antes y 3 meses después de la intervención. Los ítems evaluados corresponden a: Comprensión temprana, Comprensión de las primeras frases, Comenzando a hablar, Lista de vocabulario y Uso descontextualizado del lenguaje (parte 1) y a Gestos totales, tempranos y tardíos (parte 2). RESULTADOS: 21 niños completaron los talleres, con una media de edad cronológica de 27,5 meses y 19,8 meses de edad cognitiva. El 29% de los participantes aumentaron sus puntajes en comprensión de frases, el 62% en producción de vocabulario con gestos, el 33% mejora la comprensión de vocabulario, el 57% perdió los gestos tempranos y el 43% aumentó la producción de gestos tardíos. CONCLUSIONES: Las capacitaciones en comunicación gestual favorecen el desarrollo de habilidades comunicativas en un grupo de niños con SD, principalmente en la com prensión inicial y producción de gestos. Existe importante variabilidad interindividual, por lo que es necesario considerar las recomendaciones niño a niño.
INTRODUCTION: Gestural communication, understood as the use of non-verbal gestures before the word appears, is a strength in children with Down syndrome (DS). OBJECTIVE: To describe com munication development behaviors in children with DS, before and after gestural communication training, based on the "Signs, words and games" workshops of the Baby Signs® program. SUBJECTS AND METHOD: Prospective study of children with DS between 18 and 22 months of cognitive age, who were trained in gestural communication according to the "Baby Signs®" methodology, evaluating communication skills through the MacArthur inventory adapted for children with DS (Communica tive Development Inventories, CDI-DS), analyzing the scores before and three months after the in tervention. The evaluated items were: Early comprehension, First sentences comprehension, Starting to speak, Vocabulary list, and Decontextualized language use (part 1) and total, early and late gestures (part 2). RESULTS: 21 children completed the workshops, with an average chronological age of 27.5 months and 19.8 months of cognitive age. 29% of the participants increased their scores in sentence comprehension, 62% in vocabulary production with gestures, 33% improved in vocabulary compre hension, 57% lost early gestures, and 43% increased late gestures production. CONCLUSIONS: Gestural communication training favors the communication skills development in a group of children with DS, mainly in the initial understanding and gesture production. There is important inter-individual variability, therefore is necessary to consider child to child recommendations.
Subject(s)
Humans , Male , Female , Infant , Child Language , Down Syndrome/psychology , Down Syndrome/rehabilitation , Gestures , Language Therapy/methods , Manual Communication , Prospective Studies , Follow-Up Studies , Treatment OutcomeABSTRACT
ABSTRACT Background: Gastrectomy is the main treatment for gastric and Siewert type II-III esophagogastric junction (EGJ) cancer. This surgery is associated with significant morbidity. Total morbidity rates vary across different studies and few have evaluated postoperative morbidity according to complication severity. Aim: To identify the predictors of severe postoperative morbidity. Methods: This was a retrospective cohort study from a prospective database. We included patients treated with gastrectomy for gastric or EGJ cancers between January 2012 and December 2016 at a single center. Severe morbidity was defined as Clavien-Dindo score ≥3. A multivariate analysis was performed to identify predictors of severe morbidity. Results: Two hundred and eighty-nine gastrectomies were performed (67% males, median age: 65 years). Tumor location was EGJ in 14%, upper third of the stomach in 30%, middle third in 26%, and lower third in 28%. In 196 (67%), a total gastrectomy was performed with a D2 lymph node dissection in 85%. Two hundred and eleven patients (79%) underwent an open gastrectomy. T status was T1 in 23% and T3/T4 in 68%. Postoperative mortality was 2.4% and morbidity rate was 41%. Severe morbidity was 11% and was mainly represented by esophagojejunostomy leak (2.4%), duodenal stump leak (2.1%), and respiratory complications (2%). On multivariate analysis, EGJ location and T3/T4 tumors were associated with a higher rate of severe postoperative morbidity. Conclusion: Severe postoperative morbidity after gastrectomy was 11%. Esophagogastric junction tumor location and T3/T4 status are risk factors for severe postoperative morbidity.
RESUMO Raciona l: A gastrectomia é o tratamento principal para o câncer de junção esofagogástrica (EGJ) e Siewert tipo II-III. Ela está associada à morbidade significativa. As taxas de morbidade total variam entre os diferentes estudos e poucos avaliaram a morbidade pós-operatória de acordo com a gravidade da complicação. Objetivo: Identificar os preditores de morbidade pós-operatória grave. Métodos: Este foi um estudo de coorte retrospectivo de um banco de dados prospectivo. Foram incluídos pacientes tratados com gastrectomia para câncer gástrico ou EGJ em um único centro. A morbidade severa foi definida como escore de Clavien-Dindo ≥3. Análise multivariada foi realizada para identificar preditores de morbidade grave. Resultados: Duzentos e oitenta e nove gastrectomias foram realizadas (67% homens, mediana de idade: 65 anos). A localização do tumor foi EGJ em 14%, o terço superior do estômago em 30%, o terço médio em 26% e o terço inferior em 28%. Em 196 (67%), foi realizada gastrectomia total com dissecção de linfonodos D2 em 85%. Duzentos e onze pacientes (79%) foram submetidos à gastrectomia aberta. O estado T foi T1 em 23% e T3/T4 em 68%. A mortalidade pós-operatória foi de 2,4% e a taxa de morbidade foi de 41%. A morbidade severa foi de 11% e foi representada principalmente por fístula esofagojejunal (2,4%), fístula duodenal (2,1%) e complicações respiratórias (2%). Na análise multivariada, a localização do EGJ e os tumores T3/T4 foram associados com maior morbidade pós-operatória grave. Conclusão: Morbidade pós-operatória severa após gastrectomia foi de 11%. A localização do tumor na junção esofagogástrica e o estado T3/T4 são fatores de risco para a morbidade pós-operatória grave.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Postoperative Complications/epidemiology , Stomach Neoplasms/surgery , Esophageal Neoplasms/surgery , Esophagogastric Junction/surgery , Gastrectomy/adverse effects , Retrospective Studies , Risk Factors , Cohort StudiesABSTRACT
INTRODUCCIÓN: La cetoacidosis (CAD) es la principal causa de morbimortalidad en niños con diabetes mellitus tipo 1 (DM1) debido a las alteraciones bioquímicas asociadas, siendo el más temido el edema cerebral, con altas tasas de mortalidad y secuelas neurológicas a largo plazo. OBJETIVO: caracterizar el perfil clínico y las complicaciones de pacientes con CAD ingresados en una unidad de paciente crítico pediátrico. PACIENTES Y MÉTODO: Revisión retrospectiva de pacientes con CAD atendidos en el Hospital Clínico de la Pontificia Universidad Católica de Chile (UPCPUC) entre los años 2000 y 2015. Se evaluaron características demográficas, manifestaciones clínicas, alteraciones bioquímicas, tratamiento, complicaciones y pronóstico. Se compararon pacientes con debut de DM1 versus diabéticos conocidos, analizándose variables según distribución. RESULTADOS: Se identificaron 46 episodios de CAD. El 67% de éstos correspondió a un debut de DM1. El 66% de los diabéticos conocidos ingresaron por mala adherencia al tratamiento. Los principales síntomas de presentación fueron: 63% polidipsia, 56% poliuria, 48% vómitos, 39% pérdida de peso y 35% dolor abdominal, con medias de Glicemia 522 mg/dL, pH 7,17 y osmolaridad plasmática 305 mOsm/L. El 89% recibió insulina en infusión. El 37% presentó hipokalemia. No se registraron episodios de edema cerebral ni muertes. CONCLUSIONES: La mayoría de los ingresos por CAD correspondió a debut de DM1. En el grupo de diabéticos conocidos, la mala adherencia al tratamiento fue la principal causa de descompensación. No se presentaron complicaciones graves ni muertes asociadas al manejo de la CAD durante el período estudiado. El diagnóstico precoz y el tratamiento adecuado y estandarizado pudieran contribuir a reducir la morbilidad y mortalidad en niños con CAD.
INTRODUCTION: Diabetic ketoacidosis (DKA) is the main cause of morbidity and mortality in children with type 1 diabetes mellitus (T1DM) due to clinical and biochemical alterations associated, cerebral edema as one of the most critical because of the high mortality rates and long-term neurological se quelae. OBJECTIVE: To analyze the clinical characteristics and complications of patients with DKA ad mitted to a pediatric intensive care unit. PATIENTS AND METHODS: Retrospective study of DKA patients treated at the Hospital Clínico, Pontificia Universidad Católica de Chile (UPCPUC) between 2000 and 2015. Demographic characteristics, clinical manifestations, biochemical alterations, treatment, complications, and prognosis were assessed. Patients with T1DM onset were compared with those patients already diagnosed with diabetes, analyzing variables according to distribution. RESULTS: 46 DKA events were identified, 67% of them were the first episode of DKA. 66% of patients already diagnosed with diabetes were admitted due to poor adherence to treatment. The main symptoms described were: 63% polydipsia, 56% polyuria, 48% vomiting, 39% weight loss and 35% abdominal pain, and mean blood sugar levels of 522 mg/dL, pH 7.17, and plasma osmolality of 305 mOsm/L. 89% of patients received insulin infusion, and 37% presented hypokalemia. No episodes of cerebral edema or deaths were registered. CONCLUSIONS: Most of the DKA admissions were due to T1DM onset. In the group of patients already diagnosed with diabetes, the poor adherence to treatment was the main cause of decompensation. There were no serious complications or deaths associated with DKA management during the studied period. Early diagnosis and proper and standardized treatment contributed to reducing morbidity and mortality in children with DKA.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Diabetic Ketoacidosis/diagnosis , Prognosis , Retrospective Studies , Treatment Outcome , Diabetic Ketoacidosis/etiology , Diabetic Ketoacidosis/physiopathology , Diabetic Ketoacidosis/therapy , Diabetes Mellitus, Type 1/complications , Intensive Care UnitsABSTRACT
Resumen: Introducción: Los prematuros extremos tienen mayor incidencia de Hipertensión Arterial (HTA) y riesgo de daño renal, secundario a un menor número de glomérulos con la consiguiente hiperfiltración de los remanentes. Objetivo: Evaluar la prevalencia de cifras tensionales alteradas usando monitorización ambulatoria de presión arterial (MAPA) y marcadores de daño renal en escolares con antecedentes de prematurez extrema. Pacientes y Método: Realización medición aislada de presión arterial, MAPA, y evaluación de función renal en el seguimiento de prematuros extremos de edad escolar. Resultados: Se reclutaron 30 pacientes, obteniéndose mediciones válidas de MAPA en 19 casos, de los cuales nueve (47,4%) presentaron alteraciones, principalmente ausencia de diferencia de presión día noche. No hubo alteraciones de la función renal en ellos. Discusión: Nuestro estudio detectó una alta prevalencia de alteraciones en MAPA en escolares con antecedentes de prematurez extrema, principalmente la ausencia de diferencia de presión día noche, que se relaciona con mayor riesgo de progresión a HTA. Se resalta la importancia de realizar MAPA dentro del estudio en pacien tes con factores de riesgo de desarrollar HTA a fin de detectar en forma precoz alteraciones y realizar un manejo y seguimiento estrecho.
Abstract: Introduction: Extremely premature children have a higher incidence of High Blood Pressure (HBP) and risk of renal damage due to decreased glomerular count with consequent hyperfiltration of the remnants. Objectives: To assess the prevalence of altered blood pressure values in outpatient measurement and ambulatory blood pressure monitoring (ABPM) in preterm infants ≤ 32 weeks and/ or ≤ 1,500 g birth weight between 5 and 7 years of age, as well as the presence of early renal damage markers. Patients and Methods: An isolated measurement of blood pressure, ABPM and laboratory tests (microalbuminuria/creatininuria ratio in an isolated urine sample, serum creatinine, blood urea nitrogen and urinalysis) were performed. Results: 30 patients were recruited, of whom valid measu rements of ABPM were obtained in 19 cases, of which nine (47,4%) presented some abnormalities, principally nocturnal day/night difference or DIP absent. No abnormal laboratory tests were found. Discussion: Our study detected a high prevalence of abnormalities in ABPM principally DIP absence, which has been related to an increased risk of progression to hypertension. The importance of per forming ABPM in the study is emphasized in patients with risk factors for developing hypertension in order to detect early alterations and close management and follow-up.
Subject(s)
Humans , Male , Female , Infant, Newborn , Child, Preschool , Child , Blood Pressure Monitoring, Ambulatory , Infant, Extremely Premature , Hypertension/diagnosis , Infant, Premature, Diseases/diagnosis , Chile/epidemiology , Prevalence , Follow-Up Studies , Hypertension/epidemiology , Infant, Premature, Diseases/epidemiologyABSTRACT
Resumen: Objetivos: Describir la frecuencia de lactancia materna exclusiva (LME) hasta los 6 meses en bino mio madre-hijo/a de niños con síndrome de Down (SD) en control en Programa de Seguimiento de Salud de Personas con SD de la Red de Salud UC CHRISTUS (PSSPSD-UC), e identificar los factores que influyen en el abandono de la LME. Pacientes y Método: Estudio de prevalencia de LME hasta los 6 meses, en el cual se estudió al binomio madre-hijo/a de niños chilenos con SD, entre 6 meses y 2 años, que se controlan en el PSSPSD-UC. Se utilizó un cuestionario on-line que incluyó datos de mográficos, antecedentes del hijo/a y experiencia en LM. Resultados: El total de la muestra obtenida fue de 73 binomios. El 46,6% (34/73) de las madres dieron LME hasta los 6 meses o más. El 67,1% (49/73) de los hijos presentó alguna patología o malformación asociada que influía en la lactancia. De las 39 madres que no dieron LME hasta los 6 meses, 25 (64,1%) fue por motivos del hijo/a. La hospitalización durante los primeros 6 meses de vida fue el factor más significativo en el cese de LME antes de los 6 meses (OR = 6,13). Conclusión Primer estudio en Chile que describe la frecuencia de LME a los 6 meses en niños con SD, en el que se obtuvo una alta frecuencia de LME en la población estudiada. El apoyo y educación adecuada sobre lactancia permitiría lograr una mayor tasa de LME en este grupo más vulnerable.
Abstract: Aim: To describe the frequency of exclusive breastfeeding at 6 months in binomial of mother and in fants with Down Syndrome (DS) attending at the Health net UC CHRISTUS (PSSPSD-UC), and iden tify the main factors associated with exclusive breastfeeding cessation. Patients and Methods: Prevalence study of exclusively breastfeeding at 6 months of age that includes mother-child binomial of Chilean infants with (DS) aged 6-24 months, who attend the PSSPSD-UC. An on-line questionnaire was conducted, which included demographic data, child's background and experience in breastfee ding. Results: The total sample consisted of 73 binomials. Forty-six percent (34/73) of the mothers exclusively breastfed until 6 months or longer, 67.1% (49/73) of the infants had a disease or malfor mation that interfere with breast feeding. Among the 39 mothers who did not exclusively breastfeed until 6 months, 25 (64.1%) referred child factors. Hospitalization during the first 6 months was the most significant factor affecting the cessation of breastfeeding (OR = 6,13). Conclusions: First study in Chile that describes the frequency of exclusive breastfeeding at 6 months of age in children with DS, which shows a large rate of exclusively breastfeeding in the studied sample. The adequate support and education in breastfeeding could allow to achieve a better rate of exclusive breastfeeding in this vulnerable group.
Subject(s)
Humans , Male , Female , Infant , Adolescent , Adult , Young Adult , Breast Feeding/statistics & numerical data , Health Status Indicators , Down Syndrome , Breast Feeding/psychology , Logistic Models , Chile , Surveys and Questionnaires , Mother-Child Relations/psychologyABSTRACT
Resumen Introducción: La vigilancia de incidencia de bacterias multi-resistentes es un indicador que permite estimar mejor la magnitud de la resistencia bacteriana en los servicios hospitalarios. Objetivo: Evaluar la incidencia de bacterias multi-resistentes relevantes en unidades de cuidados intensivos del país y establecer las diferencias entre población adulta y pediátrica. Metodología: Se solicitó a los hospitales participantes información del número de aislados de siete bacterias multi-resistentes epidemiológicamente relevantes de unidades de cuidados intensivos (UCI) de adulto y pediátrico entre enero de 2014 y octubre de 2015, y el número de días-cama ocupados en dichas unidades en el mismo período. Con estos datos se calculó incidencia por 1.000 pacientes-día para cada unidad. Resultados: Se recibió información de 20 UCI adultos y 9 UCI pediátricas. En UCI adultos las bacterias de mayor incidencia fueron K. pneumoniae productora de BLEE [4,72 × 1.000 días cama (1,21-13,89)] y S. aureus resistente a oxacilina [3,85 (0,71-12,66)]. En pediatría la incidencia fue menor, destacando K. pneumoniae productora de BLEE [2,71 (0-7,11)] y P. aeruginosa resistente a carbapenémicos [1,61 (0,31-9,25)]. Conclusión: Se observan importantes diferencias entre los distintos hospitales en la incidencia de las bacterias estudiadas. La incidencia de bacterias multi-resistentes en UCI de adultos es significativamente mayor que en UCI pediátrica para la mayoría de las bacterias estudiadas.
Introduction: Incidence of multi-resistant bacteria is an indicator that permits better estimation of the magnitude of bacterial resistance in hospitals. Aim: To evaluate the incidence of relevant multi-drug resistant bacteria in intensive care units (ICUs) of Chile. Methods: Participating hospitals submitted information about the number of isolates from infected or colonized patients with 7 epidemiologically relevant multi-resistant bacteria in adult and pediatric ICUs between January 1, 2014 and October 31, 2015 and the number of bed days occupied in these units in the same period was requested. With these data incidence was calculated per 1,000 patient days for each unit. Results: Information from 20 adults and 9 pediatric ICUs was reviewed. In adult ICUs the bacteria with the highest incidence were K. pneumoniae ESBL [4.72 × 1,000 patient day (1.21-13.89)] and oxacillin -resistant S. aureus [3.85 (0.71-12.66)]. In the pediatric units the incidence was lower, highlighting K. pneumoniae ESBL [2.71 (0-7.11)] and carbapenem -resistant P. aeruginosa [1.61 (0.31-9.25)]. Conclusion: Important differences between hospitals in the incidence of these bacteria were observed. Incidence of multi-resistant bacteria in adult ICU was significantly higher than in pediatric ICU for most of the studied bacterias.
Subject(s)
Humans , Child , Adult , Bacteria/isolation & purification , Bacteria/drug effects , Drug Resistance, Multiple, Bacterial/drug effects , Intensive Care Units/statistics & numerical data , Anti-Bacterial Agents/pharmacology , Reference Values , beta-Lactamases/isolation & purification , beta-Lactamases/drug effects , Chile , Cross Infection/microbiology , IncidenceABSTRACT
Resumen Introducción: El sangrado menstrual excesivo (SME) se presenta aproximadamente en 37% de las adolescentes y afecta en distinto grado su calidad de vida. Objetivo: Medir la magnitud del impacto del SME en la calidad de vida en adolescentes. Pacientes y Método: Se entrevistó a adolescentes con diagnóstico de SME entre 10 y 18 años y a uno de sus tutores. Se aplicó el cuestionario de calidad de vida PedsQL 4.0 escala genérica, su versión Proxy PedsQL 4.0 al tutor, más 3 preguntas sobre limitación de actividades diarias. La concordancia entre la percepción de calidad de vida del tutor y adolescente se evaluó con el gráfico de Bland y Altman. Resultados: 46 adolescentes y tutores fueron evaluados. El puntaje total promedio PedsQL 4.0 para las adolescentes fue 64,48 (DS 14,54), con un rango de 18,48 a 88,04 con mayor compromiso en la dimensión emocional. Un 50% de las adoles centes falta al colegio, 80,4% a educación física y 65,2% a actividades al aire libre o fiestas. No hubo concordancia entre la percepción de las adolescentes y sus tutores. Conclusiones: Se evidenció un deterioro de la calidad de vida de las adolescentes encuestadas, siendo la dimensión emocional la más afectada. El desempeño en el cuestionario fue incluso más bajo que en patologías crónicas publicadas con esta misma herramienta.
Abstract Introduction: Heavy menstrual bleeding (HMB) occurs in 37% of adolescents and compromise their quality of life. Objective: To measure the magnitude of the impact of the SME on the quality of life in adolescents. Patients and Method: We interviewed adolescents diagnosed with HMB between 10 and 18 years old and one of their guardians. PedsQL 4.0 generic core scale was applied to measure quality of life, its Proxy PedsQL 4.0 version was applied to the guardian and 3 more questions to adolescents about limitation of daily activities. The concordance between the guardian's perception of the adolescent quality of life and the adolescent's perception was evaluated with the Bland and Altman graph. Results: 46 adolescents and guardians were evaluated. The total average PedsQL 4.0 score for adolescents was 64.48 (SD 14.54), with a range of 18.48 to 88.04 with a greater involvement in the emotional dimension. 50% of adolescents missed school, 80.4% physical education and 65.2% outdoor activities or parties. There was no agreement between the perception of the girls and guar dians. Conclusions: We evidence a deterioration in the quality of life of the surveyed adolescents, being the emotional dimension most affected. The performance in the questionnaire was also lower than in samples of chronic diseases published with this same tool.
Subject(s)
Humans , Female , Child , Adolescent , Quality of Life/psychology , Menorrhagia/psychology , Chile , Cross-Sectional Studies , Health Status Indicators , Health SurveysABSTRACT
Objective. To estimate annual infant morbidity and mortality attributable to prenatal smoking in Chile during 2008−2012. Methods. Population-attributable fractions (PAFs) for several infant outcomes were calculated based on previous study estimates of prenatal smoking prevalence and odds ratios associated with exposure (prenatal smoking relative to non-prenatal smoking). Prenatal smoking– attributable infant morbidity and mortality cases were calculated by multiplying the average annual number of morbidity and mortality cases registered in Chile during 2008–2012 by the corresponding PAF. Results. PAFs for 1) births ≤ 27 weeks; 2) births at 28–33 weeks; 3) births at 34–36 weeks; and 4) full-term low-birth-weight infants were 12.3%, 10.6%, 5.5%, and 27.4% respectively. PAFs for deaths caused by preterm-related causes and deaths caused by sudden infant death syndrome were 11.9% and 40.0% respectively. Annually, 2 054 cases of preterm-birth and fullterm low-birth-weight (1 in 9 cases), 68 deaths caused by preterm-related causes (1 in 8 cases), and 26 deaths caused by sudden infant death syndrome (1 in 3 cases) were attributable to prenatal smoking. Conclusions. In Chile, infant morbidity and mortality attributable to prenatal smoking are unacceptably high. Comprehensive individual and population-based interventions for tobacco control should be a public health priority in the country, particularly among female adolescents and young women who will be the mothers of future generations.
Objetivo. Calcular las tasas anuales de morbilidad y mortalidad de lactantes atribuibles al tabaquismo prenatal en Chile entre los años 2008 y 2012. Métodos. Se calcularon las fracciones atribuibles a la población (FAP) correspondientes a diferentes resultados de salud en lactantes tomando como base la prevalencia estimativa del tabaquismo prenatal y las razones de posibilidad asociadas a la exposición (tabaquismo prenatal frente a tabaquismo no prenatal) calculadas en estudios previos. Los casos de mortalidad y morbilidad de lactantes atribuibles al tabaquismo prenatal se calcularon multiplicando el promedio anual de casos de morbilidad y mortalidad registrados en Chile entre los años 2008 y 2012 por la FAP correspondiente. Resultados. Las FAP para los lactantes nacidos 1) a las 27 semanas o menos de gestación; 2) de 28 a 33 semanas de gestación; 3) de 34 a 36 semanas de gestación; y 4) al término de la gestación, pero con peso bajo al nacer, fueron de 12,3%, 10,6%, 5,5% y 27,4%, respectivamente. Las FAP correspondientes a las muertes por causas relacionadas con el nacimiento prematuro y las muertes por síndrome de muerte súbita del lactante fueron de 11,9% y 40,0%, respectivamente. Al año, 2 054 casos de bebés prematuros y de bebés nacidos con peso bajo al término de la gestación (1 de 9 casos), 68 muertes por causas relacionadas con el período prenatal (1 de 8 casos) y 26 muertes causadas por el síndrome de muerte súbita del lactante (1 de 3 casos) fueron atribuibles al tabaquismo prenatal. Conclusiones. En Chile, las tasas de morbilidad y mortalidad de lactantes atribuibles al tabaquismo prenatal son inadmisiblemente altas. En el país, las intervenciones integrales para el control del tabaco a nivel individual y poblacional deben ser una prioridad de salud pública, particularmente en las mujeres adolescentes y jóvenes que serán las madres de las generaciones futuras.
Objetivo. Estimar a morbidade e a mortalidade infantis anuais atribuíveis ao tabagismo durante a gestação no Chile em 2008–2012. Métodos. As frações atribuíveis populacionais (PAFs) para vários desfechos infantis foram calculadas com base em estimativas de estudos anteriores da prevalência do tabagismo durante a gestação e razões de possibilidades associadas à exposição (tabagismo durante a gestação relativo ao tabagismo fora da gestação). Os casos de morbidade e mortalidade infantis atribuíveis ao tabagismo durante a gestação foram calculados multiplicando-se o número médio anual de casos de morbidade e mortalidade registrados no Chile em 2008–2012 pela PAF correspondente. Resultados. As PAFs para 1) recém-nascidos ≤ 27 semanas, 2) recém-nascidos com 28–33 semanas, 3) recém-nascidos com 34–36 semanas e 4) recém-nascidos de termo com baixo peso foram 12,3%, 10,6%, 5,5% e 27,4%, respectivamente. As PAFs para mortes devidas a causas relacionadas à prematuridade e mortes devidas à síndrome de morte súbita do recém-nascido foram 11,9% e 40,0%, respectivamente. Anualmente, 2.054 casos de recém-nascidos prematuros e de termo com baixo peso (1 em 9 casos), 68 mortes devidas a causas relacionadas à assistência pré-natal (1 em 8 casos) e 26 mortes devidas à síndrome de morte súbita do recém-nascido (1 em 3 casos) foram atribuíveis ao tabagismo durante a gestação. Conclusões. No Chile, a morbidade e a mortalidade infantis atribuíveis ao tabagismo durante a gestação são inadmissivelmente elevadas. Amplas intervenções individuais e populacionais para o controle do tabagismo devem ser uma prioridade de saúde pública no país, sobretudo em adolescentes e jovens que serão mães das futuras gerações.
Subject(s)
Smoking , Maternal Exposure , Attributable Risk , Morbidity , Infant Mortality , Chile , Smoking , Attributable Risk , Morbidity , Infant MortalityABSTRACT
Resumen El presente documento corresponde a la opinión del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología, en relación a los brotes de hepatitis A en Chile. Las recomendaciones emitidas se basan en antecedentes epidemiológicos, características de la infección por virus hepatitis A(VHA) y en la experiencia mundial con las vacunas disponibles En relación a la infección por virus hepatitis A, Chile ha transitado de una endemia alta a una endemia intermedia, concentrándose actualmente los casos en personas mayores de 15 años, con brotes frequentes, uno de ellos este año causado por el genotipo 1A del VHA que se concentró en hombres que tienen sexo con hombres (HSH). La endemia actual, la presencia de brotes regulares, la frecuencia de desastres naturales en el país como terremotos e inundaciones sumado a la disponibilidad de vacunas eficaces, seguras y con estudios de costo efectividad locales, nos llevan a plantear medidas para el control de brotes, medidas focalizadas en grupos de riesgo y especialmente medidas a mediano y largo plazo, que incluyen la vacunación universal de niños contra esta enfermedad.
This document represents the position of the Chilean Infectious Diseases Society Advisory Committee on Immunization Practices regarding hepatitis A epidemiological situation in Chile. The recommendations are based on local epidemiological data, the hepatitis A virus infection characteristics and the global experience with the available vaccines. In relation to hepatitis A, Chile is no longer a highly endemic area but actually an intermediate one, currently concentrating cases in individuals over 15 years of age, with frequent outbreaks. In 2017 we have seen an important outbreak of genotype 1A in men who have sex with men (MSM). The current endemic, the presence of regular outbreaks, the frequency of natural disasters in Chile, together with the availability of safe, effective vaccines and local cost-effectiveness studies led us to propose measures for outbreak control for high risk groups protection and mid and long term, including a more definitive solution which is universal vaccination against this disease in small children.