Atención en domicilio de pacientes NANEAS: experiencia del hospital de niños Dr. Roberto del Río / Home care of NANEAS patients: experience of the children's hospital Dr. Roberto del Río

El avance de las tecnologías de soporte vital ha aumentado la sobrevida de niños con patologías y secuelas graves, categorizados como NANEAS (Niños y Adolescentes con Necesidades Especiales de Atención en Salud) de mediana y alta complejidad. En el Hospital de Niños Dr. Roberto del Río se organizó un equipo de atención para NANEAS en 2014, que realiza visitas domiciliarias desde 2015 a pacientes médicamente complejos. OBJETIVO: Caracterizar la población atendida en domicilio y la modalidad de atención. PACIENTES Y MÉTODO: Estudio retrospectivo descriptivo mediante revisión de registro clínico electrónico y ficha clínica de NANEAS atendidos en domicilio del 2015 al 2018. RESULTADOS: Se analizaron 581 visitas a 81 pacientes, mediana 8 años, 78% hombres, 64% institucionalizados, 78% con patología neurológica de base, 75% de alta y mediana complejidad según clasificación SOCHIPE. De las visitas, 71% fue en comunas rurales, la mediana de tiempo de viaje 60 minutos y de atención 26 minutos. Un 60% de las visitas se realizó a pacientes con dispositivos médicos. En un 99% asistió pediatra, 33% enfermera y 68% otro profesional, que en 61% correspondió al neuropediatra. CONCLUSIONES: La mayor proporción de pacientes atendidos son de alta y mediana complejidad, usuarios de dispositivos médicos y la mayoría con patología neurológica de base, por lo que resulta fundamental contar con un neurólogo en el equipo interdisciplinario. Las visitas se realizan principalmente a comunas distantes por la dificultad de traslado de estos pacientes. Esta modalidad de atención promueve una mejor calidad de vida para niños y niñas médicamente complejos y para sus familias.

The advancement of life support technologies has increased the survival of children with serious pathologies and sequelae, categorized as NANEAS (Children and Adolescents with Special Health Care Needs) of medium and high complexity. At the Hospital de Niños Dr. Roberto del Río, a care team for NANEAS was organized in 2014, which has made home visits to medically complex patients since 2015. OBJECTIVE: To characterize the population attended at home and the care modality. PATIENTS AND METHOD: Retrospective descriptive study by reviewing the clinical file of NANEAS patients seen at home in this period. RESULTS: 581 visits were analyzed in 81 patients, median 8 years, 78% men, 63% institutionalized, 78% with neurological diseases. 75% were of high and medium complexity according to the SOCHIPE classification. Of the visits, 71% were in rural places, median travel time 60 minutes and direct attention 26 minutes. 60% of the visits were made to patients with medical devices, 99% attended by a pediatrician, 33% a nurse and 68% another professional, who in 61% corresponded to the child neurologist. CONCLUSIONS: The highest proportion of patients seen are of high and medium complexity with medical devices and with underlying neurological pathology, so it is important to have a neurologist in the interdisciplinary team. Many of the visits are made in places distant from the hospital center due to the difficulty of transferring these patients. This modality of care promotes a better quality of life for medically complex children and their families.

A report on the outbreak of Zika virus on Easter Island, South Pacific, 2014.

Zika virus (ZIKV) is an emerging mosquito-borne flavivirus circulating in Asia and Africa. In 2013, a large outbreak was reported on the archipelago of French Polynesia. In this study, we report the detection and molecular characterization of Zika virus for the first time in Chile from an outbreak among the inhabitants of Easter Island. A total of 89 samples from patients suspected of having ZIKV infection were collected between the period from January to May, 2014. Molecular diagnosis of the virus was performed by RT-PCR followed by the sequencing of the region containing the NS5 gene. A comparison of the viral nucleic acid sequence with those of other strains of ZIKA virus was performed using the MEGA software. Fifty-one samples were found positive for ZIKV by RT-PCR analysis. Further analysis of the NS5 gene revealed that the ZIKV strains identified in Easter Island were most closely related to those found in French Polynesia (99.8 to 99.9% nt and 100% aa sequence identity). These results strongly suggest that the transmission pathway leading to the introduction of Zika virus on Easter Island has its origin in French Polynesia.

Detection of dengue virus type 4 in Easter Island, Chile.

We report the detection of dengue virus type 4 (DENV-4) for the first time in Easter Island, Chile. The virus was detected in serum samples of two patients treated at the Hospital in Easter Island. The two samples were IgM positive, and the infection was confirmed by RT-PCR and genetic sequencing; viral isolation was possible with one of them. The Easter Island isolates were most closely related to genotype II of dengue type 4.

Complete nucleotide sequence analysis of a Dengue-1 virus isolated on Easter Island, Chile.

Dengue-1 viruses responsible for the dengue fever outbreak in Easter Island in 2002 were isolated from acute-phase sera of dengue fever patients. In order to analyze the complete genome sequence, we designed primers to amplify contiguous segments across the entire sequence of the viral genome. RT-PCR products obtained were cloned, and complete nucleotide and deduced amino acid sequences were determined. This report constitutes the first complete genetic characterization of a DENV-1 isolate from Chile. Phylogenetic analysis shows that an Easter Island isolate is most closely related to Pacific DENV-1 genotype IV viruses.

[Prevalence of anti-hantavirus antibodies in health care personnel in direct contact with patients with hantavirus pulmonary syndrome in Temuco, Chile 1997 to 1999]. / Prevalencia de anticuerpos anti-hantavirus en personal de salud en contacto directo con pacientes portadores del síndrome pulmonar por hantavirus. Temuco 1997 a 1999.

BACKGROUND: An outbreak of Hantavirus Cardiopulmonary Syndrome (HVCS) caused by the Andes virus, affected Chile since 1995. Antibodies to Hantavirus in health care workers who had cared patients with HVCS in Coybaique, Argentinean reports and familial clustering of bantaviral illness, raised the possibility of person to person transmission. Familial clustering could occur secondary to a similar exposure to a common infected environment of more than one member of the family. Moreover, the prevalence of antibodies in health care workers in Coyhaique does not differ from the prevalence in general population in that region. AIM: To study the prevalence of antibodies to Hantavirus in health care workers exposed to body fluids of 20 patients. MATERIAL AND METHODS: Among health care workers exposed to patients with HVCS, we registered information about the exposure to patients and to the environment outside the hospital in which they could have been infected. IgG antibodies against Hantavirus were measured by ELISA using two dilutions. RESULTS: Sixty seven workers were studied. Of these, 73% were exposed to respiratory secretions and blood, 21% to blood and 6% to respiratory secretions. Only 6% protected themselves properly, 49% used facial masks and gloves, 25% only facial masks, 7% only gloves and 12% used no protection measures. In none of these workers, Hantavirus antibodies were detected. CONCLUSIONS: These results are supporting evidence against person to person transmission of the Andes virus.

Adenovirus surveillance on children hospitalized for acute lower respiratory infections in Chile (1988-1996).

Adenoviruses (Ad) play an important role in the etiology of acute lower respiratory tract infections (ALRI) in young children in Chile. Our aim was to correlate the clinical severity of the infections with the Ad strains isolated during surveillance over 8 years. From 1988 through 1996, nasopharyngeal aspirates (NPA) were obtained for viral isolation and immunofluorescence assay (IFA) from children under 2 years of age hospitalized for ALRI; Ad isolates were further studied by restriction enzyme analysis of genomic DNA. Of 3,097 cases enrolled, the Ad isolation rate was 12.6%. The most common admission diagnoses among Ad-positive cases were pneumonia and wheezing bronchitis (69.8%). Duration of Ad shedding was studied in 74 cases by IFA. Children excreting Ad for 4 or more days had a longer hospital stay than those shedding for 1-3 days (mean: 16.8 and 7.2 days, respectively; P <.01). Viral shedding for more than 3 days was associated with more severe outcomes. Genome typing of 221 out of 390 Ad isolates resulted in 87 subgenus C and 134 subgenus B strains, including 123 Ad genome type 7h (55.6%, P <.01). The IFA from the NPA was more sensitive for the detection of subgenus B (51. 5%) than subgenus C infections (24.1%, P <.01). Children shedding Ad 7h had longer hospital stays (P <.01), a higher frequency of rectal temperatures over 39 degrees C (P <.01), and greater need for additional oxygen (P <.02) than subgenus C cases. Four cases requiring mechanical ventilation were associated with Ad 7h infections. The data presented show that, in children hospitalized for ALRI, the genome type 7h was associated with a more severe clinical outcome.

[Laboratory surveillance of measles. Chile, 1992-1995]. / Vigilancia de laboratorio en sarampión. Chile, 1992-1995.

BACKGROUND: The first massive national measles vaccination campaign in Chile was done in 1992. Since then a laboratory surveillance of the disease has been undertaken at the Instituto de Salud Pública. AIM: To report the results of laboratory surveillance of measles between 1992 and 1995. MATERIAL AND METHODS: Paired serum samples from suspected cases of measles were received at the Institute. Measles specific IgG was determined with indirect immunofluorescence methods. IgG and IgM immunoenzymatic methods were used as complementary techniques, and rubella infections were ruled out by hemmaglutination inhibition tests. RESULTS: Sera from 1087 presumptive cases (489 in 1992, 196 in 1993, 180 in 1994 and 222 in 1995) were analyzed. Only two cases of wild imported measles were confirmed, one in Arica in 1992 and the other in Santiago in 1993. Five additional post vaccine cases were detected. Eighty eight percent of samples in 1992 and 75% in 1994 were seropositive. A high percentage of cases were confirmed as rubella (55% in 1992 and 19% in 1994). CONCLUSIONS: Absence of wild measles virus circulation in Chile from 1992 to 1995 emphasizes the importance of laboratory surveillance of the disease.

[Isolation of Coxsackieviruses B5 in a fatal case of meningoencephalitis]. / Aislamiento de virus Coxsackie B-5 en un caso fatal de meningoencefalitis.

A nine months old boy was admitted to the hospital with the diagnosis of meningoencephalitis 15 days after having a clinically diagnosed chickenpox. Lumbar puncture showed clear CSF with 0.23 g/l of proteins, 57 mg/dl of glucose, 30 red cells/mm3 and 5 leukocytes/mm3. Blood count showed a packed red cell volume of 22%, a hemoglobin of 7 g/dl, 14800 leukocytes with 1% eosinophils, 5% band and 39% segmented neutrophils, 50% lymphocytes and 5% monocytes and a decreased platelet count. On the fourth hospitalization day, the patient had vomiting, irritability and stiff neck. A new lumbar puncture showed a clear CSF that differed from the former only in the glucose level that increased to 102 mg/dl. The patient died and the necropsy showed a congestive and enlarged brain and congestive meninges infiltrated with lymphocytes. There was lymphoid follicle hyperplasia in the small bowel and enlarged mesenteric lymph nodes. Samples of brain, brain stem, spinal cord and stools were sent for virological study. A Coxsackie B-5 virus was isolated from the spinal cord sample.

A seroepidemiological survey of antibodies to HTLV-I/HTLV-II in selected population groups in Paraguay.

Between March 1987 and November 1989 a cross-sectional serological survey was conducted on 884 residents of Paraguay to obtain data on the prevalence of antibodies to human T-cell leukemia virus type I/II (HTLV-I/II). Sera from 8/884 individuals (0.9%) were positive, confirmed by Western blotting and radioimmunoprecipitation (RIPA). This study shows that HTLV-I/II is very rare (or absent) among the general (healthy) population (0/338) and ethnic Japanese (0/227) in Paraguay. However, it can be detected at a rate of 2-3% in prostitutes (4/178) and homosexuals (4/117), suggesting sexual transmission as an important route for spread of HTLV-I/II in Paraguay.