[Changes in the clinical presentation of Influenza A H1N1pdm09 after the pandemic]. / Cambios en la presentación clínica de la influenza A H1N1pdm09 después de la pandemia.

BACKGROUND: After the 2009 influenza pandemic the H1N1pdm09 strain circulate seasonally. In 2015, Puerto Montt Hospital in Chile faced a simultaneous outbreak of both seasonal H3N2 and H1N1pdm09 influenza A (IA). AIM: To evaluate the clinical differences between the two viral strains and recent changes in the behavior of H1N1pdm09 IA. MATERIAL AND METHODS: We set up a retrospective study including every adult hospitalized in Puerto Montt Hospital in 2015 due to IA, confirmed by reverse transcription polymerase chain reaction. We compared epidemiological data, clinical presentation, complications, and the outcome of patients with H1N1pdm09 versus those with seasonal influenza. In parallel, we compared 62 cases of thatH1N1 IA from 2015 with 100 cases who were hospitalized and analyzed in 2009. RESULTS: Between July and October 2015, 119 adults with confirmed IA were hospitalized. From 2009 to 2015, the mean age of patients with IAH1N1pdm09 increased from 40.4 ± 17 to 58.8 ± 16 years (p < 0.01). Pneumonia as the cause of hospitalization decreased from 75 to 58% of patients, (p = 0.04). Likewise, the presence of comorbidities increased from 53 to 74%, (p < 0.01). Compared with seasonal H3N2, patients with IAH1N1pdm09 IA were more likely to require intensive care (p < 0.01) and mechanical ventilation (p < 0.01) and developed septic shock (p = 0.03). Their mortality was non-significantly higher (13 and 5% respectively). CONCLUSIONS: The clinical presentation of H1N1pdm09 IA has varied over time and now affects an older population, with a greater number of comorbidities. It also appears to be adopting the clinical behavior of a classic seasonal influenza virus.

Insulin Pump Therapy vs Multiple Daily Insulin Injections for Glycemic Control in Children With Type 1 Diabetes: A Systematic Review and Meta-Analysis.

Type 1 diabetes mellitus (T1DM), characterized by the autoimmune destruction of pancreatic beta cells and consequent insulin deficiency, leads to various complications. Management primarily focuses on optimal glycemic control through intensive insulin therapy, either via multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) using insulin pumps, which offer flexibility and improved basal insulin delivery. Despite the benefits of insulin pumps, such as reduced hypoglycemia risk and better mealtime insulin management, they pose challenges such as complexity in site changes and potential ketoacidosis due to tubing issues. This systematic review adheres to PRISMA guidelines and compares CSII with MDI in children and adolescents with T1DM, concentrating on outcomes such as glycemic control measured with HbA1c and glucose levels. The review includes studies meeting stringent criteria, encompassing a broad range of methodologies and geographies. The findings of this meta-analysis indicate the differences in glycemic control with CSII compared to MDI. However, significant heterogeneity in results and methodological variations across studies necessitate cautious interpretation. The study underscores the potential of CSII in offering better control for some patients, supporting a more personalized approach to T1DM management. It highlights the need for further research to understand the long-term effects and to refine treatment protocols, considering the variations in healthcare systems, treatment approaches, and patient demographics globally.

[ Delay time from diagnosis to surgery in drug-resistant epilepsy]. / Tiempo de retraso desde el diagnóstico hasta la cirugía en la epilepsia refractaria.

Drug-resistant epilepsy, in a good number of cases, can benefit from surgery. It is essential to make a timely referral for the pre-surgical study. We retrospectively reviewed the clinical records of our center from 2011 to 2019. The patients who underwent temporal lobectomy were selected. After performing the data analysis, an average waiting time of 23 years was observed, similar to that observed in other countries of the American continent. There is an evident need to provide strategies to reduce the waiting time for epilepsy surgery in patients who benefit from the intervention.

La epilepsia refractaria, en una buena parte de los casos, puede beneficiarse de cirugía. Es importante realizar una referencia oportuna para el estudio prequirúrgico. Se revisaron de forma retrospectiva los registros clínicos de nuestro centro desde el año 2011 al 2019 y se seleccionaron a los pacientes sometidos a lobectomía temporal. Tras realizar el análisis de los datos se objetivó un tiempo de espera medio de 23 años, similar a lo observado en otros países del continente americano. Existe una necesidad evidente de proporcionar estrategias para disminuir el tiempo de espera para la cirugía de epilepsia en los pacientes que se beneficien de la intervención.

Lupus eritematoso sistémico en una zona austral de Chile / Systemic lupus erythematosus in a southern zone of Chile

Introducción. El lupus eritematoso sistémico (LES) se caracteriza por un amplio espec-tro de manifestaciones clínicas y serológicas. La última serie de enfermos chilenos fue publicada el año 1994 y contempló un total de 218 pacientes. Objetivo. Contribuir con nuevos datos epidemiológicos en una cohorte de 67 enfer-mos con LES en una zona austral de nuestro país.Pacientes y métodos. De forma retrospectiva se revisaron 100 fichas de pacientes con diagnóstico de LES realizado por médico reumatólogo del Hospital de Puerto Montt (HPM), identificados a través de registros obtenidos a contar de julio de 2013 cuando esta patología se incluyó dentro de las Garantías Explícitas en Salud (GES). 67 cumplían al menos cuatro criterios Systemic Lupus International Collaborating Clinics (SLICC) 2012 y los datos obtenidos fueron sometidos a análisis estadístico utilizando el programa SPSS versión 15.0. Resultados: 63 (94%) son mujeres. La edad promedio al momento del diagnóstico fue 38,1 años y el tiempo transcurrido desde el inicio de los síntomas fue 12,3 me-ses. Las manifestaciones clínicas más frecuentes fueron sinovitis (65.7%), alopecia (47.8%), compromiso renal (43.3%) y alteraciones cutáneas (38.8%). Sesenta (90%) tenían ANA positivo, 34 (50.7%) anti-DNA positivo y 45 (67.2%) hipocomplementemia. Se identificaron 29 (43.3%) pacientes con compromiso clínico y/o histológico renal, de los cuales a 13 se les realizó biopsia renal, correspondiente en el 69% de los casos a nefritis lúpica membrano-proliferativa.Conclusiones. Nuestra cohorte no difiere sustantivamente de otras, salvo por la baja prevalencia de manifestaciones cutáneas. Se detectó la falta de acceso a biopsia renal y exámenes serológicos autoinmunes dado principalmente por falta de profesionales idóneos en nuestra zona que permitan el acceso universal a estos procedimientos.Este estudio permite proporcionar información actualizada de pacientes con LES en una zona austral de Chile.

Introduction. Systemic lupus erythematosus (SLE) is characterized by a broad spec-trum of clinical and serological manifestations. The last series of chilean patients was published in 1994 and included a total of 218 patients.Objective. To contribute with new epidemiological data in a cohort of 67 patients with SLE in a Southern area of our country.Patients and methods. In a retrospective way, 100 records of patients diagnosed with SLE were reviewed by a rheumatologist at the Hospital de Puerto Montt (HPM), identified through records obtained as of July 2013 when this pathology was included in the Explicit Health Guarantees. (GES) 67 met at least four criteria Systemic Lupus International Collaborating Clinics (SLICC) 2012 and the data obtained were subjected to statistical analysis using the SPSS program version 15.0.Results: 63 (94%) are women. The average age at diagnosis was 38.1 years and the time elapsed since the onset of symptoms was 12.3 months. The most frequent clinical manifestations were synovitis (65.7%), alopecia (47.8%), renal involvement (43.3%) and skin alterations (38.8%). Sixty (90%) had positive ANA, 34 (50.7%) positive anti-DNA and 45 (67.2%) hypocomplementemia. We identified 29 (43.3%) patients with clinical and / or renal histological involvement, of whom 13 were under-going a renal biopsy corresponding to 69% of the cases of membranous proliferative lupus nephritis.Conclusions. Our cohort does not differ substantively from others, except for the low prevalence of cutaneous manifestations.The lack of access to renal biopsy and self-immune serological tests was detected, mainly due to the lack of qualified professionals in our area that allow universal access to these procedures.This study allows us to provide updated information on patients with SLE in a Southern zone of Chile.

Cambios en la presentación clínica de la influenza A H1N1pdm09 después de la pandemia / Changes in the clinical presentation of Influenza A H1N1pdm09 after the pandemic

Background: After the 2009 influenza pandemic the H1N1pdm09 strain circulate seasonally. In 2015, Puerto Montt Hospital in Chile faced a simultaneous outbreak of both seasonal H3N2 and H1N1pdm09 influenza A (IA). Aim: To evaluate the clinical differences between the two viral strains and recent changes in the behavior of H1N1pdm09 IA. Material and Methods: We set up a retrospective study including every adult hospitalized in Puerto Montt Hospital in 2015 due to IA, confirmed by reverse transcription polymerase chain reaction. We compared epidemiological data, clinical presentation, complications, and the outcome of patients with H1N1pdm09 versus those with seasonal influenza. In parallel, we compared 62 cases of thatH1N1 IA from 2015 with 100 cases who were hospitalized and analyzed in 2009. Results: Between July and October 2015, 119 adults with confirmed IA were hospitalized. From 2009 to 2015, the mean age of patients with IAH1N1pdm09 increased from 40.4 ± 17 to 58.8 ± 16 years (p < 0.01). Pneumonia as the cause of hospitalization decreased from 75 to 58% of patients, (p = 0.04). Likewise, the presence of comorbidities increased from 53 to 74%, (p < 0.01). Compared with seasonal H3N2, patients with IAH1N1pdm09 IA were more likely to require intensive care (p < 0.01) and mechanical ventilation (p < 0.01) and developed septic shock (p = 0.03). Their mortality was non-significantly higher (13 and 5% respectively). Conclusions: The clinical presentation of H1N1pdm09 IA has varied over time and now affects an older population, with a greater number of comorbidities. It also appears to be adopting the clinical behavior of a classic seasonal influenza virus.