[Extubation failure after Norwood procedure in hypoplastic left heart syndrome patients]. / Extubación fallida postoperación de Norwood en pacientes con síndrome de hipoplasia de ventrículo izquierdo.

INTRODUCTION: Hypoplastic left heart syndrome (HLHS) is the main cause of mortality due to congenital heart disea se. The Norwood surgery is the first procedure of the surgical staging process towards a single ventri cle physiology or Fontan-type operation and has a mortality rate of 10% to 30%. Extubation failure during the postoperative period occurs in up to 18% of these patients and is associated with increased mortality. OBJECTIVE: To describe extubation failure rates and risk factors in pediatric patients with HLHS who underwent Norwood procedure. PATIENTS AND METHOD: Case-control study that included all the patients with HLHS managed with Norwood surgery at the Hospital Clínico de la Pontificia Universidad Catolica between January 2000 and February 2018. Cases and controls were defined as patients with extubation failure and as patients without this complication, respectively. The fo llowing variables were recorded demographic, surgical, and post-surgical ones, and univariate and multivariate analyses (logistic regression) were performed to determine risk factors associated with extubation failure. RESULTS: Out of 107 patients, 26 of them presented extubation failure (24.3%). In the univariate analysis, longer mechanical ventilation time during the postsurgical period, atelectasis, pleural effusion, chylothorax, other respiratory morbidities (i.e. apneas and tracheitis), and longer infusion times of morphine and midazolam, all were associated with a higher extubation failure rate in this population. In the multivariable analysis, chylothorax, other respiratory comorbidities, and longer infusion time of midazolam remained associated with this complication, however, it was not associated with higher mortality. CONCLUSIONS: Chylothorax, respiratory comorbidities, and longer use of Midazolam should be addressed before planning airway extubation in order to avoid failure.

[Clinical Practice Guidelines for Smoking Cessation]. / Guías de Práctica Clínica para el Tratamiento del Tabaquismo, Chile 2017.

Considering that a high proportion of the Chilean general population smokes, the Chilean Society of Respiratory Diseases in collaboration with the Chilean Societies of Cardiology and, Endocrinology and Diabetes, formed an interdisciplinary group, who issued a set of recommendations for the treatment of the smoker, methodologically advised by experts. These interventions should be prioritized in high-risk groups. Methods The panel elaborated and graded the recommendations following the GRADE methodology. To assess the effect of each intervention, systematic reviews and randomized clinical trials were identified. In addition, a search of studies done with the Chilean population was carried out. For each of the questions, the panel determined the direction and strength of the recommendation through a decision evidence table. Recommendations For all smokers, the panel recommends using brief counseling ABC on non-intervention, using mobile telephone interventions on non-intervention, using text message on non-intervention, (strong recommendation; moderate certainty in the evidence of the effects). For motivated individuals, with indication for quitting drugs the panel recommends using nicotine replacement therapy on non-intervention, using bupropion on non-intervention, using varenicline on non-intervention. (strong recommendation; moderate certainty in the evidence of the effects). Discussion This clinical practice guide provides recommendations based on the evidence for smoking cessation.

[Breastfeeding as a protective factor against overweight and obesity among pre-school children]. / Lactancia materna como factor protector de sobrepeso y obesidad en preescolares.

INTRODUCTION: The rates of overweight and obesity among children have significantly increased in Chile. OBJECTIVE: To assess the benefits of breastfeeding in preventing malnutrition by excessive intake of foods in Chilean pre-school children. METHODS: A case-control study was conducted in 2011 on pediatric patients treated in a private Chilean healthcare center (San Joaquin Medical Center, Catholic University). Gender, age, weight, height, nutritional diagnosis, type of feeding during the first 6 months of life, socioeconomic status, parental education and obesity, television viewing, and kindergarten attendance were analyzed. RESULTS: A total of 209 patients were included in the study, 53.1% of whom were male, and 60.3% were predominantly breastfed for the first 6 months of life. More than half (51.7%) were eutrophic, 29.7% were overweight, and 18.6% obese. The patients were between the ages of 2 and 3 years 11 months. The crude Odds Ratio of breast-feeding versus formula during the first 6 months of life in patients with normal weight versus overweight children was 0.442 (95% CI 0.204-0.961). CONCLUSIONS: It was found that predominantly breastfeeding during the first 6 months of life acted as a protective factor against malnutrition by excessive intake of foods in Chilean pre-school children treated in this private medical center.

[Ear, nose and throat disease profile in children with Down syndrome]. / Perfil de morbilidad otorrinolaringológica en niños con síndrome de Down.

INTRODUCTION: The children with Down syndrome (DS) are at increased risk of ear-nose-throat (ENT) disorders. International recommendations suggest early hearing screening and periodic specialist evaluation. Our goal was to characterize ENT disorders in children with DS, and propose recommendations for the Chilean population. PATIENTS AND METHOD: Cross-sectional, descriptive study, of children with DS, between 6 months and 15 years of age. The data was obtained by a health interview to the parents and review of medical records. RESULTS: We analyzed 134 patients with an average age of 44.5 months. The 78.8% had ENT disorders, the most frequent ENT disorders was allergic rhinitis and otitis media with effusion. Hearing screening was abnormal in a quarter of the patients, 50% of children over 3 years of age had obstructive sleep apnea diagnosed by polysomnogram. Older children had a statistically higher frequency of ENT disorders. CONCLUSIONS: This series shows a high rate of ENT disorders in children with DS, which supports recommendations for hearing screening, high suspicion of obstructive sleep apnea and routine referral to an ENT specialist for prevention and aggressive therapy in order to reduce hearing loss and improve development of the child with DS.

[Adherence to vitamin D supplementation and determinant factors during the first year of life]. / Adherencia a la suplementación con vitamina D y factores determinantes de ella, durante el primer año de vida.

INTRODUCTION: Breastfed infants under one year of age may not get enough vitamin D; therefore a vitamin supplement is needed. The adherence to this policy has not yet been evaluated in Chile. OBJECTIVE: To evaluate the adherence to vitamin D supplementation in children less than one year old and the determinant factors involved. PATIENTS AND METHOD: A cross-sectional study was carried out in three Catholic University Health Network centers. Breastfed infants under one year of age were included in the study. Their parents/guardians filled out a questionnaire about adherence to supplementation and its determinant factors. RESULTS: 170 infants were recruited. 164 of them received supplementation, with a good adherence of 68.9%. The main reason for non-adherence was due to maternal forgetfulness. The identified risk factor for poor adherence was the number of maternal children. CONCLUSIONS: Vitamin D supplementation in Chile reaches high levels, but its adherence is poor. More education to parents on ways to avoid forgetting the supplement is needed as well as on identifying risk factors during medical consultations.

[Foodborne disease outbreaks around the urban Chilean areas from 2005 to 2010]. / Brotes de enfermedades transmitidas por alimentos y agua en la Región Metropolitana, Chile (2005-2010).

BACKGROUND: Foodborne disease outbreaks are one of the main health problems all over the world, which have an extensive impact on human health. OBJECTIVE: [corrected] To analyze the foodborne disease outbreaks occurred in Chilean urban area from 2005 to 2010. METHODS: We made a descriptive epidemiologic study. First, criteria were defined and classified according to previous epidemiologic investigations, clinical and environment samples, then. Variables of space, time, place and person were also analyzed. RESULTS: Among 2,806 reported outbreaks, 2434 (86.7%) fulfilled the inclusion criteria. Incidence rate of the period (2005-2010) were 32 cases per 100 inhabitants. A total of 12,196 people were affected, with an average of 5 patients per outbreak. The households (36.2%), restaurants (16.3%), supermarkets (6.3%) free fair (4.4%) have been the most important outbreak areas. The foods involved were seafood (15.4%), fish (15.1%), and fast food (13.5%). The etiologic agents were Salmonella spp, Shigella spp, Vibrio parahaemolyticus. CONCLUSIONS: Outbreaks foodborne diseases are frequents in the Chilean urban area, which make vulnerable a lot of people. The largest numbers happened in the households and were due to bad handling and/or inappropriate storage of the foods.

[Clinical use of diagnostic tests (Part 1): Analysis of the properties of a diagnostic test]. / Uso de tests diagnósticos en la práctica clínica (Parte 1): Análisis de las propiedades de un test diagnóstico.

Diagnostic tests are widely used in clinical practice. Qualitative analysis of diagnostic test properties (validity, reproducibility and safety) has been systematized using clinical epidemiology tools that have introduced a series of concepts such as sensitivity, specificity and predictive values. Based on data reported by a clinical investigation, the present article illustrates the theoretical background underlying these concepts, explains the methodology for their calculation, and analyzes their main strengths and limitations. A second article (Part 2: Clinical application and usefulness of a diagnostic test), describes the manner in which information provided by a test should be applied in order to correctly resolve a clinical dilemma.

[Strategies for dealing with cholera disease. A public health perspective of the Chilean experience]. / Estrategias para el enfrentamiento del cólera. La experiencia chilena desde una perspectiva de salud pública.

During the latest Latin American epidemic of cholera (1991), more than 70,000 cases were identified and over 6,000 deaths occurred. Cholera started in Peru and expanded to the rest of Latin American countries, including Chile. Compared to Peru, the epidemic in Chile had minor consequences due to the strategies adopted by the National System of Health Services, together with other public institutions. These strategies included the establishment of a National Committee for Cholera, strategic planning of health services, strengthening of epidemiologic surveillance systems and of clinical and environmental laboratories, education of the population, and preventive strategies, among others. Maintenance of environmental health measures and the population's collaboration are essential to avoid future emergence of this disease.

[Clinical-epidemiological characterization of neonatal necrotizing enterocolitis of seven public hospitals]. / Caracterización clínico-epidemiológica de las enterocolitis necrosantes neonatales de siete hospitales públicos.

BACKGROUND: Necrotizing enterocolitis (NEC) presents high mortality and postoperative, gastrointestinal and neurodevelopmental morbidity. There is limited information about NEC in Chile. AIM: To describe the clinical/epidemiological behavior of newborns who underwent NEC. METHODS: Multicenter descriptive study of patients with NEC from seven hospitals of Santiago, Chile, during 2016. Descriptive statistics and univariate/multivariate analysis were performed (SPSS v22 software). RESULTS: 75 cases were collected. Median days of life at diagnosis was 11, gestational age was 29 weeks, birth weight 1,114 g. The incidence was 2.6 per 1,000 live newborns and mortality was 18.6%, higher in ≤ 750 g, ≤ 25 weeks and surgical NEC. There was 45.3% microbiological isolation and 19 different empirical antibiotic schemes were used for the treatment of NEC. The multivariate analysis showed a higher risk of surgery in umbilical arterial catheter users, CRP > 10 mg/L and positive microbiological isolation. The highest risk of death was in umbilical arterial catheter users. DISCUSSION: This ie the first multicenter study that collects local data information. The incidence was similar to that found in medical reports but with a lower mortality. There is no consensus of antibiotic treatment to use. With these results we hope to advance in improving the diagnosis and unify antimicrobial treatments, to reduce morbidity and mortality figures.

[Moses Maimonides, "physician of princes, prince of physicians"]. / Moisés Maimónides, "médico de príncipes, príncipe de los médicos".

Moses Maimonides (1135-1204) is considered the most prominent figure of Judaism during the Middle Ages. Born within the Sephardic Jewish community of Cordoba, his rich intellectual education (theological, philosophical and medical) together with a deep spirituality gave birth to the figure of a highly humanitarian, rational and dedicated physician. His medical legacy includes ten treatises, among them 'Medical Aphorisms of Moses', a set of 1,500 aphorisms organized in 25 chapters, each dealing with a different area of medicine. His theological works and the renowned 'Guide for the Perplexed' raised his figure as a theologist and modern philosopher, being the latest his most universal creation. His life and legacy are an invitation to raise the medical vocation and practice beyond a simple occupation.

[Vaccine safety: description of the adverse events reported to the surveillance system in Chile, 2014 to 2016]. / Seguridad en vacunas: descripción de los eventos adversos notificados al sistema de vigilancia en Chile, 2014 a 2016.

BACKGROUND: Passive surveillance systems for adverse events following immunization (AEFI) allow the monitoring of known adverse effects (AE) and the investigation of infrequent AE. AIM: To describe the AEFI notified in Chile between 2014 and 2016. METHODOLOGY: This was a study of epidemiological surveillance. A general analysis of AEFI and sub-analysis for pentavalent vaccine was carried out. It was calculated the global reporting rate of AEFI every 100,000 doses of vaccines, the reporting rate of AEFI considered of interest and the odds ratio of reporting (ROR) of apneas for pentavalent. RESULTS: The total AEFI reported was 2,552 with a global reporting rate of 9,13. 13.4% of AEFI were serious. The vaccine reporting rate of events of interest was generally lower than the reference rates. The vaccine with the highest reporting rate (44.3) was pentavalent, with an ROR of apnea versus other vaccines of 10.5 (95% CI 3.77-29.47). DISCUSSION: This study provides an overview of the AEFI notified in Chile. The global reporting rate was similar to other studies, but those of events of interest were lower than international references. A possible association between apnea and pentavalent vaccine is shown.

[Climate change and infectious diseases. A novel epidemiological scenario]. / Cambio climático y enfermedades infecciosas. Un nuevo escenario epidemiológico.

For the international scientific community, it is undoubted that planetary temperature is increasing, being projected an average raise of 1.0 degrees C-3.5 degrees C by the year 2100. Forecasted consequences are diverse, most of them adverse for human health, including the establishment of favorable epidemiological scenarios for the emergence and reemergence of infectious diseases. The present article summarizes the available evidence regarding the mechanisms that promote climate change, its environmental effects and its consequences on human health. In order to accomplish this objective, demonstrated changes in the dynamics of zoonotic, vectorial, food and water-borne diseases are described. The position of Chile in the international community is commented, as well as multiple pending challenges, among which outstands the importance of incorporating professionals that work in the health sector to the national debate.

Detección molecular de patógenos en deposiciones en niños consultantes por diarrea aguda en Servicios de Urgencia / Molecular detection of pathogens in stool samples of children consulting for acute diarrhea in emergency services

INTRODUCCIÓN: La diarrea aguda continúa siendo una de las principales causas de morbilidad en niños; sin embargo, el diagnóstico etiológico presenta limitaciones dada la baja sensibilidad de los métodos tradicionales. OBJETIVO: Describir los microorganismos identificados en niños que acudieron al Servicio de Urgencia (SU) de un hospital universitario en Santiago, Chile, por diarrea aguda y a los que se le solicitó panel molecular gastrointestinal. MÉTODOS: Se revisaron fichas clínicas y resultados de panel gastrointestinal realizados entre junio de 2017 y marzo de 2020. RESULTADOS: Se incluyeron 198 pacientes, edad promedio de 54,5 meses y 60,6% (120/198) de sexo masculino. La positividad del panel fue de 78,8% (156/198) con 35,3% (55/156) de las muestras polimicrobianas. Se identificaron 229 microorganismos, de los cuales 72,9% (167/229) corresponden a bacterias, 25,8% (59/229) a virus y 1,3% (3/229) a parásitos. Destacaron Campylobacter spp. y Escherichia coli enteropatógena (ECEP) como las bacterias más frecuentemente identificadas. Los pacientes con detección de Campylobacter spp. presentaron con mayor frecuencia fiebre (p = 0,00). ECEP se aisló principalmente (82,5%) en muestras polimicrobianas. DISCUSIÓN: Los resultados enfatizan el potencial que poseen los estudios moleculares para mejorar el diagnóstico etiológico de la diarrea, pero a la vez llevan a cuestionar el rol patogénico de algunos microorganismos identificados.

BACKGROUND: Acute diarrhea continues to be one of the main causes of morbidity in children, however the etiologica diagnosis presents limitations given the low sensitivity of traditional methods. AIM: To describe the microorganisms identified in children who attended the emergency department (ED) in Santiago, Chile, due to acute diarrhea and to whom a gastrointestinal panel was requested as part of their study. MATERIAL AND METHODS: Clinical records and results of the gastrointestinal panel carried out between June 2017 and March 2020 were reviewed. RESULTS: 198 patients were included, the average age was 54.5 months and 60.6% (120/198) were males. Positivity was 78.8% (156/198) with 35.3% (55/156) of the samples being polymicrobial. 229 microorganisms were identified, of which 72.9% (167/229) corresponded to bacteria, 25.8% (59/229) to viruses, and 1.3% (3/229) to parasites. Campylobacter spp. and enteropathogenic Escherichia coli (EPEC) were the most frequently identified bacteria. Patients with detection of Campylobacter spp. presented a higher frequency of fever (p = 0.00). EPEC was isolated in 82.5% of the cases in polymicrobial samples. DISCUSSION: The results emphasize the potential of molecular studies to improve the etiological diagnosis of diarrhea and at the same time lead to question the pathogenic role of some microorganisms.

Factores asociados a mayor sobrevida en pacientes con cáncer de páncreas tratados mediante pancreatoduodenectomía. Estudio de casos y controles

Introducción: El cáncer de páncreas (CP) tiene un pronóstico ominoso a pesar de los avances en técnica quirúrgica y en los cuidados peri/postoperatorios. Nuestro objetivo fue identificar factores asociados a mayor sobrevida en pacientes con CP tratados mediante pancreatoduodenectomía (PD). Material y Método: Estudio de casos y controles de pacientes con CP tratados mediante PD en el Hospital Clínico de la Universidad Católica entre 2002-2015. Se definió como caso al paciente con sobrevida ≥ 3 años y como control a aquel con sobrevida inferior a ese plazo. Se comparó entre casos y controles datos biodemográficos, clínicos, histopatológicos, de morbilidad y mortalidad mediante regresión logística. Resultados: Se analizaron 70 pacientes, con una edad media de 62 ± 11 años; 40 (57%) mujeres. Hubo morbilidad en 26 enfermos (37,1%); Clavien-Dindo ≥ Illa en 8 (11,4%). La mediana (rango) de días de hospitalización fue 12 (7-84). La sobrevida actuarial a 1, 3 y 5 años fue 77%, 32% y 22% respectivamente. Se identificaron 21 casos (30%) y 49 controles (70%). En el análisis univariable, la resección R0, los ganglios regionales negativos, la ausencia de infiltración perineural, los estadios más precoces (IA, IB y IIA) y la ausencia de diabetes mellitus (DM2) al momento del diagnóstico, fueron variables asociadas a sobrevida ≥ 3 años (p 100 U/mL) y los tratamientos complementarios no se asociaron a diferencias significativas en sobrevida. En el análisis multivariable, se identificó la ausencia de DM2 (OR ajustado: 12; IC95% 1,7-84,3), la ausencia de infiltración perineural (OR ajustado: 7; IC95% 1,3-36,3) y los estadios precoces IA, IB y IIA (OR ajustado: 10,3; IC95% 2,1-49,1) como los factores independientes asociados a sobrevida mayor a 3 años. Conclusión: Los pacientes no diabéticos, con etapas precoces del CP sin infiltración perineural, resecados R0 mediante PD pueden obtener una sobrevida mayor a 3 años.

Introduction: Pancreatic cancer (PC) remains one of the most lethal malignancies, despite developments in surgical and non-surgical therapies. Significant improvements in long-term survival have not been achieved. Only radical surgical resection has obtained a moderate extension in survival. We aim to identify factors associated with longer survival in patients with PC treated by pancreatoduodenectomy (PD). Material and Method: We designed a case-control study of patients with PC treated by PD in our center between 2002-2015. We compare patients who survived ≥ 3 years (case) with those not achieving it (control). Bio-demographic, clinical, histopathological, morbidity and mortality data were compared between cases and controls using logistic regression. Results: Seventy patients were analyzed; mean age 62 ± 11 years; 40 (57%) women. Morbidity was found in 26 patients (37.1%); Clavien-Dindo ≥ Illa in 8 (11.4%). The median (range) of hospitalization days was 12 (7-84). The actuarial 1, 3, and 5 years survival was 77%, 32%, and 22%, respectively, for the entire series. Twenty-one cases (30%), and 49 controls (70%) were identified. In the univariate analysis, R0 resection, negative regional lymph nodes, the absence of perineural infiltration, the earliest stages (IA, IB, and IIA) and the absence of diabetes mellitus (DM) at time of diagnosis were variables associated with survival ≥ 3 years (p 100 U / mL), and neo/adjuvant treatments, did not significantly show differences in survival. In the multivariate analysis, no DM at diagnosis (adjusted OR: 12; 95% CI 1.7 - 84.3), no perineural infiltration (adjusted OR: 7; 95% CI 1.3 - 36.3) and early stages IA, IB, and IIA (adjusted OR: 10.3; 95% CI 2.1 - 49.1) were identified as independent factors associated with survival > 3 years. Conclusion: Nondiabetic patients with early stages PC without perineural infiltration, resected R0 by PD can achieve survival over 3 years.

[John Snow, the cholera epidemic and the foundation of modern epidemiology]. / John Snow, la epidemia de cólera y el nacimiento de la epidemiología moderna.

John Snow (1813-1858) was a brilliant British physician. Since young he stood out for his acute observation capacity, logical thinking and perseverance, first in anesthetics and later in epidemiology. The successive outbreaks of cholera that affected London, motivated him to study this disease from a populational point of view. He related the appearance of cases to the consumption of "morbid matter", responsible for the acute diarrhea with dehydration that characterizes this disease. Bravely, Snow opposed to certain theories present at his time, sacrificing his own prestige. He was a pioneer in the use of modern epidemiological investigation methodologies such as conducting surveys and spatial epidemiology. Fairly, he is considered nowadays as father of modern epidemiology by the scientific community.

Extubación fallida postoperación de Norwood en pacientes con síndrome de hipoplasia de ventrículo izquierdo / Extubation failure after Norwood procedure in hypoplastic left heart syndrome patients

Resumen: Introducción: En pacientes con Síndrome de Hipoplasia de Ventrículo Izquierdo (SHVI) la primera etapa hacia una fisiología univentricular de Fontan es la operación de Norwood, cuya mortalidad es 10-30%. En estos pacientes la extubación fallida se presenta en un 18% y se ha asociado a aumento de la mortali dad. Objetivo: Describir la frecuencia de extubación fallida y sus factores de riesgo en pacientes con SHVI operados (Norwood). Pacientes y Método: Estudio de casos y controles que incluyó a todos los pacientes con SHVI manejados con cirugía de Norwood en el Hospital Clínico de la Pontificia Universidad Católica (enero-2000 a febrero-2018). Se define como casos a pacientes con falla en la extubación y como controles a los pacientes sin esta complicación. Se registraron variables demográficas, quirúrgicas, y post-quirúrgicas, y se realizó análisis univariado y multivariado (regresión logística) para determinar los factores de riesgo asociados a la falla en la extubación. Resultados: De un total de 107 pacientes, 26 pacientes tuvieron extubación fallida (24,3%). En el análisis univariado los factores asociados a extubación fallida fueron: mayor tiempo de ventilación mecánica postquirúrgico, desarrollar atelectasias, derrame pleural, quilotórax, tener otras comorbilidades respiratorias (apnea y traqueítis), y mayor tiempo de uso de morfina y midazolam. En el análisis multivariado, la presencia de quilotórax, otras comorbilidades respiratorias, y mayor tiempo de uso de midazolam fueron variables asociadas a extubación fallida (p<0,03). La extubación fallida no se asoció a mayor mortalidad. Conclusiones: La presencia de quilotórax, complicaciones respiratorias y uso de mida zolam prolongado deben considerarse para definir el momento de la extubación, con el objetivo de evitar su fracaso.

Abstract: Introduction: Hypoplastic left heart syndrome (HLHS) is the main cause of mortality due to congenital heart disea se. The Norwood surgery is the first procedure of the surgical staging process towards a single ventri cle physiology or Fontan-type operation and has a mortality rate of 10% to 30%. Extubation failure during the postoperative period occurs in up to 18% of these patients and is associated with increased mortality. Objective: To describe extubation failure rates and risk factors in pediatric patients with HLHS who underwent Norwood procedure. Patients and Method: Case-control study that included all the patients with HLHS managed with Norwood surgery at the Hospital Clínico de la Pontificia Universidad Catolica between January 2000 and February 2018. Cases and controls were defined as patients with extubation failure and as patients without this complication, respectively. The following variables were recorded demographic, surgical, and post-surgical ones, and univariate and multivariate analyses (logistic regression) were performed to determine risk factors associated with extubation failure. Results: Out of 107 patients, 26 of them presented extubation failure (24.3%). In the univariate analysis, longer mechanical ventilation time during the postsurgical period, atelectasis, pleural effusion, chylothorax, other respiratory morbidities (i.e. apneas and tracheitis), and longer infusion times of morphine and midazolam, all were associated with a higher extubation failure rate in this population. In the multivariable analysis, chylothorax, other respiratory comorbidities, and longer infusion time of midazolam remained associated with this complication, however, it was not associated with higher mortality. Conclusions: Chylothorax, respiratory comorbidities, and longer use of Midazolam should be addressed before planning airway extubation in order to avoid failure.

Caracterización clínico-epidemiológica de las enterocolitis necrosantes neonatales de siete hospitales públicos

Resumen Introducción: Enterocolitis necrosante (ECN) representa una elevada mortalidad y morbilidad post-quirúrgica, gastrointestinal y del neuro-desarrollo. Existe limitada información en Chile. Objetivo: Describir el comportamiento clínico/epidemiológico de recién nacidos que cursaron con ECN. Pacientes y Métodos: Estudio multicéntrico descriptivo de pacientes con ECN de siete hospitales de Santiago, Chile, durante el 2016. Se realizó estadística descriptiva y análisis univariable/multivariable (software SPSS v22). Resultados: Se recolectaron 75 casos. Mediana de edad al diagnóstico fue 11 días, el promedio de edad gestacional 29 semanas y peso de nacimiento 1.285 g. La incidencia fue 2,6 por 1.000/recién nacidos vivos y letalidad de 18,6%, mayor en ≤ 750 g, ≤ 25 semanas y ECN quirúrgica. Hubo aislamiento microbiológico en 45,3% y se utilizaron 19 distintos esquemas antimicrobianos empíricos para el tratamiento de ECN. El análisis multivariable mostró tendencia a que la ECN fuese quirúrgica en usuarios de catéter umbilical arterial, PCR > 10 mg/L y aislamiento microbiológico, y hubo tendencia a fallecer en usuarios de catéter umbilical arterial. Discusión: Es el primer estudio multicéntrico que recopila información de datos locales. La incidencia fue similar a la descrita en la literatura médica, en cambio la letalidad fue algo menor. No existen consensos del tratamiento antimicrobiano a utilizar. Con estos resultados esperamos avanzar en mejorar el diagnóstico y unificar tratamientos antimicrobianos, para reducir cifras de morbimortalidad.

Abstract Background: Necrotizing enterocolitis (NEC) presents high mortality and postoperative, gastrointestinal and neurodevelopmental morbidity. There is limited information about NEC in Chile. Aim: To describe the clinical/epidemiological behavior of newborns who underwent NEC. Methods: Multicenter descriptive study of patients with NEC from seven hospitals of Santiago, Chile, during 2016. Descriptive statistics and univariate/multivariate analysis were performed (SPSS v22 software). Results: 75 cases were collected. Median days of life at diagnosis was 11, gestational age was 29 weeks, birth weight 1,114 g. The incidence was 2.6 per 1,000 live newborns and mortality was 18.6%, higher in ≤ 750 g, ≤ 25 weeks and surgical NEC. There was 45.3% microbiological isolation and 19 different empirical antibiotic schemes were used for the treatment of NEC. The multivariate analysis showed a higher risk of surgery in umbilical arterial catheter users, CRP > 10 mg/L and positive microbiological isolation. The highest risk of death was in umbilical arterial catheter users. Discussion: This ie the first multicenter study that collects local data information. The incidence was similar to that found in medical reports but with a lower mortality. There is no consensus of antibiotic treatment to use. With these results we hope to advance in improving the diagnosis and unify antimicrobial treatments, to reduce morbidity and mortality figures.

Seguridad en vacunas: descripción de los eventos adversos notificados al sistema de vigilancia en Chile, 2014 a 2016 / Vaccine safety: description of the adverse events reported to the surveillance system in Chile, 2014 to 2016

Resumen Introducción: Los sistemas de vigilancia pasiva de los eventos supuestamente atribuidos a vacunación o inmu nización (ESAVI) permiten monitorizar efectos adversos (EA) conocidos y pesquisar EA infrecuentes. El objetivo de este estudio fue describir los ESAVI notificados en Chile entre los años 2014 y 2016. Material y Método: Estudio de vigilancia epidemiológica. Se realizó un análisis general y un sub-análisis para vacuna pentavalente. Se calculó la tasa de reporte (TR) global de ESAVI cada 100.000 dosis de vacunas, la TR de ESAVI considerados de interés y el odds ratio de reporte (ROR) de apneas para pentavalente. Resultados: El total de ESAVI notificados fue de 2.552 con una TR global de 9,13. Un 13,4% de los ESAVI fueron serios. La TR de eventos de interés fue en general menor a las tasas de referencia. La vacuna con mayor TR (44,3) fue pentavalente, con un ROR de apnea versus otras vacunas de 10,5 (IC 95% 3,77-29,47). Discusión: Este estudio entrega una visión general de los ESAVI notificados en Chile. La TR global fue similar a otras reportadas, pero las de eventos de interés fueron menores a las referencias internacionales. Se muestra una posible asociación entre apneas y vacuna pentavalente.

Background: Passive surveillance systems for adverse events following immunization (AEFI) allow the monitoring of known adverse effects (AE) and the investigation of infrequent AE. Aim: To describe the AEFI notified in Chile between 2014 and 2016. Methodology: This was a study of epidemiological surveillance. A general analysis of AEFI and sub-analysis for pentavalent vaccine was carried out. It was calculated the global reporting rate of AEFI every 100,000 doses of vaccines, the reporting rate of AEFI considered of interest and the odds ratio of reporting (ROR) of apneas for pentavalent. Results: The total AEFI reported was 2,552 with a global reporting rate of 9,13. 13.4% of AEFI were serious. The vaccine reporting rate of events of interest was generally lower than the reference rates. The vaccine with the highest reporting rate (44.3) was pentavalent, with an ROR of apnea versus other vaccines of 10.5 (95% CI 3.77-29.47). Discussion: This study provides an overview of the AEFI notified in Chile. The global reporting rate was similar to other studies, but those of events of interest were lower than international references. A possible association between apnea and pentavalent vaccine is shown.

Cesación de tabaquismo en embarazo / Smoking cessation during pregnancy

In Chile, women of childbearing age and pregnant women have a high prevalence of smoking. Tobacco use during pregnancy has antenatal effects (e.g. spontaneous abortion, stillbirth) and is a risk factor for infant morbidity and mortality. All women of childbearing age should be encouraged to stop smoking, and women who are already pregnant should be continuously encouraged to stop smoking throughout their pregnancy, from the earliest possible moment to the postpartum period. We present a set of background information and recommendations for smoking cessation in pregnant women, based on international guidelines on this topic.

En Chile, las mujeres en edad fértil y las embarazadas presentan una alta prevalencia de tabaquismo. El consumo de tabaco durante el embarazo tiene efectos antenatales (por ejemplo, aborto espontáneo, mortinatalidad) y es un factor de riesgo de morbilidad y mortalidad infantil. Todas las mujeres en edad fértil deben ser alentadas a dejar de fumar, y las mujeres que ya están embarazadas deben ser alentadas a dejar de fumar continuamente durante todo el embarazo, desde el momento más precoz posible hasta el período posterior al parto. Se presenta un conjunto de antecedentes y recomendaciones para la cesación de tabaquismo en embarazadas, basadas en guías internacionales sobre este tema.