Consistency between POLARS and LARS scores regarding the incidence of low anterior resection syndrome in a Chilean population undergoing rectal surgery secondary to cancer in a high-volume hospital

AIM

The aim of this work was to evaluate the concordance between the low anterior resection syndrome (LARS) and preoperative LARS (POLARS) scores regarding the incidence of LARS in a Chilean population undergoing rectal surgery for cancer in a high-volume hospital.

METHOD

The LARS score questionnaire, following telephone requests, was used to determine the presence and severity of LARS. The POLARS score was calculated based on variables described previously. Correlations and qualitative and quantitative concordance were evaluated using Spearman's correlation coefficient, the kappa coefficient and the Bland-Altman plot with Lin's concordance correlation coefficient.

RESULTS

A total of 120 patients met the inclusion criteria: 37.5% underwent neoadjuvant radiotherapy, 61% underwent total mesorectal excision (TME) and 51.6% underwent ostomy. A total of 49% of patients did not present with LARS, whereas 28% had major LARS. The correlation between scales was poor, with a fair qualitative concordance to determine the presence/absence of LARS and a slight qualitative concordance to determine the degree of the intensity. The quantitative concordance was poor.

CONCLUSION

In the Chilean population, concordance between the LARS and POLARS scores was qualitatively fair to determine the presence/absence of the disease and qualitatively slight to determine the degree of intensity. We do not suggest using the POLARS score in the perioperative period in the Chilean population deliberately, as the score may help to determine the presence/absence of LARS but cannot determine its degree of intensity. Additional evaluations are required to determine the factors contributing to the degree of agreement between the scales.

Risk factors for readmission after a cholecystectomy: a case-control study

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.

Factors associated to the duration of COVID-19 lockdowns in Chile

During the first year of the COVID-19 pandemic, several countries have implemented non-pharmacologic measures, mainly lockdowns and social distancing, to reduce the spread of the SARS-CoV-2 virus. These strategies varied widely across nations, and their efficacy is currently being studied. This study explores demographic, socioeconomic, and epidemiological factors associated with the duration of lockdowns applied in Chile between March 25th and December 25th, 2020. Joint models for longitudinal and time-to-event data were used. In this case, the number of days under lockdown for each Chilean commune and longitudinal information were modeled jointly. Our results indicate that overcrowding, number of active cases, and positivity index are significantly associated with the duration of lockdowns, being identified as risk factors for longer lockdown duration. In short, joint models for longitudinal and time-to-event data permit the identification of factors associated with the duration of lockdowns in Chile. Indeed, our findings suggest that demographic, socioeconomic, and epidemiological factors should be used to define both entering and exiting lockdown.

[What is the best method for estimating final height in patients with precocious puberty?]

Central precocious puberty is the premature activation of the hypothalamic-pituitary-gonadal axis, leading to an early epiphyseal fusion and, in many cases, heights below the genetic target. Therefore, a proper adult stature prediction is essential for the treatment decision.

OBJECTIVE

To compare the concordance of final height using height prediction made by two validated methods versus the ge netic target height in girls who consulted due to central precocious puberty.

PATIENTS AND METHOD

Retrospective, non-concurrent cohort study including 93 girls with central precocious puberty, who were not treated with LHRH analogs and had reached their final adult height. The data was obtained from the clinical records. To predict height, the Bayley-Pinneau method and the Roche-Wainer- Thissen method were applied, and the results were compared with the genetic target height. The concordance between the estimated final height and the final height obtained was evaluated using the Bland-Altman method.

RESULTS

When comparing the final height obtained with that predicted by the Bayley-Pinneau method, there was a mean difference of 1.01 cm, and using the Rocke-Wainer- Thissen method, there was a difference of +0.96 cm. The calculation of the genetic target height showed a difference of +0.05 cm with respect to the final height.

CONCLUSION

The prediction of height made by the Bayley-Pinneau and Roche-Wainer-Thissen methods was adequate and, contrary to expectations, it was similar to the calculation of the genetic target height that does not use the age of bone maturation. This also presented better concordance and less dispersion of the results with respect to the final height obtained.

[Seasonal variation of acute myocardial infarction deaths in Chile]

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.

[Temporal association between the circulation of respiratory viruses and hospitalizations due to Kawasaki disease]

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.

[Consolidated recommendations of the Advisory Committee on Vaccines and Immunization Strategies- on prioritizing COVID-19 vaccination]

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.

Insulin resistance and liver histopathology in metabolically unhealthy subjects do not correlate with the hepatic abundance of NLRP3 inflammasome nor circulating IL-1β levels

INTRODUCTION

Systemic chronic low-grade inflammation has been linked to insulin resistance (IR) and non-alcoholic steatohepatitis (NASH). NOD-like receptor protein 3 (NLRP3) inflammasome and its final product, interleukin (IL)-1β, exert detrimental effects on insulin sensitivity and promote liver inflammation in murine models. Evidence linking hepatic NLRP3 inflammasome, systemic IR and NASH has been scarcely explored in humans. Herein, we correlated the hepatic abundance of NLRP3 inflammasome components and IR and NASH in humans.

RESEARCH DESIGN AND METHODS

Metabolically healthy (MH) (n=11) and metabolically unhealthy (MUH) (metabolic syndrome, n=21, and type 2 diabetes, n=14) subjects were recruited. Insulin sensitivity (homeostatic model assessment of IR (HOMA-IR) and Oral Glucose Sensitivity (OGIS₁₂₀)), glycemic (glycated hemoglobin), and lipid parameters were determined by standard methods. Plasma cytokines were quantified by Magpix. Hepatic NLRP3 inflammasome components were determined at the mRNA and protein levels by reverse transcription-quantitative PCR and western blot, respectively. Liver damage was assessed by histological analysis (Non-alcoholic Fatty Liver Disease Activity Score (NAS) and Steatosis, Inflammatory Activity, and Fibrosis (SAF) scores). IR and liver histopathology were correlated with NLRP3 inflammasome components as well as with liver and plasma IL-1β levels.

RESULTS

Body Mass Index, waist circumference, and arterial hypertension frequency were significantly higher in MUH subjects. These patients also had increased high-sensitivity C reactive protein levels compared with MH subjects. No differences in the plasma levels of IL-1β nor the hepatic content of Nlrp3, apoptosis-associated speck-like (Asc), Caspase-1, and IL-1β were detected between MUH and MH individuals. MUH subjects had significantly higher NAS and SAF scores, indicating more severe liver damage. However, histological severity did not correlate with the hepatic content of NLRP3 inflammasome components nor IL-1β levels.

CONCLUSION

Our results suggest that NLRP3 inflammasome activation is linked neither to IR nor to the inflammatory status of the liver in MUH patients.

Safety and immunogenicity evaluation of recombinant BCG vaccine against respiratory syncytial virus in a randomized, double-blind, placebo-controlled phase I clinical trial

BACKGROUND

Respiratory syncytial virus (RSV) is responsible for most respiratory tract infections and hospitalizations in infants and represents a significant economic burden for public health. The development of a safe, effective, and affordable vaccine is a priority for the WHO.

METHODS

We conducted a double-blinded, escalating-dose phase 1 clinical trial in healthy males aged 18-50 years to evaluate safety, tolerability, and immunogenicity of a recombinant Mycobacterium bovis BCG vaccine expressing the nucleoprotein of RSV (rBCG-N-hRSV). Once inclusion criteria were met, volunteers were enrolled in three cohorts in an open and successive design. Each cohort included six volunteers vaccinated with 5 × 10³, 5 × 10⁴, or 1 × 10⁵ CFU, as well as two volunteers vaccinated with the full dose of the standard BCG vaccine. This clinical trial (clinicaltrials.gov NCT03213405) was conducted in Santiago, Chile.

FINDINGS

The rBCG-N-RSV vaccine was safe, well-tolerated, and no serious adverse events related to the vaccine were recorded. Serum IgG-antibodies directed against Mycobacterium and the N-protein of RSV increased after vaccination, which were capable of neutralizing RSV in vitro. Additionally, all volunteers displayed increased cellular response consisting of IFN-γ and IL-2 production against PPD and the N-protein, starting at day 14 and 30 post-vaccination respectively.

INTERPRETATION

The rBCG-N-hRSV vaccine had a good safety profile and induced specific cellular and humoral responses.

FUNDING

This work was supported by Millennium Institute on Immunology and Immunotherapy from Chile (P09/016), FONDECYT 1190830, and FONDEF D11E1098.

Road traffic accidents of the elderly in Chile between the years 2008-2017: A register-based descriptive study

Objective

To determine whether Chilean elderly persons have higher rates of traffic incidents, resulting in death or injury, compared to non-older adults between 2008 and 2017.

Method

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

Older adults 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 the elderly, 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

The elderly presented greater vulnerability to die in a traffic accident. 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 in the elderly.

[Clinical and epidemiological characterization of healthcare acquired influenza in critical ill patients]

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.

Towards Inpainting and Denoising Latent Fingerprints: A Study on the Impact in Latent Fingerprint Identification

In this paper, we provide a study about the impact of the most prominent inpainting and denoising solutions on the latent fingerprint identification. From an in-depth analysis, we show how some of the analyzed inpainting and denoising solutions can improve up 63% for Rank-1 and 26% for Rank-20 the fingerprint identification rates when state-of-the-art minutiae extractors are used. Nevertheless, it is necessary to create new denoising and inpainting solutions that are specifically built to deal with latent fingerprints and their associated issues.

What the Appearance Channel from Two-Stream Architectures for Activity Recognition Is Learning?

The automatic recognition of human activities from video data is being led by spatio-temporal Convolutional Neural Networks (3D CNNs), in particular two-stream architectures such as I3D that reports the best accuracy so far. Despite the high performance in accuracy of this kind of architectures, very little is known about what they are really learning from data, resulting therefore in a lack of robustness and explainability. In this work we select the appearance channel from the I3D architecture and create a set of experiments aimed at explaining what this model is learning. Throughout the proposed experiments we provide evidence that this particular model is learning the texture of the largest area (which can be the activity or the background, depending on the distance from the camera to the action performed). In addition, we state several considerations to take into account when selecting the training data to achieve a better generalization of the model for human activity recognition.

Not All Swear Words Are Used Equal: Attention over Word n-grams for Abusive Language Identification

The increasing propagation of abusive language in social media is a major concern for supplier companies and governments because of its negative social impact. A large number of methods have been developed for its automatic identification, ranging from dictionary-based methods to sophisticated deep learning approaches. A common problem in all these methods is to distinguish the offensive use of swear words from their everyday and humorous usage. To tackle this particular issue we propose an attention-based neural network architecture that captures the word n-grams importance according to their context. The obtained results in four standard collections from Twitter and Facebook are encouraging, they outperform the \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$F_1$$\end{document} scores from state-of-the-art methods and allow identifying a set of inherently offensive swear words, and others in which its interpretation depends on its context.

Towards Dendrite Spherical Neurons for Pattern Classification

This paper introduces the Dendrite Spherical Neuron (DSN) as an alternative to the Dendrite Ellipsoidal Neuron (DEN), in which hyperspheres group the patterns from different classes instead of hyperellipses. The reasoning behind DSN is simplifying the computation of DEN architecture, where a centroid and covariance matrix are two dendritic parameters, whereas, in DSN, the covariance matrix is replaced by a radius. This modification is useful to avoid singular covariance matrices since DEN requires measuring the Mahalanobis distance to classify patterns. The DSN training consists of determining the centroids of dendrites with the k-means algorithm, followed by calculating the radius of dendrites as the mean distance to the two nearest centroids, and finally determining the weights of a softmax function, with Stochastic Gradient Descent, at the output of the neuron. Besides, the Simulated Annealing automatically determines the number of dendrites that maximizes the classification accuracy. The DSN is applied to synthetic and real-world datasets. The experimental results reveal that DSN is competitive with Multilayer Perceptron (MLP) networks, with less complex architectures. Also, DSN tends to outperform the Dendrite Morphological Neuron (DMN), which uses hyperboxes. These findings suggest that the DSN is a potential alternative to MLP and DMN for pattern classification tasks.

Analysis of Repair Costs of Scholar Buildings Affected by Earthquakes Using Data Mining. Case Study: Earthquakes of 2017 in Mexico

Earthquakes are events that cannot be predicted. However, when they occur, devastating consequences are shown in economic, social and structural areas, among others. In this paper, the mining of association rules is carried out in order to estimate the repair cost required by schools affected during the earthquakes of September 7th and 19th, of 2017 in Mexico. For that, we use the public data collected by the Mexican FONDEN.

Restoration of Range Images by the Gaussian Pyramid Method, Testing Different Interpolation Techniques to Select the Best Performance

The inpainting method implemented in this work was used to estimate the missing information in a range image from a single image, achieved independence of the RGB image of the scene or multiple range images to perform the restoration. The proposal is based on improving the results of restoring range images using the Gaussian Pyramid method. This, finding the best interpolation technique to use in this method to estimate the missing information. Different interpolation techniques were computed and applied in order to know the best option to implement. This is carried out considering the amount of information that can be estimated, processing time and the total of information missing in the image to be restored. The method was tested with five different databases, one of which was created specifically for this work. These databases include different interior scenarios with several objects. A qualitative and quantitative comparative analysis of the obtained results was performed.

A Preliminary Study on Score-Based Hyper-heuristics for Solving the Bin Packing Problem

The bin packing problem is a widespread combinatorial problem. It aims at packing a set of items by using as few bins as possible. Among the many available solving methods, approximation ones such as heuristics have become popular due to their reduced cost and generally acceptable solutions. A further step in this regard is given by hyper-heuristics, which literature usually defines as “high-level heuristics to choose heuristics”. Hyper-heuristics choose one suitable heuristic from a set of available ones, to solve a particular portion of an instance. As the search progresses, heuristics can be exchanged, adapting the solution process to the current problem state under exploration. In this work, we describe how to generate and use hyper-heuristics that keep a record of the scores achieved by individual heuristics on previously solved bin packing problem instances in the form of rules. Then, hyper-heuristics manage those scores to estimate the performance of such heuristics on unseen instances. In this way, the previous actions of the hyper-heuristics determine which heuristic to use on future unseen cases. The experiments conducted under different scenarios yield promising results where some of the hyper-heuristics produced outperform isolated heuristics.

Comparison of Recurrent Neural Networks for Wind Power Forecasting

Integrating wind power to the electrical grid is complicated due to the stochastic nature of the wind, which makes its prediction a challenging task. Then, it is important to devise forecasting tools to support this task. For example, a network that integrates an Echo State Network architecture and Long Short-Term Memory blocks as hidden units (ESN+LSTM) has been proposed, showing good performance against a physical model. This paper proposes to compare this network versus Echo State Network (ESN) and Long Short-Term Memory (LSTM), to forecast wind power from 1 to 24 h ahead. Results show than the ESN+LSTM model outperforms the performance reached for ESN and LSTM, in terms of MSE, MAE, and the metrics used in the Taylor diagram. In addition, we observe that the advantage of this network is statistically significant during the first moments of the forecast horizon, in terms of T-test and Wilcoxon-test.

New Method for Extreme Color Detection in Images

In image processing and computer vision, it is common to find applications, in which it is necessary to detect reference points characterized by extreme color, i.e., a primary color RGB or complementary CMY with very high saturation. Thus, there are cases in which a certain class of objects can be distinguished according to their characteristic extreme color, which can be used as landmarks or to identify objects. Therefore, there is an interest in identifying landmarks characterized by extreme colors. In this paper, a new method for detecting objects with an extreme color is introduced and compared with other approaches found in the literature. The methods are analyzed and compared using a color palette in which a transition between R, G, B, C, M and Y colors is generated. The results obtained show that the methods studied allow the specific colors to be adequately discriminated, while the proposed method is the only one that allows the full range of extreme colors R, G, B, C, M and Y to be detected, being more selective than the others, by taking practically the areas corresponding to each color separately .

A Simple Methodology for 2D Reconstruction Using a CNN Model

In recent years, Deep Learning research have demonstrated their effectiveness in digital image processing, mainly in areas with heavy computational load. Such is the case of aerial photogrammetry, where the principal objective is to generate a 2D map or a 3D model from a specific terrain. In these topics, high-efficiency in visual information processing is demanded. In this work we present a simple methodology to build an orthomosaic, our proposal is focused in replacing traditional digital imagen processing using instead a Convolutional Neuronal Network (CNN) model. The dataset of aerial images is generated from drone photographs of our university campus. The method described in this article uses a CNN model to detect matching points and RANSAC algorithm to correct feature’s correlation. Experimental results show that feature maps and matching points obtained between pair of images through a CNN are comparable with those obtained in traditional artificial vision algorithms.

Automatic Estrus Cycle Identification System on Female Dogs Based on Deep Learning

Vaginal cytology is a complementary economic method and of simple realization, an indicative to determine in which stage of the estrous cycle the dog is, to achieve a higher fertility and fertility rate. This method is based on determining the type and quantity of cells of the different stages of the estrous cycle, since the hormonal changes that the vaginal mucosa undergoes during the estrous cycle are shown in the morphology of its epithelial cells. The canine female in her reproductive life goes through different phases of activity and hormonal rest that are repeated cyclically. This is called the estrous cycle and consists of 4 stages: proestrus, estrus, diestrus and anestrus. The interpretation of vaginal cytology’s, is a process to which a considerable amount of time is dedicated by its observation in the microscope and the same interpretation by the doctor which can become subjective and poorly performed, causing economic losses for the owners. Therefore, this work proposes an automatic system that will identify six types of cells and the quantity of them in the glass slide, based on a Faster R-CNN to determine in which stage of the estrous cycle the dog is. Our results show an accuracy of 91.6%. The proposed system will improve the efficiency and speed of cytology’s to decreased from 1 h approximately to just a few seconds.

A Novel Set of Moment Invariants for Pattern Recognition Applications Based on Jacobi Polynomials

A novel set of moment invariants for pattern recognition applications, which are based on Jacobi polynomials, are presented. These moment invariants are constructed for digital images by means of a combination with geometric moments, and are invariant in the face of affine geometric transformations such as rotation, translation and scaling, on the image plane. This invariance is tested on a sample of the MPEG-7 CE-Shape-1 dataset. The results presented show that the low-order moment invariants indeed possess low variance between images that are affected by the mentioned geometric transformations.

RISK FACTORS FOR SEVERE POSTOPERATIVE COMPLICATIONS AFTER GASTRECTOMY FOR GASTRIC AND ESOPHAGOGASTRIC JUNCTION CANCERS

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.

[Development of communicative abilities in infants with Down syndrome after systematized training in gestural communication]

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.

A Single-Nucleotide Polymorphism of αVβ₃ Integrin Is Associated with the Andes Virus Infection Susceptibility

The AndesOrthohantavirus (ANDV), which causes the hantavirus cardiopulmonary syndrome, enters cells via integrins, and a change from leucine to proline at residue 33 in the PSI domain (L33P), impairs ANDV recognition. We assessed the association between this human polymorphism and ANDV infection. We defined susceptible and protective genotypes as “TT” (coding leucine) and “CC” (coding proline), respectively. TT was present at a rate of 89.2% (66/74) among the first cohort of ANDV cases and at 60% (63/105) among exposed close-household contacts, who remained uninfected (p < 0.05). The protective genotype (CC) was absent in all 85 ANDV cases, in both cohorts, and was present at 11.4% of the exposed close-household contacts who remained uninfected. Logistic regression modeling for risk of infection had an OR of 6.2–12.6 (p < 0.05) in the presence of TT and well-known ANDV risk activities. Moreover, an OR of 7.3 was obtained when the TT condition was analyzed for two groups exposed to the same environmental risk. Host genetic background was found to have an important role in ANDV infection susceptibility, in the studied population.

Clinical profile of children with diabetic ketoacidosis in fifteen years of management in a Critical Care Unit

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.

1264. Healthcare-Acquired Influenza in Critical Ill Patients

Background

Healthcare-associated infections (HAIs) increases morbidity and mortality. During 2014, at Hospital Clínico Red de Salud UC CHRISTUS (RS-UCCH), was estimated that 15% of viral respiratory infections were acquired during hospitalization, and influenza was the main etiologic agent. The aim of this study was to obtain clinical characterization of HAIs due to influenza virus in patients hospitalized in critical care units (CCU) and special care units (chronic patients who need hospitalized nurse care).

Methods

Descriptive study of CCU and special care patients with hospital acquired influenza during 2014–2017. HAI due to influenza was defined as: symptoms onset and/or positive influenza PCR ≥48 hours after hospital admission, without previous respiratory symptoms or with negative PCR.

Results

22 patients with median age of 74 years old were identified, only three pediatric cases. The average time of acquired influenza was at 13th day of hospitalization. In 77% Influenza A was the only agent detected and 27% had respiratory co-infection. Thirteen (59%) were previously hospitalized in CCU, but only 2 (15%) due to respiratory problems. Nineteen patients (86%) presented comorbidity such as arterial hypertension (59%), chronic kidney disease (18%), and immunosuppression (18%). Half of them had a decompensation, mainly respiratory, associated to influenza infection. The observed lethality was 18%. Among all the influenza HAI, 59% occurred in unvaccinated patients, although 46% of them met criteria for vaccination recommendation.

Conclusion

HAI due to influenza occurred in chronic, older, and unvaccinated patients. Education about HAIs and continuing high vaccination coverage must be a priority.

Disclosures

All authors: No reported disclosures.

[High frequency of dyslipidemia in children and adolescents with Down Syndrome]

Down Syndrome (DS) shows an increased risk of chronic diseases, associated to higher morbidity and mortality for cardiovascular disease. Some studies have shown a worse lipid profile in children with DS, however, until now there is no recommendation for screening for dyslipidemia in these subjects.

OBJECTIVE

To describe the frequency of dyslipidemia in a population of Chilean children and adolescents with DS.

PATIENTS AND METHOD

Retrospective study, including patients with DS, aged 2 to 18 years, who participated in a special health care program for people with DS in Health Net UC CHRISTUS, between 2007 and 2015. Patients who had a lipid profile between their routine laboratory tests were included. Clinical characteristics, relevant comorbidities, malformations, medications, nutritional status and pubertal development were obtained from medical records. Diagnosis of dyslipidemia was considered according to the criteria of the NHLBI 2011.

RESULTS

The medical records of 218 children with DS were revised, 58,3% had some type of dyslipidemia. The most frequent single dyslipidemias were low HDL Chol (15,1%) and hypertriglyceridemia (12,8%). Atherogenic dyslipidemia (low HDL plus hypertriglyceridemia) was the most frequent combined dyslipidemia (13,3%). The occurrence of atherogenic dyslipidemia was not associated with overnutrition and obesity.

CONCLUSIONS

A high frequency of dyslipidemia was found in Chilean children and adolescents with DS. Our results make us suggest that lipid profile should be performed early in all patients with DS, independent of the presence of risk factors for dyslipidemia.

[Heavy menstrual bleeding affects quality of life in adolescents]

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.

Ambulatory blood pressure monitoring in school children with a history of extreme prematurity

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.

[Statement of the Advisory Committee on Immunizations of Sociedad Chilena de Infectología about outbreaks of hepatitis A in Chile]

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.

Volume Management by Renal Replacement Therapy in Acute Kidney Injury

Management of fluid balance is one of the basic but vital tasks in the care of critically ill patients. Hypovolemia results in a decrease in cardiac output and tissue perfusion and may lead to progressive multiple organ dysfunction, including the development of acute renal injury (AKI). However, in an effort to reverse pre-renal oliguria, it is not uncommon for patients with established oliguric acute renal failure, particularly when associated with sepsis, to receive excessive fluid resuscitation, leading to fluid overload. In patients with established oliguria, renal replacement therapy may be required to treat hypervolemia. Safe prescription of fluid loss during RRT requires intimate knowledge of the patient's underlying condition, understanding of the process of ultrafiltration and close monitoring of the patient's cardiovascular response to fluid removal. To preserve tissue perfusion in patients with AKI, it is important that RRT be prescribed in a way that optimizes fluid balance by removing fluid without compromising the effective circulating fluid volume. In patients who are clinically fluid overloaded, it is equally important that the amount of fluid removed be as exact as possible. Fluid balance errors can occur as a result of inappropriate prescription, operator error or machine error. Some CRRT machines have potential for significant fluid errors if alarms can be overridden. Threshold values for fluid balance error have been developed which can be used to predict the severity of harm. It is important that RRT education programs emphasize the risk associated with fluid balance errors and with overriding machine alarms.

Fluids for Prevention and Management of Acute Kidney Injury

Fluids are the only known method of attenuating renal injury. Furthermore, whether for hydration, resuscitation or renal replacement therapy, fluid prescriptions must be tailored to the fluid and electrolyte, cardiovascular status and residual renal function of the patient. Different fluids have significantly different effects both on volume expansion as well as on the electrolyte and acid-base balance; while controversial, different fluids may even influence renal function differently. This systematic review focuses on fluids for prevention and management of acute kidney injury. We have reviewed the available evidence and have made recommendations for clinical practice and future studies.

Infant morbidity and mortality attributable to prenatal smoking in Chile

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 full-term 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.

[Strategies to protect the newborn and infants under 6 months of age against pertussis: Statement of the Advisory Committee for Immunizations of the Chilean Infectious Diseases Society]

In recent years there have been Pertussis outbreaks not seen in the last 50 years affecting adults, adolescents and children and causing deaths in young unvaccinated infants. In Chile an outbreak of Pertussis started in year 2011, leaving 16 infants less than 3 months dead during this year, twice the number seen in a non epidemic year. These children were infected before receiving the programmatic vaccines indicated at 2, 4 and 6 months of age, usually from close contacts, especially their mothers. Pertussis control has not been possible for several reasons, such as limited immunity duration of available vaccines and their poor impact on nasopharyngeal carriage, situation that keeps the agent's circulation and transmission, condition often asymptomatic or unrecognized. Additionally, the use of acellular vaccines appears to be a determining factor because they induce an immune response with poor immune memory and consequently a short time duration. The acellular vaccines with reduced antigen content, available for adolescents and adults, has allowed the evaluation of various strategies but none has succeeded in reducing infant mortality. Recently a new strategy of vaccinating pregnant women against Pertussis in the second or third semester has shown remarkable results reducing up to 90% infant deaths due to Pertussis infection. This strategy prevents mother's infection avoiding child infection through respiratory droplets and also provides the child with antibodies from placental transmission. Improved pertussis vaccines are required, in the meantime the Committee considers that the pregnant immunization strategy, between the 27 and 36 weeks, with acellular pertussis vaccine should be included in our national vaccine program.

[Morbidity profile among adolescents with Down syndrome]

BACKGROUND

There is a paucity of information about morbidity and mortality of adolescents with Down syndrome (DS).

AIM

To describe morbidity and mortality of a cohort of Chilean adolescents with DS.

MATERIAL AND METHODS

Review of electronic clinical records of 67 ambulatory patients with DS aged 10 to 20 years (37 women), seen between the years 2007 and 2014 in outpatient clinics of a University hospital.

RESULTS

The mean age at the last consultation was 13 ± 3 years. Ninety-eight percent of patients had a chronic condition: 37.1% where overweight or obese, 58.2% had a congenital heart disease, 11.9% where being evaluated or had the diagnosis of autism and 44.8% had hypothyroidism. Pubertal development was consistent with chronologic age in 93.7% of patients. In three patients puberty had been suppressed. In women, average age of menarche was 12.2 ± 1.1 years. There were no deaths reported.

CONCLUSIONS

There was a high rate of comorbidities in this group of adolescents with DS, most of them with frequencies comparable to those reported in literature.