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Quinones L.A.,University of Chile | Lavanderos M.A.,University of Chile | Cayun J.P.,University of Chile | Garcia-Martin E.,University of Extremadura | And 19 more authors.
Current Drug Metabolism | Year: 2014

Pharmacogenetics and Pharmacogenomics areas are currently emerging fields focused to manage pharmacotherapy that may prevent undertreatment while avoiding associated drug toxicity in patients. Large international differences in the awareness and in the use of pharmacogenomic testing are presumed, but not well assessed to date. In the present study we review the awareness of Latin American scientific community about pharmacogenomic testing and the perceived barriers for their clinical application. In order to that, we have compiled information from 9 countries of the region using a structured survey which is compared with surveys previously performed in USA and Spain. The most relevant group of barriers was related to the need for clear guidelines for the use of pharmacogenomics in clinical practice, followed by insufficient awareness about pharmacogenomics among clinicians and the absence of regulatory institutions that facilitate the use of pharmacogenetic tests. The higher ranked pairs were TPMT/thioguanine, TPMT/azathioprine, CYP2C9/warfarin, UGT1A1/irinotecan, CYP2D6/amitriptiline, CYP2C19/citalopram and CYP2D6/clozapine. The lower ranked pairs were SLCO1B1/simvastatin, CYP2D6/metoprolol and GP6D/chloroquine. Compared with USA and Spanish surveys, 25 pairs were of lower importance for Latin American respondents. Only CYP2C19/esomeprazole, CYP2C19/omeprazole, CYP2C19/celecoxib and G6PD/dapsone were ranked higher or similarly to the USA and Spanish surveys. Integration of pharmacogenomics in clinical practice needs training of healthcare professionals and citizens, but in addition legal and regulatory guidelines and safeguards will be needed. We propose that the approach offered by pharmacogenomics should be incorporated into the decision-making plans in Latin America. © 2014 Bentham Science Publishers.


De La Maza V.,Hospital Luis Calvo Mackenna | Simian D.,Research Subdirection | Castro M.,Research Subdirection | Torres J.P.,Hospital Luis Calvo Mackenna | And 6 more authors.
Pediatric Infectious Disease Journal | Year: 2015

Background: Early administration of antimicrobial (AM) is relevant in children with cancer, fever and neutropenia (FN). The recommendation is to administer the first dose of AM within the first hour of hospital admission. Our aims were to determine the time from the moment that a child with FN is admitted to the hospital until they receive their first dose of AM and to determine the association with clinical outcomes. Methods: This prospective, multicenter study evaluated the time elapsed from the admission to the first dose of AM, comparing this variable by admitting hospital and presentation location (Emergency Department/Oncology Units) and evaluating the clinical outcomes by the following variables: days of fever, days of hospitalization, hypotension, transfer to intensive care unit, sepsis and mortality. Results: A total of 226 children with 388 episodes of FN were enrolled from 5 hospitals (July 2012-April 2014). The median time between hospital admission and administration of the first dose of AM was 132 minutes (interquartile range: 60-246 minutes). The median time to AM administration was significantly different between hospitals (70 vs. 200 minutes, P < 0.0001) and between presentation locations (Emergency Department vs. Oncology Units, median: 200 vs. 100 minutes, P < 0.0001). Twenty-five percentage of children received AM within 1 hour of admission. The administration of AM after 60 minutes was not associated with worse outcomes. Conclusions: Time to AM administration was longer than the recommendation. The findings described provide an opportunity to identify gaps and implement programs aimed at improving the equity and excellence of care in children with cancer and FN. © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Ramirez A.E.,Dr Luis Calvo Mackenna Hospital | Soto C.A.,University of Santiago de Chile | Nunez F.J.,University of Chile | Briones C.A.,Dr Luis Calvo Mackenna Hospital | And 2 more authors.
Additive Manufacturing | Year: 2016

Soft tissue defects of the sacroiliac area, usually can be covered by local flaps. However, for more complex defects, free flap transfers became necessary. We report a case of reconstruction with a free anterolateral thigh (ALT) perforator flap for coverage of a sacroiliac bone exposure in a child. A six-years-old boy, suffered a car accident, resulting in pelvic and sacral fractures, as well as degloving injuries of the left thigh, buttocks, and trunk. The patient evolved with an unstable scar over the sacroiliac region with bone exposure. ALT free flap was performed. Left superior gluteal vessels were used as the recipient vessels. A stable coverage was achieved without complications. This is the first case reported of a free ALT perforator flap for sacroiliac coverage in the pediatric population. In cases of complex reconstruction in children, free perforator flap is a safe choice and should be considered in the algorithm of treatment. © 2016 The Authors


Morovic C.G.,Dr Luis Calvo Mackenna Hospital | Morovic C.G.,Pediatric Plastic Surgery Unit | Morovic C.G.,University of Chile | Searle S.,University of Santiago de Chile | And 2 more authors.
Journal of Craniofacial Surgery | Year: 2010

The use of a local island flap, designed with retroauricular skin, is an excellent, simple, and reproducible innovation to the classic microtia ear reconstruction, allowing adequate coverage of the cartilage framework, specifically of the conchal area, sparing tense skin closure, reducing skin suffering and necrosis, with a better aesthetic result achieving the naturally depressed concha aspect. The flap design and surgical technique is described. This flap was used in 13 consecutive microtia ear reconstructions in our unit, no complications were encountered, and aesthetic results were excellent. Copyright © 2010 by Mutaz B. Habal, MD.


Morovic C.G.,Dr Luis Calvo Mackenna Hospital | Morovic C.G.,Pediatric Plastic Surgery Unit | Morovic C.G.,University of Chile | Florin C.,Dr Luis Calvo Mackenna Hospital | And 2 more authors.
Journal of Craniofacial Surgery | Year: 2011

Parotid fistulae are a very infrequent complication after ear reconstruction in microtia when the local conditions are favorable. We report 2 cases of salival fistulae after microtic ear reconstruction. Timing of the diagnosis is important to decide the treatment. We recommend conservative management by restricted citric diet in early postoperative salival fistulae and Botox injections in the case that it persists. Copyright © 2011 by Mutaz B. Habal, MD.


Vaccari C.M.,University of Genoa | Romanini M.V.,University of Genoa | Musante I.,University of Genoa | Tassano E.,Instituto Giannina Gaslini | And 9 more authors.
BMC Medical Genetics | Year: 2014

Background: Poland Syndrome (PS) is a rare disorder characterized by hypoplasia/aplasia of the pectoralis major muscle, variably associated with thoracic and upper limb anomalies. Familial recurrence has been reported indicating that PS could have a genetic basis, though the genetic mechanisms underlying PS development are still unknown.Case presentation: Here we describe a couple of monozygotic (MZ) twin girls, both presenting with Poland Syndrome. They carry a de novo heterozygous 126 Kbp deletion at chromosome 11q12.3 involving 5 genes, four of which, namely HRASLS5, RARRES3, HRASLS2, and PLA2G16, encode proteins that regulate cellular growth, differentiation, and apoptosis, mainly through Ras-mediated signaling pathways.Conclusions: Phenotype concordance between the monozygotic twin probands provides evidence supporting the genetic control of PS. As genes controlling cell growth and differentiation may be related to morphological defects originating during development, we postulate that the observed chromosome deletion could be causative of the phenotype observed in the twin girls and the deleted genes could play a role in PS development. © 2014 Vaccari et al.; licensee BioMed Central Ltd.


Romanini M.V.,Dr Luis Calvo Mackenna Hospital | Vidal C.,Dr Luis Calvo Mackenna Hospital | Godoy J.,Dr Luis Calvo Mackenna Hospital | Morovic C.G.,Dr Luis Calvo Mackenna Hospital
Journal of Plastic, Reconstructive and Aesthetic Surgery | Year: 2013

Background/purpose Poland syndrome (PS) is a congenital anomaly of the thoracic wall characterised by a variable degree of unilateral agenesis of pectoralis major and minor muscles associated with ipsilateral breast, rib and upper-arm anomalies. In female patients, breast reconstruction is particularly challenging because of cranial pectoralis muscle defects and partial or complete breast agenesis. Different techniques have been used to treat the thoracic anomaly, including the positioning of an implant, fat transfer or latissimus dorsi transposition, but in some cases these techniques are not feasible resulting in a poor reconstruction. Methods We present our experience in correction of the chest anomaly of PS in a teenage population by using a pedicled laparoscopically harvested omental flap (LOF) to cover a pectoral or breast prosthesis. Procedures were performed by a surgical team which included experienced plastic surgeons and general paediatric surgeons. Preoperative endocrinological and psychological evaluation helped to determine the best timing for the correction. Results The technique was adopted in 20 patients aged 14-18 years, affected by the syndrome. In all cases, it was possible to harvest an adequate amount of pedicled omentum laparoscopically. Neither significant complications nor conversions to open surgery occurred. The aesthetic outcome of the LOF technique was, in all cases, a soft, natural-looking breast and a satisfactorily corrected infraclavicular defect. Conclusions The LOF technique is a valid alternative to reconstruction in selected PS cases. It provides a satisfactory reconstruction of the breast and pectoral region and corrects the infraclavicular defect by filling in the area. It avoids the invasiveness and morbidity of a latissimus dorsi transposition. © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

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