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Ceballos Osorio M.L.,Hospital Luis Calvo Mackenna | Cano Schuffeneger F.,Hospital Luis Calvo Mackenna
Revista Chilena de Pediatria | Year: 2016

Growth failure is one of the most relevant complications in children with chronic kidney disease (CKD). Among others, growth hormone (GH) resistance and bone mineral disorders have been identified as the most important causes of growth retardation. Objectives: 1. To characterize bone mineral metabolism and growth hormone bio-markers in CKD children treated with chronic peritoneal dialysis (PD).2. To evaluate height change with rhGH treatment. Patients and method: A longitudinal 12-month follow-up in prepuberal PD children. Exclusion criteria: Tanner stage >1, nephrotic syndrome, genetic disorders, steroids, intestinal absorption disorders, endocrine disturbances, treatment with GH to the entry of the study. Demographic and anthropometric data were registered. FGF23, Klotho, VitD, IGF-1, IGFBP3, and GHBP were measured to evaluate mineral and growth metabolism. Results: 15 patients, 7 male, age 6.9. ±. 3.0 y were included. Time on PD was 14.33. ±. 12.26 months. Height/age Z score at month 1 was -1.69. ±. 1.03. FGF23 and Klotho: 131.7. ±. 279.4 y 125.9. ±. 24.2. pg/ml, respectively. 8 patients were treated with GH during 6-12 months, showing a non-significant increase in height/age Z-score during the treatment period. Bivariate analysis showed a positive correlation between Klotho and delta ZT/E, and between GHBP vs growth velocity index (p. <. .05). Conclusions: FGF23 values were high and Klotho values were reduced in children with CKD in PD, comparing to healthy children. Somatotropic axis variables were normal or elevated. rhGH tends to improve height and there is a positive correlation of GHBP and growth velocity in these children. © 2016 Sociedad Chilena de Pediatría.

Ledermann W.,Hospital Luis Calvo Mackenna
Revista Chilena de Infectologia | Year: 2013

The history of antibiotics begins with the first observations of Pasteur and Joubert about microbial antagonism at the end of the XIX century. Three types of antagonism were studied: bacterial killing by other bacteria, virus against bacteria and blockade of cellular receptors by bacterial filtrates. In the first type, the piocianase from Pseudomonas aeruginosa and the activity of Bacillus subtilis over Mycobacterium tuberculosis were the better examples; in the second, the French D'Herelle was a pioneer using bacteriophages against Shigella dysenteriae; and another French, Besredka, headed the third line with his "antivirus thérapie" on Staphylococcus aureus.

Memories of W.G. Sebald from the diphtheria he suffered as a child, gave rise to a discussion about the origin of classic clinical descriptions and the traps memory tends. Good examples of the latter are some experiences of Stendhal, who must also be distrusted given his hypersensitivity, which gave name to a psychosomatic syndrome. Mark Twain, a more practical man, brings us back to reality with a funny story about the terror the disease caused in the late nineteenth century. This leads us to remember isolation measures and topical treatments from the period immediately preceding the antitoxin. They included manual removal of the pseudo membranes, maneuver that led Marañón to misinterpret a painting by Goya on a scene of "Lazarillo de Tormes".

Cofre J.,Hospital Luis Calvo Mackenna
Revista Chilena de Infectologia | Year: 2016

Pertussis may cause death in neonates and very young infants. In these ages pertussis vaccine has not been administered yet or infants haven’t received enough doses of vaccine to protect them. Cocoon strategy have been implemented in several countries and has limited efficacy because of low coverage among households. In vaccinated pregnant women transplacental transfer of pertussis antibodies starts at 32-34 weeks of pregnancy. United Kingdom, The United States of America and afterward other countries in Europe and America have adopted this strategy. Recent British research about security and effectiveness of pertussis vaccination in pregnant women to reduce pertussis incidence and fatality cases in neonate and very young infants infant support this strategy despite the fact that controlled studies about the efficacy and security in mothers and neonates have not been published. Several studies still not published or in progress are trying to answer these two questions and to evaluate possible interference between transplacentaly transferred pertussis antibodies and infants immune response to routine vaccines. Recently WHO has recommended pertussis vaccination during pregnancy in countries where neonatal pertussis is a public health problem. Nowadays, Chilean experts discuss if pertussis vaccination of pregnant women must be adopted in our country. © 2016, Sociedad Chilena de Infectologia. All Rights Reserved.

Erazo-Torricelli R.,Hospital Luis Calvo Mackenna
Revista de Neurologia | Year: 2013

Introduction. Congenital myopathies are a heterogeneous group of diseases that share clinical early onset and specific hystopathological alterations in muscle. Genetic studies allow to determine the causative mutation in most cases. Genotypic and phenotypic heterogeneity exists, which is illustrated by noting that a genotype can be expressed in more than one clinicopathologic way and a phenotype may be caused by different genetic mutations. Development. In this review we detail the characteristics of major congenital myopathies that allow clinical, pathological and genetic identification. We describe the findings of muscle biopsy that are the mainstay diagnosis. We emphasize and detail the importance of differential diagnosis by ruling out other diseases that present with hypotonia in infancy or neonatal period. We highlight the severe neonatal forms (nemaline, X-linked myotubular) to be identified early to establish prognosis and provide appropriate genetic counseling. We emphasize mutations of ryanodine gene (RYR1) through its association with malignant hyperthermia and mutations of selenoprotein 1 (SEPN1) and nemaline by its association with nocturnal hypoventilation. Conclusions. The deep knowledge of structural congenital myopathies facilitates diagnostic confirmation of congenital myopathy, allowing the timely implementation of measures related to breathing and feeding in more severe cases and the optimization of motor function in all patients with myopathy congenital. © 2013 Revista de Neurología.

We report the case of a 10 year old girl with a relapsed acute lymphoblastic leukemia, who underwent a haploidentical hematopoietic stem cell transplant (HSCT), with grade II skin and digestive graft versus host disease, treated with corticosteroids and cyclosporine. On day + 54, she presented fever, with no other remarkable clinical findings. Imaging study showed the presence of lung and liver nodules, liver biopsy was performed. The study included histology, staining and culture for bacteria and fungi, and the preservation of a piece of tissue at -20°C for future prospective studies. Ziehl Nielsen stain was positive, and study for Mycobacterium infection was performed. Microbiological smears of tracheal and gastric aspirate, and bronchial fluid obtained by bronchoalveolar lavage (BAL) were positive. The final report confirmed Mycobacterium tuberculosis in gastric content, sputum, BAL and liver tissue, susceptible to rifampin, isoniazid, streptomycin and ethambutol, with determination of mutations for genes rpoβ and kat G (-). Tuberculosis (TB) diagnosis was confirmed. The girl received daily therapy for two months and then she continued on three times per week therapy for 9 months. Controlled by the transplant, infectious diseases and respiratory teams, the patient remained in good general condition, with radiologic resolution of pulmonary and liver involvement and negative smears. We conclude that Mycobacterium tuberculosis infection should be part of differential diagnosis of febrile illness in patients undergoing HSCT, and biopsy should be a standard practice of early diagnosis in these patients.

Santolaya M.E.,Hospital Luis Calvo Mackenna
Current Opinion in Oncology | Year: 2010

PURPOSE OF REVIEW: To provide an update on the rational approach of febrile neutropenia in children with cancer and discuss future research aspects in the field. RECENT FINDINGS: Clinical and laboratory variables and new biomarkers associated with an increased risk for a severe outcome including invasive bacterial infection (IBI), sepsis, and mortality have been identified for children with cancer and febrile neutropenia. These variables and biomarkers are currently being used for an early risk assessment in order to identify children at low or high risk for IBI or at high risk for sepsis and death. Early identification of children with a differential risk has allowed the implementation of selective treatment regimens. More recently, host genetic differences have been associated with a differential risk for IBI. The individual gene profile based on selected polymorphisms could further fine-tune the early risk assessment allowing tailor-made management strategies. SUMMARY: In the last decades, efforts have focused on the stratification of the heterogeneous group of children with cancer and febrile neutropenia according to their risk for developing an IBI. This effort has allowed a less aggressive treatment strategy for children at low risk, including early hospital discharge and use of intravenous and oral antimicrobials at home. More recently, advances have been made in the early identification of children in the other spectrum of infection, those at high risk for sepsis and mortality, with the aim of rapid implementation of aggressive therapy. © 2010 Wolters Kluwer Health | Lippincott Williams &Wilkins.

Ledermann W.,Hospital Luis Calvo Mackenna
Revista Chilena de Infectologia | Year: 2014

In 1902, being Chile a country free of yellow fever, the British steamship Oropesa arrived from Rio de Janeiro with three passengers suffering this disease. Captain Hayes rejected the quarantine imposed by the local Junta of Sanity in Punta Arenas and also in Coronel, following his journey with the sick passengers to Valparaíso, port where he accepted a brief quarantine and medical services for the most compromised of the three patients, who unfortunately died. The knowledge about yellow fever and the applicable epidemiological measures in that time in Chile come to us through the sessions of the Superior Council of Public Hygiene. The threat that implicated the presence of the Oropesa in Chilean coasts is compared with the arrival of British pirates and corsairs in the colonial centuries, before the independence, announced with the alarm cry ¡charque (for Sharp) is coming to Coquimbo!.

Ledermann W.,Hospital Luis Calvo Mackenna
Revista Chilena de Infectologia | Year: 2014

The author remembers, sometimes in a very personal and colloquial way, the successive adoption by the ancient Bacteriological Institute of Chile of different nontreponemal tests for the serological diagnosis of syphilis: Wassermann, Kahn and VDRL. The outstanding figures of some agents of those changes, like Rudolf Kraus, Eduardo Dussert and Reuben Kahn, are recreated in the words of first hand eyewitness. © 2014 Sociedad Chilena de Infectologia. All rights reserved.

Fuentealba I.,Harvard University | Fuentealba I.,Hospital Luis Calvo MacKenna | Taylor G.A.,Harvard University
Pediatric Radiology | Year: 2012

Background: Tubes and catheters are frequently used in the care of hospitalized children. Yet little is known about errors in diagnosis in commonly implanted devices in a pediatric population. Objective: The purpose of this study was to determine the frequency and range of diagnostic errors with inserted devices in a pediatric population. Materials and methods: During a 9-year period 142,041 cases were reviewed as part of our ongoing quality-assurance process. Of 4,084 disagreements in diagnosis encountered, 50 cases with diagnostic errors related to endovascular catheters, gastrointestinal, genitourinary and neurosurgical tubes, and pacemaker wires were identified and retrospectively reviewed. Diagnostic error was defined as a diagnosis that was unintentionally delayed, wrong or missed. These errors were classified as perceptual, cognitive, system-related or unavoidable and were graded according to potential clinical impact using a scale from 1 to 4, with 4 being the most serious. Results Device-related diagnostic errors accounted for 1.2% of all discrepancies identified and 10% of errors potentially leading to a change in therapy. Seventeen of the 50 diagnostic errors were related to vascular catheters (34%), including wrong anatomical location of catheter tip (12) and missed catheter fracture or migration (5). Twenty-seven errors (54%) were related to non-vascular catheters and involved enteric tube location (15), ventricular drainage catheters (7), endotracheal tubes (3) and genitourinary catheters (2). Six additional errors involved a vascular stent, endovascular cuff, needle, chest tube and epicardial wire placement (2). Conclusion: Device-related diagnostic errors are not frequent in complex pediatric patients. However, they can have a clinically significant impact on patient outcomes and management. High-risk situations include altered patient anatomy, poor or limited image quality, inconspicuous lines and incomplete review of prior studies. © Springer-Verlag 2012.

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