Las Condes Research Articles

Impacto de la morfología espermática en las tasas de embarazo con inseminación intrauterina

Introduction and objectiveSperm morphology has been used as a prognostic factor in in vitro fertilization, however, in intrauterine insemination (IUI) its predictive role is controversial. The aim of this study was to determine the impact of sperm morphology as isolated parameter of the spermiogram has on the probability of pregnancy in couples that are treated with IUI. Material and methodsRetrospective study of IUI cycles performed in the Reproductive Medicine Unit of Clínica Las Condes between January 2016 and December 2018. Logistic regression of the following variables: sperm morphology grouped in 0-1%, 2-3% and≥4%, total progressively motile sperm count inseminated, age of the woman and the man. ResultsA total of 385 cases were included and clinical pregnancy was diagnosed in 85 of them. When separating into groups of sperm morphology<4% and≥4%, the pregnancy rate was 22% in both groups. The age of the woman was the only statistically significant factor in the logistic regression. The area under the ROC curve of sperm morphology as a predictor of pregnancy was 0.53. ConclusionsOur study concludes that sperm morphology should not be considered as a single parameter when deciding whether or not a couple can be treated with IUI, eliminating isolated teratozoospermia as a direct indication for in vitro fertilization. It was not possible to determine a cut-off point for sperm morphology that serves as a predictor of pregnancy.

Emergency visits and mortality caused by ischemic heart disease attributable to fine particulate matter during COVID-19 pandemic in Chile

BACKGROUND AND AIM: A reduction in PM2.5 was reported worldwide during the COVID-19 pandemic confinement. Santiago, a Chilean city, characterized by high concentrations of PM2.5 caused by vehicular traffic, improved its air quality as a collateral effect of the quarantine implemented in the second quarter of 2020. We aim at revealing an ensuing decrease of emergency visits by acute myocardial infarction (AMI) and deaths due to ischemic heart disease (IHD) attributable to PM2.5, comparing equivalent periods of 2019 and 2020. METHODS: In Santiago, the air quality monitoring is accomplished through nine monitors located in nine communes of Santiago: Cerrillos, Cerro Navia, El Bosque, Independencia, La Florida, Las Condes, Pudahuel, Quilicura, and Santiago. These communes differ widely; Las Condes, located at East Santiago's foothills and plenty of green space, is one of the most affluent territories in the country. The other six counties range from the middle class (i.e., La Florida, Cerrillos, and Quilicura) to mostly deprived areas (i.e., Pudahuel and Cerro Navia), which are set into the flatlands in the northwestern area, with scarce green space and poor ventilation. We described daily average PM2.5 concentration with time-series graphs of means and standard deviations, and the AMI-emergency visits and IHD-deaths were reported for each quarter each year. To estimate the impact of the PM2.5 excess, we estimated the population attributable fractions (PAF) for IAM-emergency visits and IHD-deaths. RESULTS:We corroborated the daily average of PM2.5 decreased in 8 out of 9 communes in Santiago; however, the reduction was significant only in 3 communes. AMI-emergency visits and IHD-deaths attributable to PM2.5 decreased slightly but significantly in these three communes. The PAF in other communes remained similar to 2019 despite the quarantine. CONCLUSIONS:We concluded that reductions in PM2.5 had an impact in attributable AMI emergency visits and IHD deaths in those comunes with significant reduction KEYWORDS: particulate matter, ischemic heart disease, myocardial infarction, COVID-19, pandemic, Chile

Emergency visits and mortality caused by ischemic heart disease attributable to fine particulate matter during the COVID-19 pandemic in Chile

BackgroundA reduction in PM2.5 was reported worldwide during the COVID-19 pandemic lockdown. Santiago, the capital and largest city of Chile, is characterized by high concentrations of PM2.5, being vehicular traffic a major contributor. Its air quality was improved as a collateral effect of the lockdown imposed in the second quarter of 2020. We aimed at highlighting an ensuing decrease of emergency visits for treatment of acute myocardial infarction (AMI) and deaths due to ischemic heart diseases (IHD) attributable to PM2.5, comparing equivalent periods in 2019 and 2020. MethodsIn Santiago, air quality monitoring is carried out by nine monitors located in nine communes: Cerro Navia, Cerrillos, El Bosque, Pudahuel, Independencia, La Florida, Quilicura, downtown Santiago and Las Condes (ranked from highest to lowest in terms of multidimensional poverty).We described average daily PM2.5 concentration with time-series graphs of means and standard deviations. AMI-emergency visits and IHD deaths were reported for each quarter by year. To estimate the impact of PM2.5 excess, we estimated the population attributable fractions (PAF) for AMI-emergency visits and IHD-related deaths. ResultsDaily average PM2.5 decreased in eight out of nine communes in Santiago. However, the reduction was significant in only three communes. AMI-emergency visits and IHD-related deaths attributable to PM2.5 decreased slightly but significantly in these three communes. The PAF in other communes remained similar to 2019 despite the lockdown. ConclusionsA significant reduction of PM2.5 PAF potentially responsible for AMI emergency visits and IHD deaths was observed only in communes with a significant reduction of the daily average concentration of PM2.5 during the COVID-19 pandemic.

Resilient urban design in the foothills of Santiago? Contrast of communal scenarios with seismic risk due to the San Ramón Fault

In recent decades, Santiago has seen a substantial increase in urbanized areas along its eastern foothills, where the San Ramon Fault (FSR) is also located. This has become a new geological risk scenario. Using the unquestionable appeal of the natural setting, the panoramic view of the city, and a healthy environment, luxury housing projects have been promoted that coexist with this seismic risk, something that seems to have been disregarded by communal and metropolitan planning instruments. The purpose of this article is to explore the urban design conditions on Santiago’s foothills to face the San Ramon Fault, through a contrast analysis of two specific sectors located within the potential buffer of the San Ramon Fault - the urban districts of Hospital de Carabineros in Las Condes and El Peral in Puente Alto - and the way these articulate with the natural and built environments, including critical infrastructure. Methodologically speaking, a mixed approach is applied through an analysis matrix of urban design elements that includes three areas of action - built, natural and regulatory - to identify critical situations in the areas studied, where the resilient response is either high or low. It is concluded that contrasting urban design experiences under extreme conditions regarding seismic risk is illustrative, both for permeating the operational layers of risk management such as communal and metropolitan regulations, and to consider the foothills in a resilient way, recognizing the San Ramon Fault as a new base criterion of urban design.

¿Es posible vivir juntos? Conflictos por la vivienda en el Gran Santiago

A partir de casos de estudio situados en Las Condes y Peñalolén, ambos municipios del Gran Santiago, se propone un examen de los conflictos que gatilla la integración a través de instrumentos subsidiarios impulsados por el Estado en el marco de nuevas orientaciones políticas para la integración social y territorial. La propuesta teórica se enmarca en tres ejes: la crisis del vínculo social, el principio del reconocimiento y los conflictos en torno al fenómeno NIMBY. Los casos de estudio contemplan distintas etapas para estos conflictos, lo que permite entregar como consideraciones finales un ensayo de clasificación, para avanzar en su estudio y contribuir en el futuro en una política aún novedosa en el contexto chileno.

Infant Mortality in the Metropolitan Region, Chile 2005-2014.

Infant mortality depends on the economic, social, and cultural level of development of the place of residence. To describe the infant mortality rates (IMR) and the late infant mortality rates (LIMR) of the Metropolitan Region (MR) communes and to evaluate their trend between 2005 and 2014. Ecological study that describes the rates of the 52 communes of the MR. For the analysis, the IMR and LIMR were elaborated for each year and com mune and were compared using population attributable risk (PAR), attributable risk percent (AR%), and rate ratio (RR). Trends were analyzed through the Prais-Winsten model. A value p < 0.05 was considered a statistically significant trend. The commune 'Independencia' presented the hig hest IMR and LIMR with 12.7 and 4.05 per 1000 live births respectively, 1.75 and 2.05 times more compared with the IMR and LIMR of the MR. The commune 'Las Condes' and 'Vitacura' presented the lowest IMR and LIMR respectively. The IMR trend regarding 2005 increased in Lo Barnechea, Lo Espejo, and Recoleta, and decreased in Las Condes, Macul, Pudahuel and San Bernardo. The LIMR decreased in Peñalolén, Puente Alto, Las Condes, Providencia, San Bernardo, Macul, Pudahuel, Tala- gante, Pedro Aguirre Cerda, and Quilicura, and increased in Peñaflor. The regional IMR and LIMR hide the slight increase in rates and the persistence of heterogeneity among communes. This forces us to explore the causes of these inequities through future analytical studies.

The effect of “moss bag” shape in the air monitoring of metal(oid)s in semi-arid sites: Influence of wind speed and moss porosity

The moss bag technique has been widely used in Europe for the monitoring of metal(oid)s in the air. However, the effect of moss bag shape and moss porosity in the capture and retention of metal(oid)s linked to particulate matter (PM) has not been studied in detail. The objective of the study was to compare the capture of metal(oid)s in air between two shapes of moss bag, rounded bag (traditional shape) and semi-sphere bag. The factors and methods considered were i) wind speed and porosity characteristics of the medium (moss-matrix), evaluated by modeling and simulations in 3D with the COMSOL™ platform, and ii) net accumulations (NE) of Cu, Fe, Al, Zn, Sb, Ba and Pb with the moss bag technique. Exposure period was 30 days (August to November) in two districts of Santiago de Chile (Las Condes and Ñuñoa). Results revealed that i) semi-sphere bag had a greater accumulation by sedimentation of PM (>2.5 μm), mainly in its upper zone, with the most effective (average) porosity range for the capture and retention of PM being 0.45 to 0.7, and ii) the semi-sphere moss bag had higher NE for Al, Zn, Sb and Pb and lower coefficients of variation for Fe, Al, Pb, Ba and Cu. Our results show that in high wind speeds events, the shape of the moss bag can determine PM retention.

P080 Association between intestinal mucosa and plasmatic levels of infliximab and TNFa in Chilean patients with inflammatory bowel disease

BACKGROUND: Inflammatory bowel disease (IBD) is characterized by chronic intestinal inflammation. Tumor Necrosis Factor a (TNFa) levels have been found to be elevated in the intestinal mucosa of patients with Crohn's Disease (CD) and Ulcerative Colitis (UC), which turned the anti-TNFa agents as one of the mainstays of the treatment. Nevertheless, some patients fail to respond or loose response, despite adequate plasmatic levels of anti-TNFa agents. The aim of this study was to determine intestinal mucosa levels of infliximab (IFX) and TNFa and its possible association with their plasmatic levels and the endoscopic activity in IBD patients. METHODS: Cross–sectional study of patients with IBD enrolled at the IBD program of Clínica Las Condes, Chile. The enrollment was done between May 2016 and January 2017. Tissue and plasmatic IFX and TNFa samples were taken the same day just before the next IFX infusion. The endoscopic activity was determined by colonoscopy using Mayo Score for UC and SES-CD/Rutgeerts for CD. Samples of mucosa were taken from colon in patients in remission and from inflamed and non-inflamed colon tissue in active patients. Mucosal levels of IFX and TNFa were normalized by total protein levels. The statistical analysis was performed using paired t-test analysis for comparison between inflamed and non-inflamed sites and an alpha value of &lt;0.05 was considered statistically significant. RESULTS: Fourteen patients were included (9 UC and 5 CD) of which 6 were in remission and 8 with active disease (2 mild, 5 moderate and 1 severe). Plasmatic levels of IFX were higher in patients in remission compared to patients with active disease (4.488 AU/mL vs 2.378 AU/mL; P = 0.1355). In this last group, higher levels were observed in patients with mild than moderate endoscopic activity (4.785 AU/mL vs 1.552 AU/mL; P = 0.0264). Plasmatic TNFa levels were higher in patients with active disease compared to patients in remission (111.938 pg/mL vs 23.467 pg/mL; P = 0.0011), as opposed to IFX levels. Mucosal IFX levels were higher in patients with active disease vs remission, not statistically significant (6.136 ng/mL vs 3.917 ng/mL; P = 0.1186). On the contrary, mucosal TNFa levels were significantly higher in patients in remission vs active disease (65.062 pg/mL vs 36.479 pg/mL; P = 0.0330). In patients with active disease (n = 8), there was no statistical difference between the IFX level in the inflamed compared to the non-inflamed mucosa (6.136 ng/mL vs 5.000 ng/mL; P = 0.3534). TNFa in the non-inflamed mucosa was significantly higher compared to inflamed mucosa (64.846 pg/mL vs 36.479 pg/mL; P = 0.0066). In both, no difference was observed according to endoscopic activity level. The proportion of IFX/TNFα in mucosa was higher in patients with mild and moderate activity (0.182 and 0.179, respectively) than patients with severe activity (0.074). CONCLUSION(S): The discordance between plasmatic and intestinal mucosa IFX and TNFα, in patients with active disease, indicate that the inflammatory cascade might be determined by others specific inflammatory pathways. Further studies need to be performed in a larger sample of patients to better elucidate the mechanistic explanation for persistent inflammation in certain IBD patients.

Non-BRCA1/2 Variants Detected in a High-Risk Chilean Cohort With a History of Breast and/or Ovarian Cancer.

PURPOSELittle is known about the genetic predisposition to breast and ovarian cancer among the Chilean population, in particular genetic predisposition beyond BRCA1 and BRCA2 mutations. In the current study, we aim to describe the germline variants detected in individuals who were referred to a hereditary cancer program in Santiago, Chile.METHODSData were retrospectively collected from the registry of the High-Risk Breast and Ovarian Cancer Program at Clínica Las Condes, Santiago, Chile. Data captured included index case diagnosis, ancestry, family history, and genetic test results.RESULTSThree hundred fifteen individuals underwent genetic testing during the study period. The frequency of germline pathogenic and likely pathogenic variants in a breast or ovarian cancer predisposition gene was 20.3%. Of those patients who underwent testing with a panel of both high- and moderate-penetrance genes, 10.5% were found to have pathogenic or likely pathogenic variants in non-BRCA1/2 genes.CONCLUSIONTesting for non-BRCA1 and -2 mutations may be clinically relevant for individuals who are suspected to have a hereditary breast or ovarian cancer syndrome in Chile. Comprehensive genetic testing of individuals who are at high risk is necessary to further characterize the genetic susceptibility to cancer in Chile.

Envejecimiento y trato hacia las personas mayores en Chile: una ruta de la desigualdad persistente

Aging in Chile is crossed by multiple inequalities, which are enhanced under the condition of being an adult. Old age itself refers to a production of categorical inequality expressed, among other forms, in the treatment that older people receive from other actors and institutions. The article delves into the production routes of persistent inequalit specifically in groups of older adults. The results presented are based on the Survey on the Perception of Treatment of Older Adults carried out in the communities of Recoleta and Las Condes with a sample of 198 older adults during 2017. They make it possible to demonstrate the presence of different expressions of abuse towards these older adults, fundamentally of a psychological nature, where the condition of gender and old age together with others such as living with family members, the socioeconomic and educational level amplify the reproduction of persistent inequalities and associated practices.

Measurement of rest energy expanditure in pediatric oncological patients: concordance between indirect calorimetry and predictive equations

in childhood cancer, the disease impacts resting energy expenditure (GER) in a way that is not estimable by predictive equations. the aim of this study is to determine the concordance between the measurement of resting energy expenditure (REE) by indirect calorimetry in pediatric oncology patients versus the World Health Organization (WHO) and Schofield predictive equations. cross-sectional study in children aged 5-15 years receiving chemotherapy, in outpatient Clínica Las Condes and Hospital Dr. Sótero del Río, from July 2013 to July 2015. REE measurement was performed by indirect calorimetry and WHO and Schofield equations. Concordance analysis, with clinically relevant cut-off point and concordance coefficient of 90%. twenty-seven children were included and 27 calorimetries were performed; 66% of these children were diagnosed with leukemia, 15% with central nervous system tumor and 81% were in the maintenance stage of their treatment. There is no significant difference between indirect calorimetry measurement versus WHO (p 0.18) or Schofield (p 0.07), neither when stratifying by nutritional status or type of cancer diagnosis. Concordance was calculated between calorimetry and Schofield, with a concordance coefficient of Lin = 79.4% (95% CI = 65.2-93.6) and versus WHO = 78% (95% CI = 62.9-93.2). this level of agreement, less than 80% in both cases, is insufficient. With both equations for estimating REE, there is overestimation or underestimation of energy requirements in more than 20% of cases. There is no agreement between the measurement of REE measured with indirect calorimetry versus its estimation with Schofield's and the WHO equations. Consequently, indirect calorimetry is required as part of the nutritional assessment in a nutritionally at-risk population such as pediatric patients with oncological pathology.

Young Investigator: Inflammatory Bowel Disease Nurse in the Follow-Up of Patients From an IBD Program

BACKGROUND: Inflammatory bowel disease (IBD) requires long-term treatment to keep disease control. A favourable follow-up of patients implies education, self-management and effective communication through a multidisciplinary team to achieve and preserve remission, where the IBD nurse acquires importance. The aim is to describe the role of an IBD nurse in the management and follow up of patients treated in an IBD Program in a tertiary center in Chile. METHODS: The IBD Program at Clínica Las Condes has a cohort of 1173 patients (July 2012–April 2017). In 2015, an IBD nurse was incorporated to the multidisciplinary team. From January 2016 on, all nurse contacts (telephone, mail and face-to-face) were registered. An observational descriptive study was designed, including all patients in follow-up during the period between January 2016-April 2017 (at least one follow-up medical visit during the year after the admission to the Program). The contacts made by the IBD nurse were classified as follows: reinforcement of medical indications, disease follow-up, lab results assessment, formal education on disease management (30 minutes session), administrative support, scheduling office visits and coordination of outpatient procedures and patient admissions. Demographic and clinical variables were also included in the analysis. Patient satisfaction with the IBD Program was assessed in a randomized sample of patients. RESULTS: 597 patients (51%) were in follow-up in the 16-month period; 63% diagnosed with ulcerative colitis, 27% with Crohn's disease and 10% with non-classifiable IBD, with a median age of 35 years (range 15-93). The median of disease duration were 5 years (range 0-42). The IBD nurse performed 760 contacts during the study period in 253 patients, representing 42% of the follow-up patients from the IBD Program. The most frequent nurse interventions were reinforcement of medical indications (42%), assessment of lab results (17%) and disease follow-up (12%). Almost half of the interventions were related to education (49%). Most of the contacts were made by mail (43%), followed by face-to-face (32%) and telephone (25%). Seventy seven percent of contacts were “nursing job”, the rest were administrative work. Nurse interventions were focused in more severely ill patients; when comparing patients who contacted the IBD nurse with those who did not, the first group presented more flares during the follow-up (37% vs 23%; P=0.0001), more biological therapy (15% vs 4%; P=0.0001), immunomodulators (40% vs 19%; P=0.0001) and steroids (14% vs 9%; P=0.0460). From a sample of 94 patients surveyed, 96% perceived the IBD program as excellent/good. CONCLUSION(S): The IBD nurse has an important role in the follow-up and management, specifically in education, of more severely ill patients with major need of guidance and a higher risk of adverse events due to IBD treatment. This study allowed to determine that the IBD nurse was able to evaluate 40% of the patients of the program, meanwhile nearly one third of her time was occupied by administrative issues. Administrative personnel are necessary in order to enable the IBD nurse to more direct patient care. Finally, the vast majority of patients are satisfied with the presence of an IBD nurse in our Program.

Percepciones y creencias sobre criopreservación embrionaria en mujeres y hombres que se realizan técnicas de reproducción asistida en Santiago, Chile.

Although embryo cryopreservation is frequently used as part of assisted reproductive technology, quantitave information addressing how infertile couples live the experience of having cryopreserved embryos is lacking in Chile. The aim of this study is to examine men and women's perception and beliefs regarding their cryopreserved embryos, as well as their perspective on embryo donation and disposition. Methods: 153 women and men with frozen embryos from a public hospital, Instituto de Investigactiones Materno Infantil, and a private clinic, Clínica Las Condes, in Santiago, Chile, responded between May 2015 and May 2016 to an anonymous online survey addressing their perceptions and beliefs concerning their cryopreserved embryos. Respondents considered their frozen embryos to be equivalent to a child (53.2%) or a potential child (40.7%). Only 8% regard them as an organized group of cells. Over 60% of respondents disagree with destroying surplus embryos or using them for research. Participants from the public hospital are more willing to donate their embryos to another couple than those from the private center (61% vs 40%; P=0.016); 34% of respondents agreed to donate surplus embryos to same sex couples. This study reveals that Chilean couples are emotionally bound to their frozen embryos, and that discarding them is not an option. The results from this survey will help strengthen counseling for couples to enable them to make informed decisions regarding their surplus embryos.

Inflammatory bowel disease: A descriptive study of 716 local Chilean patients.

To demographically and clinically characterize inflammatory bowel disease (IBD) from the local registry and update data previously published by our group. A descriptive study of a cohort based on a registry of patients aged 15 years or older who were diagnosed with IBD and attended the IBD program at Clínica Las Condes in Santiago, Chile. The registry was created in April 2012 and includes patients registered up to October 2015. The information was anonymously downloaded in a monthly report, and the information on patients with more than one visit was updated. The registry includes demographic, clinical and disease characteristics, including the Montreal Classification, medical treatment, surgeries and hospitalizations for crisis. Data regarding infection with Clostridium difficile (C. difficile) were incorporated in the registry in 2014. Data for patients who received consultations as second opinions and continued treatment at this institution were also analyzed. The study included 716 patients with IBD: 508 patients (71%) were diagnosed with ulcerative colitis (UC), 196 patients (27%) were diagnosed with Crohn's disease (CD) and 12 patients (2%) were diagnosed with unclassifiable IBD. The UC/CD ratio was 2.6/1. The median age was 36 years (range 16-88), and 58% of the patients were female, with a median age at diagnosis of 29 years (range 5-76). In the past 15 years, a sustained increase in the number of patients diagnosed with IBD was observed, where 87% of the patients were diagnosed between the years 2001 and 2015. In the cohort examined in the present study, extensive colitis (50%) and colonic involvement (44%) predominated in the patients with UC and CD, respectively. In CD patients, non-stricturing/non-penetrating behavior was more frequent (80%), and perianal disease was observed in 28% of the patients. There were significant differences in treatment between UC and CD, with a higher use of corticosteroids, and immunosuppressive and biological therapies was observed in the patients with CD (P < 0.05 and P < 0.01). Significant surgical differences were also observed: 5% of the UC patients underwent surgery, whereas 38% of the CD patients required at least one surgery (P < 0.01). The patients with CD were hospitalized more often during their disease course than the patients with UC (55% and 35% of the patients, respectively; P < 0.01). C. difficile infection was acquired by 5% of the patients in each group at some point during the disease course. Nearly half of the patients consulted at the institution for a second opinion, and 32% of these individuals continued treatment at the institution. IBD has continued to increase in the study cohort, slowly approaching the level reported in developed countries.

Genetic Variants of Cytochrome CYP2D6 in Two Mixed Chilean Populations

Objectives: It is known that the interindividual and interethnic variability of the genetic polymorphisms of CYP2D6 plays an important role in the presentation of adverse drug reactions and concerning lack of therapeutic effects in humans. However, there are few data available from mixed populations of Latin America, including the Chilean. The aim of this study was therefore to estimate the frequencies of CYP2D6 variants in two samples of hospitals from the northern (Hospital San José, HSJ) and eastern (Clínica Las Condes, CLC) parts of Santiago, Chile, with different degrees of Amerindian admixture (HSJ: 34.5%; CLC: 15.9%). Methods: We used polymerase chain reaction followed by restriction endonuclease digestion (PCR-RFLP) to genotype 7 CYP2D6 alleles in 250 healthy unrelated individuals of Chilean Mestizo background. The detection of allele CYP2D6*5 and the duplication of this gene was performed by long-PCR. Results: The degrees of Amerindian admixture are reflected in the observed frequencies of the CYP2D6*1 (HSJ: 58.26%; CLC: 41.06%), CYP2D6*2 (HSJ: 28.10%; CLC: 40.65%), and CYP2D6*4 (HSJ: 8.26%; CLC: 12.60%) alleles; the frequencies of CYP2D6*1 (p = 0.0002) and CYP2D6*2 (p = 0.0036) are significantly different between the samples. Four individuals (CLC: 0.41%; HSJ: 1.24%) could not be assigned to a genotype. We identified 3.25% of the genotypes which predict a poor metabolizer phenotype in CLC and 1.65% in HSJ. Conclusion: Our data indicate ethnic group-dependent genetic differences in the vulnerability to treatment with the large variety of drugs metabolized by the enzyme CYP2D6.

TEMPERATURE AS THUMB RULE PREDICTOR OF OZONE LEVELS IN SANTIAGO DE CHILE GROUND AIR

ABSTRACT Ozone concentrations in the urban air of Santiago de Chile frequently surpass the air quality standard in summertime, particularly in the eastern part of the city (Las Condes). The main parameter that determines ozone episodes is the ground level daily maximum temperature. In the present work we propose that this single parameter can be employed as a simple predictor of the expected ozone levels. In particular, it is found that high ozone episodes takes place in Las Condes when the maximum daily temperature is higher than 30 oC. This single criterion applies during all the summer period (from December to March) and for weekdays and weekends. On the other hand, ozone episodes in downtown take place only when the maximum daily temperature reaches values higher than 32.5 oC. These simple relationships imply that weather forecast could be employed by the citizens to estimate the risk associated to carry out outdoors activities. Keywords : tropospheric ozone; ozone forecast; air temperature; weekends; ozone episodes; Santiago de Chile.

Single-incision laparoscopic sleeve gastrectomy: initial experience in 20 patients and 2-year follow-up

SummaryBackgroundThe transumbilical route began being clinically feasible with or without unique access devices.SettingThe setting for this study was a private practice at Clínica Las Condes, Santiago, Chile.ObjectiveThe objective was to describe our experience performing a laparoscopic sleeve gastrectomy (LSG) via transumbilical route using a single-port access device in addition to standard laparoscopic instruments.MethodA prospective nonrandomized protocol was applied to patients fulfilling the following inclusion criteria: to have been medically indicated for an LSG, to have a body mass index (BMI) of less than or equal to 40 kg/m2, and the distance between the xiphoid appendix and umbilicus should be less than 22 cm. All patients were female with a median (p50) age of 34.5 (ranging from 21 to 57) years, a median weight of 92 (ranging from 82.5 to 113) kg, and a median BMI of 35.1 (ranging from 30.5 to 40) kg/m2. The device insertion technique, the gastrectomy, and postoperative management are described.ResultsLSG via transumbilical route was successfully carried out in 19 of the 20 patients in whom the procedure was performed; one patient had to be converted to a conventional laparoscopic procedure. Mean operating time was 127 (ranging from 90 to 170) min. On the second postoperative day, all patients were assessed through an upper gastrointestinal barium-contrasted radiological series. There was neither morbidity nor mortality in this group. Excess weight loss at 25 months after surgery was 114 %.ConclusionsSingle-port LSG can be successfully performed in selected obese patients with a BMI of less than 40 kg/m2 using traditional laparoscopic instruments. The technique allows performing a safe and effective vertical gastrectomy.

Febrile Seizures and Face Emotion Recognition

Investigators at University-Hospital of Parma, Universities of Verona, Modena, and Bologna, Italy; and Epilepsy Clinic Las Condes, Santiago, Chile, studied facial emotion recognition ability in a group of 38 school-aged children with antecedent febrile seizures (FSs) and in an age- and sex-matched control group.

Peritonsillar abscess: Treatment with immediate tonsillectomy – 10 years of experience

Conclusion: Immediate tonsillectomy in patients with peritonsillar abscess is a safe and effective treatment that should be considered as an alternative to conventional incision and drainage. Objective: To assess the efficacy, safety, and microbiology of immediate tonsillectomy over 10 years, in patients with peritonsillar abscess. Methods: This was a retrospective study. We reviewed the clinical charts of patients diagnosed with peritonsillar abscess in Clínica Las Condes from September 2000 to August 2010, who were treated with immediate unilateral or bilateral tonsillectomy. The patients' epidemiological information, antibiotic therapy, laterality of the surgery, results of microbiological cultures, complications, and recurrences were recorded. Results: A total of 112 patients were studied, with a mean age of 24 years. There were no events of sepsis, and there were only four cases (3.6%) of postoperative bleeding, two of which resolved spontaneously. Only 29% of the patients required morphine pump-based analgesia in the postoperative period. The mean length of hospital stay was 3.4 days. Among the 28 unilateral tonsillectomies, 4 (14.2%) developed streptococcal tonsillitis and 2 (7.1%) were readmitted with a contralateral peritonsillitis: one cellulitis and one abscess that required drainage and tonsillectomy. The most frequently isolated microorganisms were gram-positive bacteria (Streptococcus pyogenes and other streptococci) and anaerobic bacteria (mainly Bacteroides spp. and Fusobacterium nucleatum).

Labia Majora Lifting: Aesthetic and Functional Solution for Hypertrophy and/or Flaccidity of Labia Majora

Introduction: During recent years many women have been searching for an improvement in the appearance of their vulva. We present our experience to evaluate the efficiency and safety of lifting of labia majora and evaluate the level of satisfaction with the surgical technique. Materials and Methods: Between March 2004 and June 2011, a total of 60 patients diagnosed with flaccidity and/or hypertrophy of labia majora were selected for surgery at the Urogynecology and Vaginal Surgery Unit in Clínica Las Condes, Santiago, Chile. The patients were asked to assess the results of surgery in terms of the degree of satisfaction with the obtained results. Results: The primary indication for surgery was aesthetic factors (100%); 20 patients also considered functional factors (33%), and only 6 women (10%) also considered psychologic factors. For aesthetic reasons, hypertrophy and flaccidity were the primary indication, less frequent were asymmetry and previous scars. During the early postoperative period 6.7% of women had a minimal suture dehiscence with spontaneous resolution. A total of 80% of the women were very satisfied, 15% were satisfied, and 5% were unsatisfied. Four patients presented cellulitis (6.7%). Conclusions: According to our experience, the lifting labioplasty of labia majora is a feasible, safe, and effective surgical procedure, with aesthetic results and high levels of satisfaction in patients.