Browsing by Author "Uribe, Javier"

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    Clinical features and prognosis of malignant small bowel tumors: Experience from a university hospital in Chile
    (2024) Silva, Felipe; Bustamante, Miguel; Latorre, Gonzalo; Flandez, Jorge; Montero, Isabella; Dukes, Eitan; Gandara, Vicente; Robles, Camila; Uribe, Javier; Iglesias, Andres; Bellolio, Felipe; Molina, Maria Elena; Migueles, Rodrigo; Urrejola, Gonzalo; Larach, Tomas; Besser, Nicolas; Sharp, Allan; Aguero, Carlos; Riquelme, Arnoldo; Vargas, Jose Ignacio; Candia, Roberto; Monrroy, Hugo; De Simone, Federico; Espino, Alberto
    Background: Small bowel tumors (SBT) are infrequent and represent a small proportion of digestive neoplasms. There is scarce information about SBT in Latin America. Aim: To describe the epidemiology, clinical characteristics, diagnostic methods, and survival of malignant SBTs. Methods: Retrospective observational study of adult patients with histopathological diagnosis of SBT between 2007 and 2021 in a university hospital in Chile. Results: A total of 104 patients [51.9% men; mean age 57 years] with SBT. Histological type: neuroendocrine tumor (NET) (43.7%, n = 38), gastrointestinal stromal tumors (GIST) (21.8%, n = 19), lymphoma (17.2%, n = 15) and adenocarcinoma (AC) (11.5%, n = 10). GIST was more frequent in duodenum (50%; n = 12) and NET in the ileum (65.8%; n = 25). Metastasis was observed in 17 cases, most commonly from colon and melanoma. Nausea and vomiting were significantly more often observed in AC ( p = 0.035), as well as gastrointestinal bleeding in GIST ( p = 0.007). The most common diagnostic tools were CT and CT enteroclysis with an elevated diagnostic yield (86% and 94% respectively). The 5 -year survival of GIST, NET, lymphoma and AC were 94.7% (95%CI: 68.1 - 99.2), 82.2% (95%CI: 57.6 - 93.3), 40.0% (95%CI: 16.5 - 82.8) and 25.9% (95%CI: 4.5 - 55.7%), respectively. NET (HR 6.1; 95%CI: 2.1 - 17.2) and GIST (HR 24.4; 95%CI: 3.0 - 19.8) were independently associated with higher survival compared to AC, adjusted for age and sex. Conclusions: Malignant SBT are rare conditions and NETs are the most common histological subtype. Clinical presentation at diagnosis, location or complications may suggest a more probable diagnosis. GIST and NET are associated with better survival compared to other malignant subtypes. (c) 2024 Elsevier Espana, S.L.U. All rights reserved.
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    Corticosteroids use and risk of respiratory coinfections in mechanically ventilated patients with COVID-19
    (2021) Ceballos, María Elena; Núñez Palma, Carolina Verónica; Uribe, Javier; Vera Alarcón, María Magdalena; Castro López, Ricardo; García C., Patricia; Arriata, Gabriel; Gándara, Vicente; Vargas, Camila; Domínguez De Landa, María Angélica; Cerón, Inés; Born, Pablo; Espíndola, Eduardo
    Background: To describe respiratory coinfections, predictive factors and outcomes in patients requiring mechanical ventilation (MV) with COVID-19. Methods: Cohort study, carried out in a Chilean single tertiary Hospital. All patients with COVID-19 admitted to ICU that required MV were included between 1 June and 31 July 2020 Results: 175 patients were admitted to ICU and required MV. Of these, 71 patients developed at least one respiratory coinfection (40.6 %). Early coinfections and late coinfections were diagnosed in 1.7% and 31.4% of all patients admitted to ICU respectively. Within late coinfections, 88% were bacterial, 10% were fungal, and 2% were viral coinfections. One third of isolated bacteria were multidrug-resistant. Multivariate analysis showed that the risk for coinfection was 7.7 times higher for patients with history of corticosteroids (adOR = 7.65, CI 95%: 1.04-56.2, p=0,046) and 2.7 times higher for patients that received dexamethasone during hospitalization (adOR=2.69; CI 95%: 1.14-6.35, p=0,024) than patients that were not exposed. For each additional day in MV, the risk of coinfection increases 1.1 times (adOR=1.06; CI 95%: 1.01-1.11, p=0,025)
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    Diseño e implementación de un modelo de enseñanza en ambiente simulado de paracentesis abdominal
    (2017) Uslar, Thomas; Pizarro Rojas, Margarita Alicia; Villagrán Gutiérrez, Ignacio Andrés; Chahuan, Javier; Caro Pinto, Iván; Marziano, Gianpiero; Irribarra, María Ignacia; Uribe, Javier; Ruz Ruz, Cristian Daniel; Villafranca, Carlos; Godoy, Camila; Ordenes, María Jesús; Orus,Cristian; Rodríguez, Sebastián; Roble, Javier
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    Experience of continuing online education in gastroenterology for non specialist medical doctors
    (SOC MEDICA SANTIAGO, 2019) Isbej, Lorena; Uribe, Javier; Carrasco, Olga; Villarroel, Isaac; Pizarro, Margarita; Isabel Jiron, Maria; Sanhueza, Edgar; Alvarez Lobos, Manuel; Hernandez Rocha, Cristian; Rollan, Antonio; Monsalve, Ximena; Antonio Diaz, Luis; Alejandra Cerda, Maria; Kramer, Tomas; Munizaga, Fernando; Riquelme, Arnoldo
    Background: Continuing education is essential for health professions and online courses can be a good way for professional development. Aim: To describe the experience with online courses for continuing education in hepatology and gastroenterology and to analyze their educational impact. Material and Methods: A three years' experience in courses on liver diseases and digestive tract is described. Their curricular design, methodology, and the educational impact was analyzed using the four levels of the Kirkpatrick's model. Results: On average, there were 321 students per course (2015-2017). 94% were Chilean and 6% from abroad (20 countries). In the educational impact analysis, in level 1 "reaction": 93% said that the course fulfilled their expectations and 92% would recommend it. In level 2 "learning": 42% approved the courses. Level 3 "behavior" was not evaluated and level 4 "organizational change" highlighted that the traditional face-to-face continuing education model of Chilean Gastroenterology Society (SChG) changed to full distance model in these three courses, with 1284 students from South America, Asia and Europe, in a 3-years-period. Additionally, these programs were included in the Medical Society of Santiago (SMS) continuing education agenda. Conclusions: The alliance between the SMS and the SChG generated on line courses that meet the educational needs of physicians and medical students, with excellent results and student perception.
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    Implementation of the updated Sydney system biopsy protocol improves the diagnostic yield of gastric preneoplastic conditions: Results from a real-world study
    (2024) Latorre, Gonzalo; Vargas, Jose Ignacio; Shah, Shailja C.; Ivanovic-Zuvic, Danisa; Achurra, Pablo; Fritzsche, Martin; Leung, Jai-Sen; Ramos, Bernardita; Jensen, Elisa; Uribe, Javier; Montero, Isabella; Gandara, Vicente; Robles, Camila; Bustamante, Miguel; Silva, Felipe; Dukes, Eitan; Corsi, Oscar; Martinez, Francisca; Binder, Victoria; Candia, Roberto; Espino, Alberto; Agueero, Carlos; Sharp, Allan; Torres, Javiera; Roa, Juan Carlos; Pizarro, Margarita; Corvalan, Alejandro H.; Rabkin, Charles S.; Camargo, M. Constanza; Riquelme, Arnoldo
    Background: The updated Sydney system biopsy protocol (USSBP) standardizes the sampling of gastric biopsies for the detection of preneoplastic conditions ( e.g. , gastric intestinal metaplasia [GIM]), but the real-world diagnostic yield is not well-described. Aim: To determine whether regular application of USSBP is associated with higher detection of chronic atrophic gastritis (CAG), GIM and autoimmune gastritis (AIG). Methods: We performed a real-world retrospective study at an academic urban tertiary hospital in Chile. We manually reviewed medical records from consecutive patients undergoing esophagogastroduodenoscopy (EGD) from January to December 2017. Seven endoscopists who performed EGDs were categorized into two groups (USSBP 'regular' and USSBP 'infrequent') based on USSBP adherence, using minimum 20% adherence as the prespecified threshold. Multivariable logistic regression models were used to estimate the odds ratios (aOR) and 95% confidence intervals (CI) for the association between endoscopist groups and the likelihood of diagnosing CAG, GIM or AIG. Results: 1206 patients were included in the study (mean age: 58.5; 65.3% female). The USSBP regular group demonstrated a higher likelihood of detecting CAG (20% vs . 5.3%; aOR 4.03, 95%CI: 2.69-6.03), GIM (12.2% vs. 3.4%; aOR 3.91, 95%CI: 2.39-6.42) and AIG (2.9% vs. 0.8%; aOR 6.52, 95%CI: 1.87-22.74) compared to infrequent group. Detection of advanced-stage CAG (Operative Link for Gastritis Assessment stage III/IV) was significantly higher in the USSBP regular vs. infrequent group (aOR 5.84, 95%CI: 2.23-15.31). Conclusions: Routine adherence to USSBP increases the detection rates of preneoplastic conditions, including CAG, GIM and AIG. Standardized implementation of USSBP should be considered in high gastric cancer risk populations. (c) 2023 Elsevier Espana, S.L.U. All rights reserved.
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    Prospective follow-up of chronic atrophic gastritis in a high-risk population for gastric cancer in latin america
    (2022) Latorre, Gonzalo; Silva, Felipe; Montero, Isabella; Bustamante, Miguel; Dukes, Eitan; Gandara, Vicente; Robles, Camila; Uribe, Javier; Corsi, Oscar; Crispi, Francisca; Espinoza Sepúlveda, Manuel Antonio; Cuadrado, Cristobal; Fuentes-Lopez, Eduardo; Shah, Shailja; Camargo, M. Constanza; Torres, Javiera; Roa, Juan Carlos; Corvalan, Alejandro H.; Candia, Roberto; Aguero, Carlos; Gonzalez, Robinson G.; Vargas Domínguez, José Ignacio; Espino, Alberto; Riquelme, Arnoldo
    Background. Gastric adenocarcinoma (GA) is preceded by premalignant conditions such as chronic atrophic gastritis (CAG) with or without gastric intestinal metaplasia (GIM). Endoscopic follow-up of these conditions has been proposed as a strategy for the detection of early-stage GA. Aim. To describe the risk of progression to gastric dysplasia (GD) and early-stage GA of patients who underwent esophagogastroduodenoscopy (EGD) with gastric biopsies obtained following the updated Sydney System biopsy protocol (USSBP). Methods. We conducted a real-world, multicenter, prospective cohort study. Patients undergoing EGD surveillance with USSBP were enrolled between 2015 and 2021 from three endoscopy units at Santiago, Chile. Patients with prior history of GA or gastric resection were excluded. Follow-up surveillance schedule was determined by gastroenterologist in accordance with the Chilean Digestive Endoscopy Association Guidelines. CAG was confirmed by two expert GI pathologists and categorized by the Operative Link on Gastritis Assessment as stage 0 (normal) through stage IV (advanced stage). The primary endpoint was a composite of GD (low-grade, LGD or high-grade, HGD) or GA, while secondary endpoints were progression in OLGA and separate outcomes of LGD, HGD or GA. Multivariable Cox regression analysis was used to estimate the association between CAG +/- GIM and the outcomes, adjusted for age, sex and Helicobacter pylori (Hp) infection. Results. 600 patients were included in the cohort (64% female; mean age 58 years). At baseline 32.3% (n=194) had active Hp infection. OLGA stage was: 31% (n=184) OLGA 0, 48% (n=291) OLGA I-II and 21% (125) OLGA III-IV. GIM was identified in 52% (n=312) and autoimmune gastritis in 6.2% (n=37). Median follow-up was 28 months (IQR 17-42). During follow-up, 6 early-stage GA, 3 HGD and 6 LGD were observed. No advanced-stage GA was diagnosed. Only 19% (n=35) of baseline OLGA 0 patients progressed to OLGA I-IV, with <2% progressing to OLGA III/IV (Figure 1). Persistence of Hp infection (aOR 2.1; 95%CI 1.1-4.0) was independently associated with increase of at least 1 point in the OLGA scale during follow-up. GA/GD free survival at 3- years for OLGA 0, I-II and III-IV was 99.4%, 97.1% and 91.7%, respectively (p=0.0015) (Figure 2). Based on multivariable Cox regression, OLGA III-IV (vs. OLGA 0) was associated with a 12.1-fold (95%CI 1.5-97.4) higher risk of GA, while GIM was associated with a 13.0-fold (95%CI 1.7-101.2) higher risk, although the CI was wide; this was particularly between 2 and 3 years of follow-up. Discussion: These findings, including the observation that all GAs were early-stage, support endoscopic/histologic surveillance for patients with advanced OLGA stages or GIM, which is a common finding in patients with advanced CAG. Further studies are needed to determine the optimal time interval for surveillance.
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    Secondary respiratory early and late infections in mechanically ventilated patients with COVID-19
    (2022) Ceballos, María Elena; Nuñez, Ingrid; Uribe, Javier; Vera Alarcón, María Magdalena; Castro López, Ricardo; García C., Patricia; Arriata, Gabriel; Gándara, Vicente; Vargas Muñoz, Camila; Domínguez De Landa, María Angélica; Cerón, Inés; Born, Pablo; Espíndola, Eduardo
    Background: Patients with COVID-19 receiving mechanical ventilation may become aggravated with a secondary respiratory infection. The aim of this study was to describe secondary respiratory infections, their predictive factors, and outcomes in patients with COVID-19 requiring mechanical ventilation. Methods: A cohort study was carried out in a single tertiary hospital in Santiago, Chile, from 1st June to 31st July 2020. All patients with COVID-19 admitted to the intensive care unit that required mechanical ventilation were included. Results: A total of 175 patients were enrolled, of which 71 (40.6%) developed at least one secondary respiratory infection during follow-up. Early and late secondary infections were diagnosed in 1.7% and 31.4% respectively. Within late secondary infections, 88% were bacterial, 10% were fungal, and 2% were of viral origin. One-third of isolated bacteria were multidrug-resistant. Bivariate analysis showed that the history of corticosteroids used before admission and the use of dexamethasone during hospitalization were associated with a higher risk of secondary infections (p = 0.041 and p = 0.019 respectively). Multivariate analysis showed that for each additional day of mechanical ventilation, the risk of secondary infection increases 1.1 times (adOR = 1.07; 95% CI 1.02–1.13, p = 0.008) Conclusions: Patients with COVID-19 admitted to the intensive care unit and requiring mechanical ventilation had a high rate of secondary infections during their hospital stay. The number of days on MV was a risk factor for acquiring secondary respiratory infections.
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    The Janus of a disease: Diabetes and metabolic dysfunction-associated fatty liver disease
    (2024) Barrera, Francisco; Uribe, Javier; Olvares, Nixa; Huerta, Paula; Cabrera, Daniel; Romero-Gomez, Manuel
    Metabolic Dysfunction-Associated Fatty Liver Disease and Diabetes Mellitus are two prevalent metabolic disorders that often coexist and synergistically contribute to the progression of each other. Several pathophysiological pathways are involved in the association, including insulin resistance, inflammation, and lipotoxicity, providing a foundation for understanding the complex interrelationships between these conditions. The presence of MASLD has a significant impact on diabetes risk and the development of microvascular and macrovascular complications, and diabetes significantly contributes to an increased risk of liver fibrosis progression in MASLD and the development of hepatocellular carcinoma. Moreover, both pathologies have a synergistic effect on cardiovascular events and mortality. Therapeutic interventions targeting MASLD and diabetes are discussed, considering lifestyle modifications, pharmacological agents, and emerging treatment modalities. The review also addresses the challenges in managing these comorbidities, such as the need for personalized approaches and the potential impact on cardiovascular health. The insights gleaned from this analysis can inform clinicians, researchers, and policymakers in developing integrated strategies for preventing, diagnosing, and managing these metabolic disorders. (c) 2024 Published by Elsevier Espa & ntilde;a, S.L.U. on behalf of Fundaci & oacute;n Cl & iacute;nica M & eacute;dica Sur, A.C. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
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    Undergraduate student's perception of clinical simulation workshops: assessment of an instrument
    (2018) Villagran, Ignacio; Tejos, Rodrigo; Chahuan, Javier; Uslar, Thomas; Pizarro Rojas, Margarita Alicia; Varas, Julian; Achurra Tirado, Pablo; Leiva Rodríguez, Isabel; Nazar Jara, Claudio; Sirhan Nahum, Marisol; Uribe, Javier; Ruz Ruz, Cristian Daniel; Villafranca, Carlos; Soza, Romina; Solis, Na