Publicaciones académicas

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Esta colección incluye artículos de profesores de la Pontificia Universidad Católica de Chile, publicados en revistas nacionales y extranjeras.

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A comparative pharmacokinetic study of micronized estradiol valerate administered alone and in combination with medroxyprogesterone acetate in postmenopausal women
(LIPPINCOTT WILLIAMS & WILKINS, 2004) Saavedra, I; Leon, J; Prado, J; Sanchez, MP; Lopez, F; Gaete, L
The objective of this study was to evaluate a possible pharmacokinetic interaction between 17beta-estradiol (E-2) and medroxyprogesterone (MP) when administered together in a combined tablet because both hormones have common metabolic routes of biotransformation. The study assessed the mean pharmacokinetics parameters of E2 found after 1-dose administration of 2 different tablets containing E-2, 1 containing 2 mg of micronized 17beta-estradiol valerate (E2V) and the other, administered after 2 weeks, 2 mg of E,V in combination with 5 mg of medroxyprogesterone acetate (MPA). The subjects were 15 healthy postmenopausal women with normal laboratory and clinic tests. The study was randomized, double blind, crossover, with 2 periods and 2 sequences. The blood samples were obtained at 0, 1, 2, 3, 4, 6, 8, 10, 12, and 24 hours after each administration. The F, serum concentrations were determined by electrochemoluminiscence assay. From these data, the following pharmacokinetic parameters were calculated for E, alone and E, in combination with MPA (E2V/MPA): C-max = 104.89 +/- 26.96, 103.27 +/- 44.40; AUC(0-24) = 1900.30 +/- 392.23, 1783.70 +/- 756.39; AUC(0-infinity) = 5576.06 +/- 4065.87, 5317.89 +/- 3702.54; k(a) = 1.06 +/- 0.31, 1.09 +/- 0.13; t1/2 = 35.65 +/- 20.62, 36.12 +/- 18.04; MRT = 16.29 +/- 8.77,16.27 +/- 4.88; V/F = 16.29 +/- 8.76, 16.27 +/- 4.88. No significant differences between the pharmacokinetic parameters of E-2 and E-2/MPA were found, which led us to conclude that there is no pharmacokinetic interaction.
A comparison of single and combined visual, cytologic, and virologic tests as screening strategies in a region at high risk of cervical cancer
(AMER ASSOC CANCER RESEARCH, 2003) Ferreccio Readi, Catterina; Bratti, María C.; Sherman, Mark E.; Herrero, Rolando; Marshall Rivera, Guillermo; Wacholder, Sholom; Hildesheim, Allan; Burk, Robert D.; Hutchinson, Martha; Alfaro, Mario; Greenberg, Mitchell D.; Morales, Jorge; Rodríguez, Ana C.; Schussler, John; Eklund, Claire; Schiffman, Mark
A DETECTIVE ON THE CLUE OF FEMICIDE. EL LEVE ALIENTO DE LA VERDAD BY RAMON DIAZ ETEROVIC
(UNIV CONCEPCION, FAC HUMANIDADES ARTE, 2016) Vasquez Mejias, Ainhoa
El leve aliento de la verdad, novel by Chilean writer Ramon Diaz Eterovic is inserted in the Latin American neopolicial in his criticism of a corrupt, patriarchal and sexist society, a system that violent women in sexual, domestic, labor field, until culminating in femicide. A criticism adds a complaint regarding the existence of corrupt and inefficient police and unequal application of laws in Chile. However, this novel Diaz Eterovic can not fully defined under the model neopolicial - and it also detaches from his previous novels- because the detective gets a criminal punishment for femicidal who murdered prostitutes, triumphing over corrupt authorities.
A genetic association study of maternal and fetal candidate genes that predispose to preterm prelabor rupture of membranes (PROM)
(MOSBY-ELSEVIER, 2010) Romero, Roberto; Friel, Lara A.; Edwards, Digna R. Velez; Kusanovic, Juan Pedro; Hassan, Sonia S.; Mazaki Tovi, Shali; Vaisbuch, Edi; Kim, Chong Jai; Erez, Offer; Chaiworapongsa, Tinnakorn; Pearce, Brad D.; Bartlett, Jacquelaine; Salisbury, Benjamin A.; Anant, Madan Kumar; Vovis, Gerald F.; Lee, Min Seob; Gomez, Ricardo; Behnke, Ernesto; Oyarzun, Enrique; Tromp, Gerard; Williams, Scott M.; Menon, Ramkumar
OBJECTIVE: We sought to determine whether maternal/fetal single-nucleotide polymorphisms (SNPs) in candidate genes are associated with preterm prelabor rupture of membranes (pPROM).
A longitudinal study of angiogenic (placental growth factor) and anti-angiogenic (soluble endoglin and soluble vascular endothelial growth factor receptor-1) factors in normal pregnancy and patients destined to develop preeclampsia and deliver a small for gestational age neonate
(TAYLOR & FRANCIS LTD, 2008) Romero, Roberto; Nien, Jyh Kae; Espinoza, Jimmy; Todem, David; Fu, Wenjiang; Chung, Hwan; Kusanovic, Juan Pedro; Gotsch, Francesca; Erez, Offer; Mazaki Tovi, Shali; Gomez, Ricardo; Edwin, Sam; Chaiworapongsa, Tinnakorn; Levine, Richard J.; Karumanchi, S. Ananth
Introduction. Accumulating evidence suggests that an imbalance between pro-angiogenic (i.e., vascular endothelial growth factor (VEGF) and placental growth factor (PlGF)) and anti-angiogenic factors (i.e., soluble VEGF receptor-1 (sVEGFR-1, also referred to as sFlt1)) is involved in the pathophysiology of preeclampsia (PE). Endoglin is a protein that regulates the pro-angiogenic effects of transforming growth factor , and its soluble form has recently been implicated in the pathophysiology of PE. The objective of this study was to determine if changes in maternal plasma concentration of these angiogenic and anti-angiogenic factors differ prior to development of disease among patients with normal pregnancies and those destined to develop PE (preterm and term) or to deliver a small for gestational age (SGA) neonate.
A PREPUBERTAL SURGE OF THYROTROPIN PRECEDES AN INCREASE IN THYROXINE AND 3,5,3'-TRIIODOTHYRONINE IN NORMAL-CHILDREN
(ENDOCRINE SOC, 1991) MICHAUD, P; FORADORI, A; RODRIGUEZPORTALES, JA; ARTEAGA, E; LOPEZ, JM; TELLEZ, R
The variations in plasma levels of TSH, T4, T3, and rT3, during the pubertal period, were studied in 647 school students from the urban area of Santiago in Chile (47% males and 53% females) with ages ranging between 7.5 and 15 yr. The subjects were grouped by age in consecutive intervals of 6 months each, and pubertal development was determined in every subject. TSH showed a significant increase, reaching a peak in the 9- to 9.5-yr interval. The same was found for T3 and T4, which reached a peak by 10 and 11 yr. The T4/T3 ratio did not show any significant variation with age. After 9.5 yr, a decrease in rT3 and increase in the T4/rT3 ratio was found. The TSH peak preceded the onset of clinical pubertal development, while the T3 and T4 peaks coincided with this onset. The variations in rT3 suggest an increase of peripheral conversion of T4 to T3. These transient events, not described until now, could be termed thyroidarche and could have a significant effect on pubertal growth and development.
A short cervix in women with preterm labor and intact membranes: A risk factor for microbial invasion of the amniotic cavity
(MOSBY-ELSEVIER, 2005) Gomez, R; Romero, R; Nien, JK; Chaiworapongsa, T; Medina, L; Kim, YM; Yoon, BH; Carstens, M; Espinoza, J; Iams, JD; Gonzalez, R
Objective: The purpose of this study was to determine whether there was a relationship between sonographic cervical length and the presence of culture-proven microbial invasion of the ammotic cavity in women with preterm labor and intact membranes.
A weight gain chart for pregnant women designed in Chile
(WILEY, 2005) Mardones, Francisco; Rosso, Pedro
The weight gain chart for pregnant women, developed by Rosso and Mardones (RM chart, 1997), is analysed and compared with other charts in terms of its usefulness for targeting nutritional interventions aimed at preventing low or high birth weights. The RM chart defines categories of maternal nutritional status in early gestation based on weight/height, expressed either as percentage of standard weight (PSW) or body mass index (BMI), and desirable gestational weight gains for each of these categories. Weight gain recommendations of the RM chart are proportional to maternal height. For underweight women the weight recommendation was derived from actual data, while for overweight and obese women it is based on data extrapolations. Since 1987 the Chilean National Health Service has used the RM chart as a standard in prenatal care in all its clinics, covering approximately 70% of the country's population, mostly middle and low income women. During the 1987-2001 period the proportion of underweight pregnant women and infants with birth weight <3000 g decreased significantly and proportionally. Nevertheless, the proportion of obese pregnant women and infants with birth weight >= 4000 g increased during this period. Multifactorial social changes including a decade of substantial economic growth in the country with improved family income, precludes the possibility of determining the efficacy of the RM chart in this group. However, the widespread use of the RM chart indicates that it is a helpful and easy-to-use instrument in the field. Further, by its clear graphical presentation of maternal nutritional status it helps draw the attention of health personnel to women who need special nutritional advice and support.
About the attribution of the "auto sacramental" La Araucana: Andres de Claramonte versus Lope de Vega
(SERVICIO PUBL UNIV NAVARRA, 2017) Faundez Carreno, Rodrigo
The present article examines the authorship of the "auto sacramental" La Araucana, attributed to Lope de Vega in 1893 by Marcelino Menendez Pelayo. A study of the auto compared with Andres de Claramonte's plays regarding meter characteristics, parallel passages and noun series, suggests that this last poet of the Spanish Golden Age would be the closest playwright as to the literary style of La Araucana.
Academic challenges in a school of medicine
(SOC MEDICA SANTIAGO, 2008) Sánchez Díaz, Ignacio
Access to the Emergency Contraceptive Pill and Women's Reproductive Health: Evidence From Public Reform in Chile
(DUKE UNIV PRESS, 2021) Clarke, Damian; Salinas Ulloa, Viviana Monzerratt
We exam ine the sharp expan sion in avail abil ity of the emer gency con tra- cep tive pill in Chile fol low ing legal ized access through munic i pal pub lic health care cen ters. We study the period 2002-2016 and a broad roll out of the emer gency con tra- cep tive pill occur ring between 2008 and 2011. By com bin ing a num ber of admin is tra- tive data sets on health out comes and phar ma ceu ti cal use, and using event -study and difference-in -differences methods, we document that this expansion improved certain clas ses of women's repro duc tive health out comes, nota bly reduc ing rates of abor tion- related mor bid ity. These improve ments were greater in areas of the coun try where the roll out of the emer gency con tra cep tive pill was more exten sive. We also doc u ment some evi dence that refusal to pro vide the emer gency con tra cep tive pill upon a women's request was linked with a wors en ing in repro duc tive health out comes. These results point to the impor tance of con tra cep tive access as a deter mi nant of women's repro- duc tive health and well-being and relates to a grow ing body of work documenting the impor tance of women's auton omy as a deter mi nant of health.
Alendronate in early postmenopausal women: Effects on bone mass during long-term treatment and after withdrawal
(ENDOCRINE SOC, 2000) Ravn, P; Weiss, SR; Rodriguez Portales, JA; McClung, MR; Wasnich, RD; Gilchrist, NL; Sambrook, P; Fogelman, I; Krupa, D; Yates, AJ; Daifotis, A; El Hajj Fuleihan, G; Alendronate Osteoporosis Preventio
We studied the effect on bone mass of alendronate treatment for 5 yr and its withdrawal. Four hundred and forty-seven postmenopausal women with normal bone mass entered a 3-yr randomized trial followed by a 2-yr open label extension. Three hundred and eleven women completed the first 3 yr, and 263 consented to continue and completed the extension. We are reporting data from groups using the dose of alendronate currently approved for osteoporosis prevention (5 mg) or from the group in which alendronate treatment was withdrawn: 52 women received alendronate (5 mg) for 5 yr (group I), 56 received 3 yr of placebo followed by alendronate (5 mg) for 2 yr (group II), and 52 received alendronate (20 mg) for 2 yr followed by 3 yr off therapy (group III). In group I, alendronate (5 mg) increased bone mineral density (BMD) at the spine and trochanter by 2.5-3.2% (P < 0.001 vs. baseline) and stabilized total body and femoral neck BMD (change vs. baseline, P = NS) over 5 yr. By the end of 5 yr, BMD was comparable at the spine, hip, and total body in groups I and III. The 3-yr decrease in BMD after withdrawal of alendronate (20 mg) in group III was 1.8-5.7% (P < 0.01 vs, baseline) and similar to the 3-yr decrease in BMD in group II during the initial 3 yr. In conclusion, alendronate (5 mg) for 5 yr or alendronate (20 mg) for 2 yr followed by 3 yr off therapy prevented postmenopausal bone lass. After withdrawal of alendronate (20 mg), bone loss resumed at the normal early postmenopausalrate.
Allergy-induced preterm labor after the ingestion of shellfish
(TAYLOR & FRANCIS LTD, 2010) Romero, Roberto; Kusanovic, Juan Pedro; Munoz, Hernan; Gomez, Ricardo; Lamont, Ronald F.; Yeo, Lami
Preterm parturition is a syndrome caused by several mechanisms of disease, including intrauterine infection/inflammation, uteroplacental ischemia, uterine overdistension, cervical disease, maternal/fetal stress, abnormal allogeneic responses, allergic reactions, and unknown insults. An allergic-like mechanism was proposed as a potential etiology for the preterm parturition syndrome, based on the observation that eosinophils were present in the amniotic fluid in a fraction of women with preterm labor and a history of allergy, coupled with the observation that conditioned media from degranulated mast cells (the effector cells of type 1 hypersensitivity) induced contractility of human myometrial strips. This communication describes a case of a pregnant woman who had an allergic reaction and regular uterine contractions after the ingestion of lobster meat, to which she was known to be allergic. Preterm labor subsided after the treatment of antihistamines and steroids. The patient subsequently delivered at term. At follow-up, the child was diagnosed with atopy and asthma, and required frequent use of inhaled corticosteroids and beta-2 adrenergic agents. The immunological basis for preterm labor induced by an allergic-like reaction (hypersensitivity) is reviewed.
An elevated fetal interleukin-6 concentration can be observed in fetuses with anemia due to Rh alloimmunization: implications for the understanding of the fetal inflammatory response syndrome
(TAYLOR & FRANCIS LTD, 2011) Vaisbuch, Edi; Romero, Roberto; Gomez, Ricardo; Kusanovic, Juan Pedro; Mazaki Tovi, Shali; Chaiworapongsa, Tinnakorn; Hassan, Sonia S.
Methods. aEuro integral Fetal blood sampling was performed in sensitized Rh-D negative women with suspected fetal anemia (n aEuroS== aEuroS16). Fetal anemia was diagnosed according to reference range nomograms established for the assessment of fetal hematologic parameters. An elevated fetal plasma IL-6 concentration was defined using a cutoff of > 11 pg/ml. Concentrations of IL-6 were determined by immunoassay. Non-parametric statistics were used for analysis.
An ethical and medical perspective on the voluntary termination of pregnancy
(SOC MEDICA SANTIAGO, 2015) Echeverria B., Carlos; Serani M., Alejandro; Maria Arriagada U., Ana; Goic G., Alejandro; Herrera C., Carolina; Quintana V., Carlos; Rojas O., Alberto; Ruiz Esquide, Gonzalo; Salinas R., Rodrigo; Taboada R., Paulina; Vacarezza Y., Ricardo
"Voluntary termination of pregnancy" can refer to actions intended to make a delivery easier, to provide medical care to the fetus, or to protect the life or health of the mother. All of these are proper medical actions and are by definition voluntary. In other cases, the expression denotes a termination of pregnancy before the embryo or fetus is viable, leading to the death of the latter. This action is constitutive of abortion under current Chilean law. The product of conception living being, who develops in the womb during pregnancy, is an individual, both in the sense that it is different from its mother and father, and in that it is a biological individual. For these reasons, such living being constitutes another patient in itself The free and voluntary medical action of health care professionals is geared toward disease prevention or health recovery and medical terminations of pregnancy, as distinguished from abortion, are not criminalized in our country. Therefore, the idea of legalizing abortive terminations of pregnancy so that they become "legitimate health care services" is a call to the medical community, which should engage in a debate about the meaning and consequences of an eventual mandate of the State that would be at odds with the Hippocratic tradition. A woman can feel that her health is at risk due to her pregnancy, and she certainly has the right to request medical help. Health professionals should care both at the medical and emotional level for all those who require their services, especially when such persons are undergoing situations of vulnerability and distress. When requested to perform an abortion, the physician faces dilemmas that should be addressed in line with the present state of the medical art.
An explanatory model of parental sensitivity in the mother-father-infant triad
(WILEY, 2022) Paola Olhaberry, Marcia; Jose Leon, Maria; Coo, Soledad; Barrientos, Mauricio; Carola Perez, J.
Quality of early family interactions has been associated with child development, bonding, and mental health. Childhood adversity, stress, and depression impact parenting, affecting the quality of the interaction within the mother-father-child triad. The aim of the present study was to analyze the influence of parents' adverse childhood experiences, depressive symptoms, and parental stress, on their sensitive response toward their tooddler and quality of traidic interactions. A correlational cross-sectional method was used. The sample included 80 mother-father-child triads, of toddlers with social-emotional difficulties. Parents early adverse experiences, parental stress, and depressive symptoms were assessed through self-report measures. Observational measures on parental sensitivity and triadic interaction were used. For mothers and fathers, adverse childhood experiences were associated with depressive symptoms in adulthood. Sensitivity toward their child and stress were positively associated among both parents. Symptoms of depression in mothers were associated with lower sensitivity toward their child, but in fathers, their sensitive response was influenced by the level of parental stress in the mother. In both parents, greater sensitivity in the dyadic interaction with the child was associated with a higher quality of the triadic interactions, in the triad as a whole, and in the regulation and involvement of the child.
Anterior and distal tunnel orientation for anatomic reconstruction of the medial patellofemoral ligament is safer in patients with open growth plates
(SPRINGER, 2020) Irarrazaval, Sebastian; Besa, Pablo; Fernandez, Francisco; Fernandez, Tomas; Tuca, Maria; Lira, Maria J.; Orrego, Mario
Purpose In patients with open growth plates, the direction of tunneling that avoids distal femoral physis (DFP) damage in anatomic reconstructions of the medial patellofemoral ligament (MPFL) has been a topic of discussion. The objective of this study was to determine the ideal orientation for anatomic reconstructions of MPFL tunneling that minimized DFP damage while avoiding breaching the intercondylar notch. Methods Eighty magnetic resonance images of patients aged 10 through 17 were obtained, randomly sampled from the institutional database. A de novo software was developed to obtain 3D models of the distal femur and DFP. In each model, the anatomical insertion point of the MPFL was determined as defined by Stephen. A 20-mm-depth drilling was simulated, starting from the insertion point at every possible angle within a 90 degrees cone using 5-, 6- and 7-mm drills. Physeal damage for each pair of angles and each drill size was determined. Damage was expressed as a percentage of total physis volume. Statistical analysis was conducted using Student'sttest and one-way ANOVA. Results Maximum physeal damage (5.35% [4.47-6.24]) was obtained with the 7-mm drill when drilling 3 degrees cephalic and 15 degrees posterior from insertion without differences between sexes (n.s.). Minimal physeal damage (0.22% [0.07-0.37]) was obtained using the 5-mm drill aimed 45 degrees distal and 0 degrees anteroposterior, not affected by sex (n.s.). Considering intra-articular drilling avoidance, the safest zone was obtained when aiming 30 degrees-40 degrees distal and 5 degrees-35 degrees anterior, regardless of sex. Conclusion Ideal femoral tunnel orientation, avoiding physeal damage and breaching of the intercondylar notch, was obtained when aiming 30 degrees-40 degrees distal and 5 degrees-35 degrees anterior, regardless of sex. This area is a safe zone that allows anatomic MPFL reconstruction of patients with an open physis.
ANTICARDIOLIPIN ANTIBODIES IN ACUTE RHEUMATIC-FEVER
(J RHEUMATOL PUBL CO, 1992) FIGUEROA, F; BERRIOS, X; GUTIERREZ, M; CARRION, F; GOYCOLEA, JP; RIEDEL, I; JACOBELLI, S
Recent reports describe the association of antiphospholipid antibodies (aPL) with chorea or severe heart valve lesions in systemic lupus erythematosus, lupus-like disease, or the primary antiphospholipid antibody syndrome. We conducted a case series and a case-control investigation of patients with rheumatic fever with Sydenham chorea or other manifestations of rheumatic fever for anticardiolipin antibodies (aCL) during the acute attack and disease remission. Eighty percent of patients were positive for aCL during the rheumatic fever attack vs 40% when inactive (p = 0.035); IgG and IgM aCL increased significantly with disease activity. Individuals with or without Sydenham chorea were equally positive for aCL (76 and 83%, respectively). A significant association was found between IgM aCL and carditis: All patients with valvulitis had IgM aCL (100%) vs 37% of patients without valvular involvement (p = 0.02). aPL may play a role in the pathogenesis of some clinical manifestations of acute rheumatic fever.
App-based intervention for reducing depressive symptoms in postpartum women: Protocol for a feasibility randomized controlled trial
(2023) Franco Vivanco, Pamela Verónica; Olhaberry Huber, Marcia; Cuijpers, Pim; Kelders, Saskia; Muzard, Antonia
Background: Chile has a high prevalence of postpartum depression and a significant treatment gap. Some barriers to postpartum depression care uncover the need for more easily accessible and lower-cost interventions. Chile's high utilization of digital technologies across all social strata and the increased use of pregnancy and parenting apps open the possibility of delivering interventions through mobile devices. Cognitive-behavioral internet-based interventions have proven to be effective in reducing symptoms of depression in high-income countries. However, in Chile, this is an underdeveloped field. This manuscript describes a randomized controlled trial protocol that will examine the feasibility and acceptability of a guided 8-week cognitive-behavioral app-based intervention for Chilean postpartum women with depressive symptoms. Method: A small-scale parallel 2-arms trial will be conducted. Postpartum women with minor or major depression will be randomized to the app-based intervention or waitlist. The primary outcomes are feasibility and acceptability variables, mainly; recruitment and eligibility rates, intervention and study adherence, and participants' intervention satisfaction, use, and engagement. Semi-structured interviews with a sub-sample will provide more information about the participants' experience with the intervention. Women's depression status will be assessed at pre-treatment, post-treatment, and 1-month follow-up. Other secondary outcomes will include participants' perceived social support, mother-infant bonding, and maternal satisfaction and self-efficacy. Discussion: This will be the first internet-based intervention aimed at reducing postpartum depression symptoms developed and studied in Chile. If the intervention and procedures prove feasible and acceptable, we plan to study its efficacy in a definitive controlled trial. If the intervention demonstrates to be effective, the aim is to implement it within the Chilean healthcare setting.
Are B cells altered in the decidua of women with preterm or term labor?
(2019) Leng, Yaozhu; Romero, Roberto; Xu, Yi; Galaz Alarcón, José; Slutsky, Rebecca; Arenas Hernández, Marcia; García Flores, Valeria; Motomura, Kenichiro; Hassan, Sonia S.; Reboldi, Andrea; Gómez López, Nardhy

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