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A nomogram for predicting serious complications in patients with solid tumors and apparently stable febrile neutropenia: prospective data on 781 consecutive episodes from the FINITE study
(2014) Ghanem, Ismael; Rebollo, Maite Antonio; Garrido, Marcelo; Martínez, Jerónimo; Font, Carme; Ramchandani, Avinash; Biosca, Merce; Beato, Carmen; Martínez de Castro, Eva; Castanon, Eduardo; Virizuela Echaburu, Juan; Espinosa, Javier; Sevillano, Elena; Aragon Manrique, Isabel; Cardona, Merce; Mondejar, Rebeca; Baron, Francisco; Acevedo Claros, Francisco Nicolás; Jiménez-Fonseca, Paula; Carmona Bayonas, Alberto
Background: An accurate estimate of the likelihood of serious complications in patients with otherwise apparently stable febrile neutropenia (FN) may assist in decision-making regarding individualized therapy. Our group has developed a prognostic score for predicting complications in patients with solid tumors and apparently stable episodes called CISNE (Clinical Index for Stable Febrile Neutropenia). The purpose of this study is to present a nomogram based on the previously mentioned index in a broader dataset of patients. Methods: FINITE is a prospective and multicenter study which aims to investigate prognostic factors and outcomes of FN episodes with clinical stability at first assessment, defined as events without acute organ dysfunction, vital signs abnormalities or major infections. We performed a nomogram based on the CISNE score which includes the following prognostic variables: ECOG PS≥2, chronic obstructive pulmonary disease, cardiovascular disease, mucositis NCI grade ≥2, monocytes <200/mm3 and stress-induced hyperglycemia. A calibration plot was used to analyze the accuracy of this multivariate nomogram. Results: From October 2012 to December 2013, 781 patients with apparently stable FN were recruited in 21 Spanish hospitals. The rate of infection-related complications and death was 15.6% (95% confidence interval [CI], 12.9-18.6%) and 1.7% (95% CI, 0.98%-3.01%). A nomogram was designed according to the CISNE score. The area under the ROC curve was 0.836 (95% CI, 0.808-0.861). The observed and predicted probabilities also matched closely. Conclusions: Our group has developed a user-friendly nomogram for predicting complications in patients with apparently stable FN. This nomogram may be particularly useful to prevent premature discharges of cancer patients starting inpatient management.
A randomized controlled trial of mindfulness-based stress reduction (MBSR) in health workers (E-Poster Presentations)
(Cambridge Univ. Press, 2020) Errazuriz Concha, Antonia; Figueroa Cabello, Rodrigo Andrés
Abstract PS6-37: Clinical stage is the only predictor of survival in breast cancer patients with a complete pathological response
(2021) Acevedo, Francisco; Walbaum, Benjamin; Merino, Tomas; Petric, Militza; Sanchez, Cesar
INTRODUCTION In breast cancer (BC) patients, achieving a complete pathological response (pCR) after neoadjuvant chemotherapy (NCT) is associated with better prognosis. Despite this, some of these patients will experience recurrences of the disease and will eventually die of BC. We identified clinical factors that can affect recurrence and survival in BC patients who achieve pCR.METHODSRetrospective analysis of a Chilean BC database including patients treated in public and private hospitals in Santiago, Chile from 2010 to 2019. pCR was defined as the absence of residual invasive disease in the breast and in the axillary lymph nodes (ypT0/is N0) at the completion of the NCT. Invasive Disease-Free Survival (IDFS), Distant Disease-Free Survival (DDFS) and BC-specific survival (BCS) was measured from the time of diagnosis to the event or lost to follow-up. We performed Cox regression analysis to identify factors associated with prognosis.RESULTSFrom 855 patients who received NCT, 195 (22.8%) achieved pCR and were included in this study. Clinical characteristics are shown in table 1. 76 (37.9%) patients had hormone receptor positive (HR+) and 113 (57.4%) had Human epidermal growth factor 2 (HER2) positive tumors. 88.7% were treated with a regimen that included anthracyclines and taxanes. With a median follow-up of 36 months, three-year IDFS, DDFS and BCS and their 95% confidence intervals were 90.9% (84.7 - 94.6), 91.8% (86.0 - 95.3) and 93.8% (87.8 - 97.5); respectively. The stage at diagnosis was the only predictor associated with IDFS (Hazard ratio (HR) = 5.6; p = 0.02), DDFS (HR = 4.1, p = 0.07), and BCS (HR = 8.3, p = 0.04). Body mass index (BMI), age, hospital, HR or HER2 status, lymph node involvement, or the presence of an in-situ component, were not associated with prognosis in the multivariate analysis.CONCLUSIONThe clinical stage at diagnosis was the only predictor of survival in patients who achieved pCR after NCT. Short follow-up and few events may have affected these results. This data is consistent with previously published work. Table 1. Tumor and patient characteristicsMedian age49 (24 – 78)HospitalPublic57.4%Private43.6%BMIMedian27.2 (18.5 – 44.7)Overweight38.0%Obese31.9%Receptor StatusRH+/HER2-16.4%RH+/HER2+21.5%RH-/HER2+35.9%RH-/HER2-26.2%Clinical StageI2.1%II47.4%III50.5%Lymph Node +69.7%ypT0/N078.1%ChemotherapyAnthracycline5.1%Taxane6.2%Anthracycline-Taxane88.7% Citation Format: Francisco Acevedo, Benjamin Walbaum, Tomas Merino, Militza Petric, Cesar Sanchez. Clinical stage is the only predictor of survival in breast cancer patients with a complete pathological response [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-37.
Analysis of Emergency Room Episodes Duration Through Process Mining
(2019) Rojas, Eric; Cifuentes Soto, Andrés Alonso; Burattin, A.; Muñoz Gama, Jorge; Sepúlveda, Marcos; Capurro, Daniel
This study presents the proposal of a performance analysis method for ER Processes through Process Mining. This method helps to determine which activities, sub-processes, interactions and characteristics of episodes explain why the process has long episode duration, besides providing decision makers with additional information that will help to decrease waiting times, reduce patient congestion and increment quality of provided care. By applying the exposed method to a case study, it was discovered that when a loop is formed between the Examination and Treatment sub-processes, the episode duration lengthens. Moreover, the relationship between case severity and the number of repetitions of the Examination-Treatment loop was also studied. As the case severity increases, the number of repetitions increases as well.
BPIC 2013: Volvo incident and problem management behavior analysis
(2013) Arias, Michael; Rojas, Eric
This essay has the purpose of presenting the results of a work performed as part of Third International Business Process Intelligence Challenge. This challenge presents an event log from Volvo IT Belgium Company related with incident and problem management, focusing on a couple process owner´s questions. The authors of this document present the analysis realized applying different kind of tools and process mining techniques in order to solve the challenge presented. We provide an analysis, which discovered behavior characteristics, associated with products, resources and organizational lines. The results obtained provide useful information that Volvo can use to have more knowledge about the process that they are executing and have more information to make decisions and improve the actual process.
Characterization of the gastric lesions in Chilean children with sysptomatic Helicobacter pylori associated gastritis
(1999) Guiraldes, E.; Pena, A.; Duarte, I.; Trivino, X.; Schultz, M.; Larrain, F.; Espinosa, M.N.; Harris, Paul R.
Clusters of Autoimmune Diseases in Children and the Role of PTPN22 C1858T Gene Polymorphism in Pediatric Polyautoimmunity
(2014) Borzutzky Schachter, Arturo; Seiltgens, Cristián; Iruretagoyena B., Mirentxu; Cristi, Francisca; Ponce, María Jesús ; Melendez, Patricia; Martínez Aguayo, Alejandro; Hodgson Bunster, María Isabel; Talesnik Guendelman, Eduardo; Riera Cassorla, Francisca Paz; Méndez, Cecilia; Harris D., Paul R.; García Bruce, Hernán; Gana Ansaldo, Juan Cristóbal; Godoy, Claudia; Cattani Ortega, Andreína
Background/Purpose:Autoimmune diseases (AIDs) have familial aggregation and frequently share a common genetic background, but few studies have evaluated autoimmune clusters in children with AIDs and their families. Children with more than one AID (pediatric polyautoimmunity) may have a stronger genetic component than children with a single AID. The objectives of this study were to identify clusters of AIDs in children and their first-degree relatives and to evaluate the association of PTPN22 C1858T gene polymorphism with pediatric polyautoimmunity.Methods:A cross-sectional study was performed in subjects with an AID of pediatric onset (<18 years)recruited at Pediatric Rheumatology, Endocrinology and Gastroenterology Clinics at the Health Network of the Pontificia Universidad Católica de Chile School of Medicine. Clusters of AIDs were identified by K-means cluster analysis. The PTPN22 C1858T gene polymorphism was determined by RT-PCR in subjects with pediatric polyautoimmunity and in subjects with three common AIDs: juvenile idiopathic arthritis (JIA), autoimmune thyroid disease (AITD), and type I diabetes (T1D).Results:191 subjects with pediatric AIDs were included, of which 45 (24%) had polyautoimmunity. Mean age was 12.1 years (range 1–19) and 68% were female. Most frequent AIDs were JIA (36%), AITD (25%), T1D (19%), uveitis (8%), celiac disease (6%), and vitiligo (6%). 59% of subjects with pediatric autoimmunity had first-degree relatives with an AID. Five clusters of AID were identified in families of children with autoimmunity (Table 1). Among the 45 subjects with pediatric polyautoimmunity, four clusters of AIDs were identified (Table 2). Genomic DNA from 128 subjects was evaluated for PTPN22 C1858T gene polymorphism revealing common homozygosity (C/C) in 85.2%, heterozygosity (C/T) in 13.3%, and rare homozygosity (T/T) in 1.6 %, in equilibrium with Hardy Weinberg equation (P = 0.4). 26% of polyautoimmune subjects had the T allele in contrast with 11% of monoautoimmune subjects (P = 0.04). No significant difference was found in the age of onset of autoimmunity between mono and polyautoimmune subjects (P = 0.44) or between subjects with C/C genotype vs. C/T and T/T genotypes (P = 0.81).
Generating and comparing knowledge graphs of medical processes using pMineR
(2017) Gatta, R.; Vallati, M.; Lenkowicz, J.; Rojas, E.; Damiani, A.; Sacchi, L.; De Bari, B.; Dagliati, A.; Fernandez-Llatas, C.; Montesi, M.; Marchetti, A.; Castellano, M.; Valentini, V.
Process mining focuses on extracting knowledge, under the form of models, from data generated and stored in information systems. The analysis of generated models can provide useful insights to domain experts. In addition, models of processes can be used to test if a considered process complies with some given specifications. For these reasons, process mining is gaining significant importance in the healthcare domain, where the complexity and flexibility of processes makes extremely hard to evaluate and assess how patients have been treated. In this paper we describe how pMineR, an R library designed and developed for performing process mining in the medical domain, is currently exploited in Hospitals for supporting domain experts in the analysis of the extracted knowledge models. In its current release, pMineR can encode extracted processes under the form of directed graphs, which are easy to interpret and understand by experts of the domain. It also provides graphical comparison between different processes, allows to model the adherence to a given clinical guidelines and to estimate performance and the workload of the available resources in healthcare.
Helicobacter pylori-associated hypochlorhydria in children relates to the development of iron deficiency
(2010) Harris, Paul R.; Villagran, A.; Serrano, C.; Duarte, I.; Windle, H. J.; Crabtree, J. E.
Introduction Acute H pylori infection is associated with transient hypochlorhydria of variable duration. Hypochlorhydria in H pylori-associated atrophy has a role in iron deficiency (ID) through changes in the physiology of iron absorption. The role of hypochlorhydria in H pylori-associated ID in childhood has not been investigated. The aims were to evaluate the association between H pylori-associated hypochlorhydria and ID in children. Methods A total of 123 children were prospectively enrolled in the study. Any child with peptic ulceration, or who received antacids, PPIs, H2 antagonists, and antibiotics in the previous 4 weeks was excluded. Blood was taken for complete blood count and iron profile. Gastric biopsies were taken for H. pylori determination by histology and rapid urease test. H pylori status was defined as +ve if either test was positive. Gastric juice was obtained at the beginning of the endoscopy avoiding water insufflation. Duodenal biopsies were taken for exclusion of coeliac disease (CD). Stool samples were collected for parasitology/microbiology. Of the 123 children, 2 with CD, 8 with non-specific duodenal inflammation (DI), 5 with lost blood analysis and 9 with parasitic infections (2 with DI) were excluded. Results Of the remaining 101 children 31 were H pylori +ve and 10 were hypochlorhydric (pH>4). There were no differences in demographic characteristics with regard to infection status, or gastric pH. In H pylori +ve children with pH >4 (n=6) serum iron (median (IQR): 60.2 (45–66) μg/dl) and transferrin saturation levels percentage (16.6 (15–19)) were significantly lower (p<0.01) than H pylori positive children (n=25) with pH≤4 (iron 113.2 (91–132); transferrin saturation 32.6 (24–38)). No differences in ferritin or TIBC were observed. In H pylori negative children with pH>4 (n=4) both iron (119 (101–137)), and transferrin saturation (36.4 (31–41)), were not significantly different from children with pH≤4 (n=66) (iron 98.7 (80–122); transferrin saturation 32.2 (25–40)). Conclusion: Low serum iron and transferrin in childhood H pylori infection is associated with hypochlorhydria. In uninfected children, hypochlorhydria was not associated with altered serum iron parameters, indicating a combination of H pylori infection and/or inflammation and hypochlorhydria has a role in the aetiology of iron deficiency. Even though H pylori-associated hypochlorhydria may reflect a transient period during acute gastritis, it alters iron homeostasis with clinical impact in developing countries with a high H pylori prevalence. Funded by EU CONTENT Project (INCO-CT-2006-032136) and CONICYT/BM (RUE #29).
Historical exposure to arsenic in drinking water and risk of late fetal and infant mortality - Chile 1950-2005
(2014) Ríos, P.; Cortés, S.; Villarroel, L.; Ferreccio, C.
A previous study comparing two Chilean cities demonstrated significant increase in fetal mortality in relation to increase in arsenic (As) exposure. Our aim was to confirm this association increasing size and variation of the comparison group, extending the time interval and measuring additional potential confounders. We used time series analysis of infant mortality indicators. We confirmed the clear excess of risk of late fetal death following the increase of the As concentration in drinking water, and the rapid return to the baseline mortality rate in response to the removal of arsenic after 1973. The effect was lower for neonatal and post-neonatal mortality. This study confirms that fetus is more sensitive to As and that regulations should consider additional protection for pregnant women and small children.
Pediculus capitis: Terapias disponibles
(2003) Rosso A., Roberto; Ramírez G., M. Soledad; Torres H., Marisa
Polygastric flexor muscle of the index finger and its clinical implications
(2023) Riveros, Andrés; Inzunza, Óscar; Burdiles, Álvaro; Farfán, Emilio
Although muscle variations in the forearm have been widely reported, the presence of supernumerary muscles in this compartment may be associated with compressive disorders of the nerves of the upper limb. The purpose of this study was to report the finding of a polygastric flexor muscle of the index finger (PFID), a supernumerary muscle associated with the anterior compartment of the forearm, the morphology and pathway of which are closely related to the median nerve. The PFID was found in a routine dissection of an upper right limb. Following a dissection methodology by planes, a narrow, polygastric muscle was identified, formed sequentially and interspersed by four tendons and three muscle bellies, that extended between the common flexor muscle mass of the anterior compartment of the forearm and the index finger. The sixth part of the PFID was partially in the carpal tunnel and established close relation with the median nerve, which was displaced superficially. Knowledge of this and other muscle variations that appear in the forearm and carpal tunnel are relevant when performing a differential diagnosis of carpal tunnel syndrome or in planning surgery on this canal.
Proinflammatory cytokine levels in gastric mucosa of Helicobacter pylori-infected children in Chile
(1999) Harris, Paul R.; Pena, A.; Espinoza, N.; Bravo, R.; Guiraldes, E.
ResRec: A multi-criteria tool for resource recommendation
(2016) Arias, Michael; Rojas, Eric; Lee, Wai Lam Jonathan; Muñoz Gama, Jorge; Sepúlveda Fernández, Marcos Ernesto
Dynamic resource allocation is considered a key aspect withinbusiness process management. Selecting the most suitable resources is achallenge for those in charge of making the allocation, because the efficiency with which this task is executed, can contribute to the quality ofthe results, and improve the process performance. Different mechanismshave been proposed to improve resource allocation. However, there is aneed for more flexible allocation methods that integrate a set of conditions and requirements defined at run-time, and also, allow the combination of different criteria to evaluate resources. In this paper, we presentResRec, a novel Multi-factor Criteria tool that can be used to recommend and allocate resources dynamically. The tool provides the featureof solving individual requests (On-demand), or requests made in blocks(Batch) through a recommender system developed in ProM.

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