Universidad del Desarrollo

About: Universidad del Desarrollo is a education organization based out in Santiago, Chile. It is known for research contribution in the topics: Population & Entrepreneurship. The organization has 2695 authors who have published 3578 publications receiving 52302 citations.

Degree and Timing of Intensive Blood Pressure Lowering on Hematoma Growth in Intracerebral Hemorrhage: Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial-2 Results.

Abstract: Background and Purpose— Degree and timing of blood pressure (BP) lowering treatment in relation to hematoma growth were investigated in the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial-2 (INTERACT2). Methods— INTERACT2 was an international clinical trial of intensive (target systolic BP [SBP], Results— Greater SBP reduction was associated with reduced hematoma growth (13.3, 5.0, and 3.0 mL for P trend 6 hours (5.4 mL). The smallest mean absolute hematoma growth (2.0 mL) was in those achieving target SBP 5 to 8 times versus 3 to 4 (3.1 mL) and 0 to 2 times (5.2 mL). Conclusions— Intensive BP lowering with greater SBP reduction, which is achieved quickly and maintained consistently, seems to provide protection against hematoma growth for 24 hours. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00716079.

Dexmedetomidine Improves Cardiovascular and Ventilatory Outcomes in Critically Ill Patients: Basic and Clinical Approaches.

Abstract: Dexmedetomidine (DEX) is a highly selective α2-adrenergic agonist with sedative and analgesic properties, with minimal respiratory effects. It is used as a sedative in the intensive care unit and the operating room. The opioid-sparing effect and the absence of respiratory effects make dexmedetomidine an attractive adjuvant drug for anesthesia in obese patients who are at an increased risk for postoperative respiratory complications. The pharmacodynamic effects on the cardiovascular system are known; however the mechanisms that induce cardioprotection are still under study. Regarding the pharmacokinetics properties, this drug is extensively metabolized in the liver by the uridine diphosphate glucuronosyltransferases. It has a relatively high hepatic extraction ratio, and therefore, its metabolism is dependent on liver blood flow. This review shows, from a basic clinical approach, the evidence supporting the use of dexmedetomidine in different settings, from its use in animal models of ischemia-reperfusion, and cardioprotective signaling pathways. In addition, pharmacokinetics and pharmacodynamics studies in obese subjects and the management of patients subjected to mechanical ventilation are described. Moreover, the clinical efficacy of delirium incidence in patients with indication of non-invasive ventilation is shown. Finally, the available evidence from DEX is described by a group of Chilean pharmacologists and clinicians who have worked for more than 10 years on DEX.

Enterococcal Endocarditis: Can We Win the War?

Abstract: Treatment of enterococcal infections has long been recognized as an important clinical challenge, particularly in the setting of infective endocarditis (IE). Furthermore, the increase prevalence of isolates exhibiting multidrug resistance (MDR) to traditional anti-enterococcal antibiotics such as ampicillin, vancomycin and aminoglycosides (high-level resistance) poses immense therapeutic dilemmas in hospitals around the world. Unlike IE caused by most isolates of Enterococcus faecalis, which still retain susceptibility to ampicillin and vancomycin, the emergence and dissemination of a hospital-associated genetic clade of multidrug resistant Enterococcus faecium, markedly limits the therapeutic options. The best treatment of IE MDR enterococcal endocarditis is unknown and the paucity of antibiotics with bactericidal activity against these organisms is a cause of serious concern. Although it appears that we are winning the war against E. faecalis, the battle rages on against isolates of multidrug-resistant E. faecium.

Anal sphincter defects and fecal incontinence 15-24 years after first delivery: a cross-sectional study.

Abstract: Objectives To establish the prevalence of external (EAS) and internal anal sphincter (IAS) defects 15–24 years after childbirth in association to mode of delivery and faecal incontinence (FI), and compare the proportion of obstetric anal sphincter injuries (OASIS) reported at delivery with defects on ultrasound. Methods This was a cross-sectional study including 563 women, who delivered their first child from 1990–97. Women responded to a validated questionnaire (PFDI) in 2013–14. The proportion of women with FI was recorded. Information about OASIS was obtained from the National Birth Registry. Study participants underwent 4D transperineal ultrasound examination. A defect of the EAS and IAS of ≥30° in ≥4/6 planes on tomographic ultrasound was registered. Multiple logistic regression was used to calculate adjusted odds ratios (aOR) for comparison of prevalence of EAS defects between different modes of delivery and in association to FI. Fisher's exact test was used for IAS defects. Results Defects of EAS and IAS were found after normal delivery (n = 201): 10% and 1%; forceps (n = 144): 32% and 7%; vacuum (n = 120): 15% and 4%, and no defects after caesarean section (n = 98). Forceps was associated with increased risk of EAS defects compared to normal delivery (aOR 4.1, 95% CI 2.3-7.2) and vacuum (aOR 3.0, 95% CI 1.6-5.6) and increased risk of IAS defects compared to normal delivery (cOR 7.4, 95% CI 1.5-70.5). The difference between vacuum and normal delivery was not significant. FI was indicated by 18% of women with EAS defects, 29% with IAS defects and 8% without sphincter defects. EAS and IAS defects were associated with increased risk of FI (aOR 2.5, 95% CI 1.3-4.9; cOR 4.2, 95% CI 1.1-13.5). 80% of ultrasonographical sphincter defects were not reported as OASIS at first or subsequent deliveries. Conclusions Anal sphincter defects visualized by transperineal ultrasound 15–24 years after delivery were associated with forceps and FI. Undetected OASIS was frequent.