Browsing by Author "Carvajal, Claudia"

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    Aortic Stenosis and Acquired von Willebrand Disease: Lack of Association
    (W B SAUNDERS CO-ELSEVIER INC, 2011) Carrasco, Esperanza; Lopez, Rodrigo; Rattalino, Marcos; Lema, Guillermo; Pereira, Jaime; Canessa, Roberto; Zalaquett, Ricardo; Carvajal, Claudia; Carrasco, Paulo
    Objectives: The association between aortic stenosis (AS) and acquired von Willebrand disease type 2A has been described. It may be present in up to 90% of patients with AS. Shear stress has been proposed as the underlying mechanism; however, the physiopathology of this condition is not completely understood. No specific treatment has been studied in this specific population besides aortic valve replacement (AVR). As a coadjuvant therapy, some cardiac surgery centers use desmopressin routinely. The authors report the first stage of an ongoing study designed to compare the effects of desmopressin versus placebo in patients with severe AS scheduled for AVR. Because of the different incidences of the acquired von Willebrand type 2A reported in the literature, the first stage was conducted to describe the incidence of this clinical association in the present population, allowing the sample size for the second stage of the study to be obtained.
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    Decreased Nitric Oxide Products in the Urine of Patients Undergoing Cardiac Surgery
    (W B SAUNDERS CO-ELSEVIER INC, 2009) Lema, Guillermo; Urzua, Jorge; Jalil, Roberto; Canessa, Roberto; Vogel, Andrea; Moran, Sergio; Fajuri, Alejandro; Carvajal, Claudia; Aeschlimann, Nicolas; Jaque, Maria P.
    Objective: Renal vasoconstriction has been blamed as a cause of perioperative renal dysfunction after cardiac surgery. Endothelial function is a critical determinant of vascular tonus, including vasoconstriction. The objective of this study was to establish whether the release of the endothelial vasodilator nitric oxide (NO) or NO products is altered in patients undergoing surgery with cardiopulmonary bypass in 3 different clinical conditions.
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    Renal function and cardiopulmonary bypass in pediatric cardiac surgical patients
    (2006) Lema, Guillermo; Vogel, Andrea; Canessa, Roberto; Jalil, Roberto; Carvajal, Claudia; Becker, Pedro; Jaque, Maria Paz; Fajardo, Christian; Urzua, Jorge
    We studied prospectively the perioperative changes of renal function in nine children undergoing cardiac surgery with cardiopulmonary bypass (CPB). Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured with inulin and I-131-hippuran clearances before CPB, during hypo and normothermic CPB, following sternal closure and 1 h postoperatively. Urinary alpha glutathione S-transferase (alpha GS-T) was measured pre- and postoperatively as a marker for tubular cellular damage. Plasma and urine creatinine and electrolytes were measured. Free water, osmolal and creatinine clearances, as well as fractional excretion of sodium (FeNa) and potassium transtubular gradient (TTKG) were calculated. GFR was normal before and after surgery. ERPF was low before and after surgery; it increased significantly immediately after CPB. Filtration fraction (FF) was abnormally elevated before and after surgery; however, a significant decrease during normothermic CPB and sternal closure was found. Alpha GS-T presented a moderate, but nonsignificant increase postoperatively. FeNa also increased in this period, but not significantly. Creatinine, osmolal, free water clearances, as well as TTKG, were normal in all patients pre- and postoperatively. We conclude that there is no evidence of clinically significant deterioration of renal function in children undergoing repair of cardiac lesions under CPB. Minor increases of alpha GS-T in urine postoperatively did not confirm cellular tubular damage. There was no tubular dysfunction at that time.
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    Retrospective study on disparities in time-to-treatment by health insurance system in Chilean breast cancer patients
    (2025) Acevedo, Johanna; Ip, Teresa; Maureira, Lea; Sánchez Rojel, César Giovanni; Osorio, Claudia; Carvajal, Claudia; Araos, Rafael; Letelier, Hernan; Acevedo, Francisco; Merino, Tomas
    Breast cancer is the most common malignancy in the Americas, and the second leading cause of cancer death. Disparities in the time to treatment can significantly impact patient outcomes and typically affect lower socioeconomic individuals and/or ethnic minorities. Our study sought to evaluate disparities in time to treatment at three health institutions in Chile according to their type of health insurance (public or private). METHODS Our study analyzed a database of breast cancer patients diagnosed between 2017 and 2018. Analyses included descriptive statistics and a linear regression model that incorporated clinical and demographic variables. Additionally, using a proportional risks model, we analyzed the association between clinical variables and mortality. RESULTS Public health insurance (National Health Fund, FONASA) was associated with longer time-to-treatment and extended treatment times versus private health insurance (Social Security Institutions, ISAPRE; p < 0.0001). As expected, a more advanced stage at diagnosis was associated with lower survival. Our proportional risks model found that age was a predictor of breast cancer mortality in stage II patients. Also, total treatment time significantly increased the risk of breast cancer mortality in stage I patients. Conversely, total treatment time did not affect mortality on stages II or III. CONCLUSIONS We found significant disparities in the time to treatment of Chilean breast cancer patients using FONASA versus private ISAPRE. FONASA patients experience delays in the initiation of treatment and longer total treatment times compared to their private insurance counterparts. Finally, longer time-to-treatment was associated with more advanced stages and increased mortality.