Browsing by Author "Mardones S., Francisco"

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    A reply to MS Kramer, Isocaloric protein supplementation during pregnancy
    (2000) Mardones S., Francisco; Marshall Rivera, Guillermo; Rosso R., Pedro Pablo; Uiterwaal, D,
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    Alta morbimortalidad de cáncer pulmonar en Chile: creación de un comité de acceso oportuno de drogas de alto costo a niveles locales para el tratamiento de pacientes con cáncer pulmonar
    (2025) Contreras Reyes, Daniel Alberto; Mardones S., Francisco; Pontificia Universidad Católica de Chile. Escuela de Salud Pública
    El cáncer pulmonar representa una de las principales causas de morbimortalidad en Chile, como en el mundo; con una alta carga sanitaria y social debido a su diagnóstico, habitualmente, tardío, y la limitada disponibilidad de tratamientos efectivos en el sistema público. En este contexto, se hace imperativo diseñar estrategias que permitan mejorar un acceso equitativo y oportuno a terapias innovadoras, muchas de ellas con un alto costo, como las de tipo de inmunoterapia y terapias dirigidas, que han demostrado un impacto significativo en la sobrevida y calidad de vida de los pacientes. Este trabajo propone la creación y la implementación de un “Comité de Drogas de Alto Costo”, a nivel loca que permita un acceso oportuno, específicamente enfocado en el tratamiento del cáncer pulmonar. Dicho comité tendría como objetivo principal agilizar los procesos de evaluación, priorización y distribución de medicamentos en los hospitales y servicios de salud regionales, incorporando criterios clínicos, epidemiológicos, farmacoeconómicos y de equidad. Se plantea, así, una estructura multidisciplinaria e interprofesional integrada por Médico Oncólogo, Químico Farmacéutico Clínico, Bioeticista, Gestores Oncológicos y representantes de los pacientes, con apoyo técnico del MINSAL y de las Dirección por parte del hospital. Este modelo busca descentralizar las decisiones terapéuticas, adecuándolas a la realidad loca, sin perder la rigurosidad, ni la transparencia. La implementación de este comité puede contribuir a reducir las brechas de acceso, mejorar la eficiencia del gasto publico en salud y disminuir la carga de enfermedad asociada al cáncer pulmonar en Chile. Además, fortalece la gobernanza sanitaria a nivel local y promueve una política de salud más justa y centrada en el paciente y en su entorno familiar.
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    Alta morbimortalidad por cáncer de pulmón en Chile: del diagnóstico tardío a la prevención secundaria con una propuesta de implementación escalonada del tamizaje con tomografía computada torácica de bajas dosis
    (2025) Funes Ferrada, Rodrigo Mario Ignacio; Mardones S., Francisco; Pontificia Universidad Católica de Chile. Escuela de Medicina
    El cáncer de pulmón (CP) es la primera causa de muerte oncológica en Chile. La carga se distribuye de manera inequitativa: los quintiles socioeconómicos más bajos presentan mayor prevalencia de tabaquismo y menor acceso a diagnóstico oportuno. El sistema cuenta con dos garantías explícitas en salud (GES): N.o 81, que cubre diagnóstico y tratamiento una vez sospechado el tumor, y N.o 90, que financia la cesación tabáquica; sin embargo, persiste un vacío de prevención secundaria justo en la fase asintomática y potencialmente curable de la enfermedad.Esta tesis demuestra que el tamizaje con tomografía computada de baja dosis (LDCT) cierra dicho vacío y, además, constituye un acto de justicia sanitaria. Ensayos pivotales como NLST y NELSON muestran reducciones de mortalidad de 20–26 % y razones de costo-efectividad favorables. Al proyectar la evidencia al contexto chileno se identificaron más de 400 000 personas elegibles para la pesquisa, concentradas en quintiles vulnerables.La propuesta plantea un piloto clínico que arrancará en agosto 2025 en Clínica RedSalud Santiago. Su objetivo es validar la capacidad del sistema para convocar a la población de riesgo, realizar LDCT de manera estandarizada y derivar sin demoras a quienes necesiten confirmación diagnóstica. La información obtenida de este estudio tiene la intención de modelar la futura incorporación del tamizaje al GES.La articulación entre GES 90 (prevención primaria), el tamizaje propuesto (prevención secundaria) y GES 81 (diagnóstico-tratamiento) generaría un sistema preventivo escalonado y sinérgico, capaz de reducir la mortalidad y las brechas territoriales del CP. Este trabajo deja una hoja de ruta intersectorial que demuestra la factibilidad de converger evidencia, financiamiento y gobernanza en un sistema fragmentado. Si el piloto confirma su viabilidad clínica y financiera, Chile dispondrá por primera vez de una política integral que aborda tabaquismo, detección precoz y tratamiento oportuno, allanando el camino para cerrar brechas históricas de acceso y salvar vidas donde más se necesitan.
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    Maternal obesity and neonatal insulin resistance in the origin of metabolic syndrome in childhood
    (2013) Farías Jofré, Marcelo Enrique; Villalobos Labra, Roberto Esteban; Sáez Pedraza, Pablo José; Westermeier Lafuente, Francisco David; Poblete Lizana, José Andrés; Kusanovic, Juan Pedro; Mardones S., Francisco; Sobrevía Luarte, Luis Alberto
    Obesity during pregnancy has been recognized as an independent risk factor for maternal and fetal complications, including congenital anomalies, gestational diabetes mellitus, gestational hypertension and preeclampsia, caesarean delivery, macrosomia (birth weight > 4000 g), increased neonatal adiposity and hyperinsulinemia. In addition to perinatal complications associated to maternal obesity, rising epidemiological evidence has suggested the intrauterine programming of whole body insulin resistance (IR) in the offspring of obese pregnant woman, evaluated both at early neonatal stage and at young adulthood. Our cohort data showed association among elevated neonatal anthropometry measurements (birth weight and height) and increased levels of waist circumpherence and blood pressure in childohood, two components of the metabolic syndrome (MetS). In the other hand, the homeostasis model assesment index of insulin resistance (HOMA-IR) was correlated to the number of MetS components in this population. In order to describe potential mechanisms of relationship between maternal obesity and future development of MetS, we have evaluated modulators of neonatal insulin signaling pathway in human and animal models of maternal obesity. We have found increased levels of neonatal insulin secretion (serum C-peptide) and sub-clinical markers of cellular insulin resistance and endoplasmic reticulum stress (ER-stress) in offsprings of women with maternal weight excess. The ER stress response has been related to IR and diabetes mellitus development in multiple models of obesity. Thus, a mechanistic link could be proposed between maternal obesity, ER stress and IR in fetal tissues as part of the physiopathology route that connects abnormal intrauterine nutrition with elevated risk of MetS in childhood.
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    Metabolic syndrome and subclinical atherosclerosis in children
    (2011) Arnáiz Gómez, Pilar; Villarroel del Pino, Luis A.; Godoy J., Iván; Barja Y., Salesa; Castillo Valenzuela, Oscar; Farías Jofré, Marcelo Enrique; Domínguez de Landa, María Angélica; Mardones S., Francisco
    Atherosclerosis begins in childhood in response to the clustering of metabolic syndrome (MS) risk components since early life. Carotid intima-media thickness (CIMT), a surrogate marker of subclinical atherosclerosis, has been strongly related with cardiovascular disease and Diabetes 2 in adulthood. We aimed to study the possible association of CIMT with the MS components in a population of Chilean children. A cross-sectional study of 304 children of low socio-economic strata from an urban area of Santiago was performed during 2009-2010. This sample was selected mainly considering the presence of one or more MS components and insulin resistance (IR). Anthropometry and systolic and diastolic blood pressure were assessed by trained personnel. While fasting, a blood sample was taken to determine lipids (enzymatic colorimetric tests), glycemia (hexoquinase), insulin (quimioluminiscence) and HOMA. CIMT was assessed using ultrasonography with automated software. Pearson correlation, chi-squared test and stepwise regression were used. Mean age was 11.5 ± 0.9 years old; 57% girls and 42% pre-pubertal; 64% overweight; and 25% had MS. MS components distribution was: 20% had 0, 29% had one, 26% had two and 25% had three or more. Pearson coefficients for CIMT medium and maximum with systolic blood pressure were: 0.206 (p 0.0003) and r: 0.213 (p 0.0002). Some MS components and IR had higher proportions of children over the 75th percentile of CIMT medium and maximum in the contingency tables: 1) the proportion of children with high CIMT medium was significantly higher for IR (0.035) and CHDL ≤ 40 mg/dL (p 0.039); 2) A tendency for significant differences was found for the proportions of children with high (>75th percentile) CIMT medium with waist circumference (p 0.052) and children with high (>75th percentile) CIMT maximum with CHDL ≤ 40 mg/dL (p 0.062). Multiple linear regression models for CIMT medium and maximum selected just systolic blood pressure in both; p values were 0.0003 and 0.0002. Univariate analyses showed that CIMT medium and maximum were directly associated with systolic blood pressure. Bivariate analyses showed that CIMT medium was significantly associated with IR and CHDL ≤ 40 mg/dL. However, multiple regression models for both CIMTs just selected systolic blood pressure, a fact that would make it a proxy for CIMTs. These results are the first reported in our country.
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    Metabolic syndrome prevalence in chilean children according to three different criteria and its agreement with insulin resistance
    (2013) Barja Y., Salesa; Arnáiz Gómez, Pilar; Domínguez de Landa, María Angélica; Villarroel del Pino, Luis A.; Castillo Valenzuela, Oscar; Farías Jofré, Marcelo Enrique; Mardones S., Francisco
    Background and objectives: There is not a consensus in Metabolic Syndrome (MS) definition for children and adolescents, although its prevalence is increasing. The aim of the present study was tocompare the prevalence of MS according to three diagnostic criteria for children and adolescents and to study the agreement with insulin resistance (IR). Methods: Cross-sectional study (2009-2011) of 3325 students, 10-15 years old, from schools in Puente Alto County, Santiago, Chile. Anthropometry was performed, measuring blood pressure (BP) and in a fast blood sample: glicemia, insulin, blood lipids. We calculated HOMA-IR (Homeostasis Model Assessment index); values >90th percentile of a normal sub-sample were considered as IR. We compared three criteria of MS: International Diabetes Federation (IDF), Cook S. and De Ferranti S. They define different cut-offs for the five components of MS (waist circumference, triglycerides, HDLCholesterol, blood pressure and glicemia) having bnormal at least three of them. Results: Prevalence of MS was 3.82% for IDF, 7.25% for Cook and 20.48% for de Ferranti criterion (Cochran Q-test, p<0.001). In total 859 subjects were IR (25.8%). 73.2% and 69.7% of the children diagnosed with MS according the first two criteria had IR in but only 52.7% according to the third one (Predictive Positive Values: PPV). To predict IR, each criterion had ROC-AUC of 0.60, 0.62 and 0.67 respectively (adjusted for sex and puberty). IR predicted the presence of MS according the different criteria with PPV of 10.8%, 19.6% and 41.8% and ROC-AUC for HOMA-IR was: 0.84, 0.82 and 0.76 respectively (adjusted for sex and puberty). Conclusions: Prevalence of MS varies significantly according to different criteria. IDF and Cook´s criteria are similar predictors for IR (even the former has higher cutoffs for MS components), better than de Ferranti´s. HOMA-IR was a good predictor of the three MS criteria.
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    Prenatal Growth and Metabolic Syndrome Components in Children
    (2011) Mardones S., Francisco; Villarroel del Pino, Luis A.; Barja, Salesa; Arnaíz, Pilar; Castillo, Oscar; Farías, Marcelo; Domínguez, Angélica
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    Prospective follow-up of chronic atrophic gastritis in a high-risk population for gastric cancer in latin america
    (2022) Mardones S., Francisco; Burgueño Peña, Rocca Leticia; Rosso R., Pedro Pablo; Villarroel del Pino, Luis A.; Bacallao, Jorge; Farías Jofré, Marcelo Enrique
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    Reduced Insulin Response in Human Umbilical Vein Endothelial Cells from Pregnancies with Maternal Obesity Is Associated with Activation of PERK Branch of Endoplasmic Reticulum Stress Pathway
    (2013) Farías Jofré, Marcelo Enrique; Westermeier Lafuente, Francisco David; Kusanovic Pivcevic, Juan Pedro; Poblete Lizana, José Andrés; Mardones S., Francisco; Sobrevía Luarte, Luis Alberto