Browsing by Author "Navarrete, Pablo"

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    Aproximaciones al desarrollo urbano sustentable en Chile desde la percepción de sus habitantes
    (Centro de Desarrollo Urbano Sustentable, 2021) Fuentes, Luis; Greene, Margarita; Berríos, Emilio; Flores, Mónica; Henríquez, Cristián; Link, Felipe; Luneke, Alejandra; Navarrete, Pablo; Ramírez, María Inés; Rehner, Johannes; Rodríguez, Sebastián; Ruiz Tagle, Javier; Salazar, Gonzalo; Señoret Swinburn, Andrés; Truffello Robledo, Ricardo Enrique; Valenzuela Levi, Nicolás Darío; CEDEUS (Chile)
    El Desarrollo Urbano Sustentable adquiere cada vez más relevancia dentro de la investigación y planificación de las ciudades. Si bien existen esfuerzos sistemáticos para medir sus diferentes dimensiones (Jordán, Rehner, Samaniego, 2010), son pocos los estudios que proponen un foco a escala de barrio tomando en cuenta la percepción individual de los habitantes. En este documento, se propone una definición de desarrollo urbano sustentable y una metodología para estudiarlo a través de diferentes tipologías de ciudad. Además, se presentan los principales hallazgos de una encuesta de percepción del desarrollo urbano sustentable aplicada en tres dimensiones y en las diferentes tipologías de ciudad del Gran Santiago y Gran Concepción
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    Continuous prolonged prone positioning in COVID-19-related ARDS: a multicenter cohort study from Chile
    (2022) Cornejo, Rodrigo A.; Montoya, Jorge; Gajardo, Abraham I. J.; Graf, Jerónimo; Alegría Vargas, Leyla; Baghetti, Romyna; Irarrázaval, Anita; Santis, César; Pavez, Nicolás; Leighton, Sofía; Tomicic, Vinko; Morales, Daniel; Ruiz Balart, Carolina; Navarrete, Pablo; Vargas, Patricio; Gálvez, Roberto; Espinosa, Victoria; Lazo, Marioli; Pérez-Araos, Rodrigo A.; Garay, Osvaldo; Sepúlveda, Patrick; Martinez, Edgardo; Bruhn, Alejandro; The SOCHIMI Prone-COVID-19 Group; Pontificia Universidad Católica de Chile. Escuela de Medicina
    Background Prone positioning is currently applied in time-limited daily sessions up to 24 h which determines that most patients require several sessions. Although longer prone sessions have been reported, there is scarce evidence about the feasibility and safety of such approach. We analyzed feasibility and safety of a continuous prolonged prone positioning strategy implemented nationwide, in a large cohort of COVID-19 patients in Chile. Methods: Retrospective cohort study of mechanically ventilated COVID-19 patients with moderate-to-severe acute respiratory distress syndrome (ARDS), conducted in 15 Intensive Care Units, which adhered to a national protocol of continuous prone sessions  ≥ 48 h and until PaO2:FiO2 increased above 200 mm Hg. The number and extension of prone sessions were registered, along with relevant physiologic data and adverse events related to prone positioning. The cohort was stratified according to the first prone session duration: Group A, 2–3 days; Group B, 4–5 days; and Group C, > 5 days. Multivariable regression analyses were performed to assess whether the duration of prone sessions could impact safety. Results: We included 417 patients who required a first prone session of 4 (3–5) days of whom 318 (76.3%) received only one session. During the first prone session the main adverse event was grade 1–2 pressure sores in 97 (23.9%) patients; severe adverse events were infrequent with 17 non-scheduled extubations (4.2%). 90-day mortality was 36.2%. Ninety-eight patients (24%) were classified as group C; they exhibited a more severe ARDS at baseline, as reflected by lower PaO2:FiO2 ratio and higher ventilatory ratio, and had a higher rate of pressure sores (44%) and higher 90-day mortality (48%). However, after adjustment for severity and several relevant confounders, prone session duration was not associated with mortality or pressure sores. Conclusions: Nationwide implementation of a continuous prolonged prone positioning strategy for COVID-19 ARDS patients was feasible. Minor pressure sores were frequent but within the ranges previously described, while severe adverse events were infrequent. The duration of prone session did not have an adverse effect on safety.
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    Diseño urbano como herramienta para reducir la persepción de inseguridad
    (Centro de Desarrollo Urbano Sustentable, 2020) Navarrete, Pablo; Lunecke, Alejandra; Fuentes, Luis; Trufello, Ricardo; CEDEUS (Chile)
    La inseguridad en el espacio público no solo reduce el bienestar psicológico de las personas, sino también su uso y la participación en la vida de barrio. Por este motivo, diversos programas gubernamentales se han centrado en el rediseño del espacio público. Se propone una metodología para mapear la percepción de inseguridad y medir ex ante el impacto que tendrán las intervenciones de los programas de regeneración urbana en los habitantes, utilizando métodos de interpolación espacial y experimentos aleatorios de control y tratamiento basados en imágenes. Como resultado se identifican zonas de alta concentración de inseguridad, lo que permite seleccionar aquellos proyectos de intervención de mayor impacto mejorando el costo-eficiencia de la inversión pública
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    Long-term mortality of coronavirus disease 2019 critically ill patients that required percutaneous tracheostomy in Chile: A multicenter cohort study
    (Wolters Kluwer Health, Inc., 2024) Ulloa Morrison, Rodrigo; Escalona, José; Navarrete, Pablo; Espinoza, Javiera; Bravo Morales, Sebastián Ignacio; Pastore Thomson, Antonia; Reyes, Sebastián; Bozinovic, Milan; Abbott, Francisco; Pairumani, Ronald; Noguera, Roselyn; Vera Alarcón, María Magdalena; González, Felipe; Valle, Felipe; Bakker, Jan; Bugedo Tarraza, Guillermo; Kattan Tala, Eduardo José
    Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection leads to mechanical ventilation (MV) in approximately 20% of hospitalized patients. Tracheostomy expedites weaning of respiratory support. Moreover, there is a paucity of data regarding long-term outcomes of tracheostomized coronavirus disease 2019 (COVID-19) patients. The objective of this study was to describe 1-year mortality in a cohort of COVID-19 critically ill patients who required percutaneous tracheostomy in Chile and to assess the impact of age on outcomes. Methods: A multicenter prospective observational study was conducted in 4 hospitals in Chile between March 2020 and July 2021. Patients with confirmed SARS-CoV-2 infection connected to MV and required percutaneous tracheostomy were included. Baseline data, relevant perioperative and long-term outcomes, such as 1-year mortality, MV duration, intensive care unit (ICU), and hospital length of stay were registered. Patients were dichotomized according to age group (< and ≥ 70 years). Univariate and multivariate logistic regressions were performed to identify predictors of 1-year mortality. Results: Of 1319 COVID-19 ventilated critically ill patients, 23% (304) required a percutaneous tracheostomy. One-year mortality of the study group was 25% (20.2%-30.3%). ICU and hospital length of stay (LOS) were of 37 (27-49) and 52 (40-72) days. One-year mortality was higher in patients ≥ 70 years (36.9% vs. 21.2%, P = 0.012). Multivariate analysis confirmed age and baseline sequential organ failure assessment (SOFA) score as independent predictors, while time from intubation to tracheostomy was not. Conclusion: In COVID-19 critically ill patients who required percutaneous tracheostomy in Chile, the 1-year mortality rate was 25%, with a relevant impact of age on outcomes. An appropriate patient selection likely accounted for the low mortality rate. Future studies should confirm these results.
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    Pensar, conceptualizar y operacionalizar la sustentabilidad: conceptos, métodos y resultados desde el centro de desarrollo urbano sustentable
    (2024) Fuentes Arce, Luis; Greene Zúñiga, Margarita; Rodríguez, Sebastián; Señoret Swinburn, Andrés; Figueroa Martínez, Cristhian; Berríos Álvarez, Emilio Moisés; Henríquez, Cristián; Ruiz-Tagle, Javier; Link Lazo, Felipe Alejandro; Salazar Preece, Gonzalo Eduardo; Rehner, Johannes; Truffello Robledo, Ricardo Enrique; Valenzuela Levi, Nicolás Darío; Navarrete, Pablo; Ramírez, María; Flores, Mónica; CEDEUS (Chile)
    El Centro de Desarrollo Urbano Sustentable (CEDEUS) propone comprender la sustentabilidad como el proceso a través del cual las comunidades florecen de forma armónica tanto en las generaciones actuales como en las futuras. Diferentes investigaciones han tomado esta definición y discutido ¿qué tipologías de barrio son más sustentables? y ¿cómo la percepción y experiencia de las personas releva prácticas, usos del espacio y lugares significativos que contribuyen a la comprensión de la sustentabilidad? En este documento se muestran las principales metodologías, resultados y aprendizajes de este proceso, para así, contribuir a la reflexión sobre cómo las comunidades pueden transitar hacia la sustentabilidad urbana.
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    Perfil clínico y epidemiológico de los casos de tuberculosis atendidos en una red de salud universitaria en Santiago de Chile entre los años 2000-2010
    (2012) Morgado Ahumada, Álvaro Esteban; Köhnenkampf, Ruth; Balcells Marty, María Elvira; Navarrete, Pablo; García Cañete, Patricia Del Carmen
    Background: The incidence and epidemiological profile of tuberculosis (TB) has changed significantly in the recent years in Chile. Aim: To evaluate the clinical and epidemiological characteristics of TB cases diagnosed in the last decade at a university hospital in Santiago. Material and Methods: The Mycobacterium tuberculosis culture registry of the microbiology laboratory was reviewed. Medical records of patients with a positive culture registered between 2000 and 2010 were retrieved and analyzed. Results: Two hundred forty positive Mycobacterium tuberculosis cultures were identified and the medical records of 158 of these patients were accessed for analysis. The median age was 53 years (range: 3 to 89), 55.1% were female and nearly 42% had extra-pulmonary TB. Among known risk factors, 32.9% of patients were older than 65 years, 4.4% were health care workers and 3.9% immigrants. Twenty eight percent (41/145) had some type of immunosuppression at diagnosis: 11.7% HIV infection and 16.6% were using immunosuppressive drugs. In this group, a previous tuberculin skin test was done in only 5 cases (12.2%). Adverse events related to TB treatment were reported in 21.3% of cases (17/80). No cases of fulminant hepatitis or death from this cause were identified. Four of 92 patients that had a complete follow up during treatment, died. Two of these patients were receiving steroids. Conclusions: Almost one third of TB cases occurred among immunosuppressed patients and 42% were extra-pulmonary forms. The prevention of TB reactivation in this group should be strengthened.