Browsing by Author "Pedreros, C."

Now showing 1 - 4 of 4
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    First 'training in clinical research methodologies in Chile' (EMIC-Chile). Psychoeducational foundations
    (2010) Cabieses Valdez, Báltica Beatriz; Espinoza, M.; Pedreros, C.; Zitko, Pedro; Cerda, J.; Bambs S., Claudia
    EMIC-Chile ("Entrenamiento en Metodologías para la Investigación Clínica en Chile") is an academic project developed in Chile during 2008 to train health professionals in clinical research. The purpose of this initiative was to improve the quality of rese
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    Persistent sepsis-induced hypotension without hyperlactatemia: A distinct clinical and physiological profile within the spectrum of septic shock
    (2012) Hernández P., Glenn; Bruhn, Alejandro; Castro, R.; Pedreros, C.; Rovegno Echavarria, Maxiliano; Kattan Tala, Eduardo José; Veas, E.; Fuentealba, A.; Regueira Heskia, Tomás; Ruiz, C.; Ince, C.
    Introduction. A subgroup of septic shock patients will never develop hyperlactatemia despite being subjected to a massive circulatory stress. Maintenance of normal lactate levels during septic shock is of great clinical and physiological interest. Our aim was to describe the clinical, hemodynamic, perfusion, and microcirculatory profiles associated to the absence of hyperlactatemia during septic shock resuscitation. Methods. We conducted an observational study in septic shock patients undergoing resuscitation. Serial clinical, hemodynamic, and perfusion parameters were registered. A single sublingual microcirculatory assessment was performed in a subgroup. Patients evolving with versus without hyperlactatemia were compared. Results. 124 septic shock patients were included. Patients without hyperlactatemia exhibited lower severity scores and mortality. They also presented higher platelet counts and required less intensive treatment. Microcirculation was assessed in 45 patients. Patients without hyperlactatemia presented higher PPV and MFI values. Lactate was correlated to several microcirculatory parameters. No difference in systemic flow parameters was observed. Conclusion. Persistent sepsis-induced hypotension without hyperlactatemia is associated with less organ dysfunctions and a very low mortality risk. Patients without hyperlactatemia exhibit less coagulation and microcirculatory derangements despite comparable macrohemodynamics. Our study supports the notion that persistent sepsis-induced hypotension without hyperlactatemia exhibits a distinctive clinical and physiological profile.
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    Severe abnormalities in microvascular perfused vessel density are associated to organ dysfunctions and mortality and can be predicted by hyperlactatemia and norepinephrine requirements in septic shock patients
    (2013) Hernández P., Glenn; Boerma, C.; Dubin, A.; Bruhn, Alejandro; Koopmans, M.; Kanoore, V.; Ruiz Balart, Carolina; Castro López, Ricardo; Pozo M., Omar; Pedreros, C.; Veas, E.; Fuentealba, A.; Kattan Tala, Eduardo José; Rovegno Echavarria, Maxiliano
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    Therapeutic Drug Monitoring of Mycophenolic Acid in Kidney Transplant Patients: A Abbreviated Sampling Strategy
    (2007) Muller, H.; Solari Gajardo, Sandra; Zuniga, C.; Guerra Venegas, Irene Del Carmen; Troncoso, J.; Ovalle, R.; Morente, J.; Pedreros, C.
    Mycophenolic acid (MPA) levels have demonstrated a good correlation with clinical outcomes, but with great pharmacokinetic variability between patients. Therapeutic drug monitoring (TDM) is recommended to include a 12-hour area under the concentration–time curve (AUC). Since full AUC estimates are not practical for routine monitoring, limited sampling strategies have been suggested. We evaluated MPA pharmacokinetics in 18 stable renal transplant patients receiving mycophenolate mofetil (MMF) as part of their immunosuppressive therapy. The correlation between measured and estimated AUC was assessed using 4 different sparse sampling algorithms. The mean values for C0 and AUC0–6h were 1.8 ± 1.2 mg/L and 31.1 ± 14.8 mg*h/L, respectively. The dose-corrected AUC0–6h was 35.4 ± 17.9 mg*h/L. Regarding the single time points, C0 showed a low correlation with AUC0–6h (r2 = .34); C1.5, the best correlation (r2 = .72); and C3, the worst (r2 = .07). Sparse sample algorithms used to estimate 12-hour AUC including C0, C1, C2, C3, C4, and/or C6 showed a good correlation with the calculated AUC0–6 (r2 = .81–.96). The algorithm that used C0, C1, C2, and C4 showed the best correlation, but we also found a good correlation (r2 = .91) with C0, C1, and C2. Based on these results, we have suggested using the 3-point algorithm (C0, C1, and C2) for MPA TDM in stable renal transplant patients due to the good correlation with drug exposure and better functionality than an algorithm using a 4-hour postdose measurement.