Hospital Dipreca

We examine how structural characteristics of health systems in Latin America and the Caribbean (LAC) shape access to innovative therapies, using emicizumab for hemophilia A as a case study. Although the therapy is available in the region, access remains uneven and constrained by high costs and fragmented health system arrangements. Using a descriptive structural approach, we characterize the health system configurations associated with financial coverage of emicizumab across 16 LAC countries, representing more than 85% of the regional population. Regulatory approval timelines and coverage status were described, and principal component analysis (PCA) was applied to synthesize multiple indicators into a Global Characteristics Index capturing five core health system functions: resource generation, financing, service delivery, general governance, and therapy-specific governance. Coverage is defined as formal access with explicit financial protection provided by the health system. Substantial heterogeneity was observed across countries. Regulatory approval was often achieved relatively rapidly, but this did not consistently translate into timely or comprehensive coverage. Countries with stronger structural characteristics-particularly in resource generation, service delivery, and governance-tended to achieve broader and more sustained coverage, although institutional capacity alone was not sufficient in all cases. Our results emphasize the need to strengthen health governance and adopt specific policies for rare diseases in the region.

BackgroundAdvances in the management of HIV and AIDS have shifted the primary health concerns for these patients from opportunistic infections to cardiovascular diseases. Although antiretroviral therapy (ART) has significantly improved survival, it has also been linked to complications such as dyslipidemia, hypertension, carbohydrate metabolism disorders, and coronary and peripheral artery disease. In the Dominican Republic, a middle-high-income country, healthcare practices for people living with HIV are generally not focused on preventing these comorbidities.Table 1.Patients demographicsCardiovascular risk factors 3 or more months after starting ARVsMethodsThis cross-sectional study analyzed data from the HIV care program at a tertiary hospital in Santiago de los Caballeros, Dominican Republic. The aim was to identify and characterize dyslipidemia and its relationship with hypertension and diabetes mellitus. Lipid profiles, serum glucose levels, and blood pressure readings were compared before and at least three months after starting antiretroviral treatment to assess any significant changes.Correlation between gender and cardiovascular risk factorsResultsA total of 298 medical records were reviewed, with 82% of patients on an antiretroviral regimen consisting of Tenofovir/lamivudine + Dolutegravir. Hypertriglyceridemia was the most common form of dyslipidemia (33.2%), followed by hypercholesterolemia (26.5%). Hypertension was prevalent in 72.5% of patients, and 40.6% exhibited fasting hyperglycemia. Dyslipidemia was significantly associated with gender (p=0.03), but no statistically significant relationships were found between dyslipidemia, hypertension, and hyperglycemia.ConclusionThe high prevalence of hypertension and diabetes or pre-diabetes in the studied population highlights the need for preventive measures to address these chronic non-communicable diseases in HIV patients. It is crucial for healthcare providers to implement lifestyle modifications and consider medications that could slow the development of these complications.DisclosuresAll Authors: No reported disclosures

Introduction:Gustilo–Anderson type IIIB open tibial fractures carry a high risk of fracture-related infection (FRI) due to extensive soft tissue damage and frequent delays in coverage. Although early orthoplastic intervention lowers infection rates, many trauma centers lack the resources for same-day or early flap coverage. This study aimed to assess the relationship between timing of flap coverage and FRI risk in a young, healthy population, and to define a clinically relevant therapeutic window.Materials and Methods:A retrospective cohort study was conducted at a single Level I trauma center (2012–2023). Patients with GA IIIB tibial fractures were treated under a standardized protocol with strict inclusion criteria. Timing of flap coverage was analyzed using Levene test, Student t test, and ROC curve analysis with the Youden index to determine the optimal infection-risk threshold.Results:Out of 332 open tibial fractures, 41 patients with GA IIIB injuries met inclusion criteria. Mean time to coverage was 24.6 days. FRI occurred in 15 patients (36.6%). Delayed coverage was significantly associated with FRI (P < 0.001). ROC analysis showed an AUC of 0.83; the Youden index identified <12 days as the optimal cutoff (100% sensitivity, 34.6% specificity). None of the 10 patients treated within 12 days developed FRI, versus 56.6% in those treated later (P < 0.05).Conclusions:Coverage within 12 days minimizes infection risk in GA IIIB tibial fractures. Although immediate coverage remains ideal, a defined 12-day window offers practical guidance, especially where early orthoplastic care is not feasible.

This case report details the first use of ravulizumab in Chile for a patient with acetylcholine receptor (AChR)-positive myasthenia gravis (MG) who did not respond to rituximab (RTX). A 26-year-old female presented with progressive MG symptoms, including fatigue and bilateral ptosis. Despite conventional treatment and thymectomy, she experienced multiple myasthenic crises. Following the lack of response to RTX, ravulizumab was initiated, resulting in a significant improvement in the Myasthenia Gravis Activities of Daily Living (MG-ADL) score in less than two weeks. Ravulizumab, a monoclonal antibody that inhibits complement component C5, was approved for MG in 2022 and is being assessed for efficacy in neurological disorders. This report highlights its potential as a therapy for MG in the absence of robust local evidence, offering a novel therapeutic option for managing this debilitating condition.

Acinetobacter bereziniae has emerged as a significant human pathogen, acquiring multiple antibiotic resistance genes, including carbapenemases. This study focuses on characterizing the plasmids harboring the blaNDM-1 and tet(Y) genes in two carbapenem-resistant A. bereziniae isolates (UCO-553 and UCO-554) obtained in Chile during the COVID-19 pandemic. Methods: Antibiotic susceptibility testing was conducted on UCO-553 and UCO-554. Both isolates underwent whole-genome sequencing to ascertain their sequence type (ST), core genome multilocus sequence-typing (cgMLST) profile, antibiotic resistance genes, plasmids, and mobile genetic elements. Conjugation experiments were performed for both isolates. Results: Both isolates exhibited broad resistance, including resistance to carbapenems, third-generation cephalosporins, fluoroquinolones, tetracycline, cotrimoxazole, and aminoglycosides. Both isolates belong to sequence type STPAS1761, with a difference of 17 out of 2984 alleles. Each isolate carried a 47,274 bp plasmid with blaNDM-1 and aph(3')-VI genes and two highly similar plasmids: a 35,184 bp plasmid with tet(Y), sul2, aph(6)-Id, and aph(3″)-Ib genes, and a 6078 bp plasmid containing the ant(2″)-Ia gene. Quinolone-resistance mutations were identified in the gyrA and parC genes of both isolates. Importantly, blaNDM-1 was located within a Tn125 transposon, and tet(Y) was embedded in a Tn5393 transposon. Conjugation experiments successfully transferred blaNDM-1 and tet(Y) into the A. baumannii ATCC 19606 strain, indicating the potential for horizontal gene transfer. Conclusions: This study highlights the critical role of plasmids in disseminating resistance genes in A. bereziniae and underscores the need for the continued genomic surveillance of this emerging pathogen. The findings emphasize the importance of monitoring A. bereziniae for its potential to cause difficult-to-treat infections and its capacity to spread resistance determinants against clinically significant antibiotics.

AimsTo evaluate the feasibility of a transthoracic echocardiogram using an apical-subcostal protocol in invasive mechanical ventilation (IMV) and prone position.MethodsProspective study of adults who required a prone position during IMV. A pillow was placed only under the left hemithorax in the prone position to elevate and ease the apical and subcostal windows. A critical care cardiologist (prone group) acquired and evaluated the images using the apical-subcostal protocol. Besides, we used ambulatory echocardiograms performed as a comparative group (supine group).Results86 patients were included, 43 in the prone and 43 in the supine. In the prone group, the indication to perform an echocardiogram was hemodynamic monitoring. All patients were ventilated with protective parameters, and the mean end-expiratory pressure was 10.6 cmH2O. The protocol was performed entirely in 42 of 43 patients in the prone group because one patient did not have any acoustic window. In the 43 patients in the prone group analyzed and compared to the supine group, global biventricular function was assessed in 97.7% (p = 1.0), severe heart valve disease in 88.4% (p = 0.055), ruled out of the presence of pulmonary hypertension in 76.7% (p = 0.80), pericardial effusion in 93% (p = 0.12), and volume status by inferior vena cava in 93% (p = 0.48). Comparing prone versus supine position, a statistical difference was found when evaluating the left ventricle apical 2-chamber view (65.1 versus 100%, p < 0.01) and its segmental function (53.4 versus 100%, p < 0.01).ConclusionThe echocardiogram using an apical-subcostal protocol is feasible in patients in the IMV and prone position.Graphical