Browsing by Author "Cruz, Juan Pablo"

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    Determination of variables for a more accurate diagnostic approach in suspected acute invasive fungal rhinosinusitis: A non-concurrent cohort study
    (2021) Lagos Villaseca, Antonia Elisa; García-Huidobro Núñez, Francisco Gustavo; Valeria Sepúlveda; Cruz, Juan Pablo; González, Claudia; Callejas Cánepa, Claudio Andrés
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    Efficacy of andrographolide in not active progressive multiple sclerosis: a prospective exploratory double-blind, parallel-group, randomized, placebo-controlled trial
    (2020) Ciampi, Ethel; Uribe-San-Martin, Reinaldo.; Cárcamo Rodríguez, Claudia Andrea; Cruz, Juan Pablo; Reyes, Ana.; Reyes, Diego.; Pinto, Carmen.; Vásquez Torres, Macarena.; Burgos, Rafael A.; Hancke, Juan.
    Abstract Background Multiple sclerosis (MS) is a chronic immune mediated disease and the progressive phase appears to have significant neurodegenerative mechanisms. The classification of the course of progressive MS (PMS) has been re-organized into categories of active vs. not active inflammatory disease and the presence vs. absence of gradual disease progression. Clinical trial experience to date in PMS with anti-inflammatory medications has shown limited effect. Andrographolide is a new class of anti-inflammatory agent, that has been proposed as a potential drug for autoimmune disorders, including MS. In the present trial, we perform an exploratory pilot study on the efficacy and safety of andrographolide (AP) compared to placebo in not active PMS. Methods A pilot clinical trial using 140 mg oral AP or placebo twice daily for 24 months in patients with not active primary or secondary progressive MS was conducted. The primary efficacy endpoint was the mean percentage brain volume change (mPBVC). Secondary efficacy endpoints included 3-month confirmed disability progression (3-CDP) and mean EDSS change. Results Forty-four patients were randomized: 23 were assigned to the AP group, and 21 were assigned to the placebo group. The median baseline EDSS of both groups was 6.0. Annualized mPBVC was − 0.679% for the AP group and − 1.069% for the placebo group (mean difference: -0.39; 95% CI [− 0.836–0.055], p = 0.08, relative reduction: 36.5%). In the AP group, 30% had 3-CDP compared to 41% in the placebo group (HR: 0.596; 95% CI [0.200–1.777], p = 0.06). The mean EDSS change was − 0.025 in the AP group and + 0.352 in the placebo group (mean difference: 0.63, p = 0.042). Adverse events related to AP were mild rash and dysgeusia. Conclusions AP was well tolerated and showed a potential effect in reducing brain atrophy and disability progression, that need to be further evaluated in a larger clinical trial. Trial registration ClinicalTrials.gov NCT02273635 retrospectively registered on October 24th, 2014.
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    Enhancing Brain Lesions after Endovascular Treatment of Aneurysms
    (2014) Cruz, Juan Pablo; Marotta, T.; O'Kelly, C.; Holtmannspoetter, M.; Saliou, G.; Willinsky, R.; Krings, T.; Agid, R.
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    Espectro fenotípico de Síndrome de CHARGE neonatal
    (2019) Sánchez Otayza, Natalia Alejandra; Hernández, Marta; Cruz, Juan Pablo; Mellado Sagredo, Cecilia
    El Síndrome de CHARGE (SCH), es un síndrome genético de amplia variabilidad fenotípica, de herencia autosómica dominante, causado por variantes patogénicas en el gen CHD7. Objetivo: Describir el amplio espectro fenotípico de un SCH neonatal, heterocigoto para el gen CDH7 y la utilidad de la secuenciación en la confirmación diagnóstica, considerando los diagnósticos diferenciales. Caso Clínico: recién nacida prematura de 34 semanas, con antecedentes prenatales de polihidroamnios severo, translucencia nucal aumentada y foco hiperecogénico cardiaco, con estudio de TORCH antenatal, que descartó infección congénita. Al nacer se pesquisó parálisis facial periférica, atresia de coanas, dismorfias múltiples, cardiopatía congénita y coloboma retinocoroideo bilateral. Las neuroimágenes mostraron hipoplasia de cóclea y de canales semicirculares bilaterales e hipoplasia pontocerebelosa. Los potenciales evocados auditivos mostraron hipoacusia sensorioneural profunda derecha y anacusia izquierda. Evolucionó con hipocalcemia y alteraciones en la inmunidad, confirmándose un hipoparatiroidismo e hipoplasia de timo. El cariograma fue normal y la amplificación de sondas dependiente de ligandos múltiples (MLPA) excluyó microdeleción 22q11.2. La sospecha clínica de SCH se confirmó con la detección de una variante patogénica en el gen CHD7. Conclusiones: La superposición de características clínicas del SCH con otros síndromes genéticos requiere confirmación genética molecular considerando diferencias en evolución, terapias y riesgos de recurrencia
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    Estudios de exactitud diagnóstica : Herramientas para su Interpretación
    (2015) Bravo Grau, Sebastián; Cruz, Juan Pablo
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    Intravascular devices with a higher risk of polymer emboli : The need for particulate generation testing
    (2020) Chopra, A. M.; Rapkiewicz, A.; Daggubati, R.; Sequeira, A.; Hu, Y. C.; Bhatt, D. L.; Sharma, S. K.; Cruz, Juan Pablo; Tzafriri, A. R.; Edelman, E. R.
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    Neural lesions in obstetrics : a diagnostic tree
    (2022) Lacassie Quiroga, Héctor; Mellado T., Patricio; Cruz, Juan Pablo
    Letter to the editor.
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    Neuropatía ciática en pediatría : presentación clínica y seguimiento a largo plazo
    (2020) Jaque Almendras, C.; Escobar Henríquez, Raúl; Caicedo Feijoo, A.; Beytía Reyes, María de Los Ángeles; Correa Pérez, S.; Gejman Enríquez, Roger; Cruz, Juan Pablo; Contreras Olea, Oscar; Avila Smirnow, Daniela
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    Refractory epilepsy associated with anti-ribosomal P antibodies successfully treated with topiramate
    (2020) Uribe San Martín, Reinaldo; Ciampi, Ethel; Cruz, Juan Pablo; Vásquez, M.; Cárcamo Rodríguez, Claudia Andrea
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    Resonancia magnética funcional : principios básicos y aplicaciones en neurociencias
    (2018) Labbé Atenas, Tomás; Ciampi, Ethel; Cruz, Juan Pablo; Uribe Arancibia, Sergio A.; Cárcamo Rodríguez, Claudia Andrea
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    Secondary paroxysmal dyskinesia in multiple sclerosis: Clinical-radiological features and treatment. Case report of seven patients.
    (2017) Ciampi, Ethel; Uribe San Martín, Reinaldo; Godoy Santín, Jaime; Cruz, Juan Pablo; Cárcamo Rodríguez, Claudia Andrea; Juri Clavería, Carlos Andrés
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    Social cognition in Multiple Sclerosis is associated to changes in brain connectivity : A resting-state fMRI study
    (2020) Labbé Atenas, Tomás; Zurita, M.; Montalba, C.; Ciampi, Ethel; Cruz, Juan Pablo; Vásquez, M.; Uribe Arancibia, Sergio A.; Crossley, Nicolás; Cárcamo Rodríguez, Claudia Andrea
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    Socioeconomic, health-care access and clinical determinants of disease severity in Multiple Sclerosis in Chile
    (2023) Ciampi Díaz, Ethel Leslie; Soler León, Bernardita María; Uribe San Martín, Reinaldo; Jurgensen Heinrich, Lukas; Guzmán, I.; Keller Matamala, Karina Pascale; Reyes C., Ana Belén; Bravo Grau, Sebastián Eduardo; Cruz, Juan Pablo; Cárcamo Rodríguez, Claudia Andrea
    Background: MS severity may be affected by genetic, patient-related, disease-related and environmental factors. Socioeconomic status, including income and healthcare access, amongst others, may also have a role in affecting diagnostic delay or therapy prescription. In Chile, two main healthcare systems exist, public-healthcare and private-healthcare, nonetheless universal care laws (e.g., access to High Efficacy Therapy-HET), including both systems, have been recently enacted for people with MS. Objective: To assess the role of Socioeconomic Conditions (SEC), clinical variables and public health policies on the impact of disease severity of MS patients in Chile. Methods: Multicentric, observational, cross-sectional study including patients from two reference centres (1 national reference centre from the private-health system and 1 regional reference centre from the public-health system). SEC and clinical variables included healthcare insurance (private or public), subclassification of health insurance according to monthly income, sex, age at onset, diagnostic delay, disease duration, diagnosis before HET law (as a proxy of HET delay), and current HET treatment. Progression Index (PI), EDSS ≥6.0 and Progressive MS diagnosis were used as outcome measures. Multivariable binary logistic regression was performed. Results: We included 604 patients (460 private-health, 144 public-health), 67% women, 100% white/mestizo, 88% RRMS, mean age 42±12 years, mean age at onset 32±11 years, mean disease duration 10±6 years, median diagnostic delay 0 (0–34) years, 86% currently receiving any DMT, 55% currently receiving HET, median EDSS at last visit of 2.0 (0–10), and median PI 0.17 (0–4.5). Lower monthly income was associated with higher EDSS and higher PI. In the multivariable analysis, public-healthcare (OR 10.2), being diagnosed before HET-law (OR 4.89), longer diagnostic delay (OR 1.26), and older age at onset (OR 1.05) were associated with a higher risk of PI>0.2, while current HET (OR 0.39) was a protective factor. Diagnosis before HET-law (OR 7.59), public-healthcare (OR 6.49), male sex (OR 2.56), longer disease duration (OR 1.2) and older age at onset (OR 1.1) were associated with a higher risk of Progressive MS. Public-healthcare (OR 5.54), longer disease duration (OR 1.14) and older age at onset (OR 1.08) were associated with a higher risk of EDSS ≥6.0 while current treatment with HET had a trend as being a protective factor (OR 0.44, p = 0.05). Conclusion: MS severity is impacted by non-modifiable factors such as sex and age at onset. Interventions focused on shortening diagnostic delay and encouraging early access to high-efficacy therapies, as well as initiatives that may reduce the disparities inherent to lower socioeconomic status, may improve outcomes in people with MS.
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    The META score for differentiating metastatic from osteoporotic vertebral fractures : an independent agreement assessment
    (2018) Besa, Pablo; Urrutia Escobar, Julio Octavio; Campos Daziano, Mauricio Andrés; Mobarec Katunaric, Sebastián Ignacio; Cruz, Juan Pablo; Cikutovic Molina, Pablo Andrés; Díaz, Gonzalo
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    The Pfirrmann classification of lumbar intervertebral disc degeneration : an independent inter- and intra-observer agreement assessment
    (2016) Urrutia Escobar, Julio Octavio; Besa, P.; Campos, M.; Cikutovic, P.; Cabezón, M.; Molina, M.; Cruz, Juan Pablo