Browsing by Author "Gana, Juan Cristobal"
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- ItemAcute Liver Injury Among Pediatric Liver Transplantation Recipients With Coronavirus Disease 2019: An International Collaborative Study(2021) Sin, Priscila; Diaz, Luis Antonio; Martinez, Mercedes; Vizcaya, Cecilia; D'Agostino, Daniel; Gana, Juan CristobalCoronavirus disease 2019 (COVID-19) is an ongoing pandemic. The occurrence of acute liver injury (ALI) has been reported in liver transplant (LT) recipients; however, the findings on children remain controversial. This is the first extensive, worldwide report on the impact of COVID-19 on pediatric LT recipients. Our online survey reported 110 pediatric LT recipients with severe acute respiratory syndrome coronavirus 2 infection. Of these, 37 were symptomatic and 20 out of them (54%) had complicated COVID-19, which included ALI and acute liver graft rejection. No mortality was reported. Pediatric LT recipients who had undergone transplantation less than 6 months before contracting COVID-19 had a greater number of hospital admissions and a higher ALI frequency (P = 0.013 and P = 0.033, respectively) than those who had undergone transplantation more than 6 months prior. Our study found that COVID-19 cases among pediatric LT recipients demonstrated a high complication rate. We propose that these patients must be followed up strictly.
- ItemClusters of Autoinmune Diseases in Children(KARGER, 2016) Seiltgens, Sorrel Cristian; Iruretagoyena Bruce, Mirentxu Ines; Melendez Escobar, Patricia Eugenia; Ponce Arqueros, Maria Jesus; Talesnik Guendelman, Eduardo; Méndez Rivera, Cecilia Del Pilar; Godoy Cortes, Claudia Loreto; Martinez Aguayo, Alejandro Gregorio; Hogdson, Isabel; Harris Diez, Paul Richard; Gana, Juan Cristobal; Riera Cassorla, Francisca Paz; Garcia Bruce, Hernán Gabriel; Cattani Ortega, Andreina; Borzutzky Schachter, Arturo Jose
- ItemEarly Obesity: Risk Factor for Fatty Liver Disease(LIPPINCOTT WILLIAMS & WILKINS, 2020) Cuzmar, Valeriau; Alberti, Gigliola; Uauy, Ricardo; Pereira, Ana; Garcia, Cristian; De Barbieri, Florencia; Corvalan, Camila; Santos, Jose L.; Mericq, Veronica; Villarroel, Luis; Gana, Juan CristobalNonalcoholic fatty liver disease (NAFLD), defined as fat accumulation greater than 5% in hepatocytes, may progress to fibrosis or cirrhosis later in life. NAFLD prevalence in adolescents has increased significantly in direct relation with obesity prevalence. Fatty liver has become the most frequent indication for liver transplantation in adults. Objective: The aim of the study was to identify anthropometric variables during the first 10 years of life associated to the risk of developing NAFLD in adolescence. Methods: Longitudinal cohort study 'Growth and Obesity Chilean Cohort Study' (GOCS) consisting of 513 children born in 2002 to 2003, with yearly anthropometric data collected over a 10-year period. The presence of intrahepatic fat in the livers of subjects 14 to 16 years of age was determined using abdominal ultrasound. In addition, elastography was performed on all participants with ultrasound evidence of NAFLD. Results: 9.7% of the participants presented findings compatible with NAFLD. After 2 years of age, obesity significantly and progressively increased the probability of NAFLD occurrence in adolescence. Obesity at 5 years of age was associated with the highest OR for NAFLD, reaching values of 8.91 (95% CI 3.03-16.11). Among participants with NAFLD, those with altered liver elasticity (>= 7 kPa) had greater weight, BMIz-score, waist and hip circumference, and altered liver enzymes (P < 0.05). Conclusion: The risk of developing NAFLD in adolescence increases progressively with early obesity starting at age 2 years.
- ItemEvaluación prospectiva de la seguridad y tolerancia de los procedimientos colonoscópicos en pacientes pediátricos(2006) Gana, Juan Cristobal; Glenz, Constanza; Marchant, Pamela; Vaca, Carina; García, Ximena; Larraín, Francisco; Harris, Paul R.Background: Colonoscopy is a well established diagnostic and therapeutic procedure in pediatrics. Aim: To evaluate colon preparation alternatives for colonoscopy or sigmoidoscopy, type of sedation, clinical indications and findings. Patients and methods: Prospective study of 123 children referred for colonoscopy. Demographic data, type of colon preparation, sedation, type of endoscope and endoscopic results were obtained. The following day, a phone interview was carried out inquiring about duration, quality and adverse effects of the sedation and procedure. Results: Seventy one boys (58%) and 52 girls (42%) with a mean age of 6.7±4.4 years, were recruited. The main indication was lower gastrointestinal bleeding (71%). The different colon preparations produced elimination of clear liquid stools in 50%, non transparent liquid in 23%, semi liquid in 22% and solid in 6% of the patients. Most common side effects were abdominal distension (20%) and nausea (16.8%). The most commonly used drugs were midazolam (76%) and demerol (43%). The average duration of the procedure was 18.3 minutes (range: 4-50). The most common findings were rectal polyps (18.7%) and hemorrhagic colitis (14.6%). In 77% of cases, the sedation was considered very good or good. Colon visualization was described as very good (51%) or good (36%). Seventy three percent of children had complete amnesia. The most common adverse effect was vomiting (7.5%). Conclusion: Lower endoscopies are feasible procedures to carry out in children, in an ambulatory basis, with intravenous sedation and minimum adverse effects.
- ItemLiver PDFF estimation using a multi-decoder water-fat separation neural network with a reduced number of echoes(2023) Meneses, Juan Pablo; Arrieta, Cristobal; della Maggiora, Gabriel; Besa, Cecilia; Urbina, Jesus; Arrese, Marco; Gana, Juan Cristobal; Galgani, Jose E.; Tejos, Cristian; Uribe, SergioObjectiveTo accurately estimate liver PDFF from chemical shift-encoded (CSE) MRI using a deep learning (DL)-based Multi-Decoder Water-Fat separation Network (MDWF-Net), that operates over complex-valued CSE-MR images with only 3 echoes.MethodsThe proposed MDWF-Net and a U-Net model were independently trained using the first 3 echoes of MRI data from 134 subjects, acquired with conventional 6-echoes abdomen protocol at 1.5 T. Resulting models were then evaluated using unseen CSE-MR images obtained from 14 subjects that were acquired with a 3-echoes CSE-MR pulse sequence with a shorter duration compared to the standard protocol. Resulting PDFF maps were qualitatively assessed by two radiologists, and quantitatively assessed at two corresponding liver ROIs, using Bland Altman and regression analysis for mean values, and ANOVA testing for standard deviation (STD) (significance level: .05). A 6-echo graph cut was considered ground truth.ResultsAssessment of radiologists demonstrated that, unlike U-Net, MDWF-Net had a similar quality to the ground truth, despite it considered half of the information. Regarding PDFF mean values at ROIs, MDWF-Net showed a better agreement with ground truth (regression slope = 0.94, R-2 = 0.97) than U-Net (regression slope = 0.86, R-2 = 0.93). Moreover, ANOVA post hoc analysis of STDs showed a statistical difference between graph cuts and U-Net (p < .05), unlike MDWF-Net (p = .53).ConclusionMDWF-Net showed a liver PDFF accuracy comparable to the reference graph cut method, using only 3 echoes and thus allowing a reduction in the acquisition times.
- ItemSevere acute pancreatitis secondary to hypertriglyceridemia as the onset of Type 1 Diabetes Mellitus in the pediatric age(2024) Munoz, Camila; De Toro, Valeria; Gana, Juan Cristobal; Harris, Paul R.; Loureiro, Carolina; Alberti, GigliolaHypertriglyceridemia (HTG)-induced acute pancreatitis (AP) secondary to insulin deficiency following the onset of type 1 diabetes mellitus (T1DM) is a rare but serious complication in children. Objective: To describe the diagnosis and treatment of severe HTG and to emphasize the need for timely diagnosis of T1DM. Clinical Case: A 15-year-old female adolescent with a history of overweight presented with a two-weeks history of fever, anorexia, and diffuse abdominal pain. Laboratory tests revealed triglycerides of 17,580 mg/dL, lipase of 723 U/L, and blood glucose of 200 mg/dL. An abdominal CT scan showed an enlarged and edematous pancreas. She was hospitalized with a diagnosis of AP and severe HTG, which progressed to acute necro-hemorrhagic pancreatitis. Treatment included continuous intravenous insulin infusion until triglyceride levels decreased. Upon discontinuation of insulin, fasting hyperglycemia (206 mg/dL) and metabolic acidosis recurred, therefore DM was suspected. Upon targeted questioning, a history of polydipsia, polyuria, and weight loss during the last 3 months stood out. Glycated hemoglobin was markedly elevated (14.7%). Insulin therapy was optimized, achieving stabilization of laboratory parameters after 15 days of treatment and complete anatomical resolution of pancreatic involvement at one year of follow-up. Conclusions: The presence of severe HTG in pediatrics compels us to consider its secondary causes, such as the onset of T1DM. It is crucial to improve the ability to diagnose T1DM early, as it may present with infrequent and high-risk presentations for the patient.
- ItemThe Association Between Breast Density and Gut Microbiota Composition at 2 Years Post-Menarche: A Cross-Sectional Study of Adolescents in Santiago, Chile(2021) Yoon, Lara S.; Jacobs, Jonathan P.; Hoehner, Jessica; Pereira, Ana; Gana, Juan Cristobal; Corvalan, Camila; Michels, Karin B.The gut microbiome has been linked to breast cancer via immune, inflammatory, and hormonal mechanisms. We examined the relation between adolescent breast density and gut microbial composition and function in a cohort of Chilean girls. This cross-sectional study included 218 female participants in the Growth and Obesity Cohort Study who were 2 years post-menarche. We measured absolute breast fibroglandular volume (aFGV) and derived percent FGV (%FGV) using dual energy X-ray absorptiometry. All participants provided a fecal sample. The gut microbiome was characterized using 16S ribosomal RNA sequencing of the V3-V4 hypervariable region. We examined alpha diversity and beta diversity across terciles of %FGV and aFGV. We used MaAsLin2 for multivariable general linear modeling to assess differential taxa and predicted metabolic pathway abundance (MetaCyc) between %FGV and aFGV terciles. All models were adjusted for potential confounding variables and corrected for multiple comparisons. The mean %FGV and aFGV was 49.5% and 217.0 cm(3), respectively, among study participants. Similar median alpha diversity levels were found across %FGV and aFGV terciles when measured by the Shannon diversity index (%FGV T1: 4.0, T2: 3.9, T3: 4.1; aFGV T1: 4.0, T2: 4.0, T3: 4.1). %FGV was associated with differences in beta diversity (R-2 = 0.012, p=0.02). No genera were differentially abundant when comparing %FGV nor aFGV terciles after adjusting for potential confounders (q > 0.56 for all genera). We found no associations between predicted MetaCyc pathway abundance and %FGV and aFGV. Overall, breast density measured at 2 years post-menarche was not associated with composition and predicted function of the gut microbiome among adolescent Chilean girls.