Browsing by Author "Harris D., Paul R."

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    Adaptation to the reality of Latin America of the NASPGHAN/ESPGHAN 2016 Guidelines on the Diagnosis, Prevention and Treatment of Helicobacter pylori Infection in Pediatrics
    (2020) Harris D., Paul R.; Calderon-Guerrero, O. G.; Vera Chamorro, J. F.; Lucero, Y.; Vasquez, M.; Ogata, S. K.; Angulo, D.; Madrazo, A.; Gonzales, J.; Gana Ansaldo, Juan Cristóbal; Rivero, A.
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    Apnoea in infancy: Clinical and laboratory characteristicsEvolución clínica y de laboratorio en lactantes con inmadurez del centro respiratorio que presentan episodios de apnea
    (SPRINGER INTERNATIONAL PUBLISHING AG, 2004) Sánchez, Ignacio; Mobarec Katunaric, Sebastián Ignacio; Muñoz O., Carla; Brockmann Veloso, Pablo Edmundo; Mesa, Tomás; Holmgren P., Linus; Harris D., Paul R.
    Introduction: Episodes of central pauses and periodic breathing are normal in infants and decrease with age and growth. Objective: to evaluate a group of infants that had a polysomnography (PSG) performed due to an episode of apnoea, with elevated immature sleep characteristics and who required home cardiorespiratory monitoring (HCRM) and further control PSGs. Methods: 34 patients, 22 (65%) were male, mean age 27 ± 2 months (PSG 1), range 0,3-9 years, were studied between May 1997 and May 2001. Along with the first PSG (PSG 1) a second was performed (PSG 2) prior to the suspension of HCRM. Apnoea was defined as the absence of respiration for more than 20 sec (central) or more than 10 sec (obstructive and mixed); respiratory pauses as the absence of respiration for more than 6 sec and less than 20 sec (central) or more than 6 sec and less than 10 sec (obstructive). Results: The main indications for PSG were apnoea (27 pts), cyanosis (4 pts) and gastro-oesophageal reflux (GER)in 2. Respiratory events showed mean respiratory pauses of 14.1/hr, mostly central and periodic breathing during 4, 5% of the total sleep time (TST). PSG 1 was abnormal in 32 cases, with desaturation in 23, apnoea in 8, central pauses in 19, obstructive pauses in 9 and GER in 5. PSG 2 was performed at a mean age of 11,5 ± 4 months, range 6-24 months. The comparision of PSG 1 vs PSG 2 showed significant differences in the total respiratory index (p < 0.01), central pauses (p < 0.05) and periodic breathing (p < 0.05), being always lower in the PSG 2. We conclude that the majority of patients with episodes of apnoea and immature sleep patterns normalized their sleep pattern in the first year of life. In this group the correct use of HCRM is indicated.
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    Atresia Esofágica y Fístula Traqueoesofágica. Evolución y Complicaciones Postquirúrgicas
    (2010) Jakubson S., Leticia; Paz C., Fernando; Zavala Busquets, Alejandro Luis; Harris D., Paul R.; Bertrand N., Pablo
    La Atresia esofágica (AE) con o sin fístula traqueoesofágica (FTE) es una malformación congénita que se asocia a complicaciones respiratorias y digestivas. Objetivo: Describir las características de estos pacientes, su morbilidad respiratoria, digestiva y hospitalizaciones en su evolución a largo plazo. Materiales y Métodos: Se revisaron en forma retrospectiva 15 fi chas de pacientes con diagnóstico de FTE evaluados por el equipo de Neumología Pediátrica de la Universidad Católica de Chile entre 1995 y 2007. Resultados: N = 15 pacientes, sexo masculino 9 diagnóstico el primer día de vida 13/15 pacientes. Clasifi cación de Gross: A= 0, B= 0, C= 12, D= 2, E= 1. Clasifi cación de Waterston A1: 6, B1: 1, B2: 4 y C2: 4 Malformaciones asociadas: en 7/15. Complicaciones respiratorias: Neumonía recurrente 8/15, sibilancias recurrentes 12/15, Recurrencia de fístula: 3 /15 pacientes, Apnea: 1 paciente, Traqueomalacia (TM) (9/15). Complicaciones digestivas: Refl ujo gastroesofágico 15/15, Estenosis esofágica: 7/ 15. Un paciente requirió cirugía de Nissen. Todos los pacientes se hospitalizaron en al menos una oportunidad y en el 12/15 la causa fue respiratoria. Conclusión: La FTE es una enfermedad de resolución quirúrgica con alta morbilidad respiratoria, digestiva y frecuentes hospitalizaciones en los primeros años de vida.
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    Clusters of Autoimmune Diseases in Children and the Role of PTPN22 C1858T Gene Polymorphism in Pediatric Polyautoimmunity
    (2014) Borzutzky Schachter, Arturo; Seiltgens, Cristián; Iruretagoyena B., Mirentxu; Cristi, Francisca; Ponce, María Jesús ; Melendez, Patricia; Martínez Aguayo, Alejandro; Hodgson Bunster, María Isabel; Talesnik Guendelman, Eduardo; Riera Cassorla, Francisca Paz; Méndez, Cecilia; Harris D., Paul R.; García Bruce, Hernán; Gana Ansaldo, Juan Cristóbal; Godoy, Claudia; Cattani Ortega, Andreína
    Background/Purpose:Autoimmune diseases (AIDs) have familial aggregation and frequently share a common genetic background, but few studies have evaluated autoimmune clusters in children with AIDs and their families. Children with more than one AID (pediatric polyautoimmunity) may have a stronger genetic component than children with a single AID. The objectives of this study were to identify clusters of AIDs in children and their first-degree relatives and to evaluate the association of PTPN22 C1858T gene polymorphism with pediatric polyautoimmunity.Methods:A cross-sectional study was performed in subjects with an AID of pediatric onset (<18 years)recruited at Pediatric Rheumatology, Endocrinology and Gastroenterology Clinics at the Health Network of the Pontificia Universidad Católica de Chile School of Medicine. Clusters of AIDs were identified by K-means cluster analysis. The PTPN22 C1858T gene polymorphism was determined by RT-PCR in subjects with pediatric polyautoimmunity and in subjects with three common AIDs: juvenile idiopathic arthritis (JIA), autoimmune thyroid disease (AITD), and type I diabetes (T1D).Results:191 subjects with pediatric AIDs were included, of which 45 (24%) had polyautoimmunity. Mean age was 12.1 years (range 1–19) and 68% were female. Most frequent AIDs were JIA (36%), AITD (25%), T1D (19%), uveitis (8%), celiac disease (6%), and vitiligo (6%). 59% of subjects with pediatric autoimmunity had first-degree relatives with an AID. Five clusters of AID were identified in families of children with autoimmunity (Table 1). Among the 45 subjects with pediatric polyautoimmunity, four clusters of AIDs were identified (Table 2). Genomic DNA from 128 subjects was evaluated for PTPN22 C1858T gene polymorphism revealing common homozygosity (C/C) in 85.2%, heterozygosity (C/T) in 13.3%, and rare homozygosity (T/T) in 1.6 %, in equilibrium with Hardy Weinberg equation (P = 0.4). 26% of polyautoimmune subjects had the T allele in contrast with 11% of monoautoimmune subjects (P = 0.04). No significant difference was found in the age of onset of autoimmunity between mono and polyautoimmune subjects (P = 0.44) or between subjects with C/C genotype vs. C/T and T/T genotypes (P = 0.81).
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    Current situation of pediatric endoscopy in Latin America: Report of the endoscopy and procedures committee of the latinamerican society of pediatric gastroenterology, hepatology and nutrition (LASPGHAN)
    (2017) Pierre, Reinaldo; González, Beatríz; Toca, María del Carmen; Targa, Cristina; Medina, Fernando; Oviedo, César; González, Mónica; Harris D., Paul R.; Ramírez, Nélson; Mejía, Milton; Angulo, Diana; Rivera, Juán; Guzmán, Celina; Zablah, Roberto; Iglesias, Claudio; Delgado, Laura
    La Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición Pediátrica (SLAGHNP), a través de su Comité de Endoscopía y Procedimientos, ha realizado una evaluación cuantitativa y cualitativa de los Centros de Endoscopía Pediátrica (CEP) y de los Centros de Entrenamiento en Endoscopía Digestiva Pediátrica (CEEDP) de 13 países latinoamericanos. Simultáneamente hemos investigado la existencia de criterios para la obtención de la certificación de competencia en endoscopía pediátrica y de la disponibilidad en la región de centros para la realización de otros procedimientos de carácter diagnóstico tales como impedancia, manometría, etc. La información contenida en el presente informe permite realizar un diagnóstico de la situación de la endoscopía pediátrica en Latinoamérica, identificar áreas de mayor desarrollo y promover la elaboración de planes de intercambio, actividades académicas y programas de certificación que contribuyan y favorezcan el acceso de la población a una mejor calidad de los servicios especializados de endoscopía pediátrica diagnóstica, terapéutica y avanzada.
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    Curvas manométricas rectales en niños. Estudio promano fase I
    (2009) Jaime Méndez, María Francisca; Saavedra Gutierrez, Silvana Jeanette; Gana Ansaldo, Juan Cristóbal; Larraín B., Francisco J.; Harris D., Paul R.
    Propósito del estudio: Evaluar el rol de la manometría rectoanal (MRA) y establecer valores de normalidad en un grupo de niños referidos por desórdenes de defecación. Pacientes y Métodos: Revisión retrospectiva de MRA efectuadas durante un período de 8 años. Resultados: Se analizaron los resultados obtenidos de 789 niños (52,6% hombres). Éstos se clasificaron en cuatro grupos según resultado de la MRA como "Grupo control" (CL), "Grupo con probable megarrecto" (PMG), "Grupo con anormalidades de la inervación intrínseca" (All) y "Grupo con anormalidades de la inervación extrínseca" (ALE). Setenta y nueve porciento de los pacientes fueron referidos para evaluación de constipación crónica y 10% por sospecha de anormalidades de inervación intrínseca; en 94% y 83% de ellos respectivamente, la MRA descartó causas orgánicas. Los niños se distribuyeron en: CL (48,0%), PMG (42,6%), All (7,5%) y AIE (1,5%). El grupo CL y PMG mostraron diferencias edad-dependiente en algunos parámetros manométricos. Además se encontró diferencias en parámetros manométricos entre CL, PMG, All y AIE. Conclusiones: La principal indicación de MRA fue para estudio de constipación crónica, siendo las alteraciones orgánicas confirmadas sólo en un bajo porcentaje. Se describió cuatro patrones diferentes en 789 pacientes referidos para evaluación de dificultades en la defecación.
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    D-lactoacidosis como Complicación del Síndrome de Intestino Corto
    (2010) Arancibia Assael, Gabriel; Hodgson Bunster, María Isabel; Harris D., Paul R.
    Short bowel syndrome is defined as the loss, congenital or acquired, anatomical or functional, of a large part of the small intestine that generates inadequate absorption of nutrients and the frequent need of prolonged parenteral nutrition. The etiology of short bowel is diverse and varies with age. The necrotizing enterocolitisis and the midgut volvulus are among the most frequent causes. The bacterial overgrowth is frequently observed in children with short bowel, due to the secondary dilation of the remaining small bowel and to the associated intestinal dysmotility. It is more frequent in absence of the ileocecal valve. We present a 6 year old boy with short bowel syndrome secondary to extensive intestinal resection after a volvulous of the medium small intestine, 9 months before admission to the hospital, and who was on cyclical parenteral nutrition at home. The child developed ataxia, disarthria, dizziness and conscience compromise been admitted to de intensive care unit in deep sopor. An extensive work up including metabolic, infectious, toxicology and SNC imaging was negative except for metabolic acidosis. He was discharged on good conditions. Even though the child was on supportive therapy, the patient was readmitted few hours later with similar symptoms. D-lactoacidosis was suspected and confirmed with a value of 6.69 mmol/l (normal range: 0,0-0,25). Literature about this uncommon complication and its mechanism is reviewed. D-lactoacidosis should be suspected in every patient with short bowel syndrome and unexplained metabolic acidosis associated with neurologic symptoms.
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    Desarrollo de la Microbiota Gastrointestinal en Lactantes y Su Rol en Salud y Enfermedad
    (2016) Serrano Honeyman, Carolina; León, M. A.; Harris D., Paul R.; Serrano Honeyman, Carolina; León, M. A.; Harris D., Paul R.
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    Desarrollo del microbioma intestinal en niños: impacto en salud y enfermedad
    (2016) Serrano Honeyman, Carolina; Harris D., Paul R.; Serrano Honeyman, Carolina; Harris D., Paul R.
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    Downregulated Th17 responses are associated with reduced gastritis in Helicobacter pylori-infected children
    (2013) Serrano Honeyman, Carolina; Venegas Muñoz, Alejandro Andrés; Harris D., Paul R.; Serrano Honeyman, Carolina; Venegas Muñoz, Alejandro Andrés; Harris D., Paul R.
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    Early origins of allergy and asthma (ARIES): study protocol for a prospective prenatal birth cohort in Chile.
    (2020) Hernández Vargas, Caroll Daffner; Casanello Toledo, Paola Cecilia; Harris D., Paul R.; Castro Rodríguez, José Antonio; Iturriaga, Carolina; Pérez Mateluna, Guillermo; Farías Jofré, Marcelo Enrique; Urzúa, Marcela; Hernández Carreño, Cherie Francisca; Serrano Honeyman, Carolina; Hernández Vargas, Caroll Daffner; Casanello Toledo, Paola Cecilia; Harris D., Paul R.; Castro Rodríguez, José Antonio; Iturriaga, Carolina; Pérez Mateluna, Guillermo; Farías Jofré, Marcelo Enrique; Urzúa, Marcela; Hernández Carreño, Cherie Francisca; Serrano Honeyman, Carolina
    Abstract Background Growing evidence shows that atopic dermatitis (AD), food allergy (FA), allergic rhinitis, and asthma are largely determined during the first 1000 days (time elapsed from conception to the 2nd birthday). The ARIES birth cohort aims to determine prenatal and perinatal conditions, as well as genetic and epigenetic factors, that participate in the early setting of immune responses, and the role of these in the later determination of the risk of allergic diseases and asthma in the offspring. Methods We have designed a birth cohort of 250 families with prenatal recruitment (~ 14 weeks). We will genotype relevant allergy/asthma-associated variants in trios and will perform immunophenotyping and evaluation of allergy biomarkers in cord blood. At 1 and 2 years of age we will assess if infants have developed allergic sensitization, AD, FA, as well as biomarkers of asthma including the asthma predictive index. We will also evaluate how maternal conditions modify immune programming through epigenetic modifications and will then depict newborn epigenetic cues of allergy/asthma risk. Next, we will assess composition/diversity of maternal gut, placenta, breastmilk and infant gut microbiome and their association with immunophenotype and biomarkers at birth, and clinical outcomes at age 1 and 2. Finally, we plan to assess how environmental exposures (perinatal outdoor and indoor pollution, allergens and endotoxin) affect the incidence of allergic sensitization, AD, FA, and risk of asthma. Discussion The in-depth study of the ARIES birth cohort shall provide crucial information to understand the rising incidence of allergies and asthma in developing countries, and hopefully provide cues on how to prevent and treat these diseases. Trial registration clinicaltrials.gov NCT04186949, retrospectively registered on December 5, 2019.
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    Eradication of Helicobacter pylori in Children Restores the Structure of the Gastric Bacterial Community to That of Noninfected Children
    (2019) Serrano Honeyman, Carolina; Pierre, Reinaldo; Van Der Pol, William J.; Morrow, Casey D.; Smith, Phillip D.; Harris D., Paul R.; Serrano Honeyman, Carolina; Pierre, Reinaldo; Van Der Pol, William J.; Morrow, Casey D.; Smith, Phillip D.; Harris D., Paul R.
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    Evolución clínica y de laboratorio en lactantes con inmadurez del centro respiratorio que presentan episodios de apnea
    (2004) Sánchez, Ignacio; Mobarec Katunaric, Sebastián Ignacio; Muñoz O., Carla; Brockmann Veloso, Pablo Edmundo; Mesa, Tomás; Holmgren P., Linus; Harris D., Paul R.
    Introduction: Episodes of central pauses and periodic breathing are normal in infants and decrease with age and growth. Objective: to evaluate a group of infants that had a polysomnography (PSG) performed due to an episode of apnoea, with elevated immature sleep characteristics and who required home cardiorespiratory monitoring (HCRM) and further control PSGs. Methods: 34 patients, 22 (65%) were male, mean age 27 ± 2 months (PSG 1), range 0,3-9 years, were studied between May 1997 and May 2001. Along with the first PSG (PSG 1) a second was performed (PSG 2) prior to the suspension of HCRM. Apnoea was defined as the absence of respiration for more than 20 sec (central) or more than 10 sec (obstructive and mixed); respiratory pauses as the absence of respiration for more than 6 sec and less than 20 sec (central) or more than 6 sec and less than 10 sec (obstructive). Results: The main indications for PSG were apnoea (27 pts), cyanosis (4 pts) and gastro-oesophageal reflux (GER)in 2. Respiratory events showed mean respiratory pauses of 14.1/hr, mostly central and periodic breathing during 4, 5% of the total sleep time (TST). PSG 1 was abnormal in 32 cases, with desaturation in 23, apnoea in 8, central pauses in 19, obstructive pauses in 9 and GER in 5. PSG 2 was performed at a mean age of 11,5 ± 4 months, range 6-24 months. The comparision of PSG 1 vs PSG 2 showed significant differences in the total respiratory index (p < 0.01), central pauses (p < 0.05) and periodic breathing (p < 0.05), being always lower in the PSG 2. We conclude that the majority of patients with episodes of apnoea and immature sleep patterns normalized their sleep pattern in the first year of life. In this group the correct use of HCRM is indicated.
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    Helicobacter pylori infection and UBT-13C values are associated with changes in body mass index in children and adults
    (2022) Bruera, María J.; Amezquita García, María Virginia; Riquelme Pérez, Arnoldo; Serrano Honeyman, Carolina; Harris D., Paul R.
    Background: The urea breath test (UBT-13C) is a non-invasive technique that allows the diagnosis and confirmation of eradication of Helicobacter pylori infection. Aim: To evaluate H. pylori positivity and values of UBT-13C among infected Chilean children and adults, and to analyze its variation in relation to sex, nutritional status, and age of the patients. Material and Methods: Retrospective study of 1141 patients aged 6 to 94 years, with an indication for a UBT-13C either for diagnosis or for confirmation of eradication of H. pylori infection. 13C enrichment was measured using an infrared spectrometer calculating the delta 13C values before and after the ingestion of 13C marked urea. The clinical data of the patients were obtained at the time of the examination. Results: We included 241 children and 900 adults. Infected children obtained lower UBT-13C delta values than infected adults (16.1 ± 8.7 and 37 ± 52.9, respectively). The rates of infection were higher in males who were recruited for diagnosis. Significant differences were obtained between positivity for H. pylori in overweight and obese children but not adults. UBT-13C titers were significantly associated with the body mass index (BMI) only in adults. Conclusions: H. pylori infection rates are similar between sexes and are higher in children probably because of selection bias. In children, H. pylori positivity is associated with higher BMI and excess malnutrition although with similar UBT-13C values. In adults, H. pylori infection is not related with BMI, but a higher BMI impacts UBT-13C titers.
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    Helicobacter pylori infection is associated with an altered gastric microbiota in children
    (2017) Brawner, K.; Kumar, R.; Serrano Honeyman, Carolina; Ptacek, T.; Lefkowitz, E.; Morrow, C.; Zhi, D.; Kyanam, K.; Smythies, L.; Harris D., Paul R.; Smith, P.; Brawner, K.; Kumar, R.; Serrano Honeyman, Carolina; Ptacek, T.; Lefkowitz, E.; Morrow, C.; Zhi, D.; Kyanam, K.; Smythies, L.; Harris D., Paul R.; Smith, P.
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    Helicobacter pylori Infection Is Associated with Decreased Expression of SLC5A8, a Cancer Suppressor Gene, in Young Children
    (2016) Orellana Manzano, Andrea; O’Ryan, Miguel G.; Lagomarcino, Anne J.; George, Sergio; Muñoz, Mindy S.; Mamani, Nora; Serrano Honeyman, Carolina; Harris D., Paul R.; Ramilo, Octavio; Mejías, Asunción; Torres, Juan P.; Lucero, Yalda; Quest, Andrew F. G.; Orellana Manzano, Andrea; O’Ryan, Miguel G.; Lagomarcino, Anne J.; George, Sergio; Muñoz, Mindy S.; Mamani, Nora; Serrano Honeyman, Carolina; Harris D., Paul R.; Ramilo, Octavio; Mejías, Asunción; Torres, Juan P.; Lucero, Yalda; Quest, Andrew F. G.
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    Helicobacter pylori vacA virulence factor in uncultured Helicobacter heilmannii sensu lato from an infected child
    (2016) Hernandez, Caroll; Serrano Honeyman, Carolina; Villagran, Andrea; Torres Montes, Paula Javiera; Venegas, Alejandro; Harris D., Paul R.; Hernandez, Caroll; Serrano Honeyman, Carolina; Villagran, Andrea; Torres Montes, Paula Javiera; Venegas, Alejandro; Harris D., Paul R.
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    Helicobacter pylori-Clarithromycin Resistance in Symptomatic Pediatric Patients in a High Prevalence Country
    (2017) Serrano Honeyman, Carolina; Leon, Miguel A.; Palma, Camila; Vera, Macarena; Hernandez, Caroll; Harris D., Paul R.; Serrano Honeyman, Carolina; Leon, Miguel A.; Palma, Camila; Vera, Macarena; Hernandez, Caroll; Harris D., Paul R.
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    Helicobacter pylori: una causa no tradicional de deficiencia de hierro y anemia
    (2012) Serrano Honeyman, Carolina; Villagrán T., Andrea; Harris D., Paul R.
    Helicobacter Pylori (H. pylori) is the most common cause for chronic gastritis, duodenal ulcers, MALT lymphoma and gastric cancer. H. pylori has also been associated with several extra gastric diseases such as iron deficiency (ID) and iron deficiency anemia (IDA). Several mechanisms by which H. pylori might contribute to the development of ID/IDA have been proposed. Alterations in the physiology of gastric mucosa and of iron metabolism as a consequence of the infection as well as direct competition for iron by H. pylori have been proposed as possible causes for ID/IDA development. H. pylori causes alterations in gastric pH as well as in the concentration of ascorbic acid in the stomach limiting the absorption of dietary iron in the gastrointestinal tract. In addition, pro-inflammatory cytokine secretion in response to the infection, in particular IL-1β are able to modulate acid secretion and stimulate the secretion of hepcidin from the liver inhibiting liberation of iron from iron stores. These results in less iron available for eritropoyesis, thus contributing to ID/IDA development. Several studies have suggested a direct relationship between the presence of the infection and the development of ID/IDA in children, adolescents and adults. H. pylori eradication has been associated to a better response to oral iron therapy in IDA patients. However some controversy still remains regarding the role of the infection in ID/IDA and the mechanisms involved. Studies aimed to evaluate the relationship between H. pylori and acid output in gastric mucosa, as well as studies to determine iron capture in strains isolated from IDA patients are still being conducted in order the shed some definitive light in the relationship between this bacterium and ID/IDA and their contributing mechanisms.