Browsing by Author "Astudillo Paredes, Patricio Andrés"

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    Clinical-epidemiological analysis of infections in pediatric patients with liver and heart trasplants
    (SOC CHILENA INFECTOLOGIA, 2024) Jung Montanares, Francisca Andrea; Astudillo Paredes, Patricio Andrés; Vrsalovic Papic, Katica Ivanka; Rosales Alfaro, Valentina José; Marinovic, Nicole L'Huillier; Vizcaya Altamirano, María Cecilia; Ferres Garrido, Marcela Viviana; Urcelay Montecinos, Gonzalo Eduardo; Gana Ansaldo, Juan Cristobál; Abarca Villaseca, Katia
    Background: Liver and heart transplantation represents the definitive treatment for end-stage failure of these organs. In recent years, an increasing number of pediatric patients have undergone these procedures, which are associated with various complications. Among them, infections stand out as one of the main causes of morbidity and mortality. Aim: To describe the infections that affect pediatric recipients of liver and heart transplants (Tx.). Methods: A characterization of the type and timing of infections identified in 31 children who underwent heart transplantation and 27 who underwent liver transplantation at a tertiary university hospital since 2002 (cardiac Tx) and 2009 (hepatic Tx), both to 2022 is presented. Results: Biliary atresia and dilated cardiomyopathy were the main reasons for liver and heart transplantation, respectively. Bacterial infections predominated during the first month after these surgical procedures, while viral infections predominated later. Bacterial infections in general, and bacteriemia were more common in liver Tx. recipients. Cytomegalovirus (CMV) and Epstein-Barr virus, mainly in the form of reactivations, were the most frequently identified viruses, with a higher frequency of CMV in liver Tx. recipients. One patient from each group died in a late period due to bacterial sepsis, without a specific agent identified. Conclusion: The preponderance of infections due to latent viral agents, such as CMV, in pediatric liver or heart transplant recipients, reveals the need to optimize the management of these infections in this growing population in Chile.
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    Immune responses during COVID-19 breakthrough cases in vaccinated children and adolescents
    (Frontiers Media SA, 2024) Rivera Pérez, Daniela; Méndez Vejar, Constanza Soledad; Diethelm Varela, Benjamín Manuel; Melo González, Felipe Andrés; Vázquez Hernández, Yaneisi; Meng, Xing; Xin, Qianqian; Fasce, Rodrigo A.; Fernández, Jorge; Mora, Judith; Ramírez, Eugenio; Acevedo, Mónica L.; Valiente Echeverria, Fernando; Soto Rifo, Ricardo; Grifoni, Alba; Weiskopf, Daniela; Sette, Alessandro; Astudillo Paredes, Patricio Andrés; Le Corre Pérez, Monique Nicole; Abarca Villaseca, Katia; Perret Pérez, Cecilia; González Muñoz, Pablo Alberto; Soto Ramírez, Jorge Andrés; Bueno Ramírez, Susan; Kalergis, Alexis M.
    Background: Vaccine effectiveness against SARS-CoV-2 infection has been somewhat limited due to the widespread dissemination of the Omicron variant, its subvariants, and the immune response dynamics of the naturally infected with the virus. Methods: Twelve subjects between 3-17 years old (yo), vaccinated with two doses of CoronaVac®, were followed and diagnosed as breakthrough cases starting 14 days after receiving the second dose. Total IgGs against different SARS-CoV-2 proteins and the neutralizing capacity of these antibodies after infection were measured in plasma. The activation of CD4+ and CD8+ T cells was evaluated in peripheral blood mononuclear cells stimulated with peptides derived from the proteins from the wild-type (WT) virus and Omicron subvariants by flow cytometry, as well as different cytokines secretion by a Multiplex assay. Results: 2 to 8 weeks post-infection, compared to 4 weeks after 2nd dose of vaccine, there was a 146.5-fold increase in neutralizing antibody titers against Omicron and a 38.7-fold increase against WT SARS-CoV-2. Subjects showed an increase in total IgG levels against the S1, N, M, and NSP8 proteins of the WT virus. Activated CD4+ T cells showed a significant increase in response to the BA.2 subvariant (p<0.001). Finally, the secretion of IL-2 and IFN-γ cytokines showed a discreet decrease trend after infection in some subjects. Conclusion: SARS-CoV-2 infection in the pediatric population vaccinated with an inactivated SARS-CoV-2 vaccine produced an increase in neutralizing antibodies against Omicron and increased specific IgG antibodies for different SARS-CoV-2 proteins. CD4+ T cell activation was also increased, suggesting a conserved cellular response against the Omicron subvariants, whereas Th1-type cytokine secretion tended to decrease. Clinical Trial Registration: clinicaltrials.gov #NCT04992260
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    Inicio tardío de programas de atención temprana en niños y niñas con síndrome de down
    (2021) Fredes Araya, Danys Camila; Astudillo Paredes, Patricio Andrés; Lizama Calvo, Macarena
    La atención temprana (AT) es una intervención clave en la vida de niños y niñas con síndrome de Down (NNcSD). Iniciarla antes de los 60 días de vida (ddv) tiene mejores resultados en el desarrollo futuro. Objetivo: Evaluar los factores que retrasan el inicio de la AT en NNcSD. Sujetos y Método: Participaron padres/madres de NNcSD que asistieron a programas de AT durante su primer año de vida. Se registraron factores sociales, familiares y de salud relacionados al momento de inicio de la AT y se compararon de acuerdo al periodo de inicio de la AT, antes vs después de 60ddv. Para el análisis de variables categóricas se usó test exacto de Fisher y para la asociación entre variables numéricas test de t student para muestras independientes. Resultados: Se analizaron 125 cuestionarios. El 51,2% inició AT después de los 60ddv, de ellos, el 25% después de 6 meses. El inicio tardío de AT se asoció a hospitalización antes de los 3 meses de edad (OR = 2,5), estadías hospitalarias largas (OR 2,4), menor nivel educativo del padre (OR = 4,7) y de la madre (OR 3,4), nacimiento en sistema público (OR = 11,8) y acceso a centros gratuitos de AT (OR = 2,4). El nivel socioeconómico alto fue el único factor protector (OR = 0,4) para inicio precoz. Conclusiones: Más del 50% de los NNcSD inicia tardíamente programas de AT, principalmente por factores de salud y socioeconómicos. Esto se asoció a hospitalización precoz, prolongadas estadías intrahospitalarias y nivel socioeconómico. Es urgente destinar recursos y generar políticas públicas que permitan un acceso garantizado a programas de AT.
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    New paradigms in acute viral bronchiolitis: Is it time to change our approach?
    (2024) Castro Rodríguez, José Antonio; Astudillo Paredes, Patricio Andrés; Puranik , Sandeep; Brown, Mark A.; Custovic, Adnan; Forno, Erick
    Viral bronchiolitis is the most common pediatric acute respiratory infection leading to hospitalization, and it causes a significant healthcare burden worldwide. Current guidelines recommend supportive management after many clinical trials on specific therapies failed to demonstrate benefits. However, several studies in the past decade have revealed that bronchiolitis may not be a homogeneous disease, but instead may constitute an umbrella comprised of different “endotypes” and “phenotypes” based on patient characteristics, etiology, pathophysiological mechanisms, and clinical presentation. In this extensive review, we summarize the current evidence that several different types of bronchiolitis (“bronchiolitides”) coexist, with different short- and long-term consequences on respiratory health and the risk of asthma development. Disease pathobiology, immune response, and clinical characteristics may differ between the two most prevalent viral agents, respiratory syncytial virus and rhinovirus. Recent randomized trials have shown that some subgroups of children may benefit from the use of systemic corticosteroids and/or bronchodilators. These findings also suggest that some children may benefit from individualized therapeutical approaches for viral bronchiolitis rather than following broad recommendations for treating all patients uniformly using only supportive management.
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    Wheezing on admission: a marker for bronchiolitis severity and asthma development
    (2025) Astudillo Paredes, Patricio Andrés; Rodríguez Fernández, María; Castro Rodríguez, José Antonio; López Lastra, Marcelo Andrés
    Background: Supervised clustering of bronchiolitis patients, according to their clinical characteristics at hospital admission, helps predict short-term hospital outcomes and the risk of developing childhood respiratory illness. Thus, we evaluated the use of wheezing status for stratifying bronchiolitis patients. Methods: A prospective cohort study was conducted involving 668 previously healthy, full-term Chilean infants ( < 2 years old) hospitalized with bronchiolitis. Patients categorized based on their wheezing status at hospital admission were monitored during hospitalization and followed for 4 years after discharge. Results: Wheezing children presented a more severe illness requiring more oxygen during their hospital stay. Upon discharge, they were more likely to develop preschool wheezing at 12 months and asthma at 4 years of age. Among the non-wheezing, those with RSV had more severe disease. Risk factors exclusively associated with persistent asthma development for the wheezing were clinical bacterial coinfection, parental asthma history, and having had a severe bronchiolitis episode. Risk factors exclusive for non-wheezing were maternal smoking during pregnancy and severe retractions. Conclusion: Bronchiolitis patients can be categorized based on their wheezing status at hospital admission, helping predict short-term clinical outcomes and identify infants at risk of developing severe short- and long-term respiratory illnesses.