Browsing by Author "Guerra, Catalina"

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    Consequences of the exposome to gestational diabetes mellitus
    (2023) Rudge, Marilza V. C.; Alves, Fernanda C. B.; Hallur, Raghavendra L. S.; Oliveira, Rafael G.; Vega, Sofia; Reyes, David R. A.; Floriano, Juliana F.; Prudencio, Caroline B.; Garcia, Gabriela A.; Reis, Fabiana V. D. S.; Emanueli, Costanza; Fuentes, Gonzalo; Cornejo, Marcelo; Toledo, Fernando; Valenzuela-Hinrichsen, Andres; Guerra, Catalina; Grismaldo, Adriana; Valero, Paola; Barbosa, Angelica M. P.; Sobrevia, Luis
    The exposome is the cumulative measure of environmental influences and associated biological responses throughout the lifespan, including those from the environment, diet, behaviour, and endogenous processes. The exposome concept and the 2030 Agenda for the Sustainable Development Goals (SDGs) from the United Nations are the basis for understanding the aetiology and consequences of non-communicable diseases, including gestational diabetes mellitus (GDM). Pregnancy may be developed in an environment with adverse factors part of the immediate internal medium for fetus development and the external medium to which the pregnant woman is exposed. The placenta is the interface between maternal and fetal compartments and acts as a protective barrier or easing agent to transfer exposome from mother to fetus. Under and over-nutrition in utero, exposure to adverse environmental pollutants such as heavy metals, endocrine-disrupting chemicals, pesticides, drugs, pharmaceuticals, lifestyle, air pollutants, and tobacco smoke plays a determinant role in the development of GDM. This phenomenon is worsened by metabolic stress postnatally, such as obesity which increases the risk of GDM and other diseases. Clinical risk factors for GDM development include its aetiology. It is proposed that knowledge-based interventions to change the potential interdependent ecto-exposome and endo-exposome could avoid the occurrence and consequences of GDM.
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    Effect of acute on chronic liver failure over post-transplant survival
    (2023) Benitez, Carlos; Arnold, Jorge; Cambindo, Veronica; Schoenfeldt, Fernanda; Cancino, Alejandra; Ibanez, Samuel; Grandy, Catalina; Hunfan, Paola; Gonzalez, Jorge; Guerra, Catalina; Godoy, Esteban; Araneda, Veronica; Mollo, Constanza; Poniachik, Jaime; Urzua, Alvaro; Cattaneo, Maximo; Roblero, Juan Pablo; Oppenheimer, Ilan; Pizarro, Vicente
    Introduction and Objectives: Acute-on-chronic liver failure (ACLF) is associated with reduced short-term sur-vival, and liver transplantation is frequently the only therapeutic option. Nonetheless, the post-transplanta-tion prognosis seems to be worse in ACLF patients.Materials and Methods: The databases of two university centers were retrospectively evaluated, and adult patients with cirrhosis who underwent transplantation between 2013 and 2020 were included. One-year survival of patients with ACLF was compared to that of patients without ACLF. Variables associated with mor-tality were identified.Results: A total of 428 patients were evaluated, and 303 met the inclusion criteria; 57.1% were male, the mean age was 57.1 +/- 10.2 years, 75 patients had ACLF, and 228 did not. The main etiologies of ACLF were NASH (36.6%), alcoholic liver disease (13.9%), primary biliary cholangitis (8.6%) and autoimmune hepatitis (7.9%). Mechanical ventilation, renal replacement therapy, the use of vasopressors and the requirement of blood product transfusion during liver transplantation were significantly more frequent in ACLF patients. Among those recipients without and with ACLF, survival at 1, 3 and 5 years was 91.2% vs. 74.7%, 89.1% vs. 72.6% and 88.3% vs. 72.6%, respectively (p=0.001). Among pre-transplantation variables, only the presence of ACLF was independently associated with survival (HR 3.2, 95% CI: 1.46-7.11). Post-transplantation variables indepen-dently associated with survival were renal replacement therapy (HR 2.8, 95% CI: 1.1-6.8) and fungal infec-tions (HR 3.26, 95% CI: 1.07-9.9).Conclusions: ACLF is an independent predictor of one-year post-transplantation survival. Importantly, trans-plant recipients with ACLF require the use of more resources than patients without ACLF. (c) 2023 Fundacion Clinica Medica Sur, A.C. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)