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

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    Adaptación a la realidad de Latinoamérica de la Guía Clínica NASPGHAN/ESPGHAN 2016 sobre Diagnóstico, Prevención y Tratamiento de Infección por Helicobacter pylori en Pediatría
    (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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    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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    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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    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 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-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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    Large mitochondrial DNA deletion in an infant with addison disease
    (Springer, 2012) Durán Saavedra, Gloria Patricia; Martínez Aguayo, Alejandro; Poggi, Helena; Lagos Lucero, Marcela; Gutiérrez, D.; Harris D., Paul R.
    Background: Mitochondrial diseases are a group of disorders caused by mutations in nuclear DNA or mitochondrial DNA, usually involving multiple organ systems. Primary adrenal insufficiency due to mitochondrial disease is extremely infrequent and has been reported in association with mitochondrial DNA deletion syndromes such as Kearns–Sayre syndrome. Aim: To report a 3-year-old boy with Addison disease, congenital glaucoma, chronic pancreatitis, and mitochondrial myopathy due to large mitochondrial DNA deletion. Method: Molecular analysis of mitochondrial DNA samples obtained from peripheral blood, oral mucosa, and muscle tissue. Results: A novel large mitochondrial DNA deletion of 7,372bp was identified involving almost all genes on the big arch of mtDNA. Conclusions: This case reaffirms the association of adrenal insufficiency and mitochondrial DNA deletions and presents new evidence that glaucoma is another manifestation of mitochondrial diseases. Due to the genetic and clinical heterogeneity of mitochondrial disorders, molecular analysis is crucial to confirm diagnosis and to allow accurate genetic counseling.
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    Pancreatitis aguda recurrente, caso clínico
    (2007) Argollo Mamani, Pamela Denise; García B., Cristián; Harris D., Paul R.
    Background: Recurrent acute pancreatitis (RAP) is defined as episodes of acute pancreatitis with complete clinical and anatomical resolution between each episode. The etiology is diverse in children (20-35% unknown). Objective: Analyze the etiology, diagnosis and most appropriate screening of RAP in children. Case-report: A 9 year-old boy with 6 episodes of acute pancreatitis (AP); 4 of them required hospital admission. The study included a normal colangiopancreatography, normal basic immunologic and metabolic exams and negative genetic assessment of the cystic fibrosis' most common mutation. During the episodes of AP, 3 computed tomography images were obtained and showed AP in different degrees (Baltasar C and E). Genetic testing for hereditary pancreatitis was negative. Laparoscopic colecistectomy was performed. Conclusion: RAP must be suspected in children with recurrent abdominal pain and elevated serum amylase-lipase concentration, in order to initiate an adequate evaluation. © 2007 Sociedad Chilena de Pediatría
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    Peptic Ulcer Disease in Helicobacter pylori-Infected Children : Clinical Findings and Mucosal Immune Response
    (2014) Hernández C.; Serrano Honeyman, Carolina; Einisman, H.; Villagrán, A.; Peña Villegas, Alfredo Javier; Duarte, Ignacio; Torres Montes, Paula Javiera; Riera Cassorla, Francisca Paz; Harris D., Paul R.; Hernández C.; Serrano Honeyman, Carolina; Einisman, H.; Villagrán, A.; Peña Villegas, Alfredo Javier; Duarte, Ignacio; Torres Montes, Paula Javiera; Riera Cassorla, Francisca Paz; Harris D., Paul R.
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    Prevalencia de la infección por Helicobacter pylori en niños : estimando la edad de adquisición
    (2013) Jaime Méndez, María Francisca; Villagrán, Andrea; Serrano Honeyman, Carolina; Cerda, Jaime; Harris D., Paul R.; Jaime Méndez, María Francisca; Villagrán, Andrea; Serrano Honeyman, Carolina; Cerda, Jaime; Harris D., Paul R.
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    Rol de la microbiota del jugo gástrico en la respuesta inmune innata de mucosa en la infección pediátrica por h. pylori
    (2019) Hernández Vargas, Caroll Daffner; Hernández Vargas, Caroll Daffner; Serrano Honeyman, Carolina; Harris D., Paul R.; Serrano Honeyman, Carolina; Harris D., Paul R.; Pontificia Universidad Católica de Chile. Facultad de Medicina
    Helicobacter pylori (H. pylori) es una bacteria colonizadora del estómago humano, cuya adquisición temprana en la niñez, está asociada con una modificación en la composición de la microbiota del estómago. Esta tesis estudió el rol de la microbiota del jugo gástrico de niños infectados y no infectados con H. pylori sobre la estructura y función inmune innata que ocurre a nivel de la barrera de células epiteliales gástricas, planteando como hipótesis que la microbiota del jugo gástrico de niños infectados con H. pylori, altera la integridad de la barrera y la respuesta inmune de las células epiteliales gástricas. Se utilizaron cultivos in vitro de la línea celular gástrica AGS y un cultivo primario de monocapas de células epiteliales diferenciadas de stem cells de organoides gástricos pediátricos, los cuales fueron estimulados con el jugo gástrico de niños infectados y no infectados con H. pylori. En estos dos modelos se evaluó los posibles sitios de acción de la microbiota, como los receptores tipo TLRs, proteínas formadoras de uniones estrechas y el efecto sobre factores inmunes como citoquinas y β-defensinas. Adicionalmente, en el cultivo de monocapa de células epiteliales diferenciadas de organoides, se evaluó distintos patrones de distribución de la proteína formadora de unión estrecha zónulaocludens 1 (ZO-1), que incluyeron quiebres en la estructura de la barrera de células epiteliales, inmuno-tinción de ZO-1 difusa, débil, puntiforme y formación de estructuras en forma de anillos. También, en este modelo se estudió la primo infección por H. pylori por medio de un ensayo de desafío con la bacteria en células pre-incubadas con la microbiota del jugo gástrico de niños no infectados, evaluando el efecto sobre los patrones de distribución de ZO-1. En el modelo de células AGS, se encontró que el jugo gástrico de niños no infectados indujo una disminución de la expresión de mRNA de claudina-2 (Cldn-2) y de la βdefensina-1 (hBD-1) en comparación a las células sin tratar. Por otro lado, el jugo gástrico de niños infectados con H. pylori produjo un aumento de la expresión de mRNA del receptor TLR-2. Tanto en células AGS como en monocapa de células epiteliales el jugo gástrico ejerció un aumento en la secreción de IL-8 y TNF-α de manera dependiente de la presencia del componente bacteriano e independiente del estatus de infección por H. pylori. En las monocapas de células epiteliales, la microbiota del jugo gástrico de ambos grupos, indujo la expresión de la β-defensina-2 (hBD-2), mientras que el jugo gástrico de niños infectados con H. pylori indujo la expresión de IL-8 y TNF-α y un aumento en el porcentaje de células que presentan estructuras en forma de anillo de ZO-1, lo cual es dependiente de la presencia del componente bacteriano. El análisis de las estructuras en forma de anillo de ZO-1, sugirió la formación de un poro entre la unión célula-célula, lo cual podría modificar la función de la barrera de células epiteliales. Finalmente, el ensayo de primo-infección por H. pylori mostró que el jugo gástrico de niños no infectados disminuye la alteración estructural de la barrera de célula epiteliales producida por infección temprana de H. pylori. En conclusión, la microbiota del jugo gástrico de niños sanos previene el efecto inducido por la infección temprana por H. pylori, estimulando la respuesta inmune innata y disminuyendo la alteración estructural de la barrera de célula epiteliales. Sin embargo, si los mecanismos de defensa son sobrepasados y se establece la infección por H. pylori, la microbiota del jugo gástrico asociada a la infección estimula la respuesta inmune innata para hacerla más efectiva, pero altera la integridad de la barrera de las células epiteliales gástricas, lo que podría tener un rol en el daño asociado a la infección. De este modo, el jugo gástrico de niños no infectados por H. pylori, podría ser un posible blanco terapéutico para modular la respuesta inmune y disminuir alteraciones en la estructura de la barrera en las células epiteliales gástricas en presencia de H. pylori, sin la necesidad de erradicar la bacteria de su nicho.
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    Valores de normalidad de eosinófilos en mucosa gástrica y duodenal de niños referidos a endoscopía digestiva alta.
    (Sociedad Chilena de Pediatría, 2021) Ortiz Menares, Marlene Andrea; Jaime. Francisca; Ortiz, Loreto; Carrasco Gaete, Ruby; Orellana Gonzalez, Maria José; Torres, Javiera; Villagrán Torres, Andrea Alejandra; Harris D., Paul R.
    With the increasing incidence of food allergies, the presence of eosinophils (Eos) in the gastrointestinal mucosa has received increased attention, particularly in the esophagus and colon. However, normal values for the Eos count in the stomach and duodenum in pediatric patients are still limited. The objective of this study was to estimate Eos reference values in stomach and duodenal biopsies of children referred to upper gastrointestinal endoscopy. Patients and Methods: Cross-sectional study of biopsies from symptomatic children referred to upper gastrointestinal endoscopy. The endoscopic report, Rapid Urease Test for the presence of H. pylori, and the quantitative histological evaluation (number of cells/HFP, high power field) were analyzed. The Eos distribution is described as mean and standard deviation, and also as percentiles since the counts did not have a normal distribution. Statistical analysis included χ2 test, Wilcoxon test, analysis of variance, and linear regression curves were evaluated as appropriate. Results: Of the 170 patients referred to endoscopy, 72 met “normal” criteria (normal endoscopy in macroscopic analysis, negative Rapid Urease Test, and normal biop-sy). The median age was 11 years (range 4-16), and 68% were girls. The Eos count (mean ± 1SD) in gastric antrum (n = 72) was 1.13 ± 1.79 Eos/HPF; in gastric body (n = 27), 1.06 ± 1.79 Eos/HPF; and in duodenum (n = 30), 10.44 ± 7.09 Eos/HPF. There were no significant differences by age and sex, or by H. pylori infection (p = 0.095). Conclusions: We propose an Eos count of 0-3 Eos/HPF for the gastric body, 0-3 Eos/HPF in the antrum, and 3-17 Eos/HPF in the duodenum as a normal range for gastric mucosa in children. This study suggests that in areas with a high prevalence of H. pylori infec-tion, the count of Eos does not seem to be a distinctive element and that Eos are commonly present in the gastroduodenal mucosa.