Browsing by Author "Cristobal Gana, Juan"

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    A Clinical Prediction Rule and Platelet Count Predict Esophageal Varices in Children
    (W B SAUNDERS CO-ELSEVIER INC, 2011) Cristobal Gana, Juan; Turner, Dan; Mieli Vergani, Giorgina; Davenport, Mark; Miloh, Tamir; Avitzur, Yaron; Yap, Jason; Morinville, Veronique; Brill, Herbert; Ling, Simon C.
    BACKGROUND & AIMS: The validation of noninvasive tests to diagnose esophageal varices is a priority in children because repeated endoscopic evaluations are too invasive. We measured the ability of a previously developed noninvasive clinical prediction rule (CPR) to predict the presence of esophageal varices in children. METHODS: We analyzed data from 108 children, younger than age 18, who received endoscopies at 8 centers, to assess portal hypertension from chronic liver disease or portal vein obstruction. Blood test and abdominal ultrasound scan results were obtained within 4 months of endoscopy. Grading of varices identified by endoscopy was confirmed by independent blinded review. Spleen size, based on data from the ultrasound scan, was expressed as a standard deviation score relative to normal values for age. RESULTS: Of the children studied, 74 had esophageal varices (69%), including 35 with large varices (32%). The best noninvasive predictors of esophageal varices of any size were as follows: platelet: spleen size z-score ratio (area under the receiver operating characteristic curve [AUROC], 0.84; 95% confidence interval [CI] 0.75-0.93), CPR (AUROC, 0.80; 95% CI, 0.70-0.91), and platelet count (AUROC, 0.79; 95% CI, 0.69-0.90). The positive predictive values for the CPR and platelet count were 0.87 and 0.86, the negative predictive values were 0.64 and 0.63, the positive likelihood ratios were 3.06 and 2.76, and the negative likelihood ratios were 0.64 and 0.63, respectively. Based on positive and negative predictive values, the most accurate noninvasive tests were the CPR and platelet counts. CONCLUSIONS: Noninvasive tests such as CPR and platelet count can assist in triaging children for endoscopy to identify esophageal varices.
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    NADPH oxidase complex and IBD candidate gene studies: identification of a rare variant in NCF2 that results in reduced binding to RAC2
    (BMJ PUBLISHING GROUP, 2012) Muise, Aleixo M.; Xu, Wei; Guo, Cong Hui; Walters, Thomas D.; Wolters, Victorien M.; Fattouh, Ramzi; Lam, Grace Y.; Hu, Pingzhao; Murchie, Ryan; Sherlock, Mary; Cristobal Gana, Juan; Russell, Richard K.; Glogauer, Michael; Duerr, Richard H.; Cho, Judy H.; Lees, Charlie W.; Satsangi, Jack; Wilson, David C.; Paterson, Andrew D.; Griffiths, Anne M.; Silverberg, Mark S.; Brumell, John H.; NEOPICS
    Objective The NOX2 NADPH oxidase complex produces reactive oxygen species and plays a critical role in the killing of microbes by phagocytes. Genetic mutations in genes encoding components of the complex result in both X-linked and autosomal recessive forms of chronic granulomatous disease (CGD). Patients with CGD often develop intestinal inflammation that is histologically similar to Crohn's colitis, suggesting a common aetiology for both diseases. The aim of this study is to determine if polymorphisms in NOX2 NADPH oxidase complex genes that do not cause CGD are associated with the development of inflammatory bowel disease (IBD).
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    Trasplante hepático: Evolución, curva de aprendizaje y resultados después de los primeros 300 casos
    (2019) Francisco Guerra, Juan; Luis Quezada, Jose; Cancino, Alejandra; Arrese, Marco; Wolff, Rodrigo; Benitez, Carlos; Carlos Pattillo, Juan; Cristobal Gana, Juan; Concha, Mario; Cortinez, Luis; Vera, Magdalena; Miranda, Paula; Rubilar, Francisco; Troncoso, Andres; Briceno, Eduardo; Dib, Martin; Jarufe, Nicolas; Martinez, Jorge
    Background: Liver transplantation (LT) is an option for people with liver failure who cannot be cured with other therapies and for some people with liver cancer. Aim: To describe, and analyze the first 300 LT clinical results, and to establish our learning curve. Material and Methods: Retrospective cohort study with data obtained from a prospectively collected LT Program database. We included all LT performed at a single center from March 1994 to September 2017. The database gathered demographics, diagnosis, indications for LT, surgical aspects and postoperative courses. We constructed a cumulative summation test for learning curve (LC-CUSUM) using 30-day post-LT mortality. Mortality at 30 days, and actuarial 1-, and 5-year survival rate were analyzed. Results: A total of 281 patients aged 54 (0-71) years (129 women) underwent 300 LT. Ten percent of patients were younger than 18 years old. The first, second and third indications for LT were non-alcoholic steatohepatitis, chronic autoimmune hepatitis and alcoholic liver cirrhosis, respectively. Acute liver failure was the LT indication in 51 cases (17%). The overall complication rate was 71%. Infectious and biliary complications were the most common of them (47 and 31% respectively). The LC-CUSUM curve shows that the first 30 patients corresponded to the learning curve. The peri-operative mortality was 8%. Actuarial 1 and 5-year survival rates were 82 and 71.4%, respectively. Conclusions: Outcome improvement of a LT program depends on the accumulation of experience after the first 30 transplants and the peri-operative mortality directly impacted long-term survival.
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    Variation in Care for Children With Esophageal Varices: A Study of Physicians', Patients', and Families' Approaches and Attitudes
    (LIPPINCOTT WILLIAMS & WILKINS, 2011) Cristobal Gana, Juan; Valentino, Pamela L.; Morinville, Veronique; O'Connor, Constance; Ling, Simon C.
    Background and Aims: Inadequate evidence to guide the management of children with esophageal varices may lead to variation in care and the provision of poor-quality care to some children. The aims of the study were to describe approaches taken by pediatric gastroenterologists for the management of esophageal varices in children, and to determine the attitudes of children, parents, and physicians toward screening endoscopy for identification of varices.
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    Viral Hepatitis in Children
    (LIPPINCOTT WILLIAMS & WILKINS, 2012) Nel, Etienne; Sokol, Ronald J.; Comparcola, Donatella; Nobili, Valerio; Hardikar, Winita; Cristobal Gana, Juan; Abarca, Katia; Wu, Jia Feng; Chang, Mei Hwei; Renner, James Kweku