RESUMO
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD), the most common chronic liver disease in adolescents, is a feature of metabolic syndrome (MetS). Obesity and insulin resistance (IR) are risk factors for NAFLD, as well as inflammation-related genetic markers. The relationship between metabolic or inflammation-related genetic markers and alanine aminotransferase (ALT) is not fully understood. We examined the relationship of MetS, metabolic and inflammation-related genetic markers with elevated ALT in adolescents. METHODS: A total of 674 adolescents participated in a cross-sectional study in Guadalajara, Mexico. Elevated ALT (>40 IU/L), a surrogate marker of NAFLD, and MetS (International Diabetes Federation definition) were evaluated. Obesity, IR, lipids, C-reactive protein (CRP) and genetic markers (TNFA-308G>A, CRP+1444C>T, IL1RN and IL6-597/-572/-174 haplotype) were evaluated. Multivariate logistic regression was performed. RESULTS: Elevated ALT was observed in 3% and 14.1% (total and obese, respectively) of the adolescents. Obesity (odds ratio [OR], 5.86; 95% confidence interval [95% CI], 1.16-25.89), insulin (OR, 8.51; 95% CI, 2.61-27.71), IR (OR, 9.10; 95% CI, 2.82-29.38), total cholesterol (TC) (OR, 3.67; 95% CI, 1.25-10.72), low-density lipoprotein-cholesterol (LDL-C) (OR, 3.06; 95% CI, 1.06-8.33), non-high-density lipoprotein-cholesterol (HDL-C) (OR, 3.88; 95% CI, 1.27-11.90) and IL1RN (OR, 4.64; 95% CI, 1.10-19.53) were associated with elevated ALT. Among males, ≥2 MetS criteria were associated with elevated ALT (OR, 4.22; 95% CI, 1.14-15.71). CONCLUSIONS: Obesity, insulin, IR, high TC, high LDL-C, high non-HDL-C and IL1RN polymorphism were associated with elevated ALT. Among males, ≥2 MetS criteria were associated with elevated ALT. There is an urgent need to reduce obesity and IR in adolescents to prevent NAFLD.
Assuntos
Alanina Transaminase/metabolismo , Marcadores Genéticos , Resistência à Insulina , Síndrome Metabólica/diagnóstico , Obesidade/complicações , Adolescente , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/genética , Síndrome Metabólica/metabolismo , México/epidemiologia , Prognóstico , Fatores de Risco , Adulto JovemRESUMO
ABSTRACT Introduction. There is little information on survival rates of patients with primary biliary cholangtis (PBC) in developing countries. This is particularly true in Latin America, where the number of liver transplants performed remains extremely low for patients with advanced liver disease who fulfill criteria for liver transplantation. The goal of this study was to compare survival rate of patients with PBC in developing countries who were treated with ursodeoxycholic acid (UDCA) versus survival of patients who received other treatments (OT) without UDCA, prescribed before the UDCA era. Material and methods. A retrospective study was performed, including records of 78 patients with PBC in the liver unit in a third level referral hospital in Mexico City. Patients were followed for five years from initial diagnosis until death related to liver disease or to the end of the study. Patients received UDCA (15 mg/kg/per day) (n = 41) or OT (n = 37) before introduction of UDCA in Mexico. Results. Response to treatment was higher in the group that received UDCA. In the five years of follow-up, survival rates were significantly higher in the UDCA group than in the OT group. The hazard ratio of death was higher in the OT group vs. UDCA group, HR 8.78 (95% Cl, 2.52-30.61); Mayo Risk Score and gender were independently associated with the risk of death. Conclusions. The study confirms that the use of UDCA in countries with a limited liver transplant program increases survival in comparison to other treatments used before the introduction of UDCA.(AU)
Assuntos
Humanos , Ácido Ursodesoxicólico/uso terapêutico , Transplante de Fígado/efeitos adversos , Cirrose Hepática Biliar/fisiopatologia , Taxa de Sobrevida , Estudos Retrospectivos , América LatinaRESUMO
INTRODUCTION: There is little information on survival rates of patients with primary biliary cholangtis (PBC) in developing countries. This is particularly true in Latin America, where the number of liver transplants performed remains extremely low for patients with advanced liver disease who fulfill criteria for liver transplantation. The goal of this study was to compare survival rate of patients with PBC in developing countries who were treated with ursodeoxycholic acid (UDCA) versus survival of patients who received other treatments (OT) without UDCA, prescribed before the UDCA era. MATERIAL AND METHODS: A retrospective study was performed, including records of 78 patients with PBC in the liver unit in a third level referral hospital in Mexico City. Patients were followed for five years from initial diagnosis until death related to liver disease or to the end of the study. Patients received UDCA (15 mg/kg/per day) (n = 41) or OT (n = 37) before introduction of UDCA in Mexico. RESULTS: Response to treatment was higher in the group that received UDCA. In the five years of follow-up, survival rates were significantly higher in the UDCA group than in the OT group. The hazard ratio of death was higher in the OT group vs. UDCA group, HR 8.78 (95% CI, 2.52-30.61); Mayo Risk Score and gender were independently associated with the risk of death. CONCLUSIONS: The study confirms that the use of UDCA in countries with a limited liver transplant program increases survival in comparison to other treatments used before the introduction of UDCA.
Assuntos
Colagogos e Coleréticos/uso terapêutico , Colangite/tratamento farmacológico , Acessibilidade aos Serviços de Saúde , Cirrose Hepática Biliar/tratamento farmacológico , Transplante de Fígado , Doadores de Tecidos/provisão & distribuição , Ácido Ursodesoxicólico/uso terapêutico , Adulto , Colangite/diagnóstico , Colangite/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Cirrose Hepática Biliar/diagnóstico , Cirrose Hepática Biliar/mortalidade , Masculino , México , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
Background: Primary Immune Thrombocytopenia (TIP) is an autoimmune disease that accelerates the peripheral destruction of platelets and alters megakaryocytopoiesis. Helicobacter pylori infection and eradication has been associated with an increase in the platelet count in patients with IPT. The aim of this article is to evaluate the platelet response after H. pylori eradication in patients with chronic splenectomized IPT Methods: Between 2008 and 2009, adult patients with a diagnosis of chronic IPT, splenectomized; They were given breath test with carbon 13-labeled urea (PAU13C). Patients who tested positive received eradication treatment with amoxicillin, omeprazole and clarithromycin for 14 days. After 6 weeks of treatment, a second PAU13C was performed. Baseline platelet counts were performed and every six months until the completion of two years. Results: 40 patients, 34 women and 6 men were included, PAU13C was positive in 17 patients (42.5%). H. pylori eradication was obtained in 16 patients (94%) confirmed by post-treatment PAU13C. In the follow-up of the patients it was observed that there was increase of platelets in 7 of the patients with eradication of H. pylori, while of the patients not infected in 9 also an increase of platelets was observed. Conclusions: There were no differences in the increase in platelet count among patients positive or negative to the H. pylori breath test at followup at 24 months.
Introducción: La trombocitopenia inmune primaria (TIP) es una enfermedad autoinmune que acelera la destrucción periférica de las plaquetas y altera la megacariocitopoyesis. La erradicación de la infección por Helicobacter pylori se ha asociado al incremento en la cuenta de plaquetas en los pacientes con TIP. El objetivo de este trabajo fue evaluar la respuesta de plaquetas después de la erradicación del H. pylori en pacientes con TIP crónica esplenectomizados. Métodos: Entre 2008-2009 fueron incluidos pacientes adultos con diagnóstico de TIP crónica, esplenectomizados; se les realizó prueba de aliento con urea marcada con carbono 13 (PAU13C). Los pacientes que resultaron positivos a la prueba recibieron tratamiento de erradicación con amoxicilina, omeprazol y claritromicina por 14 días. Después de 6 semanas de tratamiento, se realizó una segunda PAU13C. Se realizaron cuenta de Plaquetas basal y cada seis meses hasta completar dos años. Resultados: Se incluyeron 40 pacientes, 34 mujeres y 6 hombres, la PAU13C resultó positiva en 17 pacientes (42.5%). La erradicación del H. pylori se obtuvo en 16 pacientes (94%) confirmado por PAU13C postratamiento. En el seguimiento de los pacientes se observó que hubo incremento de las plaquetas en 7 de los pacientes con erradicación del H. pylori, mientras que de los pacientes no infectados en 9 también se observó aumento de plaquetas. Conclusiones: No hubo diferencias en el incremento en la cuenta de plaquetas entre los pacientes positivos o negativos a la prueba de aliento para H. pylori en el seguimiento a 24 meses.
Assuntos
Antibacterianos/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori , Inibidores da Bomba de Prótons/uso terapêutico , Púrpura Trombocitopênica Idiopática/complicações , Esplenectomia , Adulto , Amoxicilina/uso terapêutico , Doença Crônica , Claritromicina/uso terapêutico , Quimioterapia Combinada , Feminino , Seguimentos , Infecções por Helicobacter/complicações , Infecções por Helicobacter/diagnóstico , Humanos , Masculino , Omeprazol/uso terapêutico , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática/sangue , Púrpura Trombocitopênica Idiopática/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Parenteral nutrition (PN) is a mixture that covers the nutritional needs when enteral nutrition is not an option; however, PN is not free of complications. The aim of our study was to determine the indication and frequency of NP complications in pediatric patients treated at a tertiary center. METHODS: Children receiving PN at the Hospital de Pediatría del Centro Médico Nacional Siglo XXI were included. Demographic and anthropometric characteristics were recorded, as well as the reason of indicating PN, the time of administration, and the complications associated to this type of nutrition. RESULTS: Sixty-nine pediatric patients with PN were included: 33 neonates, 18 infants (between one and 11 months of age), nine preschoolers (from 1 to 5 years of age), and nine children over five years of age. Instructions for initiating the PN were given for the treatment of 71 % of the patients with diseases of the digestive tract who were treated surgically. Complications of PN occurred in 87 % of the children and 76.7 % had more than one complication. Metabolic complications occurred in 98 % of the children while mechanical and infectious complications only in 1 %, respectively. CONCLUSIONS: Parenteral nutrition was indicated more frequently in pediatric patients with digestive diseases treated surgically. Metabolic complications were the main concern in pediatric patients with PN.
Introducción: la nutrición parenteral (NP) es una mezcla que cubre las necesidades nutricionales cuando no es posible lograr esta tarea por la vía enteral en el paciente; sin embargo, no está exenta de complicaciones. El objetivo del estudio fue conocer la indicación y la frecuencia de complicaciones de la NP en pacientes pediátricos atendidos en un centro de tercer nivel. Métodos: se incluyeron niños que recibieron NP en el Hospital de Pediatría del Centro Médico Nacional Siglo XXI del Instituto Mexicano del Seguro Social. Se registraron las características demográficas, antropométricas, la causa de la indicación de la NP, su tiempo de administración y las complicaciones asociadas a este tipo de nutrición. Resultados: se incluyeron 69 pacientes pediátricos: 33 recién nacidos (RN) y 18 lactantes entre uno y 11 meses de edad; nueve preescolares entre uno y cinco años, y nueve niños mayores de cinco años. Las enfermedades del tracto digestivo tratadas quirúrgicamente constituyeron el 71 % de las indicaciones para el inicio de NP. Se presentaron complicaciones en el 87 % de los pacientes y 76.7% tuvieron más de una complicación. Las complicaciones metabólicas representaron 98 %, las mecánicas 1 % y las infecciosas 1 %. Conclusión: la NP en este centro de tercer nivel se indicó principalmente a pacientes sometidos a cirugía del tracto digestivo.
Assuntos
Doenças do Sistema Digestório/terapia , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Infecções/etiologia , Masculino , Doenças Metabólicas/etiologia , México , Estudos Prospectivos , Centros de Atenção TerciáriaRESUMO
INTRODUCTION: Extrahepatic portal vein obstruction is an important cause of portal hypertension among children. The etiology is heterogeneous and there are few evidences related to the optimal treatment. AIM AND METHODS: To establish guidelines for the diagnosis and treatment of EHPVO in children, a group of gastroenterologists and pediatric surgery experts reviewed and analyzed data reported in the literature and issued evidence-based recommendations. RESULTS: Pediatric EHPVO is idiopathic in most of the cases. Digestive hemorrhage and/or hypersplenism are the main symptoms. Doppler ultrasound is a non-invasive technique with a high degree of accuracy for the diagnosis. Morbidity is related to variceal bleeding, recurrent thrombosis, portal biliopathy and hypersplenism. Endoscopic therapy is effective in controlling acute variceal hemorrhage and it seems that vasoactive drug therapy can be helpful. For primary prophylaxis of variceal bleeding, there are insufficient data for the use of beta blockers or endoscopic therapy. For secondary prophylaxis, sclerotherapy or variceal band ligation is effective; there is scare evidence to recommend beta-blockers. Surgery shunt is indicated in children with variceal bleeding who fail endoscopic therapy and for symptomatic hypersplenism; spleno-renal or meso-ilio-cava shunting is the alternative when Mesorex bypass is not feasible due to anatomic problems or in centers with no experience. CONCLUSIONS: Prospective control studies are required for a better knowledge of the natural history of EHPVO, etiology identification including prothrombotic states, efficacy of beta-blockers and comparison with endoscopic therapy on primary and secondary prophylaxis.
RESUMO
INTRODUCTION: Identifying liver fibrosis is important to evaluate the severity of liver damage and to establish a prognosis. Utility of non-invasive markers of liver fibrosis has been proved in adults but there are few reports in children. The aim of this study was to evaluate Fibrotest® score and APRI suitability to identify children with liver fibrosis. MATERIAL AND METHODS: 68 children with chronic liver disease requiring liver biopsy were prospectively included from three 3rd-level pediatric hospitals. The same pathologist evaluated all liver biopsies; fibrosis degree was determined by METAVIR score. Serum samples were obtained to determine Fibrotest® and APRI. AUROC were used to determine cut-off and differentiate between advanced fibrosis (METAVIR F3, F4) and no fibrosis (F0). RESULTS: 68 biopsies were evaluated; METAVIR > F3 was identified in 26 (38%). Non invasive liver fibrosis markers to differentiate between advanced and no fibrosis were: Fibrotest® AUROC = 0.90 (95% CI 0.77-1.00) (cut-off value 0.35) sensitivity 88.00% (95% CI 68-96) and specificity 80% (95% CI 29-98); and for APRI AUROC = 0.97 (95% CI 0.92-1.00) (cut-off value 0.82), sensitivity 88% (95% CI 68-96) and specificity = 100% (95% CI 46-100). CONCLUSION: These results suggest the utility of Fibrotest® and APRI to identify advanced fibrosis; they can be recommended to select patients for liver biopsy and during patient follow-up.
Assuntos
Aspartato Aminotransferases/sangue , Cirrose Hepática/sangue , Cirrose Hepática/diagnóstico , Hepatopatias/complicações , Índice de Gravidade de Doença , Adolescente , Biomarcadores/sangue , Biópsia , Criança , Pré-Escolar , Doença Crônica , Testes Diagnósticos de Rotina , Feminino , Humanos , Fígado/patologia , Cirrose Hepática/patologia , Hepatopatias/sangue , Hepatopatias/etnologia , Masculino , México , Contagem de Plaquetas , Prognóstico , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: It has been suggested that liver cirrhosis (LC), regardless of etiology, may be associated with anatomical cardiac alterations. OBJECTIVE: To describe the frequency and type of macroscopical anatomic cardiac abnormalities present in alcoholic and non-alcoholic cirrhotic patients in an autopsy series. MATERIAL AND METHODS: The autopsy records performed at our institution during a 12-year period (1990-2002) were reviewed. All cases with final diagnosis of LC were included, their demographic characteristics as well as cirrhosis etiology and macroscopic anatomical cardiac abnormalities (MACA) analyzed. Patients with any known history of heart disease prior to diagnosis of cirrhosis were excluded. RESULTS: A total of 1,176 autopsies were performed, of which 135 cases (11.5%) were patients with LC. Two patients with cardiac cirrhosis were excluded. Chronic alcohol abuse (29%) and chronic hepatitis due to hepatitis C virus (HCV) infection (20%) were the most common causes of cirrhosis. The etiology was not identified in 35% of the cases, even after exhaustive clinical, serological and/or radiological assessment. In the postmortem analysis, 43% of the cases were informed to have MACA (47% in the group of patients with alcoholic cirrhosis and 41% in other types of cirrhosis); this rate increased to 62% in patients with ascites. The most frequent alterations were cardiomegaly and left ventricular hypertrophy (LVH). CONCLUSION: The results confirm the high frequency of cardiac abnormalities in patients with cirrhosis, regardless of cirrhosis etiology.
Assuntos
Cardiomegalia/epidemiologia , Cirrose Hepática/etiologia , Miocárdio/patologia , Adulto , Idoso , Autopsia , Cardiomegalia/etiologia , Cardiomegalia/patologia , Feminino , Hepatite C Crônica/complicações , Humanos , Hipertrofia Ventricular Esquerda/epidemiologia , Hipertrofia Ventricular Esquerda/patologia , Cirrose Hepática/virologia , Cirrose Hepática Alcoólica/complicações , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos RetrospectivosRESUMO
Objetivo: Comparar el resultado clínico de la mucosectomía rectal con engrapadora (MRE) sola y de la MRE combinada con esfinterotomía y con plastia anal de colgajos cutáneos, y examinar qué factores influyen sobre las complicaciones y la satisfacción del paciente. Material y métodos: Se incluyeron pacientes con enfermedad hemorroidal grados II a IV sometidos a MRE sola o en combinación con otros procedimientos. Se analizaron las complicaciones posoperatorias, resolución de síntomas y grado de satisfacción. Resultados: 241 pacientes consecutivos con seguimiento mínimo de un año se dividieron en tres grupos: MRE sola (n = 187), MRE combinada con esfinterotomía (n = 31) y MRE combinada con plastia de colgajos (n = 23). Los pacientes con MRE con esfinterotomía presentaron un porcentaje de complicaciones mayor que el resto (32 versus 12.8 % y 13 %, respectivamente, p = 0.02). La MRE con esfinterotomía se asoció con mayor riesgo de complicaciones que la MRE sola (RM = 3.5, IC 95 % = 1.4-8.7); la inclusión exclusiva de epitelio columnar en la zona resecada se asoció con menor riesgo de complicaciones que cuando se incluyó además epitelio transicional (RM = 0.4, IC 95 % = 0.2-0.8). La resolución de síntomas preoperatorios en la mayor parte de los pacientes fue > 80 % en los tres grupos. No hubo asociación de complicaciones o del tipo de procedimiento con el grado de satisfacción. Cuando el porcentaje de síntomas resueltos fue < 80 % se asoció con grado bajo o intermedio de satisfacción (p < 0.001). Conclusiones: La resolución de los síntomas preoperatorios con los tres procedimientos es similar. La MRE con esfinterotomía tiene mayor riesgo de complicaciones. El grado de satisfacción se asocia con la resolución de los síntomas preoperatorios.
BACKGROUND: We undertook this study to compare the clinical outcome of stapled rectal mucosectomy (SRM) alone and in combination with sphincterotomy and cutaneous flap anoplasty and to determine the influence of factors related to complications and patient satisfaction. METHODS: Patients with second- to fourth-degree hemorrhoids who underwent SRM alone or in combination with other anorectal procedures were included. Postoperative complications, symptom resolution and patient satisfaction were analyzed. RESULTS: Two hundred forty one patients with a minimum follow-up of 1 year were divided into three groups: SRM alone (n = 187), SRM combined with sphincterotomy (n = 31) and SRM combined with cutaneous flap anoplasty (n = 23). Patients with SRM with sphincterotomy showed a higher complication rate than the other groups (32 vs. 12.8% and 13%, respectively, p = 0.02). SRM combined with sphincterotomy was associated with a higher rate of complications (OR = 3.5; 95% CI = 1.4-8.7). SRM alone with low mucosal resection was associated with a lower complications rate (OR = 0.4, 95% CI = 0.2-0.8). Resolution of preoperative symptoms was >80% among the three groups. There was no association between complications and type of procedure with satisfaction level. Resolution of symptoms <80% was associated with low/intermediate level of satisfaction (p <0.001). CONCLUSIONS: Resolution of preoperative symptoms is similar among the three groups. SRM combined with sphincterotomy has a higher risk of complications. The satisfaction level is associated with resolution of preoperative symptoms.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Hemorroidas/cirurgia , Grampeamento Cirúrgico , Terapia Combinada , Grampeamento Cirúrgico/efeitos adversos , Análise Multivariada , Mucosa Intestinal/cirurgia , Satisfação do Paciente , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Reto/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: We undertook this study to compare the clinical outcome of stapled rectal mucosectomy (SRM) alone and in combination with sphincterotomy and cutaneous flap anoplasty and to determine the influence of factors related to complications and patient satisfaction. METHODS: Patients with second- to fourth-degree hemorrhoids who underwent SRM alone or in combination with other anorectal procedures were included. Postoperative complications, symptom resolution and patient satisfaction were analyzed. RESULTS: Two hundred forty one patients with a minimum follow-up of 1 year were divided into three groups: SRM alone (n = 187), SRM combined with sphincterotomy (n = 31) and SRM combined with cutaneous flap anoplasty (n = 23). Patients with SRM with sphincterotomy showed a higher complication rate than the other groups (32 vs. 12.8% and 13%, respectively, p = 0.02). SRM combined with sphincterotomy was associated with a higher rate of complications (OR = 3.5; 95% CI = 1.4-8.7). SRM alone with low mucosal resection was associated with a lower complications rate (OR = 0.4, 95% CI = 0.2-0.8). Resolution of preoperative symptoms was >80% among the three groups. There was no association between complications and type of procedure with satisfaction level. Resolution of symptoms <80% was associated with low/intermediate level of satisfaction (p <0.001). CONCLUSIONS: Resolution of preoperative symptoms is similar among the three groups. SRM combined with sphincterotomy has a higher risk of complications. The satisfaction level is associated with resolution of preoperative symptoms.