RESUMO
OBJECTIVES: To compare the impact of different formulas on the occurrence of other atopic manifestations and the time of immune tolerance acquisition. STUDY DESIGN: In a 36-month prospective cohort study, the occurrence of other atopic manifestations (eczema, urticaria, asthma, and rhinoconjunctivitis) and the time of immune tolerance acquisition were comparatively evaluated in immunoglobulin E-mediated children with cow's milk allergy (CMA) treated with extensively hydrolyzed casein formula containing the probiotic L. rhamnosus GG (EHCF + LGG), rice hydrolyzed formula, soy formula, extensively hydrolyzed whey formula (EHWF), or amino acid-based formula. RESULTS: In total, 365 subjects were enrolled into the study, 73 per formula cohort. The incidence of atopic manifestations was 0.22 (Bonferroni-corrected 95% CI 0.09-0.34) in the EHCF + LGG cohort; 0.52 (0.37-0.67) in the rice hydrolyzed formula cohort; 0.58 (0.43-0.72) in the soy formula cohort; 0.51 (0.36-0.66) in the EHWF cohort; and 0.77 (0.64-0.89) in the amino acid-based formula cohort. The incidence of atopic manifestations in the rice hydrolyzed formula, soy formula, EHWF, and amino acid-based formula cohorts vs the EHCF + LGG cohort was always greater than the prespecified absolute difference of 0.25 at an alpha-level of 0.0125, with corresponding risk ratios of 2.37 (1.46-3.86, P < .001) for rice hydrolyzed formula vs EHCF + LGG; 2.62 (1.63-4.22, P < .001) for soy formula vs EHCF + LGG; 2.31 (1.42-3.77, P < .001) for EHWF vs EHCF + LGG; and 3.50 (2.23-5.49, P < .001) for amino acid-based formula vs EHCF + LGG. The 36-month immune tolerance acquisition rate was greater in the EHCF + LGG cohort. CONCLUSIONS: The use of EHCF + LGG for CMA treatment is associated with lower incidence of atopic manifestations and greater rate of immune tolerance acquisition.
Assuntos
Asma/prevenção & controle , Conjuntivite Alérgica/prevenção & controle , Dermatite Atópica/prevenção & controle , Tolerância Imunológica , Fórmulas Infantis , Hipersensibilidade a Leite/dietoterapia , Rinite Alérgica/prevenção & controle , Aminoácidos , Asma/epidemiologia , Asma/imunologia , Caseínas , Pré-Escolar , Conjuntivite Alérgica/epidemiologia , Conjuntivite Alérgica/imunologia , Dermatite Atópica/epidemiologia , Dermatite Atópica/imunologia , Feminino , Seguimentos , Humanos , Incidência , Lactente , Fórmulas Infantis/efeitos adversos , Fórmulas Infantis/química , Fórmulas Infantis/microbiologia , Lacticaseibacillus rhamnosus , Masculino , Hipersensibilidade a Leite/complicações , Hipersensibilidade a Leite/imunologia , Oryza , Probióticos/uso terapêutico , Estudos Prospectivos , Rinite Alérgica/epidemiologia , Rinite Alérgica/imunologia , Glycine max , Resultado do Tratamento , Soro do LeiteRESUMO
INTRODUCTION: Spleen stiffness (SS) has been found to mirror dynamic changes in portal pressure after transjugular intrahepatic portosystemic shunt (TIPS) placement. However, there is no data available regarding SS in patients with spontaneous portosystemic shunting (SPSS), especially in regards to prediction of hepatic decompensation. METHODS: We retrospectively selected patients with confirmed SPSS and esophageal varices (EVs) at endoscopic examination, and recorded any decompensating event (i.e., variceal hemorrhage, overt hepatic encephalopathy, refractory ascites, spontaneous bacterial peritonitis, hepatorenal syndrome) in the first twelve months following liver and spleen elastography. RESULTS: The patients who presented decompensating events showed lower platelet count (94.5 vs. 121.5â¯g/L, pâ¯<â¯0.001), higher SS (44 vs. 30â¯kPa, pâ¯<â¯0.001), higher probability of EVs according to SS (77 vs. 2 %, pâ¯<â¯0.001), and higher spleen diameter (14 vs. 12â¯cm, pâ¯=â¯0.043). They also showed a higher prevalence of splenorenal shunts (66.7 vs. 31.2%), and a significantly wider SPSS major diameter (14.5 vs. 8â¯mm, pâ¯<â¯0.001). CONCLUSION: SS could predict SPSS efficacy in relieving portal pressure, and could predict decompensating events in patients with SPSS.
Assuntos
Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/cirurgia , Derivação Portossistêmica Transjugular Intra-Hepática , Baço/diagnóstico por imagem , Idoso , Técnicas de Imagem por Elasticidade , Endoscopia , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/etiologia , Feminino , Humanos , Hipertensão Portal/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION AND OBJECTIVES: Surrogate biomarkers of liver fibrosis developed in tertiary care are increasingly used in general populations. We evaluated the association between liver stiffness (LS) and five continuous (AST/ALT, APRI, Forns Index, FIB-4, GGT) and two discrete biomarkers (BARD, BAAT) in a general population. PATIENTS AND METHODS: 636 (29%) of the 2159 citizens of the Bagnacavallo Study had LS measured by transient elastography. Using linear regression with univariate multiple imputation, we evaluated the association of LS with the above biomarkers in the total sample of 2159 citizens. RESULTS: The mean change of LS between the 5th and 95th internal percentile of any continuous biomarker was ≤1kPa. The mean change of LS between scores 0 and 3 of BARD and scores 0 and ≥3 of BAAT was >1kPa but of doubtful clinical relevance. CONCLUSION: We found a modest association between LS and seven biomarkers of liver fibrosis in a general population.
Assuntos
Fígado Gorduroso Alcoólico/sangue , Cirrose Hepática/sangue , Hepatopatia Gordurosa não Alcoólica/sangue , Adulto , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Técnicas de Imagem por Elasticidade , Fígado Gorduroso Alcoólico/diagnóstico por imagem , Feminino , Humanos , Cirrose Hepática/diagnóstico por imagem , Masculino , Síndrome Metabólica , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Obesidade , Sobrepeso , Contagem de Plaquetas , gama-Glutamiltransferase/sangueRESUMO
INTRODUCTION AND OBJECTIVES: Recent findings pointed out that even low-risk esophageal varices (EVs) are markers of severe prognosis. Accordingly, we analyzed spleen stiffness (SS) as a non-invasive method to predict EVs of any grade in a cohort of patients with compensated liver cirrhosis. METHOD: We measured SS and liver stiffness (LS) using point-Shear-Wave Elastography (pSWE) with Philips Affiniti 70 system in 210 cirrhotic patients who had undergone endoscopic screening for EVs. We compared SS and LS predictive capability for EVs of any grade. RESULTS: SS was higher in cirrhotic patients with EVs if compared to patients without EVs (p<0.001). The cut-off analysis detected 31kPa (100% sensitivity and negative predictive value) as the value to rule-out EVs and 69kPa (100% specificity and positive predictive value) to rule-in EVs. Besides, we developed the Spleen Stiffness Probability Index (SSPI), that can provide a probability of presence/absence of EVs. SSPI was the best model according to all discriminative and calibration metrics (AIC=120, BIC=127, AUROC=0.95, Pseudo-R2=0.74). SS demonstrated higher correlation with spleen bipolar diameter and spleen surface (r=0.52/0.55) if compared to LS (r=0.30/0.25) - and with platelet count as well (r=0.67 vs r=0.4). CONCLUSION: SS showed significantly higher performance than other parameters, proving to be the best non-invasive test in the screening of EVs: by directly applying SS cut-off of 31kPa, our department could have safely avoided endoscopy in 36% of patients. Despite cut-off analyses, it was possible to create a probability model that could further stratify low-risk from high-risk patients (for any grade of EVs).
Assuntos
Técnicas de Imagem por Elasticidade , Varizes Esofágicas e Gástricas/diagnóstico , Cirrose Hepática/diagnóstico por imagem , Baço/diagnóstico por imagem , Idoso , Endoscopia do Sistema Digestório , Varizes Esofágicas e Gástricas/etiologia , Feminino , Humanos , Fígado/diagnóstico por imagem , Cirrose Hepática/complicações , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Baço/patologiaRESUMO
OBJECTIVE: To investigate whether the addition of the probiotic Lactobacillus rhamnosus GG (LGG) to the extensively hydrolyzed casein formula (EHCF) for cow's milk allergy (CMA) treatment could reduce the occurrence of functional gastrointestinal disorders (FGIDs). STUDY DESIGN: This cohort study included children with a positive history for CMA in the first year of life who were treated with EHCF alone or in combination with LGG and had evidence of immune tolerance acquisition to cow's milk for at least 12 months. FGID was diagnosed according to the Rome III diagnostic criteria by investigators unaware of previous treatment. A cohort of consecutive healthy children was also evaluated as a control population. RESULTS: A total of 330 subjects were included, 110 per cohort (EHCF, EHCF+LGG, and healthy controls). The rate of subjects with ≥1 FGID was significantly lower in the EHCF+LGG cohort compared with the EHCF cohort (40% vs 16.4%; P < .05). In the EHCF+LGG cohort, a lower incidence was observed for all components of the main study outcome. The prevalence of FGIDs in the healthy cohort was lower than that in the EHCF cohort and similar to that in the EHCF+LGG cohort. The incidence rate ratio of FGIDs for the EHCF+LGG cohort vs the EHCF cohort (0.40; 95% CI, 0.25-0.65; P < .001) was unmodified after correction for age at CMA diagnosis, breastfeeding, weaning time, and presence of a first-degree relative with an FGID. CONCLUSIONS: These results confirm the increased risk for developing FGIDs in children with CMA and suggest that EHCF+LGG could reduce this risk.
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Caseínas/química , Alimentos Formulados , Gastroenteropatias/prevenção & controle , Lacticaseibacillus rhamnosus , Hipersensibilidade a Leite/dietoterapia , Probióticos/administração & dosagem , Animais , Bovinos , Criança , Pré-Escolar , Dieta , Feminino , Humanos , Hidrólise , Tolerância Imunológica , Masculino , Leite , Prevalência , Estudos Prospectivos , Risco , Resultado do TratamentoRESUMO
UNLABELLED: Introduction and aim. Liver disease is associated with cognitive dysfunction also at early stages, and minimal hepatic encephalopathy, affecting 20-70% of patients, is frequently under-recognized. The main purpose of this work was to demonstrate that a substantial number of patients, enrolled due to an acute confusional state in absence of a diagnosis of liver disease, suffers of hepatic encephalopathy. MATERIAL AND METHODS: Before a diagnosis of a well-compensated liver diseases was performed, 410 patients with an acute confusional state were enrolled in this study. RESULTS: Even in the presence of minimal alterations of hepatic function, the psychometric tests applied demonstrated early signs of cerebral frontal alteration. The alteration was associated with the severity of liver disease, paralleling the progression of the patient to minimal hepatic failure or chronic liver disease. CONCLUSIONS: These psychometric tests are essential to detect early and subclinical frontal failure. Frontal dysfunction may be a useful tool in the follow-up of these patients.
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Atenção , Conscientização , Comportamento , Confusão/psicologia , Função Executiva , Encefalopatia Hepática/psicologia , Julgamento , Cirrose Hepática/psicologia , Adulto , Apatia , Estudos de Casos e Controles , Confusão/diagnóstico , Feminino , Encefalopatia Hepática/diagnóstico , Humanos , Hepatopatias/psicologia , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , PsicometriaAssuntos
Fígado Gorduroso/diagnóstico , Fígado Gorduroso/epidemiologia , Hepatite/diagnóstico , Hepatite/epidemiologia , Alanina Transaminase/metabolismo , Biópsia , Citocinas/metabolismo , Diagnóstico Diferencial , Ácidos Graxos/metabolismo , Fígado Gorduroso/fisiopatologia , Hepatite/fisiopatologia , Humanos , Resistência à Insulina/fisiologia , Fígado/metabolismo , Fígado/patologia , Prevalência , Prognóstico , Fatores de RiscoRESUMO
There is increasing evidence that fatty liver may be the most frequent liver disorder in Western countries. However, the epidemiology of fatty liver is still not fully understood and there is a clear need of better assessing and defining the potential role of the risk factors identified by clinical series in the general population. This article reviews the available data on the epidemiology of fatty liver and addresses some important questions that should be answered in much needed future research.