RESUMO
INTRODUCTION AND OBJECTIVES: To present the diagnostic process of CD Celiac disease among adults showing variable signs of nutritional derangements assisted at two tertiary-level health care institutions in Havana City (Cuba) between 2004 - 2007 for non-exhaustively characterized gastrointestinal disorders. MATERIAL AND METHOD: Clinical, serological, histo-pathological and nutritional findings were integrated into an ad hoc created scoring system. Weight gain was monitored during the study observation window. RESULTS: Twenty-eight presumptive celiac patients were identified among those assisted. CD diagnosis was as follows: Confirmed: 17.9% (Score: 9.2 +/- 0.4); Highly likely: 60.7% (Score: 6.6 +/- 1.1); Non-conclusive: 32.1% (Score: 4.7 +/- 0.5); respectively. Ninety-two point eight percent of subjects were malnourished at the moment of the first interview. Total intestinal villi atrophy was observed in less than one-third of the identified celiac patients. Tittering of antibodies associated with CD was as follows: Anti-gliadin: Completed: 25; Positive: 72.0%; Anti-transglutaminase: Completed: 11; Positive: 54.5%. Nutritional replenishment actions comprised: Diet gluten withdrawal (100.0%); Vitamins and minerals prescription (92.9%); supplementary Enteral Nutrition (57.2%); and Parenteral Nutrition (21.4%). Weight gain was of 400 grams in 80.8% of CD patients after 33.7 days of follow- up; and of 700 grams in 13 of them after 321 days. The scoring system presented in this study could be useful for diagnosis and treatment of CD: a condition that keeps baffling physicians and nutritionists alike.
Assuntos
Doença Celíaca/diagnóstico , Gastroenteropatias/diagnóstico , Desnutrição/complicações , Idoso , Doença Celíaca/patologia , Doença Celíaca/terapia , Cuba , Feminino , Humanos , Intestinos/patologia , Masculino , Desnutrição/etiologia , Pessoa de Meia-Idade , Estado Nutricional , Apoio Nutricional , Aumento de PesoRESUMO
Nutrient Energy Malnutrition (NEM) is a common feature among liver cirrhosis (LC) patients, and might constitute a negative predictor of patient's survival. A prospective descriptive study was carried out in order to assess the influence of LC patient's nutritional status on the occurrence of complications and mortality in a tertiary care health institution in Havana City (Cuba). One-hundred twenty-one patients were recruited for the study (Women: 52.9%; Younger than 60 years: 59.0%; Whites: 90.0%). C virus infection, alcoholism, and B virus infection accounted for 71.0% of LC cases. Ninety-two percents of the patients had less than 5 yearse of diagnosis. Subjective Global Assessment (SGA) of nutritional status returned a 45.0% of malnutrition. Malnutrition was associated with disease progression: twenty-one percent of A Child-Pugh Stage patients was malnourished, but this rate increased to become 90.0% among those in C stage. Fat and skeletal muscle compartments were reduced in 36.0 and 37.0% of the patients, respectively. Complications affected 44.6% of the patients. Sixty percent of them were malnourished (p <0.01). One-year mortality rate was 11.0%. Ninety-two percent of deceased patients were malnourished (p < 0.01). LC malnourished patients have greater risk of complications and death as compared to well-nourished ones.