RESUMO

OBJECTIVE: Medical nutrition therapy provides the opportunity to compensate for muscle wasting and immune response activation during stress and trauma. The objective of this systematic review is to assess the safety and effectiveness of early enteral nutrition (EEN) in adults with sepsis or septic shock. METHODS: The MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and ICTRP tools were searched from inception until July 2023. Conference proceedings, the reference lists of included studies, and expert content were queried to identify additional publications. Two review authors completed the study selection, data extraction, and risk of bias assessment; disagreements were resolved through discussion. Inclusion criteria were randomized controlled trials (RCTs) and non-randomized studies (NRSs) comparing the administration of EEN with no or delayed enteral nutrition (DEE) in adult populations with sepsis or septic shock. RESULTS: Five RCTs (n = 442 participants) and ten NRSs (n = 3724 participants) were included. Low-certainty evidence from RCTs and NRSs suggests that patients receiving EEN could require fewer days of mechanical ventilation (MD -2.65; 95% CI, -4.44-0.86; and MD -2.94; 95% CI, -3.64--2.23, respectively) and may show lower SOFA scores during follow-up (MD -1.64 points; 95% CI, -2.60--0.68; and MD -1.08 points; 95% CI, -1.90--0.26, respectively), albeit with an increased frequency of diarrhea episodes (OR 2.23, 95% CI 1.115-4.34). Even though the patients with EEN show a lower in-hospital mortality rate both in RCTs (OR 0.69; 95% CI, 0.39-1.23) and NRSs (OR 0.89; 95% CI, 0.69-1.13), this difference does not achieve statistical significance. There were no apparent differences for other outcomes. CONCLUSIONS: Low-quality evidence suggests that EEN may be a safe and effective intervention for the management of critically ill patients with sepsis or septic shock.

Assuntos

Nutrição Enteral , Sepse , Choque Séptico , Humanos , Nutrição Enteral/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial , Sepse/terapia , Sepse/mortalidade , Choque Séptico/terapia , Choque Séptico/mortalidade , Fatores de Tempo , Resultado do Tratamento

RESUMO

We report the histopathological study of a large, black, crusted lesion with symmetrical distribution in both buttocks and perineum, never described, in a man who has sex with men (MSM) and proctitis associated with Human Monkey Pox Virus (hMPXV) and HIV-AIDS infection never treated. A 39-year-old male, homosexual, HIV-AIDS without Highly Active Antiretroviral Therapy (HAART), was admitted to a hospital in Lima, Peru, with papulopustular lesions on the body and perianal area. Days later, a large, crusty, black lesion with a symmetrical distribution appeared on the buttocks and perineum. The tissue culture was negative. Wedge biopsy of the lesion showed typical MPXV cytopathogenics lesions in addition to fibrin micro thrombosis in the underlying papillary dermis. The histopathological findings of the scabby and black lesion are the classic ones described by Stagles, except for the phenomenon of fibrin micro thrombosis in the papillary dermis, a novel cytopathogenic effect of MPXV with clinical relevance (epidermal-dermal necrosis).

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Reportamos el estudio histopatológico de una gran lesión costrosa, negra, de distribución simétrica en ambas nalgas y periné, nunca descrito, en un hombre que tiene sexo con hombres (HSH) y proctitis asociado a Viruela del Mono Humana (hMPXV) e infección por VIH-SIDA nunca tratado. Un varón de 39 años, homosexual, VIH-SIDA sin Terapia Antirretroviral de Gran Actividad (TARGA), ingresó en un hospital de Lima, Perú, con lesiones papulopustulosas en el cuerpo y el area perianal. Días después apareció una gran lesión negra, costrosa de distribución simétrica en las nalgas y periné. El cultivo de tejidos fue negativo. La biopsia en cuña de la lesión mostró lesiones citopatogénicas típicas de MPXV, además de microtrombosis de fibrina en la dermis papilar subyacente. Los hallazgos histopatológicos de la lesión costrosa y negra que reportamos son los clásicos descritos por Stagles, a excepción del fenómeno de microtrombosis de fibrina en la dermis papilar, un efecto citopatogénico novedoso de MPXV con relevancia clínica (necrosis epidermo-dérmico).

RESUMO

OBJECTIVES: The aim of the study was to assess neurodevelopmental outcomes among children with biliary atresia (BA) surviving with their native liver at ages 3 to 12 years and evaluate variables that associate with neurodevelopment. METHODS: Participants (ages 3-12 years) in a prospective, longitudinal, multicenter study underwent neurodevelopmental testing with Weschler Preschool and Primary Scale of Intelligence, 3rd edition (WPPSI-III, ages 3-5 years) and Weschler Intelligence Scale for Children, 4th edition (WISC-IV, ages 6-12 years). Continuous scores were analyzed using Kolmogorov-Smironov tests compared with a normal distribution (mean = 100 ±â€Š15). Effect of covariates on Full-Scale Intelligence Quotient (FSIQ) was analyzed using linear regression. RESULTS: Ninety-three participants completed 164 WPPSI-III (mean age 3.9) and 51 WISC-IV (mean age 6.9) tests. WPPSI-III FSIQ (104 ±â€Š14, P < 0.02), Verbal IQ (106 ±â€Š14, P < 0.001), and General Language Composite (107 ±â€Š16, P < 0.001) distributions were shifted higher compared with test norms. WISC-IV FSIQ (105 ±â€Š12, P < 0.01), Perceptual Reasoning Index (107 ±â€Š12, P < 0.01), and Processing Speed Index (105 ±â€Š10, P < 0.02) also shifted upwards. In univariate and multivariable analysis, parent education (P < 0.01) was a significant predictor of FSIQ on WPPSI-III and positively associated with WISC-IV FSIQ. Male sex and higher total bilirubin and gamma glutamyl transferase (GGT) predicted lower WPPSI-III FSIQ. Portal hypertension was predictive of lower WISC-IV FSIQ. CONCLUSIONS: This cohort of children with BA and native liver did not demonstrate higher prevalence of neurodevelopmental delays. Markers of advanced liver disease (higher total bilirubin and GGT for age ≤5 years; portal hypertension for age ≥6) correlate with lower FSIQ and may identify a vulnerable subset of patients who would benefit from intervention.

Assuntos

Atresia Biliar/psicologia , Transtornos do Neurodesenvolvimento/epidemiologia , Atresia Biliar/sangue , Atresia Biliar/patologia , Bilirrubina/sangue , Criança , Desenvolvimento Infantil , Pré-Escolar , Escolaridade , Feminino , Humanos , Hipertensão Portal/etiologia , Hipertensão Portal/psicologia , Fígado/patologia , Estudos Longitudinais , Masculino , Transtornos do Neurodesenvolvimento/etiologia , Prevalência , Estudos Prospectivos , Fatores de Risco , Escalas de Wechsler , gama-Glutamiltransferase/sangue

RESUMO

OBJECTIVES: Biliary atresia (BA) is a progressive neonatal fibroinflammatory cholangiopathy. We hypothesized that intravenous immunoglobulin (IVIg) would be safe, feasible, acceptable, and efficacious for the treatment of BA. The primary objective of this study was to establish the feasibility, acceptability, and safety profile of IVIg administration after hepatoportoenterostomy (HPE) in BA. The secondary objective was to determine the treatment efficacy of IVIg based on good bile drainage and survival with the native liver. METHODS: A multicenter, prospective, open-labeled, phase I/IIA trial of IVIg was conducted, with 1 g/kg/dose of IVIg infused at 3-5, 30, and 60 days post-HPE, and subjects followed for 360 days post-HPE. Twenty-nine participants completed the study. RESULTS: Administration of IVIg infusions was feasible and acceptable in 79%. None of the serious adverse events (SAEs) were directly related to IVIg infusions; however, 90% of participants had an SAE. Compared with a historical placebo-arm group, there was no significant increase in the proportion of IVIg participants with a serum total bilirubin <1.5 mg/dL at 90, 180, or 360 days post-HPE. Survival with the native liver in the IVIg participants showed no significant benefit over the historical placebo arm, with a difference at 360 days of -11.9% (IVIg: 58.6%, placebo: 70.5%; 90% UCB: 2.1%; P > 0.05). CONCLUSIONS: Although IVIg infusions in infants with BA post-HPE were feasible, acceptable and safe, there was no trend to lower bilirubin levels or improved 360-day survival with the native liver. CLINICAL TRIAL: Safety Study of Intravenous Immunoglobulin Post-Portoenterostomy in Biliary Atresia; #NCT01854827.

Assuntos

Atresia Biliar/cirurgia , Imunoglobulinas Intravenosas/uso terapêutico , Atresia Biliar/mortalidade , Pré-Escolar , Drenagem , Feminino , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Lactente , Recém-Nascido , Transplante de Fígado , Masculino , Portoenterostomia Hepática , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Resultado do Tratamento

RESUMO

Osteopenia and bone fractures are significant causes of morbidity in children with cholestatic liver disease. Dual-energy X-ray absorptiometry (DXA) analysis was performed in children with intrahepatic cholestatic diseases who were enrolled in the Longitudinal Study of Genetic Causes of Intrahepatic Cholestasis in the Childhood Liver Disease Research Network. DXA was performed on participants aged >5 years (with native liver) diagnosed with bile acid synthetic disorder (BASD), alpha-1 antitrypsin deficiency (A1AT), chronic intrahepatic cholestasis (CIC), and Alagille syndrome (ALGS). Weight, height, and body mass index Z scores were lowest in CIC and ALGS. Total bilirubin (TB) and serum bile acids (SBA) were highest in ALGS. Bone mineral density (BMD) and bone mineral content (BMC) Z scores were significantly lower in CIC and ALGS than in BASD and A1AT (P < 0.001). After anthropometric adjustment, bone deficits persisted in CIC but were no longer noted in ALGS. In ALGS, height-adjusted and weight-adjusted subtotal BMD and BMC Z scores were negatively correlated with TB (P < 0.001) and SBA (P = 0.02). Mean height-adjusted and weight-adjusted subtotal BMC Z scores were lower in ALGS participants with a history of bone fractures. DXA measures did not correlate significantly with biliary diversion status. Conclusion: CIC patients had significant bone deficits that persisted after adjustment for height and weight and generally did not correlate with degree of cholestasis. In ALGS, low BMD and BMC reference Z scores were explained by poor growth. Anthropometrically adjusted DXA measures in ALGS correlate with markers of cholestasis and bone fracture history. Reduced bone density in this population is multifactorial and related to growth, degree of cholestasis, fracture vulnerability, and contribution of underlying genetic etiology.

Assuntos

Densidade Óssea , Colestase/etiologia , Transtornos do Crescimento/etiologia , Hepatopatias/complicações , Hepatopatias/fisiopatologia , Absorciometria de Fóton , Adolescente , Criança , Doença Crônica , Correlação de Dados , Feminino , Humanos , Estudos Longitudinais , Masculino

RESUMO

OBJECTIVE: To investigate the impact of corticosteroid therapy on the growth of participants in the Steroids in Biliary Atresia Randomized Trial (START) conducted through the Childhood Liver Disease Research Network. The primary analysis in START indicated that steroids did not have a beneficial effect on drainage in a cohort of infants with biliary atresia. We hypothesized that steroids would have a detrimental effect on growth in these infants. STUDY DESIGN: A total of 140 infants were enrolled in START, with 70 randomized to each treatment arm: steroid and placebo. Length, weight, and head circumference were obtained at baseline and follow-up visits to 24 months of age. RESULTS: Patients treated with steroids had significantly lower length and head circumference z scores during the first 3 months post-hepatoportoenterostomy (HPE), and significantly lower weight until 12 months. Growth trajectories in the steroid and placebo arms differed significantly for length (P < .0001), weight (P = .009), and head circumference (P < .0001) with the largest impact noted for those with successful HPE. Growth trajectory for head circumference was significantly lower in patients treated with steroids irrespective of HPE status, but recovered during the second 6 months of life. CONCLUSIONS: Steroid therapy following HPE in patients with biliary atresia is associated with impaired length, weight, and head circumference growth trajectories for at least 6 months post-HPE, especially impacting infants with successful bile drainage. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00294684.

Assuntos

Corticosteroides/efeitos adversos , Atresia Biliar/tratamento farmacológico , Atresia Biliar/cirurgia , Insuficiência de Crescimento/induzido quimicamente , Sarcopenia/induzido quimicamente , Corticosteroides/uso terapêutico , Atresia Biliar/mortalidade , Peso Corporal/efeitos dos fármacos , Cefalometria/métodos , Desenvolvimento Infantil/efeitos dos fármacos , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Método Duplo-Cego , Insuficiência de Crescimento/epidemiologia , Insuficiência de Crescimento/fisiopatologia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Monitorização Fisiológica/métodos , Portoenterostomia Hepática/métodos , Portoenterostomia Hepática/mortalidade , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Valores de Referência , Medição de Risco , Sarcopenia/epidemiologia , Sarcopenia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento

RESUMO

OBJECTIVES: To assess neurodevelopmental outcomes among participants with biliary atresia with their native liver at ages 12 months (group 1) and 24 months (group 2), and to evaluate variables predictive of neurodevelopmental impairment. STUDY DESIGN: Participants enrolled in a prospective, longitudinal, multicenter study underwent neurodevelopmental testing with either the Bayley Scales of Infant Development, 2nd edition, or Bayley Scales of Infant and Toddler Development, 3rd edition. Scores (normative mean = 100 ± 15) were categorized as ≥100, 85-99, and <85 for χ2 analysis. Risk for neurodevelopmental impairment (defined as ≥1 score of <85 on the Bayley Scales of Infant Development, 2nd edition, or Bayley Scales of Infant and Toddler Development, 3rd edition, scales) was analyzed using logistic regression. RESULTS: There were 148 children who completed 217 Bayley Scales of Infant and Toddler Development, 3rd edition, examinations (group 1, n = 132; group 2, n = 85). Neurodevelopmental score distributions significantly shifted downward compared with test norms at 1 and 2 years of age. Multivariate analysis identified ascites (OR, 3.17; P = .01) and low length z-scores at time of testing (OR, 0.70; P < .04) as risk factors for physical/motor impairment; low weight z-score (OR, 0.57; P = .001) and ascites (OR, 2.89; P = .01) for mental/cognitive/language impairment at 1 year of age. An unsuccessful hepatoportoenterostomy was predictive of both physical/motor (OR, 4.88; P < .02) and mental/cognitive/language impairment (OR, 4.76; P = .02) at 2 years of age. CONCLUSION: Participants with biliary atresia surviving with native livers after hepatoportoenterostomy are at increased risk for neurodevelopmental delays at 12 and 24 months of age. Those with unsuccessful hepatoportoenterostomy are >4 times more likely to have neurodevelopmental impairment compared with those with successful hepatoportoenterostomy. Growth delays and/or complications indicating advanced liver disease should alert clinicians to the risk for neurodevelopmental delays, and expedite appropriate interventions. TRIAL REGISTRATION: Clinicaltrials.gov: NCT00061828 and NCT00294684.

Assuntos

Atresia Biliar/terapia , Deficiências do Desenvolvimento/etiologia , Fígado/fisiologia , Testes Neuropsicológicos , Atresia Biliar/complicações , Pré-Escolar , Cognição , Deficiências do Desenvolvimento/diagnóstico , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Destreza Motora , Análise Multivariada , Estudos Observacionais como Assunto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Análise de Regressão , Risco , Resultado do Tratamento , Populações Vulneráveis

RESUMO

INTRODUCCIÓN: El prolapso de los órganos pélvicos (POP) es una condición cuya prevalencia aumenta con la edad. Es necesario que los cirujanos comprendan las indicaciones, riesgos, limitaciones y resultados de las varias técnicas quirúrgicas disponibles. En este artículo se aborda el tratamiento quirúrgico obliterativo del POP (colpocleisis y colpectomia) en base a la revisión de estudios. TÉCNICA: En la literatura son descritas muchas variaciones de las técnicas obliterativas. Con el objetivo de reglamentar la técnica para futuros estudios, describimos la técnica de LeFort modificada, realizada por los autores. Los métodos obliterativos tienen un tiempo operatório, morbilidad perioperatoria reducida y una tasa baja de recurrencia del prolapso. El índice de calidad de vida y satisfacción de la paciente son altos. CONCLUSIÓN: La literatura existente respecto a la colpocleisis es limitada por la calidad metodológica. Por tanto, no hay nivel de evidencia I o II, en lo que se refiere a la colpocleisis. Sin embargo, esta técnica debe hacer parte del arsenal terapéutico del cirujano en el abordaje de los prolapsos severos en mujeres mayores.

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INTRODUCTION. The pelvic organ prolapse (POP) is a condition whose prevalence increases with age. Surgeons need to understand the indications, risks, constraints and results of various surgical techniques. This article is about obliterative surgical treatment of POP (colpocleisis and colpectomia) and it is based on the review of studies is discussed. TECHNICAL. In the literature are many variations of the techniques obliterative. In order to regulate the art for future study, we describe the technique of LeFort modified by the authors. The obliterative methods have operatory time, reduced perioperative morbidity and a low rate of recurrence of prolapse. The index ofquality oflife and patient satisfaction are high. CONCLUSION. The literature regarding the colpocleisis is limited by methodological quality. Therefore no evidence level I or II, in what concerns the colpocleisis. However, this technique should be part of the armamentarium of the surgeon in addressing severe prolapse in elderly women.

Assuntos

Prolapso Uterino , Doenças Vaginais

RESUMO

Calculation of energy and protein doses for critically ill patients is still a matter of controversy. For more than 40 years of nutrition support, the total amount of nutrients to be delivered to these patients has been calculated based on expert recommendations, and this calculation is based on the administration of nonprotein calories in one attempt to ameliorate catabolic response and avoid the weight loss. New evidence suggests protein delivery is the most important intervention to improve clinical and metabolic outcomes. This article describes the metabolic rationale and the new evidence supporting a change in the approach of metabolic support of the critically ill, proposing a physiological-based intervention supported by the recognition of ancillary characteristics of the metabolic response to trauma and injury. A moderate dose of calories around 15 kcal/kg/d with a delivery of protein of 1.5 g/kg/d appears to be the new recommendation for many hypercatabolic patients in the first week following injury.

Assuntos

Estado Terminal , Ingestão de Energia , Necessidades Nutricionais , Apoio Nutricional , Nutrição Parenteral/normas , Humanos

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is a burgeoning health problem worldwide and an important risk factor for both hepatic and cardiometabolic mortality. The rapidly increasing prevalence of this disease and of its aggressive form nonalcoholic steatohepatitis (NASH) will require novel therapeutic approaches to prevent disease progression to advanced fibrosis or cirrhosis and cancer. In recent years, bile acids have emerged as relevant signaling molecules that act at both hepatic and extrahepatic tissues to regulate lipid and carbohydrate metabolic pathways as well as energy homeostasis. Activation or modulation of bile acid receptors, such as the farnesoid X receptor and TGR5, and transporters, such as the ileal apical sodium-dependent bile acid transporter, appear to affect both insulin sensitivity and NAFLD/NASH pathogenesis at multiple levels, and these approaches hold promise as novel therapies. In the present review, we summarize current available data on the relationships of bile acids to NAFLD and the potential for therapeutically targeting bile-acid-related pathways to address this growing world-wide disease. (Hepatology 2017;65:350-362).

Assuntos

Ácidos e Sais Biliares/fisiologia , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico , Hepatopatia Gordurosa não Alcoólica/etiologia , Metabolismo Energético , Glucose/metabolismo , Humanos , Inflamação/etiologia , Metabolismo dos Lipídeos , Fígado , Microbiota , Hepatopatia Gordurosa não Alcoólica/genética , Receptores Citoplasmáticos e Nucleares/agonistas , Receptores Citoplasmáticos e Nucleares/antagonistas & inibidores , Receptores Acoplados a Proteínas G , Transdução de Sinais

RESUMO

OBJECTIVES: To prospectively assess the value of serum total bilirubin (TB) within 3 months of hepatoportoenterostomy (HPE) in infants with biliary atresia as a biomarker predictive of clinical sequelae of liver disease in the first 2 years of life. STUDY DESIGN: Infants with biliary atresia undergoing HPE between June 2004 and January 2011 were enrolled in a prospective, multicenter study. Complications were monitored until 2 years of age or the earliest of liver transplantation (LT), death, or study withdrawal. TB below 2 mg/dL (34.2 µM) at any time in the first 3 months (TB <2.0, all others TB ≥ 2) after HPE was examined as a biomarker, using Kaplan-Meier survival and logistic regression. RESULTS: Fifty percent (68/137) of infants had TB < 2.0 in the first 3 months after HPE. Transplant-free survival at 2 years was significantly higher in the TB < 2.0 group vs TB ≥ 2 (86% vs 20%, P < .0001). Infants with TB ≥ 2 had diminished weight gain (P < .0001), greater probability of developing ascites (OR 6.4, 95% CI 2.9-14.1, P < .0001), hypoalbuminemia (OR 7.6, 95% CI 3.2-17.7, P < .0001), coagulopathy (OR 10.8, 95% CI 3.1-38.2, P = .0002), LT (OR 12.4, 95% CI 5.3-28.7, P < .0001), or LT or death (OR 16.8, 95% CI 7.2-39.2, P < .0001). CONCLUSIONS: Infants whose TB does not fall below 2.0 mg/dL within 3 months of HPE were at high risk for early disease progression, suggesting they should be considered for LT in a timely fashion. Interventions increasing the likelihood of achieving TB <2.0 mg/dL within 3 months of HPE may enhance early outcomes. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00061828 and NCT00294684.

Assuntos

Atresia Biliar/cirurgia , Bilirrubina/sangue , Progressão da Doença , Portoenterostomia Hepática , Ascite/epidemiologia , Atresia Biliar/epidemiologia , Biomarcadores/sangue , Canadá/epidemiologia , Pré-Escolar , Bases de Dados Factuais , Coagulação Intravascular Disseminada/epidemiologia , Seguimentos , Transtornos do Crescimento/epidemiologia , Humanos , Hipoalbuminemia/epidemiologia , Lactente , Recém-Nascido , Transplante de Fígado/estatística & dados numéricos , Modelos Logísticos , Prognóstico , Estudos Prospectivos , Estados Unidos/epidemiologia

RESUMO

Diagnosis of cystic echinococcosis (CE) is based on the identification of the cyst(s) by imaging, using immunodiagnostic tests mainly as complementary tools in clinical settings. Among the antigens used for immunodiagnosis, previous studies described a good performance of the recombinant antigen B8/1 (rAgB) in an enzyme-linked immunosorbent assay (ELISA) format; however, in remote parts of areas where the disease is endemic, the implementation of an ELISA is difficult, so a more simple, rapid, and reliable method such as the immunochromatographic test (ICT) is required. In this study, using a set of 50 serum samples from patients with surgically confirmed CE, we compared the performance of an ICT and that of an ELISA using the rAgB. The overall sensitivities of ICT and ELISA were not statistically different (78% versus 72%; P = 0.36). The overall agreement between both tests was moderate (κ = 0.41; P < 0.01). Concordance between ICT and ELISA was substantial or almost perfect for patients with liver involvement (κ = 0.65; P < 0.001) and patients with more than one hydatid cyst (κ = 0.82; P < 0.001), respectively. Moreover, specificity analysis using a total of 88 serum samples from healthy individuals (n = 20) and patients (n = 68) with other parasitic infections revealed that ICT had a specificity of 89.8%. ICT and ELISA had similar performance for the detection of specific antibodies to E. granulosus, and ICT had a high specificity, opening the possibility of using ICT as a screening tool in rural settings.

Assuntos

Anticorpos Anti-Helmínticos/sangue , Antígenos de Helmintos/imunologia , Cromatografia de Afinidade/métodos , Equinococose/diagnóstico , Ensaio de Imunoadsorção Enzimática , Humanos , Proteínas Recombinantes/imunologia , Sensibilidade e Especificidade

RESUMO

OBJECTIVES: To assess health-related quality of life (HRQOL) in children with Alagille syndrome (ALGS) in comparison with healthy and other liver disease cohorts, and to identify determinants of HRQOL in patients with ALGS. STUDY DESIGN: Within the Childhood Liver Disease Research Network prospective study of cholestasis, Pediatric Quality of Life Inventory (PedsQL) questionnaires were administered to 70 children with ALGS, 95 children with alpha-1-antitrypsin deficiency (A1ATD), and 49 children with other causes of chronic intrahepatic cholestasis (IHC) aged 5-18 years. Parent proxy PedsQL scores were recorded for children aged 2-18 years (98 ALGS, 123 A1ATD, and 68 IHC). RESULTS: Mean ages and total bilirubin (mg/dL) were ALGS 9.4 years; 4.4, A1ATD 9.5 years; 0.7, and IHC 10.3 years; 2.9. ALGS child PedsQL scores were lower than in healthy children and children with A1ATD (mean 73 vs 83; P = .001). Children with ALGS and IHC were similar, except in physical scores (73 vs 79; P = .05). Parents of children with ALGS perceived their children to have worse HRQOL than A1ATD (P ≤ .001) and marginally lower compared with IHC. Univariate analysis revealed ALGS child-reported scores were positively associated with better growth and inversely with total bilirubin. Growth failure, elevated international normalized ratio, and an intracardiac defect were predictive of poor parental scores (P ≤ .05). In multivariate analysis, only weight z-score remained significant for child- and parent-reported scores. CONCLUSIONS: HRQOL is impaired in children with ALGS compared with healthy and children with A1ATD, similar to children with IHC and is associated with growth failure, which is a potentially treatable cause of impaired HRQOL.

Assuntos

Síndrome de Alagille/complicações , Síndrome de Alagille/psicologia , Nível de Saúde , Qualidade de Vida , Adolescente , Síndrome de Alagille/fisiopatologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos de Coortes , Emoções , Feminino , Humanos , Masculino , Comportamento Social , Inquéritos e Questionários , Deficiência de alfa 1-Antitripsina/complicações , Deficiência de alfa 1-Antitripsina/fisiopatologia , Deficiência de alfa 1-Antitripsina/psicologia

RESUMO

Variability in the relative abundance, size structure and sex ratio of the dolphinfish Coryphaena hippurus (Pisces: Coryphaenidae) in the Gulf of Tehuantepec, México. The dolphinfish (Coryphaena hippurus), is an oceanic epipelagic fish found worldwide in tropical and subtropical waters, with a high dispersal capability via large-scale migrations. This fast-swimming top-level predator is abundant in the Gulf of Tehuantepec, where it is caught incidentally by artisanal fisheries, and represents a target species for both recreational and commercial fisheries in Mexico, Ecuador, Peru and Central America. Nowadays, local fishery information on this species is scarce, thus our objective was to analyze the size structure by sex and the catch-per-unit-effort (CPUE) tendency of dolphinfish caught in the Gulf of Tehuantepec, from 2000 to 2007. For this, fishery catches information was obtained from the artisanal fleet, at six landing sites in the Gulf, and the sex ratio, fork length (FL) and the catch per unit effort (CPUE) were estimated. From all sampling sites, a total of 3 494 females, and 3 877 males were obtained, and dolphinfish size as fork length (FL) ranged from 20.5 to 152cm. Fish size ranged from 25.5 to 148cm furcal length (FL) in males, and 20.5 to 129cm FL in females. The sex ratio (males:females) was 1:1, except in April-May (1:1.5, p < 0.05) and November (1:0.5, p < 0.05). The sex ratio at different size classes showed a significant bias towards females at smaller sizes (< 75cm FL), whereas the males were predominant in larger size classes (> 100cm FL). The size structure was bimodal, with a variation in the size average; the modes were defined as the small group (FL = 50-55cm) and the large size group (FL = 100-110cm). The CPUE showed seasonal changes: values were high for the November-December period, and values were lower for July-August. The seasonal and inter annual variation in the abundance of dolphinfish is probably related to a pre-spawning migration in close relation to the rain-drought regime characteristic of the region, and the associated wind upwelling season of "Tehuanos" in the Gulf of Tehuantepec.

Assuntos

Perciformes/anatomia & histologia , Perciformes/classificação , Animais , Feminino , Masculino , México , Densidade Demográfica , Estações do Ano , Razão de Masculinidade

RESUMO

The dolphinfish (Coryphaena hippurus), is an oceanic epipelagic fish found worldwide in tropical and subtropical waters, with a high dispersal capability via large-scale migrations. This fast-swimming top-level predator is abundant in the Gulf of Tehuantepec, where it is caught incidentally by artisanal fisheries, and represents a target species for both recreational and commercial fisheries in Mexico, Ecuador, Peru and Central America. Nowadays, local fishery information on this species is scarce, thus our objective was to analyze the size structure by sex and the catch-per-unit-effort (CPUE) tendency of dolphinfish caught in the Gulf of Tehuantepec, from 2000 to 2007. For this, fishery catches information was obtained from the artisanal fleet, at six landing sites in the Gulf, and the sex ratio, fork length (FL) and the catch per unit effort (CPUE) were estimated. From all sampling sites, a total of 3 494 females, and 3 877 males were obtained, and dolphinfish size as fork length (FL) ranged from 20.5 to 152cm. Fish size ranged from 25.5 to 148cm furcal length (FL) in males, and 20.5 to 129cm FL in females. The sex ratio (males:females) was 1:1, except in April-May (1:1.5, p<0.05) and November (1:0.5, p<0.05). The sex ratio at different size classes showed a significant bias towards females at smaller sizes (<75cm FL), whereas the males were predominant in larger size classes (>100cm FL). The size structure was bimodal, with a variation in the size average; the modes were defined as the small group (FL=50-55cm) and the large size group (FL=100-110cm). The CPUE showed seasonal changes: values were high for the November-December period, and values were lower for July-August. The seasonal and inter annual variation in the abundance of dolphinfish is probably related to a pre-spawning migration in close relation to the rain-drought regime characteristic of the region, and the associated wind upwelling season of “Tehuanos” in the Gulf of Tehuantepec. Rev. Biol. Trop. 62 (2): 611-626. Epub 2014 June 01.

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El dorado Coryphaena hippurus es un depredador oceánico epipelágico que se distribuye en aguas tropicales y subtropicales de todos los océanos. Son peces con alta capacidad de dispersión por su migración a gran escala. El Golfo de Tehuantepec es una de las áreas de mayor abundancia de C. hippurus, donde se registran capturas incidentales en la pesca artesanal y sostiene pesquerías recreacionales y comerciales de pequeña escala en México, Ecuador, Perú y Centroamérica. Aquí se analizan los cambios inter-anuales en la estructura de tallas por sexo del dorado durante 2000-2007, así como la tendencia de la captura por unidad de esfuerzo (CPUE) de dorado efectuada por la flota ribereña. Los resultados están basados en 3 494 hembras y 3 877 machos capturados por pesca artesanal en 6 localidades del Pacífico Sur provenientes de muestreos mensuales. Se estimó la CPUE a partir del número de organismos capturados por viaje de pesca. Los machos pre- sentaron tallas entre 25.5 a 148cm de longitud furcal (Lf), mientras que en hembras las tallas registradas fueron de 20.5 a 129cm Lf. La proporción de sexos mostró patrones estacionales a lo largo del año y diferencias con respecto de Lf, a tallas pequeñas predominaron las hembras (<75cm FL) y a tallas grandes los machos (>100cm Lf). La estructura de Lf mostró una tendencia bimodal, con una variación en la Lf promedio de 2000 a 2007; las modas estuvieron definidas como el grupo de tamaño pequeño (Lf=50-55cm) y el grupo de tamaño grande (Lf=100 a 110cm). La CPUE tuvo cambios estacionales: los periodos más altos se registraron en noviembre-diciembre y mayo; los más bajos en julio-agosto. La variación estacional e interanual en la abundancia del dorado probablemente se encuentre relacionada con una migración pre desove, en estrecha relación con el régimen lluvias-estiaje característico de la región, y la temporada de surgencias eólicas asociadas a la temporada de “Tehuanos” en el Golfo de Tehuantepec.

Assuntos

Animais , Feminino , Masculino , Perciformes/anatomia & histologia , Perciformes/classificação , México , Densidade Demográfica , Estações do Ano , Razão de Masculinidade

RESUMO

OBJECTIVES: To examine the medical status of children with biliary atresia (BA) with their native livers after hepato- portoenterostomy (HPE) surgery. STUDY DESIGN: The Childhood Liver Disease Research and Education Network database was utilized to examine subjects with BA living with their native livers 5 or more years after HPE and to describe the prevalence of subjects with BA with an "ideal" outcome, defined as no clinical evidence of chronic liver disease, normal liver biochemical indices (aspartate aminotransferase, alanine aminotransferase, γ-glutamyl transpeptidase, platelet count, total bilirubin, international normalized ratio, and albumin), and normal health-related quality of life 5 or more years after HPE. RESULTS: Children with BA (n = 219; 43% male) with median age 9.7 years were studied. Median age at HPE was 56 (range 7-125) days. Median age- and sex-adjusted height and weight z-scores at 5-year follow-up were 0.487 (IQR -0.27 to 1.02) and 0.00 (IQR -0.74 to 0.70), respectively. During the 12 preceding months, cholangitis and bone fractures occurred in 17% and 5.5%, respectively. Health-related quality of life was reported normal by 53% of patients. However, only 1.8% met the study definition of "ideal" outcome. Individual tests of liver synthetic function (total bilirubin, albumin, and international normalized ratio) were normal in 75%, 85%, and 73% of the study cohort. CONCLUSION: Cholangitis and fractures in long-term survivors underscore the importance of ongoing medical surveillance. Over 98% of this North American cohort of subjects with BA living with native livers 5 or more years after HPE have clinical or biochemical evidence of chronic liver disease.

Assuntos

Atresia Biliar/cirurgia , Nível de Saúde , Qualidade de Vida , Canadá , Criança , Enterostomia , Feminino , Humanos , Fígado/cirurgia , Masculino , Sobreviventes , Fatores de Tempo , Estados Unidos

RESUMO

Echinococcus granulosus infections are a major public health problem in livestock-raising regions around the world. The life cycle of this tapeworm is sustained between dogs (definitive host, canine echinococcosis), and herbivores (intermediary host, cystic hydatid disease). Humans may also develop cystic hydatid disease. Echinococcosis is endemic in rural areas of Peru; nevertheless, its presence or the extension of the problem in urban areas is basically unknown. Migration into Lima, an 8-million habitant's metropolis, creates peripheral areas where animals brought from endemic areas are slaughtered without veterinary supervision. We identified eight informal, unlicensed abattoirs in a peripheral district of Lima and performed a cross-sectional study in to assess the prevalence of canine echinococcosis, evaluated by coproELISA followed by PCR evaluation and arecoline purge. Eight of 22 dogs (36%) were positive to coproELISA, and four (18%) were confirmed to be infected with E. granulosus tapeworms either by PCR or direct observation (purge). Later evaluation of the human population living in these abattoirs using abdominal ultrasound, chest X-rays and serology, found 3 out of 32 (9.3%) subjects with echinococcal cysts in the liver (two viable, one calcified), one of whom had also lung involvement and a strongly positive antibody response. Autochthonous transmission of E. granulosus is present in Lima. Informal, unlicensed abattoirs may be sources of infection to neighbouring people in this urban environment.

Assuntos

Matadouros , Doenças do Cão/epidemiologia , Equinococose/epidemiologia , Equinococose/veterinária , Echinococcus granulosus/isolamento & purificação , Adolescente , Adulto , Idoso , Animais , Criança , Pré-Escolar , Estudos Transversais , Doenças do Cão/parasitologia , Cães , Equinococose/diagnóstico , Equinococose/parasitologia , Ensaio de Imunoadsorção Enzimática , Fezes/parasitologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Reação em Cadeia da Polimerase , Prevalência , População Urbana , Adulto Jovem

RESUMO

Cystic hydatid disease (CHD) is a worldwide zoonosis caused by the larval stage of the dog tapeworm Echinococcus granulosus. Diagnosis is based on imagenological tools (abdominal ultrasound, chest X-rays, or computed tomography [CT] scan). Serological antibody-detecting assays, using diverse native antigens, have been used as a supportive diagnostic tool, but their sensitivities and specificities differ greatly. The use of synthetic peptides as antigens should provide more reliability and allow better assessment and comparison of test formats and case series. The synthetic peptide p176, corresponding to the N-terminal extreme of the subunit of antigen B (AgB8/1), has shown promising performances for diagnosis of CHD. We evaluated the performance of the synthetic peptide p176 for the diagnosis of pulmonary hydatid disease in an enzyme-linked immunosorbent assay (ELISA) format. Sixty-one serum samples from patients with a diagnosis of pulmonary hydatidosis confirmed by surgery and 128 from healthy volunteers were tested. The overall sensitivity and specificity of the p176 ELISA for lung CHD were 78.69% and 96.88%, respectively. On bivariate analysis, positive serum antibody reactions were associated with the presence of complications and with the number of cysts (single/multiple). Only the presence of persistent complications significantly associated with seropositivity on multivariate logistic regression analysis (odds ratio [OR], 9.58; 95% confidence interval [CI], 2.15 to 42.6; P = 0.003). The p176 ELISA performs well for the diagnosis of lung CHD and adds an easily reproducible diagnostic assay to the existing diagnostic tools.

Assuntos

Equinococose Pulmonar/diagnóstico , Echinococcus granulosus/imunologia , Lipoproteínas , Adulto , Animais , Equinococose Pulmonar/parasitologia , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Humanos , Masculino , Sensibilidade e Especificidade , Testes Sorológicos/métodos

RESUMO

BACKGROUND: Cystic echinococcosis (CE) constitutes an important public health problem in Peru. However, no studies have attempted to estimate the monetary and non-monetary impact of CE in Peruvian society. METHODS: We used official and published sources of epidemiological and economic information to estimate direct and indirect costs associated with livestock production losses and human disease in addition to surgical CE-associated disability adjusted life years (DALYs) lost. FINDINGS: The total estimated cost of human CE in Peru was U.S.$2,420,348 (95% CI:1,118,384-4,812,722) per year. Total estimated livestock-associated costs due to CE ranged from U.S.$196,681 (95% CI:141,641-251,629) if only direct losses (i.e., cattle and sheep liver destruction) were taken into consideration to U.S.$3,846,754 (95% CI:2,676,181-4,911,383) if additional production losses (liver condemnation, decreased carcass weight, wool losses, decreased milk production) were accounted for. An estimated 1,139 (95% CI: 861-1,489) DALYs were also lost due to surgical cases of CE. CONCLUSIONS: This preliminary and conservative assessment of the socio-economic impact of CE on Peru, which is based largely on official sources of information, very likely underestimates the true extent of the problem. Nevertheless, these estimates illustrate the negative economic impact of CE in Peru.

Assuntos

Doenças dos Bovinos/economia , Doenças dos Bovinos/epidemiologia , Equinococose/epidemiologia , Equinococose/veterinária , Custos de Cuidados de Saúde/estatística & dados numéricos , Doenças dos Ovinos/economia , Doenças dos Ovinos/epidemiologia , Animais , Bovinos , Equinococose/economia , Humanos , Peru/epidemiologia

RESUMO

Introducción. La hidatidosis, zoonosis producida por el estadio larvario de la taenia Echinococcus granulosus, es un problema de salud pública a nivel nacional, en especial en aquellas regiones dedicadas a la crianza de ganado. A la fecha, se han descrito factores, a nivel individual, asociados con la infección por E. granulosus; sin embargo, no se encontró reporte previo que explore la asociación entre características de la vivienda y la presencia de esta enfermedad en alguno de sus miembros. Objetivos. Explorar la asociación entre las características de la vivienda y la presencia de hidatidosis entre las personas que la habitan. Materiales y métodos. Se realizó un estudio transversal en viviendas de tres comunidades rurales de Junín. Se evaluó el grado de asociación entre las características de la vivienda y la presencia de hidatidosis en el hogar mediante un análisis de regresión logística múltiple (RLM). Resultados. De un total de 417 viviendas evaluadas, 56 (13 por ciento) de ellas tenían al menos un caso positivo entre sus miembros; luego del análisis de RLM se observó que aquellas viviendas con más de tres miembros, localizadas en la comunidad con quintil de pobreza más bajo, que refirieron crianza de animales, y con una cobertura de evaluación mayor al 25 por ciento presentaron una mayor probabilidad de tener al menos un caso de positivo entre sus miembros. Conclusión. Las características observadas deben ser tomadas en cuenta para la determinación preliminar de subgrupos de alto riesgo, optimizando así el uso de los recursos y mejorando la eficacia de los programas de despistaje.

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Introduction. Hydatid disease, a zoonosis caused by the larval stage of the parasite Echinococcus granulosus, is a public health problem at national level, especially in those regions dedicated to raising livestock. By now, there are many factors, at individual level, that have been associated to the infection by E. granulosus; nevertheless there is not any previous report that explore the association between household characteristics and the presence of the disease among household members. Objective. To explore the association between household characteristics and the presence of hydatid disease among household members. Material and methods. We performed a cross-sectional study in the households of 3 rural communities located in Junín, we evaluated the association between household characteristics and the presence of hydatid disease by multiple logistic regression (MLR). Results. From 417 evaluated households, 56 (13 percent) of them had at least one positive case among its members. Multivariate analysis showed that households with three or more members, located in the community with the lowest quintile of poverty, that reported raising livestock, and with evaluation coverage greater than 25 percent were more likely to have at least one positive case among its members. Conclusion. The observed characteristics be taken into account in the preliminary definition of high-risk subgroups, optimizing the use of resources and improving the effectiveness of screening programs.

Assuntos

Adulto , Feminino , Humanos , Masculino , Equinococose/epidemiologia , Características da Família , Estudos Transversais , Peru/epidemiologia , Fatores de Risco , Saúde da População Rural