[Risk factors for atherosclerosis in children and adolescents with family history of premature coronary artery disease]. / Fatores de risco para aterosclerose em crianças e adolescentes com história familiar de doença arterial coronariana prematura.

OBJECTIVES: To identify the prevalence of dyslipidemia in a group of 109 children and adolescents with a family history of premature coronary artery disease and to investigate the association between dyslipidemia and other risk factors for atherosclerosis. METHODS: Total cholesterol, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), triglycerides, body mass index, blood pressure, physical activity, smoking, per capita income and maternal schooling were investigated. RESULTS: Total cholesterol and LDL-C levels were higher than desirable in 27.5% and 19.3%, respectively, of our patients; 13.8% had lower HDL-C values and 13.0% presented hypertriglyceridemia. Obesity and excess weight were observed in 25.7% of the cases. Out of these, 57.1% had abnormal lipid values. Dyslipidemia was observed in 38.5%, either alone or in combination with other risk factors. Smoking was observed in 3.6%, hypertension in 2.7% and physical inactivity in 72.5%. There was no relationship between dyslipidemia and per capita income, maternal schooling and physical inactivity. However, obesity and excess weight were identified as significantly associated with the occurrence of dyslipidemia (p = 0.02; odds ratio = 2.82, 95% CI = 1.6-6.81). CONCLUSION: In children and adolescents with a family history of premature coronary artery disease, early identification of the risk factors for atherosclerosis is essential to allow the implementation of preventive measures.

Serum soluble interleukin-2 receptor, interleukin-6, and tumor necrosis factor-alpha levels in children with celiac disease: response to treatment.

OBJECTIVES: T-cell mediated immune response to dietary gluten and cytokines release are important for the enteropathy seen in celiac disease. We investigated the serum levels of soluble interleukin-2 receptor, interleukin-6, and tumor necrosis factor-alpha in celiac children before and after gluten exclusion. METHODS: Cytokine levels were determined using enzyme immunoassay in serum from 12 untreated celiac patients, 16 treated celiac patients on a gluten-free diet for at least two years, and from 26 control children. Eight of 12 untreated patients were also investigated at 6 and 12 months after gluten exclusion. Serum IgA antiendomysium antibodies were also assayed by indirect immunofluorescence. RESULTS: Soluble interleukin-2 receptor and interleukin-6 levels were significantly increased in untreated celiac patients compared with treated and control children. There was no difference in the tumor necrosis factor-alpha levels between the groups. Soluble interleukin-2 receptor levels were the only ones significantly decreased at 12 months after gluten exclusion. However, soluble interleukin-2 receptor and interleukin-6 levels at 12 months were significantly higher compared with controls. Antiendomysium antibodies had a diagnostic sensitivity of 100% and the titers decreased significantly after 12 months of gluten exclusion. A significant positive correlation was found between antiendomysium antibody titers with both soluble interleukin-2 receptor and interleukin-6 values. CONCLUSIONS: The serum soluble interleukin-2 receptor and interleukin-6 levels may be used as a noninvasive measure of celiac disease activity and response to treatment.

Fatores de risco para aterosclerose em crianças e adolescentes com história familiar de doença arterial coronariana prematura / Risk factors for atherosclerosis in children and adolescents with family history of premature coronary artery disease

OBJETIVOS: Analisar a prevalência de dislipidemia em 109 crianças e adolescentes com história familiar de doença arterial coronariana prematura e a associação com outros fatores de risco para aterosclerose. MÉTODOS: Foram determinados valores séricos de colesterol total, de lipoproteínas de baixa densidade (LDL-C), alta densidade (HDL-C), triglicérides, índice de massa corpórea e pressão arterial. Foram também avaliados: prática de atividade física, tabagismo, renda familiar e escolaridade da mãe. RESULTADOS: Do total, 27,5 e 19,3 por cento apresentaram, respectivamente, valores de colesterol total e LDL-C acima do normal, 13,8 por cento valores de HDL-C diminuídos e 13,0 por cento trigliceridemia elevada. Excesso de peso (obesidade e sobrepeso) foi detectado em 25,7 por cento dos casos; destes, 57,1 por cento apresentavam valores anormais de lipídios. A prevalência de dislipidemia, isolada ou concomitante com outros fatores de risco, foi de 38,5 por cento. Hábito de fumar ocorreu em 3,6 por cento dos casos, hipertensão arterial em 2,7 por cento, e 72,5 por cento não praticavam atividade física. Não houve associação entre as variáveis renda familiar, escolaridade da mãe e prática de atividade física e dislipidemia. Entretanto, observou-se associação significativa entre dislipidemia e excesso de peso (p = 0,02; odds ratio = 2,82; IC 95 por cento = 1,16-6,81). CONCLUSAO: Fatores de risco para aterosclerose em crianças e adolescentes com história familiar de doença arterial coronariana prematura devem ser identificados o mais cedo possível para que sejam adotados programas preventivos de saúde.

Doença celíaca: diagnóstico tardio por problemas sociais / Celiac disease: late diagnosis by social problems

Os autores relatam um caso de doença celíaca, de diagnóstico tardio, responsável pelo agravo nutricional importante para o paciente, apresentando clinicamente baqueteamento dos dedos e episódios de tetania. O objetivo é enfatizar a importância do diagnóstico precoce desta entidade, devendo sempre fazer parte do diagnóstico diferencial das formas crônicas diarréicas associadas à desnutriçäo

Diabetes mellitus tipo I e doença celíaca / Diabetes mellitus an Coeliac disease

Os autores descrevem o caso clínico de uma criança de 2 anos e 8 meses do sexo feminino, portadora de Diabetes Mellitus tipo I, com baixa estrutura e distensäo abdominal. A paciente näo apresentava queixas gastrointestinais nem esteatorréia, no entanto houve suspeitas que levaram ao diagnóstico de Doença Celíaca, o qual foi confirmado pela dosagem de anticorpo antigliadina sérico e biópsia jejunal