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1.
J Pediatr ; 200: 174-180, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29903531

RESUMO

OBJECTIVE: To assess the prevalence and severity of nonalcoholic liver disease (NAFLD) in children in a diverse population sample in New York City. STUDY DESIGN: Liver specimens were examined from children 2-19 years old who died of unexpected causes within 48 hours of medical presentation and underwent autopsy in New York City from 2005 to 2010. Records were reviewed for age, sex, weight, height, and race. Two hepatopathologists evaluated each liver specimen to determine pathologic diagnosis. RESULTS: The final study cohort (n = 582) was 50% black, 33% Hispanic, 12% white, 3% Asian, and 2% other; 36% had a body mass index >85%. There were 26 cases of NAFLD (4.5%) of which 10 had nonalcoholic steatohepatitis (1.7%). There were no cases with severe fibrosis or cirrhosis. One percent (3/290) of black children had NAFLD and none had nonalcoholic steatohepatitis. White and Hispanic children had the highest percentages of NAFLD at 8.3% and 7.9%, respectively. In multiple logistic regression models, we observed that body mass index z-score (P < .001) was associated with NAFLD, and that white (P = .003) and Hispanic (P = .005) children had higher odds of having NAFLD compared with black children. CONCLUSIONS: This review of liver tissue demonstrates a lower prevalence and severity of NAFLD in black children compared with the general obese pediatric population. Hispanic children did not have a significantly increased rate of NAFLD compared with white children, most likely related to the large proportion of Caribbean Hispanic children in New York City.


Assuntos
Fígado/patologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Adolescente , Fatores Etários , Autopsia , Índice de Massa Corporal , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Cidade de Nova Iorque/epidemiologia , Hepatopatia Gordurosa não Alcoólica/patologia , Prevalência , Índice de Gravidade de Doença , Adulto Jovem
2.
Am J Med Qual ; 30(6): 509-11, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26497489
3.
J Pediatr ; 167(1): 178-82.e1, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25929979

RESUMO

OBJECTIVES: To determine interoffice variability in routinely performed sudden unexpected infant death (SUID) postmortem studies for infection and to assess availability and perceived utility of various tests of infectious diseases. STUDY DESIGN: Online surveys were sent to all 154 offices of US medical examiners and coroners serving populations >300,000 people. Surveys included a set of potential laboratory tests for infectious disease. Respondents were asked to select which tests were available in their offices, and which tests were performed routinely in SUIDs vs which tests should be performed routinely. RESULTS: Of the 45 complete responses, 4.4% did not routinely perform histology, 8.9% did not routinely perform viral studies (ie, culture or molecular diagnostics), 22.2% did not routinely perform blood cultures, 26.7% did not routinely perform lung bacterial cultures, and 44.4% did not routinely perform cerebrospinal fluid cultures. CONCLUSIONS: Our findings suggest that there is considerable interoffice variability with testing for infectious diseases in SUIDs. This appeared to be largely the result of a perceived lack of testing utility rather than a lack of test availability. Evidence-based practice guidelines regarding the interpretation of microbial testing results, as well as common testing protocols/algorithms, may lead to more accurate and standardized data, thus improving SUID investigation and surveillance.


Assuntos
Técnicas de Laboratório Clínico/estatística & dados numéricos , Doenças Transmissíveis/diagnóstico , Médicos Legistas , Padrões de Prática Médica/estatística & dados numéricos , Morte Súbita do Lactente , Biópsia/estatística & dados numéricos , Sangue/microbiologia , Sangue/virologia , Líquido Cefalorraquidiano/microbiologia , Líquido Cefalorraquidiano/virologia , Humanos , Lactente , Pulmão/microbiologia , Pulmão/virologia , Reação em Cadeia da Polimerase/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
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