Drug-induced liver injury: Relation between the R ratio and histopathology.

INTRODUCTION AND AIM: Drug-induced liver injury (DILI) is a diagnosis based on the ruling out of potential liver diseases and consolidated by establishing causality through the temporal relation between a potentially hepatotoxic substance and altered liver biochemistry. Incidence fluctuates greatly worldwide, with very few reports of causal agents of DILI in Colombia. A retrospective study on patients treated at the Centro de Estudios en Salud (CES), within the time frame of January 2015 and June 2020, was conducted to document the causal substances of DILI in patients with liver biopsy and to correlate the types of histologic patterns with the biochemical pattern of liver injury (R ratio). RESULTS: Of the 254 adult patients with liver biopsy and no tumor etiology, 20 patients were identified as cases of DILI (7.87%). The two most frequently found causal substances were efavirenz, in three HIV-positive patients, and Moringa oleifera (moringa), in two patients. There was a statistically significant association between cholestatic patterns (p = 0.037) and mixed patterns (p = 0.031), in the comparison of the histopathologic categories and the R ratio. CONCLUSION: To the best of our knowledge, there are no reports on DILI secondary to Moringa oleifera (moringa). The R ratio could be a useful tool, in relation to the histologic pattern of injury, in cases of mixed and cholestatic patterns.

Gluten-free-rendered products contribute to imbalanced diets in children and adolescents with celiac disease.

PURPOSE: As well as adhering to the safe limit for gluten intake, a suitable gluten-free (GF) diet must also be nutritionally balanced. However, malnutrition has been observed in the population with celiac disease (CD). This is even more important in the case of children and adolescents, whose GF diet must also ensure their proper growth. The aim of the present study was to assess the diet quality of children and adolescents with CD to attain optimal nutritional status, determining the most relevant factors that affect a balanced diet. METHODS: Eighty-three children and adolescents with CD (9.2 ± 3.8 years) took part in the study. Height, weight and body composition were measured. An analysis of energy consumption and of the macronutrient distribution of their diet was carried out. Adherence to Mediterranean diet by KIDMED index was analyzed, and energy and nutrients intake. RESULTS: The diet of participants was not balanced, containing more fat and less carbohydrate than recommended. Most children and adolescents revealed adequate body mass index and suitable body fat percentage. Two-thirds of them showed moderate or poor KIDMED index, the case of girls being remarkable. When the GF diet, containing GF-rendered foodstuffs, was compared to a similar type of diet but substituting GF products with their analogs containing gluten, important nutritional differences were revealed. CONCLUSIONS: Even though celiac children and adolescents' diet is unhealthy due to its inappropriate dietary pattern, following a diet based on GF products raises extra difficulty in complying with the nutritional recommendations.