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1.
Am J Trop Med Hyg ; 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34583333

RESUMO

The route of hepatitis B transmission is believed to be horizontal in India, though pediatric studies showed mother as source in the majority of chronic HBV (CHB) cases. We aimed at establishing the fact that mother-child transmission is the main route of acquisition by documenting genotypically identical viruses in mother-child pairs. Blood samples of consecutive children (≤18 years) with CHB and high DNA (>10,000 IU/mL) and their positive mother were collected from January 2013 to December 2015. Polymerase chain reaction (PCR) products of HBV-DNA were amplified and sequenced by using BigDye Terminator Cycle Sequencing Kit v3.1 and aligned with previously described sequences in the region of interest for genotypes A to G by using BioEdit software. Phylogenetic tree was generated using p-distance algorithm in MEGA software version 6. Genotyping of 59 (33 children and 26 mothers) subjects include genotype A in 24 (40.7%) and genotype D in 35 (59.3%). Both mother-child pair genotyping was possible in 25. The median age of 25 children (20 males) was 9 (interquartile range, IQR: 4-11). The distribution of genotypes among mother-child pairs was similar. The concordance between children and their mothers was 24 of 25 (96%). Evolutionary analyses showed significant similarities between mother and child sequences for both genotype A and D, suggesting thereby the same virus. In conclusion, mother-baby transmission seems to be the major route of acquisition of HBV in children in India and near-complete homology in genetic sequences between mother-child pairs is definite proof for that. However, a larger epidemiological study is required to substantiate our findings.

2.
J Gastroenterol Hepatol ; 36(3): 680-686, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32710649

RESUMO

BACKGROUND AND AIM: Functional dyspepsia (FD) is common in children, and treatment targeted towards the altered pathophysiology can improve outcome. We evaluated FD children for abnormality of gastric accommodation and emptying, psychological stressors (PS), Helicobacter pylori (HP) infection, and post-infectious FD. METHODS: Diagnosis of FD was based on ROME III criteria. Clinical evaluation including dyspeptic symptom scoring and assessment for PS was performed. Satiety drink test for gastric accommodation, gastroscopy with biopsy for HP infection, and solid meal gastric emptying were performed. Sixty-seven healthy children were enrolled for assessing PS and satiety drink test. RESULTS: Fifty-five FD children (33 boys, age 12 [6-18] years) with symptoms for 4 (2-48) months and dyspeptic score of 5 (1-13) were enrolled. PS were more common in FD than in controls (46/55 vs 9/67; P < 0.001). Median satiety drink volume was 360 mL (180-1320 mL); no patients had satiety drink volume of < 5th centile of healthy children. The frequency (98% vs 85%; P = 0.01) and severity (65 [10-175] vs 50 [5-130]; P < 0.001) of postprandial symptoms were higher in FD than in controls. Of the postprandial symptoms, pain (20.3% vs 0%; P = 0.000) was present only in FD. Delayed gastric emptying was present in 6.5%, HP infection in 11%, and post-infectious FD in 13% cases. Etiological factor was identified in 87% children, with 20% having multiple factors. CONCLUSIONS: Abnormality of gastric sensorimotor function is seen in one-fourth of FD cases. HP infection and post-infectious FD are present in 11% and 13% cases, respectively.


Assuntos
Dispepsia/diagnóstico , Dispepsia/etiologia , Adolescente , Criança , Técnicas de Diagnóstico do Sistema Digestório , Dispepsia/fisiopatologia , Feminino , Esvaziamento Gástrico , Gastrite/complicações , Gastrite/microbiologia , Infecções por Helicobacter , Humanos , Masculino , Índice de Gravidade de Doença , Estresse Psicológico/complicações
3.
Pancreatology ; 21(1): 74-80, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33262050

RESUMO

BACKGROUND: Malnutrition and bone disease are common in adults with chronic pancreatitis (CP). We studied the nutritional status and bone mineral density (BMD) of children with CP and the factors predicting them. METHODS: CP children were prospectively evaluated with a detailed questionnaire, anthropometry, 25-hydroxy vitamin D, fecal elastase and BMD [total body less head (TBLH), spine and hip] by dual energy x-ray absorptiometry. Body mass index (BMI) Z score of -1 to -1.9, -2 to -2.9 and <-3 was taken as mild, moderate and severe malnutrition respectively. Low BMD and osteoporosis were defined as per International Society for Clinical Densitometry. RESULTS: 83 children (46 boys, 14[4.3-21]years) with CP were enrolled. Majority had Cambridge IV (51,62.2%) or III (15,18.3%) changes. 34(41%) had undernutrition (mild-37.3%, moderate-2.4%, severe-1.2%). Overweight and obesity were present in 3.6% and 1.2% cases. BMI had a significant correlation with haemoglobin, serum albumin, percentage body fat and BMD. A majority had low fecal elastase (69 [84.1%], <100 µg/g) and vitamin D deficiency (70[84.3%],<20 ng/ml). 9 cases had a history of fractures. 14/75(18.6%) cases had low TBLH-BMD and this group had a lower BMI (-1.3[-1.9 to 0.34] vs 0.8 [-2.1 to 5.50; p = 0.03) than patients with normal BMD. There was no difference in age, disease duration, vitamin D, fecal elastase and Cambridge grade between normal and low BMD. CONCLUSIONS: 41% CP children have undernutrition with a majority having mild undernutrition. Nearly 20% have low BMD, with osteoporosis in none. Subjects with low BMI have lower BMD and percentage body fat.


Assuntos
Densidade Óssea , Transtornos da Nutrição Infantil/complicações , Estado Nutricional , Pancreatite Crônica/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Prevalência , Estudos Prospectivos , Deficiência de Vitamina D , Adulto Jovem
4.
Eur J Pediatr ; 178(1): 61-67, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30269249

RESUMO

Various atypical manifestations have been described in acute viral hepatitis (AVH). We evaluated the prevalence, clinical features, response to treatment and outcome of various atypical manifestations of AVH in children. Consecutive children (≤ 18 years) with AVH due to hepatitis A, B, or E were studied while patients with acute or acute on chronic liver failure were excluded. Diagnosis of atypical manifestations was based on standard criteria. A total of 477 children with AVH (median age 7.0 (5-11) years, 74% boys) were seen; 22% (n = 106) had atypical manifestations. Prolonged cholestasis was the most common (11%), followed by ascites (7%), intravascular hemolysis (3%), relapsing hepatitis (2%), acute pancreatitis (1.3%), and thrombocytopenia (0.7%). Atypical manifestations were more common in HAV as compared to HBV (30% vs. 3%, p = 0.00) and HEV (30% vs. 15%, p = 0.07). Prolonged cholestasis was significantly more common in older children (20% in > 10 years vs. 9% in 6-10 years ; p = 0.009 and 5% in 0-5 years of age [p < 0.000]). Ascites was more common in younger children, although not significant. All patients recovered with supportive treatment.Conclusions: Twenty-two percent of children with AVH have atypical manifestations, more often with HAV infection, and prolonged cholestasis is most common. Recognition of these manifestations ensures correct diagnosis and treatment. What is Known: • Acute viral hepatitis is a major public health problem in developing countries. • There is limited information about atypical manifestations which may lead to unnecessary investigations, delayed diagnosis and morbidity. What is New: • Atypical manifestations are common in children, seen most often with HAV infection, and prolonged cholestasis is most common. • Prompt recognition of these manifestations helps in early diagnosis, appropriate management, and preventing unnecessary investigations. • Ensure follow-up until complete recovery and not to miss underlying chronic liver disease.


Assuntos
Hepatite Viral Humana/diagnóstico , Hepatovirus , Doença Aguda , Criança , Pré-Escolar , Feminino , Hepatite Viral Humana/epidemiologia , Hepatite Viral Humana/terapia , Humanos , Lactente , Masculino , Prevalência , Estudos Retrospectivos
5.
Indian J Gastroenterol ; 36(5): 405-410, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29071541

RESUMO

BACKGROUND: Nutrient drink test (NDT) is a simple, non-invasive method to assess gastric function including accommodation. However, data on normal satiety drink volume (SDV) in children is scanty with no information about postprandial symptoms (PPS). Our aims were to establish normal values of NDT in healthy children and evaluate its correlation with age, gender, and anthropometry. METHODS: Six- to 18-year-old healthy children underwent the NDT. The nutrient drink (0.94 kcal/mL) was given at a constant rate of 15 mL/min in 6-12-year-old subjects and at 30 mL/min in 13-18-year-old subjects till satiety score of 5 was reached. Postprandial symptoms (30 min) of fullness, nausea, bloating, and pain were scored using a visual analogue scale (0-100 mm) individually and as aggregate score. RESULTS: Sixty-seven children (40 boys, age 12 [6-18 years]) were enrolled. Median SDV was 360 [180-960 mL], higher in 13-18-year-olds in comparison to 6-12-year-old children (360 [240-1002] vs. 300 [148-960] mL; p=0.005). SDV showed significant correlation with age, weight, and height. SDV was higher in boys than girls (450 [240-1074] vs. 330 [240-480] mL; p=0.02) in the older children (13-18 y), but it was similar in the younger children. Mild fullness (40 [0-80]) was the only PPS seen in 85% children and none had pain. PPS were not different between boys and girls or younger and older children. CONCLUSION: The study provides normative data of SDV and PPS by NDT in 6-18-year-old children. SDV correlated with age and was higher in adolescent boys than girls.


Assuntos
Técnicas de Diagnóstico do Sistema Digestório , Dispepsia/diagnóstico , Dispepsia/fisiopatologia , Alimentos , Estômago/fisiologia , Estômago/fisiopatologia , Adolescente , Fatores Etários , Antropometria , Criança , Feminino , Humanos , Índia , Masculino , Período Pós-Prandial , Valores de Referência
6.
J Hepatol ; 66(3): 528-536, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-27815224

RESUMO

BACKGROUND & AIMS: Data on minimal hepatic encephalopathy (MHE) in children is scarce. We aimed to study MHE in children with chronic liver disease (CLD) and to validate non-invasive objective tests which can assist in its diagnosis. METHODS: We evaluated 67 children with CLD (38 boys; age 13 [7-18] years) and 37 healthy children to determine the prevalence of MHE. We also assessed the correlation of MHE with changes in brain metabolites by magnetic resonance spectroscopy (1HMRS), diffusion tensor imaging (DTI) derived metrics, blood ammonia and inflammatory cytokines (interleukin-6 [IL6], tumor necrosis factor alpha [TNF-α]). In addition, the accuracy of MR-based investigations for diagnosis of MHE in comparison to neuropsychological tests was analysed. RESULTS: Thirty-four (50.7%) children with CLD had MHE on neuropsychological tests. MHE patients had higher BA (30.5 [6-74] vs. 14 [6-66]µmol/L; p=0.02), IL-6 (8.3 [4.7-28.7] vs. 7.6 [4.7-20.7]pg/ml; p=0.4) and TNF-α (17.8 [7.8-65.5] vs. 12.8 [7.5-35]pg/ml; p=0.06) than No-MHE. 1HMRS showed higher glutamine (2.6 [2.1-3.3] vs. 2.4 [2.0-3.1]; p=0.02), and lower choline (0.20 [0.14-0.25] vs. 0.22 [0.17-0.28]; p=0.1) and myo-inositol (0.25 [0.14-0.41] vs. 0.29 [0.21-0.66]; p=0.2) in MHE patients than those without MHE. Mean diffusivity (MD) on DTI was significantly higher in 6/11 brain areas in patients with MHE vs. no MHE. Brain glutamine had a significant positive correlation with blood ammonia, IL-6, TNF-α and MD of various brain regions. Neuropsychological tests showed a negative correlation with blood ammonia, IL6, TNF-α, glutamine and MD. Frontal white matter MD had a sensitivity and specificity of 73.5% and 100% for diagnosing MHE. CONCLUSIONS: In children with CLD, 50% have MHE. There is a significant positive correlation between markers of hyperammonemia, inflammation and brain edema and these correlate negatively with neuropsychological tests. MD on DTI is a reliable tool for diagnosing MHE. LAY SUMMARY: Fifty percent of children with chronic liver disease develop minimal hepatic encephalopathy (MHE) and perform poorly on neuropsychological testing. These children have raised blood ammonia, inflammatory cytokines and mild cerebral edema on diffusion tensor imaging as compared to children without MHE. The higher the ammonia, inflammatory cytokines and cerebral edema levels the poorer the performance on neuropsychological assessment. The estimation of mean diffusivity on diffusion tensor imaging is an objective and reliable method for diagnosing MHE.


Assuntos
Encefalopatia Hepática/etiologia , Hepatopatias/complicações , Adolescente , Encéfalo/metabolismo , Estudos de Casos e Controles , Criança , Doença Crônica , Citocinas/metabolismo , Imagem de Tensor de Difusão , Feminino , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/epidemiologia , Humanos , Índia/epidemiologia , Espectroscopia de Ressonância Magnética , Masculino , Testes Neuropsicológicos , Prevalência
7.
Indian J Gastroenterol ; 35(5): 372-378, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27663711

RESUMO

BACKGROUND: Type 1 diabetes (T1D) patients are at an increased risk of having celiac disease (CD). We evaluated the prevalence and clinical profile of CD in children and adolescents with T1D and reviewed the Indian literature to determine prevalence and reasons for variability. METHODS: In this cross-sectional study, subjects with T1D were prospectively evaluated with a demographic and gastrointestinal (GI) questionnaire, human IgA-tissue transglutaminase (IgA-tTGA), and endoscopic duodenal biopsy in serology positive patients. Studies evaluating prevalence of CD in T1D from India were reviewed. RESULTS: Fourteen (13.6 %) of the 103 (52 boys, 13 years [2-20]) T1D patients were IgA-tTGA (182 U [47-300]) positive and 3.8 % (4/103) had villous atrophy on histology. Subjects with T1D and CD (n = 4) were younger at onset of T1D (32.5 ± 12.6 vs. 110.5 ± 53.8 months; p < 0.005) and more often had GI symptoms (pain abdomen [2/4 vs. 6/89; p = 0.01], stool frequency of 2-3/day [3/4 vs. 38/89; p = 0.004]) than screen negative T1D (n = 89). Growth and glycemic control were not different between the groups. In the 7 Indian studies involving 915 children and adults, 13.8 % (8 % to 17.8 %) T1D were serology positive. Prevalence of CD was reported as 6.9 % (2.3 % to 11.1 %), but only 3.1 % (2.3 % to 4.2 %) had villous atrophy on histology. CONCLUSIONS: Potential CD and CD were present in 13.6 % and 3.8 % children with T1D respectively. T1D with CD have onset of diabetes at younger age and were more often symptomatic than screen negative T1D.


Assuntos
Doença Celíaca/complicações , Doença Celíaca/epidemiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Adolescente , Idade de Início , Doença Celíaca/imunologia , Criança , Pré-Escolar , Estudos Transversais , Diabetes Mellitus Tipo 1/imunologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Prevalência , Estudos Prospectivos
8.
Indian Pediatr ; 53(1): 27-31, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26840667

RESUMO

OBJECTIVE: To analyze the presentation and predictors of outcome of children with galactosemia. METHODS: Analysis of clinical, laboratory, microbiological profile and outcome of patients fulfilling the diagnostic criteria: i) clinical setting; ii) reduced erythrocyte Gal-1-PUT enzyme activity; and iii) unequivocal response to lactose-free diet. RESULTS: 24 patients; median age of symptom onset and diagnosis: 10 (3-75) d and 55 (15-455) days, respectively. 71% had uncorrectable coagulopathy; 71% systemic infections; and 54% had ascites. CONCLUSION: Despite delayed referral, high Pediatric end-stage liver disease scores and systemic infections, long-term outcome in galactosemia is rewarding. A subset of children have developmental delay.


Assuntos
Galactosemias , Doenças do Recém-Nascido , Feminino , Galactosemias/diagnóstico , Galactosemias/epidemiologia , Galactosemias/terapia , Humanos , Índia , Lactente , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/terapia , Masculino , Encaminhamento e Consulta , Estudos Retrospectivos , Resultado do Tratamento
9.
Dig Liver Dis ; 47(8): 709-14, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25981744

RESUMO

BACKGROUND: Genetic predisposition in paediatric idiopathic acute, acute recurrent pancreatitis and its consequences are unknown. We studied frequency of genetic markers in acute, acute recurrent, chronic pancreatitis and their impact on natural history. METHODS: Over a period of 2 years 68 consecutive children with pancreatitis (35.3% acute, 32.3% acute recurrent, 32.3% chronic) and 25 controls were recruited in a single centre. Common mutations for serine-protease-inhibitor (SPINK1 N34S), protease-inhibitor (PRSS1 R122H) and cystic fibrosis transmembrane conductance regulator (CFTR DeltaF508, 5T) were analysed. RESULTS: Mean age was 13.4±2.5 years. Overall, 30 cases (SPINK1 N34S n=26, CFTR 5T n=4) and 1 control (SPINK1 N34S) had mutations (p=0.0001). The prevalence of SPINK1 N34S mutation was similar in chronic and acute recurrent pancreatitis (45%). Six children with severe acute pancreatitis had SPINK1 N34S mutations (25%, p<0.05), and 4 were homozygous. On follow-up 5 acute pancreatitis patients with mutations and 1 without mutations developed chronic pancreatitis (p=0.004); 8 cases of acute recurrent pancreatitis progressed to chronic pancreatitis (38%); of these 66.7% had mutations vs. 16.7% who did not (p=0.03). CONCLUSIONS: Almost 50% of idiopathic chronic, acute recurrent and 33% of acute pancreatitis in children are genetically predisposed. Presence of genetic mutations in acute and recurrent acute pancreatitis increases the risk of developing chronic pancreatitis.


Assuntos
Proteínas de Transporte/genética , Regulador de Condutância Transmembrana em Fibrose Cística/genética , Predisposição Genética para Doença/genética , Pancreatite/genética , Tripsina/genética , Adolescente , Biomarcadores , Estudos de Casos e Controles , Criança , Progressão da Doença , Feminino , Homozigoto , Humanos , Masculino , Mutação , Pancreatite Crônica/genética , Recidiva , Inibidor da Tripsina Pancreática de Kazal
10.
Eur J Gastroenterol Hepatol ; 27(4): 375-7, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25874508

RESUMO

AIMS: Occult hepatitis B infection (OBI) may adversely affect the outcome of patients with chronic liver disease (CLD). There are no data on OBI and CLD in children. This study determined the prevalence and effect of OBI in HBsAg-negative CLD children. MATERIALS AND METHODS: CLD children were prospectively evaluated with a demographic, clinical, and investigative proforma. All HBsAg-negative CLD cases were tested for exposure to hepatitis B (total anti-HBc, anti-HBs). Serum hepatitis B virus DNA was measured in exposed (total anti-HBc positive) patients. RESULTS: A total of 115 HBsAg-negative CLD children (59 boys, age 9.0±3.6 years) were enrolled. The etiology of CLD was known in 94 cases and 21 children had cryptogenic CLD. Of these, 45 (39.1%) had evidence of HBV exposure (23 total anti-HBc positive, 17 total anti-HBc and anti-HBs positive, five only anti-HBs positive without previous vaccination). The anti-HBc-positive children had a higher Child's score than the anti-HBc-negative children [11 (5-13) vs. 7 (5-13); P=0.00]. A total of 4/45 children had seropositive OBI with serum HBV DNA of 8, 36, 133, and 156 IU/ml, respectively. The proportion of total anti-HBc positivity (8/21 vs. 32/94; P=0.8) and OBI (2/21 vs. 2/94; P=0.1) was similar in cryptogenic CLD and known cause CLD. CONCLUSION: Seropositive OBI is infrequent in Indian children with CLD. The prevalence is similar in cryptogenic and CLD of known etiology.


Assuntos
Insuficiência Hepática/etiologia , Hepatite B/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Hepatite B/diagnóstico , Hepatite B/epidemiologia , Humanos , Masculino , Prevalência , Estudos Prospectivos
11.
J Pediatr Gastroenterol Nutr ; 59(3): 393-7, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24840513

RESUMO

OBJECTIVES: Infection with hepatotropic viruses is a common cause of acute deterioration and adverse outcome in children with chronic liver disease (CLD). Such superimposed infections may be preventable through vaccination. The present study aimed to evaluate the exposure rates of hepatitis A, B, and E viruses in children with CLD and suggest an optimal vaccination strategy. METHODS: Children with CLD were prospectively evaluated with a demographic, clinical, and investigative proforma. Hepatitis B surface antigen positive cases were labeled as hepatitis B virus-CLD, and all other etiologies as non-HBV-related CLD. Patients were tested for exposure to hepatitis A (total anti-hepatitis A virus [HAV], immunoglobulin M anti-HAV), hepatitis B (hepatitis B surface antigen, total anti-hepatitis B core, anti-hepatitis B surface), and hepatitis E (IgG anti-hepatitis E virus). RESULTS: A total of 142 children with CLD (age 9.1 ±â€Š3.7 years, 83 [58.5%] boys) were enrolled. A total of 3.5% (5/142) and 38.7% (55/142) had received HAV and HBV vaccines, respectively. A total of 134 (94.4%) were total anti-HAV positive including 5 postimmunization patients, with higher positivity in those older than 5 years (19/25 vs 115/117; P = 0.001). Of the 115 patients with non-HBV-related CLD, 45 (39.1%) had exposure to HBV (40 total anti-hepatitis B core positive and 5 anti-HBs positive without immunization). Only 28 of 142 (19.7%) patients were IgG anti-HEV positive, with no difference across age. CONCLUSIONS: A total of 90.8%, 39.1%, and 19.7% of children with CLD from the developing world are exposed to hepatitis A, B, and E infections, respectively. Selective hepatitis A vaccination (patients younger than 5 years of age) and universal hepatitis B vaccination are required to protect children with CLD. Sanitation improvement and HEV vaccine trial are needed for prevention against HEV.


Assuntos
Vírus da Hepatite A/imunologia , Anticorpos Anti-Hepatite/sangue , Antígenos do Núcleo do Vírus da Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/imunologia , Vírus da Hepatite E/imunologia , Hepatopatias/sangue , Adolescente , Fatores Etários , Criança , Pré-Escolar , Doença Crônica , Feminino , Anticorpos Anti-Hepatite A/sangue , Anticorpos Anti-Hepatite B/sangue , Humanos , Imunoglobulina G/sangue , Índia , Lactente , Hepatopatias/etiologia , Masculino , Estudos Prospectivos , População Rural , População Urbana , Vacinação
12.
J Gastroenterol Hepatol ; 25(2): 319-24, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19929927

RESUMO

BACKGROUND AND AIM: Data on prevalence, human leukocyte antigen (HLA) typing and small bowel histology among first-degree relatives of subjects with celiac disease (CD) is scarce. This prospective study evaluated the prevalence and role of HLA DQ2/8 testing in screening of first-degree relatives of children with CD. METHODS: Thirty confirmed children with CD and 91/94 first-degree relatives (parents and siblings) were enrolled. HLA DQ2/8 testing was carried out in all index CD cases. Clinical evaluation with a questionnaire, total serum immunoglobulin A (IgA), human IgA-tissue transglutaminase (IgA-tTGA) and HLA DQ2/8 testing was carried out in all first-degree relatives. Subjects who were positive for IgA-tTGA were recommended endoscopic duodenal biopsy to document histological changes of CD. RESULTS: Nine first-degree relatives were positive for IgA-tTGA, seven underwent duodenal biopsy and four subjects had Marsh IIIa changes suggestive of CD. The prevalence of histologically confirmed CD in first-degree relatives was 4.4%. The prevalence of potential CD was 9.8%. IgA-tTGA-positive subjects (4/9) were significantly more often symptomatic than IgA-tTGA-negative first-degree relatives (2/82). Twenty-nine (96.6%) index cases of CD and all IgA-tTGA-positive first-degree relatives were positive for HLA DQ2. None of the index CD cases or first-degree relatives were HLA DQ8-positive. A total of 85% of the first-degree relatives were positive for HLA DQ2 and thus at risk of developing CD. CONCLUSIONS: In this first Asian study on a limited number of families of children with CD, 4.4% of the first-degree relatives had CD. Only 15% of the first-degree relatives were negative for HLA DQ2/DQ8. Initial evaluation with HLA and serology followed by only serial serology in HLA-positive relatives is recommended.


Assuntos
/genética , Doença Celíaca/diagnóstico , Antígenos HLA-DQ/sangue , Teste de Histocompatibilidade , Programas de Rastreamento/métodos , Adolescente , Adulto , Autoanticorpos/sangue , Biópsia , Doença Celíaca/etnologia , Doença Celíaca/genética , Doença Celíaca/imunologia , Doença Celíaca/patologia , Criança , Pré-Escolar , Duodenoscopia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Linhagem , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Fatores de Risco , Inquéritos e Questionários , Transglutaminases/imunologia
13.
Clin Rheumatol ; 27(6): 717-22, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17985193

RESUMO

SSB/La antigen, expressed on surface of polymorphonuclear neutrophils (PMN), is one of the cognate antigens recognized by antineutrophil antibodies. The present study was aimed to assess PMNs in systemic lupus erythematosus (SLE) patients for their phagocytic efficiency and its correlation with history of infections and presence of anti-SSB/La antibodies and their capacity to produce interleukin (IL)-12 in response to lipopolysaccharide (LPS) with or without interferon gamma (IFN-gamma). Fifty patients with SLE, fulfilling American College of Rheumatology criteria of diagnosis, and 20 healthy controls were enrolled for the study. Phagocytic efficiency was evaluated by flow cytometry, using flourescein isothiocyanate (FITC)-labeled Escherichia coli, and expressed as mean channel fluorescence (MFI). PMNs were stimulated with LPS or LPS + IFN-gamma for 18 h, IL-12p40 was estimated in supernatants by enzyme-linked immunosorbent assay, and anti-SSB/La antibodies were detected in serum by Western blot. The mean MFI values were significantly lower in patients with SLE than controls (P < 0.0001), and among patients, it was lower in patients with history of infection than in those without (P < 0.005). Anti-SSB/La positivity was also associated with lower MFI (P < 0.005) and higher frequency among patients with history of infective episodes (P < 0.05). LPS- and LPS + IFN-gamma-stimulated IL-12 levels were lower among SLE patients than in controls. However, there was no difference in the levels of IL-12 between patients with and without history of infection. These data suggest that the autoantibodies to SSB/La may modulate PMN function in SLE.


Assuntos
Anticorpos Antinucleares/sangue , Anticorpos Antinucleares/imunologia , Lúpus Eritematoso Sistêmico/imunologia , Neutrófilos/imunologia , Fagocitose/imunologia , Adolescente , Adulto , Células Cultivadas , Criança , Ensaio de Imunoadsorção Enzimática , Feminino , Citometria de Fluxo , Humanos , Interleucina-12/sangue , Masculino , Neutrófilos/citologia , Células Th1/imunologia
14.
J Ethnopharmacol ; 108(3): 398-406, 2006 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-16824715

RESUMO

Semecarpus anacardium (SA) Linn. (family Anacardiaceae), is a plant well-known for its medicinal value in Ayurveda. The nut extracts of this plant have been traditionally used as antihelminthic, anti-fungal, anti-carcinogenic and in the treatment of nervous debilities and arthritis. In this study we have evaluated crude ethanolic extract of SA nuts for its anti-inflammatory activities in vitro using peripheral blood and synovial fluid mononuclear cells of healthy individuals and rheumatoid arthritis (RA) patients. SA extract inhibited the spontaneous and LPS induced production of proinflammatory cytokines IL-1beta and IL-12p40 but had no effect on TNF-alpha and IL-6 production, both at protein and mRNA level. The crude extract also suppressed LPS induced nuclear translocation of transcription factors, NF-kappaB and AP-1; the inhibition of NF-kappaB was through the inhibition of IkappaBalpha phosphorylation. The extract also suppressed LPS activated nitric oxide production in mouse macrophage cell line, RAW 264.7. Our results for the first time show that SA extract can inhibit proinflammatory cytokine production and demonstrate its mechanism of action.


Assuntos
Artrite Reumatoide/sangue , Monócitos/efeitos dos fármacos , Extratos Vegetais/farmacologia , Semecarpus/química , Adulto , Animais , Artrite Reumatoide/patologia , Western Blotting , Linhagem Celular , Núcleo Celular/efeitos dos fármacos , Núcleo Celular/metabolismo , Células Cultivadas , Ensaio de Desvio de Mobilidade Eletroforética , Humanos , Subunidade p40 da Interleucina-12/genética , Subunidade p40 da Interleucina-12/metabolismo , Interleucina-1beta/genética , Interleucina-1beta/metabolismo , Interleucina-6/genética , Interleucina-6/metabolismo , Lipopolissacarídeos/farmacologia , Macrófagos/citologia , Macrófagos/efeitos dos fármacos , Macrófagos/metabolismo , Pessoa de Meia-Idade , Monócitos/citologia , Monócitos/metabolismo , NF-kappa B/metabolismo , Óxido Nítrico/metabolismo , Fosforilação/efeitos dos fármacos , Extratos Vegetais/química , Extratos Vegetais/isolamento & purificação , Transporte Proteico/efeitos dos fármacos , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fator de Transcrição AP-1/metabolismo
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