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1.
Zhonghua Nei Ke Za Zhi ; 59(2): 124-128, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32074685

RESUMO

Objective: To analyze the clinical value of capsule endoscopy (CE) in small intestinal diseases and to explore the correlation between the diagnosis and clinical characteristics. Methods: From June 2016 to April 2019, a total of 194 patients receiving CE were enrolled in the Department of Gastroenterology, Shanxi People's Hospital, including 68 patients with obscure gastrointestinal bleeding, 104 with chronic abdominal pain and 22 with diarrhea. Results: The detection rate of small intestinal lesions by CE was 53.6%(104/194), of which gastrointestinal bleeding was 66.2% (45/68), chronic abdominal pain was 53.8%(56/104), and diarrhea was 13.6%(3/22). The first three positive diagnostic criteria of CE for gastrointestinal bleeding were non-specific inflammation, small intestinal ulcer and vascular malformation. CE findings in patients with abdominal pain were non-specific inflammation, small intestinal ulcer and Crohn's disease; while the major endoscopic presentations in patients with diarrhea were small intestinal ulcer and non-specific inflammation. Logistic regression analysis suggested that the clinical manifestations and gender were correlated with positive diagnosis by CE (P<0.05), and the positive diagnostic rate of CE in female patients was significantly lower than that in male patients [31.6%(25/79) vs. 51.3%(59/115), P<0.05]. The diagnostic rates of CE in patients with gastrointestinal bleeding and chronic abdominal pain were similar [55.9%(38/68) vs. 41.4%(43/104)], which was significantly higher than those with diarrhea [9.1%(2/22), P<0.05]. Conclusions: Capsule endoscopy has a high detection rate for small intestinal diseases, which could be the first choice in patients with unexplained gastrointestinal bleeding. Male patients and gastrointestinal bleeding are predictors of positive findings by CE.


Assuntos
Endoscopia por Cápsula , Doença de Crohn/diagnóstico , Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/diagnóstico , Enteropatias/diagnóstico , Intestino Delgado/patologia , Doença de Crohn/epidemiologia , Feminino , Hemorragia Gastrointestinal/epidemiologia , Humanos , Enteropatias/epidemiologia , Masculino
2.
Medicine (Baltimore) ; 98(44): e17783, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689848

RESUMO

RATIONALE: Postoperative intussusception in adults is a rare but serious complication after gastrointestinal anastomosis surgery. Postoperative intussusception in adults caused by tube feeding was rarely been reported before. The aim of the current study was to summarize the clinical data on a group of patients with tube feeding associated postoperative intussusceptions. The possible etiology and preventive measures will also be discussed. PATIENT CONCERNS: During the period from May 2013 to January 2018, patients who received gastrointestinal anastomosis in our center were retrospectively reviewed. Preoperative variables including standard demographic and pathological characteristics as well as the treatment and prognosis were also analyzed. DIAGNOSES: Tube feeding associated postoperative intussusceptions. INTERVENTIONS: 7 patients were identified with tube feeding associated postoperative intussusceptions with a prevalence of 0.38%. Intussusceptions occurred from 10 to 69 days (median 25.7 days) postoperatively in an acute form. OUTCOMES: None of the patients had spontaneous reduction and all patients underwent surgery. Antegrade efferent limb intussusceptions were found in all the cases. Intussusception occurred at efferent loop at 23.6 cm (range 15-60) from the gastrointestinal or Braun anastomosis. None of the patients was found recurrence throughout the follow-up period. LESSONS: In contrast with other postoperative intussusceptions, the tube feeding associated postoperative intussusceptions have special clinical manifestations. It is more likely to occur in early period of time after the surgery and in an acute form. Surgical correction is recommended for most of patients. Several measures have been proposed to prevent such complications after gastrointestinal surgery, however more research and information are still needed.


Assuntos
Anastomose Cirúrgica/efeitos adversos , Nutrição Enteral/efeitos adversos , Enteropatias/epidemiologia , Intussuscepção/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Humanos , Enteropatias/etiologia , Intussuscepção/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Prevalência , Estudos Retrospectivos
3.
BMC Infect Dis ; 19(1): 766, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477044

RESUMO

BACKGROUND: Intestinal infectious diseases (IIDs) have caused numerous deaths worldwide, particularly among children. In China, eight IIDs are listed as notifiable infectious diseases, including cholera, poliomyelitis, dysentery, typhoid and paratyphoid (TAP), viral Hepatitis A, viral Hepatitis E, hand-foot-mouth disease (HFMD) and other infectious diarrhoeal diseases (OIDDs). The aim of the study is to analyse the spatio-temporal distribution of IIDs from 2006 to 2016. METHODS: Data on the incidence of IIDs from 2006 to 2016 were collected from the public health science data centre issued by the Chinese Center for Disease Control and Prevention. This study applied seasonal decomposition analysis, spatial autocorrelation analysis and space-time scan analysis. Plots and maps were constructed to visualize the spatio-temporal distribution of IIDs. RESULTS: Regarding temporal analysis, the incidence of HFMD and Hepatitis E showed a distinct increasing trend, while the incidence of TAP, dysentery, and Hepatitis A presented decreasing trends over the last decade. The incidence of OIID remained steady. Summer is the season with the greatest number of cases of different IIDs. Regarding the spatial distribution, approximately all p values for the global Moran's I from 2006 to 2016 were less than 0.05, indicating that the incidences of the epidemics were unevenly distributed throughout the country. The high-risk areas for HFMD and OIDD were located in the Beijing-Tianjin-Tangshan (BTT) region and south China. The high-risk areas for TAP were located in some parts of southwest China. A higher incidence rates for dysentery and Hepatitis A were observed in the BTT region and some west provincial units. The high-risk areas for Hepatitis E were the BTT region and the Yangtze River Delta area. CONCLUSIONS: Based on our temporal and spatial analysis of IIDs, we identified the high-risk periods and clusters of regions for the diseases. HFMD and OIDD exhibited high incidence rates, which reflected the negligence of Class C diseases by the government. At the same time, the incidence rate of Hepatitis E gradually surpassed Hepatitis A. The authorities should pay more attention to Class C diseases and Hepatitis E. Regardless of the various distribution patterns of IIDs, disease-specific, location-specific, and disease-combined interventions should be established.


Assuntos
Doenças Transmissíveis/epidemiologia , Enteropatias/epidemiologia , Infecções Intra-Abdominais/epidemiologia , Adulto , Criança , China/epidemiologia , Disenteria/epidemiologia , Epidemias , Doença de Mão, Pé e Boca/epidemiologia , Hepatite E/epidemiologia , Humanos , Incidência , Prevalência , Estações do Ano , Análise Espacial , Análise Espaço-Temporal
4.
Cir Cir ; 87(5): 559-563, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448804

RESUMO

Background: Intestinal failure (IF) was first defined as "a reduction in the functioning gut mass below the minimal amount necessary for adequate digestion and absorption." In our environment, there are no statistical data for IF in adult patients' extended length of stay (LOS), nor the economic impact that it implies. Objective: The objective of the study was to describe the association between the IF type and extended LOS. Methods: Patients admitted to our IF Unit between March 2016 and March 2018 were enrolled. We conducted a 2-year retrospective cross-sectional study. Results: From the total of 53 patients, 35% corresponded to type I IF, 58.5% to type II IF, and 7.5% to type III IF. The mean LOS, according to the type of functional IF was 51 days for type I, 77.48 days for type II, and 68.25 days for type III. The mean LOS for the three IF types was 67.79 days. Conclusion: Extended LOS occurs in an important proportion of patients with IF, resulting in increased morbidity and mortality, as well as in costs and associated side effects. Future research should focus on economic studies, to know the economic impact that this subject entails for our health systems.


Assuntos
Hospitalização/estatística & dados numéricos , Enteropatias/classificação , Escores de Disfunção Orgânica , Estudos Transversais , Custos Hospitalares/estatística & dados numéricos , Unidades Hospitalares/economia , Unidades Hospitalares/estatística & dados numéricos , Hospitalização/economia , Humanos , Enteropatias/epidemiologia , Enteropatias/cirurgia , Enteropatias/terapia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , México/epidemiologia , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
5.
EBioMedicine ; 45: 456-463, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31229436

RESUMO

BACKGROUND: Children with severe acute malnutrition (SAM), with or without diarrhoea, often have enteropathy, but there are few molecular data to guide development of new therapies. We set out to determine whether SAM enteropathy is characterised by specific transcriptional changes which might improve understanding or help identify new treatments. METHODS: We collected intestinal biopsies from children with SAM and persistent diarrhoea. mRNA was extracted from biopsies, sequenced, and subjected to a progressive set of complementary analytical approaches: NOIseq, Gene Set Enrichment Analysis (GSEA), and correlation analysis of phenotypic data with gene expression. FINDINGS: Transcriptomic profiles were generated for biopsy sets from 27 children of both sexes, under 2 years of age, of whom one-third were HIV-infected. NOIseq analysis, constructed from phenotypic group extremes, revealed 66 differentially expressed genes (DEGs) out of 21,386 mapped to the reference genome. These DEGs include genes for mucins and mucus integrity, antimicrobial defence, nutrient absorption, C-X-C chemokines, proteases and anti-proteases. Phenotype - expression correlation analysis identified 1221 genes related to villus height, including increased cell cycling gene expression in more severe enteropathy. Amino acid transporters and ZIP zinc transporters were specifically increased in severe enteropathy, but transcripts for xenobiotic metabolising enzymes were reduced. INTERPRETATION: Transcriptomic analysis of this rare collection of intestinal biopsies identified multiple novel elements of pathology, including specific alterations in nutrient transporters. Changes in xenobiotic metabolism in the gut may alter drug disposition. Both NOIseq and GSEA identified gene clusters similar to those differentially expressed in pediatric Crohn's disease but to a much lesser degree than those identified in coeliac disease. FUND: Bill & Melinda Gates Foundation OPP1066118. The funding agency had no role in study design, data collection, data analysis, interpretation, or writing of the report.


Assuntos
Diarreia/genética , Enteropatias/genética , Desnutrição Aguda Grave/genética , Transcriptoma/genética , Biópsia , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/patologia , Feminino , Perfilação da Expressão Gênica , Humanos , Lactente , Enteropatias/epidemiologia , Enteropatias/patologia , Mucosa Intestinal/metabolismo , Masculino , Análise de Sequência de RNA , Desnutrição Aguda Grave/epidemiologia , Desnutrição Aguda Grave/patologia , Zâmbia/epidemiologia
6.
Int J Infect Dis ; 85: 188-194, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31202907

RESUMO

BACKGROUND: The United Arab Emirates (UAE) is a rapidly developing high-income country that has experienced significant population growth, urbanization, and improvements in the standard of living since its formation in 1971. Published estimates on the prevalence of infectious intestinal diseases (IID) in the UAE are scarce and exclusively based on hospital data. The aim of this study was to provide the first prevalence estimates of IID in the UAE. METHODS: A population-based cross-sectional study design using a telephone-based questionnaire was used to estimate the IID prevalence in the previous 4 weeks in a representative sample of the Ras Al Khaimah (RAK) population from January to September 2017. RESULTS: Data were collected from 1254 participants (57.3% male; 25.2% <18 years). The prevalence of IID was 4.2% in the 4 weeks prior to the interview. Multivariate logistic regression analysis identified that being female (odds ratio (OR) 2.4, 95% confidence interval (CI) 1.2-5.1) and having a middle-range monthly household income (approx. USD 4080-<6800: OR 5.42, 95% CI 1.15-25.48; approx. USD 6800-<9530: OR 7.13, 95% CI 1.47-34.57) were positively associated with IID. Age ≥6 years was negatively associated with IID (OR 0.95, 95% CI 0.90-0.99). Forty-nine percent of participants with an IID sought medical care and 20.8% took over-the-counter medication. CONCLUSIONS: This study provides the first population-based prevalence estimates of IID in the UAE, which are similar to those reported in China (4%), but lower than those reported in Canada (10%), the Netherlands (7%), and the USA (6%).


Assuntos
Doenças Transmissíveis/epidemiologia , Enteropatias/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prevalência , Inquéritos e Questionários , Emirados Árabes Unidos/epidemiologia , Adulto Jovem
7.
Rev Chil Pediatr ; 90(1): 60-68, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31095220

RESUMO

INTRODUCTION: Home parenteral nutrition (HPN) has been shown to offer important benefits for pa tients and the health system. In Chile, the number of patients who are receiving this type of treatment or who could be candidates for it is unknown. Objetive: To determine the prevalence and clinical characteristics of patients with intestinal insufficiency (II) currently receiving HPN or who are can didates for it. PATIENTS AND METHOD: Cross-sectional descriptive study which included patients aged between 0 to 18 years with diagnosis of II who were receiving parenteral nutrition (PN) for over three months, either at home or in the hospital, with a stable clinical situation and a long-term venous catheter (CVC). Through a digitalized survey, the following variables were collected and studied: gender, birth history, indication to initiate parenteral nutritional support, age of initiation of PN, type of CVC, frequency of PN, nutritional status and feeding in the last control and complications as sociated with the use of PN. Data analysis was performed using the SPSS Statistics Software, Version 21, Macintosh. The descriptive analysis considered frequency analysis and central trend measures. The Chi-square and Fisher tests were used for comparison of proportions. RESULTS: Data from 46 patients were recorded. The average age was 55.5 months. The main indication for initiating the PN was the decrease of the intestinal surface (78.3%). 63% of the patients were hospitalized. No signi ficant differences were found between the place of treatment and the nutritional status and catheter infections variables in the last year. CONCLUSIONS: The prevalence of patients with long-term PN and their clinical characteristics were identified. No differences were found to support the administration of this treatment in the hospital over the home. Public policies must be developed to guarantee the option of receiving this treatment at home.


Assuntos
Enteropatias/terapia , Nutrição Parenteral no Domicílio , Adolescente , Criança , Pré-Escolar , Chile/epidemiologia , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Enteropatias/diagnóstico , Enteropatias/epidemiologia , Masculino , Nutrição Parenteral no Domicílio/efeitos adversos , Prevalência , Resultado do Tratamento
9.
Acta Vet Scand ; 61(1): 12, 2019 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-30850006

RESUMO

BACKGROUND: Lawsonia intracellularis, an obligate intracellular bacterium, causes equine proliferative enteropathy, mainly in horses around weaning. This disease is rarely reported in the Scandinavian countries. RESULTS: Five cases of equine proliferative enteropathy were diagnosed between 2008-2016 at the University of Copenhagen Large Animal Teaching Hospital. Cases were Danish Warmbloods and a Friesian horse, aged 6-7 months, presenting with typical clinical signs of lethargy, poor body condition, pyrexia and diarrhea. Clinical pathology was consistent with previous reports of severe hypoalbuminemia and leukocytosis. Diagnosis was confirmed by fecal polymerase chain reaction, serum immunomonolayer peroxidase assay and/or immunofluorescence and fluorescence in situ hybridization performed on formalin-fixed ileum samples. Concurrent intestinal parasitism was present in all five cases. Treatment consisted of antimicrobial therapy, anti-inflammatories, intravenous crystalloids and plasma. Three foals were euthanised due to deterioration and poor response to treatment, one with complications of septic arthritis and Strongylus vulgaris associated intestinal infarct. The other two foals survived and were reported by the owners to be healthy on long-term follow-up. CONCLUSIONS: Equine proliferative enteropathy is a disease to consider in young horses presenting with diarrhea and hypoproteinemia in Denmark.


Assuntos
Infecções por Desulfovibrionaceae/veterinária , Doenças dos Cavalos/microbiologia , Enteropatias/veterinária , Lawsonia (Bactéria)/isolamento & purificação , Animais , Dinamarca/epidemiologia , Infecções por Desulfovibrionaceae/epidemiologia , Infecções por Desulfovibrionaceae/patologia , Diarreia/veterinária , Feminino , Doenças dos Cavalos/epidemiologia , Doenças dos Cavalos/patologia , Cavalos , Enteropatias/epidemiologia , Enteropatias/microbiologia , Enteropatias/patologia , Masculino
11.
BMC Infect Dis ; 19(1): 158, 2019 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-30764764

RESUMO

BACKGROUND: Clinical characteristics (taxonomy, virulence genes and antimicrobial resistance ) of Aeromonas in isolated from extra-intestinal and intestinal infections were investigated to describe epidemiology, associated virulence factors and optimal therapy options. METHODS: Clinical samples (n = 115) of Aeromonas were collected from a general hospital in Beijing between the period 2015 and 2017. Taxonomy was investigate by Multilocus phylogenetic analysis (MLPA), 10 putative virulence factors by use of polymerase chain reaction (PCR) and antimicrobial resistance to 15 antibiotics by use of the microbroth dilution method. RESULTS: The most common species of Aeromonas detected in samples of intestinal tract included; A. caviae (43.9%), A. veronii (35.7%), and A. dhakensis (12.2%). Prevalent species of Aeromonas collected from extra-intestinal infections included; A. hydrophila (29.4%), A. caviae (29.4%), and A. dhakensis (23.5%). A. hydrophila were detected in 1% of stool samples and 29.4% (5/17) of extra-intestinal infections. A. hydrophila strains in extra-intestinal infections were related to malignancy. The most common medical conditions among patients with Aeromonas infections included malignancy and liver-transplant related cholecystitis. Multiple drug resistance (MDR) was prevalent in extra-intestinal isolates (82.3%, 14/17) and was greater than the prevalence in intestinal isolates (30.6%, 30/98) (P < 0.05). Resistant rates of extra-intestinal isolates were 70.6, 35.3, 23.5 and 5.9% for ceftriaxone, ciprofloxacin, gentamicin and imipenem, respectively, and were higher than found in previous studies. Despite differences in the number and type of virulence genes among samples of Aeromonas, no significant correlation was found between invasion and virulent genes in intestinal or extra-intestinal infections. CONCLUSIONS: Overall results of this study support a role for Aeromonas spp. as a potential causative infectious agent of gastroenteritis, and malignancy, liver cirrhosis, post liver transplantation in immunocompromised patients. A. hydrophila was more prevalent in samples of extra-intestinal infections when compared to samples of intestinal infections, and was especially prominent in samples of patients presenting with malignancy. Aeromonas isolates from extra-intestinal samples had high rates of drug resistance but 3rd generation cephalosporins, fluoroquinolones and aminoglycosides remain as options to treat severe diarrhea. However, increasing MDR of extra-intestinal infection samples warrants monitoring.


Assuntos
Aeromonas/classificação , Aeromonas/isolamento & purificação , Farmacorresistência Bacteriana , Infecções por Bactérias Gram-Negativas/microbiologia , Enteropatias/microbiologia , Infecções Intra-Abdominais/microbiologia , Fatores de Virulência/genética , Adolescente , Adulto , Aeromonas/efeitos dos fármacos , Aeromonas/genética , Antibacterianos/uso terapêutico , Técnicas de Tipagem Bacteriana , Criança , Pré-Escolar , China/epidemiologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Farmacorresistência Bacteriana/genética , Feminino , Gastroenterite/tratamento farmacológico , Gastroenterite/epidemiologia , Gastroenterite/microbiologia , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Enteropatias/tratamento farmacológico , Enteropatias/epidemiologia , Infecções Intra-Abdominais/tratamento farmacológico , Infecções Intra-Abdominais/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Filogenia , Prevalência , Virulência/genética , Adulto Jovem
12.
BMC Infect Dis ; 19(1): 87, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30683063

RESUMO

BACKGROUND: Norovirus is the commonest cause of infectious intestinal disease (IID) worldwide. In the UK community incidence of norovirus has been estimated at 59/1000 population, equating to four million cases a year. Whilst norovirus infects people of all ages, a substantial burden occurs in infants and young children. The population of viruses found in sporadic cases among infants has been observed to be more diverse than that associated with outbreaks. In this study, we analysed norovirus-positive specimens collected during the second study of infectious intestinal diseases (IID2 Study) a national community cohort study conducted between April 2008 and August 2009 We examined the data for differences in circulating norovirus strains between two arms of a community cohort, and differences between genotypes and disease outcomes such as illness duration and symptom profiles. METHODS: Analysis was conducted to assess genetic diversity of noroviruses in the community. We also assessed differences in the cycle threshold (Ct) value, as a proxy for viral load, between norovirus genogroups and genotypes, and differences in reported symptoms or length of illness in relation to genogroup and genotype. RESULTS: There were 477 samples where norovirus was detected. Whilst 85% of people recovered within two days for vomiting; diarrhoea symptoms were reported to day 4 for 83% of the cases, and 10% of people reported symptoms of diarrhoea lasting between five and six days. Both diarrhoea and vomiting symptoms lasted longer in children aged < 5 years compared to adults. There was a significantly higher proportion of GII.4 in samples obtained from the GP arm of the study (chi-square = 17.8, p < 0.001) compared to samples received via post in the self-reporting arm. In the latter group, the prevalence of GII.6 was significantly higher (chi-square = 7.5, p < 0.001). CONCLUSIONS: We found that there is a difference in disease severity by age group. Children aged < 5 years had longer duration of illness, with 10% still having diarrhoea at seven days, and vomiting of between four and five days. The duration of illness reported is higher overall than one might expect for cases in the community in otherwise healthy individuals which has implications for infection control. No differences were observed in relation to duration of vomiting and or diarrhoea by genotype.


Assuntos
Infecções por Caliciviridae/virologia , Enteropatias/virologia , Norovirus/isolamento & purificação , Adolescente , Adulto , Idoso , Infecções por Caliciviridae/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Surtos de Doenças , Feminino , Variação Genética , Genótipo , Humanos , Incidência , Lactente , Recém-Nascido , Enteropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Norovirus/classificação , Norovirus/genética , Prevalência , Carga Viral , Adulto Jovem
13.
Early Hum Dev ; 130: 38-43, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30660017

RESUMO

BACKGROUND: Survival rates of infants with intestinal failure (IF) are increasing, yet multiple medical factors may impact development. AIMS: This study examines neurodevelopmental outcomes at 12-15 and 26-32 months corrected age in a cohort of children with IF. STUDY DESIGN: Prospective single centre neurodevelopmental assessments of children admitted to an intestinal rehabilitation program between 2011 and 2013. Outcome measures include: Mullen Scales of Early Learning (12 and 26 months), and Vineland-II Adaptive Behaviour Scales - Caregiver Report (26 months). Standard scores were correlated with medical and demographic factors. RESULTS: Thirty-one children (17 males), median gestational age 34 weeks (IQR 30-36) with birth weight (BW) 2.12 kg (IQR 1.24-2.52). Ten (32.2%) were dependent on parental nutrition (PN) at the second assessment. At 12 months, 11/30 (36.7%) scored below average (>1SD below mean) on the early learning composite and 24/30 (80%) were below average on the gross motor subscale. Comparatively, at 26 months, mean early learning scores were significantly lower with >50% scoring below average. Mean gross motor scores remained low, and 14/27 (51.9%) were below average on the Vineland-II motor domain. At 12 months, factors significantly associated with lower scores are primarily related to prematurity. At 26 months, the impact of IF-related variables such as bowel length and PN days are more apparent. CONCLUSION: Children with IF are at risk of developmental delay in multiple domains. While gross motor skills appear to be most significantly affected, cognitive deficits become more apparent at 26 months, highlighting the importance of early developmental follow up.


Assuntos
Deficiências do Desenvolvimento/epidemiologia , Doenças do Prematuro/epidemiologia , Recém-Nascido Prematuro/crescimento & desenvolvimento , Enteropatias/epidemiologia , Pré-Escolar , Cognição , Feminino , Humanos , Lactente , Recém-Nascido , Aprendizagem , Masculino , Destreza Motora
14.
Korean J Intern Med ; 34(1): 90-98, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29172402

RESUMO

BACKGROUND/AIMS: Olmesartan, a widely used angiotensin II receptor blocker (ARB), has been linked to sprue-like enteropathy. No cases of olmesartan-associated enteropathy have been reported in Northeast Asia. We investigated the associations between olmesartan and other ARBs and the incidence of enteropathy in Korea. METHODS: Our retrospective cohort study used data from the Korean National Health Insurance Service to identify 108,559 patients (58,186 females) who were initiated on angiotensin converting enzyme inhibitors (ACEis), olmesartan, or other ARBs between January 2005 and December 2012. The incidences of enteropathy were compared among drug groups. Changes in body weight were compared after propensity score matching of patients in the ACEis and olmesartan groups. RESULTS: Among 108,559 patients, 31 patients were diagnosed with enteropathy. The incidences were 0.73, 0.24, and 0.37 per 1,000 persons, in the ACEis, olmesartan, and other ARBs groups, respectively. Adjusted rate ratios for enteropathy were: olmesartan, 0.33 (95% confidential interval [CI], 0.10 to 1.09; p = 0.070) and other ARBs, 0.34 (95% CI, 0.14 to 0.83; p = 0.017) compared to the ACEis group after adjustment for age, sex, income level, and various comorbidities. The post hoc analysis with matched cohorts revealed that the proportion of patients with significant weight loss did not differ between the ACEis and olmesartan groups. CONCLUSION: Olmesartan was not associated with intestinal malabsorption or significant body weight loss in the general Korean population. Additional large-scale prospective studies of the relationship between olmesartan and the incidence of enteropathy in the Asian population are needed.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/efeitos adversos , Imidazóis/efeitos adversos , Enteropatias/etiologia , Tetrazóis/efeitos adversos , Adulto , Idoso , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Doença Celíaca/epidemiologia , Doença Celíaca/etiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Enteropatias/epidemiologia , Síndromes de Malabsorção/epidemiologia , Síndromes de Malabsorção/etiologia , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco
15.
Am J Cardiol ; 123(2): 249-253, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30477805

RESUMO

The pathophysiology of spontaneous coronary artery dissection (SCAD) is heterogeneous, associated with systemic arteriopathies and inflammatory diseases, and often compounded by environmental precipitants, genetics, or stressors. However, the frequency of these associated conditions with SCAD on a population level remains unknown. Therefore, the objective of this analysis was to evaluate heterogeneous phenotypes of SCAD in the United States using data from the Nationwide Inpatient Sample collected from January 1, 2004, to September 31, 2015. Among 66,360 patients diagnosed with SCAD, the mean age was 63.1 ± 13.2 years and 44.2% were women. A total of 3,415 (5.14%) had depression, 670 (1.0%) had rheumatoid arthritis, 640 (0.96%) had anxiety, 545 (0.82%) had a migraine disorder, 440 (0.66%) used steroids, 385 (0.58%) had malignant hypertension, 280 (0.42%) had systemic lupus erythematosus, 250 (0.38%) had cocaine abuse, 215 (0.32%) had hypertensive heart or renal disease, 130 (0.19%) had coronary spasm, 105 (0.16%) had fibromuscular dysplasia, 85 (0.13%) had Crohn's disease, 75 (0.11%) had celiac disease, 60 (0.09%) had adult autosomal dominant polycystic kidney disease, 60 (0.09%) had hormone replacement therapy, 55 (0.08%) had sarcoidosis, 55 (0.08%) had amphetamine abuse, 15 (0.02%) had granulomatosis polyangiitis, 10 (0.02%) had α1-antitrypsin deficiency, 10 (0.02%) had Marfan syndrome, 10 (0.02%) had Ehlers-Danlos syndrome, 10 (0.02%) had Kawasaki disease, 10 (0.02%) had polyarteritis nodosa, and 5 (0.01%) had multiparity. In conclusion, most cases of SCAD had no apparent concomitant arteriopathy, inflammatory disorder, or evident risk factor.


Assuntos
Aneurisma Dissecante/epidemiologia , Aneurisma Coronário/epidemiologia , Vasos Coronários/lesões , Distribuição por Idade , Doenças Autoimunes/epidemiologia , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Doenças do Tecido Conjuntivo/epidemiologia , Bases de Dados Factuais , Feminino , Humanos , Enteropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia
16.
Am J Trop Med Hyg ; 100(1): 192-201, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30398137

RESUMO

Recent evidence suggests that enteropathy of the gut due to environmental conditions (i.e., environmental enteropathy [EE]) in young children is negatively associated with linear growth. Using a case-control study design, we examined the potential determinants of stunting in stunted and non-stunted children 22-28 months of age. Potential determinants included inflammation biomarkers C-reactive protein, alpha-1-acid glycoprotein (AGP), and endotoxin-core antibody (EndoCAb) measured in serum samples; enteropathy markers alpha-1-antitrypsin, neopterin, myeloperoxidase (MPO) measured in stools samples; and demographic, health, feeding, and household characteristics. We also explored the determinants of EE by testing associations of composite EE scores and individual biomarkers with potential risk factors. Fifty-two percent of children (n = 310) were found to be stunted, and mean height-for-age Z scores (HAZ) were -1.22 (standard deviation [SD] ± 0.56) among non-stunted (control) children and -2.82 (SD ± 0.61) among stunted (case) children. Child HAZ was significantly (P < 0.05) and inversely associated with AGP, and child stunting was significantly positively associated (P < 0.05) with low dietary diversity, severe household hunger, and absence of soap in the household. Alpha-1-acid glycoprotein and EndoCAb concentrations were also significantly higher (P < 0.05) among children in households with no soap. Our study documented a seemingly localized cultural practice of young children (25%) being fed their dirty bathwater, which was associated with significantly higher concentrations of MPO (P < 0.05). Alpha-1-acid glycoprotein showed the most consistent associations with child growth and hygiene practices, but fecal EE biomarkers were not associated with child growth. The lack of retrospective data in our study may explain the null findings related to fecal EE biomarkers and child growth.


Assuntos
Transtornos do Crescimento/epidemiologia , Inflamação/epidemiologia , Enteropatias/epidemiologia , Banhos , Biomarcadores/sangue , Estatura , Proteína C-Reativa/análise , Estudos de Casos e Controles , Pré-Escolar , Características da Família , Feminino , Humanos , Higiene , Lactente , Masculino , Orosomucoide/análise , Estudos Retrospectivos , Tanzânia/epidemiologia , Água , alfa 1-Antitripsina/sangue
17.
Nutr Clin Pract ; 34(2): 242-249, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30511404

RESUMO

BACKGROUND: To support families managing the complex requirements of home parenteral nutrition (HPN) in pediatric patients, health professionals need information about HPN indications and complications. Nationally representative information is limited. METHODS: A retrospective cohort analysis of the Truven Health MarketScan Commercial Claims and Encounters Database was performed and identified 683 patients aged ≤18 years receiving HPN during dates of service from January 2013 through September 2015. Baseline diagnoses were measured in the 30 days before the first observed HPN claim (preindex). Indications for older (aged 13-18 years) and younger (aged ≤12 years) children were compared. Hospital and emergency department (ED) utilization rates were measured for 30 postindex days. RESULTS: Gastrointestinal diagnoses and/or symptoms affected more than three-quarters of patients. Short bowel syndrome was more common in younger than in older patients (24% vs 7%, respectively), and colitis was less common (13% vs 33%; both P < .01). Cancer was common in both age groups (22%-23%). Additional diagnoses indicating complex medical conditions were observed in a minority of patients: sepsis (9%), convulsions/epilepsy (7%), encephalopathy (3%), and immune deficiency (3%). From the preindex to postindex periods, rates of inpatient hospitalization declined from 78% to 41%, but hospital ED visits increased from 10% to 14%. In both periods, >95% of hospital and ED use was disease related. CONCLUSION: In a nationally representative sample of commercially insured pediatric patients treated with HPN, complex medical conditions were common. Findings highlight the importance of American Society for Parenteral and Enteral Nutrition recommendations for team-based care.


Assuntos
Enteropatias , Nutrição Parenteral no Domicílio , Adolescente , Criança , Pré-Escolar , Colite/epidemiologia , Colite/terapia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Enteropatias/epidemiologia , Enteropatias/terapia , Masculino , Prevalência , Estudos Retrospectivos , Síndrome do Intestino Curto/epidemiologia , Síndrome do Intestino Curto/terapia , Resultado do Tratamento
18.
Eur J Obstet Gynecol Reprod Biol ; 231: 65-69, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30326376

RESUMO

OBJECTIVES: Previous studies have found a high prevalence of irritable bowel syndrome (IBS). However, data on this relation in women without bowel endometriosis is limited. The aim of this study was to compare the prevalence of IBS in women with endometriosis to the prevalence in women without endometriosis and to investigate if the prevalence of IBS was associated with bowel involved endometriosis. STUDY DESIGN: Information for this cross-sectional study was collected through an online questionnaire. A total of 373 women completed the questionnaire. After exclusions, 254 with endometriosis and 102 without endometriosis were included (N = 356). Endometriosis was identified by self-reported diagnosis. IBS was identified by; 1. self-reported diagnosis prior to the study and 2. fulfillment of ROME III diagnostic criteria in this study. Odds ratios were calculated to estimate the strength of the association between IBS and endometriosis. A separate analysis, restricted to women without bowel involved endometrioses, was conducted. Adjustment for potential confounders (age, gastroenterological comorbidities and length of education) was performed. RESULTS AND CONCLUSIONS: The prevalence of IBS was higher in women with endometriosis compared to the women without endometriosis (OR = 5.32 (CI: 2.88; 9.81)). In the analysis restricted to women without bowel involved endometriosis, the prevalence was also higher in women with endometriosis compared to women without endometriosis (OR = 6.54 (CI95% 3.22; 13.29)). Thus, this study found a higher prevalence of IBS in women with endometriosis compared to women without endometriosis. This finding seems to be unrelated to bowel involvement. This opens new perspectives in relation to treatment of endometriosis.


Assuntos
Endometriose/epidemiologia , Síndrome do Intestino Irritável/epidemiologia , Adolescente , Adulto , Idoso , Estudos Transversais , Endometriose/complicações , Feminino , Humanos , Enteropatias/epidemiologia , Síndrome do Intestino Irritável/diagnóstico , Pessoa de Meia-Idade , Razão de Chances , Inquéritos e Questionários
19.
Biomed Res Int ; 2018: 2893012, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30112374

RESUMO

Background: According to national epidemiological surveillance records, in Mexico six intestinal infectious diseases (IID) are among the top infectious communicable diseases. However, their incidence, relative importance, and spatial patterns have not been studied in detail. Aims: We examine the epidemiology of IID due to bacteria and protozoa to identify which diseases are most important at two spatial scales, what is their integrated importance locally, and how their incidence correlates with Human Development Index (HDI). Methods: We retrieved yearly number of new cases of eight IID from the national epidemiological morbidity report from 2003 to 2012 at the national level, by state, and to assess such information at a higher spatial resolution we included the municipalities for Mexico City. However, no comparisons were made to other municipalities due to unavailability of data. We compared incidence, obtained the disease-specific relative importance, and inspected spatial patterns for the integrated incidence. Finally, we tested whether HDI is correlated with incidence. Results: We found that, except for two diseases, the relative importance of the other six IID contrasted not only between the national level and Mexico City, but also among states and municipalities in Mexico City. Besides, at both scales the distribution of the incidence showed disease-specific spatial patterns. Finally, there was a lack of consistent correlation between HDI and individual IID at both scales. Conclusion: Our results emphasize the need for local disease-focused selective models for control and prevention of IID. The maps displaying our analyses of epidemiological similarities may be used in orienting such effort.


Assuntos
Infecções Bacterianas/epidemiologia , Enteropatias/epidemiologia , Infecções por Protozoários/epidemiologia , Bactérias , Cidades , Humanos , Incidência , Enteropatias/microbiologia , Enteropatias/parasitologia , México/epidemiologia
20.
Indian J Med Microbiol ; 36(2): 247-250, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30084419

RESUMO

Context: Cryptosporidiosis is intestinal opportunistic infection commonly occurring in immunocompromised patients including renal transplant (RT) recipients receiving continuous immunosuppressive therapy. Knowledge about species of Cryptosporidium-infecting RT recipients is necessary to know about mode of its transmission (anthroponotic or zoonotic). Various genes such as small subunit rRNA (SSU rRNA) and Cryptosporidium oocyst wall protein (COWP) genes may help in species identification though their sensitivity and specificity are highly variable. Subjects and Methods: A total of 993 and 575 stool samples were examined for Cryptosporidium by microscopy from 358 RT recipients and 200 healthy controls, respectively. Stool samples of RT recipients and healthy controls were subjected to polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP) for species identification. Results: Cryptosporidium was more commonly detected amongst RT recipients than healthy controls (30/358, 8.4% vs. 0/200, respectively; P < 0.001). The infection was more common amongst patients with diarrhoea than those without (26/162, 16.1% vs. 4/145, 2.8%; P < 0.001). Cryptosporidium parvum was identified in 10/30 (33.3%) and Cryptosporidium hominis in 20/30 (66.7%) samples. SSU gene PCR-RFLP proved to be more sensitive (100%) than COWP (90%); however, specificity of both was same (100%). Conclusions: Cryptosporidiosis is common amongst RT recipients, particularly those with diarrhoea. C. hominis is the most common species in the studied population. SSU rRNA PCR was more sensitive molecular method for the differentiation of Cryptosporidium species.


Assuntos
Criptosporidiose/epidemiologia , Enteropatias/epidemiologia , Enteropatias/parasitologia , Transplante de Rim , Proteínas de Protozoários/metabolismo , Adulto , Estudos de Casos e Controles , Criptosporidiose/genética , Cryptosporidium/genética , Cryptosporidium/patogenicidade , Diarreia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas de Protozoários/genética
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