2,5cm da reborda costal direita) firme, e/ou esplenomegalia, e/ou aumento persistente e significativo (>1,5 vezes o limite superior da normalidade, por pelo menos seis meses) de pelo menos duas das enzimas hepáticas (AST, ALT, GGT e FA). Resultados: hepatomegalia foi verificada em sete pacientes (6,6%), e esplenomegalia em cinco (4,7%). A atividade da AST mostrou-se alterada em 18,9% dos pacientes, ALT em 9,4%, GGT em 11,3% e FA em 46,2%. Elevações significativas e persistentes das enzimas hepáticas ocorreram em nove pacientes (8,5%). Dez fibrocísticos (9,4%) preencheram os critérios de hepatopatia. Foram excluídas outras causas de doença hepática. A média de idade dos pacientes com alterações sugestivas de hepatopatia foi de 7,7 anos. Houve predominância absoluta do sexo masculino. Todos os pacientes permanecem assintomáticos. Conclusões: a prevalência da hepatopatia associada à fibrose cística foi de 9,4%. A maior freqüência de elevações transitórias e pouco significativas das enzimas hepáticas é bem documentada na literatura. A sua significância como preditor de hepatopatia ainda não foi determinada. No entanto, esses achados ressaltam a necessidade de avaliações seqüenciais para a definição dos casos de hepatopatia na fibrose cística.]]>
Objectives: To describe the hepatic abnormalities revealed by ultrasound examination of cystic fibrosis (CF) patients followed at the CF Outpatient Clinic at the Federal University of Minas Gerais; to compare ultrasound data with clinical and biochemical parameters; to validate the Williams ultrasound score for the diagnosis of liver disease in CF.Methods: Seventy cystic fibrosis patients were followed prospectively and underwent clinical, biochemical and ultrasound examinations. The ultrasound findings were compared to the results of the clinical and biochemical examinations. Clinical and biochemical criteria were used as the gold standard for the validation of the Williams ultrasound score. We calculated the sensitivity, specificity, and positive and negative predictive values for the Williams score. The patients were divided into two groups: normal (score = 3) or abnormal (score > 3) ultrasound examination.
Objective: the purpose of this study was to compare the effectiveness of a pre-thickened infant formula (Nan AR) with a conventional homemade formula in the reduction of regurgitation and vomiting in infants with gastroesophageal reflux.Methods: a hundred children, under 12 months, not exclusively breast feeding, were select for the study. Forty-eight were treated with conventional formula with starch and 52 with pre-thickened infant formula.Results: there was no statistically significant difference between the two groups in the improvement or cure of symptoms, each treatment having been effective. Conclusions ResumoObjetivo: o presente estudo foi realizado com o objetivo de comparar a eficácia de uma fórmula infantil pré-espessada (Nan AR) com fórmula convencional, de espessamento caseiro, com amido de milho, na redução de episódios de regurgitações e vômitos de lactentes com refluxo gastroesofágico (RGE).Métodos: foram estudadas 100 crianças, menores de 12 meses de idade, que não faziam uso de leite materno exclusivo. Por sorteio, 48 receberam fórmula convencional, e 52 receberam fórmula infantil pré-espessada (Nan AR), com comparação dos resultados clínicos após 3 meses.Resultados: não houve diferença estatisticamente significativa na melhora ou cura dos sintomas entre os dois grupos, tendo sido ambos os tratamentos eficazes.Conclusões: o espessamento dietético, seja com fórmulas infantis especiais, seja com medidas caseiras, tem eficácia semelhante no tratamento do refluxo gastroesofágico do lactente. O refluxo gastroesofágico (RGE), definido como o fluxo retrógrado involuntário do conteúdo gástrico para o esôfago, constitui uma das três principais causas de consulta em gastroenterologia pediátrica, sendo responsável por 75% das doenças do esôfago 1 . Pode ser fisiológico ou patológico, dependendo das complicações associadas.O RGE fisiológico é comum nos primeiros meses de vida, mas pode ocorrer em qualquer faixa etária. As regurgitações pós-alimentares surgem entre o nascimento e os
objectIve. To report practical experience in obtaining consent for a retrospective study conducted at the Brazilian National Cancer Institute (INCA). The study involved review of medical records and analysis of paraffin blocks of patients surgically treated for colon cancer between 2000 and 2004. Attempts to obtain informed consent were made in compliance with the resolution 196/96 of the Brazilian National Health Council and determination of INCA Research Ethics Committee. Methods. At scheduled appointments, we could approach only four patients for consent during three months. After attempting contact by phone, an information sheet summarizing the content of informed consent, two copies of the consent form and a prepaid return envelope were then mailed to the patients. results. Of the 155 consent forms mailed, 115 were returned (74%). Of these, 111 patients gave consent to participate in the study, one refused consent, and we were informed that three patients had died. The time course of return of these forms ranged from 2 to 89 days (median: 10 days). Attempts to contact patients by phone were successful in 60 out of 160 cases (37.5%). The Research Ethics Committee waived the requirement of consent for those who had died or not responded. Overall mailing cost was R$ 1,004.40. conclusIon. Obtaining consent from patients by phone and mail for a retrospective clinical study is feasible. Most patients responded to contact and gave consent to participate. However, the process entails costs and risks that cannot be overlooked.
The Williams ultrasound score was not a good screening tool when compared to the clinical and biochemical examinations. Since there are currently no adequate tests that can be used to diagnose liver disease, we recommend a sequential evaluation combining clinical, biochemical and ultrasound examinations for the diagnosis of liver disease in CF.
The risk of developing liver disease is higher among patients diagnosed at an early age and those with worse clinical status as assessed by the Shwachman score, indicating that liver involvement might be part of a more severe form of the condition. These patients merit greater attention in terms of screening for liver disease and should be given treatment with ursodeoxycholic acid earlier in the event of abnormal findings.
The Williams ultrasound score was not a good screening tool when compared to the clinical and biochemical examinations. Since there are currently no adequate tests that can be used to diagnose liver disease, we recommend a sequential evaluation combining clinical, biochemical and ultrasound examinations for the diagnosis of liver disease in CF.
Objective: the purpose of this study was to compare the effectiveness of a pre-thickened infant formula (Nan AR) with a conventional homemade formula in the reduction of regurgitation and vomiting in infants with gastroesophageal reflux.Methods: a hundred children, under 12 months, not exclusively breast feeding, were select for the study. Forty-eight were treated with conventional formula with starch and 52 with pre-thickened infant formula.Results: there was no statistically significant difference between the two groups in the improvement or cure of symptoms, each treatment having been effective. Conclusions ResumoObjetivo: o presente estudo foi realizado com o objetivo de comparar a eficácia de uma fórmula infantil pré-espessada (Nan AR) com fórmula convencional, de espessamento caseiro, com amido de milho, na redução de episódios de regurgitações e vômitos de lactentes com refluxo gastroesofágico (RGE).Métodos: foram estudadas 100 crianças, menores de 12 meses de idade, que não faziam uso de leite materno exclusivo. Por sorteio, 48 receberam fórmula convencional, e 52 receberam fórmula infantil pré-espessada (Nan AR), com comparação dos resultados clínicos após 3 meses.Resultados: não houve diferença estatisticamente significativa na melhora ou cura dos sintomas entre os dois grupos, tendo sido ambos os tratamentos eficazes.Conclusões: o espessamento dietético, seja com fórmulas infantis especiais, seja com medidas caseiras, tem eficácia semelhante no tratamento do refluxo gastroesofágico do lactente. O refluxo gastroesofágico (RGE), definido como o fluxo retrógrado involuntário do conteúdo gástrico para o esôfago, constitui uma das três principais causas de consulta em gastroenterologia pediátrica, sendo responsável por 75% das doenças do esôfago 1 . Pode ser fisiológico ou patológico, dependendo das complicações associadas.O RGE fisiológico é comum nos primeiros meses de vida, mas pode ocorrer em qualquer faixa etária. As regurgitações pós-alimentares surgem entre o nascimento e os
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