Before the arrival of Spanish settlers, the East region of Paraguay, was inhabited by Guarani people. After the Paraguayan war in 1870, which ended in loss of a high percentage of the male population, the migration to the country was encouraged. Immigration data indicate a high input of Eurasians to the territory. Also, since 1960s, a large number of Brazilians and Argentineans arrived in Paraguay. Samples from the eastern provinces of Paraguay were sequenced for the mtDNA control region and 88% presented native American haplogroups. A preliminary study on the same samples using AIMs indicates a high autosomal contribution from Europe and native America. The comparison of both type of markers showed that the European ancestry for autosomes is higher than expected when averaging mtDNA and the Y chromosome. This result supports recent admixture between Paraguayans and other populations probably already admixed, where the men contributed with high European ancestry.
RATIONALE: Eosinophilic esophagitis (EoE) is likely to recur when medicine or diet treatment is discontinued; thus, adherence to long-term therapy seems critical. Some EoE experts have recommended basing therapy on patient preference and available resources. Our goal was to develop a decision aid tool (DAT) for EoE in order to educate patients/ families about treatment options and involve them in choosing a therapy consistent with their personal values. METHODS: Twenty EoE patients were randomly assigned to one of two study groups to complete a DAT or receive verbal information describing treatment options. After this intervention, patients/families chose to start treatment with cow's milk elimination diet or swallowed corticosteroids. Symptoms were reassessed after 8 weeks, and the results of repeat biopsies were reviewed. RESULTS: Five patients (25%) chose treatment with cow's milk elimination and 15 patients (75%) started swallowed fluticasone. Treatment choice was not related to study group (p50.9). All together, 16 completed a second study visit (n513) and/or repeat esophagogastroduodenoscopy (n513). Most patients who returned for follow up reported that symptoms were at least somewhat improved with treatment (12/13). For those who had repeat esophageal biopsy, histologic remission (i.e. <15 eosinophils/ high power field) was noted in 7/13 (54%) with 5/9 (56%) taking swallowed fluticasone as compared with 2/4 (50%) who had removed foods with cow's milk from the diet (p50.9). CONCLUSIONS: In spite of offering the simplest dietary treatment for EoE, the majority of our patients preferred starting medicine. Histologic remission was challenging even in the setting of close follow up and individualized treatment plans.
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