ABSTRACT
Cow's milk protein allergy (CMPA) is the most frequent cause of food allergy in the first months of life. Despite the fact that there are different guidelines and recommendations on the management of children with CMPA, there continues to be great variability in diagnostic and therapeutic criteria in Latin America. The Food Allergy Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition summoned a group of Latin American experts to reach a consensus and formulate a document to unify diagnostic and therapeutic criteria for CMPA. Three teams were formed, each with a coordinator, and the members of each team developed a series of statements for their corresponding module: a) clinical manifestations and diagnosis; b) diagnostic tools, and c) treatment. A search of the medical literature was carried out to support the information presented in each module and 28 statements were then selected. The statements were discussed, after which they were evaluated by all the experts, utilizing the Delphi method. Their opinions on statement agreement or disagreement were anonymously issued. The final statements selected were those with above 75% agreement and their corresponding recommendations were formulated, resulting in the document presented herein.
Subject(s)
Gastroenterology , Milk Hypersensitivity , Animals , Cattle , Consensus , Female , Humans , Latin America , Milk Hypersensitivity/diagnosis , Milk Hypersensitivity/therapy , Milk Proteins/adverse effectsABSTRACT
La lactosa es el principal carbohidrato de la leche materna. Es un disacárido conformado por glucosa y galactosa. Su producción en la glándula mamaria es independiente de la dieta materna. Además de proveer energía, es la única fuente de galactosa de la dieta, necesaria para la síntesis de macromoléculas como oligosacáridos, glicoproteínas y glicolípidos. Favorece la absorción y retención de calcio, magnesio y cinc. Su digestión por la enzima lactasa y posterior absorción tienen lugar en intestino delgado. El déficit de lactasa, que puede ser primario congénito (muy infrecuente), primario tardío o secundario por lesión intestinal, puede generar intolerancia con síntomas como dolor, distensión abdominal, flatulencia y diarrea. En el colon, bifidobacterias y lactobacilos pueden hidrolizarla. El manejo nutricional de la intolerancia deberá hacerse siempre preservando la lactancia materna. La reducción o suspensión de la lactosa deberá ser transitoria y se reemplazarán alimentos suspendidos por otros con adecuados aportes calóricos, proteicos y de minerales y vitaminas.
Lactose is the main carbohydrate present in humanmilk. It is a disaccharide made up of glucoseand galactose. It is produced in the mammaryglands, regardless of maternal diet. In addition toproviding energy, it is the only source of dietarygalactose, necessary for macromolecule synthesis,including oligosaccharides, glycoproteins, andglycolipids. It favors calcium, magnesium, andzinc absorption and retention. Its digestion bylactase and subsequent absorption occurs inthe small intestine. Lactase deficiency may beclassified into congenital primary (very rare),late-onset primary or secondary due to an injuryof the intestine; it may cause intolerance withpain, abdominal distension, abdominal gas, anddiarrhea. In the colon, it may be hydrolyzed bybifidobacteria and lactobacilli. The nutritionalmanagement of intolerance should alwayspreserve breastfeeding. Lactose reduction orelimination should be transient, and eliminatedfood should be replaced with other similar incalorie, protein, mineral, and vitamin content.
Subject(s)
Humans , Lactose Intolerance/diagnosis , Lactase/metabolism , Diet , Lactose/metabolism , Milk, Human/metabolismABSTRACT
Lactose is the main carbohydrate present in human milk. It is a disaccharide made up of glucose and galactose. It is produced in the mammary glands, regardless of maternal diet. In addition to providing energy, it is the only source of dietary galactose, necessary for macromolecule synthesis, including oligosaccharides, glycoproteins, and glycolipids. It favors calcium, magnesium, and zinc absorption and retention. Its digestion by lactase and subsequent absorption occurs in the small intestine. Lactase deficiency may be classified into congenital primary (very rare), late-onset primary or secondary due to an injury of the intestine; it may cause intolerance with pain, abdominal distension, abdominal gas, and diarrhea. In the colon, it may be hydrolyzed by bifidobacteria and lactobacilli. The nutritional management of intolerance should always preserve breastfeeding. Lactose reduction or elimination should be transient, and eliminated food should be replaced with other similar in calorie, protein, mineral, and vitamin content.
La lactosa es el principal carbohidrato de la leche materna. Es un disacárido conformado por glucosa y galactosa. Su producción en la glándula mamaria es independiente de la dieta materna. Además de proveer energía, es la única fuente de galactosa de la dieta, necesaria para la síntesis de macromoléculas como oligosacáridos, glicoproteínas y glicolípidos. Favorece la absorción y retención de calcio, magnesio y cinc. Su digestión por la enzima lactasa y posterior absorción tienen lugar en intestino delgado. El déficit de lactasa, que puede ser primario congénito (muy infrecuente), primario tardío o secundario por lesión intestinal, puede generar intolerancia con síntomas como dolor, distensión abdominal, flatulencia y diarrea. En el colon, bifidobacterias y lactobacilos pueden hidrolizarla. El manejo nutricional de la intolerancia deberá hacerse siempre preservando la lactancia materna. La reducción o suspensión de la lactosa deberá ser transitoria y se reemplazarán alimentos suspendidos por otros con adecuados aportes calóricos, proteicos y de minerales y vitaminas.
Subject(s)
Lactose Intolerance , Diet , Humans , Lactase/metabolism , Lactose/metabolism , Lactose Intolerance/diagnosis , Milk, Human/metabolismABSTRACT
INTRODUCTION: There are discrepancies in the diagnosis and management of cow's milk protein allergy (CMPA) in Spain and Latin America. The aim of the present study was to find out how Spanish and Latin American pediatric gastroenterologists diagnose and treat CMPA. MATERIAL AND METHODS: Pediatric gastroenterologists, members of the Sociedad Latinoamericana de Gastroenterología, Hepatología y Nutrición, were invited to fill out a structured survey, the results of which were then compared with the 2012 and 2014 diagnosis and treatment guidelines, respectively. RESULTS: The survey results showed that 17% of the participants follow the diagnostic recommendations based on the published consensus and guidelines. To diagnose non-IgE-mediated CMPA, 15% of the participants utilize IgE-specific skin prick tests, 22% use IgE-specific blood tests, and 45% employ oral food challenges. To diagnose IgE-mediated CMPA the percentages for the same diagnostic methods were 57, 83 and 22%, respectively. Once diagnosis is confirmed, 98% of the participants provide dietary recommendations. In children that are not breastfed, 89% of the participants prescribe an initial extensively hydrolyzed formula, 9% an amino acid formula, 1% a soy formula, and 1% a hydrolyzed rice formula. In patients with IgE-mediated CMPA, 34% of the participants carry out an oral challenge once treatment is completed, 39% according to symptom severity, and 27% in relation to IgE-specific testing. CONCLUSION: CMPA management is diverse and there is poor adherence to the clinical practice guidelines.
Subject(s)
Gastroenterology , Milk Hypersensitivity/diagnosis , Milk Hypersensitivity/therapy , Pediatrics , Animals , Cattle , Diet , Guideline Adherence , Guidelines as Topic , Hematologic Tests , Humans , Immunoglobulin E/immunology , Infant , Infant Formula , Infant, Newborn , Latin America , Practice Guidelines as Topic , Skin Tests , Societies, Medical , Surveys and QuestionnairesABSTRACT
INTRODUCTION AND OBJECTIVE: Eosinophilic esophagitis is a chronic, immune-mediated disease described in case series and publications worldwide. Over the past twenty years, the authors of different studies have attempted to evaluate its incidence and prevalence. The objetive of the present study was to estimate the prevalence of eosinophilic esophagitis in a group of children seen at 36 pediatric gastroenterology centers in ten Latin American countries. MATERIALS AND METHODS: A multicenter, observational, and cross-sectional study was conducted that estimated the period prevalence of eosinophilic esophagitis in children seen at outpatient consultation and that underwent diagnostic upper gastrointestinal endoscopy for any indication at 36 centers in 10 Latin American countries, within a 3-month time frame. RESULTS: Between April and June 2016, 108 cases of eosinophilic esophagitis were evaluated. Likewise, an average of 29,253 outpatient consultations and 4,152 diagnostic upper gastrointestinal endoscopies were carried out at the 36 participating centers. The period prevalence of eosinophilic esophagitis in the population studied (n=29,253) was 3.69 cases×1,000 (95% CI: 3.04 to 4.44), and among the children that underwent routine upper gastrointestinal endoscopy (n=4,152), it was 26x1,000 (95% CI: 22.6 to 29.4). CONCLUSIONS: The general period prevalence of eosinophilic esophagitis in a group of children evaluated at 36 Latin American pediatric gastroenterology centers was 3.69×1,000, and in the children that underwent endoscopy, it was 26×1,000. There was important prevalence variability between the participating countries and centers. The present analysis is the first study conducted on the prevalence of pediatric eosinophilic esophagitis in Latin America.
Subject(s)
Eosinophilic Esophagitis/epidemiology , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Female , Gastroenterology , Hospitals, Special , Humans , Infant , Latin America/epidemiology , Male , PrevalenceABSTRACT
AIM: The enumeration of intraepithelial lymphocytes subsets (total, γδ, and CD3(-) IELs) by flow cytometry (FCM), named as IEL lymphogram, constitutes a useful tool for celiac disease (CD) diagnosis. The aim of this study was to quantify IELs by FCM and their diagnostic value to differentiate active, silent and potential CD. METHODS: Prospective study of 60 active and 20 silent CD patients, and 161 controls in which duodenal biopsy and IEL quantification by FCM was performed. RESULTS: Active and silent CD patients had significant higher levels of both total and γδ IELs than absent CD patients (P < 0.0001 and P < 0.0001, P = 0.012 and P < 0.011; respectively). Active and silent CD patients had significant lower levels of CD3(-) IELs than absent CD patients (P < 0.047 and P < 0.009, respectively). Moreover, they were lower in silent than in active CD patients (P = 0.002). Changes of IELs subsets were more marked in children than adults active CD. The optimal IEL lymphogram cut off values for active CD diagnosis were: ≥10, ≥15 and ≤9 %, and with better performance characteristics for silent CD: ≥ 11, ≥10 and ≤5 %. CONCLUSION: The evaluation of IELs subsets by FCM is useful to confirm diagnosis of active and silent CD.
ABSTRACT
OBJECTIVES: Infected carotid prosthetic patches (ICPP) are a rare but catastrophic complication of carotid endarterectomy (CEA). Prevention and appropriate surgical management is essential. We report our experience of carotid artery reconstruction for ICPP. DESIGN: Single-center retrospective study. METHODS: 10-year review of the surgical treatment of ICPP. RESULTS: Twelve patients presented with patch infection following CEA. Three patients presented acutely with an expanding hematoma, eight with chronic complications (abscess/discharging sinus n = 5, carotid pseudoaneurysm n = 3). Mean age was 75 years. Replacement conduits included superficial femoral artery (n = 6), cadaveric homograft (n = 3), long saphenous vein (n = 2) and one patient had primary closure. Five patients had muscle flaps fashioned for carotid artery protection. Operative complications included hypoglossal nerve injury (1 patient), superficial skin infection (2 patients) and one patient was returned to the operating room for a neck haematoma. Five surgical specimens were culture positive for: Staphylococcus aureus (n = 3), Corynebacterium propionibacterium (n = 1) and Streptococcus anginous (n = 1). There were no 30-day mortalities. Mean hospital stay was 6 days. Median follow-up was 16 months (range 3-108 months). CONCLUSION: Carotid artery reconstruction in a contaminated wound represents a significant surgical challenge. Unlike previous reports that used venous conduits, this is the first series where cadaveric or autologous arterial conduits were preferred. Arterial conduits achieved durable short term follow-up.
Subject(s)
Blood Vessel Prosthesis/adverse effects , Endarterectomy, Carotid/adverse effects , Plastic Surgery Procedures/methods , Prosthesis-Related Infections/surgery , Aged , Aged, 80 and over , Antibiotic Prophylaxis , Contrast Media , Female , Humans , Magnetic Resonance Angiography , Male , Middle Aged , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/mortality , Plastic Surgery Procedures/mortality , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, Doppler, DuplexABSTRACT
INTRODUCTION: We described the results of the auditory multiple steady state response (MSSR) technique in the assessment of two patients with auditory neuropathy (AN). The aim of this study was to corroborate the correspondence between the MSSR generators elicited by amplitude modulated tones ranging between 80-100 Hz, with the generators of auditory brain stem response (ABR). Moreover, we would also try to demonstrate the validity of the MSSR in the diagnosis of AN in children. MATERIAL AND METHODS: Two children diagnosed of hyperbilirrubinemia, aged, 18 months and 10 years have been studied with MSSR (500, 1000, 2000 and 4000Hz); ABR with clicks; OAE; behavioural audiometry; MRI and acoustic reflexes. RESULTS: A difference between electrophysiological and behavioural audiogram in both cases diagnosed with auditory neuropathy have been found. The auditory thresholds were similar using the two types of evoked potentials (MSSR and ABR). Both techniques showed an increment of auditory threshold congruous with a severe auditory impairment, while behavioural audiometry showed only a mild elevation of auditory threshold. We can also see how the threshold differed between frequencies using behavioral audiometry and MSSR. CONCLUSION: It is concluded that our findings are in agreement with previous studies and they sustain the theory about the coincidence of MSSR at fast rate (80-110 Hz) and ABR generators. Also, we demonstrate the usefulness of the MSSR as an objective [corrected] electroaudiometric tool in patients with auditory neuropathy as ABR. This technique is thus a recommendable test to complete the audiological study in infants with AN, to establish a more precise treatment.
Subject(s)
Cochlea/pathology , Evoked Potentials, Auditory/physiology , Hearing Loss, Sensorineural/diagnosis , Cerebellopontine Angle/pathology , Child , Evoked Potentials, Auditory, Brain Stem/physiology , Hearing Loss, Sensorineural/congenital , Humans , Infant , Magnetic Resonance Imaging , Male , Severity of Illness Index , Speech PerceptionABSTRACT
OBJECTIVE: To analyze a neonatal hearing screening protocol with transient evoked otoacoustic emissions (OAE) and auditory brainstem response (ABR). PATIENTS AND METHODS: We studied 1,532 newborns with a protocol using transient evoked otoacoustic emissions and auditory brainstem response. We also evaluated auditory development until twelve months of age with quarterly questionnaires. RESULTS: A total of 1,485 (97 %) newborns had normal OAE, 185 (12 %) were referred for ABR exploration and only 11 (0.7 %) were referred to the otorhinolaryngology service for auditory study and diagnosis. Four neonates had auditory disjunction. No false negatives were detected in the follow-up. CONCLUSIONS: This hearing screening protocol with OEA and ABR is useful for detecting hearing loss in neonates. The prevalence of hearing loss in this study was 2.6 % of live newborns.
Subject(s)
Hearing Disorders/diagnosis , Hearing Disorders/epidemiology , Neonatal Screening/methods , Evoked Potentials, Auditory, Brain Stem/physiology , Female , Humans , Infant , Infant, Newborn , Male , Otoacoustic Emissions, Spontaneous/physiologyABSTRACT
Objetivo: El objetivo de este estudio es analizar un protocolo de cribado auditivo neonatal en el que se combina el uso de otoemisiones acústicas (OEA) evocadas y potenciales evocados auditivos de tronco cerebral (PEATC). Pacientes y métodos. Se estudiaron 1.532 recién nacidos con un protocolo en el que se realizaron OEA y PEATC. Además, se realizó una evaluación del desarrollo auditivo hasta los 12 meses de edad mediante unos cuestionarios trimestrales. Resultados: Superaron las OEA 1.485 niños (97%), a 185 bebés (12%) fue necesario realizarles PEATC y sólo 11 niños (0,7%) precisaron ser remitidos al servicio de otorrinolaringología para completar el estudio y realizar el diagnóstico definitivo. En 4 niños se detectó enfermedad auditiva. En este estudio no se detectó ningún falso negativo durante el seguimiento. Conclusiones: Este protocolo de estudio en el que se usa OEA y PEATC de forma combinada, demuestra ser útil para la detección de la hipoacusia en recién nacidos. La prevalencia de la hipoacusia detectada en este estudio fue de 2,6 recién nacidos vivos (AU)
Subject(s)
Male , Infant, Newborn , Infant , Female , Humans , Neonatal Screening , Evoked Potentials, Auditory, Brain Stem , Otoacoustic Emissions, SpontaneousABSTRACT
Se enumeran las causas que favorecen la produccion de caries dentarias en especial las correspondientes a los glucidos. Se destaca el papel del fluor y su mecanismo de accion en la formacion dentaria y en la profilaxis de las caries.Se recomienda implementar un programa de prevencion empleando en las cifras de consumo, fluor en la dosis de 0,8 a 1,2 ppm, segun las zonas geograficas
Subject(s)
Dental Caries , Fluorine , Preventive DentistryABSTRACT
Se enumeran las causas que favorecen la produccion de caries dentarias en especial las correspondientes a los glucidos. Se destaca el papel del fluor y su mecanismo de accion en la formacion dentaria y en la profilaxis de las caries.Se recomienda implementar un programa de prevencion empleando en las cifras de consumo, fluor en la dosis de 0,8 a 1,2 ppm, segun las zonas geograficas
