Daily Vitamin D Supplementation Improves Vitamin D Deficiency in Patients With Chronic Liver Disease.

OBJECTIVE: The objective of this article is to evaluate the response to 6000 IU oral cholecalciferol (OC) treatment in children with chronic liver disease (CLD) and 25(OH)D deficiency. METHODS: This historical cohort included non-transplanted CLD patients younger than 18 years old, which were analyzed for serum 25(OH)D, liver function, bone metabolism, Child-Pugh classification, and anthropometry. Patients with 25(OH)D deficiency (defined as 25(OH)D < 20 ng/mL) who received 6000 IU/day of OC were analyzed pre- and post-intervention, and considered responders if 25(OH)D > 20 ng/mL after at least 60 days. We compared clinical and laboratory data from patients with and without 25(OH)D deficiency, responders and nonresponders. RESULTS: We studied 96 patients, of which 57.2% had biliary atresia. The prevalence of 25(OH)D deficiency was 67.7% (65/96). These patients were younger ( P < 0.001), had higher Child-Pugh scores ( P < 0.001), higher levels of total bilirubin (TB) ( P < 0.001), gamma-glutamyl transferase ( P < 0.001), and alkaline phosphatase ( P = 0.002), as well as lower levels of phosphorus ( P = 0.009) compared with patients without 25(OH)D deficiency. The median treatment length was 126 days (70-307 days). At the end of treatment, we observed a higher median of 25(OH)D ( P < 0.001), and lower median of parathyroid hormone (PTH) ( P = 0.023). Nine patients (29%) restored 25(OH)D to normal range; they had lower Child-Pugh score ( P = 0.001), lower TB levels ( P = 0.001), and higher level of phosphorus ( P = 0.003) after treatment. CONCLUSION: Despite an increase in 25(OH)D and decrease in PTH levels, 6000 IU/day of OC was not sufficient to restore 25(OH)D deficiency in most of the patients in this study.

Conflito com a lei e sexismo: percepções de adolescentes de Sergipe (Brasil) / Conflicto con la ley y sexismo: percepciones de adolescentes de Sergipe (Brasil) / Conflict with the law and sexism: perceptions of adolescents in Sergipe (Brazil)

Resumo O objetivo deste estudo é investigar como adolescentes do gênero feminino, em privação de liberdade, percebem a situação de conflito com a lei e o sexismo. Participaram quatro adolescentes que cumpriam medida socioeducativa de privação de liberdade em Sergipe (Brasil). Foram realizadas entrevistas semiestruturadas, interpretadas por meio da análise temática de conteúdo. Emergiram duas categorias: «Diferenças de gênero no ato infracional: a transgressão como característica masculina¼ e «Diferenças de gênero na medida socio-educativa: a obediência como característica feminina¼, indicando o impacto do gênero na percepção dessas adolescentes. Em conjunto, os resultados evidenciam que atentar ao recorte de gênero e às relações entre conflito com a lei e o sexismo são aspectos fundamentais para alcançar o ideário da legislação brasileira, o atendimento às especificidades das adolescentes numa proteção integral e igualitária.

Resumen El objetivo de este estudio es investigar cómo adolescentes, privadas de libertad, perciben la situación de conflicto con la ley y el sexismo. Participaron cuatro adolescentes que cumplían medida so-cioeducativa de privación de libertad en Sergipe (Brasil). Se realizaron entrevistas semiestructuradas, interpretadas mediante análisis de contenido temático. Surgieron dos categorías: «diferencias de género en la infracción: la transgresión como característica masculina¼ y «diferencias de género en la medida socioeducativa: la obediencia como característica femenina¼, indicando el impacto del género en la percepción de estas adolescentes. En conjunto, los resultados muestran que la atención al género y la relación entre conflicto con la ley y sexismo son aspectos fundamentales para lograr los ideales de la legislación brasileña, que es respetar las especificidades de las adolescentes en una protección integral e igualitaria.

Abstract This study aims to research how female adolescents who are deprived of their liberty perceive the relationship between their conflict with the law and sexism. The participants were four adolescents who were detained in a correctional facility in Sergipe (Brazil). Semi-structured interviews were conducted and these were interpreted using thematic content analysis. Two categories emerged: «Gender differences in infractions: transgression as a male characteristic¼ and «Gender differences in so-cioeducational scenarios: obedience as a female characteristic¼, highlighting the impact of gender on the perceptions of these adolescents. The results obtained through this research indicate that concentrating gender and the relationship between conflict with the law and sexism are fundamental aspects for achieving ideal legislation that respects the specific situations experienced by adolescents and provides them with integrated and equal protection.

Severity of Ascites Is Associated with Increased Mortality in Patients with Cirrhosis Secondary to Biliary Atresia.

BACKGROUND: Very few prior studies have investigated the presence of ascites as a prognostic factor in children with cirrhosis. To the best of our knowledge, there are no prior studies evaluating the relationship between severity of ascites and patient survival in children with biliary atresia and cirrhosis. AIMS: To evaluate the association between severity of ascites and survival of children with cirrhosis and biliary atresia. METHODS: All children with cirrhosis secondary to biliary atresia evaluated at our institution from 2000 to 2014 were included in this study. Patients were classified into four groups: NA = no ascites; A1 = grade 1 ascites; A2 = grade 2 ascites; and A3 = grade 3 ascites. The primary endpoint of the study was mortality within the first year after patient inclusion. Ninety-day mortality was also evaluated. Prognostic factors related to both endpoints also were studied. RESULTS: One-year patient survival for NA was 97.1%, versus 80.8% for A1, versus 52% for A2, versus 13.6 for A3 (p < 0.001). The presence of ascites increased mortality by 17 times. In the multivariate analysis, clinically detectable ascites (HR 3.14, 95% CI 1.14-8.60, p = 0.026), lower sodium (HR 1.15, 95% CI 1.04-1.27, p = 0.006), higher bilirubin (HR 1.06, 95% CI 1.00-1.12, p = 0.023), and higher PELD score (HR 1.05, 95% CI 1.02-1.08, p = 0.001) were all associated with decreased survival. Lower serum sodium (HR 1.20, 95% CI 1.09-1.32, p < 0.001) and higher PELD score (HR 1.03, 95% CI 1.001-1.063, p = 0.043) were associated with increased 90-day mortality. CONCLUSIONS: Clinically detectable ascites is associated with decreased 1-year survival of children with biliary atresia. These patients should be treated with caution and prioritized for liver transplantation.

Increased thermal stability of anthocyanins at pH 4.0 by guar gum in aqueous dispersions and in double emulsions W/O/W.

This study investigated the potential of guar gum and a double emulsion to increase the thermal stability of anthocyanins. The effect of different guar gum concentrations (0%, 0.25%, 0.50%, 0.75%, 1%, 1.25%, 1.5% and 1.75%) was evaluated in relation to color stability, concentration of anthocyanins and antioxidant capacity under storage for 10 days at 40 °C in the presence of light. The addition of guar gum (0.75-1.75%) significantly increased the color stability and bathochromic displacement of the samples, suggesting the occurrence of a co-pigmentation process. The total anthocyanin content was to 41% after storage in treatments without guar gum, but when using 1.25% guar gum the final concentration was 70% and there was a 2.4 fold increase in the half-life time of anthocyanins. A significant effect of guar gum addition on the antioxidant capacity of the samples was observed. In the second step, the anthocyanins were added together with 1.25% guar gum in the internal aqueous phase of the double emulsion and stored for 10 days at 40 °C in the presence of light. The double emulsion presented high encapsulation efficiency (90.6%) and high kinetic stability under the conditions evaluated, in addition to protecting anthocyanin molecules against degradation.

Variability index of tacrolimus serum levels in pediatric liver transplant recipients younger than 12 years: Non-adherence or risk of non-adherence?

MLVI has been used to assess adherence. To determine the MLVI in children <12 years of age at transplantation and to identify demographic correlates and consequences for the graft. This is a retrospective study of 50 outpatients (4.0 ± 3.5 years), at least 13-month post-liver transplantation. The outcomes evaluated were MLVI, ALT > 60 IU/L, ACR, death, and graft loss. We analyzed demographic and socioeconomic characteristics, indication for transplantation, and type of donor. Student's t test and the chi-square test were used. Statistical significance was set at P ≤ .05. Seventy-two percent were infants or preschoolers, 62% biliary atresia. Seventy-four percent of the mothers had middle-school education, and 54% of the families had an income ≤3632.4 US$/y. Twenty-two (44%) patients had a MLVI ≥ 2 SD; this was more prevalent in families with higher incomes (P = .045). ALT levels > 60 IU/L were more common in MLVI ≥ 2 SD group (P = .035). ACR episodes were similar between groups (P = 1.000). No patient died or lost the graft. MLVI ≥ 2 SD may be an indicator of the risk of medication non-adherence.

Neonatal Liver Failure and Congenital Cirrhosis due to Gestational Alloimmune Liver Disease: A Case Report and Literature Review.

Neonatal liver failure (NLF) is a major cause of neonatal morbidity and mortality, presenting as acute liver failure and/or congenital cirrhosis. Many affected patients show antenatal signs of fetal injury. There are several causes of NLF and early diagnosis is mandatory to elucidate the etiology and determine a specific treatment or the best management strategy. Gestational alloimmune liver disease associated with neonatal hemochromatosis (GALD-NH) is a rare but potentially treatable cause of NLF. It should be considered in any neonate with fetal signs of disease and postnatal signs of liver failure with no other identifiable causes. GALD-NH is often diagnosed late and patients are therefore referred late to specialized centers, delaying treatment. This case highlights the consequences of late diagnosis and treatment of GALD-NH and emphasizes the importance of a high grade of suspicion of this disease in order to refer the patient to a specialized center soon enough to perform the appropriate treatment.

A label-free electrochemical affisensor for cancer marker detection: The case of HER2.

In this paper, we report the development of a sensitive label-free impedimetric biosensor based on the use of affibody as bioreceptor and gold nanostructured screen-printed graphite as a sensor platform for the detection of human epidermal growth factor receptor 2 (HER2). The affisensor is realized by immobilizing a terminal cysteine-modified affibody on gold nanoparticles. The sensor was characterized by electrochemical techniques and scanning electron microscopy (SEM). Furthermore, surface plasmon resonance (SPR) technology was also applied to explore the potential of affibodies as small-molecule discriminating tools. Using optimized experimental conditions, a single-use affisensor showed a good analytical performance for HER2 detection from 0 to 40 µg/L. The estimated limit of detection was 6.0 µg/L. Finally, the realized affisensor was applied to human serum samples.

A label-free impedimetric immunosensor for direct determination of the textile dye Disperse Orange 1.

A strategy for a label-free impedimetric immunosensor is described for detection of the textile dye Disperse Orange 1 (DO1). The compounds 1,12-diaminododecane (DADD) and then 1,7-diaminoheptane (DAH) were firstly successively grafted onto a glassy carbon electrode (GCE) surface by electro-oxidation of one amino group, while the other terminal amino group was modified with the antibody anti-DO1. The construction process of the immunosensor was characterized by cyclic voltammetry, electrochemical impedance spectroscopy and capacitance measurements. The electron transfer resistance (Rct) exhibited an effective response to the affinity between the immobilized antibody and the antigen in solution. The linear range for the target compound was from 5.0 nmol L(-1) to 0.5 µmol L(-1) (R=0.9980), and the limit of detection (LOD) was 7.56 nmol L(-1). The proposed impedimetric immunosensor has the advantages of simplicity, cost-effectiveness, and sensitivity.