What do Brazilian pediatricians know about celiac disease?

INTRODUCTION: Celiac disease (CD) is a common illness, affecting 0.5-1% of the population. Its classic presentation consists of gastrointestinal symptoms, however, many extra-intestinal symptoms and some associated diseases have been studied. Pediatricians should know the typical and atypical presentations of CD and how to diagnosis and treat its complications. The aim of this study was describe what pediatricians in Brazil know about CD. METHODS: A descriptive, cross-sectional study with pediatricians who participated in the Nestlé Pediatrics Course, in the city of Natal, Brazil, in 2008. They were asked to complete a self-applicable questionnaire covering aspects concerning the prevalence, diagnosis, and treatment of CD and the conditions associated with this disease. RESULTS: A total of 632 pediatricians completed the questionnaire. The majority of respondents (82.9%) were female. All the geographical regions of Brazil were represented. More than 65% of respondents had undergone specialist training in pediatrics, and 40% of respondents had worked as pediatricians for more than 25 years. Only 22% replied that celiac disease may be asymptomatic, 57% stated that antigliadin antibody measurement represents the best screening tool for the disease, and two-thirds replied that bowel biopsy would be the most indicated method. The pathologies and conditions associated with celiac disease were identified by fewer than 50% of respondents. Exclusion of gluten from the patient's diet was mentioned as the treatment for celiac disease by 86.4% of the pediatricians. CONCLUSIONS: We conclude that pediatricians have superficial information about CD. The need for relevant information on celiac disease is fundamental and is recognized by the pediatricians themselves.

Hepatobiliary abnormalities in pediatric patients with sickle cell disease.

OBJECTIVE: to describe clinical, laboratory and ultrasonographic abnormalities in the hepatobiliary system of pediatric patients with sickle cell disease in the city of Salvador, Brazil. MATERIAL AND METHODS: pediatric patients with sickle cell disease were clinically evaluated, their charts were reviewed and findings of supplementary tests were examined to identify hepatobiliary abnormalities. RESULTS: a total of 134 patients were evaluated, 65 of whom (48.9%) presented hepatomegalia. Elevated transaminases were present in 42.2% and 11.4% presented cholelithiasis. There was a statistically significant association between the presence of hepatomegalia and SS homozygotes and between cholelithiasis and patients over 10 years of age (p = 0.01 and p = 0.00, respectively). CONCLUSION: hepatobiliary abnormalities in patients with sickle cell disease were common, particularly in patients with hemoglobin SS and in adolescent patients.

[Knowledge of obstetricians about the vertical transmission of hepatitis B virus]. / Conhecimento dos obstetras sobre a transmissão vertical da hepatite B.

CONTEXT: Vertical transmission is responsible for 35%-40% of the new cases of hepatitis B worldwide and it is associated with an increased risk of chronic hepatitis B, cirrhosis and hepatocellular carcinoma. OBJECTIVE: To describe obstetricians' knowledge on the recommended measures to the diagnosis of the infection by the hepatitis virus B in pregnant women and to prevent the transmission of this infection to the babies of infected mothers. METHODS: Obstetricians registered at the 'Sociedade de Ginecologia e Obstetrícia da Bahia', Salvador, BA, Brazil were randomly selected and invited to answer a questionnaire with questions regarding their academic formation, workplace, contact with medical students and their practices about the hepatitis virus B. Individuals who were not currently working as obstetricians or were not living in the state of Bahia were excluded from the study. Data were analyzed with the EpiInfo software with a 95% confidence interval. RESULTS: Three hundred and one obstetricians answered the questionnaire: 90.3% of them recognized that the hepatitis virus B could be transmitted vertically and 81.7% routinely screened their patients for hepatitis virus B infection during prenatal consultations; 66.0% considered HBsAg the best serological marker to be employed on the screening. Only 13.0% systematically recommended the vaccination against hepatitis virus B and the administration of immunoglobulin to the newborns of infected mothers in the first 12 hours of life. The frequency of correct answers about the vertical transmission of hepatitis virus B, the best serological marker for screening and the management of infected mothers and their newborns was higher among professionals who had the 'Título de Especialista em Ginecologia e Obstetrícia (TEGO)' than among the remaining ones (P = 0.018, P = 0.001 and P = 0.002, respectively). CONCLUSION: We observed that the knowledge of the obstetricians about the diagnosis and management of hepatitis virus B infection during pregnancy is not adequate, reinforcing the need of continuous medical education programs on the infections that can be transmitted vertically.

Conhecimento dos obstetras sobre a transmissão vertical da hepatite B / Knowledge of obstetricians about the vertical transmission of hepatitis B virus

CONTEXTO: A transmissão vertical é responsável por 35 por cento a 40 por cento dos novos casos de hepatite B no mundo e a infecção precoce pelo vírus da hepatite B aumenta o risco de evolução para a hepatite crônica, cirrose e carcinoma hepatocelular. OBJETIVO: Determinar o conhecimento dos obstetras sobre as práticas para o diagnóstico da infecção pelo vírus da hepatite B em gestantes e as condutas para a prevenção desta infecção em recém-nascidos de mães infectadas. MÉTODOS: Foram sorteados aleatoriamente profissionais de saúde cadastrados na Sociedade de Obstetrícia e Ginecologia da Bahia, que foram convidados a responder um questionário anônimo com informações sobre sua formação acadêmica, o local de trabalho, o contato com estudantes e as suas práticas profissionais em relação ao vírus da hepatite B. Adotou-se como critério de exclusão o não exercício atual da obstetrícia e a não residência na Bahia. A análise dos dados foi feita através do programa estatístico Epiinfo e para análise das correlações foi adotado intervalo de confiança de 95 por cento. RESULTADOS: Foram entrevistados 301 obstetras, dos quais 90,3 por cento reconheciam a transmissibilidade vertical do vírus da hepatite B e 81,7 por cento solicitavam algum exame para detecção de hepatite B durante o pré-natal de suas pacientes. Sessenta e seis por cento dos médicos entrevistados referiram o AgHBs como o marcador sorológico mais adequado para avaliar a presença de infecção pelo VHB. Apenas 13,0 por cento destes profissionais indicavam de modo sistemático a vacina contra a hepatite B e a administração de imunoglobulina nas primeiras 12 horas de vida do recém-nascido de mães infectadas. O número de respostas corretas quanto à transmissibilidade vertical do VHB, ao marcador sorológico mais adequado e à conduta para o recém-nascido de mãe infectada foi maior entre os obstetras que possuíam o Título de Especialista em Ginecologia e Obstetrícia que entre os demais profissionais...

CONTEXT: Vertical transmission is responsible for 35 percent-40 percent of the new cases of hepatitis B worldwide and it is associated with an increased risk of chronic hepatitis B, cirrhosis and hepatocellular carcinoma. OBJECTIVE: To describe obstetricians' knowledge on the recommended measures to the diagnosis of the infection by the hepatitis virus B in pregnant women and to prevent the transmission of this infection to the babies of infected mothers. METHODS: Obstetricians registered at the "Sociedade de Ginecologia e Obstetrícia da Bahia", Salvador, BA, Brazil were randomly selected and invited to answer a questionnaire with questions regarding their academic formation, workplace, contact with medical students and their practices about the hepatitis virus B. Individuals who were not currently working as obstetricians or were not living in the state of Bahia were excluded from the study. Data were analyzed with the EpiInfo software with a 95 percent confidence interval. RESULTS: Three hundred and one obstetricians answered the questionnaire: 90.3 percent of them recognized that the hepatitis virus B could be transmitted vertically and 81.7 percent routinely screened their patients for hepatitis virus B infection during prenatal consultations; 66.0 percent considered HBsAg the best serological marker to be employed on the screening. Only 13.0 percent systematically recommended the vaccination against hepatitis virus B and the administration of immunoglobulin to the newborns of infected mothers in the first 12 hours of life. The frequency of correct answers about the vertical transmission of hepatitis virus B, the best serological marker for screening and the management of infected mothers and their newborns was higher among professionals who had the "Título de Especialista em Ginecologia e Obstetrícia (TEGO)" than among the remaining ones (P = 0.018, P = 0.001 and P = 0,002, respectively). CONCLUSION: We observed that the knowledge...

Manifestações auto-imunes associadas com hepatite auto-imune / Concurrent autommune manifestations in patients with AIH

Pacientes com hepatite auto-imune (HAI) apresentam diversas manifestações de auto-imunidade associadas e, muitas vezes, desenvolvem doenças auto-imunes que necessitam de reconhecimento precoce. Este trabalho tem por objetivo descrever a freqüência de manifestações auto-imunes em portadores de Hepatite auto-imune. Estudo descritivo de série de casos foi realizado na cidade de Salvador, Bahia, no qual foram selecionados por conveniência 69 pacientes, entre adultos e crianças com diagnóstico prévio de hepatite auto-imune, com o objetivo de avaliar a freqüência de manifestações auto-imunes associadas nesses pacientes. Os participantes do estudo foram entrevistados quanto à presença de manifestação auto-imune associada ao quadro de hepatite, e, em seguida, avaliaram-se os prontuários para obtenção dos exames que confirmassem o referido diagnóstico de outra manifestação auto-imune. A freqüência das manifestações auto-imunes associadas foi de 23,2 por cento, e a artrite foi a manifestação auto-imune mais freqüente (8,7 por cento), seguida de diabetes mellitus tipo 1 (4,3 por cento). A retocolite ulcerativa e a colangite esclerosante primária foram igualmente freqüentes, ocorrendo em 2,9 por cento dos pacientes. As outras manifestações auto-imunes associadas obtiveram uma freqüência de 1,4 por cento para cada uma delas. Concluiu-se que a ocorrência de manifestações auto-imunes é freqüente e ocorre de forma variada nos pacientes com HAI. Assim, o reconhecimento precoce dessas condições auto-imunes associadas é fundamental para a realização de medidas terapêuticas específicas, evitando-se as possíveis complicações.