RESUMO
Coeliac Disease (CD) is an immune-mediated systemic disorder elicited by the ingestion of gluten. Small-bowel biopsies and histology has been the gold standard for diagnosing CD. The modified ESPGHAN guidelines recommend that in symptomatic children with anti-tissue-Transglutaminase (tTG) titre of > 10 times Upper-Limit-of-Normal (ULN), diagnosis of CD can be made without small-bowel biopsies. However, positive HLA-DQ2/DQ8 serotype and anti-Endomysial Antibodies (EMA) are necessary. Studies from resource-limited countries have demonstrated applicability of the ESPGHAN guidelines for serological diagnosis of CD. CD should not be diagnosed on the basis of a single high tTG-titre. Small-bowel biopsies are necessary for diagnosing CD in asymptomatic children and those with tTG-titre < 10 x ULN. Management of CD needs lifelong gluten free diet.
Assuntos
Doença Celíaca/diagnóstico , Antígenos HLA-DQ/sangue , Intestino Delgado/patologia , Guias de Prática Clínica como Assunto , Transglutaminases/imunologia , Autoanticorpos/imunologia , Biomarcadores/sangue , Biópsia , Doença Celíaca/sangue , Doença Celíaca/imunologia , Doença Celíaca/patologia , Criança , Feminino , Glutens/imunologia , Humanos , Masculino , Paquistão , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
In developed countries, invasive meningococcal disease (IMD) is a leading infectious cause of death among children. In the UK, Neisseria meningitidis serogroup B is the most frequently identified cause of IMD. This article describes a clinical audit in which early management of IMD is compared with recommendations in the relevant guidelines. It confirms the importance of early recognition of IMD and the need to review previous, less serious diagnoses in ill children. Emergency department nurses play a vital role in the early recognition and management of IMD. Introduction of a meningococcal B vaccine is likely to benefit children in the UK.
