Ultrasound attenuation imaging: a reproducible alternative for the noninvasive quantitative assessment of hepatic steatosis in children.

BACKGROUND: Pediatric hepatic steatosis is a global public health concern, as an increasing number of children are affected by this condition. Liver biopsy is the gold standard diagnostic method; however, this procedure is invasive. Magnetic resonance imaging (MRI)-derived proton density fat fraction has been accepted as an alternative to biopsy. However, this method is limited by cost and availability. Ultrasound (US) attenuation imaging is an upcoming tool for noninvasive quantitative assessment of hepatic steatosis in children. A limited number of publications have focused on US attenuation imaging and the stages of hepatic steatosis in children. OBJECTIVE: To analyze the usefulness of ultrasound attenuation imaging for the diagnosis and quantification of hepatic steatosis in children. MATERIAL AND METHODS: Between July and November 2021, 174 patients were included and divided into two groups: group 1, patients with risk factors for steatosis (n = 147), and group 2, patients without risk factors for steatosis (n = 27). In all cases, age, sex, weight, body mass index (BMI), and BMI percentile were determined. B-mode US (two observers) and US attenuation imaging with attenuation coefficient acquisition (two independent sessions, two different observers) were performed in both groups. Steatosis was classified into four grades (0: absent, 1: mild, 2: moderate and 3: severe) using B-mode US. Attenuation coefficient acquisition was correlated with steatosis score according to Spearman's correlation. Attenuation coefficient acquisition measurements' interobserver agreement was assessed using intraclass correlation coefficients (ICC). RESULTS: All attenuation coefficient acquisition measurements were satisfactory without technical failures. The median values for group 1 for the first session were 0.64 (0.57-0.69) dB/cm/MHz and 0.64 (0.60-0.70) dB/cm/MHz for the second session. The median values for group 2 for the first session were 0.54 (0.51-0.56) dB/cm/MHz and 0.54 (0.51-0.56) dB/cm/MHz for the second. The average attenuation coefficient acquisition was 0.65 (0.59-0.69) dB/cm/MHz for group 1 and 0.54 (0.52-0.56) dB/cm/MHz for group 2. There was excellent interobserver agreement at 0.94 (95% CI 0.92-0.96). There was substantial agreement between both observers (κ = 0.77, with a P < 0.001). There was a positive correlation between ultrasound attenuation imaging and B-mode scores for both observers (r = 0.87, P < 0.001 for observer 1; r = 0.86, P < 0.001 for observer 2). Attenuation coefficient acquisition median values were significantly different for each steatosis grade (P < 0.001). In the assessment of steatosis by B-mode US, the agreement between the two observers was moderate (κ = 0.49 and κ = 0.55, respectively, with a P < 0.001 in both cases). CONCLUSION: US attenuation imaging is a promising tool for the diagnosis and follow-up of pediatric steatosis, which provides a more repeatable form of classification, especially at low levels of steatosis detectable in B-mode US.

Bidimensional shear-wave elastography for assessing liver fibrosis in children: a proposal of reference values that correlate with the histopathological Knodell-Ishak score.

BACKGROUND: A limited number of publications correlate bidimensional shear-wave elastography (2-D SWE) and stages of liver fibrosis in children. OBJECTIVE: To correlate liver elastography values using 2-D SWE and liver biopsy classified by Knodell-Ishak score to evaluate fibrosis in pediatric patients with liver disease, and to propose values of 2-D SWE (kPa) correlating with Knodell-Ishak score, which have not been defined in the literature. MATERIALS AND METHODS: We conducted a prospective cross-sectional observational study on the performance of diagnostic tests. Between June 2016 and June 2018, elastography was performed in 213 children and young adults who had undergone liver biopsy. B mode, Doppler and 2-D SWE were performed using an Aixplorer (SuperSonic Imagine, Aix-en-Provence, France). Histology samples were classified using the Knodell-Ishak score. We evaluated performance by assessing sensitivity, specificity, positive predictive value and negative predictive value. To determine cut-off points for the continuous variables, we used receiver operating characteristic (ROC) curves. All the cutoff values we established apply only to the SuperSonic Aixplorer system. RESULTS: Measurement with 2-D SWE was successful, with a good correlation with fibrosis stage. The area under the curve (AUC) to differentiate between early (Stages 1-2) and moderate (Stages 3-4) fibrosis was 0.91 (95% confidence interval [CI]: 0.87-0.96), with a sensitivity of 92% and specificity of 86%, with a cutoff value 12 kPa (2 m/s). The AUC of severe fibrosis (early stages of cirrhosis; Stage 5) was 0.95 (95% CI: 0.92-0.97), with a sensitivity of 94% and specificity of 90%, with a cutoff value 18.5 kPa (2.48 m/s). In two patients with hematopoietic stem cell transplantation and suspicion of graft versus host disease we found high 2-D SWE values in correlation with the fibrosis stages (Stage 0 with a median of 13 kPa [2.08 m/s] with hemosiderosis Grade 2 in one child and Stage 2 with a median of 46 kPa [3.91 m/s] and hemosiderosis Grade 4 in the other). CONCLUSION: Our study shows the usefulness and accuracy of 2-D SWE for detecting liver fibrosis in pediatric patients. We propose reference values for Knodell-Ishak Stages 1 and 5. We found hemosiderosis as a possible confounding factor that hasn't been described with 2-D SWE.

Coordinación sociosanitaria y evaluación integral en demencias: El rol de las asociaciones de familiares de enfermos de alzheimer / No disponible

La coordinación de servicios sociales y sanitarios en España es una labor que recientemente ha comenzado a desarrollarse. La adecuación de las demencias en la valoración de la dependencia es una de las cuestiones que se analiza en este artículo, donde se reflexiona sobre la aportación de las asociaciones de familiares en el proceso diagnóstico, la atención asistencial y la provisión de servicios y/o recursos. Se presenta un protocolo de evaluación general para el diagnóstico de demencia y analizaremos la relevancia de la detección temprana de estadios iniciales como el deterioro cognitivo leve. Los profesionales psicólogos podrían ser considerados como agentes facilitadores para los “gestores de casos” en el proceso de las valoraciones y la adjudicación de los servicios (AU)

The coordination of social and health services in Spain is an undertaking of recent development. The adaptation of dementias in dependency assessments is the main question analyzed in this paper where we take into consideration the contributions made by Alzheimer’s disease associations in the diagnostic process, medical care and the provision of resources and services. We present a general assessment protocol for the diagnosis of dementia and we analyze the relevance of initial stages as mild cognitive impairment. Psychologists could be considered to be “case management” providers in the assessment process and the allocation of services (AU)

Programas intergeneracionales: reflexiones generales a través del análisis DAFO / Intergenerational programs: general reflections through DAFO analysis

Actualmente los programas intergeneracionales están teniendo un gran auge como forma de intervención psicosocial en el colectivo de personas mayores y/o dependientes, asumiendo el principio de la solidaridad entre generaciones. En este artículo se ofrece un análisis crítico a cerca de las posibilidades de mejora en la planificación, diseño, implementación y evaluación de este tipo de intervención de carácter psicosocial.

Currently, intergenerational programs are having a great boom as a form of psychosocial intervention in the group of elderly and / or dependent people, assuming the principle of solidarity between generations. This article offers a critical analysis of the possibilities for improvement in the planning, design, implementation and evaluation of this type of psychosocial intervention.

La investigación con cuidadores de personas dependientes: revisión de publicaciones en dos revistas españolas / Research with caregivers of dependent people: review of publications in two Spanish journals

En este artículo se integran la revisión y clasificación descriptiva de las principales investigaciones encontradas en los últimos años, sobre los/as cuidadores/as de personas dependientes y con algún tipo de demencia, en dos revistas científicas españolas dedicadas al sector de la gerontología. Se ofrece una breve reseña de cada estudio hallado.

This article integrates the descriptive review and classification of the main research found in recent years, on caregivers of dependent people and with some type of dementia, in two Spanish scientific journals dedicated to the gerontology sector. A brief review of each study found is provided.