Daniel D'Agostino - Academia.edu (original) (raw)
Papers by Daniel D'Agostino
Cardiovascular Drugs and Therapy, 1990
Summary The 24-hour blood pressure (BP) profile of a new sustained-release preparation of nicardi... more Summary The 24-hour blood pressure (BP) profile of a new sustained-release preparation of nicardipine was assessed in 16 patients with essential hypertension (supine cuff diastolic BP>95 mmHg). Twenty-four hour ambulatory intraarterial BP monitoring (Oxford system) before treatment revealed a mean (SD) daytime BP of 174 (19) mmHg systolic and 105 (8) mmHg diastolic, and a mean nighttime BP of 142 (26) mmHg systolic and 83 (12) mmHg diastolic. Sustained release nicardipine (60 mg) was administered twice daily for 4–6 weeks and the ambulatory BP monitoring repeated. No significant change in heart rate occurred throughout the 24-hour period. However, there was a significant reduction (p<0.0001) in the mean daytime BP of 21 (13) mmHg systolic and 12 (9) mmHg diastolic and of mean nighttime BP of 21 (15) mmHg systolic and 13 (11) mmHg diastolic. A similar reduction in hourly mean BP occurred throughout the whole 24-hour period, including the steep early morning rise in BP. Although vasodilatory-type side effects occurred, they were generally mild to moderate and transient. This preparation produces a significant reduction in BP throughout the 24-hour period without reflex tachycardia.
Journal of Pediatric Gastroenterology & Nutrition, 2008
Journal of Pediatric Gastroenterology & Nutrition, 2019
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Clinical Immunology, May 1, 2023
Transplantation direct, Aug 18, 2022
Pediatric Gastroenterology, Hepatology & Nutrition
Purpose: To analyze the characteristics of pediatric inflammatory bowel disease (IBD) over the pa... more Purpose: To analyze the characteristics of pediatric inflammatory bowel disease (IBD) over the past three decades in Argentina and determine if there are differences between the first two decades and the past decade. Methods: We conducted a retrospective multicenter analytical study in children with IBD between 0 and 18 years of age diagnosed between 1987 and 2017 in three tertiary health centers in Argentina. The evaluation included clinical characterization, endoscopy, histology, and imaging data together with therapeutic strategies. The patients were divided into two groups: Group 1, diagnosed between 1987 and 2007, and Group 2, diagnosed between 2008 and 2017. Results: Of the 756 patients included, 409 (54%) had ulcerative colitis (UC), 250 (33%) had Crohn's disease (CD), and 97 (13%) had IBD-unclassified (IBD-U). The positive family history was 3.8%, which was more frequent among children under two years of age (6.7%). There were no significant differences in clinical presentation and extraintestinal manifestations between periods, with hepatic manifestations being the most frequent. In the last decade, we found an upward trend in CD, a downward trend in UC/IBD-U, even after adjustment for socioeconomic status, and a decrease of 50% in surgical treatments coinciding with the advent of biological therapy. Conclusion: This is the first multicenter cohort study in a Latin American country to describe clinical, endoscopic, and therapeutic data across the past 30-year period. Although CD was responsible for the overall increase in incidence, UC was still prevalent in this region.
Objectives: To determine whether changes related to age in gastroesophageal reflux (GER) in infan... more Objectives: To determine whether changes related to age in gastroesophageal reflux (GER) in infants and children are due to acid, non acid reflux or both, as determined by 24 hr pH probe (pH) and Multichannel Intraluminal Impedance (MII). Methods: Tracings of simultaneous pH-MII from 243 infants and children who presented with either digestive or respiratory symptoms attributable to GER were reviewed and analyzed using Mann-Whitney U test. Results: The number of GER episodes recorded was similar among children with predominantly gastrointestinal and those with respiratory symptoms. A significantly higher total number of GER episodes was observed by pH probe and MII in children under 22.8 mos of age compared with those who were older (median 159 vs. 110.5, p = 0.002). There was no significant change with age of acid reflux (AR) parameters. The changes observed were due to the significant decrease of non AR for all parameters measured, regardless of the presenting symptom. Conclusions...
Pediatrics, 2019
Juvenile polyposis syndrome is a rare autosomal dominant condition characterized by multiple hama... more Juvenile polyposis syndrome is a rare autosomal dominant condition characterized by multiple hamartomatous polyps throughout the gastrointestinal tract. Juvenile polyposis of infancy is a generalized severe form of juvenile polyposis syndrome associated with a poor prognosis. A 47-month-old female infant presented initially with gastrointestinal bleeding and protein-losing enteropathy at 4 months of age. At the age of 12 months, the condition worsened, requiring albumin infusions every 24 to 48 hours and red blood cell transfusions every 15 days. Upper gastrointestinal endoscopy, colonoscopy, and small-bowel enteroscopy revealed diffuse polyposis that was treated with multiple endoscopic polypectomies. Despite subtotal colectomy with ileorectal anastomosis, protein-losing enteropathy and bleeding persisted, requiring continued blood transfusions and albumin infusions. A chromosomal microarray revealed a single allele deletion in chromosome 10q23, involving both the PTEN and BMPR1A g...
Archivos argentinos de pediatria, 2017
Drug- and substance-induced liver injury accounts for approximately 20% of pediatric cases of acu... more Drug- and substance-induced liver injury accounts for approximately 20% of pediatric cases of acute liver failure. It is caused by two mechanisms: direct and idiosyncratic hepatotoxicity. Direct hepatotoxicity is the result of the administration of a drug with intrinsic toxicity and is dose-dependent (e.g., acetaminophen). Idiosyncratic hepatotoxicity is unpredictable, uncommon, variable in presentation, and doseindependent. The clinical, histological, and laboratory manifestations include hepatitis, which is generally asymptomatic but with a significant increase of liver enzymes; cholestasis, accompanied with jaundice, pruritus, prominent elevation of alkaline phosphatase, and mild elevation of aminotransferases; or mixed, with elements of both hepatitis and cholestasis. Time to recovery is variable, depending on the type of liver injury. Early detection and discontinuation of the causative drug is the most effective and important step for the fast resolution of histological and cl...
Toxins, 2017
In January 2015, a 20-month-old child and her family took part in recreational activities at Carr... more In January 2015, a 20-month-old child and her family took part in recreational activities at Carrasco and Malvín beaches (Montevideo, Uruguay). An intense harmful algae bloom (HAB) was developing along the coast at that time. A few hours after the last recreational exposure episode, the family suffered gastrointestinal symptoms which were self-limited except in the child's case, who was admitted to hospital in Uruguay with diarrhea, vomiting, fatigue, and jaundice. The patient had increased serum levels of liver enzymes and bilirubin and five days later presented acute liver failure. She was referred to the Italian Hospital in Buenos Aires, being admitted with grade II-III encephalopathy and hepatomegaly and requiring mechanical respiratory assistance. Serology tests for hepatitis A, B, and C, Epstein-Barr virus, and cytomegalovirus were negative. Laboratory features showed anemia, coagulopathy, and increased serum levels of ammonium, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin. Autoimmune Hepatitis Type-II (AH-II) was the initial diagnosis based on a liver kidney microsomal type 1 antibodies (LKM-1) positive result, and twenty days later a liver transplant was performed. The liver histopathology had indicated hemorrhagic necrosis in zone 3, and cholestasis and nodular regeneration, which were not characteristic of AH-II. LC/ESI-HRMS (liquid chromatography electrospray ionization high-resolution mass spectrometry) analysis of MCs in the explanted liver revealed the presence of Microsytin-LR (MC-LR) (2.4 ng•gr −1 tissue) and [D-Leu 1 ]MC-LR (75.4 ng•gr −1 tissue), which constitute a toxicological nexus and indicate a preponderant role of microcystins in the development of fulminant hepatitis.
Boletín médico del Hospital Infantil de México, 1984
Revista de la Facultad de Ciencias Médicas (Córdoba, Argentina), 2011
To determine whether changes related to age in gastroesophageal reflux (GER) in infants and child... more To determine whether changes related to age in gastroesophageal reflux (GER) in infants and children are due to acid, non acid reflux or both, as determined by 24 hr pH probe (pH) and Multichannel Intraluminal Impedance (MII). Tracings of simultaneous pH-MII from 243 infants and children who presented with either digestive or respiratory symptoms attributable to GER were reviewed and analyzed using Mann-Whitney U test. The number of GER episodes recorded was similar among children with predominantly gastrointestinal and those with respiratory symptoms. A significantly higher total number of GER episodes was observed by pH probe and MII in children under 22.8 mos of age compared with those who were older (median 159 vs. 110.5, p = 0.002). There was no significant change with age of acid reflux (AR) parameters. The changes observed were due to the significant decrease of non AR for all parameters measured, regardless of the presenting symptom. The decrease in GER parameters that is ob...
Journal of Pediatric Gastroenterology and Nutrition, 1988
ABSTRACT A simple micromethod is described for estimating the stool fat content of newborn babies... more ABSTRACT A simple micromethod is described for estimating the stool fat content of newborn babies. It is quick and reliable, requires only a small amount of stool, and can be used as a screening test for newborn babies suspected of fat malabsorption.
Journal of Pediatric Gastroenterology and Nutrition, 2006
Background: The relationship between the increased intestinal permeability observed in several ac... more Background: The relationship between the increased intestinal permeability observed in several acute and chronic diseases and the expression of tight junctions (TJ) proteins is not well established. Our aim was to investigate the expression at transcriptional level of 3 transmembrane TJ proteins, Occludin, Claudin-1, Claudin-2 and of 2 scaffold TJ proteins, zonula occludens-1 (ZO-1) and Myosin 9B in intestinal biopsies from patients affected by celiac disease (CD), Crohn's disease (CrD), peptic ulcer disease (PUD) and type 1 diabetes (IDDM). Methods: Samples of small intestinal mucosa were taken from the second/third portion of the duodenum from all the subjects studied. After total RNA extraction and cDNA synthesis, quantitative real time polymerase chain reaction assays with SYBR Green was performed. Data were normalized by using18S rRNA as standard. Results: Shown in the Table. A significant down-regulation of all 5 genes studied was observed in patients affected by celiac disease before gluten-free diet, while no significant change was observed in IDDM patients. Conclusions: The down-regulation of TJ transmembrane or/and intracellular components observed in all but IDDM might explain the increased intestinal permeability reported in these pathological conditions. The meaning of TJs disruption in the pathogenesis of each of this pathological condition warrants further investigation. The normal transcriptional level observed in celiacs on GFD suggests that the down-regulation of TJs in CD is reversible and secondary to gliadin exposure rather than to a genetic predisposition.
Journal of Pediatric Gastroenterology and Nutrition, 2005
Journal of Pediatric Gastroenterology and Nutrition, 2005
Background: Although IgA endomysial antibodies (EMA) and tissue transglutaminase (TG) are sensiti... more Background: Although IgA endomysial antibodies (EMA) and tissue transglutaminase (TG) are sensitive and specific serologic tests for the diagnosis of celiac disease, there is limited information on the association of the magnitude of antibody level with the severity of the histological abnormalities of the intestine. Purpose: To determine if EMA and TG titers correlate with the severity of histological changes in patients with celiac disease. Methods: We identified 148 children from our laboratory database that had EMA, TG and intestinal biopsies performed. IgA EMA was determined by indirect immunofluorescence with results expressed as a dilutional titer with positivity determined at 1:5. IgA TG was determined by an enzyme linked human immunosorbent ELISA assay with results expressed in standardized units. A modified Marsh histological grading system was used to describe the duodenal biopsies: Type 0 normal, I increased intraepithelial lymphocytes (IEL), II hyperplastic crypts, IIIa partial villus atrophy, IIIb subtotal villus atrophy, IIIc total villous atrophy. Results: Mean values for EMA (Table 1) and TG (Table 2) progressively increased with increasing Marsh score. Conclusion: There was considerable variability in EMA and TG levels for each Marsh grade, so that an individual level could not be utilized to predict histological severity. The data show that as a group, increasing severity of the histological lesion in celiac disease was associated with increased levels of both IgA EMA and TG antibodies.
American Journal of Roentgenology, 1986
During the past 5 years, 104 angiographic studies were performed in 87 petients (45 children and ... more During the past 5 years, 104 angiographic studies were performed in 87 petients (45 children and 42 adufts) with 92 transplanted livers for evaluation of possible vascular complications. Seventy percent of the studies were abnormal. Hepatic artery thrombosis was the most common complication (seen in 42% of children studied, compared with only 12% of adults) and was a major complication that frequently resulted in graft failure, usually necessitating retransplantation. In six children, reconstitution of the intrahepatic arteries by collaterals was seen. Three survived without retranspiant. Arterial stenosis at the anastomosis or in the donor hepatic artery was observed in 11% of patients. Portal vein thrombosis or stenosis occurred in 13% of patients. Two children and one adult with portal vein thrombosis demonstrated hepatopetalcollaterals that reconstituted the intrahepatic portal vessels. Uncommon complications included anastomotic and donor hepatic artery pseudoaneurysms, a hepatic artery-dissecting aneurysm, pancre aticoduodenal mycotic aneurysms, hepatic artery-portal vein fistula, biliary-portal vein fistula, hepatic vein occlusion, and inferior vena cava thrombosis.
Pediatric Hepatology and Liver Transplantation, 2019
LA is a conglomerate of adjacent countries whose official languages (Spanish and Portuguese) evol... more LA is a conglomerate of adjacent countries whose official languages (Spanish and Portuguese) evolved from Latin. Its population represents 8.55% of the total world population. Different levels of medical complexity even within one same country are the main factors that have led to different medical developments. Particular genetics and environmental and socioeconomic factors play a key role in the different characteristics of PLD of this population. The registries of different pathologies are scarce because few countries keep regular records. Over the last decades, NAFLD and NASH have been considered a common cause of liver disease and have emerged as the leading cause of chronic liver disease in children and adolescents. Between 5% and 10% of the pediatric population in LA may be experiencing NAFLD/NASH due to overweight. There is a lack of governmental support, and not all of the countries provide universal health coverage for transplantation, with only eight countries having reported transplantation. Due to a delay in diagnosis and nonavailability of liver transplantation in many countries, a significant proportion of children develop end-stage liver disease and its complications. Transplant registries are still scarce because few countries keep a regular record of donations and transplantation availability. Social and economic disparities within the countries can explain the concentration of LT in centers located in regions with higher economic power. Liver transplantation is mainly related to living donors and is not accessible to a large proportion of the population because of financial constraints and a lack of expertise.
Cardiovascular Drugs and Therapy, 1990
Summary The 24-hour blood pressure (BP) profile of a new sustained-release preparation of nicardi... more Summary The 24-hour blood pressure (BP) profile of a new sustained-release preparation of nicardipine was assessed in 16 patients with essential hypertension (supine cuff diastolic BP>95 mmHg). Twenty-four hour ambulatory intraarterial BP monitoring (Oxford system) before treatment revealed a mean (SD) daytime BP of 174 (19) mmHg systolic and 105 (8) mmHg diastolic, and a mean nighttime BP of 142 (26) mmHg systolic and 83 (12) mmHg diastolic. Sustained release nicardipine (60 mg) was administered twice daily for 4–6 weeks and the ambulatory BP monitoring repeated. No significant change in heart rate occurred throughout the 24-hour period. However, there was a significant reduction (p<0.0001) in the mean daytime BP of 21 (13) mmHg systolic and 12 (9) mmHg diastolic and of mean nighttime BP of 21 (15) mmHg systolic and 13 (11) mmHg diastolic. A similar reduction in hourly mean BP occurred throughout the whole 24-hour period, including the steep early morning rise in BP. Although vasodilatory-type side effects occurred, they were generally mild to moderate and transient. This preparation produces a significant reduction in BP throughout the 24-hour period without reflex tachycardia.
Journal of Pediatric Gastroenterology & Nutrition, 2008
Journal of Pediatric Gastroenterology & Nutrition, 2019
Take-down policy If you believe that this document breaches copyright please contact us providing... more Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.
Clinical Immunology, May 1, 2023
Transplantation direct, Aug 18, 2022
Pediatric Gastroenterology, Hepatology & Nutrition
Purpose: To analyze the characteristics of pediatric inflammatory bowel disease (IBD) over the pa... more Purpose: To analyze the characteristics of pediatric inflammatory bowel disease (IBD) over the past three decades in Argentina and determine if there are differences between the first two decades and the past decade. Methods: We conducted a retrospective multicenter analytical study in children with IBD between 0 and 18 years of age diagnosed between 1987 and 2017 in three tertiary health centers in Argentina. The evaluation included clinical characterization, endoscopy, histology, and imaging data together with therapeutic strategies. The patients were divided into two groups: Group 1, diagnosed between 1987 and 2007, and Group 2, diagnosed between 2008 and 2017. Results: Of the 756 patients included, 409 (54%) had ulcerative colitis (UC), 250 (33%) had Crohn's disease (CD), and 97 (13%) had IBD-unclassified (IBD-U). The positive family history was 3.8%, which was more frequent among children under two years of age (6.7%). There were no significant differences in clinical presentation and extraintestinal manifestations between periods, with hepatic manifestations being the most frequent. In the last decade, we found an upward trend in CD, a downward trend in UC/IBD-U, even after adjustment for socioeconomic status, and a decrease of 50% in surgical treatments coinciding with the advent of biological therapy. Conclusion: This is the first multicenter cohort study in a Latin American country to describe clinical, endoscopic, and therapeutic data across the past 30-year period. Although CD was responsible for the overall increase in incidence, UC was still prevalent in this region.
Objectives: To determine whether changes related to age in gastroesophageal reflux (GER) in infan... more Objectives: To determine whether changes related to age in gastroesophageal reflux (GER) in infants and children are due to acid, non acid reflux or both, as determined by 24 hr pH probe (pH) and Multichannel Intraluminal Impedance (MII). Methods: Tracings of simultaneous pH-MII from 243 infants and children who presented with either digestive or respiratory symptoms attributable to GER were reviewed and analyzed using Mann-Whitney U test. Results: The number of GER episodes recorded was similar among children with predominantly gastrointestinal and those with respiratory symptoms. A significantly higher total number of GER episodes was observed by pH probe and MII in children under 22.8 mos of age compared with those who were older (median 159 vs. 110.5, p = 0.002). There was no significant change with age of acid reflux (AR) parameters. The changes observed were due to the significant decrease of non AR for all parameters measured, regardless of the presenting symptom. Conclusions...
Pediatrics, 2019
Juvenile polyposis syndrome is a rare autosomal dominant condition characterized by multiple hama... more Juvenile polyposis syndrome is a rare autosomal dominant condition characterized by multiple hamartomatous polyps throughout the gastrointestinal tract. Juvenile polyposis of infancy is a generalized severe form of juvenile polyposis syndrome associated with a poor prognosis. A 47-month-old female infant presented initially with gastrointestinal bleeding and protein-losing enteropathy at 4 months of age. At the age of 12 months, the condition worsened, requiring albumin infusions every 24 to 48 hours and red blood cell transfusions every 15 days. Upper gastrointestinal endoscopy, colonoscopy, and small-bowel enteroscopy revealed diffuse polyposis that was treated with multiple endoscopic polypectomies. Despite subtotal colectomy with ileorectal anastomosis, protein-losing enteropathy and bleeding persisted, requiring continued blood transfusions and albumin infusions. A chromosomal microarray revealed a single allele deletion in chromosome 10q23, involving both the PTEN and BMPR1A g...
Archivos argentinos de pediatria, 2017
Drug- and substance-induced liver injury accounts for approximately 20% of pediatric cases of acu... more Drug- and substance-induced liver injury accounts for approximately 20% of pediatric cases of acute liver failure. It is caused by two mechanisms: direct and idiosyncratic hepatotoxicity. Direct hepatotoxicity is the result of the administration of a drug with intrinsic toxicity and is dose-dependent (e.g., acetaminophen). Idiosyncratic hepatotoxicity is unpredictable, uncommon, variable in presentation, and doseindependent. The clinical, histological, and laboratory manifestations include hepatitis, which is generally asymptomatic but with a significant increase of liver enzymes; cholestasis, accompanied with jaundice, pruritus, prominent elevation of alkaline phosphatase, and mild elevation of aminotransferases; or mixed, with elements of both hepatitis and cholestasis. Time to recovery is variable, depending on the type of liver injury. Early detection and discontinuation of the causative drug is the most effective and important step for the fast resolution of histological and cl...
Toxins, 2017
In January 2015, a 20-month-old child and her family took part in recreational activities at Carr... more In January 2015, a 20-month-old child and her family took part in recreational activities at Carrasco and Malvín beaches (Montevideo, Uruguay). An intense harmful algae bloom (HAB) was developing along the coast at that time. A few hours after the last recreational exposure episode, the family suffered gastrointestinal symptoms which were self-limited except in the child's case, who was admitted to hospital in Uruguay with diarrhea, vomiting, fatigue, and jaundice. The patient had increased serum levels of liver enzymes and bilirubin and five days later presented acute liver failure. She was referred to the Italian Hospital in Buenos Aires, being admitted with grade II-III encephalopathy and hepatomegaly and requiring mechanical respiratory assistance. Serology tests for hepatitis A, B, and C, Epstein-Barr virus, and cytomegalovirus were negative. Laboratory features showed anemia, coagulopathy, and increased serum levels of ammonium, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin. Autoimmune Hepatitis Type-II (AH-II) was the initial diagnosis based on a liver kidney microsomal type 1 antibodies (LKM-1) positive result, and twenty days later a liver transplant was performed. The liver histopathology had indicated hemorrhagic necrosis in zone 3, and cholestasis and nodular regeneration, which were not characteristic of AH-II. LC/ESI-HRMS (liquid chromatography electrospray ionization high-resolution mass spectrometry) analysis of MCs in the explanted liver revealed the presence of Microsytin-LR (MC-LR) (2.4 ng•gr −1 tissue) and [D-Leu 1 ]MC-LR (75.4 ng•gr −1 tissue), which constitute a toxicological nexus and indicate a preponderant role of microcystins in the development of fulminant hepatitis.
Boletín médico del Hospital Infantil de México, 1984
Revista de la Facultad de Ciencias Médicas (Córdoba, Argentina), 2011
To determine whether changes related to age in gastroesophageal reflux (GER) in infants and child... more To determine whether changes related to age in gastroesophageal reflux (GER) in infants and children are due to acid, non acid reflux or both, as determined by 24 hr pH probe (pH) and Multichannel Intraluminal Impedance (MII). Tracings of simultaneous pH-MII from 243 infants and children who presented with either digestive or respiratory symptoms attributable to GER were reviewed and analyzed using Mann-Whitney U test. The number of GER episodes recorded was similar among children with predominantly gastrointestinal and those with respiratory symptoms. A significantly higher total number of GER episodes was observed by pH probe and MII in children under 22.8 mos of age compared with those who were older (median 159 vs. 110.5, p = 0.002). There was no significant change with age of acid reflux (AR) parameters. The changes observed were due to the significant decrease of non AR for all parameters measured, regardless of the presenting symptom. The decrease in GER parameters that is ob...
Journal of Pediatric Gastroenterology and Nutrition, 1988
ABSTRACT A simple micromethod is described for estimating the stool fat content of newborn babies... more ABSTRACT A simple micromethod is described for estimating the stool fat content of newborn babies. It is quick and reliable, requires only a small amount of stool, and can be used as a screening test for newborn babies suspected of fat malabsorption.
Journal of Pediatric Gastroenterology and Nutrition, 2006
Background: The relationship between the increased intestinal permeability observed in several ac... more Background: The relationship between the increased intestinal permeability observed in several acute and chronic diseases and the expression of tight junctions (TJ) proteins is not well established. Our aim was to investigate the expression at transcriptional level of 3 transmembrane TJ proteins, Occludin, Claudin-1, Claudin-2 and of 2 scaffold TJ proteins, zonula occludens-1 (ZO-1) and Myosin 9B in intestinal biopsies from patients affected by celiac disease (CD), Crohn's disease (CrD), peptic ulcer disease (PUD) and type 1 diabetes (IDDM). Methods: Samples of small intestinal mucosa were taken from the second/third portion of the duodenum from all the subjects studied. After total RNA extraction and cDNA synthesis, quantitative real time polymerase chain reaction assays with SYBR Green was performed. Data were normalized by using18S rRNA as standard. Results: Shown in the Table. A significant down-regulation of all 5 genes studied was observed in patients affected by celiac disease before gluten-free diet, while no significant change was observed in IDDM patients. Conclusions: The down-regulation of TJ transmembrane or/and intracellular components observed in all but IDDM might explain the increased intestinal permeability reported in these pathological conditions. The meaning of TJs disruption in the pathogenesis of each of this pathological condition warrants further investigation. The normal transcriptional level observed in celiacs on GFD suggests that the down-regulation of TJs in CD is reversible and secondary to gliadin exposure rather than to a genetic predisposition.
Journal of Pediatric Gastroenterology and Nutrition, 2005
Journal of Pediatric Gastroenterology and Nutrition, 2005
Background: Although IgA endomysial antibodies (EMA) and tissue transglutaminase (TG) are sensiti... more Background: Although IgA endomysial antibodies (EMA) and tissue transglutaminase (TG) are sensitive and specific serologic tests for the diagnosis of celiac disease, there is limited information on the association of the magnitude of antibody level with the severity of the histological abnormalities of the intestine. Purpose: To determine if EMA and TG titers correlate with the severity of histological changes in patients with celiac disease. Methods: We identified 148 children from our laboratory database that had EMA, TG and intestinal biopsies performed. IgA EMA was determined by indirect immunofluorescence with results expressed as a dilutional titer with positivity determined at 1:5. IgA TG was determined by an enzyme linked human immunosorbent ELISA assay with results expressed in standardized units. A modified Marsh histological grading system was used to describe the duodenal biopsies: Type 0 normal, I increased intraepithelial lymphocytes (IEL), II hyperplastic crypts, IIIa partial villus atrophy, IIIb subtotal villus atrophy, IIIc total villous atrophy. Results: Mean values for EMA (Table 1) and TG (Table 2) progressively increased with increasing Marsh score. Conclusion: There was considerable variability in EMA and TG levels for each Marsh grade, so that an individual level could not be utilized to predict histological severity. The data show that as a group, increasing severity of the histological lesion in celiac disease was associated with increased levels of both IgA EMA and TG antibodies.
American Journal of Roentgenology, 1986
During the past 5 years, 104 angiographic studies were performed in 87 petients (45 children and ... more During the past 5 years, 104 angiographic studies were performed in 87 petients (45 children and 42 adufts) with 92 transplanted livers for evaluation of possible vascular complications. Seventy percent of the studies were abnormal. Hepatic artery thrombosis was the most common complication (seen in 42% of children studied, compared with only 12% of adults) and was a major complication that frequently resulted in graft failure, usually necessitating retransplantation. In six children, reconstitution of the intrahepatic arteries by collaterals was seen. Three survived without retranspiant. Arterial stenosis at the anastomosis or in the donor hepatic artery was observed in 11% of patients. Portal vein thrombosis or stenosis occurred in 13% of patients. Two children and one adult with portal vein thrombosis demonstrated hepatopetalcollaterals that reconstituted the intrahepatic portal vessels. Uncommon complications included anastomotic and donor hepatic artery pseudoaneurysms, a hepatic artery-dissecting aneurysm, pancre aticoduodenal mycotic aneurysms, hepatic artery-portal vein fistula, biliary-portal vein fistula, hepatic vein occlusion, and inferior vena cava thrombosis.
Pediatric Hepatology and Liver Transplantation, 2019
LA is a conglomerate of adjacent countries whose official languages (Spanish and Portuguese) evol... more LA is a conglomerate of adjacent countries whose official languages (Spanish and Portuguese) evolved from Latin. Its population represents 8.55% of the total world population. Different levels of medical complexity even within one same country are the main factors that have led to different medical developments. Particular genetics and environmental and socioeconomic factors play a key role in the different characteristics of PLD of this population. The registries of different pathologies are scarce because few countries keep regular records. Over the last decades, NAFLD and NASH have been considered a common cause of liver disease and have emerged as the leading cause of chronic liver disease in children and adolescents. Between 5% and 10% of the pediatric population in LA may be experiencing NAFLD/NASH due to overweight. There is a lack of governmental support, and not all of the countries provide universal health coverage for transplantation, with only eight countries having reported transplantation. Due to a delay in diagnosis and nonavailability of liver transplantation in many countries, a significant proportion of children develop end-stage liver disease and its complications. Transplant registries are still scarce because few countries keep a regular record of donations and transplantation availability. Social and economic disparities within the countries can explain the concentration of LT in centers located in regions with higher economic power. Liver transplantation is mainly related to living donors and is not accessible to a large proportion of the population because of financial constraints and a lack of expertise.