Symptomatic Solitary Gastric Diverticulum: A Rare Endoscopic Finding

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Alergia alimentar a frutos em crianças: estudos in vivo e in vitro

Introdução. A prevalência da alergia alimentar tem vindo a aumentar nas últimas décadas. Na população pediátrica, o seu conhecimento é ainda escasso, principalmente em Portugal. Material e Metodologia. Estudo analítico transversal de uma população pediátrica, dos 3-11 anos, inscrita nas escolas da Cova da Beira. Inicialmente, foi aplicado um questionário preliminar para avaliar a presença de reacção adversa a alimentos. Posteriormente, as crianças com questionário positivo para os frutos frescos foram avaliadas em consulta, para aplicação de um questionário alargado e, realização de testes de hipersensibilidade in vivo e in vitro para os frutos suspeitos e alergénios com reactividade cruzada para frutos (látex e pólenes). Resultados. Por questionário, a prevalência das reacções adversas a frutos foi 3-5 vezes superior à da Alergia Alimentar a Frutos (AAF) propriamente dita. A frequência da AAF foi de 0,53% (IC 95% [0,24;0,82]). Os frutos mais implicados foram o kiwi e o pêssego. A clínica predominante foi a de reacção imediata, unissintomática e mucocutânea localizada, nomeadamente a Síndrome de alergia oral. Os frutos apresentaram elevada sensibilização cruzada com o látex e os pólenes. Conclusão. A frequência da AAF foi semelhante à de outros países europeus. Na Cova da Beira, os frutos frescos foram o principal grupo alimentar envolvido na alergia alimentar para a faixa etária pediátrica. Este estudo contribuiu para o conhecimento epidemiológico desta região de Portugal, no sentido de melhorar as abordagens diagnóstica e terapêutica futuras.Background. The prevalence of food allergy has been increasing, mainly in the past few decades. In paediatric population, knowledge about this issue is currently scarce, namely in Portugal. Materials and Methods. Cross-sectional study of a paediatric population, with an age range between 3 and 11 years, from Cova da Beira schools. A preliminary questionnaire was initially applied to assess the presence of any adverse food reactions. Children with a positive questionnaire for fresh fruits were observed in an outpatient clinic at the hospital, where an extended questionnaire was applied and, in vitro and in vivo hypersensitivity tests were performed with the suspected fruit. Cross-reactivity between fruits and latex and, fruits and pollen allergens was also determined. Results. Based upon the questionnaire, the prevalence of adverse reactions to fresh fruits was 3 to 5 times more frequent than that of actual Allergy to Fresh Fruits (AFF). The frequency of AFF was 0.53% (CI 95% [0.24;0.82]). Peach and Kiwi fruit were the most frequently implicated fresh fruits. The most frequently reported clinical feature of AFF was that of an immediate type, monosymptomatic reaction consisting of localized mucocutaneous expression, mainly the oral allergy syndrome. Fresh fruits showed a high degree of crossreactivity with latex and pollen allergens. Conclusion. The prevalence of AFF was similar to that observed in other European countries. In Cova da Beira, fresh fruits were the most frequently involved foodstuff in a paediatric population. This study contributed towards increasing epidemiological knowledge about this problem in this area of Portugal, with a view to improve upon diagnostic and management approaches to this type of allergy

A Rare Clinical Presentation of Cholangiocarcinoma

Cholangiocarcinoma is an uncommon tumor, often diagnosed in the context of obstructive jaundice. Brain metastasis rarely occurs with the cerebellum being a rare site of spread of this type of tumor. Few cases of cholangiocarcinoma have been reported in the literature and this type of tumor is associated with a very poor outcome. We present a very rare form of clinical presentation of cholangiocarcinoma with neurologic symptoms due to cerebellar metastases

Lysosomal Acid Lipase: Can it be a New Non-Invasive Serum Biomarker of Cryptogenic Liver Fibrosis and Cirrhosis?

Introduction and aim. The association between lysosomal acid lipase (LAL) activity and liver steatosis or fibrosis is poorly studied. The aim of our study was to determine the predictive power of LAL for cryptogenic liver steatosis and cryptogenic significant fibrosis/cirrhosis.Material and methods. Cross-sectional observational study of 101 adult patients with unexplained elevated liver enzymes/hepatomegaly with or without dyslipidemia submitted to the determination of LAL activity and LIPA gene (E8SJM-C.894G^A) mutation. Seventy-one patients underwent liver biopsy or FibroScan®. Patients with an identifiable liver dysfunction cause and well-stablished NAFLD/NASH risk factors were excluded. Predictors for liver steatosis, significant fibrosis (> F2) or cirrhosis (F4) were evaluated.Results. Liver steatosis and fibrosis were mainly assessed by liver biopsy (74.6%; n = 53). Steatosis was present in 62.0% (n = 44), significant fibrosis in 47.9% (n = 34) and cirrhosis in 39.4% (n = 28). The median LAL was 0.36 (0.21-0.46)nmol/spot/h (vs. 0.29 (0.20-0.47); p = 0.558) for liver steatosis, 0.22 (0.11-0.29) nmol/spot/h (vs. 0.40 (0.34-0.51); p <0.001) for significant fibrosis and 0.21 (0.11-0.27) nmol/spot/h (vs. 0.40 (0.32-0.52); p < 0.001) for cirrhosis. No LIPA gene mutations were found. LAL activity was the strongest predictor of significant fibrosis (AUROC: 0.833; p < 0.001) with a cut-off of 0.265 (sensitivity: 85.9%; specificity: 75.0%) and cirrhosis (AUROC: 0.859; p < 0.001) with a cut-off of 0.235 (sensitivity: 86.2%; specificity: 75.0%), being higher than FIB4, GUCI or APRI. However, LAL activity was not associated with liver steatosis (AUROC: 0.536; p =0.558).Conclusion. LAL activity can be considered a non-invasive new marker of cryptogenic liver fibrosis with higher accuracy than other known biomarkers. LAL activity < 0.265 nmol/spot/h was strongly associated with cryptogenic significant fibrosis and <0.235 nmol/spot/h with cryptogenic cirrhosis. LAL activity was not associated with cryptogenic liver steatosis

Red cell distribution width and red cell distribution width to total serum calcium ratio as major predictors of severity and mortality in acute pancreatitis

Abstract Background Acute pancreatitis (AP) is associated with considerable morbidity and mortality. Current severity scores include multiple variables and some of them are only complete within 48 h of admission. Red cell distribution width (RDW) is a simple and routine parameter that seems to be related to inflammatory status. Our aims were to evaluate the diagnostic value of RDW in severity and mortality of AP comparing with other prognostic scoring systems. Methods Retrospective case-control study of a total of 312 patients with AP admitted between 2014 and 2016. Patients with severe AP (cases) were compared with patients with mild AP (controls) in the 1:1 proportion. Additionally, a comparison between survivor and nonsurvivor AP patients was performed. Diagnosis and severity of AP were defined according to the revised Atlanta classification 2012. Variables evaluated included demographics, comorbidities, hospital stay, laboratorial parameters, arterial blood gas analysis, prognostic scores within 24 h of admission (Ranson, BISAP and Modified Marshall) and mortality. Results Included 91 cases of severe AP, most males (58.2% vs 51.6%; p = 0.228) with mean age of 64.8 ± 16.3 years (vs 67.9 ± 13.7; p = 0.239). RDW0h was higher in patients with severe AP (14.6 ± 1.3 vs 12.7 ± 0.5; p  13.0 and RDW0h-to-total serum calcium ratio > 1.4 were excellent predictors for severity and RDW0h > 14.0 and RDW0h-to-total serum calcium ratio > 1.7 were very-good predictors for mortality, being superior to conventional prognostic scoring systems