Journal of pediatric gastroenterology and nutrition
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J. Pediatr. Gastroenterol. Nutr. · Feb 2009
High-titer antibody to hepatitis B surface antigen before liver transplantation can prevent de novo hepatitis B infection.
De novo hepatitis B virus (HBV) infection is defined as infection occurring in HBV surface antigen (HBsAg)-negative patients who become HbsAg positive after organ transplantation. We assessed the incidence and risk factors of de novo HBV infection in pediatric liver transplant recipients. ⋯ In the absence of adequate prophylaxis, the incidence of de novo HBV infection in pediatric OLT recipients is 15.3%. An anti-HBs titer of >200 mIU/mL before OLT may be sufficient to prevent de novo HBV infection in HBsAg-negative recipients.
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J. Pediatr. Gastroenterol. Nutr. · Nov 2008
Effects of infliximab and parenteral nutrition on albumin and fibrinogen synthesis rates in pediatric Crohn disease.
Tumor necrosis factor-alpha (TNF-alpha) may play a significant role in growth disturbance in pediatric Crohn disease. The aim of this study was to determine the effects of anti-TNF-alpha therapy on albumin and fibrinogen synthesis during both fasting and parenteral nutrition infusion in pediatric patients with active Crohn disease. ⋯ Following infliximab therapy, during parenteral nutrition infusion, albumin synthesis increased significantly. Conversely, serum fibrinogen levels decreased following infliximab therapy in the absence of significant change in synthesis rates.
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Liver transplantation in infants younger than 90 days is increasingly common. These infants typically arrive for transplantation in fragile medical condition. It is commonly assumed that they may experience high complication rates, difficult postoperative courses, and poor graft and patient survival. ⋯ Young infants experience graft and patient survival similar to that in older cohorts of liver transplant recipients. Posttransplant complication rates, including the reoperation rate, were higher in this younger group, and the duration of hospitalization and intensive support were significantly longer. Future studies to better examine the factors, including age, that may contribute to the need for reoperation in children are warranted. Recognition and further analysis of the cost of care in this age group is also needed.
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J. Pediatr. Gastroenterol. Nutr. · Sep 2008
Compliance with gluten-free diet in children with coeliac disease.
Coeliac disease (CD) is a lifelong disorder with gluten-induced manifestations in different organs. Gluten-free diet (GFD) is required to achieve remission and prevent complications; however, study reports on GFD growth effect are not consistent. ⋯ Almost half of the coeliac patients were likely to abandon GFD without experiencing major symptoms, thus increasing the risk for developing complications later in life. An active attitude is required in the follow-up of patients with CD.
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Clinical trials use scientific methods to evaluate the effectiveness and safety of treatments or other interventions. Trials should have both internal and external validity, and a well-conducted randomised controlled trial is considered to be the most powerful tool for evaluating interventions. ⋯ In an internally valid trial, external validity refers to the ability of the results to be generalised to the "real world" population. Issues to consider in determining the external validity of a study include the setting of the trial, the study population, the types of interventions used, duration of follow-up, and the types of outcome and how they were assessed.