ResumoObjetivo: verificar os níveis plasmáticos de vitamina D de pacientes colestáticos crônicos e relacionar com estado nutricional, tempo de colestase e uso de suplemento vitamínico.Métodos: estudo transversal controlado, cujo fator em estudo é colestase crônica e o desfecho, o nível plasmático de vitamina D. Pacientes entre quatro meses a 18 anos, atendidos na unidade de gastroenterologia pediátrica do HCPA; como controles, crianças eutróficas da mesma faixa etária. Foi coletado sangue para as dosagens por radioimunoensaio, e realizadas avaliação antropomé-trica, pesquisa de tempo de colestase e uso de suplemento vitamínico.Resultados: foram avaliadas 22 crianças e adolescentes com colestase crônica e 17 controles. O valor médio de vitamina D entre os pacientes foi de 13,7 ± 8,39 ng/ml, enquanto que nos controles foi de 25,58 ± 16,73 ng/ml (p= 0,007). A prevalência de hipovitaminose D, entre os pacientes, foi de 36%. A mediana do tempo de colestase foi de um ano. A avaliação antropométrica (NCHS) demonstrou 36% de desnutrição pelo peso, e 41% para estatura. Na avaliação antropométrica pelo escore z, obtivemos prevalência de desnutrição para os critérios altura/idade e peso/idade de 33,3% e 23,8%, respectivamente. Avaliado peso em relação altura, não observamos valores abaixo de dois desvios padrão. Não foi observada relação entre o estado nutricional, o uso de suplemento oral e os níveis plasmáticos de vitamina D Conclusões: os níveis plasmáticos de vitamina D em colestáti-cos foram menores do que os dos controles, sem relação com estado nutricional, tempo de colestase e/ou uso suplementação vitamínica. AbstractObjective: to verify blood levels of vitamin D in patients with chronic cholestasis, and relate them to nutritional status, length of time since the onset of cholestasis and use of vitamin supplement.Methods: controlled cross-sectional study with chronic cholestasis as study factor and blood levels of vitamin D as outcome. The study included patients aged between 4 months and 18 years, who were cared for at the Pediatric Gastroenterology Unit of Hospital de Clínicas de Porto Alegre. Controls were eutrophic children in the same age range. Blood was collected for radioimmunoassay. Anthropometric analyses were performed, as was determination of the length of time since the onset of cholestasis and use of vitamin supplement.Results: twenty-two patients and 17 controls were evaluated. Average vitamin D level in patients was 13.7 ± 8.39 ng/ml, compared to 25.58 ± 16.73 ng/ml in controls (p = 0.007). Prevalence of hypovitaminosis D in patients was 36%. Median of period of time since the onset of cholestasis was 1 year with variation of 6 months to the 25th percentile and 3.9 years to the 75th percentile. Anthropometric evaluation (NCHS) showed 36% of malnutrition by weight and 41% by height. Anthropometric evaluation according to Z score showed 33.3% and 23.8% prevalence of malnutrition for the criteria height/age and weight/age, respectively. The evaluation of weight regarding height did not show values bel...

Background Serological screening for celiac disease (CD) allows the identification of individuals genetically predisposed, as type 1 diabetes mellitus (T1DM). However, the diagnosis is confirmed by intestinal biopsy. The aim was to determine the prevalence of immunoglobulin‐A anti‐tissue transglutaminase antibodies (IgA‐tTG) and CD in a large cohort of young T1DM patients. Methods Screening for CD was randomly conducted in 881 T1DM by IgA‐tTG and total IgA. Individuals with positive antibodies were referred to endoscopy/duodenal biopsy. Results The age of the cohort at the screening was 14.3 ± 5.9 years and at T1DM onset was 7.9 ± 4.4 years. The prevalence of positive serology was 7.7%. Median IgA‐tTG levels were 117.7 U/mL (interquartile range [IQR] 35.7‐131.5 U/mL). Of the 62 duodenal biopsy, CD was diagnosed in 79.0%, yielding an overall prevalence of 5.6%. The mean age of CD patients was 15.6 ± 6.5 years and, at T1DM onset was 6.3 years (4.0‐9.9 years). The modified Marsh‐Oberhuber histological classification was 22.5% (3a), 36.7% (3b), and 40.8% (3c). In the biopsy‐proven patients, T1DM onset occurred at slightly younger ages (6.3 vs 9.7 years, P = 0.1947), gastrointestinal (GI) manifestations, predominantly abdominal pain and distension, were more prevalent (71.4% vs 38.5%, P = 0.027) and higher IgA‐tTG titers (128.0 vs 26.3 U/mL, P = 0.0003) were found than in those with negative‐biopsies. Conclusion Our results demonstrate the prevalence of 7.7% of IgA‐tTG and 5.6% of CD in T1DM patients in South Brazil and, emphasize the importance of the screening in high‐risk individuals. Furthermore, the presence of GI manifestations and higher IgA‐tTG titers strongly suggest the diagnosis of CD.

Blood levels of vitamin D in patients with cholestasis were lower than those of controls, but were not related to nutritional status, period of time since the onset of cholestasis or use of vitamin supplement.

AIMS: To validate the Brazilian version of the Fresno test of competence in Evidence-Based Medicine.METHODS: This is a cross-sectional, validation study. Phase 1: translation of the Fresno instrument. Phase 2: validation of the translated version, which was tested in 70 undergraduate medical students. The psychometric properties evaluated were validity, internal consistency, and sensitivity to change.RESULTS: Overall, validity was adequate; most items showed a moderate to strong and significant correlation with the total score; there was an important and significant difference between both groups, with and without previous contact with Evidence-Based Medicine (median, 55 [IQ25-75, 45.2-61.7] vs. median, 18.5 [IQ25-75, 6.0-29.7]) (p <0.001). Internal consistency was also adequate (α-C 0.718), and sensitivity to change showed a considerable and significant difference between pre and post-test (median, 18.5 [IQ25-75, 6.0-29.7] vs. median, 44 [IQ25-75, 34.0-60.0]) (p <0.001).CONCLUSIONS: The Brazilian version of the Fresno test showed satisfactory psychometric properties, and it can now be used as a tool to assess the knowledge and skills of Evidence-Based Medicine in Brazilian medical students.