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The Global Burden of Disease Study 2010 (GBD 2010) is the largest ever systematic effort to describe the global distribution and causes of a wide array of major diseases, injuries, and health risk factors. The results show that infectious diseases, maternal and child illness, and malnutrition now cause fewer deaths and less illness than they did twenty years ago. As a result, fewer children are dying every year, but more young and middleaged adults are dying and suffering from diseases and injuries, as non-communicable diseases, such as cancer and heart disease, become the dominant causes of death and disability worldwide. Since 1970, men and women worldwide have gained slightly more than ten years of life expectancy overall, but they spend more years living with injury and illness. Blood pressure is the biggest global risk factor for disease, followed by tobacco, alcohol, and poor diet, but child undernutrition and suboptimal breastfeeding remain a key risk factor in sub-Saharan Africa and southeast Asia, where reproductive, newborn, and child diseases remain the top causes of mortality.

Benelli E.,University of Trieste | Ronfani L.,Servizio di Epidemiologia e Biostatistica | Radillo O.,Laboratorio Of Immunopatologia Clinica | Martelossi S.,University of Trieste | Ventura A.,University of Trieste
Medico e Bambino | Year: 2011

Introduction - Intestinal biopsy is still considered the referral test for definitive diagnosis of coeliac disease. Nevertheless, according to the new ESPGHAN guidelines, it seems that avoiding the intestinal biopsy in few selected cases could be an option. Aims and methods - The main aim of the study was to assess, by means of a systematic review of the literature, whether there is enough evidence to assert that coeliac disease can be diagnosed without recurring to the intestinal biopsy at least in those cases with overt symptoms and positive anti-tTG or EMA antibodies. Secondly, the Authors estimated the predictive value of positive anti-tTG and EMA IgA in clinical practice, through a retrospective analysis of a population directly accessing the laboratory of the IRCCS "Burlo Garofolo"(anti-tTG and EMA blood tests being prescribed by the general practitioner). Finally, analyzing the cases in their Institute, the Authors estimated how many coeliac patients could be diagnosed without intestinal biopsy, by applying the new protocol. Results - From the analysis of the literature (1820 papers initially selected) anti-tTG and EMA IgA resulted having a 100% specificity in the diagnosis of coeliac disease in overtly symptomatic children. Also from the analysis of the population selected through the Institute's laboratory, the predictive value of concomitant positivity of anti-tTG and EMA IgA resulted practically absolute: 100% in children with typical symptoms, 97% in children without typical symptoms. By applying the new protocol, 50% of the children diagnosed in the Institute in the past 5 years could have received the diagnosis without biopsy. Conclusions - In children with overt symptoms and high titre anti-tTG and EMA IgA, the diagnosis of coeliac disease may be certain even without biopsy. Prospective studies are needed in order to evaluate the effects of the new protocol in terms of costs and of quality of the management of coeliac patients.

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