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The significance of constitutional values
HN Nisihara
Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad , 2001,
Abstract:
The significance of constitutional values
HN Nisihara
Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad , 2001,
Abstract: This article addresses the question of the meaning and legal significance of constitutional values in contemporary times. The article attends also to related questions namely, what constitute “constitutional values” and what are the limitations of the meaning afforded to this notion. Attention is paid in the particular, to freedom, equality and democracy as value-neutral criteria of fairness and government neutrality with reference to the South African and German contexts as well as to value-neutrality as a culturally conditioned value. The author concludes with a cosmopolitan view of freedom and the right to peace with reference to the constitutional texts of Japan and the United States.
Celiac disease screening in patients with scleroderma
Nisihara, Renato;Utiyama, Shirley Rosa;Azevedo, Pedro Ming;Skare, Thelma Larocca;
Arquivos de Gastroenterologia , 2011, DOI: 10.1590/S0004-28032011000200014
Abstract: both celiac disease and scleroderma have autoimmune etiology and affect the bowel causing diarrhea. as an association of autoimmune disease in a single individual is not rare, it is important to know if a patient with scleroderma may also have celiac disease. to analyze this we studied 105 scleroderma patients and 97 volunteers for iga-ema by indirect immunofluorescence assay. we could not find a higher prevalence of this autoantibody in scleroderma patients. the authors conclude that there is no need to screen scleroderma patients with diarrhea for celiac disease unless there is a clear clinical indication for this.
A Brazilian experience of the self transglutaminase-based test for celiac disease case finding and diet monitoring
Lorete Maria da Silva Kotze, Ana Paula Brambila Rodrigues, Luiz Roberto Kotze, Renato Mitsunori Nisihara
World Journal of Gastroenterology , 2009,
Abstract: AIM: To evaluate the effectiveness of a rapid and easy fingertip whole blood point-of-care test for celiac disease (CD) case finding and diet monitoring.METHODS: Three hundred individuals, 206 females (68.7%) and 94 males (31.3%), were submitted to a rapid and easy immunoglobulin-A-class fingertip whole blood point-of-care test in the doctor’s office in order to make immediate clinical decisions: 13 healthy controls, 6 with CD suspicion, 46 treated celiacs, 84 relatives of the celiac patients, 69 patients with dyspepsia, 64 with irritable bowel syndrome (IBS), 8 with Crohn’s disease and 9 with other causes of diarrhea.RESULTS: Upper gastrointestinal endoscopy with duodenal biopsies was performed in patients with CD suspicion and in individuals with positive test outcome: in 83.3% (5/6) of the patients with CD suspicion, in 100% of the patients that admitted gluten-free diet transgressions (6/6), in 3.8% of first-degree relatives (3/79) and in 2.9% of patients with dyspepsia (2/69). In all these individuals duodenal biopsies confirmed CD (Marsh’s histological classification). The studied test showed good correlation with serologic antibodies, endoscopic and histological findings.CONCLUSION: The point-of-care test was as reliable as conventional serological tests in detecting CD cases and in CD diet monitoring.
Compara o dos anticorpos anti-reticulina e antiendomísio classe IGA para diagnóstico e controle da dieta na doen a celíaca
KOTZE Lorete Maria da Silva,UTIYAMA Shirley Ramos da Rosa,NISIHARA Renato Mitsunori,MOCELIN Valmir
Arquivos de Gastroenterologia , 1999,
Abstract: Sensibilidade ao glúten é um estado de elevada resposta iamunológica (celular e humoral) à ingest o de proteínas do glúten do trigo, centeio, cevada e aveia, em indivíduos geneticamente predispostos. A doen a celíaca é sua express o mais freqüente, variando as formas de apresenta o. Tem como tratamento a exclus o de alimentos contendo as gliadinas tóxicas. Embora a biopsia do intestino delgado proximal seja necessária, tem-se ressaltado a importancia de testes sorológicos no rastreamento, diagnóstico e monitoriza o da dieta isenta de glúten em pacientes com doen a celíaca. O objetivo do presente estudo foi investigar a presen a dos anticorpos antiendomísio (EmA-IgA) e anti-reticulina (ARA-IgA) em 56 pacientes celíacos (17 recém diagnosticados; 24 aderentes à dieta; 15 com transgress o à dieta). Os anticorpos foram detectados por imunofluorescência indireta, utilizando como substrato cord o umbilical humano para os EmA-IgA, fígado e rim de rato para os ARA-IgA. Nos pacientes recém diagnosticados e no grupo com transgress o à dieta houve positividade total de 100% para os EmA-IgA e 59,4% para ARA-IgA. Nos pacientes aderentes à dieta nenhum dos anticorpos foi detectado. Dentre os 32 pacientes positivos, a concordancia foi de 59,4% (19), sendo que 40,6 % (13/32) eram ARA-IgA negativo e EmA-IgA positivo. Nenhum paciente mostrou-se positivo para os ARA-IgA e negativo para os EmA-IgA. Portanto, a sensibilidade para os EmA-IgA foi de 100% e de 59,4% para os ARA-IgA. A associa o dos dois testes n o aumentou os índices de positividade total nas amostras. Conclui-se que, atualmente, a pesquisa dos EmA-IgA pode constituir teste sorológico de escolha, seja para diagnóstico, seja para seguimento dos pacientes celíacos, pelo alto valor preditivo, alta sensibilidade e especificidade e relativo baixo custo quando se utiliza cord o umbilical humano como substrato.
Celiac disease in native Indians from Brazil: A clinical and epidemiological survey
Shirley Ramos da Rosa Utiyama,Jo?o Luis Coelho Ribas,Renato Mitsunori Nisihara,Lorete Maria da Silva Kotze
North American Journal of Medical Sciences , 2010,
Abstract: Background: Celiac disease has been described in populations from around the world, with recent data emphasizing the occurrence of the disease in ethnic minorities. There are only a few studies evaluating celiac disease in native Indians. Aims: This study aimed to screen the anti-endomysial antibody (IgA-EmA) in Kaingang and Guarani Indians from southern Brazil, in order to establish a clinical serological evaluation of celiac disease in these individuals. Material and Methods: Serum samples from 321 individuals (125 male and 196 female; 4-86 years old) from Mangueirinha Indigenous Reserve, State of Parana, Brazil, and 180 non-Indigenous healthy individuals (62 male and 118 female; 2-81 years old) were analysed to the presence of anti-endomysial antibody class IgA by indirect immunofluorescence assay. Amongst the Indians, 158 were Kaingang, 98 Guarani and 65 of mixed race. Indians presenting complaints of diarrhea (N=12) were also evaluated to the IgG class of anti-endomisyal antibody. Results: None of the individuals showed positive results either to IgA or IgG anti-endomysial antibodies. Conclusions: Although the results indicate an absence of celiac disease in Kaingang and Guarani Indians, the authors call attention to the importance of following up indigenous children or adults presenting gastrointestinal complaints or other symptoms related to the disease. Consideration should be given to the genetic background of these individuals, allied to the inter ethnic marriages and the changing habits or occupational activities, that have gradually introduced diseases previously not described in indigenous populations.
Antiendomysium antibodies in brazilian patients with celiac disease and their first-degree relatives
KOTZE Lorete Maria da Silva,UTIYAMA Shirley Ramos da Rosa,NISIHARA Renato Mitsunori,ZENI Márgara Patrícia Bini
Arquivos de Gastroenterologia , 2001,
Abstract: Background - Literature data have shown high specificity of antiendomysial antibodies (EmA IgA) in celiac disease. The scarcity of Brazilian reports concerning this subject motivated the present study. Objectives - To determine the sensitivity and specificity of antiendomysial IgA antibodies in Brazilian celiac patients at diagnosis and after treatment, to confirm patient adherence to a gluten-free diet and to screen first-degree relatives. Methods - An extensive clinical and serological study was performed by investigating the presence of these antibodies in 392 individuals from Southern Brazil. Indirect immunofluorescence using human umbilical cord as substrate was employed and the total levels of IgA were determined by turbidimetry in all groups. The study was conducted on 57 celiac patients (18 at diagnosis, 24 who adhered to a gluten-free diet and 15 with marked or slight transgression of the diet), 115 relatives of celiac patients (39 families), 94 patients with other gastrointestinal diseases, and 126 healthy individuals from the general population. Results - The results demonstrated 100% positivity for the recently diagnosed patients and for those consuming gluten, in contrast to the patients who complied with the diet (0%). In the control group one individual was positive, but refused to undergo a biopsy. In the group of other gastrointestinal diseases, one positive patient presented ulcerative colitis, Down's syndrome and epilepsy, and the intestinal biopsy was diagnostic for celiac disease. These data showed 99.3% specificity for the test. Eighteen relatives were positive for antiendomysial antibodies IgA (15.65%), and comparison with the healthy population revealed a significant difference. An intestinal biopsy was obtained from seven subjects (one with total villous atrophy and six withouth alterations in the mucosal architecture, but all with a high number of intra-epithelial lymphocytes). Conclusions - The method revealed 100% sensitivity and 99.3% specificity. Because it is not an invasive method it can be used for the screening of atypical and latent forms of celiac disease to avoid serial biopsies and to control adherence to a gluten-free diet with implications in the prevention of malignancy in celiac disease.
Altera??es do TSH em pacientes com síndrome de Down: uma interpreta??o nem sempre fácil
Nisihara, Renato M.;Utiyama, Shirley R.R.;Fiedler, Patrícia T.;Oliveira, Nanci P.;Kotze, Lorete M.S.;Messias-Reason, Iara;
Jornal Brasileiro de Patologia e Medicina Laboratorial , 2006, DOI: 10.1590/S1676-24442006000500005
Abstract: objective: to evaluate the thyroid stimulating hormone (tsh) levels and the presence of antithyroperoxidase antibody (anti-tpo) in down?s syndrome (ds) patients from hospital de clínicas of universidade federal do paraná (hc/ufpr). methods: seventy-two ds patients, non-related and consecutively selected (mean age 6.15) were included in the study. eighty matched healthy children were used as controls. the tsh measurement and the anti-tpo were determined by immunometric assay in all samples. results: thirty patients with ds (42.9%) presented abnormal levels of tsh; 4.3% showed values below 0.5μiu/ml and 38.6% presented values higher than 5μiu/ml (range 5.1-22; mean 5.56 ± 4.18μiu/ml). the mean concentration of tsh in the controls was 2.76 ± 1.14μiu/ml, indicating a significant increase in tsh levels in the ds patients (p < 0.001). similarly, a significant difference was observed in the anti-tpo positivity in the patients? group (15.4%) when compared with the controls (0%; p < 0.001). in addition, the tsh levels of patients older than 9 years presented a significant increase (mean of 6.86 ± 4.6μiu/ml) when compared with the levels observed in patients younger than 9 years (mean of 5.24 ± 3.81μiu/ml; p = 0.006). the same pattern was observed in the positivity of anti-tpo (6/20 vs. 5/52; p = 0.041). conclusions: the results demonstrated high prevalence of elevated tsh and anti-tpo in the patients from the ds ambulatory of hc/ufpr, with increased frequency in those older than 9 years. the data indicate that the evaluation of thyroid function in ds patients must receive special attention from health professionals who take care of these patients.
Doen?a celíaca em crian?as e adolescentes com síndrome de Down
Nisihara, Renato M.;Kotze, Lorete M. S.;Utiyama, Shirley R. R.;Oliveira, Nanci P.;Fiedler, Patrícia T.;Messias-Reason, Iara T.;
Jornal de Pediatria , 2005, DOI: 10.2223/JPED.1381
Abstract: objectives: high prevalence rates of celiac disease in patients with down syndrome have been reported in several countries. however, in brazil there are no data regarding this association. in this study we report the prevalence of celiac disease in down syndrome children and adolescents from southern brazil. methods: seventy-one patients (32 female and 39 male, 2-18 years) from curitiba, brazil, were studied. eighty young people (42 male and 38 female, 2-19 years) were used as controls. all subjects were screened for the iga-antiendomysium antibody (ema) and iga anti-tecidual transglutaminase (anti-ttg). ema was measured by an immunofluorescence assay using umbilical cord as the substrate and anti-ttg by elisa with tecidual transglutaminase as the antigen. the total iga serum level was determined by turbidimetry. results: five ds patients (7%) were positive for ema-iga, with titers from 1/5 to 1/80 and 14 (17.5%) for anti-ttg (21-340 units). all ema positive patients also presented anti-ttg antibodies simultaneously. clinical and histological findings of the intestinal mucosa confirmed celiac disease diagnoses in four patients. the other ema positive patient was asymptomatic and was not submitted to duodenal biopsy. patients only positive for anti-ttg presented borderline values (< 25 units) and were asymptomatic. none of the controls were positive for ema or anti-ttg. no down syndrome patients or controls presented iga deficiency. conclusions: these data indicate a high prevalence (5.6%) of confirmed celiac disease in down syndrome patients from southern brazil.
Antibodies anti-Saccharomyces cerevisiae (ASCA) do not differentiate Crohn's disease from celiac disease
Kotze, Lorete Maria da Silva;Nisihara, Renato Mitsunori;Utiyama, Shirley Ramos da Rosa;Kotze, Paulo Gustavo;Theiss, Petra Mirella;Olandoski, Márcia;
Arquivos de Gastroenterologia , 2010, DOI: 10.1590/S0004-28032010000300006
Abstract: context: anti-saccharomyces cerevisiae antibodies (asca), considered serologic markers for crohn's disease, were described in patients with celiac disease, disappearing after a gluten-free diet. objectives: evaluation of asca positivity in patients with crohn's disease and celiac disease in relation to healthy individuals. methods: a total of 145 individuals were studied: 36 with crohn's disease and 52 with celiac disease, that fulfilled the diagnostic criteria for both affections, and 57 healthy individuals for control. the celiac patients were divided as follow: group ced i at diagnosis (n = 34), group ced ii with gluten-free diet compliance (n = 13) and group ced iii with transgressions to the diet (n = 5). asca iga and igg were determined by elisa. results: with statistical significance, asca iga were positive in crohn's disease, celiac disease at diagnosis and celiac disease with diet transgressions; asca igg in crohn's disease and in all groups with celiac disease. conclusions: the detection of asca in patients with celiac disease allows to suggest that asca is not a specific marker for crohn's disease, but was associated with the inflammation of the small intestine. the increased levels of positive asca may be due to genetic factors and increased intestinal permeability.
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