1
|
Gluten-free diet adherence and implications for the diagnosis of coeliac disease. Pathology 2022; 54:606-610. [PMID: 35337666 DOI: 10.1016/j.pathol.2021.12.297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/21/2021] [Accepted: 12/06/2021] [Indexed: 12/19/2022]
Abstract
Coeliac disease (CD) is an autoimmune disorder caused by the ingestion of gluten containing foods in genetically susceptible individuals, with a worldwide prevalence of up to 1%. Currently, the only available treatment is a gluten-free diet (GFD). Screening for CD is primarily performed using serum based testing for anti-tissue transglutaminase (tTG) antibodies. Patients must be on a gluten containing diet at the time of testing to ensure an accurate serological result. We investigated the prevalence of a GFD in hospital clinic settings and the general population using survey data to estimate the proportion of CD patients that may be misdiagnosed for CD based on serological tests. Data were collected at clinics of a metropolitan hospital in Sydney, Australia, and the general population. Data from Medicare Benefits Scheme and tTG results from a large Australian private laboratory were reviewed for comparison. Of 778 participants who responded to the survey, 58 (7.5%) were on a GFD. More patients attending the immunology (15.9%) and gastroenterology (12.1%) clinics adopted a GFD than those attending the diabetes (2.6%) or endocrinology (6.1%) clinics, or in the general population (4.3%). More females than males excluded gluten from their diet (p<0.0001). Medicare statistics between 2013 and 2019 demonstrated an increase in CD serological testing; however, tTG data from a private pathology highlighted a stable level of elevated tTG antibodies of 3% of total tests performed. The high number of individuals on a GFD is likely impacting the ability to accurately diagnose CD using serum-based testing.
Collapse
|
2
|
Zhang JZ, Abudoureyimu D, Wang M, Yu SR, Kang XJ. Association between celiac disease and vitiligo: A review of the literature. World J Clin Cases 2021; 9:10430-10437. [PMID: 35004975 PMCID: PMC8686139 DOI: 10.12998/wjcc.v9.i34.10430] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/25/2021] [Accepted: 10/20/2021] [Indexed: 02/06/2023] Open
Abstract
Celiac disease (CD) is an autoimmune intestinal disease caused by the intake of gluten-containing cereals and their products by individuals with genetic susceptibility genes. Vitiligo is a commonly acquired depigmentation of the skin; its clinical manifestation are skin patches caused by localized or generalized melanin deficiency. Both diseases have similar global incidence rates (approximately 1%) and are associated to similar diseases, including autoimmune bullous disease, inflammatory bowel disease, autoimmune thyroiditis, autoimmune gastritis, and type 1 diabetes. The relationship between CD and vitiligo has been reported in several studies, but their conclusions are inconsistent. Further, it has also been reported that a gluten-free diet (GFD) can improve the symptoms of immune-related skin diseases such as vitiligo. In this mini-review, we summarize and review the literature on the relationship between CD and vitiligo, assess the therapeutic significance of GFD for patients with vitiligo, and explore their possible physiopathology. We are hopeful that the information summarized here will assist physicians who treat patients with CD or vitiligo, thereby improving the prognosis.
Collapse
Affiliation(s)
- Jing-Zhan Zhang
- Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Key Laboratory of Dermatology Research, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Dilinuer Abudoureyimu
- Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Key Laboratory of Dermatology Research, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Man Wang
- Department of Gastroenterology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Shi-Rong Yu
- Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Key Laboratory of Dermatology Research, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| | - Xiao-Jing Kang
- Department of Dermatology, People’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Key Laboratory of Dermatology Research, Urumqi 830001, Xinjiang Uygur Autonomous Region, China
| |
Collapse
|
3
|
|
4
|
Pavlovic M, Berenji K, Bukurov M. Screening of celiac disease in Down syndrome - Old and new dilemmas. World J Clin Cases 2017; 5:264-269. [PMID: 28798921 PMCID: PMC5535317 DOI: 10.12998/wjcc.v5.i7.264] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/28/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023] Open
Abstract
Celiac disease (CD) is a common and well defined autoimmune disorder caused by gliadin and related proteins of wheat, rye, and barley. Epidemiologic studies confirmed that CD is highly associated with other autoimmune diseases and with Down syndrome (DS). The symptomatic form of CD in patients with DS is more frequent than asymptomatic forms. However, growth impairment, anemia, intermittent diarrhea, and constipation are symptoms and signs typically of children with DS without CD. Late identification of the disease can lead to various complications, sometimes even very severe. Therefore, systematic screening for CD is essential in the management of children and adolescents with DS. Many medical organizations recommend screening in this group of patients. However, current policy statements vary in their recommendations for screening and there is still a need for establishing uniform diagnostic criteria.
Collapse
|
5
|
RIBEIRO PVDM, SANTOS ADP, ANDREOLI CS, RIBEIRO SMR, JORGE MDP, MOREIRA AVB. Nutritional status variation and intestinal and extra intestinal symptomatology in patients with celiac disease and non-celiac gluten sensitivity given specialized dietary advice. REV NUTR 2017. [DOI: 10.1590/1678-98652017000100006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: To investigate the nutritional status variation and symptomatology of patients with celiac disease and non-celiac gluten sensitivity after specialized dietary advice Methods: This prospective study included 80 patients with celiac disease and non-celiac gluten sensitivity. Clinical, metabolic, and nutritional variables were collected from medical records, and the symptomatology was investigated by the Metabolic Screening Questionnaire. The variables were assessed on two occasions (T1 - before dietary advice and T2 - after dietary advice) with an interval of three months between T1 and T2 Results: The median age was 42 years. The prevalences of celiac disease and non-celiac gluten sensitivity were 66.2% and 33.8%, respectively. Normal weight prevailed at T1 (58.8%) and T2 (56.3%), but 30.0% of the patients at T1 and 34.9% of the patients at T2 had excess weight. The two conditions had similar symptomatology. The most frequent signs and symptoms on both occasions involved the gastrointestinal tract, followed by energy/activity and emotions. All symptoms decreased significantly after the introduction of a proper diet Conclusion: The patients were normal weight on both study occasions (T1 and T2), and the symptoms improved after dietary advice. Thus, we reinforce the importance of proper dietary management in both clinical conditions to make dietary adjustments that improve these individuals' symptomatology.
Collapse
|
6
|
Polanco I, Koester Weber T, Martínez-Ojinaga E, Molina M, Sarria J. Efficacy of a point-of-care test based on deamidated gliadin peptides for the detection of celiac disease in pediatric patients. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 109:743-748. [DOI: 10.17235/reed.2017.5028/2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
7
|
Microbiota and gastrointestinal diseases. An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
8
|
Polanco Allué I. [Microbiota and gastrointestinal diseases]. An Pediatr (Barc) 2015; 83:443.e1-5. [PMID: 26534880 DOI: 10.1016/j.anpedi.2015.07.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 07/29/2015] [Indexed: 02/08/2023] Open
Abstract
The bacterial colonisation is established immediately after birth, through direct contact with maternal microbiota, and may be influenced during lactation. There is emerging evidence indicating that quantitative and qualitative changes on gut microbiota contribute to alterations in the mucosal activation of the immune system, leading to intra- or extra-intestinal diseases. A balance between pathogenic and beneficial microbiota throughout childhood and adolescence is important to gastrointestinal health, including protection against pathogens, inhibition of pathogens, nutrient processing (synthesis of vitamin K), stimulation of angiogenesis, and regulation of host fat storage. Probiotics can promote an intentional modulation of intestinal microbiota favouring the health of the host. A review is presented on the modulation of intestinal microbiota on prevention, and adjuvant treatment of some paediatric gastrointestinal diseases.
Collapse
Affiliation(s)
- I Polanco Allué
- Departamento de Pediatría, Facultad de Medicina, Universidad Autónoma, Madrid, España.
| |
Collapse
|
9
|
Ferreira SMR, de Mello AP, de Caldas Rosa dos Anjos M, Krüger CCH, Azoubel PM, de Oliveira Alves MA. Utilization of sorghum, rice, corn flours with potato starch for the preparation of gluten-free pasta. Food Chem 2015; 191:147-51. [PMID: 26258714 DOI: 10.1016/j.foodchem.2015.04.085] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 03/27/2015] [Accepted: 04/14/2015] [Indexed: 11/29/2022]
Abstract
The aim of this study was to evaluate the use of mixture of sorghum-rice-corn flour and potato starch in the development of gluten-free pasta for celiac disease patients. The experiment was designed according to simplex-lattice method and different types of gluten-free flours were used, such as sorghum, rice, corn, and potato starch. The fifteen formulations were subjected to sensory analysis (Mixed Structured Scale - MSS) and seven formulations were selected in respect to taste and grittiness. These formulations were subjected to Quantitative Descriptive Analysis (QDA), which evaluated the attributes: appearance, color, odor, hardness, elasticity, stickiness, grittiness, taste, residual bitterness and overall quality. Results showed significant difference in appearance, color and hardness. The formulations that showed the best sensory results were submitted to chemical analysis and cooking quality of pasta. It was observed that the best results for mixing is sorghum flour, rice flour and potato starch.
Collapse
Affiliation(s)
- Sila Mary Rodrigues Ferreira
- Universidade Federal do Paraná, Programa de Pós-graduação em Segurança Alimentar e Nutricional, Setor de Ciências da Saúde, Campus III, Jardim Botânico, Av. Pref. Lothário Meissner 632, Curitiba, PR 80210-170, Brazil.
| | - Ana Paula de Mello
- Universidade Federal do Paraná, Programa de Residência Integrada Multiprofissional em Atenção Hospitalar, Hospital de Clínicas, Curitiba, PR, Brazil
| | - Mônica de Caldas Rosa dos Anjos
- Universidade Federal do Paraná, Departamento de Nutrição, Setor de Ciências da Saúde, Campus III, Jardim Botânico, Curitiba, PR, Brazil
| | - Cláudia Carneiro Hecke Krüger
- Universidade Federal do Paraná, Programa de Pós-graduação em Segurança Alimentar e Nutricional, Setor de Ciências da Saúde, Campus III, Jardim Botânico, Av. Pref. Lothário Meissner 632, Curitiba, PR 80210-170, Brazil
| | - Patrícia Moreira Azoubel
- Universidade Federal de Pernambuco, Departamento de Engenharia Química, Av. Prof. Arthur de Sá, s/n, Cidade Universitária, Recife, PE 50740-521, Brazil
| | - Márcia Aurelina de Oliveira Alves
- Universidade Federal do Paraná, Departamento de Nutrição, Setor de Ciências da Saúde, Campus III, Jardim Botânico, Curitiba, PR, Brazil
| |
Collapse
|
10
|
MARIANI M, OLIVEIRA VRD, FACCIN R, RIOS ADO, VENZKE JG. Elaboração e avaliação de biscoitos sem glúten a partir de farelo de arroz e farinhas de arroz e de soja. BRAZILIAN JOURNAL OF FOOD TECHNOLOGY 2015. [DOI: 10.1590/1981-6723.6514] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A exclusão do glúten da dieta é um grande desafio, pois muitos produtos que o contém fazem parte dos hábitos alimentares da população. Esse trabalho teve como objetivo avaliar as características físicas, químicas e sensoriais de biscoitos sem glúten, elaborados a partir de farinha de arroz, farelo de arroz e farinha de soja. Foram elaboradas quatro formulações: FT- padrão (trigo); FAFS- farinhas de arroz e de soja; FEFS- farelo de arroz e farinha de soja (1:1); FAFEFS- farinhas de arroz e de soja e farelo de arroz (1:1:1). Foram avaliados os seguintes parâmetros físicos: peso pós-cocção, diâmetro e espessura pós-cocção, e fator de expansão. Foram determinadas as quantidades de umidade, proteínas, lipídios, cinzas e carboidratos. Na análise sensorial, avaliou-se os atributos de aparência, cor, textura, sabor e aceitação global, e a intenção de compra. Em relação aos parâmetros físicos, FAFEFS apresentou diferença estatística significativa (p < 0,05) quanto ao aumento de diâmetro e fator de expansão. Quanto às análises químicas, FEFS apresentou valores estatisticamente significativos (p < 0,05) quanto ao teor proteico. Sobre a aceitabilidade, os biscoitos dos tratamentos alternativos não diferiram estatisticamente do padrão. Os biscoitos do tratamento FAFEFS obtiveram maior porcentagem de intenção de compra. Pode-se concluir, portanto, que os biscoitos elaborados com farelo de arroz e farinha de soja (FEFS) como substituto de farinha de trigo, se caracterizaram como uma alternativa viável do ponto de vista nutricional e sensorial.
Collapse
|
11
|
Pasha I, Saeed F, Sultan MT, Batool R, Aziz M, Ahmed W. Wheat Allergy and Intolerence; Recent Updates and Perspectives. Crit Rev Food Sci Nutr 2013; 56:13-24. [DOI: 10.1080/10408398.2012.659818] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
12
|
Collaco AM, Jakab RL, Hoekstra NE, Mitchell KA, Brooks A, Ameen NA. Regulated traffic of anion transporters in mammalian Brunner's glands: a role for water and fluid transport. Am J Physiol Gastrointest Liver Physiol 2013; 305:G258-75. [PMID: 23744739 PMCID: PMC3742856 DOI: 10.1152/ajpgi.00485.2012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The Brunner's glands of the proximal duodenum exert barrier functions through secretion of glycoproteins and antimicrobial peptides. However, ion transporter localization, function, and regulation in the glands are less clear. Mapping the subcellular distribution of transporters is an important step toward elucidating trafficking mechanisms of fluid transport in the gland. The present study examined 1) changes in the distribution of intestinal anion transporters and the aquaporin 5 (AQP5) water channel in rat Brunner's glands following second messenger activation and 2) anion transporter distribution in Brunner's glands from healthy and disease-affected human tissues. Cystic fibrosis transmembrane conductance regulator (CFTR), AQP5, sodium-potassium-coupled chloride cotransporter 1 (NKCC1), sodium-bicarbonate cotransporter (NBCe1), and the proton pump vacuolar ATPase (V-ATPase) were localized to distinct membrane domains and in endosomes at steady state. Carbachol and cAMP redistributed CFTR to the apical membrane. cAMP-dependent recruitment of CFTR to the apical membrane was accompanied by recruitment of AQP5 that was reversed by a PKA inhibitor. cAMP also induced apical trafficking of V-ATPase and redistribution of NKCC1 and NBCe1 to the basolateral membranes. The steady-state distribution of AQP5, CFTR, NBCe1, NKCC1, and V-ATPase in human Brunner's glands from healthy controls, cystic fibrosis, and celiac disease resembled that of rat; however, the distribution profiles were markedly attenuated in the disease-affected duodenum. These data support functional transport of chloride, bicarbonate, water, and protons by second messenger-regulated traffic in mammalian Brunner's glands under physiological and pathophysiological conditions.
Collapse
Affiliation(s)
- Anne M. Collaco
- 1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut;
| | - Robert L. Jakab
- 1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut;
| | - Nadia E. Hoekstra
- 1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut;
| | - Kisha A. Mitchell
- 2Department of Pathology, Yale University School of Medicine, New Haven, Connecticut; and
| | - Amos Brooks
- 2Department of Pathology, Yale University School of Medicine, New Haven, Connecticut; and
| | - Nadia A. Ameen
- 1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut; ,3Department Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut
| |
Collapse
|
13
|
Mouterde O, Dumant C, Mallet E. [Symptoms of Celiac disease in childhood]. PATHOLOGIE-BIOLOGIE 2013; 61:e53-e55. [PMID: 21616608 DOI: 10.1016/j.patbio.2011.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 03/23/2011] [Indexed: 05/30/2023]
Abstract
The knowledge regarding celiac disease has increased dramatically in recent years, due to the availability of accurate serologic markers. Mass screening studies have shown that the prevalence of sensitization can be as high as 1/80. The range of symptoms is wide, from the classic growth failure, denutrition and diarrhea in infancy to clinically and histologically asymptomatic sensitized subjects. The interest of a routine mass screening is debated. The classical celiac disease in infancy is well known. Atypical symptoms and potentially associated disease are more frequent and potentially confounding. Physicians should be aware of any clue for celiac disease in atypical cases in order to improve the diagnostic yield, and therefore avoiding short or long term consequences.
Collapse
Affiliation(s)
- O Mouterde
- Unité de Gastroentérologie Pédiatrique, Hôpital Charles-Nicolle, Centre Hospitalier Universitaire de Rouen, 76031 Rouen cedex, France.
| | | | | |
Collapse
|
14
|
Abstract
The bacterial colonization is defined immediately after birth, through direct contact with maternal microbiota and may be influenced during lactation. There is emerging evidence indicating that quantitative and qualitative changes on gut microbiota contribute to alterations in the mucosal activation of immune system leading to intra- or extra-intestinal diseases. A balance between pathogenic and beneficial microbiota throughout childhood and adolescence is important to gastrointestinal health, including protection against pathogens, inhibition of pathogens, nutrient processing (synthesis of vitamin K), stimulation of angiogenesis, and regulation of host fat storage. Probiotics can promote an intentional modulation of intestinal microbiota favoring the health of the host. This paper is a review about modulation of intestinal microbiota on prevention and adjuvant treatment of pediatric gastrointestinal diseases.
Collapse
|
15
|
Abstract
BACKGROUND AND OBJECTIVES Heat shock protein (HSP) 72, a known chaperone, has potential epithelial barrier protecting, antiapoptotic, and immune system regulatory effects; therefore, our aim was to study its involvement in the pathology of celiac disease (CD). PATIENTS AND METHODS Duodenal biopsy specimens were collected from children with untreated and treated CD and from controls. mRNA expression, protein level, and localization of HSP72 were determined. RESULTS Elevated HSP72 mRNA expression and higher protein levels were found in the duodenal mucosa of children with untreated CD as well as in children with treated CD compared with those in controls. In the duodenal mucosa of children with treated CD, HSP72 mRNA expression was decreased and HSP72 protein levels were lower than those in children with untreated CD. We detected intensive HSP72 staining in the villous enterocytes and immune cells of the lamina propria in the duodenal villi of children with untreated CD compared with that in controls. CONCLUSIONS The increased expression and altered localization of HSP72 in CD indicate that HSP72 should have a role in protection against gliadin-induced cytotoxicity. HSP72 may exert antiapoptotic effect and contribute to preservation of intestinal epithelial barrier integrity. Moreover, HSP72 as a ligand of TLR2 and TLR4 may promote innate immune responses and warn the cells of the potential injury.
Collapse
|
16
|
Nemet D, Raz A, Zifman E, Morag H, Eliakim A. Short stature, celiac disease and growth hormone deficiency. J Pediatr Endocrinol Metab 2009; 22:979-83. [PMID: 20020588 DOI: 10.1515/jpem.2009.22.10.979] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Celiac disease (CD) is a prevalent, genetically determined, autoimmune, chronic inflammatory state caused by intolerance to gluten that results mainly in gastrointestinal manifestations. One of the most common extra-intestinal manifestations of CD is short stature, and in some patients, short stature may be the presenting and only symptom of the disease, making the diagnosis of CD challenging. Impaired growth in children with CD results mainly from nutritional deficits, and withdrawal of gluten from the diet is frequently associated with a marked improvement of linear growth. In some patients, CD may be characterized by growth hormone (GH) resistance, as suggested by normal or elevated GH levels and low insulin-like growth factor-I (IGF-I) levels. Rarely, it has been shown that poor catch-up growth and/or IGF-I response to gluten-free diet may be due to the coexistence of celiac disease and GH deficiency. We present two children with coexisting CD and GH deficiency. One patient had MRI findings suggesting congenital isolated GH deficiency, and a possibility of developing multiple pituitary hormone deficiencies later in life.
Collapse
Affiliation(s)
- D Nemet
- Gastrointestinal and Endocrine Clinic, Pediatric Department, Meir Medical Center, Kfar Saba, Israel
| | | | | | | | | |
Collapse
|
17
|
Caballero-Villarraso J, Flores-Moreno S, Villegas-Portero R, Rodríguez-Cantalejo F. [Monitoring coeliac disease using point of care testing: expectations and realities]. Aten Primaria 2009; 41:526-527. [PMID: 19481300 DOI: 10.1016/j.aprim.2009.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Accepted: 01/19/2009] [Indexed: 10/20/2022] Open
Affiliation(s)
- Javier Caballero-Villarraso
- Servicio de Análisis Clínicos, Hospital Universitario Reina Sofía, Córdoba, España; Agencia de Evaluación de Tecnologías Sanitarias de Andalucía, Sevilla, España.
| | | | | | | |
Collapse
|