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Microtensile bond strength of total-etch and self-etching adhesives to caries-affected dentine.

OBJECTIVES: To evaluate the microtensile bond strength of total-etch or self-etch adhesives to caries-affected versus normal dentine, and to correlate these bond strengths with DIAGNOdent laser fluorescence and Knoop microhardness (KH) measurements of the substrates. METHODS: Extracted carious human molars were ground to expose flat surfaces where the caries lesion was surrounded by normal dentine. Surfaces were bonded with either Prime & Bond NT, Scotchbond 1, Clearfil SE Bond or Prompt L-Pop, according to manufacturers' recommendations. A crown was built up using resin composite (Tetric Ceram). After storage in water (37 degrees C, 24 h), teeth were vertically serially sectioned into 0.7 mm thick slabs and trimmed to yield 1 mm(2) test area that contained either caries-affected or normal dentine. Samples were tested in tension in an Instron machine at 1 mm/min. The quality of the dentine just beneath each fractured specimen was measured by laser fluorescence and KH. RESULTS: Total-etch adhesives yielded higher bond strengths than self-etching systems. Significantly lower results were obtained with Prompt L-Pop. All the adhesives attained higher strengths in normal than in caries-affected dentine, but the differences were only significant for Prime & Bond NT and Clearfil SE Bond. Higher laser fluorescence values and lower KH (p<0.001) were recorded in caries-affected dentine compared to normal dentine. CONCLUSIONS: The total-etch adhesives evaluated produced higher bond strengths to normal and caries-affected dentine than self-etching systems. Laser fluorescence measurements discriminated caries-affected dentine from normal dentine, and were strongly correlated with KH. However, laser fluorescence and KH did not permit high correlations with resin-dentine bond strengths in caries-affected dentine.

Acid Etching, Dental↗

Autism, affective and other psychiatric disorders: patterns of familial aggregation.

BACKGROUND: The liability to autism confers a risk for a range of more subtle autistic-like impairments, but it remains unclear whether it also confers a risk for other psychiatric disturbances. METHODS: To investigate this, we studied the pattern of familial aggregation of psychiatric disorders in relatives of 99 autistic and 36 Down's probands, using family history and direct interview measures. RESULTS: Family history data showed that motor tics, obsessive-compulsive (OCD) and affective disorders were significantly more common in relatives of autistic probands and that individuals with OCD were more likely to exhibit autistic-like social and communication impairments. Direct interview data confirmed the increased rate of affective disorders (especially major depressive disorder) in the first-degree relatives. There was no evidence to indicate significant co-morbidity between affective disorders and the broadly defined phenotype of autism. Moreover, the characteristics of the probands' and the relatives' that were associated with the liability to familiarity of the broader phenotype of autism differed from those that predicted the liability to the familiarity of affective disorders. Examination of the onset of affective disorders suggested that the increased risk was not confined to the period following the birth of the child with autism. CONCLUSIONS: Overall, the results indicated that OCD, but not affective disorders, may index an underlying liability to autism. They also indicated that the increased risk of affective disorders was not solely the consequence of the stress of raising a child with autism and that further research will be required to clarify the mechanisms involved.

Adolescent↗

Gender differences in negative affect and well-being: the case for emotional intensity.

Affect intensity (AI) may reconcile 2 seemingly paradoxical findings: Women report more negative affect than men but equal happiness as men. AI describes people's varying response intensity to identical emotional stimuli. A college sample of 66 women and 34 men was assessed on both positive and negative affect using 4 measurement methods: self-report, peer report, daily report, and memory performance. A principal-components analysis revealed an affect balance component and an AI component. Multimeasure affect balance and AI scores were created, and t tests were computed that showed women to be as happy as and more intense than men. Gender accounted for less than 1% of the variance in happiness but over 13% in AI. Thus, depression findings of more negative affect in women do not conflict with well-being findings of equal happiness across gender. Generally, women's more intense positive emotions balance their higher negative affect.

Adult↗

Clustering of Crohn's disease within affected sibships.

Crohn's disease (CD) is a complex genetic disorder for which aetiology is unknown. Recently, genetic factors for susceptibility have been described. Several genetic loci have been mapped and partially explain the familial aggregations of the disease. However, environmental factors may also contribute to these aggregations. We considered that if the role of non-genetic factors was negligible, CD patients would be randomly distributed in sibships with multiple affected siblings. On the other hand if there was a significant environmental contribution, the siblings would be affected non-randomly over exposure status. In order to test this hypothesis, we studied 102 sibships with two or more affected siblings. A statistical test, named Cluster of Affected Sibling Test or CAST, was developed, based on the exact calculation of the probability of observing a given number of clusters of affected siblings in multiplex families. The null hypothesis of a random distribution of affected siblings was rejected (P=0.005). The observed excess of affected sibling clusters indicates that birth order influences the disease status. Considering that an adjacent order of birth is a global estimate of environmental sharing, this observation strongly suggests that environmental factors contribute to the observed familial aggregations of the disease. This observation provides evidence that familial CD is a relevant tool for further studies of environmental factors and gene-environment interaction. More generally, the CAST statistics may be widely applicable to estimate the involvement of environmental factors in the aetiology of other binary traits which may be observed in multiple members of the same sibship.

Adult↗

Age-at-first-registration and heterogeneity in affective psychoses.

BACKGROUND: Previous research into age of onset in affective disorders has produced conflicting results. This paper examines the influence of heterogeneity on the age-at-first-registration distribution for the ICD-9 diagnostic group 'affective psychosis'. METHOD: For 1979-1991, data for age-at-first-registration for 4985 individuals diagnosed with affective psychosis (ICD-9 296.x) were extracted from a name-linked mental health register. These data were divided into (i) '296.1 only', a category used to code unipolar depression (males = 700; females = 1321); and (ii) '296 other', all 296 cases other than 296.1 (males = 1280; females = 1684). Inception rates for each 5-year age division were adjusted for the background population age-structure as a rate per 100,000 population. RESULTS: The age-at-first-registration distribution for affective psychosis has a wide age range, with women outnumbering men. There is a near-linear increase in inception rates for both men and women with 296.1 only, while the bulk of those with affective psychoses (296 other) have an inverted U-shaped age distribution. Males have an earlier modal age-at-first-registration for 296 other compared to females. CONCLUSION: The heterogeneity in terms of subtypes and sex in affective psychosis clouds the interpretation of age-at-first-registration. Separating those with unipolar psychotic depression from other subclassifications and differentiating by sex may provide clues to factors that precipitate the onset of affective psychosis.

Adolescent↗

Optimal weighting scheme for affected sib-pair analysis of sibship data.

Application of the affected sib-pair method of linkage analysis to sibships with variable numbers of affected and unaffected members requires a scheme for weighting the contributions from the sibships in the calculation of an overall test statistic. Currently accepted weighting schemes are based on the concepts of independent pairs and Shannon information content. Here, we show that the weighting scheme with maximum power to detect linkage can be determined from the theoretical means and variances of the sibship contributions under the null and alternative hypotheses. We derive the theoretical means and variances of the contributions from different types of sibships under a generalized single locus model. We use these theoretical means and variances to obtain the optimal weights for a variety of single locus models, and compare the power of existing weighting schemes relative to the optimum. The results suggest that, under a range of plausible assumptions, optimal power is nearly obtained by weighting to all sibpairs equally, except those occurring in sibships with so many affected siblings (usually five or more) that the probability of parental homozygosity for the disease allele becomes substantial. A corollary is that, in affected sib-pair analysis, the 'informativeness' of a sibship is more nearly proportional to the number of affected sib-pairs than to the number of affected siblings, up to about five affected siblings.

Alleles↗

[Disability payments due to unipolar depressive and bipolar affective disorders].

OBJECTIVE: Little is known concerning the frequency of disability payments due to depressive and bipolar affective disorders in Germany. METHOD: 177 consecutive psychiatric in-patients were assessed with standardized interviews concerning diagnosis (SCID-I, DSM-IV) and illness history. To compare unipolar depressive and bipolar affective patients, a survival analysis was calculated. RESULTS: 116 patients suffered from unipolar depression, 61 from bipolar affective disorder. Highly significantly, patients with bipolar affective disorders were granted disability payments more frequently and at an earlier age. Half of the bipolar affective patients received disability payments by the age of 46 years, half of the unipolar depressive patients by the age of 58 years. CONCLUSIONS: In this sample, bipolar affective patients received disability payments frequently and at an early age, which stresses that the prognosis of bipolar affective disorders is not as good as has been assumed for a long time. Early disability payments may lead to poverty and may obstruct access to social rehabilitation.

Adult↗

Pneumonectomy for malignant disease: factors affecting early morbidity and mortality.

OBJECTIVE: The purpose of this report is to analyze factors affecting morbidity and mortality after pneumonectomy for malignant disease. METHODS: We retrospectively reviewed the cases of all patients who underwent pneumonectomy for malignancy at the Mayo Clinic. Between January 1, 1985, and September 30, 1998, 639 patients (469 men and 170 women) were identified. Median age was 64 years (range 20 to 86 years). Indication for pneumonectomy was primary lung cancer in 607 (95.0%) patients and metastatic disease in 32 (5.0%). Factors affecting morbidity and mortality were analyzed by univariate and multivariate analysis. RESULTS: Cardiopulmonary complications occurred in 245 patients (38.3%; 95% confidence interval 34.6%-42.2%). Factors adversely affecting morbidity with univariate analysis included age (P <.0001), male sex (P =.04), associated respiratory (P =.02) or cardiovascular disease (P <.0001), cigarette smoking (P =.02), decreased vital capacity (P =.01), forced expiratory volume in 1 second (P <.0001), forced vital capacity (P =.002), diffusion capacity of the lung to carbon monoxide (P =.005), oxygen saturation (P <.05), arterial PO (2) (P =.007), preoperative radiation (P =.02), bronchial stump reinforcement (P =.007), crystalloid infusion (P =.01), and blood transfusion (P =.02). Factors adversely affecting morbidity with multivariate analysis included age (P =.0001), associated cardiovascular disease (P =.001), and bronchial stump reinforcement (P =.0005). There were 45 deaths (7.0%; 95% confidence intervals 5.2%-9.3%). Factors adversely affecting mortality with univariate analysis included associated cardiovascular (P <.0001) or hematologic disease (P <.005), lower preoperative serum hemoglobin level (P =.004), preoperative chemotherapy (P =.01), decreased diffusion capacity of lung to carbon monoxide (P =.002), right pneumonectomy (P =.0006), extended resection (P =.04), bronchial stump reinforcement (P =.007), and crystalloid infusion (P =.01). Factors affecting mortality with multivariate analysis included hematologic disease (P =.01), lower preoperative serum hemoglobin (P =.003), and completion pneumonectomy (P =.01). CONCLUSION: Multiple factors adversely affected morbidity and mortality after pneumonectomy for malignant disease. Appropriate selection and meticulous perioperative care are paramount to minimize risks in those patients who require pneumonectomy.

Adult↗

Affect and outcome in short-term group therapy for loss.

Affect and work variables were monitored for 12 of 16 groups involved in a controlled outcome study of psychoanalytically oriented short-term group therapy. Groups were conducted by experienced therapists for outpatients who experienced difficulties adapting to personal losses through death, separation, or both. Postsessional ratings of positive and negative affect were provided by individual patients, therapists, and other patients. Psychodynamic work was rated independently using a content analysis system. Patients who had experienced separation were more inhibited in their affective expression. Rating sources agreed that positive affect increased over time. Direct relationships were found between positive affect and favorable outcome. Concerning negative affect, the strongest predictors of favorable outcome involved the interaction of affect and work. Implications of these findings are discussed in terms of the cathartic hypothesis.

Adult↗

Automatic processing of facial emotion in schizophrenia with and without affective negative symptoms.

INTRODUCTION: It is assumed that people spontaneously evaluate any incoming stimulus as pleasant or unpleasant. The evaluative response appears to structure perception and to have direct links to emotional states. METHODS: To investigate the automatic processing of face valence a sequential priming task based on emotional face stimuli was administered to schizophrenia patients with a flat affect expression, schizophrenia patients suffering from anhedonia, schizophrenia patients not suffering from anhedonia or flat affect, and healthy controls. The Scale for the Assessment of Negative Symptoms (Andreasen, 1989) was applied to evaluate affective symptoms and categorize patients into groups. RESULTS: Schizophrenia patients without affective negative symptoms exhibited reversed priming effects similar to that of healthy subjects. In contrast, flat affect patients and anhedonic patients showed only a prime effect due to negative facial valence. In the flat affect patient group, negative prime faces facilitated the evaluation of target faces, whereas in the anhedonic patient group negative prime faces tended to inhibit the evaluation of subsequent target faces. CONCLUSIONS: The present findings support the idea that chronic schizophrenia patients extract automatically the valence of emotional facial expression but they also suggest processing differences between schizophrenia patients as a function of affective symptoms.

Journal Article↗

Robustness and power of the maximum-likelihood-binomial and maximum-likelihood-score methods, in multipoint linkage analysis of affected-sibship data.

The maximum-likelihood-binomial (MLB) method, based on the binomial distribution of parental marker alleles among affected offspring, recently was shown to provide promising results by two-point linkage analysis of affected-sibship data. In this article, we extend the MLB method to multipoint linkage analysis, using the general framework of hidden Markov models. Furthermore, we perform a large simulation study to investigate the robustness and power of the MLB method, compared with those of the maximum-likelihood-score (MLS) method as implemented in MAPMAKER/SIBS, in the multipoint analysis of different affected-sibship samples. Analyses of multiple-affected sibships by means of the MLS were conducted by consideration of all possible sib pairs, with (weighted MLS [MLSw]) or without (unweighted MLS [MLSu]) application of a classic weighting procedure. In simulations under the null hypothesis, the MLB provided very consistent type I errors regardless of the type of family sample (sib pairs or multiple-affected sibships), as did the MLS for samples with sib pairs only. When samples included multiple-affected sibships, the MLSu led to inflation of low type I errors, whereas the MLSw yielded very conservative tests. Power comparisons showed that the MLB generally was more powerful than the MLS, except in recessive models with allele frequencies <.3. Missing parental marker data did not strongly influence type I error and power results in these multipoint analyses. The MLB approach, which in a natural way accounts for multiple-affected sibships and which provides a simple likelihood-ratio test for linkage, is an interesting alternative for multipoint analysis of sibships.

Computer Simulation↗

Instability and frequency-domain variability of heart rates in fetuses with or without growth restriction affected by severe preeclampsia.

This study investigated how the instability and frequency-domain variability in heart rates differ between fetuses affected only by severe preeclampsia and fetuses affected by both severe preeclampsia and growth restriction. From their antepartum fetal heart rates and those of control fetuses, the very short-term intermittency (C1alpha) and the spectral powers were calculated to evaluate the instability and frequency-domain variability, respectively. The fetuses affected only by severe preeclampsia showed abnormally high C1alpha and low- and high-frequency power. The fetuses affected by severe preeclampsia and growth restriction showed even higher C1alpha than that of the fetuses affected by severe preeclampsia and abnormally reduced low-frequency power. Conclusively, when compared to the heart rates of fetuses affected only by severe preeclampsia, the heart rates of fetuses affected by severe preeclampsia and growth restriction showed a greater abnormal instability and an abnormally reduced variability at low-frequency range.

Adult↗

Neonatal age and period of estrogen exposure affect porcine uterine growth, morphogenesis, and protein synthesis.

To determine whether neonatal age and estrogen exposure affect uterine growth, morphogenesis, and protein synthesis, crossbred gilts were randomly assigned at birth (Day 0) to receive either corn oil vehicle (CO) or estradiol-17 beta valerate (EV; 50 micrograms/kg BW/day). Gilts were treated for 7 days, chosen to coincide with specific periods of uterine development, prior to hysterectomy on Day 7, 14, or 49. Uteri were weighed, and tissues were fixed for histology or explanted with L-4,5-[3H]leucine (3H-leu) for 24 h. Endometrial and myometrial thicknesses were measured in uterine wall cross sections. Radiolabeled proteins produced by uterine wall tissues from 3H-leu and released into explant medium were identified by fluorography of two-dimensional SDS-PAGE gels. Proteins for which fluorographic spot intensities were consistently affected by age and/or treatment were excised from gels, and associated radioactivity was quantified. Normal growth and histogenesis were observed in uteri from CO-treated gilts. Exposure to EV increased (p < 0.01) uterine wet weight on all days examined, although effects were most pronounced on Day 49 (day x treatment, p < 0.01). Histologically, uteri of EV-treated gilts exhibited precocious or altered patterns of development of endometrial glands and folds. Endometrial thickness was greater (p < 0.01) in EV-treated gilts, and response was most pronounced on Day 49 (day x treatment, p < 0.01). Treatment with EV increased (p < 0.01) myometrial thickness on Day 49 only. Twenty-five uterine proteins were identified to be affected consistently by neonatal age, EV, or both. Production of four of these proteins was affected by age alone, while six were affected exclusively by treatment with EV alone, and 15 were affected differentially by both age and EV. Treatment with EV affected production of three of these 25 proteins on Day 7, 8 of 25 on Day 14, and 14 of 25 on Day 49. Results indicate that uterine growth and development of the porcine uterine wall during early neonatal life are accompanied by predictable alterations in patterns of uterine protein synthesis. Data also demonstrate that the neonatal porcine uterus is estrogen-sensitive and that both physical and biochemical responses of uterine tissues to estrogen vary with period of exposure. It is suggested that EV may be useful as a tool with which to induce developmental lesions in neonatal porcine uterine tissues.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Depressed affect, hopelessness, and the risk of ischemic heart disease in a cohort of U.S. adults.

Major depression has been associated with mortality from ischemic heart disease (IHD). In addition, a symptom of depression--hopelessness--has been suggested as a determinant of health status. We studied the relation of both depressed affect and hopelessness to IHD incidence using data from a cohort of 2,832 U.S. adults age 45-77 years who participated in the National Health Examination Follow-up Study (mean follow-up = 12.4 years) and had no history of IHD or serious illness at baseline. We used the depression subscale of the General Well-Being Schedule to define depressed affect and a single item from the scale to define hopelessness. At baseline, 11.1% of the cohort had depressed affect; 10.8% reported moderate hopelessness, and 2.9% reported severe hopelessness. Depressed affect and hopelessness were more common among women, blacks, and persons who were less educated, unmarried, smokers, or physically inactive. There were 189 cases of fatal IHD during the follow-up period. After we adjusted for demographic and risk factors, depressed affect was related to fatal IHD [relative risk = 1.5; 95% confidence interval (CI) = 1.0-2.3]; the relative risks of fatal IHD for moderate and severe levels of hopelessness were 1.6 (95% CI = 1.0-2.5) and 2.1 (95% CI = 1.1-3.9), respectively. Depressed affect and hopelessness were also associated with an increased risk of nonfatal IHD. These data indicate that depressed affect and hopelessness may play a causal role in the occurrence of both fatal and nonfatal IHD.

Aged↗

The serotonin transporter is a potential susceptibility factor for bipolar affective disorder.

The serotonin transporter is a strong candidate for aetiological involvement in affective disorders and psychosis. We analysed a VNTR in intron 2 of the human serotonin transporter gene (hSERT) for allelic association with bipolar affective disorder, unipolar depression and schizophrenia. An increased frequency of allele 12 of the VNTR was observed in subjects with bipolar affective disorder (n = 191; chi 2 p = 0.00048 by allele) but not unipolar depression (n = 86; chi 2 p = 0.18, ns) or schizophrenia (n = 129; chi 2 p = 0.08, ns), although a trend towards an excess of allele 12 was observed for the latter. There was also a significant difference in the frequency of allele 12 between bipolar affective disorder and unipolar depression (p = 0.0087). The relative risk for bipolar affective disorder with respect to allele 12 was 1.84 (95% CI 0.97-3.56) for heterozygotes, and 3.10 (95% CI 1.60-6.07) for homozygotes, with evidence for a gene-dosage effect. Because allele 12 is common in the population, the attributable risk is 50.8% (95% CI 14.5%-73.3%). We hypothesize that either the VNTR affects regulation of expression of hSERT at the transcriptional level or it is in linkage disequilibrium with another functional polymorphism in the gene, and this results in an increased risk for the development of bipolar affective disorder.

Alleles↗

Psychiatric diagnoses in the child and adolescent members of extended families identified through adult bipolar affective disorder probands.

OBJECTIVE: To investigate the type and distribution of psychiatric disorders in the child and adolescent members of extended pedigrees identified through bipolar probands. METHOD: The child and adolescent offspring (24 male, 26 female, aged 6 to 17 years) and the adult parents (60) of 14 bipolar pedigrees ascertained for the National Institutes of Mental Health Genetics Initiative Study of Bipolar Affective Disorder were personally assessed using structured psychiatric interviews. A parent was also interviewed about each child or adolescent offspring. RESULTS: Twelve of the 50 interviewed offspring received a lifetime DSM-III-R diagnosis of an affective disorder. This included six cases of bipolar disorder, five cases of major depressive disorder, and one case of dysthymia. Eight of the offspring who received an affective disorder diagnosis also qualified for an anxiety disorder (four), a disruptive behavior disorder (two), or both (two). Offspring who had a parent with an affective disorder had a 5.1-fold higher risk for receiving an affective disorder diagnosis than did offspring with healthy parents. CONCLUSIONS: In a consecutive series of families identified through a proband with bipolar disorder, there were significant increases in the prevalence of affective disorder diagnoses in the child and adolescent offspring. The distribution of illness in offspring was compatible with the presence of important genetic factors which contribute to early-onset affective illness.

Adolescent↗

Comorbidity of select anxiety and affective disorders with alcohol dependence in southwest California Indians.

BACKGROUND: Native Americans, overall, have the highest prevalence of alcohol dependence of any US ethnic group. In several large national surveys, alcohol dependence has been significantly associated with higher rates of anxiety and affective disorders (comorbidity). However, the frequencies of these disorders and their comorbidity with alcohol dependence in Native American populations are relatively unknown. METHODS: Demographic information and DSM-III-R diagnoses were obtained by using the Semi-Structured Assessment for the Genetics of Alcoholism developed for the Collaborative Study on the Genetics of Alcoholism from 483 Southwest California Indian adults residing on contiguous reservations. The Semi-Structured Assessment for the Genetics of Alcoholism allowed differentiation of each anxiety and affective disorder into one of three types: independent of substance use, concurrent with alcohol use, and concurrent with drug use. RESULTS: Sixty-six percent of the men and 53% of the women sampled had a lifetime diagnosis of alcohol dependence. Fourteen percent of the sample had a lifetime independent anxiety disorder, and 14% of the sample had a lifetime independent affective disorder. Alcohol- and/or drug-concurrent major depression occurred in 8%, and other alcohol- and/or drug-concurrent anxiety and affective disorders each occurred in less than 1.1% of the sample. No significant comorbidity was found between alcohol dependence and independent agoraphobia, social phobia, or major depressive disorder. CONCLUSIONS: In this Southwest California Indian sample, rates of anxiety and affective disorders were substantially similar to those reported in the National Comorbidity Survey; however, comorbidity of independent disorders with alcohol dependence was not as pervasive as in the National Comorbidity Survey. Rates of concurrent anxiety and affective disorders were low. These data support the hypothesis that despite high rates of alcohol dependence, Southwest California Indians do not have higher rates of anxiety and affective disorders or comorbidity of these disorders with alcohol dependence than those reported in large surveys of non-American Indian populations.

Adolescent↗

High prevalence of celiac disease among patients affected by Crohn's disease.

BACKGROUND: Recent literature has shown a correlation between Crohn's disease (CD) and celiac disease, but a prospective study has not been performed. Our aim was to evaluate the prevalence of celiac disease in a consecutive series of patients affected by CD, in whom the disease was diagnosed for the first time. METHODS: From January to December 2004, we diagnosed 27 patients affected by CD (13 men and 14 women; mean age, 32.3 yrs; range, 16-69 yrs). In all patients, we performed antigliadin, antiendomysium, and antitransglutaminase antibody tests, and the sorbitol H2 breath test evaluation. In case of antibodies and/or sorbitol positivity, esophagogastroduodenoscopy was performed for a small bowel biopsy. RESULTS: Antigliadin, antiendomysium, and antitransglutaminase antibody tests were positive in 8/27 (29.63%), 4/27 (14.81%), and 5/27 (18.52%) patients, respectively, whereas the sorbitol H2 breath test was positive in 11/27 (40.74%) patients: all of them underwent esophagogastroduodenoscopy. Nine of 11 patients showed signs of duodenal endoscopic damage, and 5/9 (55.55%) showed histologic features of celiac disease (18.52% of overall CD population studied): 2 showed Marsh IIIc lesions (1 patient affected by ileal CD and 1 affected by ileo-colonic CD), 2 showed Marsh IIIb lesions (all of them affected by ileo-colonic CD), 1 showed a Marsh IIIa lesion (1 patient affected by colonic CD). CONCLUSIONS: Prevalence of celiac disease seems to be high among patients affected by CD, and this finding should be kept in mind at the time of the first diagnosis of CD; a gluten-free diet should be promptly started.

Adolescent↗