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Toxoplasma gondii is a widespread protozoan parasite (phylum Apicomplexa), which causes a zoonotic parasitic disease, known as toxoplasmosis. The aim of this study was to evaluate the occurrence and genotypes of T. gondii in wild boars of southern Italy and thus to assess the risk of infection for consumers. The boars were inspected during the hunting season within the regional project ‘Wild Boar Emergency Plan in Campania’, and molecular analyses were performed on 338 boars analysing a total number of 884 matrices (263 brains, 310 hearts and 311 masseter muscles). Toxoplasma gondii was detected in 134 out of 338 boars (39.6%). No significant statistical difference between genders was found (χ2 = 0.15 p = .70). The prevalence was 47.1%, 39.3% and 39.2% in piglets, yearlings and adults, respectively (χ2 = 0.41; p = .81). The highest prevalence of T. gondii was found in masseter muscles (74/311, 23.8%), followed by the heart (70/310, 22.6%) and brain (58/263, 22.0%), respectively. Microsatellite (MS) analysis of 11 samples revealed eleven T. gondii genotypes (nine atypical, one belonging to type II one to type III). Most of the genotypes found were thus atypical and may be virulent in humans. Hierarchical clustering analysis showed the presence of three distinct clusters, with the majority of atypical genotypes in the GII-GIII cluster. The high prevalence of infection in masseters highlights the potential risk for public health, considering that this muscle is commonly used to prepare raw meat products (‘guanciale’ and sausages), which may be a source of T. gondii infection in humans. Wild boars may act as an interface role between wildlife, livestock and humans. Our data highlight the urgent need to minimize the risk of infection for animals and humans by setting up a surveillance programme and preventive strategies in a One Health approach to wildlife species.

OBJECTIVE: To investigate in a large sample of overweight/obese (OW/OB) children and adolescents the prevalence of prediabetic phenotypes such as impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), and to assess their association with cardiometabolic risk (CMR) factors including hepatic steatosis (HS). METHODS: Population data were obtained from the CARdiometabolic risk factors in children and adolescents in ITALY study. Between 2003 and 2013, 3088 youths (972 children and 2116 adolescents) received oral glucose tolerance test (OGTT) and were included in the study. In 798 individuals, abdominal ultrasound for identification of HS was available. RESULTS: The prevalence of IFG (3.2 vs. 3.3%) and IGT (4.6 vs. 5.0%) was similar between children and adolescents. Children with isolated IGT had a 2-11 fold increased risk of high LDL-C, non-HDL-C, Tg/HDL-C ratio, and low insulin sensitivity, when compared to those with normal glucose tolerance (NGT). No significant association of IFG with any CMR factor was found in children. Among adolescents, IGT subjects, and to a lesser extent those with IFG, showed a worse CMR profile compared to NGT subgroup. In the overall sample, IGT phenotype showed a twofold increased risk of HS compared to NGT subgroup. CONCLUSIONS: Our study shows an unexpected similar prevalence of IFG and IGT between children and adolescents with overweight/obesity. The IGT phenotype was associated with a worse CMR profile in both children and adolescents. Phenotyping prediabetes conditions by OGTT should be done as part of prediction and prevention of cardiometabolic diseases in OW/OB youth since early childhood.

Acantocheilonema reconditum is a parasite transmitted by fleas, lice and ticks and is included among the filaroid species infecting dogs. Contrary to the more well-studied Dirofilaria immitis and Dirofilaria repens, A. reconditum is believed to be less pathogenic, as adult worms are localized in the subcutaneous tissues and in the perirenal fat. Although previous studies reported the absence of clinical symptoms in infected dogs, there are few data regarding the haematological and biochemical changes that could be potentially caused by this parasite. Because hunting dogs are frequently exposed to vector-borne pathogens, the aim of the present study was to assess the prevalence, risk factors and potential hematobiochemical abnormalities associated with A. reconditum infection in this specific canine population. Blood samples were collected from 3,020 hunting dogs living in Campania region, and were tested by a modified Knott technique to count and identify microfilariae. Out of 3,020 dogs tested, 84 were positive to A. reconditum, with an overall prevalence of 2.78% (95% CI: 2.19– 3.37%). The number of microfilariae/ml ranged from 1 to 442. After excluding dogs co-infected by different filarial worm species and/or other vector-borne pathogens common in Southern Italy, n. 74 dogs showed A. reconditum single infection. The main clinical features observed were dehydration (n. 1), fever (n. 1), congested mucous membranes (n. 2) and exercise intolerance (n. 2). Complete blood cell count results revealed leukocytosis (n. 16), anaemia (n. 2), thrombocytopenia (n. 8), eosinophilia (n. 1). Biochemical data showed increased serum values of total globulins (n. 14), albumins (n. 9), gamma glutamyl transferase (n. 2) and alkaline phosphate (n. 1), hypoalbuminemia was observed in one dog. Dogs co-infected with other vector-borne pathogens were not included in the statistical analysis. The living area (p

BACKGROUND: Pediatric hypertension is typically defined as blood pressure ≥ sex-, age-, and height-specific 95th percentile (high) cutoffs. Given the number of strata, there are hundreds of cutoffs for defining elevated and high blood pressure that make it cumbersome to use in clinical practice. This study aimed to evaluate the utility of the static cutoffs for pediatric hypertension (120/80 mm Hg for children and 130/80 mm Hg for adolescents) in determining high carotid intimamedia thickness (cIMT) in children and adolescents. METHODS: Data were from 6 population-based cross-sectional studies in Brazil, China, Greece, Italy, Spain, and the United Kingdom. A total of 4280 children and adolescents, aged 6 to 17 years, were included. High cIMT was defined as cIMT ≥ sex-, age- and cohort-specific 90th percentile cutoffs. RESULTS: Compared with normal blood pressure, hypertension defined using the percentile-based cutoffs from 2017 American Academy of Pediatrics guideline, and the static cutoffs were associated with similar higher odds for high cIMT (percentile-based cutoffs: odds ratio [OR], 1.46, 95% confidence interval [CI], 1.15-1.86; static cutoffs: OR, 1.65, 95% CI, 1.25-2.17), after adjustment for sex, age, race/ethnicity, body mass index, high-density lipoprotein-cholesterol, triglyceride, and fasting blood glucose. The similar utility of 2 definitions in determining high cIMT was further confirmed by area under the receiver operating characteristic curve and net reclassification improvement methods (P for difference > 0.05). CONCLUSION: Static cutoffs (120/80 mm Hg for children, 130/80 mm Hg for adolescents) performed similarly compared with percentile-based cutoffs in determining high cIMT, supporting the use of static cutoffs in identifying pediatric hypertension in clinical practice.

OBJECTIVE: The clinical utility of screening for pediatric metabolic syndrome (MetS) in children and adolescents is still controversial. We examined the performance of pediatric MetS vs. clustering of cardiovascular risk factors (which are the components of MetS) for predicting high carotid intima-media thickness (cIMT) in children and adolescents. METHODS: Participants included 2427 children and adolescents aged 6-17 years from population-based studies in three countries (Brazil, China and Italy). Pediatric MetS was defined using either the modified National Cholesterol Education Program Adult Treatment Panel III criteria or the modified International Diabetes Federation criteria. Clustering of cardiovascular risk factors was calculated as the sum of five components of MetS (i.e. central obesity, elevated blood pressure, elevated triglycerides, reduced HDL-cholesterol and elevated fasting blood glucose). High cIMT was defined as cIMT at least 95th percentile values for sex and age developed from European children. RESULTS: Presence of one, two or at least three cardiovascular risk factors (using the National Cholesterol Education Program Adult Treatment Panel III criteria), as compared with none, was associated with gradually increasing odds of high cIMT [odds ratios (95% confidence intervals): 1.60 (1.29-1.99), 2.89 (2.21-3.78) and 4.24 (2.81-6.39), respectively]. High cIMT was also associated with presence (vs. absence) of MetS (odds ratio = 2.88, 95% confidence interval = 1.95-4.26). However, clustering of cardiovascular risk factors predicted high cIMT markedly better than MetS (area under the curve of 0.66 vs. 0.54, respectively). Findings were similar using the International Diabetes Federation criteria for pediatric MetS. CONCLUSION: In children and adolescents, a graded score based on five cardiovascular risk factors (used to define MetS) predicted high cIMT markedly better than MetS. These findings do not support the clinical utility of MetS for screening youth at increased cardiovascular risk, as expressed in this study by high cIMT.

Background: Pediatric hypertension is typically defined as blood pressure ≥ sex-, age-, and height-specific 95th percentile (high) cutoffs. Given the number of strata, there are hundreds of cutoffs for defining elevated and high blood pressure that make it cumbersome to use in clinical practice. This study aimed to evaluate the utility of the static cutoffs for pediatric hypertension (120/80 mm Hg for children and 130/80 mm Hg for adolescents) in determining high carotid intimamedia thickness (cIMT) in children and adolescents. Methods: Data were from 6 population-based cross-sectional studies in Brazil, China, Greece, Italy, Spain, and the United Kingdom. A total of 4280 children and adolescents, aged 6 to 17 years, were included. High cIMT was defined as cIMT ≥ sex-, age- and cohort-specific 90th percentile cutoffs. Results: Compared with normal blood pressure, hypertension defined using the percentile-based cutoffs from 2017 American Academy of Pediatrics guideline, and the static cutoffs were associated with similar higher odds for high cIMT (percentile-based cutoffs: odds ratio [OR], 1.46, 95% confidence interval [CI], 1.15-1.86; static cutoffs: OR, 1.65, 95% CI, 1.25-2.17), after adjustment for sex, age, race/ethnicity, body mass index, high-density lipoprotein-cholesterol, triglyceride, and fasting blood glucose. The similar utility of 2 definitions in determining high cIMT was further confirmed by area under the receiver operating characteristic curve and net reclassification improvement methods (P for difference > 0.05). Conclusion: Static cutoffs (120/80 mm Hg for children, 130/80 mm Hg for adolescents) performed similarly compared with percentile-based cutoffs in determining high cIMT, supporting the use of static cutoffs in identifying pediatric hypertension in clinical practice. © 2020 Canadian Cardiovascular Society

Canine vector-borne diseases (CVBDs) result from a range of pathogens transmitted to dogs by arthropods. The present study aimed to examine a population of hunting dogs from southern Italy using both serological and molecular diagnostic methods for evidence of infection by known pathogens of CVBDs. Blood samples were collected from hunting dogs (n. 1,191) in the Avellino and Salerno provinces of Campania region of southern Italy. Serological testing for Ehrlichia canis, Anaplasma spp., and Borrelia burgdorferi sensu lato-specific antibodies and Dirofilaria immitis-specific antigen was performed using a commercial in-clinic enzyme-linked immunosorbent assay kit, SNAP® 4Dx® Plus. Molecular diagnostic testing for the blood-borne presence of Ehrlichia canis, Ehrlichia chaffeensis, Anaplasma platys, Anaplasma phagocytophilum, Babesia canis, Babesia vogeli, Babesia gibsoni, Dirofilaria immitis, Dirofilaria repens, Hepatozoon canis, and Leishmania spp. was performed by real time polymerase chain reaction (RT-PCR) assays. Seropositive rates for the four individual pathogens were: E.canis 7.7%; Anaplasma spp. 4.2%; D.immitis,1.4%; and B.burgdorferi s.l. 0.3%. PCR positive rates for eight detected pathogens were: H.canis 16.8%; A.platys 2.4%; E.canis 1.9%; B.vogeli 1.6%; Leishmania spp. 0.4%; B.canis 0.2%; D.repens 0.2%; and D.immitis 0.1%. Co-infections were detected at a rate of 2.3% by serology and 2.7% by RT-PCR with Anaplasma/E.canis and E.canis/H.canis co-infections occurring most frequently by serology and PCR, respectively. The results of present survey indicate that hunting dog populations are at risk of CVBDs in southern Italy. Further studies are needed to evaluate the role of hunting dogs in the epidemiology of vector-borne agents and the relationship to sympatric populations of wild animals.

To interpret correctly the results of procalcitonin (PCT) accuracy studies for the diagnosis of neonatal sepsis, it is time to begin to debate the methods we use to measure PCT performance, rather than just how PCT performs. Therefore we should move toward the better use of the information available including criteria to: (1) substantiate (or rule-out) the diagnosis of neonatal sepsis; (2) define the normal(and abnormal) upper limits of PCT; (3) identify which prenatal, perinatal and neonatal variables are in play in modulating host characteristics and PCT response in the healthy, uninfected and infected neonate, respectively; and (4) evaluate the quality of reporting of PCT accuracy studies for diagnosing neonatal sepsis in terms of internal (risk of bias) and external (generalizability) validity of the results.

Concomitantly with the increase in the prevalences of overweight/obesity, nonalcoholic fatty liver disease (NAFLD) has worldwide become the main cause of chronic liver disease in both adults and children. Patients with fatty liver display features of metabolic syndrome (MetS), like insulin resistance (IR), glucose intolerance, hypertension and dyslipidemia. Recently, epidemiological studies have linked obesity, MetS, and NAFLD to decreased bone mineral density and osteoporosis, highlighting an intricate interplay among bone, adipose tissue, and liver. Osteoprotegerin (OPG), an important symbol of the receptor activator of nuclear factor-B ligand/receptor activator of nuclear factor kappa B/OPG system activation, typically considered for its role in bone metabolism, may also play critical roles in the initiation and perpetuation of obesity-related comorbidities. Clinical data have indicated that OPG concentrations are associated with hypertension, left ventricular hypertrophy, vascular calcification, endothelial dysfunction, and severity of liver damage in chronic hepatitis C. Nonetheless, the relationship between circulating OPG and IR as a key feature of MetS as well as between OPG and NAFLD remains uncertain. Thus, the aims of the present review are to provide the existent knowledge on these associations and to discuss briefly the underlying mechanisms linking OPG and NAFLD.

Background and Aims Subclinical inflammation is a central component of cardiometabolic disease risk in obese subjects. The aim of the study was to evaluate whether the white blood cell count (WBCc) may help to identify an abnormal cardiometabolic phenotype in overweight (Ow) or obese (Ob) children. Methods and Results A cross-sectional sample of 2835 Ow/Ob children and adolescents (age 6–18 years) was recruited from 10 Italian centers for the care of obesity. Anthropometric and biochemical variables were assessed in the overall sample. Waist to height ratio (WhtR), alanine aminotransferase (ALT), lipids, 2 h post-load plasma glucose (2hPG), left ventricular (LV) geometry and carotid intima-media thickness (cIMT) were assessed in 2128, 2300, 1834, 535 and 315 children, respectively. Insulin resistance and whole body insulin sensitivity index (WBISI) were analyzed using homeostatic model assessment (HOMA-IR) and Matsuda's test. Groups divided in quartiles of WBCc significantly differed for body mass index, WhtR, 2hPG, HOMA-IR, WBISI, lipids, ALT, cIMT, LV mass and relative wall thickness. Children with high WBCc (≥8700 cell/mm 3 ) showed a 1.3–2.5 fold increased probability of having high normal 2hPG, high ALT, high cIMT, or LV remodeling/concentric LV hypertrophy, after adjustment for age, gender, pubertal status, BMI and centers. Conclusions This study shows that WBCc is associated with early derangements of glucose metabolism and preclinical signs of liver, vascular and cardiac damage. The WBCc may be an effective and low-cost tool for identifying Ow and Ob children at the greatest risk of potential complications.

In Italy despite the increasing use of donkeys in leisure activities, onotherapy and milk production, there are no epidemiological data regarding the parasites affecting this species. A survey was conducted to determine the prevalence of the principal endoparasitic infections in 50 donkey farms. Between March 2012-2015, faecal samples were collected from 961 donkeys and examined individually using a modified McMaster technique. In addition a centrifugation/flotation technique (Proudman test) and a sedimentation technique were used for the diagnosis of Anoplocephalidae and Fasciola hepatica eggs, respectively. On each farm pooled coprocoltures were made. Strongyles were the most common parasitic species found, with a prevalence of 88.5%. 11.4% of donkeys were not infected and infection intensity was lower than the donkey cut-off selective therapy of 300 eggs per gram (epg) in 33.4% of animals. The other epg values were 300–500 in 14.3%, 501–1,000 in 26.0%, 1,001-2,000 in 12.8% and > 2,000 in 2.1% of donkeys. In all tested farms, coprocoltures revealed the presence of Cyathostomes (100%) followed by Strongylus vulgaris in 13 farms (26%), Poteriostomum spp. (24%), Triodontophorus spp. (6%) and S. edentatus (4%). Other parasites found in studied donkeys were: Oxyuris equi (7.8%), Dictyocaulus arnfieldi (4.4%), Parascaris equorum (2.8%), Anoplocephala perfoliata (1.1%) Eimeria leuckarti (0.6%) and Strongyloides westeri (0.1%). No positivity was detected for F. hepatica. This study represents the first large-scale survey in Italy and added data to the parasitological scenario of donkey population.

Moxidectin (MOX) has a wide range of ecto-endoparasitic activity in many species including horses. There is a paucity of data on the efficacy of anthelmintics used in donkeys. The aims of the present study were to evaluate the field efficacy and Egg Reappearance Period (ERP) of MOX up to 84 days at horse dose against natural infection of Cyathostominae in donkeys. The trial was conducted in northern Italy, twenty-nine donkeys, were selected on the basis of faecal egg counts (FEC) > 300 EPG. Animals were treated on Day 0 with an oral gel containing MOX, at the manufacturer’s recommended horse dose (0.4mg/kg BW). FECs were performed on each donkey at least every fortnight during 84 days after treatment using a modified McMaster technique with a sensitivity 10 EPG. The efficacy and ERP values were determined following the AAEP Parasite Control Guidelines. The percentage reductions in FEC were 99.7% at the day 14, 99.5% at the day 28, 97.7% at the day 56 and 73.3% on day 84 post treatment. This trial demonstrates that MOX at horse dose was effective and safe for the treatment of Cyathostominae in donkeys, however with a shortened ERP this could be the first indication of developing anthelmintic resistance. Considering that the donkeys have a greater capacity to metabolize certain drugs compared with horses, a higher dosage or shorter intervals could be required for maintaining effective drug concentrations. The shorter ERP observed in the studied donkeys could be associated with a sub-therapeutic level of MOX.

Background and aims Lipid ratios to estimate atherosclerotic disease risk in overweight/obese children are receiving great attention. We aimed to compare the performance of non-high-density lipoprotein-cholesterol (HDL-C) versus triglycerides-to-HDL-C ratio (Tg/HDL-C) in identifying cardiometabolic risk factors (CMRFs) or preclinical signs of organ damage in outpatient Italian overweight/obese children. Methods and results In this retrospective, cross-sectional study, 5505 children (age 5–18 years) were recruited from 10 Italian centers for the care of obesity, of which 4417 (78%) showed obesity or morbid obesity. Anthropometric, biochemical, and blood pressure variables were analyzed in all children. Liver ultrasound scan, carotid artery ultrasound, and echocardiography were performed in 1257, 601, and 252 children, respectively. The entire cohort was divided based on the 75th percentile of non-HDL-C (≥130 mg/dl) or Tg/HDL-C ratio (≥2.2). The odds ratio for insulin resistance, high blood pressure, metabolic syndrome, presence of liver steatosis, increased levels of carotid intima-media thickness (cIMT) and concentric left ventricular hypertrophy (cLVH) was higher in children with high levels of Tg/HDL-C with respect to children with high levels of non-HDL-C. Conclusions In an outpatient setting of overweight/obese children, Tg/HDL-C ratio discriminated better than non-HDL-C children with CMRFs or preclinical signs of liver steatosis, and increased cIMT and cLVH.

Novel data indicate that nonalcoholic fatty liver disease (NAFLD) may increase the risk for cardiac dysfunction. The present study aimed to determine whether, in children, NAFLD is associated with subclinical left ventricular (LV) structural and functional abnormalities independently of metabolic risk factors. We performed a complete echocardiographic study including tissue Doppler imaging, magnetic resonance imaging (MRI) for measurement of hepatic fat fraction (HFF) and abdominal fat mass distribution, along with lipid profile, insulin sensitivity, and high-sensitivity C-reactive protein in 108 obese children, 54 with (HFF >=5%) and 54 without NAFLD, and 18 lean healthy subjects. The three groups were matched on age, gender, and pubertal status, and obese children with NAFLD were matched on body mass index/standard deviation score with those without NAFLD. Forty-one of the children with NAFLD underwent liver biopsy. Compared to controls and children without liver involvement, those with NAFLD had features of LV diastolic dysfunction, including higher E-to-e' ratio and lower e' tissue velocity. The Tei index (reflecting the combined systolic and diastolic LV function) was also significantly higher in NAFLD children. Among children with biopsy-proven NAFLD, 26 had definite nonalcoholic steatohepatitis (NASH) and 15 were not-NASH. Patients with definite-NASH had significantly lower e' velocity and significantly higher E-to-e' and Tei index (P < 0.001, respectively) than those without NASH. In multiple logistic regression analysis, NAFLD was the only statistically significant variable associated with increased E-to-e' ratio, whereas NAFLD and systolic blood pressure were significantly associated with increased Tei index. Conclusion: Our findings demonstrate that asymptomatic obese children with NAFLD exhibit features of early LV diastolic and systolic dysfunction, and that these abnormalities are more severe in those with NASH. (Hepatology 2013;)

Over the last two decades, the rise in the prevalence rates of overweight and obesity explains the emergence of nonalcoholic fatty liver disease (NAFLD) as the leading cause of chronic liver disease worldwide. As described in adults, children and adolescents with fatty liver display insulin resistance, glucose intolerance, and dyslipidemia. Thus NAFLD has emerged as the hepatic component of the metabolic syndrome (MetS) and a strong cardiovascular risk factor even at a very early age. Several studies, including pediatric populations, have reported independent associations between NAFLD and markers of subclinical atherosclerosis including impaired flow-mediated vasodilation, increased carotid artery intima-media thickness, and arterial stiffness, after adjusting for cardiovascular risk factors and MetS. Also, it has been shown that NAFLD is associated with cardiac alterations, including abnormal left ventricular structure and impaired diastolic function. The duration of these subclinical abnormalities may be important, because treatment to reverse the process is most likely to be effective earlier in the disease. In the present review, we examine the current evidence on the association between NAFLD and atherosclerosis as well as between NAFLD and cardiac dysfunction in the pediatric population, and discuss briefly the possible biological mechanisms linking NAFLD and cardiovascular changes. We also address the approach to treatment for this increasingly prevalent disease, which is likely to have an important future global impact on the burden of ill health, to prevent not only end-stage liver disease but also cardiovascular disease.

The SIGENP Group has created an Italian Liver Transplantation database. The study considers all patients under 18 yr of age on the waiting list or transplanted between 1984 and 2005. Demographic and clinical data were collected and a descriptive analysis was conducted. Kaplan-Meier survival curves were calculated and Cox's proportional-hazards regression analysis were performed to identify predictors of death after transplantation. Twenty-two Italian centers took part and data were collected on 622 cases: only 53.8% of the transplants performed up until 1998 were carried out in Italy, while this was true of 97.7% of the operations performed between 1999 and 2005. Recipient survival curve analysis revealed one-, two- and five-yr survival rates of 88, 87 and 84%, respectively, and a significant improvement in survival after 1998 (p = 0.0322). Cox's analysis identified the following risk factors for death after liver transplantation, i.e. transplantation before 1998, neoplasms or fulminant hepatic failure as indications, being in intensive care at the time of transplantation and retransplantation. The center where the transplant is performed also revealed an influence on patient survival. Thanks to a better patient follow-up and more cooperation between specialists, the mean survival after liver transplantation is improving and Italian children can be transplanted in Italy.

Non-alcoholic fatty liver disease (NAFLD) encompasses a range of liver histology severity and outcomes in the absence of chronic alcohol use. The mildest form is simple steatosis in which triglycerides accumulate within hepatocytes. A more advanced form of NAFLD, non-alcoholic steatohepatitis (NASH), includes inflammation and liver cell injury, progressive to cryptogenic cirrhosis. Although prevalence in children is very difficult to establish, NAFLD is probably the most common cause of liver disease in preadolescent and adolescent groups. Over the last two decades the rise in the prevalence rates of overweight and obesity likely explains the NAFLD epidemic worldwide. NAFLD is strongly associated with abdominal obesity, type 2 diabetes, and dyslipidemia, and most patients have evidence of insulin resistance. Thus, NAFLD shares many features of the metabolic syndrome, a highly atherogenic condition, and its presence could signify a substantial cardiovascular risk. Accurate diagnosis and staging of NAFLD requires liver biopsy. The development of non-invasive surrogate markers and the advancement in imaging technology will aid in the screening of large populations at risk for NAFLD. While the optimal treatment has yet to be determined, lifestyle modification through diet and exercise should be attempted in children diagnosed with NAFLD. This review outlines current understanding, recent advances and challenges on pediatric NAFLD for both clinicians and researchers. Key words: Fatty liver.