Incidence of diarrhea in children living in urban slums in Salvador, Brazil

Diarrhea remains a major health issue in developing countries, with high morbidity and mortality rates. Determining the incidence of acute diarrhea in children and its associated factors is crucial to the planning of preventive approaches. The objective of this study was to determine the incidence of diarrhea and to assess some relevant associated factors to it in children younger than 40 months living in two slums of Salvador, Brazil. This is the first prospective cohort, community-based study that was performed in two periurban slums of Salvador, Brazil. Eighty-four children younger than 40 months were randomly selected and visited every other day for one year. The chi-square test was used to evaluate the occurrence of diarrhea and its associated factors. During the surveillance period, 232 diarrhea episodes were identified, resulting in an incidence rate of 2.8 episodes/child/year. In average (mean value of 84 children),each child suffered 11.1 days of diarrhea per year, yielding an average duration of 3.9 days per episode. The highest incidence rates were found among children under one year old. Early weaning, male sex, malnutrition, having a mother younger than 25 years or who considered her child malnourished, missed immunizations and previous pneumonia were associated factors for suffering diarrheal episodes. The rates of incidence and duration of diarrhea that we found are in accordance to those reported by others. Additionally, our results reinforce the importance of environmental and health-related associated factors to the onset of diarrhea.

Incidence of diarrhea: poor parental recall ability

Several methodological issues may have an impact on the incidence rates of childhood acute diarrhea reported by community-based studies. This study was performed to assess the impact of parental recall ability and definition of diarrhea on the estimate of incidence of acute diarrhea. Eighty-four children younger than 40 months were randomly selected and visited every other day for four weeks and the occurrence of diarrhea was registered. On the last day of the study, another visit was performed and the informants were inquired about the occurrence of diarrhea during the previous four weeks. Data gathered during the four weeks were compared to those obtained on the last visit. Additionally, the informants' definition of diarrhea was investigated and compared to the one adopted by this study. During the observation period, 33 children suffered diarrhea, but only 10 (30.3 percent) informants reported the occurrence of diarrhea. Although 42.4 percent of those informants reported that their children had been ill over that period, they did not report diarrhea. Further, 60.6 percent children who had diarrhea suffered at least one episode in the two weeks prior to the visitation. The same definition of diarrhea used in this study was adopted by 52.1 percent of the informants inquired. Parental recall is an unreliable method to estimate the incidence of diarrhea and studies with a short interval between the visits should be necessary to correctly evaluate this important health problem. Moreover, assessing the informants' own definition of diarrhea is a significant contribution to the interpretation of the results.

Tricobezoar gástrico em criança: relato de caso / Gastric trichobezoar in a child: case report

Bezoar é uma massa compacta formada pelo acúmulo de materia exógeno não digerido em qualquer ponto do trato gastrointestinal, sendo o estômago o local mais comum. Muitos são os materiais que podem formar bezoares, destacando-se fibras vegetais (fitobezoar) e cabelos (tricobezoar). A sintomatologia é inespecífica e insidiosa, relacionando-se à localização. Frequentemente, o diagnóstico só é feito em face das manifestações de complicações, como obstrução intestinal e úlceras de pressão. Aqui é relatado o caso de uma menina de cinco anos que teve uma tumoração abdominal descorberta ocasionalmente numa consulta de rotina. A avaliação posterior demonstrou que se tratava de um grande tricobezoar gástrico. Uma vez que a endoscopia digestiva alta não conseguiu removê-lo, foi realizada a retirada cirúrgica do bezoar, com sucesso terapêutico. O diagnóstico diferencial de massas abddominais é muito amplo, sendo necessário alto grau de suspeição para que se avente precocemente a possibilidade de um bezoar. Hábitos alimentares bizarros e áreas de alopecia são sinais que devem chamar atenção, possibilitando o diagnóstico precoce e evitanto a ocorrência de graves complicações tardias como obstrução intestinal e hemorragia digestiva

Pediatric knowledge about acute viral hepatitis

Knowledge about hepatotropic viruses is crucial for pediatricians because of the high prevalence of viral hepatitis during childhood. The multiplicity of hepatotropic viruses, the spectrum of acute and chronic infections, and the sequels of viral hepatitis result in a need for physicians to better understand the clinical and epidemiological context of patients with viral hepatitis, as well as the importance of prevention measures for hepatitis. A descriptive cross-sectional study was made of pediatrician's knowledge about viral hepatitis, through questionnaires to 574 pediatricians, with no obligation of identification. The pediatricians were recruited among those who attended a national Congress of Pediatrics in Brasília, Brazil. Among these pediatricians, 50.1 percent frequently treated cases of hepatitis, and 74.7 percent indicated that they had knowledge of the existence of five hepatotropic viruses; 14.5 percent knew about at least four types of hepatitis complications, while only 7.7 percent and 4.3 percent were able to correctly diagnose viral hepatitis A and B, respectively. Many (28.4 percent) did not know how to treat the patients adequately. Only 37.5 percent had already recommended vaccination against hepatitis B. Only 50.2 percent of the pediatricians had been vaccinated against hepatitis B. We concluded that it is crucial to make pediatricians more knowledgeable about viral hepatitis, through continued education programs, especially emphasizing prevention procedures.

Acute liver failure complicating viral hepatitis A

Hepatitis A is one of the most frequent infectious liver diseases affecting children worldwide. The disease is usually mild and self-limited, and complications are very rare. Nevertheless, hepatitis A can sometimes cause acute liver failure (ALF), a severe, life-threatening condition. Herein is reported a case of a child who presented ALF during a course of hepatitis A. The need for early identification of possible ALF cases among hepatitis A patients, and for effective ways of evaluating such a possibility, are discussed. We also emphasize the importance of prevention measures, especially vaccination.

Tolerância hereditária à frutose: causa de vômitos recorrentes na infância / Hereditary fructose intolerance: cause of recurrent vomiting in childhood

A intolerância hereditária à frutose é uma doença metabólica infrequente que apresenta sintomas gastrointestinais acompanhados de hipoglicemia, devendo ser considerada na investigação de vomitos recorrentes de etiologia desconhecida em crianças e adultos jovens. Entretanto, por ser pouco comum, essa possibilidade é frequentemente esquecida na elaboração do diagnostico diferencial, o que pode fazer casos passarem despercebidos, pretelando o tratamento o aumentando o custo do diagnóstico. Com o objetivo de resaltar a importância de considerar a intolerância à frutose na elaboração do diagnóstico diferencial, relata-se um caso dessa doença diagnosticado em uma menina de nove anos de idade que aprentava vômitos recorrentes desde o período do desmame. Após o diagnóstico de intolerância hereditária à frutose, surgiram queixas ósseas que possivelmente estão ligadas a essa doença. A fisiopatologia e as medidas diagnósticas e terapêuticas são discutidas

Comparação do diagnóstico endoscópico com o histopatológico em crianças portadoras de esofagite / Endoscopic diagnosis versus histologic diagnosis in children with esophagitis

O refluxo gastroesofágico representa o fluxo retrógrado do conteúdo gástrico para o esôfago. A doença do refluxo gastroesofágico é a condição na qual estão presentes sintomas e/ou complicações digestivas, dentre elas a esofagite. O diagnóstico da esofagite é realizado através da endoscopia digestiva alta (EDA) e do exame histopatológico da mucosa esofágica. O presente estudo teve como objetivo comparar os achados endoscópicos e histopatológicos da região esofágica em crianças portadoras de esofagite. Foram revisados resultados de EDA e de biópsias de 125 crianças com idade entre 0 a 18 anos com esofagite, no período de 1997 a 2001. Destes pacientes, 69 (52,20 por cento) eram do sexo feminino. Nos resultados endoscópicos, 104 (83,20 por cento) pacientes tiveram o diagnóstico de esofagite edematosa; na histologia, 48 (33,40 por cento) das crianças apresentaram esofagite crônica, enquanto na de 29 (23,20 por cento) não ocorreram alterações. Quando correlacionados à histopatologia, os resultados da EDA não são fidedignos a ponto de justificar-se o uso isolado desta. É fundamental a realização da biópsia para esclarecimento diagnóstico desta patologia e para acompanhamento dos pacientes. Há ainda a necessidade de múltiplas biópsias para análise adequada do processo e para identificação precoce do esôfago de Barrett.