Alterações Dermatológicas em Pacientes Submetidos à Cirurgia Bariátrica / Dermatological Changes in Patients Undergoing Bariatric Surgery

Introdução: O consumo de glúten e patologias a ele relacionadas ­ Doença Celíaca (DC), Sensibilidade ao Glúten Não Celíaca (SGNC) e Alergia ao Glúten (AG) ­ vem adquirindo maiores prevalências anualmente. A DC acomete 1% da população mundial, com epidemiologia dependente de fatores genéticos e sociais. Esta afeta o intestino delgado, com inflamação, atrofia vilositária e hiperplasia de criptas. As manifestações, tanto da DC quanto SGNC, são majoritariamente digestivas; todavia, podem ocorrer manifestações extraintestinais, entre elas, as dermatológicas. A Dermatite Herpetiforme é a mais conhecida, manifestada com urticária, pápulas, vesículas, bolhas e escoriações em cotovelos, ombros, joelhos e nádegas de celíacos. Embora a DC seja a que mais promove lesão dermatológica, esta também pode existir na SGNC e AG. As manifestações cutâneas relacionadas ao glúten são o objeto desta pesquisa, enfatizando a correlação entre DC, SGNC e AG e lesões cutâneas vistas em ambulatórios clínicos e dermatológicos. Objetivo: Avaliar manifestações cutâneas relacionadas ao glúten em pacientes de dermatologistas da cidade de Criciúma/SC. Métodos: Estudo observacional transversal, com coleta censitária de dados primários e abordagem quantitativa. Realizado em clínicas dermatológicas particulares em Criciúma, com aplicação de questionário a pacientes de ambos os sexos e qualquer idade, cuja hipótese diagnóstica é de lesão cutânea causada pelo consumo de glú- ten, mediante autorização com assinatura do Termo de Consentimento Livre e Esclarecido. Resultados: Espera-se encontrar padrão semelhante de acometimento dermatológico entre os pacientes com hipótese diagnóstica de lesão cutânea causada pela ingestão de glúten.

Introduction: Gluten consumption and related pathologies - Celiac Disease (CD), Non-Celiac Gluten Sensitivity (NCGS), and Gluten Allergy (GA) - are becoming more prevalent every year. CD affects 1% of the world's population, with its epidemiology dependent on genetic and social factors. CD affects the small intestine with inflammation, villous atrophy, and crypt hyperplasia. The manifestations of both CD and NCGS are predominantly digestive. However, extraintestinal manifestations may occur, including dermatological ones. Dermatitis Herpetiformis is the best known, manifesting with hives, papules, vesicles, blisters, and excoriations on the elbows, shoulders, knees, and buttocks of celiac patients. Although CD is the one that most promotes dermatologic injury, this can also exist in NCGS and GA. Gluten-related skin manifestations are the subject of this research, emphasizing the correlation between CD, NCGS, GA, and skin lesions seen in clinical and dermatological outpatient clinics. Objective: To evaluate gluten-related skin manifestations in patients of dermatologists in the city of Criciúma/SC. Methods: Cross-sectional observational study, with census collection of primary data and quantitative approach. It was carried out in private dermatology clinics in Criciúma, with the application of a questionnaire to patients of both sexes and any age whose diagnostic hypothesis is a skin lesion caused by gluten consumption - upon authorization by signing an Informed Consent Form. Results: We expect to find a similar pattern of dermatological symptoms among patients with a diagnostic hypothesis of skin lesions caused by gluten ingestion.

Karshya -A Critical Review on Nutritional Deficiency as per Ayurveda

Ayurveda emphasize prevention over cure. A balanced diet with proper dietetic rule can help avoid a lot of common health concerns. The source of life for all living beings is food, growth, strength, intelligence, satisfaction, all are established in food. Food is significant as a nutritional source, as well as having therapeutic value, and it plays an important part in regaining strength lost due to the disease's detrimental effects throughout the post-treatment phase and also excess exercise, or addiction too. Ayurveda classic haphazardly explain nutritional issues. Each and every disease is due to faulty Ahara and Vihara. Ahara vidhi is equally important to get optimum benefits from consumed food. Childhood malnutrition is thought to be the cause of 35% of all fatalities in children under the age of five, as well as 21% of total worldwide disability-adjusted life years lost in children. Karshya not only concerns with weight loss, but also compares with malnutrition-like disorders. In Ayurveda, Karshya is a disease as well as cause, prodromal symptoms, feature of different diseases and bad prognostic sign. Karsha is also a physiological in Vataja prakriti individual. This illness is linked to growth and development issues in children and adolescence group. In adults, malnutrition results in weakness, fatigue, low immune response, protein, vitamin, minerals, fats deficiencies, and more prone to degenerative diseases. The aim of this review article is highlighted the Ayurvedic perspective on Karsha in term of malnutrition. All material for this article is collected from classical Ayurvedic texts. Understanding the cause and pathophysiology and accurate treatment as per Ayurved classics all are discussed here elaborately

Effectiveness of Multimodal Ayurvedic Treatment in Vataja Pandu w.s.r Nutritional Deficiency Anemia - A Case Report

Panduroga is a condition where in Pitta Pradhana Tridoshas affect the Dhathus causing deterioration of Varna and Bala, leading to Twak Vaivarnyatha or Pandutha. In present day medical science, symptoms of Pandu are alike to that of anaemia. Anemia is a condition presenting with a depletion of hemoglobin concentration below normal values, or Hematocrit or Red blood cells in the blood. On an average, about 30% or nearly one third of world’s population is claimed to be affected by anemia because of numerous causes. In India prevalence is extremely high compared to world prevalence, close to 51%. Nutritional macrocytic anemia (NMA) in prevailing population and in pregnancy, commonly seen in India, most likely represents combined deficiency of iron, folic acid and vitamin B12. A 45 years old female presented with complaints of Panduta (Pallor of skin), Daurbalya (weakness), Aruchi (loss of appetite), Padashopha (pedal oedema), Pindikodweshtana (leg cramps), Shrama Shwasa (exertional dyspnoea) and Hriddrava (palpitation) with haemoglobin concentration 3.7gm% visited OPD of SJIIM, GAMC, Bengaluru. Initially she was started with oral medications followed by admission to in-patient ward on the succeeding visit. The present case study is intended to understand the accuracy of multimodal Ayurvedic approach consisting of oral medications and Matra Basti with Dadimadya Ghrita, in the management of Panduroga and is found to be effective in overcoming Vataja Pandu

Aetiology of pancytopenia: Experience of a South African tertiary academic centre

Background: Pancytopenia is a manifestation of numerous disease entities. The causes of pancytopenia differ with geographic region, socio-economic factors and HIV prevalence. Awareness of the common causes of pancytopenia may aid timely diagnosis. Objective: This study aimed to determine the aetiology of pancytopenia in a South African population.Methods: A retrospective observational study of adult patients presenting with pancytopenia at Tygerberg Academic Hospital, South Africa, from January 2016 to December 2017 was performed. Data on pancytopenia cases were obtained from the laboratory information system and utilised to determine the causes of pancytopenia. Results: A total of 673 cases of pancytopenia were identified. The most common causes of pancytopenia were chemoradiation therapy (25%), sepsis (18%), haematological malignancy (9%), advanced HIV (7%), and megaloblastic anaemia (6%). The diagnostic yield of bone marrow examinations (BME) was 57% (n = 52/91). The aetiology of pancytopenia differed according to age, with malignancy being a more common cause of pancytopenia among the elderly. Conclusion: Several easily recognisable and treatable conditions can manifest as pancytopenia. Prompt management of such conditions, notably sepsis and megaloblastic anaemia, can result in the resolution of the cytopenias and negate the need for a BME. However, haematological malignancy and unexplained pancytopenia strongly rely on a BME to establish a diagnosis. Pancytopenia investigations, when guided by appropriate clinic-laboratory findings, can promptly identify the underlying aetiology, while also identifying cases where an expedited BME is required. This is valuable in resource-conscious medicine

Stunting and zinc deficiency among 3-5 years old Kankana-ey children in Kibungan, Benguet, Philippines

@#Introduction: There is a dearth of public health and nutrition information available pertaining to the indigenous groups in the Philippines. Hence, this study described the prevalences of stunting and zinc deficiency, as well as factors associated with zinc status of 3-5 years old children among the Kankana-ey people, an indigenous group living in Kibungan, Benguet, Philippines. Methods: A cross-sectional design was used in the conduct of the study where 63 study participants were randomly selected from a chronological list of names of eligible Kankana-ey children by drawing lots. The mothers/primary caregivers of these children were interviewed to collect their socio-economic and demographic data, and dietary intake was assessed through three non-consecutive days 24-hour food recall. Height and weight of the children were also measured to determine their nutritional status. Lastly, blood samples were collected to determine the zinc status of the children based on serum zinc concentration, analysed through atomic absorption spectrophotometer. Results: Results showed that 54.0% and 50.8% of the Kankana-ey children had stunting and zinc deficiency, respectively. There was significant positive association between being exclusively breastfed and current zinc status (p=0.001). On the other hand, a statistically significant negative correlation was observed between zinc intake and zinc serum concentration (r=-0.291, p=0.021). Conclusion: Undernutrition among Kankana-ey children is a major public health concern in Kibungan, Benguet. Preventive actions must be taken to alleviate the severity of both stunting and zinc deficiency, and to mitigate possible consequences by strengthening the current nutrition and health programmes for indigenous groups, especially among young children.

Role of nutritional deficiency in the development of autism spectrum disorders

Autism spectrum disorders (ASD) are characterized by behavioural abnormalities and impaired communication skills. Both genetic and environmental factors have been attributed as causative factors. It has been reported that there are alterations in the organization of functional networks in brain as well as in the balance between structural and functional net-works in brain in children and adolescents with ASD when compared to normal children. Various studies have shown that lower levels of micronutrients like magnesium, selenium, Vitamin A, Vitamin D and Vitamin E, Folic acid and iron are found in children with ASD. This narrative review was undertaken to highlight the role of nutritional deficiency in the development of ASD in children relevant literature was collected from Google scholar, Pubmed, Cross Ref and Scopus. This review also takes into consideration how nutritional deficiency during pregnancy, infancy and childhood can have a role in the development of ASD in children.

Nutrient intakes and medication use in elderly individuals with and without dry mouths

BACKGROUND/OBJECTIVES: The nutrition of the elderly depends on various factors. Oral health, especially oral dryness, can be an important risk factor. In this study, we attempted to determine whether dry mouth is associated with compromised nutrient intakes.SUBJECTS/METHODS: A total of 120 participants aged 65–86 yrs (mean age: 69 ± 1 y) were included in this study. Demographic and health-related characteristics, living status, meals, number of medications, medical conditions, chewing ability, and quality of life, the Oral Health Impact Profile (the OHIP-14) were assessed. We performed one day 24-hr recall assessment for nutrient analyses. The differences of the means between the dry-mouth and non-dry-mouth groups were analyzed. Elderly subjects with xerostomia-induced dry mouth were classified as those who reported at least one dryness symptom on a questionnaire.RESULTS: A significant difference in population distribution was observed among the elderly who took medications for hypertension, diabetes and osteoporosis and was significantly higher in the dry-mouth group (70.2%) than in the non-dry-mouth group (44.4%) (P = 0.005). Compared with the non-dry-mouth group (50.8%), a significantly higher proportion (73.7%) of participants in the dry-mouth group took multiple medicines (≥ 4 medications) (P = 0.019). The intakes of vegetable fat, vitamin E, folate and water in the dry-mouth group were lower than in the non-dry-mouth group. The intakes of fluoride and ω-3 fatty acids were significantly lower in the dry-mouth group than in the non-dry-mouth group.CONCLUSION: The participants in the dry-mouth group exhibited low nutrient and water intakes. It is recommended that the elderly with dry mouth should drink sufficient water and receive targeted and specific nutritional guidance to prevent malnutrition.

A case report on hyperpigmentation in vitamin B12 deficiency

Cobalamin (Vitamin B12) is a water-soluble vitamin. Cobalamin is synthesized only by microorganisms. The only source of vitamin B12 for humans is food of animal origin. Hyperpigmentation of skin has been reported only rarely as the presenting manifestation of vitamin B12 deficiency. We report a patient who had hyperpigmentation as her presenting medical complaint and in whom Vitamin B12 deficiency was the cause.  A 36-year-old female presented with generalised weakness and progressive and asymptomatic hyperpigmentation of hand and feet for 5 months. She is vegetarian by diet. On examination, hyperpigmentation was present over dorsal aspect of metacarpophalangeal, proximal and distal interphalangeal joints. Hyperpigmentation were present over dorsum of the foot and over the joints. The tongue was depaillated, and hyperpigmentation was present. Her serum level of vitamin B12 was diminished (83pg/ml). Megaloblastic anemia presents with protean manifestations. The association between vitamin B12 deficiency and hyperpigmentation, although unusual, has been described. Cutaneous manifestations associated with B12 deficiency include characteristic mucocutaneous hyperpigmentation (most common), vitiligo, angular cheilitis, and hair-nail changes. It mainly affects knuckle pads and oral mucosa. It is an under-recognized sign of megaloblastic anemia and should always be looked for in the setting of pallor. Hyperpigmentation could be the earliest manifestation of vitamin B12 deficiency before anemia sets in. It is worthwhile to consider the possibility of vitamin B12 or folate deficiency in a patient with unexplained pigmentary changes. Early detection and adequate treatment will prevent anemia and various neurological manifestations.

Escorbuto secundario a una dieta restrictiva en un niño con diagnóstico de trastorno del espectro autista: Reporte de un caso / Scurvy due to restrictive diet in a child with autism spectrum disorder: Case report

Actualmente, el escorbuto es una entidad infrecuente en pediatría. Se han publicado reportes de casos que describen la enfermedad en lactantes alimentados con leche hervida, en pacientes con sobrecarga de hierro por enfermedades hematológicas y en niños con restricciones alimentarias por trastornos del neurodesarrollo. Se reporta el caso de un paciente masculino de 4 años con diagnóstico de trastorno del espectro autista que desarrolló la enfermedad por un hábito alimentario selectivo de larga evolución, sin ingesta de frutas ni verduras. La importancia del reporte radica en informar al pediatra y a otros profesionales dedicados a la atención primaria de salud acerca del desarrollo de escorbuto como potencial consecuencia de las dietas restrictivas en niños con trastornos del neurodesarrollo y de la trascendencia de la anamnesis alimentaria en pacientes con patología para evitar enfermedades asociadas a micronutrientes.

Scurvy is a very uncommon entity in pediatric population. Some case reports have been published in infants fed with boiled milk, in patients with iron overload secondary to hematological diseases and in children with food restrictions secondary to neurodevelopmental disorders. We report a case of a 4-year-old male patient with a diagnosis of autism spectrum disorder, which developed scurvy secondary to a long-term selective eating habit without fruit or vegetable intake. The objective of this case report is to announce the pediatrician and other professionals dedicated to primary health care about scurvy as a potential consequence of restrictive diets in children with autism spectrum disorders as well as the importance of dietary history in sick patients to prevent associated micronutrient deficiencies.

Influence of laparoscopic sleeve gastrectomy on nutritional status in patients with obesity / 中华临床营养杂志

Objective To assess the influence of laparoscopic sleeve gastrectomy (LSG) on the nutritional status in patients with obesity.Methods From August 2014 to July 2015, 24 obese patients underwent LSG in Dongfang Hospital Affiliated to Tongji University.Weight and nutritional status of these patients were measured pre-operatively and 3, 6, and 12 months after surgery.Results The mean body weight of the 24 obesity patients was (81.94±21.39) kg, (78.83±24.49) kg, (62.67±10.79) kg 3, 6, and 12 months after surgery, respectively, which were significantly lower than the preoperative body weight [(99.02±23.92)kg] (P=0.004).The serum levels of albumin, hemoglobin, and trace elements (including calcium, iron, zinc, magnesium, and copper) showed no significant change after surgery (all P>0.05).Plasma vitamin D[25(OH)D] increased significantly from (13.1±4.1)μg/L preoperatively to (19.8±5.3)μg/L 12 months after surgery (P=0.031).Folic acid was (6.2±3.9)μg/L before LSG and significantly increased to (14.2±9.2) μg/L 3 months later surgery (P=0.009);the folic acid level gradually decreased 6 and 12 months after LSG but was still higher than the preoperative level.Conclusion Vitamin D deficiency is present in obese patients before LSG.After surgery, while the serum albumin and trace elements have no obvious change, the vitamin D and folic acid levels remarkably increase.

Probable Cases of Scurvy in Subadults Crania from Archaeological Sites, South Korea / 체질인류학회지

In this study, the skeletal abnormalities associated with scurvy in subadults crania from three archaeological skeletal collections (Nukdo, Imdang, Yeanri), South Korea was analyzed to examine the prevalence and distribution of childhood scurvy of ancient Korea. For this, 30 subadults crania from the Nukdo, Imdang, Yeanri site were examined. Using criteria described by Ortner and Ericksen (1997) for identifying scurvy in skeletal material we evaluated the cranial skeleton of the subadults for evidence of abnormal porosity. All skeletal materials were macroscopically evaluated for pathological changes associated with scurvy. In results, lesions indicative of probable scurvy were observed in 22 individuals of 30 individuals. Based on the results, childhood disease relating to nutrition and metabolism in ancient Korea might have been widespread, along with scurvy. The results of the present study will be useful for understanding the health condition of the ancient Korean populations. Future work will add significantly to the larger picture of diet and disease within populations of ancient Korea.

Stunting in children under five years old is still a health problem in the Western Brazilian Amazon: a population-based study in Assis Brasil, Acre, Brazil / Nanismo em crianças menores de cinco anos de idade ainda é um problema de saúde na Amazônia Ocidental Brasileira: um estudo de base populacional em Assis Brasil, Acre, Brasil

Abstract Despite the process of nutritional transition in Brazil, in some places, such as the Amazon region, stunting is still an important public health problem. We identified the prevalence and factors associated with stunting in children under five years old residing in the urban area of Assis Brasil. A survey was conducted in which a questionnaire on socioeconomic, maternal and children’s conditions was applied, and height or length was measured. The children with height for age index below -2 Z-scores were considered stunted, according to the criteria by the World Health Organization. Four hundred and twenty-eight children were evaluated. Of these, 62 were stunted. Factors associated with stunting, according to adjusted models, were: the presence of open sewer, the wealth index for households, the receipt of governmental financial aid and the mother’s height, age and education. Therefore, it was observed that family and the mother’s characteristics as well as environmental and socioeconomic factors were closely related to the occurrence of stunting in the population studied, and such nutritional disturbance is still a health problem in the Brazilian Amazon.

Resumo Apesar do processo de transição nutricional no Brasil, em alguns lugares, como a região amazônica, o nanismo ainda é um importante problema de saúde pública. Identificou-se a prevalência e fatores associados ao déficit de crescimento em crianças menores de cinco anos de idade residentes na área urbana de Assis Brasil. Um inquérito foi realizado utilizando instrumento semiestruturado sobre características socioeconômicas, maternas e das crianças, e foram aferidas medidas antropométricas. As crianças com índice de estatura para idade inferior a -2 escores-Z foram consideradas com déficit de crescimento, de acordo com os critérios da Organização Mundial da Saúde. Quatrocentos e vinte e oito crianças foram avaliadas. Destas, 62 apresentaram déficit de crescimento. Os fatores associados à baixa estatura, de acordo com modelos ajustados, foram: presença de esgoto a céu aberto, índice de riqueza para as famílias, recebimento de ajuda financeira governamental, altura materna, idade e escolaridade maternas. Portanto, observou-se que as características familiares e da mãe, bem como fatores ambientais e socioeconômicos estavam intimamente relacionados com a ocorrência de déficit de crescimento na população estudada, e que a desnutrição ainda é um problema de saúde na Amazônia brasileira.

PROPOSAL OF A REVISIONAL SURGERY TO TREAT SEVERE NUTRITIONAL DEFICIENCY POST-GASTRIC BYPASS / PROPOSTA DE CIRURGIA REVISIONAL PARA TRATAMENTO DE DESNUTRIÇÃO SEVERA APÓS BYPASS GÁSTRICO

ABSTRACT Background The gastric bypass has nutritional and electrolyte disturbances rate of approximately 17%. The most common deficits are protein malnutrition, ferric and zinc, in addition to the vitamin. Although rare, some malnutrition stages reach such severity that ends up being necessary hospitalization and sometimes revisional or reversal surgical procedures. Aim: To present a proposal of surgical revision for treatment of severe malnutrition after bariatric surgery. Methods: The procedure is to reconstitute the food transit through the duodenum and proximal jejunum, keeping the gastric bypass restrictive component. As an additional strategy, the gastric fundus resection is performed, aiming to intensify the suppression of the greline and avoiding excessive weight regain. Results: After initial stabilization, nutritional and electrolytic support, the procedure was performed in two patients as definitive treatment of malnutrition status. Good results were observed at one year follow up. Conclusion: As improvement option and/or resolution of the nutritional alterations, surgical therapy is one of the alternatives. There is still no consensus on the surgical technique to be performed. This procedure is based on pathophysiological factors for the treatment of this condition, with good initial results, without significant clinical alterations. Longer follow-up will determine its effectiveness.

RESUMO Racional: O bypass gástrico consta com taxa de distúrbios nutricionais e eletrolíticos de aproximadamente 17%. Os déficits mais frequentes são a desnutrição proteica, férrica e de zinco, além das vitamínicas. Apesar de raros, alguns quadros de desnutrição atingem tal gravidade que acaba sendo indicada internação e, por vezes, procedimentos cirúrgicos revisionais ou de reversão. Objetivo: Apresentar proposta de cirurgia revisional para tratamento de desnutrição severa após bypass gástrico. Métodos: O procedimento consiste em reconstituir o trânsito alimentar pelo duodeno e jejuno proximal, mantendo o componente restritivo do bypass gástrico. Como estratégia adicional, é realizada ressecção do fundo gástrico, visando intensificar a supressão da grelina e evitando reganho excessivo de peso. Resultado: Após estabilização inicial com suporte hidroeletrlítico e nutricional, o procedimento foi realizado em dois pacientes como tratamento definitivo do quadro de desnutrição. Bons resultados foram observados em seguimento de um ano. Conclusão: Como opção de melhora e/ou resolução da defasagem nutricional, a terapia cirúrgica é uma das alternativas. Ainda não há consenso quanto à técnica a ser utilizada. O procedimento aqui apresentado é baseado em fatores fisiopatológicos para o tratamento desta condição, com bons resultados iniciais, sem efeitos colaterais significativos. Seguimento de mais longo prazo é necessário para determinação de sua eficácia.

Health profile of adolescents of Bhavnagar district, Gujarat, India: a cross sectional study.

Background: Adolescence and young adulthood are periods of critical development and transition. Adolescent constitutes over 23% of the population in India. Nutrition and health needs of the adolescent are more because of more requirements for growth spurt and increase in physical activity. Objective: To study health profile of adolescents of Bhavnagar district. Methods: The study was carried by Medicine Department, K.J. Mehta Hospital, Amargadh, Bhavnagar during period from September 2014 to August 2015. After taking the permission of principals of 10 schools and consent of the parents of adolescents, 842 adolescents from 10 schools of Bhavnagar district were examined for nutritional deficiencies. The data was collected by predesign, pretested proforma and analyzed using SPSS 17.0 (Trial version). Results: Mean age was 15.8 ± 1.96 years. Out of 867, 433 (51.4%) were boys and 409 (48.6%) were girls. Vitamin A deficiency was present in 53 (6.3%) adolescents. Vitamin B complex deficiency signs were seen in 139 (16.5%) adolescents. Vitamin C deficiency signs were seen in 84 (10.0%) adolescents. PEM was observed in 90 (10.7%) adolescents. The study revealed that 67.0% girls were suffering from anaemia compare to 58.7% of boys. 117 (13.9%) adolescents had visual impairment. Conclusions: Poor personal hygiene and nutritional deficiency among these adolescents needs great attention and health education.

Enfermedad celíaca: revisión / Celiac disease: a review

La Enfermedad Celiaca (EC) tiene una prevalencia cercana al 1% de la población general y se considera que hay un número importante de pacientes asintomáticos no diagnosticados. Su presentación clínica es variable comprendiendo el clásico síndrome de malabsorción, formas menores y la EC silente. El diagnóstico serológico tiene una elevada sensibilidad y especificidad y siempre debe confirmarse con biopsia. El diagnóstico en pacientes en dieta libre de gluten incluye test de tipificación de HLA y prueba de dieta con gluten con estudio serológico e histológico posterior. El pilar del tratamiento es la dieta libre de gluten, que debe ser supervisada por un nutriólogo con experiencia. La monitorización de la terapia debe realizarse con serología. La EC mal controlada puede determinar complicaciones como linfoma y adenocarcinoma de intestino delgado. En el futuro es probable que nuevas terapias farmacológicas sean de utilidad en el manejo de la EC.

Celiac disease has a prevalence near to 1% of general population and there is an important amount of asymptomatic people not yet diagnosed. Clinical presentation includes the classical malabsorption syndrome, minor and silent celiac disease. Serologic diagnosis has an elevated sensitivity and specificity, and must be confirmed by biopsy. Diagnosis in those on gluten free diet includes HLA type and gluten challenge with posterior serologic and histologic evaluation. The core of the treatment is the gluten free diet that must be supervised by an expert nutritionist. Monitoring is with serology. Poor disease control can determine complications such as lymphoma and small bowel adenocarcinoma. In the future, it is likely that new pharmacologic therapies will be available for the management of celiac disease.

Correlation factors of nutritional deficiencies in critically ill children / 中华临床营养杂志

Objective To assess the nutritional status of critically ill children and the nutritional intake during their stay in pediatric intensive care unit (PICU),and analyze the correlation factors of nutritional deftciencies.Methods One hundred and twenty-seven patients who met the PICU admission standards with a PICU stay of ＞72 h were recruited from June to October 2012 in Shanghai Children's Medical Center.Anthropometric measurements and all nutrition-related indicators of those patients were recorded from day 1 to day 10.Results 59 of the 127 patients (46.5％) showed malnutrition at admission,in which 49.2％ had severe malnutrition.65 of the 127 patients (51.2％) showed malnutrition at discharge,in which 63.1％ were severely malnourished.Median estimated energy requirements (EER) by American Society for Parenteral and Enteral Nutrition was 376.7 kJ/ (kg · d) [interquartile range,IQR:314.0～376.7 kJ/ (kg · d)],prescribed calories were 237.8 kJ/ (kg· d) [IQR:159.5 ～291.8 kJ/ (ks· d)],and delivered calories were 220.2 kJ/ (kg· d)[IQR:132.3 ～ 279.2 k J/ (kg · d)],showing significant difference (P =0.000).The delivered energy was ＜90％ of EER in 80.7％ of the 1021 recorded days and the prescribed energy was ＜90％ of EER in 74.3％of the 1021 recorded days.The cumulative calory deficiency from day 1 to day 10 in PICU was (933.5 ±745.5) kJ/ (kg · person),and the cumulative protein deficiency was (4.0 ±5.0) g/ (kg · person).83 patients (65.4％) experienced at least one feeding interruption.Altogether 170 times of feeding interruption were recorded,of which 117 (68.8％) could be explained by examination procedures.Conclusions There is a high prevalence of malnutrition in critically ill children at admission into PICU,and their nutritional status deteriorates during hospital stay.Discrepancies between required and delivered energy were mainly attributed to under-prescription,while discrepancies between prescribed and delivered energy were mainly attributed to feeding interruptions.Appropriate care for these children entails early nutritional risk screening and correct nutrition support to avoid nutritional deficiencies.

Características de deficiência nutricional do amendoinzeiro submetido à omissão de N, P, K / Characteristics of nutritional deficiency in groundnut submitted to the absence of N, P, and K

O amendoim é uma excelente alternativa agrícola para a região Nordeste do Brasil, porém, poucos estudos têm sido realizados para esta cultura, no tocante à sua adubação. Sendo assim, foi realizado um estudo com o objetivo de avaliar o rendimento e as características visuais de deficiência nutricional do amendoinzeiro (Arachis hypogaea L.) submetido à omissão de N, P e K. O experimento foi realizado em casa de vegetação da Universidade Federal do Recôncavo da Bahia, no Centro de Ciências Agrárias, Ambientais e Biológicas, situada em Cruz das Almas ­ BA, no período de Agosto a Outubro de 2010. O delineamento experimental foi em blocos casualizados, constando de sete tratamentos e quatro repetições. Os tratamentos estudados foram: T1- Solução Completa; T2- Omissão de N; T3- Omissão de P; T4 - Omissão K; T5- Omissão de NP; T6- Omissão PK e T7- Omissão de NPK. Durante todo o ciclo da cultura avaliou-se os possíveis aspectos visuais de deficiência. Ao final do experimento foram avaliados dados de altura e teor de clorofila. Aos 60 dias após a emergência, as plantas foram coletadas e particionadas em folhas, hastes e raízes, e secadas a 65ºC em estufa com circulação forçada de ar até atingir peso constante para quantificar a massa seca da parte aérea e da raiz. Nestas condições experimentais a omissão de K não se mostrou um fator limitante para o acúmulo de massa seca de folhas e haste nas plantas de amendoim. O fósforo se mostrou bastante requerido para o crescimento em altura e acúmulo de massa seca das folhas e hastes. O teor de clorofila da planta foi menor nos tratamento onde houve a omissão de N. Dos tratamentos aplicados, o que se mostrou mais limitante foi o tratamento com omissão de NPK, confirmando a importância da aplicação destes nutrientes às plantas de amendoim.

The groundnut is a great agricultural alternative for the Northeast region of Brazil, but few studies have been carried out for this crop in relation to its fertilization. Thus, a study was conducted to evaluate the performance and visual characteristics of nutritional deficiency in groundnut (Arachis hypogaea L.) submitted to the absence of N, P, and K. The experiment was conducted in a greenhouse at the Federal University of Bahia Recôncavo, at the Center for Agricultural, Environmental and Biological Sciences, located in Cruz das Almas, BA, from August to October 2010. The experimental design was in randomized blocks, consisting of seven treatments and four replications. The treatments were: T1 - Complete Solution; T2 - Omission of N; T3 - Omission of P; T4 - Omission of K; T5 - Omission of NP; T6 ­ Omission of PK; and T7 - Omission of NPK. Throughout the crop cycle possible visual aspects of deficiency were assessed. At the end of the experiment, the data were evaluated in height and chlorophyll content. At sixty days after emergence (DAE) plants were collected and partitioned into leaves, stem and root for drying in air forced oven at 65°C until constant weight was obtained to measure the dry mass of shoot and root. Under these experimental conditions the omission of K was not a limiting factor for dry mass of leaves and stem in peanut plants. Phosphorus is an element that proved to be enough for the required growth in height and accumulation of dry mass of leaves and stem. The chlorophyll content of the plant was lower in the treatment in which there was the omission of N. The treatment with omission of NPK was the most limiting, demonstrating the importance of applying these nutrients to the groundnut plants.

Relação entre deficiência de ferro e anemia em crianças de até 4 anos de idade / Relationship between iron deficiency and anemia in children younger than 4 years

OBJETIVO: Avaliar a prevalência de anemia, deficiência de ferro e anemia por deficiência de ferro em uma coorte de crianças. MÉTODOS: Estudo de coorte aninhado a um ensaio de campo randomizado. As crianças foram selecionadas ao nascimento na maternidade do único hospital público da cidade de São Leopoldo (RS), Brasil. O presente estudo avaliou o estado nutricional de ferro (hemoglobina e ferritina sérica) quando essas crianças apresentavam idade de 12-16 meses e, posteriormente, na idade de 3-4 anos. A anemia foi definida pela concentração de hemoglobina < 11,0 g/dL; a deficiência de ferro, por ferritina sérica < 15,0 µg/L; e a anemia por deficiência de ferro, pela presença de concentrações de hemoglobina < 11,0 g/dL com deficiência de ferro. RESULTADOS: Na idade de 12-16 meses, a prevalência geral de anemia, deficiência de ferro e anemia por deficiência de ferro foi de 63,7, 90,3 e 58,8 por cento, respectivamente. Esses valores, para a faixa etária de 3-4 anos, foram de 38,1, 16,1 e 7,4 por cento, respectivamente. Na idade de 12-16 meses, 95 por cento dos casos de anemia foram associados à deficência de ferro, e na idade de 3-4 anos, apenas 19,3 por cento dos casos. CONCLUSÕES: Observou-se que a deficiência de ferro foi a principal causa da anemia no segundo ano de vida, porém não na idade de 3-4 anos. Assim, enfatiza-se que a anemia em crianças de idade pré-escolar pode ter outras etiologias e merece avaliações cuidadosas.

OBJECTIVE: To evaluate the prevalence of anemia, iron deficiency and iron deficiency anemia in a cohort of children. METHODS: A cohort study nested in a randomized field trial. Children were recruited at birth at the maternity unit of the only public hospital in the city of São Leopoldo, southern Brazil. This study assessed iron status (hemoglobin and serum ferritin) when children were 12-16 months old and later at the age of 3-4 years. Anemia was defined as hemoglobin concentration < 11.0 g/dL; iron deficiency as serum ferritin < 15.0 µg/L; and iron deficiency anemia as hemoglobin concentration < 11.0 g/dL with iron deficiency. RESULTS: At age 12-16 months, the overall prevalence of anemia, iron deficiency and iron deficiency anemia was 63.7, 90.3 and 58.8 percent, respectively. The values for age group 3-4 years were 38.1, 16.1 and 7.4 percent, respectively. At age 12-16 months, 95 percent of anemia cases were associated with iron deficiency against only 19.3 percent of cases at age 3-4 years. CONCLUSIONS: Iron deficiency was the main cause of anemia in the second year of life, but not at age 3-4 years. Thus, we point out that anemia in preschool children may have other causes and deserves careful assessment.

Spectrum of haemoglobinopathies diagnosed by cation exchange-HPLC & modulating effects of nutritional deficiency anaemias from north India.

Background & objectives: The usefulness of cation exchange high performance liquid chromatography (CE-HPLC) as a tool for detection of thalassaemia/haemoglobin variants was evaluated in a prospective study in a tertiary care centre in north India. We also tried to evaluate the effect of concurrent nutritional deficiency on the HPLC pattern in the local ethnic population. Methods: A total of 800 blood samples were analyzed on the Bio-Rad Variant HPLC system by β-thal short program. The retention times, proportion of the haemoglobin (%), and the peak characteristics for all haemoglobin fractions were recorded. Alkaline and acid haemoglobin electrophoresis was performed to document the identities of the haemoglobin variants, wherever necessary. Many cases were subjected to family studies for a definitive diagnosis. Results: Among 800 samples tested, 553 (69.1%) were found to have normal HPLC pattern. Apart from β- thalassaemia, nine additional variants were encountered; HbS (2.8%), HbE (2.5%) and HbD (1.1%) being the most common variants present. Other variants included Hb Q-India, Hb-Lepore, δβ-thalassemia/ HPFH, HbD-Iran, HbJ-Meerut and HbH disease. There was a significant decrease in the level of HbA2 associated with iron deficiency anaemia (IDA) (P=0.004) and increase in megaloblastic anaemia (P<0.001) among subjects with normal HPLC pattern. Interpretation & conclusions: HPLC was found to be a simple, rapid and reliable method for the detection of hemoglobin variants. An accurate diagnosis can be provided in majority of cases by use of retention time, proportion of total haemoglobin, and peak characteristics of HPLC. Haemoglobin electrophoresis and family studies play a valuable role in difficult cases. Concurrent nutritional deficiency also has an effect on HbA2 levels.

Niveles plasmáticos de hierro, cobre y zinc en escolares Barí / Blood plasma concentrations of iron, copper and zinc in Indigenous Bari schoolchildren

Introducción: Los micronutrientes hierro (Fe), cobre (Cu) y zinc (Zn) participan en funciones biológicas importantes, tales como el crecimiento y desarrollo del niño, la formación de células sanguíneas, el metabolismo energético y la respuesta inmune. El objetivo de este estudio fue determinar los niveles plasmáticos de hierro, cobre y zinc es escolares Barí.Métodos: Fueron colectadas muestras de sangre periférica de 42 niños con edades entre 6-12 años, habitantes de la comunidad indígena Barí “Kumanda” en la Sierra de Perijá, Estado Zulia. Se realizó la evaluación nutricional antropométrica por combinación de los indicadores peso/edad, peso/talla y talla/edad. Las concentraciones de Fe, Zn y Cu fueron determinadas mediante espectrometría de absorción atómica. Para el estudio del consumo dietético de los minerales se utilizó como metodología la etnografía focalizada.Resultados: Los niveles plasmáticos de minerales (µg/ml) en la población infantil Barí fueron: Fe 0,44±0,10; Zn 0,32±0,04; Cu 0,76±0,06, sin diferencias entre sexos (p>0,05). El 88,1%, 92,9% y 69,1% de los niños presentaron valores bajos de Fe (<0,50 µg/ml), Zn (<0,70 µg/ml) y Cu (<0,90 µg/ml), respectivamente. La evaluación nutricional antropométrica mostró un 71,4% de los niños Barí con déficit, 26,2% normales y 2,4% con exceso. La ingesta diaria de minerales fue muy deficiente, con adecuaciones de 59,77% (Fe), 7,37% (Zn) y 14,67% (Cu).Conclusión: En la muestra estudiada se encontró deficiencia de hierro, cobre y zinc y elevada prevalencia de desnutrición.

Introduction: The micronutrients iron (Fe), copper (Cu) and zinc (Zn) are involved in important biological functions such as growth and child development, blood cell formation, energy metabolism, and immune response. The purpose of our study was to determine plasma concentrations of iron, copper and zinc in Bari schoolchildren. Methods: Peripheral blood samples were collected from 42 children aged 6-12 years in the indigenous Bari community, "Kumanda", in the Perija mountain range of Venezuela's Zulia state. Assessment was performed by combining the anthropometric nutritional indicators of weight/age, weight/height, and height/age. Concentrations of Fe, Zn and Cu were determined by atomic absorption spectrometry. Focused ethnography was used to study dietary mineral intake. Results: Plasma concentrations of minerals (µg/ml) in Bari children were Fe 0.44±0.10, Zn 0.32±0.04, and Cu 0.76±0.06, with no gender differences (p> 0.05).Low levels of Fe (<0.50 µg/ml) were found in 88.1%, Zn (<0.70 µg/ml) in 92.9%, and Cu (<0.90 µg/ml) in 69.1% of children. Anthropometric nutritional assessment showed 71.4% of Bari children as deficient, 26.2% as normal, and 2.4% overweight. Daily intake of minerals was very poor, reaching 59.77% for Fe, 7.37% for Zn, and 14.67% for Cu. Conclusion: The study sample presented deficiencies of iron, copper, and zinc, with a high prevalence of malnutrition.