Early clinical and CT features of COVID-19 and community-acquired pneumonia from a fever observation ward in Ningbo, China

INTRODUCTION@#We aimed to compare the early clinical manifestations, laboratory results and chest computed tomography (CT) images of COVID-19 patients with those of other community-acquired pneumonia (CAP) patients to differentiate CAP from COVID-19 before reverse transcription-polymerase chain reaction results are obtained.@*METHODS@#The clinical and laboratory data and chest CT images of 51 patients were assessed in a fever observation ward for evidence of COVID-19 between January and February 2020.@*RESULTS@#24 patients had laboratory-confirmed COVID-19, whereas 27 individuals had negative results. No statistical difference in clinical features was found between COVID-19 and CAP patients, except for diarrhoea. There was a significant difference in lymphocyte and eosinophil counts between COVID-19 and CAP patients. In total, 22 (91.67%) COVID-19 patients had bilateral involvement and multiple lesions according to their lung CT images; the left lower lobe (87.50%) and right lower lobe (95.83%) were affected most often, and all lesions were located in the peripheral zones of the lung. The most common CT feature of COVID-19 was ground-glass opacity, found in 95.83% of patients, compared to 66.67% of CAP patients.@*CONCLUSION@#Diarrhoea, lymphocyte counts, eosinophil counts and CT findings (e.g. ground-glass opacity) could help to distinguish COVID-19 from CAP at an early stage of infection, based on findings from our fever observation ward.

Eosinofilia duodenal en pacientes Colombianos con dispepsia funcional: un estudio de casos y controles / Duodenal eosinophilia in functional dyspepsia in a Colombian sample: a case-control study

Introducción: La dispepsia funcional (DPF) es una entidad compleja cuya fisiopatología no está claramente definida. Existen alteraciones motoras gastroduodenales y recientemente se ha dado importancia a la eosinofilia duodenal. Objetivo: El objetivo de este estudio fuedeterminar si existe asociación entre eosinofilia duodenal y DPF. Materiales y métodos: Estudio de casos y controles. Pacientes mayores de 18 años con dispepsia según ROMA IV, a quienes se descartó DP orgánica con endoscopia alta (EVDA). Los controles fueron pacientes con anemia ferropénica y diarrea crónica a quienes de rutina se toman biopsias tanto del estómago como del duodeno. Se calcularon 70 pacientes en cada grupo. La información se recolectó en un formulario específico. Resultados: Hubo 243 pacientes elegibles. Se incluyeron 84 pacientes en grupo. El 80% eran mujeres. Edad promedio 53,6 años. Se encontró eosinofilia duodenal con diferencia significativa en los pacientes con saciedad precoz (p=0,01). No hubo diferencia significativa en los pacientes con llenura posprandial (p=0,63), dolor o ardor epigástrico (p=0,26), síntomas de reflujo gastroesofágico (p=0,13), alergia e intolerancia a alimentos (p=0,42) y tabaquismo (p=0,28). Asimismo, no se encontró relación entre mastocitosis duodenal y saciedad precoz (p=0,98), llenura posprandial (p=0,78) y dolor o ardor epigástrico (p=0,82). Conclusiones: La eosinofilia duodenal fue más frecuente en pacientes con DPF que tenían saciedad precoz.

Introduction: Functional dyspepsia (FD) is a complex symptom. Currently there are multiple therapeutic options that are used for the management of these patients; however, FD therapies are based on symptomatic control and do not address the pathophysiological pathways involved in its development. The duodenum has been proposed as a key site to understand the complex pathophysiology involved in FD. Objective: The aim of the study is to determine duodenal eosinophilia in patients with FD and establish the clinical-pathological correlation with the cardinal symptoms of dyspepsia. Material and methods: Case-control study. Patients older than 18 years with dyspepsia according to the Rome IV criteria, and upper gastrointestinal endoscopy normal (FD group).Patients with iron deficiency anemia and chronic diarrhea (control group). Biopsies were taken in the stomach, duodenal bulb and second portion of duodenum. A sample size of 140 patients (70 patients in the FD group and 70 patients in the control group) was calculated. The collected information was described and analyzed by conventional statistical techniques. Results: 243 patients were recruited. 84 patients were included in the FD group and 84 patients in the control group. 135 patients were women (80.3%). The mean age was 53.6 years (SD 14.9). Duodenal eosinophilia was found with significant difference in patients with early satiety (p=0.01). There was no difference in patients with postprandial fullness (p=0.63), epigastric pain or burning (p=0.26), gastroesophageal reflux symptoms (p=0.13), allergy and food intolerance (p=0.42) and smoking (p=0.28). There was no relationship between duodenal mastocytosis and early satiety (p=0.98), postprandial fullness (p=0.78), and epigastric pain or burning (p=0.82). Conclusions: Duodenal eosinophilia was similar in FD and controls. In subgroup analysis, duodenal eosinophilia occurs in patients with early satiety.

Outbreak of neonatal diarrhea caused by multiple genotypes of rotavirus A in a beef calves herd / Surto de diarreia neonatal por múltiplos genótipos de rotavírus A em um rebanho de bovinos de corte

Calf diarrhea causes substantial economic losses to beef cattle production worldwide. It is a complex multifactorial pathological condition influenced by infectious, nutritional and environmental factors. The present study focused on analyzing the pathological and molecular characterization of bovine rotavirus A (BoRVA) during a diarrhea outbreak in a beef cattle herd located in the state of Mato Grosso, central-western region, Brazil. The outbreak caused high morbidity (80%) and mortality (12%) among 1,100 calves up to 30 days of age. The BoRVA was identified in 53.3% (16/30) of the diarrheic fecal samples analyzed using the silver-stained polyacrylamide gel electrophoresis (ss-PAGE) technique. The nucleotide sequence analysis of VP7 (G genotype) and VP4 (P genotype) via RT-PCR from eight BoRVA-positive fecal samples showed the genotypes G6P[5] (n = 6), G6P[11] (n = 1) and G6P[X] (n = 1). Three calves were necropsied and the gross findings included edema and thickened, wrinkled bowel mucosa in the small intestine. Microscopic lesions were confined to the villi of the small intestine, characterized mainly by villus fusion and moderate multifocal lymphoplasmacytic enteritis. Immunohistochemical examination of three cases was positive for BoRVA. The 53.3% of the diarrheic fecal samples that were positive for BoRVA in this study suggested that RV was the etiological agent involved in this neonatal calf diarrhea outbreak.(AU)

A diarreia neonatal provoca perdas econômicas substanciais na produção de bovinos em todo o mundo. É uma condição patológica multifatorial complexa influenciada por fatores infecciosos, nutricionais e ambientais. O presente estudo teve por objetivo caracterizar o rotavírus tipo A (BoRVA) através da análise patológica e molecular durante um surto de diarreia em um rebanho bovino localizado no estado de Mato Grosso, região centro-oeste, no Brasil. O surto causou alta morbidade (80%) e letalidade (12%) em um rebanho composto 1.100 bezerros até 30 dias de idade. O BoRVA foi identificado em 53,3% (16/30) das amostras fecais diarreicas analisadas usando a técnica de eletroforese em gel de poliacrilamida corada com prata (ss-PAGE). A análise da sequência nucleotídica de VP7 (genótipo G) e VP4 (genótipo P) via RT-PCR a partir de oito amostras fecais BoRVA-positivas mostrou os genótipos G6P [5] (n = 6), G6P [11] (n = 1) e G6P [X] (n = 1). Três bezerros foram submetidos à necropsia e os achados macroscópicos incluíram edema e espessamento da mucosa do intestino delgado. As lesões microscópicas foram observadas nas vilosidades do intestino delgado, sendo caracterizadas principalmente por fusiosamento de vilosidades e enterite linfoplasmocitária multifocal moderada. O exame imunohistoquímico dos três casos foram positivos para o BoRVA. As 53,3% das amostras fecais diarreicas positivas para o BoRVA sugeriram que o rotavírus é o agente etiológico envolvido neste surto de diarreia neonatal em bezerros.(AU)

Microscopic analysis of patients with chronic diarrhea without macroscopic disease / Análise microscópica de pacientes com diarreia crônica sem doença macroscópica

BACKGROUND: Colonoscopy is part of the current diagnostic armamentarium. However, in some patients with chronic diarrhea, a colonoscopy may show normal mucosa; in these cases, serial biopsies can provide important information for the diagnosis and treatment of patients. AIM: To analyze patients with chronic diarrhea having a macroscopically normal colonoscopy, by evaluating histological changes. METHODS: 30 patients with chronic diarrhea and normal colonoscopy were prospectively evaluated and submitted to serial biopsies of the terminal ileum, ascending colon and rectum. RESULTS: The sample of 30 patients showed a ratio of 18 men (60%) and 12 women (40%). On histological types, it was found that 13 patients (43.3%) had lymphoid hyperplasia, eosinophilic inflammation in 4 (13.3%), nonspecific inflammation in 4 (13.3%), regenerative changes in 3 (10%), lymphocytic colitis in 2 (6.6%) and changes consistent with Crohn's disease in 1 (3.3%). CONCLUSIONS: One can observe that even chronic diarrhea patients, without other associated factors, benefited from colonoscopy with biopsy, because it held the etiologic diagnosis in some cases as also excluded by histopathology. It was noticed that the frequency of patients with altered biopsy and less dragged diarrheal episodes (84.2%) was large, should consider their achievement.

INTRODUÇÃO: A colonoscopia faz parte do arsenal de diagnóstico atual. Porém, em alguns pacientes com diarreia crônica, a colonoscopia pode evidenciar mucosa normal; nesses casos biópsias seriadas podem trazer informações importantes para o diagnóstico e tratamento dos pacientes. OBJETIVO: Analisar pacientes com diarreia crônica submetidos à colonoscopia macroscopicamente normal, avaliando assim histologicamente as alterações. MÉTODOS: Análise prospectiva da histologia 30 pacientes com diarreia crônica e colonoscopias normais, submetidos a biópsias seriadas de íleo terminal, cólon ascendente e reto. RESULTADOS: A amostra de 30 pacientes mostrou uma proporção de 18 homens (60%) e 12 mulheres (40%). Sobre os tipos de alterações histológicas, foi verificado que 13 pacientes (43,3%) apresentaram hiperplasia linfóide, inflamação eosinofílica em 4 (13,3%), inflamação inespecífica em 4 (13,3%), alterações regenerativas em 3 (10%), colite linfocítica em 2 (6,6%) e alterações compatíveis com Doença de Crohn em 1 (3,3%). CONCLUSÕES: Observou-se que mesmo pacientes com diarreia crônica, sem outros fatores associados, beneficiaram-se da colonoscopia com biópsia, pois a mesma realizou o diagnóstico etiológico em alguns casos como também o excluiu através da histopatologia. Verificou-se que a frequência de pacientes com biópsia alterada e quadros diarreicos menos arrastados (84,2%) foi grande, devendo-se considerar a realização do exame.

Efficacy of Lactose-free Milk in Korean Adults with Lactose Intolerance / 대한소화기학회지

BACKGROUND/AIMS: Lactose-free milk (LFM) is available for nutrient supply for those with lactose intolerance (LI). However, there are no consistent results of the efficacy of LFM in LI subjects. We aimed to examine the changes of gastrointestinal (GI) symptoms and hydrogen breath test (HBT) values after ingestion of lactose contained milk (LCM) vs. LFM. METHODS: From May 2015 to September 2015, thirty-five healthy adults with history of LCM-induced GI symptoms were recruited at a tertiary hospital. For the diagnosis of LI, HBT with LCM 550 mL (lactose 25 g) was performed every 20 minutes for 3 hours. The test was defined as "positive" when H2 peak exceeded 20 ppm above baseline values (DeltaH2>20 ppm). When the subjects are diagnosed as LI, the second HBT using LFM 550 mL (lactose 0 g) was performed 7 days later. Subjects were asked to complete a questionnaire about the occurrence and severity of GI symptoms. RESULTS: Among a total of 35 subjects, 31 were diagnosed with LI at first visit, and their LCM-related symptoms were abdominal pain (98.6%), borborygmus (96.8%), diarrhea (90.3%), and flatus (87.1%). The DeltaH2 value in subjects taking LCM (103.7+/-66.3 ppm) significantly decreased to 6.3+/-4.9 ppm after ingesting LFM (p<0.0001). There were also significant reduction in total symptom scores and the severity of each symptom when LCM was changed to LFM (p<0.0001). CONCLUSIONS: This is the first report that LFM reduce LCM-related GI symptoms and H2 production in Korean adults. LFM can be an effective alternative for LCM in adults with LI.

Antidiarrhoeal evaluation of rhizomes of Cryptocoryne spiralis Fisch. ex Wydler: Antimotility and antisecretory effects.

The antidiarrhoeal activity of Cryptocoryne spiralis rhizomes extract (250, 500, 750 mg/kg, po) was evaluated using faecal excretion, castor oil-induced diarrhoea, small intestinal transit, intestinal fluid accumulation, gastric emptying and PGE2 induced enteropooling models in rats. In addition, various biochemical estimations, histopathological studies and antibacterial evaluations on strains responsible for diarrhoea were also performed. The results illustrated a significant reduction in normal faecal output rate after 5th and 7th h of treatment, while castor oil-induced diarrhoea model depicted a protection of 55.44% at same dose level from diarrhoea. The other models except, gastric emptying test demonstrated more pronounced effect at same dose level. A significant inhibition in nitric oxide, increase in carbohydrates, protein, DNA, Na+ and K+ level with minimum degeneration of colonic fibrous tissues and potent antibacterial activity were also observed. The antidiarrhoeal potential of C. spiralis may be as a result of antimotility and antisecretory type effect mediated through nitric oxide pathway.

Hidratação enteral associada ou não a antimicrobiano no tratamento de bezerros com diarréia experimentalmente induzida / Entral hydration with or without antimicrobial treatment of calves with experimentallu induce diarrhea / Hidratación enteral asociada o no a antimicrobiano en el tratamiento de terneros con diarrea a inducida experimentalmente

Quinze bezerros foram submetidos à indução de diarreia osmótica para avaliação da eficácia de um composto comercial para hidratação enteral. Além do exame clínico, foram realizados o hemograma, gasometria e urinálise e dosados os níveis plasmáticos de ácido lático e séricos de ureia, creatinina e os íons cloro, potássio, cálcio, sódio e fósforo, além do pH fecal. Após um período de indução de 36h, os animais apresentaram desidratação moderada (10%), aumento na densidade urinária, nos valores de ureia e creatinina e diminuição do pH urinário e fecal. O uso de solução de hidratação enteral promoveu o restabelecimento do equilíbrio ácido-básico 24h após o início do tratamento pelo mecanismo de aumento do débito urinário e como fonte exógena de bicarbonato.

Fifteen calves were subjected to the induction of osmotic diarrhea in order to assess the efficacy of a compound for commercial enteral hydration. In addition to clinical examination, complete blood count, blood gas and urinalysis were performed and the plasma levels of lactic acid and serum urea, creatinine and chloride ions, potassium, calcium, sodium and phosphorus, besides fecal pH were measured. After an induction period of 36 h, the animals presented moderate dehydration (10%), increased urine gravity values of urea and creatinine, and decrease in urinary and fecal pH. The use of enteral hydration solution promoted the restoration of acid-base balance 24 hours after the beginning of treatment by increasing urinary output and as an exogenous source of bicarbonate.

Quince terneros han sido sometidos a inducción de diarrea osmótica para evaluación de la eficacia de un compuesto comercial para hidratación enteral. Además del examen clínico, se ha realizado hemograma, gasometría y análisis de orina, medidos los niveles plasmáticos de ácido láctico y séricos de urea, creatinina y los iones de cloruro, potasio, calcio, sodio y fósforo, además del pH fecal. Después de un período de inducción de 36h, los animales presentaron deshidratación moderada (10%), aumento en la densidad urinaria, en los valores de urea y creatinina, disminución del pH urinario y fecal. El uso de solución de hidratación enteral promovió el restablecimiento del equilibrio ácido-básico 24h después del inicio del tratamiento por mecanismo de aumento del débito urinario y como fuente exógena de bicarbonato.

Infección experimental de aislados humanos de Blastocystis sp. en ratones inmunosuprimidos con dexamentasona / Experimental infection using human isolates of Blastocystis sp. in dexamethasone immunosurpressed mice

Blastocystis sp. es un protozoario controversial en cuanto a su papel patogénico, asociado a enfermedad gastrointestinal, con alta prevalencia. A fin de evaluar signos, síntomas y hallazgos de laboratorio producidos por Blastocystis sp., ratones inmunosuprimidos con dexametasona fueron infectados con morfologías del parásito obtenidos de pacientes sintomáticos y asintomáticos. Los parásitos se aislaron empleando gradiente de densidad con lymphoprep™, se realizó semicuantificación de las morfologías presentes en las muestra de heces, y se inocularon 1,6 × 105 parásitos en ratones Balb/c, vía intragástrica. En heces de pacientes sintomáticos se encontraron seis veces más vacuolares que granulares, mientras que en asintomáticos la relación fue apenas dos veces mayor. Los síntomas más frecuentes en los pacientes fueron: flatulencia (85%), dolor de cabeza(62%), dolor abdominal (55%), fiebre (30%) y estreñimiento (8%). La semicuantificación de parásitos por campo en humanos no encontró relación directa entre carga parasitaria y sintomatología gastrointestinal, mientras que en la cuantificación de parásitos por gramo de heces si existió. Los ratones presentaron signos variables luego de la infección, todos aquellos infectados con muestras de pacientes sintomáticos presentaron signos, mientras que solo algunos de los infectados con muestras de pacientes asintomáticos los desarrollaron. Se demostró que no existe relación estadísticamente significativa (p= 0,8) entre la morfología del parásito y los signos manifestados por el ratón; sin embargo hubo una relación estadísticamente significativa (p=0,02) entre las formas vacuolares del parásito y la aparición de síntomas en los pacientes. Se concluye que Blastocystis sp. tiene capacidad de producir signos sugestivos de patología en ratones.

Blastocystis sp. is a controversial protozoan in terms of its pathogenic role associated with high-prevalence gastrointestinal disease. To evaluate signs, symptoms and laboratory findings produced by Blastocystis sp., dexamethasone immunosuppressed mice were infected with parasite morphologies obtained from symptomatic and asymptomatic patients. The parasites were isolated using density gradient with lymphoprep™, semi-quantification of the morphologies present in the stool sample was performed and 1.6 × 105 parasites were inoculated into Balb/c mice, intragastrically. In the faeces of symptomatic patients, vacuolar morphology was six times greater than granular morphology, whereas the ratio in asymptomatic patients was only two times greater. The most common symptoms in patients were flatulence (85%), headache (62%), abdominal pain (55%), fever (30%) and constipation (8%). The semi-quantification of parasites per field in humans evidenced no direct relationship between parasite burden and gastrointestinal symptoms, while in parasite quantification per gram of feces, a direct relationship was found. The mice showed variable signs after infection; all those infected with samples from symptomatic patients showed signs, while only some of those infected with samples from asymptomatic patients developed them. It was demonstrated that no statistically significant (p = 0.8) relationship exists between the morphology of the parasite and the signs manifested by the mouse; nevertheless, there was a statistically significant (p = 0.02) relationship between the vacuolar forms of the parasite and onset of symptoms in patients. Conclusions are that Blastocystis sp. is capable of producing signs suggestive of pathology in mice.

Efeito de probiótico no desenvolvimento de leitões desafiados com Escherichia coli / Effect of probiotic on the development of piglets challenged with Escherichia coli

Foram utilizados 72 animais aos 21 dias de idade para averiguar o efeito do probiótico no desempenho de leitões desafiados com E. coli. O delineamento foi em blocos casualizados, com arranjo fatorial 2x2. Os quatro tratamentos foram: probiótico com desafio; probiótico sem desafio; sem probiótico com desafio; sem probiótico e sem desafio. O probiótico Protexin™ foi administrado via ração, dos 21 aos 63 dias de idade e aos 35 dias, os animais dos tratamentos 1 e 3 foram desafiados. As variáveis analisadas foram: peso médio aos 35, 49 e 63 dias de idade; ganho diário de peso dos 35 aos 49 dias; dos 49 aos 63 dias; dos 35 aos 63 dias e escore fecal. As variáveis ganho diário de peso, peso médio e escore fecal foram submetidos à análise de variância pelo PROC GLM. Em relação ao peso e ganho de peso verificou-se ação benéfica do probiótico quando se associaram estas características com a ocorrência de diarréia pós-desafio e a redução da E. coli. Concluiu-se que o probiótico no modelo experimental aplicado apresentou efeito notório nas reduções de E. coli e da diarréia, podendo exercer influência no desempenho dos leitões.

We used 72 piglets at 21 days old and the aim was to determine the effect of probiotics on performance of piglets challenged with E. coli. The design was a randomized block design with 2x2 factorial arrangement. The four treatments were: with probiotic and challenge, with probiotic without challenge, without probiotic with challenge, without probiotic and challenge. The probiotic was administered via Protexin ™ diet, from 21 to 63 days old and 35 days, the animals in treatments 1 and 3 were challenged. The variables were: average weight at 35, 49 and 63 days old, daily weight gain from 35 to 49 days, 49 to 63 days, from 35 to 63 days and fecal score. The variables average weight, daily weight gain and diarrhea score were subjected to analysis of variance by PROC GLM. In terms of weight and weight gain was found beneficial effect of probiotic when these characteristics were associated with the occurrence of diarrhea post-challenge and the reduction of E. coli. It was concluded that the probiotic used in the experimental model showed clear effect on the reductions of E. coli and diarrhea, are relatively influenced in the performance of piglets.

Cáncer gástrico temprano o precoz: revisión de la literatura / Early gastric cancer: review of the literature

El cáncer gástrico precoz, se diagnostica cada día con más frecuencia no solo en Japón sino en todo el mundo y, aunque su tratamiento endoscópico es relativamente sencillo, en nuestro medio hay poca experiencia sobre la resección de lesiones sospechosas. El pronóstico de cáncer gástrico temprano es muy bueno y la tasa de supervivencia a los 5 años es del 90%. Por ello, basado en el criterio del tratamiento temprano de cáncer gástrico tiene mejor pronóstico, es importante la detección temprana masiva esta enfermedad antes de que evolucione a un estado avanzado.

Cryptosporidium sp. y otros parásitos intestinales en niños menores de 5 años con diarrea y su relación con las pruebas coprocualitativas / Cryptosporidium sp. and other intestinal parasites in children under 5 years old with diarrhea and their relationship to coproquilitative tests

Para determinar la presencia de Cryptosporidium sp. y otros parásitos intestinales; así como su relación con las pruebas coprocualitativas, se analizaron 100 muestras fecales de niños de 3 meses a 5 años de edad, que asistieron al Laboratorio de Parasitología del Servicio Autónomo del Hospital Universitario de Maracaibo (SAHUM) con diagnóstico clínico de diarrea. Estas muestras fueron sometidas a un examen macroscópico y microscópico con SSF (0,85%) y lugol, coloración de Kinyoun para la detección de coccidios intestinales y las pruebas coprocualitativas: sangre oculta, azucares reductores y pH. Del total de muestras estudiadas, el 12% evidenció parásitos. Las especies encontradas fueron Cryptosporidium sp., Giardia lamblia y Blastocystis hominis con 4%cada uno, Trichuris trichiura (2%), Ascaris lumbricoides (1%), Pentatrichomonas hominis (1%). No se encontró correlación entre las pruebas coprocualitativas y las especies parasitarias identificadas, así como tampoco entre parasitosis y sexo. Cryptosporidium sp. y Giardia lamblia fueron los parásitos patógenos más frecuentes en niños < 2 años de edad

To determine the presence of Cryptosporidium sp. and other intestinal parasites, as well as their relation to coproqualitative tests, fecal samples were analyzed from 100 children ranging from 3 months to 5 years old, who attended the Autonomous Service Parasitology Laboratory at the University Hospital of Maracaibo (SAHUM) with a clinical diagnosis of diarrhea. These samples were subjected to macroscopic and microscopic examination with SSF (0.85%) and iodine, Kinyoun stain for the detection of intestinal coccidia, coproqualitative tests (occult blood, reducing sugars and pH). Of all the samples studied, 12% evidenced parasites. The species found were Cryptosporidium sp. (4%), Ascaris lumbricoides (1%), Trichuris trichiura (2%) Pentatrichomonas hominis (1%), Giardia lamblia and Blastocystis hominis at (4%). There was no correlation between the coproqualitative tests and the parasitic species identified, nor was there any relation ship between parasitosis and gender. Cryptosporidium sp. and Giardia lamblia were the most frequent pathogenic parasites in children < 2 years old

Doença inflamatória intestinal como causa de diarreia crônica em paciente infectado pelo HIV: relato de caso e revisão da literatura / Inflammatory bowel disease causing chronic diarrhea in HIV – seropositive patient

Relata-se o caso clínico de um paciente portador do HIV que nunca apresentou doença definidora de AIDS, com diarreia crônica. O diagnóstico obtido por meio de biopsia intestinal foi de retocolite ulcerativa. Este relato alerta os médicos sobre a importância da inclusão de doenças não-infecciosas e não-oportunistas no diagnóstico diferencial de diarreia crônica no paciente infectado pelo HIV.

This is a case-report of an HIV - infected patient who was admitted to hospital withchronic diarrhea. The diagnosis obtained by intestinal biopsy was ulcerative colitis. After initiating treatment with prednisone, the patient`s symptoms improved. This case-report should alert the clinicians to the importance of including non- infectious and non- opportunist pathologies in the differential diagnosis of chronic diarrhea in a patient infected with the HIV.

Contribuição da histopatologia na diarreia com colonoscopia normal: análise crítica e revisão da literatura / Contribution of the histopathology in diarrhea with normal colonoscopy: critical analysis and literature review

Introdução- dentre as várias indicações para a realização de colonoscopias, duas das mais frequentes são a hematoquezia (20,5%) e diarreia de etiologia inexplicável (8,8%). Cerca de 40% das colonoscopias, em estudos retrospectivos, são normais e a realização de biópsias para histopatologia complementar não tem sido uma rotina nos diversos serviços de endoscopia. Objetivos- avaliar a contribuição da histopatologia para o esclarecimento diagnóstico em pacientes diarreicos e com colonoscopias normais. Método- foi realizado um levantamento bibliográfico no PubMed, Scielo, Medline e Biblioteca Cochrane com as palavras chave diarreia e colonoscopia normal, e levantados retrospectivamente os resultados da histopatologia de pacientes com diarreia e com colonoscopias normais. Resultados- num período de 2 anos, foram realizadas 1.342 vídeocolonoscopias. Destes, 119 (8,86%) foram por diarreia, diarreia + dor abdominal ou descargas intestinais, sendo 74 (5,51%) submetidos a biópsias endoscópicas, 34 (2,53%) com alguma anormalidade macroscópica, e 40 (2,98%) com colonoscopias normais. Destes 40, foram analisados os laudos histopatológicos de 30, e 10 foram excluídos por impossibilidade de recuperação da histopatologia. Dos 30, 29 são leucodérmicos (96,7%) e 1 melanodérmico (3,3%), com idade entre 16 anos e 64 anos, sendo 13 masculinos (43,3%) e 17 femininos (56,7%). O íleo terminal foi examinado em 11 pacientes (36,7%) e não foi possível a ileoscopia em 19 (63,3%). As biópsias foram no retossigmoide em 26 pacientes (86,7%), no retossigmoide, cólon esquerdo e cólon direito no mesmo exame em 1 (3,3%) e somente no íleo terminal em 3 (10%). Das 30 histopatologias revistas foram definidas como sem alterações dignas de nota em 27 (90%), alterações inespecíficas em 1 (3,3%) e colite inespecífica em 2 (6,7%). Em 5 pacientes havia registro da presença de edema (16,7%), em 4, ausência de edema (13,3%), e em 21 não havia menção sobre edema (70%). Houve 22 relatos de que as criptas estavam preservadas (73,3%) e em 8 não havia menção sobre as mesmas (26,7%). Presença de infiltrado linfocitário ou linfoplasmocitário em 10 (33,3%), ausência deste infiltrado em 3 (10%) e sem menção sobre o mesmo em 17 (56,7%). Presença de eosinófilos em 3 (10%), ausência em 8 (26,7%) e sem relato sobre eosinófilos em 19 (63,3%). Menção sobre conteúdo caliciforme adequado em 2 (6,7%), e nenhum registro sobre este conteúdo em 28 (93,3%). Nos íleos examinados houve infiltrado linfocitário em 2 (6,7%), infi ltrado linfocitário com atrofia em 1 (3,3%), infiltrado linfocitário e eosinofílico com atrofia em 2 (6,7%), infiltrado neutrofílico em 1 (3,3%), sem alterações dignas de nota em 3 (10%), e não biopsiados 2 (6,7%). Dados negativos- ausência de granuloma, fibrose, micro-organismos e malignidade em 3 (10%); malignidade em 4 (13,3%); inflamação micro-organismos e malignidade em 2 (6,7%); abscesso, granuloma, e micro-organismos em 3 (10%); malignidade e especificidade em 3 (10%); e abscesso, granuloma e parasitas em 1 (3,3%). Não houve relato de dados negativos em 14 casos (46,7%). Conclusões- para o diagnóstico de colite microscópica, a literatura sugere biópsias do íleo e de vários níveis do cólon. Na análise de 30 casos, não houve uma afirmativa definitiva de colite linfocítica, eosinofílica ou colágena nos laudos histopatológicos, e não houve um padrão uniforme para a descrição dos achados microscópicos e para a definição diagnóstica. Sugere-se uma discussão com uniformização decritérios histopatológicos para diagnóstico à semelhança do que foi feito com o sistema Sidnei para a classificação das gastrites.

Introduction- among many indications for colonoscopy two very frequent are hematoquezia (20,5%) and diarrhea of obscure etiology (8,8%). Forty percent of colonoscopies in retrospective studies are normal and biopsies have not being a routine. Objective- to evaluate the contribution of histopathology in the diagnostic of patients with diarrhea and normal colonoscopies. Method- it was performed a bibliographic study in PubMed, Scielo, Medline and Cochrane Library using the key words diarrhea and normal colonoscopy, furthermore were studied retrospectively the results of histopathology of patients with diarrhea and normal colonoscopies. Results- in two years, 1.342 colonoscopies were performed. From all 119 (8,86%) the indication was diarrhea, diarrhea plus abdominal pain or diarrhea flushes, 74 (5,51%) undergone to endoscopy biopsies, 34 (2,53%) having any macroscopic abnormalit, and 40 (2,98%) with normal colonoscopies. In thirty out of this 40 cases was possible to analyse the histopatological report, and 10 were discharged because of impossibility of recovering the report. Twenty nine (96,7%) leucodermic and 1 (3,3) melanodermic, ranging from 16 to 64 years old, 13 (43,3%) male and 17 (56,7%) female. The terminal ileum was examined in 11 patients (36,7%) and in 19 (63,3%) it was not possible. The biopsies were taken in the recto and sigmoid in 26 (86,7%) patients, in recto sigmoid left colon and right colon in the same examination in 1 (3,3%), and only in terminal ileum in 3 (10%). From the 30 histopathology reports information were collected about no important alteration in 27 (90%), unspecific alterations in 1 (3,3%) and unspecific colitis in 2 (6,7%). In 5 (16,7%) there were report of edema, in 4 (13,3%) absence of edema and in 21 (70%) no report about edema. In 22 (73,3%) there were report of preserved crypts and in 8 (26,7%) no report about crypts. Presence of lymphocyte or lymphoplasmocitary infiltrate in 10 (33,3%) absence of these infiltrate in 3 (10%) and no report about infiltrates in 17 (56,7%). Presence of eosinophils in 3 (10%), absence in 8 (26,7%) and no report of eosinophils in 19 (63,3%). Report of adequate caliciform lining in 2 (6,7%) and no report of this in 28 (93,3%). In the terminal ileum examined there were lymphocyte infiltrate in 2 (6,7%), lymphocyte infiltrate with atrophy in 1 (3,3%), lymphocity and eosinophil infiltrate with atrophy in 2 (6,7%), neutrophil infiltrate in 1 (3,3%), no important finding in 3 (10%), and 2 (6,7%) not submitted to biopsies. There were negative data: absence of granuloma fibrosis microorganisms and malignity in 3 (10%), malignity in 4 (13,3%), inflammation microorganisms and malignity in 2 (6,7%), abscess granuloma granuloma microorganisms in 3 (10%), malignity and specificity in 3 (10%), abscess granuloma and parasites in 1 (3,3%). There were no report of negative data in 14 cases (46,7%). Conclusions- for the diagnose conclusion in microscopic colitis the literature sugest biopsies of the ileum and in many parts of the colon. Analyzing our 30 cases there were not a definitive conclusion of lymphocyte, eosinophil or collagencolitis in the histopathology reports, and there were not a uniform pattern to describe the findings to conclude the diagnosis. We suggest a discussion in order to uniform de histopathology criteria to reach the diagnose, as the Sydnei system used to classify the gastritis.

Bacteriological and pathological studies on some aerobic and anaerobic bacteria causing diarrhoea in camel calves

The present study was carried out to investigate the problem of diarrhoea among camel calves, by isolation, identification, histopathological findings and controlling of the associated infective agents [E. coli, Salmonella and C. perfringens]. Faecal, internal organs [spleen, kidneys, liver and part of small intestine] and blood samples were obtained from 120 camel calves [aged 10-18 month] for microbiological examination. The isolated rate of E. coli, Salmonella and C perfringens from diarrhoeic animals were [41.1%], [7.8%] and [65.6%], respectively. The isolated rate from the apparently healthy animals were [13.3%], [0%] and [33.3%], respectively. The serological identification of the isolated E. coli and salmonella strains detailed that [O111/K58 and O55/K59] serovars of E. coli and [S. Entertidis and S. Typhimurium] were the most common causes of diarrhoea in camel calves. The rate of both Beta and Epsilon toxins of C. perfringens was [53.3%] and [23.3%], while individually was [14.4% and 3.3%] and [27.8% and 10%] in diarrhoeic and apparently healthy camel calves, respectively. The microscopical examination revealed degenerative changes with marked necrosis in the hepatic and renal tissues, spleenic depletion and desquamation of the intestinal lining epithelium indicated the toxic effect of C. perfringens type [C and D]. In Salmonella Typhimiurium infection vasculitis and thrombi in blood vessels of the lamina propria and submucosa resulting in focal intestinal infarctions and ulceration, were the most important findings. Caecal glands were dilated and filled with gases and aggregation of inflammatory cells were observed in E. coli infection. The antibiotics used in the treatment of diarrhoea were Augmentin, Chloramphenicol, Gentamycine, Ciprofloxacin, Florofenicol, Rifampicin and Metronidazol, according to sensitivity test

Generalidades en diarrea aguda: [revisión] / General aspects in acute diarrhea: [review]

Existen dos avances en el manejo de la diarrea, que podrían reducir el número de muertes infantiles; el primero la formulación de Sales de Rehidratación Oral con menor concentración de glucosa y sodio; el segundo la suplementación con zinc para disminuir la duración, severidad y episodios futuros. La OMS/OPS define la diarrea aguda como la eliminación de tres o más evacuaciones intestinales líquidas o semilíquidas en 24 horas. El enterocito, como unidad funcional del intestino, posee una serie de transportadores donde ocurre el proceso de movilización de glucosa y de iones, para mantener el equilibrio eléctrico adecuado. En la evaluación del paciente la anamnesis se realiza con el fin de precisar la severidad de la diarrea y su posible causa. En el examen físico se tendrá en cuenta que esta enfermedad puede ser un signo o síntoma que se relaciona con trastornos extraintestinales. El examen de heces puede ser una herramienta útil en la investigación etiológica. Puede cuantificarse el gradiente osmótico (GAP fecal) y determinar si estamos en presencia de una diarrea osmótica o secretora. La presencia de 5 o más leucocitos fecales sugiere un proceso invasivo siendo de utilidad la realización de un recuento diferencial, si los polimorfonucleares se encuentran en 64% o más, puede ser posible recuperar bacterias en el coprocultivo. Este último tendrá indicación en algunos grupos que por edad o patología se consideran de riesgo elevados por ser no inmuno competentes. La serología para rotavirus permitiría el aislamiento rápido de pacientes infectados para limitar un brote.

Two recent advances in the management of diarrhea which could reduce child deaths are the formulation of Oral Rehydration Salts with a lower concentration of glucose and sodium, and zinc supplementation to decrease the duration and severity of future episodes. Acute diarrhea is defined by the WHO as the passage of three or more loose stools in 24 hours. The enterocyte, as the functional unit of the intestine, has a number of carriers which contribute to the mobilization process of glucose and ions to maintain the proper electrical balance. In the evaluation of the patient, the medical history will clarify the severity of diarrhea and its possible cause. During the physical examination, the fact that this disease may be a sign or symptom associated with extra intestinal disorders should be taken into account. Feces analysis may be a diagnostic tool. Osmotic gradient can be quantified (fecal GAP) to distinguish osmotic from secretory diarrhea. The presence of 5 or more fecal leukocytes suggests an invasive process and if PMNs are found in 64% or more in the differential cell count, it maybe possible to recover bacteria in a stool culture. The latter is indicated in some children considered of high risk for their low immune competence due to their age or to certain pathologies. Serology for rotavirus allows the rapid isolation of infected patients in order to limit an outbreak.

Conocimiento de las madres cuidadoras ante un niño con diarrea aguda en hogares de cuidado diario / Knowledge of mothers with a child care with acute diarrhea in day care

Con el propósito de incrementar el nivel de conocimiento sobre el manejo correcto de los síndromes diarreicos agudos por parte de las madres cuidadoras integrales ubicadas en una barriada, se realizó un estudio analítico, longitudinal, descriptivo, prospectivo de tipo intervención educativa durante 45 días. Universo constituido por 26 madres y una muestra de 23 (88,46 por ciento). Evaluación inicial sobre los conocimientos poseídos sobre manejo de los síndromes diarreicos agudos en los hogares de cuidado diario. Detección de necesidades educativas. Aplicación de intervención educativa según el Programa de Capacitación de Atención Integrada a las Enfermedades Prevalentes de la Infancia de la OPS. Nueva evaluación de conocimientos a los 45 días. Pre-capacitación el 52,17 por ciento sabían definir diarreas; 82,61 por ciento tenían prácticas alimentarias correctas en diarreas infantiles; el 73.91 por ciento dijo no dar alimento al niño durante la diarrea; el 17,9 por ciento daban medicamentos sin prescripción; el 65,22 por ciento dijo que la lactancia materna no protege frente a la diarrea y 69,57 por ciento que la vacuna contra el sarampión tampoco; 56,52 por ciento preparaba correctamente el suero oral y el 100 por ciento no sabe la del suero casero; 86,96 por ciento lo daba con tetero y erraba al no darlo después de cada evacuación (56,52 por ciento) no usar taza (82,61 por ciento), ni cuchara (69,57 por ciento); se equivocan al calificar sin riesgo los ojos hundidos (56,52 por ciento) llanto sin lágrimas (78.26 por ciento) y orinar menos (65,22 por ciento). Todos estos niveles mejoraron en más del 95 por ciento post-capacitación. La capacitación según AIEPI logra mejorar las prácticas en la atención de casos de diarrea por las Madres Integrales de los Hogares de CuidadoDiario.

Detección molecular de Escherichia coli productor de shiga toxina (Stx1) y rotavirus en heces de niños con diarrea / Molecular detection of shiga toxin-producing (stx1) Escherichia coli and rotavirus in stoolos of children with diarrhea

Se investigó la presencia de E. coli productora de shiga toxina y rotavirus en heces de 90 niños diarreicos con edades comprendidas entre 0 y 3 años. De cada muestra se tomaron tres alícuotas: una se sometió a enriquecimiento previo para E. coli O157, con otra se hizo siembra directa en placas con agar MacConkey-Sorbitol y Rojo Eosina con MUG y la ultima se congeló a –70°C para el análisis posterior de rotavirus. La búsqueda de E. coli O157 se realizó por inmunocromatografía in vitro de Coris Bioconcept (Bélgica) y O157:H7 por serología con antisueros FUVESIN. La presencia del antígeno O157 (rbfO157) y de los genes que codifican para las shiga toxinas (stx1 y stx2) se determinó por PCR. Los rotavirus se detectaron por electroforesis en geles de poliacrilamida. Las 90 muestras de heces analizadas resultaron negativas para el antígeno O157 y para O157:H7. La PCR corroboró que 9 cepas sospechosas aisladas de los medios de cultivos, eran cepas STEC no O157 y portadoras del gen stx1, mostrando un 10% de positividad. La electroforesis para el ARN viral detectó rotavirus en 21 (23,33%) muestras. Se confirma el predominio de rotavirus y se sugiere que la circulación de cepas STEC no 0157, es un indicio de la participación de estas cepas en la etiología de las diarreas agudas.

Cytomegaloviral colitis in HIV positive patients: endoscopic findings / Colite por citomegalovírus em pacientes HIV positivo: aspectos endoscópicos

BACKGROUND: Diarrhea in seropositive human immunodeficiency virus patients is one of the most important and disabling symptoms, and often decreases their quality of life. Cytomegalovirus colitis is among the principal causes of this symptom and colonoscopy is the gold standard examination to diagnose it. AIM: To define the main endoscopic findings in seropositive human immunodeficiency virus patients with cytomegalovirus colitis. METHODS: Two hundred and forty-three colonoscopies were performed in 200 seropositive human immunodeficiency virus patients with diarrhea associated or not to abdominal pain or gastrointestinal bleeding, over 10-year period, whom 51 patients were diagnosed with cytomegalovirus colitis. Full length colonoscopy with ileum intubation was always tried and multiple biopsies of all segments examined, including endoscopically normal segments, were attempted. All diagnoses were confirmed by histologic and immunohistochemical studies. RESULTS: Total colonoscopy was possible in 98.03 percent and ileum intubation in 88.23 percent of these cytomegalovirus colitis patients. At colonoscopy, a heterogeneous ulcerative pattern was presented in 72.54 percent, an inflammatory process of the mucosa in 21.56 percent and 5.88 percent of the patients mucosa was endoscopically normal. CONCLUSION: Full length colonoscopy with ileum intubation and multiples biopsies of all segments, even when they are endoscopically normal, have always to be attempted in cases of seropositive human immunodeficiency virus patient with diarrhea.

RACIONAL: Diarréia em pacientes soropositivos para o vírus da imunodeficiência adquirida é um dos sintomas mais importantes e debilitantes e freqüentemente reduz sua qualidade de vida. Colite por citomegalovírus está entre as principais causas desse sintoma e a colonoscopia é o exame padrão-ouro para seu diagnóstico. OBJETIVO: Definir os principais achados endoscópicos em pacientes HIV+ com colite por citomegalovírus. MÉTODO: Duzentas e quarenta e três colonoscopias foram realizadas em 200 pacientes HIV+ com diarréia associada ou não à dor abdominal ou sangramento gastrointestinal, em período de 10 anos, dos quais 51 pacientes foram diagnosticados com colite por citomegalovírus. Colonoscopia total com entubação ileal foi sempre tentada e múltiplas biopsias de todos os segmentos, incluindo segmentos endoscopicamente normais, foram realizadas. Todos os resultados foram confirmados por estudos histológicos e imunoistoquímicos. RESULTADOS: A colonoscopia total foi possível em 98,03 por cento e entubação ileal em 88,23 por cento dos pacientes com colite por citomegalovírus. Nestes pacientes, identificou-se padrão ulcerativo heterogêneo em 72,54 por cento, processo inflamatório da mucosa em 21,56 por cento e mucosa de aspecto normal em 5,93 por cento das colonoscopias. CONCLUSÃO: Podemos concluir que colonoscopia total com entubação ileal com múltiplas biopsias de todos os segmentos, mesmo quando são endoscopicamente normais, têm que ser sempre realizadas em casos de pacientes HIV+ com diarréia.