Síndrome de Good, una causa infrecuente de diarrea crónica / Good Syndrome, a rare cause of chronic diarrhea

Chronic diarrhea is a frequent cause of consultation in daily clinical practice. There are multiple diagnostic algorithms that allow a staggered approach to the most frequent pathologies, leaving out some lesser-known ones. This article reports the case of a 66-year-old female patient with a history of arterial hypertension, dyslipidemia and resected AB thymoma and a history of chronic diarrhea of 8 weeks of evolution. The etiological study ruled out infectious causes, celiac disease and negative viral serology. Due to a history of thymoma, immunoglobulin count was performed, showing severe pan-hypogammaglobulinemia. Good's Syndrome is the combination of thymoma and hypogammaglobulinemia, where patients may present with diarrhea secondary to immunodeficiency. Hypogammaglobulinemia associated with the presence of a thymoma is a rare cause but widely described in the literature as Good's Syndrome. Therefore, it seems relevant to describe a case, its approach and subsequent management.

La diarrea crónica constituye una causa frecuente de consulta en la práctica clínica diaria. Existen múltiples algoritmos diagnósticos que permiten realizar un abordaje escalonado de las patologías más frecuentes y permiten descartar algunas menos conocidas. En el presente artículo se reporta el caso de una paciente de género femenino de 66 años, antecedentes de hipertensión arterial, dislipidemia y timoma AB resecado con historia de diarrea crónica de 8 semanas de evolución. Dentro del estudio etiológico se descartan las causas infecciosas, enfermedad celíaca y serologías virales negativas. Por antecedente de timoma, se realizó recuento de inmunoglobulinas, evidenciando una severa pan-hipogammaglobulinemia. El Síndrome de Good es la combinación de timoma e hipogammaglobulinemia, donde los pacientes podrían presentar diarreas secundarias a inmunodeficiencia. La hipogammaglobulinemia asociada a la presencia de un timoma es una causa poco frecuente pero ampliamente descrita en la literatura como Síndrome de Good. Por lo antes señalado, nos parece relevante describir un caso, su abordaje y manejo posterior.

Trastornos funcionales gastrointestinales. Cómo tratar sin medicar / Functional gastrointestinal disorders. How to manage them without medication

Los trastornos funcionales gastrointestinales (TFGI) se caracterizan por síntomas atribuibles al tracto gastrointestinal que no pueden ser explicados por anormalidades estructurales ni bioquímicas. Durante el primer año de vida, pueden generar mucho malestar en el lactante y preocupación en sus padres. Su diagnóstico se basa en criterios clínicos que expertos han determinado y en una historia clínica y un examen físico completo que descartan causas orgánicas. El objetivo de esta actualización es presentar estrategias para el manejo de los TFGI más frecuentes durante el primer año de vida: cólicos, regurgitaciones, disquecia y estreñimiento, bajo la visión de los nuevos conocimientos fisiopatológicos, que eviten los estudios y medicaciones innecesarias.

Functional gastrointestinal disorders (FGIDs) are characterized by symptoms attributable to the gastrointestinal tract that cannot be explained by the presence of structural or biochemical abnormalities. During the first year of life, FGIDs can cause great discomfort in infants and concern in their parents. The diagnosis of FGIDs is based on clinical criteria determined by experts and on a comprehensive case-taking process and physical exam to rule out organic causes. The objective of this update is to describe strategies for the management of the most frequent FGIDs during the first year of life: colics, regurgitations, dyschezia, and constipation, in light of new pathophysiological insights, to avoid unnecessary tests and medications.

Gastrointestinal involvement due to graft-versus-host disease / Compromiso gastrointestinal por enfermedad de injerto contra huésped

Abstract Graft-versus-host disease is a common complication after stem cell transplantation. The digestive tract is affected in many patients who suffer from it, with consequences that can be fatal. The proper approach, which includes endoscopic studies, allows ruling out differential diagnoses and managing the disease early.

Resumen La enfermedad de injerto contra huésped es una complicación frecuente después del trasplante de células madre. El tracto digestivo se afecta en una gran proporción de los pacientes que la sufren, con consecuencias que pueden llegar a ser fatales. El abordaje adecuado, que incluye el uso de estudios endoscópicos, permite descartar diagnósticos diferenciales y brindar un manejo temprano de la enfermedad.

Growth of infants with gastrointestinal manifestations of cow's milk protein allergy / Crescimento de lactentes com manifestações gastrointestinais de alergia à proteína do leite de vaca

ABSTRACT Objective To assess linear growth and weight gain in infants with suspected cow's milk protein allergy with gastrointestinal manifestations, seen at a gastropediatrics clinic. Methods A retrospective cohort study conducted with demographic, clinical, anthropometric and dietary information on 84 infants first seen between 2015 and 2018 and followed-up for six months. Stature-for-age, weight-for-age, and body mass index-for-age in z-scores were evaluated according to the cut off points established by the World Health Organization in 2006. Accelerated growth or catch-up was considered a gain ?0.67 in the z-score of the referred indices, evaluated at 3 and 6 months. Results Median age at baseline was 4.0 months and 88.1% of the infants were already in diet exclusion. Regarding the anthropometric evaluation short stature frequency was 15.5% and the underweight frequency was 8.3% and 3.6% respectively based on the weight-for-age and body mass index-for-age indices. High recovery growth was observed during the follow-up period but was not considered catch up. In boys, the gains in weight-for-age and body mass index-for-age were significant (p=0.02 and p=0.01 respectively) and close to the threshold that characterizes the catch up, 0.58 and 0.59, respectively. In girls, significant gains in stature-for-age and weight-for-age (0.38 and 0.37 respectively, p=0.02 for both) were observed. Conclusion Infants with suspected cow's milk protein allergy with gastrointestinal manifestations should have early access to specialized nutritional counseling to avoid exposure to allergenic food and control allergy symptoms, thereby avoiding malnutrition and ensuring adequate nutritional recovery.

RESUMO Objetivo Avaliar o crescimento linear e o ganho de peso de lactentes com suspeita de alergia à proteína do leite de vaca, com manifestações gastrointestinais, atendidos em um ambulatório de gastropediatria. Métodos Estudo de coorte retrospectivo, com informações demográficas, clínicas, antropométricas e dietéticas de 84 lactentes que iniciaram atendimento entre 2015 e 2018 e foram acompanhados durante seis meses. Foram avaliados os índices estatura/idade, peso/idade e índice de massa corporal/idade em escore-z, segundo os pontos de corte da Organização Mundial de Saúde de 2006. Considerou-se crescimento acelerado (ou catch-up growth) um ganho ?0,67 escore-z nos referidos índices, avaliados em três e seis meses. Resultados No baseline, a mediana de idade foi 4,0 meses e 88,1% dos lactentes já estavam em dieta de exclusão. A frequência de baixa estatura foi de 15,5% e a de baixo peso foi de 8,3% e de 3,6% segundo os índices peso/idade e índice de massa corporal/idade, respectivamente. Houve elevado crescimento de recuperação durante o período de acompanhamento, mas que não configurou catch up. Nos meninos, ganhos no peso/idade e índice de massa corporal/idade foram significantes (p=0,02 e p=0,01) e próximos do limiar que caracteriza catch up: 0,58 e 0,59, respectivamente. Nas meninas, foram observados ganhos significantes na estatura/idade e peso/idade, de 0,38 e 0,37 (p=0,02 para ambos). Conclusão Demonstrou-se que lactentes com suspeita de alergia à proteína do leite de vaca, com manifestações gastrointestinais, deveriam ter acesso precoce ao aconselhamento nutricional para evitar exposição ao alimento alergênico, controlar sintomas e, assim, evitar a desnutrição ou garantir recuperação nutricional adequada.

Monitoring of gastrointestinal dysfunction by near-infrared spectroscopy in children with sepsis: a prospective study / 中国当代儿科杂志

OBJECTIVES@#To investigate the incidence and mortality of gastrointestinal dysfunction in children with sepsis, the application of near-infrared spectroscopy (NIRS) in monitoring mesenteric regional tissue oxygen saturation (rSO2), and the association between rSO2 and gastrointestinal dysfunction.@*METHODS@#In this prospective study, 79 children with sepsis in the pediatric intensive care unit (sepsis group) and 40 children who underwent physical examination in the Department of Child Healthcare (healthy control group) from January to December, 2021 were enrolled as subjects. The related medical data were collected, including general information on admission and at discharge, treatment during hospitalization, and laboratory examination results. NIRS was used to measure mesenteric rSO2. Clinical characteristics were compared between the patients with and without gastrointestinal dysfunction.@*RESULTS@#For the 79 children with sepsis, the incidence rate of gastrointestinal dysfunction was 49% (39/79), and the mortality rate of the children with gastrointestinal dysfunction was 26% (10/39). The children with gastrointestinal dysfunction had a longer duration of mechanical ventilation and a higher 28-day mortality rate (P<0.05). The children with gastrointestinal dysfunction had a significantly lower median rSO2 (64%) than the children without gastrointestinal dysfunction (72%) and the healthy control group (78%) (P<0.05).@*CONCLUSIONS@#There are high incidence and mortality rates of gastrointestinal dysfunction in children with sepsis, and the reduction in rSO2 may be associated with the development of gastrointestinal dysfunction.

Alterações gastrointestinais durante o acompanhamento nutricional de pacientes oncológicos em acompanhamento ambulatorial de quimioterapia / Gastrointestinal changes during nutritional follow-up of cancer patients undergoing outpatient chemotherapy

ABSTRACT BACKGROUND: Cancer patients may have gastrointestinal changes that influence nutritional status. OBJECTIVE: To investigate the occurrence of gastrointestinal changes resulting from outpatient chemotherapy treatment in cancer patients. METHODS: In a retrospective longitudinal study, the nutritional status and chemotherapy gastrointestinal changes (nausea, vomit, diarrhea, constipation, mucositis, dysphagia, xerostomia, inappetence, dysgeusia and heartburn) in cancer patients (n=187) were investigated in an outpatient follow-up. For the study of the parameters over time, the generalized estimating equation (GEE) method was used. Kruskal-Wallis, Mann-Whitney tests and Spearman coefficient, at a significance level of 5% were also used. RESULTS: The majority of the patients were female (63.64%) and the mean age was 57.5±12.1 years. The most frequent symptoms were nausea (18.54%); inappetence (18.31%); intestinal constipation (11.58%); diarrhea (7.98%); xerostomia (7.59%) and vomiting (7.43%). The nutritional status did not exhibit any relevant changes (P=0.7594). However, a higher prevalence of eutrophy was observed, followed by overweight; vomiting exhibited a significant difference (P=0.0211). The nausea symptom exhibited a significant difference with a higher prevalence of colorectal neoplasia when compared to breast neoplasia (P=0.0062); as well as vomiting in lung and colorectal neoplasias (P=0.0022), and dysphagia, in head and neck neoplasia, when compared to other neoplasms (P<0.001). There was a statistically significant difference between the number of medical appointments and gender (P=0.0102) and between dysphagia and gender (P<0.0001). CONCLUSION: The study findings enhance the need for signs and symptoms follow up, as well as nutritional status follow up of patients undergoing outpatient chemotherapy.

RESUMO CONTEXTO: Pacientes oncológicos podem apresentar alterações gastrointestinais que influenciam o estado nutricional. OBJETIVO: Investigar a ocorrência de alterações gastrointestinais decorrentes do tratamento ambulatorial de quimioterapia, em pacientes oncológicos. MÉTODOS: Num estudo longitudinal retrospectivo, investigou-se o estado nutricional e as alterações gastrointestinais (náuseas, vômito, diarreia, constipação, mucosite, disfagia, xerostomia, inapetência, disgeusia e pirose) de pacientes oncológicos (n=187), em acompanhamento ambulatorial de quimioterapia. Para o estudo dos parâmetros ao longo do tempo, utilizou-se o método das equações de estimação generalizadas (EEG). Também foram utilizados os testes de Kruskal-Wallis, Mann-Whitney e o coeficiente de Spearman, com nível de significância de 5%. RESULTADOS: A maioria dos pacientes era do sexo feminino (63,64%) e a média de idade foi 57,5±12,1 anos. Os sintomas mais frequentes foram náuseas (18,54%); inapetência (18,31%); constipação intestinal (11,58%); diarreia (7,98%); xerostomia (7,59%) e vômito (7,43%). O estado nutricional não apresentou alterações relevantes (P=0,7594). No entanto, observou-se maior prevalência de eutrofia, seguido do sobrepeso e o vômito apresentou diferença significativa (P=0,0211). O sintoma de náusea apresentou diferença significativa com maior prevalência na neoplasia colorretal, quando comparado à neoplasia de mama (P=0,0062); assim como o vômito nas neoplasias de pulmão e colorretal (P=0,0022). E a disfagia, na neoplasia de cabeça e pescoço, quando comparada às demais neoplasias (P<0,001). Houve diferença estatisticamente significante entre o número de consultas médicas e sexo (P=0,0102) e entre disfagia e sexo (P<0,0001). CONCLUSÃO: Os achados encontrados no estudo permitem reforçar a necessidade do acompanhamento de sinais e sintomas, bem como do estado nutricional, de pacientes em acompanhamento ambulatorial de quimioterapia.

Gastric disorders of cattle in western Rio Grande do Sul State, Brazil / Distúrbios gástricos de bovinos no Oeste do Rio Grande do Sul

A retrospective study of gastric disorders in autopsied cattle in the Western region of Rio Grande do Sul State, was performed. The exam reports of bovine necropsy of the Veterinary Pathology Laboratory, Unipampa, were analyzed in the period from 2010 to 2018. All cases in which death was primarily caused by disturbance in the gastric chambers were included. During the period evaluated, 141 cattle were necropsied. Of those, 25 had gastric disorders. Of those, 53% had alterations in the rumen, followed by abomasum (17%), involvement of two chambers (13%) and reticulum (9%). Most cases corresponded to beef cattle raised in an extensive system and most them for calf production and fattening with an average age of approximately three years. The cases occurred in farms of four different municipalities. Bullous bloat by excessive Trifolium repens ingestion was the gastric disturbance with the highest number of dead cattle observed in this study, especially in irrigated áreas of livestock farms. Cases such as lactic acidosis, ruminal alkalosis due to excessive urea ingestion and Baccharis coridifolia poisoning were also important gastric disturbances in necropsied cattle, associated especially with poor management and period of scarcity of good quality fodder. Cases of Clostridium perfringens infection were also observed in young cattle suggesting that it is an important infectious agent in the evaluated cattle herds, also showing failures in vaccination of the herds. As observed, gastric disturbances in cattle in the western region of Rio Grande do Sul have several causes. Metabolic/toxic and infectious disturbances were important causes of mortality in the herds, inducing considerable economic losses. Based on this study, it is clear that the majority of outbreaks or isolated cases occurred due to errors in the management of the properties and the vast majority of them could have been avoided with improvements in the technical qualification of the workers and simple adjustments in the farming methods. It is also emphasized the importance of the conclusive diagnosis to control these disorders, once after the orientation to the producers, was observed significant decrease in cattle losses in the farms.(AU)

Foi realizado estudo retrospectivo dos distúrbios gástricos em bovinos necropsiados na região Oeste do Rio Grande do Sul. Foram analisados os relatórios de exame de necropsia de bovinos do Laboratório de Patologia Veterinária (LPV) da Universidade Federal do Pampa (Unipampa), Rio Grande do Sul, no período de 2010 a 2018. Foram incluídos todos os casos nos quais a morte foi causada primariamente pelo distúrbio nas câmaras gástricas. De um total de 141 bovinos necropsiados, 25 corresponderam a distúrbios gástricos. Dentre esses, 53% apresentaram alterações no rúmen, seguido de abomaso 17%, acometimento concomitante de duas câmaras 13% e retículo 9%. A maioria dos casos ocorreram em bovinos de corte criados em sistema extensivo e a maioria destinados à produção de bezerros e engorda com média de idade de aproximadamente três anos. Os casos ocorreram em propriedades rurais de quatro municípios da região Oeste do estado. O timpanismo bolhoso por ingestão excessiva de Trifolium repens foi o distúrbio gástrico com maior número de bovinos mortos observados nesse estudo, especialmente em propriedades com criação de animais em áreas de irrigação. Casos como acidose láctica, alcalose ruminal por intoxicação por ureia e intoxicação por Baccharis coridifolia também foram importantes distúrbios gástricos nos bovinos necropsiados e percebeu-se sua associação a falhas no manejo e à época de escassez de forragem de boa qualidade. Foram observados ainda casos de infecção por Clostridium perfringens em bovinos jovens o que sugere também tratar-se de um importante agente infeccioso nos rebanhos bovinos avaliados, demonstrando ainda falhas na vacinação dos rebanhos. Conforme observado, diversos são os distúrbios gástricos em bovinos na região Oeste do Rio Grande do Sul, tendo como importantes causas de mortalidades os distúrbios metabólicos/tóxicos e infecciosos, induzindo consideráveis perdas econômicas. Com base nesse levantamento, percebe-se que a maioria dos surtos ou casos isolados estudados ocorreram por erros no manejo nas propriedades e, na sua grande maioria, poderiam ter sido evitados com especialização da mão de obra e ajustes simples. Ressalta-se ainda a importância do diagnóstico conclusivo para controle desses distúrbios, uma vez que, após a orientação aos produtores, observou-se significativa diminuição das perdas de bovinos nas propriedades.(AU)

Manifestaciones gastrointestinales de pacientes infectados con el nuevo Coronavirus SARS-CoV-2 / Gastrointestinal manifestations in infected patients with the novel Coronavirus SARS-CoV-2

The pandemic of the novel coronavirus SARS-CoV-2 has caused more than 2.5 millions of confirmed cases worldwide, with a mortality rate around 7%. Most cases appear to be mild with the most common symptoms being fever, dry cough, myalgia, fatigue, and dyspnea but can result in more severe disease. Also, there are described gastrointestinal manifestations: anorexia 27%, diarrhea 12%, nausea/vomiting 10%, and abdominal pain 9%. In Chile, diarrhea has been described in 7.3%, and abdominal pain 3.7%. The primary mechanism proposed is the entry of SARS-CoV-2 into the enterocytes binding the Angiotensin-converting enzyme 2 (ACE2), which is widely distributed among the gastrointestinal tract. Also, SARS-CoV-2 can cause elevated liver enzymes in up to 40% of cases. This alteration could also be caused by the binding to the ACE2 receptor in hepatocytes and cholangiocytes. Gastrointestinal symptoms and elevated liver enzymes are more frequent in severe cases. Viral RNA has been detected in stools, which may suggest a possible fecal-oral transmission. It is essential to pay attention to gastrointestinal manifestations because they are frequent and more prevalent in severe cases. The presence of viral RNA in stool forces us to take preventive measures faced with a possible mechanism of fecal-oral transmission, mainly in the gastroenterology and endoscopy services.

La pandemia por el nuevo coronavirus SARS-CoV-2 ha causado más de 2,5 millones de casos confirmados en el mundo, con una mortalidad cercana al 7%. La mayoría de los casos parecen ser leves y los síntomas más comunes son fiebre, tos seca, mialgia, fatiga y disnea, pero pueden provocar una enfermedad más grave. También se han descrito síntomas gastrointestinales: anorexia 27%, diarrea 12%, náuseas/vómitos 10%, y dolor abdominal 9%. En Chile, se ha descrito diarrea en 7,3%, y dolor abdominal 3,7%. El principal mecanismo fisiopatológico propuesto es el ingreso al enterocito utilizando la Enzima Convertidora de Angiotensina 2 (ECA2) como receptor, el cual es ampliamente distribuido a lo largo del tracto gastrointestinal. También se ha descrito alteración de pruebas hepáticas hasta en 40% de los casos. Esta alteración también podría ser causada por el ingreso a los hepatocitos y colangiocitos mediante la ECA2. Los síntomas gastrointestinales, y las alteraciones de pruebas hepáticas son más frecuentes en los pacientes graves. Se ha detectado la presencia de ARN viral en deposiciones de pacientes, lo que podría sugerir una posible vía de transmisión fecal-oral. Es importante prestar atención a las manifestaciones gastrointestinales, ya que son comunes y más frecuentes en pacientes graves. La presencia viral en las heces nos obliga a tomar medidas de precaución y prevención de un posible mecanismo de transmisión fecal-oral, especialmente en los servicios de gastroenterología y endoscopia.

Manifestaciones inusuales en enfermedad por dengue en pediatría. ¿Olvidadas o infrecuentes? / Unusual manifestations in pediatric dengue disease. ¿Forgotten or infrequent?

Introducción: El dengue representa un importante problema de salud pública en países como Colombia. Usualmente se trata de una patología autolimitada con buena respuesta a manejo sintomático ambulatorio, sin embargo, cuadros con síntomas atípicos pueden complicar el diagnóstico dando lugar a manifestaciones inusuales que comprometen la vida del paciente. Objetivo: Describir la información del tema expuesto resaltando aspectos relevantes como diagnóstico y manejo. Metodología: Se efectuó una revisión bibliográfica con búsqueda electrónica en las siguientes bases de datos: PubMed, MEDLINE, Medscape, Scopus; en inglés y español incluyéndose diferentes tipos de artículo (artículos originales, revisiones de temas y guías de manejo que abordaran síntomas inusuales de dengue en pediatría desde el año 2009 al 2019. Resultados: Se obtuvo 414 referencias después de una revisión de artículos, donde se describe el tema de complicaciones relacionadas con esta patología en pediatría, se seleccionaron 50 artículos en texto completo que cumplían los requisitos de búsqueda. Conclusiones: El tema de manifestaciones atípicas del dengue tiene poca revisión registrada en el área de pediatría, son complicaciones poco frecuentes por lo cual la evidencia es escasa, estas se deben tener en cuenta para manejo y tratamiento oportuno.

Introduction: Dengue represents a major public health problem in countries like Colombia. Usually it is a self-limited pathology with good response to outpatient symptomatic management, however, pictures with atypical symptoms can complicate the diagnosis resulting in unusual manifestations that compromise the patient's life. Objective: Describe the information on the exposed topic highlighting relevant aspects such as diagnosis and management. Methodology: A bibliographic review was carried out with electronic search in the following databases: PubMed, MEDLINE, Medscape, Scopus; in English and Spanish including different types of article (original articles, review of topics and management guides that will address unusual symptoms of dengue in pediatrics from 2009 to 2019. Results: 414 references were obtained after an article review, which describes the topic of complications related to this pathology in pediatrics, 50 articles were selected in full text that met the search requirements. Conclusions: The issue of atypical manifestations of dengue has little revision registered in the area of pediatrics, they are rare complications, so the evidence is scarce, these should be taken into account for timely management and treatment.

Influence of early use of antimicrobial on the health and performance of Holstein calves in the first month of life / Influência do uso precoce de antimicrobiano na sanidade de bezerras holandesas no primeiro mês de vida

The early use of antimicrobial therapy has been introduced in many farms to prevent diarrhea and respiratory disease in young calves; however, there is controversy about whether this practice has a beneficial effect on the health of these animals. This study evaluated the influence of the early use of antimicrobials on the health and performance of neonatal Holstein calves. Twenty-six Holstein calves were screened and divided into two groups, according to the administration (ATB+), or not (ATB-) of tulathromycin (2.5mg/kg, subcutaneously) within the first 12 hours of life. Calves were evaluated by general clinical examination, fecal score, respiratory score, and external palpation of the umbilical region, besides fecal output of dry matter. Anemia was determined by using an automatic system and, also, using a commercial kit for iron dosage. Diarrhea was diagnosed by a centrifuge-flotation technique using a sugar solution (Cryptosporidium) and multiplex semi-nested RT-PCR (rotavirus/coronavirus). The performance of the calves was estimated by Daily Weight Gain (DWG). The young dairy calves were evaluated within 12 hours of birth (≤12h) and at 3-5th (D3-5), 7-9th (D7-9), 13-15th (D13-15), 20-23rd (D20-23), and 27-30th (D27-30) days of life. No difference was noted between the ATB+ and ATB- groups concerning heart rate, respiratory frequency, and rectal temperature. Erythrogram showed a higher frequency of anemia in ATB- group (P=0.016) at the D3-5 check-up; lower values of serum iron were also observed simultaneously (P=0.051). Thirteen cases of respiratory disease were detected during this study; however, no significant difference was observed between the groups in this regard. The frequency of diarrhea (fecal score 2-3) was high in both groups, peaking at D13-D15. No differences were noted between the groups regarding the frequency of diarrhea when considering the dry fecal matter. The predominant etiological agent for diarrhea was Cryptosporidium spp.. The DWG was similar between groups, with maximum weight reduction on D13-15. The administration of tulathromycin in prophylactic dose (2.5mg/kg) at birth decreased the frequency of anemia but did not influence weight gain or the prevalence of diarrhea.(AU)

O uso precoce de antimicrobianos tem sido adotado em muitas fazendas para profilaxia das diarreias e doença respiratória em bezerras, no entanto existem controvérsias sobre os beneficios desta prática na saúde desses animais. Esta pesquisa avaliou a influência do uso precoce de antimicrobiano na sanidade e desempenho de bezerras holandesas recém-nascidas. Para tanto foram selecionadas 26 bezerras Holandesas distribuídas de acordo com a aplicação (ATB+) ou não (ATB-) de tulatromicina (2,5mg/Kg) por via subcutânea até 12h de vida. As bezerras foram examinadas por meio de exame clínico geral, escore fecal, escore respiratório e palpação externa da região umbilical, além da matéria seca fecal. A presença de anemias foi determinada pelo eritrograma utilizando sistema automático e além da dosagem de ferro utilizando kit comercial. O diagnóstico etiológico das diarreias foi investigado por meio da técnica de flutuação em solução saturada de sacarose (Cryptosporidium) e multiplex semi-nested RT-PCR (rotavírus/coronavírus). O desempenho das bezerras foi estimado pelo ganho de peso. As bezerras foram avaliadas até doze horas após o nascimento (≤12h); 3-5º (D3-5); 7-9º (D7-9); 13-15º (D13-15); 20-23º (D20-23); e 27-30º dias de vida (D27-30). Não foram encontradas diferenças entre os grupos ATB+ e ATB- em relação à frequência cardíaca, frequência respiratória e temperatura retal. O eritrograma revelou maior frequência de anemias no grupo ATB- (P=0,016) no D3-5. Neste momento também foram observados menores valores de ferro sérico (P=0,051). Foram detectados treze casos de doença respiratória durante o estudo, no entanto não foi possível detectar diferença entre os grupos. A frequência de diarreias (escore fecal 2 e 3) foi alta em ambos os grupos, observando-se pico no D13-15 (ATB+=92,3%; ATB-=92,3%). Não observamos diferenças entre os grupos em relação a frequência de diarreia considerando-se a matéria seca fecal. O agente etiológico predominante nas diarreias foi o Cryptosporidium. O ganho de peso diário foi igual entre grupos, com intensa redução no GPD no D13-15. A administração de tulatromicina na dose profilática (2,5mg/Kg) ao nascimento diminuiu a frequência de anemias e não influenciou no ganho de peso e prevalência de diarreias.(AU)

Neonatal diarrhea and rotavirus A infection in beef and dairy calves, Brazil, 2006-2015 / Diarreia neonatal e infecção por rotavírus A em bezerros de corte e leite, Brasil, 2006-2015

Calf diarrhea causes substantial economic losses in the cattle industry worldwide. Bovine rotavirus A (RVA) is the main viral agent that leads to enteric infection and diarrhea outbreaks in calves throughout the world. The aim of this retrospective (2006-2015) study was to determine the frequency of RVA detection in diarrheic fecal samples from beef and dairy calves from the three main cattle-producing regions of Brazil. Diarrheic fecal samples (n=1,498) of 124 beef and 56 dairy cattle herds from the Midwest, South, and Southeast geographical regions of Brazil were evaluated using the silver-stained polyacrylamide gel electrophoresis (ss-PAGE) technique. RVA double stranded-RNA was identified by the ss-PAGE technique in 410 (27.4%) fecal samples. The frequency of positive samples found in beef calves (31.9%; 328/1,027) was higher than the frequency found in diarrheic fecal samples from dairy calves (17.4%; 82/471). RVA infection was identified in calves from the three Brazilian geographical regions analyzed. However, the frequency of positive diarrheic calves in the Midwest region (39.4%), predominantly beef calves, was higher than in the South (19.4%) and Southeast (17.6%) regions. The temporal distribution of RVA-infected calves evaluated by two five-year periods (2006-2010, 24.5%; 2011-2015, 28.8%) demonstrated a very similar frequency of RVA in both periods. Considering the wide regional and temporal scope of this study, it can be concluded that RVA remains an important etiology of neonatal diarrhea in calves of Brazilian cattle herds.(AU)

A diarreia neonatal ocasiona perdas econômicas importantes na pecuária bovina em todo o mundo. Rotavírus A (RVA) é o principal agente etiológico viral de infecções entéricas e surtos de diarreia em bezerros de rebanhos de corte e leite. O objetivo deste estudo retrospectivo (2006-2015) foi determinar a frequência de detecção de RVA em amostras de fezes diarreicas de bezerros de corte e leite das três principais regiões produtoras de bovinos do Brasil. Amostras de fezes diarreicas (n=1.498) de 124 rebanhos bovinos de corte e 56 rebanhos bovinos de leite das regiões Centro-Oeste, Sul e Sudeste do Brasil foram avaliadas utilizando a técnica de eletroforese em gel de poliacrilamida (EGPA). O genoma segmentado de RVA foi identificado pela técnica de EGPA em 410 (27,4%) amostras de fezes. A frequência de amostras positivas encontrada em bezerros de rebanhos de corte (31,9%; 328/1.027) foi maior que a frequência identificada em amostras de fezes diarreicas de bezerros de rebanhos leiteiros (17,4%; 82/471). A infecção por RVA foi identificada em bezerros das três regiões geográficas brasileiras analisadas. No entanto, a frequência de bezerros com diarreia positivos para RVA na região Centro-Oeste (39,4%), predominantemente de bezerros de rebanhos de corte, foi maior que nas regiões Sul (19,4%) e Sudeste (17,6%). A distribuição temporal dos bezerros infectados com RVA avaliados por dois períodos de cinco anos (2006-2010, 24,5%; 2011-2015, 28,8%) demonstrou uma frequência muito semelhante em ambos os períodos. Considerando a amplitude regional e temporal deste estudo, pode-se concluir que RVA continua sendo uma importante etiologia de diarreia neonatal em bezerros de rebanhos bovinos brasileiros.(AU)

Síntomas gastrointestinales en la enfermedad por COVID-19 y sus implicaciones en la Enfermedad Inflamatoria Intestinal / Gastrointestinal symptoms in COVID-19 and its implications in Inflammatory Bowel Disease

La pandemia por SARS-Cov-2, ha tomado gran relevancia por su impacto en los diversos sistemas de sa-lud en el mundo. Inicialmente solo se contemplaba la importancia de los síntomas respiratorios y la fiebre; sin embargo, a diario tenemos más reportes y publicaciones sobre la relevancia que está teniendo en el sistema digestivo, ya que algunos pacientes informan síntomas gastrointestinales como diarrea, vómito y dolor abdominal. Los estudios han identificado el ARN del SARS-CoV-2 en muestras de heces de pacientes infectados, en las que se encontró que su receptor que es el de la enzima convertidora de angiotensina 2 (ECA2) se expresaba altamente en las células epiteliales gastrointestinales. Esto sugiere que el SARS-CoV-2 puede infectar activamente y replicarse en el tracto gastrointestinal. Esto tiene implicaciones importantes para el tratamiento de la enfermedad, la transmisión y el control de infecciones. En pacientes con patologías crónicas como la enfermedad inflamatoria intestinal (EII), se han generado gran cantidad de preguntas e incertidumbres ante la presencia de COVID-19 junto con las implicaciones que pueden tener tanto en la severidad de los síntomas, como en la descompensación de la patología de base y en la continuidad del tratamiento inmunosupresor.(AU)

The SARS-Cov-2 pandemic has taken great relevance due to its diverse impact in the worldwide health systems. Initially, only the importance or respiratory symptoms and fever was considered, however daily we have more reports and publications about the relevance that gastrointestinal symptoms, like diarrhea, vomit, and abdominal pain, are having in COVID-19. Several studies have identified SARS-CoV-2 RNA in stool samples of infected patients, and it was also found that the viral receptor, the angiotensin-converting enzyme 2 (ACE2) receptor is highly express in the gastrointestinal cells. These findings suggest that SARS-Cov-2 can actively infect and replicate in the gastrointestinal tract. All the above have relevant implications in the disease treatment, transmission, and infection control. In patients with chronic pathologies, such as inflammatory bowel disease (IBD), many questions and uncertainties, about symptoms severity, disease decompensation and use of immunosuppressive drugs, have been generated in the presence of COVID-19.(AU)

Manifestaciones gastrointestinales de la infección por el nuevo coronavirus / Gastrointestinal features of the new coronavirus infection

El 11 de marzo del 2020 la Organización Mundial de la Salud (OMS) declaró la pandemia por el brote de la enfer-medad por coronavirus 2019 (COVID-19). Los primeros datos acerca de las manifestaciones clínicas provienen de estudios retrospectivos de Wuhan, China, epicentro de la pandemia; además del compromiso respiratorio, se ha descrito la afectación del sistema gastrointestinal. Aunque no está del todo claro el porqué del tropismo de COVID-19 por el tracto gastrointestinal, se ha demostrado que la enzima convertidora de angiotensina 2 (ECA2), la cual tiene una alta expresión en el sistema gastrointestinal, es empleada como receptor de entrada del virus. Se ha logrado documentar la posibilidad de trasmisión fecal-oral luego de demostrar la existencia del virus en las heces, incluso hasta dentro de 7-12 días después de la conversión negativa en la muestra faríngea, inde-pendientemente de la presencia o no de síntomas gastrointestinales. La afectación del sistema gastrointestinal en pacientes con infección por COVID-19 no es infrecuente; los datos reportan que los pacientes con síntomas gastrointestinales tienen un peor pronóstico. El conocimiento de estas manifestaciones nos permite aumentar la sospecha clínica y, de esta manera, establecer diagnósticos tempranos.(AU)

The World ́s Heath Organization (WHO) declared the new coronavirus infection COVID-19 a pandemic in March 11 2020. The first data about the disease clinical features were reported from Wuhan China the epi-center of the outbreak; aside from the respiratory involvement, gastrointestinal manifestations have been described. Even though the exact mechanism for the new coronavirus tropism for the gastrointestinal tract is not well understood, angiotensin converting enzyme 2 receptor seems to play an important role as the entry site for the virus, since it is widespread located throughout the enteric mucosa. Fecal oral transmission is a possible contagion route, regardless of the presence of gastrointestinal symptoms, the virus has been isolated from feces even 7-12 days after a negative pharyngeal swab. COVID's-19 gastrointestinal involvement is not an infrequent event, data reports patients who present with these symptoms have worst prognosis. Knowing the possible gastrointestinal manifestations might rise our clinical suspicion in order to establish earlier and timely diagnosis.(AU)

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease / Consenso Brasileiro de Nutrição no Transplante de Células Tronco Hematopoiéticas: doença do enxerto contra o hospedeiro

ABSTRACT The Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplantation: Graft- versus -host disease was approved by Sociedade Brasileira de Transplante de Medula Óssea , with the participation of 26 Brazilian hematopoietic stem cell transplantation centers. It describes the main nutritional protocols in cases of Graft- versus -host disease, the main complication of hematopoietic stem cell transplantation.

RESUMO O Consenso Brasileiro de Nutrição no Transplante de Células Tronco Hematopoiéticas: doença do enxerto contra o hospedeiro foi aprovado pela Sociedade Brasileira de Transplante de Medula Óssea, com a participação de 26 centros brasileiros de transplante de células-tronco hematopoiéticas. O Consenso descreve as principais condutas nutricionais em casos de doença do enxerto contra o hospedeiro, a principal complicação do transplante de células-tronco hematopoiéticas.

Trastornos gastrointestinales funcionales después de un episodio de dengue no grave sin signos de alarma / Post-infectious functional gastrointestinal disorders in children after a non-severe dengue episode without warning signs

RESUMEN Introducción. La patogenia de los trastornos funcionales gastrointestinales involucra agentes infecciosos como los virus. Objetivo. Investigar el desarrollo de trastornos funcionales gastrointestinales en niños, a los 3, 6, 9 y 12 meses después de un episodio de dengue no grave sin signos de alarma. Materiales y métodos. Se hizo un estudio de cohorte de 73 niños con diagnóstico de dengue no grave sin signos de alarma atendidos en el Hospital Universitario del Valle "Evaristo García" y de 62 niños sanos de Cali, Colombia. Mediante el 'Cuestionario para síntomas gastrointestinales pediátricos Roma III' (Questionnaire for Pediatric Gastrointestinal Symptoms Rome III, QPGS-III), se determinaron los trastornos gastrointestinales funcionales a los 3, 6, 9 y 12 meses de seguimiento después de un episodio de dengue no grave sin signos de alarma. Se calcularon las medidas de tendencia central, riesgo relativo y prueba de ji al cuadrado, y se usó la prueba exacta de Fisher con un nivel de significación (p) menor de 0,05. Resultados. Se incluyeron 135 niños de 10,7±1,9 años; 51,1 % de ellos correspondía al sexo masculino y 19,3 % presentaba algún trastorno funcional gastrointestinal (9,6 % con dolor abdominal relacionado). El riesgo de presentar algún trastorno funcional gastrointestinal con dolor abdominal relacionado a los 3, 6, 9 y 12 meses de seguimiento en niños con dengue no grave sin signos de alarma fue mayor que sin dicho antecedente, pero sin diferencias significativas. Conclusión. Los resultados del estudio sugieren que el dengue no grave sin signos de alarma no incrementó el riesgo de trastornos gastrointestinales funcionales y dolor abdominal relacionado a lo largo de 12 meses de seguimiento.

ABSTRACT Introduction: The pathogenesis of functional gastrointestinal disorders involves infectious agents such as viruses. Objective: To study the development of functional gastrointestinal disorders 3, 6, 9 and 12 months after an episode of non-severe dengue without warning signs in children. Materials and methods: We conducted a cohort study in 73 children diagnosed with non-severe dengue without warning signs at Hospital Universitario del Valle "Evaristo García" and 62 healthy children from Cali, Colombia. Using the Questionnaire for Pediatric Gastrointestinal Symptoms Rome III (QPGS-III) in Spanish we identified functional gastrointestinal disorders 3, 6, 9, and 12 months after non-severe dengue without warning signs. Measurements of central tendency, relative risk, chi square, and Fisher's exact test were performed, with p<0.05 being significant. Results: We included 135 children who were 10.7±1.9 years old; 51.1% of them were male and 19.3% had a functional gastrointestinal disorder (9.6% of them had abdominal pain related to functional gastrointestinal disorders). There was a greater risk to present a functional gastrointestinal disorder and related abdominal pain in children after non-severe dengue without warning signs at 3, 6, 9, and 12 months of follow-up, but without significant differences. Conclusion: Our study suggests that non-severe dengue without warning signs does not increase the risk of functional gastrointestinal disorders and related abdominal pain for up to 12 months of follow-up.

Superposición de desórdenes gastrointestinales funcionales en escolares y adolescentes latinoamericanos / Overlapping of functional gastrointestinal disorders in latinamerican schoolchildren and adolescents

Resumen: Introducción: Hay pocos estudios sobre Desórdenes Gastrointestinales Funcionales superpuestos (DGFs-s). Objetivo: Describir la prevalencia y posibles factores de riesgo en niños Latinoamericanos (Latam) para presentar DGFs-s. Pacientes y Método: Estudio de prevalencia en niños escolares La tam entre 8-18 años. Se incluyeron variables sociodemográficas; se utilizaron los Criterios de Roma III en español, y se consideró DGFs-s cuando se presentaron 2, 3 o 4 y más DGFs en un mismo niño. El análisis estadístico incluyó t de student, chi cuadrado, prueba exacta de Fisher, análisis uni y multivariados y cálculo de los ORs e IC95%, siendo considerada una p < 0,05 significativa. Resul tados: Fueron analizados 6193 niños Latam (11,8 ± 2,2 años; 62,2% entre 8-12 años; 50,4% niñas; 68,0% colegio público), con diagnóstico de algún DGFs del 23,4%. Hubo superposición de DGFs en un mismo niño, en 8,4% (5,5% con 2 DGFs; 2,1% con 3 DGFs y 0,9% con 4 o más DGFs), siendo las principales superposiciones el Síndrome de intestino irritable (SII) + Dolor abdominal funcio nal (DAF) (2,6%) y el SII + DAF + Estreñimiento funcional (1,1%). Hubo predomino del género femenino. Conclusión: Hay una baja prevalencia de DGFs-s en escolares y adolescentes Latam, con predominio en el sexo femenino y de presentación muy variable.

Abstract: Introduction: There are few studies on overlapping Functional Gastrointestinal Disorders (FGIDs). Objective: To describe the prevalence and possible risk factors in Latin American children (Latam) to present overlapping FGIDs. Patients and Method: Prevalence study in Latam schoolchildren bet ween 8-18 years of age. Sociodemographic variables were included; the Rome III Criteria in Spanish were used, and overlapping FGIDs were considered when two, three or four and more FGIDs were presented in the same child. The statistical analysis included Student's T-test, chi-square test, Fisher's exact test, univariate and multivariate analysis, and calculation of ORs and 95% CI, being considered a significant p < 0.05. Results: 6,193 Latam children were analyzed (11.8 ± 2.2 years, 62.2% between 8-12 years of age, 50.4% girls, 68.0% public school), and 23.4% with a diagnosis of some kind of FGIDs. There was overlap of FGIDs in the same child, in 8.4% (5.5% with 2 FGIDs, 2.1% with 3 FGIDs and 0.9% with 4 or more FGIDs), the main overlaps were irritable bowel syndrome (IBS) + functional abdominal pain (FAP) (2.6%), and IBS + FAP + functional constipation (1.1%). There was predominance of the female gender. Conclusion: There is a low prevalence of overlapping FGIDs in Latam schoolchildren and adolescents, with a predominance in females and of very variable pre sentation.

Reações adversas no dia zero do transplante de células-tronco hematopoéticas: revisão integrativa / Reacciones adversas en el día cero del trasplante de células madre hematopoyéticas: revisión integrativa / Adverse reactions on day zero of hematopoietic stem cell transplantation: integrative review

Resumo OBJETIVO Identificar as reações adversas ligadas à infusão de células-tronco hematopoéticas no dia zero do transplante de células-tronco hematopoéticas. MÉTODO Revisão integrativa da literatura, sem recorte temporal, a partir de fontes de informação: PubMed, CINAHL, SCOPUS, BVS, SciELO, Web of Science e CAPES; a amostra final foi constituída por dezoito artigos científicos, publicados entre 1998 e 2017, com base nos critérios de inclusão e exclusão. RESULTADOS Reações adversas leves e moderadas foram mais frequentes nos estudos que utilizaram a classificação por severidade, sendo náusea e êmese as de maior incidência; os sistemas orgânicos mais afetados foram o cardiovascular, respiratório e gastrointestinal. CONCLUSÕES As principais reações adversas identificadas nos estudos foram náusea e êmese. As classificadas como leves e moderadas foram as mais frequentes nos estudos que utilizaram a classificação por severidade; e os sistemas cardiovascular, respiratório e gastrointestinal foram os mais afetados naqueles que utilizaram a classificação por sistemas orgânicos.

Resumen OBJETIVO Identificar las reacciones adversas ligadas a la infusión de células madre hematopoyéticas en el día cero del trasplante de células madre hematopoyéticas. METODOLOGÍA Revisión integrativa de la literatura, sin recorte temporal, a partir de los siguientes bancos de datos: PubMed, CINAHL, SCOPUS, BVS, SciELO, Web of Science y CAPES; la muestra final fue constituida por 18 artículos científicos, publicados entre 1998 y 2017, sobre la base de los criterios de inclusión y exclusión. RESULTADOS Las reacciones adversas leves y moderadas fueron las más frecuentes en los estudios que utilizaron la clasificación por severidad, siendo náuseas y vómito las de mayor incidencia; los sistemas orgánicos más afectados fueron el cardiovascular, respiratorio y gastrointestinal. CONCLUSIÓN Las principales reacciones adversas identificadas en los estudios fueron náuseas y éstas. Las clasificadas como leves y moderadas fueron las más frecuentes en los estudios que utilizaron la clasificación por severidad; y los sistemas cardiovascular, respiratorio y gastrointestinal fueron los más afectados en aquellos que utilizaron la clasificación por sistemas orgánicos.

Abstract OBJECTIVE To identify the adverse reactions associated with the infusion of hematopoietic stem cells on day zero of hematopoietic stem cell transplantation. METHODOLOGY Integrative literature review, without temporal cut, with search in the following databases: PubMed, CINAHL, SCOPUS, BVS, SciELO, Web of Science and CAPES; the final sample consisted of 18 scientific articles, published between 1998 and 2017, based on the inclusion and exclusion criteria. RESULTS Mild and moderate adverse reactions were the most frequent in studies that used the classification by severity, and nausea and emesis had the highest incidence; the most affected organ systems were the cardiovascular, respiratory and gastrointestinal. CONCLUSION The main adverse reactions identified in the studies were nausea and emesis. Those classified as mild and moderate were the most frequent in the studies that used the severity classification; and the cardiovascular, respiratory and gastrointestinal systems were the most affected in those that used the classification by organic systems.