THE RELEVANCE OF NUTRITIONAL STATUS AND HISTOPATHOLOGICAL FINDINGS ON THE INFECTIOUS PROCESS OF BALB/C MICE INOCULATED WITH Lacazia loboi / A relevância do estado nutricional e alterações histopatológicas no processo infeccioso de camundongos BALB/c inoculados com Lacazia loboi

SUMMARY The aim of this study was to evaluate the effects of the protein-calorie malnutrition in BALB/c isogenic mice infected with Lacazia loboi, employing nutritional and histopathological parameters. Four groups were composed: G1: inoculated with restricted diet, G2: not inoculated with restricted diet, G3: inoculated with regular diet, G4: not inoculated with regular diet. Once malnutrition had been imposed, the animals were inoculated intradermally in the footpad and after four months, were sacrificed for the excision of the footpad, liver and spleen. The infection did not exert great influence on the body weight of the mice. The weight of the liver and spleen showed reduction in the undernourished groups when compared to the nourished groups. The macroscopic lesions, viability index and total number of fungi found in the footpads of the infected mice were increased in G3 when compared to G1. Regarding the histopathological analysis of the footpad, a global cellularity increase in the composition of the granuloma was observed in G3 when compared to G1, with large numbers of macrophages and multinucleated giant cells, discrete numbers of lymphocytes were present in G3 and an increase was observed in G1. The results suggest that there is considerable interaction between Jorge Lobo's disease and nutrition.

RESUMO O objetivo do estudo foi avaliar os efeitos da desnutrição protéico-calórica em camundongos isogênicos da linhagem BALB/c inoculados com Lacazia loboi, empregando parâmetros nutricionais e histopatológicos. Foram constituídos quatro grupos: G1- inoculados com restrição dietética; G2- não inoculados com restrição dietética; G3- inoculados sem restrição dietética; G4- não inoculados sem restrição dietética. Após instalada a desnutrição, os animais foram inoculados via intradérmica no coxim plantar e após quatro meses foram sacrificados para remoção do coxim plantar, fígado e baço. A infecção não exerceu grande influência no peso corporal dos camundongos. O peso do fígado e baço apresentou redução nos grupos desnutridos em comparação aos grupos nutridos. A lesão macroscópica, a viabilidade e o número total de fungos dos coxins plantares dos camundongos inoculados revelaram aumento no G3 quando comparado com o G1. Em relação à análise histopatológica dos coxins plantares observou-se aumento da celularidade global na composição do granuloma no G3 em relação ao G1, com grande número de macrófagos e células gigantes multinucleadas, discretos números de linfócitos estavam presentes em G3 e aumentados no G1. Os resultados sugerem que existe grande interação entre nutrição e doença de Jorge Lobo.

Hábitos y conductas en la alimentación de lactantes menores: hospitalizados por desnutrición grave: [revisión] / Habits and behaviors in infants: hospitalized with severe malnutrition: [review]

El riesgo de desnutrición infantil está relacionado con prácticas inadecuadas de lactancia materna, destete, incorporación de nuevos alimentos, hábitos y conductas alimentarias, especialmente durante el primer año de vida. El objetivo del presente trabajo es determinar la presencia de estos factores en lactantes menores con desnutrición grave hospitalizados por esta causa, que pudiesen haber favorecido esta situación. Se realizó un estudio transversal en julio-octubre 2006, en lactantes entre 1 y 11 meses, con desnutrición grave: Marasmo, Kwashiorkor o Mixto. Antes de la hospitalización, se recopiló información sobre tipo de lactancia, tipo y dilución de fórmula láctea, inicio y progresión de alimentación complementaria, horario y frecuencia de comidas, lugar de consumo, duración y compañía durante las comidas, y presencia de elementos distractores. La asociación entre las variables se determinó con la prueba Chi cuadrado (X²). La duración de lactancia materna exclusiva fue menor de seis meses en el 55% de los casos. Fórmulas infantiles y leche entera de vaca fueron iniciados precozmente, siendo la dilución inadecuada. El destete se realizó antes de los 3 meses en 74,2%, por razones injustificadas, y 43,3% iniciaron la alimentación complementaria antes de los 3 meses. Sin embargo, la progresión fue adecuada y dirigida principalmente por las madres. El horario, número de comidas, lugar de alimentación y tipo de acompañante, fueron adecuados. La identificación temprana de hábitos y/o conductas alimentarias inadecuadas en grupos de riesgo, permitirá establecer precozmente medidas sobre estas prácticas y así disminuir la probabilidad de desarrollar algún tipo de desnutrición.

The risk of child's malnutrition is related to inadequate breast feeding practices, weaning, and incorporation of new eating habits and feeding behaviors, especially during the first year of life. The objective of this study is to investigate the presence of these factors in infants with severe malnutrition hospitalized for this cause, which could have contributed to this situation. A transversal study was conducted in July-October 2006, in infants between 1 and 11 months, with severe malnutrition: marasmus, kwashiorkor or mixed. Previous to hospitalization, information about type of lactation, type and dilution of milk formula, onset and progression of supplementary feeding, feeding schedule and frequency of meals, feeding place, duration of and company durin gmeals, and presence of distracting elements, were collected. Association between variables was determined with Chi square test (X²). The duration of exclusive breast feeding was less than six months in 55% of cases. Infant’s formulas and whole cow milk were initiated early, with inadequate dilution. 74 % of infants were weaned before 3 months of age for unjustified reasons, and 43,3 % began complementary feeding before this age. However, progression was adequate and directed primarily by mothers. Schedule, number of meals, feeding place and company during meals was adequate. Early identification of inadequate habits and/or feeding behaviors in risk groups, will allow prompt implementation of appropriate measures to decrease the probability of developing some type of malnutrition.

Reduced pancreatic β-cell mass is associated with decreased FoxO1 and Erk1/2 protein phosphorylation in low-protein malnourished rats

A low-protein diet leads to functional and structural pancreatic islet alterations, including islet hypotrophy. Insulin-signaling pathways are involved in several adaptive responses by pancreatic islets. We determined the levels of some insulin-signaling proteins related to pancreatic islet function and growth in malnourished rats. Adult male Wistar rats (N = 20 per group) were fed a 17 percent protein (normal-protein diet; NP) or 6 percent protein (low-protein diet; LP), for 8 weeks. At the end of this period, blood glucose and serum insulin and albumin levels were measured. The morphometric parameters of the endocrine pancreas and the content of some proteins in islet lysates were determined. The β-cell mass was significantly reduced (≅65 percent) in normoglycemic but hypoinsulinemic LP rats compared to NP rats. Associated with these alterations, a significant 30 percent reduction in insulin receptor substrate-1 and a 70 percent increase in insulin receptor substrate-2 protein content were observed in LP islets compared to NP islets. The phosphorylated serine-threonine protein kinase (pAkt)/Akt protein ratio was similar in LP and NP islets. The phosphorylated forkhead-O1 (pFoxO1)/FoxO1 protein ratio was decreased by 43 percent in LP islets compared to NP islets (P < 0.05). Finally, the ratio of phosphorylated-extracellular signal-related kinase 1/2 (pErk1/2) to total Erk1/2 protein levels was decreased by 71 percent in LP islets compared to NP islets (P < 0.05). Therefore, the reduced β-cell mass observed in LP rats is associated with the reduction of phosphorylation in mitogenic-related signals, FoxO1 and Erk proteins. The cause/effect basis of this association remains to be determined.

Frequency of pneumonitis among malnourished autopsied adults / Frequência de pneumonite em adultos subnutridos autopsiados

The objective of this study was to investigate whether malnourished autopsied adults would present higher frequency of pneumonitis than non-malnourished ones would. All of the autopsied adults (n = 175; age > 18 years) with complete records, including weight and height data, were included. Pneumonitis was observed more frequently in malnourished individuals (59.1 percent) than in non-malnourished individuals (41.3 percent). This study showed that the percentage of pneumonitis among autopsied adults was high, in addition to an increased risk of pneumonitis among these individuals.

O objetivo deste estudo foi verificar se adultos subnutridos autopsiados teriam maior freqüência de pneumonite que adultos não-subnutridos. Todos os adultos autopsiados ((nº = 175); idade > 18 anos) com dados completos, incluindo peso e estatura, foram incluídos. Pneumonite foi observada com maior frequência em subnutridos (59,1 por cento) do que em não-subnutridos (41,3 por cento). Este estudo mostrou uma alta porcentagem de pneumonite entre os adultos autopsiados, além do aumento do risco de pneumonite entre estes.

Efeito da desnutrição protéica pré e pós-natal sobre a morfologia, a diferenciação e o metabolismo do tecido muscular estriado esquelético em ratos / The effects of prenatal and postnatal malnutrition on the morphology, differentiation, and metabolism of skeletal striated muscle tissue in rats

OBJETIVO: Estudar características morfológicas, metabolismo e habilidades contráteis do músculo submetido a desnutrição protéica pré e pós-natal. MÉTODOS: Distribuição dos animais em dois grupos: controle, dieta normoprotéica (GC; n = 15; 5/5/5) e desnutrido, dieta hipoprotéica (GD; n = 15; 5/5/5), observados respectivamente no sétimo, 14º e 28º dia do período experimental. Foram avaliados massa corporal total, peso, habilidades contráteis e a morfologia do músculo tibial anterior. Amostras de tecidos com 8 m de espessura de ratos com idades de 7, 14 e 28 dias, corados por hematoxilina e eosina, e outros submetidos aos métodos histoquímicos nicotinamida adenina tetrazólio redutase (NADH-TR) e miofibrilar (m-ATPase) (pH = 4,4). RESULTADOS: Os pesos corporal e muscular apresentaram-se menores nos grupos desnutridos. Aos 7 dias de desnutrição, o músculo apresentou fibras com menor diâmetro, maior polimorfismo e maior teor de tecido conjuntivo endomisial. Nas histoquímicas, tipos de fibras sem delimitação segura. Aos 14 dias de desnutrição, fibras menores, mais polimórficas, muitas com núcleos centrais e moderado teor de tecido conjuntivo endomisial. Quanto à contração, a reação m-ATPase evidenciou fibras lentas e rápidas. A reação NADH-TR revelou os tipos de fibras slow oxidative, fast oxidative glycolytic e fast glycolytic. Aos 28 dias de desnutrição, fibras menores, agrupadas com contornos variáveis. Quanto ao tipo de contração e metabolismo, os três tipos de fibras apresentaram limites de reconhecimento indistinto. CONCLUSÃO: Os resultados experimentais sugerem que, além da redução no número de fibras, a desnutrição promove um retardamento na diferenciação das características morfológicas, metabólicas e contráteis dos tipos de fibras musculares esqueléticas em ratos na fase de crescimento.

OBJECTIVE: To study the contractile properties, metabolism and morphological characteristics of muscles submitted to prenatal and postnatal protein malnutrition. METHODS: Animals were distributed into two groups: Control, normoprotein diet (CG; n = 15; 5/5/5), and Malnourished, hypoprotein diet (MG; n = 15; 5/5/5), and examined on the 7th, 14th, and 28th days of the experiment. Total body mass, weight, and the contractile properties and morphology of the anterior tibial muscle were assessed. Several 8 µm-thick tissue samples were taken from 7, 14, and 28 day old rats and stained with HE or subjected to NADH-TR or m-ATPase (pH = 4.4) techniques. RESULTS: Body and muscle weight were lower in the malnourished group. On the 7th day of malnutrition, muscle samples exhibited fibers with smaller diameter, higher polymorphism and higher endomysial conjunctive tissue content. Histochemical methods were unable to precisely determine the types of fiber present. On the 14th day, there were smaller muscle fibers, more polymorphism, many of them with central nuclei and moderate endomysial conjunctive tissue content. With reference to contractile properties, the m-ATPase reaction identified both slow and fast fibers. The NADH-TR reaction revealed the following types of fiber: slow oxidative (SO), fast oxidative glycolytic (FOG) and fast glycolytic (FG). On the 28th day smaller, bunched muscle fibers varying shapes. All three types of fiber exhibited unclear recognition limits with respect to contraction and metabolism. CONCLUSION: Our experimental results suggest that, in addition to the reduction in numbers of fibers, malnutrition retards the differentiation of the morphological, metabolic, and contractile characteristics of skeletal muscle fibers in growing rats.

Influencia del género y la percepción de la imagen corporal en las conductas alimentarias de riesgo en adolescentes de Mérida / Influences of gender and body image perception in risk eating disorders in adolescents in Mérida

Este estudio tuvo como objetivo analizar la influencia del género y la percepción de la imagen corporal en las conductas alimentarias de riesgo asociadas con los trastornos de la conducta alimentaria en adolescentes del primero y segundo año de educación media y diversificada en ocho instituciones educativas públicas del Municipio Libertador estado Mérida Venezuela, seleccionadas de forma intencional. Se realizó un estudio de campo, descriptivo, en el cual participaron 421 adolescentes, 56.5 por ciento varones y 43.5 por ciento hembras, el promedio de edad para los varones fue 15.75 ± 1.05 años y para las hembras 15.80 ±1.07 años. Para la recolección de los datos de imagen corporal se diseñó y se validó un instrumento donde el participante seleccionó entre cuatro alternativas la opción que más representaba su condición para el momento. El 57,5 por ciento, se percibió normal, 30.6 por ciento como delgados; y el 11,9 por ciento con sobrepeso. No se reportó percepción de imagen corporal obesa. La imagen corporal normal y delgada fueron percibidas entre los adolescentes con una frecuencia más alta en los varones (32,5 por ciento), mientras que la percepción de la imagen con sobrepeso fue más frecuente en las hembras (7,4 por ciento). El registro de la conducta alimentaria se realizó a través de un cuestionario diseñado y validado por expertos constituidos por nutricionistas, sociólogos y psicólogos clínicos en el que solicitó al entrevistado reportar la conducta alimentaria practicada para el control del peso en los últimos seis meses. Los hallazgos permiten confirmar que las mujeres cuya percepción de su imagen se caracteriza por el exceso, presentan mayor riesgo asociado con los trastornos de la conducta alimentaria (9,586 F=2 p=0,008) (12,622 F=5 p=0,027).

The object of this study was to analyze the influence of gender and body image perception in risk eating conducts associated with the upheavals of eating disorders in adolescents of first and second year of highschool in eight public institutions of the Municipio Libertador in Merida Venezuela, They were selected in an intentional form. A descriptive field, was performed, in which 421 adolescents participated, 56,5% men and 43,5% females, the average of age for the 15,75 men was ± 1,05 years and for 15,80 females ± 1.07 years. For the gathering of the corporal Image data, an instrument was designed and validated, In this the participant chose between four alternatives the option that represented more his/her condition at the moment, 57.5%, perceived themselves as normal, 30.6%, as thin; and 11.9% with overweight. The perception of obese corporal image was not reported. The normal and thin body image were perceived among the adolescents with a higher frequency in men 32.5%, whereas the perception of the image with overweight was more frequent in the females (7.4%). The registry of eating disorders was done through a questionnaire designed and validated by a group of experts constituted by dietitians, sociologists and clinical psychologists in which the interviewed was asked in person to report the eating conduct practiced for the control of weight during the previous six months. The findings allow us to confirm that women whose perception of their image is characterized by the excess present major risks associated with the upheavals of the eating disorders (9,586 F=2 p=0,008 (12,622 F=5 p=0,027).

Evaluation of nutritional status of nonhospitalized patients with liver cirrhosis

BACKGROUD: Protein-calorie malnutrition is a frequent finding in patients with chronic liver disease, but investigations of nutritional status have been rarely performed in individuals seen at outpatient clinics AIM: To evaluate the nutritional status of patients with alcoholic and nonalcoholic cirrhosis, attended for the first time at a reference outpatient clinic for liver diseases. PATIENTS AND METHODS: A total of 300 consecutive patients attended at the outpatient clinics of a reference center for liver diseases were investigated. Anthropometric evaluation was performed by the usual parameters: triceps skinfold, arm circumference and arm muscle circumference. Biochemical parameters included creatinine/height index, serum albumin and lymphocytes count. The nutritional diagnosis was based on the PCM score proposed by Mendenhall et al. Food intake was retrospectively evaluated using 24-hour dietary recall data. RESULTS: About 71 percent of the patients studied were chronic alcohol abusers, whereas in 29 percent cirrhosis was of nonalcoholic etiology. Independently of the disease etiology 75.3 percent of the patients showed some degree of protein-calorie malnutrition, which was moderate or severe in 38.3 percent of them. More advanced protein-calorie malnutrition degrees were associated with lower energy and protein intake. The prevalence of moderate or severe protein-calorie malnutrition was higher in patients classified as Child-Pugh C than in patients classified as Child-Pugh A (21 percent x 58 percent, respectively). Regarding sexual differences, fat reserves, evaluated by triceps skinfold, were more depleted in females than in males (48.6 percent x 26.6 percent) regardless of the etiology of the cirrhosis, whereas muscle reserves (arm muscle circumference) were more depleted in males (43.4 percent x 13.4 percent) regardless of the etiology of cirrhosis. In contrast, cirrhosis of alcoholic etiology was determinant in reducing arm...

RACIONAL: A desnutrição calórica e protéica é achado freqüente em pacientes com doença hepática. Poucas investigações da desnutrição calórica e protéica têm sido realizadas em pacientes atendidos em ambulatório OBJETIVO: Avaliar o estado nutricional de pacientes com cirrose hepática (alcoolistas e não-alcoolistas), atendidos na primeira consulta em ambulatório de referência para doenças hepáticas. PACIENTES E MÉTODOS: Trezentos pacientes consecutivamente atendidos pela primeira vez em ambulatório de doenças hepáticas foram incluídos neste estudo. Os mesmos foram submetidos a avaliação nutricional que constou de antropometria: dobra cutânea do tríceps, circunferência do braço e circunferência muscular do braço, e bioquímica: índice creatinina/altura, albumina sérica e contagem total de linfócitos. O diagnóstico do estado nutricional foi baseado pelo escore de desnutrição calórica e protéica proposto por Mendenhall e colaboradores e a ingestão alimentar por recordatório de 24 h RESULTADOS: Setenta e um porcento dos pacientes cirróticos estudados foram de causa alcoólica e 29 por cento não-alcoólica. Independentemente da causa, a prevalência de desnutrição calórica e protéica foi de 75,3 por cento, sendo que 38.3 por cento deles já a apresentavam moderada e grave. Os pacientes com desnutrição calórica e protéica moderada e grave apresentavam pior ingestão de proteína e energia. A prevalência de moderada e grave foi mais elevada nos pacientes classificados como Child-Pugh C do que nos pacientes classificados como Child-Pugh A (21 por cento x 58 por cento, respectivamente). Em função das variáveis sexo e causa, as reservas de gordura, avaliadas pela dobra cutânea do tríceps, estiveram mais depletadas em mulheres cirróticas que nos homens cirróticos (48,6 por cento x 26,6 por cento). Já as reservas musculares, avaliadas por circunferência muscular do braço, estiveram mais depletadas em homens cirróticos (43,4 por cento x 13,4 por cento), independentemente...

Malnutrición y trastornos del crecimiento en consulta especializada 2001-2005: [revisión] / Malnutrition and growth disorders in a specialized clinic 2001-2005: [review]

Conocer la tendencia de malnutrición y trastornos del crecimiento en la consulta de Nutrición, Crecimiento y Desarrollo del Hospital de Niños J.M de Los Ríos entre los años 2001-2005. Estudio retrospectivo, transversal y descriptivo que incluye todos los pacientes evaluados por primera vez en dicho período. Se tomó el peso, talla, circunferencia media del brazo y pliegues tricipital y subescapular. Se tomaron como valores de referencia para la evaluación nutricional y el crecimiento el National Center for Health Statisties (NCHS), con sus respectivos puntos de corte y el Estudio Transversal de Caracas (ETC) para evaluar la composición corporal. De 16.462 pacientes evaluados 4.683 fueron de primera vez, predominando malnutrición por déficit (p<0,001) con tendencia al aumento (variación interanual promedio 2,91 ± 0,19 DE). La desnutrición leve se observó en 32,17 por ciento pacientes (p<0,05 por ciento), la grave en 13,31 por ciento con tendencia al incremento (variación interanual promedio 10,11 ± 1,78 DE). En el grupo de desnutridos graves, la forma edematosa predominó durante el año 2003 (52,58 por ciento), mientras que la forma marasmática fue la predominante durante el resto del período. La malnutrición por exceso presentó tendencia negativa. El 64,70 por ciento de los pacientes presentó déficit de crecimiento, con tendencia al incremento (variación interanual 3,53 ± 0,09 DE). Analizando los últimos 5 años de consulta predominó malnutrición por déficit con tendencia al aumento progresivo y pico en el 2003, probablemente consecuencia de la reagudización de la crisis social, económia y política del país, para aquel momento. En contraste al incremento mundial de obesidad, se observó tendencia negativa. La desnutrición sigue siendo el problema nutricional predominante de la consulta. El déficit de crecimiento presentó tendencia positiva.

To know the tendency of malnutrition and growth disorders in the Department of Nutrition, Growth and Development of the Children’s Hospital J.M de los Ríos, 2001-2005. A retrospective, transversal and descriptive study, which includes all new patients evaluated during such period. Weight, height, mid-arm circunference and tricipital skin fold were assessed. The National Center for Health Statisties and Caracas´ Transversal Study were the references used for the nutritional and growth evaluation. From 16.462 patients, 4.683 were evaluated for the first time. Malnutrition by deficit (p<0.001) was predominant with atendency to increase (average year-to-year difference 2.91 ± 0.19 SD). The degree of malnutrition observed was as follows: mild 32,17%(p<0,05); severe 13,31% with a tendency to increase (average year-to-year difference 10,11 ± 1,78 DE). In the group of severely malnourished children, the edematous form predominated in 2003 (52.58 %), while marasmus was the predominant form during the rest of the period. Malnutrition by excess resulted with a negative tendency. Growth deficit was present in 64.70% of patients, with increasing tendency (year-to-year difference 3.53 ± 0.09 SD). Malnutrition by deficit predominated during the 5 years analyzed, with a progressive increase during the entire period and a peak in 2003, as a consequence of the social, economical and political crisis of the country at the time. There was a negative tendency of obesity, in contrast with its worldwide increase. Undernutrition still the mayor nutritional problem in the department. Growth deficit showed a positive tendency.

Quantitative Study of the Myenteric Plexus of the Descending Colon of Young Rats Subjected to Intense Protein Deficiency / Estudio Cuantitativo del Plexo Mientérico del Colon Descendente de Ratas Jóvenes Sometidas a Intensa Deficiencia Proteica

We studied the effects of a severely hypoproteic diet on the quantitative aspects of the myenteric plexus of the descending colon of young rats. Eighteen rats were divided into two groups, one of them being fed with a chow having 26% protein (control) and the other with a chow having 4% protein, balanced for minerals and vitamins, during 12 weeks. The whole-mounts of the descending colon had their myenteric neurons stained either with Giemsa or NADPH diaphorase. The rats from the experimental group had deficits of body weight (54.23%) and area of the descending colon (48.14%); additionally, we observed that there was no alteration in the total number of neurons of the colon, but a decrease in the number of NADPH-diaphorase positive neurons (37.80%). The implications of these results concerning the priority that some cellular types may have when nutrients are less available are discussed.

Estudiamos los efectos crónicos de una dieta severamente hipoproteica sobre los aspectos cuantitativos del plexo mientérico del colon descendente de ratones jóvenes. 18 ratones fueron divididos en dos grupos, a uno de estos grupos se le dió ración con contenido proteico del 26% (control) y al otro, ración con contenido proteico del 4%. Se mantuvo el balance vitamínico y mineral, durante 12 semanas. Elaboramos los preparados de membrana del colon descendente y marcamos las neuronas del plexo mientérico con Giemsa y NADPH-diaforasa. Los ratones del grupo experimental presentaron déficit de peso corporal (54,23%) y del área del colon descendente (48,14%); además, observamos que no hubo alteración en el número total de neuronas en todo el colon; sin embargo, hubo una disminución en la marcación de neuronas NADPH-diaforasa positivas (37,80%). Los resultados son discutidos, respecto a la prioridad que ciertos tipos celulares pudiesen tener, con la menor disponibilidad de nutrientes.

Estudo morfométrico do miocárdio em adultos com subnutriçäo protéico-energética / Myocardial morphometric study in protein-energy malnourished adults

Objetivo - Comparar o tamanho das células musculares e a presença de lipofuscina no coração de adultos necropsiados, subnutridos e controles. Método - De uma casuística inicial de 315 necropsias de adultos, foram excluídos casos com sinais de retenção hídrica, cardiopatias, hepatopatias, hipertensão e nefropatias. Subnutrição foi caracterizada pelo índice de massa corporal (IMC) <17kh/m2. Fragmentos de miocárdio foram processados para morfometria computadorizada, determinando-se a espessura dos miocardiócitos e a presença de lipofuscina. Resultados - Subnutridos (n=8) e controles (n=4) foram estatisticamente diferentes, respectivamente, quanto ao IMC (14,86+1,13 vs 22,02+0,9 kg/m2), relação peso cardíaco/peso corporal (0,68+0,09 vs 0,54+0,07 por cento), espessura de miocardiócitos (10,91+0,77 vs 12,90+54,4 por cento). Conclusão - Comparados aos controles, adultos subnutridos têm menores espessuras de miocardiócitos e presença de lipofuscina, fenômenos que refletir um distúrbio metabólico com repercussões clínicas danosas em pacientes terminais.

Scanning electron microscopy of the jejunum in children with protein-energy malnutrition

Samples of jejunum from seven children dying from severe oedematous malnutrition were fixed with intralumenal glutaraldehyde in combination with external immersion, using a rapid autopsy protocol. Selected areas were post-fixed in osmium tetroxide, dehydrated with an ethanol series and critical point dried. After mounting on aluminium stubs, specimens were sputter-coated with a thin layer of gold and palladium. Scanning electron microscopy showed patterns ranging from subtotal villous atrophy, through partial villous atrophy with low ridges, to longer, taller ridges with cerebriform convolutions. In one case, villous height had been interpreted as normal on light microscopy. The scanning electron microscope revealed that the mucosa in this case was composed of ridges and leaf forms. Processing for scanning electron microscopy is simple. The specimens can be viewed and photographed in a relatively short time. In addition, the three-dimensional record provides clarification of ambiguities which often arise from routine histological sections.

Ultrastructure of voluntary muscle in childhood malnutrition

This paper is part of a study on the electron microscopy of protein-energy malnutrition, using a rapid autopsy protocol. Samples of voluntary muscle, obtained from eight children dying of severe oedematous malnutrition, were fised in glutaraldehyde within 75 minutes of death. Atrophy of myofibres, increased prominence of satellite cells, and segmental necrobiosis were seen by light microscopy. Electron microscopy showed variable depletion of myofibrils. In the most severe case, there was focal absence of myofibrils, also disorganized Z lines, and absent M bands. Residual atrophic myofibrils measured less than 0.1 µm in width. Other specimens showed sarcomere disorganization, mitochondrial swelling, glycogen depletion, sarcoplasmic oedema, and focal contractions of sarcomeres. Though non-specific, rigor may phosphates. These conditions may exist in severe malnutrition, complicated by terminal infection and metabolic disturbances

Mineralización ósea adolescentes que padecieron desnutrición posnatal temprana / Bone mineralization of adolescents that suffered of early postnatal undernutrition

Se analizó el grado de adecuación de la mineralización ósea en 6 adolescentes de sexo masculino y 18 de sexo femenino, que habían padecido de desnutrición calórico proteica severa en su primer año de vida y cuyo promedio de edad fue de 12 años y 11 meses. Estos niños han sido controlados en nuestro Instituto desde el inicio de su rehabilitación nutricional. La mineralización ósea se estudió en cuerpo entero, columna y caderas por medio de un densitómetro isotópico de doble haz (Gd 153). Se compararon los resultados con los de niños normales de igual edad y sexo. Se encontró que los adolescentes que padecieron desnutrición temprana no presentaron diferencias en a adecuación de su peso para la talla comparado con los normales, estando ambos sobre el 100 por ciento de adecuación. El porcentaje de adecuación de la talla para la edad fue significativamente menor en los antecedentes de desnutrición. Las densitometrías mostraron una menor masa ósea total en cuerpo total, columna y cuello femoral en los desnutridos comparados con los normales, diferencias que perdieron la significancia al expresarlas por 100 cm de estatura. No se encontraron diferencias en la densidad mineral ósea en las áreas medidas. Se concluye que la posible alteración de la mineralización ósea que produce la desnutrición posnatal temprana se podría recuperar con una adecuada rehabitación, vigilancia con apoyo nutricional y de salud de estos niños

Reduction of liver mass due to malnutrition in rats: correlation with emaciation of animals and size of organs

We studied the effects of protein-energy malnutrition on the liver morphology of rats as compared to animal emaciation and to reduction in size of the organs not irrigated by splanchnic blood such as kidneys and spleen. The animals were divided into two groups, one of them fed ad libitum rate (N=10) and the other (N=14) receiving water but no food for 7 days, and the changes in animal weight, liver, kidney and spleen mass were determined. DNA and the protein/DNA ratio, as well as hepatocyte size, were determined in liver tissue. The liver decreased in mass (27.14 percent) at a significantly higher proportion (p<0.05) when compared to body emaciation (19.22 percent). Similar to the reduction in body weight, the masses of kidneys and spleen were reduced by 18.68 percent and 24.28 percent, respectively The reduction in liver mass occurred due to hypoplasia and atrophy, i.e., a decrease in hepatocyte number and size, respectively. We conclude that there is a preferential consumption of liver protein in protein-energy malnutrition which is suggested to result from the additive action of the effects of overall consumption of organic reserves due to malnutrition proper and to the reduction of the hepatotrophic stimulus.

Pathology of the lungs in childhood malnutrition in Jamaica: light and electron microscopy

The autopsy records of 115 children with severe protein-energy malnutrition were reviewed. Sections of the lung histology showed evidence of bacterial pneumonia in 49 per cent of cases. An additional 18 per cent showed bronchitis, bronchiolitis or interstitial pneumonitis. Aspiration of gastric contents was evident in 10 per cent of cases; 6 per cent showed pulmonary oedema and congestion. In the remaining cases, no lung pathology was identified (17 per cent ). In 8 cases, rapid autopsy examination permitted fixation of lung tissue for electron microscopy. These included 4 cases of bronchopneumonia, one of which was associated with viral pneumonia. Another interstitial pneumonitis, probably of viral aetiology, was also studied. Both these virus-associated cases showed loss of type I pneumocytes and hyperplasia of type II pneumocytes. Another patient with herpes simplex hepatitis showed necrotic emboli in pulmonary capillaries with virions, as well as colonies of interstitial bacteria. One patient with acute pulmonary oedema displayed severe endothelial cell swelling on electron microscopy. In one case, there was no evidence of respiratory changes, apart from desquamation of type I pnuemocytes. Useful information can be obtained on the fine structure of the lung, using samples taken soon after death.

Peroxisomes and the hepatic pathology of childhood malnutrition

Liver specimens obtained immediately after death from eight severly malnourished children were examined by electron microscopy, and compared with seven liver biopsy specimens from children who recovered from malnutrition. The liver cells from the fatal cases showed mitochondrial swelling, with coarse densities in the matrix, cholestasis, depletion of the endoplasmic reticulum and Golgi apparatus, diminished glycogen stores, prominent lipid deposits and focal cytoplasmic degradation. The nucleoli were enlarged. There was marked reducation in peroxisomes. In contrast, the biopsies from recovering children showed good cellular organisation, and a normal frequency of peroxisomes. Multiple factors, including sepsis, may lead to depletion of peroxisomes. Loss of peroximes may interrupt beta-oxidation of long-chain fatty acids and accentuate the accumulation of lipid. Moreover, a reduction in the concentration of catalase may remove one avenue for the detoxification of free radicals. As the concentration of other anti-oxidants, notably glutathione, is also reduced, free radical damage may occur, leading to lipid peroxidation of membranes, mitochondrial damage, pump failure and influx of water and electrolyted into the cell.

The exocrine pancreas in kwashiorkor and marasmus. Light and electron microscopy

Histological sections of pancreas and liver from 65 cases of children dying from childhood malnutrition were reviewed. The extent of pancreatic atrophy and fibrosis was compared with fatty change in the liver. Pancreatic atrophy was common, and often associated with severe fatty change in the liver, but also occurred in marasmic children with scanty liver fat. Pancreatic fibrosis, when present, was only of mild degree. Among 16 patients with marasmus, fibrosis was only seen in one pancreas. Fibrosis was recorded in 8/25 cases of kwashiorkor, and in 7/24 cases diagnosed as marasmic-kwashiorkor. Electron microscopy of the pancreas was performed in seven cases, using tissue collected at immediate autopsy. Atrophy and variable amounts of degranulation of acinar cells were seen. There was often disorganization of the endoplasmic reticulum with intracisternal sequestration. Mitochondrial swelling was consistent with terminal anoxia. Centro-acinar cells were prominent. Some acini were dilated and contained fibrillar material. These findings support the pioneer paper by Blackburn and Vinijchaikul (1969) and underlie the importance of pancreatic atrophy in the pathology of protein-energy malnutrition.

Estudo morfológico de tireóides de recém-nascidos e lactentes desnutridos / Morphologic study of thyroid glands of newborn and lactents

Foram estudadas 177 glândulas tireóides de recém-nascidos e lactentes eutróficos e desnutridos, submetidos à necrópsia, a fim de se avaliar morfologicamente eventuais alteraçöes estruturais. A idade variou de O a 24 meses de vida. Cento e duas eram eutróficas e 75 desnutridas; as desnutridas foram graduadas de + a +++, observando-se 31 casos grau +, 26 grau ++ e 18 grau +++. O estudo microscópico mostrou folículos tireoídeos arredondados e preenchidos por colóide nas crianças eutróficas e, angulosos e de aspecto bizarro, com rarefaçäo de colóide, nas desnutridas. Näo houve correlaçäo entre o grau de desnutriçäo e as alteraçöes histológicas encontradas.