Untreated Congenital Hypothyroidism Mimicking Hirschsprung Disease: A Puzzling Case in a One-Year-Old Child.

Congenital hypothyroidism is a clinical emergency due to its potential risk of mental retardation. Constipation might be present in hypothyroid children. However, Hirschsprung disease is rarely associated with congenital hypothyroidism. Herein, a case of congenital hypothyroidism in a one-year-old child mimicking Hirschsprung disease is described. Adequate treatment with levothyroxine sodium tablets controlled intestinal dysmotility that mimicked congenital intestinal aganglionosis due to the critical influence of thyroid hormones on bowel motility.

Home-made feeding bottles have inadequacies in their nutritional composition regardless of socioeconomic class.

Fifty-four and fifty samples of home-prepared feeding bottles for infants from a public health unit (low socioeconomic group, LSG) and from a private pediatric clinic (high socioeconomic group, HSG), respectively, were chemically analyzed, and their energy, macronutrient and iron contents were compared with the standard composition recommended for follow-up formulas. Cow's milk and sucrose and cereals added to the bottles were largely used in the study. Energy, protein and carbohydrate contents were higher than the recommended level in 75.9, 27.7 and 81.5% of LSG samples and 62.0, 48.0 and 34.0% of HSG samples, respectively. Fat content was lower than the recommended level in 83.3% of LSG and 58.0% of HSG samples. Excessive values of energy, carbohydrates and protein, low fat content and macronutrient imbalance were found regardless of the socioeconomic class, thus indicating the need to improve the domestic feeding bottles' preparation practices and discourage the use of cow's milk and the addition of other ingredients.

A novel and potentially valuable exposure measure: Escherichia coli in oral cavity and its association with child daycare center attendance.

This study investigated the occurrence of Escherichia coli, an indicator of fecal contamination, in saliva samples from 141 children up to 36 months old, 53 not attending and 88 attending a child daycare center after exposure to a public daycare center and home environments. Two samples from each child were collected on the same day at 07:00 and 15:00 h and plated on MacConkey agar for identification. Samples E. coli negative in the morning and positive in the afternoon were statistically associated with the condition of the child attending daycare center (Odds ratio = 2.72; 95% confidence interval = 1.15/6.46). Exposure to the daycare center environment favored the potential risk of transmission of enteropathogens, as demonstrated by the presence of E. coli in saliva. The method proved to be easy to sample, non-invasive and feasible in young children. The findings suggest a novel and potentially valuable exposure measure.

Effect of soluble fiber pectin on growth and intestinal iron absorption in rats during recovery from iron deficiency anemia.

The objective of this study was to verify whether soluble fiber pectin interferes in growth and intestinal iron absorption in rats during iron deficiency anemia recovery. Twenty-one-day-old Wistar rats (n = 48) were fed for 2 weeks on a diet without iron in order to induce iron deficiency anemia. The anemic animals (age = 36 days) were divided into two groups: (1) pectin, 50 g of pectin per kilogram of diet, and (2) control, diet without dietary fiber. Iron was added to the diets for the two groups in order to reverse the anemia. During the iron deficiency anemia recovery phase (3 weeks), the pectin group showed lower mean values (p < 0.05) of weekly food intake (89.18 +/- 10.82; 107.60 +/- 11.70; 114.50 +/- 16.29 g, respectively, for the pectin group and 99.56 +/- 10.60; 116.36 +/- 15.33; 125.66 +/- 17.25 g, respectively, for the control group). The body weight of the pectin group was lower (p < 0.05) during the study's second and third weeks (192.42 +/- 16.67 and 228.75 +/- 19.81 g, respectively, and 202.87 +/- 19.96 and 243.51 +/- 20.44 g for the control group). Pectin led to a reduction in food intake and growth but not to iron absorption when taking into account the regeneration of hemoglobin mass.

Fasting breath hydrogen concentration in short bowel syndrome patients with colon incontinuity before and after antibiotic therapy.

OBJECTIVE: Nutrition success in short bowel syndrome (SBS) depends on the intake nutrients and the intestinal absorption capacity. An evaluation of energy expenditure and oxidation of substrate can be obtained with indirect calorimetry by measuring O(2) and CO(2) in the respiration. Elevated colonic fermentation can occur in SBS, producing H(2) and CO(2), which can also be eliminated through respiration and as a consequence affect the results from indirect calorimetry. The objective of this study was to determine the fasting breath H(2) concentration and alterations before and after antibiotic therapy in patients with severe SBS with colon in continuity. METHODS: The study was conducted in two phases. In phase 1, the fasting breath H(2) concentrations were measured in 10 patients with severe SBS with colon incontinuity and a control group of 10 healthy volunteers. In phase 2, the fasting breath H(2) concentrations were re-evaluated after treatment for 7 d with antibiotics in six patients with high rates of H(2). The analyses were performed with a gas chromatograph (microanalyzer DP; Quintron Instruments, Milwaukee, WI, USA), with results of breath hydrogen and methane concentration expressed in parts per million (ppm). RESULTS: In phase 1, the levels of fasting breath H(2) were higher in the patients with severe SBS with colon incontinuity than in the healthy controls (32.00 +/- 17.77 versus 5.30 +/- 3.31 ppm; P < 0.001), with 7 of 10 patients presenting levels of H(2) above the normal rate (12 ppm). The presence of an ileocecal valve did not modify the results significantly. In phase 2, all six patients treated with antibiotics presented normalization in the levels of fasting breath H(2) (from 43.50 +/- 6.90 ppm to 1.33 +/- 1.03 ppm; P < 0.001) and concomitant improvement in the gastrointestinal symptoms. CONCLUSIONS: In relation to the healthy controls, patients with SBS with colon incontinuity presented higher levels of fasting breath H(2). Antibiotic therapy normalized the levels of fasting breath H(2) and improved the gastrointestinal symptoms. We suggest that the breath H(2) test may be performed routinely in patients with SBS to diagnose elevated intestinal fermentation, prevent errors in the interpretation of the indirect calorimetry, and treat eventual associated gastrointestinal symptoms.