A randomized double-blind clinical trial of the effect of non-absorbable oral polymyxin on infants with severe infectious diarrhea.

The present study evaluated the effect of non-absorbable oral polymyxin on the duodenal microflora and clinical outcome of infants with severe infectious diarrhea. Polymyxin was chosen because classic enteropathogenic Escherichia coli was more sensitive to this antibiotic. Twenty-five infants were randomly assigned to a 7-day treatment with oral polymyxin (2.5 mg/kg in 4 daily doses) or placebo. Duodenal and stool cultures were performed before and after the treatment. Five patients were excluded during the study because of introduction of parental antibiotic therapy due to clinical sepsis (N = 3) or rapid clinical improvement (N = 2). In the polymyxin group, small bowel bacterial overgrowth occurred in 61.5% of the cases (8/13) before treatment and in 76.9% (10/13) after treatment. In the placebo group these values were 71.4% (5/7) and 57.1% (4/7), respectively. By the 7th day, clinical cure was observed in 84.6% of the cases (11/13) in the polymyxin group and in 71.4% (5/7) in the placebo group (P = 0.587). Considering all 25 patients included in the study, clinical cure occurred on the 7th day in 12/14 cases (85.7%) in the polymyxin group and 6/11 cases (54.5%) in the placebo group (P = 0.102). Clinical sepsis occurred in 3/11 (27.3%) of the patients in the placebo group and in none (0/14) in the polymyxin group (P = 0.071). Oral polymyxin was not effective in reducing bacterial overgrowth or in improving the clinical outcome of infants hospitalized with severe infectious diarrhea. Taking into account the small sample size, the rate of cure on the 7th day and the rate of clinical sepsis, further studies with greater number of patients are necessary to evaluate these questions.

A randomized double-blind clinical trial of the effect of non-absorbable oral polymyxin on infants with severe infectious diarrhea

The present study evaluated the effect of non-absorbable oral polymyxin on the duodenal microflora and clinical outcome of infants with severe infectious diarrhea. Polymyxin was chosen because classic enteropathogenic Escherichia coli was more sensitive to this antibiotic. Twenty-five infants were randomly assigned to a 7-day treatment with oral polymyxin (2.5 mg/kg in 4 daily doses) or placebo. Duodenal and stool cultures were performed before and after the treatment. Five patients were excluded during the study because of introduction of parental antibiotic therapy due to clinical sepsis (N = 3) or rapid clinical improvement (N = 2). In the polymyxin group, small bowel bacterial overgrowth occurred in 61.5 percent of the cases (8/13) before treatment and in 76.9 percent (10/13) after treatment. In the placebo group these values were 71.4 percent (5/7) and 57.1 percent (4/7), respectively. By the 7th day, clinical cure was observed in 84.6 percent of the cases (11/13) in the polymyxin group and in 71.4 percent (5/7) in the placebo group (P = 0.587). Considering all 25 patients included in the study, clinical cure occurred on the 7th day in 12/14 cases (85.7 percent) in the polymyxin group and 6/11 cases (54.5 percent) in the placebo group (P = 0.102). Clinical sepsis occurred in 3/11 (27.3 percent) of the patients in the placebo group and in none (0/14) in the polymyxin group (P = 0.071). Oral polymyxin was not effective in reducing bacterial overgrowth or in improving the clinical outcome of infants hospitalized with severe infectious diarrhea. Taking into account the small sample size, the rate of cure on the 7th day and the rate of clinical sepsis, further studies with greater number of patients are necessary to evaluate these questions.

[Dermatoglyphic patterns in celiac disease]. / Padrões dermatoglíficos na doença celíaca.

In 1990 a project was performed in Israel in which the authors reported a higher frequency of whorls and a lower frequency of ulnar loops in the dermatoglyphic pattern of children with celiac disease than in children belonging to control group. Based on these findings we carried out a similar study with our local population. Thirty six celiac children, their parents and siblings had their fingerprints analysed and compared to a control group matching for age, sex and race, in order to assess the efficiency of this method for the diagnosis of celiac disease. A statistically significant higher frequency of whorls and arches was found in celiac children than in control group (whorls = 40.6%, arches = 11.7%; whorls = 30.3%, arches = 5.0%, respectively) as well as a strong correlation between the dermatoglyphic pattern of the parents and their celiac children. There was also a statistically higher frequency of whorls > = 4 in celiac children (55.6%) than in controls (30.6%). The conclusion is that the dermatoglyphic pattern analysis can be used as a complementary data. Due to its low sensitivity (55.6%) and specificity (69.4%) considering the presence of four or more whorls, it is not useful as a screening or as a method itself, for the diagnosis of celiac disease.

[Steatocrit and Sudan III in the study of steatorrhea in children: comparison with the Van de Kamer method]. / Esteatócrito e Sudan III na pesquisa de esteatorréia em crianças: comparação com o método de Van de Kamer.

Steatorrhea was investigated in 50 children, through Van de Kamer test, Sudan III and steatocrit, in order to compare these three methods. Steatocrit showed better correlation with Van de Kamer test, obtaining sensibility and specificity of 91% and 87%, respectible, on stools took before homogenizing the feces collected during 72 hours. In this same situation, Sudan III showed sensibility of 73% and specificity of 69%. As in the Van de Kamer test, steatocrit represents the final expression of all fecal lipids, what does not happen with Sudan III.

[Serum antigliadin antibodies in the diagnosis and follow-up of celiac disease]. / Anticorpo sérico antigliadina no diagnóstico e seguimento da doença celíaca.

Between July 1985 and June 1990, we prospectively investigated 236 children suspected of having malabsorption syndrome. Each patient had a xylose absorption test and small intestinal biopsy. Blood samples were collected to AGA assay. The aim of the study was to evaluate the use of antigliadin antibodies test, IgG and IgA, in screening celiac disease for intestinal biopsy and in the monitoring of gluten-free diet and challenge in celiac patients. Twenty patients were diagnosed with celiac disease confirmed by three small intestinal biopsies; 12 patients were suspected of having celiac disease, with two biopsies, before and one year after a gluten-free diet; 106 patients had environmental enteropathy; 45 patients had protracted diarrhea and 56 children had failure to thrive with no gastrointestinal symptoms. The AGA test was considered a reliable test in screening for biopsy and in the differential diagnosis between celiac disease and other causes of malabsorption syndrome. The IgG AGA test had high sensitivity (90.4%) and the IgA AGA test had high specificity (92.1%) in screening for celiac disease. In the follow-up of the celiac patients the antibody levels were significantly higher during gluten containing diet than after gluten avoidance being thus a reliable test to evaluate dietary compliance.

Características clínicas da doença diarréica em lactentes na cidade do Recife / Etiological and clinical fratures of diarrheal disease in infantis in Recife city

Analisaram-se a etiologia e as características clínicas da doença-diarréica em 161 lactentes pertencentes a famílias de baixas condiçöes sócio-econômicas na cidade de Recife. O estudo foi realizado no Hospital Geral de Pediatria do Instituto Materno Infantil de Pernambuco. Acompanhou-se a evoluçäo clínica do quadro diarréico de 128 lactentes. Conclue-se que a doença diarréica é predominantemente de etiologia bacteriana no grupo estudado

Doença celíaca e enteropatia ambiental: diagnósticos diferencial em crianças de baixo nível sócio-econômico / Celiac diseases and environmental bowel diseases: differential diagnosis in children of low socioeconomic status

A alta prevalência de Enteropatia Ambiental em nosso meio e em determinados casos, sua semelhança clínica, funcional e histológica com Doença Celíca, näo permite o diagnóstico diferencial entre essas duas patologias. Foram estudadas 12 crianças portadoras de Enteropatia Ambiental, com diarréia crônica, alteraçäo da prova de absorçäo da D-Xilose e atrofia vilositária subtotal da mucosa do intestino delgado. O acompanhamento das crianças com dieta isenta de glúten só permitiu o diagnóstico diferencial em metade dos pacientes. Conclui-se ser necessário o desenvolvimento de técnicas auxiliares para o diagnóstico de Doença Celíaca

[Nutritional status of Indian children of Alto Xingu and evaluation of the use of arm perimeter in the diagnosis of protein-calorie malnutrition]. / Estado nutricional de crianças índias do Alto Xingu e avaliação do uso do perímetro braquial no diagnóstico da desnutrição protéico-calórica.

STUDY OBJECTIVE: The purpose of this study was to determine the presence of malnutrition in indian children of Alto Xingu region in Brazil, and to evaluate the usefulness of arm circumference and QUAC index in the diagnosis of protein-energy malnutrition (PEM). SITE: The indian population of Alto Xingu maintains most of its traditional customs. PATIENTS: 335 children were studied prospectively in at least one of seven consecutive years between 1974 and 1980, and 1278 measurements were obtained of weight, height, and arm circumference. MEASUREMENTS AND RESULTS: The annual prevalence of PEM (weight-for-height) less than 90% according to Brazilian reference tables was 4.1% in children aged under 1 year, 7.3% in children from 1 to 5 years of age, and 7.5% in children older than 5. According NCHS tables, however, values of 1.0%, 2.8%, and 1.1% were obtained for the respective age groups. The sensitivity and specificity of arm circumference and QUAC index were calculated in relation to the weight-for-height relation. According to Brazilian reference tables, arm circumference had a sensitivity of 8.9% and specificity of 99.3%, whereas the QUAC index had a sensitivity of 11.1% and specificity of 98.3%. However, according to NCHS tables, slightly different values were obtained. The sensitivity and specificity in this case were 23.5% and 99.3%, respectively, for arm circumference and 35.3% and 98.3%, respectively, for the QUAC index. CONCLUSIONS: The authors concluded that the prevalence of PEM was low in the Alto Xingu and that arm circumference and the QUAC index should only be used in situations suited to their sensitivity and specificity.

[Efficiency of D-xilose and triglycerides absorption tests in the investigation of chronic diarrhea]. / Eficiência das provas de absorção da D-xilose e dos triglicérides na investigação da diarréia crônica.

The D-xylose and triglyceride absorption tests have been widely used as screening tests to characterize malabsorption and indicate intestinal biopsy. In this paper we report the efficiency of these tests in the differential diagnosis of the various causes of chronic diarrhea and their possible relationship to jejunal villous atrophy. Two hundred and fifteen children with chronic diarrhea were submitted to the D-xylose and triglyceride absorption tests, and small intestinal biopsy. The patients were divided into 5 groups, that is: I--celiac disease, 53; II--protracted diarrhea, 24; III--environmental enteropathy, 50: IV--celiac disease under gluten free diet, 11; V--irritable bowel syndrome, 77. D-xylose and triglyceride absorption tests were within normal limits in 3.8% and 4.2% patients belonging respectively to groups I and II. On the other hand, only 7.8% of the patients belonging to group V would be included in the group of patients that would have indication for intestinal biopsy, since both tests revealed abnormal results. Moreover, both tests showed an excellent relationship with the intensity of villous atrophy.

[Celiac disease associated with insulin-dependent diabetes mellitus: report of a case]. / Doença celíaca (DC) associada à diabetes mellitus insulino-dependente (DMID): relato de um caso.

We report the association of diabetes mellitus and celiac disease in one patient, which was confirmed by intestinal biopsy, the withdraw of gluten from the diet, and by a positive challenge test. We emphasize the importance to recognize this association to improve the clinical management of patients with diabetes mellitus.

[Menetrier's disease in children: report of 3 cases and review of the literature]. / Doença de Ménétrier na criança: relato de três casos e revisão da literatura.

Three cases of Ménétrier's disease in childhood are reported and 38 other cases previously described in the literature are reviewed. The disease manifests in children as a protein-losing gastropathy and a characteristic hypertrophic gastric rugae is demonstrated by upper gastrointestinal radiographs or endoscopy. In contrast to the usual chronicity of the disease in adults, the course is usually benign in children and the symptoms resolve spontaneously in weeks or months. The possible etiology and differential diagnosis are discussed. Ménétrier's disease in children may be more common than report.

Realimentaçäo de crianças com síndrome diarréica aguda: comparaçäo entre HN-25 milupa e produto a base de soja / Feeding in children with acute diarrhea syndrome: comparison between HN-25 milupa and a soy formula

Objetivou-se, por ensaio comparativo, avaliar a aceitaçäo, tolerabilidade e ganho de peso, de crianças eutróficas ou com DPC I, com idade de 1 até 12 meses, com síndrome de diarréia aguda, separadas em 2 grupos. O grupo I, de 25 crianças, recebeu a fórmula alimentar com baixo teor de lactose HN-25 MILUPA e o Grupo II, de 24 criancas, recebeu produto a base de soja. O controle clínico foi feito pela anotaçäo diária do peso, volume do alimento ingerido, número de características das evacuaçöes, com determinaçäo do pH e de substâncias redutoras nas fezes. Realizou-se coprocultura com pesquisa de enteropatógenos e rotavírus. Além da hidrataçäo apropriada quando necessária, procedeu-se a realimentaçäo precoce administrando os alimentos em volume e concentraçäo adequados. Os resultados mostraram boa evoluçäo em 18 das 25 criancas do grupo da fórmula alimentar com baixo teor de lactose e 10 das 24 crianças do grupo soja. Houve ganho ponderal médio diário de 25,00 g no Grupo 1 e 12,9 no grupo II da soja. A aceitaçäo média diária por Kg de peso foi de 156,6 ml/dia no grupo I da fórmula alimentar com pouca lactose e de 116,9 ml no grupo II, da soja. Concluiu-se pela melhor evoluçäo da diarréia, melhor aceitaçäo da realimentaçäo e melhor ganho ponderal nas crianças realimentadas com a fórmula com baixo teor de lactose

Protracted diarrhea in infancy: clinical aspects and ultrastructural analysis of the small intestine.

Protracted diarrhea is a clinical entity characterized by diarrhea lasting greater than 2 weeks, starting before 3 months of age, with severe nutritional aggravation and negative stool culture for enteropathogens. This report deals with the ultrastructural abnormalities found in the intestinal mucosa of children with protracted diarrhea. Forty children (mean age 5.1 months) were studied. They were submitted to the following tests of intestinal function: D-xylose, triglyceride tolerance, small bowel biopsy (light and electron microscope), sigmoidoscopy, and sweat test. D-Xylose absorption and triglyceride tolerance test in these patients were both significantly lower than controls. Ultrastructural analysis of the small bowel of 12 patients showed various degrees of alterations, mainly shortening of the microvilli, increased number of multivesicular bodies, and vacuolation of mitochondria and endoplasmic reticulum. These lesions were totally reversible after clinical and nutritional recovery as could be proven in two children. The most common cause of protracted diarrhea in these patients was secondary carbohydrate intolerance and dietary protein cow's milk and soy bean intolerance, which resulted in colitis or malabsorption as a consequence of intestinal mucosa injury due to acute gastroenteritis.

Ultrastructural study of alterations in the small intestinal epithelium of children with acute diarrhea.

We studied the ultrastructure of the jejunal epithelium of six children suffering from acute episodes of gastroenteritis. Ultrastructural alterations of the jejunal mucosa occurred in practically all of the fragments analyzed, although the intensity of the abnormalities observed varied considerably. In most of the patients the alterations were confined to the microvilli, which appeared shortened and tufted in comparison with controls. These ultrastructural alterations are nonspecific and may represent a general response of the intestinal mucosa against different noxious agents. Severe alteration of the epithelial cells was observed in only one patient. In this case the cytoplasm contained multiple vacuoles that may correspond to dilated endoplasmic reticulum. It is hypothesized that the small intestinal lesions observed in these patients may allow penetration of food antigens, resulting in the appearance of food intolerance frequently described in children suffering from acute diarrhea.

[Visceral larva migrans in childhood: report of 2 cases]. / Larva migrans visceral na infância: relato de dois casos.

Reports of Visceral larva migrans (VLM) are not frequent in Brazil, but the prevalence of this disease may be more common due to poor environmental conditions to which most of the children are exposed. The most common infectious agent is Toxocara canis, a parasite of the intestinal tract of dogs. Children get infected eating contaminated material with feces of dogs. The ova are swallowed and reach the intestinal lumen of the children. Systemic migration occurs by lymphatic or portal circulation to several organs, most frequently, to the liver and lungs, causing hepatosplenomegaly and/or bronchospasm.

Absorption of D-xylose in full term newborns adequate for gestational age: prospective study up to third month.

Studies of the D-xylose absorption capacity in newborns are scarce and the results reported are controversial. We evaluated the xylose absorption in full term newborns adequate for gestational age in the first days of life and prospectively up to the third month. D-xylosemia values of the first and second hours at birth and at 3-5 days are significantly lower than on the 15th day at one month and at three months. On the other hand, the values obtained in these last three groups showed no differences among themselves. The comparison of first hour D-xylose values between a control group and those children investigated on the 15th day at one month and at three months, revealed significant differences, but second hour values did not show statistic differences. We concluded that enterocyte absorption capacity is already completely developed at 15 days of life in full term newborns adequate for gestational age.

Absortion of D-xilose in full term newborns adequate for gestational age prospective study up to third month

Os estudos sobre a capacidade de absorcao da D-xilose em recem-nascido sao escassos e os seus resultados sujeitos a controversias. Os autores avaliaram a absorcao da D-xilose em recem-nascido de termo, adequados para a idade gestacionall, nos primeiros dias de vida e prospectivamente ate o terceiro mes. Os valores da D-xilosemia para as primeiras e segundas horas apos o nascimento e tres a cinco dias apos, foram significativamente menores do que do decimo quinto dia, com um e tres meses de vida. Por outro lado, os valores obtidos nestes tres ultimos grupos nao revelam diferencas entre si. A comparacao dos valores de D-xilose da primeira hora, entre o grupo de controle e as criancas investigadas no decimo quinto dia com um e tres meses, revelaram diferencas significativas, porem os valores da segunda hora nao mostraram diferencas estatisticamente significantes. Os autores concluem que a capacidade de absorcao do enterocito ja se encontra completamente desenvolvida no decimo quinto dia de vida em recem-nascidos de termo, adequados para a idade gestacional

Larva migrans visceral na infancia: relato de dois casos. / Visceral larva migrans in childhood: report of 2 cases

A descricao da larva migrans visceral (LMV) nao e comum no nosso meio, porem a prevalencia desta infeccao com certeza deve ser mais frequente, pois as possibilidades dos pacientes provenientes de nivel socio-economico baixo, que constituem a grande maioria da nossa populacao contrairem a infeccao sao extremamente altas. O agente infecciosos mais comum e o parasita do cao Toxocara canis, e ela e adquirida mais frequentemente atraves do habito de geofagia, com a ingestao do solo contaminado com ovos embrionados de Toxocara. Ocorre migracao pela via linfatica ou circulacao portal para varios tecidos, mais comumente, figado e pulmoes, porem ocasionalmente no coracao, SNC e olhos

Diarreia protraida. II. Alteracoes ultra-estruturais do intestino delgado. / Protracted diarrhea. II. Ultrastructural changes of small intestine

Estudos ultra-estruturais da mucosa do intestino delgado nao foram descritos em pacientes com diarreia protraida. Neste trabalho descrevemos as alteracoes ultra-estruturais do epitelio intestinal em 12 pacientes de 1 a 10 meses, portadores de diarreia de evolucao superior a duas semanas. A analise ultra-estrutural dos fragmentos do intestino delgado revelou que a grande maioria (11/12) das biopsias intestinais avaliadas durante a fase ativa da enfermidade mostravam alguma anormalidade.Diminuicao do numero e na altura das microvilosidades, presenca consideravelmente aumentada de corpos multivesiculares, inchaco e destruicao de mitocondrias e reticulo endoplasmico foram as alteracoes mais frequentemente observadas. Em dois pacientes a analise ultra-estrutural realizada apos a recuperacao clinica mostrou total regressao das lesoes inicialmente observadas