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Biomedical subjects

U Fagundes Neto

Publications and source records attributed to U Fagundes Neto.

At least 19 recordsLinked to original sources
PubMed2000

[Persistent diarrhea]

INTRODUCTION: Persistent diarrhea has high impact on infantile morbidity and mortality rates in developing countries. Several studies have shown that 3 to 20% of acute diarrheal episodes in children under 5 years of age become persistent. DEFINITION: Persistent diarrhea is defined as an episode that lasts more than 14 days. ETIOLOGY: The most important agents isolated in persistent diarrhea are: Enteropathogenic E. coli (EPEC), Salmonella, Enteroaggregative E. coli (EAEC), Klebisiella and Cryptosporidium. CLINICAL ASPECTS: In general, the clinical characteristics of patients with persistent diarrhea do not change with the pathogenic agent. Persistent diarrhea seems to represent the final result of a several insults a infant suffers that predisposes to a more severe episode of diarrhea due to a combination of host factors and high rates of enviromental contamination. Therefore, efforts should be made to promptly treat all episodes of diarrhea with apropriate follow-up. THERAPY: The aim of the treatment is to restore hydroelectrolytic deficits and to replace losses until the diarrheal ceases. It is possible in the majority of the cases, using oral rehydration therapy and erly an appropriate type of diet. PREVENTION: It is imperative that management strategies also focus on preventive aspects. The most effective diarrheal prevention strategy in young infants worldwide is promotion of exclusive breast feeding.

Journal Article↗
PubMed1994

Asymptomatic environmental enteropathy among slum-dwelling infants.

OBJECTIVE: We documented asymptomatic environmental enteropathy, which may occur in low socioeconomic populations, and which is manifested by bacterial proliferation in the upper portions of the small bowel and by alterations in the digestive-absorptive capacity. DESIGN: Forty asymptomatic infants (< 1 year) of the Cidade Leonor slum in São Paulo, Brazil, were investigated for digestive-absorptive function, bacterial proliferation in the small bowel lumen, and jejunal morphology. They were compared with a control group of 8 well-nourished children from economically sound families. RESULTS: Mean value of the D-xylose absorption test in the slum infants 21.0 +/- 10.0 mg%) was significantly lower than in controls (46.0 +/- 13.8 mg%) (p < 0.001). Colonic bacterial proliferation in the small bowel was identified in 25 (62.5%) of slum-dwelling infants. Grade II villous atrophy with inflammatory infiltration in the lamina propria was the most frequent alteration found. CONCLUSION: These data show that alterations in the microecology, function and morphology of the small intestine can occur even in the absence of diarrhea. Therefore, the absence of symptoms does not necessarily imply a healthy well-being among children living in a slum.

Bacteria↗
PubMed1993

Negative findings for use of coconut water as an oral rehydration solution in childhood diarrhea.

This study reports the chemical composition of coconut water during its maturation. Composition was measured at 5, 6, 7, 8, 9, 10, 11 and 12 months maturation. Concentrations of sodium and glucose, and the osmolality values showed great variation throughout maturation. The concentration of sodium remained constant between the 5th and 7th months (mean 2.9 mEq/l), but increased after the 8th month (mean 12.5 mEq/l). The concentration of glucose remained constant between the 5th and 8th months (mean 3392.4 mg%), but abruptly decreased after the 9th month (mean 820 mg%). Osmolality followed the variation of the glucose concentration averaging 377.3 mOsm/l up to the 8th month, then decreasing to 310.3 mOsm/l after the 9th month. This study showed great variability in coconut water composition during maturation of the fruit. In no instance did the coconut water contain sodium and glucose concentrations of potential value as an oral rehydration solution.

Chlorides↗
PubMed1991

Refeeding of infants with acute diarrheal disease.

The purpose of this study was to determine which infant formula among five would be the most efficacious for the refeeding of infants during an acute episode of diarrhea. Fifty male infants less than 12 months of age with severe diarrhea and at least 5% dehydration were admitted to a metabolic unit and studied in a prospective, single-blind protocol. Ten infants randomly received one of five types of formula: two-thirds diluted cow milk, cow milk formula (Nanon, Nestle, Inc., São Paulo, Brazil), Portagen, Pregestimil, or Prosobee (Mead Johnson & Co. Division, Evansville, Ind.). They continued to receive the same formula for 72 hours unless dehydration occurred. There were no associated infections, and they received no prior antibiotic treatment. Oral hydration together with intravenous fluid therapy was given to all patients during the initial treatment. During the first 72 hours of refeeding, patients fed Portagen excreted the least amount of stool and required reduced quantities of intravenous fluids or oral hydration. In contrast, patients fed diluted cow milk or any other formula had more severe diarrhea. Nine of the 10 patients fed Portagen completed the 72-hour treatment, whereas only 2 of 10 fed diluted cow milk tolerated it. Similarly, the cumulative proportions for high purging rate, dehydration, carbohydrate intolerance, and vomiting were more favorable for Portagen and least acceptable for diluted cow milk. No differences were found among the remaining three formulas tested. These data show that diluted cow milk is poorly tolerated by infants with severe diarrhea, whereas Portagen is more effective.

Acute Disease↗
PubMed1989

Protracted diarrhea: the importance of the enteropathogenic E. coli (EPEC) strains and Salmonella in its genesis.

The etiology of the protracted diarrhea is ill-defined, but in the underdeveloped countries acute gastroenteritis might be the most common triggering factor, especially due to certain enteropathogenic bacteria, such as enteropathogenic E. coli (EPEC) and Salmonella. We investigated the role of these agents in the genesis of protracted diarrhea in 29 infants with a mean age of 4.6 months. The patients underwent the following tests: stool culture, culture of the jejunal secretion, and small bowel and rectal biopsies. The stool culture was positive for some enteropathogenic bacteria in 17 (58.6%) patients: EPEC serotypes 0126, 0125, 055, 026, 0111, 0127, 0114, 0158, and 0119 and Salmonella were identified. The jejunal secretion culture revealed bacterial proliferation in 15 (51.7%) patients, and the following bacteria were isolated: EPEC 0142, Proteus, Klebsiella, Enterobacter, EPEC 0114, Pseudomonas, EPEC 0111, Salmonella, and EPEC 0119. The small bowel biopsy showed subtotal villous atrophy in 13 (44.8%) patients, and the rectal biopsy revealed colitis in 13 (44.8%) patients. These findings stress the importance of those enteropathogenic bacteria in the genesis of protracted diarrhea in underdeveloped countries mainly due to food intolerance leading to aggravation of the nutritional status.

Diarrhea, Infantile↗
PubMedDate not supplied

[Celiac disease: evolution in knowledge since its original centennial description up to the present day].

In the recent past, some celiac disease features have been discussed in literature specially related to genetic susceptibility, pathogenesis, clinical presentation and diagnostic criteria. Immunological abnormalities characteristic of celiac disease, such as circulating antibodies and increased numbers of intra-epithelial lymphocytes containing a high percentage of gamma-delta T cells have been demonstrated. Other pictures of clinical presentation besides the classical one deserve attention namely short stature, iron-resistant anaemia, enamel hypoplasia, constipation, neurological manifestation and osteoporosis, among others. Asymptomatic presentation has been recognized since development of serological markers such as anti-gliadin, anti-reticulin and anti-endomysium antibodies. Up to now, small intestinal biopsy is the only decisive diagnostic approach. A Federal law has recently imposed food manufactures to place labels informing the presence of gluten in industrialized foods in Brazil. Lately there has been an increase in celiac disease patients registered in the Brazilian Celiac Association.

Celiac Disease↗
PubMedDate not supplied

[Severe acute diarrhea associated to classic enteropathogenic Escherichia coli (EPEC): clinical features and fecal losses in hospitalized infants].

UNLABELLED: Enteropathogenic Escherichia coli (EPEC) strains are the most prevalent enteropathogenic agents isolated in the stools of hospitalized infants with severe acute diarrhea in São Paulo. These microorganisms induce a severe intestinal secretion of fluids and electrolytes that can cause dehydration leading to hospital admission in the majority of the cases. OBJECTIVES: This investigation aims at the following objectives: 1) to study the clinical features of acute diarrhea in male infants who were hospitalized owing to EPEC infection; 2) to determine the fecal fluid losses, formula intake and variation of the body weight during the evolution of the disease. PATIENTS AND METHODS: Thirty eight male infants with acute diarrhea due to EPEC strains were studied. The clinical and epidemiological features of the patients were recorded and the different EPEC serogroups were identified. The infants were kept in a metabolic bed in order to allow the collection of stools and urine separately during the whole period of the disease, and daily metabolic balances were also obtained. The mean duration of the metabolic study was 5.8 days, and during this period of time 220 daily metabolic balances were accumulated and analyzed. RESULTS: The main clinical features of the studied group were as follows: age below 12 months; low birth weight; precocious weaning; severe protein-calorie malnutrition. EPEC 0111 was the most frequent serogroup identified, present in 68.4% of the infants. The average daily fecal fluid losses were 66 ml/kg and the mean daily formula intake was 85.2 ml/kg. Cow's milk was the most precocious food utilized and the infants who received cow's milk feeding presented the largest stool losses in comparison with lactose free formulas and total parenteral nutrition. CONCLUSION: EPEC strains are able to induce moderate to severe fecal fluid losses in infants and the duration of diarrhea is usually below 15 days, although in several circumstances diarrhea can show a protracted evolution owing to food intolerance associated or not with intestinal secretion.

Acute Disease↗
PubMedDate not supplied

[The effect of the supernatants of enteropathogenic Escherichia coli strains on the intestinal transport of sodium in rats "in vivo"].

We studied the effect of the supernatants of 2 to 5 samples of one of the following serotypes of EPC: 026:H, 086:H34, 0111:H-, 0119:H6, 0126:H21, 0128ab:H35 and 0142:H-, isolated from the stools of infants with gastroenteritis. We also studied 3 samples of the serotype 0157:HNT, that produces the Shiga-like toxin. The following control solutions were selected 1-SC1 (glucose-saline solution); 2-SC2 (TSB broth culture solution); 3-SC3 (E.coli K12 711 culture supernatant, a non enterotoxigenic serotype). These solutions were perfused in the small intestine of rats "in vivo" and sodium transport was determined. The comparison among the 3 control solutions revealed that there was always sodium absorption, but there was a difference in the intensity of the transport (SC1 >SC2 and SC3). The serotypes 0111:H-, 026:H-, 0126:H21, and 0142:H2, as well as the serotype 0157:HNT, induced sodium secretion and these values were significantly different in comparison with the 3 control solutions. On the other hand, the serotypes 0128ab:H35 and 0119:H6 induced sodium secretion but the differences were only significant in comparison with the SC1 and SC2, and SC1, respectively. The supernatants of the serotypes investigated provoked an important derangement in sodium transport probably due to the presence of an enterotoxin.

English Abstract↗
PubMedDate not supplied

[Intestinal transport of coconut water sodium and glucose in rats "in vivo"].

The chemical composition of coconut water shows a great variability during its maturational process and in no instance this fluid can be considered as an oral rehydration under scientific basis. The jejunal transport of water, sodium and glucose was studied in rats in vivo with coconut water during the different stages of maturation of the fruit. There was water absorption (mean = 1.07 -/+ 0.45 microl/min/cm), sodium secretion (mean =-169.04 -/+ 29.06 microEq/min/cm) and glucose absorption (mean = 5212.70 -/+ 2098.47 microg%/min/cm) in all the stages studied. This study demonstrates that sodium secretion impedes considering coconut water a rehydrating solution.

English Abstract↗
PubMedDate not supplied

[Proliferation of anaerobic flora in the small intestine of infants with acute and protracted diarrhea].

Bacterial proliferation in the small intestine can induce the protraction of diarrhea due to malabsorption of the nutrients. We performed the culture of the small intestine juice for the aerobic and anaerobic flora in 40 infants with persistent and acute diarrhea. Bacterial proliferation was observed in 32 (80%) patients, being 30 (75%) due to the aerobic microflora and 17 (43%) due to the anaerobic microflora. There was no statistical difference in the bacterial growth between acute and persistent diarrhea. The aerobic bacteria most frequently isolated was E. coli in 23 patients, and Bacteroides sp was the most prevalent anaerobic bacteria, isolated in 9 cases. The transitory flora was significantly more abundant in patients with persistent diarrhea.

English Abstract↗
PubMedDate not supplied

Gastroduodenal lesions in children with juvenile rheumatoid arthritis.

BACKGROUND/AIMS: There are few studies about gastrointestinal abnormalities in patients with juvenile rheumatoid arthritis-probably due to the fact that this association is not frequently recognized. The aim of our study was to observe the prevalence of endoscopic gastroduodenal lesions in these patients. METHODOLOGY: Fourteen patients with juvenile rheumatoid arthritis, all of them using non-steroidal anti-inflammatory drugs associated or not with methotrexate, were assessed clinically and by endoscopy. Gastric antrum biopsy and Helicobacter pylori search were also performed. RESULTS: The mean age of the patients was 10.6 years (7 boys). Abdominal pain was observed in 27% of them. Macroscopic endoscopic lesions were found in 43% and infection by Helicobacter pylori in 57%. The correlation between anemia and endoscopic abnormalities was statistically significant (p < 0.05). CONCLUSIONS: Our data show that patients with juvenile rheumatoid arthritis have considerable susceptibility to gastroduodenal lesions, especially if they are using any drug association and present anemia.

Adolescent↗
PubMedDate not supplied

[Lethality in hospitalized infants with acute diarrhea: risk factors associated with death].

OBJECTIVES: Acute diarrhea is a very frequent disease in developing countries and is the first cause of death in infants under 2 years of age. This study was designed to evaluate the clinical and epidemiological factors associated to the death of 17 out of 511 infants hospitalized owing to severe acute diarrhea, between January 1989 and December 1995. PATIENTS AND METHODS: The patients were divided into two groups according to their clinical evolution: Group I--Death and Group II--Survival. The following parameters were evaluated: birth weight, sex, age, duration of diarrhea (days) prior to admission, nutritional status, hydration, presence of an enteropathogenic agent in the stools, food intolerance and duration of hospitalization. RESULTS: The analyzed factors have shown a significant association with death for the following variables: age, relative risk (RR) = 4.0 for infants less than 6 months of age, identification of an enteropathogenic Escherichia coli (EPEC) strain in the stools (RR = 3.3), severe malnutrition at admission to the hospital (RR = 4.5), Occurrence of food intolerance during hospitalization (RR = 2.7). Some enteropathogenic agent was identified in the stools of 253 (54.9%) infants, among the 461 (90.2%) studied. Group I revealed the presence of an enteropathogenic agent in 75% of the cases. The most frequent agents identified in Group I was: EPEC (56.3%) and Shigella (12.5%), while in Group II EPEC was identified in 26.5% of the patients. CONCLUSIONS: The association of some factors such as age less than 6 months, severe malnutrition, food intolerance and the identification of EPEC strains in the stool culture are indicators of high risk of death in infants hospitalized due to severe acute diarrhea.

Acute Disease↗
PubMedDate not supplied

Clinical usefulness of acid steatocrit in pediatric practice.

The steatocrit technique has been frequently used in the follow up of malabsorption syndromes. The classical steatocrit method has recently been improved by adding perchloric acid to the fecal homogenate (acid steatocrit), this technique showed a better correlation with fecal fat concentration than the classical test. In our protocol, we aimed at an assessment of the clinical usefulness of the acid steatocrit when compared to the traditional technique. Children who were referred to the laboratory for evaluation of steatorrhea were studied by the fecal fat balance, which was taken as a gold standard method for the comparison between both steatocrits. The method was slightly modified, by using hydrochloric instead of perchloric acid. Our results showed a sensitivity of 88.8% for the acid steatocrit and 66.7% for the classical method, at a 1.6% cut off value. We suggest the method as useful to rule out steatorrhea, thus selecting those children who should not be submitted to more laborious and time consuming methods such as the fecal fat balance.

Celiac Disease↗