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Biomedical subjects

J Wehba

Publications and source records attributed to J Wehba.

At least 19 recordsLinked to original sources
PubMed1985

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.

Absorption↗
PubMed1984

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.

Acute Disease↗
PubMed1983

Giardiasis in childhood and its effects on the small intestine.

The effects of Giardia lamblia on small bowel function were studied. Thirty-three asymptomatic children were studied before and after treatment with metronidazole (Nimorazol). Patients had a small intestinal biopsy, bile salt determinations, and the following absorptive tests: D-xylose, triglyceride, and lactose and sucrose tolerance tests. Before treatment, 87% had unconjugated bile salts in duodenal fluid but afterwards only 60% did. Small bowel biopsy changes did not correlate with the pre- and posttreatment periods. Triglyceride absorption showed significant differences between patients at different periods of the study; D-Xylose absorption did not reveal differences between the periods of the study but was significantly impaired when compared with controls. Lactose malabsorption was detected in 56% and sucrose in 7% of the patients. G. lamblia may have some pathogenic role, although nonspecific to intestinal function. It probably acts more in a synergistic way with other pathogenic agents that inhabit the intestinal lumen of children living under unfavorable conditions producing the picture of tropical enteropathy.

Bile Acids and Salts↗
PubMed1983

Caroli's disease in childhood: report of two new cases.

Caroli's disease is a rare congenital disorder characterized by segmentary saccular dilatation of the intrahepatic bile ducts, which manifests itself clinically by cholangitis and bile stones. We report two cases of Caroli's disease in schoolgirls with clinical signs of recurrent abdominal pain associated with intermittent crises of cholestatic jaundice. Diagnosis was made by retrograde cholangiography in one patient and by intravenous cholangiography in the other.

Abdomen↗
PubMed1981

Observations of the Alto Xingu Indians (central Brazil) with special reference to nutritional evaluation in children.

Little information concerning the nutritional status of Brazilian Indians living primitively in a large area of the Amazon region is available at present. This study took place in the Xingu National Park, created to preserve the Indian population living in this area, along with its culture. Field work was done in three consecutive years (1974, 1975, 1976). At the end of this period 175 children had been studied (97 male and 78 female) all estimated to be under 5 yr of age. Two kinds of studies were performed: 1) cross-sectional: studying the children that entered in the nutritional survey every year, and 2) longitudinal: studying the children that were under observation for 2 or 3 consecutive yr. The nutritional status was evaluated by two age-independent anthropometric indices, namely, weight-for-height and arm-circumference-for-height. The weight-for-height index showed that 96.0% of the children examined were classified as well nourished, 3.4% suffered of 1st degree malnutrition and 0.6% of 2nd degree malnutrition. The arm-circumference-for-height revealed that 97.1% were well nourished and 2.9% were classified as suffering of a mild degree of malnutrition. Since both indices used can give normal results in a population in which there is severe stunting or nutritional dwarfism, a longitudinal study was drawn. Growth in height was studied, resulting normal in 84.8% of the measurements taken. In contrast to children from low income families living in the outskirts of large urban centers where malnutrition reaches 54.0%, the Indians remain as healthy as they were when last examined 30 yr ago.

Anthropometry↗
PubMed1979

Jejunal mucosa in marasmic children. Clinical, pathological, and fine structural evaluation of the effect of protein-energy malnutrition and environmental contamination.

Seven children suffering from marasmus were investigated clinically, biochemically and morphologically. The fine structure of the jejunal mucosa obtained by peroral biopsy was evaluated. The mucosal changes noted agree with the only other ultrastructural study reported by Brunser et al. (8) and add information on three additional features: an increase in theliolymphocytes, excessive epithelial cell extrusion and abnormalities in the appearances of the mucosal plasma cells, suggesting possible local deficiency in immune function.

Animals↗
PubMedDate not supplied

[Celiac disease associated with insulin-dependent diabetes mellitus: report of a case].

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.

Celiac Disease↗
PubMedDate not supplied

[Nutritional status of Indian children of Alto Xingu and evaluation of the use of arm perimeter in the diagnosis of protein-calorie malnutrition].

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.

Anthropometry↗
PubMedDate not supplied

[Efficiency of D-xilose and triglycerides absorption tests in the investigation of chronic diarrhea].

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.

Adolescent↗
PubMedDate not supplied

[Menetrier's disease in children: report of 3 cases and review of the literature].

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.

Child↗
PubMedDate not supplied

An Escherichia coli strain that causes diarrhea by invasion of the small intestinal mucosa and induces monosaccharide intolerance.

E. coli can induced diarrhea either by enterotoxin production or by invasion of the colonic mucosa. Here we report a 2/12 year old infant with caute diarrhea induced by E. coli strain, isolated from the jejunal fluid, that had no enterotoxigenic activity but invaded the small intestinal mucosa and induced severe morphological alterations. Total villous atrophy and monosaccharide intolerance occured. After 51 days of hospitalization there was a partial recovery of the small intestinal morphology and the patient could also tolerate disaccharides again.

Acute Disease↗
PubMedDate not supplied

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.

Humans↗
PubMedDate not supplied

[Visceral larva migrans in childhood: report of 2 cases].

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.

Brazil↗
PubMedDate not supplied

Catch-up growth after the introduction of a gluten-free diet in children with celiac disease.

The rhythm of nutritional recovery in 11 children with celiac disease after the introduction of a gluten-free diet was studied. The mean age of the patients at the moment of the diagnosis was 2.8 +/- 1.2 years and they were followed up for a period of 3.4 +/- 1.9 years. The nutritional status was evaluated by the utilization of the following parameters: the weight-for-age, height-for-age and weight-for-height. It was verified that none child was well nourished at the moment of the diagnosis and during the evolution 9 of them reached a complete recovery of their nutritional status for the weight in a mean period of time of 5.8 +/- 2.7 months; 5 of these children remained well nourished during the follow-up, 3 for 33 months and 1 for just a month. The other 2 children were initially classified as PCM II and turned to PCM I. The height-for-age index revealed that only 6 children had recovered from malnutrition and only 4 remained like this during all the follow-up. The other 2 children suffered nutritional aggravation and turned to be PCM I, but after a mean time of 18.4 months both resumed the rhythm of growth. Nutritional dwarfsism in 45.45% and chronic evoluted malnutrition in 54.55% were the patterns of malnutrition observed in this group of patients.

Body Height↗
PubMedDate not supplied

[Tropical enteropathy: morphologic and functional changes of the small intestine and their effects on nutritional status].

Tropical enteropathy has been described in children and adults that live in developing countries. This disease may be symptomatic or may present without symptoms. We studied 66 patients with tropical enteropathy with special reference to the nutritional status and the intestinal function. The follow-up of the nutritional status revealed that 63 (95.49%) presented current malnutrition. The D-xylose absorption test was significantly lower than those found in the control group. The mean plasmatic triglyceride increment after the margarine load was significantly lower than that found in the control group. Carbohydrate tolerance tests revealed 51.3% lactose malabsorption, 35.07% sucrose malabsorption and 5% glucose malabsorption. Small bowel biopsy showed partial villous atrophy as the most frequent morphological characteristic observed. These children constitute an homogenous group representative of the majority of the population of the Third World.

Child, Preschool↗
PubMedDate not supplied

[Congential malabsorption of glucose and galactose in 2 brothers].

Congeneeital glucose-galactose malabsorption is a rare clinical entity transmitted by autossomic recessive gen. The defect is in the small intestinal active transport system which is shared by glucose and galactose. Diarrhea and failure to thrive from the first week of life are the prominent symptoms. We report two sibs from consaguineous parents with diarrhea and failure to thrive since they were born. Both children had glucose and galactose malabsorption but tolerated well formula containing fructose as the only source of carbohydrate. They showed flat blood glucose curves when tested with glucose and galactose loads but normal increments of the sugar blood levels with fructose load. The small intestinal biopsy performed in both patients revealed normal villous pattern. When put under a diet containing fructose as the only source of carbohydrate, both patients had their symptoms subsided and reassumed the normal pattern of growth.

Body Weight↗