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Biomedical subjects

U Fagundes-Neto

Publications and source records attributed to U Fagundes-Neto.

At least 37 records · Page 2Linked to original sources
PubMed1998

Nutritional management of regurgitation in infants.

Infantile regurgitation is a frequently occurring problem. Throughout the world, anxious parents are imploring physicians to eliminate their infant's regurgitation. General practitioners, pediatricians and pediatric gastroenterologists strive to alleviate infantile regurgitation and its related parental stress. In this paper we define the scope of the problem and analyze the optimal, cost-efficient management approach to simple regurgitation in infants. The intent of this paper is to disseminate this information to practicing physicians and other health care professionals in an attempt to minimize the impact of this annoying problem of infancy and to eliminate confusion and expensive diagnostic tests and use of sub-optimal treatment modalities. Parental reassurance and dietary management by feeding thickened formula are important components in managing regurgitation in infants while maintaining optimal nutritional intake for adequate growth and development.

Gastroesophageal Reflux↗
PubMed1998

[Estimated dietary fiber intake in children according to different food composition reference tables].

The importance of dietary fiber intake in the prevention and treatment of adult diseases has been widely emphasized in the literature for several years. Recommendations for fiber intake by children have only recently began to be published. The present study estimated the fiber intake by children with or without constipation according to five food composition tables. We studied 114 children under 12 years of age, of whom 56 were constipated and 58 had normal bowel movements. We used a 24 hour recall questionnaire and fiber consumption was analysed by five food composition tables: 1. Association of Official Agricultural Chemist-AOAC, 2. Southgate, 3. Mendez, 4. Englyst and 5. crude fiber. The statistical analysis showed significant differences between the medians of the estimated fiber consumption calculated using all tables, except the AOAC and Southgate tables. The median value and percent is 25th and 75th presented between parenthesis were (grams/day): Mendez--15.4 (11.9-19.6); Southgate--10.5 (7.8-13.5); AOAC--10.2 (7.3-14.0); Englyst--4.5 (3.0-6.0) and crude fiber--2.1 (1.4-2.9). There were statistical significant correlations between all pairs of tables but the best correlation was observed between Mendez and Southgate (r = +0.90), AOAC and Southgate (r = +0.88); and Mendez and AOAC (r = +0.84). Constipated children presented lower estimated fiber intake than those with normal bowel movements, with statistical significance according to all tables. In conclusion, it is important to determine which reference table should be utilized when recommending dietary fiber.

Child↗
PubMed1996

Nutritional impact and ultrastructural intestinal alterations in severe infections due to enteropathogenic Escherichia coli strains in infants.

OBJECTIVE: Enteropathogenic Escherichia coli (EPEC) strains are able to adhere to human intestinal tissue inducing a typical lesion causing dissolution of the brush border membrane and loss of microvillus structure at sites of bacterial attachment. The presence of these lesions can provoke perpetuation of diarrhea associated with malabsorption of the nutrients and nutritional aggravation. In this paper we report the nutritional impact of severe EPEC gastroenteritis in infants in a small bowel ultrastructural study. METHODS AND RESULTS: Two infants aged 3 months and one 4 month old infant with profuse watery diarrhea lasting less than 6 days were studied. After rehydration therapy, the patients were fed a cow's milk formula and since food intolerance was diagnosed, a protein-hydrolisate, lactose-free formula was introduced. This dietary modification was successful, diarrhea ceased, the patients were discharged and followed up for 30 days. The following EPEC strains were identified in the stools and in the jejunal secretion: O111ab:H2, O119:H6 and O18ab:H14. A small bowel biopsy was performed and the electron microscopic study revealed bacteria tightly adhered to the apical portion of the enterocyte and effacement of the microvilli. These lesions were more prominent in the areas where bacteria were present. CONCLUSION: The patients underwent an acute nutritional aggravation due to food intolerance, but the introduction of a protein-hydrolisate, lactose-free formula, allowed prompt cessation of diarrhea and nutritional recovery.

Acute Disease↗
PubMed1996

Attaching and effacing enteropathogenic Escherichia coli O18ab invades epithelial cells and causes persistent diarrhea.

A case of persistent diarrhea following Escherichia coli O18ab gastroenteritis is reported. Electron microscopy of a biopsy of the small intestine showed effacement of the brush border, attachment of bacteria to the epithelial cells with pedestal formation, and bacteria within the enterocytes. The bacterial isolate was an enteropathogenic E. coli isolate which did not contain the adherence factor (EAF) but possessed the attaching-effacing eae gene, was able to invade HeLa cells in a gentamicin invasion assay, and also invaded rabbit intestinal cells. Results suggest that E. coli organisms of the O18ab serotype may cause diarrhea by an as yet unknown pathogenic mechanism, involving attaching to and effacing of enterocytes followed by invasion of the epithelial cells.

Adhesins, Bacterial↗
PubMed1990

The response to dietary treatment of patients with chronic post-infectious diarrhea and lactose intolerance.

The response to dietary treatment of patients with chronic post-infectious diarrhea and lactose intolerance was prospectively studied in 29 infants less than 1 year of age. All had gastroenteritis with diarrhea which persisted for more than 3 weeks. In the hospital, diarrhea continued and lactose intolerance was documented while being fed half-strength cow's milk formula. They were given dietary treatment with one of three formulas used for treatment of diarrhea in infancy. Improvement of diarrhea was more frequently achieved with Pregestimil when given as the initial therapy than with the other two formulas. With Pregestimil nine of 10 patients improved whereas only four of nine infants fed Portagen and one of 10 patients initially treated with soy formula improved. Pregestimil was also effective in three of five patients who initially failed to improve with Portagen and in four of eight patients tried with soy formula with or without carbohydrate. Additionally, in the patients who improved, recovery was more rapidly achieved with Pregestimil than with the other two formulas. Formula failures were due to intolerance to glucose polymers in three patients, possibly to protein in seven infants, and an intolerance to all nutrients in five patients. The improvement of the diarrhea was slower in patients who had evidence of colitis in rectal biopsies regardless of the dietary treatment given, but was not correlated with other variables, i.e., etiology of diarrhea, jejunal histology, or duration of diarrhea prior to treatment. However, as a group, the patients who failed to respond to Pregestimil were younger (less than 3 months of age), had more formula changes and associated infections, and were given more antibiotics; they also had more prolonged diarrhea before treatment and more severe jejunal mucosal lesions and jejunal bacterial overgrowth. The data suggests that Pregestimil seems to be the most effective formula for the treatment of infants with chronic post-infectious diarrhea and lactose intolerance.

Age Factors↗
PubMed1989

Rotavirus identification in jejunal juice and stools of acute and chronic forms of infantile gastroenteritis.

1. The present study investigates, by means of a combined enzyme immunoassay for rotaviruses and adenoviruses (EIARA), the occurrence of rotaviruses in stools and jejunal juices from 31 children with acute diarrhea and 18 with chronic diarrhea. 2. Stools from 8 acute cases contained rotaviruses (26%). In two of these cases rotaviruses were also detected in the jejunal juice. 3. In the chronic diarrhea group we identified rotaviruses in the stools of one patient and in the jejunal juice of another. 4. Some of the electropherotypes of the rotaviruses identified showed different patterns of RNA migration. 5. Abnormalities of the jejunal mucosa were characterized in 6 acute rotavirus-positive cases. No morphological or functional abnormalities of the intestinal mucosa were observed in the chronic diarrhea rotavirus-positive cases.

Diarrhea, Infantile↗
PubMed1985

Tolerance to glucose polymers in malnourished infants with diarrhea and disaccharide intolerance.

The response of infants with diarrhea and lactose intolerance to feedings containing soy protein and sucrose (Sobee), and/or to a carbohydrate free formula (RCF), to which glucose polymers (GP) were added, was assessed in twenty patients. They all were less than ten months of age and had varying degrees of malnutrition. Eleven had acute diarrhea and nine had chronic diarrhea. None of them had classical enteropathogenic strains and parasites in the stools. All had lactose intolerance when feedings were begun with cow's milk formula and some also had sucrose intolerance when fed sucrose containing soy formulas. They had persistent loose stools and excreted feces with an acid pH and with carbohydrates, thus they were given dietary treatment with RCF with GP. There were 9 patients with acute diarrhea and lactose intolerance (1 of them also had sucrose intolerance), who improved on RCF with GP feedings; but 2 patients (lactose and sucrose intolerant) failed to respond to this diet. There were six patients with chronic diarrhea and lactose intolerance (four of them also had sucrose intolerance), who improved on RCF with GP formula, but there were three patients who failed on this treatment. These data show that some infants with diarrhea, malnutrition, and lactose-sucrose intolerance may also develop intolerance to GP and require further dietary management with glucose as the source of carbohydrate in the diet.

Acute Disease↗
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

Disaccharide feedings enhance rat jejunal macromolecular absorption.

Disaccharide feedings to post-weaning rats alters their jejunal barrier to macromolecular absorption. Penetration of horseradish peroxidase (HRP) across the jejunum was enhanced after short-term high concentration gavage (30 g . kg-1 . day-1) of lactose that produces weight loss, osmotic diarrhea, and jejunal mucosal damage. HRP absorption was also increased by longer term feedings of lower levels of disaccharide that did not produce body weight alterations, diarrhea, or cell damage. Rats without diarrhea and gavaged with 7.5 g . kg-1 . day-1 of either lactose or maltose showed an increase in lumen to blood HRP absorption after 21 days of feedings. Also, lactose or maltose in the solid food diet at 30 g . kg-1 . day-1 for 21 days did not lead to diarrhea but produced an increase in jejunal lumen to blood HRP absorption. Rats having no diarrhea and receiving 15 g . kg-1 . day-1 of lactose or maltose in the drinking water for 21 days, showed an increase in jejunal HRP absorption. When rats were fed either lactose or maltose for 21 days glucose absorption became totally dependent upon the sugar concentration in the perfusion medium. The kinetics of this glucose absorption are compatible with a decrease in the "unstirred" layer. Disaccharide-induced HRP absorption may be mediated by transport from endocytotic vesicles across the jejunal epithelium.

Animals↗
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↗
PubMed1981

Jejunal macromolecular absorption and bile salt deconjugation in protein-energy malnourished rats.

The combined stress of protein-energy malnutrition (PEM) and exposure of the jejunum to pathophysiological (0.5 mM) levels of a bacterial metabolite, deconjugated bile salts, led to alterations not apparent with either stress alone. Perfusion of the jejunum of PEM rats with 0.5 mM deoxycholate (DCh) and a 40,000 dalton macromolecular tracer, horseradish peroxidase, led to higher serum horseradish peroxidase levels than were seen in PEM rats not exposed to DCh or in well-nourished controls treated with DCh. Semiquantitative cytochemical analysis indicated an increased number of villi with horseradish peroxidase penetration in PEM rats treated with 0.5 mM DCh. DCh perfusion of PEM rats also produced fine structural damage to epithelial cells not apparent in other preparations. And, perfusion with 0.5 mM cholate only produced sodium secretion in PEM rats. These observations in an animal model of PEM suggest that malnourished children with a colonic type of bacterial overgrowth of the small bowel may attain increased levels of foreign antigens or toxins from the intestinal lumen.

Animals↗
PubMed1981

Bile salt-enhanced rat jejunal absorption of a macromolecular tracer.

Bile salt deconjugation may occur in the jejunum under conditions of fecal colonic overgrowth of the small intestine. We studied the effects of conjugated and deconjugated bile salts on rat jejunal absorption of a macromolecular tracer, horseradish peroxidase, in an in vivo perfusion system. At a 0.5 mM perfusion concentration, only the deconjugated bile salts, cholate and deoxycholate, produced a significant increase in horseradish peroxidase absorption into serum. At a 0.5 mM concentration of the conjugated salt, taurocholate, horseradish peroxidase-absorption was indistinguishable from that seen in bile salt-free preparations. At a higher 5 mM concentration, both the conjugated and deconjugated salts increased jejunal HRP absorption into serum over that seen in bile salt-free preparations; this absorption wa most marked with the deconjugated salts. At a 0.5 mM level, the bile salts induced minimal sodium and glucose transport alterations but did not produce evidence of morphologic damage to villi or absorptive epithelial cell organelles. At a 5 mM level, the deconjugated salts induced glucose and sodium transport abnormalities and appeared to damage cellular organelles. Our observations suggest that an alteration in the tight junctional barrier to macromolecular absorption may play a role in some of the enhanced horseradish peroxidase absorption seen with deoxycholic acid in these experiments. The process of an increased absorption of intact macromolecules induced by products of bacterial metabolism may be of pathologic significance in the etiology of immunologically related intestinal disease or in toxigenic processes.

Animals↗