Pre-germination treatments of melon seeds for the production of seedlings irrigated with biosaline water / Tratamentos pré-germinativos de sementes de melão para a produção de mudas irrigadas com água biossalina

Abstract Melon production in the Brazilian semi-arid region is subject to the use of marginal waters with high salinity. However, the use of regulators and bioactivators in seed treatment can mitigate the harmful effects of salts in irrigation water. In this context, the objective was to evaluate the effect of pre-germination treatments with plant regulators and bioactivator in melon seeds for the production of seedlings irrigated with biosaline water from fish farming effluent. For this, two trials with the Goldex and Grand Prix hybrids were carried out separately. A completely randomized design was used in a 4 × 3 factorial scheme (pre-germination treatments × water dilutions). In addition to the control, the seeds were treated with salicylic and gibberellic acids and thiamethoxam. The waters used for irrigation were local-supply water, fish farming effluent (biosaline water) and these diluted to 50%. Physiological and biochemical analyses were performed for fourteen days. Biosaline water (5.0 dS m-1) did not affect the emergence of Goldex melon seedlings, but compromised the establishment of the Grand Prix cultivar. Seed pre-treatments with salicylic and gibberellic acids attenuate the effects of water salinity and promote growth modulations, resulting in more vigorous melon seedlings.

Resumo A produção de meloeiro no semiárido brasileiro está sujeita a utilização de águas marginais com salinidade elevada. Entretanto, a utilização de reguladores e bioativadores no tratamento de sementes podem mitigar os efeitos nocivos dos sais na água de irrigação. Nesse sentido, objetivou-se avaliar o efeito de tratamentos pré-germinativos com fitorreguladores e bioativador em sementes de melão para a produção de mudas irrigadas com água biossalina de efluente de piscicultura. Para isso, dois ensaios com os híbridos Goldex e Grand Prix foram realizados separadamente. Utilizou-se delineamento inteiramente casualizado em esquema fatorial 4 × 3 (tratamentos pré-germinativos × diluições de água). Além do controle, as sementes foram tratadas com os ácidos salicílico e giberélico, e tiametoxam. As águas utilizadas para irrigação foram a de abastecimento local, efluente de piscicultura (água biossalina) e estas diluídas a 50%. Durante quatorze dias foram realizadas as análises fisiológicas e bioquímicas. A água biossalina (5,0 dS m-1) não afetou a emergência de plântulas de meloeiro Goldex, mas prejudicou o estabelecimento da cultivar Grand Prix. Os pré-tratamentos de sementes com os ácidos salicílico e giberélico atenuam os efeitos da salinidade da água e promovem modulações no crescimento, proporcionando mudas de meloeiro mais vigorosas.

Pre-germination treatments of melon seeds for the production of seedlings irrigated with biosaline water

Abstract Melon production in the Brazilian semi-arid region is subject to the use of marginal waters with high salinity. However, the use of regulators and bioactivators in seed treatment can mitigate the harmful effects of salts in irrigation water. In this context, the objective was to evaluate the effect of pre-germination treatments with plant regulators and bioactivator in melon seeds for the production of seedlings irrigated with biosaline water from fish farming effluent. For this, two trials with the Goldex and Grand Prix hybrids were carried out separately. A completely randomized design was used in a 4 × 3 factorial scheme (pre-germination treatments × water dilutions). In addition to the control, the seeds were treated with salicylic and gibberellic acids and thiamethoxam. The waters used for irrigation were local-supply water, fish farming effluent (biosaline water) and these diluted to 50%. Physiological and biochemical analyses were performed for fourteen days. Biosaline water (5.0 dS m-1) did not affect the emergence of Goldex melon seedlings, but compromised the establishment of the Grand Prix cultivar. Seed pre-treatments with salicylic and gibberellic acids attenuate the effects of water salinity and promote growth modulations, resulting in more vigorous melon seedlings.

Resumo A produção de meloeiro no semiárido brasileiro está sujeita a utilização de águas marginais com salinidade elevada. Entretanto, a utilização de reguladores e bioativadores no tratamento de sementes podem mitigar os efeitos nocivos dos sais na água de irrigação. Nesse sentido, objetivou-se avaliar o efeito de tratamentos pré-germinativos com fitorreguladores e bioativador em sementes de melão para a produção de mudas irrigadas com água biossalina de efluente de piscicultura. Para isso, dois ensaios com os híbridos Goldex e Grand Prix foram realizados separadamente. Utilizou-se delineamento inteiramente casualizado em esquema fatorial 4 × 3 (tratamentos pré-germinativos × diluições de água). Além do controle, as sementes foram tratadas com os ácidos salicílico e giberélico, e tiametoxam. As águas utilizadas para irrigação foram a de abastecimento local, efluente de piscicultura (água biossalina) e estas diluídas a 50%. Durante quatorze dias foram realizadas as análises fisiológicas e bioquímicas. A água biossalina (5,0 dS m-1) não afetou a emergência de plântulas de meloeiro Goldex, mas prejudicou o estabelecimento da cultivar Grand Prix. Os pré-tratamentos de sementes com os ácidos salicílico e giberélico atenuam os efeitos da salinidade da água e promovem modulações no crescimento, proporcionando mudas de meloeiro mais vigorosas.

Antifungal and antibiofilm activities of the essential oil of leaves from Lippia gracilis Schauer against phytopathogenic fungi.

AIMS: This study aimed to evaluate the antifungal and antibiofilm effects of essential oil (EO) from leaves of Lippia gracilis and its major constituents, thymol and carvacrol, against phytopathogenic fungi. METHODS AND RESULTS: The leaves of L. gracilis were hydrodistilled to obtain the EO and the chemical composition was determined by GC/MS analysis. The antifungal activity of EO of L. gracilis was evaluated on the vegetative and mycelial growth of Colletotrichum gloeosporioides, Colletotrichum lindemuthianum, Fusarium oxysporum and Fusarium solani. In addition, the ability of the oil to inhibit fungal biofilm formation was assessed by total biomass quantification using crystal violet staining, analysis of metabolic activity, and scanning electron microscopy (SEM). Moreover the antifungal and antibiofilm activities of the monoterpenes, thymol and carvacrol, present in EO of L. gracilis were evaluated against F. oxysporum. The analysis of the chemical composition of EO extracted from L. gracilis, revealed the presence of monoterpenes (94·13%), which included carvacrol (48·57%) and thymol (7·78%), and 4 sesquiterpenes (3·74%). In general, EO showed significant antifungal activity and inhibited the formation of fungal biofilms. Furthermore, thymol and carvacrol showed significant antifungal and antibiofilm activities against F. oxysporum. SEM images showed structural changes in fungal morphology upon treatment with EO of L. gracilis. CONCLUSION: The results presented in this study showed promising antifungal and antibiofilm effects of EO of L. gracilis and its major components, carvacrol and thymol. SIGNIFICANCE AND IMPACT OF THE STUDY: These findings indicate that the EO extracted from L. gracilis, and the monoterpenes, carvacrol and thymol have a great potential as antifungal and antibiofilm agents. Furthermore, this is the first report of the antibiofilm activity of the EO of L. gracilis and its major components against phytopathogenic fungi.

Ecotoxicological assessment of the anticancer drug cisplatin in the polychaete Nereis diversicolor.

Anticancer drugs are designed to inhibit tumor cell proliferation by interacting with DNA and altering cellular growth factors. When released into the waterbodies of municipal and hospital effluents these pharmaceutical compounds may pose a risk to non-target aquatic organisms, due to their mode of action (cytotoxic, genotoxic, mutagenic and teratogenic). The present study aimed to assess the ecotoxicological potential of the alkylating agent cisplatin (CisPt) to the polychaete Nereis diversicolor, at a range of relevant environmental concentrations (i.e. 0.1, 10 and 100ngPtL-1). Behavioural impairment (burrowing kinetic impairment), ion pump effects (SR Ca2+-ATPase), neurotoxicity (AChE activity), oxidative stress (SOD, CAT and GPXs activities), metal exposure (metallothionein-like proteins - MTLP), biotransformation (GST), oxidative damage (LPO) and genotoxicity (DNA damage), were selected as endpoints to evaluate the sublethal responses of the ragworms after 14-days of exposure in a water-sediment system. Significant burrowing impairment occurred in worms exposed to the highest CisPt concentration (100ngPtL-1) along with neurotoxic effects. The activity of antioxidant enzymes (SOD, CAT) and second phase biotransformation enzyme (GST) was inhibited but such effects were compensated by MTLP induction. Furthermore, LPO levels also increased. Results showed that the mode of action of cisplatin may pose a risk to this aquatic species even at the range of ngL-1.

Estabelecimento de protocolo para micropropagação de Lippia gracilis Schauer / Establishment of protocol for Lippia gracilis Schauer micropropagation

A espécie Lippia gracilis SCHAUER (Verbenaceae) é nativa do Nordeste brasileiro e se destaca pela capacidade de acumular nos tricomas glandulares óleos essenciais com atividade antimicrobiana. Tendo em vista que não constam trabalhos na literatura sobre o estabelecimento in vitro dessa espécie, este trabalho teve como objetivo estabelecer protocolo para micropropagação de L. gracilis. Para tanto, ramos contendo folhas foram coletados de plantas matrizes no habitat natural para a confecção de estacas. Em laboratório, os explantes provenientes do processo de estaquia foram assepticamente tratados e inoculados em meio MS, acrescido de fitorreguladores, com o intuito de se estabelecer a melhor dose para o desenvolvimento dos explantes. Em decorrência de altos níveis de contaminação, avaliou-se o efeito da cefalexina. No entanto, apesar do antibiótico ter apresentado diminuição na contaminação bacteriana, a porcentagem de oxidação foi elevada. Portanto, testou-se o carvão ativado, ácido ascórbico, ácido cítrico e metade dos sais de MS quanto a eficiência no controle da oxidação. Concluiu-se que, o antibiótico na concentração utilizada provocou a oxidação dos explantes e os fitorreguladores, bem como os métodos antioxidantes testados, não apresentaram resultados consistentes para o melhor desenvolvimento dos explantes e controle da oxidação, respectivamente.

The species Lippia gracilis Schauer (Verbenaceae) is native to Northeastern Brazil and has been important for its ability to accumulate essential oils with antimicrobial activity in the glandular trichomes. Since there are no reports in the literature on the micropropagation of this species, the present work aimed to establish a protocol for L. gracilis micropropagation. Thus, branches containing leaves were collected from plant matrices in their natural habitat to prepare cuttings. In the laboratory, explants from cutting were aseptically treated and inoculated onto MS medium plus plant growth regulators in order to establish the best dose for the development of explants. Due to high levels of contamination, the effect of cephalexin was evaluated. Although the antibiotic decreased the bacterial contamination, the percentage of oxidation was high. Then, activated charcoal, ascorbic acid, citric acid and half the salts of MS were tested for their effectiveness to control oxidation. In conclusion, the used antibiotic concentration resulted in oxidation of explants. Furthermore, plant growth regulators and antioxidant methods did not show consistent results for a better development of explants and control of oxidation, respectively.

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.

Twenty-four-hour esophageal pH monitoring in children and adolescents with chronic and/or recurrent rhinosinusitis.

Gastroesophageal reflux (GER) disorder was studied in children and adolescents with chronic and/or recurrent rhinosinusitis not associated with bronchial asthma. Ten children with a clinical and radiological diagnosis of chronic and/or recurrent rhinosinusitis, consecutively attended at the Pediatric Otolaryngology Outpatient Clinic, Federal University of São Paulo, were evaluated. Prolonged esophageal pH monitoring was used to investigate GER disorder. The mean age of the ten patients evaluated (eight males) was 7.4 +/- 2.4 years. Two patients presented vomiting as a clinical manifestation and one patient presented retrosternal pain with a burning sensation. Twenty-four-hour esophageal pH monitoring was performed using the Sandhill apparatus. An antimony probe electrode was placed in the lower third of the esophagus, confirmed by fluoroscopy and later by a chest X-ray. The parameters analyzed by esophageal pH monitoring included: total percent time of the presence of acid esophageal pH, i.e., pH below 4 (<4.2%); total number of acid episodes (<50 episodes); number of reflux episodes longer than 5 min (3 or less), and duration of the longest reflux episode (<9.2 min). One patient (1/10, 10%) presented a 24-h esophageal pH profile compatible with GER disorder. This data suggest that an association between chronic rhinosinusitis not associated with bronchial asthma and GER disorder may exist in children and adolescents, especially in those with compatible GER disorder symptoms. In these cases, 24-h esophageal pH monitoring should be performed before indicating surgery, since the present data suggest that 10% of chronic rhinosinusitis surgeries can be eliminated.

Twenty-four-hour esophageal pH monitoring in children and adolescents with chronic and/or recurrent rhinosinusitis

Gastroesophageal reflux (GER) disorder was studied in children and adolescents with chronic and/or recurrent rhinosinusitis not associated with bronchial asthma. Ten children with a clinical and radiological diagnosis of chronic and/or recurrent rhinosinusitis, consecutively attended at the Pediatric Otolaryngology Outpatient Clinic, Federal University of São Paulo, were evaluated. Prolonged esophageal pH monitoring was used to investigate GER disorder. The mean age of the ten patients evaluated (eight males) was 7.4 ± 2.4 years. Two patients presented vomiting as a clinical manifestation and one patient presented retrosternal pain with a burning sensation. Twenty-four-hour esophageal pH monitoring was performed using the Sandhill apparatus. An antimony probe electrode was placed in the lower third of the esophagus, confirmed by fluoroscopy and later by a chest X-ray. The parameters analyzed by esophageal pH monitoring included: total percent time of the presence of acid esophageal pH, i.e., pH below 4 (<4.2 percent); total number of acid episodes (<50 episodes); number of reflux episodes longer than 5 min (3 or less), and duration of the longest reflux episode (<9.2 min). One patient (1/10, 10 percent) presented a 24-h esophageal pH profile compatible with GER disorder. This data suggest that an association between chronic rhinosinusitis not associated with bronchial asthma and GER disorder may exist in children and adolescents, especially in those with compatible GER disorder symptoms. In these cases, 24-h esophageal pH monitoring should be performed before indicating surgery, since the present data suggest that 10 percent of chronic rhinosinusitis surgeries can be eliminated.

Morphological and functional alterations of the intestine of rats with iron-deficiency anemia.

The present study was designed to assess the intestinal absorption of D-xylose and jejunal morphometry in rats with iron-deficiency anemia. Male Wistar rats were randomly divided into a control group (diet containing 50 mg Fe/kg, N = 12) and an anemic group (diet containing <5 mg Fe/kg, N = 12). The animals were housed in individual metabolic cages and deionized water and diet were provided ad libitum for 6 weeks. Hemoglobin and hematocrit were determined at 0, 2, 4, and 6 weeks. At the end of the study the rats were submitted to a D-xylose absorption test (50 mg/100 g body weight) and sacrificed and a jejunal specimen was obtained for morphometric study. At the end of the study the hemoglobin and hematocrit of the anemic rats (8.7 +/- 0.9 g/dl and 34.1 +/- 2.9%, respectively) were significantly (P < 0.05) lower than those of the controls (13.9 +/- 1.4 g/dl and 47.1 +/- 1.5%, respectively). There was no statistical difference in D-xylose absorption between the anemic (46.5 +/- 7.4%) and control (43.4 +/- 9.0%) groups. The anemic animals presented statistically greater villus height (445.3 +/- 36.8 microm), mucosal thickness (614.3 +/- 56.3 microm) and epithelial surface (5063.0 +/- 658.6 microm) than control (371.8 +/- 34.3, 526.7 +/- 62.3 and 4401.2 +/- 704.4 microm, respectively; P < 0.05). The increase in jejunum villus height, mucosal thickness and epithelial surface in rats with iron-deficiency anemia suggests a compensatory intestinal mechanism to increase intestinal iron absorption.

Morphological and functional alterations of the intestine of rats with iron-deficiency anemia

The present study was designed to assess the intestinal absorption of D-xylose and jejunal morphometry in rats with iron-deficiency anemia. Male Wistar rats were randomly divided into a control group (diet containing 50 mg Fe/kg, N = 12) and an anemic group (diet containing <5 mg Fe/kg, N = 12). The animals were housed in individual metabolic cages and deionized water and diet were provided ad libitum for 6 weeks. Hemoglobin and hematocrit were determined at 0, 2, 4, and 6 weeks. At the end of the study the rats were submitted to a D-xylose absorption test (50 mg/100 g body weight) and sacrificed and a jejunal specimen was obtained for morphometric study. At the end of the study the hemoglobin and hematocrit of the anemic rats (8.7 ± 0.9 g/dl and 34.1 ± 2.9 percent, respectively) were significantly (P < 0.05) lower than those of the controls (13.9 ± 1.4 g/dl and 47.1 ± 1.5 percent, respectively). There was no statistical difference in D-xylose absorption between the anemic (46.5 ± 7.4 percent) and control (43.4 ± 9.0 percent) groups. The anemic animals presented statistically greater villus height (445.3 ± 36.8 µm), mucosal thickness (614.3 ± 56.3 µm) and epithelial surface (5063.0 ± 658.6 µm) than control (371.8 ± 34.3, 526.7 ± 62.3 and 4401.2 ± 704.4 µm, respectively; P < 0.05). The increase in jejunum villus height, mucosal thickness and epithelial surface in rats with iron-deficiency anemia suggests a compensatory intestinal mechanism to increase intestinal iron absorption.

Dietary cellulose has no effect on the regeneration of hemoglobin in growing rats with iron deficiency anemia.

The objective of the present study was to determine the effect of cellulose on intestinal iron absorption in rats during recovery from iron deficiency anemia. Twenty-one-day-old male Wistar-EPM rats were fed an iron-free ration for two weeks to induce anemia. At 5 weeks of age, the rats were divided into two groups (both groups receiving 35 mg of elemental iron per kg diet): cellulose group (N = 12), receiving a diet containing 100 g of cellulose/kg and control (N = 12), receiving a diet containing no cellulose. The fresh weight of the feces collected over a 3-day period between the 15th and 18th day of dietary treatment was 10.7 +/- 3.5 g in the group receiving cellulose and 1.9 +/- 1.2 g in the control group (P<0.001). Total food intake was higher in the cellulose group (343.4 +/- 22.0 g) than in the control (322.1 +/- 13.1 g, P = 0.009) during the 3 weeks of dietary treatment. No significant difference was observed in weight gain (cellulose group = 132.8 +/- 19.2, control = 128.0 +/- 16.3 g), hemoglobin increment (cellulose group = 8.0 +/- 0.8, control = 8.0 +/- 1.0 g/dl), hemoglobin level (cellulose group = 12.3 +/- 1.2, control = 12.1 +/- 1.3 g/dl) or in hepatic iron levels (cellulose group = 333.6 +/- 112.4, control = 398.4 +/- 168.0 g/g dry tissue). We conclude that cellulose does not adversely affect the regeneration of hemoglobin, hepatic iron level or the growth of rats during recovery from iron deficiency anemia.

Dietary cellulose has no effect on the regeneration of hemoglobin in growing rats with iron deficiency anemia

The objective of the present study was to determine the effect of cellulose on intestinal iron absorption in rats during recovery from iron deficiency anemia. Twenty-one-day-old male Wistar-EPM rats were fed an iron-free ration for two weeks to induce anemia. At 5 weeks of age, the rats were divided into two groups (both groups receiving 35 mg of elemental iron per kg diet): cellulose group (N = 12), receiving a diet containing 100 g of cellulose/kg and control (N = 12), receiving a diet containing no cellulose. The fresh weight of the feces collected over a 3-day period between the 15th and 18th day of dietary treatment was 10.7 + or - 3.5 g in the group receiving cellulose and 1.9 + or - 1.2 g in the control group (P<0.001). Total food intake was higher in the cellulose group (343.4 + or - 22.0 g) than in the control (322.1 + or - 13.1 g, P = 0.009) during the 3 weeks of dietary treatment. No significant difference was observed in weight gain (cellulose group = 132.8 + or - 19.2, control = 128.0 + or - 16.3 g), hemoglobin increment (cellulose group = 8.0 + or - 0.8, control = 8.0 + or - 1.0 g/dl), hemoglobin level (cellulose group = 12.3 + or - 1.2, control = 12.1 + or - 1.3 g/dl) or in hepatic iron levels (cellulose group = 333.6 + or - 112.4, control = 398.4 + or - 168.0 æg/g dry tissue). We conclude that cellulose does not adversely affect the regeneration of hemoglobin, hepatic iron level or the growth of rats during recovery from iron deficiency anemia

Dietary fiber, energy intake and nutritional status during the treatment of children with chronic constipation

The present prospective study was carried out to determine dietary fiber and energy intake and nutritional status of children during the treatment of chronic constipation. Twenty-five patients aged 2 to 12 years with chronic constipation were submitted to clinical evaluation, assessment of dietary patterns, and anthropometry before and after 45 and 90 days of treatment. The treatment of chronic constipation included rectal disimpaction, ingestion of mineral oil and diet therapy. The standardized diet prescribed consisted of regular food without a fiber supplement and met the nutrient requirements according to the recommended daily allowance. The fiber content was 9.0 to 11.9 g for patients aged less than 6 years and 12.0 to 18.0 g for patients older than 6 years. Sixteen patients completed the 90-day follow-up and all presented clinical improvement. The anthropometric variables did not change, except midarm circumference and triceps skinfold thickness which were significantly increased. Statistically significant increases were also found in percent calorie intake adequacy in terms of recommended daily allowance (55.5 to 76.5 percent on day 45 and to 68.5 percent on day 90; P = 0.047). Percent adequacy of minimum recommended daily intake of dietary fiber (age + 5 g) increased during treatment (from 46.8 to 52.8 percent on day 45 and to 56.3 percent on day 90; P = 0.009). Food and dietary fiber intake and triceps skinfold thickness increased during follow-up. We conclude that the therapeutic program provided a good clinical outcome

[Celiac disease: evaluation of compliance to gluten-free diet and knowledge of disease in patients registered at the Brazilian Celiac Association (ACA)]. / Doença celíaca: avaliação da obediência à dieta isenta de glúten e do conhecimento da doença pelos pacientes cadastrados na Associação dos Celíacos do Brasil (ACELBRA).

BACKGROUND: The compliance to a gluten-free diet may prevent the development of both non-malignant and malignant complications. AIM: To evaluate compliance to a gluten-free diet and knowledge of the disease in celiac patients registered at the Brazilian Celiac Association (BCA). METHODS: A structured questionnaire was designed to assess compliance to a gluten-free diet as well as knowledge of the celiac disease. It was mailed to 584 members of BCA. RESULTS: Five hundred and twenty nine (90.6%) of a total of 534 (91.4%) answered questionnaires were analyzed; 69.4% were classified as compliant patients whereas 29.5% were classified as noncompliant. The proportion of patients age 21 or older who consume gluten frequently or without any restriction is larger (17.7%) than those who were younger than 21 years (9.9%). Frequency of dietary compliance was higher when the diagnosis had taken less than 5 years to be established; 82% of the patients replied that the small intestine was the part of the body affected by the disease. The most common symptoms of the disease according to the answers were diarrhea (96.6%), weight loss (93.4%), protuberant abdomen (90.4%), anemia (68.1%) and vomiting (59.6%). Only 59.0% agreed with the existence of genetic predisposition; 90.4% answered that the disease is permanent and 96.2% stated that the diet should exclude gluten absolutely; 67.1% answered that the gluten is a protein and according to 92.1% questionnaires this protein is present in wheat, rye, barley and oat. Greater compliance was observed when there was an understanding of the disease and diet. The small intestine biopsy was considered necessary for just 67.5% of the patients, and greater compliance was observed in patients who had undergone at least one small intestine biopsy. CONCLUSION: Our findings indicate that the more the patients know and understand about the disease, the better able they are to comply with the diet.

Cow's milk protein intolerance and chronic constipation in children.

Cow's milk protein (CMP) allergy was investigated in 25 children (age-range 3 months to 11 years) with chronic constipation. A diagnosis of constipation was made on the basis of a history of painful elimination of hard stools for at least 1 month, whether or not associated with a reduced frequency of stools or soiling. The children were evaluated using clinical parameters and the following laboratory tests: total serum immunoglobulin E (IgE); specific IgE (radioallergosorbent test [RAST]) for whole cow's milk, alpha-lactoalbumin, beta-lactoglobulin, and a food group; and skin-prick tests with whole milk, alpha-lactoalbumin, beta-lactoglobulin, and casein. Following the evaluation, the children were submitted to a CMP-free diet for a period of 4 weeks. In seven patients (28%), constipation disappeared during the CMP-free diet and reappeared within 48-72 h following challenge with cow's milk. In two infants a rectal biopsy revealed allergic colitis and they therefore did not undergo the challenge. High serum levels of total IgE were observed in five of the children who showed a clinical improvement (71%), a positive skin-test in two (29%), and detectable specific IgE in two (29%). These results suggest that CMP allergy or intolerance should be considered as a cause of chronic refractory constipation in children, although the underlying mechanism still require further investigation.

[Association of patterns of Escherichia coli adherence to HEp-2 cells with acute and persistent diarrhea]. / Associação de padrões de adesão de Escherichia coli às células HEp-2 com diarréia aguda e persistente.

In Brazil diarrhea is the cause of approximately 15% of death among infants. Enteropathogenic E coli is the most important bacterial agent causing acute diarrhea, which is defined as less than 14 days of duration. About 30% of these cases may evolve to persistent diarrhea, defined as lasting more than 14 days. In this work it was carried out a case-control study including 34 children under 2 years of age, and admitted to hospital facilities in São Paulo for rehydration therapy. Thirty-four age matched children hospitalized in the same facilities, and presenting no gastrointestinal symptoms were included as controls. Stool samples were analyzed for the presence of bacterial pathogens (diarrheagenic E coli, Shigella, Salmonella, Yersinia, and Campylobacter), protoparasytes, rotavirus, and enteric adenovirus. The E coli strains isolated were analyzed for their ability to adhere to HEp-2 cultured cells, in a 3 h adhesion assay. Search for homology with DNA probes for localized adherence (EAF, eaeA probes), AA (enteroagregative adherence) (AA probe), and diffuse adherence (F1845, AIDA-I probes) was carried out by the colony hybridization method. Twenty-four of the cases were acute diarrhea and 10 persistent diarrhea. Strains with localized adherence were associated with acute and persistent diarrhea. About 23.5% of E coli were associated with typical Enteropathogenic E coli strains (EAF+, eaeA+). Enteroaggregative E coli (EAggEC) (AA+) was isolated only from cases and in similar frequency for acute and persistent diarrhea. Diffusely adherent E coli (DAEC) which did not hybridize with the diffuse adherence probes were isolated among cases and controls. E coli eaeA+ with localized-like adherence was isolated from cases in a frequency three times higher than in controls, suggesting that it may really have a pathogenic potential.

[Celiac disease: evolution in knowledge since its original centennial description up to the present day]. / Doença celíaca: a evolução dos conhecimentos desde sua centenária descrição original até os dias atuais.

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.

Diarréia aguda grave associada à Escherichia coli enteropatogênica clássica (EPEC): características clínicas e perdas fecais em lactentes hospitalizados / Severe acute diarrhea associated to classic enteropathogenic Escherichi coli (EPEC) by clinical features and fecal losses in hospitalized infants

Escherichia coli enteropatogênica clássica (EPEC) tem sido o agente enteropatogênico mais freqüentemente isolado nas fezes de lactentes, de baixo nível socioeconômico, hospitalizados com diarréia aguda grave, na cidade de Säo Paulo. Objetivos. 1) Analisar as características clínicas de lactentes do sexo masculino, hospitalizados com diarréia aguda grave associada à EPEC; 2) quantificar suas perdas fluidas fecais, ingestäo de fórmulas alimentares e variaçöes de peso corporal durante a evoluçäo intra-hospitalar. Casuística e Métodos. Estudaram-se 38 lactentes do sexo masculino. Foram avaliadas as características clínicas e epidemiológicas dos pacientes e a freqüência dos diferentes sorogrupos de EPEC identificados. As crianças foram mantidas em cama metabólica, e balanços metabólicos diários foram obtidos durante toda a duraçäo do quadro diarréico. Os lactentes permaneceram, em média, 5,8 dias em estudo metabólico. Duzentos e vinte balanços diários foram acumulados e analisados. Resultados. O grupo estudado apresentou como principais características clínicas: idade inferior a 12 meses, peso insuficiente ao nascer; desmame precoce e formas graves de desnutriçäo protéico-calórica. O sorogrupo O111 foi o mais freqüentemente identificado (68,4 por cento), sendo a idade dos pacientes com tal agente significativamente maior que a dos portadores do sorogrupo O55. A média dos volumes fecais diários foi de 66mL/kg/dia, havendo diferentas segundo dias de estudo. A média de ingestäo diária de fórmulas alimentares foi de 85,2mL/kg/dia. Leite de vaca foi a dieta mais precocemente utilizada e as crianças que dela fizeram uso apresentaram volumes fecais maiores que os que receberam caseinato ou nutriçäo parenteral e incremento de peso corporal menor que os que utilizaram hidrolisado protéico ou NPT. Conclusöes. Os sorogrupos de EPEC acarretaram perdas fluidas fecais de moderada e grave intensidade nos lactentes estudados. A duraçäo da diarréia mostrou curso agudo (menor ou igual a 14 dias) na maioria das crianças estudadas reafirmando a evoluçäo potencialmente autolimitada da diarréia aguda. Sete (18,4 por cento) pacientes, entretanto, desenvolveram quadro de diarréia persistente, indicando que tal evoluçäo é esperada em uma parcela razoável de lactentes jovens hospitalizados com tal enfermidade. Os volumes médios de ingestäo das fórmulas alimentares encontrados mostram o impacto da diarréia aguda na diminuiçäo da ingestäo alimentar...