Duración de la diarrea aguda infecciosa con el uso de leche deslactosada vs leche con lactosa en la población pediátrica: Revisión sistemática / Duration of acute infectious diarrhea with the use of lactose-free milk vs. lactose-containing milk in the pediatric population: A systematic review

Introducción: La diarrea aguda es una entidad frecuente en pediatría, constituyendo una de las principales causas de mortalidad en países en desarrollo y en niños menores de cinco años. Si bien la alimentación representa uno de los pilares fundamentales en el tratamiento de la misma, no existe consenso entre los profesionales en cuanto a la indicación de leche deslactosada durante el curso del cuadro. Objetivos: Realizar una revisión sistemática para estudiar el impacto del consumo de leche deslactosada vs leche regular en la duración de la diarrea aguda infecciosa en niños. Materiales y métodos: Se realizó una revisión sistemática incluyendo artículos publicados desde el año 2008 al 2023, utilizando para la búsqueda las bases de datos PubMed, Lillacs, Cochrane Library y literatura gris. Se incluyeron estudios experimentales, observacionales, revisiones, guías de atención y metaanálisis, realizados en pacientes pediátricos sin patologías de base, cursando cuadro de diarrea aguda infecciosa, que compararan el uso de leche deslactosada frente a leche regular. Resultados: Se seleccionaron doce artículos. En 9 de ellos se constató una disminución en la duración de la diarrea en los pacientes que recibieron leche deslactosada con una diferencia de medias de 18 horas (en un rango entre 4 y 32.6 horas). No se reportaron diferencias estadísticamente significativas en la mortalidad entre el uso de una u otra fórmula láctea. En relación al uso de una u otra fórmula no se objetivaron variaciones en el peso estadísticamente significativas. La necesidad de hospitalización fue similar entre ambos grupos. Solo un artículo analizó la frecuencia o volumen de deposiciones sin encontrar diferencias significativas (AU)

Introduction:Acute diarrhea is frequent in pediatrics, and constitutes one of the main causes of mortality in developing countries and in children under five years of age. Although feeding is one of the fundamental pillars in the treatment of diarrhea, there is no consensus among professionals regarding the indication of lactose-free milk during the course of the symptoms. Objectives: To conduct a systematic review to study the impact of lactose-free milk vs. regular milk consumption on the duration of acute infectious diarrhea in children. Materials and methods: A systematic review was conducted including articles published between 2008 and 2023, using PubMed, Lillacs, Cochrane Library databases, and gray literature for the search. Experimental and observational studies, reviews, care guidelines and meta-analysis were included, conducted in pediatric patients without underlying diseases, with acute infectious diarrhea, comparing the use of lactose-free milk versus regular milk. Results: Twelve articles were selected. Nine of them showed a decrease in the duration of diarrhea in patients who received lactose-free milk with a mean difference of 18 hours (ranging from 4 to 32.6 hours). No statistically significant differences in mortality were reported between the use of one or the other milk formula. Regarding the use of one or the other formula, there were no statistically significant variations in weight. The need for hospital admission was similar between the two groups. Only one article analyzed stool frequency or volume with no significant differences (AU)

La diarrea inducida con lactosa es mas severa, prolongada y produce mayores pérdidas fecales de macronutrientes en ratas cecotomizadas que en ratas intactas / Lactose-induced diarrhea is more severe, last longer and produces more fecal macronutrient losses in cecectomized than in intact rats

La diarrea inducida con lactosa en ratas ha servido para estudiar la alimentación durante la diarrea. Sin embargo, las ratas se adaptan al consumo de lactosa por lo que la diarrea dura aproximadamente una semana. Para establecer si la remoción del ciego podría prolongarla, aquí se comparó esta diarrea en ratas intactas y cecotomizadas. El experimento incluyó 16 ratas intactas y 16 cecotomizadas. A la mitad de las ratas en cada grupo se les ofreció una dieta con 45% de lactosa (grupo diarrea) y a la otra mitad una dieta sin lactosa (grupo control). El experimento duró 21 días con 3 recolecciones de heces de 48 h (días 2-4, 9-11 y 17-19). Los resultados mostraron que durante la primera recolección hubo diarreas similares tanto en los grupos de ratas intactas como cecotomizadas, pero en las próximas, sólo las cecotomizadas tenían una diarrea cuya severidad aumentó (3,5 veces) con el tiempo. Adicionalmente, en los dos tipos de ratas, las pérdidas fecales de proteína y grasa fueron proporcionales a la masa fecal húmeda excretada, pero fueron 2 veces más altas en las cecotomizadas. Se concluye que la cecotomía previene la adaptación, aumenta la severidad y prolonga la diarrea inducida con lactosa e incrementa notablemente las pérdidas fecales de los macronutrientes y reduce la eficiencia del alimento(AU)

Lactose induced diarrhea in rats has been used for studying the appropriated feeding during diarrhea. However, rats adapt to lactose and this diarrhea last approximately one week. In order to establish if cecum removal could prolong it, here lactose induced diarrhea was produced in intact and cecectomized rats. In the experiment there were 16 intact and 16 cecectomized rats. Halve of the rats in each group were fed a diet with 45% lactose (Diarrhea group) and the other halve a lactose free diet (Control group). The experiment lasted 21 days and included three 48h fecal collections (days 2-4, 9-11 and 17-19). The results showed that during the first collection both groups had diarrheas of similar severity but thereafter, only the cecectomized had a diarrhea whose severity increased (3.5 times) with time. Additionally, in both groups of rats, protein and fat fecal losses were proportional to fecal output but they were higher (2 times) in the cecectomized group. In conclusion, cecectomy prevents lactose adaptation and results in a diarrhea that last longer and it is more severe (3.5 times). Also in these rats fecal losses of macronutrients are higher whereas feed efficiency is lower(AU)

Utilidad de las proteínas de pollo y de soja en ratas nutridas o desnutridas con diarrea inducida por lactosa / Utility of chicken and soybean protein in well-nourished or undernourished rats with lactose-induced diarrhea

En el tratamiento nutricional de la diarrea infantil se han utilizado con éxito preparaciones líquidas que contienen pollo combinado con cereales y/o tubérculos, que se preparan en la institución de hospitalización o en la casa. En un estudio anterior, se comparó la efectividad de fórmulas con proteínas de pollo o aislado de soja en el tratamiento de la diarrea infantil. El objetivo de este trabajo fue estudiar en ratas con o sin diarrea, la utilización de las proteínas y la disponibilidad de nutrientes de dietas preparadas con pollo o aislado proteico de soja, para determinar si los resultados obtenidos en los niños eran comparables a los obtenidos en ratas. Dado que la diarrea y la desnutrición frecuentemente están presentes de manera simultánea, también se estudiaron grupos de animales con o sin diarrea previamente desnutridos. Los resultados mostraron que durante la diarrea las ratas desnutridas fueron igualmente eficientes que las nutridas en utilizar los nutrientes presentes en las dietas con pollo o soja, por lo que no experimentaron un deterioro nutricional mayor que las nutridas. Adicionalmente, la severidad de la diarrea fue similar en las ratas asignadas a las dietas con pollo o soja. Asimismo, las ratas con diarrea consumieron, crecieron, absorbieron y retuvieron menos de los macronutrientes dietarios que las ratas control. Sin embargo, este efecto de la diarrea fue similar en las ratas que consumieron proteína de soja o de pollo. Como estos resultados coinciden con los obtenidos previamente en niños con diarrea aguda, se concluye que la proteína de soja es tan efectiva como la de pollo en el manejo nutricional de la diarrea y que la diarrea producida con lactosa en ratas es un modelo apropiado para el estudio de las consecuencias nutricionales de la misma.

In the nutritional treatment of diarrhea, good results have been obtained using liquid formulas with chicken meat together with cereals and/or starchy vegetables, prepared at home or at the clinic. In a previous study, formulas prepared with chicken meat or isolated soybean protein were tested in the treatment of infantile diarrhea. In order to determine if the results obtained in children could be reproduced in rats, the objective of the present study was to evaluate the effectiveness of the same diets in the nutritional treatment of well-nourished as well as undernourished rats with lactose induced diarrhea. The results showed that all the rats with diarrhea absorbed and retained less of the dietary nutrients and consequently, grew less than their counterparts without diarrhea. However, the absorption and retention measured in the nourished as well as in the undernourished rats were similar, indicating that a short period of malnutrition previous to the diarrhea episode, did not affect rats' absorption capacity. In addition, similarly to the results previously obtained in children, the rats with lactose induced diarrhea utilised equally well the dietary nutrients present in the chicken as well as in the soybean protein based diets. These results confirmed the value of isolated soybean protein in the nutritional treatment of diarrhea and showed that lactose induced diarrhea in rats is an appropriate model to study the nutritional consequences of diarrhea.

Optimization of fibrinase productivity from Actinomycetes

Fibrinolytic enzymes that dissolve blood clots and show promise for thrombosis therapy have been successfully identified from various sources. A wide range of microorganisms has been screened for their fibrinolytic properties. A fibrinolytic protease has been isolated from Streptomyces violaceoruber and Streptomyces spiroverticillatus culture filtrate. The purification procedure involved ammonium sulphate fractionation, dialysis, calcium phosphate gel purification and gel filtration on Sephadex G-100. By using native polyacrylamide gel electrophoresis [Native PAGE] to determine molecular weight of the enzyme. The optimum temperature for the high production of fibrinase from S. violaceoruber was 30[degree] C and from S. spiroverticillatus was 35[degree] C and the optimum pH was 9.0. The best incubation period is 6 days. The incorporation of lactose as carbon source, yeast extract as nitrogen source and MnCl[2] to culture media highly increased the production of fibrinase from the two species. The molecular weight was about 30 KDa. It exhibited fibrinolytic enzyme activity. In vitro studies revealed that fibrinase dissolves clots made by blood

Diferentes fontes proteicas em rações de leitões sobre atividade da tripsina e parâmetros sangüíneos / Different protein sources in rations of piglets on activity of trypsin and blood parameters

Foram utilizados 64 leitões, submetidos a oito tratamentos: ração com leite em pó (LP), três rações com níveis crescentes de plasma suíno (PS), três rações com níveis crescentes de ovo inteiro (OI) eração com alto nível de farelo de soja (FS). Foi coletado sangue dos animais aos 27 e 34 dias de idade para avaliação dos parâmetros sangüíneos, e aos 28 e 35 dias de idade quatro animais por tratamento foram abatidos para coleta do pâncreas e posterior determinação do peso absoluto (PA) e peso relativo (PR) do pâncreas e da atividade datripsina (AT). Os tratamentos não influenciaram significativamente o PA e a AT. Verificou-se efeito significativo dos níveis crescentes de PS,com redução linear dos leucócitos e aumento do volume globular,aos 27 dias; enquanto aos 34 dias, observou-se aumento linear das hemácias. Aos 27 dias, os animais arraçoados com níveis de PS apresentaram menor percentagem de eosinófilos do que aqueles arraçoados com níveis de OI. A utilização de plasma suíno promoveu menor estímulo à resposta imune, enquanto que a utilização de ovo inteiro promoveu maior resposta humoral dos leitões

Were used 64 piglets submitted eight treatments: ration with skim milk (SM), three rations with crescent levels of swine plasma (SP),three rations with whole egg (WE) and a ration with high inclusion of soybean meal (SB). Were monitored the blood parameters (BP) in pigs at 27 and at 34 days of age. The piglets were slaugther at 28 and at 35 days of age, for collections pancreas and posterior mensurements of absolut (AW) and relative weigth (RW) of pancreas and trypsinactivity (TA). Treatments not influencied AW and TA. Significant effect of the crescent levels was verified of SP, with lineal reduction ofthe leukocytes and increase of the globular volume, to the 27 days;while to the 34 days, lineal increase of the hematias was observed. At27 days, animals feds rations with crescent levels of SP have inferior percentage of e osinophils than others that consumed crescent levelsof WE. The utilization of SP promoted smaller stimulus to the immune reply, while the use of WE promoted larger humoral replyof the piglets

Influência da sacarose, lactose e glicose + frutose no potencial cariogênico de S. mutans: estudo in situ e in vitro / Influence of sucrose, lactose and glucose + fructose on the cariogenic potential of S. mutans: an in situ and in vitro study

Objetivo: Este estudo determinou o efeito in situ de sacarose, lactose e glicose+frutose na colonização do esmalte por S. mutans e seu potencial cariogênico in vitro. Metodologia: Doze voluntários participaram da etapa in situ, tipo duplo-cego, cruzada, em quatro etapas de 48 horas. Dispositivos palatinos contendo três blocos de esmalte bovino receberam uma gota de substrato 4 vezes/dia. O biofilme formado foi inoculado em meio de cultura Mitis-Salivarius-Bacitracina (MSB) para determinação do número de colônias (UFC). No experimento in vitro, os açúcares e S. mutans foram adicionados ao meio Brain-Heart-Infusion; o pH foi aferido após 6, 12, 24, 48 horas; o peso úmido do biofilme foi determinado e inoculado em MSB. Resultados: Não houve diferença estatisticamente significante na colonização pelos microorganismos no modelo in situ. No estudo in vitro, os meios contendo sacarose e lactose apresentaram maior número de colônias e de peso úmido de biofilme que glicose+frutose (P<0,05). O pH reduzido do meio foi mantido por maior período de tempo na presença de sacarose (48h/pH=4,4). Conclusão: Embora não tenha havido diferença de colonização por S. mutans frente à sacarose e lactose neste delineamento in situ, o estudo in vitro mostrou potencial cariogênico distinto das soluções testadas.

Purpose: This study evaluated the in situ effect of sucrose, lactose, and glucose+fructose on dental enamel colonization by S. mutans and its in vitro cariogenic potential. Methods: Twelve volunteers participated in a crossover double-blind in situ study, comprising four 48-hour stages. Acrylic resin appliances with three bovine enamel blocks received a drop of experimental solution 4 times/day. The biofilm formed was inoculated in Mitis-Salivarius-Bacitracin (MSB) culture to determine the number of colonies (CFU). In the in vitro experiment, the solutions and S. mutans were added to the Brain-Heart-Infusion medium; the pH was measured after 6, 12, 24, and 48 hours; the biofilm-wet weight was determined and inoculated in MSB. Results: There was no in situ effect of any solution on S. mutans colonization. The in vitro results showed that sucrose and lactose yielded larger number of colonies and biofilm wet-weight than glucose+fructose solution (P<0.05); sucrose samples sustained reduced pH values for a longer period of time (48 hours/pH=4.4). Conclusion: Although there was no difference of S. mutans colonization under sucrose and lactose challenge in situ, the study vitro showed different cariogenic potential of the tested solutions.

Tratamento dietético da intolerância à lactose infantil: teor de lactose em alimentos / Dietary treatment of the intolerance to the child lactose: lactose text in foods

A lactose está presente em diversos tipos de leite e todos os mamíferos, inclusive o ser humano, quando nascem em condições normais, estão aptos a digerir este açúcar. No entanto, aproximadamente 75 por cento da população mundial é intolerante à lactose. Para a lactose ser assimilada pelo organismo é necessário que seja hidrolisada no intestino delgado, pela ação da enzima lactase, também chamada de beta galactosidase, em: galactose e glicose. Na ausência da lactose na mucosa intestinal, a lactose não pode ser absorvida e utilizada. No cólon os microorganismos a fermentam, resultado em ácidos e gases, aparecendo sintomas clínicos como: diarréia, flatulência, dores de barriga e inchaço no abdômen. O tratamento da intolerância à lactose consiste basicamente na retirada ou diminuição desse açúcar da dieta, o que leva ao desaparecimento progressivo dos sintomas. Uma das grandes preocupações com a redução da lactose da alimentação é a garantia do fornecimento de quantidade apropriada de proteínas, cálcio, riboflavina e vitamina D, cuja maior fonte é o leite e seus derivados. É de fundamental importância um planejamento dietético apropriado em crianças, que assegura um crescimento satisfatório. Com o intuito de propiciar um melhor tratamento nutricional à pacientes intolerantes à lactose este trabalho tem por objetivo apresentar o teor de lactose em alimentos que são geralmente consumidos por crianças obtido através de pesquisa junto à algumas indústrias alimentícias, bem como apresentar um cardápio balanceado e equilibrado para crianças na faixa etária de 4 a 6 anos, que contribua para a prevenção de possíveis carências nutricionais.

Tratamento dietético da intolerância à lactose infantil: teor de lactose em alimentos / Dietary treatment of the intolerance to the child lactose: lactose text in foods

A lactose está presente em diversos tipos de leite e todos os mamíferos, inclusive o ser humano, quando nascem em condições normais, estão aptos a digerir este açúcar. No entanto, aproximadamente 75 por cento da população mundial é intolerante à lactose. Para a lactose ser assimilada pelo organismo é necessário que seja hidrolisada no intestino delgado, pela ação da enzima lactase, também chamada de beta galactosidase, em: galactose e glicose. Na ausência da lactose na mucosa intestinal, a lactose não pode ser absorvida e utilizada. No cólon os microorganismos a fermentam, resultado em ácidos e gases, aparecendo sintomas clínicos como: diarréia, flatulência, dores de barriga e inchaço no abdômen. O tratamento da intolerância à lactose consiste basicamente na retirada ou diminuição desse açúcar da dieta, o que leva ao desaparecimento progressivo dos sintomas. Uma das grandes preocupações com a redução da lactose da alimentação é a garantia do fornecimento de quantidade apropriada de proteínas, cálcio, riboflavina e vitamina D, cuja maior fonte é o leite e seus derivados. É de fundamental importância um planejamento dietético apropriado em crianças, que assegura um crescimento satisfatório. Com o intuito de propiciar um melhor tratamento nutricional à pacientes intolerantes à lactose este trabalho tem por objetivo apresentar o teor de lactose em alimentos que são geralmente consumidos por crianças obtido através de pesquisa junto à algumas indústrias alimentícias, bem como apresentar um cardápio balanceado e equilibrado para crianças na faixa etária de 4 a 6 anos, que contribua para a prevenção de possíveis carências nutricionais.

Lactose is a sugar present in several types of milk and in all mammals, including human beings. Humans born under normal conditions, are capable of digesting this sugar. However, approximately 75% of the world population are intolerant to lactose. For its assimilation by the organism, lactose I1lUStbe broken into galactose and glucose, in a hydrolysis reaction, catalyzed by the lactase (also called beta galactosidase) enzyme. ln the absence of lactase in the intestinal mucous membrane, lactose cannot be absorbed and used. In the colon, it is fermented by the microorganisms, forming acids and gas, responsible for gastrointestinal symptoms such as: diarrhea, flatulence, cramps and bloating. The treatment of lactose intolerance consists basically of the withdrawal or decrease of lactose content of the diet, what leads to the progressive disappearance of the symptoms. However, one of the major concerns with the reduced lactose diet is the supply of appropriate amount of protein, calcium, riboflavine and vitamin O, to hose main source is milk and its subproducts. In this context, appropriate dietary planning is of fundamental importance in children, where satisfactory growth must be assured. So being, with the intention of propitiating a better nutritional treatment to the lactose intolerant patient, this work's objective was to research the lactose amounts present in foods usually consumed by children (data obtained from industry sources as well as to propose balanced food plans elaborated for children in the age group from 4 to 6 years, as a contribution to the prevention of possible nutritional deficiencies.

Alteración del metabolismo de la galactosa / Galactose metabolism defect

Las alteraciones del metabolismo de la galactosa se producen por el defecto de las enzimas: galactoquinasa (GALK), galactosa-1-fosfato-uridil transferasa (GAL1-PUT) y uridin difosfato galactosa 4' epimerasa (UDPGAL); de ellas la más frecuente es la galactosemia clásica producida por la deficiencia de GAL1PUT. Producto de este defecto se acumula galactosa-1-fosfato, galactosa libre y galactitol en sangre y tejidos, los que producen alteraciones hepáticas, renales y cerebrales. Su herencia es autosómica recesiva y la incidencia estimada a nivel mundial fluctúa entre 1:60.000 a 1:33.000 recién nacidos. Los síntomas y signos más característicos son vómito, diarrea, ictericia, hepatomegalia, cataratas. Si la enfermedad no es tratada oportunamente ocasiona la muerte del niño. El tratamiento consiste en eliminar la lactosa y galactosa de la alimentación, lo que incluye alimentos tales como la leche de todo tipo y sus derivados, la galactosa y alimentos o medicamentos que contenga alguno de estos productos. Se entrega leche de soya y los requerimientos de macro y micro nutrientes se indican según las recomendaciones para edad y sexo. La dieta dura toda la vida ya que la galactosa se transforma en galactitol, existiendo riesgo de producir catarata y daño renal en cualquier momento de la vida. Un buen control se obtiene al mantener el nivel sanguíneo de galactosa-1-fosfato igual o menor a 3.0 mg/dL y urinario de galactitol bajo 0.8 mmol/mol de creatinina.

Histological changes in intestine in semichronic diarrhoea induced by lactose enriched diet in rats: effect of Diarex-Vet.

Efficacy of Diarex-Vet (The Himalaya Drug Company, Makali, Bangalore, India) was evaluated histologically in semichronic diarrhoea induced by lactose enriched diet in rats. The rats in different groups were given lactose enriched diet alone for 2 days before starting the treatment with Diarex-Vet at a dose of 250, 500 and 750 mg/kg body weight along with lactose enriched diet for 5 days. Animals were euthanised at the end of 5 days of treatment and histological changes were observed in the ileum, caecum and colon. Semiquantitative analysis of goblet cells in intestines showed dose dependent response among the treated groups. The morphological changes were comparable to normal in the group given 750 mg/kg body wt Diarex-Vet. The effects observed were attributed to the lactase like analogous activity of Diarex-Vet or the inhibition of the osmotic processes in the intestinal lumen thereby reducing the morphological changes in the intestines.

Use of nucleotides in weanling rats with diarrhea induced by a lactose overload: effect on the evolution of diarrhea and weight and on the histopathology of intestine, liver and spleen

Until recently, dietary sources of nucleotides were thought not to be essential for good nutrition. Certain states with higher metabolic demands may require larger amounts that cannot be provided by endogenous production. The objective of the present study was to determine the action of nucleotides on the recovery from lactose-induced diarrhea in weaned rats. Thirty-six weanling Fisher rats were divided into two groups. Group 1 received a standard diet and group 2 received a diet containing lactose in place of starch. On the 10th day, six animals per group were sacrificed for histopathological evaluation. The remaining animals were divided into two other subgroups, each with 6 animals, receiving a control diet, a control diet with nucleotides (0.05 percent adenosine monophosphate, 0.05 percent guanosine monophosphate, 0.05 percent cytidine monophosphate, 0.05 percent uridine monophosphate and 0.05 percent inosine monophosphate), a diet with lactose, and a diet with lactose and nucleotides. On the 32nd day of the experiment all animals were sacrificed. Animals with diarrhea weighed less than animals without diarrhea. The introduction of nucleotides did not lead to weight gain. Mean diet consumption was lower in the group that continued to ingest lactose, with the group receiving lactose plus nucleotides showing a lower mean consumption. Animals receiving lactose had inflammatory reaction and deposits of periodic acid-Schiff-positive material in intestinal, hepatic and splenic tissues. The introduction of nucleotides led to an improvement of the intestinal inflammatory reaction. In lactose-induced diarrhea, when the stimulus is maintained - lactose overload - the nucleotides have a limited action on the weight gain and on recovery of intestinal morphology, although they have a protective effect on hepatic injury and improve the inflammatory response

Diarrea y nutrición: experiencias en niños y ratas / Nutrition and diarrhea: experiences with childrens and rats

La diarrea infantil es un problema de salud pública en Venezuela y el proceso diarreico es un problema clínico que acompaña numerosas patologías. Independientemente de la causa, la diarrea deteriora el estado nutricional del paciente. El déficit nutricional ocurre por el bajo consumo de alimentos, una menor absorción y retención de nutrientes y el incremento en los requerimientos nutricionales. A su vez, el déficit nutricional limita la capacidad inmunitaria y altera la morfología de la mucosa intestinal facilitando el ciclo diarrea-desnutrición. Nuestro interés se ha enfocado en los aspectos nutricionales del manejo del niño con diarrea y en la utilización de los nutrientes durante el proceso diarreico. Realizamos estudios de balance en 165 niños con diarrea aguda y en 15 niños con diarrea aguda y en 15 niños con diarrea prolongada. Encontramos que los niños con diarrea aguda consumen solo un 50-75 por ciento de su requerimiento energético y que la absorción de macronutrientes provenientes de diferentes fuentes alimentarias fue de 55-78 por ciento; siendo la grasa, el nutriente menos afectado por la severidad de la diarrea. Cuantitativamente la reducción en el consumo es el elememto mas importante en el deterioro nutricional. Adicionalmente, hemos realizado estudios de balance en ratas con diarrea inducida por lactosa o bisoxatin acetato encontrando tendencias similares a lo observado en niños. Por tanto, aparte de la rehidratación oral, lo mas importante en el tratamiento del niño con diarrea es lograr un adecuado consumo energético

Persistent diarrhea: management in a diarrhea treatment unit.

Five hundred ninety two children (6.0%) were diagnosed as persistent diarrhea (PD) out of a total attendance of 9795 cases in the Diarrhea Training and Treatment Unit (DTU) over a period of 1 year. Most of the cases were initially managed as outpatients on dietary advice and treatment of associated infections. Eighty eight per cent of the cases followed as outpatients from the DTU responded to treatment and only 11.5% of them had to be hospitalized. A total of 49/592 cases (8.3%) required to be hospitalized on account of treatment failure from outpatients and other indications. Clinical spectrum of hospitalized children included severe malnutrition (40.8%), pneumonia (40.8%), urinary tract infection (32.7%), lactose intolerance (32.7%), anemia (28.6%), septicemia (16.3%), dysentery (8.2%) and neck flop due to hypokalemia (4.1%). Dietary management included modifications in the diet already offered to hospitalized patients. Thirty eight children were fed on one of these diets. Of these 13/35 children (37.1%) were successfully managed with lactose reduced diet., 18/22 cases (81.8%) with lactose free diet and only in 2 cases carbohydrate free diet was given. In 3 cases, normal feeding was continued. Eleven cases were too sick to be offered any oral feeding. Eleven of forty nine cases (22.4%) expired. Mortality was highest in infants <6 months (31.6%). The causes of death included severe malnutrition (14.3%), septicemia (14.3%) and pneumonia (12.2%). Screening and treating cases of PD for associated infections like septicemia, pneumonia and urinary tract infection seems to be a key factor which determines morbidity and mortality in these cases. Feeding on a hospital food modified as lactose reduced/free diet can benefit majority of cases with PD and a very small proportion of cases may require carbohydrate free diet.

Dilataçäo experimental de ceco e cólon em ratos: III. Modelo induzido pela adiçäo prolongada da lactose na raçäo de animais em fase crônica da infecçäo pela cepa Y de T. cruzi / Experimental dilatation of the cecum, and colon in rats: III. Model induced by prolonged addiction of lactose in the diet of animals in chronic phase of infection by the Y strain of T. cruzi

Cinqüenta ratos Wistar (fêmeas) com 30 dias de idade, pesando em média 60 g cada, foram inoculados individualmente por via peritoneal com 100 parasitas/g da cepa Y de T. cruzi mantida em laboratório por repicagens sucessivas em camundongos. Como controles foram incluídos 30 animais da mesma idade e sexo. Cem dias após, os animais foram divididos nos seguintes grupos - Grupo I: (controle) subdividido em subgrupo L (recebendo lactose durante quatro semanas) e subgrupo S (recebendo sacarose durante quatro semanas); Grupo II: (inoculado) com os mesmos subgrupos anteriores; Grupo III: (controle) constituído pelo subgrupo L-S (quatro semanas com lactose, sendo a seguir este açucar substituído por sacarose durante 4 semanas) e pelo subgrupo S (8 semanas com sacarose); Grupo IV: (inoculado) subdividido nos mesmos subgrupos do grupo anterior. A quantidade de dissacarídeo (lactose ou sacarose) adicionada à dieta, correspondeu a 25 g/100 g do peso final da mesma, utilizando-se na mistura a raçäo habitualmente empregada na alimentaçäo destes animais. No fim dos períodos, os animais foram sacrificados para medida do volume externo e pesagem individual do ceco e cólon. Os resultados indicaram que animais inoculados, recebendo lactose, apresentaram tendência à dilataçäo e aumento do peso do ceco e cólon de forma mais acentuada que nos controles, contudo, da mesma forma que nos últimos, houve reversäo do fenômeno com a substituiçäo do açúcar na raçäo. Säo feitas consideraçöes sobre a possível participaçäo da lactose na induçäo da dilataçäo do intestino grosso em pacientes na fase crônica da doença de Chagas