Association between vitamin D deficiency and anemia in inflammatory bowel disease patients with ileostomy / Associação entre deficiência de vitamina D e anemia em pacientes com doença inflamatória intestinal submetidos a ileostomia

ABSTRACTBackground:Vitamin D deficiency is commonly seen in patients with inflammatory bowel disease (IBD). Vitamin D deficiency in IBD patients with ileostomy has not been systemically studied. The aim of the study was to assess the frequency and risk factors associated with low 25(OH) D3 levels in those patients.Methods:112 eligible IBD patients with ileostomy were studied. Demographic, clinical, and endoscopic variables were analyzed. Vitamin D levels before and after ileostomy were compared when available. Levels of serum 25(OH)D3 <20 ng/mL were classed as being deficient.Results:112 eligible ileostomy patients were included. The mean vitamin D level was 21.47 ± 1.08 ng/dl. Low levels of vitamin D (<30 ng/dl) were present in 92 patients (82%). Vitamin D deficiency (<20 ng/dL) was seen in 55 patients (49%). There was no difference between patients with or without vitamin D deficiency regarding demographic variables, medication use and duration of ileostomy. Neo-ileal inflammation on endoscopy was not associated with vitamin D deficiency (p= 0.155). Lower levels of phosphorus (p= 0.020) or hemoglobin (p= 0.019) and shorter duration of IBD (p= 0.047) were found in patients with vitamin D deficiency. In multivariate analysis, lower levels of phosphorus (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.16-2.89, p= 0.009) and hemoglobin (OR: 1.32, 95% CI: 1.08-1.60, p= 0.006) remained significantly associated with vitamin D deficiency.Conclusion:Vitamin D deficiency is common in IBD patients with ileostomy and is associated with low hemoglobin levels. Further studies are needed to evaluate vitamin D supplementation as a possible adjuvant in the treatment of anemia of chronic disease in IBD patients.

RESUMOIntrodução:A deficiência de vitamina D em pacientes com doença inflamatória intestinal submetidos a ileostomia não foi estudada sistematicamente. O objetivo desse estudo foi avaliar a frequência e os fatores de risco associados com a deficiência de vitamina D nesses pacientes.Resultados:112 pacientes elegíveis foram incluídos. A média dos níveis de vitamina D na população estudada foi de 21.47 ± 1.08 ng/dl. Níveis de vitamina D abaixo do normal (<30 ng/dl) e deficiência de vitamina D (<20 ng/dL) foram encontrados em 92 pacientes (82%) e em 55 pacientes (49%) respectivamente. Encontrou-se uma associação entre deficiência de vitamina D e níveis mais baixos de fosforo (p = 0.020), hemoglobina (p = 0.019) e duração da doença inflamatória intestinal (p = 0.047). Na análise multivariada, níveis mais baixos de fósforo (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.16-2.89, p = 0.009) e hemoglobina (OR: 1.32, 95% CI: 1.08-1.60, p = 0.006) permaneceram associados com deficiência de vitamina D.Conclusão:A deficiência de vitamina D é comum em pacientes com doença inflamatória intestinal submetidos a ileostomia e está associada com níveis baixos de hemoglobina. Mais estudos são necessários para avaliar se a suplementação de vitamina D pode ser um adjuvante no tratamento de anemia da doença crônica nesses pacientes.

Environmental effects on reproductive performance of Nellore cows widely raised in the Cerrado/Pantanal ecotone / Interação do ambiente com desempenho reprodutivo de matrizes Nelores criadas extensivamente no ecótono Cerrado/Pantanal

We analyzed the pregnancy rate (PR) and birth rate (BR) of Nellore cows raised extensively in the Cerrado/Pantanal during 4 mating seasons (20092012), assessing the relationship with the temperature and humidity index (THI) and the effect of the year and breeding season. We used information from 2,116 cows, which were categorized as either multiparous (n = 1430), primiparous (n = 338), or nulliparous (n = 348). In the months of the breeding season (DecemberFebruary), temperature and relative humidity data were collected to calculate the temperature and humidity index (THI). An ANOVA was performed with a model that included sources of variation from the fixed effects of category of cow and year on PR and BR; and a linear regression analysis and correlation between THI and PR and BR. We observed a significant effect (p 0.05) on PR. We classified the average across breeding seasons as a moderate THI. The THI of the breeding seasons showed high and significant (p 0.05) effects only on the nulliparous BR, and low values in other categories. It is concluded that the seasonal THI was not related to the performance of cows, except BR in nulliparous cows

Analisou-se taxa de prenhez (TP) e de natalidade (TN) de matrizes Nelores criadas extensivamente no Cerrado/Pantanal, acasaladas durante 4 estações de monta natural (2009 a 2012), avaliando relação com índice de temperatura e umidade (ITU) e efeito do ano da estação de monta. Utilizaram-se 2.116 informações de matrizes, pertencentes às categorias de multíparas (n = 1430), primíparas (n = 338) e nulíparas (n = 348). Nos meses de estação de monta (dezembro a fevereiro) coletaram-se informações da temperatura e umidade relativa do ar, para o cálculo de índice de temperatura e umidade (ITU). Realizaram-se análise de variância com um modelo contendo como fontes de variação os efeitos fixos de categoria e ano de estação de monta sob a TP e TN; e análise da regressão linear e correlação entre o ITU e a TP e TN. Observaram-se efeito significativo (p 0,05) de categoria sob a TP. Classificou-se o ITU médio entre as estações de monta como moderado. O ITU das estações de monta apresentou relação alta e significativa (p 0,05) apenas na TN das nulíparas, e baixas tendências de relação com as demais. Conclui-se que o ano da estação de monta e o ITU não apresentaram relação com desempenho das matrizes, exceto as nulíparas considerando ITU e TN

Environmental effects on reproductive performance of Nellore cows widely raised in the Cerrado/Pantanal ecotone / Interação do ambiente com desempenho reprodutivo de matrizes Nelores criadas extensivamente no ecótono Cerrado/Pantanal

We analyzed the pregnancy rate (PR) and birth rate (BR) of Nellore cows raised extensively in the Cerrado/Pantanal during 4 mating seasons (20092012), assessing the relationship with the temperature and humidity index (THI) and the effect of the year and breeding season. We used information from 2,116 cows, which were categorized as either multiparous (n = 1430), primiparous (n = 338), or nulliparous (n = 348). In the months of the breeding season (DecemberFebruary), temperature and relative humidity data were collected to calculate the temperature and humidity index (THI). An ANOVA was performed with a model that included sources of variation from the fixed effects of category of cow and year on PR and BR; and a linear regression analysis and correlation between THI and PR and BR. We observed a significant effect (p 0.05) on PR. We classified the average across breeding seasons as a moderate THI. The THI of the breeding seasons showed high and significant (p 0.05) effects only on the nulliparous BR, and low values in other categories. It is concluded that the seasonal THI was not related to the performance of cows, except BR in nulliparous cows(AU)

Analisou-se taxa de prenhez (TP) e de natalidade (TN) de matrizes Nelores criadas extensivamente no Cerrado/Pantanal, acasaladas durante 4 estações de monta natural (2009 a 2012), avaliando relação com índice de temperatura e umidade (ITU) e efeito do ano da estação de monta. Utilizaram-se 2.116 informações de matrizes, pertencentes às categorias de multíparas (n = 1430), primíparas (n = 338) e nulíparas (n = 348). Nos meses de estação de monta (dezembro a fevereiro) coletaram-se informações da temperatura e umidade relativa do ar, para o cálculo de índice de temperatura e umidade (ITU). Realizaram-se análise de variância com um modelo contendo como fontes de variação os efeitos fixos de categoria e ano de estação de monta sob a TP e TN; e análise da regressão linear e correlação entre o ITU e a TP e TN. Observaram-se efeito significativo (p 0,05) de categoria sob a TP. Classificou-se o ITU médio entre as estações de monta como moderado. O ITU das estações de monta apresentou relação alta e significativa (p 0,05) apenas na TN das nulíparas, e baixas tendências de relação com as demais. Conclui-se que o ano da estação de monta e o ITU não apresentaram relação com desempenho das matrizes, exceto as nulíparas considerando ITU e TN(AU)

Helicobacter pylori virulence genes detected by string PCR in children from an urban community in northeastern Brazil.

The accuracy of a nested PCR in gastric DNA obtained by a string test for the diagnosis of Helicobacter pylori infection in asymptomatic children was 94.0%. The cagA-positive toxigenic vacAs1m1 strains were the most prevalent strains, indicating that this population is colonized early by the strains associated with gastric cancer.

Higher frequency of cagA EPIYA-C phosphorylation sites in H. pylori strains from first-degree relatives of gastric cancer patients.

BACKGROUND: To evaluate the prevalence of more virulent H. pylori genotypes in relatives of gastric cancer patients and in patients without family histories of gastric cancer. METHODS: We evaluated prospectively the prevalence of the infection by more virulent H. pylori strains in 60 relatives of gastric cancer patients comparing the results with those obtained from 49 patients without family histories of gastric cancer. H. pylori status was determined by the urease test, histology and presence of H. pylori ureA. The cytotoxin associated gene (cagA), the cagA-EPIYA and vacuolating cytotoxin gene (vacA) were typed by PCR and the cagA EPIYA typing was confirmed by sequencing. RESULTS: The gastric cancer relatives were significant and independently more frequently colonized by H. pylori strains with higher numbers of CagA-EPIYA-C segments (OR = 4.23, 95%CI = 1.53-11.69) and with the most virulent s1m1 vacA genotype (OR = 2.80, 95%CI = 1.04-7.51). Higher numbers of EPIYA-C segments were associated with increased gastric corpus inflammation, foveolar hyperplasia and atrophy. Infection by s1m1 vacA genotype was associated with increased antral and corpus gastritis. CONCLUSIONS: We demonstrated that relatives of gastric cancer patients are more frequently colonized by the most virulent H. pylori cagA and vacA genotypes, which may contribute to increase the risk of gastric cancer.

Helicobacter pylori vacA and cagA genotypes in patients from northeastern Brazil with upper gastrointestinal diseases.

Helicobacter pylori causes chronic gastric inflammation and significantly increases the risk of duodenal and gastric ulcer disease and distal gastric carcinoma. In this study, we evaluated the Helicobacter pylori vacA and cagA genotypes in patients from a Brazilian region where there is a high prevalence of gastric cancer. Polymerase chain reaction (PCR) was used to investigate vacA mosaicism and cagA status in the gastric mucosa of 134 H. pylori-positive patients, including 76 with gastritis: 28 with peptic ulcer disease and 30 with gastric cancer. The s1m1 variant was the predominant vacA genotype observed, whereas the s1 allele was more frequently observed in patients with more severe diseases associated with H. pylori infection [p = 0.03, odds ratio (OR) = 5.72, 95% confidence interval (CI) = 1.15-38.60]. Furthermore, all of the s1 alleles were s1b. Mixed vacA m1/m2 strains were found more frequently in patients with gastric cancer and a cagA-positive status was significantly associated with gastric cancer (p = 0.016, OR = 10.36, 95% CI = 1.35-217.31). Patients with gastric cancer (21/21, 100%, p = 0.006) or peptic ulcers (20/21, 95%, p = 0.02) were more frequently colonised by more virulent H. pylori strains compared to gastritis patients (41/61, 67.2%). In conclusion, in the northeastern of Brazil, which is one of the regions with the highest prevalence of gastric cancer in the country, infection with the most virulent H. pylori strains, carrying the cagA gene and s1m1 vacA alleles, predominates and is correlated with more severe H. pylori-associated diseases.

Helicobacter pylori vacA and cagA genotypes in patients from northeastern Brazil with upper gastrointestinal diseases

Helicobacter pylori causes chronic gastric inflammation and significantly increases the risk of duodenal and gastric ulcer disease and distal gastric carcinoma. In this study, we evaluated the Helicobacter pylori vacA and cagA genotypes in patients from a Brazilian region where there is a high prevalence of gastric cancer. Polymerase chain reaction (PCR) was used to investigate vacA mosaicism and cagA status in the gastric mucosa of 134 H. pylori-positive patients, including 76 with gastritis: 28 with peptic ulcer disease and 30 with gastric cancer. The s1m1 variant was the predominant vacA genotype observed, whereas the s1 allele was more frequently observed in patients with more severe diseases associated with H. pylori infection [p = 0.03, odds ratio (OR) = 5.72, 95% confidence interval (CI) = 1.15-38.60]. Furthermore, all of the s1 alleles were s1b. Mixed vacA m1/m2 strains were found more frequently in patients with gastric cancer and a cagA-positive status was significantly associated with gastric cancer (p = 0.016, OR = 10.36, 95% CI = 1.35-217.31). Patients with gastric cancer (21/21, 100%, p = 0.006) or peptic ulcers (20/21, 95%, p = 0.02) were more frequently colonised by more virulent H. pylori strains compared to gastritis patients (41/61, 67.2%). In conclusion, in the northeastern of Brazil, which is one of the regions with the highest prevalence of gastric cancer in the country, infection with the most virulent H. pylori strains, carrying the cagA gene and s1m1 vacA alleles, predominates and is correlated with more severe H. pylori-associated diseases.

Natural history of Helicobacter pylori infection in childhood: eight-year follow-up cohort study in an urban community in northeast of Brazil.

BACKGROUND: Helicobacter pylori infection is acquired predominantly in childhood. There is also evidence that children loss the infection. Therefore, factors that account for children remain infected need to be investigated because once established the infection persists throughout the life unless treated. METHODS: This study aimed to evaluate the H. pylori infection in children of a low-income community at baseline and 8years later to determine the predictor factors linked to the maintenance, acquisition, and loss of the infection using regression models of generalized estimating equations. H. pylori status was determined by (13) C-urea breath test. RESULTS: Data from 37.7% (133/353) of the children were available. No difference between the characteristics of the included and nonincluded children was observed. The prevalence of infection increased from 53.4 to 64.7%. Thirty-nine children (29.3%) remained noninfected, 47.4% remained infected, 17.3% became infected, and 6.0% lost the infection. Factors associated with to remain infected compared with to remain noninfected included the age, increased number of children in the household, and the use of well water instead of municipal water. The acquisition of the infection was associated with the male gender. CONCLUSION: Factors linked to remain and to gain H. pylori infection in a poor region were increased number of children in the household and the male gender. Also, the acquisition rates were higher than the loss rates, which lead to an increase in the infection prevalence with age.

Low prevalence of H. pylori infection in HIV-positive patients in the northeast of Brazil.

BACKGROUND: This study conducted in Northeastern Brazil, evaluated the prevalence of H. pylori infection and the presence of gastritis in HIV-infected patients. METHODS: There were included 113 HIV-positive and 141 age-matched HIV-negative patients, who underwent upper gastrointestinal endoscopy for dyspeptic symptoms. H. pylori status was evaluated by urease test and histology. RESULTS: The prevalence of H. pylori infection was significantly lower (p < 0.001) in HIV-infected (37.2%) than in uninfected (75.2%) patients. There were no significant differences between H. pylori status and gender, age, HIV viral load, antiretroviral therapy and the use of antibiotics. A lower prevalence of H. pylori was observed among patients with T CD4 cell count below 200/mm3; however, it was not significant. Chronic active antral gastritis was observed in 87.6% of the HIV-infected patients and in 780.4% of the control group (p = 0.11). H. pylori infection was significantly associated with chronic active gastritis in the antrum in both groups, but it was not associated with corpus chronic active gastritis in the HIV-infected patients. CONCLUSION: We demonstrated that the prevalence of H. pylori was significantly lower in HIV-positive patients compared with HIV-negative ones. However, corpus gastritis was frequently observed in the HIV-positive patients, pointing to different mechanisms than H. pylori infection in the genesis of the lesion.

Younger siblings play a major role in Helicobacter pylori transmission among children from a low-income community in the Northeast of Brazil.

BACKGROUND AND AIMS: To further evaluate intrafamilial transmission of H. pylori infection during childhood, we investigated the prevalence of H. pylori in family members from a poor H. pylori high-prevalence urban community in the Northeast of Brazil. METHODS: H. pylori infection was investigated in 570 members of 128 households, by (13) C-urea breath test in children and by ELISA in mothers and other adult relatives. RESULTS: The overall prevalence of H. pylori infection (376/570) increased with age (p < .001) and ranged from 28.9%, in children aged 6 months to 5 years, to 82% in adults over 40 years. An H. pylori positive mother and the number of infected siblings are independent risk factors for childhood H. pylori infection (OR = 2.2, 95% CI = 1.0-4.6 and OR = 4.3, 95% CI = 2.3-8.1, respectively) The number of siblings, number of younger siblings, and number of infected younger siblings were also associated with the infection in the univariate analysis. The number of infected younger siblings remained independently associated with the infection (p = .000), even after controlling for all the above cited variables, in addition to the H. pylori status of siblings and mothers, age, number of people per room, and number of children in the household. CONCLUSION: The transmission of H. pylori occurs from infected mothers to their offspring and among siblings, notably from younger siblings to the older ones.

Helicobacter pylori colonization among children up to 6 years: results of a community-based study from Northeastern Brazil.

AIM: To determine the prevalence and risk factors associated with Helicobacter pylori infection among children up to 6 years. METHODS: Cross-sectional study carried out in a poor urban community in Fortaleza Northeast Brazil. A standardized questionnaire was applied. Helicobacter pylori status was evaluated by (13)C-urea breath test ((13)C-UBT) in children up to 48 months and by ELISA in the mothers. Sera were assayed by the Cobas Core anti-H. pylori IgG EIA. RESULTS: The overall prevalence of H. pylori infection was 40% (88/217), 41% (46/112) boys and 40% (42/105) girls were infected. The prevalence rate of infection by H. pylori increased significantly with age, from 29% (27/93) in the youngest group (3 months to 2 years) to 59% (35/59) in the oldest group (6 years), (p < 0.001). There was no significant difference in the prevalence of infection between gender, height and weight adjusted for age, history of breastfeeding, mother's education, number of people per room, number of people per bed, smoking habit of the mother and children's history of antibiotic intake. A significant difference was found in the prevalence of H. pylori infection and H. pylori status of mother (p = 0.02; odds ratio (OR) 2.98; 95% confidence interval (CI): 1.19-7.46) that remained significant after adjustment for covariates in multivariate analysis (p = 0.012; OR 4.65; 95%CI: 1.39-15.58). CONCLUSIONS: This study shows that children living in low socioeconomic status and poor hygienic conditions are infected very early in childhood. It identifies age and H. pylori positive mother as independent risk factors for infection.

The association between Helicobacter pylori infection and height in children from an urban community in north-east Brazil.

BACKGROUND: An association between Helicobacter pylori infection and short stature in children has been described recently. AIM: To describe differences in stature between H. pylori-infected and non-infected children in a low-income community in north-east Brazil. METHODS: H. pylori status was evaluated by 13C-urea-breath test; centile values for weight and height were calculated for each child. RESULTS: The prevalence of H. pyloni was 55.8% (197/353) and increased with age. Of 197 H. pylori-positive children, 62% were below the 25th centile for height compared with 48% of H. pylori-negative children (75/156) [AOR (adjusted odds ratio) 1.61, 95% CI 1.04-2.49, p=0.03] after adjustment for variables with p < 0.25 in univariate analysis (gender, number of residents, of children per household and of persons per bed). These results were significant only when older children were included. Thus, in children aged 8-14 years, 80% (89/111) of H. pylori-positive were <25th centile for height compared with 63% (35/56) of H. pylori-negative children (p=0.01). Compared with children with a height >25th centile, the AOR for H. pylori infection increased from 2.42 in the crude analysis to 6.62 after adjustment (p=0.006). CONCLUSIONS: H. pylori is associated with short stature in older children living in a poor urban community in Brazil.