Antimicrobial susceptibility profile of enterotoxigenic and enteropathogenic Escherichia coli isolates obtained from fecal specimens of children with acute diarrhea / Perfil de suscetibilidade a drogas antimicrobianas de amostras de Escherichia coli enterotoxigênica e enteropatogênica isoladas de espécimes fecais de crianças com doença diarreica aguda

ABSTRACT Among the diseases which etiopathogenesis is associated with Escherichia coli, acute diarrhea stands out. Studies on the characterization of the antimicrobial susceptibility profile contribute to the selection of appropriate empirical antimicrobial therapy. In this study, the antimicrobial susceptibility profile of 98 enterotoxigenic E. coli (ETEC) and enteropathogenic E. coli (EPEC) strains isolated from fecal specimens of children with acute diarrhea was evaluated. The resistance rates to ampicillin, sulfamethoxazole/trimethoprim, amoxicillin/clavulanate, and nalidixic acid were high, ranging from 34.7% to 10.2%. The result of this research recommends the use of cefotaxime and ceftriaxone for the empirical treatment of children with acute diarrhea which the etiology suggested is ETEC or EPEC.

RESUMO Entre as doenças cuja etiopatogenia está associada à Escherichia coli, destaca-se a doença diarreica aguda. Estudos que visam à caracterização do perfil de suscetibilidade antimicrobiana contribuem para o delineamento de antibioticoterapia empírica eficaz. Neste estudo, foi avaliado o perfil de suscetibilidade a antimicrobianos de 98 amostras de E. coli enterotoxigênica (ETEC) e E. coli enteropatogênica (EPEC) isoladas de crianças com doença diarreica. As frequências de resistência a ampicilina, sulfametoxazol-trimetoprima, amoxicilina-clavulanato e ácido nalidíxico foram elevadas, variando entre 34,7% e 10,2%. Esta pesquisa recomenda o emprego de cefotaxima e ceftriaxona para o tratamento empírico de crianças com quadro de diarreia cuja etiologia sugerida seja ETEC ou EPEC.

Nutritional evaluation of children with chronic cholestatic disease / Avaliação nutricional de crianças com colestase crônica

Abstract Objective: To evaluate the nutritional status of children with persistent cholestasis and to compare the anthropometric indices between children with and without liver cirrhosis and children with and without jaundice. Methods: Children with persistent cholestasis, i.e. increased direct bilirrubin or changes in the canalicular enzyme gamma-glutamyl transferase (GGT), were included. The anthropometric measures were weight (W), height or length (H), arm circumference (AC), triceps skinfold thickness (TST), arm muscle circumference (AMC), and body mass index (BMI). Results: Ninety-one children with cholestasis, with current median age of 12 months, were evaluated. W/age (A) and H/A indices below −2 Z-scores were observed in 33% and 30.8% of patients, respectively. Concerning the W/H index and BMI, only 12% and 16% of patients, respectively, were below −2 Z-scores. Regarding AC, 43.8% of 89 evaluated patients had some depletion. Observing the TST, 64% of patients had depletion, and 71.1% of the 45 evaluated patients had some degree of depletion regarding the ACM index. Conclusion: Evaluation using weight in patients with chronic liver diseases may overestimate the nutritional status due to visceromegaly, subclinical edema, or ascites. Indices that correlate weight and height, such as W/H and BMI, may also not show depletion because of the chronic condition in which there are depletion of both weight and height. TST, AC, and ACM are parameters that better estimate nutritional status and should be part of the management of patients with liver diseases and cholestasis.

Resumo Objetivo: Avaliar a situação nutricional de crianças com colestase persistente e comparar os índices antropométricos entre crianças com e sem cirrose hepática e crianças com e sem icterícia. Métodos: Foram incluídas crianças com colestase persistente, ou seja, aumento da bilirrubina direta ou alterações na enzima canalicular, gamaglutamiltransferase (GGT). As medidas antropométricas foram peso, estatura ou altura, circunferência do braço (CB), espessura da prega cutânea do tríceps (TST), circunferência muscular do braço (CMB) e índice de massa corporal (IMC). Resultados: Foram avaliadas 91 crianças com colestase, com idade média de 12 meses; 33% e 30,8% dos pacientes apresentaram índices P/I e A/I com escore Z abaixo de –2, respectivamente. Com relação ao índice P/A e IMC, somente 12% e 16% dos pacientes, respectivamente, apresentaram escore Z abaixo de –2. Com relação à CB, 43,8% de 89 pacientes avaliados apresentaram alguma depleção. Observando a TST, 64% dos pacientes que apresentaram depleção, 71,1% dos 45 pacientes avaliados apresentaram algum grau de depleção com relação ao índice de CMB. Conclusão: A avaliação do peso em pacientes com doenças hepáticas crônicas poderá superestimar a situação nutricional devido a visceromegalia, edema subclínico ou ascite. Os índices que correlacionam peso e altura, como P/A e IMC, também podem não mostrar depleção devido à doença crônica em que há depleção tanto do peso quanto da altura. A TST, BC e CMB são parâmetros que estimam melhor a situação nutricional e devem fazer parte de gestão de pacientes com doenças hepáticas e colestase.

Nutritional evaluation of children with chronic cholestatic disease.

OBJECTIVE: To evaluate the nutritional status of children with persistent cholestasis and to compare the anthropometric indices between children with and without liver cirrhosis and children with and without jaundice. METHODS: Children with persistent cholestasis, i.e. increased direct bilirrubin or changes in the canalicular enzyme gamma-glutamyl transferase (GGT), were included. The anthropometric measures were weight (W), height or length (H), arm circumference (AC), triceps skinfold thickness (TST), arm muscle circumference (AMC), and body mass index (BMI). RESULTS: Ninety-one children with cholestasis, with current median age of 12 months, were evaluated. W/age (A) and H/A indices below -2 Z-scores were observed in 33% and 30.8% of patients, respectively. Concerning the W/H index and BMI, only 12% and 16% of patients, respectively, were below -2 Z-scores. Regarding AC, 43.8% of 89 evaluated patients had some depletion. Observing the TST, 64% of patients had depletion, and 71.1% of the 45 evaluated patients had some degree of depletion regarding the ACM index. CONCLUSION: Evaluation using weight in patients with chronic liver diseases may overestimate the nutritional status due to visceromegaly, subclinical edema, or ascites. Indices that correlate weight and height, such as W/H and BMI, may also not show depletion because of the chronic condition in which there are depletion of both weight and height. TST, AC, and ACM are parameters that better estimate nutritional status and should be part of the management of patients with liver diseases and cholestasis.

Perfil antropométrico de pacientes com doença celíaca atendidos pelo Ambulatório de Gastroenterologia Pediátrica da UFMG, Belo Horizonte, MG - Brasil / Anthropometric profile of patients with celiac disease tended at the Pediatric Gastroenterology Clinic of UFMG, Belo Horizonte, MG - Brasil

Objetivo: A doença celíaca caracteriza-se por ser autoimune, desencadeada pela presença da gliadina do trigo e de proteínas da cevada e do centeio, na dieta de pessoas suscetíveis. A não adesão à dieta apropriada pode levar a deficiência nutricional e alteração na composição corporal. Este estudo avaliou o perfil antropométrico e a composição corporal de crianças, adolescentes e jovens adultos com a doença celíaca. Métodos: Foram avaliados 31 pacientes com doença celíaca e 31 pessoas-controle, na faixa etária de três a 23 anos. Foram comparados peso, altura, circunferência abdominal e do quadril e calculado o índice de massa corporal. O percentual de gordura corporal, massa muscular e água total foi obtido pela bioimpedância elétrica. Foram realizados questionário de frequência alimentar e registro alimentar para avaliar sua relação coma composição corporal. Utilizaram-se os testes de Fisher, t de Student e de Wilcoxon para comparação dos grupos. Resultados: A análise antropométrica e a composição corporal não apresentaram diferenças significativas (p<0,05) entre os dois grupos. Asproporções de indivíduos com parâmetros corporais acima, abaixo ou adequado de saúde foram semelhantes. Conclusão: O paciente com doença celíaca que segue a dieta isenta de glúten tem composição corporal normal. A dieta isenta de glúten não se provou prejudicial, neste estudo, à composição corporal desses indivíduos.

Objective: celiac disease is characterized by being autoimmune, triggered by the presence of wheat gliadin and barley and rye proteins in the diet of susceptible people. The non-adherence to proper diet can lead to nutritional deficiency and alteration in body composition. This studyevaluated the anthropometric profile and body composition of children, adolescents, and young adults with celiac disease. Methods: 31 patients with celiac disease and 31 control persons,within the age range from 3 to 23 years, were evaluated. Weight, height, waist and hip circumference were compared and body mass index was calculated. The percentage of bodyfat, muscle mass, and total water was obtained by electrical bioimpedance. Food frequency and food record questionnaires were applied to evaluate its relationship with body composition. The Fisher, Student's t, and Wilcoxon tests were used for comparison of groups. Results:the anthropometric and body composition analyses did not show significant differences (p < 0.05) between the two groups. The proportions of individuals with bodily parameters above, below, or at the healthy appropriate level were similar. Conclusion: the patient with celiacdisease following a gluten-free diet has normal body composition. In this study, the gluten-free diet has not been proved detrimental to the body composition of these individuals.

Doença celíaca / Celiac disease

A doença celíaca (DC) é uma enteropatia caracterizada pela intolerância permanente ao glúten desencadeada por mecanismos autoimunes nos indivíduos geneticamente predispostos. A DC com seu quadro clínico típico e principalmente atípico tem se mostrado mais frequente do que se imaginava. Seu diagnóstico é baseado em suspeita clínica, exames sorológicos e biópsia intestinal. Devido à evolução dos marcadoressorológicos e revisão dos critérios diagnósticos, discute-se sobre a real necessidade da realização da biópsia intestinal em casos selecionados. O tratamento da DC continua sendo a dieta isenta de glúten.

Celiac disease (CD) is an enteropathy characterized by permanent intolerance to gluten triggered by autoimmune mechanisms in genetically predisposed individuals. The frequency of CD, with its typical clinical condition and mainly atypical, has been higher than expected. Its diagnosis is based on clinical suspicion, serologic tests, and intestinal biopsy. The evolution of the knowledge about serological markers and revision of thediagnostic criteria prompts questions about the real need of intestinal biopsy in selected cases. The treatment of CD remains the gluten-free diet.

Biliary atresia: evaluation on two distinct periods at a reference pediatric service.

CONTEXT: Biliary atresia is a progressive, idiopathic, fibro-obliterative disease of the extrahepatic biliary tree that presents with biliary obstruction exclusively in the neonatal period. OBJECTIVES: To assess the differences regarding age at referral, age at surgery, duration of propaedeutics and waiting time for surgery between two groups of infants in different periods. METHODS: Retrospective study of infants diagnosed with biliary atresia on two periods: 1983-1993 and 1998-2011. RESULTS: Biliary atresia was diagnosed in 129 infants, being 48 in casuistic I and 81 in casuistic II. The median age at admission was 94 and 60 days, respectively (P = 0.0001). On evaluating patients who had undergone portoenterostomy before 120 days of age, no difference was observed regarding the duration of propaedeutics or waiting time for surgery (P = 0.15), but difference was found when comparing the age at surgery (P = 0.002). Among those infants with no biliary flow and without liver transplantation or death after 18 post-operative months, the estimated probability of survival was 44.6% and 38.7% in casuistics I and II, respectively. In casuistic I, all infants who showed biliary flow were alive during the observation period and, in casuistic II, 80.3% were alive after 7 years of follow-up. CONCLUSIONS: Even though patients were admitted and treated earlier, it is clear that surgery could be done sooner. Delay in referral and timely propaedeutics were the main contributors.

BILIARY ATRESIA: evaluation on two distinct periods at a reference pediatric service / Atresia biliar: avaliação em dois períodos distintos em um serviço de referência

Context Biliary atresia is a progressive, idiopathic, fibro-obliterative disease of the extrahepatic biliary tree that pre­sents with biliary obstruction exclusively in the neonatal period. Objectives To assess the differences regarding age at referral, age at surgery, duration of propaedeutics and waiting time for surgery between two groups of infants in different periods. Methods Retrospective study of infants diagnosed with biliary atresia on two periods: 1983-1993 and 1998-2011. Results Biliary atresia was diagnosed in 129 infants, being 48 in casuistic I and 81 in casuistic II. The median age at admission was 94 and 60 days, respectively (P = 0.0001). On evaluating patients who had undergone portoenterostomy before 120 days of age, no difference was observed regarding the duration of propaedeutics or waiting time for surgery (P = 0.15), but difference was found when comparing the age at surgery (P = 0.002). Among those infants with no biliary flow and without liver transplantation or death after 18 post-operative months, the estimated probability of survival was 44.6% and 38.7% in casuistics I and II, respectively. In casuistic I, all infants who showed biliary flow were alive during the observation period and, in casuistic II, 80.3% were alive after 7 years of follow-up. Conclusions Even though patients were admitted and treated earlier, it is clear that surgery could be done sooner. Delay in referral and timely propaedeutics were the main contributors. .

Contexto A atresia biliar é uma doença progressiva, idiopática, fibro obliterativa, da vias bilares extra hepáticas que se apresenta com obstrução biliar exclusivamente no periodo neonatal. Objetivos Caracterizar duas épocas distintas visando avaliar se ocorreram alterações quanto a idade de encaminhamento das crianças, idade cirúrgica, duração do tempo entre internação e realização da cirurgia de Kasai, resultados cirúrgicos quanto a presença de fluxo biliar e sobrevida entre dois períodos. Métodos Estudo retrospectivo de crianças com diagnóstico de atresia biliar em dois períodos: 1983-1993 e 1998-2011. Resultados Foram admitidas 129 crianças com diagnóstico de AB, 48 (casuística I) e 81 (casuística II), com idade de admissão mediana de 94 e 60 dias, nas casuísticas I e II, respectivamente (P = 0,0001). Na avaliação dos pacientes submetidos à portoenterostomia com idade até 120 dias de vida, não houve diferença em relação ao tempo entre internação e realização da cirurgia de Kasai (P = 0,15), mas ocorreu ao comparar a idade à cirurgia entre os dois períodos (P = 0,002). A probabilidade estimada de sobrevida dos pacientes sem fluxo biliar livre de transplante ou óbito em 18 meses foi de 44,6%, 38,7% nas casuísticas I e II, respectivamente. Com fluxo biliar, todos estavam vivos ao longo do seguimento da casuística I e 80,3% em sete anos na casuística II. Conclusões Apesar dos pacientes chegarem mais cedo e serem submetidos à portoenterostomia, ainda se opera tarde. Encaminhamento tardio e a propedêutica prolongada são os principais contribuintes. Quanto maior a idade cirúrgica, menor a probabilidade de se obter fluxo biliar e consequentemente menor sobrevida. .

Adesão ao tratamento de doenças crônicas em pediatria: uma revisão crítica da literatura / Adherence to treatment of chronic diseases in pediatrics: a critical literature review

O objetivo do estudo é apresentar revisão da literatura sobre os fatores relacionados à adesão e à não adesão a medicamentos prescritos para pacientes portadores de doenças crônicas prevalentes na faixa etária pediátrica. Foi realizada revisão crítica da literatura, tendo sido selecionados artigos referentes à não adesão, publicados nas bases de dados Medline e Lilacs, no período de 1999 a 2011. A porcentagem de adesão a diversos tipos de tratamento é variável, sendo encontrados dados na literatura, em relação a doenças crônicas, de 4,6 a 100% de adesão, podendo ser atribuída à dificuldade de padronização da definição de critérios utilizados para a avaliação, bem como a diversidade das amostras dos estudos. Vale destacar que a resposta a um tratamento vai além da sua eficácia clínica, o que impõe o conceito de não adesão. Adesão ao tratamento medicamentoso em doenças crônicas é tema complexo. Os profissionais de saúde devem estar atentos aos pacientes que não estão respondendo ao tratamento, reduzindo, desta forma, sequelas e comorbidades, assim como custos adicionais em saúde...

The aims of this study was to present a review of the literature on the factors related to adherence and no adherence to medications prescribed to patients with chronic diseases prevalent in the pediatric population. We performed a critical review of the literature, having been selected articles from non-compliance, published in Medline and Lilacs in the period 1999 to2011. The percentages of adherence to various types of treatment is variable, and find data in the literature in relation to chronic diseases from 4.6 to 100% compliance, which can be attributed to the difficulty in standardizing the definition of criteria used for evaluation, and the diversity of the study samples. Note that the response to treatment goes beyond the clinical efficacy, which imposes the concept of non-compliance. Adherence in chronic diseases is a complex issue. Health professionals should be alert to patients who are not responding totreatment, thus reducing sequel and comorbidities, as well as additional costs in health...

Shift in human rotavirus distribution in Belo Horizonte, Brazil detected by ribonucleic acid electrophoresis.

Rotavirus has been considered the main agent of infectious diarrhea especially among younger children. We addressed the prevalence of rotavirus-associated diarrhea and the diversity of circulating electropherotypes by immunochromatography and RNA electrophoresis. Stool samples were taken from 391 children (267 with diarrhea) from the lower socioeconomic stratum who sought treatment in the Hospital Infantil João Paulo II/Belo Horizonte, during 2005 and 2006. Rotavirus was detected in 79/20.2% of subjects, 64/24.0% with diarrhea and 15/12.1% with no diarrhea. The virus was strongly associated with diarrhea (p = 0.003). A total of 76/19.4% and 69/17.6% rotavirus-positive children were identified by immunochromatography and electrophoresis, respectively. Rotavirus-associated diarrhea was more frequently detected in dry months (p < 0.001) and almost exclusively in children aged up to three years. Long profile strains prevailed (54/78.3%) but a shift toward short electropherotype was identified. Despite the decrease seen in 2006, rotavirus infection is still very common in our area. Although viral RNA electrophoresis is useful as a typing method, it should not be used exclusively in the diagnosis of rotavirus infection. We confirmed a shift from long to short profile strains, as already described for other South American countries.

Shigella in Brazilian children with acute diarrhoea: prevalence, antimicrobial resistance and virulence genes.

Diarrhoeal disease is still considered a major cause of morbidity and mortality among children. Among diarrhoeagenic agents, Shigella should be highlighted due to its prevalence and the severity of the associated disease. Here, we assessed Shigella prevalence, drug susceptibility and virulence factors. Faeces from 157 children with diarrhoea who sought treatment at the Children's Hospital João Paulo II, a reference children´s hospital in Belo Horizonte, state of Minas Gerais, Brazil, were cultured and drug susceptibility of the Shigella isolates was determined by the disk diffusion technique. Shigella virulence markers were identified by polymerase chain reaction. The bacterium was recovered from 10.8% of the children (88.2% Shigella sonnei). The ipaH, iuc, sen and ial genes were detected in strains isolated from all shigellosis patients; set1A was only detected in Shigella flexneri. Additionally, patients were infected by Shigella strains of different ial, sat, sen and set1A genotypes. Compared to previous studies, we observed a marked shift in the distribution of species from S. flexneri to S. sonnei and high rates of trimethoprim/sulfamethoxazole resistance.

Acute diarrhea associated with Salmonella enterica in Belo Horizonte-MG: prevalence and characterization of isolates / Diarreia aguda associada a Salmonella enterica em Belo Horizonte-MG: prevalência e caracterização das amostras isoladas

Introduction: Acute infectious diarrhea is still regarded as a public health problem associated with a wide range of etiologic agents, from which Salmonella enterica is particularly worth mentioning inasmuch as it is a major cause of inflammatory diarrhea in both developed and developing countries. Objective: To assess the distribution of S. enterica among children with acute diarrhea in Belo Horizonte and to characterize bacterium isolates. Material and methods: The study group comprised a total of 157 children from low socioeconomic background. Stool samples were collected for leukocyte analysis and Salmonella bacterial culture. The isolates were serotyped and evaluated as to antimicrobial susceptibility profile, extended-spectrum â-lactamases (ESBL) production, and presence of virulence markers (invA, iroB, and spvC). RESULTS: A total of 5/3.2% children were infected by S. enterica, 3/60% by S. enterica Typhimurium, 1/20% by S. enterica Enteritidis and 1/20% S. enterica subsp. enterica serotype 8.20:z4,z23:-. Fecal leucocytes were detected in two out of five fecal specimens positive for S. enterica. Isolates from three children were resistant to nalidixic acid, nalidixic acid + chloramphenicol, and nalidixic acid + chloramphenicol + ampicillin. ESBL production was not detected. All samples presented invA and iroB genes. spvC marker was observed in isolates from two children infected by S. Typhimurium and S. Enteritidis. Conclusion: The results demonstrate that S. enterica infection is uncommon among children from our region. Furthermore, they indicate the need for periodic monitoring of bacterial antimicrobial susceptibility profile in order to establish suitable antimicrobial therapy when required.

INTRODUÇÃO: A diarreia infecciosa aguda é considerada um problema de saúde pública associado a uma ampla gama de agentes etiológicos, entre os quais destaca-se Salmonella enterica, causa importante de diarreia inflamatória em países desenvolvidos e em desenvolvimento. OBJETIVOS: Avaliar a distribuição de S. enterica em crianças com diarreia aguda em Belo Horizonte e caracterizar as amostras isoladas. MATERIAL E MÉTODO: O grupo de estudo consistiu de 157 crianças de nível socioeconômico baixo. Espécimes fecais foram empregados para pesquisa de leucóc itos e cultivo de Salmonella. As amostras isoladas foram sorotipadas e submetidas à avaliação do perfil de suscetibilidade a antimicrobianos, da produção de betalactamases de amplo espectro (ESBL) e da presença de marcadores de virulência (invA, iroB e spvC). RESULTADOS: Cinco/3,2% crianças apresentaram-se infectadas por S. enterica; três/60%, por S. enterica Typhimurium; uma/20%, por S. enterica Enteritidis; e uma/20%, por S. enterica subsp. enterica sorotipo 8,20:z4,z23:-. Leucócitos fecais foram detectados em dois dos cinco espécimes positivos para S. enterica. As amostras isoladas de três crianças apresentaram resistência a ácido nalidíxico, ácido nalidíxico + cloranfenicol e ácido nalidíxico + cloranfenicol + ampicilina. Nenhuma amostra produziu ESBL. Todas as amostras albergavam os genes invA e iroB. O marcador spvC foi observado em amostras isoladas de duas crianças infectadas por S. Typhimurium e S. Enteritidis. CONCLUSÃO: Os resultados demonstram que diarreia associada a S. enterica é raramente observada entre crianças da nossa região e indicam a necessidade de avaliação periódica do perfil de suscetibilidade a antimicrobianos da bactéria para orientar o estabelecimento de antibioticoterapia, quando indicada.

Shigella in Brazilian children with acute diarrhoea: prevalence, antimicrobial resistance and virulence genes

Diarrhoeal disease is still considered a major cause of morbidity and mortality among children. Among diarrhoeagenic agents, Shigella should be highlighted due to its prevalence and the severity of the associated disease. Here, we assessed Shigella prevalence, drug susceptibility and virulence factors. Faeces from 157 children with diarrhoea who sought treatment at the Children's Hospital João Paulo II, a reference children´s hospital in Belo Horizonte, state of Minas Gerais, Brazil, were cultured and drug susceptibility of the Shigella isolates was determined by the disk diffusion technique. Shigella virulence markers were identified by polymerase chain reaction. The bacterium was recovered from 10.8% of the children (88.2% Shigella sonnei). The ipaH, iuc, sen and ial genes were detected in strains isolated from all shigellosis patients; set1A was only detected in Shigella flexneri. Additionally, patients were infected by Shigella strains of different ial, sat, sen and set1A genotypes. Compared to previous studies, we observed a marked shift in the distribution of species from S. flexneri to S. sonnei and high rates of trimethoprim/sulfamethoxazole resistance.

Endoscopic and pharmacological secondary prophylaxis in children and adolescents with esophageal varices.

OBJECTIVE: The aim of this study was to describe the results of endoscopic secondary prophylaxis, alone or in combination with propranolol, used to prevent upper gastrointestinal bleeding (UGIB) in children and adolescents with esophageal varices. METHODS: This observational study followed 43 patients younger than 18 years who received secondary prophylaxis between August 2001 and December 2009. Sclerotherapy and/or band ligation were performed, and propranolol was used when no contraindications were present. The rebleeding rate, number of endoscopic sessions required for variceal eradication, rate of varix recurrence, the occurrence of varices at the gastric fundus, and the occurrence of portal hypertensive gastropathy were evaluated. RESULTS: Endoscopic prophylaxis in combination with propranolol was performed in 25 patients (58.1%) and endoscopic prophylaxis alone was performed in 18 patients (41.9%). Esophageal varices were eradicated in all of the patients after a median of 3 sessions. Varices recurred in 22 patients (51.2%). Rebleeding occurred in 13 patients (30.2%). Fundal varices and portal hypertensive gastropathy developed in 31% and 61.9% of patients, respectively. No deaths related to the endoscopic procedure or UGIB occurred. No statistically significant differences in any of the studied variables were observed when comparing endoscopic prophylaxis with propranolol and endoscopic prophylaxis alone. CONCLUSIONS: No significant differences were observed between sclerotherapy and band ligation. Secondary prophylaxis was effective in eradicating esophageal varices. The use of propranolol did not affect the results of the endoscopic prophylaxis. Furthermore, randomized studies will be necessary to assess the best form of prevention during childhood.

Prevalência baixa de adenovírus em crianças com diarreia em Belo Horizonte-MG / Low prevalence of adenoviruses in children with acute diarrhea in Belo Horizonte-MG

INTRODUÇÃO: Diversos microrganismos são reconhecidos como agentes de diarreia aguda, entre eles, os adenovírus, cuja associação com a doença apresenta variações geográficas e é pouco conhecida no Brasil. OBJETIVOS: Investigar a presença de adenovírus em fezes de crianças com diarreia aguda e sem diarreia, em Belo Horizonte-MG, e estudar os fatores epidemiológicos associados à adenovirose intestinal. MATERIAL E MÉTODOS: O teste imunocromatográfico qualitativo (kit VIKIA® Rota-Adeno, bioMérieux) foi utilizado para pesquisa de antígenos de adenovírus em amostras fecais obtidas de 268 crianças com diarreia aguda e 124 sem diarreia, em 2005 e 2006, no Hospital Infantil João Paulo II, Belo Horizonte-MG. Dados laboratoriais, clínicos e epidemiológicos foram registrados em banco de dados (SPSS Statistical package, IBM). RESULTADOS: Adenovírus foi detectado nas fezes de 16 crianças (4,1%): 12 (4,5%) com diarreia e quatro (3,2%) sem diarreia. A virose foi mais comum em meninas e a distribuição etária da infecção foi homogênea. Entre as 16 crianças com infecção pelo vírus, 11 (68,8%) tinham até 12 meses de idade. Entretanto, diferença significativa não foi observada para os parâmetros analisados. Distribuição sazonal da infecção por adenovírus não foi detectada. CONCLUSÃO: Nossos dados demonstram que a prevalência da adenovirose é baixa na população pediátrica no nosso meio.

INTRODUCTION: Several microorganisms, among them enteric adenovirus, are widely recognized as etiological agents of acute diarrhea. The association between adenovirus and the disease varies among geographical regions and is poorly known in Brazil. OBJECTIVES: To investigate the presence of adenovirus in stool samples from children with and without diarrhea in Belo Horizonte-MG. To study factors associated with enteric adenovirus infection. MATERIAL AND METHOD: A qualitative immunochromatographic assay (kit VIKIA® Rota-Adeno, bioMérieux) was performed to detect adenovirus antigens in stool samples from 268 children with acute diarrhea and 124 without diarrhea at Hospital Infantil João Paulo II from January/2005 to December/2006. Clinical, laboratory, and epidemiologic data were recorded in SPSS database (SPSS Statistical package, IBM). RESULTS: Adenovirus was detected in 16 samples (4.1%): 12 of them (4.5%) were from children with acute diarrhea and 4 of them (3.2%) from children without diarrhea. The viral infection was more prevalent among girls and the age distribution was homogenous. Among the 16 children infected by adenovirus,11 (68.8%) were younger than 12 months old. However, no significant statistical difference was observed within the analyzed parameters. There was no seasonal distribution of adenovirus infection. CONCLUSION: Our data demonstrate that the prevalence of enteric adenovirus infection is low among children with diarrhea in Belo Horizonte-MG.

Evaluation of the presence of hereditary and acquired thrombophilias in Brazilian children and adolescents with diagnoses of portal vein thrombosis.

OBJECTIVE: The aim of this study was to describe the prevalence of main hereditary thrombophilias, Janus kinase 2 (JAK2) V617F mutation, antiphospholipid antibody syndrome (APS), and hyperhomocysteinemia in Brazilian children and adolescents diagnosed with portal vein thrombosis (PVT) without associated hepatic disease. METHODS: A cross-sectional study was carried out with 32 children with PVT in accompaniment at Hospital das Clínicas of the Universidade Federal de Minas Gerais from January 1990 to July 2011. Laboratory evaluation of thrombophilias was performed from September 2010 to July 2011. RESULTS: Thirty-two patients were evaluated; 59% were boys. Median age at diagnosis was 2.4 years. Mean time of patients' accompaniment was between 4.7 and 5.2 years. The presence of hereditary and acquired thrombophilias occurred in 34.4% of patients, and 9 of them also showed other risk factors in the previous history evaluation. Risk factors were absent in the previous history of 18 patients (56.3%). Two patients showed persistent high titres of anticardiolipin antibodies. Hyperhomocysteinemia was not observed. One patient was heterozygous for factor V Leiden and prothrombin G20210A mutation (3.1%). Eleven patients (34.4%) showed heterozygous methylenetetrahydrofolate reductase (MTHFR) C677T, and no patient had the JAK2V617F mutation. CONCLUSIONS: Even after investigation of main hereditary and acquired thrombophilia, PVT remains without apparent cause in most patients. Nevertheless, association of local and systemic risk factors seems to be important also in the pediatric age group. Therefore, despite the low prevalence, a complete investigation, which includes both hereditary and acquired thrombophilias, may be necessary.

Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center.

CONTEXT: Portal vein thrombosis refers to a total or partial obstruction of the blood flow in this vein due to a thrombus formation. It is an important cause of portal hypertension in the pediatric age group with high morbidity rates due to its main complication - the upper gastrointestinal bleeding. OBJECTIVE: To describe a group of patients with portal vein thrombosis without associated hepatic disease of the Pediatric Hepatology Clinic of the Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil with emphasis on diagnosis, presentation form and clinical complications, and the treatment of portal hypertension. METHODS: This is a descriptive study of a series of children and adolescents cases assisted from January 1990 to December 2010. The portal vein thrombosis diagnosis was established by ultrasound. RESULTS: Of the 55 studied patients, 30 (54.5%) were male. In 29 patients (52.7%), none of the risk factors for portal vein thrombosis was observed. The predominant form of presentation was the upper gastrointestinal bleeding (52.7%). In 20 patients (36.4%), the initial manifestation was splenomegaly. During the whole following period of the study, 39 patients (70.9%) showed at least one episode of upper gastrointestinal bleeding. The mean age of patients in the first episode was 4.6 ± 3.4 years old. The endoscopic procedure carried out in the urgency or electively for search of esophageal varices showed its presence in 84.9% of the evaluated patients. The prophylactic endoscopic treatment was performed with endoscopic band ligation of varices in 31.3% of patients. Only one died due to refractory bleeding. CONCLUSIONS: The portal vein thrombosis is one of the most important causes of upper gastrointestinal bleeding in children. In all non febrile children with splenomegaly and/or hematemesis and without hepatomegaly and with normal hepatic function tests, it should be suspect of portal vein thrombosis. Thus, an appropriate diagnostic and treatment approach is desirable in an attempt to reduce morbidity and mortality.

Prevalência de Salmonella enterica em crianças com idade inferior a 5 anos com diarreia aguda e controles em Teresina-PI / Prevalence of Salmonella enterica in children aged less than 5 years with acute diarrhea and controls in Teresina-PI

We investigated the prevalence of Salmonella enterica (SE) among children (n = 400/250 with diarrhea) in Teresina-PI from 2004 to 2007. SE Newport was isolated from two samples and O-C2-C3-ND, Enteritidis, and Muenchen serological variants were isolated from one sample each. SE infection was more prevalent among children aged less than six months. Increased fecal volume, 3-10 evacuations/day, vomit and fever were reported for all cases. Resistance to nalidixic acid (NAL) and sulphamethoxazole-trimethoprim (SXT) was ubiquitous. Our data substantiate the need for monitoring SE infections worldwide and the emergence of antimicrobial resistance.

Foi estudada a prevalência de Salmonella enterica (SE) em crianças (n = 400; 250 com diarreia) em Teresina-PI, entre 2004 e 2007. SE Newport foi isolada de duas crianças e os sorotipos O-C2-C3-ND, Enteritidis e Muenchen foram encontrados em uma criança cada. A infecção foi mais comum em crianças com até 6 meses de idade. Volume fecal aumentado, três a 10 evacuações/dia, vômitos e febre foram relatados para todas as crianças. Foi comum resistência a ácido nalidíxico (NAL) e sulfametoxazol-trimetoprima (SXT). Nossos dados demonstram a necessidade de monitoramento da magnitude das salmoneloses em diferentes regiões do mundo e da emergência de padrões de resistência.

Portal vein thrombosis in children and adolescents: 20 years experience of a pediatric hepatology reference center / Trombose de veia porta em crianças e adolescentes: experiência de 20 anos de um serviço de referência em hepatologia pediátrica

CONTEXT: Portal vein thrombosis refers to a total or partial obstruction of the blood flow in this vein due to a thrombus formation. It is an important cause of portal hypertension in the pediatric age group with high morbidity rates due to its main complication - the upper gastrointestinal bleeding. OBJECTIVE: To describe a group of patients with portal vein thrombosis without associated hepatic disease of the Pediatric Hepatology Clinic of the Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil with emphasis on diagnosis, presentation form and clinical complications, and the treatment of portal hypertension. METHODS: This is a descriptive study of a series of children and adolescents cases assisted from January 1990 to December 2010. The portal vein thrombosis diagnosis was established by ultrasound. RESULTS: Of the 55 studied patients, 30 (54.5%) were male. In 29 patients (52.7%), none of the risk factors for portal vein thrombosis was observed. The predominant form of presentation was the upper gastrointestinal bleeding (52.7%). In 20 patients (36.4%), the initial manifestation was splenomegaly. During the whole following period of the study, 39 patients (70.9%) showed at least one episode of upper gastrointestinal bleeding. The mean age of patients in the first episode was 4.6 ± 3.4 years old. The endoscopic procedure carried out in the urgency or electively for search of esophageal varices showed its presence in 84.9% of the evaluated patients. The prophylactic endoscopic treatment was performed with endoscopic band ligation of varices in 31.3% of patients. Only one died due to refractory bleeding. CONCLUSIONS: The portal vein thrombosis is one of the most important causes of upper gastrointestinal bleeding in children. In all non febrile children with splenomegaly and/or hematemesis and without hepatomegaly and with normal hepatic function tests, it should be suspect of portal vein thrombosis. Thus, an appropriate diagnostic and treatment approach is desirable in an attempt to reduce morbidity and mortality.

CONTEXTO: Trombose da veia porta refere-se a uma obstrução total ou parcial do fluxo de sangue nesta veia devido à formação de um trombo. É uma causa importante da hipertensão porta na faixa etária pediátrica, com taxas elevadas de morbidade devido a sua principal complicação - a hemorragia digestiva alta. OBJETIVO: Descrever o grupo de crianças e adolescentes com trombose de veia porta sem doença hepática associada do Ambulatório de Hepatologia Pediátrica do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brasil, com ênfase no diagnóstico, forma de apresentação, complicações clínicas e na abordagem da hipertensão porta. MÉTODOS: Trata-se de estudo descritivo de uma série de casos de crianças e adolescentes atendidos de janeiro de 1990 a dezembro de 2010. O diagnóstico de trombose de veia porta foi estabelecido por ultrassonografia. RESULTADOS: Dos 55 pacientes analisados, 30 (54,5%) eram do gênero masculino. Em 29 pacientes (52,7%) não foi identificado nenhum fator de risco para trombose de veia porta. A forma de apresentação predominante foi hemorragia digestiva alta (52,7%). Em 20 pacientes (36,4%), a manifestação inicial foi esplenomegalia. Durante todo o período de seguimento, 39 pacientes (70,9%) apresentaram, pelo menos, um episódio de hemorragia digestiva alta. A média de idade dos pacientes neste primeiro episódio foi de 4,6 ± 3,4 anos. O exame endoscópico, seja realizado na urgência ou eletivamente para pesquisa de varizes esofágicas, mostrou sua presença em 84,9% dos pacientes avaliados. O tratamento endoscópico profilático foi realizado com ligadura elástica de varizes em 31,3% dos pacientes. Apenas um evoluiu para óbito devido a sangramento refratário. CONCLUSÕES: A trombose de veia porta é uma das causas mais importantes de hemorragia digestiva alta em crianças. Deve-se suspeitar de trombose de veia porta em toda criança com esplenomegalia afebril e/ou hematêmese, sem hepatomegalia e com testes de função hepática normais. Desta forma, uma abordagem diagnóstica e terapêutica adequada é desejável na tentativa de reduzir a morbimortalidade.

Attaching and effacing Escherichia coli and Shiga toxin-producing E. coli in children with acute diarrhoea and controls in Teresina/PI, Brazil.

This 3.5-year prospective study was conducted to ascertain the level of attaching and effacing Escherichia coli (AEEC) associated diarrhoea in children from Teresina, a northeastern state of Brazil. Passed faecal specimens from 400 patients (250 with and 150 without diarrhoea) up to 60 months of age attending from 2004 to 2007 at two public hospitals were investigated. Conventional microbiology methods and PCR were employed. Escherichia coli was isolated from 390 children, 240 of them with diarrhoea. A total of 117 AEEC strains were cultivated from specimens from 63 children, 37 with and 26 without diarrhoea. No association between AEEC and diarrhoea was observed. Atypical enteropathogenic E. coli (a-EPEC) (79.4%) was more commonly found than typical EPEC (t-EPEC). Association between EPEC and EPEC subtypes and diarrhoea was not detected. Mixed infection by t-EPEC and a-EPEC and infection by Shiga toxin-producing E. coli (STEC) were rare. Enteropathogenic E. coli was more common in males and in children aged less than 12 months. Correlation between serotyping and PCR results was 0.19. High resistance rates of AEEC to ampicillin, cephalotin, and trimethoprim-sulfamethoxazole were found. In conclusion, EPEC is very common in children with diarrhoea and controls in the population we studied, with a-EPEC predominating. This diarrhoeagenic E. coli (DEC) pathotype is more common in infant males and is resistant to drugs frequently used in clinical practice.