Brazilian pediatricians' adherence to food allergy guidelines-A cross-sectional study.

Food allergy is an emerging clinical condition in pediatrics, so recommendations on its management have been widely published. Studying pediatricians' adherence to these clinical practice guidelines (CPG) and understanding the reasons for their non-compliance can help to promote better management of this condition. A cross-sectional study was conducted by a survey among Brazilian pediatricians, randomly selected during the 38th Brazilian Congress of Pediatrics, which took place in October, 2017. A validated questionnaire with 16 questions addressing knowledge and practice on food allergy, as well as self-reported adherence to international guidelines was applied. Of the total of 415 pediatricians from all regions of the country who were surveyed, only 69 (16.7%) had a satisfactory adherence rate (≥80%). Adequate adherence to the guidelines was associated with the variables: 'evaluating more than 10 children with suspected cow's milk allergy (CMA) per month'; 'having read the Brazilian consensus'; or 'being aware of any international food allergy guideline'. In 8 of the 10 questions that assessed conscious adherence, a minority of those surveyed (20.3-42.3% variation) stated that they knew that their response was in line with the guidelines. This finding was statistically significant (p<0.05) in 7 of these 8 questions. The self-reported adherence of Brazilian pediatricians to international food allergy guidelines was low. Pediatricians who evaluated a higher number of children with suspected CMA or who were aware of the recommendations, had a higher rate of adherence. The results of the survey found that lack of resource was the major reported barrier to guideline adherence but lack of awareness must be a relevant non perceived barrier. This study shows the pediatricians´ self-reported adherence to food allergy guidelines in a widely overview for the first time in Brazil. More studies are necessary to investigate adherence to guidelines by pediatricians in other countries and to develop strategies to improve adherence.

Transporte transepitelial de glicose, sódio e água e RNA mensageiro dos transportadores de glicose no intestino delgado de ratos com anemia ferropriva / Transepithelial transport of glucose, sodium and water and mRNA of glucose transporters in the small intestine of rats with iron-deficiency anemia

Objetivos: Avaliar em ratos com anemia por deficiência de ferro o transporte transepitelial de sódio, glicose, potássio e água, e o conteúdo de mRNA da proteína cotransportadora de sódio / glicose (SGLT1) e da proteína facilitadora do transporte de glicose (GLUT2) no intestino delgado. r Métodos: Foram utilizados, para cada experimento, ratos machos Wistar-EPM com 21I dias completos de vida, que receberam dieta pobre em ferro (<5 mg de ferro elementar/kg - grupo anêmico) ou com conteúdo normal de ferro (>35 mg de ferro elementar/kg - grupo controle) durante seis semanas. O transporte transepitelial de sódio, glicose, potássio e água foi avaliado por meio do modelo experimental da perfusao intestinal In vivo" em ratos com anemia ferropriva (n=9) e ratos sem anemia (n=10). A perfusao intestinal In vivo" foi realizada em 20 cm de jejuno, utilizando-se a soluçao de reidrataçao da O.M.S. Em 12 ratos anêmicos e 11 ratos sem anemia foram avaliados o conteúdo relativo do mRNA do SGLT1 e do GLUT2 nas porçoes proximal, intermédia e distal do intestino delgado, por meio da técnica de Northem Blotting. Os dois experimentos foram realizados em períodos e com ratos diferentes. Resultados: Após seis semanas de tratamento dietético a concentraçao sangüínea da hemoglobina e o conteúdo de ferro hepático dos ratos anêmicos submetidos à perfusao intestinal (Hb: 8,7 g/dl / DP=1,0 g/dl; ferro hepático: 0,099 mg/g / DP=0,012 mg/g) ou utilizados para determinaçao do mRNA (Hb: 3,9 g/dl / DP=0,7 g/dl; ferro hepático: 0,078 mg/g / DP=0,015 mg/g) foram estatisticamente inferiores a dos ratos controles, tanto no primeiro experimento (Hb: 13,9 g/dl I DP=1,5 g/dl; ferro hepático: 0,344 mg/g I DP=0,074 mg/g) quanto no segundo (Hb: 11,7 g/dl / DP=1,3 g/dl; ferro hepático: 0,192 mg/g I DP=0,030 mg/g). O transporte transepitelial médio de sódio (-32,96 pEqlmin.cm / DP=370,81 pEq/min.cm), glicose (425,95 pM/min.cm / DP=535,84 gMlmin.cm) e água (0,44 pl/min.cm / DP=4,18 pl/min.cm) no intestino delgado dos ratos anêmicos foi significantemente menor do que o do grupo controle (sódio: 349,13 pEq/min.cm / DP=227,26 pEq/min.cm; glicose: 842,62 pM/min.cm / DP=297,64 gMlmin.cm; água: 4,32 pl/min.cm / DP=2,79 pl/min.cm). Nao foi observada diferença com relaçao ao transporte transepiteliaL de potássio. O conteúdo relativo de mRNA, expresso em unidades arbitrárias (UA), do SGLT1 dos ratos anêmicos nos segmentos...(au)