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

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

Intestinal microbiota and allergic diseases: A systematic review.

Evidence suggests that possible imbalances in intestinal microbiota composition may be implicated in the occurrence of allergic diseases. Although several studies published until 2006 indicated a correlation between microbiota composition and allergic symptoms, it has not been possible to distinguish protective microorganisms from those associated with increased risk of allergic diseases. Therefore, the objective of this study was to review the studies published since 2007 that address the intestinal microbiota in allergic diseases. Twenty-one studies were identified after excluding those that performed a clinical intervention before stool collection. In the early microbiota of children who later developed allergies, lower bacterial diversity was observed, with a predominance of Firmicutes; a higher count of Bacteroidaceae; a higher prevalence of the anaerobic bacteria Bacteroides fragilis, Escherichia coli, Clostridium difficile, Bifidobacterium catenulatum, Bifidobacterium bifidum, and Bifidobacterium longum; and a lower prevalence of Bifidobacterium adolescentis, B. bifidum, and Lactobacillus. In the microbiota of allergic children whose intestinal microbiota was assessed at the onset of allergic symptoms, there was a higher count of Bacteroides; a lower count of Akkermansia muciniphila, Faecalibacterium prausnitzii, and Clostridium; a higher prevalence of B. adolescentis; a lower prevalence of B. catenulatum and Staphylococcus aureus; and a lower bacterial diversity.

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

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

Consensus on the diagnosis and treatment of cow's milk protein allergy of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

Cow's milk protein allergy (CMPA) is the most frequent cause of food allergy in the first months of life. Despite the fact that there are different guidelines and recommendations on the management of children with CMPA, there continues to be great variability in diagnostic and therapeutic criteria in Latin America. The Food Allergy Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition summoned a group of Latin American experts to reach a consensus and formulate a document to unify diagnostic and therapeutic criteria for CMPA. Three teams were formed, each with a coordinator, and the members of each team developed a series of statements for their corresponding module: a) clinical manifestations and diagnosis; b) diagnostic tools, and c) treatment. A search of the medical literature was carried out to support the information presented in each module and 28 statements were then selected. The statements were discussed, after which they were evaluated by all the experts, utilizing the Delphi method. Their opinions on statement agreement or disagreement were anonymously issued. The final statements selected were those with above 75% agreement and their corresponding recommendations were formulated, resulting in the document presented herein.

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

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

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

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

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

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

A randomized double-blind clinical trial of the effect of non-absorbable oral polymyxin on infants with severe infectious diarrhea.

The present study evaluated the effect of non-absorbable oral polymyxin on the duodenal microflora and clinical outcome of infants with severe infectious diarrhea. Polymyxin was chosen because classic enteropathogenic Escherichia coli was more sensitive to this antibiotic. Twenty-five infants were randomly assigned to a 7-day treatment with oral polymyxin (2.5 mg/kg in 4 daily doses) or placebo. Duodenal and stool cultures were performed before and after the treatment. Five patients were excluded during the study because of introduction of parental antibiotic therapy due to clinical sepsis (N = 3) or rapid clinical improvement (N = 2). In the polymyxin group, small bowel bacterial overgrowth occurred in 61.5% of the cases (8/13) before treatment and in 76.9% (10/13) after treatment. In the placebo group these values were 71.4% (5/7) and 57.1% (4/7), respectively. By the 7th day, clinical cure was observed in 84.6% of the cases (11/13) in the polymyxin group and in 71.4% (5/7) in the placebo group (P = 0.587). Considering all 25 patients included in the study, clinical cure occurred on the 7th day in 12/14 cases (85.7%) in the polymyxin group and 6/11 cases (54.5%) in the placebo group (P = 0.102). Clinical sepsis occurred in 3/11 (27.3%) of the patients in the placebo group and in none (0/14) in the polymyxin group (P = 0.071). Oral polymyxin was not effective in reducing bacterial overgrowth or in improving the clinical outcome of infants hospitalized with severe infectious diarrhea. Taking into account the small sample size, the rate of cure on the 7th day and the rate of clinical sepsis, further studies with greater number of patients are necessary to evaluate these questions.

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

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

Low-dietary fiber intake as a risk factor for recurrent abdominal pain in children.

OBJECTIVE: To evaluate dietary fiber intake in children with recurrent abdominal pain. DESIGN: Cross-sectional study with control group. SETTING: Outpatients of the Pediatric Gastroenterology public health clinic of the Darcy Vargas Children's Hospital, Brazil. SUBJECTS: Forty-one patients with recurrent abdominal pain were evaluated and 41 children, as a control group. INTERVENTIONS: Macronutrients and fiber intake evaluation by the Daily Food Intake method. Two tables of fiber composition in foods were used. RESULTS: According to the Brazilian table the mean intake of fiber (g/day) by the children of the recurrent abdominal pain groups with chronic constipation or not, and the control group was, respectively, 18.2, 16.6 and 23.7 for total fiber (P=0.001), 7.5, 6.9 and 9.5 for soluble fiber (P=0.001) and 10.7, 9.7 and 14.1 for insoluble fiber (P=0.002). According to the AOAC table, the recurrent abdominal pain group with chronic constipation or not (10.6 and 9.9 g/day) also had lower intake of total fiber than the control group (13.4 g/day) (P=0.008). The intake of fiber was lower than the minimum recommended value (age+5 g) and statistically associated (P=0.021) with the recurrent abdominal pain group (78%) in comparison with the control one (51.2%). The odds ratio was 3.39 (95% CI, 1.18-9.95). CONCLUSION: fiber intake below the minimum recommended value is a risk factor for recurrent abdominal pain in children.

Can bacterial translocation be a beneficial event?

Infection is a major concern in intestinal transplant recipients. Bacterial migration to extraintestinal sites is a central component of the gut hypothesis of sepsis. However, some studies have cited the beneficial effects of bacterial translocation (BT) on the host acquired immune system. We evaluated the role of previous BT on a subsequent BT challenge, examined the BT index in organs as well as changes in white blood cell (WBC) count in mesenteric lymph and blood for correlation with outcomes. Wistar rats (n = 60) were divided into a BT group (n = 20), which underwent inoculation of 10 mL of 10(10) CFU/mL Escherichia coli R-6 confined to the small intestine as opposed to a BT1-14 group (n = 20), which underwent the BT procedure on days 1 and 14 or a S1-BT14 group (n = 20) that received 10 mL of saline on day 1 and the BT procedure on day 14. Half of the animals were killed 2 hours following the BT procedure. Samples from different compartments were collected for culture. Mesenteric lymph and peripheral blood were examined for WBC counts. The other half of the hosts was subjected to outcome evaluation concerning weight gain and mortality. Animals undergoing double BT showed a significantly lower index of bacterial recovery (liver, spleen, and blood) compared with those having a single BT (P < .05). The WBC count of mesenteric lymph cells after double BT was similar to naïve animals, but significantly lower than the single BT group (P < .05). The outcome was unchanged among double BT versus other groups. A previous BT challenge was efficient to generate a host-defense mechanism against a second BT episode induced by intestinal overgrowth with the same bacterial strain.

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

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

Observations of the Alto Xingu Indians (central Brazil) with special reference to nutritional evaluation in children.

Little information concerning the nutritional status of Brazilian Indians living primitively in a large area of the Amazon region is available at present. This study took place in the Xingu National Park, created to preserve the Indian population living in this area, along with its culture. Field work was done in three consecutive years (1974, 1975, 1976). At the end of this period 175 children had been studied (97 male and 78 female) all estimated to be under 5 yr of age. Two kinds of studies were performed: 1) cross-sectional: studying the children that entered in the nutritional survey every year, and 2) longitudinal: studying the children that were under observation for 2 or 3 consecutive yr. The nutritional status was evaluated by two age-independent anthropometric indices, namely, weight-for-height and arm-circumference-for-height. The weight-for-height index showed that 96.0% of the children examined were classified as well nourished, 3.4% suffered of 1st degree malnutrition and 0.6% of 2nd degree malnutrition. The arm-circumference-for-height revealed that 97.1% were well nourished and 2.9% were classified as suffering of a mild degree of malnutrition. Since both indices used can give normal results in a population in which there is severe stunting or nutritional dwarfism, a longitudinal study was drawn. Growth in height was studied, resulting normal in 84.8% of the measurements taken. In contrast to children from low income families living in the outskirts of large urban centers where malnutrition reaches 54.0%, the Indians remain as healthy as they were when last examined 30 yr ago.

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

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

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

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

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

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

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

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

[Breath hydrogen test to evaluate lactose absorption and small bowel bacterial overgrowth in children]. / Teste do H2 no ar expirado na avaliação de absorção de lactose e sobrecrescimento bacteriano no intestino delgado de escolares.

The aim of this study was to determine the lactose absorption capacity and possible existence of bacterial overgrowth in the small bowel in asymptomatic school children of low social economic level in Marilia, a city located in the interior of São Paulo state. Eighty three children aging 7 to 15 years old without any gastrointestinal manifestations at least 30 days prior to the tests were studied. All the patients had fasted for at least 8 hours before the tests were performed. Lactose absorption was evaluated by breath hidrogen test after an overload of lactose 18 g in 10% aquous solution. Lactose intolerance was determined by the occurrence of clinical symptoms, such as diarrhea, abdominal pain, flatulence, etc in the following 24 hours after the test was performed. Bacterial overgrowth was evaluated by the breath hidrogen test after a 10 g lactulose load in aqueous solution. Lactose malabsorption was detected in 19 (22.9%) children and lactose intolerance was observed in 10 (12%) children. Lactose intolerance was more frequently observed in children who showed lactose malabsorption (6/19; 31.6%) than in those who presented a normal test (4/64; 6.3%) (P = 0.008). Bacterial overgrowth was detected in six (7.2%) children and showed no statistical relationship with lactose malabsorption. Ontogenetic lactose malabsorption verified in this group of school children is similar to the reported for Caucasian populations. Presence of bacterial overgrowth confirms the existence of asymptomatic environmental enteropathy in children of low social economic level.

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

In the recent past, some celiac disease features have been discussed in literature specially related to genetic susceptibility, pathogenesis, clinical presentation and diagnostic criteria. Immunological abnormalities characteristic of celiac disease, such as circulating antibodies and increased numbers of intra-epithelial lymphocytes containing a high percentage of gamma-delta T cells have been demonstrated. Other pictures of clinical presentation besides the classical one deserve attention namely short stature, iron-resistant anaemia, enamel hypoplasia, constipation, neurological manifestation and osteoporosis, among others. Asymptomatic presentation has been recognized since development of serological markers such as anti-gliadin, anti-reticulin and anti-endomysium antibodies. Up to now, small intestinal biopsy is the only decisive diagnostic approach. A Federal law has recently imposed food manufactures to place labels informing the presence of gluten in industrialized foods in Brazil. Lately there has been an increase in celiac disease patients registered in the Brazilian Celiac Association.

[Assessment of gliadin in pharmaceutical products - important information to the orientation of celiac disease patients]. / Pesquisa de gliadina em medicamentos--informação relevante para a orientação de pacientes com doença celíaca.

BACKGROUND: Some drugs might contain gliadin which can be dangerous for celiac disease patients. OBJECTIVE: Detect gliadin in pharmaceutical products commonly used in Brazil. METHODS: We analyzed 78 pharmaceutical products selected aleatory from a list of 180 products most frequently sold at Brazilian community pharmacies. The analyzed samples were analgesics (n = 9), anthelmintics (n = 3), antacids (n = 8), antibiotics (n = 13), anticholesteremics (n = 1), anticonvulsants (n = 2), antidepressants (n = 2), antiemetics (n = 3), antihypertensives (n = 3), antihistaminics (n = 3), anti-inflammatories (n = 7), antipyretics (n = 2), bronchodilators (n = 1), laxatives (n = 1), oral contraceptives (n = 5) and vitamins (n = 10). The samples were analyzed by enzyme immunoassay based on monoclonal antibodies omega-gliadins, the elected technique according to the Codex Alimentarius Commission WHO/FAO. All samples were analyzed in duplicate. The sensitivity of this test is 4 mg of gliadin/100 g of product. RESULTS: Only one (1.3%) out of 78 pharmaceutical products contained detectable amounts of gliadin (5.5 mg/100 g). The active ingredient of this drug is ranitidine. According to the Codex Alimentarius Commission WHO/FAO the intake of 10 mg of gliadin/day should not be exceeded by celiac disease patients. Considering the amount of gliadin in each capsule of ranitidine, the ingested quantity would be lower than the maximum allowed for celiac patients. CONCLUSIONS: In this study gliadin was not detected in pharmaceutical products in harmful amount for celiac disease patients.

[Serum antigliadin antibodies in the diagnosis and follow-up of celiac disease]. / Anticorpo sérico antigliadina no diagnóstico e seguimento da doença celíaca.

Between July 1985 and June 1990, we prospectively investigated 236 children suspected of having malabsorption syndrome. Each patient had a xylose absorption test and small intestinal biopsy. Blood samples were collected to AGA assay. The aim of the study was to evaluate the use of antigliadin antibodies test, IgG and IgA, in screening celiac disease for intestinal biopsy and in the monitoring of gluten-free diet and challenge in celiac patients. Twenty patients were diagnosed with celiac disease confirmed by three small intestinal biopsies; 12 patients were suspected of having celiac disease, with two biopsies, before and one year after a gluten-free diet; 106 patients had environmental enteropathy; 45 patients had protracted diarrhea and 56 children had failure to thrive with no gastrointestinal symptoms. The AGA test was considered a reliable test in screening for biopsy and in the differential diagnosis between celiac disease and other causes of malabsorption syndrome. The IgG AGA test had high sensitivity (90.4%) and the IgA AGA test had high specificity (92.1%) in screening for celiac disease. In the follow-up of the celiac patients the antibody levels were significantly higher during gluten containing diet than after gluten avoidance being thus a reliable test to evaluate dietary compliance.