Celiac disease (CD) is an underdiagnosed disease occurring in different clinical forms. This study aimed to determine the prevalence of CD among blood donors from Ribeirão Preto, Brazil, and to study some demographic characteristics of celiac patients. Blood samples from 3000 blood donors were tested for the presence of tissue transglutaminase antibody and positive samples were tested for endomysial antibody. Donors positive to both tests were referred for clinical evaluation and for a jejunal biopsy. Twenty-four samples were moderately/strongly positive for transglutaminase, with 9 of them being endomysial negative and 15 positive. Of the 13 biopsies obtained from 12 females and 1 male, 1 was classified as Marsh grade IV, 4 as grade III, 2 as grade II, 4 as grade I, and 2 as grade 0. Estimated prevalence was therefore 1:273 (0.33%; 95% CI, 0.127 to 0.539). The 1:273 estimated prevalence of CD detected indicates that the disease is not rare in Brazil. The frequency was higher among females and among individuals of European descent, with a significantly higher frequency for a family history of digestive tract cancer or epilepsy.

Abstract. Capillaria hepatica is a helminth that may cause an extremely rare condition of parasitic hepatitis. Only 29 cases have been published, 2 of them in Brazil. We report here 3 cases of children in Brazil with massive hepatic capillariasis who presented the characteristic triad of this type of infection, i.e., persistent fever, hepatomegaly, and eosinophilia. The diagnosis was made by liver biopsy. All children responded well after treatment with thiabendazole (case 1), albendazole (case 3), and albendazole in combination with a corticoid (case 2). Case 1 has been followedup for 24 years, an event not previously reported in the literature.

Iron-deficiency anemia is the nutritional deficiency most frequently occurring throughout the world, which manifests as a complex systemic disease involving all cells, affecting enzyme activities and modifying protein synthesis. In view of these considerations, the objective of the present study was to determine the effects of irondeficiency anemia on disaccharidases and on the epithelial morphokinetics of the jejunal mucosa. Newly weaned male Wistar rats were divided into 4 groups of 10 animals each: C6w received a standard ration containing 36 mg elemental iron per kg ration for 6 weeks; E6w received an iron-poor ration (5-8 mg/kg ration) for 6 weeks; C10w received an iron-rich ration (36 mg/kg ration) for 10 weeks; E10w received an iron-poor ration for 6 weeks and then an iron-rich ration (36 mg/kg) for an additional 4 weeks. Jejunal fragments were used to measure disaccharidase content and to study cell proliferation. The following results were obtained: 1) a significant reduction (P<0.001) of animal weight, hemoglobin (Hb), serum iron and total iron-binding capacity (TIBC) in group E6w as compared to C6w; reversal of the alterations in Hb, serum iron and TIBC with iron repletion (E10w = C10w); animal weights continued to be significantly different in groups E10w and C10w. 2) Sucrase and maltase levels were unchanged; total and specific lactase levels were significantly lower in group E6w and this reduction was reversed by iron repletion (E10w = C10w).3) The cell proliferation parameters did not differ between groups. On the basis of these results, we conclude that lactase production was influenced by iron deficiency and that this fact was not related to changes in cell population and proliferation in the intestinal mucosa.

These results indicate that CCLD limits bone mass gain in children. A reduction in hepatic IGF-1 production might be responsible, at least in part, for the low bone mass of these patients.

RESUMO: Objetivo: analisar algumas características clínicas e laboratoriais de crianças com doença de Hirschsprung. Métodos: estudo retrospectivo de 53 crianças com diagnóstico final de doença de Hirschsprung, atendidas de janeiro de 1981 a dezembro de 1999, no Hospital das Clínicas/ USP, Ribeirão Preto. Foram analisados alguns parâmetros clínicos (distribuição segundo o gênero, idade no início dos sinais e sintomas, na 1 a consulta e no diagnóstico da doença, principais sinais e sintomas e estado nutricional) e laboratoriais da 1 a consulta, que permitiram o diagnóstico (enema opaco, manometria anorretal e biópsia retal), bem como a evolução dos pacientes após o tratamento cirúrgico. Resultados: 42 crianças (79,2%) eram meninos. Os primeiros sinais e sintomas ocorreram no 1 0 mês, em 43 casos (81,1%), a idade, na primeira consulta, teve mediana de 7 meses e idade de diagnóstico, mediana de 8,8 meses. As principais manifestações clínicas foram: distensão abdominal em 83,0%, constipação intestinal em 73,6%, atraso na eliminação do mecônio em 60,7% dos casos. Não foi evidenciado importante comprometimento ponderoestatural. O enema opaco mostrou zona de transição em 47,2% (17/36) e, na manometria anorretal, observou-se ausência de reflexo reto esfincteriano em 73,7% (14/19). Todas as biópsias anorretais evidenciaram aganglionose. Uma das crianças foi submetida a tratamento clínico e 52 a tratamento cirúrgico. A colostomia foi realizada em 22/52 crianças (42,3%) e o tratamento cirúrgico definitivo em 49, sendo, em 77,6%, cirurgia de Duhamel Haddad, em 20,4%, cirurgia de Soave e, em 2,0%, cirurgia de Lestar Martin. As complicações pré-operatórias mais freqüentes foram obstrução intestinal em 28,3% e enterocolite em 11,3% dos casos. As principais complicações pós operatórias da colostomia foram: eventração e/ou prolapso e/ou estenose em 22,7% dos casos e do tratamento cirúrgico definitivo: escape e/ou incontinência fecal em 28,6%, infecção e/ou deiscência de ferida cirúrgica em 22,4% e enterocolite e/ou diarréia em 20,4%. Três crianças não foram submetidas a tratamento cirúrgico definitivo. Dez crianças (18,9%) obtiveram alta, 14 (26,4%) continuam em seguimento ambulatorial e 27 (50,9%) abandonaram o serviço após a cirurgia definitiva. Houve um óbito devido a enterocolite algum tempo após a cirurgia definitiva e 1 criança continua em seguimento ambulatorial em outro serviço, após a reconstrução do trânsito. Cinco das 14 crianças (35,7%) que permanecem em seguimento e 8 (29,6%) das 27 crianças que abandonaram o serviço mantinham escape e/ou incontinência fecal na última consulta. Conclusão: houve uma discrepância entre a idade de início dos sintomas e a idade de diagnóstico, evidenciando retardo no encaminhamento dos pacientes para comprovação diagnóstica. O diagnóstico tardio, possivelmente, determinou a alta porcentagem das complicações pré-operatórias da doença, que permanecem com as principais causas de morbimortalidade relativa à doença.

Abstract-Hip osteoarthritis (OA) is a degenerative disease, and total hip arthroplasty (THA) is one of the surgical procedures of choice to improve the OA patient's quality of life. Without a rehabilitation program, THA patients will develop functional limitations. A randomized double-blind trial was performed between July 2009 and October 2011 to compare over a short follow-up time two groups of patients who underwent THA for OA. The THA protocol (THAP) group received verbal instructions and physiotherapy exercise demonstrations, and the THA physiotherapy care protocol (THAPCP) group received the same verbal instructions and demonstrations associated with daily exercise practice guided by a physiotherapist. The outcomes that were assessed preoperatively and 15 d postoperatively in 106 patients were muscle strength force, goniometry, Medical Outcomes Study 36-Item Short Form Health Survey, and Merle d'Aubigné and Postel score. Higher muscle strength force scores and degrees in range of motion were found in the THAPCP group. Greater improvements were also observed for the THAPCP group than the THAP group in the Merle d'Aubigné and Postel score. At the end of the follow-up period, the intervention in the THAPCP group improved functional capacity, quality of life, mobility, muscle strength, goniometry, and pain. It appears to be a safe tool for accelerating recovery in THA patients.Clinical Trial Registration: ClinicalTrials.gov; NCT01491048, "Evaluation of functional rehabilitation in patients undergoing physiotherapy after total hip arthroplasty (arthrosis)"; https://clinicaltrials.gov/ct2/show/NCT01491048

Hypolactasia associated with severe iron-deficiency anemia has been reported in several studies. The objective of the present study was to determine whether hypolactasia is associated with the degree and duration of iron-deficiency anemia. Newly weaned male Wistar rats were divided into a control group receiving a diet supplemented with iron (C) and an experimental group (E) receiving a diet not supplemented with iron (iron-deficiency diet). The animals were studied on the 3rd, 5th, 7th, 14th, 21st, 28th and 35th days of the experiment, when overall and iron nutritional status and disaccharidase activity in the small intestine were determined by the Dahlqvist method. A reduction in weight occurred in the anemic animals starting on the 5th day of the study. Anemia was present in the experimental animals, with a progressive worsening up to the 14th day (hemoglobin: C = 13.27 and E = 5.37) and stabilizing thereafter. Saccharase and maltase activities did not differ significantly between groups, whereas lactase showed a significant reduction in total (TA) and specific activity (SA) in the anemic animals starting on the 21st day of the study. Median lactase TA for the C and E groups was 2.27 and 1.25 U on the 21st day, 2.87 and 1.88 U on the 28th day, and 4.20 and 1.59 U on the 35th day, respectively. Median lactase SA was 0.31 and 0.20 U/g wet weight on the 21st day, 0.39 and 0.24 U/g wet weight on the 28th day, and 0.42 and 0.23 U/g wet weight on the 35th day, respectively. These findings suggest a relationship between the enzymatic alterations observed and both the degree and duration of the anemic process. Analysis of other studies on intestinal disaccharidases in anemia suggests that the mechanism of these changes may be functional, i.e., that the enterocytes may suffer a reduction in their ability to synthesize these enzymes.

Objetivos: estudar a prevalência de constipação intestinal crô-nica funcional na infância, em uma unidade básica de saúde, e observar as suas principais características clínicas nessa população. Casuística e métodos: 313 crianças, pacientes da unidade básica de saúde Centro de Saúde Escola de Vila Tibério, Ribeirão Preto (SP), com idades entre 1 a 10 anos incompletos, compuseram a amostra. Destas, foram selecionadas 84 constipadas por critérios instituídos pelos autores. O teste do qui-quadrado foi aplicado para a comparação entre os grupos de constipados e não constipados (nível de significância = 0,01).Resultados: a prevalência de constipação intestinal crônica funcional foi de 26,8%. Das crianças constipadas, 85,7% tinham fezes endurecidas, 25% volume fecal diminuído, 17,9% intervalos às evacuações maiores que 2 dias (todas as crianças que apresentavam intervalo maior que 2 dias eram constipadas), 14,3% escape fecal, e 21,4% sangramento às evacuações.Conclusões: a prevalência de constipação intestinal foi elevada, e o intervalo entre as evacuações foi um critério diagnóstico importante para a seleção das crianças constipadas.J Pediatr (Rio J) 2002;78(6):497-502: constipação intestinal, puericultura, hábito intestinal. AbstractObjective: to study the frequency of chronic constipation in childhood at a Primary Health Care Unit and to observe its characteristics in this population.Methods: the sample consisted of 313 children aged between one and 10 years treated at the Centro de Saúde Escola, in the district of Tibério, in the town of Ribeirão Preto. Among these, 84 children with chronic constipation were selected. The chi-squared test was used to compare the groups of constipated and nonconstipated children (p = 0.01).Results: the prevalence of chronic constipation was 26.8%. In the group of chronic constipation, 85.7% of the children had hardened stools, 25% showed reduction in fecal mass, 17.9% had an interval between evacuations longer than 2 days (constipated children), 14.3% revealed fecal soiling and 21.4% presented blood in stools.Conclusion: the prevalence of chronic constipation was high and the interval between evacuations was as an important diagnostic criterion for the selection of constipated children.J Pediatr (Rio J) 2002;78(6) IntroduçãoA constipação intestinal é um problema freqüente na infância, e constitui-se da queixa principal em 3% das consultas pediátricas de rotina 1 . Na infância, a maior causa de constipação é a crônica funcional, compondo 95% de todos os casos 2 , e sua prevalência comunitária tem merecido maior preocupação por parte dos pesquisadores na última década, principalmente no nosso país 3-6 , onde pas-