Intestinal bacterial overgrowth after Roux-en-Y gastric bypass

The aim of the present study was to report the occurrence of serious subnutrition, associated to intestinal bacterial overgrowth, in two patients submitted to bariatric surgery. Two female patients (body mass index, 49 and 50 kg/m(2), respectively) were submitted to Y-en-Roux gastric bypass. The first patient evolved a 52% loss of body weight within 21 months after surgery; the other, a 34% loss of initial body weight within 15 months after surgery, results corresponding, respectively, to 62 and 45 kg weight losses. However, both patients reported asthenia, hair fallout, and edema, and one also reported diarrhea, but none was feverish. Their respective albuminemias were of 24 and 23 g/l. A respiratory hydrogen test suggested bacterial hyperproliferation. Thirty days after ciprofloxacin and tetracyclin treatments, they showed improved albumin levels and nutritional states, both confirmed by results of hydrogen breath tests. Bacterial overgrowth is an important complication that can compromise clinical evolution of patients submitted to intestinal surgery like gastroplasty with Y-Roux anastomosis. In cases of clinical suspicion or a confirmed diagnosis, adequate antibiotics, sometimes requiring to be cyclically repeated, should be administered.

Short-Term Effects of Duodenocecostomy on Body Weight, Glucose Absorption, Serum Components, and Intestinal Histopathology in Four Normal Horses

The objective of this study was to evaluate duodenocecostomy in horses performed through a ventral midline laparotomy and report its influence oil body weight, glucose absorption, serum components, and characteristics of jejunum, cecum, and large colon histology. Four horses were submitted to the duodenocecostomy technique through a ventral midline laparotomy with animals in dorsal recumbency under inhalation anesthesia, followed by abdominal exploration. A side-to-side anastomosis was performed between the duodenojejunal flexure and the base of the cecum with two simple continuous suture lines of the serosal and muscular layers. The size of the opening created was approximately 2 cm in diameter. The mucosa layer was not Sutured. After 30 days, animals were submitted to a second laparotomy to check the patency of the duodenocaecal fistula. During both laparotomy procedures, excisional biopsies of different segments of the gastrointestinal tract were performed. Information on physical examination findings, results of hematologic and histopathologic evaluations, and oral glucose absorption test were recorded. The horses did not have significant weight loss from baseline, and absorption curve of glucose did not significantly vary from baseline. Only triglycerides had significant alterations. Histologic evaluation of jejunum, cecum, and large colon did not show alterations of intestinal structure and morphology. We concluded that the proposed technique, principally in relation to the fistula size and not suturing the mucosa layer, allowed partial or total Occlusion of the fistulae without the necessity of a second surgery and avoided the permanent bypass of ingesta and weight loss.

Heat stress impairs performance parameters, induces intestinal injury, and decreases macrophage activity in broiler chickens

Studies on environmental consequences of stress on animal production have grown substantially in the last few years for economic and animal welfare reasons. Physiological, hormonal, and immunological deficits as well as increases in animals` susceptibility to diseases have been reported after different stressors in broiler chickens. The aim of the current experiment is to describe the effects of 2 different heat stressors (31 +/- 1 and 36 +/- 1 degrees C/10 h per d) applied to broiler chickens from d 35 to 42 of life on the corticosterone serum levels, performance parameters, intestinal histology, and peritoneal macrophage activity, correlating and discussing the obtained data under a neuroimmune perspective. In our study, we demonstrated that heat stress (31 +/- 1 and 36 +/- 1 degrees C) increased the corticosterone serum levels and decreased BW gain and food intake. Only chickens submitted to 36 +/- 1 degrees C, however, presented a decrease in feed conversion and increased mortality. We also showed a decrease of bursa of Fabricius (31 +/- 1 and 36 +/- 1 degrees C), thymus (36 +/- 1 degrees C), and spleen (36 +/- 1 degrees C) relative weights and of macrophage basal (31 +/- 1 and 36 +/- 1 degrees C) and Staphylococcus aureus-induced oxidative burst (31 +/- 1 degrees C). Finally, mild multifocal acute enteritis characterized by an increased presence of lymphocytes and plasmocytes within the jejunum`s lamina propria was also observed. The stress-induced hypothalamic-pituitary-adrenal axis activation was taken as responsible for the negative effects observed on the chickens` performance and immune function and also the changes of the intestinal mucosa. The present obtained data corroborate with others in the field of neuroimmunomodulation and open new avenues for the improvement of broiler chicken welfare and production performance.

Histologic and immunohistochemical evaluation of intestinal innervation in dogs with and without intussusception

Objective-To assess viability of innervation in bowel segments appearing macroscopically viable from dogs with intussusception. Animals-7 dogs without gastrointestinal dysfunction that had been euthanized for reasons unrelated to the study (control dogs) and 13 dogs with intussusception that underwent enterectomy and intestinal anastomosis (affected dogs). Procedures-A total of 31 samples of intestinal tissue were obtained from the control dogs; 28 samples were obtained from affected dogs during surgery. Samples were histologically and immunohistochemically prepared and subjectively scored for degree of vacuolization and staining, respectively. Other data collected included mean muscle cell density of circular and longitudinal muscular layers, ratio between areas of muscular layers, mean number of myenteric plexuses, mean ganglion cell density of myenteric plexuses, and degree of degeneration in neuronal plexuses as estimated through synaptophysin and neuron-specific enolase (NSE) immunoreactivity. Results-Mean muscle cell density of longitudinal muscular layers, ratio between areas of muscular layers, and synaptophysin immunoreactivity did not differ significantly between affected and control dogs; values of all other variables did. Correlations were evident between mean ganglion cell density in myenteric plexuses and mean muscle cell density in circular muscular layers, degree of neuronal degeneration in myenteric plexuses and NSE immunoreactivity, and degree of neuronal degeneration in myenteric plexuses and mean ganglion cell density of myenteric plexuses. Conclusions and Clinical Relevance-Innervation may be impaired in bowel segments that appear macroscopically viable. Therefore, careful evaluation of preserved surgical margins during enterectomy and enteroanastomosis and monitoring of digestive function after surgery are important. (Am J Vet Res 2010;71:636-642)

Two Atypical Enteropathogenic Escherichia coli Strains Induce the Production of Secreted and Membrane-Bound Mucins To Benefit Their Own Growth at the Apical Surface of Human Mucin-Secreting Intestinal HT29-MTX Cells

In rabbit ligated ileal loops, two atypical enteropathogenic Escherichia coli (aEPEC) strains, 3991-1 and 0421-1, intimately associated with the cell membrane, forming the characteristic EPEC attachment and effacement lesion of the brush border, induced a mucous hypersecretion, whereas typical EPEC (tEPEC) strain E2348/69 did not. Using cultured human mucin-secreting intestinal HT29-MTX cells, we demonstrate that apically aEPEC infection is followed by increased production of secreted MUC2 and MUC5AC mucins and membrane-bound MUC3 and MUC4 mucins. The transcription of the MUC5AC and MUC4 genes was transiently upregulated after aEPEC infection. We provide evidence that the apically adhering aEPEC cells exploit the mucins` increased production since they grew in the presence of membrane-bound mucins, whereas tEPEC did not. The data described herein report a putative new virulence phenomenon in aEPEC.

Stimulation of protein kinase C-dependent and -independent signaling pathways by bistratene A in intestinal epithelial cells

The marine toxin bistratene A (BisA) potently induces cytostasis and differentiation in a variety of systems. Evidence that BisA is a selective activator of protein kinase C (PKC) delta implicates PKC delta signaling in the negative growth-regulatory effects of this agent. The current study further investigates the signaling pathways activated by BisA by comparing its effects with those of the PKC agonist phorbol 12-myristate 13-acetate (PMA) in the IEC-18 intestinal crypt cell line. Both BisA and PMA induced cell cycle arrest in these cells, albeit with different kinetics. While BisA produced sustained cell cycle arrest in G(o)/G(1) and G(2)/M, the effects of PMA were transient and involved mainly a G(o)/G(1), blockade. BisA also produced apoptosis in a proportion of the population, an effect not seen with PMA. Both agents induced membrane translocation/activation of PKC, with BisA translocating only PKC delta and PMA translocating PKC alpha, delta, and epsilon in these cells. Notably, while depletion of PKC alpha, delta, and epsilon abrogated the cell cycle-specific effects of PMA in IEC-18 cells, the absence of these PKC isozymes failed to inhibit BisA-induced G(o)/G(1), and G(2)/M arrest or apoptosis. The cell cycle inhibitory and apoptotic effects of BisA, therefore, appear to be PKC-independent in IEG-18 cells. On the other hand, BisA and PMA both promoted PKC-dependent activation of Erk 1 and 2 in this system. Thus, intestinal epithelial cells respond to BisA through activation of at least two signaling pathways: a PKC delta -dependent pathway, which leads to activation of mitogen-activated protein kinase and possibly cytostasis in the appropriate context, and a PKC-independent pathway, which induces both cell cycle arrest in G(o)/G(1) and G(2)/M and apoptosis through as yet unknown mechanisms. (C) 2001 Elsevier Science Inc. All rights reserved.

Dietary supplementation with vitamin E modulates avian intestinal immunity

The effect of dietary vitamin E on immunoglobulin A (IgA) antibody production, which acts as the first line of defence at the intestinal mucosa, has not been evaluated in chickens. In the present study the impact of the inclusion of supplementary levels of vitamin E to the diet, on total and antigen-specific IgA antibody titres, T-cell subsets and Ia+ cells, was assessed. From hatching, chickens received a maize-based diet which was supplemented with either 25, 250, 2500 or 5000 mg dl-alpha-tocopherol acetate/kg. Primary immunisation with tetanus toxoid (T. toxoid) emulsified in a vegetable oil-in-water adjuvant was administered by the intraperitoneal route at 21 d of age. At 35 d of age all birds received an oral booster vaccination of T. toxoid. Significantly higher total IgA antibody titres were present in the day 42 intestinal scrapings of birds receiving the 5000 mg/kg vitamin E-supplemented diet (VESD) (P=0.05) and a notable increase was observed in birds receiving the 250 mg/kg VESD (P=0.06). At days 21 and 42 total serum IgA antibody titres of birds receiving the 250 mg/kg VESD was significantly higher (P

Imunofluorescência para neuropeptídeos na mucosa nasal humana: avaliação de técnica para peptídeo intestinal vasoativo (VIP)

Os neuropeptídeos são neurotransmissores relevantes na fisiologia nasal e o conhecimento crescente acerca de seu papel na fisiopatologia de doenças nasais abre novas perspectivas. A sua investigação na mucosa nasal humana baseia-se em grande parte em marcação imunológica, método complexo e sujeito a inúmeros fatores de erro. Com o intuito de viabilizar este tipo de pesquisa em nosso meio, um método de imunofluorescência para peptídeo intestinal vasoativo (VIP) na mucosa nasal humana é proposto e avaliado. FORMA DE ESTUDO: Coorte transversal. MATERIAL E MÉTODO: Oito pacientes submetidos a cirurgia funcional do nariz têm um fragmento de mucosa coletado da concha inferior. O tecido foi fixado em solução de Zamboni (paraformaldeído 4% tamponado e ácido pícrico 0,4%), congelado em nitrogênio líquido e armazenado. Cortes de 14 µm foram realizados e submetidos à reação de imunofluorescência para VIP (Península Laboratories). As imagens microscópicas foram documentadas em fotografia convencional. A especificidade, sensibilidade e reprodutibilidade de execução foram avaliadas. A reprodutibilidade de interpretação de resultados foi avaliada através da comparação de graus de marcação (0 a 4) atribuídos às fotos por seis observadores. RESULTADOS: Os resultados mostraram ser o método suficientemente específico, sensível, além de reprodutível em sua execução. A interpretação de resultados mostrou depender do perfeito esclarecimento do observador no julgamento das imagens de imunofluorescência, mas mostrou uniformidade. CONCLUSÃO: O método proposto foi considerado útil na pesquisa de neuropeptídeos na mucosa nasal humana.

Medicina privada e saúde pública estariam convergindo? I. O problema e argumentos que justificariam o preparo do estudante de medicina em medicina comunitária

Tece-se considerações sôbre a aproximação que parece estar havendo entre o ensino médico e o de saúde pública, em virtude da criação de Departamentos de Medicina Comunitária em algumas Escolas de Medicina. São apresentados alguns argumentos que estariam a indicar a evolução da medicina privada no sentido de uma atuação mais efetiva na comunidade, contribuindo assim para a real integralização do campo médico.

Autovacinas: técnicas de preparo e fatores de eficiência

Verificou-se que a obtenção de excelentes autovacinas é possível usando-se a técnica de semeadura, dos germes apropriados, isolados de um material clínico em meios de cultura selecionados. As condições do cultivo devem ser adequadas para estimular, ou pelo menos preservar, as qualidades antigênicas dos germes. O processo de inativação necessita ser cuidadosamente acertado, a fim de não lesar os antígenos presentes. Foram descritos métodos capazes de cumprir estes requisitos, e que ao mesmo tempo fossem práticos e relativamente simples em sua execução, com equipamentos ao alcance de qualquer laboratório clínico.

Estágio integrado na Faculdade de Saúde Pública da Universidade de São Paulo: preparo para o trabalho multiprofissional

O presente trabalho relata a experiência havida em 1975 na Faculdade de Saúde Pública da USP no Estágio Integrado dos alunos. A comissão incumbida do estágio resolveu introduzir algumas modificações na metodologia utilizada tendo em vista os precários resultados da chamada Carta Sanitária até agora em vigor. Procurou-se conduzir os alunos em seus trabalhos para um diagnóstico setorial de saúde através de parte das técnicas da CENDES/OPS e Programação Integrada de Saúde. Neste trabalho são apontadas dificuldades encontradas e alguns resultados auspiciosos conseguidos. Conclue-se pela continuação da experiência.

Importância da reabsorção do ferro da hemorragia intestinal provocada pela ação dos vermes na progressão da anemia

Foram estudados 10 doentes, portadores de anemia ancilostomótica e de grande parasitose. Foram determinados alguns parâmetros hematológicos como dosagem de hemoglobina, contagem de hemácias, hematócrito, volume corpuscular médio, hemoglobina corpuscular média, ferro sérico e siderofilina. Foram estudados o volume da perda de sangue intestinal, o ferro perdido nesta hemorragia e eliminado nas fezes, e o ferro reaborvido da hemorragia intestinal. Conclui-se que a reabsorção do ferro da hemoglobina por dia no tubo digestivo é de suma importância no retardamento da instalação da anemia ferropriva, causada pela parasitose ancilostomótica.

Percepção de professores do Sistema de Ensino do Estado de São Paulo sobre o seu preparo em saúde do escolar

Apresenta-se estudo sobre o preparo de professores para realizarem ações que visam à identificação e atendimento de escolares com problemas de saúde. Pretendeu-se oferecer subsídios para o planejamento de programas de treinamento de docentes aos setores governamentais interessados na temática. A população foi constituída por 532 professores da primeira série do primeiro grau, de escolas estaduais situadas em treze municípios do Estado de São Paulo, Brasil, onde inicialmente foi implantado o "Sistema Integrado de Atendimento Médico ao Escolar". Utilizou-se questionário como instrumento de medida. Os resultados revelaram que 74,3% dos professores se consideraram atingidos pela orientação sobre observação de saúde e medidas para solucionar desvios de saúde. A cobertura na orientação transmitida pelos orientadores de ações de assistência ao escolar (OAE) variou, entre os municípios, nos limites de 70 a 100%. A relação entre o fato de o professor ter recebido explicações do OAE e o melhor grau na auto-avaliação de preparo, indica, provavelmente, eficácia do trabalho do OAE. Recomenda-se incremento de orientação na rede estadual de ensino, ampliando os conhecimentos sobre saúde e a compreensão do professor a respeito de sua participação em programas de saúde escolar.