Nestas
últimas semanas estive pesquisando na internet algumas informações para uma
matéria que estou escrevendo sobre a história da organização do III Congresso
Mundial de Gastroenterologia, Hepatologia e Nutrição em Pediatria que se
realizou em agosto de 2008, em Foz do Iguaçu, do qual fui Presidente, e, nessa
busca, encontrei publicações que me surpreenderam de forma altamente positivas.
Como estas notícias dizem respeito à minha trajetória acadêmica de mais de 40
anos de atuação e que foi construída com a estreita colaboração de um sem
número de colegas, alunos, residentes, pós-graduandos, que tiveram participação
efetiva e decisiva para o êxito da nossa missão, decidi compartilhar estes
achados, que muito me honram, com todos aqueles que me acompanham nas publicações nos meios eletrônicos.
A
primeira delas diz respeito a um artigo publicado na revista Pediatric
Research, em 2003, o qual encontrei por mera casualidade, escrito por dois dos
mais prestigiosos colegas da nossa especialidade, William Allan Walker,
professor da Harvard University e John Walker-Smith, professor da London
University, que versa sobre uma revisão da História da Gastroenterologia
Mundial. Trata-se de um extenso artigo abordando com riqueza de detalhes toda a
construção da nossa especialidade desde os primórdios do século 20 até os dias
atuais. Senti-me altamente orgulhoso ao ver meu nome citado no referido artigo
por duas vezes. Na primeira vez pelo reconhecimento da contribuição científica
do meu labor no mundo em desenvolvimento nas pesquisas que versam a respeito de
um melhor conhecimento para solucionar os graves problemas que envolvem o
binômio diarreia-desnutrição. A segunda citação diz respeito a fundação da
Sociedade Latino-americana de Gastroenterologia, Hepatologia e Nutrição em
Pediatria, em 1974, juntamente com meus Mestres Horácio Toccalino, José Vicente
Martins Campo e Ricardo Licastro. Abaixo estão transcritos alguns trechos do
referido artigo.
Why did such pediatric subspecialties
emerge? A simple answer to this question is urgent clinical need. The
development of each of the pediatric subspecialties, as well as (in an earlier
era) the development of pediatrics itself, was the result of the perception
that children with special needs were receiving poor clinical care. Such a need
had long been perceived. However, it was only when specialized techniques and
resulting expertise in accurate diagnosis and effective treatment (which could
expertly meet this need) had been achieved, that pediatric subspecialties
emerged. By the early 1970s, such expertise had developed and the need for
pediatric subspecialties became recognized in the United Kingdom (as well as in
Europe and North America) by the pediatric community as a whole (6).
In the developing world, with a
decline in mortality from acute infectious diarrhea and with the advent of oral
rehydration therapy, the problem of children with chronic or persistent
diarrhea following acute diarrhea has emerged as an important therapeutic
dilemma. Pediatric gastroenterologists such as Ulysses Fagundes Neto in
Brazil have explored the relationship between infection, small intestinal
mucosal damage, and food intolerance (26).
Other international societies and the
Federation of Societies of Pediatric Gastroenterology and Nutrition. The Latin
American Society for Pediatric Gastroenterology and Nutrition (LAPSGAN) was
founded in October 1974 in Buenos Aires. There were four founders, Horacio
Toccalini (the pioneer of pediatric gastroenterology in Latin America) and Ricardo
Licastro from Argentina and Jose Vicente Martins Campos and Ulysses
Fagundes-Neto from Brazil. Their goal was to model the society after ESPGHAN
and to encourage young doctors to develop the field and especially an
understanding and management of diarrhea and malnutrition in children, a major
regional problem.
Outra
notícia auspiciosa diz respeito a entidade Enteropatia Ambiental por mim
descrita, em 1984, com a colaboração de um grande número de orientandos e que
passou a ser mundialmente reconhecida neste século. Ao longo de vários anos de
incessante trabalho pudemos descrever a história natural desta enfermidade de
cunho eminentemente socioeconômico, desde o habitat dos pacientes (favela
Cidade Leonor), as alterações físicas dos mesmos (desnutrição crônica associada
a episódios de diarreia), as deficiências de absorção dos nutrientes, as
anormalidades morfológicas do trato digestivo à microscopia óptica e
eletrônica, e a contaminação do intestino delgado pela microflora colônica. A
Enteropatia Ambiental está também reconhecida com a devida citação do meu nome na
Wikipedia, cujo texto transcrevo integralmente abaixo.
Environmental enteropathy
From Wikipedia, the
free encyclopedia
Environmental
enteropathy, also known as tropical enteropathy or environmental
enteric dysfunction (EED), is a condition or subclinical
disorder believed to be due to frequent intestinal infections.[1] There are often minimal acute symptoms.[1] There may be chronic problems with
absorbing nutrients which may result in malnutrition and growth stunting in
children.[1] It may be the chronic form of tropical sprue which is
usually brief and presents with diarrhea.[1] Environmental enteropathy results in a
number of changes in the intestines including: smaller
villi, larger crypts (called crypt hyperplasia),
increased permeability, and inflammatory cell build-up within the intestines. These changes
result in poor absorption of food, vitamins and minerals – or
"modest malabsorption".[2]
Signs
and symptoms[edit]
Environmental enteropathy
is believed to result in chronic malnutrition and
subsequent growth stunting (low
height-for-age measurement) as well as other child development deficits.
Especially the first two years (and the prior 9 months of fetal life) are
critical for linear growth and maybe even more importantly brain development.
Stunting is an easy to measure symptom of these child development deficits and
the effects have been found to be mostly irreversible. Furthermore, contrary to
the negative impacts of diarrheal episodes on the growth of children below the
age of two, which can usually be cought up in between these episodes (given
adequate nutrition), the chronic effects of environmental enteropathy are not
recovered from easily.[3]
Effect on oral vaccination[edit]
Many oral vaccines, both live and non-living, have proven to be
less immunogenic or less protective when administered to infants, children or adults living in low
socioeconomic conditions in developing countries than they are when used in industrialized countries.
Wide spread environmental enteropathy is hypothised to be one of the causes for
this.[4][5]
Cause[edit]
An important cause of
environmental enteropathy is most likely the constant exposure of children to
their own and other people's fecal bacteria if the children live in an
environment characterised by widespread open defecation and lack of sanitation like
in many informal settlements in developing countries.[2]
Mechanisms[edit]
Environmental enteropathy
results in a number of changes in the intestines including: smaller villi, larger crypts (called crypt hyperplasia), increased permeability, and
inflammatory cell build-up within the intestines. These changes result in poor
absorption of food, vitamins and minerals – or "modest malabsorption".[2]
History[edit]
The term
"environmental enteropathy" was first used in 1984 by Fagundes-Neto
to describe a syndrome that includes non-specific histopathological and
functional changes of the small intestine in children of poor
families living in conditions lacking basic sanitary facilities and chronically
exposed to fecal contamination. The term was introduced to replace the
previously term "tropical enteropathy" (sometimes also "tropical
jejunopathy") as the condition described is not only found in tropical
areas and is believed to be caused by environmental factors.[6]
References[edit]
1.
Korpe, PS; Petri WA, Jr
(June 2012). "Environmental
enteropathy: critical implications of a poorly understood condition.". Trends in molecular medicine 18 (6): 328–36. doi:10.1016/j.molmed.2012.04.007. PMC 3372657. PMID 22633998.
2. Humphrey, JH (2009). "Child
undernutrition, tropical enteropathy, toilets, and handwashing.". Lancet 374 (9694): 1032–5. doi:10.1016/s0140-6736(09)60950-8.PMID 19766883.
3. Prendergast, Andrew;
Kelly, Paul (2012). "Review: Enteropathies in
the Developing World: Neglected Effects on Global Health". Am. J. Trop. Med. Hyg. 5 (85): 756–763.doi:10.4269/ajtmh.2012.11-0743.
4. Levine, Myron M (4
October 2010). "Immunogenicity and
efficacy of oral vaccines in developing countries: lessons from a live cholera
vaccine". BMC Biology 8 (129).doi:10.1186/1741-7007-8-129. Retrieved 14 November 2014.
5. Haque, Rashidul (16
January 2014). "Oral polio
vaccine response in breast fed infants with malnutrition and diarrhea". Vaccine 32 (4): 478–482.doi:10.1016/j.vaccine.2013.11.056. Retrieved 30 September 2015.
6.
Fagundes-Neto, Ulysses;
Viaro, Tania; Wehba, Jamal; Patricio, Francy Reis da Silva; Machado, Nelson
Lourenço (1984). "Tropical
enteropathy (environmental enteropathy) in early childhood: a syndrome caused
by contaminated environment.". Trop Pediatr 4 (30): 204–209. doi:10.1093/tropej/30.4.204. Retrieved 14 November 2014.
Por
fim, mas não menos importante, acabo de receber o convite oficial do Congresso
Mundial da especialidade que será realizado em outubro próximo em Montreal para
proferir uma palestra sobre Enteropatia Ambiental, conforme abaixo transcrevo.
Conforme
anteriormente mencionei reitero a enorme satisfação e orgulho em compartilhar
com todos aqueles que colaboraram comigo nestes anos de vida acadêmica estes
fatos altamente relevantes e aproveitar a oportunidade para render minha mais elevada gratidão a todos os colaboradores que trilharam comigo esta longa jornada.
