Vitamin D deficiency and insufficiency in Africa and the Middle East, despite year-round sunny days

Exposure to sunlight, specifically ultraviolet B (UVB), is essential for cutaneous vitamin D synthesis. Despite significant daily sunlight availabilityin Africa and the Middle East, persons living in these regions are frequently vitamin D insufficient or deficient. Vitamin D insufficiency(25-hydroxyvitamin D (25(OH)D) between 15 and 20 ng/mL (37.5 - 50 nmol/L)) has been described in various population groups, ranging from 5%to 80%. Risk factors include traditional dress and avoidance of sunlight exposure, and multiple dietary factors as a result of specific cultural beliefs.Vitamin D resistance due to calcium deficiency mechanisms has been described in similar population groups, which may lead to hypovitaminosis D.Should the new diseases related to hypovitaminosis D prove to be truly associated, Africa and the Middle East will become an epicentrefor many of these conditions. Urgent attention will need to be paid to cultural dress and dietary behaviours if hypovitaminosis D is to betaken seriously. Should such factors not be correctable, new strategies for supplementation or food fortification will have to be devised

Congenital Diarrhea and Cholestatic Liver Disease: Phenotypic Spectrum Associated with MYO5B Mutations.

Myosin Vb (MYO5B) is a motor protein that facilitates protein trafficking and recycling in polarized cells by RAB11- and RAB8-dependent mechanisms. Biallelic MYO5B mutations are identified in the majority of patients with microvillus inclusion disease (MVID). MVID is an intractable diarrhea of infantile onset with characteristic histopathologic findings that requires life-long parenteral nutrition or intestinal transplantation. A large number of such patients eventually develop cholestatic liver disease. Bi-allelic MYO5B mutations are also identified in a subset of patients with predominant early-onset cholestatic liver disease. We present here the compilation of 114 patients with disease-causing MYO5B genotypes, including 44 novel patients as well as 35 novel MYO5B mutations, and an analysis of MYO5B mutations with regard to functional consequences. Our data support the concept that (1) a complete lack of MYO5B protein or early MYO5B truncation causes predominant intestinal disease (MYO5B-MVID), (2) the expression of full-length mutant MYO5B proteins with residual function causes predominant cholestatic liver disease (MYO5B-PFIC), and (3) the expression of mutant MYO5B proteins without residual function causes both intestinal and hepatic disease (MYO5B-MIXED). Genotype-phenotype data are deposited in the existing open MYO5B database in order to improve disease diagnosis, prognosis, and genetic counseling

Pediatric Duodenal Mucosal Biopsies with Eosinophilic Infiltrates: A Clinicopathologic Study

Aims: To describe the clinicopathologic features of children with Duodenal eosinophilic infiltrates (DEI). Study Design: Retrospective. Place and Duration of Study: Pediatric Gastroenterology Division, Texas Children’s Hospital over 24 months (Jan 1, 1998 –Dec 31, 1999). Methodology: Children with DEI at Texas Children’s Hospital over 24 months were identified. Clinical symptomatology was analyzed by a retrospective medical record review. Two pediatric pathologists re-evaluated all biopsies. Follow-up was done by contacting the patients 12-36 months after the initial diagnosis. Results: Total number of GI biopsies that included duodenum over the study period was 1145 biopsies. Out of 1145 cases, 780(68%) cases indicated eosinophilic infiltrates (EI) at some GI site. Out of these, 287(37%) cases had DEI. Mean age was 10.4 years. (F: M .2:1). Race: 197(79%) Caucasians, 37(15%) Latin Americans, 9(4%) African Americans and 6(2%) Arabs. Clinical symptomatology: 249 records were available for evaluation. 69.9% complained of abdominal pain, 55% had vomiting, 34.9% with diarrhea and 32.9% had weight loss. 105 patients were available for follow up; 38% continued to have abdominal pain, 15.2% with vomiting, 10.5% diarrhea and 7.6% had a persistent weight loss. Peripheral eosinophilia was present in 35.2%. Medical treatment included proton pump inhibitors (57.0%), H2-blockers (55.4%), steroids (26.5%), and elemental diet (9.6%). Histopathology: 6% had 20 eos/hpf. There were no significant differences in the number of eos/hpf between those with or without a specific symptom. Fourteen children (5.6%) subsequently developed IBD; their histopathological data did not differ from the rest. Conclusion: 1) children with DEI present with variable chronic symptoms 2) symptoms persisted in a significant number of patients despite therapy, 3) Close observation is warranted since a small number of patients may develop IBD

Epidemiological evaluation of acute gastroenteritis and therapeutic approaches in Middle East Countries

OBJECTIVE: Gastroenteritis represents with respiratory tract infection the most common infectious disease syndrome of humans in developing countries. Gut microbiota regional variation and dysbiosis play a crucial role in triggering and worsening this devastating GI disease. MATERIALS AND METHODS: With this manuscript, we want to explore and emphasize the critical aspect of acute gastroenteritis in Middle-East Countries and its correlation with the clinical aspect of gut microbiota modification and intestinal homeostasis. RESULTS: Approximately 1 of 50 children born each year in developed nations is hospitalized for acute gastroenteritis sometime during childhood. The highest rate of illness occurs in children between 3 and 24 months of age. The common causes of diarrhea are infections with viruses and bacteria, diarrhea due to a systemic infection other than gastrointestinal, diarrhea associated with antibiotic administration, and feeding related diarrhea. The single most common diarrheal disorder observed in the Emergency Department and general practice is viral gastroenteritis. In particular, Rotavirus is the cause of more than 2 million hospitalizations and over half a million deaths from acute GE in infants and young children. This burden produces also direct and indirect economic costs. The use of probiotics to counterbalance commensal dysbiosis is emerging as a standard medical practice in these countries. CONCLUSIONS: In this scenario, one of the most interesting aspects is that probiotics and gut microbiota modulation could deeply improve the prevention and treatment of this devastating GI pathology. At the same time, vaccination might represent a cost-effective strategy to reduce the health and economic burden of some pathogens, such as rotavirus. PMID: 27735025 [PubMed - in process] Free full tex