PURPOSE: Various gastrointestinal factors may contribute to maladaptive behavior in children with autism spectrum disorders (ASD). To determine the association between maladaptive behavior in children with ASD and gastrointestinal symptoms such as severity, intestinal microbiota, inflammation, enterocyte damage, permeability and absorption of opioid peptides. METHODS: This observational cross-sectional study compared children with ASD to healthy controls, aged 2-10 years. Maladaptive behavior was classified using the Approach Withdrawal Problems Composite subtest of the Pervasive Developmental Disorder Behavior Inventory. Dependent variables were gastrointestinal symptom severity index, fecal calprotectin, urinary D-lactate, urinary lactulose/mannitol excretion, urinary intestinal fatty acids binding protein (I-FABP) and urinary opioid peptide excretion. RESULTS: We did not find a significant difference between children with ASD with severe or mild maladaptive behavior and control subjects for gastrointestinal symptoms, fecal calprotectin, urinary D-lactate, and lactulose/mannitol ratio. Urinary opioid peptide excretion was absent in all children. Children with ASD with severe maladaptive behavior showed significantly higher urinary I-FABP levels compared to those with mild maladaptive behavior (p=0.019) and controls (p=0.015). CONCLUSION: In our series, maladaptive behavior in ASD children was not associated with gastrointestinal symptoms, intestinal inflammation (no difference in calprotectin), microbiota (no difference in urinary D-lactate) and intestinal permeability (no difference in lactulose/manitol ratio). ASD children with severe maladaptive behavior have significantly more enterocyte damage (increased urinary I-FABP) than ASD children with mild maladaptive behavior and normal children.
Absorption ; Autistic Disorder* ; Carrier Proteins ; Autism Spectrum Disorder* ; Child* ; Cross-Sectional Studies ; Enterocytes ; Fatty Acids ; Humans ; Inflammation ; Leukocyte L1 Antigen Complex ; Microbiota ; Opioid Peptides ; Permeability

INTRODUCTIONSince the first human cases of H5N1 avian influenza virus infection were detected in Indonesia in 2005, the Sulianti Saroso Infectious Diseases Hospital in Jakarta has managed 27 confirmed cases from September 2005 to December 2007.

MATERIALS AND METHODSWe reviewed the clinical and epidemiological data of these patients.

RESULTSClinical and radiological features were not specific. Most patients were young and had indirect contact with infected poultry. The majority of cases presented to the Infectious Diseases hospital late when the patients already had features of the systemic inflammatory response syndrome (SIRS). The mortality was high at 77%.

CONCLUSIONThere is clearly an urgent need for better field diagnostics and therapeutics for the management of this emerging pathogen.

Adolescent ; Adult ; Animals ; Birds ; Child ; Child, Preschool ; Female ; Humans ; Indonesia ; epidemiology ; Infant ; Infant, Newborn ; Influenza A Virus, H5N1 Subtype ; isolation & purification ; Influenza in Birds ; diagnosis ; epidemiology ; Male ; Retrospective Studies ; Risk Factors

Purpose: Impaired intestinal mucosal integrity may affect the gastrointestinal function, especially in relation to nutrition, absorption, and barrier function. The purpose of this study was to measure the prevalence of impaired intestinal mucosal integrity in presumed healthy children aged 1–3 years and assess the effects of zinc, glutamine, fiber, and prebiotic supplementation in them. Methods: A cross-sectional study was conducted in 200 children aged 1–3 years in Pasar Minggu, South Jakarta, Indonesia. A randomized double-blind parallel group method clinical trial was then performed to assess the effects of zinc, glutamine, fiber, and prebiotic supplementation. Results: Elevated calprotectin was found in 91/200 subjects (45.5%) at the onset of the study. After 10 months, 144 subjects completed the study: 72 subjects received the trial formula, whereas the other 72 received the standard formula. A transitory decrease in fecal calprotectin (FC) was observed after 6 months in the subgroup with normal FC levels, who were fed the test formula (p=0.012). Conclusion The prevalence of impaired intestinal mucosal integrity in this group of Indonesian children aged 1–3 years was high. Supplementation with zinc, glutamine, fiber, and prebiotics during 6 months reduced FC only in those who had low levels at baseline but not in those with impaired integrity.