{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:17:37Z","timestamp":1792289857447,"version":"4.4.0"},"reference-count":32,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","license":[{"start":{"date-parts":[[2023,4,5]],"date-time":"2023-04-05T00:00:00Z","timestamp":1680652800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,5]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Environmental enteric dysfunction (EED) is a subclinical enteropathy prevalent in resource-limited settings, hypothesized to be a consequence of chronic exposure to environmental enteropathogens, resulting in malnutrition, growth failure, neurocognitive delays, and oral vaccine failure. This study explored the duodenal and colonic tissues of children with EED, celiac disease, and other enteropathies using quantitative mucosal morphometry, histopathologic scoring indices, and machine learning\u2013based image analysis from archival and prospective cohorts of children from Pakistan and the United States. We observed villus blunting as being more prominent in celiac disease than in EED, as shorter lengths of villi were observed in patients with celiac disease from Pakistan than in those from the United States, with median (interquartile range) lengths of 81 (73, 127) \u00b5m and 209 (188, 266) \u00b5m, respectively. Additionally, per the Marsh scoring method, celiac disease histologic severity was increased in the cohorts from Pakistan. Goblet cell depletion and increased intraepithelial lymphocytes were features of EED and celiac disease. Interestingly, the rectal tissue from cases with EED showed increased mononuclear inflammatory cells and intraepithelial lymphocytes in the crypts compared with controls. Increased neutrophils in the rectal crypt epithelium were also significantly associated with increased EED histologic severity scores in duodenal tissue. We observed an overlap between diseased and healthy duodenal tissue upon leveraging machine learning image analysis. We conclude that EED comprises a spectrum of inflammation in the duodenum, as previously described, and the rectal mucosa, warranting the examination of both anatomic regions in our efforts to understand and manage EED.<\/jats:p>","DOI":"10.4269\/ajtmh.22-0063","type":"journal-article","created":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T12:29:59Z","timestamp":1678710599000},"page":"672-683","source":"Crossref","is-referenced-by-count":8,"title":["Quantitative Morphometry and Machine Learning Model to Explore Duodenal and Rectal Mucosal Tissue of Children with Environmental Enteric Dysfunction"],"prefix":"10.4269","volume":"108","author":[{"given":"Marium","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zehra","family":"Jamil","sequence":"additional","affiliation":[{"name":"Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lubaina","family":"Ehsan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Zulqarnain","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjana","family":"Srivastava","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saman","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Raghib","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurav","family":"Sengupta","sequence":"additional","affiliation":[{"name":"School of Data Science, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zia","family":"Mujahid","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zubair","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romana","family":"Idrees","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheraz","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fayaz","family":"Umrani","sequence":"additional","affiliation":[{"name":"Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najeeha","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Moskaluk","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shyam","family":"Raghavan","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Pathology, Rush University, Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Moore","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Asad","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junaid","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan;"},{"name":"Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Syed","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia;"},{"name":"Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan;"},{"name":"School of Data Science, University of Virginia, Charlottesville, Virginia;"},{"name":"Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"J Pediatr Gastroenterol Nutr","first-page":"6","article-title":"Environmental enteric dysfunction in children: a review","volume":"63","author":"Syed","year":"2016"},{"key":"b2","series-title":"Trends Mol Med","first-page":"328","article-title":"Environmental enteropathy: critical implications of a poorly understood condition","volume":"18","author":"Korpe","year":"2012"},{"key":"b3","series-title":"J Pediatr","first-page":"7","article-title":"Risk factors for malnutrition and environmental enteric dysfunction-you really are what you 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