Further observation on the unusual manifestations of rheumatic disease with report of some cases

On careful analysis of the clinical history of Case IV, we find that the patient from childhood has been having frequent fevers and joints pains and that during the present illness which has lasted for one year previous to admission, aside from the symptoms of cardiac failure and those referable to the lungs due to pulmonary tuberculosis, he had pain and swelling of the joints and also fever. Such clinical history is certainly very suggestive of rheumatic infection. Blood Wassermann was negative, and the autopsy findings including the histological examination of the viscera showed no evidence of syphilitic infection. The absence of Aschoff bodies is not against rheumatic infection inasmuch as they are not always found in the organs affected by rheumatic infeciton and they are especially absent in the chronic stage of the disease. The role played by rheumatic infection in the production of lesion in the aorta and in other arteries is very well recognizedAccording to M.A. Clerc and Noel Daschamps certain infections such as malaria, scarlet fever, typhoid, pneumonia, la grippe, and above all, acute articular rheumatism especially in children are mentioned as causative factors of aneurysm of the arch of the aortaV.P. Sydenstricker speaks of arteritis as one of the complications of rheumatic infection, although he says that arteritis is seldom recognized clinically but it may be suspected when there is tenderness on pressure over superficial arteritis. Aortic lesion due to rheumatic arteritis has been observedMalcolm Goodridge, discussing the diagnosis of syphilitic aortitis, in the Textbook of Medicine by Cecil, 4th edition, 1937, p. 1146, says: the age incidence of syphilitic diseases of the aorta is somewhat helpful in differentiating it from artheroma of the aorta, which is prone to occur in the declining years of life and from rheumatic aortitis which occurs in adolescence or early adult life. (Conclusion)

A double-blind controlled clinical trial on the efficacy and safety of the use of L-alanine oral rehydration solution (ORS) in the management of acute diarrhea in children

The addition of a neutral amino acid like l-alanine to an ORS has been found to enhance sodium and water reabsorption. A double-blind randomized trial was conducted to determine the efficacy and safety of using an ORS containing 90 mmol/L of l-alanine and 90 mmol/L of glucose as compared to the standard WHO-ORS in the management of acute diarrhea in children. Included were 140 male patients, 3-36 months, with a history of 3 or more watery stools in the past 24 hours of not more than 5 days, with signs of moderate to severe dehydration and with weight for length /_ 70% of NCHS standards. Rehydration was done following WHO recommendations using either the standard or l-alanine ORS. Feedings, in the form of breastmilk, formula and/or semi-solids were resumed thereafter. Stools were replaced by volume with ORS until diarrhea ceased. The clinical and laboratory characteristics of the 2 groups, 70 each, were comparable before intervention. Mean diarrheal duration was similar in both groups after intervention (71 +/_ 50 vs 60 +/_ 31 hours in the l-alanine ORS and WHO-ORS groups respectively). No difference was observed between the two formulations for all other variables except the mean urine output on the 6th-24th hours (40 vs. 31 ml/kg body weight/day, p = 0.05) which was greater in the l-alanine group. Further studies among infants and children have to be conducted to determine the optimal osmolality of the solution and amino acid and glucose concentration.