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.

Oral vitamin A in the treatment of xerophthalmia in diarrheic and non-diarrheic children

Fifty (50) patients, 27 non-diarrheic and 23 diarrheic, all with positive staining with Lissamine green were given 200,000 IU of oral oil-miscible vitamin A on two consecutive days. Serum vitamin A levels were determined before and one week after treatment. Lissamine reaction was also assessed post-therapy. The findings were as follows1. Serum vitamin A rose significantly in both the diarrheic and non-diarrheic groups with no significant difference in the degree of rise between these two groups2. Clinical response to treatment was not significantly different between the diarrheic and non-diarrheic groups. (Summary)

Child-to-child program in the Philippine setting

The Philippines is an archipelago with a growing population, largely rural, 50% of which is in the 0-14 years old age groupAs noted by WHO, the leading death problems are communicable diseases, malnutrition, poor environmental sanitation, malaria and schistosomiasis, rapid population growth, drug-abuse/dependenceHealth care delivery is hampered by insufficient number and maldistribution of personnel, health clinics and hospitals. The predominant attitude of curative rather than preventive approach to health problems shared by consumers and care givers alike. Passive and meager participation if at all on the part of recipients also contribute to deficient health care deliveryChild-to-Child Health Programs would be most useful in depressed areas of the country, especially in the rural setting and should be widely implemented if feasible. Data concerning the community involved will include resources, strengths and weaknesses, and degree of commitment from its members. We hope to have in the Philippines more experience in Child-to-Child Programs in health care delivery in the future. (Summary and Conclusions)

On malnutrition in childhood in the Philippines III. pathological findings in malnutrition in the Philippines

The histologic changes in different organs of 32 Filipino infants who died in a state of severe malnutrition were studied. Changes in the intestines, liver and pancreas which have already been described were confirmed. A significant finding was that hemorrhage had occurred in some organs in a total of 29 (91%) of the cases. The frequency distribution of hemorrhages in various organs is as follows: adrenals (medulla) - 26 (81%); bone marrow - 16 (50%); kidneys - 13 (41%); lungs - 13 (41%); liver - 7 (22%); pituitary gland - 5 (16%); heart muscle, thymus, and lymph nodes - 2 cases each (6%); and testes - 1 (3%). The brain was not studied in most of these casesThese findings are interpreted to indicate a general hemorrhagic tendency among cases of severe malnutrition in Filipino infants; furthermore, massive hemorrhages in the adrenal medulla is apparently the cause of death in a high percentage of these cases. The underlying mechanism of this hemorrhagic tendency has yet to be clarifiedHyperemia found in different organs suggests impairment of cardiac function which cannot be detected by electrocardiography as the entire heart muscle seems to be involved. Histologically evident infections seem to play only a minor role in malnutrition; however, complete bacteriologic study of malnutrition cases is strongly indicated. Degenerative changes in the kidney with discharge of a hyaline material into the tubules was observed in about one-half of the cases. (Summary and Conclusions)