The world of synbiotics: a review of literature and clinical evidence in diarrhoea from the lens of a paediatrician

The use of synbiotics in the management of acute diarrhoea in children is becoming a common practice in India. However, since this is an upcoming modality of treatment, it is essential to review the scientific rationale and evidence on clinical efficacy and safety in the context of paediatric diarrhoea. In addition, most synbiotics contain a combination of multiple probiotics along with a prebiotic. Thus arises, a parallel need to understand whether a combination of probiotics performs better than single probiotics, hence justifying the rationale for such combinations. A review of available evidence suggests that synbiotics are indeed safe and superior in efficacy to single probiotics (like Bacillus clausii, Lactobacillus rhamnosus GG etc) and that there is a good body of evidence to support the efficacy and tolerability of synbiotics in the management of paediatric acute gastroenteritis. There is also evidence to suggest that combination probiotics have superior benefits compared to single probiotics, thus justifying their use as part of synbiotics. The overall benefits of synbiotics reported in various clinical trials on paediatric diarrhoea include, a rapid normalization of the gastrointestinal flora, a reduction in the duration of diarrhoea, quicker improvement in stool consistency, lesser administration of additional medications like antibiotics, antiemetics and antipyretics, higher physician reported treatment satisfaction scores and enhanced overall efficacy against gastrointestinal pathogens, including diarrhoea of rota virus origin. Hence, synbiotics put up a strong case to look beyond probiotics and single probiotic formulations in paediatric diarrhoea.

Umbilical Cord Blood Banking: Consensus Statement of the Indian Academy of Pediatrics

Justification: Practitioners and people need information about the therapeutic potential of umbilical cord blood stem cells and pros andcons of storing cord blood in public versus private banks.Process: Indian Academy of Pediatrics conducted a consultative meeting on umbilical cord blood banking on 25th June 2016 in Pune,attended by experts in the field of hematopoietic stem cell transplantation working across India. Review of scientific literature was alsoperformed. All expert committee members reviewed the final manuscript.Objective: To bring out consensus guidelines for umbilical cord banking in India.Recommendations: Umbilical cord blood stem cell transplantation has been used to cure many malignant disorders, hematologicalconditions, immune deficiency disorders and inherited metabolic disorders, even when it’s partially HLA mismatched. Collectionprocedure is safe for mother and baby in an otherwise uncomplicated delivery. Public cord blood banking should be promoted over privatebanking. Private cord blood banking is highly recommended when an existing family member (sibling or biological parent) is sufferingfrom diseases approved to be cured by allogenic stem cell transplantation. Otherwise, private cord blood banking is not a ‘biologicalinsurance’, and should be discouraged. At present, autologous cord stem cells cannot be used for treating diseases of genetic origin,metabolic disorders and hematological cancers. Advertisements for private banking are often misleading. Legislative measures arerequired to regularize the marketing strategies of cord blood banking.

Clearing’ Pediatric Airways.

Let’s look at a common case-scenario. A two-year-old presents with recurrent episodes of fever, cold, cough and wheezing since the age of 6 months. Each time, the episode begins with high fever that lasts for 2 to 3 days, accompanied with cold and progressively worsening cough, followed by wheezing. Wheezing settles down within a short time but the cough continues for two weeks. Routine investigations are normal. The child remains well in between episodes, and maintains good growth and development. No one in family has history suggestive of asthma or atopy. The child receives repeated courses of antibiotics and inhaled steroids for 3 months, but there is no change in frequency of episodes. Each and every time pediatrician’s ‘mann ki baat’ rotates around questions like…Is it viral?...Is it bacterial?...Can I label it as asthma?...Kahin ye ‘woh’ toh nahin? (Tuberculosis!)... finally realizing that it is Wheeze Associated Lower Respiratory Infection (WALRI).

In a Lighter Vein Live Life, Not Just Survive.

Recently I met one of my MBBS batchmates (MBBS admission batch to be precise, since departure batches differ!). I casually asked him – How are you doing ? He said – "I am living on one capsule of Dhaklamycin per day." When I asked him about this new medicine, he said –"Zindagi Dhakel raha hoon (I am simply pushing my life). My children are abroad; they are not in medical profession… Lot of money lying idle in the bank and cupboard... I have no interest whatsoever, neither in practice nor in life." Another friend said: "All throughout the life, I have been listening to only ten complaints – cold, cough, fever, vomiting, loose motions, abdominal pain, constipation, itching, breathlessness and febrile convulsions. Why won’t I get bored by listening to the same complaints over and over again?" Sensing frustration from these talks, I started introspecting. Like the layers of an onion, we get surrounded by ‘d’ layers of degrees, dear ones and dollars, and the central doctor starts behaving like a diplomat presenting different faces to different groups of people. The child-like qualities of the ‘child’ specialist start dwindling over time! High fives start taking an upper hand ...High BMI, hypertension, high blood sugar, high lipid levels and the better half start creeping in and becoming difficult to handle!