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Objective@#To evaluate the efficacy and safety of Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea (AAD) in infants and young children.@*Method@#From November 2012 to September 2013, ten research units of large teaching hospitals or children′s hospitals participated in this multicenter randomized controlled clinical trial. Hospitalized young children aged between 1 month and 3 years (nongastrointestinal infection and antibiotic therapy required)were involved in our study. The children were randomly divided into control group and prevention group by means of block random allocation method. The control group received antibiotic therapy and other conventional treatment. The prevention group was given additional Saccharomyces boulardii (250 mg/d) orally. Diarrhea rates of two groups were compared both during the usage of antibiotics and within 14 days after the antibiotics withdrawal. The adverse reactions of Saccharomyces boulardii were observed all through this study. The results were analyzed by χ2 test or Kruskal-Wallis test or t test.@*Result@#Totally 408 cases (213 cases in prevention group and 195 cases in control group) were enrolled. The age ranged from 1 month to 3 years, with an average age of 1.14 years. The basic diseases were parenteral infections: 368 cases with different kinds of respiratory tract infections or pneumonia, 10 cases of bacterial meningitis, 9 cases with septicemia or sepsis, 6 cases with pertussis or pertussis like syndrome, 5 cases with urinary infection, 5 cases with skin or subcutaneous tissue infections, 3 cases of Kawasaki disease, one with scarlet fever and one with congenital syphilis. During the administration of antibiotics, the incidence of AAD in prevention group was 10.3% (22 cases), which was significantly lower than that of control group (57 cases, 29.2%, χ2=23.296, P<0.05). Within 14 days after the discontinuation of antibiotics, the percent of new diarrhea cases in prevention group (2.4%, 5/213) was also significantly lower than that in control group (16.4%, 32/195, χ2=23.4, P<0.05). Further analysis revealed that the rate of AAD in children less than or equal to 1 year old (25.1%, 52/207) was significantly higher than that of over 1 year old (13.4%, 27/201, χ2=8.922, P<0.05). The incidence of AAD in children treated with antibiotics for more than 5 days was 22.2%(60/270), which was significantly higher than that of less than or equal to 5 days (13.8%, 19/138, χ2=4.180, P<0.05). Although no significant difference was observed, the AAD rate of patients with combined use of two antibiotics was higher than that of using one. During the antibiotic therapy, compared with the control group, the risk of AAD in children under 1 year old was reduced by 52% (χ2=9.217, P<0.05), and 91% (χ2=20.35, P<0.05) in the children over 1 year old in prevention group. The risk of AAD of prevention group decreased by 66% (χ2=13.67, P<0.05) in patients treated with one antibiotics, and 65% in children with combined use of antibiotics (χ2=10.57, P<0.05). In patients treated with antibiotics for less than or equal to 5 days, the risk of AAD decreased by 74% in prevention group (χ2=7.38, P<0.05); and 63% if the course lasted for over 5 days (χ2=16.87, P<0.05). Within 14 days after the withdrawal of antibiotics, compared with the control group, the risk of diarrhea in the prevention group decreased by 82% (χ2=13.35, P<0.05) in infants (≤1 year old) and 93% (χ2=12.00, P<0.05) in children (>1 year old); the risk of diarrhea was reduced by 86% (χ2=9.57, P<0.05) and 87% (χ2=17.71, P<0.05) respectively in prevention group with single and combined use of antibiotics. In patients treated with antibiotics for more than 5 days, the risk of diarrhea in prevention group was reduced by 63% (χ2=22.79, P<0.05), while there was no significant difference if the antibiotics course was less than or equal to 5 days (χ2=2.97, P>0.05). No adverse effects related with Saccharomyces boulardii were observed in our study.@*Conclusion@#Saccharomyces boulardii is effective and safe to prevent AAD of infants and young children both during the usage of antibiotics and up to 14 days after drug discontinuance. It can be one of the drugs of for choice prevention of AAD in infants and young children. Trial registration Chinese Clinical Trial Tegister, ChiECRCT-2012-25.
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Zinc supplementation can reduce the mean duration,the recurrence rate and mortality of diarrhea.Nonetheless,it has no effect on stool frequency or stool output.Zinc supplementation results in different effort for the difference of the duration of diarrhea,pathogens,zinc type and doses of zinc,and shows no effect in infants younger than 6 months.Using iron as a co-intervention can reduce the effect of zinc,but vitamin A or ORS have a synergistic effect with the meeting.Average baseline zinc levels did not contribute to variations in the effect size.Zinc supplements are unlikely to improve compliance with the treatment for diarrheal disease.Longer course,zinc alone,malnutrition,diarrhea,breast-feeding children are prone to vomiting after oral administration of zinc.
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@#ObjectiveTo investigate the effect of early rehabilitation at bedside motor function in children with acute flaccid paralysis （AFP）. Methods45 patients were divided into two groups. The treatment group (n=23) received rehabilitation when the vital signs were stable and nervous symptom did not advance. The control group (n=22) received rehabilitation after acute stage. ResultsThe muscular strength of treatment group recovered more significantly than the control group 2 weeks and 4 weeks after treatment （P＜0.05）.ConclusionEarly rehabilitation at bedside can facilitate the motor function recovery in AFP.
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@#ObjectiveTo investigate the clinical characteristics and epidemic analysis in children with hand foot and mouth disease(HFMD) following acute flaccid paralysis(AFP).Methods30 children with HFMD following AFP in Hunan Province Children's Hospital were surveyed retrospectively.ResultsAll the patients were below 5 years old, 83.34％ were 1～3 years old, 90% from countryside. Besides AFP of limbs, 86.67% complicated with encephalitis. The major clinical characteristics as followed: fever(100.00%), skin rash(100.00%), startle and skip(80.00%), emesis(63.33%), neurogenic pulmonary edema(13.33%) and urinary retention(16.67%). The most palsy occurred in 3～5 days after onset, and the palsy in lower limbs was major, only a few had palsy in upper extremities or tetraplegia. 26 cases were infected with enterovirus type 71(EV 71), 1 case infected other EV, 3 cases were negatively. The EMG showed that the amplitude of active potential lowered in the femoral nervus, tibial nerve, peroneal nerve, axillay nerve and musculocutaneous nerve, or/and the motor conduction velocity slowed down, the damage of proximate nerve was the most common.ConclusionThe most children with HFMD following AFP were infected with EV 71. Encephalitis was the common complication. The symptom of EV 71 was more severious than distribute EV.
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Objective To summarize the clinical characters, diagnostic and therapeutic strategy of the cured patient with human H5N1 avian influenza pneumonia in mainland of China,and to provide effective experiences for the physicians to diagnose human avian influenza infection.Methods The clinical data of the cured patient with H5N1 avian influenza infection in China was analyzed.Results The patient was treated with short-term symmetrel and ribavirin for antiviral therapy companied with the lowdosage and long-term(4 weeks) glucocorticoid therapy.The CPAP assistant ventilation was used and the airway was kept unobstructed.The antibiotic was used to prevent and control the followed infection.The supportive treatment was applied to protect the organ′s function of the patient.The pathogenetic condition of the patient became better with the hemogram risen and the lungs pathological changes absorbed gradually.The chest CT reexamined at the 7th day of the hospitalized-term suggested that the left lung fibrosis started to be absorbed and it was obviously absorbed at the 16th day.The breath function and all the internal organs functions became better.The patient convalesced and left hospital at the 46th day.Conclusion In the human avian influenza infection,the pathogenetic condition may progress quickly after the pneumonia appears.The lung injury and lung fibrosis as well as the multi-organs dysfunction were emerged in the patient rapidly.The progression of disease can be controlled and the prognosis can be improved by the prompt and correct treatment.