Current trends in the management of acute diarrhea in children below 5 years of age

Background: Diarrhea can cause significant deaths and morbidity in children whose age is below 5 years in developing countries. In children under five, it is the third cause of mortality. Aims and Objectives: The main aim of this study was to examine recent trends in the management of acute diarrhea in children below 5 years of age and to identify the pattern of pharmacotherapy for acute diarrhea in children the specific age group of <5 years of age. Materials and Methods: A non-interventional study that was prospective and observational in nature was conducted in 50 patients that were admitted in the pediatric wards at a teaching hospital that was tertiary care. Only those participants whose parents/guardian gave written informed consent were included in the study. Results: Of enrolled 50 patients, 30 (60%) were male patients and 20 (40%) were female patients. Most patients (42%) were between the ages of 6 months–1 year. All the 50 participants were prescribed WHO-ORS and Zinc. About 60% of children were administered the antibiotics with intravenous fluids. Antipyretics were administered to 90% children, antispasmodic and antisecretory agents to 40%, and probiotics to 92% children. The commonly used antibiotics were ceftriaxone, cefpodoxime, metronidazole, ofloxacin, and ornidazole. Conclusion: There was strict adherence to guidelines for treating the children who suffered with acute diarrhea. However, there was poor awareness among the parents regarding the compliance to the treatment, hygienic practices, and its consequences.

Assessment of role of zinc in the management of acute diarrhea in children at a teaching hospital

Background: Pediatric diarrhea is one of the major causes of childhood mortality around the world. Oral rehydrationtherapy (ORT) along with zinc supplementation can reduce the irrational antimicrobial use and stay in hospital. Aims and Objectives: This study aims to evaluate the role of zinc in reduction of stool frequency and duration of diarrheal episode. Materials and Methods: A prospective observational study was performed for 12 months at pediatric in-patient unit of BRIMS teaching hospital, Bidar. We evaluated 400 prescriptions of acute diarrhea cases for the role of zinc based on reduction of stool frequency and decrease in the duration of diarrheal episode. Results: A study revealed a very statistically significant reduction (P < 0.001) in both stool frequencies during the 3rd–5th day and there was reduction in mean duration of diarrheal episode in the group treated with ORT/parenteral rehydration+ zinc. Conclusion: We observed significant decrease in both stool frequency and mean duration of diarrheal episodes in the group treated with ORT/parenteral rehydration+ zinc as compared to ORT/parenteral rehydration alone. Thus, we recommend practitioners to use ORS and zinc which reduces the stay in hospital and helps in faster recovery. And also, it would definitely reduce the practice of polypharmacy and inappropriate antibiotic prescribing practices.

Risk Factors for Dyselectrolytemia in Children with Acute Diarrhoea in the Inpatient Setting in North India

Background: Dyselectrolytemia is a common accompaniment of acute diarrheal illnesses and contributes to increased morbidity and mortality. Aim: To study the incidence and identify the risk factors for developing dyselectrolytemia in children getting admitted with acute diarrhoea. Study design: Prospective observational study. Methods: Detailed history, examination, and investigations were recorded in specially designed proforma. Serum electrolyte levels were measured at admission in all the study subjects and correlated with clinical presentation and demographic profile. Results: Out of 107 children, 64.5% had no dehydration, 31.8% had some dehydration, and only 3.4% were severely dehydrated at the time of admission. Most common electrolyte abnormality were hyponatremia(25.2%) and hypochloraemia (25.2%), followed by hypokalaemia (11.2%), hyperchloremia (9.3%) and hypernatremia (6.5%). The degree of dehydration was found to significantly affect serum electrolyte profile (p value<0.05). Hyponatremia (41%), hypokalaemia(26.5%), and hypochloraemia(35%) were seen more commonly in patients with some dehydration, while a higher proportion of patients with severe dehydration had hypernatremia (50%) and hyperkalaemia (25%). Consumption of diluted ORS was significantly associated with the development of hyponatremia (73.9%), hypokalaemia(34.8%), and hypochloraemia(56.5%) p value<0.05. Conclusion: Dyselectrolytemia is a common accompaniment of diarrheal dehydration, the most common being hyponatremia. The severity of dehydration and dilute ORS administration are important risk factors for dyselectrolytemia.

A systematic review and meta-analysis on effectiveness of rice-based oral rehydrating solution for the treatment of acute watery diarrhea among children

OBJECTIVES@#This study aims to compare the effectiveness of rice-based ORS as compared with glucose-based ORS in the treatment of acute watery diarrhea among children. Specifically, it aims to review and analyze the effectiveness of rice-based ORS as compared to glucose-based ORS as to stool output, duration of diarrhea and effect of osmolarity on treatment of diarrhea and to determine associated adverse events associated with rice-based ORS and glucose-based ORS.@*METHOD@#This study used systemic review and meta-analysis of randomized trials. Primary outcomes were computed with 95% confidence intervals to determine the effectiveness of ricebased ORS. Adverse event was expressed as risk ratios with 95% confidence intervals.@*RESULTS@#Sixteen studies met the criteria for the systematic review and meta-analysis. Duration of acute diarrhea was shorter by 5 hours with rice-based ORS (MD= −5.27 hours, 95% CI= −9.63 to −0.91, p-value= 0.02) compared to glucose-based ORS. The stool output was 62.35 mL/kg lower with rice-based ORS (MD= −62.35 mL/kg, 95%CI= −128.43 to 3.74, p-value= 0.06) compared to glucose-based ORS. Vomiting was the only reported associated event with ORS intake (RR= 1.08, 95%CI= 0.81to 1.43, p-value= 0.60).@*CONCLUSION@# Sixteen studies met the criteria for the systematic review and meta-analysis. Duration of acute diarrhea was shorter by 5 hours with rice-based ORS (MD= −5.27 hours, 95% CI= −9.63 to −0.91, p-value= 0.02) compared to glucose-based ORS. The stool output was 62.35 mL/kg lower with rice-based ORS (MD= −62.35 mL/kg, 95%CI= −128.43 to 3.74, p-value= 0.06) compared to glucose-based ORS. Vomiting was the only reported associated event with ORS intake (RR= 1.08, 95%CI= 0.81to 1.43, p-value= 0.60).

Study of electrolyte disturbances and renal parameters in acute gastroenteritis under 5 years of age in a tertiary care hospital of Bengaluru, India

Background: Diarrhoea still continues to be a major cause of hospitalization and death in under fives. Electrolyte disturbances play an important role in the associated morbidity and mortality.  Acute renal failure is one of the important complications of acute gastroenteritis (AGE) in children. Early intervention and proper fluid replacement may lessen this risk. This study was designed to find out the incidence of acute gastroenteritis and the status of associated electrolyte derangements and renal involvement.Methods: This was a cross sectional study conducted at KIMS, Bengaluru in which 117 children from the age of 1 month to 5 years with acute diarrhea were included based on a predefined inclusion and exclusion criteria. Demographic profile of the patients, details of diarrhea, clinical examination and accompanying degree of dehydration (defined as per WHO criteria) were recorded. Serum electrolytes along with renal parameters were investigated.Results: Total 117 children with acute gastroenteritis were enrolled in the study as per the inclusion criteria which constituted 5% of total paediatric admissions. Children aged 1-12 months had the highest incidence of diarrhea (50%). Male to female ratio is 1.3:1. 65% had some dehydration, 19% no dehydration and 16% had severe dehydration. Isonatremia was seen in 58% followed by hyponatremia in 35% and hypernatremia in only 7%. 83% had isokalemia, hypokalemia in 12%, hyperkalemia in 5%. Levels of serum sodium and potassium decreased with the severity of dehydration. Serum urea and creatinine were significantly high in severe dehydration (p value 0.001). Out of 28 children who were given diluted ORS before admission, majority had hyponatremia (39%) and all of them who received concentrated ORS had hypernatremia.Conclusions: Hyponatremic dehydration is the second most common type of dehydration next to isonatremic dehydration, but it is more common in children who took diluted ORS. Increased awareness regarding ORS preparation may help in preventing electrolyte imbalance in AGE. The levels of serum sodium and potassium decreased and urea and creatinine increased with severity of dehydration. Measurements of serum electrolytes and renal parameters early can help to predict the complications due to AGE and may help in the prevention of diarrhea related complications in children.

A study to identify knowledge, attitude and practices prevalent amongst the caregivers of children below five years presenting with acute diarrhoea in a tertiary care centre

Background: Diarrhoeal infections are the second leading cause of death worldwide in under-five children covering 9% of the total deaths. The objective of the study was to assess and compare mothers' knowledge, attitude and practice regarding prevention and management of diarrhoea in children.Methods: A cross-sectional hospital-based observational study was conducted in a tertiary centre amongst all 356 children between age group 2 months to 60 months admitted with acute watery diarrhea. A pre-tested questionnaire and face-to-face interviews with the mothers was used as a data collection tool.Results: Most of the mothers 282 (79.2%) were 20-30-year-old, 51.4% were illiterate, 57.3% were unemployed and 27.2% were daily wage labourers. 44.6% people came from rural background and 78.9% belonged to lower socio-economic strata. 30.3% were exclusively breastfed and 69.7% were on top feeds. Animal milk was taken by 62.1%, 46.6% had dilution and 50.6% used bottles for feeding. 70.5% of mothers washed their hands at the time of feeding of their child, 93.8% mother covered food in their houses while only 26.7% of mothers gave freshly cooked food. Mother's outlook on various aspects of diarrhea was sought. Very few mothers considered poor sanitation (2.5%) andcontaminated water (12.6%) as a source of diarrhea. Only 8.7% mothers knew about the role of ORS in diarrhea and maximum (53.4%) considered that diarrhea could not be avoided by any measure.Conclusions: Mother's knowledge regarding causes, management and prevention of diarrhea needs to be upgraded to allow better utilisation of health resources by the families.

Prescription audit of online booked outpatients for department of medicine and dermatology in a tertiary care hospital: a comparative observational study

Background: A regular and effective prescription audit is a key tool to ensure rational use of drugs and to assess drug utilization in the health care system. This study is first of its kind, in Rajendra Institute of Medical Sciences (RIMS), Ranchi, highlighting comparative assessment of prescriptions of online booked appointments in department of medicine and dermatology via online registration system (ORS) using WHO prescribing indicators. This ORS is an integral part under Digital India Initiative.Methods: This was a comparative, observational study conducted in Department of Pharmacology of RIMS, Ranchi. The study period was 6 months from 1 March 2019 to 31 August 2019. Prescriptions details of outpatient department (OPD) patients were collected from the government authorized pharmacy facility “Dawai Dost “at RIMS. 75 prescriptions from each of the departments were analyzed.Results: 75 prescriptions from patients who attended medicine and dermatology outpatient department (OPD) during the study period, after registering appointment via ORS, was collected and comparative assessment was done. This audit highlights important correctable parameters although legibility was not the major concern. Adherence to National List of Essential Medicines (NLEM) was 45% and 49% for department of medicine and dermatology respectively.Conclusions: The prescription audit process should be done regularly to assess ORS prescription to ensure high quality rational prescribing and support Digital India initiative. Adherence to NLEM of India should be 100%. The latest NLEM of India should be provided to the concerned departments and feedback should be provided to the physicians.

How knowledgeable and practicable are the mothers of under five children in urban slum, Tamil Nadu on: utilization of ORS, homemade fluids and feeding practices during acute diarrhoeal diseases

Background: Globally, acute diarrhoea claims around 1.5 million lives of under-five children. In India, ADD accounts for 8% of deaths in <5yrs age group. Child may be pushed into an irreversible outcome as stunting because of inadequate nutrition and repeated bouts of infection during the first 1000 days of life. Oral rehydration therapy is the most effective treatment intervention which can avert about 14% of deaths in under five children. Methods: A cross sectional study was done among 270 mothers of under five children from our urban health centre service area of PSGIMSR. Results: Among 270 mothers of under five children most of them belonged to the age group of ≤25 years. Only 10.7% of the mothers were aware that infection or germs cause diarrhea, signs of dehydration were not known by 80% of mothers. Mothers’ with more than one child and mothers with education more than 8th class were emerged as the factors affecting ORS preparation. Conclusions: The knowledge on diarrhoea was low. Although awareness regarding spread of diarrhoea and ORS was adequate in this community, knowledge regarding continuation of feeding and signs of dehydration were deficient. Thus educating the mothers of under-five children regarding correct practices of home management of diarrhoea is likely to further reduce diarrhoea morbidity and mortality.

A study to assess the practices of mothers of under-five children in childhood diarrhoea in a tertiary care hospital of Northeast India

Background: Diarrhoea is one of the major causes of morbidity and mortality in under-five children. The incidence of diarrhoea has remained almost unchanged over the past few decades. A mother is the primary care-giver of a child. Therefore, one of the key factors that determine the survival of a sick-child is her attitude and practices in the event of diarrhoea. The present study was therefore undertaken to understand the different aspects of their care-giving behaviour.Methods: A hospital-based cross-sectional study was carried out in the Department of Paediatrics, Agartala Government Medical College and G. B. Pant Hospital, Agartala, Tripura, India over a period of two months. 700 mothers of under-five children attending the OPD were interviewed with a pre-designed and structured interview schedule.Results: The usage of ORS was about one-fourth. And only one-fifth out of all the participating mothers could show how to prepare ORS solution correctly. Correct practices regarding various aspects of administering ORS solution like duration of usage, frequency of administering, duration of the therapy, etc were not observed in majority of the participating mothers. A preference for home-made fluids was also noted in most of the participants. Educational level and past experience of managing a child with diarrhoea significantly affected their practices.Conclusions: Even though ORS is widely and easily available, easy to use and cost-effective, considerable work needs to be done in the context of adequate practices in its administration to a child affected by diarrhoea and increase its acceptability.

Knowledge, attitude and practices of oral rehydration therapy among mothers coming to tertiary care centre

Background: Diarrhoea is a major cause of morbidity and mortality among under-five children. Correct knowledge regarding oral rehydration therapy (ORT) helps prevent morbidity and mortality due to diarrhoea. The objective of this study is to assess the knowledge, attitude and practice of mothers of under-five children regarding ORT and home management of diarrhoea.Methods: Study period from December 1st, 2017 to December 31st, 2017, total of 200 mothers were enrolled in this study. The data was entered in Microsoft excel sheet and percentages were calculated.Results: 95% of mothers were aware about ORS. ORS was given by parents on own in16%, 55% were advised by doctor. Only 60% knew how to prepare ORS correctly. About 45.7% had used bottle to give ORS and 55.3% used cup and spoon. About 67.9% had knowledge of quantity of ORS to be given during diarrhoea episode. Exclusive breast feeding was practised in 86% of mothers till 6 months of age. Misconceptions about the use of ORS were seen in 60% and more among illiterates. About 21% mothers' felt ORS should be stopped if diarrhoea continues. Only 5% of mothers felt ORS can be given even if child has vomiting. About 9% mothers felt no fluids should be given during diarrhoea.Conclusions: Mothers' knowledge and attitude on use of ORS in diarrhoea need to be improved.

A Comparative Study of Probiotic Lactic Acid Bacilli alone and in Combination with Bifidobacterium and Saccharomyces as Adjuvants to ORS and Zinc in the Management of Acute Pediatric Diarrhoea

Introduction: Pediatric diarrhoea is the second leading cause of childhood mortality. It is a major global health problem, particularly affecting children under the age of 5 years. It is managed with oral rehydration salt, and zinc supplements. Recently, there has been a trend of prescribing probiotics which help in reducing the frequency and duration of diarrhoea. As India is fast emerging as a potential market for probiotics, scientific studies are required to ensure their efficacy. With this background, this study was undertaken to evaluate the role of probiotics in the treatment of acute onset mild and moderate pediatric diarrhea. Materials and Methods: This was an observational, prospective, open label, comparative study. It was conducted on 90 children after obtaining informed consent from their guardian. The participants were allocated to one of three study groups as follows; Group A: ORS & zinc Group, B: ORS, Zinc and lactic acid bacilli; Group C: ORS, Zinc and combination of lactic acid bacilli acidophilus, Bifidobacterium lactis and Saccharomyces boulardii. They were followed up for 72 hours after receiving the treatment and after 7 days. The outcome measures were reduction in mean duration and mean frequency of diarrhea. Data was collected in case report forms. Statistical analysis was done using ANOVA followed by Dunnet’s test. Results: The mean frequency of diarrhea on day 1 in Group A, B and C were 5.87±1.23; 6.5±1.15 and 6.63±1.42 respectively. On day 2, in Group A it was 2.93±0.82; Group B, 3.23±0.99 and in Group C, 2.73±0.89 respectively. On day 3, in Group A it was 1.33±0.47; Group B, 0.86±0.5 and in Group C, 0.53±0.5 respectively. The mean duration of diarrhea in Group A, B and C were 4.5±0.76, 3.47±0.5 and 3.17±0.37 days respectively. There was significant reduction in mean frequency and duration of diarrhea in Group B and C compared to Group A (p˂0.05).   Conclusion: Probiotics when used alone or in combination as adjuvant to ORS and Zinc in the treatment of acute pediatric diarrhea results in significant reduction in mean frequency and mean duration of diarrhea.

Prevalence of Norovirus and epidemiology of acute gastroenteritis in children

Pediatric gastroenteritis is a major cause of childhood mortality and morbidity worldwide, especially in developing countries. Diarrhoea can be caused by a variety of different pathogens including bacteria, viruses and parasites. Among the viruses; Rotavirus has been extensively studied and is responsible for 44% of GE cases. As the Rotavirus vaccination coverage improves, the causative agent’s shift may be more towards the Calciviruses (Norovirus, Sappovirus) and other similar viruses, and consequently the investigations should focus on these viruses in future. This study was conducted in a Teaching hospital, Hyderabad, Telangana State included 118 cases of Gastroenteritis of which 6 cases were positive for Norovirus (NoV) i.e.; 5% of cases were NoV positive by RIDASCREEN EIA and RIDA QUICK, the rapid test for NoV virus. These 6 cases were children between 7 months and one and half year old. The age profile showed a fall in the number of diarrhoea cases as the child’s age increases. 63 (53.3%) were male children and 55 (46.6%) were female children. In children < 2 years (n=83), 22 (26.5%) were breast fed, 30 (36.1%) were bottle fed and 7 (8.4%) were on mixed Alimelu M, Radha Mohan M., Vindhya Tuladi, Sudhershan Reddy P, Shailaja V.V., Preeti Nagaraj G. Prevalence of Norovirus and epidemiology of acute gastroenteritis in children. IAIM, 2016; 3(6): 157-163. Page 158 feeds. Among mothers 25.42% never washed their hands with soap, 60.16% used soap occasionally and only 14.4% always used soap. 43.2 % presented with no dehydration, 27.96% presented with some dehydration and 28.8% presented with severe dehydration. 70.3% of mothers continued to feed during diarrhoea. Regarding the treatment used for diarrhoea before admission in hospital, 42.37% used ORS, 27.11% used both ORS and antibiotics, 55.08% were on antibiotics and 11% took no treatment at all.

Promotion of Zinc Tablets with ORS through Child Health Weeks Improves Caregiver Knowledge, Attitudes, and Practice on Treatment of Diarrhoea in Nigeria.

We examined whether the Maternal, Newborn and Child Health Weeks (MNCHW) in Nigeria would present an opportunity to raise awareness of and demand for the use of zinc and ORS in the treatment for diarrhoea, guided by a conceptual framework designed to assess three theoretical underpinnings (characteristics and performance standard of the health workers, potential reach, and intensity of the intervention), along the impact pathway. Zinc and ORS with education for their appropriate use during the next diarrhoeal episode were delivered as part of the November 2010 and May 2011 MNCHW. On the day of but before participating in MNCHW activities, semi-structured interviews were used for collecting information on knowledge, attitudes, and practice (KAP) relating to diarrhoea from 602 caregivers with children aged less than five years. Forty-eight health workers were also interviewed. Nearly all health workers (98%) correctly mentioned the dosage of zinc while only 58% correctly stated the preparation of ORS. The proportion of caregivers with knowledge on the treatment for diarrhoea increased from 46.4% in November 2010 pre-MNCHW to 71.3% in May 2011 pre-MNCHW interviews (p<0.001). More caregivers correctly mentioned the dosage of zinc (80.9%) and stated the preparation of ORS (88.8%) in the November 2010 exit interview immediately after the MNCHW encounter compared to the levels a few months later in the home follow-up visit (53.1% and 37.4% respectively). After attending both rounds of November 2010 and May 2011 MNCHW, caregivers’ knowledge on the treatment of diarrhoea increased seven times compared to the caregivers who attended the May 2011 MNCHW only (OR=7.0, p<0.001). Additionally, caregivers were 40% less likely to seek advice outside the home in the treatment for diarrhoea if they had attended both the MNCHWs than if they had attended the May 2011 MNCHW only (OR=0.6, p<0.029). We conclude that providing opportunities for caregivers to receive a sample of zinc and ORS and to learn about its use in the treatment for diarrhoea, from trained health workers during MNCHW, has the potential to increase KAP relating to the use of zinc and ORS in the treatment for diarrhoea and for future diarrhoeal episodes.

Eficacia del agregado del zinc al suero de hidratación oral versus hidratación oral clásica sobre el estado clínico nutricional e inmunitario en el tratamiento de niños con diarrea aguda / Effectiveness of the addition of Zinc in hydration serum versus oral hydration classic on growth and immune response in the treatment of children with acute diarrhea

Objetivo: determinar la eficacia del agregado del zinc en la preparación de suero de hidratación oral versus administración clásica de hidratación y su efecto en el crecimiento, estado clínico nutricional e inmunitario de niños con diarrea aguda menores de 5 años. Métodos: estudio experimental aleatorizado realizado en el Hospital del Nin@ Manuel Ascencio Villarroel. De 700 niños con diarrea aguda 117 ingresaron al estudio previo consentimiento de padres: 31 conformaron el grupo estudio, 42 fueron controles (44 abandonaron); con criterios de inclusión, exclusión. El GTROCRIN (SRO+ZINC) recibió zinc 20mg/1000cc en la misma preparación del suero y el GSROH (SRO) solución hidratante oral hipo-osmolar aparte zinc 2mg/Kg. Se realizaron: Examen clínico, tomas de muestras para hemograma, orina, heces además de antropometría, cuantificación de aporte calórico, tolerancia oral, gasto fecal y respuesta inmunitaria por ecografía de timo repetidos a diez días. Los datos fueron procesados SPSS 19, p< 0,05; IC: 95%. Resultados: al ingreso ningún niño presentó deshi-dratación grave ni complicaciones severas, copro-parasitológicos fueron negativos 51,61% (16) GTROCRIN, 35,71 % (15) GSROH. AMEBAS: GTROCRIN: 32,25%(10); GSROH: 50%(21).GIARDIA: GTROCRIN: 12,90%(4); GSROH: 14,28%(6). AMBOS PARÁSITOS: GTROCRIN: 3,22% (1). Al concluir el estudio GTROCRIN: P/TZ, T/EZ, P/EZ, IMC/Z,MM,MG,SOM mejoraron (p<0,0001). Diarrea duró 4,16±1,55 (GTROCRIN) vs7, 80±1,1 días (GSROH). GTROCRIN recibió mayor aporte calórico (P<0,0001), tolero mejor, tuvo menor gasto fecal, la diarrea cedió 81,64% (25). (p<0,001), mejoró la superficie, espesor del timo 617,52±111; 24,44±3,85vs GSROH: 453,46±74,82; 19,80±1,61 (p<<0,001) en este grupo la evolución fue tórpida en 11,9% (5) niños. Conclusiones: el estudio muestra mayor eficacia en el tratamiento de la diarrea aguda con el agregado del zinc en suero de hidratación oral que sin el, en la mejoría clínico-nutricional e inmunitaria.

Objective: to determine the efficacy of the addition of zinc in the preparation of oral rehydration serum versus classical administration of hydration and its effect on growth, nutritional status and clinical immune children with acute diarrhea in children under 5 years. Methods: experimental randomized study of the Children's Hospital Manuel Ascencio Villarroel. From seven hundred children with acute diarrhea 117 were studied prior consent of parents. 31 formed the study group, 42 were controls (44 abandoned ). The GTROCRIN group (SRO + ZINC ) received zinc 20mg/1000cc in the same preparation of oral serum, and GSROH group (GSROH ) received oral hypo-osmolar hydrating solution with zinc 2mg/Kg apart. It were performed clinical examination, samples for blood count, urine, feces plus anthropometry, quantification of caloric intake, oral tolerance, fecal output and immune response of thymus repeated ultrasound to ten days. Data were processed SPSS 19, p < 0.05; IC: 95 %. Results: on admission no child had severe dehydration or severe complications were negative copro-parasitological 51.61 % (16) GTROCRIN, 35.71 % (15) GSROH. AMOEBAE: GTROCRIN: 32.25% (10); GSROH: 50 % (21). GIARDIA: GTROCRIN: 12.90% (4); GSROH: 14.28% (6 ) . BOTH PARASITES: GTROCRIN: 3.22 % (1). At the conclusion of the study GTROCRIN: P/T, T/EZ, P/EZ, IMC/ Z, MM, MG, SOM improved (p < 0.0001). Diarrhea lasted 4.16 ± 1.55 (GTROCRIN) vs. 7,80 ± 1.1 days ( GSROH ) . GTROCRIN received increased energy intake (P < 0.0001), I tolerate better, had less stool output, diarrhea yielded 81.64 % (25), (p < 0.001), improved surface thickness thymus 617.52 ± 111; 24.44 ± 3.85 vs. GSROH: 453.46 ± 74.82; 19.80 ± 1.61 (p < < 0.001) in this group evolution was torpid in 11.9 % (5) children. Conclusions: The study shows greater efficacy in the treatment of acute diarrhea with the addition of zinc in serum without oral hydration in clinical nutrition and immune improvement.

Conocimientos sobre hidratación oral por las madres de pacientes de 1 a 5 años de vida con enfermedad diarreica aguda: República Dominicana / Knowledge about oral hydration by mothers of patients 1 to 5 years old with acute diarrhea: Dominican Republic

Determinar el nivel de conocimiento de la madre con respecto a la hidratación oral del paciente durante un episodio diarreico agudo. Material y Métodos: Estudio observacional, descriptivo con recolección prospectiva y de corte transversal, en el cual se recolectaron datos entre la segunda semana de mayo a la segunda semana de junio 2013; con un cuestionario de 12 ítems con preguntas cerradas con el fin de medir el conocimiento de la madre con relación a la hidratación oral durante el episodio de diarrea. Se eligió la muestra de manera no probabilística por conveniencia. Resultados: La mayoría de las madres conocía las implicancias sobre la salud de su hijo de la enfermedad diarreica aguda, y conocía la importancia de mantener una hidratación adecuada durante el mismo. Se evidenció que un porcentaje de la población, desconocía la preparación y viabilidad del Suero de rehidratación oral (SRO), y se evidenció el uso de otro tipo de bebidas no adecuadas durante el episodio de diarrea aguda. (Bebidas hidratantes comerciales y carbonatados) como terapia de hidratación durante la diarrea. Conclusiones: Se identificó que se hace necesario una mayor información y capacitación a las madres acerca de la manera de rehidratar a sus hijos con diarrea aguda...

Determine the level of Knowledge of the mother regarding oral hydration practices of a child during an acute diarrheal episode. Material and Methods: Observational, descriptive with prospective data collection and transversal cut study, in which data was collected from the second week of may until the second week of June 2013; using a 12 item questionnaire, with close questions with the intent to measure the level of Knowledge of the mother regarding oral hydration practices of the child during an acute diarrheal episode. The simple was taken using a non-probabilistic convenience method. Results: The majority of the mothers knew the health implications regarding acute diarrhea, and the importance of adequate oral hydration during the illness. However, these need to be strengthened, because it was witnessed that a percentage of the population didnÆt know the preparation and the viability of the ORS, and were using other non-adequate beverages during the acute diarrheal episode, like a high percentage of commercial hydration beverages and not on a high percentage the use of carbonated beverages (soda) as a hydration therapy during the diarrhea. Conclusions: Advanced maternal age was associated with a higher rate of C-sections and a higher risk of having a child with Down syndrome. There was no evidence that advanced maternal age is associated with increased neonatal morbidity...

Simultaneous determination of nineteen trace elements in Andrographis paniculata by inductively coupled plasma mass spectrometry with octopole reaction system / 中国药学杂志

OBJECTIVE: To establish an ICP-MS method for simultaneous determination of 19 trace elements, i.e. Na, Mg, Al, Si, K, Ti, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Ag, Cd, Sn, Hg, and Pb, in Andrographis Herba. METHODS: After microwave digestion treatment, samples were directly determined by inductively coupled plasma mass spectrometry based in octopole reaction system (ORS). RESULTS: The validated method indicated that the correlative coefficients (r) for all elements were above 0.9990. The limits of detections were in the range of 0.001-0.051 μg · kg-1. The reproducibility and stability were satisfactory with all RSDs below 10%. The spiked recoveries for Andrographis paniculata were between 88.64% and 102.98%. CONCLUSION: The method is simple, rapid and sensitive, which meets the requirement of trace analysis and can be used for the quality control of Andrographis Herba.

Use of Only Oral Rehydration Salt Solution for Successful Management of a Young Infant with Serum Sodium of 201 mmol/L in an Urban Diarrhoeal Diseases Hospital, Bangladesh.

A boy aged 4 months 7 days was admitted to the Intensive Care Unit (ICU) of the Dhaka Hospital of icddr,b, Dhaka, Bangladesh, with the problems of acute watery diarrhoea with some dehydration, pneumonia, lethargy, and hypernatraemia (serum sodium of 201 mmol/L). Correction for hypernatraemia was tried by using only oral rehydration salt (ORS) solution. Seizures occurred during correction of the hypernatraemia. These were difficult to control and required three doses of injection lorazepam, a loading dose of injection phenobarbitone, followed by injection phenytoin and finally two doses of injection mannitol (even though there was no clinical or imaging evidence by ultrasonography or computed tomography of cerebral oedema). The correction was continued with ORS, and all the anticonvulsants were successfully weaned without any further seizures, and the patient recovered without any overt neurological sequelae. We present a case report of extreme hypernatraemia, which was successfully managed using only ORS.

Lessons from cholera & Vibrio cholerae.

Cholera is an acute form of diarrhoeal disease that plagued human civilization over the centuries. The sudden and explosive onset of the disease in the form of an outbreak or epidemic, coupled with high mortality and morbidity rates, had a tragic impact on the personal as well as social life of people living in the affected areas. The enormity of human sufferings led clinicians and scientists to carry out extensive research on cholera and Vibrio cholerae (the causative bacterium of the disease) leading to major discoveries that opened up novel areas of research or new disciplines in biomedical sciences. An attempt is made here to summarize some of these breakthroughs and outline their significance in broader perspectives. Finally, the possible impact of the global socio-political scenario on the spread of cholera epidemics (pandemicity of cholera) is briefly discussed.

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.

Diagnostic Significance of the CEA, AgNORs and PCNA in the Gastric Dysplasia and Adenocarcinoma

This study aimed to differentiate gastric mucosal lesions such as the inflammatory gastric mucosa, gastric dysplasia and adenocarcinoma, using the CEA(carcinoembryonic antigen), AgNORS(Nucleolar organizer regions) and PCNA(proliferating cell nuclear antigen) stains. The tissue samples were taken from 30 cases of inflammatory gastric mucosa (19 gastritis and 11 regenerative hyperplasia), 28 cases of gastric dysplasia (9 mild dysplasia, 10 moderate dysplasia and 9 severe dysplasia) and 21 cases of gastric adenocarcinoma. The CEA was expressed in 16 of 21 adenocarcinomas(76%), but in neither inflammatory nor dysplastic gastric mucosae. The mean number of AgNORs per nucleus was 1.54 in inflammatory gastric mucosa, 1.80 in gastric dysplasia, and 1.88 in adenocarcinoma. The number of AgNORs was increased in dysplasia and adenocarcinoma compared to the inflammatory gastric mucosa without statistical significance. The percentage of the PCN A positive cells was 35.2% in inflammatory gastric mucosa, 44.1 % in gastric dysplasia, and 69.0% in gastric adenocarcinoma. The positivity of the PCNA was significantly increased in adenocarcinoma compared to the inflammatory gastric mucosa and dysplasia. In conclusion, the frequency of the CEA positive staining was increased in the gastric adenocarcinoma, and so CEA stain will be able to provide an additive method for the differential diagnosis between severe dysplasia and adenocarcinoma of the stomach.