Compliance with 14 day zinc therapy for acute diarrhoea: a prospective observational study

Background: Acute diarrheal diseases remain a leading cause of global morbidity and mortality in young children. The effective implementation of provision of zinc in addition to low osmolarity ORS remains very poor.Methods: A prospective observational study was done to determine compliance with zinc therapy on 103 children aged between two months to five years with acute gastroenteritis. They were started on WHO ORS and zinc in the form of syrup (20 mg/day in those >6 months of age and 10mg/day in those <6 months of age) and advised to continue for 14 days. Further episodes of diarrhea was considered as the primary outcome variable. Number of days zinc taken was considered as the primary explanatory variable. p-value <0.05 was considered statistically significant.Results: The mean age was 19.49'14.41 months. The compliance to complete 14-day zinc therapy was 62.14%.' The mean number of days zinc was taken was 11.28'3.81 days. In 11.65% of participants, there was further episodes of diarrhea. The main reasons for discontinuation were diarrhea stopped (45%), Ignorance (37.5%), URI (12.5%).Conclusions: Findings indicate that the syrup formulation is acceptable, but further efforts are required to enhance adherence. These findings also highlight the importance of guiding in ensuring adherence to zinc duration while also addressing the tendency of caregivers to terminate treatment once a child appears to have recovered from an acute diarrheal episode.

Knowledge and practices among caregivers in cases of persisitent diarrhoea in children of age group 6 months-12 years

Background: Persistent diarrhoea has a variety of infectious and non-infectious etiology and it seriously affects the growth and development of children. The objective of the is to the identify the knowledge and practices prevalent amongst caregivers of children to understand environmental and behavioral risk factors and their interactions associated with the disease and its management.Methods: It is a hospital based cross-sectional study which included 70 children in the age group 6 months-12 years admitted in a tertiary care center at Bhopal over a period of one year with complaints of loose stools lasting for more than 14 days. A pre-tested questionnaire was used as a data collection tool for face-to-face interviews with the mothers or caretakers of the cases. Statistical analysis was done using Statistical Package of Social Science (SPSS Version 20; Chicago Inc., USA). Data comparison was done by applying specific statistical tests to find out the statistical significance of the comparisons.Results: Most of children's mother were Illiterate, 27.1% were educated till primary school and only 5.7% were graduate. Out of 70 cases, most of 51(72.8%) were have understanding that drinking untreated water is a risk factor, only 11(15.7%) understands the value of filtered water and 8(11.4%) know the importance of doing boiling. Most of 46(65.7%) were using open field for sanitation and only 11(15.7%) were using toilets at home. 42(60.0%) were having the habit of hand washing before taking meal.'Conclusions: Community education about the prevention and management of diarrhoea will reduce the mortality and morbidity associated with persistent diarrhoea.

Prognostic significance of initial management of childhood diarrhoea in rural areas: an observational study

Background: To identify current evidence in order to guide scaling up of initial management of diarrhoea among children of age group 2-60 months in rural areas of the country.Methods: This hospital based cross sectional study included all children 2 months to 60 months of age admitted with chief complains of loose stools in the last 7 days over a period of one year. A pre-tested questionnaire was used as the data collection tool and face to face interviews were conducted on mothers of children.' All the data were analyzed using IBM SPSS version 20 software. Chi-square/Fisher Exact/ Student t-test and ANOVA test has been used. Significance was assessed at 5%.Results: Data showed the use of antibiotic in 55.9% cases, IV fluids in 50.3%, ORS in 6.7%, zinc in 2.0% and blood transfusion in 13.8% cases as an initial management of diarrhoea in peripheral health care centers. Of these, 37.6% cases were severely dehydrated, and 8.14% cases were in shock at the time of admission. 10.1% mothers did not intervene in the first 3 days of the disease whereas 45.2% consulted some health care center only in the later part. 4.5% cases expired after admission of which 69% were malnourished.Conclusions: This study summarizes the importance of initial management of a child with diarrhoea in defining the further course of the disease and also the failure of effective promotion and propagation of the most appropriate and cost-effective therapy (ORS and Zinc) for diarrhoea in this part of the country. Pre-existing malnutrition further complicates the situation.

Comparison of Health Education, Oral Rehydration Solution, Metoprolol and Midodrine Intervention in Children with POTS

Introduction: The postural orthostatic tachycardia syndromeis heterogeneous group of disorder. When a healthy individualstands up, gravity causes about 10%-15% of his or her bloodto settle in the abdomen or limbs. This pooling of bloodmeans that less blood reaches the brain, the result of whichcan be a feeling of lightheadedness, darkening of vision, oreven fainting. Hence, the aim of the present study was toevaluate the clinical features and the effectiveness of nonpharmacological and pharmacological treatment in patientswith POTS.Material and Methods: A retrospective medical recordanalysis of the patients referred to pediatric cardiology unitof our Second Xiangya Hospital of Central South Universitysince June 2003 to February 2010 was done. This studyincluded 33 children patients aged 6 to 16 years old among17 male (mean 10.62±2.88 years) and 16 female (mean11.81±1.64 years) after medication within 14 days to 6 monthswith follow up record.Results: The most common presenting symptoms of POTSwere found to be dizziness or light-headedness (66.66%)followed by chest tightness (30.30%), syncope (27.27%),headache (24.24%) and pallor (24.24%) respectively. About75.5% of children patients met diagnostic criteria for POTSduring 5 to 10 minute of HUTT. There was significant statisticdifference in heart rate between before and after treatment oftotal patients during 5 and 10 minute of HUTT (P<0.05). Theoverall improvement found in 24(72.72%) patients whereas9(27.27%) patients not respond to the given treatment regimen.Conclusion: The most common presenting symptom of POTSwas dizziness or light-headedness. Most of the patients meetdiagnostic criteria for POTS during 5 to 10 minute durationof HUTT. Health education, ORS, propranolol and midodrinewere effective in treatment of POTS and helpful to diminishthe upright tachycardia. Whereas health education and healtheducation with midodrine hydrochloride treatment methodwere more likely effective than health education with ORSand health education with metoprolol method

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.

Costos de la rehidratación oral y nasogástrica comparadas con la rehidratación endovenosa en niños con diarrea en Colombia / Costs of oral and nasogastric rehydration compared to intravenous rehydration in children under 5 years of age with diarrhea in Colombia

RESUMEN Objetivo Evaluar los costos de las terapias de rehidratación oral (TRO) y de rehidratación nasogástrica (TRN) comparadas con la terapia de rehidratación endovenosa (TRE) para corregir la deshidratación por diarrea en niños. Metodología Análisis de minimización de costos desde la perspectiva del Sistema de Salud colombiano comparando TRO (seguida de TRN ante falla de la TRO), con la TRE. El horizonte temporal fue la duración de la rehidratación. La medida de efectividad se extrajo de una revisión sistemática de literatura. Para determinar costos, se construyó un caso típico y un árbol de decisiones, a partir de revisión de guías e historias clínicas, validado con expertos. Los costos unitarios se obtuvieron de bases de datos colombianas. Costos fueron calculados en pesos colombianos (COP) y dólares americanos (USD). Se realizaron análisis de sensibilidad de una y dos vías. Resultados La TRO y la TRE son similares en efectividad para prevenir hospitalización y lograr rehidratación. En el caso base, el costo de la TRO fue $91,221COP (40.5 USD) y para TRE $112,944COP (50.14USD), es decir, un ahorro de $21,723 COP (9.64 USD). En los análisis de sensibilidad por regímenes de aseguramiento y complejidad del hospital, la TRO suele ser la estrategia menos costosa. Discusión Ambas intervenciones son similares en efectividad, pero la TRO, seguida de TRN ante falla de la primera resulta menos costosa que la TRE. La TRO es recomendable como primera opción para corregir la deshidratación. Deberían continuarse esfuerzos por implementar TRO y TRN en los servicios de salud en Colombia.(AU)

ABSTRACT Objective To evaluate the costs of oral rehydration therapy (ORT) and nasogastric rehydration therapy (NRT) compared with intravenous rehydration therapy (IRT) to treat dehydration in children under 5 years of age with diarrhea. Methodology Cost-minimization analysis from the perspective of the Colombian Health System, comparing ORT, (followed by NRT when ORT fails), with IRT. The time horizon was the duration of rehydration. The effectiveness measure was obtained from a systematic review of the literature. To determine costs, a typical case was created based on current guidelines and medical records; this case was validated by experts. Unit costs were obtained from Colombian databases and were provided in Colombian pesos (COP) and US dollars (USD) for 2010. One- and two-way sensitivity analyzes were performed. Results ORT and ERT are similarly effective to prevent hospitalization and to achieve rehydration. In the base case, the expected cost of ORT was $91,221 COP (40.5 USD) and for IRT was $112,944 COP ($50.14 USD), saving $21,723 COP ($9.64 USD) per case. In the sensitivity analyzes by health insurance and hospital level, ORT is often the least costly strategy. Discussion Both interventions are similarly effective, but ORT, followed by NRT when ORT fails, is less costly than IRT. ORT is recommended as the first option to treat dehydration since it is effective and less expensive. Efforts should be continued to implement TRO and NRT in the health services of Colombia.(AU)

Pilot Study for Safety and Efficacy of Newly Developed Oral Carbohydrate-Rich Solution Administration in Adult Surgery Patients

PURPOSE: In surgical procedures under general anesthesia, 6 to 8 hours of a nulla per os (NPO; nothing by mouth) has been regarded as essential for prevention of respiratory complication such as aspiration. However, recent studies have reported that oral intake of water and other clear fluids up to 2 hours before induction of anesthesia does not increase respiratory problems. The purpose of this pilot study is to investigate the safety and efficacy of a newly developed carbohydrate-rich solution in elective hernia repair surgery patients. METHODS: A group of 30 adult patients scheduled for elective surgeries under general anesthesia were enrolled. The enrolled study group of patients was permitted to drink a carbohydrate-rich solution until two hours before the operation without volume limitation. Respiratory complication was investigated in the patients using the carbohydrate-rich solution until two hours before induction of general anesthesia. The feelings of thirst, hunger sense were measured pre- and post-operatively. In addition, hoarseness of voice, nausea and vomiting were investigated post-operatively. Satisfaction regarding the short time of fasting was measured. Visual analogue scale (VAS) was used for measurement of these six variables. RESULTS: No patients showed serious respiratory complication such as dyspnea, desaturation. Eight of 30 study group patients complained of mild hoarseness. Most symptoms of hoarseness were mild, with VAS score less than 3 out of 10. Two patients complained 5 out of 10. Six patients felt nausea and 1 patient had vomiting. Pre/post-operative hunger sense and thirst feeling were 1.63/1.60 and 1.90/5.76, respectively. The satisfaction score was 3.00 out of 4. CONCLUSION: Allowing the administration of an oral carbohydrate-rich solution in elective surgery patients requiring general anesthesia is safe without serious respiratory complications and effective in providing satisfaction.

Evaluation of Academic Detailing Programme on Childhood Diarrhoea Management by Primary Healthcare Providers in Banke District of Nepal.

Academic detailing is rarely practised in developing countries. A randomized control trial on healthcare service was conducted to evaluate the impact of academic detailing programme on the adherence of primary healthcare providers in Banke district, Nepal, to childhood diarrhoea treatment guidelines recommended by World Health Organization/United Nations Children’s Fund (WHO/UNICEF). The participants (N=209) were systematically divided into control and intervention groups. Four different academic detailing sessions on childhood diarrhoea management were given to participants in the intervention group. At baseline, 6% of the participants in the control and 8.3% in the intervention group were adhering to the treatment guidelines which significantly (p<0.05) increased among participants in the intervention (65.1%) than in the control group (16.0%) at the first follow-up. At the second follow-up, 69.7% of participants in the intervention group were adhering to the guidelines, which was significantly (p<0.05) greater than those in the control group (19.0%). Data also showed significant improvement in prescribing pattern of the participants in the intervention group compared to the control group. Therefore, academic detailing can be used for promoting adherence to treatment guidelines in developing countries, like Nepal.

Clinical application of oral rehydration solution

The administration of oral rehydration solution (ORS) has rescued the lives of people with diarrhea. Although diarrhea mortality rates have dropped by 75% from 1980 to 2008 in worldwide, diarrhea continues to be a major cause of child death, especially in children younger than 5 years. The clinical application of the standard WHO-ORS in large-scale campaigns resulted in decreased mortality associated with acute diarrheal disease in children. Many clinical trials on variants of ORS such as hypo-osmolar solutions, rice-based solutions, zinc supplementation, and the addition on other advantageous substances have been performed to improve outcomes of diarrheal treatment. This paper reviews the pathophysiologic base and history of ORS, composition of ORS, and its clinical use for acute diarrhea and other intestinal diseases.

Acute salt poisoning due to different oral rehydration solution (ORS) packet sizes.

The packing and composition of ORS has undergone a change since its introduction. In India, some companies are manufacturing smaller pouches (4.2 g) to be dissolved in 200 ml of water. Therefore, out of confusion some prescribers routinely advise the patients to dissolve the standard formulation ORS pouch (21 g) in a glass (200 ml) of water. Two cases are discussed. First patient developed salt poisoning due to improper dilution and recovered after rapid correction. In the second patient improper reconstitution led to hypernatremia and death.

Risk Factors and Case Management of Acute Diarrhoea in North Gondar Zone, Ethiopia.

In Ethiopia, evidence is lacking about maternal care-taking and environmental risk factors that contribute to acute diarrhoea and the case management of diarrhoea. The aim of this study was to identify the risk factors and to understand the management of acute diarrhoea. A pretested structured questionnaire was used for interviewing mothers of 440 children in a prospective, matched, case-control study at the University of Gondar Referral and Teaching Hospital in Gondar, Ethiopia. Results of multivariate analysis demonstrated that children who were breastfed and not completely weaned and mothers who were farmers were protective factors; risk factors for diarrhoea included sharing drinking-water and introducing supplemental foods. Children presented with acute diarrhoea for 3.9 days with 4.3 stools per day. Mothers usually did not increase breastmilk and other fluids during diarrhoea episodes and generally did not take children with diarrhoea to traditional healers. Incorporating messages about the prevention and treatment of acute diarrhoea into child-health interventions will help reduce morbidity and mortality associated with this disease.

Recent Advances of Oral Rehydration Therapy (ORT)

Diarrheal disease is one of the leading causes of worldwide morbidity and mortality, especially in children. It causes loss of body fluid, which may lead to severe dehydration, electrolyte imbalance, shock and even to death. The mortality rate from acute diarrhea has decreased over the last few decades. This decline, especially in developing countries is largely due to the implantation of the standard World Health Organization-oral rehydration solution (WHO-ORS). However, the use of standard ORS has been limited by its inability to reduce fecal volume or diarrhea duration. Subsequently, this has led to various attempts to modify its compositions. And these modifications include the use of reduced osmolarity ORS, polymer-based ORS and zinc supplementation. Some of these variations have been successful and others are still under investigation. Therefore, further trials are needed to progress toward the ideal ORS. In this article, we briefly reviewed the pathophysiologic basis of the ORS, followed by the standard WHO-ORS and several modifications to improve the ORS.

Acute infectious Diarrhea in Pediatirc Patients / 소아과

Acute diarrhea is one of the most common diseases that are seen in pediatric patients. In the management of acute diarrhea, several differential diagnostic criteria should be considered based on clinical and/or laboratory findings. These criteria include:(1) normal variant stool versus diarrhea (2) infectious versus non-infectious condition and (3) bacterial versus non-bacterial etiology. The use of antibiotics should be considered to manage diarrhea caused by bacteria accompanying fever and bloody diarrhea in the following cases:(1) patients with serious clinical course, (2) under three months, (3) immunocompromised patients, (4) patients with nutritional deficiency and (5) patients presenting with moderate-to-severe dehydration. In patients presenting with the symptoms suspected to be bacterial origin, whose clinical course is not serious, antibiotic therapy is not necessary. These patients are easily manageable at OPD level. Moreover, except for some cases in which the use of antibiotics is inevitable, pediatric diarrhea can be managed by providing the suitable foods alone with no necessity of other specific drugs. Accordingly, it is crucial not so much to depend on the drugs as to provide appropriate foods including oral rehydration solution(ORS) with no further episodes of diarrhea. Special attention should be paid to the fact that younger pediatric patients will undergo nutritional deficiency unless acute diarrhea is properly managed.

First Action Management of Acute Diarrhoea in Children by Rural Mithers.

Out of 2120 children with acute diarrhoea surveyed, majority (88%) were less than 5 years of age with mles having definite predominance (60%). Home available fluids and ORS were applied as first action by15.9% mothers, while in 7.8% children feeding/fluids were stopped. Household remedies were applied In 8.6% cases. Private practitioners and government health agencies were consulted by 47.3% and 20.4% mthers respectively. To conclude, ORS/home available fluids are inadequately used by rural mothers And they give preference to private practitioners as compared to government health agencies.

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.