La administración de ondansetrón no mejora la evolución de los niños con gastroenteritis aguda sin deshidratación / Administration of ondansetron does not improve the course of children with acute gastroenteritis without dehydration

Sobre la base de una viñeta clínica de un niño con gastroenteritis aguda sin deshidratación, el autor de este artículo realiza una búsqueda bibliográfica para revisar la evidencia que avala el uso de ondansetrón para tratar sus vómitos, práctica bastante común en instituciones con acceso a este fármaco en sus centrales de emergencia. Luego de dicha búsqueda, el autor concluye que en niños con gastroenteritis aguda sin deshidratación, la administración de ondansetrón no reduce la necesidad de hidratación intravenosa ni la frecuencia ni la severidad de los vómitos. (AU)

Based on a clinical vignette of a child with acute gastroenteritis without dehydration, the author of this article performs a literature search to review the evidence supporting the use of ondansetron to treat his vomiting, a fairly common practice in institutions with access to this drug in their emergency rooms. After this search, the author concludes that in children with acute gastroenteritis without dehydration, the administration of ondansetron does not reduce the need for intravenous hydration or the frequency or severity of vomiting. (AU)

Weight loss thresholds to detect early hypernatremia in newborns / Limites de perda de peso para detecção de hipernatremia precoce em recém-nascidos

ABSTRACT Objective: The literature indicates a single universal cut-off point for weight loss after birth for the risk of hypernatremia, without considering other factors. The aim of this study was to construct and internally validate cut-off points for the percentage weight loss associated with the risk of hypernatremia, taking into account risk factors. Methods: A prospective study with a three-day follow-up was conducted in 165 neonates with a gestational age ≥35 weeks. The main outcome variable was mild or moderate hypernatremia (serum sodium ≥ 145 mmol/L). Secondary variables (risk factors) were maternal and infant variables. A multivariate logistic regression model was constructed to predict hypernatremia, obtaining its probability and the optimal discriminant cut-off point for hypernatremia (receiver operating characteristic analysis). Based on this point, threshold weight loss values were obtained according to the other variables. These values were internally validated by bootstrapping. Results: There were 51 cases (30.9%) of hypernatremia. The mean percentage weight loss for hypernatremic infants was 8.6% and 6.0% for the rest. Associated variables in the multivariate model included greater weight loss, male gender, higher education level, multiparity, and cesarean delivery. The model had an area under the receiver operating characteristic curve of 0.84 (sensitivity = 77.6%; specificity = 73.2%). Similar values were obtained in the bootstrapping validation. The lowest percentage weight loss was 4.77%, for cesarean delivery in male infants of mothers with a higher education level. Conclusions: The weight loss percentage values depended on the type of delivery, parity, newborn gender, and level of maternal education. External studies are required to validate these values.

RESUMO Objetivo: A literatura indica um único ponto de corte universal na perda de peso após o nascimento para risco de hipernatremia, sem considerar outros fatores. Nosso objetivo foi criar e validar internamente pontos de corte para o percentual de perda de peso associado ao risco de hipernatremia considerando fatores de risco. Métodos: Foi feito um estudo prospectivo que incluiu 165 neonatos com idade gestacional ≥ 35 semanas, acompanhados por três dias. A principal variável de resultado foi hipernatremia leve ou moderada (sódio sérico ≥ 145 mmol/L). As variáveis secundárias (fatores de risco) foram variáveis maternas e dos neonatos. Um modelo multivariado de regressão logística foi criado para diagnosticar hipernatremia, obteve sua probabilidade e o ponto de corte discriminativo ideal para hipernatremia (análise da Característica de Operação do Receptor). Com base nesse ponto, obtivemos então os valores limites de perda de peso de acordo com as outras variáveis. Esses valores foram internamente validados por. Resultados: Há 51 casos (30,9%) de hipernatremia. O percentual de perda de peso para neonatos hipernatrêmicos foi 8,6% e 6,0% para o restante. As variáveis associadas no modelo multivariado incluíram maior perda de peso, sexo masculino, maior nível de escolaridade, multiparidade e cesárea. O modelo apresentou uma área sob a curva da Característica de Operação do Receptor de 0,84 (sensibilidade = 77,6%; especificidade = 73,2%). Valores semelhantes foram obtidos na validação da bootstrapping. O menor percentual de perda de peso foi 4,77% para cesárea em neonatos do sexo masculino de mães com maior nível de escolaridade. Conclusões: Os valores percentuais de perda de peso dependem do tipo de parto, paridade, sexo do recém-nascido e nível de escolaridade materna. São necessários estudos externos para validar esses valores.

Infected Cardiac Myxoma: an Updated Review

ABSTRACT OBJECTIVE: This study aims to present an updated clinical picture of the infected cardiac myxoma. Revankar & Clark made a systematic review of infected cardiac myxoma based on the literature before 1998. Since then, there has not been any updated information describing its recent changing trends. METHODS: A comprehensive literature search of infected cardiac myxoma was conducted on MEDLINE, Highwire Press and Google between 1998 and 2014. RESULTS: In comparison with Revankar & Clark's series, the present series disclosed a significantly decreased overall mortality. It is believed that refinement of the prompt diagnosis and timely management (use of sensitive antibiotics and surgical resection of the infected myxoma) have resulted in better outcomes of such patients. CONCLUSION: The present series of infected cardiac myxoma illustrated some aggravated clinical manifestations (relative more occasions of high-grade fever, multiple embolic events and the presence of refractory microorganisms), which should draw enough attention to careful diagnosis and treatment. In general, the prognosis of infected cardiac myxoma is relatively benign and the long-term survival is always promising.

Efficacy of HPA Lanolin® in treatment of lip alterations related to chemotherapy

The side effects of chemotherapy on the lips may cause esthetic and functional impact and increase the risk of infection. HPA Lanolin® is an option for supportive therapy because it has anti-inflammatory, antimicrobial and moisturizing properties. Objective: To evaluate the efficacy of this product in the prevention of lip alterations in a population of patients undergoing chemotherapy. Material and Methods: Patients undergoing chemotherapy (n = 57) were examined and distributed into two groups: study (used HPA Lanolin®) and control (without supportive therapy on the lips). We evaluated the patients two weeks after chemotherapy, registering oral alterations, symptoms of pain, discomfort, limitation of mouth opening and dehydration, classified according to a visual analogue scale. Results: Patients who used HPA Lanolin® had lower dehydration and experienced improvement of lip dryness (p<0.001). The main symptoms were dehydration, discomfort, limitation of mouth opening, pain. The main clinical signs were dry lips, mucositis, cheilitis, hematoma, swelling and cracking. We found no difference concerning the variables of pain, discomfort, and limitation of mouth opening between the study and control group. Conclusions: We suggest that HPA Lanolin® is effective in reducing the symptoms of dehydration and the signs of lip dryness resulting from toxicity of chemotherapy, proving to be an interesting alternative supportive therapy for cancer patients.

Clinical management of diarrhoea in children

Diarrhoea is one of the commonest reasons children require health care in Papua New Guinea (PNG). Acute watery diarrhoea is the commonest form, and is due to viruses. Oral rehydration solution, zinc and continued breastfeeding are highly effective treatments that can be delivered in homes and health facilities. Antibiotics are not useful in acute watery diarrhoea--they make it worse. Deaths from acute watery diarrhoea should be rare if basic curative services are available. Persistent diarrhoea (lasting longer than 14 days) is commonly associated with other co-morbidities, including malnutrition, anaemia, HIV (human immunodeficiency virus) infection, parasite (such as Giardia) or worm infections and environmental enteropathy. Educating parents on handwashing, food preparation, water purification, improvements in sanitation and the home environment, breastfeeding, nutrition and immunization are essential in preventing diarrhoea. Cholera appeared in PNG in 2009, causing over 500 deaths in all age groups. Cholera emerged because of limited access to safe, clean drinking water and poor sanitation. Addressing these will have beneficial effects not only on cholera but also on all causes of diarrhoea and many other common childhood infections.

Efeito de suplemento hidroeletrolítico na hidratação de jogadores juniores de futebol / Effects of a carbohydrate-electrolytic drink on the hydration of young soccer players

O estado de hidratação de jogadores sub-18 de um time de futebol foi avaliado após a ingestão de suplemento hidroeletrolítico mais aceito em teste afetivo. A aceitação de três suplementos elaborados foi avaliada por meio de teste afetivo em laboratório. O estudo foi realizado com nove jogadores de futebol, do sexo masculino, submetidos a 80 minutos de treinamento, com a ingestão de 900mL de suplemento hidroeletrolítico comercial (controle) ou suplemento mais aceito no teste sensorial e 300mL de água. Para avaliação do estado de hidratação foram determinados o tempo de movimentação, a intensidade do exercício, a densidade de urina, o peso corporal, a perda de peso corporal, a porcentagem de perda de peso corporal, o grau de hidratação e a taxa de sudorese. A bebida com 8 por cento de carboidrato teve melhor aceitação. A intensidade de exercício dos jogadores foi maior no dia de ingestão da bebida teste em comparação ao dia de ingestão da bebida controle, já o tempo de movimentação em relação à bebida teste foi significativamente menor do que a bebida controle (p = 0,008). A perda de peso, o grau de desidratação e a taxa de sudorese dos atletas com ingestão da bebida teste foram maiores quando comparadas à ingestão da bebida controle. Os atletas concluíram a partida mais desidratados com a ingestão de bebida teste; contudo, o limite de 2 por cento de perda de peso corporal não foi ultrapassado. A intensidade do exercício (de leve a moderada) e as condições climáticas (temperatura mais baixa e umidade relativa do ar mais elevada) no dia da ingestão da bebida controle podem ter favorecido os melhores resultados de capacidade de hidratação da bebida comercial.

The hydration status of nine male under 18 soccer players was evaluated after ingestion of the most accepted carbohydrate-electrolyte drink between three tests. The study was conducted during 80 minutes of training. The soccer players ingested 900 mL of a commercial carbohydrate-electrolyte drink (control) plus 300 mL of water or 900 mL of the most accepted drink (test) plus 300 mL of water. The time of training, exercise intensity, urinary status, weight, weight loss, the weight loss rate, the dehydration degree and the sweat rate were determined to verify the hydration status. The drink with 8 percent carbohydrate was the best accepted. The exercise intensity of the players was higher on the days that they ingested the tested drink. The time of training in relation to the tested drink was significantly lower than the control beverage (p = 0.008). The weight loss, the dehydration degree and sweat rate of the athletes with fluid intake test was higher when compared to control fluid intake. The athletes completed the game more dehydrated with the drinking fluid test; however, the limit of 2 percent weight loss was not exceeded. The exercise intensity (mild to moderate) and climatic conditions (lower temperature and higher relative humidity) on the day of the fluid control intake control may have helped the best results from the hydration capacity of the fluid control.

Otro método para el cálculo de la hidratación / Another method to estimate the hydration

De manera tradicional se enseñan diferentes métodos para corregir las deshidrataciones por la vía parenteral. Para ello se recurre al cálculo a partir de síntomas clínicos que permiten clasificarlas en leves, moderadas y graves. En este trabajo se expone una modificación de la fórmula general de reposición de líquidos, que permite hacer un cálculo adecuado sin necesidad de recordar otras fórmulas y multiplicaciones. En la bibliografía dedicada a este tema, tanto cubana como extranjera, no se encontraron referencias al uso de este método; tampoco en la práctica médica diaria(AU)

In a traditional way different method to correct the dehydrations by parenteral route are taught. For that reason it is appeal to estimation of clinical symptoms allowing to its classification as slight, moderated and severe. In present paper it is showed a modification of the general formula of fluid recovery allowing making an appropriate estimation without to remember other formulae and multiplications. In the Cuban and foreign bibliography devoted to this subject there weren't references as regards the use of this method neither in the daily medical practice(AU)

Rotafolio de consejería para evitar enfermedades en niñas y niños menores de 5 años / Counseling flipchart to prevent illness in girls and boys under 5

El rotafolio, como instrumento usado para la presentación de información, sirve de guía tanto para el personal de salud, como para la orientación de los pacientes, particularmente de madres con niños recién nacidos, lactantes y preescolares (menores de cinco años). En él, van paso a paso con los detalles sobre las formas de prevenir enfermedades por medios de hábitos de higiene en vivienda, tratamiento del agua, lavado de manos, entre otros; además, da los elementos necesarios para abordar síntomas como la diarrea, deshidratación, entre otros. Un instrumento didáctico de gran calidad fotográfica.

Desidratação e recomendações para a reposição hídrica em crianças fisicamente ativas: [revisão] / Dehydration and rehydration recommendations for physically active children: [review]

OBJETIVO: A prática de exercícios físicos, devido à produção inerente de calor, pode conduzir à desidratação. A maioria dos estudos que abordam os riscos da desidratação e fornecem recomendações de reposição hídrica é direcionada a indivíduos adultos residentes em regiões de clima temperado, porém, em regiões tropicais, pouco é conhecido sobre as necessidades de reposição hídrica em crianças fisicamente ativas. Esta revisão discute as recomendações para esta população e estabelece os riscos da prática esportiva em ambiente de clima tropical. FONTES DE DADOS: Análise sistemática com levantamento da literatura nacional (SciELO) e internacional (Medline) de artigos publicados entre 1972 e 2009, com os seguintes descritores isolados ou em combinação: hidratação, crianças, desidratação e reposição hídrica. Foram selecionados artigos publicados nas línguas portuguesa e inglesa. SÍNTESES DE DADOS: Observou-se que há riscos de desidratação e possível desenvolvimento de um quadro de hipertermia principalmente se as crianças são submetidas a condições climáticas desfavoráveis sem reposição hídrica adequada. O principal fator desencadeante da hipertermia é a menor adaptação das crianças aos extremos de temperatura, em comparação aos adultos, por possuírem área maior de superfície corporal e capacidade menor de termorregulação por evaporação. CONCLUSÕES: Conhecidos os fatores intervenientes da desidratação, a melhor recomendação, perante uma condição climática sabidamente desfavorável, é estabelecer um plano impositivo de hidratação com bebida com sabor e acréscimo de carboidratos e sódio, evitando-se uma perda hídrica significativa, diminuição da performance e, principalmente, com o objetivo de reduzir os riscos à saúde impostos pela hipertermia e desidratação a crianças fisicamente ativas.

OBJECTIVE: The practice of physical exercises leads to dehydration due to heat production. Most studies that address the risks of dehydration and provide recommendations for restoring water are directed to adults living in temperate climate regions, but little is known about the needs of restoring water to physically active children in tropical regions. This review discusses the recommendations for this population and the risks of sports practice in tropical climate areas. DATA SOURCE: Systematic analysis of the national (SciELO) and international (Medline) literature from 1972 to 2009, with the following keywords, alone or in combination, in Portuguese and English: hydration, children, dehydration and water replacement. DATA SYNTHESIS: There are risks related to dehydration and possible development of hyperthermia especially in adverse weather conditions without adequate fluid replacement. The main trigger for hyperthermia is that, compared to adults, children are less able of adapting to extremes of temperature due to their higher body surface area and lower capacity of thermoregulation by evaporation. Studies on this subject are scarce in face of the questions still open. CONCLUSIONS: Once dehydration factors are known, the best recommendation to aggressive climatic conditions is to establish a replacement program using flavored hydration beverage added with carbohydrates and sodium in order to avoid significant water losses and reduced performance, and to decrease health risks posed by hyperthermia and dehydration to physically active children.

Desenvolvimento de formulações cosméticas hidratantes e avaliação da eficácia por métodos biofísicos / Development of cosmetic moisturizer formulations and evaluation of hydrating eficcacy by biophysical methods

Introdução: A comprovação da eficiência de formulações hidratantes deve ser criteriosa e analisada por com métodos adequados. Objetivo: O objetivo principal do trabalho foi avaliar in vivo a eficácia hidratante de formulações contendo diferentes componentes ativos por capacitância elétrica e perda de água transepidérmica. Compararam-se os desempenhos entre Corneometer® e Moisturemeter® e entre o Vapometer® e Tewlmeter®. Verificou-se o comportamento in vitro das alterações causadas pelas substâncias hidratantes, em modelo de estrato córneo alternativo. Material e Métodos: Os compostos ativos selecionados (4% p/p) para incorporação nos géis a base de carbômero foram: uréia, extrato vegetal de Imperata cylindrica; complexo contendo fatores de hidratação natural; e os derivados do açúcar, sacarídeo isomerato e a mistura de xilitilglicosídeo e anidroxilitilglicosídeo. A avaliação in vivo da eficácia hidratante, teve o delineamento experimental baseado no projeto fatorial ANOVA three way. Os tempos estudados foram: após a aplicação e 30,60, 120; 240 e 360 minutos. O estudo de estabilidade acelerada das formulações envolveu condições drásticas de armazenamento (temperatura, umidade e luminosidade) durante 90 dias. Na avaliação in vitro do comportamento das substâncias hidratantes utilizou-se a espectroscopia Raman com transformada de Fourier (FT-Raman) e Calorimetria exploratória diferencial (DSC)...

Water status of breastfed infants during weaning in Yazd, Iran

To investigate the state of hydration in infants during the weaning period in dry and hot climates in the center of Iran. Using a refractometer, 162 urine specific gravity [USG] was measured from 400 infants, between 4 to 6 months old. They were chosen among infants who visited the primary clinics in the city of Yazd, Iran for routine vaccination during the summer and winter of 2005. A questionnaire was filled out on air conditioning system and diet from mothers. A USG > 1.020 was accepted as dehydrated, and a USG < 1.010 as well hydrated. Thirty-one percent of the infants were dehydrated, and 34% were well hydrated, infants were more dehydrated in summer [p < 0.05]. Twenty-seven percent of them started solid food without water supplementation, and dehydration was significant in most of them [p < 0.05]. We could not determine which type of air conditioning devices now used at home affect water status, but there was a trend toward dehydration in those using both fan and cooler [p=0.096]. In the desert area in the center of Iran, during weaning, approximately one third of the infants are exposed to the danger of dehydration. Our primary health care provider should consider the priority of water during weaning when water supplementation is safe

Hidratação durante o exercício: a sede é suficiente? / Hidratación durante el ejercicio: ¿la sed es suficiente? / Exercise fluid replacement: is thirst enough?

O objetivo deste trabalho é fazer uma revisão sobre a hidratação e discutir se, durante o exercício, a reposição de líquidos de acordo com a sede é suficiente para hidratar o indivíduo. A perda hídrica pela sudorese induzida pelo exercício, especialmente realizado em ambientes quentes, pode levar à desidratação, pode alterar o equilíbrio hidroeletrolítico, dificultar a termorregulação e, assim, representar um risco para a saúde e/ou provocar uma diminuição no desempenho esportivo. Tem sido citado que os atletas não ingerem voluntariamente água suficiente para prevenir a desidratação durante uma atividade física. Em função disso, têm sido propostas recomendações internacionais sobre a hidratação. Segundo o American College of Sports Medicine (ACSM), deve-se ingerir aproximadamente 500mL de líquidos nas duas horas antecedentes ao exercício. Durante o exercício, os atletas devem começar a beber desde o início e em intervalos regulares, em volume suficiente para repor as perdas pela sudorese ou o máximo tolerado. A National Athletic Trainer's Association (NATA) faz as seguintes recomendações: ingerir 500 a 600mL de água ou outra bebida esportiva duas a três horas antes do exercício e 200 a 300mL 10 a 20 minutos antes do exercício; durante o exercício, a reposição deve aproximar as perdas pelo suor e pela urina e pelo menos manter a hidratação, com perdas máximas correspondentes a 2 por cento de perda de peso corporal; após o exercício a hidratação deve ter como objetivo corrigir quaisquer perdas líquidas acumuladas. Além disso, o ACSM e o NATA fazem referências sobre temperatura e palatabilidade do líquido, adição de carboidratos e eletrólitos de acordo com a intensidade e duração do exercício e estratégias de hidratação para facilitar a acessibilidade do atleta ao líquido. No entanto, outros autores questionam o uso da reidratação em volumes predeterminados e sugerem que a ingestão de líquidos de acordo com a sede seja capaz de manter a homeostase.

The present work proposes a review about exercise fluid replacement and a discussion whether, during exercise, the fluid ingested according to thirst is sufficient to maintain hydration. Exercise sweat loss, mainly in the heat, can cause dehydration, can alter the hidroelectrolyte balance, disturb thermoregulation, presenting a health risk and/or impairing the athletic performance. It has been asserted that athletes do not drink, spontaneously, the sufficient fluid volume to prevent dehydration during the physical activity. Thus, international recommendations to fluid replacement during physical activities have been proposed. According to the American College of Sports Medicine (ACSM), about 500 mL of fluid on the two hours before the exercise must be ingested. During exercise, they propose that athletes should start fluid replacement since the beginning in regular periods and should drink enough fluid to restore all the sweating losses or ingest the maximal volume tolerated. The National Athletic Trainer's Association (NATA) proposes the following recommendations: ingestion of 500 to 600 mL of water two or three hours before exercise or other sport drink and ingestion of 200 to 300 mL 10 to 20 minutes before exercise starting. During exercise, the fluid replacement should match the sweating and urine losses and at least should maintain hydration status reaching maximal body weight losses of 2 percent. After the exercise, fluid replacement must restore all the fluid losses accumulated. In addition, ACSM and NATA asserted about fluid temperature and palatability, beverage carbohydrate and electrolyte additions according to exercise duration and intensity and recommended hydration schedules to provide easier access to fluid ingestion. However, other authors contest the use of hydration schedules based on predetermined fluid volumes and suggest that fluid replacement according to thirst is enough to maintain body homeostasis.

El objetivo de este trabajo es hacer una revisión sobre la hidratación y discutir si, durante el ejercicio, la reposición de líquidos de acuerdo con la sed es suficiente para hidratar al individuo. La pérdida hídrica por la sudoración inducida por el ejercicio, especialmente realizado en ambientes calurosos, puede llevar a la deshidratación, puede alterar el equilibrio hidroelectrolítico, dificultar la termorregulación y, así, representar un riesgo para la salud y/o provocar una disminución en el desempeño deportivo. Ha sido citado que los atletas no ingieren voluntariamente agua suficiente para prevenir la deshidratación durante una actividad física. En función de eso, han sido propuestas recomendaciones internacionales sobre la hidratación. Según American College of Sports Medicine (ACSM), se debe ingerir aproximadamente 500 ml de líquidos durante las dos horas antecedentes al ejercicio. Durante el ejercicio, los atletas deben comenzar a beber desde el inicio y a intervalos regulares, en volumen suficiente para reponer las pérdidas por la sudoración o el máximo tolerado. La National Athletic Trainer's Association (NATA) hace las siguientes recomendaciones: ingerir 500 a 600 ml de agua u otra bebida deportiva dos a tres horas antes del ejercicio y 200 a 300 ml de 10 a 20 minutos antes del ejercicio; durante el ejercicio, la reposición debe aproximarse a las pérdidas por el sudor y por la orina y por lo menos mantener la hidratación, con pérdidas máximas correspondientes a 2 por ciento de pérdida de peso corporal; después del ejercicio la hidratación debe tener como objetivo corregir cualesquier pérdidas líquidas acumuladas. Además de esto, la ACSM y la NATA hacen referencias sobre temperatura y palatabilidad del líquido, adición de carbohidratos y electrólitos de acuerdo con la intensidad y duración del ejercicio y estrategias de hidratación para facilitar la accesibilidad del atleta al líquido. A pesar de esto, otros autores cuestionan...

Zinc supplementation in acute diarrhea, does it affect copper status?

Intervention trials have shown that zinc is efficacious in treating acute diarrhea in children. In randomized double blind controlled clinical trial we evaluated the adverse effect of zinc supplementation on serum copper when used for treatment of mate infants and children [age 3-36 months] suffering from acute diarrhea. The study was carried out at Diarrheal Disease Research and Dehydration Center [DDRRC] at Bab El-Sha'reya University Hospital for one year. One hundred cases with some dehydration according to WHO classification were admitted to hospital and randomized to received either zinc or placebo for 14 days. The following investigations were performed at admission: serum Na, K, zinc, copper and hemogram. All cases were asked to come for follow up visit at the end of therapy [14 days from admission data]. At follow up visit serum for zinc and copper was investigated. At admission serum zinc and copper were within normal range in both zinc and placebo groups and without statistically significant difference. The mean duration of diarrhea for zinc treated group was shorter than that in placebo group [46.2 +/- 22.2 versus 48.9 +/- 23.9 hours] but the difference between the two groups was not statistically significant. Only 80 cases were followed up. On follow up visit serum copper was lower in zinc group than that in placebo group but the difference was not statistically significant. It is concluded that zinc supplementation for 14 days in management of acute diarrhea has no effect on serum copper

Airlangga scoring system for prediction of dehydration in diarrheal patients.

To investigate the predictive factors for dehydration in acute diarrheal patients, this case control study was conducted using the observational analytic method. Acute diarrheal patients who were admitted to the Hospital and Outpatient Pediatric Clinic, Dr Soetomo Hospital, were included in this study. By discriminant analysis, three significant variables were determined to differentiate dehydration risk in acute diarrheal patients: frequency of stool, amount of feces in the stool, and severity of vomiting (power test: 70.0%). Significant differences were found between the groups with and without dehydration for stool frequency each day (p<0.05), amount of stool per day (p<0.05), and severity of vomiting (p<0.05). Frequency of stool, amount of stool, and severity of vomiting are predictive factors for dehydration in acute diarrhea.

Creencias y conocimientos de un grupo de médicos sobre el manejo de la alimentación del niño con diarrea aguda / Beliefs and knowledge of a group of doctors about the nutritional management of the child with acute diarrhea

OBJECTIVE: To identify the beliefs and knowledge of a group of rural physicians on the dietary management of children under five years of age, with acute diarrhea. Physicians' dietary management was compared with that recommended by the World Health Organization. MATERIAL AND METHODS: A cognitive anthropology study was carried out from July to December 1998, on ten physicians that care for the infant population ascribed to Hospital Rural IMSS-Solidaridad of San Juanito Bocoyna, Chihuahua, Mexico. Data were collected through focus groups, case vignettes, free listing, pile sorting, and a semi-structured questionnaire, and then cross-referred. RESULTS: The physicians recognized the negative impact of diarrhea on the nutritional state of the child, but not all of them evaluated this state. Prevailing interventions were antibiotic therapy, fluid management, and feeding recommendations. Among the latter, the most consistent were breastfeeding, delayed feeding, and gradual feeding. CONCLUSIONS: The obtained information is in conflict with WHO's recommendations, specially with that of sustained feeding.

Hidratación y medio interno / Hydration and internal environment

Esta parte contiene los siguientes capítulos: metabolismo del agua, metabolismo del sodio, metabolismo del potasio, metabolismo del calcio, deshidratación aguda y rehidratación, deshidrataciónhiponatrémica, deshidratación hipernatrémica, manejo del potasio y alteraciones del equilibrio ácido/base

Experience in running a Diarrhoeal Training cum Treatment Unit (DTTU) in a state teaching hospital in Calcutta.

The performance of the Diarrhoeal Training cum Treatment Unit (DTTU) of NRS Medical College and Hospital, Calcutta, in a 2-year period was evaluated by record analysis. The study revealed that 73.6% cases out of a total 4349 could be successfully managed at the oral rehydration therapy (ORT) area and only 16.5% cases required indoor admission. Rest of the cases (9.9%) with "no dehydration" were sent home with advice. There were 84.7% cases out 3919 dehydration cases who could be successfully treated by ORT and only 15.3% required intravenous (i.v.) therapy. A definite decline was also evident in the proportion of diarrhoea cases requiring antibiotic therapy (13.5% in 1991 to 6.8% in 1992). The case fatality rate due to diarrhoea was 1.7% in 1992. Had all cases of diarrhoea with dehydration being admitted and treated with i.v. fluids and antibiotics, the estimated cost would have been Rs 14.2 lakhs, which with ORT, actually cost Rs 2.4 lakhs. Thus estimated total cost reduction was to the extent of Rs 11.8 lakhs in a 2-year period.