Factors associated with haemoglobin concentration among Timor-Leste children aged 6-59 months.

The study was conducted to assess the prevalence of and factors associated with haemoglobin (Hb) concentrations among children aged 6-59 months in Timor-Leste. The 2003 Demographic and Health Survey was a multi-stage cluster survey of 4,320 households from four different geographic regions in Timor-Leste. In total, 4,514 children aged 6-59 months were included in the analysis. The prevalence of anaemia (Hb concentration <11.0g/dL) was 38.2% (638/1,668) for children aged 6-23 months and 22.6% (644/2,846) for older children (p<0.001). Girls had a higher mean Hb concentration than boys (11.9g/dL vs 11.7g/ dL, p<0.006) and children who had diarrhoea in the previous two weeks had a lower Hb concentration than children without diarrhoea (11.5g/dL vs 11.9g/dL, p<0.001). Children from the richest and middle-class households had a lower average Hb concentration than those from the poorest households (11.8g/ dL, 11.7g/dL vs 12.0g/dL, p<0.001). Children of mothers with some secondary or more education had a lower mean Hb concentration than children of mothers with completed primary, some primary and no education (11.7 g/dL vs 11.9 g/dL, 11.8 g/dL, and 11.9 g/dL, p=0.002). Children from severely-anaemic mothers had a lower mean Hb concentration than children from moderately-, mild and not anaemic mothers (10.5 g/dL vs 11.1 g/dL, 11.6 g/dL, 12.0 g/dL, p<0.001). After backward stepwise hierarchical multiple regression, wasting, male sex, recent diarrhoea, household wealth index (richest and middle-class), maternal educational status (some secondary or more and some primary), and maternal anaemic status were significantly associated with a lower Hb concentration in children and increased age of child and duration of breastfeeding (6 months) with a higher Hb concentration. Anaemia-prevention programmes among children in Timor-Leste should focus on those children aged less than two years, children with recent diarrhoea, wasted children, high socioeconomic status, and anaemic mothers.

Diarrhea among children admitted to a private tertiary-care hospital, Bangkok, Thailand: a case series.

We report here a case series of pediatric diarrhea cases admitted to a private tertiary-care hospital in Bangkok, Thailand. Retrospective data were collected from computerized medical records of 2,001 children with diarrhea (80.9% Thai), ages birth to 14 years, admitted to our facility during 2000-2005. The most common symptom leading to admission was vomiting (34.6%), while the most common sign was dehydration (63.6%). The largest proportion was comprised of toddlers (45.4%), followed by infants (24.2%). Of the total 2,564 admissions, 1,874 (73.1%) stool samples were collected and examined for red blood cells (RBC) and white blood cells (WBC); 57.1% and 70.6% were negative for RBC and WBC, respectively. Of the 1,878 blood specimens collected for electrolytes, 21.6% show acidosis. Of 1,793 stool specimens collected, the majority revealed normal flora (72.9%). Enteropathogenic Escherichia coli (EPEC) were seen in 10.8%. Campylobacter jejuni was found in only 2.9% of specimens, while of 1,065 specimens tested for rotavirus antigen, 23.9% were positive. In addition to bacterial cultures and their anti-microbial sensitivities, factors associated with rotavirus infection, C. jejuni, and metabolic acidosis, were also explored in this study. Rotavirus infections were more likely to be associated with children older than toddlers (3-14 years old), being admitted within the first day of the symptoms, those who were more acidotic, and was more common in the first 3 months of each year. Our data were little different from community-acquired infections reported among the general population.

A preliminary study of thiamine status in northeastern Thai children with acute diarrhea.

This study is a preliminary determination of thiamine status in children with diarrhea and metabolic acidosis admitted to hospital. Children with diarrhea (N = 14; age 2 m-6 yr) were divided into 2 groups according to anion gap type; group 1 (21.4%) with a normal anion gap (5.5 +/- 5.2 mmol/l) and group 2 (78.6%) with a wide anion gap (21.2 +/- 5.2 mmol/l). Blood was taken on the day of admission to determine thiamine and lactate levels. Sixty-six point seven percent of patients in group 1 had a normal lactate level (1.5 +/- 0.8 mmol/l) and 33.3% had a high lactate level (2.2 mmol/l); none had thiamine deficiency (TPPE < 20%). High lactate (3.5 +/- 1.4 mmol/l) was found in 54.5% of group 2 and thiamine deficiency was observed in 18.2% of this group. In conclusion, no thiamine deficiency was noted in patients with normal anion gap, but thiamine deficiency was not uncommon in patients with a wide anion gap, regardless of lactic acidosis.

Análise comparativa do perfil clínico, hematológico e microbiota intestinal associados com quadros diarréicos e não diarréicos de macacos cynomolgus (Macaca fascicularis) cativos / Comparative analysis of the clinical, hematologic profile and intestinal microbiota associates with diarrheic and not diarrheic pictures of monkeys cynomolgus (Monkey fascicularis) captive

O conhecimento da microbiota intestinal de primatas não-humanos criados para fins experimentais, permite a prevenção de zoonoses e propicia um manejo sanitário direcionado para produção de animais livres de patógenos específicos (SPF). Assim, é possível adotar ações corretivas mais eficientes, de acordo com os padrões sanitários internacionais. Neste intuito, foi realizada uma pesquisa clínica direcionada para determinação das causas freqüentes de diarréia presentes na colônia de macacos cynomolgus (Macaca fascicularis) do Departamento de Primatologia (Deprim) do Centro de Criação de Animais de Laboratório (Cecal) da Fundação Oswaldo Cruz (Fiocruz). Ao exame macroscópio fecal, 43 por cento das amostras eram de consistência diarréica. Dentre as amostras de fezes de consistência pastosa e líquida, 31 (43,05 por cento) foram positivas para Entamoeba sp., 29 (40,02 por cento) para Balantidium sp. e 12 (38,70 por cento) para Campylobacter sp. Por meio de teste imunoenzimático de ELISA, foram obtidos índices de positividade de 35,6 por cento para E. histolytica e 21,5 por cento para G. lamblia foram encontrados na amostras de consistência pastosa, enquanto índices de 28,6 por cento para E. histolytica e de 7,1 por cento para G. Lamblia foram encontrados nas amostras de consistência formada. Embora esses microrganismos sejam incriminados como possíveis causadores de diarréia e indesejável na criação de primatas não-humanos SPF, a análise de regressão linear múltipla revelou que não houve correlação significativa destes com a presença de diarréia. O teste de qui-quadrado de Pearson revelou uma correlação significativa (p menor ou igual 0,05) entre a presença de diarréia e leucocitose com eosinofilia em macacos adultos de ambos os sexos. Apesar desta correlação, a presença de diarréia não interferiu no crescimento normal dos macacos avaliados e os valores médios de freqüências cardíaca e respiratória e temperatura retal encontrados nos animais estão de acordo...trabalho.

Antigliadin and antireticulin antibodies in celiac disease and other forms of protracted diarrhea in Kuwait

Sera were collected from 18 children with celiac disease and 49 children with other forms of chronic diarrhea. Of the 49 children with other forms of chronic diarrhea, 35 had postenteritis, 8 had giardiasis and 6 had other diagnoses. Thirty children with nongastrointestinal disorders were tested and used as controls. The sera were tested for gliadin, alpha-gliadin and reticulin antibodies: false-positive values in children with other forms of chronic diarrhea were encountered in 27, 45, and 4% and in 3, 3, and 0% of controls, respectively. The sensitivity in celiac disease was 89, 89 and 50%, while the specificity was 71, 49 and 94%, respectively. In Kuwait, postenteritis syndromes are common causes of protracted diarrhea. Antibodies to gliadins are as sensitive but significantly less specific for celiac disease [CD] than those reported in developed countries. The combined testing of antigliadin and antireticulin antibodies raised the diagnostic specificity to 94%

Estudio clínico y etiológico de 90 casos de diarrea crónica / Clinical and ethiologic study of 90 cases of chronic diarrhea

Se realizó el presente estudio prospectivo en 90 pacientes con diarrea crónica, atendidos en la consulta externa de una clínica privada de Lima, durante los años 1990 y 1991. De acuerdo a un esquema metodológico para llegar a los factores causales y/o enfermedades generadoras de la diarrea crónica. En todos los casos se practicaron exámenes hematológicos, bioquímicos, coprocultivos, coproparasitológico, radiografías de torax y tránsito intestinal. En 11, el cultivo de contenido duodenal. Radigrafías del colon en 25 casos; proctosigmoidoscopias en 14 y endoscopía digestiva alta en 19 pacientes. Ecografías abdomnales en 12 y TAC en 2 casos. Los resultados finales mostraron como enfermedades determinantes de la diarrea crónica, por orden de frecuencia, enteroparasitosis ( 23.3 por ciento ), trastornos funcionales digestivos ( 20.0 por ciento ), sobrepoblación bacteriana intestinal ( 15.5 por ciento ), de causa no determinada ( 8.8 por ciento ), divertículos del colon ( 7.7 por ciento ), infección intestinal ( 7.7 por ciento ) comprobada y probable ( 5.5 por ciento ), intolerancia a la lactosa ( 3.3 por ciento ), diabetes mellitus ( 2.2 por ciento ); y un caso ( 1.1 por ciento ) las siguientes: linfoma intestinal, tumor de páncreas, SIDA, deformación colónica y anemia megaloblástica. Las causas de diarrea crónica son variadas y multifactoriales, y en presente estudio se comprueba la predominancia de las parasitosis intestinales, transtornos funcionales y sobrepoblación bacteriana intestinal; y en menor frecuencia otras patologías variadas

Relación entre grupo sanguíneo ABO y enfermedad diarreica aguda severa causada por Vibrio cholerae / Relationship of ABO blood groups and severe acute diarrhea by cholera

Hemos comparado las prevalencias de grupos sanguíneos entre los pacientes que acudieron al Servicio de Emergencia del Hospital Nacional Cayetano Heredia (Lima, Perú) durante el mes de abril de 1991 con diarrea aguda severa con aislamiento de Vibrio cholerae en los coprocultivos, con la de un grupo control conformado por los donantes del Banco de Sangre del mismo hospital, apareados por distritos de residencia. La prevalencia de grupo sanguíneo O entre los 136 pacientes con coprocultivo positivo (todos a V. cholerae o1 biotipo El Tor serotipo Inaba) fue de 94.9 por ciento mientras que en los 544 controles fue de 79.2 por ciento (similar a la reportada en otros estudios sobre prevalencia de grupos sanguíneos en nuestra población). Aunque el diseño del estudio tiende a subestimar el real riesgo relativo, encontramos un riesgo relativo estimado de 4.832 (IC95=2.196, 10.628) de presentar diarrea aguda severa por V.cholerae entre las persona con grupo sanguíneo O (p<0.00002). Queda por descubrir la base fisiopatológica de esta asociación y el impacto que puede tener en la morbilidad y mortalidad de la presente epidemia de cólera en el Perú, país con alta prevalencia de grupo sanguíneo O

Efecto de la expansión con cloruro de sodio al 0.9 por ciento en pacientes con deshidratación moderada y severa por diarrea coleriforme: valoración clínica y bioquímica de los pacientes al ser sometidos a dos esquemas de mantenimiento diferente / Efectt of the expansión with saline solution (nace 0.9 per cent) in patients with moderate to severa dehydratation for choleriform diarrhea: clinical and byochemical veloration of patients subjected to two differents maintening schemes

Este trabajo muestra los resultados de la expansión endovenosa rápida con cloruro de sodio al 0.9 por ciento (CINa) en 142 pacientes deshidratados moderados a severos, oligoanúricos, que presentaron un cuadro compatible con cólera hasta lograr la micción espontánea. Además se presenta el efecto sobre las variables clínicas y bioquímicas en estos pacientes al ser sometidos a dos diferentes esquemas de mantenimiento (posteriormente a la recuperación de la micción): C1Na más Suero de rehidratación oral(SRO) (71 pac) y Solución polielectrolítica endovenosa por (PEV) mas SRO (71 pac). Todos estos pacientes fueron tratados en el Hospital Cayetano Heredia en mayo de 1991 durante la epidemia de Cólera en nuestro país. Los pacientes fueron personas adultas (14 a 60 años), deshidratados moderados a severos (promedio 11.5 por ciento, rango 7 a 15 por ciento de pérdida del peso corporal). Todos fueron expandidos únicamente con C1Na (promedio de 2.36 1/hora). El tiempo promedio hasta recuperar diuresis fue 1.79 mas o menos 0.73 horas. Los valores bioquímicos al ingreso fueron: Cloro sérico 100 mas o menos 8.4 mEq/L., potasio sérico 4.46 mas o menos 0.7 mEq/l., Sodio sérico 136 mas o menos 4.7 mEq/L. Reserva alcalina 23.7 mas o menos 9.2 mEq/L. y creatinina sérica 1.6 mas o menos 0.69 mg/dl. Al momento de la micción estos valores fueron: Cloro sérico 103 mas o menos 7.4 mEq/L., potasio sérico 4.3 mas o menos 0.7 mEq/L., sodio sérico 139 mas o menos 3.5 mEq/L., Reserva alcalina sérica 28.7 mas o menos 7 mEq/L. Finalmente al momento del alta los valores fueron: Cloro sérico 102.8 mas o menos 8.34 mEq/L., Reserva alcalina sérica 22.1 mas o menos 7.4 mEq/L., Sodio sérico 137 mas o menos 4.4 mEq/L., potasio sérico 4.4 mas o menos 0.6 mEq/L. y creatinina sérica 0.7 mas o menos 0.2 mg/dl. Se demuestra la utilidad y ventajas del empleo inicial de C1Na para expandir rápidamente la volemia y que además no existe diferencias clínicas ni bioquímicas en los pacientes al momento del alta entre los dos esquemas de mantenimiento. Vale resaltar que los valores de potasio, que son coincidentes con los de la literatura, sugieren que el riesgo inicial de hipokalemia en un paciente por cólera es casi nulo, constituyendo la expansión rápida del volumen intravascular hasta lograr micción y la rehidratación oral temprana las claves del tratamiento

Serum and rectal mucosal zinc levels in acute and chronic diarrhea.

Serum and rectal mucosal zinc content was estimated in children (6-18 months old) with acute diarrhea (Group I: n = 50), chronic diarrhea (Group II: n = 25), extraintestinal infections (Group III: n = 15) and apparently healthy controls (Group IV: n = 20). The sex and nutritional status of various groups was comparable. The mean serum and tissue zinc levels in acute (p less than 0.001) and chronic (p less than 0.05 for serum; p less than 0.001 for tissue) diarrhea groups were significantly lower than healthy and infected controls. Group II had significantly lower (p less than 0.001) serum and rectal zinc content in comparison to Group I. There was a significant negative correlation between serum zinc and diarrheal duration (r = 0.5676; p less than 0.001). Repeat estimation at discharge in 38 patients (25 in Group I, 13 in Group II) revealed a significant reduction in both tissue and serum zinc and only tissue zinc in acute and chronic diarrhea, respectively. A total of 23 patients (16 in Group I, and 7 in Group II) were evaluated 2 weeks after discharge. After discharge, at recovery there was no alteration in serum zinc, but tissue zinc was marginally higher (p greater than 0.05). It is concluded that zinc depletion occurs in diarrhea, more so in the chronic state; with the continuation of diarrhea, depletion progresses; and there is a tendency for repletion during convalescence.