Conjunctival impression cytology in children with persistent diarrhea as indicator of pre-clinical vitamin A deficiency.

Children with persistent diarrhea may be at a higher risk of developing vitamin A deficiency. Impression cytology of the conjunctiva has been shown to be a simple and objective diagnostic test for detection of early, physiologically significant vitamin A deficiency. We studied, changes in conjunctival impression cytology using millipore HAWG filter paper in 25 children aged less than 5 years suffering from persistent diarrhea, who had no ocular manifestations of vitamin A deficiency (Group I). Twenty five age matched healthy children constituted the control group (Group II). Seventeen of the 25 children with persistent diarrhea (68%), showed the following abnormalities: (i) the shape of the epithelial cells were abnormal, and (ii) goblet cells were absent. The study could be repeated after 2 weeks of administration of vitamin A in 7 children. Reappearance of PAS-positive mucous glycoproteins and presence of normal epithelial cells was demonstrated in all 7 children retested. This test can prove to be of significant value in assessment of response to vitamin A therapy. This study shows that children with persistent diarrhea appear to be at high risk for developing vitamin A deficiency, which can be detected by the technique of conjunctival impression cytology. This is a cheap and reliable method of detecting preclinical vitamin A deficiency which can be performed by a pediatrician in the office laboratory.

Bacterial contamination of reconstituted oral rehydration solution.

The extent and nature of bacterial contamination in oral rehydration solution reconstituted for use by individuals and for group of patients was studied. Twenty three volunteers (all qualified doctors) were asked to reconstitute a packet of prepackaged salt in half litre of clean unboiled water obtained from taps at their residence. Five ml aliquots of ORS were collected at 6, 12 and 24 hours after reconstitution for bacteriologic study. The water used by volunteers to reconstitute the ORS as well as throat swabs, peri-anal swabs and nail clippings of volunteers yielded pathogenic bacteria in all the subjects/samples. All the 23 specimens of ORS prepared by volunteers when cultured at 6 hours after reconstitution yielded pathogenic bacteria. The bacterial colony counts were found to be unacceptably high at 12 hours. Five ml samples of reconstituted ORS prepared in bulk in the children ward of PGIMER, Chandigarh were cultured at 12, and again at 24 hours after reconstitution on 10 different days. These yielded Klebsiella pneumoniae in 8 specimens (80%) and E. coli in 2 (20%). The bacterial colony count was unacceptably high, 12 hours after reconstitution.

A comparative study of different methods of training of rural subjects for reconstitution of oral rehydration solutions.

The efficacy of three methods of training rural women in reconstituting ORS was studied by analysing the sodium, potassium, and glucose contents of the ORS reconstituted by the three groups of rural women. The women in Group I were verbally instructed in the regional language regarding how to reconstitute the entire contents of a sachet containing oral rehydration salts in half a litre of water. Women from Group II, were given the same verbal instructions and in addition, were demonstrated the correct method of doing the same. Subjects from Group III were provided with plastic bags containing oral rehydration salts, which when filled with water upto the printed line, was expected to accommodate half a litre of water, when the bag was hung from a hook or held by another person from its upper ends. The contents of ORS reconstituted by Group II, who were demonstrated the actual procedure following verbal instructions, were near ideal followed by the ORS reconstituted by Group III and by Group I.