Efecto de la lactancia en las infecciones pediátricas frecuentes: estudio de cohorte prospectivo de cinco años / Effect of breastfeeding on common pediatric infections: a 5-year prospective cohort study

Introducción. En los estudios realizados se encontró que la duración de la lactancia tiene un efecto reductor sobre las infecciones frecuentes en los niños durante el período de lactancia. Objetivo. El objetivo de este estudio fue abordar la asociación entre la duración de la lactancia y las enfermedades infecciosas frecuentes en los niños hasta los 5 años de edad para demostrar los efectos protectores de la leche materna. Población y métodos. Se incluyeron 411 lactantes nacidos en Rize, Turquía, entre enero de 2011 y diciembre de 2011. Este estudio de cohorte, prospectivo duró cinco años; en este período, se realizaron 11 entrevistas con cada madre de los lactantes. Se dividió a los lactantes en dos grupos: amamantados durante más y menos de 12 meses, y se estudió la asociación entre la lactancia y las infecciones, como otitis media aguda, gastroenteritis aguda, infección respiratoria aguda e infección urinaria. Resultados. De los 411 nacimientos, se incluyeron 270 lactantes, 193 (71,5%) recibieron lactancia durante más de 12 meses y 77 (28,5%), durante menos de 12 meses. Los lactantes del primer grupo tuvieron menos casos de otitis media aguda y gastroenteritis aguda (n = 77; 28,52%) en comparación con los lactantes amamantados durante menos de 12 meses en el período de cinco años (p < 0,05). Conclusiones. Con este estudio se detectó que la lactancia durante más de 12 meses reduce significativamente las infecciones frecuentes durante la niñez, como la otitis media y la gastroenteritis durante los primeros cinco años de vida.

Introduction.The studies conducted revealed that breastfeeding duration has a reducing effect on common infectious diseases in the children during breastfeeding period. Objective. The aim of the present study was to address the association between breastfeeding duration and common infectious diseases in the children until 5 years of age to show long-term protective effects of the breast milk. Material and methods. The study included 411 infants who were born in Rize (Turkey) between January 2011 and December 2011. The present prospective-cohort study lasted for 5 years and 11 interviews were conducted with each mother of the infants during this period. The infants were divided into two groups as those who were breastfed more and less than 12 months and the association between breastfeeding and infections such as acute otitis media, acute gastroenteritis, acute respiratory tract infections and acute urinary system infections was investigated. Results. Of 270 infants 193 (71.5%) were breastfed longer than 12 months and 77 (28.5%) were breastfed less than 12 months. Infants in the first group had less acute otitis media and acute gastroenteritis (n= 77, 28.52%) when compared with the infants breastfed less than 12 months during 5-year period (p <0.05). Conclusion. The present study detected that breastfeeding duration longer than 12 months significantly reduces the common childhood infections such as otitis media and gastroenteritis during the first 5 years of life.

Campylobacter spp como causa de disentería: opciones diagnósticas: A propósito de dos casos clínicos / Campylobacter spp as a cause of dysentery: diagnostic options: Presentation of two clinical cases

En los últimos años se ha observado un aumento en la incidencia de Campylobacter spp (CSSP) como agente de diarrea, enteritis y disentería. Constituye una zoonosis así como una enfermedad trasmitida por alimentos. El diagnóstico de GEA por CSPP se realiza por identificación del agente etiológico en las heces del paciente. El objetivo de la siguiente observación es presentar dos casos clínicos de GEA en niños con diagnóstico etiológico de colitis causada probablemente por Campylobacter spp mediante la utilización de examen directo de materia fecal. El cultivo de la bacteria es el gold standard; en Uruguay sólo está disponible con fines de investigación. El método más fácil de poner en práctica en los laboratorios clínicos es la tinción y observación directa con un Gram modificado el cual sumado a la clínica, permite un diagnóstico con alto grado de presunción. En ambos pacientes el resultado motivó la instauración de un tratamiento antibiótico específico que determinó una buena evolución.

In recent years an increase in the incidence of Campylobacter spp (CSSP) as the agent of diarrhea, enteritis and dysentery was observed. It constitutes a zoonosis, as well as a food transmitted disease. Diagnosis of acute gastroenteritis by CSPP is done by identifying the etiological agent on the patients’ feces. The objective of the following observation is to present two clinical cases of acute gastroenteritis in children with an etiological diagnosis of colitis, probably caused by Campylobacter spp by means of a direct study of the stool. Culture of the bacteria is the gold standard, although in Uruguay it is only available for research purposes. The easiest method to put into practice in the clinical laboratories is staining and the direct observation with a modified Gram, which, together with the clinical examination, enables diagnosis with a high degree of presumption. In both patients, the result caused the adoption of a specific antibiotic, which determined a good evolution.

Bacteriemia recurrente por Bordetella bronchiseptica en un paciente con trasplante de medula ósea / Bordetella bronchiseptica recurrent bacteraemia in a patient with bone marrow transplantation

Se reporta un caso de bacteriemia recurrente por Bordetella bronchiseptica en un paciente inmunocomprometido con antecedentes de trasplante alogénico de medula ósea por síndrome mielodisplásico, quien ingresó al hospital por síndrome febril. Bordetella bronchiseptica es un agente patógeno veterinario poco común en humanos que afecta principalmente a pacientes inmunocomprometidos y es causa poco frecuente de bacteriemia.

We report a case of recurrent bacteraemia caused by Bordetella bronchiseptica in an immunocompromised patient with a history of allogenic bone marrow transplantation for myelodysplastic syndrome, who was admitted to hospital with febrile syndrome. Bordetella bronchiseptica is an uncommon human pathogen which mainly affects immunocompromised patients, being a rare cause of bacteraemia.

Gastroenteritis aguda: formas de presentación clínica y etiología en niños hospitalizados en el Hospital Pediátrico, Centro Hospitalario Pereira Rossell, año 2012 / Acute gastroenteritis: clinical presentation and etiology in children hospitalized at the Children's Hospital of Pereira Rossell Hospital Center in 2012

Introducción: la gastroenteritis aguda es una enfermedad prevalente de la infancia. En Uruguay disminuyó su mortalidad, ocupando el décimo lugar en el año 2012. Desde el año 2004, se implementó la unidad de internación de diarrea en el Hospital Pediátrico Pereira Rossell, facilitando la aplicación de normas de atención y control. Objetivo: conocer tasa de hospitalización y características clínicas, epidemiológicas y microbiológicas de niños hospitalizados por gastroenteritis aguda en la unidad de internación de diarrea del Hospital Pediátrico Pereira Rossell desde el 1/1 hasta el 31/12 de 2012. Describir posibles correlaciones etiológicas con la expresión clínica. Metodología: estudio descriptivo, prospectivo. Se incluyeron: niños menores de 15 años que ingresaron a la unidad de internación de diarrea. Variables: edad, motivo de ingreso, complicaciones y etiología. Análisis de datos: frecuencias absolutas y relativas para variables cualitativas; medidas de tendencia central y de dispersión para cuantitativas. Programa Excel 2011 y Epi-info. Resultados: fueron hospitalizados 826 niños por gastroenteritis aguda, tasa de hospitalización 122/mil. Los ingresos por gastroenteritis suponen un 12,3% del total de ingresos anuales. Edad media: 3 meses. Se aislaron enteropatógenos en el 20% de las muestras estudiadas: rotavirus 7,9%, Campylobacter 5,9%, y norovirus 1,6%. La deshidratación fue el motivo de ingreso más frecuente 59%. No hubo fallecimientos. Conclusiones: esta patología continúa siendo un motivo frecuente de internación. Rotavirus fue el germen mayormente aislado. Primera descripción nacional de norovirus como agente causal de gastroenteritis en pediatría. Fueron significativas las asociaciones clínicas con enteropatógenos como rotavirus, norovirus y Campylobacter.

Introduction: Acute gastroenteritis is a common disease in childhood. In Uruguay mortality decreased and it ranked tenth in 2012. In 2004, the diarrhea inpatient unit was created at the Children’s Hospital of Pereira Rossell Hospital Center, facilitating the implementation of standards of care and control. Objective: to study hospitalization rate and clinical, epidemiological and microbiological characteristics of children hospitalized for acute gastroenteritis in in the Diarrhea Inpatient Unit at Children’s Hospital of Pereira Rossell Hospital Center from 1/1 to 31/12 2012 and to describe possible etiological correlations with clinical expression. Methodology: descriptive, prospective study. Included: children under 15 years admitted to the Diarrhea Inpatient Unit. Variables: age, reason for admission, complications and etiology. Data analysis: absolute and relative frequencies for qualitative variables; measures of central tendency and dispersion for quantitative. Excel 2011 and Epi-info program. Results: There were 826 children hospitalized for acute gastroenteritis, hospitalization was rate 122 / thousand. Income from gastroenteritis represents 12.3% of total annual revenue. Average age: 3 months. Enteric pathogens were isolated in 20% of the samples studied: Rotavirus 7.9%, Campylobacter 5.9% and Norovirus 1.6%. Dehydration was the most frequent reason for 59% income. There were no deaths. Conclusions: This ongoing pathology is a frequent reason for hospitalization. Rotavirus was mostly isolated germ. First National description of Norovirus causative agent of gastroenteritis in children. There were significant clinical associations with enteropathogens such as rotavirus, norovirus and campylobacter.

[ frequency of cryptosporidiosis among gastroenteritic patients in western cities of Mazandaran Province [2007-2009][

Gastroenteritis is caused by parasitic and non-parasitic microorganisms. Cryptosporidiosis is one of the parasitic diseases leading to acute or chronic gastroenteritis caused by Cryptosporidium spp. Self-limiting gastroenteritis is observed in immunocompetent individuals, but in immunocompromised patients it causes a sever disease. High humidity, ecological conditions, water supplies, domestic and industrial animal husbandry and the rate of raining have made the Mazandaran regions as a province for transmission of parasites. The objective of this study was to determine the frequency of cryptosporidiosis among gastroenteritic patients in western cities of Mazandaran Province, during 2007-2009. This analytical study was conducted in cities of Chalus, Tonekabon, and Ramsar located in west Mazandaran province, northern Iran. Stool samples from patients with gastroenteritis and healthy individuals were collected, fixed and examined by direct method [DM] for the diagnosis of enteropathogenic and non-pathogenic parasites; acid-fast staining [AFS] and auramine phenol fluorescence [APF] for detection of Cryptosporidium oocysts and analysed using ANOVA and t-ests. The mean prevalence rate of parasitic infections in three cities was 2.38% with the highest rate of infection associated with Giardia lamblia [1.43%], Blastocystis hominis [0.71%], and Entamoeba coli [0.24%], respectively. No Cryptospordium sp. was observed among the test and control groups. Based on our data, a low rate of parasitic infection and also an absence of cryptospordiosis, compared to the previous studies, in western part of Mazandaran province were established. This may be associated with improvements in public health education, water treatment environmental sanitation, and low animal contacts during recent years

First description of gastroenteritis viruses in Lebanese children: a pilot study

Human enteric viruses are important causes of acute gastroenteritis in infants and children. The role of rotaviruses, adenoviruses, human caliciviruses and astroviruses in the development of severe acute gastroenteritis requiring hospitalization of infants and young children in North Lebanon was investigated. Stool specimens collected between April and May 2010 from 79 Lebanese infants and children hospitalized for severe acute gastroenteritis, were screened for enteric viruses by immunoassays and internally controlled multiplex PCR assay. Out of 79 stool samples, 38 [48%] were positive for rotavirus, and 5 [6%] were positive for norovirus genogroup II. Enteric adenoviruses, sapoviruses and human astroviruses were not detected. Children with severe rotavirus gastroenteritis were younger than those with severe norovirus gastroenteritis. These results highlight the importance of rotavirus and norovirus as causes of severe gastroenteritis in Lebanese children, and the need to incorporate routine screening tests for norovirus infection in clinical settings

Characteristics of rotavirus gastroenteritis in hospitalized children in Pune.

Background : Diarrheal diseases affect millions of people around the world and have the greatest impact on children, especially those in developing countries. Rotavirus is now known to contribute significantly to the etiology of diarrheal diseases in both developing and developed countries. Objective : To study demographic, clinical, and laboratory characteristics of rotavirus infection in cases of acute diarrhea admitted in the hospital who were below the age 5 years. Materials and methods : It was a prospective study conducted from June 2009 to June 2011 to determine characteristics, clinical profile, and antigenemia of rotavirus. The study group included patients up to 5 years of age hospitalized with a diagnosis of acute gastroenteritis. Statistical analysis was done using the chi-square test. Data were analyzed using SPSS (Statistical Package for Social Sciences) version 17.0. Results : From the 246 cases studied in the hospitalized patients of acute gastroenteritis, 88 cases (35.77%) were found to be positive for rotavirus infection. The occurrence of infection was found to be most common in the age group of 11-20 months (38.63%) followed by the age group of 0-10 months (23.86%). There was no association with the sex of the child. In rotavirus-positive patients, associated features were fever in 48.86%, vomiting in 29.54%, and pain in abdomen in 53.4% of cases. Seasonal variation of rotavirus infection was observed in the present study with peak in the winter season. It was found that 5.68% cases which were positive for rotavirus in their stool samples were positive for rotavirus present in their urine sample, suggesting extraintestinal manifestation of rotavirus. Conclusion : It is concluded that in spite of clean hygienic condition and vaccination rotavirus is still an important cause of infantile diarrhea in urban area like Pune. There is association between the occurrence of rotavirus and degree of dehydration, fever, vomiting, and pain in abdomen. Peak incidence was found in the months of December and January. There is association between the occurrence of rotavirus in stool and rotavirus in blood.

Prevalencia de norovirus como agente etiológico de gastroenteritis en niños venezolanos / Prevalence of norovirus like gastroenteritis etiologic agent in venezuelan children

Las gastroenteritis representan una causa importante de morbimortalidad en el mundo y en Venezuela. Su etioligía en infantes es principalmente viral, encontrando a los Norovirus como agentes asociados. Considerando la escasa documentación al respecto, se realizó este estudio para evaluar la prevalencia de Norovirus en niños de 0 a 10 años con diarrea aguda que acudieron a la Policlínica Metropolitana en Caracas; verificando su asociación con otros factores etiológicos y demográficos. 102 muestras fecales fueron sometidas al análisis bacteriológico, parasitológico y viral, utilizando para la detección de Norovirus un ensayo ELISA RIDASCREEN Norwalk-like-Virus. Al análisis estadístico incluyó los índices O. R, y Chi Cuadrado para analizar las frecuencias de los agentes etiológicos, permitiendo además verificar si la diarrea por Norovirus era Independiente de otros patogénos, del sexo y grupos etareos. Se utilizó Excel y el paquete estadístico SPSS 1.0. Los resultados sugirieron que el riesgo de diarrea por Norovirus se sextuplicó en los niños de 1-2 años en comparación con los mayores a 5 años (O.R 5,8842 p:0,0070;x210,879 p:0,012). En los casos positivos, la prevalencia de Norovirus fue del 68,9% y 30% de ellos presentó coinfección con otros patógenos, pero la asociación no fue significativa (p>0,05). Considerando los casos de diarrea que quedan sin diagnósticar, sería lógico pensar que Norovirus circularía con una lata frecuencia en Venezuela, ya que la prevalencia fue superior a la resprtada en otras poblaciones (39,2% vs 5-33%). El impacto de las infecciones por Norovirus en Venezuela se desconece completamente y debe ser estudiado con mayor profundidad.

Gastroenteritis is a very important cause of mobility and mortality in Venezuela and the rest of the World. Their etiology on children is mainly caused by viruses, including Norovirus. Considering the lack of related documentarion in Venezuela, we performed a study in order to calculate the prevalence of Norovirus on children betwen 0 to 10 years old, with acute diarrhea treated on the Policlinica Metropolitna, Caracas; also we analyzed his association with other etiological and demographic factors. 102 stool samples were tested for bacteria parasitic and viruses. For Norovirus we used the ELISA RIDASCREEN Norwalk-like-Virus, (r-biopharm, Germany). The statistical calculations included O.R. and Chi Square ratios, in order to analyze the frequency of the different etiological agents and also to verify if the diarrheas for Norovirus were independent from other pathogenic agents, sex or age groups. We used Excel and SPSS 1.0 software for statistical calculations. The results suggested that the risk of getting a diarrhea caused for Norovirus was 6 times higher on children from 1 to 2 years old than those older that five years old. (OR 5,8842 p:0,0070;x210,879p:0,012) The prevalence for Norovirus was 68,9% and 30% of them presented simultaneous infection with other pathogenic agents, but this association wasn't significative (p>0,05). Considering the high number of diarrhea cases that lack of a proper etiological diagnostic, it's possible that the Norovirus are circulating with a high frequency in Venezuela, due the prevalence reported on this study is above the reported in other population studies (39,2% vs 5-33%). The actual impact of Norovirus in Venezuela is still unknown and must be study with more detail.

Brote de enfermedad alimentaria en la localidad de El Huecú, provincia de Neuquén / Foodborne disease outbreak in El Huecú community, province of Neuquén

En febrero de 2006 ocurrió un brote epidémico de gastroenteritis aguda de origen alimentario, en ocasión de un festejo popular en una pequeña localidad de la provincia de Neuquén, Argentina. Aproximadamente 800 personas participaron de un almuerzo en las instalaciones del Gimnasio Municipal, y unas tres horas después de finalizado, cerca de 150 asistentes consultaron al hospital local, afectados por síndrome gastroentérico agudo. Se realizó una investigación epidemiológica caso-control a través de un muestreo representativo no probabilístico. Los resultados epidemiológicos establecieron un brote de ETA a fuente común, con una relación caso-control de 1:1,8. Los principales síntomas fueron cólicos abdominales (88%), vómitos (73,5%) y diarrea (60%). La torta que se sirvió en ese evento fue identificada como el alimento causal (OR 9,79; IC 95%; 2,66-36,00; valor p = 0,0001), sujeto a condiciones higiénico-sanitarias insatisfactorias en los diferentes procesos de elaboración, conservación y manipulación. De una porción de la torta se aisló una cepa de Staphylococcus aureus subespecie aureus, coagulasa positiva, enterotoxigénica, con un recuento de 2,4x10(6) UFC/g, y también se aisló este microorganismo de tres muestras de manos y narinas de personas involucradas en la preparación y el servicio. Las cepas aisladas de un operador y de la torta portaron el gen sea y presentaron el mismo patrón de SmaI-PFGE. Se atribuyó el brote de ETA a la contaminación durante el proceso de preparación de la torta consumida durante ese almuerzo popular, lo que podría estar relacionado con deficiencias en aspectos higiénicos y con la falta de refrigeración y de mantenimiento de la cadena de frío.

In the summer of 2006, an epidemic outbreak of acute gastrointestinal illness related to food consumption occurred in a small town in the province of Neuquén, Argentina. During a popular feast, approximately 800 local residents attended lunch held in the facilities of the Municipal Gymnasium. About three hours later, nearly 150 attendees sought medical assistance at the local hospital due to acute gastroenteritis. A case-control epidemiological investigation was conducted using representative non-probability sampling. The epidemiological investigation showed a common-source foodborne disease outbreak with a case-control ratio of 1:1.8. The main symptoms were abdominal cramps (88%), vomiting (73.5%) and diarrhea (60%). The cake was identified as the source of infection (OR 9.79; IC 95%, 2.66-36.00; p = 0.0001), and unsatisfactory hygienic conditions in food production, conservation and handling steps were identified. Coagulase positive, enterotoxigenic Staphylococcus aureus, subspecies aureus was detected in a piece of cake, with a count of 2.4x10(6) CFU/g, and in samples from the hands and nostrils of three people involved in food preparation and service. The strains isolated from both the cake and one of the food handlers carried the sea gene, and presented the same SmaI-PFGE pattern. The foodborne disease outbreak was considered to be due to contamination in the preparation process of the cake consumed at the feast, which was related to inadequate hygienic conditions, lack of refrigeration and cold chain disruption.

Avaliação quantitativa do risco de doença, causada por Vibrio parahaemolyticus, associado ao consumo de ostras (Crassostrea brasiliana) cruas cultivadas e comercializadas no Estado de São Paulo / Quantitative risk assessment of illness, caused by Vibrio parahaemolyticus, associated with the consumption of raw oysters (Crassostrea brasiliana) farmed and commercialized in the State of São Paulo

Vibrio parahaemolyticus (Vp) é uma bactéria naturalmente presente em regiões estuarinas, sendo a principal causa de gastrenterite de origem bacteriana associada a pescados, principalmente ostras cruas. Nesta pesquisa, foi desenvolvida uma avaliação quantitativa de risco para avaliar a probabilidade de Vp causar doença após o consumo de ostra crua, produzida e comercializada no Estado de São Paulo. O estudo incluiu a identificação e caracterização do perigo, a avaliação da exposição e a caracterização do risco. Um modelo matemático foi desenvolvido. Este modelo leva em consideração o comportamento de Vp em ostras na cadeia produtiva, em cada estação do ano, além da relação entre a dose de Vp ingerida e a probabilidade de desenvolver a doença. A avaliação da exposição foi desenvolvida em três etapas: cultivo, pós-coleta e consumo. Na etapa de cultivo foram considerados os fatores que influenciam a prevalência e o número de Vp em ostras no momento da coleta. Na etapa pós-coleta, foram descritas as práticas da indústria e foram considerados os fatores associados ao processamento, transporte e manipulação. Já na etapa de consumo foram considerados os fatores como a quantidade de ostras consumidas por porção, o peso médio por ostra consumida e a população de Vp patogênico no momento do consumo. O resultado do modelo quantitativo da avaliação da exposição foi, então, integrado ao modelo dose-resposta, Beta-Poisson, para se obter uma estimativa do risco. Esta estimativa expressa o impacto da exposição humana a Vp, sobre a saúde pública, associada ao consumo de ostras. A simulação de Monte Carlo foi utilizada para avaliar o efeito da variabilidade e incerteza das variáveis do modelo sobre a estimativa do risco. O modelo prediz uma probabilidade de ocorrência de doença de 4,6x`10 POT.`MENOS`4`, por porção de ostra, consumida ao longo do ano...

Clinical outcome of patients presenting with acute oliguria after an acute gastroenteritis episode

The purpose of the study was to describe important characteristics of acute oliguria, developing after an episode of acute gastroenteritis. This study was carried out mainly in the Medical Unit I of Nishtar Hospital Multan. December 1999 to June 2001. The sample of study was randomized to two groups. Group A was administered low dose [renal dose] Dopamine infusion along with fluid replacement and other modalities of treatment, group B was given conventional treatment. 50 patients among the above study were randomized to the group A and were administered low dose dopamine along with other modalities of treatment. The average duration of diarrhea in this group was 3.04 +/- 0.9 days. Mean creatinine level among this group was 6.7 +/- 2.9 at presentation. Hyperkalemia occurred in 10 patients [20%] in this group all of them required treatment for hyperkalemic episodes either in form of drugs or hemodialysis. 2 patients in this group developed chronic renal failure 50 patients among the above study were randomized to the group B and were not administered low dose dopamine. Mean creatinine level among this group was 6.5 +/- 3.3 at presentation. The average duration of diarrhea in this group was 3.12 +/- 0.98 days. Hyperkalemia occurred in 6 patients. No patient developed chronic renal failure in this group. Infectious food was the main cause of gastroenteritis in this study. More patients in the group A [given dopamine] developed chronic renal failure

Clinical outcome of patients presenting with acute oliguria after an acute gastroenteritis episode

The purpose of the study was to describe important characteristics of acute oliguria, developing after an episode of acute gastroenteritis. This study was carried out mainly in the Medical Unit I of Nishtar Hospital Multan. December 1999 to June 2001. The sample of study was randomized to two groups. Group A was administered low dose [renal dose] Dopamine infusion along with fluid replacement and other modalities of treatment, group B was given conventional treatment. 50 patients among the above study were randomized to the group A and were administered low dose dopamine along with other modalities of treatment. The average duration of diarrhea in this group was 3.04 +/- 0.9 days. Mean creatinine level among this group was 6.7 +/- 2.9 at presentation. Hyperkalemia occurred in 10 patients [20%] in this group all of them required treatment for hyperkaleniic episodes either in form of drugs or hemodialysis. 2 patients in this group developed chronic renal.50 patients among the above study were randomized to the group B and were not administered low dose dopamine. Mean creatinine level among this group was 6.5 +/- 3.3 at presentation. The average duration of diarrhea in this group was 3.12 +/- 0.98 days. Hyperkalemia occurred in 6 patients. No patient developed chronic renal failure in this group. Infectious food was the main cause of gastroenteritis in this study. More patients in the group A [given dopamine] developed chronic renal failure

First feed given to the new born babies - a survey in an urban community of Lahore

Pakistan being 7[th] populous country is facing a high Neonatal Mortality Rate and it is reported that acute gastroenteritis is one of the major factor to this high Neonatal Mortality Rate. Avoiding colostrums and giving some prelacteal feed are contributory factors for gastroenteritis. Which ultimately leads to high Neonatal Mortality Rate. To study the first feed practice adopted by lactating mothers in a community in Lahore. Study design. Cross sectional community based survey. Dubhi mandi near old Anarkali Lahore from January 2002 to June 2002. 180 mothers who delivered in the previous year were listed and interviewed on structured pre tested questionnaire. 32% mothers feed colostrums, and 68% started with other items like honey 27%, ghutti 18%, Araq 8%, water and sugar 4%, cow and formula milk 12%. Out of [122] those who did not started with colostrums, 59% done it intentionally under the influence of family traditions /taboos of either avoiding colostrums being a stale food or to get the first feed by a person of good fortune, 31% missed by ignorance and 10% due to medical reasons. Out of 58 mothers who started with costume 45% were motivated by health professionals, 39% by relatives/friends and 20% by media. It is conclude that still prelacteal feed is common practice. It is also observed that people change this practice under the guidance of health professionals. So situation can be improved by increasing liaison of pregnant mothers with health professionals,who should continuously motivate the mother during pregnancy and delivery, to start with colostrums with in half hour of delivery

An outbreak of cholera in Karachi following monsoon rains 2003

An epidemic of acute gastroenteritis was observed in the province of Sindh following a heavy monsoon season in July-August 2003. In Karachi, a mega-metropolitan city, large numbers of patients were evaluated for gastroenteritis and many were severely dehydrated and needed hospitalization. This study was carried out to describe epidemiologic features of the epidemic of gastroenteritis and investigate the causative agents responsible. We reviewed the medical records of all the pediatric patients admitted to the Aga Khan University [AKU] Hospital, Karachi, with the diagnosis of "Acute Gastroenteritis" over a 3 month period [1st June 31st August 2003], and analyzed their demographic and stool culture results. Epidemiological and clinical observations were recorded and the findings were correlated with the onset of the monsoon rains. A total of 327 pediatric patients were sick enough to be hospitalized with acute gastroenteritis to the AKU hospital over the 3-month period. A 3-fold increase in the number of patients admitted with gastroenteritis was noted in the period coinciding with heavy rains [mid-July to mid-August] compared to the baseline period before the onset of rains [June 2003]. Of the 327 patients hospitalized, 134 [41%] patients had stool cultures performed. Of these 134 patients, 53 [40%] had a positive stool culture. Vibrio cholerae were isolated from 34 of the 53 [64%] positive stool cultures with an overall isolation rate of over 25% from all stool samples submitted for culture. There was a significant increase in the number of cases of gastroenteritis, specifically cholera following a heavy monsoon season in Karachi. Adequate public health measures to prevent the occurrence of outbreaks of cholera and to educate the public about the dangers of drinking contaminated water are urgently needed

Toxins and bioactive compounds from cyanobacteria and their implications on human health.

Many species of cyanobacteria (blue-green algae) produce secondary metabolites with potent biotoxic or cytotoxic properties. These metabolites differ from the intermediates and cofactor compounds that are essential for cell structural synthesis and energy transduction. The mass growth of cyanobacteria which develop in fresh, brackish and, marine waters commonly contain potent toxins. Cyanobacterial toxins or cyanotoxins are responsible for or implicated in animal poisoning, human gastroenteritis, dermal contact irritations and primary liver cancer in humans. These toxins (microcystins, nodularins, saxitoxins, anatoxin-a, anatoxin-a(s), cylindrospermopsin) are structurally diverse and their effects range from liver damage, including liver cancer to neurotoxicity. Several incidents of human illness and more recently, the death of 60 haemodialysis patients in Caruaru, Brazil, have been linked to the presence of microcystins in water. In response to the growing concern about the non-lethal acute and chronic effects of microcystins, World Health Organization has recently set a new provisional guideline value for microcystin-LR of 1.0 microg/L in drinking water. Cyanobacteria including microcystin-producing strains produce a large number of peptide compounds, e.g. micropeptins, cyanopeptolins, microviridin, circinamide, aeruginosin, with varying bioactivities and potential pharmacological application. This article discusses briefly cyanobacterial toxins and their implications on human health.