Effect of an energy-dense diet on the clinical course of acute shigellosis in undernourished children

To date there have been few reports on the impact of dietary intervention on the clinical course of acute shigellosis. Current management of acute shigellosis is primarily focused on antibiotic therapy with less emphasis on nutritional management. In a randomised clinical trial, we examined the role of an energy-dense diet on the clinical outcome in malnourished children with acute dysentery due to shigellosis. Seventy-five children aged 12--48 months with acute dysentery randomly received either a milk--cereal formula with an energy density of 4960 kJ/l (test group) or a milk-cereal formula with energy of 2480 kJ/l (control group) for 10 d in hospital. In both milk-cereal formulas, protein provided 11 % energy. In addition, the standard hospital diet was offered to all children and all children received an appropriate antibiotic for 5 d. The mean food intakes (g/kg per d) in the test and control groups were: 112 (SE 2.28) and 116 (SE 3.48) on day 1; 118 (SE 2.72) and 107 (SE 3.13) on day 5; 120 (SE 2.25) and 100 (SE 3.83) on day 10. The mean energy intakes (kJ/kg per d) in the test and control groups respectively were: 622 (SE 13.2) and 315 (SE 11.3) on day 1; 655 (SE 15.1) and 311 (SE 7.98) on day 5; 672 (SE 14.7) and 294 (SE 11.1) on day 10. The food and energy intakes were mostly from the milk-cereal diet. There was no difference between two groups in resolution of fever, dysenteric (bloody and or mucoid) stools, stool frequency and tenesmus. However, vomiting was more frequently observed among the test-group children during the first 5 d of intervention (67 % v. 41 %, There was an increase in the mean weight-for-age (%) in the test group compared with the control group after the 10 d of dietary intervention (6.2 (SE 0.6) v. 2.7 (SE 0.4), In addition, resolution of rectal prolapse was better (26 % v. 8 %, in the test group v. control group after 5 d, and 13 % v. 6 %, after 10 d of dietary intervention. Supplementation with a high-energy diet does not have any adverse effect on clinical course of acute shigellosis and reduces the incidence of rectal prolapse in malnourished children.

Folic acid in the treatment of acute watery diarrhoea in children: a double-blind, randomized, controlled trial

One-hundred and six male children aged 6-23 months with a history of acute watery diarrhoea of less than 72 h duration were randomized to receive either folic acid in a dose of 5 mg at 8-h intervals or placebo for 5 d. There were 54 children in the folic acid group and 52 in the placebo group. The admission characteristics were comparable between the two groups. No significant differences were observed in the intake of oral rehydration solution or stool output between the groups. The mean+/-SD of total stool output (g kg(-1)) was 532+/-476 vs 479+/-354 and the duration (h) of diarrhoea was 108+/-68 vs 103+/-53 in the folic acid vs placebo group, respectively. The findings, therefore, should have a positive influence on preventing the inappropriate use of folic acid in acute diarrhoea.

Early feeding of an energy dense diet during acute shigellosis enhances growth in malnourished children

In a controlled clinical trial, we examined the effect of the short-term feeding of an energy-dense milk cereal formula in malnourished children with clinically severe dysentery due to acute shigellosis. Seventy-five malnourished children, aged 12-48 mo, passing blood or blood with mucous in the stool for < or = 96 h, were offered a hospital diet. In addition, study children (n = 36) were offered a milk-cereal formula with an energy of 5 kJ/g (an 11% protein diet); similarly, control children (n = 39) were offered a milk-cereal formula with an energy content of 2.5 kJ/g (an 11% protein diet). Patients were admitted to the metabolic ward of the Clinical Research and Service Centre, Dhaka, at the International Centre for Diarrhoeal Disease Research, Bangladesh. Patients were studied for 10 hospital days and were then followed up at home after 30 d. After 10 d of dietary intervention, children in the study group had a significantly greater increase vs. controls in weight-for-age (6 vs. 3%, P < 0.001) and in weight-for-height (7 vs. 3%, P < 0.001). Serum prealbumin concentrations were significantly higher (study vs. control) after 5 d (0.214 vs. 0.170 g/L, P = 0.01) and after 10 d (0.244 vs. 0.193 g/L, P = 0.006) of the study. Greater weight-for-age was sustained at home 1 mo after discharge (8 vs. 5%, P = 0.005) from the hospital. Similarly, higher weight-for-height was sustained 1 mo after discharge (8 vs. 5%, P = 0.01). During their stay at home, there was no dietary intervention. The results of this study suggest that short-term feeding of an energy-dense diet enhances growth in malnourished children with acute dysentery due to shigellosis.

Hyperimmune cow colostrum reduces diarrhoea due to rotavirus: a double-blind, controlled clinical trial

The therapeutic efficacy of hyperimmune bovine colostrum (HBC) from cows immunized with four serotypes of human rotavirus was evaluated in a double-blind, randomized trial in 75 boys, aged 6-24 months, infected with rotavirus diarrhoea. The treatment group received 100 ml of HBC three times a day for 3 consecutive days, while the controls received the same amount of bovine colostrum from significantly shorter duration of diarrhoea than the controls (median 56 versus 72 h (p<0.001); confidence interval of median difference (CI) 8-32 h). Total stool output (g/kg) between admission and cessation of diarrhoea was reduced by 29% in the HBC-treated group compared with controls (median 205 versus 290 g (p=0.04); CI = 1-154 g). In 50% of the children in the study group, diarrhoea stopped by 48 h, whereas 100% of the controls were still suffering from diarrhoea. No untoward effects were noted in either group. Colostrum from cows immunized with rotavirus antigen is clinically effective in reducing the duration and severity of childhood diarrhoea due to rotavirus.

Long-term results after excision of fixed subaortic stenosis

Forty-nine patients underwent surgical excision of fixed subaortic stenosis (discrete fibrous ring and tunnel) between 1968 and 1984 and were followed up for 1 to 16 years (5.8 +/- 4). Twenty-six patients (Group I) had isolated subaortic stenosis and 23 (Group II) had subaortic stenosis and associated cardiac defects. Discrete fibrous ring was present in 46 and tunnel type of obstruction in three patients. For the discrete ring, excision alone was done in 32 patients (four recurrences) and excision with myotomy in 17 (three recurrences). In Group I, there were no operative deaths and one late death from a noncardiac cause. In Group II, one early and two late deaths occurred. The actuarial survival rate for 10 years is 88%. Reoperations were performed in 10 patients, seven for recurrence and three for aortic valve replacement for preexisting aortic regurgitation that had progressed since the primary operation. Cardioplegia was used in 28 patients (one recurrence) and was not used in 21 patients (six recurrences). An operative residual gradient of less than 15 mm Hg was achieved in 25 of 28 patients in whom cardioplegia was used compared to 12 of 21 patients in whom cardioplegia was not used (p = 0.017). These results indicate that complete excision of the ring with the aid of cardioplegia has significantly reduced the recurrence rate of subaortic stenosis (p = 0.033), elimination of the residual gradient at the initial operation has been a significant factor in reducing the recurrence rate (p = 0.017), and addition of myotomy in this series has not altered the outcome.

Clinical advantages of papaverine cardioplegia

To determine the efficacy of papaverine in improving myocardial protection by causing a uniform distribution of the cardioplegic solution, a prospective study was carried out in 200 consecutive patients undergoing various open heart procedures. Several parameters (creatine kinase MB, electron microscopy of myocardium, perioperative myocardial infarction rate, frequency of postoperative arrhythmias) were monitored and compared with those of a control group which consisted of the previous 200 consecutive patients in whom the same cardioplegic solution was used, but without papaverine. In the papaverine group the operative mortality due to low cardiac output was 0.5% compared to 3%, and the spontaneous recovery of the heart after release of the aortic cross-clamp was 89% compared to 47% in the control group (P less than 0.01). The perioperative myocardial infarction rate was 5% and the incidence of postoperative temporary arrhythmias was also 5% in the papaverine group, while in the control group the perioperative myocardial infarction rate was 10% and the postoperative arrhythmia incidence was 13% (P less than 0.01).

Rationale for the surgical treatment of pulmonary metastases

In a twenty-six year period, 90 patients underwent surgical treatment for metastatic malignant disease of the lung. The primary tumour had apparently been completely removed and there was no evidence of other metastatic spread. Thirty patients enjoyed a survival of more than five years. In 22 cases of the lung lesion was multiple and in 17, the lesions were bilateral. In patients with pulmonary metastases, but without evidence of other dissemination of the disease, resection of the lesions provided useful palliation, and 33% survived for five years of more.