Oral rehydration solution containing trisodium citrate for treating severe diarrhoea: controlled clinical trial.
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Adolescent↗
Biomedical subjects
A N Alam
Publications and source records attributed to A N Alam.
Prognostic indicators and risk factors for increased duration of acute diarrhoea and for persistent diarrhoea in children.
To identify the prognostic indicators and risk factors for increased duration of acute diarrhoea and for occurrence of persistent diarrhoea (i.e. acute episodes lasting longer than 14 days) in children under three years, a systematic sample (3690) of patients attending a large treatment centre in Bangladesh was analysed using multiple regression, logistic regression and stratified (Mantel-Haenszel) analysis. Significant prognostic indicators or risk factors for increase in duration of acute diarrhoea, after adjusting for confounders, include bloody or mucoid diarrhoea, concomitant signs of chest infection, presence of vitamin A deficiency signs, decreased weight for age, routine use of contaminated surface water, lack of breastfeeding and increasing age; presence of rotavirus or enterotoxigenic Escherichia coli or Vibrio cholerae 01 in stool had negative association. In logistic regression and stratified analysis these factors, except for lack of breastfeeding and age, were also found to be risk factors or prognostic indicators of persistent diarrhoea. Policy implications of these findings for programmes to reduce morbidity and mortality from persistent diarrhoea include development of effective vaccines against dysentery-causing Shigella, programmes to prevent vitamin A deficiency, protein energy malnutrition and acute respiratory infections in children, and long-term programmes to provide clean water for all day-to-day needs.
Acute Disease↗
Prostacyclin concentrations in haemolytic uraemic syndrome after acute shigellosis in children.
The role of prostacyclin in the pathogenesis of haemolytic uraemic syndrome was evaluated in 11 children with acute shigellosis. Plasma concentrations of 6-keto prostaglandin, F1 alpha, a stable metabolite of prostacyclin, were measured by radioimmunoassay during acute illness, early convalescence, and after clinical recovery. Its concentration was low during acute illness in each patient, returning to normal concentrations or above at the time of the last sample. These results suggest that plasma prostacyclin may be involved in the development of the syndrome.
6-Ketoprostaglandin F1 alpha↗
Enteroaggregative Escherichia coli infections in Bangladeshi children: clinical and microbiological features.
Escherichia coli isolated from 389 children, less than 1-year of age with diarrhoea, were analyzed for the presence of Enteroaggregative E. coli (EAggEC) by their pattern of adherence to HeLa cells. EAggEC were isolated from 58 (14.8%) children either as a sole pathogen or in combination with other enteric pathogens. In 60% of these children EAggEC infection occurred in the second half of infancy (7-12 m). Thirty-eight of 47 children having EAggEC as a sole pathogen had watery diarrhoea along with vomiting (87%) and dehydration (74%). In contrast, 9 of the 47 cases had mucoid diarrhoea with infrequent vomiting and dehydration and frequent abdominal pain. Children infected with EAggEC were successfully rehydrated with oral rehydration solution (ORS) alone. Seventy-one percent of the EAggEC strains were resistant to more than three antibiotics. It was evident by phage pattern that various EAggEC strains were present in the population. The results indicated that infections with EAggEC may have a role in the development of diarrhoea among children less than 1-year of age in Bangladesh.
Bacterial Adhesion↗
Randomised double blind trial of single dose doxycycline for treating cholera in adults.
OBJECTIVE: To compare the efficacy of a single dose of doxycycline (200 or 300 mg) with the standard multiple doses of tetracycline in patients with cholera. DESIGN: Randomised double blind controlled trial. Patients were given a single 200 mg dose of doxycycline, a single 300 mg dose of doxycycline, or multiple doses of tetracycline (500 mg, six hourly intervals). SETTING: Hospital in Bangladesh treating diarrhoea. PATIENTS: 261 Patients aged over 15 admitted to the hospital with severe dehydration due to acute watery diarrhoea associated with Vibrio cholerae. All vibrios isolated from the stools and rectal swabs of patients, including those patients with prolonged excretion of vibrios, were sensitive to tetracycline. The stools of all patients at admission were negative for shigella and salmonella. INTERVENTIONS: All patients received rapid intravenous acetate solution for the first four hours after admission to hospital. They were then entered in the study and randomised. Oral rehydration was started immediately after the intravenous treatment. If signs of severe dehydration reappeared during oral treatment patients were given rapid intravenous acetate solution until dehydration was fully corrected. MAIN OUTCOME MEASURES: Stool output in first 24 hours and till diarrhoea stopped, total intake of oral rehydration fluid, duration of diarrhoea, and excretion of vibrio after receiving antibiotic treatment. RESULTS: The median stool outputs during the first 24 hours (275 ml/kg body weight) and till diarrhoea stopped (296 ml/kg body weight) were significantly higher in patients receiving 200 mg doxycycline as a single dose than in patients receiving either standard tetracycline (242 ml/kg body weight and 254 ml/kg body weight) or 300 mg doxycycline (226 ml/kg body weight and 255 ml/kg body weight). Similarly, median consumption of oral rehydration solution (18.45 l) was significantly higher in patients receiving 200 mg doxycycline than in patients receiving either 300 mg doxycycline (16.10 l) or standard tetracycline (14.80 l). Almost equal numbers of patients in each group required unscheduled intravenous acetate solution to correct dehydration during antibiotic treatment. Patients treated with doxycycline (low or high dose), however, had more prolonged excretion of bacteria. CONCLUSIONS: A single 300 mg dose of doxycycline is as effective as the standard multiple dose tetracycline treatment for cholera in terms of stool output, duration of diarrhoea, vomiting, and requirement for oral rehydration solution.
Adolescent↗
Persistent diarrhoea: clinical efficacy and nutrient absorption with a rice based diet.
Twenty six infant boys, aged 4 to 18 months, suffering from persistent diarrhoea and 25 age matched healthy controls without diarrhoea were given a diet based on rice powder, egg white, glucose, and soya oil. The clinical efficacy of the diet was studied and a 72 hour metabolic balance study was done. Twenty one patients recovered from diarrhoea within seven days. Median coefficients of absorption of nutrients in persistent diarrhoea patients were 68.0% (range 28.0 to 92.0) for total energy, 60.0% (range 21.0 to 97.0) for fat, 53.0% (range -122.0 to 82.0) for nitrogen, and 81.0% (range 23.0 to 97.0) for carbohydrates. The corresponding values among the control subjects were 90.0% (range 76.0 to 99.0), 95.0% (range 71.0 to 99.0), 70.0% (range 10.0 to 95.0), and 93.0% (range 85.0 to 98.0) respectively. Absorption of all macronutrients in the control subjects was on average significantly higher than in the patients. Nutrient absorption is substantially reduced in persistent diarrhoea and a rice based diet is clinically effective in most patients.
Bangladesh↗
Impact of acute diarrhoea on parasite loads.
Parasites and diarrhoea are more frequent in poor populations. Parasite prevalence rates in post-diarrhoeal patients of the International Centre for Diarrhoeal Disease Research (ICDDRB) and in non-diarrhoeal populations of two Dhaka poor socioeconomic communities have been compared to explore if there is any effect of acute diarrhoea on parasite prevalence rates. Stool of a 4% systemic randomly selected sample of diarrhoeal patients and the whole population of two local poor communities have been examined. The results showed that the prevalence of parasites in a post-diarrhoeal population is significantly lower than in a non-diarrhoeal population. These reductions (E. hist. 10.2% vs. 2.03%, G. lamb. 9.7% vs. 3.5%, hookworm 37.4% vs. 4.7% and Ascaris lumbricoides 81% vs. 20.6%) may be attributed mainly to the flushing effect of diarrhoea.
Acute Disease↗
Oral rehydration formula containing alanine and glucose for treatment of diarrhoea: a controlled trial.
OBJECTIVE: To determine whether adding L-alanine to the glucose based oral rehydration solution recommended by the World Health Organisation would improve its efficacy in treating acute diarrhoea. DESIGN: Randomised double blind controlled trial of oral rehydration solution containing L-alanine and glucose. SETTING: Inpatient service of a hospital treating diarrhoea. PATIENTS: 97 Male patients aged 6-59 years admitted to the hospital with acute and severe dehydration due to diarrhoea associated with Vibrio cholerae or enterotoxigenic Escherichia coli. Forty nine received the standard glucose based oral rehydration solution (control group) and 48 this solution with alanine added (study group). INTERVENTIONS: All of the patients received rapid intravenous acetate solution for the initial four hours after admission, which fully corrected the signs of dehydration. They were then admitted to the study and randomised. Immediately after the intravenous treatment oral rehydration treatment was started. All of the patients received oral tetracycline for 48 hours, starting 24 hours after start of the study. If signs of dehydration reappeared during oral treatment patients were given rapid intravenous acetate solution until they were fully corrected and then continued to take the assigned oral rehydration solution. END POINT: Passage of the last watery stool. MEASUREMENTS AND MAIN RESULTS: The median stool output/kg body weight during the initial 24 hours of oral rehydration treatment and until diarrhoea stopped was reduced in the study group compared with the control group from 309 ml to 196 ml and from 393 ml to 236 ml respectively. Intake of oral rehydration solution and intravenous acetate solution was reduced from 455 ml to 308 ml and from 616 ml to 425 ml respectively. Two patients in the study group compared with 18 patients in the control group required unscheduled rapid intravenous acetate solution to correct signs of dehydration during oral rehydration treatment. CONCLUSION: Oral rehydration solution containing L-alanine was considerably better than standard oral rehydration solution at reducing the severity of symptoms and the need for fluid of male patients with diarrhoea associated with V cholerae and enterotoxigenic E coli.
Adolescent↗
Persistent diarrhoea: a preliminary report on clinical features and dietary therapy in Bangladeshi children.
Twenty-six infants and children aged 2-24 months suffering from diarrhoea for more than 2 weeks were studied in the ICDDRB's Dhaka Treatment Centre. They presented with watery diarrhoea and the majority had moderate dehydration. A stool pathogen was isolated in only one infant. Systemic infections co-existed in half of the subjects. Subjects between 4 and 12 months of age were moderately malnourished. The remainder were severely malnourished. A range of therapeutic diets were given according to the clinical progress of the subjects. Three children improved with a milk-based diet, two with a soya-based proprietary diet, eight with a rice-based diet, 12 with comminuted chicken, and one with yoghurt. Response to various diets appeared to be age related. Body weight of 21 subjects deteriorated before cessation of diarrhoea. Case fatality rate was 11 per cent due to septicaemia and bronchopneumonia. Most persistent diarrhoea patients without severe concurrent systemic infections were effectively treated using various locally prepared diets.
Bangladesh↗
Risk factors for persistent diarrhoea.
With a systematically sampled population of children aged under 5 attending this centre for diarrhoeal disease research during 1983-5 a retrospective analysis of persistent diarrhoea (defined as greater than 14 days' duration) was performed to identify the possible risk factors for this syndrome. Of the 4155 children included in the analysis, 410 (10%) gave a history of persistent diarrhoea. A comparison with children with acute diarrhoea matched for age showed that 11 factors were correlated with persistent diarrhoea, and strongly associated factors were stools with blood or mucus, or both, lower respiratory tract infection, malnutrition, vitamin A deficiency, and antibiotic use before presentation. The peak age was 2 years, and there was no sex difference. Deaths occurred more often in the group with persistent diarrhoea. Although Shigella spp, Campylobacter jejuni, and Giardia lamblia were frequently identified, their rates of isolation were not significantly higher among patients with persistent diarrhoea. No seasonal variation was observed in the rates of persistent diarrhoea. Although the introduction of family food to the diet was associated with higher rates, this factor was difficult to separate from the age dependent risks.
Acute Disease↗
Interethnic variation in the metabolic inactivation of digoxin by the gut flora.
Digoxin is metabolized to cardioinactive reduced metabolites (digoxin reduction products) in some patients by anaerobic bacteria present in the gut flora. We compared the tendencies of Americans and Bangladeshis to reduce digoxin by this pathway. Of 97 normal Americans in New York City, 34 (35.1%) were metabolizers in contrast to 14 of 100 Bangladeshis in Dhaka (p less than 0.002). Forty-three (35.8%) of 120 American patients in New York City receiving digoxin reduced the drug compared with 4 (13.8%) of 29 Bangladeshi patients in Dhaka (p less than 0.05). In Americans who emigrated to Dhaka or Bengali immigrants to New York City, the frequency of digoxin reduction product excretion was that of their country of origin. Fourteen Bengali immigrants who were nonmetabolizers when first studied in New York did not metabolize digoxin when restudied 4 yr later. In the Bangladeshis studied in Dhaka, income, education, and most strongly, urban residence during childhood correlated positively with digoxin inactivation. The findings are consistent with the hypothesis that the metabolic functions of the anaerobic gut flora may be determined by environmental factors operative early in life and tend to remain stable in adulthood. Interethnic variations in drug metabolism may be the consequence of differences in the intestinal microflora.
Adolescent↗
Cholera, rotavirus and ETEC diarrhoea: some clinico-epidemiological features.
This paper analyses a few selected features from the history and clinical examination of 1258 patients with acute diarrhoea and a single laboratory diagnosis of either cholera, rotavirus, or enterotoxigenic (ETEC) Escherichia coli infection. Age distribution and seasonality in Bangladesh were also studied. The duration of illness before admission was not significantly different in the 3 groups. Cholera occurred especially in the spring and early winter. Most cholera patients were between 3 and 10 years of age. Over 37% of the patients developed severe dehydration. In about 90% of cholera cases, the stools were alkaline (pH greater than 7). ETEC infections were seen mostly in April-May and September-October. Infants were frequently affected but from age 25 onwards the age distribution closely followed that of cholera. Severe dehydration occurred in 8.3% of patients and was more frequent than in rotavirus cases. Stool pH was as frequently acidic as basic. Rotavirus cases were concentrated during the winter in patients under 2 years of age. They had marked vomiting, yet severe dehydration was almost absent. Cough was present in half of them. The stools were usually acidic. In spite of considerable overlap of signs and symptoms between the 3 aetiological groups, a presumptive diagnosis of cholera could be made in patients past infancy and early childhood who showed very severe dehydration. However, age-specific prevalence was strikingly different and seasonal variations considerable.
Adolescent↗
Rapid intravenous rehydration by means of a single polyelectrolyte solution with or without dextrose.
We compared the efficacy and safety of a single polyelectrolyte solution, Dhaka solution (DS), containing 133 mmol/L sodium, 13 mmol/L potassium, 98 mmol/L chloride, and 48 mmol/L acetate with and without 139 mmol/L (25 gm/L) dextrose in the rapid (4 hours) rehydration of 67 patients with diarrhea and moderate or severe dehydration requiring parenteral fluid therapy. Of the 67 patient, 31 were randomly assigned to receive the dextrose-containing solution (DS + D) and 36 DS without dextrose. On admission to the hospital, the two groups of patients were similar with respect to enteric pathogens detected, proportion with hyponatremia, magnitude of dehydration as assessed by clinical criteria, serum protein or creatinine concentration, and plasma glucose levels. At the end of the 4-hour infusion, both groups of patients had similar decreases in serum creatinine and protein levels and similar volume of urine output, but patients receiving DS + D had a significantly higher plasma glucose level than patients receiving DS (7.8 mmol/L (140 mg/dl) vs 5.39 mmol/L (97 mg/dl), P less than 0.01). One patient in the DS group had hypoglycemia (plasma glucose 2.0 mmol/L (36 mg/dl) at 4 hours. No other complications were noted. Serum protein values 24 hours after admission were little changed from 4-hour values, suggesting that rehydration was complete at the end of 4 hours. We conclude that, in our patients, rehydration can be carried out safely and rapidly with the use of a single solution and that adding 139 mmol/L (25 gm/L) of dextrose to the solution can prevent hypoglycemia without producing an osmotic diuresis.
Adolescent↗
Effect of zinc supplementation on the dietary intake and weight gain of Bangladeshi children recovering from protein-energy malnutrition.
Sixty severely malnourished children aged between 5 and 60 months were studied during nutritional rehabilitation. They all received a rice-based diet ad libitum plus vitamins and iron supplementation. Thirty children received zinc supplements (10 mg/kg/d for those weighing less than 6 kg and 50 mg daily for those over 6 kg) on a random basis. Zinc was started from the 15th hospital day when they were free of infection and continued for a period of 3 weeks. Both groups had a mean energy intake of 200 kcal/kg/d, but the majority of the supplemented children had a better rate of weight gain: 66 per cent of the supplemented compared with 33 per cent of the controls gained more than 10 g/kg body weight/d. Moreover, 76 per cent of the supplemented children compared with 23 per cent of the controls were over 90 per cent of Harvard median weight for height on discharge. It appears from this study that zinc supplementation promotes growth and enhances the rate of clinical recovery from severe PEM.
Bangladesh↗
Chloramphenicol-resistant Salmonella typhi in a patient presented with watery diarrhoea.
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Adult↗
Hydrolysed wheat based oral rehydration solution for acute diarrhoea.
A randomised three cell study was carried out in 78 children with acute diarrhoea to evaluate the relative efficacy of oral rehydration solution (ORS) made from partially hydrolysed wheat grain, cooked rice powder, or glucose. Twenty six patients with comparable age, body weight, duration of diarrhoea, and degree of dehydration were studied in each of the three groups. Initial rehydration was carried out by using intravenous Dhaka solution within one to two hours followed by administration of oral rehydration solution. The mean ORS intake during the first and second 24 hours of treatment in patients with cholera receiving wheat-ORS and rice-ORS was significantly less compared with those receiving glucose-ORS. The stool output during the same period in patients receiving wheat-ORS and rice-ORS was significantly less compared with those receiving glucose-ORS. Similar trends in both ORS intake and stool output were observed during the next 24 hours.
Acute Disease↗
Rapid detection of rotavirus in faeces by a slide latex agglutination test as compared with an enzyme-linked immunosorbent assay.
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Child, Preschool↗
Persistent protein losing enteropathy in post measles diarrhoea.
Faecal alpha 1 antitrypsin was measured in two groups of children with diarrhoea aged 6 months to 6 years during the acute and recovery stages of the illness. Group 1 comprised 19 children with a history of measles in the two weeks preceding admission to hospital. In this group there were six cases of Shigella species, six enterotoxigenic Escherichia coli, and five rotavirus, and two did not yield an aetiologic agent. Group 2 comprised 15 children with diarrhoea only. In this group there were five cases of Shigella species, five enterotoxigenic Escherichia coli, and five rotavirus. Children with rotavirus diarrhoea belonging to both groups showed a transient high faecal clearance of alpha 1 antitrypsin during the acute stage. Post measles cases of diarrhoea showed significantly higher faecal clearance of alpha 1 antitrypsin than group 2 subjects in both the acute and recovery stages. The faecal clearance of alpha 1 antitrypsin in both groups was significantly higher during the acute stage compared with the recovery stage. Highest faecal clearances of alpha 1 antitrypsin were observed in children with post measles shigellosis in the acute stage and they also had persistently raised concentrations, thus suggesting prolonged protein losing enteropathy.
Child, Preschool↗