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Biomedical subjects

D Mahalanabis

Publications and source records attributed to D Mahalanabis.

At least 55 records · Page 3Linked to original sources
PubMed1998

Helicobacter pylori colonization in infants and young children is not necessarily associated with diarrhoea.

A cohort of 151 infants and young children aged 1-23 months from a poor peri-urban community of Bangladesh was studied to determine the relationship between Helicobacter pylori colonization and morbidity due to diarrhoea. A 13C urea breath test was performed to detect the presence of H. pylori. Children were followed up at home every alternate day for 6 months and diarrhoeal morbidity data were collected. Diarrhoeal morbidity was compared between H. pylori-positive and H. pylori-negative children. Sixty-eight (45 per cent) children were H. pylori positive and 83 (55 per cent) were H. pylori negative. During the first 1-month period following the breath test, three (4.4 per cent) H. pylori-positive and four (4.8 per cent) H. pylori-negative children had diarrhoea. Thirty-two (47 per cent) of the children in the positive group and 43 (52 per cent) in the negative group had one or more episodes of diarrhoea during the 6-month follow-up period. Median number of diarrhoeal episodes was 1.0 (range 1.0-4.0) in the H. pylori-positive children and 2.0 (range 1.0-5.0) in the H. pylori-negative children (p = 0.19). No significant difference was observed in the cumulative days with diarrhoea. The results of this study suggest that H. pylori colonization is not associated with diarrhoeal morbidity in infants and young children.

Bangladesh↗
PubMed1998

Small bowel and fecal microbiology in children suffering from persistent diarrhea in Bangladesh.

BACKGROUND: The etiology of persistent diarrhea in children is multifactorial. The objective of the current study was to ascertain the role of microorganisms in the etiology and pathogenesis of persistent diarrhea in a group of children in Bangladesh. METHODS: Enteric pathogens and total aerobic microflora were studied in the duodenal aspirates of 100 children with persistent diarrhea and compared with those in aspirates of 30 children with acute diarrhea, and those in aspirates of 15 healthy control children. The enteric pathogens in the stools of these children and in stools of an additional 38 patients with persistent diarrhea and 12 with acute diarrhea were also studied. RESULTS: Approximately two thirds of the patients with acute diarrhea and persistent diarrhea, and half of the control subjects had more than 10(5) organisms per milliliter of duodenal fluid. Significantly, more patients with persistent diarrhea had a greater variety of flora than did patients with acute diarrhea and control subjects. The predominant organisms in patients with acute diarrhea and in those with persistent diarrhea were Gram-negative rods, whereas those in control subjects were Gram-positive cocci. Significantly more acute diarrhea patients and persistent diarrhea patients had enteric pathogens isolated from stool than did control subjects. Diarrheagenic Escherichia coli, as a whole, were present in significantly more persistent diarrhea patients than in acute diarrhea patients and control subjects. Among diarrheagenic E. coli, enteroaggregative E. coli were significantly associated only with persistent diarrhea. Other organisms significantly associated with persistent diarrhea were Aeromonas spp. and Klebsiella spp. Some patients in the acute diarrhea and the persistent diarrhea groups had the same pathogens isolated from both the duodenal fluid and stool. CONCLUSIONS: In accordance with results of other studies, an association between enteroaggregative E. coli and persistent diarrhea was found in the present study. This suggests that therapy directed against enteroaggregative E. coli can be evaluated for management of some cases of persistent diarrhea.

Acute Disease↗
PubMed1998

Successful treatment of rotavirus diarrhea in children with immunoglobulin from immunized bovine colostrum.

BACKGROUND: Oral ingestion of immunoglobulins in humans has been shown to be effective as prophylaxis against enteric infections. However, its therapeutic effect in children with infectious diarrhea has hitherto not been proven. We treated children with rotavirus diarrhea with immunoglobulins extracted from immunized bovine colostrum (IIBC) containing high titers of antibodies against four rotavirus serotypes. METHODS: In this double blind placebo-controlled trial, 80 children with rotavirus diarrhea were randomly assigned to receive orally either 10 g of IIBC (containing 3.6 g of antirotavirus antibodies) daily for 4 days or the same amount of a placebo preparation. The daily stool output (grams/kg/day), intake of oral rehydration solution (ml/kg/day), stool frequency (number of stools/day) and presence of rotavirus in stool were monitored for the 4 days during treatment. RESULTS: Children who received IIBC had significantly less daily and total stool output and stool frequency and required a smaller amount of oral rehydration solution than did children who received placebo (P < 0.05). Clearance of rotavirus from the stool was also earlier in the IIBC group compared with the placebo group (mean day, 1.5 vs. 2.9, P < 0.001). No adverse reactions from the colostrum treatment were observed. CONCLUSIONS: Treatment with antirotavirus immunoglobulin of bovine colostral origin is effective in the management of children with acute rotavirus diarrhea.

Administration, Oral↗
PubMed1998

Association of Providencia alcalifaciens with diarrhea in children.

It has been demonstrated in previous studies that Providencia alcalifaciens can produce diarrhea by an invasive mechanism. In the present study, P. alcalifaciens was isolated from the stool specimens of 17 of 814 diarrheal children younger than 5 years of age (2.1%) and from those of 4 of 814 matched controls (0.49%) (P = 0.004), indicating that the organism is significantly associated with diarrhea. However, 71% of P. alcalifaciens-positive diarrheal children had simultaneous infections with other recognized enteric pathogens.

Child, Preschool↗
PubMed1998

Detection of Shigellae from stools of dysentery patients by culture and polymerase chain reaction techniques.

In Bangladesh, the isolation rates of Shigella spp. range from 11% to 12% by the conventional culture technique. Since the sensitivity of this technique is low, the polymerase chain reaction (PCR) technique was used for detecting small number of Shigellae from patients' stools. Sensitivity and specificity of the two techniques were also compared. Stool samples were collected from 41 patients with dysentery who attended the Clinical Research and Service Centre of the ICDDR,B: Centre for Health and Population Research. All stool specimens were directly plated onto MacConkey, Salmonella-Shigella, Xylose lysin deoxycholate and Hectoen enteric agar media, and Shigellae were detected following standard procedures. DNA was extracted from the stool samples, and the target sequence of invasive plasmid antigen (ipa)H locus was amplified by PCR with 130 ng each of two primers (primer H8 [5'-GTTCCTTGACCGCCTTTCCGATAC-3'] and primer H15 [5'-GCCGGTCAGCCACCCTA-3']) following standard procedures. The amplified product was hybridized using an ipaH probe. The isolation rates of Shigella dysenteriae type 1, S. flexneri, S. sonnei, and S. boydii were, respectively, 17.1%, 19.5%, 4.9% and 2.4% by the conventional method. The results of the PCR technique showed that 700 bp fragment was generated in 18 of the 18 culture-positive and in 7 of the 23 culture-negative stools. One hundred twenty-three strains of Escherichia coli were also tested by PCR for identifying the enteroinvasive E. coli, but none of them yielded any positive result. This study showed that the sensitivity of the culture technique is 72% and specificity is 100%, when the PCR technique was considered as gold standard. Therefore, the PCR may be considered a more sensitive and specific technique than the conventional culture technique and has the potential to be employed in routine diagnosis of dysentery in clinical centres as well as in epidemiologic studies.

Bacteriological Techniques↗
PubMed1997

Glutamine is superior to glucose in stimulating water and electrolyte absorption across rabbit ileum.

L-Glutamine is the primary metabolic fuel of the intestinal mucosa. This in vivo study compares the effect of L-glutamine 50 mM with that of D-glucose 50 mM on water and electrolyte absorption in jejunal and ileal loops of healthy rabbits. Using polyethylene glycol (PEG) as a nonabsorbable marker and an incubation at 37 degrees C, we found that absorption of water (P = 0.000), sodium (P = 0.002), potassium (P = 0.001), and chloride (P = 0.003) from the glutamine electrolyte solution was greater than from the glucose electrolyte solution in the ileum. A similar trend was shown in the jejunum. We conclude that L-glutamine may be a useful component to be tested in oral rehydration solutions for treating diarrheal dehydration.

Animals↗
PubMed1997

Immunological testing for occult blood in patients with acute infectious diarrhea. Can it improve the specificity of the guaiac test?

Microscopic stool examination can distinguish inflammatory from noninflammatory diarrheas. The modified guaiac test was shown to have good correlation to stool microscopy. In a prospective study we evaluated the diagnostic accuracy of a modified guaiac test (Colo-Rectal-Test, Roche) and of an immunological test for fecal haemoglobin (Colo-Immun-Test, Roche) in relation to the diarrheal pathogens identified and compared it with the stool microscopy. In 304 patients, clinical presentation, stool microscopy, stool culture, and modified guaiac test were recorded. Sensitivity of the guaiac test was 69% as compared to 63-67% for the stool microscopy. Specificity could be improved by 10-15% using an immunological test to exclude false-positive guaiac reactions. A modified guaiac test can replace microscopic stool examination to distinguish between inflammatory and non-inflammatory diarrhea. Immunological testing for occult blood can improve the specificity of the guaiac test, but is too elaborate to serve as a screening test. The modified guaiac test can easily be handled by community health workers and could be important in the diagnostic work-up for acute infectious diarrhea.

Acute Disease↗
PubMed1997

Noninvasive assessment of gastric acid secretion in man. Application of electrical impedance tomography (EIT).

Electrical impedance tomography (EIT) is a tubeless technique that generates tomographic images of gastric resistivity. We investigated the application of EIT to measure gastric acid secretion. Nineteen normal subjects underwent a standard intubation test. Basal acid output (BAO) and stimulated acid output (SAO) (millimoles per hour) were measured before and after pentagastrin, respectively. On a different day, EIT was performed before (basal) and after pentagastrin (stimulated). The changes in impedance over time were measured and the area under the curve (AUC) was calculated. Both the tests were repeated in 13 subjects after omeprazole treatment. As in the intubation test, there was the expected increase in AUC value after pentagastrin (basal vs stimulated; 1.2 +/- 2.8 vs 731 +/- 297, P < 0.0001). A significant fall in acid output and AUC following omeprazole pretreatment was observed (without vs with omeprazole; 20.5 +/- 5.7 vs 0.03 +/- 0.06, P < 0.0001 for intubation test and 731 +/- 297 vs 44 +/- 172, P < 0.0001 for EIT). There was a significant correlation between SAO and the delta AUC with (r = 0.65 P < 0.001) or without (r = 0.95, P < 0.001) omeprazole and in all the experiments (r = 0.87, P < 0.001). This study demonstrates the predictable change of gastric impedance and may be useful as a noninvasive test for measuring gastric acid secretion.

Adolescent↗
PubMed1997

Helicobacter pylori: prevalence, transmission, and serum pepsinogen II concentrations in children of a poor periurban community in Bangladesh.

The aim of this study was to determine the age-specific prevalence of Helicobacter pylori infection in infants and children aged 1-99 months from a poor periurban community in Bangladesh. We also examined the frequency of infection among infants and their 53 immediate family members and evaluated the relationship between infection and fasting serum group II pepsinogen (pepsinogen II) concentration in 76 children. Sixty-one percent of 1-3 month-old infants tested positive for H. pylori; this rate declined steadily to 33% in children aged 10-15 months and then increased to 84% in children aged 5-8 years. The H. pylori infection rate was 2.5 times higher in children with illiterate mothers. No difference in infection rate was detected among the family contacts of infected vs. noninfected infants. H. pylori-infected children had significantly higher serum pepsinogen II concentrations than did noninfected children (P < .001). We conclude that infection with H. pylori is highly prevalent and occurs at an early age. An environmental factor or factors, rather than or in addition to intrafamilial spread of this infection, are important in poor communities of Bangladesh. The higher levels of serum pepsinogen II in H. pylori-positive children might indicate the presence of gastritis in such asymptomatic children.

Bangladesh↗
PubMed1997

Effect of early vitamin A supplementation on cell-mediated immunity in infants younger than 6 mo.

One hundred twenty infants were randomly assigned to receive either 15 mg vitamin A or placebo with each of three DPT/OPV (diphtheria, pertussis, tetanus/oral polio vaccine) immunizations at monthly intervals. Sixty-two received vitamin A and 58 received placebo. One month after the third supplementation dose, the response to the delayed cutaneous hypersensitivity test [multitest cell-mediated immunity (CMI) skin evaluation] for tetanus, diphtheria, and tuberculin (purified protein derivative, PPD) was the same in the vitamin A and placebo infants. The number of anergic infants was 17 (27%) and 19 (33%) in the vitamin A and placebo groups, respectively. The number of positive tests among well-nourished infants was significantly higher than that in malnourished infants irrespective of supplementation (P < 0.001). Among the infants with adequate serum retinol concentrations (> 0.7 mumol/L) after supplementation, the vitamin A-supplemented infants had a significantly higher proportion of positive CMI tests than the placebo infants (chi-square test: 8.99, P = 0.008). Among the infants with low serum retinol concentrations (< 0.7 mumol/L) after supplementation, vitamin A supplementation had no effect on CMI response. These results indicate that CMI in young infants was positively affected by vitamin A supplementation only in those infants whose vitamin A status was adequate (ie, serum retinol > 0.7 mumol/L) at the time of the CMI test. CMI was consistently better in well-nourished infants irrespective of supplementation.

Aging↗
PubMed1997

Assessment of vitamin A status by the deuterated-retinol-dilution technique and comparison with hepatic vitamin A concentration in Bangladeshi surgical patients.

Hepatic stores of vitamin A were estimated in 31 Bangladeshi surgical patients (15 males and 16 females) by the deuterated-retinol-dilution (DRD) technique and by analysis of the vitamin A concentration of a liver biopsy specimen obtained during previously scheduled abdominal surgery. Patients ranged in age from 21 to 65 y and had an average body mass index (BMI: in kg/m2) of 17.7 +/- 3.4. They received 0.753 mumol [2H4]retinyl acetate/kg body wt orally 9-11 d before surgery. Hepatic vitamin A reserves were estimated according to Furr et al (Am J Clin Nutr 1989;49:713-6) by using a single plasma isotopic-ratio measurement (18-25 d postdose). Estimated mean hepatic vitamin A stores were similar by both techniques, 0.110 +/- 0.072 mmol (by DRD) compared with 0.100 +/- 0.067 mmol (by biopsy). Regression analysis was used to compare results of the DRD and biopsy techniques. A significant linear relation was found between the two techniques (r = 0.75, P < 0.0001), and the least-squares regression line was not significantly different from y = x (P = 0.09). The results indicate that the DRD technique provided a very good estimate of hepatic vitamin A reserves for this population. However, a wide prediction interval was observed for estimates of hepatic vitamin A reserves for individual subjects. Thus, further refinement of the prediction model is necessary to improve estimates of hepatic vitamin A reserves for individual subjects.

Abdomen↗
PubMed1997

Long-term oral supplementation with iron is not harmful for young children in a poor community of Bangladesh.

The effect of long-term oral iron supplementation on morbidity due to diarrhea, dysentery and respiratory infections in 349 children, aged 2-48 mo, living in a poor community of Bangladesh, was evaluated in this double-blind study. The treatment group received 125 mg of ferrous gluconate (15 mg elemental iron) plus multivitamins and the controls received only multivitamins, daily for 15 mo. House-to-house visits were made on alternate days by trained community health workers for recording symptoms and duration of illnesses and for monitoring medicine intake. Seventy-six percent of the children continued the syrup for over 1 y. No untoward effects were noticed in either treatment group. The attack rates for diarrhea, dysentery and acute respiratory tract infections (ARI) were 3, 3 and 5 episodes per child per year, respectively. Each episode of diarrhea lasted a mean of 3 d, and those of dysentery and ARI, 5 d. The two treatment groups did not differ in the number of episodes, mean duration of each episode, or total days of illnesses due to diarrhea, dysentery and ARI. However, a 49% greater number of episodes of dysentery was observed with iron supplementation in a subset of the study children who were less than 12 mo old (P = 0.03). The results of this study suggest that long-term oral iron supplementation is not harmful for older children in a poor community. Further studies are needed to demonstrate the safety and efficacy of iron administration in young infants.

Administration, Oral↗
PubMed1997

Absorption of nutrients from an energy-dense diet liquefied with amylase from germinated wheat in infants with acute diarrhea.

BACKGROUND: Addition of a small amount of amylase rich flour (ARF) to a thick porridge instantly liquefy the porridge and increase the energy intake even by sick children. The present study examined the absorption of macronutrients and calorie from an energy dense diet liquefied with ARF in children aged 6-11 months with acute watery diarrhea. METHODS: After adequately hydrated with oral rehydration fluid over a period of 24 hours, children were randomly assigned to receive either an ARF treated liquefied porridge (test diet) or a porridge diluted with water (control diet). A 72-hour metabolic balance was performed to determine the absorption of carbohydrate, fat, protein, and calorie. RESULTS: Thirteen infants received the test diet, and 15 infants received the control diet. The intake of protein (g/kg/d), carbohydrate (g/kg.d), fat (g/kg.d) and calorie (kJ/kg.d) were 1.97, 20.6, 4.3 and 548 respectively in the test group and those in the control group were 1.12, 13.3, 2.8 and 356. The stool loss of protein, carbohydrate and fat were comparable in the two groups. The absorption coefficient (%) of carbohydrate, fat and energy were 69.6, 61.3 and 65.4 in the test group and were 73.2, 58.6 and 66.7 in the control group. The coefficient of absorption of protein was significantly higher in the test group (37.7% vs. 21.7%). The mean (95% CI) nitrogen balance (g/kg.d) in the test and control groups were 0.064 (0.026, 0.102) and -0.029 (-0.055, 0.003) respectively. CONCLUSIONS: The results suggest that energy dense diet liquefied with ARF was well absorbed in children with acute diarrhea and there was a positive nitrogen balance that may have a positive impact in preventing weight loss during acute illness.

Absorption↗
PubMed1997

Randomized, controlled, clinical trial of rice versus glucose oral rehydration solutions in infants and young children with acute watery diarrhoea.

A randomized clinical trial was carried out to compare a packaged ready-to-mix rice oral rehydration solution (ORS) to the standard glucose ORS for the treatment of childhood diarrhoea. Children were of either gender, aged 3-35 months, presenting with a history of watery diarrhoea for 72 h or less. The main outcomes examined were stool output, ORS intake, duration of diarrhoea and nutritional recovery during follow-up at 16 d of illness. Stool output in the first 24 h (106 vs 107 g kg(-1)), ORS intake in clinic (93 vs 102 ml per motion) and duration of diarrhoea (88 h vs 81 h) were similar in the two treatment groups. The few episodes that became persistent were similar (2%) in the two groups. The weight gain during follow-up was similar in the two ORS groups.

Acute Disease↗
PubMed1997

Absorption of macronutrients and nitrogen balance in children with dysentery fed an amylase-treated energy-dense porridge.

The aim of this study was to determine the absorption of macronutrients and energy from an energy-dense diet liquefied with amylase from germinated wheat (ARF) in children suffering from acute dysentery. Thirty male children aged 6-35 months presenting with acute dysentery were randomly assigned to receive either an ARF-treated porridge or a standard porridge liquefied with water to make its consistency similar to the ARF porridge. After 24-h stabilization a 72-h metabolic balance was performed. Sixteen children received an ARF-treated porridge and 14 received a standard porridge liquefied with water. The mean +/- SD coefficients of absorption (%) of carbohydrate, fat, protein and energy (ARF porridge vs regular porridge) were 81.4 +/- 11 vs 86.9 +/- 7, 86.1 +/- 10 vs 82.8 +/- 15, 57.3 +/- 12 vs 48.4 +/- 24 and 81.4 +/- 9 vs 83.1 +/- 8, respectively. The stool loss of carbohydrate, protein, fat and energy was similar in the two groups. The net absorption of energy was substantially greater in the ARF-fed than regular porridge-fed children (by 28%, p = 0.01). The nitrogen balance was 6.9 +/- 3.4 mg kg(-1) d(-1) in the ARF porridge group and 1.1 +/- 6.7 mg kg(-1) d(-1) in the regular porridge group (p = 0.01). These results show that, despite being hyperosmolar, an amylase-treated liquefied energy-dense porridge is absorbed as well as a regular porridge by malnourished children with severe dysentery. Consequently, its use substantially increased the absorption of a net amount of macronutrients and resulted in a better nitrogen balance. These results further support this innovative approach of feeding sick children in developing countries.

Acute Disease↗
PubMed1997

Randomised controlled trial of zinc supplementation in malnourished Bangladeshi children with acute diarrhoea.

OBJECTIVE: To evaluate the impact of zinc supplementation on the clinical course, stool weight, duration of diarrhoea, changes in serum zinc, and body weight gain of children with acute diarrhoea. DESIGN: Randomised double blind controlled trial. Children were assigned to receive zinc (20 mg elemental zinc per day) containing multivitamins or control group (zinc-free multivitamins) daily in three divided doses for two weeks. SETTING: A diarrhoeal disease hospital in Dhaka, Bangladesh. PATIENTS: 111 children, 3 to 24 months old, below 76% median weight for age of the National Center for Health Statistics standard with acute diarrhoea. Children with severe infection and/or oedema were excluded. MAIN OUTCOME MEASURES: Total diarrhoeal stool output, duration of diarrhoea, rate of weight gain, and changes in serum zinc levels after supplementation. RESULTS: Stool output was 28% less and duration 14% shorter in the zinc supplemented group than placebo (p = 0.06). There were reductions in median total diarrhoeal stool output among zinc supplemented subjects who were shorter (less than 95% height for age), 239 v 326 g/kg (p < 0.04), and who had a lower initial serum zinc (< 14 mmol/l), 279 v 329 g/kg (p < 0.05); a shortening of mean time to recovery occurred (4.7 v 6.2 days, p < 0.04) in those with lower serum zinc. There was an increase in mean serum zinc in the zinc supplemented group (+2.4 v -0.3 mumol/l, p < 0.001) during two weeks of supplementation, and better mean weight gain (120 v 30 g, p < 0.03) at the time of discharge from hospital. CONCLUSIONS: Zinc supplementation is a simple, acceptable, and affordable strategy which should be considered in the management of acute diarrhoea and in prevention of growth faltering in children specially those who are malnourished.

Acute Disease↗
PubMed1997

Bioelectrical impedance measurements at various frequencies to estimate human body compositions.

Bioelectrical impedance analyses (BIA) operating at various frequencies were used to estimate body composition parameters and compared with the biochemically determined parameters by using isotopic dilution method in 22 healthy adult (30-50 years old) male human subjects. BIA instruments, operating at 50,100 KHz and 5 to 500 KHz range, were used to measure body compositions, namely total body water (TBW), fat free mass (FFM), and fat mass (FM). TBW of these subjects was also determined by deuterium dilution method. BIA methods measured at 100 KHz and using multifrequencies appear to be more accurate than at 50 KHz when compared with isotopic dilution method as standard. This accuracy could be attributed due to measurements made at higher frequencies that falls in the region where current passes through both extra- and intracellularly, thereby giving an appropriate measure of TBW. All the subjects participated in this study belong socioeconomically to the middle class and do not apparently look obese or fatty. However, the mean of their body fat, as estimated by the standard deuterium dilution method, was about 30% which is suggestive of an unapparent obesity prevailing in this class of people in Bangladesh.

Adult↗