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Biomedical subjects

D Mahalanabis

Publications and source records attributed to D Mahalanabis.

At least 91 records · Page 5Linked to original sources
PubMed1995

Alanine- and glucose-based hypo-osmolar oral rehydration solution in infants with persistent diarrhoea: a controlled trial.

To evaluate the efficacy of a hypo-osmolar and a standard (World Health Organization) oral rehydration salt (ORS) solution in persistent diarrhoea, a randomized controlled clinical trial was conducted in 55 children. After a 1-day observation period the children were assigned to one of three solutions: standard ORS (WHO-ORS) (osmolality 311 mosmol/l), hypo-osmolar ORS containing L-alanine and glucose (osmolality 255 mosmol/l) and i.v. polyelectrolyte solutions (osmolality 293 mosmol/l) for ongoing replacement of stool loss for the next 4 days. Excellent acceptability of ORS (101-160 ml/kg body weight/day) by the children was observed. There were no significant differences in the total intake of solutions and food, and frequency of stools among the groups. Stool outputs were significantly less in infants receiving hypo-osmolar ORS than in those receiving WHO-ORS for 0-24 h (p = 0.04), 0-48 h (p = 0.01), 0-72 h (p = 0.04) and 0-96 h (p = 0.03). The results indicate a sufficient scope of ORS practice in persistent diarrhoea. Furthermore, we found that a hypo-osmolar ORS containing L-alanine and glucose is as efficacious as an iv solution and more effective than WHO-ORS for replacement of ongoing stool loss in persistent diarrhoea.

Bicarbonates↗
PubMed1995

Role of amylase-treated, energy-dense liquid diet in the nutritional management of acute shigellosis in children: a controlled clinical trial.

To evaluate if an energy-dense porridge liquefied by amylase-rich flour (ARF) from germinated wheat increased the calorie intake in children with acute shigellosis, we studied 66 children, aged 6-35 months, in a randomized, controlled clinical trial. Children were randomized to receive either an energy-dense porridge liquefied with ARF (group 1), a thick unaltered porridge (group 2) or a porridge diluted with water (group 3) to a similar viscosity as that in group 1. Mean +/- SD calorie intakes (kJ/kg/day) from the porridges were 280 +/- 113, 167 +/- 100 and 151 +/- 80 in groups 1, 2 and 3, respectively (p = 0.006, ANOVA). Total energy intakes (mean +/- SD) from the study diet and other food sources were 469 +/- 151, 377 +/- 121 and 351 +/- 100 kJ/kg/day, respectively (p = 0.006, ANOVA). Intake of breast milk was similar in all groups. Using multiple regression analysis the effect of ARF-treated energy-dense porridge in increasing the calorie intake persisted after adjusting for a number of confounders, such as age of the child, isolation of Shigella dysenteriae type 1 and fever. The results of this study suggest that ARF-treated porridge increases energy intake in infants and young children during acute shigellosis. This feeding approach may be useful in preventing malnutrition following dysentery due to shigellosis.

Amylases↗
PubMed1995

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.

Animals↗
PubMed1995

Development of an improved animal model of shigellosis in the adult rabbit by colonic infection with Shigella flexneri 2a.

Rabbits are not usually susceptible to intestinal Shigella infection without extensive pretreatment, including starvation and administration of antimicrobial, antimotility, and toxic agents (carbon tetrachloride). Most animals infected this way die rapidly and do not always develop colonic lesions and signs of dysentery. We describe here a successful experimental infection in the adult rabbit which does not require preparatory treatment and which reproduced characteristic features of human shigellosis. Unstarved, untreated adult rabbits were infected by direct inoculation of virulent Shigella flexneri 2a (10 ml of 10(7) bacteria per ml) into the proximal colon after ligation of the distal cecum (cecal bypass). Within 24 h of infection, most inoculated animals consistently developed clinical dysentery, characterized by liquid stool mixed with mucus and blood, leukocytosis, anorexia, and weight loss. Histologically, there were edema, exudation, superficial ulceration, and polymorphonuclear infiltrations in the lamina propria; crypt abscess formation; focal hemorrhages; and the presence of immunohistochemically stained S. flexneri in the colonic mucosa. Successful bacterial colonization was indicated by the isolation of the challenge strain of S. flexneri 2a from the colonic contents. None of the control rabbits challenged with nonvirulent S. flexneri or without cecal bypass developed dysentery or colitis. We conclude that successful Shigella infection can be induced by direct colonic inoculation with virulent S. flexneri 2a in adult rabbits without starvation and pretreatment. The colitis is dependent on the virulence of the bacteria and on the cecal bypass. This model should be useful in studies of the immunopathogenesis of Shigella infection.

Animals↗
PubMed1995

Trimethoprim-sulphamethoxazole in the treatment of persistent diarrhoea: a double blind placebo controlled clinical trial.

The efficacy of an absorbable antimicrobial agent trimethoprim-sulphamethoxazole (TMP-SMX) in the management of children with persistent diarrhoea was evaluated in a double blind, randomised, and placebo controlled trial. Of the 55 patients studied, 28 received TMP-SMX, and 27 received placebo. A trend in stool weight reduction was observed from the third day after the drug was started, and the reduction was statistically significant on day 6 and day 7. However, the difference in total stool output (g/kg) up to day 7 was not significantly different between the two groups. The proportion of children whose diarrhoea resolved by day 7 (therapeutic success) was significantly more in the treatment group compared with the placebo group (23 v 15). Additionally, mean duration of diarrhoea in the group that received TMP-SMX was less compared with the placebo group (6.0 v 8.3 days); this difference, however, was not significant. Hospital infection (probably nosocomial infection) was significantly less in the TMP-SMX treated group (1 v 10). The results of our study indicate that TMP-SMX has a clinical benefit in respect of reducing the stool output, and higher recovery rate within seven days of treatment. In addition, it prevented possible hospital acquired infection.

Child↗
PubMed1995

Bacterial translocation in the rat model of lectin induced diarrhoea.

Red kidney beans were fed to weanling Long-Evans rats to cause diarrhoea (mean (SD) faecal wet weight: 2.66 (0.73) g/day in six rats fed beans v 1.12 (0.47) g/day in six control rats, p < 0.01) and increased faecal energy loss (4.87 (0.41) v 2.14 (0.23) kcal/day, p < 0.01). In addition, the rats fed beans had heavier small intestines (80.6 (4.6) v 51.9 (8.4) g/kg body weight, p < 0.01), heavier mesenteric lymph nodes (0.72 (0.27) v 0.08 (0.08) g/kg body weight, p < 0.05), and translocation of indigenous intestinal bacteria, Citrobacter Spp and Escherichia coli, to the mesenteric lymph nodes. (Translocation positive, that is, > 100 colonies per g of nodal tissue: 75% v 0%, p < 0.005.) These data suggest that diarrhoea induced by red kidney beans is a suitable model for studies of an important cause of persistent diarrhoea--that is, systemic complications. This rat model of lectin induced diarrhoea with translocation of intraluminal enteric bacteria into mesenteric lymph nodes should be useful in understanding the well known septicaemic complications associated with prolonged diarrhoea in infants and small children and in studies on factors that may modify or prevent bacterial translocation.

Animals↗
PubMed1995

The presence of bicarbonate in oral rehydration solution does not influence fluid absorption in cholera.

BACKGROUND: On the basis of human perfusion studies it has been speculated that bicarbonate ions in oral rehydration salt solutions (ORS) to treat diarrhoea are more efficiently absorbed from the small bowel. We evaluated the role of bicarbonate in ORS by using a reduced purging rate in cholera as a proxy indicator for absorption efficiency in cholera-like severe diarrhoea. METHODS: In a double-blind randomized trial 60 patients received standard ORS containing bicarbonate or an identical solution except that sodium bicarbonate was replaced by an equimolar amount of sodium chloride (sodium, 90 mmol/l; potassium, 20 mmol/l; chloride, 80 mmol/l; bicarbonate, 30 mmol/l; glucose, 111 mmol/l; and osmolality, 331 mmol/l) after initial intravenous rehydration to correct initial dehydration and shock and until diarrhoea ceased. RESULTS: Five patients receiving standard ORS and eight receiving bicarbonate-free ORS required unscheduled intravenous therapy for recurrence of severe dehydration in spite of receiving ORS solution. ORS intake and purging rate, in ml/kg body weight/day, both including and excluding stool output during unscheduled intravenous therapy are closely similar in the two treatment groups. CONCLUSION: The results indicate that bicarbonate-containing ORS solution does not have any clinically significant effect on the absorption efficiency of ORS, either beneficial or adverse, and its use is relevant only for correction of metabolic acidosis of diarrhoeal dehydration.

Administration, Oral↗
PubMed1995

Administration of 25,000 IU vitamin A doses at routine immunisation in young infants.

OBJECTIVE: To investigate whether monthly administration of vitamin A at routine immunisation produces any side-effects, and to examine the effect of this supplementation on the vitamin A nutrition status of infants. DESIGN: A double-blind randomised placebo-controlled clinical trial. SETTING: Immunisation clinic of a large diarrhoea treatment centre. SUBJECTS: Infants aged 6-17 weeks who will receive their first diphtheria-pertussis-tetanus/oral polio vaccine (DPT/OPV) dose. METHODS: Infants were randomly assigned to receive either 25,000 IU vitamin A or placebo. Three such doses were given with each immunisation dose at monthly intervals. Infants were examined by a physician before and during 24 h after the doses and any signs of toxicity were recorded. Venous blood was drawn at entry and 1 month after the 3rd dose for retinol assay. RESULTS: One hundred and one infants received vitamin A and 98 received placebo. Decreased feeding, irritability, diarrhoea, and vomiting were comparable between the two groups. In the vitamin A group five infants developed bulging fontanelle; three of them developed it once (after 1st, 2nd and 3rd dose respectively), one developed it twice (after both the 2nd and 3rd dose), and the other infant after all three doses. In the placebo group a single child developed bulging fontanelle after the 3rd dose. In all the cases the bulging disappeared within 48 h of onset except in one infant, in whom it subsided at 60 h. The total bulging episodes in the vitamin A and placebo groups were 8 and 1 respectively (RR = 7.7; P < 0.04). However, none of these infants had irritability. At entry fasting retinol level was < 10 micrograms/dl in 35% infants and in 87% infants it was < 20 micrograms/dl. After the third dose fasting retinol level was marginally better in the vitamin A group (mean +/- s.d.: 21.9 +/- 8.2 vs 19.2 +/- 7.8; P = 0.05). However, 47% infants receiving supplementation still had serum retinol level <20 micrograms/dl. CONCLUSION: The results suggest that administration of 25,000 IU of vitamin A in young infants along with routine immunisations, though associated with increased incidence of transient bulging fontanelle without any associated adverse signs or symptoms, may still be inadequate to prevent deficiency in this population. SPONSORSHIP: This study was funded by the United States Agency for International Development (USAID) under grant no. DPE-5986-A-1009-00 with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). The ICDDR,B is supported by countries and agencies which share its concern for the health problems of developing countries.

Double-Blind Method↗
PubMed1995

Effect of antimicrobial (nalidixic acid) therapy in shigellosis and predictive values of outcome variables in patients susceptible or resistant to it.

We observed the clinical features and results of simple laboratory tests on stools of 33 children with bacteriologically proven shigellosis to identify features that could be used to assess the effectiveness of antimicrobial therapy. Persistence of fever (rectal temperature > 37.8 degrees C), abdominal pain/tenderness and anorexia on days 3 and 5 were significantly more common (P < 0.001) among children who received an antimicrobial to which the infecting Shigella was resistant. Similarly, a significantly higher number of children treated with an ineffective antimicrobial had faecal leucocytes of > 50/high power microscopic field (HPF), erythrocytes of > 50/HPF and macrophages of > 5/HPF on study day 5. The best predictors of ineffective antimicrobial therapy on days 3 and 5 of treatment were fever, presence of blood by naked eye examination of stool, and minimum change in stool frequencies. These observations suggest that by careful follow-up of clinical features and simple laboratory tests, such as stool microscopic examinations, it is possible to identify patients unlikely to respond to initial therapy by 72 hours permitting the start of alternative antimicrobial treatment. This may be of great help where stool culture and sensitivity facilities for Shigella spp. are not available.

Abdominal Pain↗
PubMed1995

Research methodology for developing efficient handwashing options: an example from Bangladesh.

Handwashing has been universally promoted for health interventions, but it is essential that the factors related to behaviour are understood in order to develop appropriate handwashing messages. We found the study of behaviour complex and had to combine several methods: in-depth interviewing, questionnaire; observational and bacteriological. Here we present our experiences in developing efficient handwashing options for rural Bangladesh. The components of handwashing practices after defecation of 90 rural women were studied (phase 1). During phase 1 an in-depth interview was used to design the observational and questionnaire surveys. Behaviour was observed using a semi-structured record form and the effectiveness of the acts was measured by means of bacteriological tests. A questionnaire survey was undertaken on socioeconomic and water sanitation-related variables since they influence behaviour. Then, to develop efficient handwashing options, an experimental phase (phase 2) tested the bacteriological efficacy of the components found appropriate in phase 1. The effectiveness of the handwashing practices is believed to be poor since the bacteriological counts were found to be high (faecal coliform count of the left hand 1995, and of the right hand 1318 colony forming units/hand). The practice comprised several components: use of an agent, handedness, frequency of rubbing, source and volume of rinsing water, and drying of the hands. Seventy-five per cent of the women reported that they could not afford soap. The experimental trials showed that soap, ash and soil give similar results under similar conditions of handwashing (faecal coliform counts of left hands: 195 (soap), 98 (ash), 129 (soil) and of right: 112 (soap), 54 (ash) and 89 (soil) cfu/hand). The use of multi-method techniques in the study helped to understand and develop efficient handwashing options.

Bangladesh↗
PubMed1994

Management of acute diarrhoea in diabetic patients using oral rehydration solutions containing glucose, rice, or glycine.

OBJECTIVE: To assess the risk of hyperglycaemia with two standard oral rehydration solutions that contain carbohydrate compared with a carbohydrate free solution during rehydration of diabetic patients with acute diarrhoea. DESIGN: Prospective randomised allocation to one of three oral rehydration solutions (World Health Organisation (glucose), rice, or glycine) groups after admission to hospital with acute diarrhoea. SETTING: Dhaka hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. SUBJECTS: 45 diabetic patients aged between 15 and 60 who had had diarrhoea for fewer than three days on admission. MAIN OUTCOME MEASURES: Fluctuation of blood glucose concentrations measured three times a day, daily stool output, and time taken for recovery from diarrhoea. RESULTS: There were no significant differences in blood glucose concentrations, stool output, and duration of recovery from diarrhoea among the three groups. CONCLUSIONS: Oral rehydration solutions containing glucose, rice powder, or glycine can be safely administered to diabetic patients with acute diarrhoea and some dehydration.

Acute Disease↗
PubMed1994

Impact of health education on the feeding of green leafy vegetables at home to children of the urban poor mothers of Bangladesh.

To evaluate the impact of health education on mothers, on the feeding of their children green leafy vegetables (GLV) at home, we studied 160 children aged 6 to 35 months and their mothers in two intervention groups and one comparison group. The mothers of the first intervention group (n = 44) were given health education including a feeding demonstration, by offering a single meal of cooked GLV to their children. The mothers in the second intervention group (n = 36) received health education only. Mothers of both the intervention groups were visited at home after eight weeks of intervention without prior notice, and for each of them an immediate neighbourhood mother having a child in the same age range was selected as a comparison mother (n = 80). During this visit, mothers were asked whether they had cooked GLV that day and fed these to their children; this was confirmed by spot-checking. Also, mothers were interviewed to elicit their perceptions about GLV. The percentages of mothers who thought that GLV are good for health were 88.7%, 86.1% and 76.2% in groups 1, 2 and comparison respectively (P = 0.06). However, the percentages of mothers who actually fed their children GLV were 57%, 64% and 26% in groups 1, 2 and comparison group respectively (P < 0.001). The influence of health education on GLV feeding persisted after controlling for the effect of maternal literacy (Mantel Haenszel chi-square = 16.99; P < 0.0001) and family income (Mantel Haenszel chi-square = 17.36; P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Bangladesh↗
PubMed1994

An epidemic of cholera due to Vibrio cholerae O139 in Dhaka, Bangladesh: clinical and epidemiological features.

We describe the disease spectrum and socio-demographic and epidemiological features of an epidemic of cholera due to a new pathogen, Vibrio cholerae O139, in patients attending a very large hospital in the metropolitan city of Dhaka, Bangladesh. This hospital treats 70,000-90,000 patients a year with diarrhoeal diseases. A 4% systematic sample of 1854 patients attending from January to April 1993 were studied. Five hundred and two (27%) of the 1854 patients were culture positive for V. cholerae O139 and 63 (3%) were culture positive for V. cholerae O1 biotype El Tor. Patients with V. cholerae O139 were mainly adults with a short history of watery diarrhoea. Eight-three percent of patients had moderate to severe dehydration. All recovered except one 80-year-old man with compromised renal function who died. Seventy-eight percent of patients required initial intravenous rehydration followed by oral rehydration therapy with rice ORS; they also received tetracycline to reduce diarrhoea severity. Most patients were from urban slums with inadequate sanitation facilities and hygiene practices. The newly recognized V. cholerae O139 infection produced an epidemic of severe dehydrating diarrhoea indistinguishable from clinical cholera in a population which experiences two epidemic peaks of cholera in a year due to V. cholerae O1. Infection with the latter does not appear to confer any cross-protection from V. cholerae O139. The new pathogen suppressed, albeit temporarily, V. cholerae O1. Unlike other non-O1 serogroups of V. cholerae this new serogroup appears to have epidemic potential.

Adolescent↗
PubMed1994

Changes in body composition of malnourished children after dietary supplementation as measured by bioelectrical impedance.

Body composition was measured with bioelectrical impedance in 35 malnourished children aged 24-59 mo to investigate the effect of a 3-wk feeding supplementation. Twenty children received a high-protein diet with 15% of total energy as protein, whereas 15 children received an isoenergetic standard-protein diet with 7.5% of energy as protein. Bioelectrical impedance analysis and anthropometry were done before and after 21 d of dietary supplementation. The children fed the high-protein diet gained significantly more body weight than those receiving the standard-protein diet (1.33 +/- 0.54 vs 0.88 +/- 0.47 kg, P < 0.02). The total body water and fat-free mass determined by bioelectrical impedance analysis showed that the group fed the high-protein diet increased significantly more (0.92 vs 0.58 kg) than those on the standard-protein diet (P < 0.02). Results of this study suggest that feeding a high-protein diet accelerates catch-up growth and restores the reference body composition in children recovering from malnutrition.

Body Composition↗
PubMed1994

Double-blind comparison of oral gentamicin and nalidixic acid in the treatment of acute shigellosis in children.

To compare the efficacy of oral gentamicin with nalidixic acid in the treatment of acute shigellosis, we studied, in a double blind-trial, 79 comparable children with bloody diarrhoea of less than 72 h duration. Of them Shigella spp. were isolated in 71 patients. Patients were randomly assigned to receive either gentamicin 30 mg/kg/day or nalidixic acid 60 mg/kg/day, both given orally in four equal doses for 5 days. Stool frequency differed significantly between the groups from day two until completion of the study. Treatment failure was observed in 14 (42 per cent) patients receiving oral gentamicin compared to none of those with nalidixic acid-sensitive strains of Shigella spp. (P = 0.0002). Although all the shigella isolates were sensitive to gentamicin in vitro, 19 (58 per cent) patients on gentamicin therapy failed to eliminate shigella organisms from stool, compared to none in the nalidixic acid treated group infected with nalidixic acid-sensitive Shigella spp. (P < 0.001). One patient in each group had a bacteriological relapse. We conclude that gentamicin given orally was therapeutically ineffective in the treatment of acute shigellosis.

Acute Disease↗