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Biomedical subjects

E Isolauri

Publications and source records attributed to E Isolauri.

141 records · Page 8Linked to original sources
PubMed1986

Glycine supplemented oral rehydration solutions for diarrhoea.

Two glycine supplemented oral rehydration solutions (ORS) and a standard ORS with sodium 60 mmol/l were compared for treatment of diarrhoeal dehydration in children. The solutions contained glycine 110 mmol/l and glucose 110 mmol/l (ORS60-Gly110), glycine 60 mmol/l and glucose 80 mmol/l (ORS60-Gly60), and glucose 144 mmol/l only (ORS60), respectively. The patients receiving ORS60-Gly110 had poor weight gain and increased stool and urine volumes after rehydration compared with the other two groups. The patients receiving ORS60-Gly60 had similar stool and urine volumes as those receiving standard ORS60. It is concluded that excess glycine in relation to sodium in an ORS may lead to osmotic diarrhoea, and a high amount of absorbed glycine may result in osmotic diuresis with poor net rehydration. Altogether, the present study failed to find any improvement ('Super-ORS') by addition of glycine to an ORS containing 60 mmol/l of sodium.

Child, Preschool↗
PubMed1986

Effect of cholestyramine on acute diarrhoea in children receiving rapid oral rehydration and full feedings.

Cholestyramine 2 g twice daily for 3 days was compared to an equivalent placebo in a randomized double-blind study of infants hospitalized for acute diarrhoea. All the patients received oral rehydration with the WHO solution, and full feedings were reintroduced after 6-10 hours' rehydration. Cholestyramine therapy, initiated at the time of feedings, significantly shortened the duration of watery diarrhoea (0.8 +/- 0.6 vs. 2.3 +/- 1.6 days, p less than 0.005), although it did not significantly reduce the total stool volume. No adverse effects were associated with cholestyramine treatment. It is concluded that diarrhoea patients treated according to the present WHO guidelines may benefit from short adjunct therapy with cholestyramine.

Acute Disease↗
PubMed1985

Clinical efficacy of the RIT 4237 live attenuated bovine rotavirus vaccine in infants vaccinated before a rotavirus epidemic.

In a randomized, double-blind, placebo-controlled trial, 331 infants aged 6 to 12 months received orally, at an interval of 1 month, either two doses of live attenuated bovine rotavirus vaccine strain RIT 4237 or equivalent placebo. The vaccinations were carried out during September to November, a non-rotavirus season; only three cases of rotavirus diarrhea occurred in the study group before the vaccinations were completed. During the epidemic season from December to May, 31 patients with clinically significant rotavirus diarrhea required therapy. Five of these were among the 168 vaccine recipients, and 26 among the 160 placebo recipients (P less than 0.001), giving a vaccine protection rate of 82%. The incidence of clinically significant diarrhea from all causes was reduced by 76% in the vaccinees. As determined by an enzyme immunoassay antibody test with homologous virus antigen, seroconversion after vaccination was obtained in 53% of the initially seronegative infants. Clinical protection correlated well with seroconversion, but the vaccinees who failed to seroconvert also had less rotavirus diarrhea than the placebo recipients, suggesting that immunity may be mediated by factors other than serum EIA antibody. Seventeen of the 23 rotavirus isolates in the epidemic season that were typed were of serotype 1, two were of serotype 2, and four were of serotype 3. The protection rates against clinically significant diarrhea were 72%, 100%, and 100% for serotypes 1, 2, and 3, respectively. We conclude that epidemic infantile winter diarrhea associated with human rotaviruses can be significantly reduced by vaccination with the live attenuated RIT 4237 bovine rotavirus vaccine before the epidemic season.

Clinical Trials as Topic↗
PubMed1985

Oral rehydration, rapid feeding, and cholestyramine for treatment of acute diarrhea.

Different combinations of fluid therapy, feeding regimen, and cholestyramine were compared in search for optimal treatment of infants hospitalized for acute diarrhea. The infants (n = 81) received either rapid oral rehydration using the oral rehydration solution-World Health Organization formula (sodium 90 mmol/L, ORS-WHO) or traditional oral fluid replacement using a commercial glucose-electrolyte solution (sodium 35 mmol/L). One-half of the infants in both groups received full feedings at 24 h of hospitalization; in the remaining infants, feedings were gradually introduced over a period of 5 days. In addition, all the children were randomized to receive either cholestyramine 2 g four times daily or an equivalent amount of placebo. Rehydration with ORS-WHO, but not traditional fluid replacement therapy, led to correction of initial metabolic acidosis after 6-10 h; no cases of hypernatremia were observed with the use of ORS-WHO. Rapid return to full feedings appropriate for age, including milk products, was associated with better weight gain and significantly shorter duration of diarrhea compared with gradual introduction of feedings. Cholestyramine treatment further shortened the duration of diarrhea without adverse effects in those children who had received ORS-WHO and thus were properly rehydrated. In contrast, in children with poor initial hydration, cholestyramine treatment was associated with prolonged metabolic acidosis. We conclude that treatment of acute diarrhea by rehydration with ORS-WHO and rapid introduction of full feedings is effective and safe, and this combination forms a therapy of choice for typical hospitalized cases of acute infantile diarrhea in Finland. Cholestyramine may be of value as an adjunct therapy after adequate rehydration.

Acute Disease↗
PubMed1985

Evaluation of an oral rehydration solution with Na+ 60 mmol/l in infants hospitalized for acute diarrhoea or treated as outpatients.

An oral rehydration solution (ORS) containing 60 mmol/l of Na+ (ORS60) was compared in a randomized trial with the ORS of WHO formula (Na+ 90 mmol/l = ORS90) for the treatment of diarrhoeal dehydration in 66 hospitalized infants aged 3 to 34 months. The infants had a 5 +/- 3% dehydration, and received within 6-10 hours 76 +/- 32 ml/kg of ORS60 or 74 +/- 41 ml/kg of ORS90 corresponding to a sodium input of 4.6 +/- 1.9 mmol/kg and 6.6 +/- 3.7 mmol/kg, respectively. Both treatments were found adequate and equally effective for the correction of dehydration and sodium deficit. The same ORS60 was also compared to a commercial low sodium glucose-electrolyte solution (sodium 35 mmol/l, glucose 3.5 milligrams) for ambulatory treatment of acute diarrhoea in infants. Satisfactory rehydration was achieved within 6 hours in 19 of 23 infants receiving ORS60 as opposed to 6 of 18 infants receiving the commercial solution (p less than 0.001); the poor result with the latter was in most cases attributed to a refusal by the infant to consume the sweetish solution. It is concluded that ORS60 is suitable for the treatment of isotonic diarrhoeal dehydration in hospitalized children as well as outpatients.

Acute Disease↗
PubMed1985

A comparative trial of cholestyramine and loperamide for acute diarrhoea in infants treated as outpatients.

Infants aged 4 to 36 months with acute diarrhoea (rotavirus 66%) were treated as outpatients with oral fluids and a rapid return to full feedings. In addition, the infants were randomized to receive for 3 days either cholestyramine 2 g twice daily (N = 10), an equivalent placebo 2 g twice daily (N = 15), or loperamide 0.10 mg/kg divided in three doses (N = 16). The duration of watery diarrhoea from the beginning of treatment was 0.9 +/- 1.0 days in the cholestyramine group, 2.5 +/- 1.3 days in the loperamide group, and 3.3 +/- 1.6 days in the placebo group (p less than 0.001 cholestyramine vs. placebo, p less than 0.005 cholestyramine vs. loperamide). The infants receiving cholestyramine also had a better weight gain than those receiving the placebo, and their metabolic acidosis was corrected sooner. There was no hyperchloraemia associated with the cholestyramine treatment. It is concluded that cholestyramine 2 g twice daily for 3 days can be safely used to shorten the course of acute diarrhoea. The use of loperamide in acute infantile diarrhoea does not appear justified.

Acute Disease↗
PubMed1984

Protection of infants against rotavirus diarrhoea by RIT 4237 attenuated bovine rotavirus strain vaccine.

A randomised, double-blind, placebo-controlled trial was conducted to evaluate the ability of RIT 4237 live attenuated bovine rotavirus (subgroup 1) vaccine strain to protect against natural rotavirus infection in children. 178 infants aged 8 to 11 months received a single oral dose of RIT 4237 vaccine or placebo and were followed up serologically and clinically during a subgroup 2 rotavirus epidemic. No side-effects attributable to the vaccine were observed. During the 5 months' observation after vaccination 2 of the 86 vaccine recipients and 18 of 92 placebo recipients had rotavirus diarrhoea lasting more than 24 h (p less than 0.001). The vaccine-protection rate was thus 88%. The 2 children in the vaccine group with rotavirus diarrhoea were regarded as primary vaccine failures since they had no detectable serum antibody responses after vaccination. Vaccine prepared from RIT 4237 strain of attenuated bovine rotavirus thus seems to protect children against heterologous subgroup 2 rotavirus diarrhoea.

Animals↗
PubMed1984

Clostridium difficile in young children. Association with antibiotic usage.

Clostridium difficile was isolated from the stools of 11/52 (21%) of children aged 0 to 2 years hospitalized with diarrhoea, and from 17/52 (33%) of a control group of hospitalized children with no diarrhoea; this difference was not significant. Direct demonstration of C. difficile toxin from the stools was positive in 1 case with diarrhoea and in 5 control cases. The children with positive stool culture for C. difficile had had significantly more treatments with antibiotics or chemotherapeutics than those with negative C. difficile culture (3.3 +/- 2.7 vs. 1.6 +/- 1.8, p less than 0.001), but there was no significant difference in the incidence of diarrhoea in the past. During a 4-6-month follow-up, C. difficile disappeared from the stools of 24 out of 28 initially culture-positive children; 3 of the 4 children with persistent C. difficile had received antibiotics during the follow-up period. We conclude that the presence of C. difficile is common in the stools of young children up to the age of 2 years, and that C. difficile is more frequently found in children who have received antimicrobial therapy. Most cases of C. difficile carriage state are symptomless at this age.

Anti-Bacterial Agents↗
PubMed1983

Immunogenicity and safety of live oral attenuated bovine rotavirus vaccine strain RIT 4237 in adults and young children.

A candidate oral live rotavirus vaccine, strain RIT 4237, of bovine origin, was tested for immunogenicity and safety in man. In adults the vaccine did not cause clinical symptoms, and a booster response in rotavirus serum antibodies was seen in 2/20 subjects. In seronegative young children one oral dose induced seroconversion to homologous virus in 15/17 (88%) children seronegative by enzyme immunoassay and in 13/19 (68%) children seronegative by a neutralisation assay. The vaccine did not produce gastrointestinal or constitutional symptoms in the children, nor did it cause rotavirus excretion in the stools. The results suggest that the RIT 4237 strain is a promising candidate for a vaccine against human rotavirus, and the vaccine-induced immunity against natural human rotavirus infection should be evaluated in future trials.

Administration, Oral↗
PubMed1983

Epidemiologic background for the need of rotavirus vaccine in Finland. Preliminary experience of RIT 4237 strain of live attenuated rotavirus vaccine in adults.

Epidemiologic evidence from Finland indicates a dramatic change in the seasonal pattern of acute diarrhoea over the past 30 years. While in the 1950's the majority of cases occurred in late summer the seasonal peak in the 1970's was in winter and spring, coinciding with the prevalence of rotavirus infections. It is not possible to determine retrospectively the aetiologic agents involved in the summer diarrhoea, but EPEC may have been one of them, as EPEC are quite rare in Finland today compared to the 1950's. Another change over the time period is a shift in the age distribution of acute diarrhoea from neonates towards older infants. Rotavirus is today associated with approximately 50% of the cases of acute diarrhoea in children in Finland. Based on experience in one Central Hospital it was estimated that the treatment of rotavirus infections may require some 7300 hospital days in Finland annually, which figure is comparable to that of mumps. As a recent cost-benefit analysis in Finland indicated that a mumps vaccination programme would be economically quite efficacious, the same could be assumed to be true for rotavirus vaccination, provided that an effective and safe vaccine was available. In a preliminary trial of RIT 4237 strain of live attenuated rotavirus vaccine in 20 healthy adult volunteers no clinical symptoms and no excretion of vaccine virus were observed. Rotavirus ELISA antibody booster response was found in 1/20 vaccinees.

Adult↗
PubMedDate not supplied

Clinical and laboratory features of Yersinia, Campylobacter and Salmonella infections in children.

Clinical and laboratory findings of 78 paediatric patients with infections due to enteroinvasive bacteria were analysed. The material included 33 cases of Yersinia enterocolitica, 21 of Campylobacter jejuni, 21 of Salmonella and 2 of Shigella infection, reflecting the current order of frequency ot these enteropathogens in Finnish paediatric population. Diarrhoea was the presenting symptom in 73% of the cases with Yersinia, 90% with Campylobacter and 100% with Salmonella. Conversely, abdominal pain on admission occurred more frequently (p less than 0.01) in patients with Yersinia (68%) than with Campylobacter (38%) or Salmonella (24%). Diarrhoea caused by each of the three enteric bacteria was clinically indistinguishable, with gross blood and mucoid stools occurring in most of the cases. However, faecal leucocytes were more frequently present in diarrhoea due to Y. enterocolitica (87%) and C. jejuni (83%) than Salmonella (36%); p less than 0.025). Diarrhoea due to Y. enterocolitica was typically associated with signs of systemic response, including fever greater than or equal to 39 degrees C, WBC count over 11 X 10(9)/l, and C-reactive protein greater than or equal to 10 mg/l. These criteria may thus be helpful in differentiating Yersinia infections from other cases of exudative diarrhoea in children. The clinical picture of Y. enterocolitica infection probably reflects the more invasive nature of this enteropathogen as compared with C. jejuni or Salmonella.

Adolescent↗
PubMedDate not supplied

Milk versus no milk in rapid refeeding after acute gastroenteritis.

Sixty-five infants (mean age 14.7 months, range 6-34 months), hospitalized for acute gastroenteritis, were treated with oral rehydration and rapid reintroduction of full feedings appropriate for age. Cow's milk and milk products were eliminated from the diet of 27 infants, whereas the remaining 38 children continued to receive their usual milk and milk products as parts of the mixed diet. There was no difference between the groups in the clinical recovery from diarrhea. No child had prolonged diarrhea. No new cases of clinical atopy were observed at 1-month follow-up, and there were no significant increases in the total or milk-specific IgE levels. Serum IgG and IgA antibodies to beta-lactoglobulin and alpha-casein were initially present in the majority of the children, but there were no appreciable changes in these cow's milk antibodies after gastroenteritis, regardless of the type of diet. It is concluded that cow's milk and milk products can be safely given in acute gastroenteritis as parts of the mixed diet for children over 6 months of age. Rapid reintroduction of feedings is beneficial for recovery from diarrhea, and there appears to be little need for dietary restrictions in this age group.

Acute Disease↗