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Biomedical subjects

G J Fuchs

Publications and source records attributed to G J Fuchs.

At least 55 records · Page 3Linked to original sources
PubMed1999

Aeromonas-associated diarrhoea in Bangladeshi children: clinical and epidemiological characteristics.

We studied the clinical and epidemiological features associated with Aeromonas diarrhoea by a hospital survey of 7,398 children under 5 years of age presenting with diarrhoea. The data were actually based upon two cohorts from this survey, the majority of the data being identified from 405 (5.5%) in whom Aeromonas was the sole enteric pathogen. Aeromonas caviae was the most prevalent species, accounting for 32% (129/405) of all isolates. Eighty-three per cent of children with Aeromonas-associated diarrhoea were younger than 3 years. The majority of the children had acute onset of vomiting and watery diarrhoea resulting in mild to moderate dehydration. Fever, non-watery diarrhoea, age less than 3 years, and diarrhoea of 7-14 days duration were found to be significantly associated with Aeromonas diarrhoea compared with Vibrio cholerae O1 infection after adjusting for confounders. Aeromonas-associated diarrhoea was most common from March to May (during the peak of the hot and humid season), and September to October, similar to Vibrio cholerae O1. Our results indicate that Aeromonas infection is common in young children presenting with diarrhoea in Bangladesh.

Aeromonas↗
PubMed1999

Double-blind, randomized, controlled trial of zinc or vitamin A supplementation in young children with acute diarrhoea.

In a double-blind, controlled trial with a factorial design, 684 patients (aged 6 months to 2 y; excludes 6 early dropouts) with acute watery diarrhoea of 3 d or less and some dehydration, who were attending a hospital, were randomly assigned to 4 groups to receive: (a) vitamin A 4500 microg retinol equivalent daily for 15 d; (b) 14.2 mg elemental zinc as acetate for the first 417 patients and 40 mg of the remaining 273 patients randomized to this group for 15 d; (c) both vitamin A 4500 microg retinol equivalent and zinc at the above doses daily for 15 d; or (d) placebo mixtures for 15 d. Patients were observed in the hospital for 24 h and followed up at home for 15 d. All received ascorbic acid 30 mg with each dose of medicine or placebo. Zinc supplementation was associated with a reduced duration of diarrhoea (13%, p = 0.03) and markedly reduced rate (43%, p = 0.017) of prolonged diarrhoea (>7 d). Vitamin A supplementation was associated with a nonsignificant trend for reduced rate of prolonged diarrhoea (p = 0.089). In conclusion, zinc supplementation as adjunct therapy had a substantial impact on the rate of prolonged diarrhoea and some impact on duration and may be beneficial in children with diarrhoea in developing countries.

Acute Disease↗
PubMed1999

Simultaneous vitamin A administration at routine immunization contact enhances antibody response to diphtheria vaccine in infants younger than six months.

A randomized, double-blind, placebo-controlled trial was conducted to evaluate the effect of simultaneous vitamin A supplementation and diphtheria, pertussis and tetanus (DPT) vaccination on the antibody levels. Infants aged 6-17 wk (n = 56) were randomly given 15 mg oral vitamin A or placebo at the time of their DPT immunization. Three such doses were given at monthly intervals. Immunoglobulin (Ig) G antibodies to diphtheria, pertussis and tetanus were assayed on enrollment and 1 mo after the third dose. Baseline antibody concentrations to diphtheria, pertussis and tetanus did not differ between the vitamin A-supplemented and placebo-treated groups. The postdose antibody to diphtheria level was significantly greater in the vitamin A than in the placebo-treated group. The geometric mean +/- SEM antibody levels (mg/L) were 22.9 +/- 1.2 and 11.0 +/- 1.3 in the vitamin A and placebo groups, respectively (P = 0.029). The postsupplementation concentrations of antibodies to pertussis and tetanus did not differ between the two groups. These results suggest that antibody response to diphtheria vaccination was potentiated by simultaneous vitamin A administration and DPT immunization.

Antibodies, Bacterial↗
PubMed1999

Long-term supplementation with iron does not enhance growth in malnourished Bangladeshi children.

To evaluate the effect of long-term oral iron supplementation on growth, 250 children aged 6-71 mo were studied in a randomized double-blind controlled trial. The intervention group received 125 mg of ferrous gluconate (15 mg elemental iron) plus multivitamins (vitamins A, D and C); the comparison group received only multivitamins daily for 12 mo. Weight (kg) and height (cm) were measured every month. Eighty three percent of the children continued the treatment for one year. The weight increment over the 12-mo period was 1.35 +/- 0.65 kg (mean +/- SD) in the intervention group and 1.39 +/- 0.54 kg in the comparison group. The height increments were 6.01 +/- 1.47 and 6.18 +/- 1.58 cm in the intervention and comparison groups, respectively. Mean weight and height increments did not differ; in an analysis stratified according to different age and nutritional categories, they also did not differ between the two groups, indicating that long-term iron supplementation does not increase growth in children.

Analysis of Variance↗
PubMed1998

Applications of electrical energy to the prostate: an evolutionary perspective.

PURPOSE: We review modern electrosurgical treatments for removing benign prostatic tissue based on an historical perspective of medical applications of electrical energy. MATERIALS AND METHODS: We reviewed historical reports and landmark observations concerning the evolution of medical applications of electrical energy in the literature, with a special focus on the development of principles pertinent to the transurethral electrosurgical removal of prostate tissue. RESULTS: Modern transurethral electrosurgery of the prostate in a fluid medium has been well founded on key electrosurgical principles. Traditionally, the best clinical results and the least complications have been obtained through an understanding of the important precepts of this form of energy. These precepts have included distinctions between the reliability of effect and safety with direct and alternating current, and how different tissue effects can be achieved, either with selective current modes (cutting and coagulating waveforms) or by varying the size and configuration of the active electrode and its application time. CONCLUSIONS: This review chronicles the prominent role of electrosurgery in our efforts to debulk an enlarged prostate in patients with symptomatic voiding dysfunction. History reminds us that many of today's "new ideas" are merely updated variations on a theme, have often been tried before in a fashion by our predecessors and have for one reason or another fallen by the wayside. The conundrum of the perfect combination of electrosurgical variables that can fulfill our goal of making this an efficient and complication-free treatment continues to stimulate and challenge us as we move towards the next millennium.

Electrosurgery↗
PubMed1998

New techniques for the administration of topical adjuvant therapy after endoscopic ablation of upper urinary tract transitional cell carcinoma.

PURPOSE: We evaluated the role of combining ureteroscopic tumor ablation and new methods of administering topical adjuvant therapy in select patients with transitional cell carcinoma of the upper urinary tract. MATERIALS AND METHODS: Patients with upper tract transitional cell carcinoma and indications for preserving renal function initially underwent ureteroscopic evaluation and tumor ablation. We treated 17 renal units in 13 patients. Three patients with distal ureteral lesions underwent uncomplicated adjuvant bacillus Calmette-Guerin therapy by the combination of Double-J stent placement and bladder instillations in the Trendelenburg position. In the remaining 14 renal units adjuvant topical therapy was administered by low pressure weekly instillations through a transvesical single-J stent whose curl was positioned in an upper calix. Patients were regularly followed with office flexible ureterorenoscopy under local anesthesia and cytology washings once they were confirmed to be tumor-free. RESULTS: Complete ureteroscopic tumor ablation was possible in all patients. Two sessions were needed due to tumor burden in 3 patients. There were intercurrent urinary infectious complications with Candida albicans in the 3 patients treated with bacillus Calmette-Guerin through the single-J stent, including 1 who received only 3 instillations due to persistent unexplained fevers but who remains disease-free at 24 months. In 2 of the 17 renal units multifocal tumor recurred within 12 months, which was treated with nephroureterectomy. At short followup (mean 14.6 months) 15 renal units have been preserved and remain tumor-free. CONCLUSIONS: The new techniques of administering adjuvant topical agents for upper tract transitional cell carcinoma after ureteroscopic tumor ablation in select cases described provide a useful and simple alternative to the percutaneous method preferred in the past. Short-term responses have been favorable but the true value of adjuvant therapy remains uncertain at present. The 2 recurrences within 12 months of treatment were readily detected by outpatient ureterorenoscopy with the patient under local anesthesia using 7.5F flexible endoscopes.

Adjuvants, Immunologic↗
PubMed1998

Retroperitoneal and pelvic extraperitoneal laparoscopy: an international perspective.

OBJECTIVES: To assess technical preferences and current practice trends of retroperitoneal and pelvic extraperitoneal laparoscopy. METHODS: A questionnaire survey of 36 selected urologic laparoscopic centers worldwide was performed. RESULTS: Twenty-four centers (67%) responded. Overall, 3988 laparoscopic procedures were reported: transperitoneal approach (n = 2945) and retroperitoneal/extraperitoneal approach (n = 1043). Retroperitoneoscopic/extraperitoneoscopic procedures included adrenalectomy (n = 74), nephrectomy (n = 299), ureteral procedures (n = 166), pelvic lymph node dissection (n = 197), bladder neck suspension (n = 210), varix ligation (n = 91), and lumbar sympathectomy (n = 6). Mean number of total laparoscopic procedures performed in 1995 per center was 41 (range 5 to 86). Major complications occurred in 49 (4.7%) patients and included visceral complications in 26 (2.5%) patients and vascular complications in 23 (2.2%). Open conversion was performed in 69 (6.6%) patients, electively in 41 and emergently in 28 (visceral injuries, n = 16; vascular injuries, n = 1 2). Retroperitoneoscopy/extraperitoneoscopy is gaining in acceptance worldwide: in 1993, the mean estimated ratio of transperitoneal laparoscopic cases versus retroperitoneoscopic/ extraperitoneoscopic cases per center was 74:26; however, in 1996 the ratio was 49:51. CONCLUSIONS: Retroperitoneoscopy and pelvic extraperitoneoscopy are important adjuncts to the laparoscopic armamentarium in urologic surgery. The overall major complication rate associated with retroperitoneoscopy/extraperitoneoscopy was 4.7%.

Humans↗
PubMed1998

Acinetobacter bacteremia in patients with diarrhoeal disease.

In 1994, 171 (27%) of all positive blood cultures in our hospital were due to Acinetobacter species. Of these, 138 cultures were considered significant, 91 (66%) were community-acquired and 47 (34%) were nosocomial. Most acinetobacter bacteraemia in children < or = 1 year old was community-acquired, while nosocomial infection was more common in children > 1 year old (P = 0.01). Most children < or = 5 years old were severely malnourished. The incidence of bacteraemia was lowest during the post-monsoon to early winter months. Acinetobacter bacteraemia associated mortality was twice (16%) that of all other patients (7.7%, P < 0.0005) and accounted for 4.5% of all hospital deaths during the study period. Bacteraemia caused by Acinetobacter species is an important cause of morbidity and mortality among our patient population with diarrhoeal disease.

Acinetobacter Infections↗
PubMed1998

Intra- and extracellular water dynamics on rehydration in cholera and noncholera patients.

To estimate the intra- and extracellular body water compartments during rehydration of patients with cholera and noncholera diarrhea by bioimpedance analyzer, we studied 30 patients with acute watery diarrhea. Total body water (TBW), intracellular water (ICW), and extracellular water (ECW) of severely dehydrated adult patients were measured with a dual frequency bioimpedance analyzer at different phases of rehydration. Fluid compartments between cholera and noncholera patients were compared. Cholera patients gained more TBW than noncholera patients during recovery. Unlike patients with noncholera diarrhea, the gain in cholera patients was mainly contributed by the ICW (1.5 +/- 1.6 vs 3.0 +/- 1.2 liters, respectively, P < 0.01). It was also observed that the recovery of the ICW compartment in cholera patients occurred rapidly within the first 2 hr after infusion. Differential dynamics of body water compartments in cholera compared to noncholera patients as observed in this study may contribute further to understanding the mechanism of dehydration in diarrheal disease, which might help in improving case management.

Adult↗
PubMed1998

Treatment of Helicobacter pylori infection in infants in rural Bangladesh with oral immunoglobulins from hyperimmune bovine colostrum.

BACKGROUND: Antibodies from hyperimmune bovine colostrum have been shown to be effective in treatment against a variety of microorganisms, including Helicobacter pylori in adults. AIM: To test this form of treatment in a small group of H. pylori infected children in a periurban community in Bangladesh. METHODS: Twenty-four infants, 4-29 months old (mean age 16.5+/-7.7 months) and infected with H. pylori, were treated with purified immunoglobulins from hyperimmune bovine colostrum for 1 month, in a placebo-controlled, double-blind pilot study. Diagnosis was established with 13C-urea breath test (UBT) before and after the treatment period and at a 1-month follow-up. RESULTS: None of the hyperimmune bovine colostrum-treated children became UBT negative. Five children initially positive in the UBT screening spontaneously became negative by the start of the study with hyperimmune bovine colostrum/placebo. At the end of the 1-month study period, three had became positive again. CONCLUSION: Hyperimmune bovine colostrum does not eradicate H. pylori infection in infants. Transient H. pylori infection is common among infants in high endemic areas, as is reinfection after clearance. This presents obstacles to evaluation of therapeutic investigations in young children in areas where H. pylori is prevalent.

Animals↗
PubMed1998

Humoral immune and clinical responses to food antigens following acute diarrhoea in children.

OBJECTIVE: To investigate the effect of acute watery diarrhoea in children upon humoral immune responses to food antigens and the subsequent development of food allergy. METHODOLOGY: Serum antibodies to cows' milk, beta-lactoglobulin, alpha-lactalbumin, bovine serum albumin and ovalbumin were measured in 30 children with acute diarrhoea in the acute phase and 1 month after recovery. The children were followed for 1 year to assess the development of food allergy. RESULTS: IgG antibeta-lactoglobulin titres for the study group increased 1 month after recovery compared to the titres during the acute phase (P = 0.02). Antibody concentration for the other antigens studied did not rise. Four children developed positive IgE antibodies to one or more of the allergens after the diarrhoeal episode, although the titres were very low. None showed evidence of allergy to cows' milk or egg during the year-long follow-up. CONCLUSIONS: Acute diarrhoea in children resulted in increased production of IgG antibody to beta-lactoglobulin and had a priming effect for development of positive IgE antibody to cows' milk. Clinical food allergy was not observed in any of the children during the year-long follow-up.

Animals↗
PubMed1998

Aetiological, clinical and epidemiological characteristics of a seasonal peak of diarrhoea in Dhaka, Bangladesh.

During the spring peak of diarrhoea in Bangladesh, 113 consecutive patients who represented a systematic 4% sample of all patients attending an urban diarrhoea treatment facility between 18 and 23 April 1995 were studied. The study was conducted to characterize enteric pathogens associated with the spring peak of the diarrhoea outbreak in Bangladesh and to describe clinical and epidemiological features of the patients. The spring peak is traditionally thought to be mostly due to V. cholerae O1. However, the most common cause of diarrhoea among the study patients was enterotoxigenic Escherichia coli (36%) followed by Vibrio cholerae O1 (23%). The V. cholerae O1 patients attended significantly (p < 0.01) sooner after onset of diarrhoea than enterotoxigenic E. coli (ETEC) patients. Studies of behavioural and environmental characteristics are important to determine risk factors for observed higher proportion of ETEC infection during seasonal diarrhoea peaks.

Bangladesh↗
PubMed1998

Shigellosis in children: a clinico-epidemiological comparison between Shigella dysenteriae type I and Shigella flexneri.

We reviewed the clinical and epidemiological features of 390 children under 5 years of age infected with either Shigella dysenteriae type I or Shigella flexneri attending a diarrhoea treatment centre from 1993 to 1995 in Dhaka, Bangladesh. Older age (24 months or more), underweight and wasting but not stunting were the host factors significantly more associated with Shigella dysenteriae type I infection than in Shigella flexneri-infected children. Moreover, use of antibiotics at home, use of water from tubewells or pipe-water for drinking and lack of sanitary facilities for defaecation were the behavioural and environmental factors strongly associated with S. dysenteriae type I infection. Children with diarrhoea due to S. flexneri presented with more watery/liquid stools and had a shorter duration of illness. Duration of diarrhoea for 4 or more days was typical of S. dysenteriae type I infection. Interventions to address malnutrition and to promote environmental hygiene would be predicted to offer greater protection against shigellosis due to S. dysenteriae than S. flexneri.

Bangladesh↗
PubMed1998

Nutritional status and diarrhoeal pathogen in hospitalized children in Bangladesh.

We studied the relationship between nutritional status and infection due to specific enteropathogens in young children with diarrhoea. Overall, 26% of the children were severely underweight, 27% were severely wasted and 19% were severely stunted. Children with Shigellae and V. cholerae O1 were significantly more severely underweight, wasted and stunted than those with rotavirus diarrhoea (p < 0.0001). Our results indicate that an effective nutrition programme for young children might have greater impact on diarrhoeal illness caused by Shigella and V. cholerae than by rotavirus diarrhoea.

Age Distribution↗
PubMed1998

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.

Acute Disease↗
PubMed1998

Air travel and thromboembolic complications after percutaneous nephrolithotomy for staghorn stone.

Thromboembolic complications after percutaneous surgery for staghorn stone are rare. We report a case of silent deep vein thrombosis (DVT) after long-distance air travel that was complicated by both recurrent pulmonary emboli and paradoxical arterial embolus despite full-dose systemic heparin anticoagulation. Management options for thromboembolic complications in the context of percutaneous renal surgery are discussed, and risk factors predisposing to silent deep vein thrombosis after long-distance air travel are outlined.

Aircraft↗
PubMed1998

Possibilities for zinc in the treatment of acute diarrhea.

Zinc therapy shows promise in the treatment of acute diarrhea. Several questions must be answered before it can be incorporated into diarrheal disease control programs, namely, whether it should be targeted at the groups of children in whom it has been shown to work and what the optimal dosing regimen should be, the amount of therapeutic zinc, optimal duration of therapy, and the interaction of zinc and copper absorption. The evidence supporting inclusion of zinc in treatment programs is strong and may become more so when these questions are answered.

Acute Disease↗