Diagnosis of Giardia intestinalis infection is usually made by examination of stool specimens and/or by more invasive methods such as microscopy of duodenal juice or small bowel mucosal biopsies. Serological diagnostic methods have been developed but have not been evaluated in children. In this study specific anti-Giardia immunoglobulin (Ig) M, IgG and IgA antibody titres were measured by enzyme-linked immunosorbent assay. Giardia parasites were sought in jejunal mucosal biopsies and in faeces from 72 children in The Gambia, West Africa; 50 jejunal biopsies, 271 stool samples and 95 serum samples were examined for evidence of Giardia infection. As a diagnostic test, a raised specific anti-Giardia IgM antibody titre (greater than or equal to 1:800) had a sensitivity of 63% and specificity of 93%, with a positive predictive value of 85% and a negative predictive value of 81%. There was poor correlation between positive microscopical identification of Giardia and elevated specific anti-Giardia IgG or IgA antibody titres in children on admission to the study. Elevated serum anti-Giardia IgM, however, was correlated well with active Giardia infection and may prove useful in epidemiological studies of giardiasis in developing countries.

Animals↗

PubMedDate not supplied

Endoscopic capsule biopsy of the small intestine.

In this article, we describe a technique for obtaining jejunal biopsies endoscopically using an infant Crosby or Watson capsule. The method is quick, safe, and may be particularly useful if radiological screening is unavailable.

Biopsy↗

PubMedDate not supplied

The effect of enteral glutamine deprivation and supplementation on the structure of rat small-intestine mucosa during a systemic injury response.

BACKGROUND: An aseptic model of tissue injury (the induction of abscesses by subcutaneous injections of turpentine) was used to examine the proposal that changes in glutamine metabolism lead to structural damage in the epithelium of the small intestine during the systemic response to injury and to investigate the role of dietary glutamine in the maintenance of mucosal structure in the small intestine of control and injured rats. METHODS: Glutamine-free and glutamine-rich (3.6% glutamine by weight) diets were fed to rats before and during an acute-phase response to injury. Pair-fed groups of animals enabled an independent assessment to be made of the effects of the associated dietary restriction on the mucosal epithelium. RESULTS: Adaptive increases in villus height and crypt depth were seen in response to 4 days of feeding of the glutamine diet. Pair-feeding (30% dietary restriction) of either diet induced mucosal atrophy (loss of wet weight and nitrogen) without changes in villus height or crypt depth in the proximal tercile of the small intestine. Systemic injury, however, had no effect on the weight or nitrogen content of the mucosa (relative to pair-feeding). Gross histologic appearance, villus height, and crypt depth were also unchanged by the response to injury. CONCLUSIONS: The study provided no evidence to support the proposal that alterations in the availability of dietary glutamine during systemic injury (induced by turpentine injections) lead to structural damage to the epithelium.

Animals↗

PubMedDate not supplied

Reducing error, improving safety. Defensive culture of British medicine needs to change.

Explore the source record for details and available documents.

Defensive Medicine↗

PubMedDate not supplied

Management of artificial nutrition in East Anglia: a community study.

In the Cambridge health district the growth of artificial nutritional support was prospectively assessed over a five-year period (1988-93). The aim of this study was to investigate the variation in the prevalence of enteral tube feeding (ETF) and parenteral nutrition (PN) in hospital and at home and to assess the organisation. There was a fourfold variability in the prevalence of artificial nutritional support in the eight districts. The prevalence of home artificial nutrition doubled between 1988 and 1993, whilst that in hospital increased to a smaller extent (31%). Overall standards of care are not keeping pace with the demand for artificial nutritional support. Only half the districts had nutrition teams, and only one had a specialist nutrition sister. Policies about ETF and PN in hospital and at home were judged to be variable in quality. About one in five patients (or carers) at home experienced problems related to organisation of nutrition support services. General practitioners were also frequently uncertain about their role in managing patients on artificial nutrition at home. Home ETF is a rapidly growing form of home care therapy in East Anglia; in 1992-93 it was quantitatively as important as ETF in hospital. Improvements in organisation are recommended.

Enteral Nutrition↗

PubMedDate not supplied

Risk management in the care of medical emergencies after referral to hospital.

An analysis of 40 medico-legal claims arising from the care of patients admitted as medical emergencies showed an excess of young patients (median age 45 years) but equal numbers of men and women. Twenty-nine patients died; with optimal management, 20 of these patients would have had a good chance of long-term survival. Of the 11 who survived, 3 were left with serious neurological deficits and 3 underwent intestinal resections that could have been avoided. Further analysis revealed probable defects in the organisation of care including: inadequate input from experienced clinicians; insufficient use of specialists; incorrect interpretation of radiographs and laboratory tests; and inadequate assessment of patients before discharge from hospital. It is suggested that there is an urgent need to collect and analyse data regarding adverse events in hospital medical practice in order to develop optimal organisational structures for the care of patients presenting as emergencies.

Adolescent↗