Shaukat R. Khan

Intestinal colonization with enterobacteriaceae in Pakistani and Swedish hospital-delivered infants.

ABSTRACT. Rectal cultures from Swedish and Pakistani hospital‐delivered newborn infants were analysed regarding the early aquisition of enterobacteria. Swedish infants were delivered vaginally, Pakistani infants were delivered either vaginally or by caesarean section. The Swedish infants were all breast‐fed, whereas breastfeeding was incomplete and often started late among the Pakistani infants. Both groups of Pakistani infants were more rapidly colonized with enterobacteria than were the Swedish infants. Cultures from Swedish infants seldom yielded more than one kind of enterobacteria; E. coli and Klebsiefla were most frequently isolated. E. coli dominated in both Pakistani groups, but especially caesarean section delivered infants were in addition often colonized with Proteus, Klebsiella, Enterobacter or Citrobacterspecies. Breastfeeding from the first day of life reduced colonization with Klebsiella/Enterobacter/Citrobucter.The results suggest that environmental exposure, delivery mode and early feeding habits all influence the early intestinal colonization with enterobacteria.

Breast feeding and protection against neonatal sepsis in a high risk population.

Protection against neonatal sepsis by breast feeding was investigated in a developing community. A case-control study was carried out with 42 cases from a hospital and 270 controls, matched for age and socioeconomic conditions from the community. Exclusive breast feeding was extremely rare, most babies being partially breast fed and a few being given formula feed or animal milk. A highly significant odds ratio of 18 was obtained, showing that even partial breast feeding protects against neonatal sepsis in such a population.

Early child health in Lahore, Pakistan: VIII. Microbiology

The causative agents of acute diarrhoea were investigated in children under the age of five years from 1985–1991 in three socio‐economically different areas in Lahore, Pakistan. The aim was to determine the frequencies of the most common enteropathogens in faeces. The total isolation rate was 73.4%; two thirds (53.5%) were of bacterial and one third (19.9%) of viral origin. ETEC‐LT (23.4%), Rota virus (19.9%), EPEC (15%) and Campylobacter (12%) were the single most frequent pathogens in all age groups and areas of living. The positivity of Campylobacter increased from 1.6% to 12% after the change of isolation technique. Shigella was isolated significantly (p>0.001) more in children over than under one year of age. The incidence of bacterial infections was high during all seasons, while in certain years Rota virus was relatively low in the summer compared to the cooler months. The prevalence of ETEC‐LT diarrhoea was higher in the periurban slum as compared to the village and the urban slum. The study is the first of its kind in Pakistan, and the results are similar to other comparable studies. It is thus possible to establish a well functioning and reliable microbiological laboratory in developing countries in a setting with restricted trained personnel and material resources.

Paralytic Ileus, a Serious Complication in Acute Diarrhoeal Disease among Infants in Developing Countries

ABSTRACT. Intestinal hypomotiHty is a common late complication in infants with acute diarrhoeal disease in Pakistan. Among the infants admitted to our gastrointestinal unit with a history of acute diarrhoea, 35% developed abdominal distension and 12% developed the full clinical picture of paralytic ileus. The infants with ileus were treated with decompression and total parenteral nutrition; in this group the mortality rate was 25%. We compared 30 infants who developed ileus (group A) with an age‐matched control group of infants (group B) who were admitted because of acute diarrhoea but did not develop ileus. The use of antimotility drugs was significantly more frequent in group A. Serum‐K was not different in group A (3.92±0.22 mmol/1) and group B (4.32±0.18 mmol/l). However, there were more patients who had serum‐K below 3 mmol/l in group A (8/30) than in group B (5/30). We conclude that the use of antimotility drugs predisposes to the development of ileus in infants with acute diarrhoea. Hypokalemia may contribute to ileus in a few cases but is generally not a prerequisite.

Breast Feeding in Reality

The decline in breast feeding during the last few decades seen first in the developed and then in the developing countries is not as unique in history as often believed. We tend to think that previously mothers always breast-fed, but we are rather repeating history. The authorities in Sweden became aware of the slow population growth during the eighteenth and nineteenth centuries through the Central Bureau of Statistics founded in 1749. It was obvious that this slow growth was due to a very high infant mortality, which was around 200 promill from 1750–1800. In local areas it remained even around 400 promille up to about 1830. According to the registries of the priests in each parish and the continuous reporting to the authorities by the provincial doctors the infant mortality was due mainly to gastroenteritis and was inversely related to the frequency of breast feeding (1,2). In some quite distinct areas in Sweden and Finland artificial feeding was predominant. Here infant mortality was high. The babies were mostly fed undiluted cow’s milk through a cow horn which could not be cleaned and was stinking so that the doctor knew already when he entered a home that there was an artificially fed baby.

The Ontogeny of the Immune Response: The Role of Maternal Factors

The newborn infant must be capable of coping with the many microorganisms to which it is exposed after birth. Most of the contact between the neonate and the microorganisms occurs on mucous membranes, which represent extensive surfaces of thin lining protecting the integrity of the host. For the understanding of the host-parasite relationship in the young infant and the ontogeny of immunity, we need to determine what factors microorganisms might use to colonize and possibly invade the mucosal membranes.

Hypocalcemia and hyperphosphatemia in severely dehydrated children with and without convulsions.

ABSTRACT. Tetanic convulsions are not uncommon among severely dehydrated children in the developing countries. This raises the question whether these children have disturbances in the homeostasis of divalent ions. Serum values are reported of calcium, magnesium, phosphorus, sodium and potassium, as well as blood pH in children below 3 years of age with acute watery diarrhoea and with an estimated weight loss of about 10%. The study was performed on dehydrated children with (DC) or without (D) convulsions. Values were obtained on admission and following rehydration therapy (RT). On admission serum calcium was low in both D and DC children. Serum phosphorus was likewise elevated in both D and DC children. Serum magnesium was slightly elevated in the DC but not in the D group. No patient had Hypernatremia. During RT, serum calcium increased significantly and serum phosphorus decreased significantly in D and DC children. Serum calcium showed a significant inverse correlation with serum phosphorus and a significant direct correlation with blood pH. Treatment of DC children with i.v. calcium and i.m. magnesium had no immediate effect on the convulsions. Our conclusion is that severely dehydrated children will develop hypocalcemia. The cause may be a redistribution of calcium into the cells, parallelled by a redistribution of phosphorus from the intra‐ to the extracellular space.

Effects of Cholera and Poliovirus Immunizations Upon Specific Antibodies in Human Milk

Human milk is rich in antibodies, primarily of the secretory IgA (SIgA) isotypes, which due to their stable structure, are specially adapted to protect mucous membranes. A number of studies,1 have shown that SIgA antibody responses in milk originate from antigenic exposure in the gut. Lymphoid cells, primarily in the Peyer’s patches, leave the intestine after antigen-presenting cells have brought them into contact with the antigen from the lumen of the intestine, and home to various sites of local SIgA production, including the mammary glands. This homing of cells from the gut to the mammary glands is called the enteromammaric pathway. Via a similar broncho-mammaric pathway, inhaled antigens also can cause transfer of committed lymphocytes to the mammary glands.2