Sufia Islam

Safety of Rapid Intravenous Rehydration and Comparative Efficacy of 3 Oral Rehydration Solutions in the Treatment of Severely Malnourished Children With Dehydrating Cholera

Objectives:Assess the safety of rapid intravenous rehydration of severely malnourished children and compare the efficacy of 3 formulations of oral rehydration salts solutions. Patients and Methods:A group of 175 severely malnourished children of either sex (weight/length <70% of National Center for Health Statistics median), ages 6 to 36 months with cholera, were randomly assigned to receive 1 of 3 oral rehydration solutions (ORSs): glucose-ORS (n = 58), glucose-ORS plus 50 g/L of amylase-resistant starch (n = 59), or rice-ORS (n = 58). Severely dehydrated children at enrollment were administered 100 mL/kg of an intravenous solution for 4 to 6 hours before randomisation, and those with some dehydration were randomised on enrollment. The electrolytes of the 3 ORSs were identical. In acute and convalescence phases, treatment was similar other than the nature of the ORSs. Results:Intravenous fluid (mean) administered to 149 study children was 103 mL/kg (95% confidence interval [CI] 96–109), and all were rehydrated within 6 hours. None of them developed overhydration or heart failure. During the first 24 hours, stool output (31%; 95% CI 14%–42%; P = 0.004) and the ORS intake (26%; 95% CI 12%–37%; P = 0.002) of children receiving rice-ORS were significantly less compared with children receiving glucose-ORS. The mean duration of diarrhoea in all children (66 hours; 95% CI 62–71), and time to attain 80% of median weight/length (7.15 ± 2.81 days) were not different. Conclusions:Dehydration in severely malnourished children can safely be corrected within 6 hours. All study ORSs were equally efficient in correcting dehydration. Rice-ORS significantly reduced the stool output and ORS intake, confirming previous reports.

Increased nitrite and nitrate concentrations in sera and urine of patients with cholera or shigellosis.

OBJECTIVES:Nitric oxide (NO) is an important regulator of cell function. In the intestine, NO regulates blood flow, peristalsis, secretion, and is associated with inflammation and tissue injury. The objectives of this study were to assess and compare the role of NO in cholera, a noninflammatory enteric infection, and in shigellosis, a bacterial inflammation of the colon.METHODS:We determined serum and urinary concentrations of nitrite and nitrate during acute illness and early convalescence in 45 hospitalized children: 24 with cholera and 21 with shigellosis; 18 healthy children served as controls. Nitrite and nitrate concentrations were determined spectrophotometrically using Greiss reaction-dependent enzyme assay.RESULTS:Serum nitrite and nitrate concentrations were significantly (p < 0.05) increased during acute illness compared to the early convalescence in both cholera and shigellosis. Urinary nitrite and nitrate excretions were significantly (p < 0.01) increased during acute disease in shigellosis, but not in cholera. Nitrite concentrations correlated with stool volume (r2= 0.851) in cholera and with leukocytosis (r2= 0.923) in shigellosis.CONCLUSIONS:Both cholera and shigellosis are associated with increased production of NO, suggesting its pathophysiologic roles in these diseases.

Glutamine is superior to glucose in stimulating water and electrolyte absorption across rabbit ileum

L-Glutamine is the primary metabolic fuel of theintestinal mucosa. This in vivo study compares theeffect of L-glutamine 50 mM with that of D-glucose 50 mMon water and electrolyte absorption in jejunal and ileal loops of healthy rabbits. Usingpolyethylene glycol (PEG) as a nonabsorbable marker andan incubation at 37°C, we found that absorption ofwater (P = 0.000), sodium (P = 0.002), potassium (P =0.001), and chloride (P = 0.003) from the glutamineelectrolyte solution was greater than from the glucoseelectrolyte solution in the ileum. A similar trend wasshown in the jejunum. We conclude that L-glutamine may be a useful component to be tested in oralrehydration solutions for treating diarrhealdehydration.

The utility of iron chelators in the management of inflammatory disorders.

Since iron can contribute to detrimental radical generating processes through the Fenton and Haber-Weiss reactions, it seems to be a reasonable approach to modulate iron-related pathways in inflammation. In the human organism a counterregulatory reduction in iron availability is observed during inflammatory diseases. Under pathological conditions with reduced or increased baseline iron levels different consequences regarding protection or susceptibility to inflammation have to be considered. Given the role of iron in development of inflammatory diseases, pharmaceutical agents targeting this pathway promise to improve the clinical outcome. The objective of this review is to highlight the mechanisms of iron regulation and iron chelation, and to demonstrate the potential impact of this strategy in the management of several acute and chronic inflammatory diseases, including cancer.

Factors associated with sclerema in infants with diarrhoeal disease: a matched case-control study.

Aim: To identify clinical and biochemical factors associated with sclerema in infants with diarrhoeal illness, and their outcome.

Predictors of mortality in infants with sclerema presenting to the Centre for Diarrhoeal Disease, Dhaka.

Abstract Background: Sclerema is an uncommon, life-threatening condition, usually of newborns, with a case-fatality rate ranging from 50 to 100%. Very little is known about factors influencing outcome. Aim: To identify clinical and biochemical predictors associated with fatal outcome of sclerema in infants with diarrhoea. Methods: Thirty infants with sclerema admitted to the Special Care Unit of the Dhaka Hospital of ICDDR,B with diarrhoea from May 2005 to end April 2006 were studied prospectively. Nine infants who died (30%) were considered to be cases while the 21 who survived constituted the comparison group. Hypothermia, severe malnutrition, septic shock, serum ammonia and CRP levels were considered to be predictors of death. Differences in proportions were compared by the χ2 test and mean differences were compared using Students t-test or the Mann–Whitney test, as appropriate. Results: The mean age of the 30 infants was 2.1 months (range 12 d to 8 m). Fatal cases were more likely than survivors to be associated with severe underweight, a positive blood culture and higher serum ammonia and serum CRP levels. After adjusting for possible confounders in logistic regression analysis, the likelihood of death was higher in infants admitted with septic shock or who developed it soon after admission (OR 17.96, 95% CI 1.5–0220.4, p=0.024). Conclusions: Sclerema is associated with a high fatality rate and scleremic infants with diarrhoea who present with septic shock are at a greater risk of death.

Water and electrolyte salvage in an animal model of dehydration and Malnutrition

Background and aim Recently, a new oral rehydration solution (ORS) called Resomal has been designed specifically for children with severe malnutrition. The aim of this study was to assess the effect of malnutrition on renal and intestinal responses to dehydration, and to compare intestinal water and electrolyte absorption from Resomal and from the standard World Health Organization-Oral Rehydration Solution (WHO-ORS). Methods Malnutrition was achieved in a rabbit model by feeding the animals daily for 30 days with half the amount of food that a well-nourished group of control animals had consumed on the previous day. Dehydration was achieved by water deprivation for 46 hours in both control and malnourished rabbits. At 46 hours, dehydration was assessed by changes in body weight, urinary volume and osmolarity, and blood urea nitrogen concentration. At that time active colonic and jejunal mucosal electrolyte transport in Ussing chambers was also measured. Small intestinal absorption of water, sodium, and potassium was measured in vivo during intestinal perfusion of the two ORSs and in vitro by measurement of mucosal electrogenic glucose-stimulated sodium absorption across intestinal patches. Results Compared to controls (C), well-nourished but dehydrated (C+D) animals lost 12% of their body weight, with an 87% reduction in urine volume, a 110% increase in urine osmolality, and a 94% increase in blood urea nitrogen. In the colon of C+D animals, short-circuit current (Isc) and net sodium transepithelial flux (JNa+ net) were increased. Almost identical results were obtained in malnourished and dehydrated (M+D) animals. In the jejunum, net in vivo absorption of water (JWater), sodium (JNa+), and potassium (JK+) were increased during standard ORS infusion in both dehydrated groups. During Resomal infusion, water absorption was the same as seen with WHO-ORS, but sodium absorption was reduced, and potassium absorption was increased in both well-nourished and malnourished dehydrated animals. In vitro, compared to controls, the glucose-stimulated short-circuit current (&Dgr;Isc), JNa+ net and G were increased in both dehydrated groups. Conclusion During experimental dehydration, the kidney and large intestine salvage water and electrolytes, thus reducing the consequences of dehydration. These findings indicate that jejunal water absorption from Resomal and WHO-ORS is increased during dehydration, but Resomal allows for less sodium and more potassium to be absorbed, both in well-nourished and malnourished dehydrated rabbits.

Effects of tropisetron, a 5-hydroxytryptamine type 3 receptor blocker, on intestinal secretion induced by cholera toxin or deoxycholic acid in rabbits in vivo.

It has been suggested that 5-hydroxytryptamine is involved in the pathogenesis of various intestinal hypersecretory states including cholera. In this study, the effect of tropisetron (ICS 205-930), a specific 5-hydroxytryptamine type-3 receptor blocker, on jejunal and colonic fluid secretion induced respectively by cholera toxin and deoxycholic acid was investigated in rabbits using isolated loops of intestine in vivo. Marked fluid accumulation in both the jejunal and colonic loops was observed after exposure to cholera toxin and deoxycholic acid respectively. Elevation of jejunal and colonic mucosal cyclic adenosine monophosphate concentrations was also noted. Intraperitoneal administration of tropisetron dose-dependent inhibited jejunal secretion induced by cholera toxin. In contrast, no significant anti-secretory effect of tropisetron was observed against colonic secretion induced by deoxycholic acid. Tropisetron did not affect elevated mucosal cyclic adenosine monophosphate concentrations. The inhibitory effect of tropisetron on intestinal secretion induced by cholera toxin, which was independent of cyclic adenosine monophosphate formation, suggests that 5- hydroxytryptamine plays an important role in this type of secretion.

Multifrequency bioelectrical impedance analysis to assess human body composition

Abstract Multifrequency bioelectrical impedance analysis (MF-BIA) was validated as a method to predict total body water (TBW), extracellular water (ECW), fat free mass (FFM) and fat mass (FM) with other laboratory based methods. Twenty-two healthy adult male volunteers were selected from the staffs of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). Ten mL of deuterium oxide (D 2 O) along with 1 mL/Kg of 3 g% NaBr solution were given orally to each subject. In order to validate the method, deuterium- and bromide-dilution principles were utilized by using isotope-ratio mass spectrophotometer (IRMS), high performance liquid chromatography (HPLC) and spectrophotometer (SP). Data obtained by these methods were compared to assess the accuracy between the methods. The mean±SD BMI was 24.2±1.7 which indicates that the volunteers were not obese or overweight anthropometrically. A significant correlation of TBW was observed between MF-BIA and IRMS techniques ( r 2 = 0.44, p 2 O dilution method whereas SP method gave the most accurate volume of ECW. The findings of the study indicate that MF-BIA method overestimated ECW although TBW by MF-BIA and IRMS correlated well. The co-efficient of variation (CV%) of ECW measured by HPLC was 9% and by SP method was 27%, indicating that ECW measured by HPLC was more accurate. In summary it could be concluded that MF-BIA is a rapid and useful technique to assess the body composition and its usefulness could be increased if ECW measurement by this method is improved further.

Preliminary clinical evaluation of automated analysis of the sublingual microcirculation in the assessment of patients with septic shock: Comparison of automated versus semi-automated software

INTRODUCTION The outcome of patients in septic shock has been shown to be related to changes within the microcirculation. Modern imaging technologies are available to generate high resolution video recordings of the microcirculation in humans. However, evaluation of the microcirculation is not yet implemented in the routine clinical monitoring of critically ill patients. This is mainly due to large amount of time and user interaction required by the current video analysis software. The aim of this study was to validate a newly developed automated method (CCTools®) for microcirculatory analysis of sublingual capillary perfusion in septic patients in comparison to standard semi-automated software (AVA3®). METHODS 204 videos from 47 patients were recorded using incident dark field (IDF) imaging. Total vessel density (TVD), proportion of perfused vessels (PPV), perfused vessel density (PVD), microvascular flow index (MFI) and heterogeneity index (HI) were measured using AVA3® and CCTools®. RESULTS Significant differences between the numeric results obtained by the two different software packages were observed. The values for TVD, PVD and MFI were statistically related though. CONCLUSION The automated software technique successes to show septic shock induced microcirculation alterations in near real time. However, we found wide degrees of agreement between AVA3® and CCTools® values due to several technical factors that should be considered in the future studies.