[Nasogastric rehydration for treating children with gastroenteritis].

PubMed

Rébeillé-Borgella, B; Barbier, C; Moussaoui, R; Faisant, A; Michard-Lenoir, A-P; Rubio, A

2017-06-01

When oral rehydration is not feasible, enteral rehydration via the nasogastric route has been the ESPGHAN recommended method of rehydration since 2008, rather than intravenous rehydration (IVR), for children with acute gastroenteritis. However, these recommendations are rarely followed in France. Since 2011, in case of failure of oral rehydration, enteral rehydration has been used as a first-line therapy in the Children's Emergency Department at the Grenoble-Alpes University Hospital. The aims of the study were to compare the length of the hospital stay, the duration of initial rehydration, and the incidence of complications and failure with the use of enteral nasogastric versus intravenous rehydration. This study compared two cohorts of children (<3 years of age) with mild-to-moderate dehydration caused by acute gastroenteritis and failure of rehydration via the oral route. The first group (winter 2010-2011) was managed according to the previous protocol (intravenous rehydration). The second group (winter 2011-2012) was managed according the new protocol (nasogastric tube rehydration [NGR]). The rest of the gastroenteritis management was identical in both groups. A total of 132 children were included, 65 were treated with nasogastric tube rehydration (NGR) and 67 with intravenous rehydration. There was a significant reduction in the duration of hospitalization in the post-emergency unit in the NGR group: 23.6h vs 40.1h (P<0.05). The duration of initial rehydration was also significantly reduced (10.5h vs 22.0h). There was no significant difference regarding serious adverse events. However, the NGR group presented more mild adverse events (22 vs 7, P<0.05) and more treatment failures (15.3% vs 3%, P=0.013). Nasogastric rehydration reduces the duration of rehydration and the length of the hospital stay without increasing the incidence of serious adverse events for dehydrated children hospitalized for acute gastroenteritis. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Oral Ondansetron in Management of Dehydrating Diarrhea with Vomiting in Children Aged 3 Months to 5 Years: A Randomized Controlled Trial.

PubMed

Danewa, Arun Singh; Shah, Dheeraj; Batra, Prerna; Bhattacharya, Swapan Kumar; Gupta, Piyush

2016-02-01

To evaluate the role of oral ondansetron in facilitating successful rehydration of under-5-year-old children suffering from acute diarrhea with vomiting and some dehydration. Children (n = 170) aged 3 months to 5 years with acute diarrhea with vomiting and some dehydration were enrolled in this double blind, randomized, placebo-controlled trial. The participants were randomized to receive either single dose of oral ondansetron (n = 85) or placebo (n = 85) in addition to standard management of dehydration according to World Health Organization guidelines. Failure of oral rehydration therapy (ORT), administration of unscheduled intravenous fluids, and amount of oral rehydration solution intake in 4 hours were the primary outcomes. Secondary outcome measures included duration of dehydration correction, number of vomiting episodes, adverse effects, and caregiver satisfaction. Failure of ORT was significantly less in children receiving ondansetron compared with those receiving placebo (31% vs 62%; P < .001; relative risk 0.50, 95% CI 0.35-0.72). Almost one-half of the children in the ondansetron group received intravenous fluids compared with those in the placebo group, but it was not statistically significant (P = .074; relative risk 0.56, 95% CI 0.30-1.07). The oral rehydration solution consumption was significantly more in the ondansetron group (645 mL vs 554 mL; mean difference 91 mL; 95% CI: 35-148 mL). Patients in the ondansetron group also showed faster rehydration, lesser number of vomiting episodes, and better caregiver satisfaction. A single oral dose of ondansetron, given before starting ORT to children <5 years of age with acute diarrhea and vomiting results in better oral rehydration. Clinical Trial Registry of India: CTRI-2011/07/001916. Copyright © 2016 Elsevier Inc. All rights reserved.

Intravenous rehydration for gastroenteritis: how long does it really take?

PubMed

Bender, Brenda J; Ozuah, Philip O

2004-04-01

For treatment of mild to moderate dehydration arising from viral gastroenteritis, the American Academy of Pediatrics recommends oral rehydration therapy over a 4-hour period. However, oral rehydration therapy remains largely underused by emergency physicians. Studies suggest that a major barrier is a perception that the time requirement for oral rehydration therapy is too long relative to intravenous (IV) hydration. : To test the hypothesis that children who receive IV hydration for gastroenteritis spend significantly less than 4 hours in the emergency department (ED). A prospective case series involving a consecutive sample of 549 children treated with IV hydration for mild to moderate dehydration at an urban pediatric ED. Treatment time was defined as period elapsed between when a physician placed a patient in an ED room and when he/she discharged the patient. We excluded time spent in the waiting room before seeing a physician. Using a standardized procedure, we collected data in September/October 2000 (fall), November 2000 to January 2001 (winter), and April/May 2001 (spring). To provide a measure of average pass-through time at this ED, we also collected data on all patients treated during consecutive 7-day periods in the fall (n = 502), winter (n = 776), and spring (n = 653). We performed univariate analysis of continuous variables using t tests for independent samples. 549 subjects received IV treatment for dehydration; of whom 55% were female, and mean age was 9.7 years. Treatment time for patients undergoing IV hydration exceeded 4 hours (mean = 5.4 +/- 2.4 hours; median = 5.0 hours). Mean time for IV treatment of dehydration was significantly longer than the mean time for treating other patients (5.4 vs. 1.2 hours, P < 0.001). Mean IV treatment times were: fall (5.1 hours), winter (5.5 hours), and spring (4.7 hours). Mean treatment time exceeded 4 hours regardless of time of day, day of the week, or age of child. Contrary to our hypothesis, mean treatment time for IV therapy for mild to moderate dehydration exceeded the 4-hour period recommended by the American Academy of Pediatrics for oral rehydration. The data did not support the perception by emergency physicians that children treated with IV hydration spend significantly less time than 4 hours in the ED. These findings have implications for addressing one of the major barriers to the use of oral rehydration therapy in the ED setting.

Treatment of mild to moderate dehydration in children with oral rehydration therapy.

PubMed

Diggins, Kristene C

2008-08-01

To review current literature on the effectiveness of oral rehydration therapy (ORT) in the treatment of mild to moderate dehydration in children. Recommendations from American Academy of Pediatrics (AAP), World Health Organization (WHO), selected research articles (2000-2006), and Internet sources. Dehydration is a common diagnosis in pediatric primary care. The literature indicates that dehydration is more often treated with intravenous (IV) therapy when ORT would be equally effective. ORT is an effective treatment for children with mild to moderate dehydration. ORT could be used more frequently rather than IV rehydration therapy. The use of ORT versus traditional methods of IV hydration matches the nursing philosophy of holistic care by enhancing client comfort and autonomy. Current practice in the treatment of mild to moderate dehydration in children does not match both AAP and WHO guidelines, which are based on evidence supporting ORT effectiveness. Treatment with ORT allows children more flexibility to be treated at home and thus decreases hospital stay. Evidence shows that the time required to initiate ORT is actually quicker than IV therapy and allows for a less stressful therapy that can be performed in the home.

Oral rehydration therapy for preoperative fluid and electrolyte management.

PubMed

Taniguchi, Hideki; Sasaki, Toshio; Fujita, Hisae

2011-01-01

Preoperative fluid and electrolyte management is usually performed by intravenous therapy. We investigated the safety and effectiveness of oral rehydration therapy (ORT) for preoperative fluid and electrolyte management of surgical patients. The study consisted of two studies, designed as a prospective observational study. In a pilot study, 20 surgical patients consumed 1000 mL of an oral rehydration solution (ORS) until 2 h before induction of general anesthesia. Parameters such as serum electrolyte concentrations, fractional excretion of sodium (FENa) as an index of renal blood flow, volume of esophageal-pharyngeal fluid and gastric fluid (EPGF), and patient satisfaction with ORT were assessed. In a follow-up study to assess the safety of ORT, 1078 surgical patients, who consumed ORS until 2 h before induction of general anesthesia, were assessed. In the pilot study, water, electrolytes, and carbohydrate were effectively and safely supplied by ORT. The FENa value was increased at 2 h following ORT. The volume of EPGF collected following the induction of anesthesia was 5.3±5.6 mL. In the follow-up study, a small amount of vomiting occurred in one patient, and no aspiration occurred in the patients. These results suggest that ORT is a safe and effective therapy for the preoperative fluid and electrolyte management of selected surgical patients.

Oral Rehydration Therapy for Preoperative Fluid and Electrolyte Management

PubMed Central

Taniguchi, Hideki; Sasaki, Toshio; Fujita, Hisae

2011-01-01

Aim: Preoperative fluid and electrolyte management is usually performed by intravenous therapy. We investigated the safety and effectiveness of oral rehydration therapy (ORT) for preoperative fluid and electrolyte management of surgical patients. Methods: The study consisted of two studies, designed as a prospective observational study. In a pilot study, 20 surgical patients consumed 1000 mL of an oral rehydration solution (ORS) until 2 h before induction of general anesthesia. Parameters such as serum electrolyte concentrations, fractional excretion of sodium (FENa) as an index of renal blood flow, volume of esophageal-pharyngeal fluid and gastric fluid (EPGF), and patient satisfaction with ORT were assessed. In a follow-up study to assess the safety of ORT, 1078 surgical patients, who consumed ORS until 2 h before induction of general anesthesia, were assessed. Results: In the pilot study, water, electrolytes, and carbohydrate were effectively and safely supplied by ORT. The FENa value was increased at 2 h following ORT. The volume of EPGF collected following the induction of anesthesia was 5.3±5.6 mL. In the follow-up study, a small amount of vomiting occurred in one patient, and no aspiration occurred in the patients. Conclusion: These results suggest that ORT is a safe and effective therapy for the preoperative fluid and electrolyte management of selected surgical patients. PMID:21897763

An operational study on implementation of oral rehydration therapy in a rural community of West Bengal, India.

PubMed

Sircar, B K; Deb, B C; Sengupta, P G; Mondal, S; Gupta, D N; Sarkar, S; Sikder, S N; Ghosh, S; Saha, N C; Pal, S C

1991-09-01

An operational study of a 3-tier strategy for implementation of oral rehydration therapy (ORT) was conducted in a block of West Bengal with 216,825 population through the existing health services facilities. All the grassroot level, health workers including their supervisors at various levels were trained regarding the management of patients of diarrhoea with mild to moderate degree of dehydration, by ORT. Another block in the same district with similar demographic features where this intervention was not provided served as control. After 22 months of observation, it was evident that despite adequate training, the performance of Community Health Guides (CHGs) and Anganwadi Workers (AWWs) was not encouraging because of the low utilization of both home available fluids (32.0%) and oral rehydration solution (18.0%) in the study area. Similarly, diarrhoea associated mortality could not be reduced significantly. Lack of motivation and failure to maintain sustained level of skill by the CHGs and AWWs constitute the major bottlenecks for the successful implementation of the programme at the community level.

The management of children with gastroenteritis and dehydration in the emergency department.

PubMed

Colletti, James E; Brown, Kathleen M; Sharieff, Ghazala Q; Barata, Isabel A; Ishimine, Paul

2010-06-01

Acute gastroenteritis is characterized by diarrhea, which may be accompanied by nausea, vomiting, fever, and abdominal pain. To review the evidence on the assessment of dehydration, methods of rehydration, and the utility of antiemetics in the child presenting with acute gastroenteritis. The evidence suggests that the three most useful predictors of 5% or more dehydration are abnormal capillary refill, abnormal skin turgor, and abnormal respiratory pattern. Studies are conflicting on whether blood urea nitrogen (BUN) or BUN/creatinine ratio correlates with dehydration, but several studies found that low serum bicarbonate combined with certain clinical parameters predicts dehydration. In most studies, oral or nasogastric rehydration with an oral rehydration solution was equally efficacious as intravenous (i.v.) rehydration. Many experts discourage the routine use of antiemetics in young children. However, children receiving ondensetron are less likely to vomit, have greater oral intake, and are less likely to be treated by intravenous rehydration. Mean length of Emergency Department (ED) stay is also less, and very few serious side effects have been reported. In the ED, dehydration is evaluated by synthesizing the historical and physical examination, and obtaining laboratory data points in select patients. No single laboratory value has been found to be accurate in predicting the degree of dehydration and this is not routinely recommended. The evidence suggests that the majority of children with mild to moderate dehydration can be treated successfully with oral rehydration therapy. Ondansetron (orally or intravenously) may be effective in decreasing the rate of vomiting, improving the success rate of oral hydration, preventing the need for i.v. hydration, and preventing the need for hospital admission in those receiving i.v. hydration. Copyright 2010. Published by Elsevier Inc.

Oral rehydration of malnourished children with diarrhoea and dehydration: A systematic review.

PubMed

Houston, Kirsty A; Gibb, Jack G; Maitland, Kathryn

2017-01-01

Background : Diarrhoea complicates over half of admissions to hospital with severe acute malnutrition (SAM). World Health Organization (WHO) guidelines for the management of dehydration recommend the use of oral rehydration with ReSoMal (an oral rehydration solution (ORS) for SAM), which has lower sodium (45mmols/l) and higher potassium (40mmols/l) content than old WHO ORS. The composition of ReSoMal was designed specifically to address theoretical risks of sodium overload and potential under-treatment of severe hypokalaemia with rehydration using standard ORS. In African children, severe hyponatraemia at admission is a major risk factor for poor outcome in children with SAM complicated by diarrhoea. We therefore reviewed the evidence for oral rehydration therapy in children with SAM. Methods : We conducted a systematic review of randomised controlled trials (RCTs) on 18 th July 2017 comparing different oral rehydration solutions in severely malnourished children with diarrhoea and dehydration, using standard search terms. The author assessed papers for inclusion. The primary endpoint was frequency of hyponatraemia during rehydration. Results : Six RCTs were identified, all published in English and conducted in low resource settings in Asia. A range of ORS were evaluated in these studies, including old WHO ORS, standard hypo-osmolar WHO ORS and ReSoMal. Hyponatraemia was observed in two trials evaluating ReSoMal, three children developed severe hyponatraemia with one experiencing convulsions. Hypo-osmolar ORS was found to have benefits in time to rehydration, reduction of stool output and duration of diarrhoea. No trials reported over-hydration or fatalities. Conclusions : Current WHO guidelines strongly recommend the use of ReSoMal based on low quality of evidence. Studies indicate a significant risk of hyponatraemia on ReSoMal in Asian children, none have been conducted in Africa, where SAM mortality remains high. Further research should be conducted in Africa to evaluate optimal ORS for children with SAM and to generate evidence based, practical guidelines. © 2017 Houston KA et al.

The effect of a rapid rehydration guideline on Emergency Department management of gastroenteritis in children.

PubMed

Waddell, Danielle; McGrath, Ian; Maude, Phil

2014-07-01

This study evaluated the use and effect of a rapid rehydration guideline for the management of gastroenteritis in children 6months to 4years of age in an Emergency Department (ED). The guideline aims to facilitate rehydration within 4h of arrival to the ED, using oral or nasogastric fluids. Primary outcome measures were ED Length of Stay (LOS) and hospital admission rates. Documentation of physiological recovery and consistency of re-hydration regimes used were examined as secondary outcomes. A quasi-experimental design using the medical records of 235 children pre and post intervention was used. Descriptive statistics (frequencies, medians, interquartile ranges) were used to summarize the data. The pre and post-test groups were compared using Chi Square and the Mann Whitney U Test. There was an increase in the ED LOS and in hospital admission rates post implementation of the rapid rehydration guideline in the ED. However, the time frame for initiation of rehydration therapy using oral or nasogastric routes improved post guideline implementation. The need for improvements in the ED management of dehydration secondary to gastroenteritis has been highlighted providing potential benefits to patient care and outcomes. Copyright © 2013 Elsevier Ltd. All rights reserved.

Experimentally induced hyperchloremic and DL-lactic acidosis in calves: an attempt to study the effects of oral rehydration on acid-base status.

PubMed

Schwedhelm, L; Kirchner, D; Klaus, B; Bachmann, L

2013-04-01

Many diarrheic calves suffer from metabolic acidosis, which is commonly treated by oral rehydration therapy. Oral rehydration solutions can be prepared in water, milk, or milk replacer. Therefore, the aim of the study was to verify dietary effects of water- or milk replacer-based oral rehydration solutions on parameters of acid-base balance in calves with experimentally induced hyperchloremic and dl-lactate acidosis. In 12 calves, hyperchloremic or dl-lactate acidosis was induced by HCl or dl-lactic acid infusions according to protocols outlined in previous literature. Immediately after induction, the calves were fed with milk replacer or water- or milk replacer-based oral rehydration solutions, or remained fasting, respectively. Blood samples were taken to monitor acid-base status over an experimental period of 4h. Using the protocols, all calves revealed a manifest hyperchloremic or dl-lactate acidosis. Because of high infusion volumes, plasma volume was expanded and effects of feeding regimens on blood parameters were rare. Unexpected clinical aberrations occurred after repeated induction of dl-lactate acidosis: all calves developed a thrombophlebitis of the jugular vein, whereas HCl infusion had no effect on endothelium. Induction of acidosis via infusion is not suitable to study dietary effects. A protocol to induce acidosis and dehydration simultaneously is required to duplicate the metabolic conditions of diarrheic calves. In further investigations, attention should be focused on effects of d-lactate or its metabolites on endothelial tissue. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Motivating consumers for National Programme on Immunization (NPI) and Oral Rehydration Therapy (ORT) in Nigeria.

PubMed

Ekerete, P P

1997-01-01

The Expanded Programme on Immunization (EPI) (changed to National Programme on Immunization (NPI) in 1996) and Oral Rehydration Therapy (ORT) were launched in Nigeria in 1979. The goal of EPI was Universal Childhood Immunization (UCI) 1990, that is, to vaccinate 80% of all children age 0-2 years by 1990, and 80% of all pregnant women were also expected to be vaccinated with Tetanus Toxoid Vaccine. The Oral Rehydration Therapy was designed to teach parents with children age 0-5 years how to prepare and use a salt-sugar solution to rehydrate children dehydrated by diarrhoea. Nigeria set up Partners-in-Health to mobilize and motivate mothers to accept the programme. In 1990 a National coverage survey was conducted to assess the level of attainment. The results show that some states were able to reach the target and some were not. It therefore became necessary to evaluate the contribution of those promotional elements adopted by Partners-in-Health to motivate mothers to accept the programme. The respondents were therefore asked to state the degree to which these elements motivated them to accept the programme. The data were collected and processed through a Likert rating scale and t-test procedure for test of significance between two sample means. The study revealed that some elements motivated mothers very strongly, others strongly, and most moderately or low, with health workers as major sources of motivation. The study also revealed that health workers alone can not sufficiently motivate mothers without the help of religious leaders, traditional leaders and mass media, etc. It was therefore recommended that health workers should be intensively used along with other promotional elements to promote the NPI/ORT programme in Nigeria.

From Cholera to Burns: A Role for Oral Rehydration Therapy

PubMed Central

Green, W.B.; Asuku, M.E.; Feldman, M.; Makam, R.; Noppenberger, D.; Price, L.A.; Prosciak, M.; van Loon, I.N.

2011-01-01

According to the practice guidelines of the American Burn Association on burn shock resuscitation, intravenous (IV) fluid therapy is the standard of care for the replacement of fluid and electrolyte losses in burn injury of ≥20% of the total body surface area. However, in mass burn casualties, IV fluid resuscitation may be delayed or unavailable. Oral rehydration therapy (ORT), which has been shown to be highly effective in the treatment of dehydration in epidemics of cholera, could be an alternate way to replace fluid losses in burns. A prospective case series of three patients was carried out as an initial step to establish whether oral Ceralyte®90 could replace fluid losses requiring IV fluid therapy in thermal injury. The requirement of the continuing IV fluid therapy was reduced by an average of 58% in the first 24 hours after the injury (range 37-78%). ORT may be a feasible alternative to IV fluid therapy in the resuscitation of burns. It could also potentially save many lives in mass casualty situations or in resource-poor settings where IV fluid therapy is not immediately available. Further studies are needed to assess the efficacy of this treatment and to determine whether the present formulations of ORT for cholera need modification. PMID:22283039

Acute Diarrhoea in Children: Determination of Duration Using a Combined Bismuth Hydroxide Gel and Oral Rehydration Solution Therapy vs. Oral Rehydration Solution

PubMed Central

Oviedo, Adriana; Díaz, Mirna; Valenzuela, María Laura; Vidal, Victoria; Racca, Liliana; Bottai, Hebe; Priore, Graciela; Peluffo, Graciela; Di Bartolomeo, Susana; Cabral, Graciela; Toca, María del Carmen

2016-01-01

Oral rehydration salt (ORS) treatment in young children with acute diarrhoea (AD) has contributed to decrease mortality associated with dehydration although effective strategies to reduce morbidity associated with this disease are required. The aim of this study was to evaluate the diarrhoea duration when using combined colloidal bismuth hydroxide gel (CBHG) and oral rehydration salt treatment compared with ORS therapy in children with AD. We designed a double-blind, randomised prospective study with treatment and control groups. Patients aged one to 12 years, with no prior pathology and with AD of less than 48 h were included. The Chi-squared and Mann-Whitney tests were used, as well as the Cox proportional hazards model and the Kaplan-Meier estimator. Patients were randomised into an ORS and CBHG treatment group and a control group for ORS plus placebo. (Average age: 3.2 years). The result of the post-treatment evaluation with respect to the average duration of AD was 25.5 h for the treated group vs. 41.5 h for the control group (p = 0.015). The average number of stools was 4.8 in the treated group and 8.2 in the control group (p = 0.032). We conclude that the use of CBHG plus ORS significantly reduced the duration of AD, the number of stools and the percentage of children with persistent AD after 24 h of treatment compared to the control group. AD remitted almost twice as fast in patients treated with CBHG and ORS compared to those who received ORS plus placebo. PMID:28009823

Acute diarrhea's recommendations on oral rehydration therapy and feeding.

PubMed

Chongbanyatcharoen, Pairoj

2005-06-01

Oral rehydration therapy and feeding for patients with diarrhea recommended by physicians who had attended the short course "Practical Approach to Common GI Problems" were compared with The Royal College of Pediatricians of Thailand Expert Committee on Gastrointestinal System's (RCPedT) Recommendations. A questionnaire was sent to physicians who had attended the short course. Physicians recommended a variety of oral rehydration solutions (ORS) which were different from RCPedT's recommendations. 42.6% of physicians recommended WHO/ORS, 54.1% recommended commercial ORS and 3.3% recommended any form of ORS. The other form of ORS, 59.0% of physicians recommended was carbonated drinks (nonphysiologic ORS) and 40.9% recommended home mixing of ORS. 55.7% of respondents recommended ORT for mild or moderate dehydration and 29.5% for mild or no dehydration only 14.8% of the physicians followed the guidelines. Although RCPedT WHO and American Academy of Pediatrics (AAP) Committee on Nutrition stated that vomiting was not a contraindication to successful use of ORT but vomiting was the most common reason (86.9%) given by respondents for failure of ORT and vomiting was the reason for starvation as well (11.5%). Early feeding of appropriate food 80.3% of respondents followed the guidelines but only 50.7% of respondents recommended breast feeding for children younger than 1 year old.

Third World Children: Promise and Problems.

ERIC Educational Resources Information Center

Hildebrand, Verna

1988-01-01

Discusses issues which concern children born to families in developing countries. Focuses on: (1) population impact on children; (2) family planning; (3) infant feeding; (4) oral rehydration therapy and immunizations; and (5) education. (RJC)

Oral rehydration with 10% carbohydrate drink for preventing postoperative nausea and vomiting (PONV) after low dose of spinal morphine.

PubMed

Raksakietisak, Manee; Chinachoti, Tithima; Iamaroon, Arissara; Thabpenthai, Yos; Halilamien, Pathom; Siriratwarangkul, Sasiya; Watanitanon, Arraya

2014-05-01

Preoperative oral carbohydrate (CHO) drink may improve patients' comfort. However, whether it prevents or reduces postoperative nausea and vomiting (PONV) is questionable. Evaluate the effect of oral rehydration with 10% CHO drink before anesthesia on incidence and severity of postoperative nausea and vomiting (PONV) after spinal morphine injection. One hundred patients scheduled for unilateral total knee replacement (TKR) were randomly divided into two equal groups (n = 50 each). Group I patients received 400 ml 10% CHO drink the preoperative night and 2-hour before anesthesia, whereas Group II patients served as control. Spinal anesthesia for all patients contained 0.5% bupivacaine 2.0 to 3.5 ml plus morphine 0.2 mg. Pain therapy was standardized with femoral nerve block, local infiltration, intravenous parecoxib, and oral paracetamol. Incidence and severity of PONV within 24 hours were recorded In addition, preoperative intensity of thirst and hunger, dry lips and throat, and anxiety was also recorded Incidence and severity of PONV (81.2% vs. 72.0%, p = 0.536) as well as preoperative thirst, hunger dry lips, and throat were not different between the groups. Preoperative oral rehydration with carbohydrate drinks had no positive effect on PONV nor patients' comfort.

Focus on the Positive: The Campaign for Child Survival. Education about Development in School and Community.

ERIC Educational Resources Information Center

DiPeri, Loretta

1987-01-01

Health measures promoted by the Campaign for Child Survival include growth monitoring, oral rehydration therapy breastfeeding, and immunization, which together form the cornerstones of the Child Survival Strategy. (CB)

Evaluation of social marketing of oral rehydration therapy.

PubMed

Koul, P B; Murali, M V; Gupta, P; Sharma, P P

1991-09-01

Attempts, at social marketing of oral rehydration therapy (ORT) through television, in changing the knowledge and practice of mothers with regard to its use was assessed. One hundred and eighty seven consecutive mothers (38 excluded due to non use of ORT) were administered a preplanned questionnaire to assess their socio-economic profile, educational status, concept of diarrhea and correct use of ORT. Fifty nine mothers who watched these programmes on TV regularly formed the study group. These were compared with 90 mothers who had gained such knowledge from non-television sources. The correct application of knowledge of ORT was significantly better in study group compared with control group. The educational status of mothers had a positive impact on motivation to use ORT at home in the study group. Mass media campaigns through "TV spots" is an effective way of improving knowledge of mothers on ORT in a developing country.

Evaluation and Management of Dehydration in Children.

PubMed

Santillanes, Genevieve; Rose, Emily

2018-05-01

The article discusses the evaluation of dehydration in children and reviews the literature on physical findings of dehydration. Pediatric dehydration is a common problem in emergency departments and wide practice variation in treatment exists. Dehydration can be treated with oral, nasogastric, subcutaneous, or intravenous fluids. Although oral rehydration is underutilized in the United States, most children with dehydration can be successfully rehydrated via the oral route. Selection of oral rehydration solution and techniques for successful oral rehydration are presented. Appropriate selection and rate of administration of intravenous fluids are also discussed for isonatremic, hyponatremic, and hypernatremic dehydration. Copyright © 2017 Elsevier Inc. All rights reserved.

Oral Ondansetron versus Domperidone for Acute Gastroenteritis in Pediatric Emergency Departments: Multicenter Double Blind Randomized Controlled Trial.

PubMed

Marchetti, Federico; Bonati, Maurizio; Maestro, Alessandra; Zanon, Davide; Rovere, Francesca; Arrighini, Alberto; Barbi, Egidio; Bertolani, Paolo; Biban, Paolo; Da Dalt, Liviana; Guala, Andrea; Mazzoni, Elisa; Pazzaglia, Anna; Perri, Paolo Francesco; Reale, Antonino; Renna, Salvatore; Urbino, Antonio Francesco; Valletta, Enrico; Vitale, Antonio; Zangardi, Tiziana; Clavenna, Antonio; Ronfani, Luca

2016-01-01

The use of antiemetics for vomiting in acute gastroenteritis in children is still a matter of debate. We conducted a double-blind randomized trial to evaluate whether a single oral dose of ondansetron vs domperidone or placebo improves outcomes in children with gastroenteritis. After failure of initial oral rehydration administration, children aged 1-6 years admitted for gastroenteritis to the pediatric emergency departments of 15 hospitals in Italy were randomized to receive one oral dose of ondansetron (0.15 mg/kg) or domperidone (0.5 mg/kg) or placebo. The primary outcome was the percentage of children receiving nasogastric or intravenous rehydration. A p value of 0.014 was used to indicate statistical significance (and 98.6% CI were calculated) as a result of having carried out two interim analyses. 1,313 children were eligible for the first attempt with oral rehydration solution, which was successful for 832 (63.4%); 356 underwent randomization (the parents of 125 children did not give consent): 118 to placebo, 119 to domperidone, and 119 to ondansetron. Fourteen (11.8%) needed intravenous rehydration in the ondansetron group vs 30 (25.2%) and 34 (28.8%) in the domperidone and placebo groups, respectively. Ondansetron reduced the risk of intravenous rehydration by over 50%, both vs placebo (RR 0.41, 98.6% CI 0.20-0.83) and domperidone (RR 0.47, 98.6% CI 0.23-0.97). No differences for adverse events were seen among groups. In a context of emergency care, 6 out of 10 children aged 1-6 years with vomiting due to gastroenteritis and without severe dehydration can be managed effectively with administration of oral rehydration solution alone. In children who fail oral rehydration, a single oral dose of ondansetron reduces the need for intravenous rehydration and the percentage of children who continue to vomit, thereby facilitating the success of oral rehydration. Domperidone was not effective for the symptomatic treatment of vomiting during acute gastroenteritis.

A Child Survival and Development Revolution?

ERIC Educational Resources Information Center

Halpern, Robert

1986-01-01

Addresses the problems of child survival and development in developing countries by discussing the biomedical causes and the concomitant social determinants of high infant mortality rates. Describes four intervention strategies recommended by UNICEF: growth monitoring, oral rehydration therapy, breast feeding, and immunization. (HOD)

Managing Radiation Therapy Side Effects: What to Do When You Have Loose Stools (Diarrhea)

MedlinePlus

... Drink lots of clear liquids, such as water, ginger ale, and clear soup. n Most people who ... beef Drinks (clear liquids) • Clear soda, such as ginger ale • Cranberry or grape juice • Oral rehydration solution ...

[Oral rehydration therapy with OS-1 for advanced and recurrent gastrointestinal cancer patients].

PubMed

Nishimura, Taku; Sakata, Kouichirou; Nakamura, Mitsuo; Okada, Toshimasa; Fukuda, Yuko; Tanaka, Shinobu; Seiki, Masakazu; Takemura, Yumi; Yamashita, Satoyoshi

2010-12-01

The aim of this study was to introduce an oral rehydration therapy with OS-1 for advanced and recurrent gastrointestinal cancer patients to reduce a hospital stay as well as having a good QOL. We targeted 10 advanced cancer patients. In this study, We recommended the OS-1 drinking amount to be 500 mL to 1, 000 mL whenever the following symptoms were observed:(1) the patient's meal consumption was decreased in half, (2) the volume of urine was decreased, and (3) the frequency of urine was decreased. Nine out of 10 patients were able to drink OS-1 in the range of 500 mL to 1, 000 mL. Most of the patients were taking the chemotherapy along with OS-1 therapy. We confirmed two distinct cases: The patients with OS- 1 short-term drinker at the time of appetite fall because of chemotherapy. Another case was the patients with OS-1 longterm drinkers due to the end of life stage which decreased in meal frequency. ORT with OS-1 may contribute to improve QOL of the terminal patient with chemotherapy.

From guidelines to local realities: evaluation of oral rehydration therapy and zinc supplementation in Guatemala.

PubMed

Hall-Clifford, Rachel; Amerson, Roxanne

2017-04-20

Diarrhea remains a leading cause of morbidity and mortality for children in low- and middle-income countries throughout the Americas. The World Health Organization (WHO) has developed guidelines on incorporating zinc supplementation (ZS) with traditional oral rehydration therapy (ORT) in order to shorten the duration of diarrheal episodes and to reduce poor health outcomes. Guatemala adopted these guidelines in 2011, but they have not yet been fully implemented at the community level. The objectives of this study were: (1) to co-design an ORT/ZS training program for community members with local health promoters that is appropriate to the local context and (2) to understand how attitudes and behaviors of community members changed after receiving training from the study promoters. In an observational study, community health promoters in rural Guatemala were trained according to WHO guidelines, and they worked collaboratively with the study team to develop a training curriculum to implement in their community. Community-based surveys, interviews, and focus group discussions were used to assess acceptability, accessibility, and availability of oral rehydration therapy and zinc supplementation. Use of ORT increased from 63% to 95% among community members following training by local health promoters. Satisfaction with the service offered by health promoters increased from 63% to 90% amongst community members trained by the study promoters. However, knowledge and use of zinc supplementation remained low, which was attributable to unavailability of zinc in the study community. Use of trained community health promoters is an effective way to translate WHO guidelines to local contexts and overcome sociocultural barriers to care. However, the health system's structure must support availability of essential medicines in order to effectively implement those guidelines.

Private sector provision of oral rehydration therapy for child diarrhea in sub-Saharan Africa.

PubMed

Sood, Neeraj; Wagner, Zachary

2014-05-01

Although diarrheal mortality is cheaply preventable with oral rehydration therapy (ORT), over 700,000 children die of diarrhea annually and many health providers fail to treat diarrheal cases with ORT. Provision of ORT may differ between for-profit and public providers. This study used Demographic and Health Survey data from 19,059 children across 29 countries in sub-Saharan Africa from 2003 to 2011 to measure differences in child diarrhea treatment between private for-profit and public health providers. Differences in treatment provision were estimated using probit regression models controlling for key confounders. For-profit providers were 15% points less likely to provide ORT (95% confidence interval [CI] 13-17) than public providers and 12% points more likely to provide other treatments (95% CI 10-15). These disparities in ORT provision were more pronounced for poorer children in rural areas. As private healthcare in sub-Saharan Africa continues to expand, interventions to increase private sector provision of ORT should be explored.

Oral Ondansetron versus Domperidone for Acute Gastroenteritis in Pediatric Emergency Departments: Multicenter Double Blind Randomized Controlled Trial

PubMed Central

Bonati, Maurizio; Maestro, Alessandra; Zanon, Davide; Rovere, Francesca; Arrighini, Alberto; Barbi, Egidio; Bertolani, Paolo; Biban, Paolo; Da Dalt, Liviana; Guala, Andrea; Mazzoni, Elisa; Pazzaglia, Anna; Perri, Paolo Francesco; Reale, Antonino; Renna, Salvatore; Urbino, Antonio Francesco; Valletta, Enrico; Vitale, Antonio; Zangardi, Tiziana; Clavenna, Antonio

2016-01-01

The use of antiemetics for vomiting in acute gastroenteritis in children is still a matter of debate. We conducted a double-blind randomized trial to evaluate whether a single oral dose of ondansetron vs domperidone or placebo improves outcomes in children with gastroenteritis. After failure of initial oral rehydration administration, children aged 1–6 years admitted for gastroenteritis to the pediatric emergency departments of 15 hospitals in Italy were randomized to receive one oral dose of ondansetron (0.15 mg/kg) or domperidone (0.5 mg/kg) or placebo. The primary outcome was the percentage of children receiving nasogastric or intravenous rehydration. A p value of 0.014 was used to indicate statistical significance (and 98.6% CI were calculated) as a result of having carried out two interim analyses. 1,313 children were eligible for the first attempt with oral rehydration solution, which was successful for 832 (63.4%); 356 underwent randomization (the parents of 125 children did not give consent): 118 to placebo, 119 to domperidone, and 119 to ondansetron. Fourteen (11.8%) needed intravenous rehydration in the ondansetron group vs 30 (25.2%) and 34 (28.8%) in the domperidone and placebo groups, respectively. Ondansetron reduced the risk of intravenous rehydration by over 50%, both vs placebo (RR 0.41, 98.6% CI 0.20–0.83) and domperidone (RR 0.47, 98.6% CI 0.23–0.97). No differences for adverse events were seen among groups. In a context of emergency care, 6 out of 10 children aged 1–6 years with vomiting due to gastroenteritis and without severe dehydration can be managed effectively with administration of oral rehydration solution alone. In children who fail oral rehydration, a single oral dose of ondansetron reduces the need for intravenous rehydration and the percentage of children who continue to vomit, thereby facilitating the success of oral rehydration. Domperidone was not effective for the symptomatic treatment of vomiting during acute gastroenteritis. PMID:27880811

Oral Rehydration Therapy in Burn Patients

ClinicalTrials.gov

2014-04-24

Burn Any Degree Involving 20-29 Percent of Body Surface; Burn Any Degree Involving 30-39 Percent of Body Surface; Burn Any Degree Involving 40-49 Percent of Body Surface; Burn Any Degree Involving 50-59 Percent of Body Surface; Burn Any Degree Involving 60-65 Percent of Body Surface

The State of the World's Children, 1986.

ERIC Educational Resources Information Center

Grant, James P.

This special UNICEF report documents the range of problems behind the decline of living standards in Africa and describes the practical steps which are being taken to confront the crisis. Discussed are (1) increasing implementation of immunization programs and progress in promoting oral rehydration therapy; (2) the impact on child survival and…

The survey for pharmacist in community pharmacy concerning the usefullness of oral rehydration therapy (ORT) in self-medication and the state of sales of products for ORT.

PubMed

Morimoto, Yasuko; Harada, Shinichi; Nakamoto, Kazuo; Tokuyama, Shogo

2013-01-01

The usefulness as one of the tools for self-medication of oral rehydration therapy (ORT), recommended as a safe and effective therapy for mild to moderate dehydration, was surveyed by questionnaire for pharmacists in community pharmacies. ORT products were sold in 112 pharmacies (61%), and the common product was OS-1(®). Approximately 50% of sellers answered that they had no particular difficulty in explaining ORT. Percentage to answer "hard to describe" is significantly higher in pharmacists who believe there is a need to consider underlying health conditions of customers or patients when implementing ORT. Around 77% of pharmacists considered ORT to be useful in patients as a method of self-medication. A significant number of pharmacists selling ORT products depends on the consultation from customers or patients and provide advice to them confirming that ORT was useful. From these results, it was suggested that further information concerning ORT, such as its use in patients with chronic disorders or signs for completion, and the initiative of pharmacists to participate are necessary for spread the efficacy of ORT for self-medication in patients.

Advances in pediatric dehydration therapy.

PubMed

Niescierenko, Michelle; Bachur, Richard

2013-06-01

To review the advances in the assessment, treatment, and evaluation of care for pediatric dehydration. Recent studies have added new information across the spectrum of care for dehydration. Advances in the assessment of dehydration allow more accurate clinical evaluation, but do not help predict the treatment outcomes. Antiemetics as an adjunct to oral rehydration therapy have been proven well tolerated, efficacious, and cost-effective. Rapid, large-volume intravenous rehydration for outpatients with dehydration did not show any benefit over more standard regimens. Clinical guidelines incorporate all these aspects of care; however, physicians show poor adherence to the guidelines despite the evidence that guidelines improve outcomes and reduce cost. Dehydration burdens the healthcare system worldwide. Through advances in its assessment, treatment with antiemetics and intravenous fluids, and standardization of practice with clinical guidelines, this burden could be reduced.

Comparison of oral and intravenous fluid therapy in newborns with hypernatremic dehydration.

PubMed

Erdemir, Aydin; Kahramaner, Zelal; Cosar, Hese; Turkoglu, Ebru; Kanik, Ali; Sutcuoglu, Sumer; Ozer, Esra Arun

2014-03-01

To evaluate the efficacy and complications of oral and intravenous fluid therapy in newborns with hypernatremic dehydration. A total of 75 term and near-term (>35 weeks) neonates with hypernatremic dehydration (Na ≥ 150 mmol/L) were included in this retrospective study. The patients were divided into two groups according to therapy approach for rehydration (breast milk-oral formula and intravenous fluid). The decline in sodium concentration (<0.5 mmol/L/h was regarded as safe drop) and complications were analyzed. The mean gestational age, birth weight and age at admission were 38.9 ± 1.4(36-42) weeks, 3341 ± 504 (2500-4500) gram and 4.3 ± 2.6 (1-17) day, respectively. Fever (61.8%) and jaundice (39.4%) were the most common presenting signs. Forty-four (58.6%) of the infants were treated with breast milk and/or oral formula (group 1) and 31 (41.4%) of the infants were treated with IV fluid (group 2). In group 1 and group 2, respectively, mean % weight loss, 5 and 7.5; median serum sodium at admission, 153 and 152 mmol/L; median change in sodium at 12 hours, 7 and 11 mmol/L; and median change in sodium at 24 hours, 10 and 15 mmol/L. The decline in sodium concentration was more safely in group 1 than group 2 at both 12 and 24 hours of rehydration. One patient had convulsion associated with cerebral edema in group 2. Otherwise no complication was observed in both groups. Enteral route for fluid replacement may be safe and effective and may be an alternative to intravenous fluid therapy in newborns with hypernatremic dehydration when clinical situation is stable.

The State of the World's Children 1985: A Report by United Nations Children's Fund (UNICEF).

ERIC Educational Resources Information Center

Early Child Development and Care, 1985

1985-01-01

Reports four basic strategies of the current child survival revolution in the world: use of oral rehydration therapy (ORT) for preventing and treating diarrheal dehydration (the biggest single killer of children in the modern world), growth monitoring to prevent child malnutrition, breast-feeding, and immunization to provide protection against six…

The Knowledge of Staff in Day Nurseries about Some Basic Measures Which Promote Child Health

ERIC Educational Resources Information Center

Cavalcante, Suzy S.; Nunes de Melo, Maria Clotildes; Carneiro, Nadya Bustani; Silva, Luciana Rodrigues

2005-01-01

Purpose: This paper aims to determine the knowledge that staff in day nurseries in Brazil had of basic measures to promote child health which are connected with high child mortality. These measures included breastfeeding, oral rehydration therapy, child growth follow-up, immunization and the identification of signs that indicate that the child…

Does an L-glutamine-containing, Glucose-free, Oral Rehydration Solution Reduce Stool Output and Time to Rehydrate in Children with Acute Diarrhoea? A Double-blind Randomized Clinical Trial

PubMed Central

Gutiérrez, Claudia; Villa, Sofía; Mota, Felipe R.; Calva, Juan J.

2007-01-01

This study assessed whether an oral rehydration solution (ORS) in which glucose is replaced by L-glutamine (L-glutamine ORS) is more effective than the standard glucose-based rehydration solution recommended by the World Health Organization (WHO-ORS) in reducing the stool volume and time to rehydrate in acute diarrhoea. In a double-blind, randomized controlled trial in a Mexican hospital, 147 dehydrated children, aged 1–60 month(s), were assigned either to the WHO-ORS (74 children), or to the L-glutamine ORS (73 children) and followed until successful rehydration. There were no significant differences between the groups in stool output during the first four hours, time to successful rehydration, volume of ORS required for rehydration, urinary output, and vomiting. This was independent of rotavirus-associated infection. An L-glutamine-containing glucose-free ORS seems not to offer greater clinical benefit than the standard WHO-ORS in mildly-to-moderately-dehydrated children with acute non-cholera diarrhoea. PMID:18330060

Oral rehydration therapy: a community trial comparing the acceptability of homemade sucrose and cereal-based solutions.

PubMed

Chowdhury, A M; Karim, F; Rohde, J E; Ahmed, J; Abed, F H

1991-01-01

Sugar-based oral rehydration therapy (ORT) for diarrhoea is promoted in many countries of the world. One programme in Bangladesh has instructed more than 13 million mothers in the preparation of a sugar-salt solution in the home; despite very high rates of correct mixing and knowledge, subsequent application was found in only some 20% of all diarrhoea episodes. Since rice is far more available in rural homes (95%) than any type of sugar (30%) and rice gruel is a widely accepted food during illness, a field trial was conducted in three areas (total population, 68,345) to compare the acceptability and use of rice-based ORT with that of sugar-based ORT. Although the mothers unanimously agreed that the rice-based solutions "stopped" the diarrhoea more quickly, they used the sugar-based solutions twice as often (in 40% of severe watery episodes) as the rice-based solutions (in 18%), because the rice-ORT was much more time-consuming and difficult to prepare. The observed reduced utilization of home-made rice-ORT makes it a poor substitute for sugar-ORT at the community level in rural Bangladesh.

Rapid IV Versus Oral Rehydration: Responses to Subsequent Exercise Heat Stress

DTIC Science & Technology

2006-01-01

Sports Exerc., Vol. 38, No. 12, pp. 2125–2131, 2006. Purpose: This study sought to determine the effect of rapid intravenous (IV) versus oral (ORAL...of fluid (ORAL trial). In the heat, fluid lost was matched with 0.45% saline in 20 min by either IV or ORAL rehydration; no fluid was given in the NF...cardiovascular and thermoregulatory strain and RPE during subsequent exer- cise in the heat, with a similar effect on exercise perform- ance (2,3,12,17). However

Maternal knowledge, attitudes and practice in diarrhea.

PubMed

Kapoor, P; Rajput, V J

1993-01-01

In developing countries where diarrhea is a major health problem, mothers are often ignorant about the cause and management of the disease and tend to restrict fluid intake instead of taking steps to prevent dehydration. 300 mothers of children hospitalized in Rewa, India, were interviewed with a pretested questionnaire on their diarrhea knowledge. 74.3% were rural and 80.6% were aged 20-30 years. 70% were illiterate and belonged to the upper lower or lower middle class. Causes of diarrhea cited by the mothers included teething (64.3%), evil eye (46%), contact with another case (36.6%), malnutrition (28.3), worm infestation (22.6%), eating mud (18.6%), mother's food habits (17.6%), eating sweets (17.3%), dirty water (15.3%), hot/cold foods (10.6%), change of food (8.3), and dirty environment (6%). During diarrhea, 266 mothers allowed breast milk, 118 pulses and rice gruel, 104 diluted cow's milk, 57 undiluted cow's milk, 25 boiled pulses water, 23 boiled rice water, 16 banana, 13 oral rehydration solution, 10 a whole diet, 8 tea, and 7 curd. Half of the mothers considered passage of liquid stools 3-5 times a day as diarrhea. Only 3% of the mothers listed dehydration as an important complication of the disease. Of the mothers using oral rehydration therapy, the fluid was often not reconstituted properly, and inadequate amounts were administered. Improved health education for mothers, with information on general hygiene, adequate diet during illness, and the use of oral rehydration solution in diarrhea would reduce diarrhea deaths.

Promotional model: a new direction for the National Programme on Immunization (NPI) and Oral Rehydration Therapy (ORT) in Nigeria.

PubMed

Ekerete, P P

2000-01-01

The National Programme on Immunization (NPI), which was formerly known as the Expanded Program on Immunization (EPI), and Oral Rehydration Therapy (ORT) were relaunched in 1984 after the problems of vaccine supply had been corrected. The aim of the NPI was to protect children against six childhood killer diseases and ORT to rehydrate the dehydrated child caused by diarrhoea. In order to achieve these objectives, a Partner-in-Health strategy was set up to educate, convince and motivate mothers, pregnant women and the community to accept the programme. To assess the effect of the promotional strategy, the government decided to conduct a National Immunization Coverage survey. The results showed that some states were able to reach the target while some were not. The survey also reported that 32% of the reason for immunization failure was due to lack of information and that 9% was lack of motivation. It therefore became necessary to design a promotional model for effective and rapid implementation of the programme. After an evaluation of the promotional strategy set up by the government, a pilot survey was conducted from which nine promotional elements were selected. These promotional elements were regarded as sources of information and motivation. Based on these, a promotional model was set up which stated that promotion depends on consumer information which in turn depends on the extent of interaction between the consumer and the promotional elements. The implication of the model is the need for the formation of a Public Health Organisation with a Public Health Committee at all levels of government.

Management of Acute Diarrhoea in Primary Care in Bahrain: Self-reported Practices of Doctors

PubMed Central

Ismaeel, Abdulrahman Y.; Khaja, Khalid A.J. Al; Damanhori, Awatif H.H.; Sequeira, Reginald P.; Botta, Giuseppe A.

2007-01-01

This nationwide study was conducted to assess the extent of adherence of primary-care physicians to the World Health Organization (WHO)-recommended guidelines on the use of oral rehydration therapy (ORT), antimicrobials, and prescribing of other drugs used in treating symptoms of acute diarrhoea in Bahrain. A questionnaire-based, cross-sectional survey was carried out in primary-care health centres. During a six-week survey period (15 August–30 September 2003), 328 (25.2%) completed questionnaires were returned from 17 of 20 health centres. In a sample of 300 patients, oral rehydration salts (ORS) solution was prescribed to 89.3% (n=268) patients; 12.3% received ORS alone, whereas 77% received ORS in combination with symptomatic drugs. Antimicrobials were prescribed to 2% of the patients. In 11.4% of the cases, rehydration fluids and other drugs were given parenterally. The mean number of drugs was 2.2+0.87 per prescription. In approximately one-third of the patients, three or more drugs were used. Primary-care physicians almost always adhered to the WHO guidelines with respect to ORT and antimicrobials. However, in several instances, ORT was prescribed along with polypharmacy, including irrational use of drugs for symptomatic relief. Effective health policies are needed to reduce the unnecessary burden on the healthcare system. PMID:17985822

Control of deaths from diarrheal disease in rural communities. I. Design of an intervention study and effects on child mortality.

PubMed

Kielmann, A A; Mobarak, A B; Hammamy, M T; Gomaa, A I; Abou-el-Saad, S; Lotfi, R K; Mazen, I; Nagaty, A

1985-12-01

From May through October 1980, the "Strengthening Rural Health Delivery" project (SRHD) under the Rural Health Department of the Ministry of Health of Egypt had conducted an investigation into prevention of child mortality from diarrheal disease through testing various modules of Oral Rehydration Therapy delivery mechanisms. In a six-cell design counting a total of almost 29,000 children, ORT was provided both as hypotonic sucrose/salt solution prepared and administered by mothers and normotonic, balanced electrolyte solution in the hands of both mothers and health care providers and the effects on child mortality during the peak season of diarrheal incidence were measured. In addition, utilization and effects of ORT when made readily available through commercial channels was similarly examined. A cost-benefit analysis was performed on the cost of the services as well as on the outcome for each of five study cells using the sixth, the control, as reference. Results showed that early rehydration with a sucrose/salt solution in the hands of mothers, backed by balanced oral rehydration solution in the hands of health care providers proved the most cost-effective means of reducing diarrhea-specific mortality as well as being as safe as prepackaged commercial preparations.

Future challenges in communication for promoting ORT--an overview.

PubMed

Dobe, M

2003-06-01

Oral rehydration therapy (ORT) is a cheap and simple intervention aimed to prevent mortality and morbidity associated with dehydration due to diarrhoea. ORT promotion strategies through programme communication, social mobilisation and social marketing, and advocacy efforts have yielded substantial improvement in the scenario. However, it has also taught us lessons and suggested changes in communication strategies to make the promotion efforts more effective in future.

A prospective randomised trial comparing nasogastric with intravenous hydration in children with bronchiolitis (protocol) The comparative rehydration in bronchiolitis study (CRIB)

PubMed Central

2010-01-01

Background Bronchiolitis is the most common reason for admission of infants to hospital in developed countries. Fluid replacement therapy is required in about 30% of children admitted with bronchiolitis. There are currently two techniques of fluid replacement therapy that are used with the same frequency-intravenous (IV) or nasogastric (NG). The evidence to determine the optimum route of hydration therapy for infants with bronchiolitis is inadequate. This randomised trial will be the first to provide good quality evidence of whether nasogastric rehydration (NGR) offers benefits over intravenous rehydration (IVR) using the clinically relevant continuous outcome measure of duration of hospital admission. Methods/Design A prospective randomised multi-centre trial in Australia and New Zealand where children between 2 and 12 months of age with bronchiolitis, needing non oral fluid replacement, are randomised to receive either intravenous (IV) or nasogastric (NG) rehydration. 750 patients admitted to participating hospitals will be recruited, and will be followed daily during the admission and by telephone 1 week after discharge. Patients with chronic respiratory, cardiac, or neurological disease; choanal atresia; needing IV fluid resuscitation; needing an IV for other reasons, and those requiring CPAP or ventilation are excluded. The primary endpoint is duration of hospital admission. Secondary outcomes are complications, need for ICU admission, parental satisfaction, and an economic evaluation. Results will be analysed using t-test for continuous data, and chi squared for categorical data. Non parametric data will be log transformed. Discussion This trial will define the role of NGR and IVR in bronchiolitis Trail registration The trial is registered with the Australian and New Zealand Clinical Trials Registry - ACTRN12605000033640 PMID:20515467

[Reduction in the mortality from acute diarrheal diseases. The experiences of an action-research program].

PubMed

Gutiérrez, G; Guiscafré, H; Reyes, H; Pérez, R; Vega, R; Tomé, P

1994-01-01

In order to accelerate the descending mortality rate of acute diarrhea in children under five years of age in Mexico, six strategies were implemented. The results showed that after nine months, 49 per cent of mothers had been trained, and improved significantly their home management of diarrhea. The use of oral rehydration salts increased from 10 to 30 per cent; use of oral rehydration therapy increased from 77 to 83 per cent; and timely and appropriate demand for medical help increased from 51 to 62 per cent (p < 0.05). One hundred percent of all physicians received training, and they improved their therapeutic practices, as shown by a decrease in the use of antibiotics from 48 to 34 per cent; prescription of restrictive diets diminished from 33 to 4 per cent; and oral rehydration therapy increased from 74 to 87 per cent. Thirty-four verbal autopsies were carried out, and they showed that 70 per cent of the children who died did so in their homes or in their way to the hospital, despite the fact that 94 per cent of them had received medical care previous to their death, and that 84 per cent of these had been seen by a doctor within 24 hours previous to their death. In 85 per cent of these cases, the physician involved was a private physician of rural or marginal areas. Monthly analysis of death certificates showed that, during the first year of the program (1991), deaths due to diarrhea diminished 20 per cent, while the corresponding figure for 1992 was 52 per cent. In conclusion, the combination of strategies followed in the program made it possible to accelerate, on a short-term basis, the descending trend of deaths due to diarrhea. It was also shown that an intervention project such as the one presented here may efficiently link results from research to decisions taken by policy-makers, and that these can be effectively turned into actions.

Reducing the burden of diarrhea among children under five years old: lessons learned from oral rehydration therapy corner program implementation in Northern Nigeria.

PubMed

Charyeva, Zulfiya; Cannon, Molly; Oguntunde, Olugbenga; Garba, Aminu Magashi; Sambisa, William; Bassi, Amos Paul; Ibrahim, Mohammed Auwal; Danladi, Saba'atu Elizabeth; Lawal, Nurudeen

2015-05-01

In Nigeria, diarrhea remains one of the leading causes of death among children under five years old. Oral Rehydration Therapy (ORT) corners were introduced to health facilities in Bauchi and Sokoto states to serve as points of treatment for sick children and equip caregivers with necessary skills in case management of diarrhea and diarrhea prevention. The operations research study examined the effect of facility-based ORT corners on caregivers' knowledge and skills in management of simple and moderate diarrhea at home, as well as caregivers' and service providers' perceived facilitators and barriers to utilization and delivering of ORT corner services. It also examined whether ORT activities were conducted according to the established protocols. This quantitative study relied on multiple sources of information to provide a complete picture of the current status of ORT corner services, namely surveys with ORT corner providers (N = 21), health facility providers (N = 23) and caregivers (N = 229), as well as a review of service statistics and health facility observations. Frequency distribution and binary analysis were conducted. The study revealed that ORT corner users were more knowledgeable in diarrhea prevention and management and demonstrated better skills for managing diarrhea at home than ORT corner non-users. However, the percentage of knowledgeable ORT users is not optimal, and providers need to continue to work toward improving such knowledge. ORT corner providers identified a lack of supplies as the major barrier for providing services. Furthermore, the study revealed a lack of information, education and communication materials, supportive supervision, and protocols and guidelines for delivering ORT corner services, as well as inadequate documentation of services provided at ORT corners. Recommendations for ORT corners program planners and implementers include ensuring all ORT corners have oral rehydration salt (ORS) packages and salt, sugar, and zinc tablets in stock, a secured commodity supply chain to avoid stockouts, and adequate policies and procedures in place.

Effect of hypovolemia, infusion, and oral rehydration on plasma electrolytes, ADH, renin activity, and +G/z/ tolerance

NASA Technical Reports Server (NTRS)

Greenleaf, J. E.; Brock, P. J.; Haines, R. F.; Rositano, S. A.; Montgomery, L. D.; Keil, L. C.

1977-01-01

Effects on plasma volume, electrolyte shifts, and +G(z) tolerance induced by: (1) blood withdrawal; (2) blood infusion; and (3) oral fluid intake, were determined at 0.5 G/min in centrifugation tests of six ambulatory male patients, aged 21 to 27 yrs. Hypovolemia induced by withdrawal of 400 ml blood, blood infusion followed by repeated centrifugation, effects of consuming an isotonic drink (0.9% NaCl) to achieve oral rehydration, and donning of red adaptation goggles were studied for effects on acceleration tolerance, pre-acceleration and post-acceleration plasma renin activity (PRA) and plasma vasopressin levels. No significant changes in post-acceleration PRA compared to pre-acceleration PRA were found, and administration of oral rehydration is found as effective as blood replacement in counteracting hypovolemic effects.

Implementation of a training program for low-literacy promotoras in oral rehydration therapy.

PubMed

Amerson, Roxanne; Hall-Clifford, Rachel; Thompson, Beti; Comninellas, Nicholas

2015-01-01

The purpose of this study was to ascertain the effectiveness of a culturally appropriate promotora training program related to oral rehydration therapy and diarrheal management. Factors that influenced the development, implementation, and evaluation of the program provided to low-literacy women in Guatemala are explored. Promotora training was conducted with 15 Mayan women from a rural community in the highlands of Guatemala. Women were selected by leaders of the community to participate in the program. Quantitative data were collected and analyzed to determine descriptive statistics and reliability coefficients for the pretests and posttests. A nonparametric Wilcoxon test for paired-samples was conducted. The qualitative data from the program evaluations were analyzed for themes. Mean scores increased from 41.73 (SD = 9.65) to 70.33 (SD = 21.29) on the pretest and posttest. The Cronbach's alpha was 0.54 on the pretest with 0.65 on the posttest. The Wilcoxon test demonstrated a significant difference between the pretest and posttest scores (Z = 3.040, p < .05). Extremely low-literacy levels played a major role in the ability of the women to successfully complete the requirements of the training program. The curriculum demonstrated effectiveness, but will benefit from replication with a larger sample. © 2014 Wiley Periodicals, Inc.

[Continuous oral hydration or with fractionated doses in acute diarrhea-induced dehydration in children].

PubMed

Mota-Hernández, Felipe; Gutiérrez-Camacho, Claudia; Cabrales-Martínez, Rosa Georgina; Villa-Contreras, Sofía

2002-01-01

To evaluate the safety and effectiveness of two oral rehydration techniques. A randomized clinical trial was conducted at the oral rehydration unit of Hospital Infantil de Mexico "Federico Gomez", between September 1998 and June 1999. Forty patients five-year old and younger children, dehydrated due to acute diarrhea, were given oral rehydration solution (ORS) ad libitum (AL group); another forty patients received ORS in fractionated doses (FD group). Clinical characteristics were similar in both groups. Results are presented as means, standard deviations and medians, according the distribution of simple and relative frequencies. The mean stool output in the AL group was 11.0 +/- 7.5 g/kg/h; as compared to 7.1 +/- 7.4 in the FD group (p = 0.03). ORS intake, rehydration time, and mean diuresis values were similar in both groups (p > 0.05). Six patients in the AL group and five in the FD group had high stool output (> 10 g/kg/h), that improved after administration of rice starch solution. One patient in the AL group and two in the FD group had persistent vomiting that improved with gastroclisis. No patient required intravenous rehydration. These results suggest that ORS administration ad libitum under supervision, is a technique as safe and effective as the fractionated doses technique, for the treatment of dehydrated children due to acute diarrhea.

Can oral rehydration solution be safely flavored at home?

PubMed

Nijssen-Jordan, C

1997-12-01

To determine the concentration of sodium, potassium, glucose, and osmolality of oral rehydration solutions (ORS) which have been flavored with varying amounts of unsweetened Kool-Aid powder, Jell-O powder, apple juice, or orange juice. Descriptive. Alberta Children's Hospital Chemistry Laboratory. None. Addition of varying amounts of flavoring easily available in all households to commercially available unsweetened ORS. Concentrations of electrolytes, glucose, and osmolality. Addition of fruit juices or flavor powders to commercially produced ORS does alter the electrolyte content and osmolality. When limited amounts of flavoring or juice is added, the osmolality of the solution approaches iso-osmolality. Small amounts of unsweetened Kool-Aid powder, Jell-O powder, and apple or orange juice can be added to oral rehydration solutions without significantly altering electrolyte composition and osmolality.

[Rice water with and without electrolytes in diarrhea with a high stool output].

PubMed

Mota-Hernández, F; Posadas-Tello, N M; Rodríguez-Leyva, G

1993-12-01

The objective of the study was to determine the efficacy and safety of two rice-based oral rehydration solutions, with and without added electrolyte in children presenting acute diarrheal dehydration with high stool output (> 10 mL/kg/h) during a two-hour rehydration period. Twenty-two patients of one to 18 months old were recruited and randomly distributed into two groups: group A received the rice-based solution without electrolytes, and group B received the rice-based solution with electrolytes. A stool output diminishing was observed in both groups and rehydration was achieved in 4.0 +/- 0.9 hours in 21 patients from group A and in 4.6 +/- 0.9 hours in 13 patients group group B. There was not a statistically significant difference between the groups regarding the laboratory results. The rice-based oral rehydration solution without added electrolytes was useful for rehydration of children presenting high stool output, after administering the WHO/ORS recommended formula during a two-hour period.

Impact of oral rehydration and selected public health interventions on reduction of mortality from childhood diarrhoeal diseases in Mexico.

PubMed Central

Gutiérrez, G.; Tapia-Conyer, R.; Guiscafré, H.; Reyes, H.; Martínez, H.; Kumate, J.

1996-01-01

Reported are the results of an analysis of mortality trends from diarrhoeal diseases among under-5-year-olds in Mexico between 1978 and 1993 in relation to the impact of education, basic sanitation, and selected medical care practices. The study period was divided into three stages; the first pre-dated the widespread application of oral rehydration therapy (ORT); the second, covered the implementation of a nationwide programme promoting ORT; and the third included additional measures, such as immunization and improvements in basic sanitation. Mortality rates decreased progressively, at an average of 1.8% per year in the first stage, 6.4% in the second, and 17.8% in the third. The importance of literacy campaigns for women and the promotion of ORT was confirmed. Both of these measures reduced mortality; however, a greater reduction resulted from a massive immunization campaign against measles and improvements in sanitation (expansion of the drainage and piped water systems, improved water chlorination procedure, and effective prohibition of the use of sanitary sewage for vegetable irrigation). PMID:8706235

Adherence to oral rehydration therapy among in-patient children aged 1-59 months with some or no dehydration.

PubMed

Migowa, A N; Gatinu, B; Nduati, R W

2010-04-01

To determine adherence to oral rehydration solution (ORS) among in-patients aged 1-59 months suffering from gastroenteritis and having some dehydration (SD) or no dehydration (ND) in two rural hospitals in Kenya. Children aged 1-59 months suffering from acute gastroenteritis with (SD) or (ND) were enrolled into the study, examined and medical records reviewed. On the second and third day of follow up, children were re-examined to ascertain hydration status and care-takers interviewed. Ninety-nine children were enrolled. Forty-five (75%) of the 60 children with SD received a correct prescription for ORS but only 12 (20%) received the correct amount. Among the 39 children with ND, 23 (59%) received a correct prescription for ORS, however only 16 (41%) received the correct amount. On the 3rd day, 9 (15%) of the 60 children with SD at baseline and 2 (5%) of the 39 with ND were classified as having SD. Four in five children with SD and 6 in 10 children with ND fail to receive the correct amounts of ORS.

Cost-effectiveness analysis of the diarrhea alleviation through zinc and oral rehydration therapy (DAZT) program in rural Gujarat India: an application of the net-benefit regression framework.

PubMed

Shillcutt, Samuel D; LeFevre, Amnesty E; Fischer-Walker, Christa L; Taneja, Sunita; Black, Robert E; Mazumder, Sarmila

2017-01-01

This study evaluates the cost-effectiveness of the DAZT program for scaling up treatment of acute child diarrhea in Gujarat India using a net-benefit regression framework. Costs were calculated from societal and caregivers' perspectives and effectiveness was assessed in terms of coverage of zinc and both zinc and Oral Rehydration Salt. Regression models were tested in simple linear regression, with a specified set of covariates, and with a specified set of covariates and interaction terms using linear regression with endogenous treatment effects was used as the reference case. The DAZT program was cost-effective with over 95% certainty above $5.50 and $7.50 per appropriately treated child in the unadjusted and adjusted models respectively, with specifications including interaction terms being cost-effective with 85-97% certainty. Findings from this study should be combined with other evidence when considering decisions to scale up programs such as the DAZT program to promote the use of ORS and zinc to treat child diarrhea.

Fluid therapy in mature cattle.

PubMed

Roussel, Allen J

2014-07-01

Fluid therapy for mature cattle differs from that for calves because the common conditions that result in dehydration and the metabolic derangements that accompany these conditions are different. The veterinarian needs to know which problem exists, what to administer to correct the problem, in what quantity, by what route, and at what rate. Mature cattle more frequently suffer from alkalosis; therefore, acidifying solutions containing K(+) and Cl(-) in concentrations greater than that of plasma are frequently indicated. The rumen provides a large-capacity reservoir into which oral rehydration solutions may be administered, which can save time and money. Copyright © 2014 Elsevier Inc. All rights reserved.

Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis

PubMed Central

Freedman, Stephen B.; Pasichnyk, Dion; Black, Karen J. L.; Fitzpatrick, Eleanor; Gouin, Serge; Milne, Andrea; Hartling, Lisa

2015-01-01

Context Gastroenteritis remains a leading cause of childhood morbidity. Objective Because prior reviews have focused on isolated symptoms and studies conducted in developing countries, this study focused on interventions commonly considered for use in developed countries. Intervention specific, patient-centered outcomes were selected. Data Sources MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, trial registries, grey literature, and scientific meetings. Study Selection Randomized controlled trials, conducted in developed countries, of children aged <18 years, with gastroenteritis, performed in emergency department or outpatient settings which evaluated oral rehydration therapy (ORT), antiemetics, probiotics or intravenous fluid administration rate. Data Extraction The study was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. Data were independently extracted by multiple investigators. Analyses employed random effects models. Results 31 trials (4,444 patients) were included. ORT: Compared with intravenous rehydration, hospitalization (RR 0.80, 95%CI 0.24, 2.71) and emergency department return visits (RR 0.86, 95%CI 0.39, 1.89) were similar. Antiemetics: Fewer children administered an antiemetic required intravenous rehydration (RR 0.40, 95%CI 0.26, 0.60) While the data could not be meta-analyzed, three studies reported that ondansetron administration does increase the frequency of diarrhea. Probiotics: No studies reported on the primary outcome, three studies evaluated hospitalization within 7 days (RR 0.87, 95%CI 0.25, 2.98). Rehydration: No difference in length of stay was identified for rapid vs. standard intravenous or nasogastric rehydration. A single study found that 5% dextrose in normal saline reduced hospitalizations compared with normal saline alone (RR 0.70, 95% CI 0.53, 0.92). Conclusions There is a paucity of patient-centered outcome evidence to support many interventions. Since ORT is a low-cost, non-invasive intervention, it should continue to be used. Routine probiotic use cannot be endorsed at this time in outpatient children with gastroenteritis. Despite some evidence that ondansetron administration increases diarrhea frequency, emergency department use leads to reductions in intravenous rehydration and hospitalization. No benefits were associated with ondansetron use following emergency department discharge. PMID:26075617

Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis.

PubMed

Freedman, Stephen B; Pasichnyk, Dion; Black, Karen J L; Fitzpatrick, Eleanor; Gouin, Serge; Milne, Andrea; Hartling, Lisa

2015-01-01

Gastroenteritis remains a leading cause of childhood morbidity. Because prior reviews have focused on isolated symptoms and studies conducted in developing countries, this study focused on interventions commonly considered for use in developed countries. Intervention specific, patient-centered outcomes were selected. MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, trial registries, grey literature, and scientific meetings. Randomized controlled trials, conducted in developed countries, of children aged <18 years, with gastroenteritis, performed in emergency department or outpatient settings which evaluated oral rehydration therapy (ORT), antiemetics, probiotics or intravenous fluid administration rate. The study was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. Data were independently extracted by multiple investigators. Analyses employed random effects models. 31 trials (4,444 patients) were included. ORT: Compared with intravenous rehydration, hospitalization (RR 0.80, 95%CI 0.24, 2.71) and emergency department return visits (RR 0.86, 95%CI 0.39, 1.89) were similar. Antiemetics: Fewer children administered an antiemetic required intravenous rehydration (RR 0.40, 95%CI 0.26, 0.60) While the data could not be meta-analyzed, three studies reported that ondansetron administration does increase the frequency of diarrhea. Probiotics: No studies reported on the primary outcome, three studies evaluated hospitalization within 7 days (RR 0.87, 95%CI 0.25, 2.98). Rehydration: No difference in length of stay was identified for rapid vs. standard intravenous or nasogastric rehydration. A single study found that 5% dextrose in normal saline reduced hospitalizations compared with normal saline alone (RR 0.70, 95% CI 0.53, 0.92). There is a paucity of patient-centered outcome evidence to support many interventions. Since ORT is a low-cost, non-invasive intervention, it should continue to be used. Routine probiotic use cannot be endorsed at this time in outpatient children with gastroenteritis. Despite some evidence that ondansetron administration increases diarrhea frequency, emergency department use leads to reductions in intravenous rehydration and hospitalization. No benefits were associated with ondansetron use following emergency department discharge.

[Is oral rehydration with nasogastric tube more efficient than rehydration with spoon? Preliminary study in children with non-severe dehydration in Joseph-Raseta-Befelatanana Hospital, Madagascar].

PubMed

Ravelomanana, T; Rabeatoandro, S; Randrianaivo, N; Ratsimbazafy, A; Raobijaona, H; Barennes, H

2010-05-01

Since its recommendation by WHO, Oral Rehydration Solutions (ORS) contributed in reducing the rate of mortality due to acute gastroenteritis. In Madagascar, the rate of lethality imputed to gastroenteritis is about 3%. Rehydration can be performed either by using spoons which reliability is unsure because of parents' potential inobservance and child's refusal, or by nasogastric tube. The nasogastric tube may resolve these obstacles at the hospital. We realized a preliminary study to evaluate the efficacy and the safety of nasogastric tube and spoon administration of the ORS in rehydration of child with moderate post-gastroenteritis dehydration. This is an open comparative study realized in the Pediatric Unit at the Joseph-Raseta-Befelatanana Hospital from the 21 January to 21 May 2008. Main outcomes was the proportion of rehydrated children at 4 hours, other were: failure at 8 hours, duration and volume of SRO, side effects. Fifty-three children from 4-month to 4-year old among 1306 patients were recruited and forty-seven patients were included. Nine patients failed (4 children received ORS by spoon and 5 children by nasogastric tube). The use of spoon was more effective: 62.5% of the patients were rehydrated at the fourth hour versus 39.3% in nasogastric tube group (P = 0.04). Making debit constant presents difficulties in rehydration with nasogastric tube (44.4 %). Tolerance of nasogastric tube is generally good but 16.7% children get out their tube during this study. No ORS' inhalation was observed with both routes. No false passage or tube or ORS rejection was recorded in both techniques. This study shows that using spoon to rehydrate is more effective for the rehydration of moderate dehydration. The use of nasogastric tube needs more surveillance.

Use of Commercially Available Oral Rehydration Solutions in Lima, Peru

PubMed Central

Pantenburg, Birte; Ochoa, Theresa J.; Ecker, Lucie; Ruiz, Joaquim

2012-01-01

Caregivers' practices concerning oral rehydration of young children during diarrheal illness were investigated in a periurban community of low socioeconomic level in Lima, Peru. Data of 330 caregivers of children aged 6–36 months were analyzed; 72.7% of all caregivers would give commercially available oral rehydration solutions (ORSs). However, only 58.6% of those caregivers with children that had experienced diarrhea during the previous week stated that they had used commercially available ORSs, a significantly lower percentage. The main reason for not using commercially available ORSs was that caregivers did not know about them. Of all recipes caregivers provided for homemade ORS, none contained the recommended concentrations of sugar and salt. Educating caregivers about availability, benefits, and use of commercially available ORSs as well as correct preparation of homemade ORS is urgently needed. PMID:22665594

The effects of water replacement by oral rehydration fluids with or without betaine supplementation on performance, acid-base balance, and water retention of heat-stressed broiler chickens.

PubMed

Sayed, M A M; Downing, J

2011-01-01

Exposing broilers to a high temperature increases water and electrolyte K(+) and Na(+) excretion, which negatively affects the heat dissipation capacity and acid-base homeostasis, resulting in losses in growth performance. In this experiment, the efficacy of providing oral rehydration therapy and betaine on growth performance, acid-base balance, and water and electrolyte retention was evaluated. A total of 432 one-day-old broiler chicks (Cobb) were allocated to 72 metabolic cages and reared to 31 d of age under standard conditions. From 32 to 41 d of age, chicks were exposed to heat stress (ambient temperature, 32°C) and high RH (80 to 100% RH) for 9 h daily. The ameliorative effects of a 3 × 3 factorial array of treatments administered via drinking water were evaluated in 8 replicates of 6 chicks per cage for each treatment. Two oral rehydration therapy (ORT) fluids, based on either citrate or bicarbonate salts, were added to tap water. In addition, betaine was added to tap water at an inclusion rate of 0, 500, or 1,000 mg/L to complete the array of 9 liquid-based treatments. Growth performance was assessed at 32, 35, and 41 d of age. From 32 to 35 d of age, chicks receiving ORT fluids exhibited improved growth performance, water balance, and electrolyte (K(+), Na(+)) retention. In addition, the physiological response to stress was attenuated, as indicated by lower heterophil-to-lymphocyte ratios and blood glucose concentrations relative to the negative controls. The addition of betaine at an inclusion rate of 500 mg/L improved BW gain. From d 36 to 41, treatments did not significantly influence growth performance, which suggests that chicks receiving tap water were able to compensate and adapt to the heat-stress conditions. The results demonstrate that the beneficial effects of providing ORT fluids and 500 mg of betaine/L were observed only during the first 4 d of heat exposure. After this period, adaptation to the heat appears to occur, and none of the treatments was successful in improving growth performance.

Probiotics in the treatment of acute rotavirus diarrhoea. A randomized, double-blind, controlled trial using two different probiotic preparations in Bolivian children.

PubMed

Grandy, Giuseppe; Medina, Marcos; Soria, Richard; Terán, Carlos G; Araya, Magdalena

2010-08-25

Evidence suggests that probiotics reduce rotavirus diarrhoea duration. Although there are several probiotic strains potentially useful, daily practice is often limited by the type and number of products locally available. In general, information about combined products is scarce. In this study we compare the effect of two probiotic products in the treatment of diarrhoea in children less than 2 years of age. A Randomized double-blind controlled clinical trial in children hospitalized for acute rotavirus diarrhoea, in the Paediatric Centre Albina Patino, Cochabamba, Bolivia.Participants were children aged 1 - 23 months, who were randomly assigned to receive one of three treatments: Oral rehydration therapy plus placebo; Oral rehydration solution plus Saccharomyces boulardii; or Oral rehydration solution plus a compound containing Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum and Saccharomyces boulardii. Sample size was 20 per group and the outcomes were duration of diarrhoea, of fever, of vomiting and of hospitalization. 64 cases finished the protocol. On admission, patients' characteristics were similar. Median duration of diarrhoea (p = 0.04) in children who received the single species product (58 hours) was shorter than in controls (84.5 hrs). Comparing children that received the single probiotic product and controls showed shorter duration of fever (18 vs 67 hrs) (p = 0.0042) and the mixed probiotic of vomiting (0 vs 42.5 hrs) (p = 0.041). There was no effect on duration of hospitalization (p = 0.31). When experimental groups were merged, statistical significance of changes increased (total duration of diarrhoea, fever and vomiting P = 0.025, P = 0.025 and P = 0.014, respectively). Both products decreased the duration of diarrhoea compared to oral rehydration solution alone. This decrease was significant only for the single species product which also decreased the duration of fever. With the multiple species product there was no vomiting subsequent to the initiation of treatment. The quantity of probiotic bacteria needed for optimum treatment of gastroenteritis remains to be determined, particularly when multiple species are included in the product.Trial registration: ClinicalTrials.gov ID: NCT00981877Link: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol/sid/S0002653/selectaction/View/ts/2/uid/U0000N04 Clinical trials NCT ID: NCT00981877.

Acute Adverse Reactions to Nonionic Iodinated Contrast Media for CT: Prospective Randomized Evaluation of the Effects of Dehydration, Oral Rehydration, and Patient Risk Factors.

PubMed

Motosugi, Utaroh; Ichikawa, Tomoaki; Sano, Katsuhiro; Onishi, Hiroshi

2016-11-01

The objective of our study was to determine the effects of dehydration and oral rehydration on the incidence of acute adverse reactions to iodinated contrast media administered during abdominal and pelvic CT in outpatients. For our prospective randomized study performed at a single institution, adult outpatients undergoing contrast-enhanced abdominal CT were randomly divided into a rehydration group (n = 2244 patients [1379 men and 865 women]; mean age, 65.2 years; age range, 18-90 years) and a control group (n = 3715 [2112 male patients and 1603 female patients]; mean age, 65.8 years; age range, 17-96 years), which included an age- and sex-matched subgroup (adjusted control group, n = 2244). The rehydration group received an oral rehydration solution (500 mL of liquid in which osmotic pressure is adjusted to enhance gastrointestinal absorption) before abdominal and pelvic CT. Patients were also divided into subclinically dehydrated (n = 997) and hydrated (n = 4962) groups according to their answers to a questionnaire that they completed before the CT examination. The patients were interviewed about contrast-induced adverse reactions before they left the CT room, and the reactions were categorized as allergiclike or physiologic. The incidence of reactions was compared between the rehydration and control groups and between the subclinical dehydration and hydrated groups. The rehydration and control groups were compared with an unpaired t test or a chi-square or Fisher test. The overall incidence of an acute adverse reaction was 4.3% (254/5959); the acute adverse reactions included 136 allergiclike and 118 physiologic reactions. Fourteen allergiclike and nine physiologic reactions were moderate grade, and none was severe. There was no significant difference between the rehydration group and adjusted control group in the overall incidence of adverse reactions (99/2244 [4.4%] vs 100/2244 [4.5%], respectively; p = 0.9422) or between the subclinically dehydrated group and hydrated group in the incidence of allergiclike reactions (25/997 [2.5%] vs 111/4962 [2.2%], p = 0.6062) and physiologic reactions (22/997 [2.2%] vs 96/4962 [1.9%], p = 0.5793). Younger age was a risk factor for both allergiclike and physiologic reactions (p ≤ 0.0019). Dehydration and oral rehydration did not affect the incidence of acute adverse reactions to iodinated contrast material for abdominal and pelvic CT in our randomized prospective trial.

Management guidelines for acute infective diarrhoea / gastroenteritis in infants.

PubMed

Wittenberg, Dankwart Friedrich

2012-01-27

Acute onset vomiting and diarrhoea is one of the most common illnesses of infancy, and is second only to respiratory illnesses as a cause of childhood deaths worldwide. Existing guidelines for management of diarrhoea are often ignored in public and private practice, possibly because of a perception that the guidelines are too simple, or because of expectations of the need to give 'real' drug therapy to stop diarrhoea. This guideline provides a problem-based approach to the basics of present-day management of acute gastroenteritis, and discusses the evidence for the recommendations. Recommendations. Each episode of diarrhoea must be seen as an opportunity for caregiver education in the prevention of the illness, in the 'what' and 'how' of oral rehydration and re-feeding, and in the recognition of when to seek help. The vast majority of patients recover rapidly, but serious complications do occur, and must be recognised and managed correctly. Validation. The guidelines are endorsed by the Paediatric Management Group (PMG) in South Africa. The aim of management is to help the child to maintain or regain hydration, and to recover from diarrhoea, with careful attention to adequate oral rehydration and judicious re-feeding.

Slow progress in diarrhea case management in low and middle income countries: evidence from cross-sectional national surveys, 1985-2012.

PubMed

Sreeramareddy, Chandrashekhar T; Low, Yue-Peng; Forsberg, Birger Carl

2017-03-21

Diarrhea remains to be a main cause of childhood mortality. Diarrhea case management indicators reflect the effectiveness of child survival interventions. We aimed to assess time trends and country-wise changes in diarrhea case management indicators among under-5 children in low-and-middle-income countries. We analyzed aggregate data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys done from 1986 to 2012 in low-and-middle-income countries. Two-week prevalence rates of diarrhea, caregiver's care seeking behavior and three case management indicators were analyzed. We assessed overall time trends across the countries using panel data analyses and country-level changes between two sequential surveys. Overall, yearly increase in case management indicators ranged from 1 · 3 to 2 · 5%. In the year 2012, <50% of the children were given correct treatment (received oral rehydration and increased fluids) for diarrhea. Annually, an estimated 300 to 350 million children were not given oral rehydration solutions, or recommended home fluids or 'increased fluids' and 304 million children not taken to a healthcare provider during an episode of diarrhea. Overall, care seeking for diarrhea, increased from pre-2000 to post-2000, i.e. from 35 to 45%; oral rehydration rates increased by about 7% but the rate of 'increased fluids' decreased by 14%. Country-level trends showed that care seeking had decreased in 15 countries but increased in 33 countries. Care seeking from a healthcare provider increased by ≥10% in about 23 countries. Oral rehydration rates had increased by ≥10% in 15 countries and in 30 countries oral rehydration rates increased by <10%. Very limited progress has been made in the case management of childhood diarrhea. A better understanding of caregiver's care seeking behavior and health care provider's case management practices is needed to improve diarrhea case management in low- and-middle-income countries.

Oral rehydration salt use and its correlates in low-level care of diarrhea among children under 36 months old in rural Western China.

PubMed

Gao, Wenlong; Yan, Hong; Wang, Duolao; Dang, Shaonong

2013-03-19

Since 2000, there has been a decline in the proportion of oral rehydration salts (ORS) therapy in childhood diarrhea. How to sustain and achieve a high level of ORS therapy continues to be a challenge. The data of 14112 households and 894 villages in 45 counties across 10 provinces of Western China were collected in 2005. Generalized estimated equation logistic regression models were used to identify the determinants of ORS use in home-based and village-level care. The therapy rate of ORS was 34.62%. This rate in home-based care (HBC) was significantly lower than that in village-level care (VLC), township-level care or county-level-or-above care. The children in the families with several pre-school-aged children (OR = 0.29 95% CI: 0.10, 0.86) or of the smaller age (12 vs 36 months: OR = 0.10 95% CI 0.02, 0.41; 24 vs 36 months: OR = 0.26 95% CI 0.09, 0.77) were less likely to receive ORS therapy against diarrhea in HBC. The children whose family had the habit of drinking boiled water (OR = 2.77 95% CI 1.30-5.91), or whose caretakers received educational materials about childhood diseases (OR = 3.08 95% CI 1.54, 6.16), or who were living in the villages in which village clinics had the available ORS packages (OR = 3.94 95% CI 2.25, 6.90) were more likely to receive ORS therapy against diarrhea in VLC. There thus, ORS promoting program should give the highest priority to home care. ORS promoting strategies for low-level care could be strengthened based on children characteristics, the habit of drinking water and the situation of receiving educational material in the families and on the availability of ORS packages in village clinics in rural Western China.

The effect of flavoring oral rehydration solution on its composition and palatability.

PubMed

te Loo, D Maroeska; van der Graaf, Fedde; Ten, Walther Tjon A

2004-11-01

As a number of mild to moderately dehydrated children refuse to drink oral rehydration solution (ORS) because of its strong salty taste, many parents and health workers flavor ORS with the childs favorite juice. The effects of flavoring ORS on electrolyte content and osmolality were assessed and the palatability of various solutions were compared with commercially flavored ORS. Osmolality, sodium, potassium, chloride and glucose content after flavoring with varying concentrations of apple juice, orange juice or orangeade was determined. Two of the solutions were offered to 30 children and adults to assess palatability. All additions to ORS (apple juice, orange juice or orangeade) caused a decrease of sodium (-30 to -53 mmol/L) and chloride (-27 to -47 mmol/L) content, whereas osmolality increased to greater than 311 mOsm/kg. These homemade oral rehydration solutions did not fulfill ESPGAN criteria for ORS, and rehydration will therefore be less effective. The majority of subjects also preferred the commercially flavored ORS. Only very small amounts of apple juice or orange juice can be added to the ORS without significantly altering electrolyte composition and osmolality. Palatability, however, does not improve compared with commercially flavored ORS. We therefore recommend using commercially flavored ORS, the composition of which fulfills ESPGAN criteria.

Pyruvate-enriched oral rehydration solution improved intestinal absorption of water and sodium during enteral resuscitation in burns.

PubMed

Hu, Sen; Liu, Wei-wei; Zhao, Ying; Lin, Zhi-long; Luo, Hong-min; Bai, Xiao-dong; Sheng, Zhi-yong; Zhou, Fang-qiang

2014-06-01

To investigate alteration in intestinal absorption during enteral resuscitation with pyruvate-enriched oral rehydration solution (Pyr-ORS) in scalded rats. To compare pyruvate-enriched oral rehydration solution (Pyr-ORS) with World Health Organisation oral rehydration solution (WHO-ORS), 120 rats were randomly divided into 6 groups and 2 subgroups. At 1.5 and 4.5 h after a 35% TBSA scald, the intestinal absorption rate, mucosal blood flow (IMBF), Na(+)-K(+)-ATPase activity and aquaporin-1 (AQP-1) expression were determined (n = 10), respectively. The intestinal Na(+)-K(+)-ATPase activity, AQP-1 expression and IMBF were markedly decreased in scald groups, but they were profoundly preserved by enteral resuscitation with WHO-ORS and further improved significantly with Pyr-ORS at both time points. Na(+)-K+-ATPase activities remained higher in enteral resuscitation with Pyr-ORS (Group SP) than those with WHO-ORS (Group SW) at 4.5 h. AQP-1 and IMBF were significantly greater in Group SP than in Group SW at both time points. Intestinal absorption rates of water and sodium were obviously inhibited in scald groups; however, rates were also significantly preserved in Group SP than in Group SW with an over 20% increment at both time points. The Pyr-ORS may be superior to the standard WHO-ORS in the promotion of intestinal absorption of water and sodium during enteral resuscitation. Copyright © 2013 Elsevier Ltd and ISBI. All rights reserved.

Influence of preoperative oral rehydration on arterial plasma rocuronium concentrations and neuromuscular blocking effects: A randomised controlled trial.

PubMed

Ishigaki, Sayaka; Ogura, Takahiro; Kanaya, Ayana; Miyake, Yu; Masui, Kenichi; Kazama, Tomiei

2017-01-01

The influence of preoperative rehydration on the action of rocuronium has not yet been investigated. The objective is to evaluate the hypothesis that preoperative rehydration lowers arterial rocuronium plasma concentrations and changes its associated neuromuscular blocking effects during induction of anaesthesia. Randomised, single-blinded study. A secondary hospital from October 2013 to July 2014. In total, 46 men undergoing elective surgery were eligible to participate and were randomly allocated into two groups. Exclusion criteria were severe hepatic, renal or cardiovascular disorder; neuromuscular disease; history of allergy to rocuronium; BMI more than 30 kg m; receiving medication known to influence neuromuscular function. Participants received 1500 ml of oral rehydration solution (rehydration group) or none (control group) until 2 hours before anaesthesia. Arterial blood samples were obtained 60, 90 and 120 s and 30 min after rocuronium (0.6 mg kg) administration during total intravenous anaesthesia. Responses to 0.1-Hz twitch stimuli were measured at the adductor pollicis muscle using acceleromyography. Arterial plasma rocuronium concentrations. Arterial plasma rocuronium concentrations at 60, 90 and 120 s in the rehydration and control groups were 9.9 and 13.7, 6.8 and 9.5 and 6.2 and 8.1 μg ml, respectively (P = 0.02, 0.003 and 0.02, respectively); the onset times in the rehydration and control groups were 92.0 and 69.5 s (P = 0.01), and the times to twitch re-appearance were 25.3 and 30.4 min (P = 0.004), respectively. Preoperative rehydration significantly reduces arterial plasma rocuronium concentrations in the first 2 minutes after administration, prolonging the onset time and shortening the duration of effect. A higher dose or earlier administration should be considered for patients who receive preoperative rehydration. Umin identifier: UMIN000011981.

Pyruvate in oral rehydration salt improves hemodynamics, vasopermeability and survival after burns in dogs.

PubMed

Liu, Rui; Hu, Xiao-Hang; Wang, Shu-Ming; Guo, Si-Jia; Li, Zong-Yu; Bai, Xiao-Dong; Zhou, Fang-Qiang; Hu, Sen

2016-06-01

To investigate whether pyruvate-enriched oral rehydration solution (Pyr-ORS), compared with citrate-enriched ORS (Cit-ORS), improves hemodynamics and organ function by alleviating vasopermeability and plasma volume loss during intra-gastric fluid rehydration in dogs with severe burn. Forty dogs subjected to severe burn were randomly divided into four groups (n=10): two oral rehydrated groups with Pyr-ORS and Cit-ORS (group PR and group CR), respectively, according to the Parkland formula during the first 24h after burns. Other two groups were the intravenous (IV) resuscitation (group VR) with lactated Ringer's solution with the same dosage and no fluid rehydration (group NR). During the next 24h, all groups received the same IV infusion. The hemodynamics, plasma volume, vasopermeability and water contents and function of various organs were determined. Plasma levels of vascular endothelial growth factor (VEGF) and platelet activating factor (PAF) were detected by ELISA. Hemodynamics parameters were significantly improved in group PR superior to group CR after burns. Levels of VEGF and PAF were significantly lower in group PR than in group CR. Organ function parameters were also greatly preserved in group PR, relative to groups CR and NR. Lactic acidosis was fully corrected and survival increased in group PR (50.0%), compared to group CR (20.0%). Pyr-ORS was more effective than Cit-ORS in improving hemodynamics, visceral blood perfusion and organ function by alleviating vasopermeability-induced visceral edema and plasma volume loss in dogs with severe burn. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Management of diarrhea in a DTU.

PubMed

Kamala, C S; Vishwanathakumar, H M; Shetti, P M; Anand, N

1996-10-01

A retrospective review of cases seen in the Diarrhea Treatment and Training Unit (DTU) of Bangalore (India) Medical College's Vani Vilas Children's Hospital during 1992-1994 confirmed the efficacy of the standard case management approach. This strategy entails oral rehydration therapy (ORT), continued feeding, and selective use of intravenous fluids and antibiotics. Of the 7966 children (4374 males and 3592 females) reporting to the DTU during the 2-year study period, only 2412 (30.5%) had received oral rehydration solution (ORS) or home-available fluids before admission. Acute watery diarrhea was present in 7316 cases (91.84%). Death occurred in 59 acute watery diarrhea cases, 6 dysentery cases, and 7 persistent diarrhea cases. The average time for cases managed in the ORT area was 2 hours and 45 minutes, while the hospital stay for admitted cases averaged 3 days. In 6957 cases (87.33%), ORS was sufficient treatment. Of the 1009 children (12.67%) who required intravenous fluids, 254 had dehydration attributable to conditions such as persistent vomiting and inability to drink due to oral thrush. Only the 512 children (6.2%) with cholera and dysentery received antibiotics. Of the 72 children who died (case fatality rate, 0.9%), 43 had associated severe malnutrition with pneumonia and anemia, 14 had a central nervous system infection, and 13 had septicemia; in only 2 cases could death be directly ascribed to diarrheal disease. One of these cases was due to shigella encephalopathy and the other to severe dehydration with acidosis. The average cost of treatment per patient was Rs 2.91 when only ORS was used compared with Rs 24.28 when intravenous rehydration was required. The finding that less than one-third of children had received ORS before admission suggests a need for the establishment of more DTUs in large hospitals that can train community-based health personnel in diarrhea case management.

Management of Diarrhoeal Dehydration in Childhood: A Review for Clinicians in Developing Countries

PubMed Central

Anigilaje, Emmanuel Ademola

2018-01-01

The survival of a child with severe volume depletion at the emergency department depends on the competency of the first responder to recognize and promptly treat hypovolemic shock. Although the basic principles on fluid and electrolytes therapy have been investigated for decades, the topic remains a challenge, as consensus on clinical management protocol is difficult to reach, and more adverse events are reported from fluid administration than for any other drug. While the old principles proposed by Holliday and Segar, and Finberg have stood the test of time, recent systematic reviews and meta-analyses have highlighted the risk of hyponatraemia, and hyponatraemic encephalopathy in some children treated with hypotonic fluids. In the midst of conflicting literature on fluid and electrolytes therapy, it would appear that isotonic fluids are best suitable for the correction of hypotonic, isonatraemic, and hypernatraemic dehydration. Although oral rehydration therapy is adequate to correct mild to moderate isonatraemic dehydration, parenteral fluid therapy is safer for the child with severe dehydration and those with changes in serum sodium. The article reviews the pathophysiology of water and sodium metabolism and, it uses the clinical case examples to illustrate the bed-side approach to the management of three different types of dehydration using a pre-mixed isotonic fluid solution (with 20 or 40 mmol/L of potassium chloride added depending on the absence or presence of hypokalemia, respectively). When 3% sodium chloride is unavailable to treat hyponatraemic encephalopathy, 0.9% sodium chloride becomes inevitable, albeit, a closer monitoring of serum sodium is required. The importance of a keen and regular clinical and laboratory monitoring of a child being rehydrated is emphasized. The article would be valuable to clinicians in less-developed countries, who must use pre-mixed fluids, and who often cannot get some suitable rehydrating solutions. PMID:29527518

[Sodium concentrations in solutions for oral rehydration in children with diarrhea].

PubMed

Mota-Hernández, F; Morales-Barradas, J A

1990-04-01

Using the appropriate treatment for dehydration due to diarrhea, over a million deaths a year in children under five are being prevented. After analyzing the information related to the concentration of sodium in solutions used for oral rehydration, the following conclusions can be made: 1. Solutions with high glucose content, as well as hyperosmolar foods, favor the development of hypernatremia. Not so, sodium concentrations of up to 90 mmol/L, with glucose under 2.5%. 2. There are other factors which correlate with the presence of hypernatremia: abundant watery diarrhea, a good state of nutrition, under six months of age and the administration of solute loads, orally (boiled milk) as well as intravenously. 3. The WHO oral rehydration solution which contains, in mmol/L: sodium 90, glucose 111 (2%), chloride 80, potassium 20 and citrate 10, with a total osmolarity of 311 or 331 mOsm/L, is the one which more closely resembles the ideal concentration and has shown to be effective, not only in the treatment of dehydration due to diarrhea, but has also been to be useful in the prevention and maintenance of rehydration, independently from the etiology, the patient's age or the state of nutrition. 4. The use of oral serum with a sodium concentration of 90 mmol/L, reduces the natremia more slowly, therefore protecting the patient with hypernatremic dehydration from developing convulsions during treatment. This sodium concentration is also the best for cases of hyponatremic dehydration. 5. Using the recommended norms in cases of children with diarrhea, including continuing regular feeding habits and the adding of complementary liquids, no cases of hypernatremia have been recorded.(ABSTRACT TRUNCATED AT 250 WORDS)

Performance of a community-based health and nutrition-education intervention in the management of diarrhoea in a slum of Delhi, India.

PubMed

Pahwa, Smriti; Kumar, Geeta Trilok; Toteja, G S

2010-12-01

Diarrhoeal infections are the fifth leading cause of death worldwide and continue to take a high toll on child health. Mushrooming of slums due to continuous urbanization has made diarrhoea one of the biggest public-health challenges in metropolitan cities in India. The objective of the study was to carry out a community-based health and nutrition-education intervention, focusing on several factors influencing child health with special emphasis on diarrhoea, in a slum of Delhi, India. Mothers (n=370) of children, aged >12-71 months, identified by a door-to-door survey from a large urban slum, were enrolled in the study in two groups, i.e. control and intervention. To ensure minimal group interaction, enrollment for the control and intervention groups was done purposively from two extreme ends of the slum cluster. Baseline assessment of knowledge, attitudes, and practices on diarrhoea-related issues, such as oral rehydration therapy (ORT), oral rehydration salt (ORS), and continuation of breastfeeding during diarrhoea, was carried out using a pretested questionnaire. Thereafter, mothers (n=195) from the intervention area were provided health and nutrition education through fortnightly contacts achieved by two approaches developed for the study--'personal discussion sessions' and 'lane approach'. The mothers (n=175) from the control area were not contacted. After the intervention, there was a significant (p=0.000) improvement in acquaintance to the term 'ORS' (65-98%), along with its method of reconstitution from packets (13-69%); preparation of home-made sugar-salt solution (10-74%); role of both in the prevention of dehydration (30-74%) and importance of their daily preparation (74-96%); and continuation of breastfeeding during diarrhoea (47-90%) in the intervention area. Sensitivity about age-specific feeding of ORS also improved significantly (p=0.000) from 13% to 88%. The reported usage of ORS packets and sugar-salt solution improved significantly from 12% to 65% (p=0.000) and 12% to 75% (p=0.005) respectively. The results showed that health and nutrition-education intervention improved the knowledge and attitudes of mothers. The results indicate a need for intensive programmes, especially directed towards urban slums to further improve the usage of oral rehydration therapy.

Gastroenteritis Aggressive Versus Slow Treatment For Rehydration (GASTRO). A pilot rehydration study for severe dehydration: WHO plan C versus slower rehydration

PubMed Central

Houston, Kirsty A.; Gibb, Jack G.; Mpoya, Ayub; Obonyo, Nchafatso; Olupot-Olupot, Peter; Nakuya, Margeret; Evans, Jennifer A; George, Elizabeth C; Gibb, Diana M; Maitland, Kathryn

2017-01-01

Background: The World Health Organization (WHO) rehydration management guidelines (Plan C) for children with acute gastroenteritis (AGE) and severe dehydration are widely practiced in resource-poor settings, yet have never been formally evaluated in a clinical trial. A recent audit of outcome of AGE at Kilifi County Hospital, Kenya noted that 10% of children required high dependency care (20% mortality) and a number developed fluid-related complications. The fluid resuscitation trial, FEAST, conducted in African children with severe febrile illness, demonstrated higher mortality with fluid bolus therapy and raised concerns regarding the safety of rapid intravenous rehydration therapy. Those findings warrant a detailed physiological study of children’s responses to rehydration therapy incorporating quantification of myocardial performance and haemodynamic changes.  Methods: GASTRO is a multi-centre, unblinded Phase II randomised controlled trial of 120 children aged 2 months to 12 years admitted to hospital with severe dehydration secondary to AGE. Children with severe malnutrition, chronic diarrhoea and congenital/rheumatic heart disease are excluded. Children will be enrolled over 18 months in 3 centres in Kenya and Uganda and followed until 7 days post-discharge. The trial will randomise children 1:1 to standard rapid rehydration using Ringers Lactate  (WHO plan ‘C’ – 100mls/kg over 3-6 hours according to age, plus additional 0.9% saline boluses for children presenting in shock) or to a slower rehydration regimen (100mls/kg given over 8 hours and without the addition of fluid boluses). Enrolment started in November 2016 and is on-going. Primary outcome is frequency of adverse events, particularly related to cardiovascular compromise and neurological sequelae.  Secondary outcomes focus on clinical, biochemical, and physiological measures related to assessment of severity of dehydration, and response to treatment by intravenous rehydration. Discussion: Results from this pilot will contribute to generating robust definitions of outcomes (in particular for non-mortality endpoints) for a larger Phase III trial. PMID:28905004

Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials.

PubMed

Bellemare, Steven; Hartling, Lisa; Wiebe, Natasha; Russell, Kelly; Craig, William R; McConnell, Don; Klassen, Terry P

2004-04-15

Despite treatment recommendations from various organizations, oral rehydration therapy (ORT) continues to be underused, particularly by physicians in high-income countries. We conducted a systematic review of randomised controlled trials (RCTs) to compare ORT and intravenous therapy (IVT) for the treatment of dehydration secondary to acute gastroenteritis in children. RCTs were identified through MEDLINE, EMBASE, CENTRAL, authors and references of included trials, pharmaceutical companies, and relevant organizations. Screening and inclusion were performed independently by two reviewers in order to identify randomised or quasi-randomised controlled trials comparing ORT and IVT in children with acute diarrhea and dehydration. Two reviewers independently assessed study quality using the Jadad scale and allocation concealment. Data were extracted by one reviewer and checked by a second. The primary outcome measure was failure of rehydration. We analyzed data using standard meta-analytic techniques. The quality of the 14 included trials ranged from 0 to 3 (Jadad score); allocation concealment was unclear in all but one study. Using a random effects model, there was no significant difference in treatment failures (risk difference [RD] 3%; 95% confidence intervals [CI]: 0, 6). The Mantel-Haenzsel fixed effects model gave a significant difference between treatment groups (RD 4%; 95% CI: 2, 5) favoring IVT. Based on the four studies that reported deaths, there were six in the IVT groups and two in ORT. There were no significant differences in total fluid intake at six and 24 hours, weight gain, duration of diarrhea, or hypo/hypernatremia. Length of stay was significantly shorter for the ORT group (weighted mean difference [WMD] -1.2 days; 95% CI: -2.4,-0.02). Phlebitis occurred significantly more often with IVT (number needed to treat [NNT] 33; 95% CI: 25,100); paralytic ileus occurred more often with ORT (NNT 33; 95% CI: 20,100). These results may not be generalizable to children with persistent vomiting. There were no clinically important differences between ORT and IVT in terms of efficacy and safety. For every 25 children (95% CI: 20, 50) treated with ORT, one would fail and require IVT. The results support existing practice guidelines recommending ORT as the first course of treatment in appropriate children with dehydration secondary to gastroenteritis.

Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials

PubMed Central

Bellemare, Steven; Hartling, Lisa; Wiebe, Natasha; Russell, Kelly; Craig, William R; McConnell, Don; Klassen, Terry P

2004-01-01

Background Despite treatment recommendations from various organizations, oral rehydration therapy (ORT) continues to be underused, particularly by physicians in high-income countries. We conducted a systematic review of randomised controlled trials (RCTs) to compare ORT and intravenous therapy (IVT) for the treatment of dehydration secondary to acute gastroenteritis in children. Methods RCTs were identified through MEDLINE, EMBASE, CENTRAL, authors and references of included trials, pharmaceutical companies, and relevant organizations. Screening and inclusion were performed independently by two reviewers in order to identify randomised or quasi-randomised controlled trials comparing ORT and IVT in children with acute diarrhea and dehydration. Two reviewers independently assessed study quality using the Jadad scale and allocation concealment. Data were extracted by one reviewer and checked by a second. The primary outcome measure was failure of rehydration. We analyzed data using standard meta-analytic techniques. Results The quality of the 14 included trials ranged from 0 to 3 (Jadad score); allocation concealment was unclear in all but one study. Using a random effects model, there was no significant difference in treatment failures (risk difference [RD] 3%; 95% confidence intervals [CI]: 0, 6). The Mantel-Haenzsel fixed effects model gave a significant difference between treatment groups (RD 4%; 95% CI: 2, 5) favoring IVT. Based on the four studies that reported deaths, there were six in the IVT groups and two in ORT. There were no significant differences in total fluid intake at six and 24 hours, weight gain, duration of diarrhea, or hypo/hypernatremia. Length of stay was significantly shorter for the ORT group (weighted mean difference [WMD] -1.2 days; 95% CI: -2.4,-0.02). Phlebitis occurred significantly more often with IVT (number needed to treat [NNT] 33; 95% CI: 25,100); paralytic ileus occurred more often with ORT (NNT 33; 95% CI: 20,100). These results may not be generalizable to children with persistent vomiting. Conclusion There were no clinically important differences between ORT and IVT in terms of efficacy and safety. For every 25 children (95% CI: 20, 50) treated with ORT, one would fail and require IVT. The results support existing practice guidelines recommending ORT as the first course of treatment in appropriate children with dehydration secondary to gastroenteritis. PMID:15086953

Safety and Efficacy of Low-osmolarity ORS vs. Modified Rehydration Solution for Malnourished Children for Treatment of Children with Severe Acute Malnutrition and Diarrhea: A Randomized Controlled Trial.

PubMed

Kumar, Ruchika; Kumar, Praveen; Aneja, S; Kumar, Virendra; Rehan, Harmeet S

2015-12-01

World Health Organization-recommended rehydration solution for malnourished children (ReSoMal) for rehydrating severe acute malnourished children is not available in India. In present study, 110 consecutive children aged 6-59 months with severely acute malnourishment and acute diarrhea were randomized to low-osmolarity oral rehydration solution (ORS) (osmolarity: 245, sodium: 75) with added potassium (20 mmol/l) or modified ReSoMal (osmolarity: 300, sodium: 45). In all, 15.4% of modified ReSoMal group developed hyponatremia as compared with 1.9% in low-osmolarity ORS, but none developed severe hyponatremia or hypernatremia. Both groups had equal number of successful rehydration (52 each). Both types of ORS were effective in correcting hypokalemia and dehydration, but rehydration was achieved in shorter duration with modified ReSoMal. © The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The effect of preventive oral care on treatment outcomes of a cohort of oral cancer patients.

PubMed

Morais, Marilia Oliveira; Elias, Marcela Ramos Abrahão; Leles, Cláudio Rodrigues; Dourado Pinezi, Juliana Castro; Mendonça, Elismauro Francisco

2016-04-01

The purpose of this study was to assess patient adherence to an oral preventive measures (OPM) protocol and its impact on cancer treatment outcomes. A retrospective cohort of oral cancer of 133 patients submitted to radiotherapy (RT) was selected, excluding those with metastasis. Patients were grouped according to their local tumor response after finishing RT (favorable or unfavorable) and adherence to an OPM (none, ≤6 months, and >6 months). OPM included education and counseling about adverse effects, elimination of infection foci, restorative procedures, fluoride therapy, oral rehydration, and maintenance and supervision of oral hygiene throughout treatment. Clinical and pathological characteristics were recorded, and patient outcomes (frequency of adverse effects, RT interruption, and overall survival) were analyzed. Patients with higher adherence to the OPM had greater occurrence of RT interruption as a consequence of symptoms (p = 0.01); however, these patients were more likely to complete the established RT protocol (p = 0.02). Overall survival (p = 0.01) was higher in the group with higher adherence. This study suggests that the implementation of oral preventive measures may contribute to improving the prognosis of squamous cell carcinoma (SCC) treatment by reducing the negative impact of oral complications.

Extracorporeal virus elimination for the treatment of severe Ebola virus disease--first experience with lectin affinity plasmapheresis.

PubMed

Büttner, Stefan; Koch, Benjamin; Dolnik, Olga; Eickmann, Markus; Freiwald, Tilo; Rudolf, Sarah; Engel, Jürgen; Becker, Stephan; Ronco, Claudio; Geiger, Helmut

2014-01-01

Therapeutic options for Ebola virus disease (EVD) are currently limited to (1) best supportive care, and (2) evolving virus-specific therapies, resulting from decades of analyzing one of the world's deadliest diseases. Supportive care ranges from oral or intravenous rehydration therapy and anti-emetics in developing countries to much more extensive life-support interventions in resource-rich countries. Current EVD-specific therapies attempt to either interfere with the earliest steps of viral replication or to elicit a strong immune response against the virus. An entirely new approach is the extracorporeal elimination of viruses and viral glycoproteins by lectin affinity plasmapheresis. Herein, we report for the first time the successful and safe use of lectin affinity plasmapheresis in a patient with severe Ebola virus disease. © 2015 S. Karger AG, Basel.

Potassium supplements for oral diarrhoea regimens.

PubMed

Clements, M L; Levine, M M; Black, R E; Hughes, T P; Rust, J; Tome, F C

1980-10-18

A study is proposed for supplementing potassium loss from diarrhea in rehydration therapies with fresh fruit and other naturally potassium-rich foods. Bananas contain .1 mol of potassium per gm. Freshly squeezed lemon or orange juices were tested for potassium and sodium content and found to have very low potassium concentration. Therefore, the banana was chosen for an upcoming study that will determine if infants and children suffering from diarrhea can ingest the amounts of the fruit necessary to elevate the potassium level sufficiently. Bananas as the potassium source are thought to be well-accepted in developing areas.

Enteric infections, diarrhea, and their impact on function and development

PubMed Central

Petri, William A.; Miller, Mark; Binder, Henry J.; Levine, Myron M.; Dillingham, Rebecca; Guerrant, Richard L.

2008-01-01

Enteric infections, with or without overt diarrhea, have profound effects on intestinal absorption, nutrition, and childhood development as well as on global mortality. Oral rehydration therapy has reduced the number of deaths from dehydration caused by infection with an enteric pathogen, but it has not changed the morbidity caused by such infections. This Review focuses on the interactions between enteric pathogens and human genetic determinants that alter intestinal function and inflammation and profoundly impair human health and development. We also discuss specific implications for novel approaches to interventions that are now opened by our rapidly growing molecular understanding. PMID:18382740

Antibacterial activity of Psidium guajava leaf and bark against multidrug-resistant Vibrio cholerae: implication for cholera control.

PubMed

Rahim, Niaz; Gomes, Donald James; Watanabe, Haruo; Rahman, Sabita Rizwana; Chomvarin, Chariya; Endtz, Hubert Ph; Alam, Munirul

2010-07-01

In clinical cholera, a 3-day course of antibiotic complements extensive rehydration therapy by reducing stool volume, shortening the illness, and averting death. However, antibiotic therapy, which has lifesaving implications for cholera, is often hindered due to multidrug resistance in Vibrio cholerae, the cause of cholera. Crude aqueous mixture and water soluble methanol extract from leaf and bark of Psidium guajava, a tropical fruit guava of the family Myrtaceae, showed strong antibacterial activity against multidrug-resistant V. cholerae O1. The in vitro minimum inhibitory concentration of the crude aqueous mixture and water soluble methanol extract, which was bactericidal against 10(7) CFU/mL of V. cholerae was determined to be 1,250 microg/mL and 850 microg/mL, respectively. The antibacterial activity of P. guajava was stable at 100 degrees C for 15-20 min, suggesting nonprotein nature of the active component. The growth of V. cholerae in rice oral rehydration saline (ORS) was completely inhibited when 10 mg/mL (wt/vol) of crude aqueous mixture was premixed with the ORS in a ratio of 1:7 (vol. extract/vol. ORS). P. guajava, which is widely distributed in Bangladesh, thus offers great potential for use in indigenous, herbal medicine for controlling epidemics of cholera.

[An evaluation of the 4 years of the Oral Rehydration Service of the Hospital Infantil de Monterrey].

PubMed

Muraira-Gutiérrez, A; Méndez-Jara, A; Ruiz-Villalpando, G

1992-06-01

At four years of being founded the Service of Oral Hydration from Hospital Infantil de Monterrey, we carried out this investigation to know its productivity, to determine costs of internments, death rates due to diarrhea and dehydration in the hospital and at a State level. The statistics from the hospital were revised in the previous and subsequent years to the institution of the Service in September of 1986, so as the statistics of death due to diarrhea from the State Health Department. The cases attended were 12,139, from which 9,024 belonged to plan A, 2,983 to plan B and 72 to plan C. Three hundred (300) doctors were trained and nine (9) research studies were accomplished. A decrease was achieved from the hospital rate admission by diarrhea and dehydration, throw the oral dehydration therapy in a 66%, the mortality rate was reduced 72% and an expenditure of $619,243,480.00 pesos in drugs and auxiliary examinations of diagnostic was avoided. At a State level the general death rate due to diarrhea got a cutdown of 13.1 to 5.8, and in infants under a year old decreased from 275 to 122.3. The oral hydration therapy applied in the State seems to be the main reason in that results.

Acoustical, morphological and optical properties of oral rehydration salts (ORS)

NASA Astrophysics Data System (ADS)

George, Preetha Mary; Jayakumar, S.; Divya, P.; Subhashree, N. S.; Ahmed, M. Anees

2015-06-01

Ultrasonic velocity, density and viscosity were measured in different concentrations of oral rehydration salts (ORS) at room temperature 303 k. From the experimental data other related thermodynamic parameters, viz adiabatic compressibility, intermolecular free length, acoustic impedence, relaxation time are calculated. The experimental data were discussed in the light of molecular interaction existing in the liquid mixtures. The results have been discussed in terms of solute-solvent interaction between the components. Structural characterization is important for development of new material. The morphology, structure and grain size of the samples are investigated by SEM. The optical properties of the sample have been studied using UV Visible spectroscopy.

Multi-school collaboration to develop and test nutrition computer modules for pediatric residents.

PubMed

Roche, Patricia L; Ciccarelli, Mary R; Gupta, Sandeep K; Hayes, Barbara M; Molleston, Jean P

2007-09-01

The provision of essential nutrition-related content in US medical education has been deficient, despite efforts of the federal government and multiple professional organizations. Novel and efficient approaches are needed. A multi-department project was developed to create and pilot a computer-based compact disc instructional program covering the nutrition topics of oral rehydration therapy, calcium, and vitamins. Funded by an internal medical school grant, the content of the modules was written by Department of Pediatrics faculty. The modules were built by School of Informatics faculty and students, and were tested on a convenience sampling of 38 pediatric residents in a randomized controlled trial performed by a registered dietitian/School of Health and Rehabilitation Sciences Master's degree candidate. The modules were reviewed for content by the pediatric faculty principal investigator and the registered dietitian/School of Health and Rehabilitation Sciences graduate student. Residents completed a pretest of nutrition knowledge and attitude toward nutrition and Web-based instruction. Half the group was given three programs (oral rehydration therapy, calcium, and vitamins) on compact disc for study over 6 weeks. Both study and control groups completed a posttest. Pre- and postintervention objective test results in study vs control groups and attitudinal survey results before and after intervention in the study group were compared. The experimental group demonstrated significantly better posttrial objective test performance compared to the control group (P=0.0005). The study group tended toward improvement, whereas the control group performance declined substantially between pre- and posttests. Study group resident attitudes toward computer-based instruction improved. Use of these computer modules prompted almost half of the residents in the study group to independently pursue relevant nutrition-related information. This inexpensive, collaborative, multi-department effort to design a computer-based nutrition curriculum positively impacted both resident knowledge and attitudes.

Lactase persistence and augmented salivary alpha-amylase gene copy numbers might have been selected by the combined toxic effects of gluten and (food born) pathogens.

PubMed

Pruimboom, Leo; Fox, Tom; Muskiet, Frits A J

2014-03-01

Various positively selected adaptations to new nutrients have been identified. Lactase persistence is among the best known, conferring the ability for drinking milk at post weaning age. An augmented number of amylase gene (AMY1) copies, giving rise to higher salivary amylase activity, has been implicated in the consumption of starch-rich foods. Higher AMY1 copy numbers have been demonstrated in populations with recent histories of starchy-rich diets. It is however questionable whether the resulting polymorphisms have exerted positive selection only by providing easily available sources of macro and micronutrients. Humans have explored new environments more than any other animal. Novel environments challenge the host, but especially its immune system with new climatic conditions, food and especially pathogens. With the advent of the agricultural revolution and the concurrent domestication of cattle came new pathogens. We contend that specific new food ingredients (e.g., gluten) and novel pathogens drove selection for lactase persistence and higher AMY gene copy numbers. Both adaptations provide ample glucose for activating the sodium glucose-dependent co-transporter 1 (SGLT1), which is the principal glucose, sodium and water transporter in the gastro-intestinal tract. Their rapid uptake confers protection against potentially lethal dehydration, hyponatremia and ultimately multiple organ failure. Oral rehydration therapy aims at SGLT1 activity and is the current treatment of choice for chronic diarrhoea and vomiting. We hypothesize that lifelong lactase activity and rapid starch digestion should be looked at as the evolutionary covalent of oral rehydration therapy. Copyright © 2014 Elsevier Ltd. All rights reserved.

Travellers' diarrhoea.

PubMed

Ericsson, Charles D

2003-02-01

Risk of travellers' diarrhoea is about 7% in developed countries and 20-50% in the developing world. Options for prevention include education and chemoprophylaxis. Vaccination is a promising but incomplete option. Achieving behaviour modification of food and water choices among tourists is difficult. Bismuth subsalicylate (BSS)-containing compounds are about 62% effective in the prevention of travellers' diarrhoea. Antibiotics are about 84% effective in preventing travellers' diarrhoea. Routine prophylaxis of travellers' diarrhoea, especially with antibiotics, should be discouraged. Oral rehydration is generally important in the treatment of diarrhoea, but travellers' diarrhoea is only infrequently dehydrating in adults. The addition of oral rehydration solutions confers no additional benefit to loperamide in the treatment of travellers' diarrhoea in adults. Presently, the most active of the antibiotics routinely available for treatment are members of the fluoroquinolone group. Antibiotics that are not absorbed such as aztreonam and a rifampicin-like agent, rifaximin, are both effective. The latter might become a therapy of choice once it is routinely available, due to predictably less adverse reactions with a non-absorbed antibiotic. Preliminary results with azithromycin look very promising. Less severe disease can be treated with a variety of non-antibiotic agents (e.g. BSS-containing compounds, loperamide and a calmodulin inhibitor, zaldaride). The combination of an antibiotic and loperamide is superior to treatment with either agent alone in a several studies and is arguably the treatment of choice for distressing travellers' diarrhoea.

Burden of laboratory-confirmed Campylobacter infections in Guatemala 2008–2012: Results from a facility-based surveillance system

PubMed Central

Benoit, Stephen R.; Lopez, Beatriz; Arvelo, Wences; Henao, Olga; Parsons, Michele B.; Reyes, Lissette; Moir, Juan Carlos; Lindblade, Kim

2015-01-01

Introduction Campylobacteriosis is one of the leading causes of gastroenteritis worldwide. This study describes the epidemiology of laboratory-confirmed Campylobacter diarrheal infections in two facility-based surveillance sites in Guatemala. Methods Clinical, epidemiologic, and laboratory data were collected on patients presenting with acute diarrhea from select healthcare facilities in the departments of Santa Rosa and Quetzaltenango, Guatemala, from January 2008 through August 2012. Stool specimens were cultured for Campylobacter and antimicrobial susceptibility testing was performed on a subset of isolates. Multidrug resistance (MDR) was defined as resistance to ≥3 antimicrobial classes. Results Campylobacter was isolated from 306 (6.0%) of 5137 stool specimens collected. For children <5 years of age, annual incidence was as high as 1288.8 per 100,000 children in Santa Rosa and 185.5 per 100,000 children in Quetzaltenango. Among 224 ambulatory care patients with Campylobacter, 169 (75.5%) received metronidazole or trimethoprim-sulfamethoxazole, and 152 (66.7%) received or were prescribed oral rehydration therapy. Antimicrobial susceptibilities were tested in 96 isolates; 57 (59.4%) were resistant to ciprofloxacin and 12 (12.5%) were MDR. Conclusion Campylobacter was a major cause of diarrhea in children in two departments in Guatemala; antimicrobial resistance was high, and treatment regimens in the ambulatory setting which included metronidazole and trimethoprim-sulfamethoxazole and lacked oral rehydration were sub-optimal. PMID:24534336

Burden of laboratory-confirmed Campylobacter infections in Guatemala 2008-2012: results from a facility-based surveillance system.

PubMed

Benoit, Stephen R; Lopez, Beatriz; Arvelo, Wences; Henao, Olga; Parsons, Michele B; Reyes, Lissette; Moir, Juan Carlos; Lindblade, Kim

2014-03-01

Campylobacteriosis is one of the leading causes of gastroenteritis worldwide. This study describes the epidemiology of laboratory-confirmed Campylobacter diarrheal infections in two facility-based surveillance sites in Guatemala. Clinical, epidemiologic, and laboratory data were collected on patients presenting with acute diarrhea from select healthcare facilities in the departments of Santa Rosa and Quetzaltenango, Guatemala, from January 2008 through August 2012. Stool specimens were cultured for Campylobacter and antimicrobial susceptibility testing was performed on a subset of isolates. Multidrug resistance (MDR) was defined as resistance to ≥3 antimicrobial classes. Campylobacter was isolated from 306 (6.0%) of 5137 stool specimens collected. For children <5 years of age, annual incidence was as high as 1288.8 per 100,000 children in Santa Rosa and 185.5 per 100,000 children in Quetzaltenango. Among 224 ambulatory care patients with Campylobacter, 169 (75.5%) received metronidazole or trimethoprim-sulfamethoxazole, and 152 (66.7%) received or were prescribed oral rehydration therapy. Antimicrobial susceptibilities were tested in 96 isolates; 57 (59.4%) were resistant to ciprofloxacin and 12 (12.5%) were MDR. Campylobacter was a major cause of diarrhea in children in two departments in Guatemala; antimicrobial resistance was high, and treatment regimens in the ambulatory setting which included metronidazole and trimethoprim-sulfamethoxazole and lacked oral rehydration were sub-optimal. Published by Elsevier Ltd.

Control of deaths from diarrheal disease in rural communities: II. Motivating and monitoring the community.

PubMed

Kielmann, A A; Nagaty, A; Ajello, C A

1986-03-01

In 1980 the Ministry of Health of Egypt undertook a short term investigation into means and methods to reduce the annually excessive number of preschool child deaths from Diarrheal Disease. This investigation sought to identify ways to overcome constraints related to logistics, supplies, and community participation. The unifying theme of this study was to examine the feasibility of stressing Oral Rehydration Therapy (ORT) instead of the then conventional parenteral treatment and heavy use of antibiotics. Study cells were arranged to test feasibility of placing responsibility for the intervention primarily with rural mothers, secondly with itinerant nurses. Appropriate health education programs, revised supervision and data collection systems were developed and implemented. Results limited to mortality indicators demonstrating that mothers could affect a significant decrease in the diarrhea-specific death rate were reported in an earlier paper. In this paper a more comprehensive presentation of various survey data associated with the investigation are presented. These data show that mothers were indeed able to recognize diarrheal disease and institute early and effective treatment, and that they developed remarkable skills of preparing safe oral rehydration fluids from home supplies of sugar and salt. In addition, the data show that health service staff increasingly gained confidence in ORT as demonstrated by increasing rates of utilization of the method, and as mothers indicated ORT to be the preferred method of treatment of diarrheal disease.

Acoustical, morphological and optical properties of oral rehydration salts (ORS)

DOE Office of Scientific and Technical Information (OSTI.GOV)

George, Preetha Mary, E-mail: preethageoti@gmail.com, E-mail: jayakumars030@gmail.com; Divya, P.; Jayakumar, S., E-mail: preethageoti@gmail.com, E-mail: jayakumars030@gmail.com

Ultrasonic velocity, density and viscosity were measured in different concentrations of oral rehydration salts (ORS) at room temperature 303 k. From the experimental data other related thermodynamic parameters, viz adiabatic compressibility, intermolecular free length, acoustic impedence, relaxation time are calculated. The experimental data were discussed in the light of molecular interaction existing in the liquid mixtures. The results have been discussed in terms of solute-solvent interaction between the components. Structural characterization is important for development of new material. The morphology, structure and grain size of the samples are investigated by SEM. The optical properties of the sample have been studied usingmore » UV Visible spectroscopy.« less

Treating foodborne illness.

PubMed

Steiner, Theodore

2013-09-01

In healthy adults and children in developed countries, most foodborne and water-borne infections are short-lived and resolve without specific treatment. In developing areas, these infections may produce acute mortality and chronic morbidity caused by developmental impairment. Immune-compromised hosts are at increased risk of life-threatening complications. This article reviews recommendations for the treatment of the most common and important foodborne illnesses, focusing on those caused by infections or toxins of microbial origin. The cornerstone of life-saving treatment remains oral rehydration therapy, although the use of other supportive measures as well as antibiotics for certain infections is also recommended. Copyright © 2013 Elsevier Inc. All rights reserved.

Diarrhea and the social marketing of oral rehydration salts in Bangladesh.

PubMed

Green, E C

1986-01-01

An anthropological study of knowledge, attitudes and practices relating to child diarrhea and specifically to ORS was carried out in Bangladesh. The purpose of the study was to help design a culturally-sensitive social marketing program. Information was gathered on indigenous classification of diarrheas, patterns of therapy recourse and diarrhea management, and understanding of dehydration symptoms as well as use and attitudes regarding ORS. Among the findings were that 58% of households sampled had tried ORS at least once; ORS was perceived as a medicine with several positive attributes; literacy was positively related to ORS use; and there were no significant cultural barriers to ORS adoption.

Rapid versus standard intravenous rehydration in paediatric gastroenteritis: pragmatic blinded randomised clinical trial

PubMed Central

Parkin, Patricia C; Willan, Andrew R; Schuh, Suzanne

2011-01-01

Objective To determine if rapid rather than standard intravenous rehydration results in improved hydration and clinical outcomes when administered to children with gastroenteritis. Design Single centre, two arm, parallel randomised pragmatic controlled trial. Blocked randomisation stratified by site. Participants, caregivers, outcome assessors, investigators, and statisticians were blinded to the treatment assignment. Setting Paediatric emergency department in a tertiary care centre in Toronto, Canada. Participants 226 children aged 3 months to 11 years; complete follow-up was obtained on 223 (99%). Eligible children were aged over 90 days, had a diagnosis of dehydration secondary to gastroenteritis, had not responded to oral rehydration, and had been prescribed intravenous rehydration. Children were excluded if they weighed less than 5 kg or more than 33 kg, required fluid restriction, had a suspected surgical condition, or had an insurmountable language barrier. Children were also excluded if they had a history of a chronic systemic disease, abdominal surgery, bilious or bloody vomit, hypotension, or hypoglycaemia or hyperglycaemia. Interventions Rapid (60 mL/kg) or standard (20 mL/kg) rehydration with 0.9% saline over an hour; subsequent fluids administered according to protocol. Main outcome measures Primary outcome: clinical rehydration, assessed with a validated scale, two hours after the start of treatment. Secondary outcomes: prolonged treatment, mean clinical dehydration scores over the four hour study period, time to discharge, repeat visits to emergency department, adequate oral intake, and physician’s comfort with discharge. Data from all randomised patients were included in an intention to treat analysis. Results 114 patients were randomised to rapid rehydration and 112 to standard. One child was withdrawn because of severe hyponatraemia at baseline. There was no evidence of a difference between the rapid and standard rehydration groups in the proportions of participants who were rehydrated at two hours (41/114 (36%) v 33/112 (30%); difference 6.5% (95% confidence interval −5.7% to 18.7%; P=0.32). The results did not change after adjustment for weight, baseline dehydration score, and baseline pH (odds ratio 1.8, 0.90 to 3.5; P=0.10). The rates of prolonged treatment were similar (52% rapid v 43% standard; difference 8.9%, 21% to −5%; P=0.19). Although dehydration scores were similar throughout the study period (P=0.96), the median time to discharge was longer in the rapid group (6.3 v 5.0 hours; P=0.03). Conclusions There are no relevant clinical benefits from the administration of rapid rather than standard intravenous rehydration to haemodynamically stable children deemed to require intravenous rehydration. Trail registration Clinical Trials NCT00392145. PMID:22094316

Modelling the cost of community interventions to reduce child mortality in South Africa using the Lives Saved Tool (LiST).

PubMed

Nkonki, Lungiswa Ll; Chola, Lumbwe L; Tugendhaft, Aviva A; Hofman, Karen K

2017-08-28

To estimate the costs and impact on reducing child mortality of scaling up interventions that can be delivered by community health workers at community level from a provider's perspective. In this study, we used the Lives Saved Tool (LiST), a module in the spectrum software. Within the spectrum software, LiST interacts with other modules, the AIDS Impact Module, Family Planning Module and Demography Projections Module (Dem Proj), to model the impact of more than 60 interventions that affect cause-specific mortality. DemProj Based on National South African Data. A total of nine interventions namely, breastfeeding promotion, complementary feeding, vitamin supplementation, hand washing with soap, hygienic disposal of children's stools, oral rehydration solution, oral antibiotics for the treatment of pneumonia, therapeutic feeding for wasting and treatment for moderate malnutrition. Reducing child mortality. A total of 9 interventions can prevent 8891 deaths by 2030. Hand washing with soap (21%) accounts for the highest number of deaths prevented, followed by therapeutic feeding (19%) and oral rehydration therapy (16%). The top 5 interventions account for 77% of all deaths prevented. At scale, an estimated cost of US$169.5 million (US$3 per capita) per year will be required in community health worker costs. The use of community health workers offers enormous opportunities for saving lives. These programmes require appropriate financial investments. Findings from this study show what can be achieved if concerted effort is channelled towards the identified set of life-saving interventions. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Rice solution and World Health Organization solution by gastric infusion for high stool output diarrhea.

PubMed

Mota-Hernández, F; Bross-Soriano, D; Pérez-Ricardez, M L; Velásquez-Jones, L

1991-08-01

We sought to determine the efficacy of three different types of treatment in children with acute diarrhea who, during the oral rehydration period, had high stool output (greater than 10 mL/kg per hour). Sixty-six children, aged 1 to 18 months, with an average stool output of 22.6 mL/kg per hour were randomly distributed into three groups: group 1 received a rice flour solution, group 2 received the World Health Organization rehydration solution by gastric infusion, and group 3 continued to receive this solution orally. In all three groups, a decrease in stool output was observed, with the higher decrease observed in group 1 patients. Such a decrease facilitated rehydration of all 22 patients in group 1 (100%) in 3.3 +/- 1.5 hours, 16 (73%) in group 2 in 4.3 +/- 2.1 hours, and 15 (69%) in group 3 in 4.9 +/- 2.0 hours. No complications were observed. These data indicate that the rice flour solution is effective in children with high stool output diarrhea.

Emergency department treatment of viral gastritis using intravenous ondansetron or dexamethasone in children.

PubMed

Stork, Christine M; Brown, Kathleen M; Reilly, Tracey H; Secreti, LaLaina; Brown, Lawrence H

2006-10-01

To compare the efficacy of intravenous ondansetron or dexamethasone compared with intravenous fluid therapy alone in children presenting to the emergency department with refractory vomiting from viral gastritis who had failed attempts at oral hydration. This double-blind, randomized, controlled trial was performed in a tertiary care pediatric emergency department. Children aged 6 months to 12 years presenting with more than three episodes of vomiting in the past 24 hours, mild/moderate dehydration, and failed oral hydration were included. Patients with other medical causes were excluded. Subjects were randomized to dexamethasone 1 mg/kg (15 mg maximum), ondansetron 0.15 mg/kg, or placebo (normal saline [NS], 10 mL). All subjects also received intravenous NS at 10-20 mL/kg/hr. Oral fluid tolerance was evaluated at two and four hours. Those not tolerating oral fluids at four hours were admitted. Discharged patients were evaluated at 24 and 72 hours for vomiting and repeat health care visits. The primary study outcome was hospitalization rates between the groups. Data were analyzed using chi-square test, Kruskal-Wallis test, Mantel-Haenszel test, and analysis of variance, with p < 0.05 considered significant. A total of 166 subjects were enrolled; data for analysis were available for 44 NS-treated patients, 46 ondansetron-treated patients, and 47 dexamethasone-treated patients. Hospital admission occurred in nine patients (20.5%) receiving placebo (NS alone), two patients (4.4%) receiving ondansetron, and seven patients (14.9%) receiving dexamethasone, with ondansetron significantly different from placebo (p = 0.02). Similarly, at two hours, more ondansetron-treated patients (39 [86.6%]) tolerated oral hydration than NS-treated patients (29 [67.4%]; relative risk, 1.28; 95% confidence interval = 1.02 to 1.68). There were no differences in number of mean episodes of vomiting or repeat visits to health care at 24 and 72 hours in the ondansetron, dexamethasone, or NS groups. In children with dehydration secondary to vomiting from acute viral gastritis, ondansetron with intravenous rehydration improves tolerance of oral fluids after two hours and reduces the hospital admission rate when compared with intravenous rehydration with or without dexamethasone.

Mobilizing the private sector. Indonesia.

PubMed

Ferraz-tabor, L

1993-12-01

The national diarrheal disease control program has made progress against diarrheal illness in Indonesia, but diarrhea still accounts for 130,000 deaths of under-5 year olds annually. The potential of the private sector had been virtually untapped until the PRITECH Project designed and implemented a private sector based program to complement government efforts to reduce childhood morbidity and mortality related to diarrhea. PRITECH wanted to motivate commercial firms to invest the capital necessary to commercialize oral rehydration salts (ORS) so that program self-sufficiency would be maximized over the long term without depending upon donor support. Sections describe the lack of commercial sector ORS promotion, supply and demand factors, raising interest in ORS, conditions for change, the potential market for ORS, demand, production capacity, previous collaborative efforts, areas for improvement, PRITECH's role as catalyst, coordination with commercial companies, marketing workshops, collaboration with the Indonesian Medical Association, the handwashing campaign, and program impact. Although the program has been in place for just 1 year, sales of ORS have increased along with the degree of sustainable collaboration among local institutions. The author stresses that for the model to be successfully replicated elsewhere, the government, medical and pediatric associations, the World Health Organization, UNICEF, groups which can promote oral rehydration therapy, and opinion leaders in the medical community must be involved. Finally, note is made that the image of ORS must be improved and that the work of the public and commercial sectors can be complementary.

Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial.

PubMed

Freedman, Stephen B; Willan, Andrew R; Boutis, Kathy; Schuh, Suzanne

2016-05-10

Gastroenteritis is a common pediatric illness. Electrolyte maintenance solution is recommended to treat and prevent dehydration. Its advantage in minimally dehydrated children is unproven. To determine if oral hydration with dilute apple juice/preferred fluids is noninferior to electrolyte maintenance solution in children with mild gastroenteritis. Randomized, single-blind noninferiority trial conducted between the months of October and April during the years 2010 to 2015 in a tertiary care pediatric emergency department in Toronto, Ontario, Canada. Study participants were children aged 6 to 60 months with gastroenteritis and minimal dehydration. Participants were randomly assigned to receive color-matched half-strength apple juice/preferred fluids (n=323) or apple-flavored electrolyte maintenance solution (n=324). Oral rehydration therapy followed institutional protocols. After discharge, the half-strength apple juice/preferred fluids group was administered fluids as desired; the electrolyte maintenance solution group replaced losses with electrolyte maintenance solution. The primary outcome was a composite of treatment failure defined by any of the following occurring within 7 days of enrollment: intravenous rehydration, hospitalization, subsequent unscheduled physician encounter, protracted symptoms, crossover, and 3% or more weight loss or significant dehydration at in-person follow-up. Secondary outcomes included intravenous rehydration, hospitalization, and frequency of diarrhea and vomiting. The noninferiority margin was defined as a difference between groups of 7.5% for the primary outcome and was assessed with a 1-sided α=.025. If noninferiority was established, a 1-sided test for superiority was conducted. Among 647 randomized children (mean age, 28.3 months; 331 boys [51.1%]; 441 (68.2%) without evidence of dehydration), 644 (99.5%) completed follow-up. Children who were administered dilute apple juice experienced treatment failure less often than those given electrolyte maintenance solution (16.7% vs 25.0%; difference, -8.3%; 97.5% CI, -∞ to -2.0%; P < .001 for inferiority and P = .006 for superiority). Fewer children administered apple juice/preferred fluids received intravenous rehydration (2.5% vs 9.0%; difference, -6.5%; 99% CI, -11.6% to -1.8%). Hospitalization rates and diarrhea and vomiting frequency were not significantly different between groups. Among children with mild gastroenteritis and minimal dehydration, initial oral hydration with dilute apple juice followed by their preferred fluids, compared with electrolyte maintenance solution, resulted in fewer treatment failures. In many high-income countries, the use of dilute apple juice and preferred fluids as desired may be an appropriate alternative to electrolyte maintenance fluids in children with mild gastroenteritis and minimal dehydration. clinicaltrials.gov Identifier: NCT01185054.

Dehydration enhances pain-evoked activation in the human brain compared with rehydration.

PubMed

Ogino, Yuichi; Kakeda, Takahiro; Nakamura, Koji; Saito, Shigeru

2014-06-01

Negative effects of dehydration on the human brain and cognitive function have been reported. In this study, we examined the effects of dehydration on pain thresholds and cortical activations in response to pain, compared with rehydration with an oral rehydration solution (ORS) by functional magnetic resonance imaging. Five healthy adult men were subjected to dehydration and rehydration on 2 different days. The condition on the first day was randomly assigned to each subject. They completed a 40-minute exercise protocol using a walking machine after 12 hours of fasting under both conditions. For rehydration, the subjects consumed up to 3000 mL ORS starting from the night before the test day. After exercise, a painful stimulus (cold pressor test) was applied to the subjects' medial forearm in a magnetic resonance imaging scanning gantry, and pain-evoked brain activation was analyzed. On the rehydration day, each of the subjects consumed an average of 2040 mL (range; 1800-2500 mL) ORS. Physiological data revealed that subjects when dehydrated lost more weight from exercise than subjects when rehydrated had a larger heart rate increase, a higher tympanic temperature, and a higher urine osmolality. Subjective data revealed that the subjects reported significantly stronger thirst while dehydrated than while rehydrated with ORS, although the levels of hunger and anxiety and mood did not significantly differ between conditions. The cold pressor test robustly activated the pain-related neural network, notably the anterior cingulate cortex, insula, and thalamus. Such activations in the dehydrated subjects were greater than those in the rehydrated subjects in terms of peak and cluster, accompanied by a decrease in pain threshold (P = 0.001). Our findings suggest that dehydration brings about increased brain activity related to painful stimuli together with enhanced thirst, whereas rehydration with ORS alleviates thirst and decreases brain activity related to painful stimuli.

Management of Burn Injuries in the Wilderness: Lessons from Low-Resource Settings.

PubMed

Bitter, Cindy C; Erickson, Timothy B

2016-12-01

Burns are a common source of injuries worldwide, with a high burden of disease in low- and middle-income countries. Burns also account for 2%-8% of wilderness injuries. Although many are minor, the potential for serious morbidity and mortality exists, and standard treatments used in high-resource settings are not readily available in the backcountry. A literature review was performed to find evidence from low-resource settings that supports alternative or improvised therapies that may be adapted to care of burns in the wilderness. There is good evidence for use of oral rehydration to support volume status in burn patients. There is moderate evidence to support cold therapy as first aid and adjunct for pain control. Some evidence supports use of alternative dressings such as boiled potato peel, banana leaf, aloe vera, honey, sugar paste, and papaya when standard therapies are not available. Copyright © 2016 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Antibiotic Adjuvants: Diverse Strategies for Controlling Drug-Resistant Pathogens

PubMed Central

Gill, Erin E; Franco, Octavio L; Hancock, Robert E W

2015-01-01

The growing number of bacterial pathogens that are resistant to numerous antibiotics is a cause for concern around the globe. There have been no new broad-spectrum antibiotics developed in the last 40 years, and the drugs we have currently are quickly becoming ineffective. In this article, we explore a range of therapeutic strategies that could be employed in conjunction with antibiotics and may help to prolong the life span of these life-saving drugs. Discussed topics include antiresistance drugs, which are administered to potentiate the effects of current antimicrobials in bacteria where they are no longer (or never were) effective; antivirulence drugs, which are directed against bacterial virulence factors; host-directed therapies, which modulate the host's immune system to facilitate infection clearance; and alternative treatments, which include such therapies as oral rehydration for diarrhea, phage therapy, and probiotics. All of these avenues show promise for the treatment of bacterial infections and should be further investigated to explore their full potential in the face of a postantibiotic era. PMID:25393203

Antimalarial Activity of Orally Administered Curcumin Incorporated in Eudragit®-Containing Liposomes.

PubMed

Martí Coma-Cros, Elisabet; Biosca, Arnau; Lantero, Elena; Manca, Maria Letizia; Caddeo, Carla; Gutiérrez, Lucía; Ramírez, Miriam; Borgheti-Cardoso, Livia Neves; Manconi, Maria; Fernàndez-Busquets, Xavier

2018-05-04

Curcumin is an antimalarial compound easy to obtain and inexpensive, having shown little toxicity across a diverse population. However, the clinical use of this interesting polyphenol has been hampered by its poor oral absorption, extremely low aqueous solubility and rapid metabolism. In this study, we have used the anionic copolymer Eudragit ® S100 to assemble liposomes incorporating curcumin and containing either hyaluronan (Eudragit-hyaluronan liposomes) or the water-soluble dextrin Nutriose ® FM06 (Eudragit-nutriosomes). Upon oral administration of the rehydrated freeze-dried nanosystems administered at 25/75 mg curcumin·kg −1 ·day −1 , only Eudragit-nutriosomes improved the in vivo antimalarial activity of curcumin in a dose-dependent manner, by enhancing the survival of all Plasmodium yoelii -infected mice up to 11/11 days, as compared to 6/7 days upon administration of an equal dose of the free compound. On the other hand, animals treated with curcumin incorporated in Eudragit-hyaluronan liposomes did not live longer than the controls, a result consistent with the lower stability of this formulation after reconstitution. Polymer-lipid nanovesicles hold promise for their development into systems for the oral delivery of curcumin-based antimalarial therapies.

[The determinants of the low case fatality rate of the cholera epidemic in the Littoral department of Benin in 2008].

PubMed

Gbary, Akpa Raphaël; Sossou, Roch Aristide; Dossou, Jean-Paul; Mongbo, Virginie; Massougbodji, Achille

2011-01-01

The 2008 cholera outbreak in Benin was characterized by a low case fatality rate (0.39 p.100) in the Littoral department, where 502 cases were recorded between July and December. The aim of this study was to identify the key factors associated with the low case fatality rate within the department. The cross-sectional, descriptive and analytical study conducted as part of this research used 404 patient records, focus group discussions with ten former patients, in-depth interviews with 8 health authorities involved in the response and structured face-to-face interviews with 12 health personnel involved in the treatment of patients. The data were analyzed using qualitative and quantitative content analysis based on EPIINFO 3.3.2 and EXCEL 2007 software. The results from several sources were cross-checked through triangulation. The mean age of patients was 23.72 ± 14.8 years. 39.35% patients were admitted with severe dehydration. Oral rehydration, intravenous rehydration and antibiotic therapy were given to 99.5%, 85% and 97.77% of patients, respectively. Only one hospital death was noted. The low case fatality rate was mainly due to the following factors: the high quality of care provided in a center with qualified personnel and available and free of charge treatment kits, protocols based on massive rehydration and appropriate hygiene measures, and patient compliance with the treatment plan. The response was also characterized by good coordination, wide mass and local health promotion, and selective antibiotic prophylaxis, which contributed significantly to reducing the spread of the infection.

Brazilian popular healers as effective promoters of oral rehydration therapy (ORT) and related child survival strategies.

PubMed

Nations, M K; de Sousa, M A; Correia, L L; da Silva, D M

1988-01-01

In Ceara State in northeastern Brazil in 1986 infant mortality reached 110-139 per 1000 live births, and 50% of those deaths were due to diarrhea and dehydration. Diarrheal deaths can be prevented by oral rehydration therapy (ORT), which replaces lost fluids and electrolytes with oral rehydration salts (ORS) and water. ORT was known in the 1830s, but only in the 1960s was the importance of sugar, which increases the body's ability to absorb fluid some 25 times, realized. In northeastern Brazil access to ORT has been severely limited by poverty, official incompetence, and bureaucratic restrictions. In 1984 a 2-year research project was initiated in the village of Pacatuba to test the theory that mobilizing and training popular healers in ORT would 1) increase awareness and use of ORS, 2) promote continued feeding during diarrhea, 3) increase breast feeding, and 4) reduce the use of costly and nonindicated drugs. 46 popular healers, including rezadeiras and oradores (prayers), Umbandistas (priests), espiritas (mediums), an herbalist, and a lay doctor, were recruited and trained. Most of these people practiced a mixture of folk medicine and religion and were highly respected in the community. For purposes of survey, Pacatuba was divided into 3 groups, each containing houses at 4 different income levels. The mothers in 204 Group 1 homes were interviewed concerning ORT and diarrhea-related knowledge before intervention, and 226 households in Group 2 were interviewed after intervention. The healers were taught the basic biomedical concept of rehydration and how to mix the ORS -- 7 bottle cap-fulls of sugar and 1 of salt in a liter of unsweetened traditional tea. The healers were also taught how to use the World Health Organization's (WHO) ORS packets (2% glucose, 90 mmol/1 of sodium chloride, 1.5 gm potassium chloride, and 2.9 gm sodium bicarbonate) for cases of moderate to severe dehydration. In addition, the healers were taught the 5 basic health messages: give ORS-tea for diarrhea and dehydration (or any similar folk illness, such as evil eye, fallen fontanelle), continue feeding, encourage breast feeding, eliminate drugs, and ask people to seek the healer quickly at the onset of diarrhea. The healers continued to perform all the popular rites and prayers traditionally associated with curing diarrhea. The healers distributed approximately 7400 liters of ORS-tea in 12 months at a unit cost of 48 cents (US). A post-intervention survey of diarrhea-related knowledge was then carried out among the 226 Group 2 households. Before the intervention 2.9% of the mothers knew about ORS; 71.2% did afterward. All of the healers demonstrated that they knew exactly how to mix the ORS-tea. Knowledge of the WHO packets also increased. The number of mothers who continued feeding their children during diarrhea increased to 92%. Following the introduction of the ORS-tea, purchases of the more costly WHO packets and other commercial medications and antibiotics fell off significantly. The people's belief in folk etiologies remained unchanged, showing that traditional healers can be successfully integrated into an effective health care program. The success rate of the ORT program in Pacatuba, carried out entirely by word of mouth, compares favorably with expensive mass media campaigns other places.

Community Mortality from Cholera: Urban and Rural Districts in Zimbabwe

PubMed Central

Morof, Diane; Cookson, Susan T.; Laver, Susan; Chirundu, Daniel; Desai, Sarika; Mathenge, Penninah; Shambare, Donald; Charimari, Lincoln; Midzi, Stanley; Blanton, Curtis; Handzel, Thomas

2013-01-01

In 2008–2009, Zimbabwe experienced an unprecedented cholera outbreak with more than 4,000 deaths. More than 60% of deaths occurred at the community level. We conducted descriptive and case–control studies to describe community deaths. Cases were in cholera patients who died outside health facilities. Two surviving cholera patients were matched by age, time of symptom onset, and location to each case-patient. Proxies completed questionnaires regarding mortality risk factors. Cholera awareness and importance of rehydration was high but availability of oral rehydration salts was low. A total of 55 case-patients were matched to 110 controls. The odds of death were higher among males (adjusted odd ratio [AOR] = 5.00, 95% confidence interval [CI] = 1.54–14.30) and persons with larger household sizes (AOR = 1.21, 95% CI = 1.00–1.46). Receiving home-based rehydration (AOR = 0.21, 95% CI = 0.06–0.71) and visiting cholera treatment centers (CTCs) (AOR = 0.07, 95% CI = 0.02–0.23) were protective. Receiving cholera information was associated with home-based rehydration and visiting CTCs. When we compared cases and controls who did not go to CTCs, males were still at increased odds of death (AOR = 5.00, 95% CI = 1.56–16.10) and receiving home-based rehydration (AOR = 0.14, 95% CI = 0.04–0.53) and being married (AOR = 0.26, 95% CI = 0.08–0.83) were protective. Inability to receive home-based rehydration or visit CTCs was associated with mortality. Community education must reinforce the importance of prompt rehydration and CTC referral. PMID:23400576

Breastfeeding promotion: the right start.

PubMed

Huffman, S

1989-09-01

A survey in Guatemala revealed that 50% of physicians did not know that breast milk provides protection against diarrhea or that it is also an important food after the 1st 6 months of life. Some countries (Indonesia, Thailand, Panama, and the US) have successfully trained health workers in the advantages of breast feeding, but not all training programs have incorporated techniques to help mothers to breast feed, e.g., how to prevent engorgement. Health workers need to show mothers the positioning of the infant which aids breast feeding. Further, some infants do not want to suck or suck ineffectively. Moreover many hospitals need to change their method of managing childbirth. Hospital workers should encourage immediate physical contact between mothers and babies after birth which facilitates breast feeding and babies are more likely to receive the protective colostrum. Similarly they should promote rooming in of newborns with their mothers. In addition, health workers should minimize analgesic use. They should also promote exclusive breast feeding and not give any glucose water or other supplements to newborns which, in addition to other reasons, sends the message that supplemental feedings are fine when indeed they contribute to diarrhea. Moreover, in oral rehydration therapy (ORT) units, oral rehydration solution (ORS) should be spoonfed to diarrhea patients and not given in bottles so mothers will not conclude that the medical community approves of bottle use. Health workers should encourage mothers to spoon feed ORS at home as well. Further, ORT units and inpatient intravenous units should encourage mothers to stay with their infants. Pediatricians should lead the way in promoting breast feeding.

Pyruvate in reduced osmolarity oral rehydration salt corrected lactic acidosis in sever scald rats.

PubMed

Liu, Rui; Wang, Shu-Ming; Li, Zong-Yu; Yu, Wen; Zhang, Hui-Ping; Zhou, Fang-Qiang

2018-06-01

A novel pyruvate-based oral rehydration salt (Pyr-ORS) was demonstrated of superiority over bicarbonate- or citrate-based one to preserve organ function and correct lactic acidosis in rehydration of lethal shock in animals. This study further compared these effects between low-osmolar Pyr-ORS and equimolar citrate-based counterpart. Eighty rats, using a fatal burn shock model, were randomized into four groups (two subgroups per group: n = 10): the sham group (group SR), Pyr-ORS group (group PR), WHO-ORS III group (group CR), and no rehydration group. ORS was delivered by manual gavage during 24 h following burns. Oral administration consisted of half of counted volume in the initial 8 h plus the rest in the later 16 h. Systemic hemodynamics, visceral organ surface blood flow, organ function, and metabolic acidosis were determined at 8 h and 24 h after burn. Another set of rats with identical surgical procedures without tests was observed for survival. Survival was markedly improved in the groups PR and CR; the former showed a higher survival rate than the latter at 24 h (40% versus 20%, P < 0.05). Systemic hemodynamics, visceral blood flow, and function of heart, liver, and kidney were greatly restored in group PR, compared with group CR (all P < 0.05). Hypoxic lactic acidosis was efficiently reversed in group PR, instead of group CR, (pH 7.36 versus 7.11, base excess 2.1 versus -9.1 mmol/L, lactate 4.28 versus 8.18 mmol/L; all P < 0.05) at 24 h after injury. Pyruvate was advantageous over citrate in low-osmolar ORS for protection of organs and survival; pyruvate, but not citrate, in the ORS corrected hypoxic lactic acidosis in rats subjected to lethal burn shock in 24 h. Copyright © 2018 Elsevier Inc. All rights reserved.

Management of acute gastroenteritis in healthy children in Lebanon - A national survey.

PubMed

Alameddine, Aouni; Mourad, Sawsan; Rifai, Nahida

2010-11-01

Acute gastroenteritis remains a common condition among infants and children throughout the world. In 1996, The American Academy of Pediatrics (AAP) revised its recommendations for the treatment of infants and children with acute gastroenteritis. The purpose of this survey was to determine how closely current treatment among Lebanese pediatricians compares with the AAP recommendations and to determine the impact of such management on the healthcare system. The outline of the study was based on a telephone questionnaire that addressed the management of healthy infants and children below five years of age with acute gastroenteritis complicated by mild to moderate dehydration. In addition, the costs of medical treatment and requested laboratory studies were calculated. A total of 238 pediatricians completed the questionnaire. Most pediatricians prescribed Oral Rehydration Solutions (ORS) for rehydration (92.4%), advised breastfeeding during acute gastroenteritis (81.5%), and avoided parenteral rehydration for mild to moderate dehydration (89.1%). In addition to ORS, oral fluids such as soda, juices, and rice water were allowed for rehydration by 43.7% of pediatricians. Thirty-one percent of pediatricians delayed re-feeding for more than 6 hours after initiation of rehydration. Only 32.8% of pediatricians kept their patients on regular full-strength formulas, and only 21.8% permitted full-calorie meals for their patients. 75.4% of pediatricians did not order any laboratory studies in cases of mild dehydration and 50.4% did not order any laboratory studies for moderate dehydration. Stool analysis and culture were ordered by almost half of the pediatricians surveyed. Seventy-seven percent prescribed anti-emetics, 61% prescribed probiotics, 26.3% prescribed antibiotics systematically and local antiseptic agents, 16.9% prescribed zinc supplements, and 11% percent prescribed antidiarrheal agents. Pediatricians in Lebanon are aware of the importance of ORS and the positive role of breastfeeding in acute gastroenteritis. However, they do not follow optimal recommendations from the AAP concerning nutrition, laboratory examinations and drug prescriptions. Consequently, this poses significant financial losses and economic burden.

Philippine campaign boosts child immunizations.

PubMed

Manuel-santana, R

1993-03-01

In 1989, USAID awarded the Philippines a 5-year, US $50 million Child Survival Program targeting improvement in immunization coverage of children, prenatal care coverage for pregnant women, and contraceptive prevalence. Upon successful completion of performance benchmarks at the end of each year, USAID released monies to fund child survival activities for the following year. This program accomplished a major program goal, which was decentralization of health planning. The Philippine Department of Health soon incorporated provincial health planning. The Philippine Department of Health soon incorporated provincial health planning in its determination of allocation of resources. Social marketing activities contributed greatly to success in achieving the goal of boosting the immunization coverage rate for the 6 antigens listed under the Expanded Program for Immunization (51%-85% of infants, 1986-1991). In fact, rural health officers in Tarlac Province in Central Luzon went from household to household to talk to mothers about the benefits of immunizing a 1-year-old child, thereby contributing greatly to their achieving a 95% full immunization coverage rate by December 1991. Social marketing techniques included modern marketing strategies and multimedia channels. They first proved successful in metro Manila which, at the beginning of the campaign, had the lowest immunization rate of all 14 regions. Every Wednesday was designated immunization day and was when rural health centers vaccinated the children. Social marketing also successfully publicized oral rehydration therapy (ORT), breast feeding, and tuberculosis control. Another contributing factor to program success in child survival activities was private sector involvement. For example, the Philippine Pediatric Society helped to promote ORT as the preferred treatment for acute diarrhea. Further, the commercial sector distributed packets of oral rehydration salts and even advertised its own ORT product. At the end of 2 years, the program had effectively spread to all 75 provinces.

Bolus fluid therapy and sodium homeostasis in paediatric gastroenteritis.

PubMed

Freedman, Stephen B; Geary, Denis F

2013-03-01

The study aims to assess the risk of developing hyponatraemia when large-volume bolus fluid rehydration therapy is administered. We conducted a prospective randomised study in a tertiary-care centre emergency department. Participants included children with gastroenteritis and dehydration requiring intravenous rehydration. They were randomised to receive 60 mL/kg (large) or 20 mL/kg (standard) 0.9% saline bolus followed by maintenance 0.9% saline for 3 h. Biochemical tests were performed at baseline and 4 h. The primary outcome measure was the development of hyponatraemia at 4 h. Secondary outcome measures were (i) change in sodium relative to baseline value; (ii) magnitude of decrease among those who experienced a decrease; (iii) risk of hypernatraemia; (iv) correlations between urine parameters and hyponatraemia; and (v) fluid overload. Eighty-four of 224 (38%) participants were hyponatraemic at baseline. At 4 h, 22% (48/217) had a dysnatraemia, and similar numbers of children were hyponatraemic in both groups: large (23% (26/112)) versus standard (21% (22/105)) (P = 0.69). Among initially hyponatraemic children, 63% (30/48) who received large-volume rehydration and 44% (15/34) of those administered standard rehydration were isonatraemic at 4 h (P = 0.10). Overall, children who received 60 mL/kg experienced a larger mean increase (1.6 ± 2.4 mEq/L vs. 0.9 ± 2.2 mEq/L; P = 0.04) and were less likely to experience a sodium decrease of ≥2 mEq/L (8/112 vs. 17/105; P = 0.04) than those administered 20 mL/kg. Large-volume bolus rehydration therapy with 0.9% saline is safe. It does not promote the development of hyponatraemia over the short term, but hastens the resolution of baseline hyponatraemia. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

[Cholera in children. A report of 8 cases].

PubMed

Lezama-Basulto, L A; Mota-Hernández, F; Bravo-Barrios, E

1993-11-01

Cholera is an acute intestinal infection caused by Vibrio cholerae 01. When an infected person presents severe dehydration and is not adequately treated, he or she will develop hypovolemic shock and eventually could died. There is scarce information concerning this disease in the Pediatric group. Herein we report on eight cases of Pediatric cholera, in children 17 month to four years of age. Seven patients out of eight were admitted presenting dehydration. Four presenting mild or moderate dehydration and three presenting hypovolemic shock. These three patients were rehydrated by intravenous route and thereafter the hydration was maintained by oral therapy. The outcome was uneventful in six patients. One patient developed abdominal distention probably due to hypopotassemia, and another patient presented hyponatremia and seizures. All the patients recovered within five days after admission.

Gastroenteritis: A Grass Root Approach.

ERIC Educational Resources Information Center

Dure-Samin, Akram; Mubina, Agboatwalla

1992-01-01

In Karachi, Pakistan, 4 resource personnel disseminated information about sanitation and breastfeeding in the prevention of gastroenteritis to 100 households. Compared to 100 that did not receive health information, the intervention group had less incidence of diarrhea and better use of oral rehydration salt. (SK)

Diarrhea Management Training in Early Childhood Settings.

ERIC Educational Resources Information Center

Winnail, Scott D.; Artz, Lynn M.; Geiger, Brian F.; Petri, Cynthia J.; Bailey, Rebecca; Mason, J.W.

2001-01-01

Addresses the health of young children and how to safely and effectively care for children with diarrhea in the home and in early child care settings. Discusses specific intervention and program activities, including specially designed materials for mixing homemade oral rehydration usage. (Author/SD)

Recombinant human hyaluronidase-enabled subcutaneous pediatric rehydration.

PubMed

Allen, Coburn H; Etzwiler, Lisa S; Miller, Melissa K; Maher, George; Mace, Sharon; Hostetler, Mark A; Smith, Sharon R; Reinhardt, Neil; Hahn, Barry; Harb, George

2009-11-01

The Increased Flow Utilizing Subcutaneously-Enabled (INFUSE)-Pediatric Rehydration Study was designed to assess efficacy, safety, and clinical utility of recombinant human hyaluronidase (rHuPH20)-facilitated subcutaneous rehydration in children 2 months to 10 years of age. Patients with mild/moderate dehydration requiring parenteral treatment in US emergency departments were eligible for this phase IV, multicenter, single-arm study. They received subcutaneous injection of 1 mL rHuPH20 (150 U), followed by subcutaneous infusion of 20 mL/kg isotonic fluid over the first hour. Subcutaneous rehydration was continued as needed for up to 72 hours. Rehydration was deemed successful if it was attributed by the investigator primarily to subcutaneous fluid infusion and the child was discharged without requiring an alternative method of rehydration. Efficacy was evaluated in 51 patients (mean age: 1.9 years; mean weight: 11.2 kg). Initial subcutaneous catheter placement was achieved with 1 attempt for 46/51 (90.2%) of patients. Rehydration was successful for 43/51 (84.3%) of patients. Five patients (9.8%) were hospitalized but deemed to be rehydrated primarily through subcutaneous therapy, for a total of 48/51 (94.1%) of patients. No treatment-related systemic adverse events were reported, but 1 serious adverse event occurred (cellulitis at infusion site). Investigators found the procedure easy to perform for 96% of patients (49/51 patients), and 90% of parents (43/48 parents) were satisfied or very satisfied. rHuPH20-facilitated subcutaneous hydration seems to be safe and effective for young children with mild/moderate dehydration. Subcutaneous access is achieved easily, and the procedure is well accepted by clinicians and parents.

Reducing deaths from diarrhoea through oral rehydration therapy.

PubMed Central

Victora, C. G.; Bryce, J.; Fontaine, O.; Monasch, R.

2000-01-01

In 1980, diarrhoea was the leading cause of child mortality, accounting for 4.6 million deaths annually. Efforts to control diarrhoea over the past decade have been based on multiple, potentially powerful interventions implemented more or less simultaneously. Oral rehydration therapy (ORT) was introduced in 1979 and rapidly became the cornerstone of programmes for the control of diarrhoeal diseases. We report on the strategy for controlling diarrhoea through case management, with special reference to ORT, and on the relationship between its implementation and reduced mortality. Population-based data on the coverage and quality of facility-based use of ORT are scarce, despite its potential importance in reducing mortality, especially for severe cases. ORT use rates during the 1980s are available for only a few countries. An improvement in the availability of data occurred in the mid-1990s. The study of time trends is hampered by the use of several different definitions of ORT. Nevertheless, the data show positive trends in diarrhoea management in most parts of the world. ORT is now given to the majority of children with diarrhoea. The annual number of deaths attributable to diarrhoea among children aged under 5 years fell from the estimated 4.6 million in 1980 to about 1.5 million today. Case studies in Brazil, Egypt, Mexico, and the Philippines confirm increases in the use of ORT which are concomitant with marked falls in mortality. In some countries, possible alternative explanations for the observed decline in mortality have been fairly confidently ruled out. Experience with ORT can provide useful guidance for child survival programmes. With adequate political will and financial support, cost-effective interventions other than that of immunization can be successfully delivered by national programmes. Furthermore, there are important lessons for evaluators. The population-based data needed to establish trends in health service delivery, outcomes and impact are not available in respect of diarrhoea, as is true for malaria, pneumonia and other major childhood conditions. Standard indicators and measurement methods should be established. Efforts to change existing global indicators should be firmly resisted. Support should be given for the continuing evaluation and documentation activities needed to guide future public health policies and programmes. PMID:11100619

Efficacy of Lactobacillus Reuteri DSM 17938 for the Treatment of Acute Gastroenteritis in Children: Protocol of a Randomized Controlled Trial.

PubMed

Szymański, Henryk; Szajewska, Hania

2017-08-23

Acute gastroenteritis (AGE) is one of the most common diseases among children. Oral rehydration therapy is the key treatment. However, despite proven efficacy, it remains underused. This is because oral rehydration solution neither reduces the frequency of bowel movements and fluid loss nor shortens the duration of illness. Hence, there is interest in adjunctive treatments. According to the 2014 guidelines developed by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition, the use of the following probiotics may be considered in the management of children with AGE in addition to rehydration therapy: Lactobacillus rhamnosus GG (low quality of evidence; strong recommendation) and Saccharomyces boulardii (low quality of evidence; strong recommendation). Less compelling evidence is available for Lactobacillus reuteri DSM 17938 (very low quality of evidence; weak recommendation). Considering that evidence on L reuteri remains limited, the goal of the study is to assess the effectiveness of L reuteri DSM 17938 in the treatment of AGE in children. Children vaccinated and not vaccinated against rotavirus will be evaluated separately. This will be a double-blind, placebo-controlled, randomized trial. Children between 1 and 60 months of age with AGE, defined as a change in stool consistency to loose or liquid form (according to the Bristol Stool Form scale or Amsterdam Stool Form scale) and/or an increase in the frequency of evacuations (typically ≥3 in 24 h) lasting for no longer than 5 days, will be recruited. A total of 72 children will receive either L reuteri DSM 17938 at a dose of 2×10 8 colony-forming units twice daily or matching placebo for 5 consecutive days. A similar sample size for rotavirus vaccinated and nonvaccinated children is planned. The primary outcome measure is the duration of diarrhea. Two separate studies and reports for rotavirus vaccinated and nonvaccinated children are planned. The recruitment started in January 2017 and is planned to be finalized in June 2018 for rotavirus nonvaccinated children. The recruitment of rotavirus-vaccinated children may be slower due to a relatively low coverage rate in Poland. Data analysis and submission to a peer-reviewed journal is expected within 3 months after completion of the study. This study will add to current knowledge on the efficacy of L reuteri DSM 17938 for the management of AGE. ClinicalTrials.gov NCT02989350; https://clinicaltrials.gov/ct2/show/NCT02989350 (Archived by WebCite at http://www.webcitation.org/6slOFkyTH). ©Henryk Szymański, Hania Szajewska. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 23.08.2017.

Oral diosmectite reduces stool output and diarrhea duration in children with acute watery diarrhea.

PubMed

Dupont, Christophe; Foo, Jimmy Lee Kok; Garnier, Philippe; Moore, Nicholas; Mathiex-Fortunet, Hèlène; Salazar-Lindo, Eduardo

2009-04-01

Diosmectite is a clay used to treat children with acute watery diarrhea. However, its effects on stool output reduction, the key outcome for pediatric antidiarrheal drugs, have not been shown. Two parallel, double-blind studies of diosmectite efficacy on stool reduction were conducted in children 1 to 36 months old in Peru (n = 300) and Malaysia (n = 302). Inclusion criteria included 3 or more watery stools per day for less than 72 hours and weight/height ratios of 0.8 or greater. Exclusion criteria were the need for intravenous rehydration, gross blood in stools, fever higher than 39 degrees C, or current treatment with antidiarrheal or antibiotic medications. Rotavirus status was determined. Diosmectite dosage was 6 g/day (children 1-12 months old) or 12 g/day (children 13-36 months old), given for at least 3 days, followed by half doses until complete recovery. Patients were assigned randomly to groups given diosmectite or placebo, in addition to oral rehydration solution (World Health Organization). Children in each study had comparable average ages and weights. The frequencies of rotavirus infection were 22% in Peru and 12% in Malaysia. Similar amounts of oral rehydration solution were given to children in the diosmectite and placebo groups. Stool output was decreased significantly by diosmectite in both studies, especially among rotavirus-positive children. In pooled data, children had a mean stool output of 94.5 +/- 74.4 g/kg of body weight in the diosmectite group versus 104.1 +/- 94.2 g/kg in the placebo group (P = .002). Diarrhea duration was reduced by diosmectite, which was well tolerated. These results show that diosmectite significantly decreased stool output in children with acute watery diarrhea, especially those who were rotavirus-positive.

Effect of hypovolemia, infusion, and oral rehydration on gradual onset +Gz acceleration tolerance

NASA Technical Reports Server (NTRS)

Greenleaf, J. E.; Brock, P. J.; Haines, R. F.; Rositano, S. A.; Montgomery, L. D.; Keil, L. C.

1976-01-01

The purpose of this study was to determine the effect of blood withdrawal, blood infusion, and oral fluid intake on +Gz tolerance at an acceleration rate of 0.5 G/min. Six healthy men aged 21-27 yr were centrifuged after the withdrawal of 400 ml of blood (hypovolemia) from each man; they were centrifuged again following blood infusion (Phase I). Three weeks later the men were accelerated after similar hypovolemia and again after consuming 800 ml of an isotonic NaCl drink (Phase II). Phase I hypovolemia resulted in a reduction in tolerance in all subjects from a mean control level of 6.42 + or - 0.35 min to 5.45 + or - 0.17 min (-15.1%, p less than 0.05). Both infusion and drinking returned tolerances to control levels. During acceleration there were significant (p less than 0.05) increases in plasma vasopressin levels to 35 pg/ml; these were not influenced appreciably by infusion or drinking. In all acceleration runs there was an obligatory shift (loss) of plasma volume and electrolytes, especially potassium, regardless of the experimental treatments. Oral rehydration is shown to be as effective as blood replacement in restoring +Gz acceleration tolerance decrements due to hypovolemia.

[Effect of a new amino acid solution in the oral hydration of nursing infants with acute diarrhea. A prospective study].

PubMed

Velásquez-Jones, L; Mota-Hernández, F

1990-01-01

Thirty-two one- to 12-month-old male infants with diarrheal dehydration treated with either the oral rehydration solution recommended by the World Health Organization (WHO), or the same solution modified by the addition of glycerine (60 mmol/L) and glycil-glycine (30 mmol/L), with a total osmolality of 379 mOsm/kg. The patients belonging to the latter group exhibited greater stool losses (10.3 +/- 8.3 vs 8.0 +/- 6.4 mL/kg/hour) and a greater urine volume (10.4 +/- 14.2 vs 4.6 +/- 4.0 mL/kg/6 hours), during the first four to six hours of the rehydration period. The results of this study show, that in contrast with those of other series, the addition of glycine and glycil-glycine to the WHO solution, at the concentrations used in the study, produces greater fecal water losses in children with dehydration due to acute diarrhea.

Early cystic fibrosis lung disease: Role of airway surface dehydration and lessons from preventive rehydration therapies in mice.

PubMed

Mall, Marcus A; Graeber, Simon Y; Stahl, Mirjam; Zhou-Suckow, Zhe

2014-07-01

Cystic fibrosis (CF) lung disease starts in the first months of life and remains one of the most common fatal hereditary diseases. Early therapeutic interventions may provide an opportunity to prevent irreversible lung damage and improve outcome. Airway surface dehydration is a key disease mechanism in CF, however, its role in the in vivo pathogenesis and as therapeutic target in early lung disease remains poorly understood. Mice with airway-specific overexpression of the epithelial Na(+) channel (βENaC-Tg) recapitulate airway surface dehydration and phenocopy CF lung disease. Recent studies in neonatal βENaC-Tg mice demonstrated that airway surface dehydration produces early mucus plugging in the absence of mucus hypersecretion, which triggers airway inflammation, promotes bacterial infection and causes early mortality. Preventive rehydration therapy with hypertonic saline or amiloride effectively reduced mucus plugging and mortality in neonatal βENaC-Tg mice. These results support clinical testing of preventive/early rehydration strategies in infants and young children with CF. Copyright © 2014 Elsevier Ltd. All rights reserved.

Massive Fluid Requirements and an Unusual BUN/Creatinine Ratio for Pre-Renal Failure in Patients with Cholera

PubMed Central

Tariq, Muhammad; Memon, Murtaza; Jafferani, Asif; Shoukat, Sana; Gowani, Saqib Ali; Nusrat, Rabeeya; Riaz, Mehmood; Patel, Junaid; Jamil, Bushra; Smego, Raymond A.

2009-01-01

Background Cholera is an important infectious cause of secretory diarrhea. The primary symptom of infection is the sudden onset of watery diarrhea with subsequent volume depletion causing renal insufficiency. The objective of this research is to study the level of dehydration at presentation and subsequent fluid management in patients with cholera. Methods This study was conducted on 191 patients of Cholera admitted at a tertiary care hospital in Karachi, Pakistan during the period of 5 years. Medical charts were evaluated retrospectively for initial hydration status, baseline lab investigations on admission and discharge and fluid therapy given to all the patients while their stay in the hospital and the data was analyzed on SPSS 15.0. Results Out of the 191 patients, 83(43%) were males and 108 (57%) were females with mean age of 42.3 years (SD±18.34). The average duration of symptoms was 3.75 days (SD±2.04). Of 191 patients, 175 (92.1%) presented with dehydration, 80 (42.3%) were given Ringer's Lactate (R/L) + Normal Saline (N/S), 45 (24%) patients were given R/L + N/S + Oral Rehydration Therapy (ORS), 27 (14.3%) of the patients were kept on R/L only and remaining were given various combinations of R/L, N/S, ORS and Dextrose Saline (D/S). On admission mean Blood Urea Nitrogen (BUN) was 24.54 (SD±16.6), mean creatinine was 2.47 (SD±2.35) and mean BUN/Creatinine ratio was 11.63 (SD±5.7). Conclusion Aggressive fluid rehydration remains the cornerstone of management of cholera. Instead of presenting with a classical BUN/Creatinine ratio of >20∶1, patients with pre-renal failure in cholera may present with a BUN/Creatinine ratio of <15∶1. PMID:19855842

[Principles for intensive therapy of status epilepticus in children].

PubMed

Bondarenko, E S; Freĭdkov, V I

1979-01-01

A total of 113 children with brain edema of infectious and toxic nature were studied. The main clinical syndrome in these conditions was an epileptical status. Among anticonvulsive drugs used seduxen appeared to be the most effective. The use of GABA, gas narcosis and myorelaxants is recommended as well. The rehydration by plasma, low molecular plasma substitutes and glucose-polyion solutions are discussed. The paper contains some information on contraindications for early dehydration and rehydration. Hypoxia is eliminated by providing adequate lung ventilation, oxygenotherapy or hyperbaric oxygenation, by using oxidative enzymes and drugs increasing the resistance of the brain to hypoxia and hypothermia. It is recommended that hormonal therapy should be used. The techniques of urgent measures and their sequence are given.

Improving World Health: A Least Cost Strategy. Worldwatch Paper 59.

ERIC Educational Resources Information Center

Chandler, William U.

Least-cost health strategies designed to attack the world's leading causes of unnecessary death are explored. Section 1 emphasizes the value of primary health-care procedures--midwifery, maternal education on breastfeeding and weaning, vaccinations, oral rehydration of victims of diarrhea, and antibiotics against respiratory infections--in…

A randomized clinical trial of recombinant human hyaluronidase-facilitated subcutaneous versus intravenous rehydration in mild to moderately dehydrated children in the emergency department.

PubMed

Spandorfer, Philip R; Mace, Sharon E; Okada, Pamela J; Simon, Harold K; Allen, Coburn H; Spiro, David M; Friend, Keith; Harb, George; Lebel, Francois

2012-11-01

Alternative treatment of dehydration is needed when intravenous (IV) or oral rehydration therapy fails. Subcutaneous (SC) hydration facilitated by recombinant human hyaluronidase offers an alternative treatment for dehydration. This clinical trial is the first to compare recombinant human hyaluronidase-facilitated SC (rHFSC) rehydration with standard IV rehydration for use in dehydrated children. This Phase IV noninferiority trial evaluated whether rHFSC fluid administration can be given safely and effectively, with volumes similar to those delivered intravenously, to children who have mild to moderate dehydration. The study included mild to moderately dehydrated children (Gorelick dehydration score) aged 1 month to 10 years. They were randomized to receive 20 mL/kg of isotonic fluids using rHFSC or IV therapy over 1 hour and then as needed until clinically rehydrated. The primary outcome was total volume of fluid administered (emergency department [ED] plus inpatient hospitalization). Secondary outcomes included mean volume infused in the ED alone, postinfusion dehydration scores and weight changes, line placement success and time, safety, and provider and parent/guardian questionnaire. 148 patients (mean age, 2.3 [1.91] years]; white, 53.4%; black, 31.8%) were enrolled in the intention-to-treat population (73 rHFSC; 75 IV). The primary outcome, mean total volume infused, was 365.0 (324.6) mL in the rHFSC group over 3.1 hours versus 455.8 (597.4) mL in the IV group over 6.6 hours (P = 0.51). The secondary outcome of mean volume infused in the ED alone was 334.3 (226.40) mL in the rHFSC group versus 299.6 (252.33) mL in the IV group (P = 0.03). Dehydration scores and weight changes postinfusion were similar. Successful line placement occurred in all 73 rHFSC-treated patients and 59 of 75 (78.7%) IV-treated patients (P < 0.0001). All IV failures occurred in patients aged <3 years; rHFSC rescue was successful in all patients in whom it was attempted. Both treatments were well tolerated. Clinicians rated fluid administration as easy to perform in 94.5% (69 of 73) of the rHFSC group versus 65.3% (49 of 75) of the IV group (P < 0.001). Parents/caregivers were satisfied or very satisfied with fluid administration in 94.5% (69 of 73) of rHFSC-treated patients and 73.3% (55 of 75) of IV-treated patients. In mild to moderately dehydrated children, rHFSC was inferior to IV hydration for the primary outcome measure. However, rHFSC was noninferior in the ED phase of hydration. Additional benefits of rHFSC included time and success of line placement, ease of use, and satisfaction. SC hydration facilitated with recombinant human hyaluronidase represents a reasonable addition to the treatment options for children who have mild to moderate dehydration, especially those with difficult IV access. ClinicalTrials.gov identifier: NCT00773175. Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

Nutrition and fluid optimization for patients with short bowel syndrome.

PubMed

Matarese, Laura E

2013-03-01

Short bowel syndrome (SBS) is characterized by nutrient malabsorption and occurs following surgical resection, congenital defect, or disease of the bowel. The severity of SBS depends on the length and anatomy of the bowel resected and the health of the remaining tissue. During the 2 years following resection, the remnant bowel undergoes an adaptation process that increases its absorptive capacity. Oral diet and enteral nutrition (EN) enhance intestinal adaptation; although patients require parenteral nutrition (PN) and/or intravenous (IV) fluids in the immediate postresection period, diet and EN should be reintroduced as soon as possible. The SBS diet should include complex carbohydrates; simple sugars should be avoided. Optimal fat intake varies based on patient anatomy; patients with end-jejunostomies can tolerate a higher proportion of calories from dietary fat than patients with a remnant colon. Patients with SBS are prone to deficiencies in vitamins, minerals, and essential fatty acids; serum levels should be periodically monitored and supplements provided as needed. Prebiotic or probiotic therapy may be beneficial for patients with SBS, although further research is needed to determine optimal protocols. Patients with SBS, particularly those without a colon, are at high risk of dehydration; oral rehydration solutions sipped throughout the day can help maintain hydration. One of the primary goals of SBS therapy is to reduce or eliminate dependence on PN/IV; optimization of EN and hydration substantially increases the probability of successful PN/IV weaning.

Hypodermoclysis therapy. In a chronic care hospital setting.

PubMed

Worobec, G; Brown, M K

1997-06-01

Occasionally, elderly patients experience acute, episodic incidents of illness that result in dehydration or a high potential for dehydration (e.g., flu, diarrhea). At times, patients may be unable, or refuse, to take fluids orally. Enteral routes via a nasogastric tube or enteral stomach tube may also not be available. In the past, these patients often had to be transferred from home or long-term care facilities to an acute care hospital for intravenous therapy. A transfer of the acutely ill elderly patient to an acute care hospital is often very stressful to the patient and his/her family and is costly to the health care delivery system. Hypodermoclysis, the process of rehydrating a patient by providing isotonic fluids into the subcutaneous tissues over a short time period, provides an alternative method to deal with acute, short-term fluid deficit problems in the elderly. Hypodermoclysis therapy can be administered in a chronic care setting thus potentially decreasing the need to transfer the elderly client to an acute care hospital. The purpose of this study was to investigate the use of hypodermoclysis therapy in solving acute, or potentially acute fluid deficit problems, that were anticipated to be both reversible and short term in nature. This was carried out in an elderly population that resided in a 284-bed chronic care hospital in southern Ontario.

Rapid intravenous rehydration of children with acute gastroenteritis and dehydration: a systematic review and meta-analysis.

PubMed

Iro, M A; Sell, T; Brown, N; Maitland, K

2018-02-09

The World Health Organization (WHO) recommends rapid intravenous rehydration, using fluid volumes of 70-100mls/kg over 3-6 h, with some of the initial volume given rapidly as initial fluid boluses to treat hypovolaemic shock for children with acute gastroenteritis (AGE) and severe dehydration. The evidence supporting the safety and efficacy of rapid versus slower rehydration remains uncertain. We conducted a systematic review of randomised controlled trials (RCTs) on 11th of May 2017 comparing different rates of intravenous fluid therapy in children with AGE and moderate or severe dehydration, using standard search terms. Two authors independently assessed trial quality and extracted data. Non-RCTs and non-English articles were excluded. The primary endpoint was mortality and secondary endpoints included adverse events (safety) and treatment efficacy. Of the 1390 studies initially identified, 18 were assessed for eligibility. Of these, 3 studies (n = 464) fulfilled a priori criteria for inclusion; most studied children with moderate dehydration and none were conducted in resource-poor settings. Volumes and rates of fluid replacement varied from 20 to 60 ml/kg given over 1-2 h (fast) versus 2-4 h (slow). There was substantial heterogeneity in methodology between the studies with only one adjudicated to be of high quality. There were no deaths in any study. Safety endpoints only identified oedema (n = 6) and dysnatraemia (n = 2). Pooled analysis showed no significant difference between the rapid and slow intravenous rehydration groups for the proportion of treatment failures (N = 468): pooled RR 1.30 (95% CI: 0.87, 1.93) and the readmission rates (N = 439): pooled RR 1.39 (95% CI: 0.68, 2.85). Despite wide implementation of WHO Plan C guideline for severe AGE, we found no clinical evaluation in resource-limited settings, and only limited evaluation of the rate and volume of rehydration in other parts of the world. Recent concerns over aggressive fluid expansion warrants further research to inform guidelines on rates of intravenous rehydration therapy for severe AGE.

Sex Roles in Instructional Materials: Testing the Stereotypes. Special Report.

ERIC Educational Resources Information Center

Zimmerman, Margot L.; And Others

1982-01-01

The hypothesis that portraying nontraditional sex roles for men in instructional health pamphlets intended for illiterates and semiliterates does not interfere with the comprehension of the technical information was confirmed. Two versions of a pamphlet on how to prepare and use an oral rehydration salts (ORS) solution with children with diarrhea…

Child Health, Education and Development.

ERIC Educational Resources Information Center

Chandler, William U.

1986-01-01

Bristling with facts, this article argues that what is needed today is a strategy of integrated development to meet basic needs all across the Third World. Stop-gap techniques such as oral rehydration programs that prevent death are good, but must be augmented by policies which promote food production, clean water, education, family planning, and…

Barriers to use of oral rehydration salts for child diarrhea in the private sector: evidence from India.

PubMed

Wagner, Zachary; Shah, Manan; Sood, Neeraj

2015-02-01

Diarrhea is the second leading cause of child mortality in India. Most deaths are cheaply preventable with the use of oral rehydration salts (ORS), yet many health providers still fail to provide ORS to children seeking diarrheal care. In this study, we use survey data to assess whether children visiting private providers for diarrheal care were less likely to use ORS than those visiting public providers. Results suggest that children who visited private providers were 9.5 percentage points less likely to have used ORS than those who visited public providers (95% CI 5-14). We complimented these results with in-depth interviews of 21 public and 17 private doctors in Gujarat, India, assessing potential drivers of public-private disparities in ORS use. Interview results suggested that lack of direct medication dispensing in the private sector might be a key barrier to ORS use in the private sector. © The Author [2014]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effect of pre-donation fluid intake on fluid shift from interstitial to intravascular compartment in blood donors.

PubMed

Deepika, Chenna; Murugesan, Mohandoss; Shastry, Shamee

2018-02-01

Fluid shifts from interstitial to intravascular space during blood donation helps in compensating the lost blood volume. We aimed to determine the volume of fluid shift following donation in donors with and without pre-donation fluid intake. We studied the fluid shift in 325 blood donors prospectively. Donors were divided in groups- with no fluid intake (GI) and either water (GII) or oral rehydrating fluids (GIII) before donation. Fluid shift following donation was calculated based on the difference between the pre and post donation blood volume. The influence of oral fluid intake, age, gender and body mass index (BMI) on volume of fluid shift was analyzed. The fluid shift was significant between donors without fluids (GI: 127 ± 81 ml) and donors with fluid intake (GII & III: 96 ± 45 ml) (p < 0.05). The difference was not significant between donors with water intake (GII: 106 ± 52 ml) and oral rehydrating fluid intake (GIII: 87 ± 41 ml). The shifted fluid volume increased with increasing BMI and decreased with increasing age in females. The fluid shift increased in females than in males. The age, gender, BMI and VVR did not significantly contribute to the volume of fluid shift following donation. As per our observation, the oral fluids before donation might not contribute to increase in fluid shift in blood donors after donation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Electrolytes, sugar, calories, osmolarity and pH of beverages and coconut water.

PubMed

Chavalittamrong, B; Pidatcha, P; Thavisri, U

1982-09-01

Oral rehydration has been recommended in patients with diarrhoea to replace fluid loss from the gastrointestinal tract and reduce the need for intravenous therapy. Beverages (i.e. Cola, Sprite etc.) and coconut water may be used as sources of oral fluid when glucose-electrolyte solution is not available. To evaluate the usefulness and effectiveness of these soft drinks, the basic data such as electrolytes, sugar, calories, osmolarity and pH were determined. The electrolytes of the beverages were significantly lower (p less than 0.001) than the coconut water, especially potassium. The osmolarity of the beverages, which were 693 mOsm/l, was significantly higher (p less than 0.001) than the coconut water (288 mOsm/l); pH of the beverages (3.1) was more acidic (p less than 0.001) than the coconut water (5.4). While the sugar content of the beverages, which were 8.7 gm/dl, was significantly higher (p less than 0.001) than the coconut water (1.1 gm/dl). On comparison, all brands of beverages would give more calories than the coconut water however the coconut water would be absorbed more easily than any brand of soft drink beverage.

Role of Antidiarrhoeal Drugs as Adjunctive Therapies for Acute Diarrhoea in Children

PubMed Central

Faure, Christophe

2013-01-01

Acute diarrhoea is a leading cause of child mortality in developing countries. Principal pathogens include Escherichia coli, rotaviruses, and noroviruses. 90% of diarrhoeal deaths are attributable to inadequate sanitation. Acute diarrhoea is the second leading cause of overall childhood mortality and accounts for 18% of deaths among children under five. In 2004 an estimated 1.5 million children died from diarrhoea, with 80% of deaths occurring before the age of two. Treatment goals are to prevent dehydration and nutritional damage and to reduce duration and severity of diarrhoeal episodes. The recommended therapeutic regimen is to provide oral rehydration solutions (ORS) and to continue feeding. Although ORS effectively mitigates dehydration, it has no effect on the duration, severity, or frequency of diarrhoeal episodes. Adjuvant therapy with micronutrients, probiotics, or antidiarrhoeal agents may thus be useful. The WHO recommends the use of zinc tablets in association with ORS. The ESPGHAN/ESPID treatment guidelines consider the use of racecadotril, diosmectite, or probiotics as possible adjunctive therapy to ORS. Only racecadotril and diosmectite reduce stool output, but no treatment has yet been shown to reduce hospitalisation rate or mortality. Appropriate management with validated treatments may help reduce the health and economic burden of acute diarrhoea in children worldwide. PMID:23533446

Culture and Dehydration: A Comparative Study of Caída de la Mollera (Fallen Fontanel) in Three Latino Populations.

PubMed

Pachter, Lee M; Weller, Susan C; Baer, Roberta D; de Alba Garcia, Javier E Garcia; Glazer, Mark; Trotter, Robert; Klein, Robert E; Gonzalez, Eduardo

2016-10-01

A sunken soft-spot or fontanel is a sign for dehydration in infants. Around the world, folk illnesses, such as caída de la mollera in some Latin American cultures, often incorporate this sign as a hallmark of illness, but may or may not incorporate re-hydration therapies in treatment strategies. This report describes a study of lay descriptions of causes, symptoms, and treatments for caída de la mollera in three diverse Latin American populations. A mixed-methods approach was used. Representative community-based samples were interviewed in rural Guatemala, Guadalajara, Mexico, and Edinburgh, Texas, with a 132 item questionnaire on the causes, susceptibility, symptoms, and therapies for caída de la mollera. Cultural consensus analysis was used to estimate community beliefs about caída. Interviews conducted in rural Guatemala (n = 60), urban Mexico (n = 62), and rural Texas on the Mexican border (n = 61) indicated consistency in thematic elements within and among these three diverse communities. The high degree of consistency in the illness explanatory models indicated shared beliefs about caída de la mollera in each of the communities and a core model shared across communities. However, an important aspect of the community beliefs was that rehydration therapies were not widely endorsed. The consistency in explanatory models in such diverse communities, as well as the high degree of recognition and experience with this illness, may facilitate communication between community members, and health care providers/public health intervention planners to increase use of rehydration therapies for caída de la mollera. Recommendations for culturally informed and respectful approaches to clinical communication are provided.

Salovum egg yolk containing antisecretory factor as an adjunct therapy in severe cholera in adult males: a pilot study.

PubMed

Alam, Nur H; Ashraf, Hasan; Olesen, Maryam; Salam, Mohammed A; Gyr, Niklaus; Meier, Remy

2011-08-01

Cholera involves stimulation of intestinal secretory process in response to cholera toxin leading to profuse watery diarrhoea that might cause death due to dehydration unless timely rehydration therapy is initiated. Efforts to identify and test potential antisecretory agents are ongoing. Antisecretory factor (AF) is a naturally-occurring protein produced in the human secretory organs, including the intestine, with antisectory properties demonstrated in animal and human models of secretory diarrhoea. Salovum egg yolk powder contains antisecretory proteins in a much higher (500 times) concentration than that of normal hen eggs. This is achieved by feeding hens with specially-processed cereals, capable of inducing antisecretory proteins in the yolk. The aim of the study was to examine the effect of Salovum egg yolk powder containing AF in the treatment of adult cholera patients. In an open, randomized controlled trial (pilot study), 40 adult male patients with severe cholera were studied: 20 received standard treatment (oral rehydration solution, antibiotic, and usual hospital diet) plus Salovum egg yolk powder (study group) and 20 received standard treatment alone (control group). All the patients received tablet doxycycline (300 mg) once immediately after randomization. Written informed consent was obtained from each subject before enrollment. The main outcome measures were stool weight and duration of diarrhoea. The demographic and baseline clinical characteristics of the study patients were comparable between the groups. No significant differences were found in the mean stool weight, g/kg of body-weight during the first 24 hours [study vs control group, mean +/- standard deviation (SD), 218 +/- 119 vs 195 +/- 136], second 24 hours (mean +/- SD, 23 +/- 39 vs 22 +/- 34), and cumulative up to 72 hours (mean +/- SD, 245 +/- 152 vs 218 +/- 169). The duration (hours) of diarrhoea after admission in the hospital was also similar in both the groups (mean +/- SD, 33 +/- 14 vs 32 +/- 10). No adverse effect was observed. Salovum egg powder containing AF as an adjunct therapy in the treatment of severe cholera could not demonstrate any beneficial effect. Further studies with higher doses of Salovum egg yolk powder might be considered in future to establish its antisecretory effect.

The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality

PubMed Central

Munos, Melinda K.; Walker, Christa L Fischer; Black, Robert E

2010-01-01

Background Most diarrhoeal deaths can be prevented through the prevention and treatment of dehydration. Oral rehydration solution (ORS) and recommended home fluids (RHFs) have been recommended since 1970s and 1980s to prevent and treat diarrhoeal dehydration. We sought to estimate the effects of these interventions on diarrhoea mortality in children aged <5 years. Methods We conducted a systematic review to identify studies evaluating the efficacy and effectiveness of ORS and RHFs and abstracted study characteristics and outcome measures into standardized tables. We categorized the evidence by intervention and outcome, conducted meta-analyses for all outcomes with two or more data points and graded the quality of the evidence supporting each outcome. The CHERG Rules for Evidence Review were used to estimate the effectiveness of ORS and RHFs against diarrhoea mortality. Results We identified 205 papers for abstraction, of which 157 were included in the meta-analyses of ORS outcomes and 12 were included in the meta-analyses of RHF outcomes. We estimated that ORS may prevent 93% of diarrhoea deaths. Conclusions ORS is effective against diarrhoea mortality in home, community and facility settings; however, there is insufficient evidence to estimate the effectiveness of RHFs against diarrhoea mortality. PMID:20348131

Impact of a social franchising program on uptake of oral rehydration solution plus zinc for childhood diarrhea in myanmar: a community-level randomized controlled trial.

PubMed

Aung, Tin; Montagu, Dominic; Su Su Khin, Hnin; Win, Zaw; San, Ang Kyaw; McFarland, Willi

2014-06-01

Diarrhea's impact on childhood morbidity can be reduced by administering oral rehydration solution (ORS) with zinc; challenges to wider use are changing health-seeking behavior and ensuring access. We conducted a randomized controlled trial to increase ORS plus zinc uptake in rural Myanmar. Village tracts, matched in 52 pairs, were randomized to standard ORS access vs. a social franchising program training community educators and supplying ORS plus zinc. Intervention and control communities were comparable on demographics, prevalence of diarrhea and previous use of ORS. One year after randomization, ORS plus zinc use was 13.7% in the most recent case of diarrhea in intervention households compared with 1.8% in control households (p < 0.001) (N = 3605). A significant increase in ORS plus zinc use was noted in the intervention (p = 0.044) but not in the control (p = 0.315) group. Social franchising increased optimal treatment of childhood diarrhea in rural Myanmar. Scale-up stands to reduce morbidity among children in similar settings. Current Controlled Trials ISRCTN73606238. © The Author [2014]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Effective prophylaxis against rotavirus diarrhea using a combination of Lactobacillus rhamnosus GG and antibodies

PubMed Central

Pant, Neha; Marcotte, Harold; Brüssow, Harald; Svensson, Lennart; Hammarström, Lennart

2007-01-01

Background Rotavirus is a worldwide cause of infectious infantile diarrhea that claims over 600,000 lives annually. Recently, two new vaccine candidates have been developed but their efficacy in developing countries, still remains to be proven. Oral delivery of specific immunoglobulins provides passive immunity and is a fast acting treatment for rotavirus diarrhea. Probiotic bacteria have also gained considerable attention lately as treatment for rotavirus diarrhea. Here we report an evaluation of the therapeutic potential of different probiotics and their combination with anti – rotavirus antibodies in a mouse model of rotavirus diarrhea. Results Of the six probiotic bacteria tested, Lactobacillus rhamnosus strain GG had the strongest influence in reducing prevalence, duration and severity of diarrhea and was therefore chosen for combination treatment with immunoglobulins. The combination treatment reduced the diarrhea outcome measures significantly, prevented histopathological changes and reduced the virus load in the intestines. Conclusion The advantages associated with immunoglobulins and probiotics based therapy is that the treatment provides a rapid therapeutic effect and is cost efficient. These components do not require special storage conditions and could potentially complement the rehydration therapy that is currently used. PMID:17900343

Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children

PubMed Central

2013-01-01

Background Oral rehydration salts (ORS), zinc, and continued feeding are the recommended treatments for community-acquired acute diarrhea among young children. However, probiotics are becoming increasingly popular treatments for diarrhea in some countries. We sought to estimate the effect of probiotics on diarrhea morbidity and mortality in children < 5 years of age. Methods We conducted a systematic review of randomized controlled trials to estimate the effect of probiotic microorganisms for the treatment of community-acquired acute diarrhea in children. Data were abstracted into a standardized table and study quality was assessed using the Child Health Epidemiology Reference Group (CHERG) adaption of the GRADE technique. We measured the relative effect of probiotic treatment in addition to recommended rehydration on hospitalizations, duration and severity. We then calculated the average percent difference for all continuous outcomes and performed a meta-analysis for discrete outcomes. Results We identified 8 studies for inclusion in the final database. No studies reported diarrhea mortality and overall the evidence was low to moderate quality. Probiotics reduced diarrhea duration by 14.0% (95% CI: 3.8-24.2%) and stool frequency on the second day of treatment by 13.1% (95% CI: 0.8 – 25.3%). There was no effect on the risk of diarrhea hospitalizations. Conclusion Probiotics may be efficacious in reducing diarrhea duration and stool frequency during a diarrhea episode. However, only few studies have been conducted in low-income countries and none used zinc (the current recommendation) thus additional research is needed to understand the effect of probiotics as adjunct therapy for diarrhea among children in developing countries. PMID:24564646

Adapting MCH strategies for the nineties.

PubMed

Abel, R

1994-01-01

Brief overview was given for strategies in maternal and child health (MCH) in India that were used in the 1980s and adapted for the 1990s in the following areas: perinatal outcomes, empowerment of women, immunization, oral rehydration, adolescent girls, anthropometric measurement, health education, management, and coordination with nongovernmental organizations (NGOs). In order to assure a healthy baby weighing 2.5 kg, monitoring of maternal health is occurring. Iron and folic acid and tetanus toxoid vaccine are provided to pregnant mothers, and fetal growth is monitored. Training of traditional birth attendants and multipurpose health workers will contribute to clean deliveries and referral of complicated pregnancies. During the 1990s, women's health in addition to maternal health has received attention. The empowerment of women to care for themselves, to learn how to mix oral rehydration packets (ORS) at home, and to receive the knowledge and skills were deemed more important than the 1980s focus on the delivery system and inputs of MCH. An excellent cold chain for delivery of vaccines has been put in place, which provides the vehicle for the 1990s to maintain high vaccine coverage. The emphasis on oral rehydration in the 1990s will be on teaching mothers about the importance of ORS treatment of diarrhea. During the 1990s, educating the adolescent girl before she becomes married and pregnant will be the focus. Greater emphasis will be placed on stunting or height for age measurements, as a measure of long term nutritional change; age weight for height for measurement of wasting; and maternal nutritional monitoring of arm circumference. Sustained health education, more media exposure to disease conditions and treatment, and social marketing in health will be better coordinated and more cost effective. Accountability for manpower, materials, and money will be in place within management. Management will focus on motivation and training, and other, newer management concepts. Government will begin to work with NGOs, including cost sharing and a favorable attitude toward NGO contributions. In general, all programs will have greater community participation and improvement in method and strategies.

Implementation of clinical decision support in young children with acute gastroenteritis: a randomized controlled trial at the emergency department.

PubMed

Geurts, Dorien; de Vos-Kerkhof, Evelien; Polinder, Suzanne; Steyerberg, Ewout; van der Lei, Johan; Moll, Henriëtte; Oostenbrink, Rianne

2017-02-01

Acute gastroenteritis (AGE) is one of the most frequent reasons for young children to visit emergency departments (EDs). We aimed to evaluate (1) feasibility of a nurse-guided clinical decision support system for rehydration treatment in children with AGE and (2) the impact on diagnostics, treatment, and costs compared with usual care by attending physician. A randomized controlled trial was performed in 222 children, aged 1 month to 5 years at the ED of the Erasmus MC-Sophia Children's hospital in The Netherlands ( 2010-2012). Outcome included (1) feasibility, measured by compliance of the nurses, and (2) length of stay (LOS) at the ED, the number of diagnostic tests, treatment, follow-up, and costs. Due to failure of post-ED weight measurement, we could not evaluate weight difference as measure for dehydration. Patient characteristics were comparable between the intervention (N = 113) and the usual care group (N = 109). Implementation of the clinical decision support system proved a high compliance rate. The standardized use of oral ORS (oral rehydration solution) significantly increased from 52 to 65%(RR2.2, 95%CI 1.09-4.31 p < 0.05). We observed no differences in other outcome measures. Implementation of nurse-guided clinical decision support system on rehydration treatment in children with AGE showed high compliance and increase standardized use of ORS, without differences in other outcome measures. What is Known: • Acute gastroenteritis is one of the most frequently encountered problems in pediatric emergency departments. • Guidelines advocate standardized oral treatment in children with mild to moderate dehydration, but appear to be applied infrequently in clinical practice. What is New: • Implementation of a nurse-guided clinical decision support system on treatment of AGE in young children showed good feasibility, resulting in a more standardized ORS use in children with mild to moderate dehydration, compared to usual care. • Given the challenges to perform research in emergency care setting, the ED should be experienced and adequately equipped, especially during peak times.

Diarrhea in the International Traveler.

PubMed

Duchini; Rodgers

1999-06-01

International travelers to developing countries have a 40% risk of developing a diarrheal illness, usually acute and occasionally chronic. Preventive measures, including diet and lifestyle modifications, are highly recommended but may not be sufficient. Prophylaxis with bismuth subsalicylate or an antimicrobial should be considered in travelers with immunodeficiencies, co-morbid conditions, achlorhydria, or those who cannot afford a loss of time. Oral rehydration is the primary goal of therapy. Bismuth-subsalicylate is a first-line agent for treatment of milder cases with less than three watery bowel movements per day and prominent nausea. Use of an antibiotic is indicated for more severe cases or in the presence of fever, dysentery, or severe dehydration. A short course of a quinolone is highly effective, safe and well tolerated. Antimicrobial resistance among enteropathogens is growing and appropriate therapeutic modifications should be considered according to specific geographic areas. Metronidazole may be empirically added in those cases that do not respond to quinolones. Specific guidelines for particular pathogens are highlighted.

The Effect of Preoperative Oral Carbohydrate or Oral Rehydration Solution on Postoperative Quality of Recovery: A Randomized, Controlled Clinical Trial.

PubMed

Asakura, Ayako; Mihara, Takahiro; Goto, Takahisa

2015-01-01

Numerous studies have demonstrated the beneficial effects of preoperative administration of oral carbohydrate (CHO) or oral rehydration solution (ORS). However, the effects of preoperative CHO or ORS on postoperative quality of recovery after anesthesia remain unclear. Consequently, the purpose of the current study was to evaluate the effect of preoperative CHO or ORS on patient recovery, using the Quality of Recovery 40 questionnaire (QoR-40). This prospective, randomized, controlled clinical trial included American Society of Anesthesiologists (ASA) physical status 1 and 2 adult patients, who were scheduled to undergo a surgical procedure of body surface. Subjects were randomized to one of the three groups: 1) preoperative CHO group, 2) preoperative ORS group, and 3) control group. The primary outcome was the global QoR-40 administered 24 h after surgery. Intraoperative use of vasopressor, intraoperative body temperature changes, and postoperative nausea and vomiting (PONV) were also evaluated. We studied 134 subjects. The median [interquartile range (IQR)] global QoR-40 scores 24 h after the surgery were 187 [177-197], 186 [171-200], and 184 [171-198] for the CHO, ORS, and control groups, respectively (p = 0.916). No significant differences existed between the groups regarding intraoperative vasopressor use during the surgery (p = 0.475). Results of the current study indicated that the preoperative administration of either CHO or ORS did not improve the quality of recovery in patients undergoing minimally invasive body surface surgery. www.umin.ac.jp UMIN000009388 https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000011029&language=E.

Impact of pharmacy worker training and deployment on access to essential medicines for children under five in Malawi: a cluster quasi-experimental evaluation.

PubMed

Babigumira, Joseph B; Lubinga, Solomon J; Jenny, Alisa M; Larsen-Cooper, Erin; Crawford, Jessica; Matemba, Charles; Stergachis, Andy

2017-09-11

Poor access to essential medicines is common in many low- and middle-income countries, partly due to an insufficient and inadequately trained workforce to manage the medicines supply chain. We conducted a prospective impact evaluation of the training and deployment of pharmacy assistants (PAs) to rural health centers in Malawi. A quasi-experimental design was used to compare access to medicines in two districts where newly trained PAs were deployed to health centers (intervention) and two districts with no trained PAs at health centers (comparison). A baseline household survey and two annual post-intervention household surveys were conducted. We studied children under five years with a history of fever, cough and difficulty in breathing, and diarrhea in the previous two weeks. We collected data on access to antimalarials, antibiotics and oral rehydration salts (ORS) during the childrens' symptomatic periods. We used difference-in-differences regression models to estimate the impact of PA training and deployment on access to medicines. We included 3974 children across the three rounds of annual surveys: 1840 (46%) in the districts with PAs deployed at health centers and 2096 (53%) in districts with no PAs deployed at health centers. Approximately 80% of children had a fever, nearly 30% had a cough, and 43% had diarrhea in the previous two weeks. In the first year of the program, the presence of a PA led to a significant 74% increase in the odds of access to any antimalarial, and a significant 49% increase in the odds of access to artemisinin combination therapies. This effect was restricted to the first year post-intervention. There was no effect of presence of a PA on access to antibiotics or ORS. The training and deployment of pharmacy assistants to rural health centers in Malawi increased access to antimalarial medications over the first year, but the effect was attenuated over the second year. Pharmacy assistants training and deployment demonstrated no impact on access to antibiotics for pneumonia or oral rehydration salts for diarrhea.

The Effect of G-ORS Along With Rice Soup in the Treatment of Acute Diarrhea in Children: A Single-Blind Randomized Controlled Trial.

PubMed

Kianmehr, Mojtaba; Saber, Ashraf; Moshari, Jalil; Ahmadi, Reza; Basiri-Moghadam, Mahdi

2016-06-01

The world health organization guidelines for treatment of diarrhea in children emphasize on continued feeding together with prescription of oral rehydration solution (ORS) and supplementary zinc therapy. However, conflicting viewpoints exist regarding the optimal diet and dietary ingredients for children with diarrhea. Moreover, few studies have investigated the effect of rice soup along with ORS in the treatment of this disease. This study aimed to explore effects of simultaneous taking of glucose oral rehydration solution (G-ORS) and rice soup in the treatment of acute diarrhea in 8 to 24-month-old children. This single-blind controlled clinical trial was conducted in the pediatric ward of 22nd of Bahman hospital, Gonabad, Iran between June 2013 and February 2014. Forty children aged 8-24 months with acute diarrhea were randomly assigned into an intervention group (G-ORS plus rice soup group) comprising 20 babies and a control group (G-ORS) of 20 children based on balanced blocking randomization. The variables under investigation were diarrhea duration, patient hospitalization, need for intravenous (IV) fluids and stool output frequency. Data was analyzed using independent samples t and chi-square test. At the end of study, the time for treating acute watery diarrhea in the intervention and control groups were 21.10 ± 8.81 and 34.55 ± 5.82 hours (P < 0.001) and hospital stay were 34.05 ± 6.62 and 40.20 ± 6.32 hours (P = 0.005). Moreover, stool output frequency were 4.20 ± 0.95 and 8.00 ± 1.37 (P < 0.001) in the first 24 hours, and 2.18 ± 0.60 and 2.80 ± 0.76 (P = 0.03) in the second 24 hours of treatment in intervention and control groups, respectively. Rice soup regimen was highly effective and inexpensive in the treatment of acute diarrhea in children. Thus, in addition to the common treatment by G-ORS, rice soup can be consumed simultaneously with G-ORS.

The effects on gastric emptying and carbohydrate loading of an oral nutritional supplement and an oral rehydration solution: a crossover study with magnetic resonance imaging.

PubMed

Nakamura, Makoto; Uchida, Kanji; Akahane, Masaaki; Watanabe, Yasushi; Ohtomo, Kuni; Yamada, Yoshitsugu

2014-06-01

Preoperative administration of clear fluids by mouth has recently been endorsed as a way to improve postoperative outcomes. A carbohydrate-containing beverage supplemented with electrolytes or proteins may have additional benefits for patients' satisfaction. However, effects on gastric residual, nausea, and emesis and the effectiveness of these beverages for improving patients' hydration status have not been well defined. We evaluated changes in gastric volume over time by magnetic resonance imaging, as well as blood glucose levels, before and after administration of 500 mL oral rehydration solution (ORS) containing 1.8% glucose and electrolytes in 10 healthy volunteers. The same volume of an oral nutritional supplement (ONS) containing 18% glucose and supplemental arginine (545 mOsm/kg) was given to the same population using a crossover design. The mean (median, 95% confidence interval) gastric fluid volume at 1 hour after oral ingestion was 55.0 (55.3, 39.0-70.9) mL in the ORS group, whereas 409.2 (410.9, 371.4-447.0) mL in the ONS group (P = 0.0002). The gastric fluid volume of all participants in the ORS group returned to <1 mL/kg at 90 minutes after ingestion, whereas none reached <1 mL/kg at 120 minutes in the ONS group. The ONS group showed a sustained increase in the blood glucose level after ingestion (P < 0.0001 to baseline at 30, 60, 120 minutes), while the ORS group showed an initial increase (P < 0.0001, P = 0.01, P = 0.205 at each time point). ORS supplemented with a small amount of glucose showed faster gastric emptying, which may make it suitable for preoperative administration. In contrast, ONS supplemented with arginine with a relatively low osmolality was associated with a longer time for gastric emptying, although it showed a sustained increase in blood glucose level.

Responses of the Human Brain to Mild Dehydration and Rehydration Explored In Vivo by 1H-MR Imaging and Spectroscopy.

PubMed

Biller, A; Reuter, M; Patenaude, B; Homola, G A; Breuer, F; Bendszus, M; Bartsch, A J

2015-12-01

As yet, there are no in vivo data on tissue water changes and associated morphometric changes involved in the osmo-adaptation of normal brains. Our aim was to evaluate osmoadaptive responses of the healthy human brain to osmotic challenges of de- and rehydration by serial measurements of brain volume, tissue fluid, and metabolites. Serial T1-weighted and (1)H-MR spectroscopy data were acquired in 15 healthy individuals at normohydration, on 12 hours of dehydration, and during 1 hour of oral rehydration. Osmotic challenges were monitored by serum measures, including osmolality and hematocrit. MR imaging data were analyzed by using FreeSurfer and LCModel. On dehydration, serum osmolality increased by 0.67% and brain tissue fluid decreased by 1.63%, on average. MR imaging morphometry demonstrated corresponding decreases of cortical thickness and volumes of the whole brain, cortex, white matter, and hypothalamus/thalamus. These changes reversed during rehydration. Continuous fluid ingestion of 1 L of water for 1 hour within the scanner lowered serum osmolality by 0.96% and increased brain tissue fluid by 0.43%, on average. Concomitantly, cortical thickness and volumes of the whole brain, cortex, white matter, and hypothalamus/thalamus increased. Changes in brain tissue fluid were related to volume changes of the whole brain, the white matter, and hypothalamus/thalamus. Only volume changes of the hypothalamus/thalamus significantly correlated with serum osmolality. This is the first study simultaneously evaluating changes in brain tissue fluid, metabolites, volume, and cortical thickness. Our results reflect cellular volume regulatory mechanisms at a macroscopic level and emphasize that it is essential to control for hydration levels in studies on brain morphometry and metabolism in order to avoid confounding the findings. © 2015 by American Journal of Neuroradiology.

Rehydration Capacities and Rates for Various Porcine Tissues after Dehydration

PubMed Central

Meyer, Jacob P.; McAvoy, Kieran E.; Jiang, Jack

2013-01-01

The biphasic effects of liquid on tissue biomechanics are well known in cartilage and vocal folds, yet not extensively in other tissue types. Past studies have shown that tissue dehydration significantly impacts biomechanical properties and that rehydration can restore these properties in certain tissue types. However, these studies failed to consider how temporal exposure to dehydrating or rehydrating agents may alter tissue rehydration capacity, as overexposure to dehydration may permanently prevent rehydration to the initial liquid volume. Select porcine tissues were dehydrated until they reached between 100% and 40% of their initial mass. Each sample was allowed to rehydrate for 5 hours in a 0.9% saline solution, and the percent change between the initial and rehydrated mass values was calculated. Spearman correlation tests indicated a greater loss in mass despite rehydration when tissues were previously exposed to greater levels of dehydration. Additionally, Pearson correlation tests indicated the total liquid mass of samples after complete rehydration decreased when previously exposed to higher levels of dehydration. Rehydration rates were found by dehydrating tissues to 40% of their initial mass followed by rehydration in a 0.9% saline solution for 60 minutes, with mass measurements occurring in 15 minute intervals. All tissues rehydrated nonlinearly, most increasing significantly in mass up to 30 minutes after initial soaking. This study suggests the ability for tissues to rehydrate is dependent on the level of initial dehydration exposure. In vitro rehydration experiments therefore require controlled dosage and temporal exposure to dehydrating and rehydrating agents to avoid incomplete rehydration, and caution should be taken when combining different tissue types in models of hydration. PMID:24023753

Cholera: an overview with reference to the Yemen epidemic.

PubMed

Rabaan, Ali A

2018-06-22

Cholera is a secretory diarrhoeal disease caused by infection with Vibrio cholerae, primarily the V. cholerae O1 El Tor biotype. There are approximately 2.9 million cases in 69 endemic countries annually, resulting in 95 000 deaths. Cholera is associated with poor infrastructure and lack of access to sanitation and clean drinking water. The current cholera epidemic in Yemen, linked to spread of V. cholerae O1 (Ogawa serotype), is associated with the ongoing war. This has devastated infrastructure and health services. The World Health Organization had estimated that 172 286 suspected cases arose between 27th April and 19th June 2017, including 1170 deaths. While there are three oral cholera vaccines prequalified by the World Health Organization, there are issues surrounding vaccination campaigns in conflict situations, exacerbated by external factors such as a global vaccine shortage. Major movements of people complicates surveillance and administration of double doses of vaccines. Cholera therapy mainly depends on rehydration, with use of antibiotics in more severe infections. Concerns have arisen about the rise of antibiotic resistance in cholera, due to mobile genetic elements. In this review, we give an overview of cholera epidemiology, virulence, antibiotic resistance, therapy and vaccines, in the light of the ongoing epidemic in Yemen.

Conjugated Linoleic Acid Reduces Cholera Toxin Production In Vitro and In Vivo by Inhibiting Vibrio cholerae ToxT Activity.

PubMed

Withey, Jeffrey H; Nag, Drubhajyoti; Plecha, Sarah C; Sinha, Ritam; Koley, Hemanta

2015-12-01

The severe diarrheal disease cholera is endemic in over 50 countries. Current therapies for cholera patients involve oral and/or intravenous rehydration, often combined with the use of antibiotics to shorten the duration and intensity of the disease. However, as antibiotic resistance increases, treatment options will become limited. Linoleic acid has been shown to be a potent negative effector of V. cholerae virulence that acts on the major virulence transcription regulator protein, ToxT, to inhibit virulence gene expression. ToxT activates transcription of the two major virulence factors required for disease, cholera toxin (CT) and toxin-coregulated pilus (TCP). A conjugated form of linoleic acid (CLA) is currently sold over the counter as a dietary supplement and is generally recognized as safe by the U.S. Food and Drug Administration. This study examined whether CLA could be used as a new therapy to reduce CT production, which, in turn, would decrease disease duration and intensity in cholera patients. CLA could be used in place of traditional antibiotics and would be very unlikely to generate resistance, as it affects only virulence factor production and not bacterial growth or survival. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

[Efficacy and safety of reduced osmolarity oral rehydration salts in treatment of dehydration in children with acute diarrhea--a multicenter, randomized, double blind clinical trial].

PubMed

Yang, Dao-Feng; Guo, Wei; Tian, De-Ying; Luo, Xiao-Ping; He, Yong-Wen; Dai, Yong-An; Xu, Hua-Lin

2007-04-01

To assess the efficacy and safety of reduced osmolarity oral rehydration salts (ROORS) in treatment of mild to moderate dehydration caused by acute diarrhea in children. A multicenter, randomized, double-blind, positive drug controlled clinical trial was conducted in 125 cases aged 1 to 17 years. These children with acute diarrhea and signs of dehydration were randomly assigned to receive either ROORS (trial group, n = 62) or oral rehydration salts II (ORS II) (control group, n = 63). The volume of intravenous infusion were recorded. The improvements of systemic symtoms and signs, diarrhea, dehydration and total scores were compared between the two groups. The adverse events and changes of electrolyte and other laboratory tests during treatment were also observed and analyzed. The overall effective rates in trial group and control group were 96.8% and 96.8%, respectively. The recovery of systemic symptoms, dehydration signs and diarrhea occurred in 96%, 97% and 78% patients in trial groups, and 96%, 98% and 85% patients in control group. The scores of symptoms and signs in both groups decreased significantly after treatment. All the above parameters and the number of cases who needed intravenous infusion (41 vs. 39) were not statistically different between two groups. However, the average volume of intravenously infused fluids in trial group was (450.98 +/- 183.07) ml, 24.5% less than that in the control group (597.30 +/- 343.37) ml (P < 0.05). The mean serum Na(+) concentration elevated from (137.48 +/- 4.55) mmol/L to (139.52 +/- 3.25) mmol/L (P < 0.01) in control group after treatment, but the change was not statistically significant in trail group. Serum K(+), Cl(-), HCO(3)(-) and other laboratory result did not change significantly after treatment. The total scores in both groups decreased obviously after treatment, but no significant difference was demonstrated between two groups (P > 0.05). A case in trial group had mild abdominal distention and recovered spontaneously. ROORS was shown to be effective and safe in the treatment of mild and moderate dehydration induced by acute diarrhea. Compared to ORS II, ROORS could decrease the intravenous supplement of fluid and lower the risk of hypernatremia.

Health care in Nicaragua.

PubMed

Britten, S

1989-01-01

A two-week health study tour in Nicaragua in 1987 organized by the Health Network of the (British) Nicaragua Solidarity Campaign afforded the author of this report access to health service planning, first-hand observation of the immunization programme, and visits to centres for rehabilitation of the disabled, both from the war and civil causes. The efficacy of the low technology immunization and oral rehydration programmes is contrasted with the struggle to rehabilitate the war disabled with grossly inadequate resources.

Bangladesh indicators improving.

PubMed

1996-01-01

In April 1996, at the 52nd Session of the UN Economic and Social Commission for Asia and the Pacific (ESCAP), the delegate from Bangladesh reported improvements in various demographic indicators for Bangladesh. Infant mortality and maternal mortality have fallen to 84/1000 and 4.5/1000, respectively, while life expectancy at birth has risen to 58 years. The Expanded Programme of Immunization and expanded use of oral rehydration therapy have played key roles in improving child survival. The contraceptive prevalence rate is at about 45%. The total fertility rate has decreased from 4.3 to 3.4. The Government of Bangladesh has an action plan to improve the status of women by developing or redirecting political, economic, and social processes and institutions to enable women to participate in decision making at the family, community, national, and international levels. The number of elderly is rising and is rather large in absolute terms; so the Ministry of Social Welfare is addressing problems the elderly encounter. The government's social development policies are geared to minimizing poverty, improving living standards, and developing human resources.

Rare mutation in the SLC26A3 transporter causes life-long diarrhoea with metabolic alkalosis

PubMed Central

Abou Ziki, Maen D; Verjee, Mohamud A

2015-01-01

SLC26A3, a chloride/bicarbonate transporter mainly expressed in the intestines, plays a pivotal role in chloride absorption. We present a 23-year-old woman with a history of congenital chloride diarrhoea (CCD) and renal transplant who was admitted for rehydration and treatment of acute kidney injury after she presented with an acute diarrhoeal episode. Laboratory investigations confirmed metabolic alkalosis and severe hypochloraemia, consistent with her underlying CCD. This contrasts with most other forms of diarrhoea, which are normally associated with metabolic acidosis. Genetic testing was offered and revealed a homozygous non-sense mutation in SLC26A3 (Gly-187-Stop). This loss-of-function mutation results in bicarbonate retention in the blood and chloride loss into the intestinal lumen. Symptomatic management with daily NaCl and KCl oral syrups was supplemented with omeprazole therapy. The loss of her own kidneys is most likely due to crystal-induced nephropathy secondary to chronic volume contraction and chloride depletion. This case summarises the pathophysiology and management of CCD. PMID:25568271

Efficacy of dioctahedral smectite in acute watery diarrhea in Indian children: a randomized clinical trial.

PubMed

Mujawar, Quais Mohammad; Naganoor, Ravi; Ali, Mir Dilshad; Malagi, Naushad; Thobbi, Achyut Narayan

2012-02-01

To determine the effects and safety of dioctahedral smectite (DS) on the duration of acute watery diarrhea in children. A Randomized, open labeled, clinical controlled trial in a tertiary care hospital outpatient department (OPD) and emergency department. Participants were one hundred and seventeen children without any chronic illness between 2 and 5 years presenting to OPD, having acute watery diarrhea for <48 h with mild to moderate dehydration, not on antibiotics and requiring oral rehydration therapy. Intervention done was DS with a dose of 1.5 g thrice daily. Freshly dissolved DS in a dose of 1.5 g thrice daily for 5 days significantly shortened the duration of acute watery diarrhea in children aged 2-5 years. There were no adverse effects on the use of DS. DS was acceptable to the children, and its administration was not accompanied with any side effects. DS reduces the duration of diarrhea in Indian children and prevents a prolonged course, and therefore, may consistently reduce the costs in treatment of acute watery diarrhea.

Apoplastic water fraction and rehydration techniques introduce significant errors in measurements of relative water content and osmotic potential in plant leaves.

PubMed

Arndt, Stefan K; Irawan, Andi; Sanders, Gregor J

2015-12-01

Relative water content (RWC) and the osmotic potential (π) of plant leaves are important plant traits that can be used to assess drought tolerance or adaptation of plants. We estimated the magnitude of errors that are introduced by dilution of π from apoplastic water in osmometry methods and the errors that occur during rehydration of leaves for RWC and π in 14 different plant species from trees, grasses and herbs. Our data indicate that rehydration technique and length of rehydration can introduce significant errors in both RWC and π. Leaves from all species were fully turgid after 1-3 h of rehydration and increasing the rehydration time resulted in a significant underprediction of RWC. Standing rehydration via the petiole introduced the least errors while rehydration via floating disks and submerging leaves for rehydration led to a greater underprediction of RWC. The same effect was also observed for π. The π values following standing rehydration could be corrected by applying a dilution factor from apoplastic water dilution using an osmometric method but not by using apoplastic water fraction (AWF) from pressure volume (PV) curves. The apoplastic water dilution error was between 5 and 18%, while the two other rehydration methods introduced much greater errors. We recommend the use of the standing rehydration method because (1) the correct rehydration time can be evaluated by measuring water potential, (2) overhydration effects were smallest, and (3) π can be accurately corrected by using osmometric methods to estimate apoplastic water dilution. © 2015 Scandinavian Plant Physiology Society.

Comparison of ultrarapid and rapid intravenous hydration in pediatric patients with dehydration.

PubMed

Nager, Alan L; Wang, Vincent J

2010-02-01

The purpose of this study is to test the efficacy of ultrarapidly infused vs rapidly infused intravenous (IV) hydration in pediatric patients with acute gastroenteritis and moderate dehydration. Patients 3 to 36 months, with vomiting and/or diarrhea and moderate dehydration, were eligible. Subjects were randomly assigned "ultra" (50 mL/kg normal saline for 1 hour) vs "standard" (50 mL/kg normal saline for 3 hours) after failing an oral fluid challenge. Subjects were weighed and had serum electrolyte testing, and urine was obtained before/after IV hydration. Input/output and vital signs were tabulated hourly during the study. Subjects were discharged after fulfilling specified criteria. A follow-up questionnaire was completed 24 hours after discharge. Comparison data included success and timing of rehydration, number of patients who returned and/or were admitted, output during the rehydration period, laboratory differences, and serious complications. Eighty-eight of 92 subjects completed the study: 45 ultra and 43 standard. Four patients failed treatment (1 ultra and 3 standard), were hospitalized, and excluded from the study. Groups were similar regarding sex, days of symptoms, episodes of vomiting/diarrhea before treatment, capillary refill time, tears, and vital signs and laboratory results. No subject had evidence of serious complications. Ninety-one percent of subjects completed the follow-up questionnaire. Seven ultra and 6 standard subjects returned. Six ultra subjects received oral fluid, one received IV fluid, and all were discharged. Five standard subjects received oral fluid, one received IV fluid, and all were discharged. Based on this pilot study, ultrarapid hydration for 1 hour preliminarily appears to be an efficacious alternative to standard rapid hydration for 3 hours and improves emergency department throughput time. Copyright 2010 Elsevier Inc. All rights reserved.

An alkalinizing oral rehydration solution containing lecithin-coated citrus fiber is superior to a nonalkalinizing solution in treating 360 calves with naturally acquired diarrhea.

PubMed

Goodell, G M; Campbell, J; Hoejvang-Nielsen, L; Stansen, W; Constable, P D

2012-11-01

The aim of this field study was to compare the efficacy and cost of 2 commercially available oral rehydration therapy (ORT) solutions in treating dairy calves with naturally acquired diarrhea. A total of 1,349 newborn Holstein-Friesian calves were prospectively enrolled in the study. Calves were housed in individual hutches and fed a mixture of pasteurized hospital milk and an all-milk protein milk replacer twice per day. Calves were monitored twice each day from d 2 of life until 30 d of age for the presence or absence of diarrhea, and were assigned a fecal score and a hydration score at each examination. Calves that developed mild to severe diarrhea that did not need intravenous fluids and did not have clinical evidence of concurrent disease (n = 360) were assigned randomly to receive 1 of 2 commercial ORT solutions: a hypertonic alkalinizing ORT containing lecithin-coated citrus fibers (Diaque, group D, n = 180; Boehringer Ingelheim, Ingelheim, Germany), and an isotonic nonalkalinizing ORT (RE-SORB, group R, n = 180; Pfizer Animal Health, New York, NY) for 2 to 8d; the duration of treatment depended on whether diarrhea was still present. No significant differences were observed in mortality rates or treatment failure rates between the 2 treatment groups. Fecal consistency returned to normal more quickly in group D calves than in group R calves; consequently, group D calves were treated for 1d less than were group R calves. The increase in body weight after 4d of treatment was larger in group D than in group R. The average daily gain from birth to weaning in calves that did not develop concurrent disease (such as pneumonia) during the study period tended to be higher in group D calves (0.53±0.11 kg/d) than in group R calves (0.51±0.09 kg/d). The smaller number of treatments at a lower cost per treatment produced a cost advantage of $4.82 per treated calf in group D calves compared with group R calves. Our findings support the concept that milk should continue to be fed to diarrheic calves that are being administered an ORT solution in order to maintain growth. Copyright © 2012 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Increased Milk Protein Concentration in a Rehydration Drink Enhances Fluid Retention Caused by Water Reabsorption in Rats.

PubMed

Ito, Kentaro; Saito, Yuri; Ashida, Kinya; Yamaji, Taketo; Itoh, Hiroyuki; Oda, Munehiro

2015-01-01

A fluid-retention effect is required for beverages that are designed to prevent dehydration. That is, fluid absorbed from the intestines should not be excreted quickly; long-term retention is desirable. Here, we focused on the effect of milk protein on fluid retention, and propose a new effective oral rehydration method that can be used daily for preventing dehydration. We first evaluated the effects of different concentrations of milk protein on fluid retention by measuring the urinary volumes of rats fed fluid containing milk protein at concentrations of 1, 5, and 10%. We next compared the fluid-retention effect of milk protein-enriched drink (MPD) with those of distilled water (DW) and a sports drink (SD) by the same method. Third, to investigate the mechanism of fluid retention, we measured plasma insulin changes in rats after ingesting these three drinks. We found that the addition of milk protein at 5 or 10% reduced urinary volume in a dose-dependent manner. Ingestion of the MPD containing 4.6% milk protein resulted in lower urinary volumes than DW and SD. MPD also showed a higher water reabsorption rate in the kidneys and higher concentrations of plasma insulin than DW and SD. These results suggest that increasing milk protein concentration in a beverage enhances fluid retention, which may allow the possibility to develop rehydration beverages that are more effective than SDs. In addition, insulin-modifying renal water reabsorption may contribute to the fluid-retention effect of MPD.

Antimicrobial drugs for treating cholera

PubMed Central

Leibovici-Weissman, Ya'ara; Neuberger, Ami; Bitterman, Roni; Sinclair, David; Salam, Mohammed Abdus; Paul, Mical

2014-01-01

Background Cholera is an acute watery diarrhoea caused by infection with the bacterium Vibrio cholerae, which if severe can cause rapid dehydration and death. Effective management requires early diagnosis and rehydration using oral rehydration salts or intravenous fluids. In this review, we evaluate the additional benefits of treating cholera with antimicrobial drugs. Objectives To quantify the benefit of antimicrobial treatment for patients with cholera, and determine whether there are differences between classes of antimicrobials or dosing schedules. Search methods We searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; African Index Medicus; LILACS; Science Citation Index; metaRegister of Controlled Trials; WHO International Clinical Trials Registry Platform; conference proceedings; and reference lists to March 2014. Selection criteria Randomized and quasi-randomized controlled clinical trials in adults and children with cholera that compared: 1) any antimicrobial treatment with placebo or no treatment; 2) different antimicrobials head-to-head; or 3) different dosing schedules or different durations of treatment with the same antimicrobial. Data collection and analysis Two reviewers independently applied inclusion and exclusion criteria, and extracted data from included trials. Diarrhoea duration and stool volume were defined as primary outcomes. We calculated mean difference (MD) or ratio of means (ROM) for continuous outcomes, with 95% confidence intervals (CI), and pooled data using a random-effects meta-analysis. The quality of evidence was assessed using the GRADE approach. Main results Thirty-nine trials were included in this review with 4623 participants. Antimicrobials versus placebo or no treatment Overall, antimicrobial therapy shortened the mean duration of diarrhoea by about a day and a half compared to placebo or no treatment (MD -36.77 hours, 95% CI -43.51 to -30.03, 19 trials, 1013 participants, moderate quality evidence). Antimicrobial therapy also reduced the total stool volume by 50% (ROM 0.5, 95% CI 0.45 to 0.56, 18 trials, 1042 participants, moderate quality evidence) and reduced the amount of rehydration fluids required by 40% (ROM 0.60, 95% CI 0.53 to 0.68, 11 trials, 1201 participants, moderate quality evidence). The mean duration of fecal excretion of vibrios was reduced by almost three days (MD 2.74 days, 95% CI -3.07 to -2.40, 12 trials, 740 participants, moderate quality evidence). There was substantial heterogeneity in the size of these benefits, probably due to differences in the antibiotic used, the trial methods (particularly effective randomization), and the timing of outcome assessment. The benefits of antibiotics were seen both in trials recruiting only patients with severe dehydration and in those recruiting patients with mixed levels of dehydration. Comparisons of antimicrobials In head-to-head comparisons, there were no differences detected in diarrhoea duration or stool volume for tetracycline compared to doxycycline (three trials, 230 participants, very low quality evidence); or tetracycline compared to ciprofloxacin or norfloxacin (three trials, 259 participants, moderate quality evidence). In indirect comparisons with substantially more trials, tetracycline appeared to have larger benefits than doxycycline, norfloxacin and trimethoprim-sulfamethoxazole for the primary review outcomes. Single dose azithromycin shortened the duration of diarrhoea by over a day compared to ciprofloxacin (MD -32.43, 95% CI -62.90 to -1.95, two trials, 375 participants, moderate quality evidence) and by half a day compared to erythromycin (MD -12.05, 95% CI -22.02 to -2.08, two trials, 179 participants, moderate quality evidence). It was not compared with tetracycline. Authors' conclusions In treating cholera, antimicrobials result in substantial improvements in clinical and microbiological outcomes, with similar effects observed in severely and non-severely ill patients. Azithromycin and tetracycline may have some advantages over other antibiotics. PLAIN LANGUAGE SUMMARY Antibiotics for treating cholera Cochrane Collaboration researchers conducted a review of the effects of antibiotics for treating people with cholera. After searching for relevant trials, they included 39 randomized controlled trials enrolling 4623 people with cholera. What is cholera and how might antibiotics work Cholera is a form of severe watery diarrhoea, which spreads from person to person through food and water contaminated with the bacterium Vibrio cholerae. Cholera is common in places with poor water and sanitation, and sometimes causes large epidemics with thousands of people falling ill. Cholera can cause severe dehydration and death, so the main treatment is to give fluids and salt either orally as oral rehydration salts, or by injection. By clearing the bacteria earlier than the patients own immune system, antibiotics could reduce the duration and severity of the illness, and reduce onward transmission to other people. What the research says Antibiotic treatment shortened the duration of diarrhoea by about one and a half days (the normal duration is between three and four days), and reduced the total amount of diarrhoea fluid by half. Consequently, the need for rehydration fluids was also reduced by almost half. Antibiotic treatment also shortened the period of time where the patient remains contagious by reducing the duration of excretion of Vibrio cholerae in the diarrhoea. The benefits of antibiotics were seen in trials recruiting only people with severe dehydration, and in those recruiting people with mixed levels of dehydration. Tetracycline or azithromycin appear more effective than some of the other antibiotics tested, but the choice of which antibiotic to use will depend on local drug resistance. PMID:24944120

Effect of temperature on water diffusion during rehydration of sun-dried red pepper ( Capsicum annuum L.)

NASA Astrophysics Data System (ADS)

Demiray, Engin; Tulek, Yahya

2017-05-01

Rehydration, which is a complex process aimed at the restoration of raw material properties when dried material comes in contact with water. In the present research, studies were conducted to probe the kinetics of rehydration of sun-dried red peppers. The kinetics associated with rehydrating sun-dried red peppers was studied at three different temperatures (25, 35 and 45 °C). To describe the rehydration kinetics, four different models, Peleg's, Weibull, first order and exponential association, were considered. Between these four models proposed Weibull model gave a better fit for all rehydration conditions applied. The effective moisture diffusivity values of red peppers increased as water rehydration temperature increased. The values of the effective moisture diffusivity of red peppers were in the range 1.37 × 10-9-1.48 × 10-9 m2 s-1. On the other hand, the activation energy for rehydration kinetic was also calculated using Arrhenius equation and found as 3.17 kJ mol-1.

Expression of GPD1 and SIP18 genes during rehydration in active dry industrial Saccharomyces cerevisiae cider-making yeast strains (ADY).

PubMed

Goncerzewicz, Anna; Kamińska-Wojteczek, Karolina; Młynarczyk, Izabella; Misiewicz, Anna

2017-01-01

In this study we determined the influence of different sugar concentration in media, time of rehydration and type of strain on relative expression level of GPD1 and SIP18 genes of active dry cider-making yeast strains, followed by the assessment of the impact of rehydration on the fermentation process. High expression of SIP18 at the beginning of rehydration was shown to be due to high transcription of the gene during the drying process. High sugar concentrations of media initiated transcription of the GPD1 gene and triggered the cellular glycerol biosynthesis pathway in examined strains. Rehydration time and type of strain showed to have no statistically significant impact on the course of the fermentation; RT qPCR results depended mainly on the time of rehydration and sugar concentration of the medium. This is the first attempt to confront rehydration time and molecular mechanisms acting upon rehydration with the course of the fermentation process.

Community pharmacists' views of the use of oral rehydration salt in Nigeria.

PubMed

Oyetunde, Olubukola; Williams, Veronika

2018-06-01

Background Oral rehydration salt (ORS) is an affordable and effective intervention for the management of acute watery diarrhoea (AWD), especially in children under 5 years. A knowledge/practice gap exists among community pharmacists (CPs) in Lagos, Nigeria, and in many low to middle income countries. This gap results in underutilization of ORS for diarrhoea management. Objective The objective was to explore CPs' views of the barriers and facilitators to the use of ORS in practice. Setting Community pharmacy practices, Lagos, Nigeria. Methods Qualitative methods were used to explore pharmacists' views. Recruitment of participants were mainly at zonal meetings. A total of ten CPs participated based on maximum variation and snowballing sampling. Semi-structured interviews conducted covered knowledge, experiences and contextual issues. Interviews were audiorecorded, transcribed and analysed using framework approach to thematic analysis. Main outcome measure Pharmacists' views of barriers and facilitators to the use of ORS. Results Barriers to the use of ORS include caregivers' expectation for an antimicrobial, which was often explicitly and specifically for metronidazole. Also, CPs seemed to doubt applicability of ORS alone, therefore, responded to caregivers' complaints about ORS, by dispensing metronidazole. These barriers appeared to have normalised metronidazole for AWD treatment in this setting. Current facilitators include the caregivers' improved awareness of ORS and access to primary health centers that often resulted in increased demand for ORS in pharmacies. Conclusion CPs' views showed that caregivers' expectations for an antimicrobial may be the main barrier to the use of ORS in their practices.

Use of rice-based oral rehydration solution in a large diarrhoea treatment centre in Bangladesh: in-house production, use and relative cost.

PubMed

Islam, M A; Mahalanabis, D; Majid, N

1994-12-01

Glucose-based oral rehydration salt (ORS) is an appropriate and cost-effective tool to treat diarrhoeal dehydration. In patients with a high purging rate, particularly due to cholera, rice-based ORS has been shown to substantially reduce stool output compared to glucose ORS. However, it is not used in the hospitals or diarrhoea treatment centres largely because of the non-availability of a ready-to-use inexpensive packaged product and because of the problem of cooking. In a large diarrhoea treatment centre in Bangladesh (with an annual ORS consumption of approximately 140,000 litres), we have maintained in-house production of rice ORS and used it routinely for more than 600,000 patients over the last nine years. Semi-literate health workers cook rice ORS and supervise mothers in its use. Rice ORS is less costly (US $0.15 per patient treated compared with US $0.37 for glucose ORS) and is well accepted. It is an attractive alternative to glucose ORS in many fixed facility treatment centres in countries where rice is a staple and cholera is endemic. The process of its in-house preparation and use is described in this report which may assist hospitals wishing to use rice ORS in treating diarrhoea patients. Availability of a low cost ready-to-use rice ORS packet (which needs no cooking) with adequate shelf-life will increase its use at fixed facilities.

Rehydration of freeze-dried and convective dried boletus edulis mushrooms: effect on some quality parameters.

PubMed

Hernando, I; Sanjuán, N; Pérez-Munuera, I; Mulet, A

2008-10-01

Quality of rehydrated products is a key aspect linked to rehydration conditions. To assess the effect of rehydration temperature on some quality parameters, experiments at 20 and 70 degrees C were performed with convective dried and freeze-dried Boletus edulis mushrooms. Rehydration characteristics (through Peleg's parameter, k(1), and equilibrium moisture, W(e)), texture (Kramer), and microstructure (Cryo-Scanning Electron Microscopy) were evaluated. Freeze-dried samples absorbed water more quickly and attained higher W(e) values than convective dried ones. Convective dehydrated samples rehydrated at 20 degrees C showed significantly lower textural values (11.9 +/- 3.3 N/g) than those rehydrated at 70 degrees C (15.7 +/- 1.2 N/g). For the freeze-dried Boletus edulis, the textural values also exhibited significant differences, being 8.2 +/- 1.3 and 10.5 +/- 2.3 N/g for 20 and 70 degrees C, respectively. Freeze-dried samples showed a porous structure that allows rehydration to take place mainly at the extracellular level. This explains the fact that, regardless of temperature, freeze-dried mushrooms absorbed water more quickly and reached higher W(e) values than convective dried ones. Whatever the dehydration technique used, rehydration at 70 degrees C produced a structural damage that hindered water absorption; consequently lower W(e) values and higher textural values were attained than when rehydrating at 20 degrees C.

Nutritional status, exclusive breastfeeding and management of acute respiratory illness and diarrhea in the first 6 months of life in infants from two regions of Indonesia.

PubMed

Oktaria, V; Lee, K J; Bines, J E; Watts, E; Satria, C D; Atthobari, J; Nirwati, H; Kirkwood, C D; Soenarto, Y; Danchin, M H

2017-12-21

Infant morbidity and mortality rates remain high in Indonesia, with acute respiratory illnesses (ARI) and diarrhea the leading two health problems in children under 5 years. We aimed to describe the nutritional status, feeding practice and case management of ARI and diarrhea of infants from two regions of Indonesia during the first 6 months of life. This study was an observational study conducted in parallel to an immunogenicity and efficacy trial of an oral rotavirus vaccine (RV3-BB) in the Klaten and Yogyakarta regions, Indonesia. Mothers were interviewed at 3 time points: within the first 6 days of their infant's life, and at 8-10 and 22-24 weeks of age. Questions asked included pregnancy history, infant nutritional status, feeding status and health of infants within up to 2 weeks prior to the assessment. Between February 2013 and January 2014, 233 mother-infant pairs were recruited. 60% (136/223) of infants were exclusively breastfed (EBF) until 6 months of age with the strongest support for EBF reported by mothers themselves 70% (101/223) and 25% (36/223) from their partners. At 6 months, 6% (14/223) of infants were underweight and severely underweight; 4% (8/ 223) wasted and severely wasted; and 12% (28/223) were stunted and severely stunted. Non-recommended medication use was high, with 54% (21/39) of infants with reported cough within 2 weeks of an assessment receiving cough medication, 70% (27 /39) an antihistamine, 26% (10/39) a mucolytic and 15% (6 /39) an oral bronchodilator. At age 22-24 week, infants with reported diarrhea within 2 weeks of an assessment had low use of oral rehydration solutions (ORS) (3/21;14%) and zinc therapy (2/ 21;10%). In this unique observational study, breastfeeding rates of 60% at 6 months were below the Indonesian national target of >75%. Adherence to WHO guidelines for management of ARI and diarrhea was poor, with high use of non-recommended cough medications and oral bronchodilators in the first 6 months of life and low use of ORS and zinc therapy. Ongoing education of primary health care workers and parents regarding management of common illness is needed in Indonesia.

Comparison of a commercially available oral nutritional supplement and intravenous fluid therapy for dehydration in dairy calves.

PubMed

Taylor, Jared D; Rodenburg, Merel; Snider, Timothy A

2017-06-01

Calf scours is a primary cause of morbidity and mortality in the dairy industry. Effective treatments are needed to minimize death, maximize welfare, and maintain growth and productivity. The objective of this trial was to compare the efficacy of a commercially available nutritional supplement (Diaque, Boehringer-Ingelheim Vetmedica Inc., St. Joseph, MO) and i.v. lactated Ringer's solution (LRS) in rehydrating, preventing acidemia, and correcting electrolyte imbalances in an experimental model for calf scours. Twenty-four colostrum-fed suckling dairy calves were used in a modified crossover design. An osmotic diarrhea was induced by orally feeding commercial milk replacer modified with high level of sucrose to create a hypertonic milk solution, and administering oral hydrochlorothiazide and spironolactone for 48 h. The intention was to create a challenge sufficient to result in moderately dehydrated, standing calves without producing severe depression or loss of suckle. The efficacy of i.v. fluid therapy and a commercial nutritional supplement were subsequently compared for reversing the effects of the diarrheal disease. Treatment A consisted of administering the nutritional supplement according to label directions (100 g in 1.9 L of warm water, 3 times a day), and treatment B consisted of i.v. LRS (2 L, once a day). Clinical signs and laboratory results were obtained once daily by a blinded observer. The induction method was effective in creating the desired effect, as demonstrated by weight loss and subjective health and hydration scores. Both treatment groups experienced increases in body weight, base excess, and bicarbonate, and decreases in total protein and packed cell volume following treatment. Both i.v. LRS and Diaque are effective methods to correct hypovolemia and control derangements in acid-base status in calves with diarrhea and dehydration. The Authors. Published by the Federation of Animal Science Societies and Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).

Recovery Estimation of Dried Foodborne Pathogens Is Directly Related to Rehydration Kinetics

PubMed Central

Lang, Emilie; Zoz, Fiona; Iaconelli, Cyril; Guyot, Stéphane; Alvarez-Martin, Pablo; Beney, Laurent; Perrier-Cornet, Jean-Marie; Gervais, Patrick

2016-01-01

Drying is a common process which is used to preserve food products and technological microorganisms, but which is deleterious for the cells. The aim of this study is to differentiate the effects of drying alone from the effects of the successive and necessary rehydration. Rehydration of dried bacteria is a critical step already studied in starter culture but not for different kinetics and not for pathogens. In the present study, the influence of rehydration kinetics was investigated for three foodborne pathogens involved in neonatal diseases caused by the consumption of rehydrated milk powder: Salmonella enterica subsp. enterica serovar Typhimurium, Salmonella enterica subsp. enterica serovar Senftenberg and Cronobacter sakazakii. Bacteria were dried in controlled relative humidity atmospheres and then rehydrated using different methods. Our results showed that the survival of the three pathogens was strongly related to rehydration kinetics. Consequently, rehydration is an important step to consider during food safety assessment or during studies of dried foodborne pathogens. Also, it has to be considered with more attention in consumers’ homes during the preparation of food, like powdered infant formula, to avoid pathogens recovery. PMID:27494169

Survival of Aerobic and Anaerobic Bacteria in Chicken Meat During Freeze-Dehydration, Rehydration, and Storage1

PubMed Central

Chipley, J. R.; May, K. N.

1968-01-01

Total and anaerobic counts were ascertained on boneless, cooked, cubed, frozen chicken meat. We determined survival of aerobes and anaerobes in the natural flora after the meat was freeze-dehydrated and rehydrated at room temperature for 30 min and at 50, 85, and 100 C for 10 min. Total and anaerobic counts of bacteria in the rehydrated meat were established during storage of samples at 4, 22, and 37 C—until a spoilage odor was detected. Samples were also inoculated with Clostridium sporogenes and were dried and rehydrated at 100 C and stored at 37 C. Approximately 21% of the aerobes and 37% of the anaerobes survived drying and rehydration at room temperature. Many genera of aerobes, anaerobes, and facultative anaerobes survived drying and rehydration at 50 C; only sporeformers survived rehydration at 85 or 100 C. Low-temperature (4 C) storage of rehydrated meat produced ample shelf life (over 20 days), whereas storage at the higher temperature resulted in a shelf life of less than 30 hr. Approximately 81% of the C. sporogenes cells survived rehydration at 100 C and grew to over 107 cells within 40 hr. Our study presents additional data for adequate microbiological control in processing of freeze-dehydrated meat. Also, it points out the natural selection for sporeformers at high temperature of rehydration, stressing the need for consumer education in product handling for safety purposes. PMID:5689798

[Efficacy of the subcutaneous route compared to intravenous hydration in the elderly hospitalised patient: a randomised controlled study].

PubMed

Duems Noriega, Oscar; Ariño Blasco, Sergio

2014-01-01

The subcutaneous (SC) route has recently emerged as a rehydration method with potential advantages in the geriatric population. Nevertheless, little is known about its application during hospitalization. The objective of the present study is to evaluate the subcutaneous non-inferiority efficacy in hydration against the intravenous (IV) route in elderly patients with dehydration. A prospective, randomized and controlled interventional trial of patients 65 years and older admitted to an Acute Geriatric Unit with mild to moderate dehydration and oral intolerance, evaluating the non-inferiority of subcutaneous fluid therapy versus the intravenous route. The intervention consisted of the administration of up to 1.5 l/day/route for 72 hours subcutaneous vs. intravenous, evaluating the variations in biochemical parameters (urea, creatinine, osmolarity), clinical outcome, and route related complications. Sixty seven patients completed the study (34 SC, age 86.4 ± 8.5 years, 41% women, vs. 33 IV, 84.3 ± 6.6, 54.5% women, with no significant differences). The amount of fluid administered per day by route was 1.320 ml ± 400 SC vs. 1.480 ml ± 340 IV, P = .092. During follow similar reductions were observed between groups without any statistical significance, with mean differences pre-postintervention of urea (49.6 ± 52.3 SC vs. 50.3 ± 52.3 IV, P=.96); creatinine (0.68 ± 0.66 SC vs. 0.60 ± 0.49 IV, P=.58), and osmolarity (15.6 ± 24.4 SC vs. 21.1 ± 31 IV, P=.43). Fewer catheter extraction episodes were observed in the SC group, which also was the group most prone to peri-clysis edema. The efficacy of subcutaneous rehydration in elderly hospitalized patients with mild-moderate dehydration is not inferior to that obtained intravenously, and may even have additional advantages. Copyright © 2013 SEGG. Published by Elsevier Espana. All rights reserved.

40 CFR 180.1260 - Muscodor albus QST 20799 and the volatiles produced on rehydration; exemption from the...

Code of Federal Regulations, 2010 CFR

2010-07-01

... volatiles produced on rehydration; exemption from the requirement of a tolerance. 180.1260 Section 180.1260... 20799 and the volatiles produced on rehydration; exemption from the requirement of a tolerance. An... Muscodor albus QST 20799, and the volatiles produced on its rehydration, when the pesticide is used for all...

Unprecedented decline in measles morbidity and mortality in Calabar, south-eastern Nigeria.

PubMed

Ekanem, E E; Ochigbo, S O; Kwagtsule, J U

2000-10-01

The features of measles presenting at the University of CalabarTeaching Hospital, in south-eastern Nigeria between January 1992 to December 1996, were compared with those of a previous period (January 1984 to December 1987) in the same institution. The aim was to detect any changes in trends, morbidity and mortality from the infection in this environment. There were only 36 cases (7.2 per year) in the current period compared with 436 (109 per year) in the previous period (chi2=48.4, P<0.001). There were also highly significant falls in the incidence of malnutrition and bronchopneumonia (P<0.05) in the current period. Notably, there were no cases of dehydration or keratomalacia in the current period. The case fatality rate was 2.8% compared with 20.0% in the previous period (P<0.02). These unprecedented changes in the incidence, morbidity and mortality from measles are attributed to the continuing Expanded Programme on Immunization, oral rehydration therapy, appropriate nutritional management and vitamin A prophylaxis. With maintenance and strengthening of these strategies, the elimination of measles and measles deaths in the near future is feasible in this environment.

Health system reform and the role of field sites based upon demographic and health surveillance.

PubMed Central

Tollman, S. M.; Zwi, A. B.

2000-01-01

Field sites for demographic and health surveillance have made well-recognized contributions to the evaluation of new or untested interventions, largely through efficacy trials involving new technologies or the delivery of selected services, e.g. vaccines, oral rehydration therapy and alternative contraceptive methods. Their role in health system reform, whether national or international, has, however, proved considerably more limited. The present article explores the characteristics and defining features of such field sites in low-income and middle-income countries and argues that many currently active sites have a largely untapped potential for contributing substantially to national and subnational health development. Since the populations covered by these sites often correspond with the boundaries of districts or subdistricts, the strategic use of information generated by demographic surveillance can inform the decentralization efforts of national and provincial health authorities. Among the areas of particular importance are the following: making population-based information available and providing an information resource; evaluating programmes and interventions; and developing applications to policy and practice. The question is posed as to whether their potential contribution to health system reform justifies arguing for adaptations to these field sites and expanded investment in them. PMID:10686747

Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region.

PubMed

Cameron, Donald; Hock, Quak Seng; Kadim, Musal; Mohan, Neelam; Ryoo, Eell; Sandhu, Bhupinder; Yamashiro, Yuichiro; Jie, Chen; Hoekstra, Hans; Guarino, Alfredo

2017-12-07

Recommendations for probiotics are available in several regions. This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Epidemiology and clinical patterns of intestinal diseases in Asia-Pacific countries were discussed. Evidence-based recommendations and randomized controlled trials in the region were revised. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by applying the Likert scale and rated using the GRADE system. Saccharomyces boulardii CNCM I-745 (Sb) and Lactobacillus rhamnosus GG ( LGG ) were strongly recommended as adjunct treatment to oral rehydration therapy for gastroenteritis. Lactobacillus reuteri could also be considered. Probiotics may be considered for prevention of (with the indicated strains): antibiotic-associated diarrhea (LGG or Sb); Clostridium difficile -induced diarrhea (Sb); nosocomial diarrhea (LGG); infantile colic ( L reuteri ) and as adjunct treatment of Helicobacter pylori (Sb and others). Specific probiotics with a history of safe use in preterm and term infants may be considered in infants for prevention of necrotizing enterocolitis. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations apply well to Asia pacific countries. These need to be validated with local randomized-controlled trials.

Separate and combined effects of airflow and rehydration during exercise in the heat.

PubMed

Mora-Rodriguez, Ricardo; Del Coso, Juan; Aguado-Jimenez, Roberto; Estevez, Emma

2007-10-01

To determine whether airflow is required to obtain the beneficial effects of rehydration (thermoregulatory and cardiovascular) during exercise in dry heat. Ten moderately trained (VO2max = 55 +/- 8 mL.kg(-1).min(-1)) heat acclimated males pedaled for 60 min at 60% VO2max in a hot-dry environment (36 +/- 1 degrees C; 29 +/- 2% relative humidity) on four different occasions: 1) without rehydration or forced airflow (control trial; CON); 2) rehydrating 100% of sweat losses by ingestion of a 6% carbohydrate-electrolyte solution (rehydration trial; REH); 3) receiving airflow at a velocity of 2.55 m.s(-1) (wind trial; WIND); and 4) combining airflow and rehydration (W + R). Without airflow, rehydration alone (REH) did not lower rectal temperature below CON (39.0 +/- 0.1 vs 39.1 +/- 0.1 degrees C at 60 min; respectively). However, with airflow, rehydration reduced final rectal temperature (38.8 +/- 0.1 vs 38.5 +/- 0.1 degrees C; P < 0.05; WIND vs W + R). In the trials with wind (WIND and W + R), skin temperature was reduced by about 0.6 degrees C (P < 0.05), and heart rate drift was prevented. In the trials with rehydration (REH and W + R trials), cardiac output (CO2-rebreathing technique) was maintained higher than CON (16.5 +/- 0.4 and 17.0 +/- 0.7 vs 15.4 +/- 0.4 L.min(-1), respectively; P < 0.05). When exercising in a hot-dry environment, airflow is required for rehydration to improve thermoregulation and cardiovascular function.

Management strategies in the treatment of neonatal and pediatric gastroenteritis

PubMed Central

Ciccarelli, Simona; Stolfi, Ilaria; Caramia, Giuseppe

2013-01-01

Acute gastroenteritis, characterized by the onset of diarrhea with or without vomiting, continues to be a major cause of morbidity and mortality in children in mostly resource-constrained nations. Although generally a mild and self-limiting disease, gastroenteritis is one of the most common causes of hospitalization and is associated with a substantial disease burden. Worldwide, up to 40% of children aged less than 5 years with diarrhea are hospitalized with rotavirus. Also, some microorganisms have been found predominantly in resource-constrained nations, including Shigella spp, Vibrio cholerae, and the protozoan infections. Prevention remains essential, and the rotavirus vaccines have demonstrated good safety and efficacy profiles in large clinical trials. Because dehydration is the major complication associated with gastroenteritis, appropriate fluid management (oral or intravenous) is an effective and safe strategy for rehydration. Continuation of breastfeeding is strongly recommended. New treatments such as antiemetics (ondansetron), some antidiarrheal agents (racecadotril), and chemotherapeutic agents are often proposed, but not yet universally recommended. Probiotics, also known as “food supplement,” seem to improve intestinal microbial balance, reducing the duration and the severity of acute infectious diarrhea. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition and the European Society of Paediatric Infectious Diseases guidelines make a stronger recommendation for the use of probiotics for the management of acute gastroenteritis, particularly those with documented efficacy such as Lactobacillus rhamnosus GG, Lactobacillus reuteri, and Saccharomyces boulardii. To date, the management of acute gastroenteritis has been based on the option of “doing the least”: oral rehydration-solution administration, early refeeding, no testing, no unnecessary drugs. PMID:24194646

Evaluation of who oral rehydration solution (ORS) and salt tablets in resuscitating adult patients with burns covering more than 15% of total body surface area (TBSA).

PubMed

Moghazy, A M; Adly, O A; Elbadawy, M A; Hashem, R E

2016-03-31

Intra-venous (IV) burn resuscitation is effective; nevertheless it has its disadvantages. WHO Oral Rehydration Solution (ORS) has shown high effectiveness in treating dehydration. WHO-ORS, with salt supplement, seems to be suitable for burn resuscitation, where IV resuscitation is not available, feasible or possible. The objective of the study was to evaluate acute phase efficacy and safety, as well as limitations and complications of burn resuscitation using WHO-ORS and salt tablets. This randomized controlled clinical trial was conducted in the Burn Unit, Suez Canal University Hospital, Ismailia, Egypt. The study group was given WHO-ORS (15% of body weight/day) with one salt tablet (5gm) per liter according to Sørensen's formula. The control group was given IV fluids according to the Parkland formula. Patients' vital signs and urine output were monitored for 72 hours after starting resuscitation. Both groups were comparable regarding age, sex, and percentage, etiology and degree of burns. For all assessed parameters, there were no major significant differences between the study group (10 cases) and control group (20 cases). Even where there was a significant difference, apart from blood pressure in the first hour of the first day, the study group never crossed safe limits for pulse, systolic blood pressure, urine output, respiratory rate and conscious level. WHO-ORS with 5gm salt tablets, given according to Sørenson's formula, is a safe and efficient alternative for IV resuscitation. It could even be a substitute, particularly in low resource settings and fire disasters.

Effect of oral rehydration solution on fatigue during outdoor work in a hot environment: a randomized crossover study.

PubMed

Ishikawa, Tomohisa; Tamura, Hideru; Ishiguro, Haruya; Yamaguchi, Keiko; Minami, Kazufumi

2010-01-01

The effects of an oral rehydration solution (ORS) on fatigue were studied in workers engaged in manual work during the summer. One hundred and fifty-three workers engaged in loading cargo onto aircraft at Tokyo International Airport who consented to participate in the study were the subjects. The study was carried out on two summer days with fine weather during the daytime shift. The subjects were randomly divided into two groups: with one group restricted to ORS intake and the other group having free-choice of their favorite drink (FAD) in a randomized crossover study. The subjects were asked about the amount of beverage that they consumed and the type of FAD that they chose on the days of the survey. The effects of the ORS and the FAD were compared using a visual analogue scale (VAS) to determine the degree of fatigue experienced immediately after completing work. The average wet bulb globe temperature (WBGT) on the survey days was 30 degrees C. The beverage intake during work was 1,000 ml for most participants and the most commonly chosen types of FAD were tea and coffee. The fatigue VAS was significantly lower on the ORS intake days than on the FAD intake days (50.0 +/- 18.3 vs. 53.9 +/- 16.3). The results of this study suggest that the intake of ORS during outdoor work in a hot environment would be effective for preventing industrial accidents and heat stroke. It is important to select an appropriate drink to ensure adequate intake of water and electrolytes.

Membranes for periodontal regeneration: From commercially available to spatially designed and functionally graded materials

NASA Astrophysics Data System (ADS)

Bottino, Marco Cicero

The aging of the global population will lead to a considerable increase in the number of surgical and restorative procedures related to oral rehabilitation or periodontal regeneration. Periodontitis is one of the most aggressive pathologies that concern the integrity of the periodontal system that can lead to the destruction of the periodontium. Guided tissue and guided bone regeneration (GTR/GBR) have been used for the repair and regeneration of periodontal tissues by utilizing an occlusive membrane. The goal of this dissertation is to advance the knowledge in the area of periodontal regeneration by investigating the properties of a commercially available freeze-dried collagen-based graft (AlloDermRTM) and by designing/fabricating a functionally graded membrane (FGM) via multilayer electrospinning. The effects of different rehydration times and of a simultaneous rehydration/crosslinking procedure on the biomechanical properties and matrix stability of the commercially available membrane were investigated. The results revealed that there are significant changes on the biomechanical properties of the graft as rehydration time increases. Moreover, it was demonstrated that the simultaneous rehydration/crosslinking protocol has a synergistic effect in terms of enhancing biomechanical properties. A FGM consisting of a core-layer (CL) and two functional surface-layers (SL) was fabricated via sequential electrospinning. Hydroxyapatite nanoparticles (n-HAp) were incorporated to enhance bone formation (SL facing bone defect), and metronidazole benzoate (MET) was added to prevent bacterial colonization (SL facing the epithelial tissue). Degradation studies performed on both the CL and the FGM confirmed that the design holds promise in terms of providing the required mechanical stability to avoid membrane collapse and, therefore, enhance bone regeneration. Finally, it was demonstrated that MET incorporation into the SL that would face epithelial tissue is effective in fighting periodontopathogens in an in vitro model. Further studies are necessary to evaluate the effectiveness of this FGM on new bone formation in bone defects and to provide a quantitative evaluation in terms of the in vivo antibacterial potential of the FGM. Keywords: Collagen-based Grafts, Periodontal Regeneration, Electrospinning, Graded-Structure, Periodontitis, Metronidazole.

Effects of relaxation of gluten network on rehydration kinetics of pasta.

PubMed

Ogawa, Takenobu; Hasegawa, Ayako; Adachi, Shuji

2014-01-01

The aim of this study was to investigate the effects of the relaxation of the gluten network on pasta rehydration kinetics. The moisture content of pasta, under conditions where the effects of the diffusion of water on the moisture content were negligible, was estimated by extrapolating the average moisture content of pasta of various diameters to 0 mm. The moisture content of imaginary, infinitely thin pasta did not reach equilibrium even after 1 h of rehydration. The rehydration of pasta made of only gluten was also measured. The rate constants estimated by the Long and Richman equation for both the pasta indicated that the rehydration kinetics of infinitely thin pasta were similar to those of gluten pasta. These results suggest that the swelling of starch by fast gelatinization was restricted by the honeycomb structural network of gluten and the relaxation of the gluten network controlled pasta rehydration kinetics.

Rehydration with sodium-enriched coconut water after exercise-induced dehydration.

PubMed

Ismail, I; Singh, R; Sirisinghe, R G

2007-07-01

This crossover study assessed the effectiveness of plain water (PW), sports drink (SD), fresh young coconut water (CW) and sodium-enriched fresh young coconut water (SCW) on whole body rehydration (R) and plasma volume (PV) restoration after exercise-induced dehydration. Ten healthy male subjects ran at 65% of VO2max in an environmental temperature of 32.06 +/- 0.02 degree C with a relative humidity (rh) of 53.32 +/- 0.17% for 90 minutes to lose 3% body weight (BW). During the 2-hour rehydration period, subjects drank, in randomized order, PW, SD, CW or SCW equivalent to 120% of BW lost in three boluses representing 50, 40 and 30% of the fluid lost at 0, 30, and 60 minutes, respectively. In all trials subjects were still somewhat dehydrated even after the 2-hour rehydration period. Indexes of percent rehydration with PW, SD, CW and SCW were 58 +/- 2, 68 +/- 2, 65+/- 2 and 69 +/- 1%, respectively, with significantly better rehydration with SD and SCW. The rehydration indexes for SD and SCW were significantly lower than PW (p < 0.01). PV was restored to euhydration levels after 2 hours of rehydration with SD, CW and SCW but not with PW. The plasma glucose concentration were significantly higher when SD, CW and SCW were ingested. SCW was similar in sweetness to CW and SD but caused less nausea and stomach upset compared to SD and PW. In conclusion, ingesting SCW was as good as ingesting a commercial sports drink for whole body rehydration after exercise-induced dehydration but with better fluid tolerance.

Evaluation of an oral electrolyte solution for treatment of mild to moderate dehydration in dogs with hemorrhagic diarrhea.

PubMed

Reineke, Erica L; Walton, Karie; Otto, Cynthia M

2013-09-15

To determine the safety and efficacy of an electrolyte solution for oral administration (OES) for the correction of mild to moderate dehydration associated with hemorrhagic diarrhea in dogs. Nonrandomized, noncontrolled clinical trial. 20 dogs that had hemorrhagic diarrhea with < 3 episodes of vomiting. All dogs underwent testing for parvovirus infection, were given maropitant citrate to control emesis, and were offered an OES. Intravenous crystalloid fluid administration was performed when dogs refused the OES or had vomiting, a 5% increase in PCV, 5% decrease in body weight, serum creatinine or BUN concentration higher than at admission, or clinically important alterations in blood electrolyte or serum glucose concentrations. 13 (65%) dogs voluntarily consumed the OES; 7 (35%) dogs refused the OES and received a balanced electrolyte solution IV instead. All 13 dogs in the OES group consumed the solution ≤ 5 hours after hospital admission. Eight and 16 hours after admission, PCV and serum total protein and BUN concentrations were significantly lower than at hospital admission in the OES group, whereas no significant changes were identified in venous blood pH, base excess, and concentrations of sodium, potassium, chloride, ionized calcium, ionized magnesium, and lactate. The cost of treatment was significantly less for the OES group than for the IV treated group. Rehydration therapy with an OES was effective and safe in dogs with mild to moderate dehydration associated with hemorrhagic diarrhea. Potential benefits of this treatment approach for gastroenteritis in dogs, compared with traditional IV fluid administration, include lower owner-related veterinary costs and decreased staff time associated with treatment.

Polymer-based oral rehydration solution for treating acute watery diarrhoea

PubMed Central

Gregorio, Germana V; Gonzales, Maria Liza M; Dans, Leonila F; Martinez, Elizabeth G

2016-01-01

Background Acute diarrhoea is one of the main causes of morbidity and mortality among children in low-income countries. Glucose-based oral rehydration solution (ORS) helps replace fluid and prevent further dehydration from acute diarrhoea. Since 2004, the World Health Organization (WHO) has recommended the osmolarity of less than 270 mOsm/L (ORS ≤ 270) versus greater than 310 mOsm/L formulation (ORS ≥ 310). Polymer-based ORS (for example, prepared using rice or wheat) slowly releases glucose and may be superior to glucose-based ORS. Objectives To compare polymer-based oral rehydration solution (polymer-based ORS) with glucose-based oral rehydration solution (glucose-based ORS) for treating acute watery diarrhoea. Search methods We searched the following sources up to 5 September 2016: the Cochrane Infectious Diseases Group (CIDG) Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2016, Issue 9), MEDLINE (1966 to 5 September 2016), EMBASE (1974 to 5 September 2016), LILACS (1982 to 5 September 2016), and mRCT (2007 to 5 September 2016). We also contacted researchers, organizations, and pharmaceutical companies, and searched reference lists. Selection criteria We included randomized controlled trials (RCTs) of people with acute watery diarrhoea (cholera and non-cholera associated) that compared polymer-based and glucose-based ORS (with identical electrolyte contents). Data collection and analysis Two review authors independently assessed the search results and risk of bias, and extracted data. In multiple-treatment arms with two or more treatment groups, we combined outcomes as appropriate and compared collectively with the control group. Main results Thirty-five trials that included 4284 participants met the inclusion criteria: 28 trials exclusively included children, five included adults, and two included both adults and children. Polymer-based ORS versus glucose-based ORS (osmolarity ≤ 270) Eight trials (752 participants) evaluated this comparison, and seven trials used rice as a polymer source. Polymer-based ORS may decrease mean stool output in the first 24 hours by 24 mL/kg (mean difference (MD) −24.60 mL/kg, 95% CI −40.69 to −8.51; one trial, 99 participants, low quality evidence). The average duration of diarrhoea may be reduced by eight hours (MD −8.24 hours, 95% CI −13.17 to −3.30; I² statistic = 86%, five trials, 364 participants, low quality evidence) with polymer ORS but results are heterogeneous. Limited trials showed no observed difference in the risk of unscheduled use of intravenous fluid (RR 0.66, 95% CI 0.43 to 1.02; I² statistic = 30%; four trials, 376 participants, very low quality evidence), vomiting (very low quality evidence), and hyponatraemia (very low quality evidence). Polymer-based ORS versus glucose-based ORS (osmolarity ≥ 310) Twenty-seven trials (3532 participants) evaluated this comparison using a variety of polymers. On average, polymer ORS may reduce the total stool output in the first 24 hours by around 65 mL/kg (MD −65.47 mL/kg, 95% CI −83.92 to −47.03; 16 trials, 1483 participants, low quality evidence), and may reduce the duration of diarrhoea by around eight hours (MD −8.57 hours; SD −13.17 to −4.03; 16 trials, 1137 participants, low quality evidence) with substantial heterogeneity. The proportion of participants that required intravenous hydration was low in most trials with fewer in the polymer ORS group (RR 0.75, 95% CI 0.57 to 0.98; 19 trials, 1877 participant, low quality evidence) . Subgroup analysis by type of pathogen suggested an effect on unscheduled intravenous fluid in those infected with mixed pathogens (RR 0.63, 95% CI 0.41 to 0.96; 11 trials, 928 participants, low quality evidence), but not in participants positive for Vibrio cholerae (RR 0.94, 95% CI 0.66 to 1.34; 7 trials, 535 participants, low quality evidence). No difference was observed in the number of patients who developed vomiting (RR 0.91, 95% CI 0.72 to 1.14; 10 trials, 584 participants, very low quality evidence), hyponatraemia (RR 1.82, 95% CI 0.52 to 6.44; 4 trials, 385 participants, very low quality evidence), hypokalaemia (RR 1.29, 95% CI 0.74 to 2.25; 2 trials, 260 participants, low quality evidence), or persistent diarrhoea (RR 1.28, 95% CI 0.68 to 2.41; 2 trials, 885 participants, very low quality evidence). Authors' conclusions Polymer-based ORS shows advantages compared to glucose-based ORS (at ≥ 310 mOsm/L). Comparisons favoured polymer-based ORS over ORS ≤ 270 but analysis was underpowered. Food-based oral rehydration solution for acute diarrhoea What is polymer-based ORS and how might it help Acute diarrhoea is a common cause of death and illness in developing countries. Oral rehydration solutions (ORS) have had a massive impact worldwide in reducing the number of deaths related to diarrhoea. The original ORS was based on glucose and had an osmolarity of ≥ 310 mOsm/L (ORS ≥ 310). Glucose-based ORS with a lower osmolarity was later introduced in attempts to improve efficacy, and is considered better at reducing the amount and duration of diarrhoea. Most ORS is in the form of a sugar–salt solution, but over the years people have tried adding a variety of compounds ('glucose polymers') such as whole rice, wheat, sorghum, and maize. The aim is to slowly release glucose into the gut and improve the absorption of the water and salt in the solution. This review updates a Cochrane Review published in 2009, and assesses the available evidence on the use of polymer-based ORS (both rice and non-rice based) versus glucose-based ORS. What the research says Cochrane researchers examined the available evidence up to 5 September 2016. Thirty-five trials including 4284 participants met the inclusion criteria: 28 trials included children; five included adults; and two included both. Most trials compared polymer-based ORS with a sugar–salt ORS with a particular strength (ORS ≥ 310), which is slightly more salty than the currently agreed best formula (≤ 270 mOsm/L). The trials' methodological quality varied. In people given polymer-based ORS versus sugar-salt ORS ≤ 270 mOsm/L there was insufficient evidence to show that one is better than the other (low tovery low quality of evidence). In those given polymer-based ORS versus sugar-salt ORS ≥ 310 mOsm/L, there was a lower amount of stool and shorter time of diarrhoea in the polymer-based ORS group. No difference was observed between the two groups regarding the number of people who needed a drip to be rehydrated. Adverse events were similar (low tovery low quality of evidence). PMID:27959472

+Gz tolerance after 14 days bed rest and the effects of rehydration.

NASA Technical Reports Server (NTRS)

Greenleaf, J. E.; Van Beaumont, W.; Bernauer, E. M.; Haines, R. F.; Sandler, H.; Young, H. L.; Yusken, J. W.

1972-01-01

Measurement of the reduction in centrifugation tolerance after two weeks of bedrest with moderate daily exercise, with an attempt to determine if rehydration improves +Gz tolerance. There were significant reductions in +Gz tolerance during bedrest periods at three acceleration levels. Rehydration resulted in a significant increase in tolerance at 2.1G but it did not restore tolerance to control levels. Rehydration did not affect tolerance at 3.2G and 3.8G.

Moss antheridia are desiccation tolerant: Rehydration dynamics influence sperm release in Bryum argenteum.

PubMed

Stark, Lloyd R; McLetchie, D Nicholas; Greenwood, Joshua L; Eppley, Sarah M

2016-05-01

Free-living sperm of mosses are known to be partially desiccation tolerant. We hypothesized that mature moss antheridia should also tolerate desiccation and that rehydration to partial turgor (prehydration) or rehydration to full turgor (rehydration) before immersion in water is required for full recovery from any damaging effects of prior desiccation. Bryum argenteum (silvery-thread moss) was grown in continuous culture for several months, produced mature perigonia (clusters of antheridia), and these were subjected to a slow rate of drying (∼36 h from full turgor to desiccation) and equilibration with 50% relative humidity. Perigonia were prehydrated (exposed to a saturated atmosphere) or rehydrated (planted upright in saturated media) for 0, 45, 90, 135, 180, and 1440 min, then immersed in sterile water. Time to first sperm mass release, number of antheridia releasing sperm masses, and the integrity of the first sperm mass released were assessed. Rehydration of dried antheridia for at least 3 h before immersion in water resulted in antheridia functioning similar to control undried antheridia. Compared with rehydration, prehydration was not effective in the recovery of antheridia from desiccation. For the first time, moss antheridia are shown to be fully desiccation tolerant at a functional level, capable of releasing fully functional sperm following a slow drying event provided the antheridia are allowed to rehydrate at least 3 h before immersion in water. © 2016 Botanical Society of America.

Oral cholera vaccine use in Zanzibar: socioeconomic and behavioural features affecting demand and acceptance

PubMed Central

Schaetti, Christian; Hutubessy, Raymond; Ali, Said M; Pach, Al; Weiss, Mitchell G; Chaignat, Claire-Lise; Khatib, Ahmed M

2009-01-01

Background Cholera remains a serious public health problem in low-income countries despite efforts in the past to promote oral rehydration therapy as major treatment. In 2007, the majority of worldwide cases (94%) and deaths (99%) were reported from Africa. To improve cholera control efforts in addition to maintaining and improving existing water supply, sanitation and hygiene behaviour measures, the World Health Organization has recently started to consider the use of vaccines as an additional public health tool. To assess this new approach in endemic settings, a project was launched in Zanzibar to vaccinate 50,000 individuals living in communities at high risk of cholera with an oral two-dose vaccine (Dukoral®). Immunisation programmes in low-income countries have suffered a reduced coverage or were even brought to a halt because of an ignorance of local realities. To ensure the success of vaccination campaigns, implementers have to consider community-held perceptions and behaviours regarding the infectious disease and the vaccine of interest. The main aim of this study is to provide advice to the Ministry of Health and Social Welfare of Zanzibar regarding routine introduction of an oral cholera vaccine from a socioeconomic and behavioural perspective as part of a long-term development for a sustained cholera prevention strategy. Methods and design Qualitative and quantitative methods of health social science research will be applied on four stakeholder levels before and after the mass vaccination campaign. Rapid assessment individual interviews and focus groups will be used to describe cholera- and vaccine-related views of policy makers, health care professionals and community representatives. The cultural epidemiological approach will be employed on the individual household resident level in a repeated cross-sectional design to estimate determinants of anticipated and actual oral cholera vaccine acceptance. Discussion The study presented here is designed to inform about people's perceptions regarding cholera and about socioeconomic and behavioural factors determining anticipated and actual oral cholera vaccine acceptance in Zanzibar. Its pre- and post-intervention design using a mixed-methods approach on different stakeholder levels in communities at high risk of cholera outbreaks will ensure the collection of locally valid data relevant for public health action and planning. PMID:19351401

The effect of antiemetics in childhood gastroenteritis

PubMed Central

2013-01-01

Introduction Diarrheal diseases are the second leading cause of childhood morbidity and mortality in developing countries and an important cause of malnutrition. An estimated 0.75 million children below 5 years of age die from diarrhea. Vomiting associated with acute gastroenteritis (AGE) is a distressing symptom and limits the success of oral rehydration in AGE leading to an increased use of intravenous rehydration, prolonged emergency department stay and hospitalization. In this review we estimate the effect of antiemetics in gastroenteritis in children. Methods We conducted a systematic review of all the efficacy and effectiveness studies. We used a standardized abstraction and grading format and performed meta-analyses for all outcomes with more than two studies. The estimated effect of antiemetics was determined by applying the standard Child Health Epidemiology Reference Group (CHERG) rules. Results We included seven studies in the review. Antiemetics significantly reduced the incidence of vomiting and hospitalization by 54%. Antiemetics also significantly reduced the intravenous fluid requirements by 60%, while it had a non-significant effect on the ORT tolerance and revisit rates. Conclusion Antiemetics are effective for the management of gastroenteritis in children and have the potential to decrease morbidity and mortality burden due to diarrhea, when introduced and scaled up. PMID:24564795

Research priorities on diarrhoeal diseases to support the Control of Diarrhoeal Diseases (CDD) programme in Indonesia.

PubMed

Sunoto

1986-01-01

A comprehensive program review of Indonesia's Control of Diarrheal Diseases (CDD) program conducted in 1983 indicated that considerable success has been achieved in this area. Oral rehydration solution (ORS) is widely available, there has been community involvement, a strong managerial structure has developed, baseline data on diarrhea morbidity and mortality are being collected, and staff have received adequate training. At the same time, there have been some problems: inadequate use of ORS, a lack of coordination among CDD programs, insufficient surveillance, budgetary problems, and a lack of laboratory support. During the last 10 years, diarrhea mortality in Indonesia has been reduced by 50-70%, to about 20,000 (20% of child mortality). The Government has established the goal of reducing mortality from diarrhea to less than 1% of child deaths by the year 2000. A major strategy for achieving this goal is integrating family planning, nutrition, maternal-child health, immunization, and CDD programs. Another strategy involves improving research in this area. Areas for further research include: epidemiologic studies, rehydration treatment, antidiarrheal agents, social aspects, immunity and vaccine development, and laboratory examination. The cause of diarrheal diseases is not only enteric infection, it is indirectly caused by acute respiratory infection, malnutrition, measles and other systemic infection as well as the health knowledge and education of the mother. Priority is to be given to 7 areas of research: 1) the use of home-prepared rehydration fluids, 2) feeding practices during acute diarrhea that can prevent chronic diarrhea and malnutrition, 3) the determinants of progression to chronic diarrhea, 4) the impact of simple health information on hygienic and feeding practices on mortality, 5) the potential of using traditional birth attendants in ORS campaigns, 6) traditional attitudes and practices, and 7) the effectiveness of traditional medicines in diarrhea treatment.

Consumer Opinion of Emergency/Assault Food Packet under Rigorous Field Conditions in a Cold Weather Environment

DTIC Science & Technology

1980-01-01

and Pudding Bars Although the beverage and pudding bars were designed to be eaten either dry, as packaged, or rehydrated, theoretically with hot water ...pudding bars being rehydrated with hot water and no cases at all of beverage bars being so rehydrated, data will be pre- sented only for the dry and...rehydrated with cold water , is shown in Table 6, which also shows the order in which the beverage and pudding bars were ranked by the survey respondents

Non-invasive airway health assessment: synchrotron imaging reveals effects of rehydrating treatments on mucociliary transit in-vivo.

PubMed

Donnelley, Martin; Morgan, Kaye S; Siu, Karen K W; Farrow, Nigel R; Stahr, Charlene S; Boucher, Richard C; Fouras, Andreas; Parsons, David W

2014-01-14

To determine the efficacy of potential cystic fibrosis (CF) therapies we have developed a novel mucociliary transit (MCT) measurement that uses synchrotron phase contrast X-ray imaging (PCXI) to non-invasively measure the transit rate of individual micron-sized particles deposited into the airways of live mice. The aim of this study was to image changes in MCT produced by a rehydrating treatment based on hypertonic saline (HS), a current CF clinical treatment. Live mice received HS containing a long acting epithelial sodium channel blocker (P308); isotonic saline; or no treatment, using a nebuliser integrated within a small-animal ventilator circuit. Marker particle motion was tracked for 20 minutes using PCXI. There were statistically significant increases in MCT in the isotonic and HS-P308 groups. The ability to quantify in vivo changes in MCT may have utility in pre-clinical research studies designed to bring new genetic and pharmaceutical treatments for respiratory diseases into clinical trials.

Non-invasive airway health assessment: Synchrotron imaging reveals effects of rehydrating treatments on mucociliary transit in-vivo

NASA Astrophysics Data System (ADS)

Donnelley, Martin; Morgan, Kaye S.; Siu, Karen K. W.; Farrow, Nigel R.; Stahr, Charlene S.; Boucher, Richard C.; Fouras, Andreas; Parsons, David W.

2014-01-01

To determine the efficacy of potential cystic fibrosis (CF) therapies we have developed a novel mucociliary transit (MCT) measurement that uses synchrotron phase contrast X-ray imaging (PCXI) to non-invasively measure the transit rate of individual micron-sized particles deposited into the airways of live mice. The aim of this study was to image changes in MCT produced by a rehydrating treatment based on hypertonic saline (HS), a current CF clinical treatment. Live mice received HS containing a long acting epithelial sodium channel blocker (P308); isotonic saline; or no treatment, using a nebuliser integrated within a small-animal ventilator circuit. Marker particle motion was tracked for 20 minutes using PCXI. There were statistically significant increases in MCT in the isotonic and HS-P308 groups. The ability to quantify in vivo changes in MCT may have utility in pre-clinical research studies designed to bring new genetic and pharmaceutical treatments for respiratory diseases into clinical trials.

Effect of hydration on some orthostatic and haematological responses to head-up tilt

NASA Technical Reports Server (NTRS)

Harrison, M. H.; Hill, L. C.; Spaul, W. A.; Greenleaf, J. E.

1986-01-01

Experiments were undertaken to determine the effects of hydration status on: (1) orthostatic responses, and on (2) relative changes in intravascular volume and protein content, during 70 deg head-up tilt (HUT). Six men underwent 45 min of HUT, preceded by 45 min supine, first dehydrated, and again 105 min later after rehydration with water. Heart rate was consistently lower following rehydration (p less than 0.01), while supine diastolic pressure was higher (p less than 0.02). Systolic pressure fell during dehydrated HUT (p less than 0.01), but not during rehydrated HUT. Postural haemoconcentration, which was reduced after rehydration (p less than 0.001), was accompanied by a decrease in intravascular albumin content (p less than 0.05). Two subjects experienced severe presyncopal symptoms during dehydrated HUT, but not during rehydrated HUT. Thus, it appears that rehydration after fluid restriction improves orthostatic tolerance. Furthermore, extravascular hydration status may be more important than intravascular hydration status in determining orthostatic tolerance.

Cost utility, budget impact, and scenario analysis of racecadotril in addition to oral rehydration for acute diarrhea in children in Malaysia

PubMed Central

Rautenberg, Tamlyn Anne; Zerwes, Ute; Lee, Way Seah

2018-01-01

Objective To perform cost utility (CU) and budget impact (BI) analyses augmented by scenario analyses of critical model structure components to evaluate racecadotril as adjuvant to oral rehydration solution (ORS) for children under 5 years with acute diarrhea in Malaysia. Methods A CU model was adapted to evaluate racecadotril plus ORS vs ORS alone for acute diarrhea in children younger than 5 years from a Malaysian public payer’s perspective. A bespoke BI analysis was undertaken in addition to detailed scenario analyses with respect to critical model structure components. Results According to the CU model, the intervention is less costly and more effective than comparator for the base case with a dominant incremental cost-effectiveness ratio of −RM 1,272,833/quality-adjusted life year (USD −312,726/quality-adjusted life year) in favor of the intervention. According to the BI analysis (assuming an increase of 5% market share per year for racecadotril+ORS for 5 years), the total cumulative incremental percentage reduction in health care expenditure for diarrhea in children is 0.136578%, resulting in a total potential cumulative cost savings of −RM 73,193,603 (USD −17,983,595) over a 5-year period. Results hold true across a range of plausible scenarios focused on critical model components. Conclusion Adjuvant racecadotril vs ORS alone is potentially cost-effective from a Malaysian public payer perspective subject to the assumptions and limitations of the model. BI analysis shows that this translates into potential cost savings for the Malaysian public health care system. Results hold true at evidence-based base case values and over a range of alternate scenarios. PMID:29588606

Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations

PubMed Central

Canani, Roberto Berni; Cirillo, Pia; Terrin, Gianluca; Cesarano, Luisa; Spagnuolo, Maria Immacolata; Vincenzo, Anna De; Albano, Fabio; Passariello, Annalisa; Marco, Giulio De; Manguso, Francesco

2007-01-01

Objective To compare the efficacy of five probiotic preparations recommended to parents in the treatment of acute diarrhoea in children. Design Randomised controlled clinical trial in collaboration with family paediatricians over 12 months. Setting Primary care. Participants Children aged 3-36 months visiting a family paediatrician for acute diarrhoea. Intervention Children's parents were randomly assigned to receive written instructions to purchase a specific probiotic product: oral rehydration solution (control group); Lactobacillus rhamnosus strain GG; Saccharomyces boulardii; Bacillus clausii; mix of L delbrueckii var bulgaricus, Streptococcus thermophilus, L acidophilus, and Bifidobacterium bifidum; or Enterococcus faecium SF68. Main outcome measures Primary outcomes were duration of diarrhoea and daily number and consistency of stools. Secondary outcomes were duration of vomiting and fever and rate of admission to hospital. Safety and tolerance were also recorded. Results 571 children were allocated to intervention. Median duration of diarrhoea was significantly shorter (P<0.001) in children who received L rhamnosus strain GG (78.5 hours) and the mix of four bacterial strains (70.0 hours) than in children who received oral rehydration solution alone (115.0 hours). One day after the first probiotic administration, the daily number of stools was significantly lower (P<0.001) in children who received L rhamnosus strain GG and in those who received the probiotic mix than in the other groups. The remaining preparations did not affect primary outcomes. Secondary outcomes were similar in all groups. Conclusions Not all commercially available probiotic preparations are effective in children with acute diarrhoea. Paediatricians should choose bacterial preparations based on effectiveness data. Trial registration number Current Controlled Trials ISRCTN56067537. PMID:17690340

Evaluation of who oral rehydration solution (ORS) and salt tablets in resuscitating adult patients with burns covering more than 15% of total body surface area (TBSA)

PubMed Central

Moghazy, A.M.; Adly, O.A.; Elbadawy, M.A.; Hashem, R.E.

2016-01-01

Summary Intra-venous (IV) burn resuscitation is effective; nevertheless it has its disadvantages. WHO Oral Rehydration Solution (ORS) has shown high effectiveness in treating dehydration. WHO-ORS, with salt supplement, seems to be suitable for burn resuscitation, where IV resuscitation is not available, feasible or possible. The objective of the study was to evaluate acute phase efficacy and safety, as well as limitations and complications of burn resuscitation using WHO-ORS and salt tablets. This randomized controlled clinical trial was conducted in the Burn Unit, Suez Canal University Hospital, Ismailia, Egypt. The study group was given WHO-ORS (15% of body weight/day) with one salt tablet (5gm) per liter according to Sørensen’s formula. The control group was given IV fluids according to the Parkland formula. Patients’ vital signs and urine output were monitored for 72 hours after starting resuscitation. Both groups were comparable regarding age, sex, and percentage, etiology and degree of burns. For all assessed parameters, there were no major significant differences between the study group (10 cases) and control group (20 cases). Even where there was a significant difference, apart from blood pressure in the first hour of the first day, the study group never crossed safe limits for pulse, systolic blood pressure, urine output, respiratory rate and conscious level. WHO-ORS with 5gm salt tablets, given according to Sørenson’s formula, is a safe and efficient alternative for IV resuscitation. It could even be a substitute, particularly in low resource settings and fire disasters. PMID:27857652

Burden of rotavirus in India--is rotavirus vaccine an answer to it?

PubMed

Taneja, Davendra K; Malik, Akash

2012-01-01

Rotavirus is currently by far the most common cause of severe diarrhea in infants and young children worldwide and of diarrheal deaths in developing countries. Worldwide Rotavirus is responsible for 611,000 childhood deaths out of which more than 80% occur in low-income countries. The resistance of rotavirus to commonly used disinfectants and ineffectiveness of oral rehydration therapy due to severe vomiting indicates that if an effective vaccine is the preferred option. WHO has recommended inclusion of rotavirus vaccine in the National Schedules where under 5 mortality due to diarrheal diseases is ≥ 10%. Currently two vaccines are available against rotavirus. Rotarix (GlaxoSmithKline) is a monovalent vaccine recommended to be orally administered in two doses at 6-12 weeks. Rota Teq (Merck) is a pentavalent vaccine recommended to be orally administered in three doses starting at 6-12 weeks of age. Serodiversity of rotavirus in India and its regional variation favor either a monovalent vaccine that can induce heterotypic immunity or a polyvalent vaccine incorporating majority of serotypes prevalent in the country. However, the efficacy of available rotavirus vaccines is less in low-income countries. Both the candidate vaccines when coadministered with OPV, immune response to first dose of these vaccines is reduced. However, immune responses to subsequent rotavirus vaccine doses are not affected. In view of this, WHO recommends three doses of either vaccine to be given to children in developing countries to produce the optimum response. Indigenous vaccine, 116E (Bharat Biotech) based on human rotavirus of serotype G9P [11] is still under Phase 2 trials. Another multivalent vaccine is being developed by Shantha Biotechnics in India. The cost effectiveness of the three dose schedule of the available and the rsults of the field trials of the indigenous vaccines should be assessed before inclusion of rotavirus vaccine in the National Immunization Schedule.

Oral ondansetron versus domperidone for symptomatic treatment of vomiting during acute gastroenteritis in children: multicentre randomized controlled trial.

PubMed

Marchetti, Federico; Maestro, Alessandra; Rovere, Francesca; Zanon, Davide; Arrighini, Alberto; Bertolani, Paolo; Biban, Paolo; Da Dalt, Liviana; Di Pietro, Pasquale; Renna, Salvatore; Guala, Andrea; Mannelli, Francesco; Pazzaglia, Anna; Messi, Gianni; Perri, Francesco; Reale, Antonino; Urbino, Antonio Francesco; Valletta, Enrico; Vitale, Antonio; Zangardi, Tiziana; Tondelli, Maria Teresa; Clavenna, Antonio; Bonati, Maurizio; Ronfani, Luca

2011-02-10

Vomiting in children with acute gastroenteritis (AG) is not only a direct cause of fluid loss but it is also a major factor of failure of oral rehydration therapy (ORT). Physicians who provide care to paediatric patients in the emergency department (ED) usually prescribe intravenous fluid therapy (IVT) for mild or moderate dehydration when vomiting is the major symptom. Thus, effective symptomatic treatment of vomiting would lead to an important reduction in the use of IVT and, consequently, of the duration of hospital stay and of frequency of hospital admission. Available evidence on symptomatic treatment of vomiting shows the efficacy of the most recently registered molecule (ondansetron) but a proper evaluation of antiemetics drugs largely used in clinical practice, such as domperidone, is lacking. To compare the efficacy of ondansetron and domperidone for the symptomatic treatment of vomiting in children with AG who have failed ORT. Multicentre, double-blind randomized controlled trial conducted in paediatric EDs. Children aged from 1 to 6 years who vomiting, with a presumptive clinical diagnosis of AG, and without severe dehydration will be included. After the failure of a initial ORS administration in ED, eligible children will be randomized to receive: 1) ondansetron syrup (0,15 mg/Kg of body weight); 2) domperidone syrup (0,5 mg/Kg of body weight); 3) placebo. The main study outcome will be the percentage of patients needing nasogastric or IVT after symptomatic oral treatment failure, defined as vomiting or fluid refusal after a second attempt of ORT. Data relative to study outcomes will be collected at 30 minute intervals for a minimum of 6 hours. A telephone follow up call will be made 48 hours after discharge. A total number of 540 children (i.e. 180 patients in each arm) will be enrolled. The trial results would provide evidence on the efficacy of domperidone, which is largely used in clinical practice despite the lack of proper evaluation and a controversial safety profile, as compared to ondansetron, which is not yet authorized in Italy despite evidence supporting its efficacy in treating vomiting. The trial results would contribute to a reduction in the use of IVT and, consequently, in hospital admissions in children with AG. The design of this RCT, which closely reflect current clinical practice in EDs, will allow immediate transferability of results. ClinicalTrials.gov: NCT01257672.

Development and characterization of a novel drug nanocarrier for oral delivery, based on self-assembled β-casein micelles.

PubMed

Bachar, Michal; Mandelbaum, Amitai; Portnaya, Irina; Perlstein, Hadas; Even-Chen, Simcha; Barenholz, Yechezkel; Danino, Dganit

2012-06-10

β-casein is an amphiphilic protein that self-organizes into well-defined core-shell micelles. We developed these micelles as efficient nanocarriers for oral drug delivery. Our model drug is celecoxib, an anti-inflammatory hydrophobic drug utilized for treatment of rheumatoid arthritis and osteoarthritis, now also evaluated as a potent anticancer drug. This system is unique as it enables encapsulation loads >100-fold higher than other β-casein/drug formulations, and does not require additives as do other formulations that have high loadings. This is combined with the ability to lyophilize the formulation without a cryoprotectant, long-term physical and chemical stability of the resulting powder, and fully reversible reconstitution of the structures by rehydration. The dry dosage form, in which >95% of the drug is encapsulated, meets the daily dose. Cryo-TEM and DLS prove that drug encapsulation results in micelle swelling, and X-ray diffraction shows that the encapsulated drug is amorphous. Altogether, our novel dosage form is highly advantageous for oral administration. Copyright © 2012 Elsevier B.V. All rights reserved.

Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region

PubMed Central

Cameron, Donald; Hock, Quak Seng; Kadim, Musal; Mohan, Neelam; Ryoo, Eell; Sandhu, Bhupinder; Yamashiro, Yuichiro; Jie, Chen; Hoekstra, Hans; Guarino, Alfredo

2017-01-01

Recommendations for probiotics are available in several regions. This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Epidemiology and clinical patterns of intestinal diseases in Asia-Pacific countries were discussed. Evidence-based recommendations and randomized controlled trials in the region were revised. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by applying the Likert scale and rated using the GRADE system. Saccharomyces boulardii CNCM I-745 (Sb) and Lactobacillus rhamnosus GG (LGG) were strongly recommended as adjunct treatment to oral rehydration therapy for gastroenteritis. Lactobacillus reuteri could also be considered. Probiotics may be considered for prevention of (with the indicated strains): antibiotic-associated diarrhea (LGG or Sb); Clostridium difficile-induced diarrhea (Sb); nosocomial diarrhea (LGG); infantile colic (L reuteri) and as adjunct treatment of Helicobacter pylori (Sb and others). Specific probiotics with a history of safe use in preterm and term infants may be considered in infants for prevention of necrotizing enterocolitis. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations apply well to Asia pacific countries. These need to be validated with local randomized-controlled trials. PMID:29259371

Child Survival Strategies: Assessment of Knowledge and Practice of Rural Women of Reproductive Age in Cross River State, Nigeria.

PubMed

Etokidem, Aniekan Jumbo; Johnson, Ofonime

2016-01-01

Introduction . Nigeria is one of the five countries that account for about 50% of under-five mortality in the world. The objective of this study was to assess the knowledge and practice of child survival strategies among rural community caregivers in Cross River State of Nigeria. Materials and Methods . This descriptive cross-sectional survey used a pretested questionnaire to obtain information from 150 women of reproductive age. Data analysis was done using SPSS version 20. Results . The child survival strategy known to most of the respondents was oral rehydration therapy as indicated by 98% followed by female education by 73.3% and immunization by 67.3%. Only 20% of the respondents had adequate knowledge of frequency of weighing a child while only 32.7% knew that breastfeeding should be continued even if the child had diarrhea. More respondents with nonformal education (83.3%) practiced exclusive breastfeeding of their last children compared to respondents with primary education (77.3%), secondary education (74.2%), and tertiary education (72.2%). Conclusion . Although respondents demonstrated adequate knowledge and practice of most of the strategies, there was evidence of gaps, including myths and misconceptions that could mar efforts towards reducing child morbidity and mortality in the state.

The impoverished gut—a triple burden of diarrhoea, stunting and chronic disease

PubMed Central

Guerrant, Richard L.; DeBoer, Mark D.; Moore, Sean R.; Scharf, Rebecca J.; Lima, Aldo A. M.

2013-01-01

More than one-fifth of the world’s population live in extreme poverty, where a lack of safe water and adequate sanitation enables high rates of enteric infections and diarrhoea to continue unabated. Although oral rehydration therapy has greatly reduced diarrhoea-associated mortality, enteric infections still persist, disrupting intestinal absorptive and barrier functions and resulting in up to 43% of stunted growth, affecting one-fifth of children worldwide and one-third of children in developing countries. Diarrhoea in children from impoverished areas during their first 2 years might cause, on average, an 8 cm growth shortfall and 10 IQ point decrement by the time they are 7–9 years old. A child’s height at their second birthday is therefore the best predictor of cognitive development or ‘human capital’. To this ‘double burden’ of diarrhoea and malnutrition, data now suggest that children with stunted growth and repeated gut infections are also at increased risk of developing obesity and its associated comorbidities, resulting in a ‘triple burden’ of the impoverished gut. Here, we Review the growing evidence for this triple burden and potential mechanisms and interventions that must be understood and applied to prevent the loss of human potential and unaffordable societal costs caused by these vicious cycles of poverty. PMID:23229327

The 2008 Cholera Epidemic in Zimbabwe: Experience of the icddr,b Team in the Field

PubMed Central

Bardhan, Pradip Kumar; Iqbal, Anwarul; Mazumder, Ramendra Nath; Khan, Azharul Islam; Islam, Md. Sirajul; Siddique, Abul Kasem; Cravioto, Alejandro

2011-01-01

During August 2008–June 2009, an estimated 95,531 suspected cases of cholera and 4,282 deaths due to cholera were reported during the 2008 cholera outbreak in Zimbabwe. Despite the efforts by local and international organizations supported by the Zimbabwean Ministry of Health and Child Welfare in the establishment of cholera treatment centres throughout the country, the case-fatality rate (CFR) was much higher than expected. Over two-thirds of the deaths occurred in areas without access to treatment facilities, with the highest CFRs (>5%) reported from Masvingo, Manicaland, Mashonaland West, Mashonaland East, Midland, and Matabeleland North provinces. Some factors attributing to this high CFR included inappropriate cholera case management with inadequate use of oral rehydration therapy, inappropriate use of antibiotics, and a shortage of experienced healthcare professionals. The breakdown of both potable water and sanitation systems and the widespread contamination of available drinking-water sources were also considered responsible for the rapid and widespread distribution of the epidemic throughout the country. Training of healthcare professionals on appropriate cholera case management and implementation of recommended strategies to reduce the environmental contamination of drinking-water sources could have contributed to the progressive reduction in number of cases and deaths as observed at the end of February 2009. PMID:22106761

Effects of rehydration nutrients on H2S metabolism and formation of volatile sulfur compounds by the wine yeast VL3.

PubMed

Winter, Gal; Henschke, Paul A; Higgins, Vincent J; Ugliano, Maurizio; Curtin, Chris D

2011-11-02

In winemaking, nutrient supplementation is a common practice for optimising fermentation and producing quality wine. Nutritionally suboptimal grape juices are often enriched with nutrients in order to manipulate the production of yeast aroma compounds. Nutrients are also added to active dry yeast (ADY) rehydration media to enhance subsequent fermentation performance. In this study we demonstrate that nutrient supplementation at rehydration also has a significant effect on the formation of volatile sulfur compounds during wine fermentations. The concentration of the 'fruity' aroma compounds, the polyfunctional thiols 3-mercaptohexan-1-ol (3MH) and 3-mercaptohexyl acetate (3MHA), was increased while the concentration of the 'rotten egg' aroma compound, hydrogen sulfide (H2S), was decreased. Nutrient supplementation of the rehydration media also changed the kinetics of H2S production during fermentation by advancing onset of H2S production. Microarray analysis revealed that this was not due to expression changes within the sulfate assimilation pathway, which is known to be a major contributor to H2S production. To gain insight into possible mechanisms responsible for this effect, a component of the rehydration nutrient mix, the tri-peptide glutathione (GSH) was added at rehydration and studied for its subsequent effects on H2S formation. GSH was found to be taken up during rehydration and to act as a source for H2S during the following fermentation. These findings represent a potential approach for managing sulfur aroma production through the use of rehydration nutrients.

Space shuttle food system study: Food and beverage package development, modification 8S

NASA Technical Reports Server (NTRS)

1976-01-01

A new, highly utile rehydration package was developed for foods in zero gravity. Rehydratable foods will become more acceptable as a result of their overall rehydration capability and improved palatability. This new package design is greatly enhanced by the specified spacecraft condition of atmospheric pressure; the pressure differential between the atmosphere and the package carries the functional responsibility for rapid food rehydration without excess package manipulation by the consumer. Crew acceptance will further be enhanced by less manipulation, hotter rehydration water temperatures and the ability to hold the foods at preparation temperatures until they are consumed.

[Rhabdomyolysis after lifting IKEA bags in a man using sertraline].

PubMed

Kummen, Ingvild; Jensen, Thomas Giver

2016-12-12

We present a case of a 28-year-old male, using sertraline, who experienced progressive oedema in both upper extremities after having lifted two IKEA bags weighing 20 kg each from his car up to the third floor. Blood creatine kinase (CK) level was measured 5,260 U/l, and the patient was admitted for oral rehydration with the diagnosis rhabdomyolysis. The MRI showed swelling in the triceps muscles and latissimus dorsi muscles resulting in compression of the brachial vein. We discuss the pathomechanism behind the increased CK level and the swelling, and the possible effect sertraline may have had on the development of rhabdomyolysis.

Prevalence of oral candidiasis in HIV/AIDS children in highly active antiretroviral therapy era. A literature analysis.

PubMed

Gaitán-Cepeda, Luis Alberto; Sánchez-Vargas, Octavio; Castillo, Nydia

2015-08-01

SummaryHighly active antiretroviral therapy has decreased the morbidity and mortality related to HIV infection, including oral opportunistic infections. This paper offers an analysis of the scientific literature on the epidemiological aspects of oral candidiasis in HIV-positive children in the combination antiretroviral therapy era. An electronic databases search was made covering the highly active antiretroviral therapy era (1998 onwards). The terms used were oral lesions, oral candidiasis and their combination with highly active antiretroviral therapy and HIV/AIDS children. The following data were collected from each paper: year and country in which the investigation was conducted, antiretroviral treatment, oral candidiasis prevalence and diagnostic parameters (clinical or microbiological). Prevalence of oral candidiasis varied from 2.9% in American HIV-positive children undergoing highly active antiretroviral therapy to 88% in Chilean HIV-positive children without antiretroviral therapy. With respect to geographical location and antiretroviral treatment, higher oral candidiasis prevalence in HIV-positive children on combination antiretroviral therapy/antiretroviral therapy was reported in African children (79.1%) followed by 45.9% reported in Hindu children. In HIV-positive Chilean children on no antiretroviral therapy, high oral candidiasis prevalence was reported (88%) followed by Nigerian children (80%). Oral candidiasis is still frequent in HIV-positive children in the highly active antiretroviral therapy era irrespective of geographical location, race and use of antiretroviral therapy. © The Author(s) 2014.

Dehydration rate determines the degree of membrane damage and desiccation tolerance in bryophytes.

PubMed

Cruz de Carvalho, Ricardo; Catalá, Myriam; Branquinho, Cristina; Marques da Silva, Jorge; Barreno, Eva

2017-03-01

Desiccation tolerant (DT) organisms are able to withstand an extended loss of body water and rapidly resume metabolism upon rehydration. This ability, however, is strongly dependent on a slow dehydration rate. Fast dehydration affects membrane integrity leading to intracellular solute leakage upon rehydration and thereby impairs metabolism recovery. We test the hypothesis that the increased cell membrane damage and membrane permeability observed under fast dehydration, compared with slow dehydration, is related to an increase in lipid peroxidation. Our results reject this hypothesis because following rehydration lipid peroxidation remains unaltered, a fact that could be due to the high increase of NO upon rehydration. However, in fast-dried samples we found a strong signal of red autofluorescence upon rehydration, which correlates with an increase in ROS production and with membrane leakage, particularly the case of phenolics. This could be used as a bioindicator of oxidative stress and membrane damage. © 2016 Scandinavian Plant Physiology Society.

Perceived Effectiveness, Self-efficacy, and Social Support for Oral Appliance Therapy Among Older Veterans With Obstructive Sleep Apnea.

PubMed

Carballo, Nancy J; Alessi, Cathy A; Martin, Jennifer L; Mitchell, Michael N; Hays, Ron D; Col, Nananda; Patterson, Emily S; Jouldjian, Stella; Josephson, Karen; Fung, Constance H

2016-11-01

Obstructive sleep apnea is a prevalent sleep disorder among older adults. Oral appliances are increasingly prescribed as therapy for obstructive sleep apnea. Adherence to oral appliance therapy is highly variable. Based on value-expectancy theory and other social-psychological theories, adherence to oral appliance therapy may be influenced by patients' perceived effectiveness of the therapy, self-efficacy, and availability of social support. We examined these perceptions among older adults with obstructive sleep apnea who were prescribed oral appliance therapy. We mailed surveys to all patients aged ≥65 years who had been prescribed oral appliance therapy for obstructive sleep apnea over the prior 36 months at a Veterans Affairs medical center. We examined frequencies of responses to items that assessed perceived effectiveness, self-efficacy, and social support for nightly use of oral appliances from friends, family, or health care staff. Thirty-nine individuals responded (response rate, 30%; mean [SD] age 71.4 [SD 6.3] years; 97% male). Thirty-six percent of the respondents perceived regular use of oral appliance therapy to be effective in managing obstructive sleep apnea; 39% agreed that they felt confident about using oral appliances regularly; 41% felt supported by people in their life in using oral appliance therapy; and 38% agreed that health care staff would help them to use their oral appliance regularly. These rates represented less than half of respondents despite the finding that 65% of patients believed that they would use their oral appliance regularly. Although oral appliance therapy is increasingly prescribed for obstructive sleep apnea, only about one third of older adults prescribed it perceived it to be an effective treatment, were confident about oral appliance use, and/or believed that they would receive needed support. Future research is needed to better understand older adults' perceptions so that interventions can be designed to improve the effectiveness of oral appliances, their self-efficacy for using oral appliances, and their social support for this therapy, which may, in turn, improve oral appliance therapy adherence. Published by Elsevier Inc.

[Severe rhabdomyolysis secondary to severe hypernatraemic dehydration].

PubMed

Mastro-Martínez, Ignacio; Montes-Arjona, Ana María; Escudero-Lirio, Margarita; Hernández-García, Bárbara; Fernández-Cantalejo Padial, José

2015-01-01

Rhabdomyolysis is a rare paediatric condition. The case is presented of a patient in whom this developed secondary to severe hypernatraemic dehydration following acute diarrhoea. Infant 11 months of age who presented with vomiting, fever, diarrhoea and anuria for 15 hours. Parents reported adequate preparation of artificial formula and oral rehydration solution. He was admitted with malaise, severe dehydration signs and symptoms, cyanosis, and low reactivity. The laboratory tests highlighted severe metabolic acidosis, hypernatraemia and pre-renal kidney failure (Sodium [Na] plasma 181 mEq/L, urine density> 1030). He was managed in Intensive Care Unit with gradual clinical and renal function improvement. On the third day, slight axial hypotonia and elevated cell lysis enzymes (creatine phosphokinase 75,076 IU/L) were observed, interpreted as rhabdomyolysis. He was treated with intravenous rehydration up to 1.5 times the basal requirements, and he showed a good clinical and biochemical response, being discharged 12 days after admission without motor sequelae. Severe hypernatraemia is described as a rare cause of rhabdomyolysis and renal failure. In critically ill patients, it is important to have a high index of suspicion for rhabdomyolysis and performing serial determinations of creatine phosphokinase for early detection and treatment. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

A national cholera epidemic with high case fatality rates--Kenya 2009.

PubMed

Loharikar, Anagha; Briere, Elizabeth; Ope, Maurice; Langat, Daniel; Njeru, Ian; Gathigi, Lucy; Makayotto, Lyndah; Ismail, Abdirizak M; Thuranira, Martin; Abade, Ahmed; Amwayi, Samuel; Omolo, Jared; Oundo, Joe; De Cock, Kevin M; Breiman, Robert F; Ayers, Tracy; Mintz, Eric; O'Reilly, Ciara E

2013-11-01

Cholera remains endemic in sub-Saharan Africa. We characterized the 2009 cholera outbreaks in Kenya and evaluated the response. We analyzed surveillance data and estimated case fatality rates (CFRs). Households in 2 districts, East Pokot (224 cases; CFR = 11.7%) and Turkana South (1493 cases; CFR = 1.0%), were surveyed. We randomly selected 15 villages and 8 households per village in each district. Healthcare workers at 27 health facilities (HFs) were surveyed in both districts. In 2009, cholera outbreaks caused a reported 11 425 cases and 264 deaths in Kenya. Data were available from 44 districts for 6893 (60%) cases. District CFRs ranged from 0% to 14.3%. Surveyed household respondents (n = 240) were aware of cholera (97.5%) and oral rehydration solution (ORS) (87.9%). Cholera deaths were reported more frequently from East Pokot (n = 120) than Turkana South (n = 120) households (20.7% vs. 12.3%). The average travel time to a HF was 31 hours in East Pokot compared with 2 hours in Turkana South. Fewer respondents in East Pokot (9.8%) than in Turkana South (33.9%) stated that ORS was available in their village. ORS or intravenous fluid shortages occurred in 20 (76.9%) surveyed HFs. High CFRs in Kenya are related to healthcare access disparities, including availability of rehydration supplies.

Organ Specific Proteomic Dissection of Selaginella bryopteris Undergoing Dehydration and Rehydration

PubMed Central

Deeba, Farah; Pandey, Ashutosh K.; Pandey, Vivek

2016-01-01

To explore molecular mechanisms underlying the physiological response of Selaginella bryopteris, a comprehensive proteome analysis was carried out in roots and fronds undergoing dehydration and rehydration. Plants were dehydrated for 7 days followed by 2 and 24 h of rehydration. In roots out of 59 identified spots, 58 protein spots were found to be up-regulated during dehydration stress. The identified proteins were related to signaling, stress and defense, protein and nucleotide metabolism, carbohydrate and energy metabolism, storage and epigenetic control. Most of these proteins remained up-regulated on first rehydration, suggesting their role in recovery phase also. Among the 90 identified proteins in fronds, about 49% proteins were up-regulated during dehydration stress. Large number of ROS scavenging proteins was enhanced on dehydration. Many other proteins involved in energy, protein turnover and nucleotide metabolism, epigenetic control were also highly upregulated. Many photosynthesis related proteins were upregulated during stress. This would have helped plant to recover rapidly on rehydration. This study provides a comprehensive picture of different cellular responses elucidated by the proteome changes during dehydration and rehydration in roots and fronds as expected from a well-choreographed response from a resurrection plant. PMID:27092152

De novo transcriptome characterization and gene expression profiling of the desiccation tolerant moss Bryum argenteum following rehydration.

PubMed

Gao, Bei; Zhang, Daoyuan; Li, Xiaoshuang; Yang, Honglan; Zhang, Yuanming; Wood, Andrew J

2015-05-28

The desiccation-tolerant moss Bryum argenteum is an important component of the Biological Soil Crusts (BSCs) found in the Gurbantunggut desert. Desiccation tolerance is defined as the ability to revive from the air dried state. To elucidate the molecular mechanisms related to desiccation tolerance, we employed RNA-Seq and digital gene expression (DGE) technologies to study the genome-wide expression profiles of the dehydration and rehydration processes in this important desert plant. We applied a two-step approach to investigate the gene expression profile upon rehydration in the moss Bryum argenteum using Illumina HiSeq2000 sequencing platform. First, a total of 57,247 transcript assembly contigs (TACs) were obtained from 54.79 million reads by de novo assembly, with an average length of 863 bp and N50 of 1,372 bp. Among the reconstructed TACs, 36,916 (64.5%) revealed similarity with existing protein sequences in the public databases. 23,509 and 21,607 TACs were assigned GO and KEGG annotation information, respectively. Second, samples were taken from 3 hydration stages: desiccated (Dry), rehydrated 2 h (R2) and rehydrated 24 h (R24), and DEG libraries were constructed for Differentially Expressed Genes (DEGs) discovery. 4,081 and 6,709 DEGs were identified in R2 and R24, compared with Dry, respectively. Compared to the desiccated sample, up-regulated genes after two hours of hydration are primarily related to stress responses. GO function enrichment network, EKGG metabolic pathway and MapMan analysis supports the idea of the rapid recovery of photosynthesis after 24 h of rehydration. We identified 770 transcription factors (TFs) which were classified into 50 TF families. 142 TF transcripts were up-regulated upon rehydration including 23 members of the ERF family. In this study, we constructed a pioneering, high-quality reference transcriptome in B. argenteum and generated three DGE libraries to elucidate the changes of gene expression upon rehydration. Expression profiles consistent with the rapid recovery of photosynthesis (at R2) and the re-establishment of a positive carbon balance following rehydration (at R24) were observed. Our study will extend our knowledge of bryophyte transcriptomes and provide further insight into the molecular mechanisms related to rehydration and desiccation-tolerance.

Multiple behaviour change intervention for diarrhoea control in Lusaka, Zambia: a cluster randomised trial.

PubMed

Greenland, Katie; Chipungu, Jenala; Curtis, Val; Schmidt, Wolf-Peter; Siwale, Zumbe; Mudenda, Mweetwa; Chilekwa, Joyce; Lewis, James J; Chilengi, Roma

2016-12-01

Effective prevention and control of diarrhoea requires caregivers to comply with a suite of proven measures, including exclusive breastfeeding, handwashing with soap, correct use of oral rehydration salts, and zinc administration. We aimed to assess the effect of a novel behaviour change intervention using emotional drivers on caregiver practice of these behaviours. We did a cluster randomised controlled trial in Lusaka Province, Zambia. A random sample of 16 health centres (clusters) were selected from a sampling frame of 81 health centres in three of four districts in Lusaka Province using a computerised random number generator. Each cluster was randomly assigned 1:1 to either the intervention-clinic events, community events, and radio messaging-or to a standard care control arm, both for 6 months. Primary outcomes were exclusive breastfeeding (self-report), handwashing with soap (observation), oral rehydration salt solution preparation (demonstration), and zinc use in diarrhoea treatment (self-report). We measured outcome behaviours at baseline before start of intervention and 4-6 weeks post-intervention through repeat cross-sectional surveys with mothers of an infant younger than 6 months and primary caregivers of a child younger than 5 years with recent diarrhoea. We compared outcomes on an intention-to-treat population between intervention and control groups adjusted for baseline behaviour. The study was registered with ClinicalTrials.gov, number NCT02081521. Between Jan 20 and Feb 3, 2014, we recruited 306 mothers of an infant aged 0-5 months (156 intervention, 150 standard care) and 343 primary caregiver of a child aged 0-59 months with recent diarrhoea (176 intervention, 167 standard care) at baseline. Between Oct 20 to Nov 7, 2014, we recruited 401 mothers of an infant 0-5 months (234 intervention, 167 standard care) and 410 primary caregivers of a child 0-59 months with recent diarrhoea (257 intervention, 163 standard care) at endline. Intervention was associated with increased prevalence of self-reported exclusive breastfeeding of infants aged 0-5 months (adjusted difference 10·5%, 95% CI 0·9-19·9). Other primary outcomes were not affected by intervention. Cluster intervention exposure ranged from 11-81%, measured by participant self-report with verification questions. Comparison of control and intervention clusters with coverage greater than 35% provided strong evidence of an intervention effect on oral rehydration salt solution preparation and breastfeeding outcomes. The intervention may have improved exclusive breastfeeding (assessed by self-reporting), but intervention effects were diluted in clusters with low exposure. Complex caregiver practices can improve through interventions built around human motives, but these must be implemented more intensely. Absolute Return for Kids (ARK) and Comic Relief. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Antimicrobial drugs for treating cholera.

PubMed

Leibovici-Weissman, Ya'ara; Neuberger, Ami; Bitterman, Roni; Sinclair, David; Salam, Mohammed Abdus; Paul, Mical

2014-06-19

Cholera is an acute watery diarrhoea caused by infection with the bacterium Vibrio cholerae, which if severe can cause rapid dehydration and death. Effective management requires early diagnosis and rehydration using oral rehydration salts or intravenous fluids. In this review, we evaluate the additional benefits of treating cholera with antimicrobial drugs. To quantify the benefit of antimicrobial treatment for patients with cholera, and determine whether there are differences between classes of antimicrobials or dosing schedules. We searched the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; African Index Medicus; LILACS; Science Citation Index; metaRegister of Controlled Trials; WHO International Clinical Trials Registry Platform; conference proceedings; and reference lists to March 2014. Randomized and quasi-randomized controlled clinical trials in adults and children with cholera that compared: 1) any antimicrobial treatment with placebo or no treatment; 2) different antimicrobials head-to-head; or 3) different dosing schedules or different durations of treatment with the same antimicrobial. Two reviewers independently applied inclusion and exclusion criteria, and extracted data from included trials. Diarrhoea duration and stool volume were defined as primary outcomes. We calculated mean difference (MD) or ratio of means (ROM) for continuous outcomes, with 95% confidence intervals (CI), and pooled data using a random-effects meta-analysis. The quality of evidence was assessed using the GRADE approach. Thirty-nine trials were included in this review with 4623 participants. Antimicrobials versus placebo or no treatment Overall, antimicrobial therapy shortened the mean duration of diarrhoea by about a day and a half compared to placebo or no treatment (MD -36.77 hours, 95% CI -43.51 to -30.03, 19 trials, 1013 participants, moderate quality evidence). Antimicrobial therapy also reduced the total stool volume by 50% (ROM 0.5, 95% CI 0.45 to 0.56, 18 trials, 1042 participants, moderate quality evidence) and reduced the amount of rehydration fluids required by 40% (ROM 0.60, 95% CI 0.53 to 0.68, 11 trials, 1201 participants, moderate quality evidence). The mean duration of fecal excretion of vibrios was reduced by almost three days (MD 2.74 days, 95% CI -3.07 to -2.40, 12 trials, 740 participants, moderate quality evidence).There was substantial heterogeneity in the size of these benefits, probably due to differences in the antibiotic used, the trial methods (particularly effective randomization), and the timing of outcome assessment. The benefits of antibiotics were seen both in trials recruiting only patients with severe dehydration and in those recruiting patients with mixed levels of dehydration. Comparisons of antimicrobials In head-to-head comparisons, there were no differences detected in diarrhoea duration or stool volume for tetracycline compared to doxycycline (three trials, 230 participants, very low quality evidence); or tetracycline compared to ciprofloxacin or norfloxacin (three trials, 259 participants, moderate quality evidence). In indirect comparisons with substantially more trials, tetracycline appeared to have larger benefits than doxycycline, norfloxacin and trimethoprim-sulfamethoxazole for the primary review outcomes.Single dose azithromycin shortened the duration of diarrhoea by over a day compared to ciprofloxacin (MD -32.43, 95% CI -62.90 to -1.95, two trials, 375 participants, moderate quality evidence) and by half a day compared to erythromycin (MD -12.05, 95% CI -22.02 to -2.08, two trials, 179 participants, moderate quality evidence). It was not compared with tetracycline. In treating cholera, antimicrobials result in substantial improvements in clinical and microbiological outcomes, with similar effects observed in severely and non-severely ill patients. Azithromycin and tetracycline may have some advantages over other antibiotics.

Lactobacillus GG (LGG) and smectite versus LGG alone for acute gastroenteritis: a double-blind, randomized controlled trial.

PubMed

Pieścik-Lech, Małgorzata; Urbańska, Magdalena; Szajewska, Hania

2013-02-01

Diarrhea treatment with either Lactobacillus GG (LGG) or smectite as an adjuvant to standard rehydration therapy has proven efficacy. In countries where both LGG and smectite are available, concomitant use is frequently practiced. We investigated whether LGG plus smectite is superior to LGG alone in the management of children with acute gastroenteritis (AGE). A double-blind, placebo-controlled, randomized trial was performed. Children aged 4 to 60 months with AGE received LGG 6 × 10(9) colony forming units/day plus randomly either smectite (3 g) or placebo as an adjuvant to the standard rehydration therapy. Of the 88 children randomized, 81 (92 %) were available for intention-to-treat analysis. The duration of diarrhea in the LGG/smectite group (n = 44) compared with the LGG/placebo group (n = 37) was similar (P = 0.43). There were no significant differences between the study groups for the secondary outcomes, with three exceptions. On day 4, in the LGG/placebo group compared to the LGG/smectite group, there was significantly reduced stool frequency (P = 0.03). While there was a significant (P = 0.05) difference in stool consistency on the Bristol Stool Form Scale on day 4, it was not of clinical relevance. Finally, in the LGG/smectite group compared to the LGG/placebo group, there was a significantly shorter duration of intravenous therapy after randomization (P = 0.02). No adverse events were observed in the study groups. LGG plus smectite and LGG alone are equally effective for treating young children with AGE. Combined use of the two interventions is not justified.

Gelatine tannate in the management of acute gastroenteritis in children: a randomised controlled trial.

PubMed

Kołodziej, Maciej; Bebenek, Dorota; Konarska, Zofia; Szajewska, Hania

2018-05-24

To assess the efficacy of gelatine tannate (a complex of tannic acid with astringent and anti-inflammatory properties, and a protective gelatine) for the treatment of acute gastroenteritis (AGE) in children. Randomised, double-blind, placebo-controlled trial. Intention-to-treat analysis. Two paediatric hospitals in Warsaw. Children younger than 5 years of age with AGE, defined as a change in stool consistency to a loose or liquid form (according to the Bristol Stool Form Scale or Amsterdam Stool Form Scale) and/or an increase in the frequency of evacuations (≥3 in 24 hours), lasting for no longer than 5 days. Seventy-two children were assigned to receive gelatine tannate (n=36) or placebo (n=36) in addition to standard rehydration therapy. The gelatine tannate was administered at an age-dependent dose (250-500 mg), and both study products were taken four times per day for 5 days. The main outcome measure was duration of diarrhoea. Secondary outcomes included the need for intravenous rehydration, need for hospitalisation of outpatients, number of watery stools per day, vomiting, weight gain, adverse events, recurrence of diarrhoea, severity of diarrhoea according to the Vesikari Scale and use of concomitant medications. Sixty-four children (89%) completed the intervention and were included in the analysis. The duration of diarrhoea after randomisation was similar in the gelatine tannate and placebo groups (75.6±27.8 vs 75.5±29.0 hours, respectively, mean difference 0.1 hours, 95% CI -14.1 to 14.3 hours). There was no significant difference between groups in the number of watery stools per day throughout the study period. There were also no differences in any other secondary outcome measures between groups. In children with AGE younger than 5 years of age, gelatine tannate was ineffective as an adjunct to rehydration therapy. NCT02280759. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Freeze/thaw stress induces organelle remodeling and membrane recycling in cryopreserved human mature oocytes.

PubMed

Nottola, Stefania Annarita; Albani, Elena; Coticchio, Giovanni; Palmerini, Maria Grazia; Lorenzo, Caterina; Scaravelli, Giulia; Borini, Andrea; Levi-Setti, Paolo Emanuele; Macchiarelli, Guido

2016-12-01

Our aim was to evaluate the ultrastructure of human metaphase II oocytes subjected to slow freezing and fixed after thawing at different intervals during post-thaw rehydration. Samples were studied by light and transmission electron microscopy. We found that vacuolization was present in all cryopreserved oocytes, reaching a maximum in the intermediate stage of rehydration. Mitochondria-smooth endoplasmic reticulum (M-SER) aggregates decreased following thawing, particularly in the first and intermediate stages of rehydration, whereas mitochondria-vesicle (MV) complexes augmented in the same stages. At the end of rehydration, vacuoles and MV complexes both diminished and M-SER aggregates increased again. Cortical granules (CGs) were scarce in all cryopreserved oocytes, gradually diminishing as rehydration progressed. This study also shows that such a membrane remodeling is mainly represented by a dynamic process of transition between M-SER aggregates and MV complexes, both able of transforming into each other. Vacuoles and CG membranes may take part in the membrane recycling mechanism.

Surviving metabolic arrest: photosynthesis during desiccation and rehydration in resurrection plants.

PubMed

Challabathula, Dinakar; Puthur, Jos T; Bartels, Dorothea

2016-02-01

Photosynthesis is the key process that is affected by dehydration in plants. Desiccation-tolerant resurrection plants can survive conditions of very low relative water content. During desiccation, photosynthesis is not operational, but is recovered within a short period after rehydration. While homoiochlorophyllous resurrection plants retain their photosynthetic apparatus during desiccation, poikilochlorophyllous resurrection species dismantle chloroplasts and degrade chlorophyll but resynthesize them again during rehydration. Dismantling the chloroplasts avoids the photooxidative stress in poikilochlorophyllous resurrection plants, whereas it is minimized in homoiochlorophyllous plants through the synthesis of antioxidant enzymes and protective proteins or metabolites. Although the cellular protection mechanisms in both of these species vary, these mechanisms protect cells from desiccation-induced damage and restore photosynthesis upon rehydration. Several of the proteins synthesized during dehydration are localized in chloroplasts and are believed to play major roles in the protection of photosynthetic structures and in recovery in resurrection species. This review focuses on the strategies of resurrection plants in terms of how they protect their photosynthetic apparatus from oxidative stress during desiccation without membrane damage and with full recovery during rehydration. We review the role of the dehydration-induced protection mechanisms in chloroplasts and how photosynthesis is restored during rehydration. © 2015 New York Academy of Sciences.

Effect of hydration on plasma vasopressin, renin, and aldosterone responses to head-up tilt

NASA Technical Reports Server (NTRS)

Harrison, M. H.; Geelen, G.; Keil, L. C.; Wade, C. A.; Hill, L. C.

1986-01-01

If plasma vasopressin (PVP), plasma renin (PRA), and plasma aldosterone (PA) responses to change in posture are mediated only by alterations in intrathoracic baroreceptor activity hydration status should have minimal influence on these responses. To test this hypothesis, six male subjects underwent 45 min of 70 deg head-up tilt (HUT) following 26 h dehydration, and again, 105 min later, following rehydration. Compared with preceding supine hydrated control values, PVP, PRA, and PA increased (p less than 0.001) during dehydrated HUT, but only PVP and PRA increased during rehydrated HUT (p less than 0.001). The dissociation during rehydrated HUT of PRA and PA may have been related more to the reduction (p less than 0.001) in plasma potassium concentration than to the accompanying decrease (p less than 0.001) in plasma osmolality and sodium concentration. Although increases in PVP and PRA during HUT were attenuated (p less than 0.01) following rehydration, this attenuation was associated with the absence of symptoms of overt hypotension following rehydration. However, since rehydration did not abolish the increases in PVP and PRA induced by HUT, it is concluded that the present observations support the concept of intrathoracic baroreceptor involvement in the regulation of vasopressin secretion and renin release.

Rehydration properties of hybrid method dried fruit enriched by natural components

NASA Astrophysics Data System (ADS)

Kowalska, Hanna; Marzec, Agata; Kowalska, Jolanta; Ciurzyńska, Agnieszka; Samborska, Kinga; Bialik, Michał; Lenart, Andrzej

2018-04-01

The aim of the study was to determine the impact of osmotic pre-dehydration and drying of fruit on the rehydration properties of dried fruit. Herein, the effect of fruit juice, applied as a natural enriching substance was very important. In addition, the properties of dried fruits obtained through combined air-drying and subsequent microwave-vacuum drying with `puffing' effect were similar to the freeze-dried fruits, but showed other rehydration properties. As raw material, frozen strawberry (Honeoye variety) and fresh apples (Idared variety) were used in the study. The apples and partially defrosted strawberries were prior dehydrated in solutions of sucrose and a mixture of sucrose with chokeberry juice concentrate at 50°C for 2 h. Next, the fruit samples were dried by one of two ways: air-drying (50°C, 5 h) and microwavevacuum drying for about 360 s; and freeze-drying (30°C, 63 Pa, 24 h). The rehydration was carried out in distilled water (20°C, 5 h). The osmotic pre-dehydration hindered fruit drying process. The impact of drying method became particularly evident while examining the kinetics of rehydration. During the rehydration of the pre-dehydrated dried fruit a slower hydration could be observed. Freeze-dried strawberries absorbed 2-3 times more water than those dried by the `puffing' effect.

Physiological and ultrastructural characterisation of a desiccation-tolerant filmy fern, Hymenophyllum caudiculatum: Influence of translational regulation and ABA on recovery.

PubMed

Garcés, M; Ulloa, M; Miranda, A; Bravo, L A

2018-03-01

The filmy fern Hymenophyllum caudiculatum can lose 60% of its relative water content, remain dry for some time and recover 88% of photochemical efficiency after 30 min of rehydration. Little is known about the protective strategies and regulation of the cellular rehydration process in this filmy fern species. The aim of this study was to characterise the filmy fern ultrastructure during a desiccation-rehydration cycle, and measure the physiological effects of transcription/translation inhibitors and ABA during desiccation recovery. Confocal and transmission electron microscopy were used to compare changes in structure during fast or slow desiccation. Transcription (actinomycin D) and translation (cycloheximide) inhibitors and ABA were used to compare photochemical efficiency during desiccation recovery. Cell structure was conserved during slow desiccation and rehydration, constitutive properties of the cell wall, allowing invagination and folding of the membranes and an important change in chloroplast size. The use of a translational inhibitor impeded recovery of photochemical efficiency during the first 80 min of rehydration, but the transcriptional inhibitor had no effect. Exogenous ABA delayed photochemical inactivation, and endogenous ABA levels decreased during desiccation and rehydration. Frond curling and chloroplast movements are possible strategies to avoid photodamage. Constitutive membrane plasticity and rapid cellular repair can be adaptations evolved to tolerate a rapid recovery during rehydration. Further research is required to explore the importance of existing mRNAs during the first minutes of recovery, and ABA function during desiccation of H. caudiculatum. © 2017 German Society for Plant Sciences and The Royal Botanical Society of the Netherlands.

The viral diarrhoea epidemic 2002 in the Marshall Islands: its impact on a small island pharmacy.

PubMed

Harding, Andrew

2002-09-01

This paper describes the increased demands on the pharmacy department of Majuro Hospital in the Marshall Islands during a recent viral diarrhoea epidemic. It discusses the increased number of patients, the increased usage of drugs and also the increased costs during this epidemic. The number of patients only rose 10%. However, the increase in workload of the outpatient department, laboratory and the pharmacy department was much greater. The percentage of children presenting to the outpatient department with diarrhoea increased from 10% to 80%. Oral rehydration solution (ORS) was the most common medication given during the epidemic in line with the World Health Organisation Guidelines.

D-Lactic Acidosis in Humans: Review of Update

PubMed Central

Kang, Kyung Pyo; Lee, Sik

2006-01-01

D-Lactic acidosis has been well documented in ruminants. In humans, D-lactic acidosis is very rare, but D-lactic acidosis may be more common than generally believed and should be looked for in a case of metabolic acidosis in which the cause of acidosis is not apparent. The clinical presentation of D-lactic acidosis is characterized by episodes of encephalopathy and metabolic acidosis. The entity should be considered as a diagnosis in a patient who presents with metabolic acidosis accompanied by high anion gap, normal lactate level, negative Acetest, history of short bowel syndrome or malabsorption, and characteristic neurologic manifestations. Low carbohydrate diet, bicarbonate treatment, rehydration, and oral antibiotics would be helpful in controlling symptoms. PMID:24459486

[Zinc and treatment of diarrhoea].

PubMed

Fontaine, O

2006-06-01

Recently WHO and UNICEF issued a joint statement revising guidelines for clinical management of diarrhoea. These updated recommendations take into account new research findings showing the beneficial effects of oral rehydration salts (ORS) containing lower concentrations of glucose and salts and of zinc supplementation. In combination with prevention and treatment of dehydration with appropriate fluids, breastfeeding, continued feeding and selective use of antibiotics, these two advances can drastically diminish the number of child deaths by reducing the duration and severity of diarrhoeal episodes and lowering their incidence. The purpose of this report is to present the research findings that demonstrated the efficacy of zinc supplementation in the management of diarrhoea and led to revision of WHO/UNCEF guidelines.

The purity of water at hospital and at home as a problem of intercultural understanding.

PubMed

Burghart, R

1996-03-01

Women in a provincial town in southern Nepal were instructed by medical doctors and compounders to boil water, and to keep it boiling for 15 minutes before mixing it with infant formula or oral rehydration salts. Most women ignored the advice. Those who seemed to follow it merely brought the water to boil. This report describes how and why women boil water and assesses the health implications of their practices. The failure of women to adopt "proper" procedures procedures provides a point of entry into an analysis of the role of intercultural dialogue in exposing one's presuppositions about health and empowering one to change them.

Clonidine reduces diarrhea and sodium loss in patients with proximal jejunostomy: a controlled study.

PubMed

Buchman, Alan L; Fryer, Jon; Wallin, Anita; Ahn, Chul W; Polensky, Sharon; Zaremba, Karen

2006-01-01

Patients with short bowel syndrome have significant fluid losses. This represents a significant management problem, especially in patients with minimal residual intestine. We determined whether clonidine, an alpha2-adrenergic agonist, is effective in decreasing fecal water and sodium (Na) losses in patients with proximal jejunostomy. Eight parenteral nutrition (PN)-dependent subjects (3 men, 5 women), aged 49.9+/-10.2 years, with a residual small bowel length of 71.8+/-152.0 cm that ended in a jejunostomy, were studied. Subjects were admitted to the North-western General Clinical Research Center (GCRC) for a 2-day equilibrium period while receiving a self-selected 100 g fat diet with protein 1.5 g/kg/d and 30 kcal/kg/d and 1 L/d of oral rehydration solution. A D-xylose test was performed after an overnight fast. On days 3-5, all stool and urine were collected for volume, weight, fat, nitrogen, energy, sodium, magnesium, potassium, and calcium. Meals were provided in duplicate and the equivalent portions consumed by each patient were analyzed for fluid volume, fat, nitrogen, energy, sodium, magnesium, calcium, and potassium in order to calculate nutrient balances. At the conclusion of the stool and urine collections (day 6), a clonidine (0.3 mg) patch was applied to the shoulder. Subjects were restudied after 1 week. Daily fecal volume and weight were 4.514+/-1.769 L/d and 4394+/-1727 g/d, respectively, at baseline. Five subjects were net "secretors" in that excreted fecal volume exceeded oral intake. Fecal volume decreased by 427+/-562 mL/d (8.9%, p=.07). Fecal weight decreased by 438+/-527 g/d (9.4%, p=.05). Urine volume correspondingly increased by 747+/-1934 mL (18.9%, p=not significant [NS]). The increase in urine output was weakly and negatively correlated with the decrease in fecal volume and weight (r=-0.37 and -0.41, respectively, p=NS). Oral fluid intake decreased slightly from 3.328+/-1.246 L/d baseline to 3.203+/-1.119 L/d with clonidine therapy (-3.8%, p=NS). Fecal Na loss was significantly decreased from baseline (887+/-996 mg/d, 11.2+/-12.3%; p=.036). This was not related to decreased oral Na intake, which actually increased from baseline (3.799+/-2.271 g/d) to 3.933+/-1.314 g/d after clonidine therapy (p=NS). No patient developed hypotension. Our results show the transdermal administration of clonidine is associated with a modest but clinically significant decrease in fecal output in patients with short bowel syndrome and high-output proximal jejunostomy that require chronic parenteral fluid infusion. This is accompanied by decreased fecal Na loss.

Oral Complications and Management Strategies for Patients Undergoing Cancer Therapy

PubMed Central

2014-01-01

With cancer survival rate climbing up over the past three decades, quality of life for cancer patients has become an issue of major concern. Oral health plays an important part in one's overall quality of life. However, oral health status can be severely hampered by side effects of cancer therapies including surgery, chemotherapy, radiotherapy, and hematopoietic stem cell transplantation. Moreover, prevention and treatment of these complications are often overlooked in clinical practice. The present paper aims at drawing health care professionals' attention to oral complications associated with cancer therapy by giving a comprehensive review. Brief comments on contemporary cancer therapies will be given first, followed by detailed description of oral complications associated with cancer therapy. Finally, a summary of preventive strategies and treatment options for common oral complications including oral mucositis, oral infections, xerostomia, and dysgeusia will be given. PMID:24511293

Two Measurement Methods of Leaf Dry Matter Content Produce Similar Results in a Broad Range of Species

PubMed Central

Vaieretti, María Victoria; Díaz, Sandra; Vile, Denis; Garnier, Eric

2007-01-01

Background and Aims Leaf dry matter content (LDMC) is widely used as an indicator of plant resource use in plant functional trait databases. Two main methods have been proposed to measure LDMC, which basically differ in the rehydration procedure to which leaves are subjected after harvesting. These are the ‘complete rehydration’ protocol of Garnier et al. (2001, Functional Ecology 15: 688–695) and the ‘partial rehydration’ protocol of Vendramini et al. (2002, New Phytologist 154: 147–157). Methods To test differences in LDMC due to the use of different methods, LDMC was measured on 51 native and cultivated species representing a wide range of plant families and growth forms from central-western Argentina, following the complete rehydration and partial rehydration protocols. Key Results and Conclusions The LDMC values obtained by both methods were strongly and positively correlated, clearly showing that LDMC is highly conserved between the two procedures. These trends were not altered by the exclusion of plants with non-laminar leaves. Although the complete rehydration method is the safest to measure LDMC, the partial rehydration procedure produces similar results and is faster. It therefore appears as an acceptable option for those situations in which the complete rehydration method cannot be applied. Two notes of caution are given for cases in which different datasets are compared or combined: (1) the discrepancy between the two rehydration protocols is greatest in the case of high-LDMC (succulent or tender) leaves; (2) the results suggest that, when comparing many studies across unrelated datasets, differences in the measurement protocol may be less important than differences among seasons, years and the quality of local habitats. PMID:17353207

Effects of Rapid Intravenous Rehydration in Children With Mild-to-Moderate Dehydration.

PubMed

Janet, Sophie; Molina, Juan Carlos; Marañón, Rafael; García-Ros, Marta

2015-08-01

New guidelines for "rapid or ultrarapid" intravenous rehydration are being developed in different emergency departments. These new guidelines propose a faster administration of fluids and electrolytes than in traditional protocols. However, there is still insufficient evidence to establish a standard protocol. Our objective was to determine the effects of an outpatient rapid intravenous rehydration regimen based on the administration of 0.9% saline + 2.5% dextrose, at a rate of 20 mL/kg per hour for 2 hours, in children with mild-to-moderate isonatremic dehydration resulting from acute gastroenteritis. We performed a 2-institution, prospective, observational, descriptive study. Eighty-three patients were included in the study. All patients underwent a first evaluation, including physical examination, laboratory tests, and assessment of clinical degree of dehydration. After this initial evaluation, all children received our intravenous rehydration regimen. A second evaluation including the same items as in the first one was made after in all the children. Intravenous rehydration was successful in 69 patients (83.1%). It failed in 14 patients (16.8%), who required hospitalization because of persistent vomiting in 9 patients and poor general appearance in 5 patients. After intravenous rehydration, we observed a statistically significant decrease in the levels of ketonemia and uremia and in the Gorelick scale score. However, no significant changes were observed in sodium, chloride, potassium, and osmolarity values. We conclude that, in children with mild-to-moderate dehydration, the administration of 20 mL/kg per hour for 2 hours of 0.9% saline solution + 2.5% glucose improved clinical scores and may be used as an alternative and safe way for intravenous rehydration.

Social, economic, health and environmental determinants of child nutritional status in three Central Asian Republics.

PubMed

Bomela, Nolunkcwe J

2009-10-01

To investigate the comparative effect of social, economic, health and environmental characteristics on the nutritional status of children aged <3 years in Central Asia. Cross-sectional analysis using data from Demographic and Health Surveys. Uzbekistan, Kyrgyzstan and Kazakhstan. Information on demographic health was gathered by Macro International Inc., Uzbekistan, Kyrgyzstan and Kazakhstan governments from a random sample of 14 067 households in the three countries. Anthropometric measurements were performed using standardized procedures on all children <3 years of age (n 2358). Only children with plausible Z-scores (n 1989) were selected for subsequent analyses. The main results indicated that country of residence, number of people in household, household wealth, birth weight, age of child, knowledge of oral rehydration therapy, maternal education, number of children <5 years of age and source of drinking water were strong predictors of child nutritional status in these countries. Furthermore, chronic malnutrition was most prevalent in all three countries but at varied levels. An unexpected finding was that fully vaccinated children were more likely to be malnourished than children who were partially vaccinated. A further unexpected finding was that breast-feeding especially in children >6 months old had a strong negative association with stunting and underweight. In summary, the results from both the descriptive and binary logistic regression analysis are similar in terms of the explanatory variables and the statistical significance in the models.

Infectious disease surveillance during emergency relief to Bhutanese refugees in Nepal.

PubMed

Marfin, A A; Moore, J; Collins, C; Biellik, R; Kattel, U; Toole, M J; Moore, P S

1994-08-03

To implement simplified infectious disease surveillance and epidemic disease control during the relocation of Bhutanese refugees to Nepal. Longitudinal observation study of mortality and morbidity. Refugee health units in six refugee camps housing 73,500 Bhutanese refugees in the eastern tropical lowland between Nepal and India. Infectious disease surveillance and community-based programs to promote vitamin A supplementation, measles vaccination, oral rehydration therapy, and early use of antibiotics to treat acute respiratory infection. Crude mortality rate, mortality rate for children younger than 5 years, and cause-specific mortality. Crude mortality rates up to 1.15 deaths per 10,000 persons per day were reported during the first 6 months of surveillance. The leading causes of death were measles, diarrhea, and acute respiratory infections. Surveillance data were used to institute changes in public health management including measles vaccination, vitamin A supplementation, and control programs for diarrhea and acute respiratory infections and to ensure rapid responses to cholera, Shigella dysentery, and meningoencephalitis. Within 4 months of establishing disease control interventions, crude mortality rates were reduced by 75% and were below emergency levels. Simple, sustainable disease surveillance in refugee populations is essential during emergency relief efforts. Data can be used to direct community-based public health interventions to control common infectious diseases and reduce high mortality rates among refugees while placing a minimal burden on health workers.

Role of 6-Gingerol in Reduction of Cholera Toxin Activity In Vitro and In Vivo

PubMed Central

Saha, Pallashri; Das, Bornita

2013-01-01

Vibrio cholerae is one of the major bacterial pathogens responsible for the devastating diarrheal disease called cholera. Chemotherapy is often used against V. cholerae infections; however, the emergence of V. cholerae with multidrug resistance (MDR) toward the chemotherapeutic agents is a serious clinical problem. This scenario has provided us with the impetus to look into herbal remediation, especially toward blocking the action of cholera toxin (CT). Our studies were undertaken to determine the antidiarrheal potential of 6-gingerol (6G) on the basis of its effect on CT, the virulence factor secreted by V. cholerae. We report here that 6G binds to CT, hindering its interaction with the GM1 receptor present on the intestinal epithelial cells. The 50% inhibitory concentration (IC50) was determined to be 10 μg/ml. The detailed mechanistic study was conducted by enzyme-linked immunosorbent assay (ELISA), fluorescence spectroscopy, and isoelectric focusing. These results were validated with in vitro studies performed with the CHO, HeLa, and HT-29 cell lines, whereas a rabbit ileal loop assay was done to estimate the in vivo action, which confirms the efficacy of 6G in remediation of the choleragenic effects of CT. Thus, 6G can be an effective adjunctive therapy with oral rehydration solution for severe CT-mediated diarrhea. PMID:23817372

Desiccation tolerance in bryophytes: The dehydration and rehydration transcriptomes in the desiccation-tolerant bryophyte Bryum argenteum.

PubMed

Gao, Bei; Li, Xiaoshuang; Zhang, Daoyuan; Liang, Yuqing; Yang, Honglan; Chen, Moxian; Zhang, Yuanming; Zhang, Jianhua; Wood, Andrew J

2017-08-08

The desiccation tolerant bryophyte Bryum argenteum is an important component of desert biological soil crusts (BSCs) and is emerging as a model system for studying vegetative desiccation tolerance. Here we present and analyze the hydration-dehydration-rehydration transcriptomes in B. argenteum to establish a desiccation-tolerance transcriptomic atlas. B. argenteum gametophores representing five different hydration stages (hydrated (H0), dehydrated for 2 h (D2), 24 h (D24), then rehydrated for 2 h (R2) and 48 h (R48)), were sampled for transcriptome analyses. Illumina high throughput RNA-Seq technology was employed and generated more than 488.46 million reads. An in-house de novo transcriptome assembly optimization pipeline based on Trinity assembler was developed to obtain a reference Hydration-Dehydration-Rehydration (H-D-R) transcriptome comprising of 76,206 transcripts, with an N50 of 2,016 bp and average length of 1,222 bp. Comprehensive transcription factor (TF) annotation discovered 978 TFs in 62 families, among which 404 TFs within 40 families were differentially expressed upon dehydration-rehydration. Pfam term enrichment analysis revealed 172 protein families/domains were significantly associated with the H-D-R cycle and confirmed early rehydration (i.e. the R2 stage) as exhibiting the maximum stress-induced changes in gene expression.

Effects of rehydration and food consumption on salivary flow, pH and buffering capacity in young adult volunteers during ergometer exercise.

PubMed

Tanabe, Mai; Takahashi, Toshiyuki; Shimoyama, Kazuhiro; Toyoshima, Yukako; Ueno, Toshiaki

2013-10-28

The aim of this study was to investigate the influences of rehydration and food consumption on salivary flow, pH, and buffering capacity during bicycle ergometer exercise in participants. Ten healthy volunteers exercised on a bicycle ergometer at 80% of their maximal heart rate. These sessions lasted for two periods of 20 min separated by 5-min rest intervals. Volunteers were subjected to one of the following conditions: (1) no water (mineral water) or food consumption, (2) only water for rehydration, (3) water and food consumption, (4) a sports drink only for rehydration, and (5) rehydration with a sports drink and food. Statistical significance was assessed using one-way analysis of variance and Dunnett's test (p < 0.05). The salivary pH decreased significantly during and after exercise in conditions 4 and 5. The salivary buffering capacity decreased significantly during exercise and/or after the exercise in conditions 1, 3, 4, and 5. The results showed that salivary pH and buffering capacity decreased greatly depending on the combination of a sports drink and food.

The influence of microwave-assisted drying techniques on the rehydration behavior of blueberries (Vaccinium corymbosum L.).

PubMed

Zielinska, Magdalena; Markowski, Marek

2016-04-01

The aim of this study was to determine the effect of: (a) different drying methods, (b) hot air temperature in a convection oven, and (c) the moisture content of fruits dehydrated by multi-stage drying which involves a transition between different stages of drying, on the rehydration kinetics of dry blueberries. Models describing rehydration kinetics were also studied. Blueberries dehydrated by multi-stage microwave-assisted drying, which involved a hot air pre-drying step at 80 °C until the achievement of a moisture content of 1.95 kg H2O kg(-1)DM, were characterized by significantly higher rates of initial and successive rehydration as well as smaller initial loss of soluble solids in comparison with the samples dried by other methods. The highest initial rehydration rate and the smallest loss of soluble solids after 30 min of soaking were determined at 0.46 min(-1) and 0.29 kg DM kg(-1)DM, respectively. The Peleg model and the first-order-kinetic model fit the experimental data well. Copyright © 2015 Elsevier Ltd. All rights reserved.

Exercise in the Heat. II. Critical Concepts in Rehydration, Exertional Heat Illnesses, and Maximizing Athletic Performance

PubMed Central

Casa, Douglas J.

1999-01-01

Objective: To acquaint athletic trainers with the numerous interrelated components that must be considered when assisting athletes who exercise in hot environments. Useful guidelines to maximize performance and minimize detrimental health consequences are presented. Data Sources: The databases MEDLINE and SPORT Discus were searched from 1980 to 1999, with the terms. “body cooling,” “dehydration,” “exercise,” “heat illnesses,” “heat,” “fluid replacement,” “acclimatization,” “hydration,” “rehydration,” “performance,” and “intravenous,” among others. Data Synthesis: This paper provides an in-depth look at issues regarding physiologic and performance considerations related to rehydration, strategies to maximize rehydration, modes of rehydration, health consequences of exercise in the heat, heat acclimatization, body cooling techniques, and practice and competition modifications. Conclusions/Recommendations: Athletic trainers have a responsibility to ensure that athletes who exercise in hot environments are prepared to do so in an optimal manner and to act properly to avoid the potentially harmful heat illnesses that can result from exercise in the heat. PMID:16558573

Time to failure of oral therapy in children with type 2 diabetes: a single center retrospective chart review.

PubMed

Barnes, Nicole S; White, Perrin C; Hutchison, Michele R

2012-11-01

There are no data in children with type 2 diabetes (T2D) regarding the durability of glycemic control with oral medication. Therefore, we assessed the likelihood of and time to failure of oral therapy in children and adolescents diagnosed with T2D. Charts of patients presenting to our large tertiary-care children's hospital between January 2000 and June 2007 with a new diagnosis of diabetes (n = 1625) were reviewed to identify those with T2D (n = 184). Subjects' initial therapy, hemoglobin A1c (HbA1c), body mass index, age, gender, and antibody status were documented, as well as subsequent therapies and HbA1c values, to determine whether baseline characteristics predicted future insulin dependence. Kaplan-Meier survival curves and Cox proportional hazards analysis demonstrated time to failure of oral therapy. Eighty-nine patients remained on insulin throughout the study. Baseline characteristics that determined future insulin dependence included being placed on insulin initially, initial HbA1c and race (whites less likely to be insulin dependent at study conclusion). Patients who failed oral therapy were more often reported to be non-compliant or unable to tolerate metformin than those who continued on oral therapy. The median time to failure of oral therapy (metformin monotherapy in 84/95) was not significantly different for patients initially treated with oral therapy (42 months) and insulin (35 months). Thus, children with T2D appear to fail oral therapy more quickly than what is reported in adults. It is not yet known if improving compliance with treatment might allow more children to remain on oral medications. © 2012 John Wiley & Sons A/S.

Oral ondansetron versus domperidone for symptomatic treatment of vomiting during acute gastroenteritis in children: multicentre randomized controlled trial

PubMed Central

2011-01-01

Background Vomiting in children with acute gastroenteritis (AG) is not only a direct cause of fluid loss but it is also a major factor of failure of oral rehydration therapy (ORT). Physicians who provide care to paediatric patients in the emergency department (ED) usually prescribe intravenous fluid therapy (IVT) for mild or moderate dehydration when vomiting is the major symptom. Thus, effective symptomatic treatment of vomiting would lead to an important reduction in the use of IVT and, consequently, of the duration of hospital stay and of frequency of hospital admission. Available evidence on symptomatic treatment of vomiting shows the efficacy of the most recently registered molecule (ondansetron) but a proper evaluation of antiemetics drugs largely used in clinical practice, such as domperidone, is lacking. Objectives To compare the efficacy of ondansetron and domperidone for the symptomatic treatment of vomiting in children with AG who have failed ORT. Methods/Design Multicentre, double-blind randomized controlled trial conducted in paediatric EDs. Children aged from 1 to 6 years who vomiting, with a presumptive clinical diagnosis of AG, and without severe dehydration will be included. After the failure of a initial ORS administration in ED, eligible children will be randomized to receive: 1) ondansetron syrup (0,15 mg/Kg of body weight); 2) domperidone syrup (0,5 mg/Kg of body weight); 3) placebo. The main study outcome will be the percentage of patients needing nasogastric or IVT after symptomatic oral treatment failure, defined as vomiting or fluid refusal after a second attempt of ORT. Data relative to study outcomes will be collected at 30 minute intervals for a minimum of 6 hours. A telephone follow up call will be made 48 hours after discharge. A total number of 540 children (i.e. 180 patients in each arm) will be enrolled. Discussion The trial results would provide evidence on the efficacy of domperidone, which is largely used in clinical practice despite the lack of proper evaluation and a controversial safety profile, as compared to ondansetron, which is not yet authorized in Italy despite evidence supporting its efficacy in treating vomiting. The trial results would contribute to a reduction in the use of IVT and, consequently, in hospital admissions in children with AG. The design of this RCT, which closely reflect current clinical practice in EDs, will allow immediate transferability of results. Trial Registration ClinicalTrials.gov: NCT01257672 PMID:21310051

Nutritional Supplements to Enhance Recovery

NASA Astrophysics Data System (ADS)

Ziegenfuss, Tim N.; Landis, Jamie; Greenwood, Mike

The ability to recover from intense exercise often separates good athletes from great ones. In the past, "recovery" often simply included rest, physical modalities (e.g., massage, hydration therapy) and meeting basic nutritional needs for fluid and energy intake. Today, athletes have a number of additional options to help them recover from high intensity training, one of which includes the judicious use of dietary supplements. This chapter briefly reviews nutritional strategies that have a strong theoretical background for enhancing rehydration/electrolyte balance, replenishing energy reserves, minimizing oxidative damage, and stimulating muscle repair.

Systematic review of strategies to increase use of oral rehydration solution at the household level.

PubMed

Lenters, Lindsey M; Das, Jai K; Bhutta, Zulfiqar A

2013-01-01

Diarrhea is one of the major causes of death in children under five years of age, disproportionately affecting children in low- and middle-income countries. Treatment of diarrhea with oral rehydration solution addresses dehydration and reduces diarrhea related deaths. The World Health Organization Programme for the Control of Diarrhoeal Disease began in 1978 and while global ORS access rates have improved substantially over the past forty years, rates of ORS use have stagnated. Investigation is required to understand which interventions are effective in promoting the use of ORS, and where there are gaps in the literature. We conducted a systematic search of peer-reviewed and grey literature and included interventions to promote the use of ORS for the treatment of acute diarrhea in children under 6 years. We used a standardized grading format based on the Child Health Epidemiology Research Group guidelines and performed meta-analysis for all categories with more than one data point. We identified 19 studies for abstraction. For co-promotion of zinc and ORS, mothers in the intervention group were 1.82 (95% CI 1.17, 2.85) times more likely to use ORS to treat their child's diarrhea episode than mothers in the comparison group. Meta-analysis of ORS social marketing and mass media strategies indicates that mothers exposed to messages were 2.05 (95% CI, 0.78, 5.42) times more likely to use ORS to treat their child's diarrhea episode than unexposed mothers. However, this is not statistically significant. Both meta-analysis had significant heterogeneity and were graded as moderate/low and low quality, respectively. We found few studies of interventions to promote the use of ORS; many categories of interventions had only one study. While there are some promising results, this analysis reinforces the need for further investigation into approaches to increasing ORS use.

Tracking Cholera through Surveillance of Oral Rehydration Solution Sales at Pharmacies: Insights from Urban Bangladesh

PubMed Central

Azman, Andrew S.; Lessler, Justin; Satter, Syed Moinuddin; Mckay, Michael V.; Khan, Azharul; Ahmed, Dilruba; Gurley, Emily S.

2015-01-01

Background In Bangladesh, pharmacy-purchased oral rehydration solution (ORS) is often used to treat diarrhea, including cholera. Over-the-counter sales have been used for epidemiologic surveillance in the past, but rarely, if ever, in low-income countries. With few early indicators for cholera outbreaks in endemic areas, diarrhea-related product sales may serve as a useful surveillance tool. Methodology/Principal Findings We tracked daily ORS sales at 50 pharmacies and drug-sellers in an urban Bangladesh community of 129,000 for 6-months while simultaneously conducting surveillance for diarrhea hospitalizations among residents. We developed a mobile phone based system to track the sales of ORS and deployed it in parallel with a paper-based system. Our objectives were to determine if the mobile phone system was practical and acceptable to pharmacists and drug sellers, whether data were reported accurately compared to a paper-based system, and whether ORS sales were associated with future incidence of cholera hospitalizations within the community. We recorded 47,215 customers purchasing ORS, and 315 hospitalized diarrhea cases, 22% of which had culture-confirmed cholera. ORS sales and diarrhea incidence were independently associated with the mean daily temperature; therefore both unadjusted and adjusted models were explored. Through unadjusted cross-correlation statistics and generalized linear models, we found increases in ORS sales were significantly associated with increases in hospitalized diarrhea cases up to 9-days later and hospitalized cholera cases up to one day later. After adjusting for mean daily temperature, ORS was significantly associated with hospitalized diarrhea two days later and hospitalized cholera one day later. Conclusions/Significance Pharmacy sales data may serve as a feasible and useful surveillance tool. Given the relatively short lagged correlation between ORS sales and diarrhea, rapid and accurate sales data are key. More work is needed in creating actionable algorithms that make use of this data and in understanding the generalizability of our findings to other settings. PMID:26641649

District focus: oral rehydration, primary health care and the scientist.

PubMed

Jansen, A A; Ebangit, M L

1986-09-01

The discovery that a solution of salt and sugar is an excellent way to treat and prevent dehydration was an important advance in the primary health care field, as it was expected that mothers, even illiterate mothers, could easily learn to prepare the solution at home, thus preventing serious consequences of untreated diarrhea. In addition to the low price, an important quality of this simple solution is that it gives the mother a sense of responsibility and the knowledge that she herself can do much to alleviate the suffering of her children. Unfortunately, the pharmaceutical industry and chemists were quick to realize that big profits can be made from oral rehydration and to package ready-made solutions. Consequently, there has been a movement away from teaching the mother how to make a simple solution at home, using salt, sugar, and water. The responsibility for this situation needs to be shared by both the scientist and the health worker. Scientists seem to have some difficulty accepting the fact that simple can be good and better is not always best. By adding 1.5 grams of potassium chloride or 2.9 grams of trisodium citrate to improve the mixture, it becomes a medicine, which only can be given/prescribed/sold by health personnel or chemists. The improved formula is good in a clinic setting, but in terms of primary health care and self-help this is not the best approach. The solution is being put beyond the reach of the poor child, certainly in the rural areas of the developing world. All health workers should know how to prepare a salt-sugar solution and also should show mothers/parents/caretakers how to make it. If one is serious about primary health care and self-help, it is best to return to using sugar and salt.

Tracking Cholera through Surveillance of Oral Rehydration Solution Sales at Pharmacies: Insights from Urban Bangladesh.

PubMed

Azman, Andrew S; Lessler, Justin; Satter, Syed Moinuddin; Mckay, Michael V; Khan, Azharul; Ahmed, Dilruba; Gurley, Emily S

2015-12-01

In Bangladesh, pharmacy-purchased oral rehydration solution (ORS) is often used to treat diarrhea, including cholera. Over-the-counter sales have been used for epidemiologic surveillance in the past, but rarely, if ever, in low-income countries. With few early indicators for cholera outbreaks in endemic areas, diarrhea-related product sales may serve as a useful surveillance tool. We tracked daily ORS sales at 50 pharmacies and drug-sellers in an urban Bangladesh community of 129,000 for 6-months while simultaneously conducting surveillance for diarrhea hospitalizations among residents. We developed a mobile phone based system to track the sales of ORS and deployed it in parallel with a paper-based system. Our objectives were to determine if the mobile phone system was practical and acceptable to pharmacists and drug sellers, whether data were reported accurately compared to a paper-based system, and whether ORS sales were associated with future incidence of cholera hospitalizations within the community. We recorded 47,215 customers purchasing ORS, and 315 hospitalized diarrhea cases, 22% of which had culture-confirmed cholera. ORS sales and diarrhea incidence were independently associated with the mean daily temperature; therefore both unadjusted and adjusted models were explored. Through unadjusted cross-correlation statistics and generalized linear models, we found increases in ORS sales were significantly associated with increases in hospitalized diarrhea cases up to 9-days later and hospitalized cholera cases up to one day later. After adjusting for mean daily temperature, ORS was significantly associated with hospitalized diarrhea two days later and hospitalized cholera one day later. Pharmacy sales data may serve as a feasible and useful surveillance tool. Given the relatively short lagged correlation between ORS sales and diarrhea, rapid and accurate sales data are key. More work is needed in creating actionable algorithms that make use of this data and in understanding the generalizability of our findings to other settings.

Scaling up access to oral rehydration solution for diarrhea: Learning from historical experience in low– and high–performing countries

PubMed Central

Wilson, Shelby E.; Morris, Saul S.; Gilbert, Sarah Skye; Mosites, Emily; Hackleman, Rob; Weum, Kristoffer L.M.; Pintye, Jillian; Manhart, Lisa E.; Hawes, Stephen E.

2013-01-01

Aim This paper aims to identify factors that systematically predict why some countries that have tried to scale up oral rehydration solution (ORS) have succeeded, and others have not. Methods We examined ORS coverage over time, across countries, and through case studies. We conducted expert interviews and literature and data searches to better understand the history of ORS scale–up efforts and why they failed or succeeded in nine countries. We used qualitative, pairwise (or three–country) comparisons of geographically or otherwise similar countries that had different outcomes in terms of ORS scale–up. An algorithm was developed which scored country performance across key supply, demand and financing activities to quantitatively assess the scale–up efforts in each country. Results The vast majority of countries have neither particularly low nor encouragingly high ORS use rates. We observed three clearly identifiable contrasts between countries that achieved and sustained high ORS coverage and those that did not. Key partners across sectors have critical roles to play to effectively address supply– and demand–side barriers. Efforts must synchronize demand generation, private provider outreach and public sector work. Many donor funds are either suspended or redirected in the event of political instability, exacerbating the health challenges faced by countries in these contexts. We found little information on the cost of scale–up efforts. Conclusions We identified a number of characteristics of successful ORS scale–up programs, including involvement of a broad range of key players, addressing supply and demand generation together, and working with both public and private sectors. Dedicated efforts are needed to launch and sustain success, including monitoring and evaluation plans to track program costs and impacts. These case studies were designed to inform programmatic decision–making; thus, rigorous academic methods to qualitatively and quantitatively evaluate country ORS scale–up programs might yield additional, critical insights and confirm our conclusions. PMID:23826508

Scaling up access to oral rehydration solution for diarrhea: Learning from historical experience in low- and high-performing countries.

PubMed

Wilson, Shelby E; Morris, Saul S; Gilbert, Sarah Skye; Mosites, Emily; Hackleman, Rob; Weum, Kristoffer L M; Pintye, Jillian; Manhart, Lisa E; Hawes, Stephen E

2013-06-01

This paper aims to identify factors that systematically predict why some countries that have tried to scale up oral rehydration solution (ORS) have succeeded, and others have not. We examined ORS coverage over time, across countries, and through case studies. We conducted expert interviews and literature and data searches to better understand the history of ORS scale-up efforts and why they failed or succeeded in nine countries. We used qualitative, pairwise (or three-country) comparisons of geographically or otherwise similar countries that had different outcomes in terms of ORS scale-up. An algorithm was developed which scored country performance across key supply, demand and financing activities to quantitatively assess the scale-up efforts in each country. The vast majority of countries have neither particularly low nor encouragingly high ORS use rates. We observed three clearly identifiable contrasts between countries that achieved and sustained high ORS coverage and those that did not. Key partners across sectors have critical roles to play to effectively address supply- and demand-side barriers. Efforts must synchronize demand generation, private provider outreach and public sector work. Many donor funds are either suspended or redirected in the event of political instability, exacerbating the health challenges faced by countries in these contexts. We found little information on the cost of scale-up efforts. We identified a number of characteristics of successful ORS scale-up programs, including involvement of a broad range of key players, addressing supply and demand generation together, and working with both public and private sectors. Dedicated efforts are needed to launch and sustain success, including monitoring and evaluation plans to track program costs and impacts. These case studies were designed to inform programmatic decision-making; thus, rigorous academic methods to qualitatively and quantitatively evaluate country ORS scale-up programs might yield additional, critical insights and confirm our conclusions.

Evaluation of a social marketing intervention promoting oral rehydration salts in Burundi.

PubMed

Kassegne, Sethson; Kays, Megan B; Nzohabonayo, Jerome

2011-03-08

Diarrhea is the second leading cause of death for children under five in Burundi; however, use of oral rehydration salts (ORS), the recommended first-line treatment, remains low. In 2004, PSI/Burundi launched a social marketing intervention to promote ORASEL among caregivers of children under five; the product was relaunched in 2006 with a new flavor. This study evaluates the intervention after the ORASEL relaunch, which included mass media and interpersonal communication activities. The study looks at trends in ORASEL use in Burundi and in behavioral determinants that may be related to its use. In 2006 and 2007, PSI conducted household surveys among Burundian females of reproductive age (15-49). Both surveys used a two-stage sampling process to select 30 households in each of 115 rural and urban collines throughout the nation. Survey respondents were asked about diarrhea treatment-related behavior; key behavioral determinants; and exposure to the ORASEL intervention. Data were analyzed to identify trends over time, characteristics of ORASEL users, and associations between exposure to the intervention and changes in ORASEL use and related behavioral determinants. ORASEL use among caregivers at their children's last diarrheal episode increased significantly from 20% in 2006 to 30% in 2007, and there were also desirable changes in several behavioral determinants associated with ORASEL use. Evaluation analysis showed that a higher level of exposure to the social marketing campaign was associated with greater use of ORASEL and with significant improvements in perceived availability, knowledge of the signs of diarrhea and dehydration, social support, and self-efficacy. ORS use can be improved through social marketing and educational campaigns that make the public aware of the availability of the product, encourage dialogue about its use, and increase skills and confidence relating to correct product preparation and administration. Further interventions in Burundi and elsewhere should promote ORS through a variety of mass media and interpersonal communication channels, and should be rigorously evaluated in the context of the total market for diarrhea treatment products.

Systematic review of strategies to increase use of oral rehydration solution at the household level

PubMed Central

2013-01-01

Background Diarrhea is one of the major causes of death in children under five years of age, disproportionately affecting children in low- and middle-income countries. Treatment of diarrhea with oral rehydration solution addresses dehydration and reduces diarrhea related deaths. The World Health Organization Programme for the Control of Diarrhoeal Disease began in 1978 and while global ORS access rates have improved substantially over the past forty years, rates of ORS use have stagnated. Investigation is required to understand which interventions are effective in promoting the use of ORS, and where there are gaps in the literature. Methods We conducted a systematic search of peer-reviewed and grey literature and included interventions to promote the use of ORS for the treatment of acute diarrhea in children under 6 years. We used a standardized grading format based on the Child Health Epidemiology Research Group guidelines and performed meta-analysis for all categories with more than one data point. Results We identified 19 studies for abstraction. For co-promotion of zinc and ORS, mothers in the intervention group were 1.82 (95% CI 1.17, 2.85) times more likely to use ORS to treat their child’s diarrhea episode than mothers in the comparison group. Meta-analysis of ORS social marketing and mass media strategies indicates that mothers exposed to messages were 2.05 (95% CI, 0.78, 5.42) times more likely to use ORS to treat their child’s diarrhea episode than unexposed mothers. However, this is not statistically significant. Both meta-analysis had significant heterogeneity and were graded as moderate/low and low quality, respectively. Conclusions We found few studies of interventions to promote the use of ORS; many categories of interventions had only one study. While there are some promising results, this analysis reinforces the need for further investigation into approaches to increasing ORS use. PMID:24564428

Hypocalcaemia following thyroidectomy unresponsive to oral therapy.

PubMed

Etheridge, Zac C; Schofield, Christopher; Prinsloo, Peter J J; Sturrock, Nigel D C

2014-01-01

Hypocalcaemia due to hypoparathyroidism following thyroidectomy is a relatively common occurrence. Standard treatment is with oral calcium and vitamin D replacement therapy; lack of response to oral therapy is rare. Herein we describe a case of hypoparathyroidism following thyroidectomy unresponsive to oral therapy in a patient with a complex medical history. We consider the potential causes in the context of calcium metabolism including: poor adherence, hungry bone syndrome, malabsorption, vitamin D resistance, bisphosphonate use and functional hypoparathyroidism secondary to magnesium deficiency. Malabsorption due to intestinal hurry was likely to be a contributory factor in this case and very large doses of oral therapy were required to avoid symptomatic hypocalcaemia.

TRAIL, Wnt, Sonic Hedgehog, TGFβ, and miRNA Signalings Are Potential Targets for Oral Cancer Therapy

PubMed Central

Farooqi, Ammad Ahmad; Shu, Chih-Wen; Huang, Hurng-Wern; Wang, Hui-Ru; Chang, Yung-Ting; Fayyaz, Sundas; Yuan, Shyng-Shiou F.; Tang, Jen-Yang

2017-01-01

Clinical studies and cancer cell models emphasize the importance of targeting therapies for oral cancer. The tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is highly expressed in cancer, and is a selective killing ligand for oral cancer. Signaling proteins in the wingless-type mouse mammary tumor virus (MMTV) integration site family (Wnt), Sonic hedgehog (SHH), and transforming growth factor β (TGFβ) pathways may regulate cell proliferation, migration, and apoptosis. Accordingly, the genes encoding these signaling proteins are potential targets for oral cancer therapy. In this review, we focus on recent advances in targeting therapies for oral cancer and discuss the gene targets within TRAIL, Wnt, SHH, and TGFβ signaling for oral cancer therapies. Oncogenic microRNAs (miRNAs) and tumor suppressor miRNAs targeting the genes encoding these signaling proteins are summarized, and the interactions between Wnt, SHH, TGFβ, and miRNAs are interpreted. With suitable combination treatments, synergistic effects are expected to improve targeting therapies for oral cancer. PMID:28708091

TRAIL, Wnt, Sonic Hedgehog, TGFβ, and miRNA Signalings Are Potential Targets for Oral Cancer Therapy.

PubMed

Farooqi, Ammad Ahmad; Shu, Chih-Wen; Huang, Hurng-Wern; Wang, Hui-Ru; Chang, Yung-Ting; Fayyaz, Sundas; Yuan, Shyng-Shiou F; Tang, Jen-Yang; Chang, Hsueh-Wei

2017-07-14

Clinical studies and cancer cell models emphasize the importance of targeting therapies for oral cancer. The tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is highly expressed in cancer, and is a selective killing ligand for oral cancer. Signaling proteins in the wingless-type mouse mammary tumor virus (MMTV) integration site family (Wnt), Sonic hedgehog (SHH), and transforming growth factor β (TGFβ) pathways may regulate cell proliferation, migration, and apoptosis. Accordingly, the genes encoding these signaling proteins are potential targets for oral cancer therapy. In this review, we focus on recent advances in targeting therapies for oral cancer and discuss the gene targets within TRAIL, Wnt, SHH, and TGFβ signaling for oral cancer therapies. Oncogenic microRNAs (miRNAs) and tumor suppressor miRNAs targeting the genes encoding these signaling proteins are summarized, and the interactions between Wnt, SHH, TGFβ, and miRNAs are interpreted. With suitable combination treatments, synergistic effects are expected to improve targeting therapies for oral cancer.

Novel small molecule epithelial sodium channel inhibitors as potential therapeutics in cystic fibrosis - a patent evaluation.

PubMed

Schoenberger, Matthias; Althaus, Mike

2013-10-01

Novel molecular platforms for epithelial sodium channel (ENaC) modulators are claimed in the following six patents: WO2012035158(A1); WO2009074575(A2); WO2011028740(A1); WO2009150137(A2); WO2011079087(A1); WO2008135557(A1). These ENaC inhibitors may be used in blocking transepithelial sodium and consequently water absorption across airway epithelia. This may result in airway rehydration and enhanced mucociliary clearance in patients with cystic fibrosis (CF) lung disease. All inhibitors resemble the classical ENaC blocker amiloride but follow different strategies to increase structural diversity in a sterically tolerant region. These substitutions can be modified to i) enhance potency of ENaC inhibition; ii) reduce epithelial permeability; and iii) broaden applicability in order to be used as potential drugs for CF therapy. Most of the claims and patent data are supported by the currently available literature. The patents deliver a solid chemical basis for a variety of chemical modifications of the ENaC inhibitor amiloride. These modifications may result in the development of a novel, applicable ENaC inhibitors which may have lasting effects on diseased airways and may achieve airway rehydration and enhanced mucociliary clearance in CF lung disease.

Vascular Uptake of Six Rehydration Drinks at Rest and Exercise

NASA Technical Reports Server (NTRS)

Greenleaf, J. E.; Geelen, G.; Jackson, C. G. R.; Saumet, J.-L.; Juhos, L. T.; Keil, L. C.; Fegan-Meyer, D.; Dearborn, A.; Hinghofer-Szalkay, H.; Whittam, J. H.

1996-01-01

A report presents data on the effectiveness of each of six rehydration fluids in restoring total body water and plasma volume in human subjects during rest and exercise. One of the six fluids was water sweetened with aspartame: the others were water containing various amounts of sodium chloride and/or sodium citrate, plus various amounts of aspartame and/or other carbohydrates. In one experiment, five men who had previously dehydrated themselves for 24 hours drank one of the rehydration fluids, then sat for 70 minutes. Pretest plasma volumes were measured and changes in plasma volumes were calculated. This procedure was repeated at weekly intervals until all six rehydration fluids had been tested. Another similar experiment involved four men who exercised on a cycle ergometer for 70 minutes in the supine position after drinking the fluids.

Fluid management of hypernatraemic dehydration to prevent cerebral oedema: a retrospective case control study of 97 children in China.

PubMed

Fang, Chengqing; Mao, Jianhua; Dai, Yuwen; Xia, Yonghui; Fu, Haidong; Chen, Yifang; Wang, Yaping; Liu, Aimin

2010-06-01

To compare the fluid management of hypernatraemic dehydration in acute gastroenteritis in those who developed cerebral oedema (cases) versus those who did not (controls). A retrospective study of 97 cases of hypernatraemic dehydration at a tertiary children's hospital in China over five years, in which rehydration regimes of 49 children who developed cerebral oedema were compared with 48 children who made an uneventful recovery. Risk factors for cerebral oedema (vs. no cerebral oedema) were an initial fluid bolus (29/49 vs. 15/48, P=0.006), the mean rate of bolus infusion (14.7+/-2.2 vs. 10.8+/-1.4 mL/kg/hr, P<0.001), the severity of hypernatraemia (serum sodium 167.7+/-7.8 vs. 161.3+/-7.9 mmol/L, P<0.001) and the overall rehydration rate (8.2+/-1.1 vs. 6.4+/-0.6 mL/kg/hr, P<0.001). On logistic regression, a rapid rehydration rate was the most significant contributor to cerebral oedema. From receive operating characteristic (ROC) curve analysis, the safe rate of rehydration was <6.8 mL/kg/hr. The key risk factors for the development of cerebral oedema during recovery from hypernatraemic dehydration were too rapid a rate of rehydration, an initial fluid bolus to rapidly expand plasma volume and the severity of the hypernatraemia. Thus, we conclude that a uniformly slow rate of rehydration is the best way of preventing cerebral oedema.

Chemical, Physicochemical, Nutritional, Microbiological, Sensory and Rehydration Characteristics of Instant Whole Beans (Phaseolus vulgaris).

PubMed

Ulloa, José Armando; Ibarra-Zavala, Silvia Jazmin; Ramírez-Salas, Silvia Patricia; Rosas-Ulloa, Petra; Ramírez-Ramírez, José Carmen; Ulloa-Rangel, Blanca Estela

2015-03-01

Instant whole beans obtained by drying at 25 °C were evaluated for their chemical, physicochemical, nutritional, microbiological, sensory and rehydration characteristics. The proximal composition of instant whole beans was typical of this kind of food, whereas a w and L* , a* and b* values were 0.639, 98.55, -0.28 and -1.52, respectively. In instant whole beans, 75% of the essential amino acids had a value greater or equal to the reference standard for adult humans; the protein quality in terms of chemical score was 95%. Microbiological counts of aerobic mesophilic bacteria, moulds, yeasts and total coliforms of rehydrated instant whole beans were <10 CFU/g, whereas the scores for colour, flavour, texture and overall acceptability were 7.22, 7.68, 7.24 and 7.34, respectively, on a 1-9 hedonic scale. The logarithmic and Pilosof models showed close fits (R 2 >0.99) to the experimental data for drying of cooked beans and rehydration of instant whole beans, respectively. In the light of the chemical, physicochemical, nutritional, microbiological, sensory and rehydration characteristics of instant whole beans found in this study, drying at 25 °C is recommended for the production of such food.

Effects of rehydration and food consumption on salivary flow, pH and buffering capacity in young adult volunteers during ergometer exercise

PubMed Central

2013-01-01

Background The aim of this study was to investigate the influences of rehydration and food consumption on salivary flow, pH, and buffering capacity during bicycle ergometer exercise in participants. Methods Ten healthy volunteers exercised on a bicycle ergometer at 80% of their maximal heart rate. These sessions lasted for two periods of 20 min separated by 5-min rest intervals. Volunteers were subjected to one of the following conditions: (1) no water (mineral water) or food consumption, (2) only water for rehydration, (3) water and food consumption, (4) a sports drink only for rehydration, and (5) rehydration with a sports drink and food. Statistical significance was assessed using one-way analysis of variance and Dunnett’s test (p < 0.05). Results The salivary pH decreased significantly during and after exercise in conditions 4 and 5. The salivary buffering capacity decreased significantly during exercise and/or after the exercise in conditions 1, 3, 4, and 5. Conclusions The results showed that salivary pH and buffering capacity decreased greatly depending on the combination of a sports drink and food. PMID:24160307

Dengue fever: a Wikipedia clinical review.

PubMed

Heilman, James M; De Wolff, Jacob; Beards, Graham M; Basden, Brian J

2014-01-01

Dengue fever, also known as breakbone fever, is a mosquito-borne infectious tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles. In a small proportion of cases, the disease develops into life-threatening dengue hemorrhagic fever, which results in bleeding, thrombocytopenia, and leakage of blood plasma, or into dengue shock syndrome, in which dangerously low blood pressure occurs. Treatment of acute dengue fever is supportive, with either oral or intravenous rehydration for mild or moderate disease and use of intravenous fluids and blood transfusion for more severe cases. Along with attempts to eliminate the mosquito vector, work is ongoing to develop a vaccine and medications targeted directly at the virus.

PubMed Central

Wolff, Jacob De; Beards, Graham M; Basden, Brian J

2014-01-01

Dengue fever, also known as breakbone fever, is a mosquito-borne infectious tropical disease caused by the dengue virus. Symptoms include fever, headache, muscle and joint pains, and a characteristic skin rash that is similar to measles. In a small proportion of cases, the disease develops into life-threatening dengue hemorrhagic fever, which results in bleeding, thrombocytopenia, and leakage of blood plasma, or into dengue shock syndrome, in which dangerously low blood pressure occurs. Treatment of acute dengue fever is supportive, with either oral or intravenous rehydration for mild or moderate disease and use of intravenous fluids and blood transfusion for more severe cases. Along with attempts to eliminate the mosquito vector, work is ongoing to develop a vaccine and medications targeted directly at the virus. PMID:25426178

D-lactic acidosis: an unusual cause of encephalopathy in a patient with short bowel syndrome.

PubMed

Dahlqvist, G; Guillen-Anaya, M A; Vincent, M F; Thissen, J P; Hainaut, P

2013-01-01

A 24-year-old woman with a short bowel syndrome following post-ischemic small bowel resection, developed several episodes of lethargy, echolalia and ataxia. D-lactic acidosis was identified as the cause of neurological disturbances. This infrequent disorder can be precipitated by intake of a large amount of sugars, in patients with short bowel syndrome. It should be suspected in the presence of metabolic acidosis with increased anion gap and a normal level of L-lactic acid. The diagnosis relies on the specific dosage of D-lactic stereoisomer. Proper management involves rehydration, diet adaptation and oral administration of poorly absorbed antibiotics in order to modify the colonic flora responsible for D-lactic production.

Diarrhoeal diseases in developing countries: a situational analysis.

PubMed

Kumar, S G; Subitha, L

2012-01-01

Recent data showed that there is no much reduction in diarrhoea related morbidity in developing countries. This is important in view of the Millennium Developmental Goal (MDG) to be achieved by 2015. This study reviewed and analyzed after gathering the recent literature information from Pubmed, internet and other sources. The authors discussed public health issues related to diarrhoeal diseases that include problem burden, determinants, intervention strategies, management, prevention and recent developments for control of diarrhoea among under-five children in developing countries. The study emphasizes the need for strengthening of comprehensive diarrhoeal disease prevention strategy at primary level including improvement of water quality, hygiene and sanitation, along with provision of oral rehydration solution and zinc supplements, and research in the field of vaccine and cost effective interventions.

Small Intestinal Infections.

PubMed

Munot, Khushboo; Kotler, Donald P

2016-06-01

Small intestinal infections are extremely common worldwide. They may be bacterial, viral, or parasitic in etiology. Most are foodborne or waterborne, with specific etiologies differing by region and with diverse pathophysiologies. Very young, very old, and immune-deficient individuals are the most vulnerable to morbidity or mortality from small intestinal infections. There have been significant advances in diagnostic sophistication with the development and early application of molecular diagnostic assays, though these tests have not become mainstream. The lack of rapid diagnoses combined with the self-limited nature of small intestinal infections has hampered the development of specific and effective treatments other than oral rehydration. Antibiotics are not indicated in the absence of an etiologic diagnosis, and not at all in the case of some infections.

The place of hyperbaric oxygen therapy and ozone therapy in sudden hearing loss.

PubMed

Ergun Taşdöven, Gülin; Derin, Alper Tunga; Yaprak, Neslihan; Özçağlar, Hasan Ümit

It is difficult to evaluate the effect of drugs clinically used for idiopathic sudden sensorineural hearing loss, mainly because its underlying mechanism remains unknown. This study assessed the efficacy of hyperbaric oxygen therapy or ozone therapy in the treatment of idiopathic sudden sensorineural hearing loss, when either therapy was included with steroid treatment. A retrospective analysis examined 106 patients with idiopathic sudden sensorineural hearing loss seen between January 2010 and June 2012. Those with an identified etiology were excluded. The patients were divided into three treatment groups: oral steroid only (n=65), oral steroid+hyperbaric oxygen (n=26), and oral steroid+ozone (n=17). Treatment success was assessed using Siegel criteria and mean gains using pre- and post-treatment audiograms. The highest response rate to treatment was observed in the oral steroid+ozone therapy group (82.4%), followed by the oral steroid+hyperbaric oxygen (61.5%), and oral steroid groups (50.8%). There were no significant differences in the response to treatment between the oral steroid and oral steroid+hyperbaric oxygen groups (p<0.355). The oral steroid+ozone group showed a significantly higher response rate to treatment than the oral steroid group (p=0.019). There were no significant differences between the oral steroid+hyperbaric oxygen and oral steroid+ozone groups (p=0.146). The efficiency of steroid treatment in patients with severe hearing loss was low. It was statistically ascertained that adding hyperbaric oxygen or ozone therapy to the treatment contributed significantly to treatment success. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Using a nasogastric tube.

PubMed

Candy, C

1986-09-01

This discussion of the use of a nasogastric tube covers the equipment needed, the method, rehydration and feeding, prolonged nasogastric feeding, and stopping nasogastric feeding. A nasogastric tube is useful when children are unable to drink safely and in sufficient amounts for any of the following reasons: severe dehydration; if intravenous (IV) therapy is unavailable; low birth weight infants; or the child is drowsy or vomiting. Severely malnourished children may be fed initially in this way if they are too weak or anorexic to eat or drink normally. The following equipment is needed: nasogastric tube; lubricating fluid; a syringe; blue litmus paper, if available; adhesive tape; stethoscope if available; and fluid to be given. Explain to the child's parents and the child, if old enough to understand, what will be done; lie infants flat; measure the approximate length from the child's nostril to the ear lobe and then to the top of the abdomen with the tube and mark the position; clean the nostrils to remove the mucus, and lubricate the tip of the tube and gently insert into the nostril; give the child a drink of water if he or she is conscious; continue to pass the tube down until the position marked reaches the nostril; use the syringe to suck up some fluid and test with blue litmus paper to check that the tube is in the stomach; and inject 5-10 ml of fluid (saline or oral rehydration solution, not milk formula) by syringe if satisfied the tube is in the correct position. Where possible, give a continuous drip of fluid. If this is not possible, give frequent small amounts using the syringe as a funnel. If feeding continues for more than 24 hours, clean the nostrils daily with warm water and change the tube to the other nostril every few days. Also keep the mouth very clean with a dilute solution of 8% sodium bicarbonate, if available, or citrus fruit juice. To remove the tube, remove the adhesive tape, take the tube out gently and smoothly, and offer the child a drink and gently cleanse the nostrils. After prolonged nasogastric feeding, a child may experience feeding problems or loss of appetite. Patient and encouragement are needed to establish feeding by mouth again.

Photodynamic therapy in treatment of severe oral lichen planus.

PubMed

Rabinovich, O F; Rabinovich, I M; Guseva, A V

2016-01-01

The aim of the study was to elaborate the rationale for the application of photodynamic therapy in complex treatment of patient with severe oral lichen planus. Complex clinical and laboratory examination and treatment was performed in 54 patients divided on 3 groups. Diagnosis of oral lichen planus was based on clinical, histological and immunohistochemical features. Group 1 received standard treatment, in the second group photodynamic therapy was conducted in addition to conventional treatment, patients in the third group received only photodynamic therapy. The study results proved photodynamic therapy to be useful tool in complex treatment of severe oral lichen planus.

Application of Stem Cells in Oral Disease Therapy: Progresses and Perspectives

PubMed Central

Yang, Bo; Qiu, Yi; Zhou, Niu; Ouyang, Hong; Ding, Junjun; Cheng, Bin; Sun, Jianbo

2017-01-01

Stem cells are undifferentiated and pluripotent cells that can differentiate into specialized cells with a more specific function. Stem cell therapies become preferred methods for the treatment of multiple diseases. Oral and maxillofacial defect is one kind of the diseases that could be most possibly cured by stem cell therapies. Here we discussed oral diseases, oral adult stem cells, iPS cells, and the progresses/challenges/perspectives of application of stem cells for oral disease treatment. PMID:28421002

[Continuous enteral nutrition in the treatment of infants with "travelers' diarrhea" and severe malnutrition].

PubMed

Collet, J P; Hermier, M; Gallet, S; Descos, B; Lachaux, A; Guillermet, F; Martin, M J

1986-01-01

A prospective study of children aged 2-22 mos with traveller's diarrhea and severe malnutrition (weight loss greater than or equal to 10%; mean 17.8%) treated with a standardized progressive semi-elemental drip feeding (Alfaré and Dextrine-maltose) after rehydration was undertaken. In 18 children, this therapy was successful and duration of the hospital stay was 15.7 days. In 6 other children, relapse was treated with the same protocol with success and duration of the hospital stay was 29 days. Total parenteral nutrition was unnecessary. Evolution of serum prealbumin and anthropometric parameters was good.

Oral cryotherapy reduces mucositis and opioid use after myeloablative therapy--a randomized controlled trial.

PubMed

Svanberg, Anncarin; Birgegård, Gunnar; Ohrn, Kerstin

2007-10-01

Mucositis is a major complication in myeloablative therapy, which often necessitates advanced pharmacological pain treatment, including i.v. opioids. Attempts to prevent oral mucositis have included oral cryotherapy, which has been shown to reduce mucositis, but there is a lack of knowledge concerning the effect of oral cryotherapy on opioid use by reducing the mucositis for patients treated with myeloablative therapy before bone marrow transplantation (BMT). The aim of the present study was to evaluate if oral cryotherapy could delay or alleviate the development of mucositis and thereby reduce the number of days with i.v. opioids among patients who receive myeloablative therapy before BMT. Eighty patients 18 years and older, scheduled for BMT, were included consecutively and randomised to oral cryotherapy or standard oral care. A stratified randomisation was used with regard to type of transplantation. Intensity of pain, severity of mucositis and use of opioids were recorded using pain visual analogue scale (VAS) scores, mucositis index scores and medical and nursing charts. This study showed that patients receiving oral cryotherapy had less pronounced mucositis and significantly fewer days with i.v. opioids than the control group. In the autologous setting, cryotherapy patients also needed significantly lower total dose of opioids. Oral cryotherapy is an effective and well-tolerated therapy to alleviate mucositis and consequently reduce the number of days with i.v. opioids among patients treated with myeloablative therapy before BMT.

Compression of rehydratable vegetables and cereals

NASA Technical Reports Server (NTRS)

Burns, E. E.

1978-01-01

Characteristics of freeze-dried compressed carrots, such as rehydration, volatile retention, and texture, were studied by relating histological changes to textural quality evaluation, and by determining the effects of storage temperature on freeze-dried compressed carrot bars. Results show that samples compressed with a high moisture content undergo only slight structural damage and rehydrate quickly. Cellular disruption as a result of compression at low moisture levels was the main reason for rehydration and texture differences. Products prepared from carrot cubes having 48% moisture compared favorably with a freshly cooked product in cohesiveness and elasticity, but were found slightly harder and more chewy.

Chemical, Physicochemical, Nutritional, Microbiological, Sensory and Rehydration Characteristics of Instant Whole Beans (Phaseolus vulgaris)

PubMed Central

Ibarra-Zavala, Silvia Jazmin; Ramírez-Salas, Silvia Patricia; Rosas-Ulloa, Petra; Ramírez-Ramírez, José Carmen; Ulloa-Rangel, Blanca Estela

2015-01-01

Summary Instant whole beans obtained by drying at 25 °C were evaluated for their chemical, physicochemical, nutritional, microbiological, sensory and rehydration characteristics. The proximal composition of instant whole beans was typical of this kind of food, whereas aw and L*, a* and b* values were 0.639, 98.55, –0.28 and –1.52, respectively. In instant whole beans, 75% of the essential amino acids had a value greater or equal to the reference standard for adult humans; the protein quality in terms of chemical score was 95%. Microbiological counts of aerobic mesophilic bacteria, moulds, yeasts and total coliforms of rehydrated instant whole beans were <10 CFU/g, whereas the scores for colour, flavour, texture and overall acceptability were 7.22, 7.68, 7.24 and 7.34, respectively, on a 1–9 hedonic scale. The logarithmic and Pilosof models showed close fits (R2>0.99) to the experimental data for drying of cooked beans and rehydration of instant whole beans, respectively. In the light of the chemical, physicochemical, nutritional, microbiological, sensory and rehydration characteristics of instant whole beans found in this study, drying at 25 °C is recommended for the production of such food. PMID:27904331

Priority Medicines for Maternal and Child Health: A Global Survey of National Essential Medicines Lists

PubMed Central

Hill, Suzanne; Yang, Annie; Bero, Lisa

2012-01-01

Background In April 2011, the World Health Organization (WHO) published a list of “priority medicines” for maternal and child health based on 1) the global burden of disease and 2) evidence of efficacy and safety. The objective of this study was to examine the occurrence of these priority medicines on national essential medicines lists. Methods and Findings All essential medicines lists published since 1999 were selected from the WHO website collection. The most-up-to date list for each country was then selected, resulting in 89 unique country lists. Each list was evaluated for inclusion of medicines (chemical entity, concentration, and dosage form) on the Priority Medicines List. There was global variation in the listing of the Priority Medicines. The most frequently listed medicine was paracetamol, on 94% (84/89) of lists. Sodium chloride, gentamicin and oral rehydration solution were on 93% (83/89) of lists. The least frequently listed medicine was the children's antimalarial rectal artesunate, on 8% of lists (7/89); artesunate injection was on 16% (14/89) of lists. Pediatric artemisinin combination therapy, as dispersible tablets or flexible oral solid dosage form, appeared on 36% (32/89) of lists. Procaine benzylpenicillin, for treatment of pediatric pneumonia and neonatal sepsis, was on 50% (45/89) of the lists. Zinc, for treatment of diarrhoea in children, was included on only 15% (13/89) of lists. For prevention and treatment of postpartum hemorrhage in women, oxytocin was more prevalent on the lists than misoprostol; they were included on 55 (62%) and 31 (35%) of lists, respectively. Cefixime, for treatment of uncomplicated anogenital gonococcal infection in woman was on 26% (23/89) of lists. Magnesium sulfate injection for treatment of severe pre-eclampsia and eclampsia was on 50% (45/89) of the lists. Conclusions The findings suggest that countries need to urgently amend their lists to provide all priority medicines as part of the efforts to improve maternal and child health. PMID:22675435

The influence of rehydration mode after exercise dehydration on cardiovascular function.

PubMed

McDermott, Brendon P; Casa, Douglas J; Lee, Elaine C; Yamamoto, Linda M; Beasley, Kathleen N; Emmanuel, Holly; Pescatello, Linda S; Kraemer, William J; Anderson, Jeffrey M; Armstrong, Lawrence E; Maresh, Carl M

2013-08-01

Our purpose was to compare the common modes of rehydration (REHY) on cardiovascular and fluid regulation recovery after exercise dehydration (EXDE). Twelve nonheat-acclimatized trained subjects (age: 23 ± 4 years, weight: 81.3 ± 3.7 kg, height: 180 ± 6 cm, V[Combining Dot Above]O2max: 56.9 ± 4.4 ml·min·kg , and body fat: 7.8 ± 3.0%) completed 20-hour fluid restriction and 2-hour EXDE to -4% body mass, and then were rehydrated to -2% body mass in a randomized, crossover design. The REHY methods included no fluid (NF), ad libitum, oral (OR), intravenous (IV), and a combination of IV and OR (IV + OR) of 1/2-normal saline (0.45% NaCl). The REHY occurred for 30 minutes, and the subjects were observed during rest for 30 minutes. Seated, standing, and mean arterial pressure (MAP) and blood pressure (BP) were measured every 15 minutes throughout REHY. Heart rate (HR), plasma arginine vasopressin concentration [AVP], and thirst perception were measured throughout REHY. The EXDE resulted in a body mass loss of 4.32 ± 0.22%. The REHY returned the subjects to -2.13 ± 0.47% body mass for controlled trials. Seated systolic BP was greater for IV + OR compared with that for OR (p = 0.015). Seated systolic BP and MAP during REHY showed that IV + OR was greater than OR, independent of time (p ≤ 0.011). Upon standing, IV + OR demonstrated a greater BP than both NF (p = 0.012) and OR (p = 0.031) did. The HR was reduced by IV and IV + OR to a greater extent than NF at REHY30 and REHY60 (p < 0.05). The IV + OR [AVP] demonstrated a strong trend for decreasing over time (p = 0.054) and was significantly less than NF at REHY60 (p = 0.003). Practical application seeking to restore cardiovascular function after EXDE, the combined use of IV + OR rather than a single REHY method seems to be most expedient.

Comparing sociocultural features of cholera in three endemic African settings.

PubMed

Schaetti, Christian; Sundaram, Neisha; Merten, Sonja; Ali, Said M; Nyambedha, Erick O; Lapika, Bruno; Chaignat, Claire-Lise; Hutubessy, Raymond; Weiss, Mitchell G

2013-09-18

Cholera mainly affects developing countries where safe water supply and sanitation infrastructure are often rudimentary. Sub-Saharan Africa is a cholera hotspot. Effective cholera control requires not only a professional assessment, but also consideration of community-based priorities. The present work compares local sociocultural features of endemic cholera in urban and rural sites from three field studies in southeastern Democratic Republic of Congo (SE-DRC), western Kenya and Zanzibar. A vignette-based semistructured interview was used in 2008 in Zanzibar to study sociocultural features of cholera-related illness among 356 men and women from urban and rural communities. Similar cross-sectional surveys were performed in western Kenya (n = 379) and in SE-DRC (n = 360) in 2010. Systematic comparison across all settings considered the following domains: illness identification; perceived seriousness, potential fatality and past household episodes; illness-related experience; meaning; knowledge of prevention; help-seeking behavior; and perceived vulnerability. Cholera is well known in all three settings and is understood to have a significant impact on people's lives. Its social impact was mainly characterized by financial concerns. Problems with unsafe water, sanitation and dirty environments were the most common perceived causes across settings; nonetheless, non-biomedical explanations were widespread in rural areas of SE-DRC and Zanzibar. Safe food and water and vaccines were prioritized for prevention in SE-DRC. Safe water was prioritized in western Kenya along with sanitation and health education. The latter two were also prioritized in Zanzibar. Use of oral rehydration solutions and rehydration was a top priority everywhere; healthcare facilities were universally reported as a primary source of help. Respondents in SE-DRC and Zanzibar reported cholera as affecting almost everybody without differentiating much for gender, age and class. In contrast, in western Kenya, gender differentiation was pronounced, and children and the poor were regarded as most vulnerable to cholera. This comprehensive review identified common and distinctive features of local understandings of cholera. Classical treatment (that is, rehydration) was highlighted as a priority for control in the three African study settings and is likely to be identified in the region beyond. Findings indicate the value of insight from community studies to guide local program planning for cholera control and elimination.

Mitigating Exertional Heat Illness in Military Personnel: The Science Behind a Rice-Based Electrolyte and Rehydration Drink.

PubMed

Moore, Brenda; O'Hara, Reginald

Exertional heat illness continues to be prevalent among members of active duty personnel, especially those in specific military occupational specialties such as loadmasters, flight crew, flight maintainers, and Special Operations Forces. Therefore, the primary objective of this article was to elucidate the various oral rehydration solutions (ORSs) on the market that are used to mitigate exertional heat illness (EHI) in military personnel, and to focus on the science behind a ricebased electrolyte drink, CeraSport®, currently used by US military personnel in mitigating EHI during sustained training operations in high-heat environments. A search of the literature (through March 2016) was performed using PubMed and ProQuest, in addition to searching bibliographies and text books. We reviewed 63 articles and three texts. Articles were limited to those published in English and to studies that used only carbohydrates (e.g., no amino acids) and drinks reported to be used by the military in field training and deployment. Heat illness is prevalent among military personnel operating in high-heat environments and a variety of ORSs and sports drinks are available to help mitigate this. However, CeraSport, compared with other ORSs and sports drinks, may offer benefits such as faster gastric emptying rates and improved absorption from the gastrointestinal tract, which can provide rapidly available carbohydrate substrates for energy needs, and increased water retention for maintenance of blood plasma volume. 2016.

Prescription frequency and predictors for the use of novel direct oral anticoagulants for secondary stroke prevention in the first year after their marketing in Europe--a multicentric evaluation.

PubMed

Luger, Sebastian; Hohmann, Carina; Kraft, Peter; Halmer, Ramona; Gunreben, Ignaz; Neumann-Haefelin, Tobias; Kleinschnitz, Christoph; Walter, Silke; Haripyan, Veronika; Steinmetz, Helmuth; Foerch, Christian; Pfeilschifter, Waltraud

2014-07-01

Direct oral anticoagulants (DOAC) are alternatives to the use of vitamin K antagonists (VKA) as oral anticoagulant therapies to prevent stroke in patients with atrial fibrillation. We assembled a representative secondary prevention cohort from four tertiary care stroke centers to identify factors that independently influence therapeutic decision making 1) not to anticoagulate with either VKA or DOAC and 2) to use DOAC if the patient appears suitable for oral anticoagulant therapy. We identified all patients discharged with the diagnoses 'ischemic stroke' (ICD-10 code I63) or 'transient ischemic attack' (G45) in combination with 'atrial fibrillation' (I48) during 1 year. We performed binary logistic regression analyses to identify factors independently influencing the aforementioned decisions. Our cohort comprised 758 patients. At discharge from the stroke service, 374 patients (49·3%) received oral anticoagulant therapy. Older age, severe stroke, poor recovery in the acute phase, and higher serum creatinine were independent factors to withhold oral anticoagulant therapy, whereas prior oral anticoagulant therapy favored the decision to anticoagulate. Among patients who were anticoagulated, prescription was balanced for VKA (50·3%) and DOAC (49·7%). Renal function and prior oral anticoagulant therapies were the most important factors in this decision. Shortly after their marketing, DOAC are used as frequently as VKA for secondary stroke prevention in patients with atrial fibrillation. The decision between VKA and DOAC is mainly determined by the patient's renal function and the absence or presence of prior oral anticoagulant therapy. © 2014 World Stroke Organization.

Rehydration beverage

NASA Technical Reports Server (NTRS)

Greenleaf, John E. (Inventor)

1995-01-01

A novel rehydration beverage containing sodium chloride, sodium citrate, and aspartame useful for rapid restoration of hydration homeostasis is disclosed. The beverage is particularly useful for restoration of normal body fluid volumes and their intracellular and extracellular distribution during a hypohydration state observed in astronauts and air passengers.

Computational modelling of internally cooled wet (ICW) electrodes for radiofrequency ablation: impact of rehydration, thermal convection and electrical conductivity.

PubMed

Trujillo, Macarena; Bon, Jose; Berjano, Enrique

2017-09-01

(1) To analyse rehydration, thermal convection and increased electrical conductivity as the three phenomena which distinguish the performance of internally cooled electrodes (IC) and internally cooled wet (ICW) electrodes during radiofrequency ablation (RFA), (2) Implement a RFA computer model with an ICW which includes these phenomena and (3) Assess their relative influence on the thermal and electrical tissue response and on the coagulation zone size. A 12-min RFA in liver was modelled using an ICW electrode (17 G, 3 cm tip) by an impedance-control pulsing protocol with a constant current of 1.5 A. A model of an IC electrode was used to compare the ICW electrode performance and the computational results with the experimental results. Rehydration and increased electrical conductivity were responsible for an increase in coagulation zone size and a delay (or absence) in the occurrence of abrupt increases in electrical impedance (roll-off). While the increased electrical conductivity had a remarkable effect on enlarging the coagulation zone (an increase of 0.74 cm for differences in electrical conductivity of 0.31 S/m), rehydration considerably affected the delay in roll-off, which, in fact, was absent with a sufficiently high rehydration level. In contrast, thermal convection had an insignificant effect for the flow rates considered (0.05 and 1 mL/min). Computer results suggest that rehydration and increased electrical conductivity were mainly responsible for the absence of roll-off and increased size of the coagulation zone, respectively, and in combination allow the thermal and electrical performance of ICW electrodes to be modelled during RFA.

Patterns of nocturnal rehydration in root tissues of Vaccinium corymbosum L. under severe drought conditions

PubMed Central

Valenzuela-Estrada, Luis R.; Richards, James H.; Diaz, Andres; Eissensat, David M.

2009-01-01

Although roots in dry soil layers are commonly rehydrated by internal hydraulic redistribution during the nocturnal period, patterns of tissue rehydration are poorly understood. Rates of nocturnal rehydration were examined in roots of different orders in Vaccinium corymbosum L. ‘Bluecrop’ (Northern highbush blueberry) grown in a split-pot system with one set of roots in relatively moist soil and the other set of roots in dry soil. Vaccinium is noted for a highly branched and extremely fine root system. It is hypothesized that nocturnal root tissue rehydration would be slow, especially in the distal root orders because of their greater hydraulic constraints (smaller vessel diameters and fewer number of vessels). Vaccinium root hydraulic properties delayed internal water movement. Even when water was readily available to roots in the wet soil and transpiration was minimal, it took a whole night-time period of 12 h for the distal finest roots (1st to 4th order) under dry soil conditions to reach the same water potentials as fine roots in moist soil (1st to 4th order). Even though roots under dry soil equilibrated with roots in moist soil, the equilibrium point reached before sunrise was about –1.2 MPa, indicating that tissues were not fully rehydrated. Using a single-branch root model, it was estimated that individual roots exhibiting the lowest water potentials in dry soil were 1st order roots (distal finest roots of the root system). However, considered at the branch level, root orders with the highest hydraulic resistances corresponded to the lowest orders of the permanent root system (3rd-, 4th-, and 5th-order roots), thus indicating possible locations of hydraulic safety control in the root system of this species. PMID:19188275

Patterns of nocturnal rehydration in root tissues of Vaccinium corymbosum L. under severe drought conditions.

PubMed

Valenzuela-Estrada, Luis R; Richards, James H; Diaz, Andres; Eissensat, David M

2009-01-01

Although roots in dry soil layers are commonly rehydrated by internal hydraulic redistribution during the nocturnal period, patterns of tissue rehydration are poorly understood. Rates of nocturnal rehydration were examined in roots of different orders in Vaccinium corymbosum L. 'Bluecrop' (Northern highbush blueberry) grown in a split-pot system with one set of roots in relatively moist soil and the other set of roots in dry soil. Vaccinium is noted for a highly branched and extremely fine root system. It is hypothesized that nocturnal root tissue rehydration would be slow, especially in the distal root orders because of their greater hydraulic constraints (smaller vessel diameters and fewer number of vessels). Vaccinium root hydraulic properties delayed internal water movement. Even when water was readily available to roots in the wet soil and transpiration was minimal, it took a whole night-time period of 12 h for the distal finest roots (1st to 4th order) under dry soil conditions to reach the same water potentials as fine roots in moist soil (1st to 4th order). Even though roots under dry soil equilibrated with roots in moist soil, the equilibrium point reached before sunrise was about -1.2 MPa, indicating that tissues were not fully rehydrated. Using a single-branch root model, it was estimated that individual roots exhibiting the lowest water potentials in dry soil were 1st order roots (distal finest roots of the root system). However, considered at the branch level, root orders with the highest hydraulic resistances corresponded to the lowest orders of the permanent root system (3rd-, 4th-, and 5th-order roots), thus indicating possible locations of hydraulic safety control in the root system of this species.

Management of paediatric illnesses by patent and proprietary medicine vendors in Nigeria.

PubMed

Treleaven, Emily; Liu, Jenny; Prach, Lisa M; Isiguzo, Chinwoke

2015-06-04

In Nigeria and elsewhere, informal drug sellers, or patent and proprietary medicine vendors (PPMVs), are a common source of care for children with malaria, diarrhoea, and pneumonia. However, their knowledge and stocking of recommended treatments for these common childhood illnesses are not well understood. A census of PPMV shops was conducted in Kogi and Kwara states. A shop survey was conducted on a subset of 250 shops. Multivariate regression analysis was used to assess associations between shop worker characteristics and (1) knowledge of optimal treatments for malaria, diarrhoea, and pneumonia, and (2) stocking of essential medicines to treat these illnesses. From the census, 89.9% of shops stocked oral rehydration solution (ORS), while 61.1% of shops stocked artemisinin-based combination therapies and 72.2% of shops stocked amoxicillin. Stocking patterns varied by state, urban/rural location, and according to whether or not the shop was headed by someone with formal health training (e.g. having a professional health education degree). In multivariate analyses, selling drugs wholesale and participating in any training in the past year was associated with a higher likelihood of naming the correct treatment for malaria, and having formal health training was associated with stocking ORS. However, few other PPMV characteristics were predictive of correct knowledge of optimal treatments and stocking behaviour. Many PPMVs lack the knowledge and tools to properly treat common childhood illnesses. PPMV knowledge and selling of essential medicines for these illnesses should be strengthened to improve child health in Nigeria.

The nutritional management of gastrointestinal tract disorders in companion animals.

PubMed

Guilford, W G; Matz, M E

2003-12-01

Dietary protein, carbohydrates, fats and fibre have marked influences on gastrointestinal tract function and dysfunction. This article reviews the nutritional management of common gastrointestinal disorders in companion animals and introduces some of the current areas of research including probiotics, prebiotics, protein-hydrolysate diets, immunonutrition and dietary fibre. Nutritional management of oesophageal disease revolves around varying the consistency of the diet and feeding the animal from an elevated container. Provision of bowel rest remains the mainstay of the management of acute gastroenteritis but food-based oral rehydration solutions are a useful adjunct. The recommended diet for chronic small bowel diarrhoea is a highly digestible, hypoallergenic, gluten-free, low-lactose and low-fat diet with modest amounts of fermentable fibre. The use of probiotics in the management of diarrhoea in companion animals has not yet been shown to be beneficial. It is likely that prebiotics will prove more effective than probiotics in the prevention of enteropathogenic infections. Approximately 50% of cats in New Zealand that suffer from chronic idiopathic vomiting or diarrhoea will respond to a novel-protein-elimination diet and approximately 30% meet the diagnostic criteria for food sensitivity. Growing evidence supports the use of protein-hydrolysate diets in the management of inflammatory bowel disease and further advances in immunonutrition are expected. The dietary management of colitis should include a hypoallergenic diet with a fermentable fibre source. Manipulation of the diet provides clinicians a powerful therapeutic strategy to be used alone or concurrently with drug therapy in the management of gastrointestinal disorders.

Religious women's groups help promote child survival and development.

PubMed

Munir, L Z

1989-07-01

Indonesia faces the 2 major problems of high infant mortality and high child mortality at present. To improve the situation, the government urges the participation of all community members, especially those already organized in the nongovernmental organizations (NGOs). Because religion has a strong influence on people's daily lives in Indonesia, a special project called the Child Survival Project was established in 1986 as a joint undertaking of the government and UNICEF. Initially 12 religious NGOs (8 Islamic, 1 Hindu, 1 Protestant, and 2 Catholic) were involved as implementing agencies. The majority of members of these NGOs are women. The strategy used has been to establish, in cooperation with the 12 NGOs, a communication network through which child survival messages would be disseminated to help generate increased use of Posyandu services, especially immunization, oral rehydration therapy, and growth monitoring. Messages are incorporated into the normal activities of these religious groups, such as Al-Quran reading classes, Sunday schools, and Bible classes. In addition, guidelines for a reporting and feedback system have been prepared for use at village, subdistrict, district, and provincial levels for project monitoring. Religious women's NGOs can serve with their specific characteristics can serve as motivators, facilitators, and catalysts of child survival and development programs for their community target groups. NGOs should be considered as partners of the government in mobilizing the community to achieve a common goal. All endeavors undertaken so far in relation to child survival and development are expected to be institutionalized.

Water pumps.

PubMed

Loo, Donald D F; Wright, Ernest M; Zeuthen, Thomas

2002-07-01

The transport of water across epithelia has remained an enigma ever since it was discovered over 100 years ago that water was transported across the isolated small intestine in the absence of osmotic and hydrostatic pressure gradients. While it is accepted that water transport is linked to solute transport, the actual mechanisms are not well understood. Current dogma holds that active ion transport sets up local osmotic gradients in the spaces between epithelial cells, the lateral intercellular spaces, and this in turn drives water transport by local osmosis. In the case of the small intestine, which in humans absorbs about 8 l of water a day, there is no direct evidence for either local osmosis or aquaporin gene expression in enterocytes. Intestinal water absorption is greatly enhanced by glucose, and this is the basis for oral rehydration therapy in patients with secretory diarrhoea. In our studies of the intestinal brush border Na+-glucose cotransporter we have obtained evidence that there is a direct link between the transport of Na+, glucose and water transport, i.e. there is cotransport of water along with Na+ and sugar, that will account for about 50 % of the total water transport across the human intestinal brush border membrane. In this short review we summarize the evidence for water cotransport and propose how this occurs during the enzymatic turnover of the transporter. This is a general property of cotransporters and so we expect that this may have wider implications in the transport of water and other small polar molecules across cell membranes in animals and plants.

Insulin 70/30 mix plus metformin versus triple oral therapy in the treatment of type 2 diabetes after failure of two oral drugs: efficacy, safety, and cost analysis.

PubMed

Schwartz, Sherwyn; Sievers, Richard; Strange, Poul; Lyness, William H; Hollander, Priscilla

2003-08-01

Subjects (n = 188) with type 2 diabetes and inadequate response to two oral medications (A1C >8.0%) were randomly assigned to treatment with either a third oral medication or an insulin 70/30 mix b.i.d. plus metformin for a comparison of efficacy, safety, and cost. The protocol called for aggressive dose titration to achieve target values of fasting blood glucose (80-120 mg/dl), postprandial glucose (<160 mg/dl), and A1C (<7%). These efficacy parameters were evaluated at weeks 2, 6, 12, and 24 of therapy. If dose adjustments failed to achieve targeted glycemic control, subjects were switched to an alternate therapy. At the end of study (week 24 of therapy), A1C and fasting plasma glucose (FPG) values showed comparable decreases in the two treatment groups. Only 31% (oral therapy) and 32% (insulin plus metformin) of subjects achieved target values of A1C (<7%). A total of 10 of the 98 subjects randomized to triple oral therapy (10.2%) who failed to improve sufficiently were switched to insulin therapy. An additional four subjects dropped out of the oral treatment group due to adverse events felt to be potentially drug related. Only two of the subjects randomized to insulin plus metformin had to be switched to basal-bolus regimens (regular insulin and NPH insulin). Cost analysis determined that insulin plus metformin (mean cost 3.20 dollars/day) provided efficacy equal to that of a triple oral drug regimen (10.40 dollars/day). Insulin 70/30 mix plus metformin was as effective as triple oral therapy in lowering A1C and FPG values. The triple oral regimen was not as cost effective, and a high percentage of subjects (total of 16.3%) did not complete this regimen due to lack of efficacy or side effects.

Preclinical Investigation of Lyophilized Platelet Preparations

DTIC Science & Technology

1994-10-31

Western blots of rehydrated platelet preparations. The AMAC antibody reacted strongly with a high molecular weight protein in the fresh platelet lysate , and...to a lesser degree with a protein of identical molecular weight in the rehydrated platelet lysate . The antibody to fibrinogen reacted strongly with

Responses of the Lichen Photobiont Trebouxia erici to Desiccation and Rehydration (II) Proteomics

USDA-ARS?s Scientific Manuscript database

Lichen desiccation tolerance is associated with cellular protection mechanisms directed against the oxidative stress produced during dehydration and/or rehydration, however, these mechanisms are not well understood. In other poikilohydric organisms, changes in the synthesis of proteins have bee...

Ganciclovir. A pharmacoeconomic review of its use as intravenous or oral maintenance therapy in the management of cytomegalovirus retinitis in patients with AIDS.

PubMed

Perry, C M; Davis, R

1997-08-01

Cytomegalovirus retinitis, an opportunistic infection caused by the herpesvirus cytomegalovirus, is a major cause of illness in patients with advanced AIDS. As infected patients require long term drug treatment to delay disease progression and minimise loss of vision, the disease is associated with substantial treatment costs which considerably increase overall expenditure on AIDS-related health care. During the last decade, intravenous ganciclovir has been a mainstay of treatment for patients with cytomegalovirus retinitis. However, notwithstanding its demonstrated efficacy as maintenance therapy for this condition, long term intravenous drug administration is both inconvenient and uncomfortable for many patients. Moreover, neutropenia and catheter-related infections have been reported commonly in patients receiving ganciclovir via the intravenous route. To overcome the limitations of intravenous ganciclovir, an oral formulation of the drug has been developed for use as maintenance therapy. In comparative clinical trials, both intravenous and oral ganciclovir maintenance therapy slowed disease progression and preserved visual acuity in patients with stabilised cytomegalo-virus retinitis, although there was evidence that the intravenous formulation was more effective in terms of delaying recurrence of active disease. This suggests that oral ganciclovir use should be limited to the treatment of patients without evidence of immediately sight-threatening cytomegalovirus retinitis. Three published cost analyses, which were based on efficacy and tolerability data derived from 2 randomised, comparative clinical trials, have shown that oral ganciclovir maintenance therapy offers cost advantages over intravenous maintenance therapy, despite the higher acquisition cost of the oral formulation. The higher overall costs of intravenous maintenance treatment, compared with oral therapy, were attributed to higher drug administration and adverse event treatment costs. In one analysis, estimated lifetime treatment costs of oral maintenance therapy were 25.2% lower than those of intravenous maintenance treatment. As yet, no formal cost-effectiveness evaluations of oral and intravenous ganciclovir have been published. Few published data are available regarding the relative effects of intravenous and oral ganciclovir on quality of life. However, in a health state utility analysis, there was a large overall preference among HIV-infected individuals for oral over intravenous maintenance treatment. In conclusion, oral ganciclovir appears to be a cost-saving and patient-preferred alternative to its intravenous counterpart for the maintenance therapy of AIDS patients with stabilised cytomegalovirus retinitis in whom there is no evidence of sight-threatening disease.

Effects of Exercise Induced Dehydration and Glycerol Rehydration on Anaerobic Power in Male Collegiate Wrestlers.

PubMed

McKenna, Zachary J; Gillum, Trevor L

2017-11-01

McKenna, ZJ and Gillum, TL. Effects of exercise induced dehydration and glycerol rehydration on anaerobic power in male collegiate wrestlers. J Strength Cond Res 31(11): 2965-2968, 2017-Wrestlers attempting to reach a specific weight class often use rapid weight loss (RWL). Rapid weight loss is associated with high levels of dehydration, which may hinder athletic performance. Thus, there is a need for wrestlers to optimize rehydration after achieving a specific weight. We sought to observe the effects of RWL on anaerobic power and the impact of glycerol on rehydration and power in male collegiate wrestlers (n = 7, 19.75 ± 1.67 years, 76.8 ± 4.32 kg, 11.6 ± 4.32% body fat, 59.9 ± 6.42 ml·kg·min). Subjects were assessed for body mass (BM), hydration, and mean power output (Wmean) before exercise (pre), immediately after exercise (3% dehydrated), and 60 minutes after exercise (rehydrated). Participants ran at 70% of V[Combining Dot Above]O2max in a heated room (30° C) until 3% BM loss (BML). Subjects rehydrated drinking either 26 ml·kg of water (control) or a 3% glycerol (treatment) solution containing 26 ml·kg of water and 1 g·kg of glycerol. Participants lost 3.00 ± 0.31% (control) and 2.89 ± 0.26% (treatment) of their BM from the pre- to dehydrated conditions. Wmean (control: 659.29 ± 79.12, 651.43 ± 70.71, 659.71 ± 82.78; treatment: 647.71 ± 110.64, 644.57 ± 118.15, 638.14 ± 100.71) did not differ across time (p = 0.87) nor condition (p = 0.80). In addition, glycerol had no significant impact on acute hydration (control: urine-specific gravity [SG] = 1.019 ± 0.010; treatment: SG = 1.017 ± 0.017). These data show that 3% BML did not impair anaerobic performance, and furthermore that glycerol proved ineffective for rehydration in a match like scenario for the competing wrestler.

Antithrombotic Therapy for Atrial Fibrillation

PubMed Central

You, John J.; Singer, Daniel E.; Howard, Patricia A.; Lane, Deirdre A.; Eckman, Mark H.; Fang, Margaret C.; Hylek, Elaine M.; Schulman, Sam; Go, Alan S.; Hughes, Michael; Spencer, Frederick A.; Manning, Warren J.; Halperin, Jonathan L.

2012-01-01

Background: The risk of stroke varies considerably across different groups of patients with atrial fibrillation (AF). Antithrombotic prophylaxis for stroke is associated with an increased risk of bleeding. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. Methods: We used the methods described in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines article of this supplement. Results: For patients with nonrheumatic AF, including those with paroxysmal AF, who are (1) at low risk of stroke (eg, CHADS2 [congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke or transient ischemic attack] score of 0), we suggest no therapy rather than antithrombotic therapy, and for patients choosing antithrombotic therapy, we suggest aspirin rather than oral anticoagulation or combination therapy with aspirin and clopidogrel; (2) at intermediate risk of stroke (eg, CHADS2 score of 1), we recommend oral anticoagulation rather than no therapy, and we suggest oral anticoagulation rather than aspirin or combination therapy with aspirin and clopidogrel; and (3) at high risk of stroke (eg, CHADS2 score of ≥ 2), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest dabigatran 150 mg bid rather than adjusted-dose vitamin K antagonist therapy. Conclusions: Oral anticoagulation is the optimal choice of antithrombotic therapy for patients with AF at high risk of stroke (CHADS2 score of ≥ 2). At lower levels of stroke risk, antithrombotic treatment decisions will require a more individualized approach. PMID:22315271

Comparison of sequential intravenous/oral ciprofloxacin plus metronidazole with intravenous ceftriaxone plus metronidazole for treatment of complicated intra-abdominal infections.

PubMed

Wacha, Hannes; Warren, Brian; Bassaris, Harry; Nikolaidis, Paul

2006-08-01

Intra-abdominal infections are a substantial clinical problem and an important cause of morbidity and death in the hospital. Optimal treatment requires both source control and antibiotic therapy. Sequential intravenous (IV) to oral therapy may improve patient convenience and reduce total health care costs. In this randomized, double-blind trial, the efficacy of sequential IV-to-oral ciprofloxacin plus metronidazole was compared with ceftriaxone plus metronidazole in adult patients with complicated intra-abdominal infections. The trial enrolled 531 patients, who began with IV therapy. Patients who improved clinically were switched to oral therapy on day three or later. The clinical and bacteriological responses four to six weeks after the end of therapy and the safety of the two regimens were assessed. To maintain blinding, the patients received placebo IV in the ciprofloxacin group or placebo orally in the ceftriaxone group. A total of 475 patients (235 ciprofloxacin plus metronidazole, 240 ceftriaxone plus metronidazole) were valid for evaluation of efficacy. All patients were included in the safety analysis. Of the patients valid for efficacy, 78% of the ciprofloxacin plus metronidazole group and 81% of the ceftriaxone plus metronidazole group were eligible for a switch to oral therapy. The clinical success rates were 98.9% and 96.9%, respectively, which were statistically equivalent. The clinical success rates for all patients, including those on continuous IV therapy, were 90.6% and 87.9%. Source control was achieved in more than 90% of the patients. The bacteriological eradication rates were similar in the two groups. Bacterial complications (e.g., surgical site infections, abscesses) were encountered more often in the ceftriaxone plus metronidazole group. Sequential ciprofloxacin plus metronidazole IV-to-oral therapy was statistically equivalent to ceftriaxone plus metronidazole. The switch to oral therapy with ciprofloxacin plus metronidazole was as effective and safe as continued IV therapy in patients able to tolerate enteral feeding.

Oral Antibacterial Therapy for Acne Vulgaris: An Evidence-Based Review.

PubMed

Bienenfeld, Amanda; Nagler, Arielle R; Orlow, Seth J

2017-08-01

To some degree, acne vulgaris affects nearly every individual worldwide. Oral antibiotic therapy is routinely prescribed for the treatment of moderate to severe inflammatory acne; however, long-term use of oral antibiotics for acne may have unintended consequences. The aim of this study was to provide a systematic evaluation of the scientific evidence on the efficacy and appropriate use of oral antibiotics in the treatment of acne. A systematic search of MEDLINE was conducted to identify randomized controlled clinical trials, systematic reviews, and meta-analyses evaluating the efficacy of oral antibiotics for acne. Overall, 41 articles that examined oral antibiotics compared with placebo, another oral therapy, topical therapy, alternate dose, or duration were included in this study. Tetracyclines, macrolides, and trimethoprim/sulfamethoxazole are effective and safe in the treatment of moderate to severe inflammatory acne. Superior efficacy of one type or class of antibiotic could not be determined, therefore the choice of antibiotic is generally based on the side-effect profile. Although different dosing regimens have been studied, there is a lack of standardized comparator trials to determine optimal dosing and duration of each oral antibiotic used in acne. The combination of oral antibiotics with a topical therapy is superior to oral antibiotics alone. This article provides a systematic evaluation of the scientific evidence of the efficacy of oral antibiotics for acne. Due to heterogeneity in the design of the trials, there is insufficient evidence to support one type, dose, or duration of oral antibiotic over another in terms of efficacy; however, due to increasing resistance to antibiotics, dermatologists should heed consensus guidelines for their appropriate use.

Effect of pretreatment on rehydration, colour and nanoindentation properties of potato cylinders dried using a mixed-mode solar dryer.

PubMed

Dhalsamant, Kshanaprava; Tripathy, Punyadarshini P; Shrivastava, Shanker L

2017-08-01

Desirable quality estimation is an important consumer driver for wider acceptability of mixed-mode solar drying of potatoes in food industries. The aim of this study is to characterise rehydration, colour, texture, nanoindentaion and microstructure of dried potato samples and to establish the influence of pre-drying treatment on the above qualities. The water absorption capacity and rehydration ability of solar dried potato were significantly influenced by pretreatment followed by rehydration temperature and sample diameter. The redness index (a*) of pretreated dried samples was lower with simultaneous higher value of yellowness index (b*), chroma (C*) and hue angle (h*). Also, the average nanohardness (H) of pretreated samples increased significantly by 22.64% compared to that of untreated samples. The average reduced modulus (E r ) and Young's modulus (E s ) of dried potato samples were 1.865 GPa and 1.403 GPa, respectively. Moreover, creep displacement of 43.27 nm was traced in the untreated potato samples during a 20 s dwell time under a constant load of 200 µN in the nanoindentation test. Micrographs revealed more uniform pore spaces in pretreated samples. Pretreated, thinner potato samples achieved better quality dried products in terms of rehydration, colour, texture and nanohardness indices with significantly improved microstructure and creep resistance properties. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

Use of flow cytometry to monitor cell damage and predict fermentation activity of dried yeasts.

PubMed

Attfield, P V; Kletsas, S; Veal, D A; van Rooijen, R; Bell, P J

2000-08-01

Viable dried yeast is used as an inoculum for many fermentations in the baking and wine industries. The fermentative activity of yeast in bread dough or grape must is a critical parameter of process efficiency. Here, it is shown that fluorescent stains and flow cytometry can be used in concert to predict the abilities of populations of dried bakers' and wine yeasts to ferment after rehydration. Fluorescent dyes that stain cells only if they have damaged membrane potential (oxonol) or have increased membrane permeability (propidium iodide) were used to analyse, by flow cytometry, populations of rehydrated yeasts. A strong relationship (r2 = 0.99) was found between the percentages of populations staining with the oxonol and the degree of cell membrane damage as measured by the more traditional method of leakage of intracellular compounds. There were also were good negative relationships (r2 > or = 0.83) between fermentation by rehydrated bakers' or wine dry yeasts and percentage of populations staining with either oxonol or propidium iodide. Fluorescent staining with flow cytometry confirmed that factors such as vigour of dried yeast mixing in water, soaking before stirring, rehydration in water or fermentation medium and temperature of rehydration have profound effects on subsequent yeast vitality. These experiments indicate the potential of flow cytometry as a rapid means of predicting the fermentation performance of dried bakers' and wine yeasts.

Effect of Water Activity and Packaging Material on the Quality of Dehydrated Taro (Colocasia esculenta (L.) Schott) Slices during Accelerated Storage

PubMed Central

Jefferies, L. K.

2016-01-01

The quality of dehydrated taro slices in accelerated storage (45°C and 75% RH) was determined as a function of initial water activity (a w) and package type. Color, rehydration capacity, thiamin content, and α-tocopherol content were monitored during 34 weeks of storage in polyethylene and foil laminate packaging at initial storage a w of 0.35 to 0.71. Initial a w at or below 0.54 resulted in less browning and higher rehydration capacity, but not in significantly higher α-tocopherol retention. Foil laminate pouches resulted in a higher rehydration capacity and increased thiamin retention compared to polyethylene bags. Type of packaging had no effect on the color of the samples. Product stability was highest when stored in foil laminate pouches at 0.4a w. Sensory panels were held to determine the acceptability of rehydrated taro slices using samples representative of the taro used in the analytical tests. A hedonic test on rehydrated taro's acceptability was conducted in Fiji, with panelists rating the product an average of 7.2 ± 1.5 on a discrete 9-point scale. Using a modified Weibull analysis (with 50% probability of product failure), it was determined that the shelf life of dehydrated taro stored at 45°C was 38.3 weeks. PMID:27891508

Contrasting strategies used by lichen microalgae to cope with desiccation-rehydration stress revealed by metabolite profiling and cell wall analysis.

PubMed

Centeno, Danilo C; Hell, Aline F; Braga, Marcia R; Del Campo, Eva M; Casano, Leonardo M

2016-05-01

Most lichens in general, and their phycobionts in particular, are desiccation tolerant, but their mechanisms of desiccation tolerance (DT) remain obscure. The physiological responses and cell wall features of two putatively contrasting lichen-forming microalgae, Trebouxia sp. TR9 (TR9), isolated from Ramalina farinacea (adapted to frequent desiccation-rehydration cycles), and Coccomyxa solorina-saccatae (Csol), obtained from Solorina saccata (growing in usually humid limestone crevices, subjected to seasonal dry periods) was characterized. Microalgal cultures were desiccated under 25%-30% RH and then rehydrated. Under these conditions, RWC and ψw decreased faster and simultaneously during dehydration in Csol, whereas TR9 maintained its ψw until 70% RWC. The metabolic profile indicated that polyols played a key role in DT of both microalgae. However, TR9 constitutively accumulated higher amounts of polyols, whereas Csol induced the polyol synthesis under desiccation-rehydration. Csol also accumulated ascorbic acid, while TR9 synthesized protective raffinose-family oligosaccharides (RFOs) and increased its content of phenolics. Additionally, TR9 exhibited thicker and qualitatively different cell wall and extracellular polymeric layer compared with Csol, indicating higher water retention capability. The findings were consistent with the notion that lichen microalgae would have evolved distinct strategies to cope with desiccation-rehydration stress in correspondence with the water regime of their respective habitats. © 2016 Society for Applied Microbiology and John Wiley & Sons Ltd.

Extremophile extracts and enhancement techniques show promise for the development of a live vaccine against Flavobacterium columnare

USGS Publications Warehouse

Powell, D.B.; Palm, R.C.; MacKenzie, A.P.; Winton, J.R.

2009-01-01

The effects of temperature, ionic strength, and new cryopreservatives derived from polar ice bacteria were investigated to help accelerate the development of economical, live attenuated vaccines for aquaculture. Extracts of the extremophile Gelidibacter algens functioned very well as part of a lyophilization cryoprotectant formulation in a 15-week storage trial. The bacterial extract and trehalose additives resulted in significantly higher colony counts of columnaris bacteria (Flavobacterium columnare) compared to nonfat milk or physiological saline at all time points measured. The bacterial extract combined with trehalose appeared to enhance the relative efficiency of recovery and growth potential of columnaris in flask culture compared to saline, nonfat milk, or trehalose-only controls. Pre-lyophilization temperature treatments significantly affected F. columnare survival following rehydration. A 30-min exposure at 0 ??C resulted in a 10-fold increase in bacterial survival following rehydration compared to mid-range temperature treatments. The brief 30 and 35 ??C pre-lyophilization exposures appeared to be detrimental to the rehydration survival of the bacteria. The survival of F. columnare through the lyophilization process was also strongly affected by changes in ionic strength of the bacterial suspension. Changes in rehydration constituents were also found to be important in promoting increased survival and growth. As the sodium chloride concentration increased, the viability of rehydrated F. columnare decreased. ?? 2009 Elsevier Inc.

Oral versus intravenous antibiotic treatment for bone and joint infections (OVIVA): study protocol for a randomised controlled trial.

PubMed

Li, Ho Kwong; Scarborough, Matthew; Zambellas, Rhea; Cooper, Cushla; Rombach, Ines; Walker, A Sarah; Lipsky, Benjamin A; Briggs, Andrew; Seaton, Andrew; Atkins, Bridget; Woodhouse, Andrew; Berendt, Anthony; Byren, Ivor; Angus, Brian; Pandit, Hemant; Stubbs, David; McNally, Martin; Thwaites, Guy; Bejon, Philip

2015-12-21

Bone and joint infection in adults arises most commonly as a complication of joint replacement surgery, fracture fixation and diabetic foot infection. The associated morbidity can be devastating to patients and costs the National Health Service an estimated £20,000 to £40,000 per patient. Current standard of care in most UK centres includes a prolonged course (4-6 weeks) of intravenous antibiotics supported, if available, by an outpatient parenteral antibiotic therapy service. Intravenous therapy carries with it substantial risks and inconvenience to patients, and the antibiotic-related costs are approximately ten times that of oral therapy. Despite this, there is no evidence to suggest that oral therapy results in inferior outcomes. We hypothesise that, by selecting oral agents with high bioavailability, good tissue penetration and activity against the known or likely pathogens, key outcomes in patients managed primarily with oral therapy are non-inferior to those in patients treated by intravenous therapy. The OVIVA trial is a parallel group, randomised (1:1), un-blinded, non-inferiority trial conducted in thirty hospitals across the UK. Eligible participants are adults (>18 years) with a clinical syndrome consistent with a bone, joint or metalware-associated infection who have received ≤7 days of intravenous antibiotic therapy from the date of definitive surgery (or the start of planned curative therapy in patients treated without surgical intervention). Participants are randomised to receive either oral or intravenous antibiotics, selected by a specialist infection physician, for the first 6 weeks of therapy. The primary outcome measure is definite treatment failure within one year of randomisation, as assessed by a blinded endpoint committee, according to pre-defined microbiological, histological and clinical criteria. Enrolling 1,050 subjects will provide 90 % power to demonstrate non-inferiority, defined as less than 7.5 % absolute increase in treatment failure rate in patients randomised to oral therapy as compared to intravenous therapy (one-sided alpha of 0.05). If our results demonstrate non-inferiority of orally administered antibiotic therapy, this trial is likely to facilitate a dramatically improved patient experience and alleviate a substantial financial burden on healthcare services. ISRCTN91566927 - 14/02/2013.

Early transition to oral antibiotic therapy for community-acquired pneumonia: duration of therapy, clinical outcomes, and cost analysis.

PubMed

Omidvari, K; de Boisblanc, B P; Karam, G; Nelson, S; Haponik, E; Summer, W

1998-08-01

Our objective was to compare therapeutic outcome and analyse cost-benefit of a 'conventional' (7-day course of i.v. antibiotic therapy) vs. an abbreviated (2-day i.v. antibiotic course followed by 'switch' to oral antibiotics) therapy for in-patients with community-acquired pneumonia (CAP). We used a multicenter prospective, randomized, parallel group with a 28 day follow-up, at the University-based teaching hospitals: The Medical Center of Louisiana in New Orleans, LA and hospitals listed in the acknowledgement. Ninety-five patients were randomized to receive either a 'conventional' course of intravenous antibiotic therapy with cefamandole 1 g i.v. every 6 h for 7 days (n = 37), or an abbreviated course of intravenous therapy with cefamandole (1 g i.v. every 6 h for 2 days) followed by oral therapy with cefaclor (500 mg every 8 h for 5 days). No difference was found in the clinical courses, cure rates, survival or the resolution of the chest radiograph abnormalities among the two groups. The mean duration of therapy (6.88 days for the conventional group compared to 7-30 days for the early oral therapy group) and the frequencies of overall symptomatic improvement (97% vs. 95%, respectively) were similar in both groups. Patients who received early oral therapy had shorter hospital stays (7.3 vs. 9.71 days, P = 0.01), and a lower total cost of care ($2953 vs. $5002, P < 0.05). It was concluded that early transition to an oral antibiotic after an abbreviated course of intravenous therapy in CAP is substantially less expensive and has comparable efficacy to conventional intravenous therapy. Altering physicians' customary management of hospitalized patients with CAP can reduce costs with no appreciable additional risk of adverse patient outcome.

Dehydration, rehydration and overhydration alter patterns of gene expression in the Antarctic midge, Belgica antarctica

USDA-ARS?s Scientific Manuscript database

We investigated molecular responses elicited by three types of dehydration (fast, slow and cryoprotective), rehydration and overhydration in larvae of the Antarctic midge, Belgica antarctica. The larvae spend most the year encased in ice but during the austral summer are vulnerable to summer storms,...

Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids: Effect of drug, dose, and device.

PubMed

Dekhuijzen, P N Richard; Batsiou, Maria; Bjermer, Leif; Bosnic-Anticevich, Sinthia; Chrystyn, Henry; Papi, Alberto; Rodríguez-Roisin, Roberto; Fletcher, Monica; Wood, Lucy; Cifra, Alessandra; Soriano, Joan B; Price, David B

2016-11-01

Little information is available on real-life occurrence of oral thrush in COPD patients treated with ICS. We investigated oral thrush incidence in COPD patients prescribed FDC ICS/LABA therapies and assessed whether it is modulated by the ICS type, dose, and delivery device. We conducted a historical, observational, matched cohort study (one baseline year before and one outcome year after initiation of therapy) using data from the UK Optimum Patient Care Research Database. We assessed oral thrush incidence in patients initiating long-acting bronchodilators or FDC ICS/LABA therapy. We then compared different combination therapies (budesonide/formoterol fumarate dihydrate [BUD/FOR] and fluticasone propionate/salmeterol xinafoate [FP/SAL]) and devices (DPI and pMDI). Patients prescribed FDC ICS/LABA had significantly greater odds of experiencing oral thrush than those prescribed long-acting bronchodilators alone (adjusted OR 2.18 [95% CI 1.84-2.59]). Significantly fewer patients prescribed BUD/FOR DPI developed oral thrush compared with FP/SAL DPI (OR 0.77 [0.63-0.94]) when allowing for differences in prescribed doses between the drugs. A significantly smaller proportion of patients developed oral thrush in the FP/SAL pMDI arm than in the FP/SAL DPI arm (OR 0.67 [0.55-0.82]). Additionally, in the FP/SAL cohort (both DPI and pMDI), increased risk of oral thrush was significantly associated with high ICS daily dose (OR 1.97 [1.22-3.17] vs low daily dose). ICS use increases oral thrush incidence in COPD and this effect is dose-dependent for FP/SAL therapies. Of the therapies assessed, FP/SAL pMDI and BUD/FOR DPI may be more protective against oral thrush. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluation of a social marketing intervention promoting oral rehydration salts in Burundi

PubMed Central

2011-01-01

Background Diarrhea is the second leading cause of death for children under five in Burundi; however, use of oral rehydration salts (ORS), the recommended first-line treatment, remains low. In 2004, PSI/Burundi launched a social marketing intervention to promote ORASEL among caregivers of children under five; the product was relaunched in 2006 with a new flavor. This study evaluates the intervention after the ORASEL relaunch, which included mass media and interpersonal communication activities. The study looks at trends in ORASEL use in Burundi and in behavioral determinants that may be related to its use. Methods In 2006 and 2007, PSI conducted household surveys among Burundian females of reproductive age (15-49). Both surveys used a two-stage sampling process to select 30 households in each of 115 rural and urban collines throughout the nation. Survey respondents were asked about diarrhea treatment-related behavior; key behavioral determinants; and exposure to the ORASEL intervention. Data were analyzed to identify trends over time, characteristics of ORASEL users, and associations between exposure to the intervention and changes in ORASEL use and related behavioral determinants. Results ORASEL use among caregivers at their children's last diarrheal episode increased significantly from 20% in 2006 to 30% in 2007, and there were also desirable changes in several behavioral determinants associated with ORASEL use. Evaluation analysis showed that a higher level of exposure to the social marketing campaign was associated with greater use of ORASEL and with significant improvements in perceived availability, knowledge of the signs of diarrhea and dehydration, social support, and self-efficacy. Conclusions ORS use can be improved through social marketing and educational campaigns that make the public aware of the availability of the product, encourage dialogue about its use, and increase skills and confidence relating to correct product preparation and administration. Further interventions in Burundi and elsewhere should promote ORS through a variety of mass media and interpersonal communication channels, and should be rigorously evaluated in the context of the total market for diarrhea treatment products. PMID:21385460

Cost-effectiveness of using a social franchise network to increase uptake of oral rehydration salts and zinc for childhood diarrhea in rural Myanmar.

PubMed

Bishai, David; Sachathep, Karampreet; LeFevre, Amnesty; Thant, Hnin New Nwe; Zaw, Min; Aung, Tin; McFarland, Willi; Montagu, Dominic

2015-01-01

This paper examines the cost-effectiveness of achieving increases in the use of oral rehydration solution and zinc supplementation in the management of acute diarrhea in children under 5 years through social franchising. The study uses cost and outcome data from an initiative by Population Services International (PSI) in 3 townships of Myanmar in 2010 to promote an ORS-Zinc product called ORASEL. The objective of this study was to determine the incremental cost-effectiveness of a strategy to promote ORS-Z use through private sector franchising compared to standard government and private sector practices. Costing from a societal perspective included program, provider, and household costs for the 2010 calendar year. Program costs including ORASEL program launch, distribution, and administration costs were obtained through a retrospective review of financial records and key informant interviews with staff in the central Yangon office. Household out of pocket payments for diarrheal episodes were obtained from a household survey conducted in the study area and additional estimates of household income lost due to parental care-giving time for a sick child were estimated. Incremental cost-effectiveness relative to status quo conditions was calculated per child death and DALY averted in 2010. Health effects included deaths and DALYs averted; the former modeled based on coverage estimates from a household survey that were entered into the Lives Saved Tool (LiST). Uncertainty was modeled with Monte Carlo methods. Based on the model, the promotional strategy would translate to 2.85 (SD 0.29) deaths averted in a community population of 1 million where there would be 81,000 children under 5 expecting 48,373 cases of diarrhea. The incremental cost effectiveness of the franchised approach to improving ORASEL coverage is estimated at a median $5,955 (IQR: $3437-$7589) per death averted and $214 (IQR: $127-$287) per discounted DALY averted. Investing in developing a network of private sector providers and keeping them stocked with ORS-Z as is done in a social franchise can be a highly cost-effective in terms of dollars per DALY averted.

L-isoleucine-supplemented Oral Rehydration Solution in the Treatment of Acute Diarrhoea in Children: A Randomized Controlled Trial

PubMed Central

Raqib, R.; Ashraf, H.; Qadri, F.; Ahmed, S.; Zasloff, M.; Agerberth, B.; Salam, M.A.; Gyr, N.; Meier, R.

2011-01-01

Antimicrobial peptides represent an important component of the innate immune defenses of living organisms, including humans. They are broad-spectrum surface-acting agents secreted by the epithelial cells of the body in response to infection. Recently, L-isoleucine and its analogues have been found to induce antimicrobial peptides. The objectives of the study were to examine if addition of L-isoleucine to oral rehydration salts (ORS) solution would reduce stool output and/or duration of acute diarrhoea in children and induce antimicrobial peptides in intestine. This double-blind randomized controlled trial was conducted at the Dhaka Hospital of ICDDR,B. Fifty male children, aged 6-36 months, with acute diarrhoea and some dehydration, attending the hospital, were included in the study. Twenty-five children received L-isoleucine (2 g/L)-added ORS (study), and 25 received ORS without L-isoleucine (control). Stool weight, ORS intake, and duration of diarrhoea were the primary outcomes. There was a trend in reduction in mean±standard deviation (SD) daily stool output (g) of children in the L-isoleucine group from day 2 but it was significant on day 3 (388±261 vs 653±446; the difference between mean [95% confidence interval (CI) (-)265 (−509, −20); p=0.035]. Although the cumulative stool output from day 1 to day 3 reduced by 26% in the isoleucine group, it was not significant. Also, there was a trend in reduction in the mean±SD intake of ORS solution (mL) in the L-isoleucine group but it was significant only on day 1 (410±169 vs 564±301), the difference between mean (95% CI) (-)154 (-288, −18); p=0.04. The duration (hours) of diarrhoea was similar in both the groups. A gradual increase in stool concentrations of ß-defensin 2 and 3 was noted but they were not significantly different between the groups. L-isoleucine-supplemented ORS might be beneficial in reducing stool output and ORS intake in children with acute watery diarrhoea. A further study is warranted to substantiate the therapeutic effect of L-isoleucine. PMID:21766553

Gastric Fluid Volume Change After Oral Rehydration Solution Intake in Morbidly Obese and Normal Controls: A Magnetic Resonance Imaging-Based Analysis.

PubMed

Shiraishi, Toshie; Kurosaki, Dai; Nakamura, Mitsuyo; Yazaki, Taiji; Kobinata, Satomi; Seki, Yosuke; Kasama, Kazunori; Taniguchi, Hideki

2017-04-01

Although preoperative fluid intake 2 hours before anesthesia is generally considered safe, there are concerns about delayed gastric emptying in obese subjects. In this study, the gastric fluid volume (GFV) change in morbidly obese subjects was investigated after ingesting an oral rehydration solution (ORS) and then compared with that in nonobese subjects. GFV change over time after the ingestion of 500 mL of ORS containing 2.5% carbohydrate (OS-1) was measured in 10 morbidly obese subjects (body mass index [BMI], >35) scheduled for bariatric surgery and 10 nonobese (BMI, 19-24) using magnetic resonance imaging. After 9 hours of fasting, magnetic resonance imaging scans were performed at preingestion, 0 min (just after ingestion), and every 30 minutes up to 120 minutes. GFV values were compared between morbidly obese and control groups and also between preingestion and postingestion time points. The morbidly obese group had a significantly higher body weight and BMI than the control group (mean body weight and BMI in morbidly obese, 129.6 kg and 46.3 kg/m, respectively; control, 59.5 kg and 21.6 kg/m, respectively). GFV was significantly higher in the morbidly obese subjects compared with the control group at preingestion (73 ± 30.8 mL vs 31 ± 19.9 mL, P = .001) and at 0 minutes after ingestion (561 ± 30.8 mL vs 486 ± 42.8 mL; P < .001). GFV declined rapidly in both groups and reached fasting baseline levels by 120 minutes (morbidly obese, 50 ± 29.5 mL; control, 30 ± 11.6 mL). A significant correlation was observed between preingestion residual GFV and body weight (r = .66; P = .001). Morbidly obese subjects have a higher residual gastric volume after 9 hours of fasting compared with subjects with a normal BMI. However, no differences were observed in gastric emptying after ORS ingestion in the 2 populations, and GFVs reached baseline within 2 hours after ORS ingestion. Further studies are required to confirm whether the preoperative fasting and fluid management that are recommended for nonobese patients could also be applied to morbidly obese patients.

Current management of oral cancer. A multidisciplinary approach.

PubMed

Ord, R A; Blanchaert, R H

2001-11-01

Recent basic science discoveries have contributed to our understanding of the etiology of oral cancer and allowed us to consider innovative approaches to therapy. The authors evaluated and summarized current approaches to the management of oral cancer, emphasizing the multidisciplinary team approach to coordinate surgery, radiation therapy and chemotherapy. Current concepts in management, including complications of therapy, are described. State-of-the-art surgical techniques can spare patients with oral cancer from much of the morbidity and complications common in the past. The refinement of treatment strategies reduces complications and improves efficacy. Many exciting new clinical trials in the areas of gene therapy and immunomodulation are showing promise. Management of oral cancer has undergone radical change in the past 10 years and continues to evolve rapidly. Discoveries in molecular biology, diagnosis, surgery, radiation therapy and medical oncology have altered many traditional concepts and practices. General dental practitioners need to understand current treatment modalities for oral and pharyngeal cancers to determine to whom they should refer patients for the most appropriate treatment, and to make recommendations regarding complications associated with these cancers.

Oral ciprofloxacin: a pharmacoeconomic evaluation of its use in the treatment of serious infections.

PubMed

Balfour, J A; Faulds, D

1993-05-01

The broad spectrum of antibacterial activity and favourable pharmacokinetic profile of ciprofloxacin permit oral treatment of many serious infections which have traditionally necessitated parenteral antibacterial therapy. This has been demonstrated in comparative studies, in which ciprofloxacin was as effective and well tolerated as standard parenteral therapies (usually aminoglycoside/beta-lactam combinations or broad spectrum cephalosporins) in small numbers of patients with infections of the lower respiratory tract, urinary tract, skin and soft tissue, and bones and joints. Oral ciprofloxacin is considerably less expensive than most parenteral therapies, does not necessitate therapeutic drug monitoring and can be administered on an outpatient basis. In addition, administration by the oral route is more comfortable and convenient for the patient. Pharmacoeconomic studies have confirmed that substitution of oral ciprofloxacin for parenteral therapy in the treatment of serious infections can achieve considerable savings in drug acquisition costs, and labour and supplies associated with parenteral drug administration, and may allow early discharge from hospital, resulting in even greater savings. Mean reductions of 43 to 83% were achieved in antibacterial costs in 3 randomised prospective studies, when patients received oral ciprofloxacin instead of various parenteral agents, from the beginning of treatment, or after 3 days' parenteral therapy. It can be concluded that oral ciprofloxacin offers considerable scope for cost avoidance when appropriately substituted for parenteral therapy in the treatment of serious infections.

Analysis of the effect of diluent for rehydration of PoulVac MycoF on vaccination seroconversion results

USDA-ARS?s Scientific Manuscript database

Direct eye drop vaccination of poultry using live Mycoplasma gallisepticum vaccines provides the most efficient route of vaccination. The research reported in this study examines the effect of diluent used to rehydrate lyophilized M. gallisepticum vaccines on its ability to induce a measurable humo...

Forming giant-sized polymersomes using gel-assisted rehydration

DOE PAGES

Greene, Adrienne C.; Sasaki, Darryl Y.; Bachand, George D.

2016-05-26

Here, we present a protocol to rapidly form giant polymer vesicles ( pGVs). Briefly, polymer solutions are dehydrated on dried agarose films adhered to coverslips. Rehydration of the polymer films results in rapid formation of pGVs. This method greatly advances the preparation of synthetic giant vesicles for direct applications in biomimetic studies.

Crack closure on rehydration of glass-ionomer materials.

PubMed

Sidhu, Sharanbir K; Pilecki, Peter; Sherriff, Martyn; Watson, Timothy F

2004-10-01

Moisture-sensitivity of immature glass-ionomer cements suggests that hydration-induced volumetric expansion might close and potentially heal established cracks. Crack closure in glass-ionomer cements (GICs) was observed following rehydration. Circular cavities were prepared in 15 teeth: 10 were restored with resin-modified GICs (5 with Fuji II LC and 5 with Photac-Fil) and 5 were restored with a conventional GIC (Fuji IX); all were dehydrated for 1 min with air and imaged immediately by confocal microscopy. Crack formation in each was located, after which water was placed on the surface and observed for 15 min via a CCD camera. Dehydration caused cracks with measurable gaps, while rehydration resulted in varying degrees of closure: closure was limited in the conventional GIC, and complete or near complete along part/s of the crack in the resin-modified GICs. In all, closure movement became imperceptible after the first 10 min. Statistical analysis indicated no significant difference between the closure behavior of all materials. However, the resin-modified GICs appeared to show a greater potential for closure of established cracks than the conventional GIC upon rehydration.

Dental Therapists as New Oral Health Practitioners: Increasing Access for Underserved Populations.

PubMed

Brickle, Colleen M; Self, Karl D

2017-09-01

The development of dental therapy in the U.S. grew from a desire to find a workforce solution for increasing access to oral health care. Worldwide, the research that supports the value of dental therapy is considerable. Introduction of educational programs in the U.S. drew on the experiences of programs in New Zealand, Australia, Canada, and the United Kingdom, with Alaska tribal communities introducing dental health aide therapists in 2003 and Minnesota authorizing dental therapy in 2009. Currently, two additional states have authorized dental therapy, and two additional tribal communities are pursuing the use of dental therapists. In all cases, the care provided by dental therapists is focused on communities and populations who experience oral health care disparities and have historically had difficulties in accessing care. This article examines the development and implementation of the dental therapy profession in the U.S. An in-depth look at dental therapy programs in Minnesota and the practice of dental therapy in Minnesota provides insight into the early implementation of this emerging profession. Initial results indicate that the addition of dental therapists to the oral health care team is increasing access to quality oral health care for underserved populations. As evidence of dental therapy's success continues to grow, mid-level dental workforce legislation is likely to be introduced by oral health advocates in other states. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

Effects of graded exercise-induced dehydration and rehydration on circulatory markers of oxidative stress across the resting and exercising human leg.

PubMed

Laitano, Orlando; Kalsi, Kameljit Kaur; Pearson, James; Lotlikar, Makra; Reischak-Oliveira, Alvaro; González-Alonso, José

2012-05-01

Exercise in the heat enhances oxidative stress markers in the human circulation, but the contribution of active skeletal muscle and the influence of hydration status remain unknown. To address this question, we measured leg exchange of glutathione (GSH), glutathione disulfide (GSSG), superoxide dismutase activity (SOD) and isoprostanes in seven males at rest and during submaximal one-legged knee extensor exercise in the following four conditions: (1) control euhydration (0% reduction in body mass), (2) mild-dehydration (2%), (3) moderate-dehydration (3.5%), (4) rehydration (0%). In all resting and control exercise conditions, a net GSH uptake was observed across the leg. In contrast, a significant leg release of GSH into the circulation (-354 ± 221 μmol/min, P < 0.05) was observed during exercise with moderate-dehydration, which was still present following full rehydration (-206 ± 122 μmol/min, P < 0.05). During exercise, mild and moderate-dehydration decreased both femoral venous erythrocyte SOD activity (195 ± 6 vs. 180 ± 5 U/L, P < 0.05) and plasma isoprostanes (30 ± 1.1 vs. 25.9 ± 1.3 pg/L, P < 0.05), but during rehydration these were not different from control. In conclusion, these findings suggest that active skeletal muscles release GSH into the circulation under moderate dehydration and subsequent rehydration, possibly to enhance the antioxidant defense.

Drugs for preventing red blood cell dehydration in people with sickle cell disease.

PubMed

Nagalla, Srikanth; Ballas, Samir K

2012-07-11

Sickle cell disease is an inherited disorder of hemoglobin, resulting in abnormal red blood cells. These are rigid and may block blood vessels leading to acute painful crises and other complications. Recent research has focused on therapies to rehydrate the sickled cells by reducing the loss of water and ions from them. Little is known about the effectiveness and safety of such drugs. To assess the relative risks and benefits of drugs to rehydrate sickled red blood cells. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register.Last search of the Group's Trials Register: 25 October 2011. Randomized or quasi-randomized controlled trials of drugs to rehydrate sickled red blood cells compared to placebo or an alternative treatment. Both authors independently selected studies for inclusion, assessed study quality and extracted data. Of the 51 studies identified, three met the inclusion criteria. The first study tested the effectiveness of zinc sulphate to prevent sickle cell-related crises in a total of 145 participants and showed a significant reduction in painful crises over one and a half years, mean difference -2.83 (95% confidence interval -3.51 to -2.15). However, analysis was restricted due to limited statistical data. Changes to red cell parameters and blood counts were inconsistent. No serious adverse events were noted in the study.The second study was a Phase II dose-finding study of senicapoc (a Gardos channel blocker) compared to placebo. Compared to the placebo group the high dose senicapoc showed significant improvement in change in hemoglobin level, number and proportion of dense red blood cells, red blood cell count and indices and hematocrit. The results with low-dose senicapoc were similar to the high-dose senicapoc group but of lesser magnitude. There was no difference in the frequency of painful crises between the three groups. A subsequent Phase III study of senicapoc was terminated early since there was no difference observed between the treatment and control groups in the primary end point of painful crises. While the results of zinc for reducing sickle-related crises are encouraging, larger and longer-term multicenter studies are needed to evaluate the effectiveness of this therapy for people with sickle cell disease.While the Phase II and the prematurely terminated phase III studies of senicapoc showed that the drug improved red cell survival (depending on dose), this did not lead to fewer painful crises.

Zinc supplementation in public health.

PubMed

Penny, Mary Edith

2013-01-01

Zinc is necessary for physiological processes including defense against infections. Zinc deficiency is responsible for 4% of global child morbidity and mortality. Zinc supplements given for 10-14 days together with low-osmolarity oral rehydration solution (Lo-ORS) are recommended for the treatment of childhood diarrhea. In children aged ≥ 6 months, daily zinc supplements reduce the duration of acute diarrhea episodes by 12 h and persistent diarrhea by 17 h. Zinc supplements could reduce diarrhea mortality in children aged 12-59 months by an estimated 23%; they are very safe but are associated with an increase in vomiting especially with the first dose. Heterogeneity between the results of trials is not understood but may be related to dose and the etiology of the diarrhea infection. Integration of zinc and Lo-ORS into national programs is underway but slowly, procurement problems are being overcome and the greatest challenge is changing health provider and caregiver attitudes to diarrhea management. Fewer trials have been conducted of zinc adjunct therapy in severe respiratory tract infections and there is as yet insufficient evidence to recommend addition of zinc to antibiotic therapy. Daily zinc supplements for all children >12 months of age in zinc deficient populations are estimated to reduce diarrhea incidence by 11-23%. The greatest impact is in reducing multiple episodes of diarrhea. The effect on duration of diarrheal episodes is less clear, but there may be up to 9% reduction. Zinc is also efficacious in reducing dysentery and persistent diarrhea. Zinc supplements may also prevent pneumonia by about 19%, but heterogeneity across studies has not yet been explained. When analyses are restricted to better quality studies using CHERG (Child Health Epidemiology Reference Group) methodology, zinc supplements are estimated to reduce diarrheal deaths by 13% and pneumonia deaths by 20%. National-level programs to combat childhood zinc deficiency should be accelerated. Copyright © 2013 S. Karger AG, Basel.

The structure and mechanical properties of articular cartilage are highly resilient towards transient dehydration.

PubMed

Boettcher, K; Kienle, S; Nachtsheim, J; Burgkart, R; Hugel, T; Lieleg, O

2016-01-01

Articular cartilage is a mechanically highly challenged material with very limited regenerative ability. In contrast to elastic cartilage, articular cartilage is exposed to recurring partial dehydration owing to ongoing compression but maintains its functionality over decades. To extend our current understanding of the material properties of articular cartilage, specifically the interaction between the fluid and solid phase, we here analyze the reversibility of tissue dehydration. We perform an artificial dehydration that extends beyond naturally occurring levels and quantify material recovery as a function of the ionic strength of the rehydration buffer. Mechanical (indentation, compression, shear, and friction) measurements are used to evaluate the influence of de- and rehydration on the viscoelastic properties of cartilage. The structure and composition of native and de/rehydrated cartilage are analyzed using histology, scanning electron microscopy, and atomic force microscopy along with a 1,9-dimethylmethylene blue (DMMB) assay. A broad range of mechanical and structural properties of cartilage can be restored after de- and rehydration provided that a physiological salt solution is used for rehydration. We detect only minor alterations in the microarchitecture of rehydrated cartilage in the superficial zone and find that these alterations do not interfere with the viscoelastic and tribological properties of the tissue. We here demonstrate the sturdiness of articular cartilage towards changes in fluid content and show that articular cartilage recovers a broad range of its material properties after dehydration. We analyze the reversibility of tissue dehydration to extend our current understanding of how the material properties of cartilage are established, focusing on the interaction between the fluid and solid phase. Our findings suggest that the high resilience of the tissue minimizes the risk of irreversible material failure and thus compensates, at least in part, its poor regenerative abilities. Tissue engineering approaches should thus not only reproduce the correct tissue mechanics but also its pronounced sturdiness to guarantee a similar longevity. Copyright © 2015 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Postexercise rehydration with beer impairs fluid retention, reaction time, and balance.

PubMed

Flores-Salamanca, Rebeca; Aragón-Vargas, Luis Fernando

2014-10-01

Beer is promoted by popular media as a good choice for rehydration, but there is limited support for the claim. To assess the effect of beer alcohol on rehydration and motor control, 11 young (24.4 ± 3.7 years old) males of legal drinking age were dehydrated to 2.12% ± 0.20% body mass (mean ± SD) by exercising in a climatic chamber (31.7 ± 1.6 °C, 55.0% ± 8.3% relative humidity) on 3 different days, 1 week apart, and rehydrated with 100% of their sweat loss using water (WATER), 4.6% alcohol beer (BEER), or low-alcohol beer (LAB), in random order. Urine output, blood alcohol content (BAC), reaction time (RT), and balance (as measured by center of pressure velocity (VCoP)) were measured every 30 min over 3 h and compared via 2-way, repeated-measures analyses of variance (ANOVAs). After consuming ≈1.6 L in 1 h, urine output was greater for BEER (1218 ± 279 mL) than for LAB (745 ± 313 mL, p = 0.007) and WATER (774 ± 304 mL, p = 0.043). BAC remained at 0 with WATER and LAB; with BEER, BAC reached 0.857 g/L (95% confidence intervals [0.752, 0.963]) immediately postrehydration. RT was longer for BEER (0.314 ± 0.039 s) than for LAB (0.294 ± 0.034 s, p = 0.009), but was no different from WATER (0.293 ± 0.049 s, p = 0.077). VCoPx was significantly higher for BEER (0.0284 ± 0.0020 m/s) compared with LAB (0.0233 ± 0.0010 m/s) or WATER (0.0238 ± 0.0010 m/s) (p = 0.022), but VCoPy was not different among beverages. In conclusion, rehydration with BEER resulted in higher diuresis, slower RT, and impaired VCoP than rehydration with LAB or WATER.

Towards decrypting cryptobiosis--analyzing anhydrobiosis in the tardigrade Milnesium tardigradum using transcriptome sequencing.

PubMed

Wang, Chong; Grohme, Markus A; Mali, Brahim; Schill, Ralph O; Frohme, Marcus

2014-01-01

Many tardigrade species are capable of anhydrobiosis; however, mechanisms underlying their extreme desiccation resistance remain elusive. This study attempts to quantify the anhydrobiotic transcriptome of the limno-terrestrial tardigrade Milnesium tardigradum. A prerequisite for differential gene expression analysis was the generation of a reference hybrid transcriptome atlas by assembly of Sanger, 454 and Illumina sequence data. The final assembly yielded 79,064 contigs (>100 bp) after removal of ribosomal RNAs. Around 50% of them could be annotated by SwissProt and NCBI non-redundant protein sequences. Analysis using CEGMA predicted 232 (93.5%) out of the 248 highly conserved eukaryotic genes in the assembly. We used this reference transcriptome for mapping and quantifying the expression of transcripts regulated under anhdydrobiosis in a time-series during dehydration and rehydration. 834 of the transcripts were found to be differentially expressed in a single stage (dehydration/inactive tun/rehydration) and 184 were overlapping in two stages while 74 were differentially expressed in all three stages. We have found interesting patterns of differentially expressed transcripts that are in concordance with a common hypothesis of metabolic shutdown during anhydrobiosis. This included down-regulation of several proteins of the DNA replication and translational machinery and protein degradation. Among others, heat shock proteins Hsp27 and Hsp30c were up-regulated in response to dehydration and rehydration. In addition, we observed up-regulation of ployubiquitin-B upon rehydration together with a higher expression level of several DNA repair proteins during rehydration than in the dehydration stage. Most of the transcripts identified to be differentially expressed had distinct cellular function. Our data suggest a concerted molecular adaptation in M. tardigradum that permits extreme forms of ametabolic states such as anhydrobiosis. It is temping to surmise that the desiccation tolerance of tradigrades can be achieved by a constitutive cellular protection system, probably in conjunction with other mechanisms such as rehydration-induced cellular repair.

Towards Decrypting Cryptobiosis—Analyzing Anhydrobiosis in the Tardigrade Milnesium tardigradum Using Transcriptome Sequencing

PubMed Central

Wang, Chong; Grohme, Markus A.; Mali, Brahim; Schill, Ralph O.; Frohme, Marcus

2014-01-01

Background Many tardigrade species are capable of anhydrobiosis; however, mechanisms underlying their extreme desiccation resistance remain elusive. This study attempts to quantify the anhydrobiotic transcriptome of the limno-terrestrial tardigrade Milnesium tardigradum. Results A prerequisite for differential gene expression analysis was the generation of a reference hybrid transcriptome atlas by assembly of Sanger, 454 and Illumina sequence data. The final assembly yielded 79,064 contigs (>100 bp) after removal of ribosomal RNAs. Around 50% of them could be annotated by SwissProt and NCBI non-redundant protein sequences. Analysis using CEGMA predicted 232 (93.5%) out of the 248 highly conserved eukaryotic genes in the assembly. We used this reference transcriptome for mapping and quantifying the expression of transcripts regulated under anhdydrobiosis in a time-series during dehydration and rehydration. 834 of the transcripts were found to be differentially expressed in a single stage (dehydration/inactive tun/rehydration) and 184 were overlapping in two stages while 74 were differentially expressed in all three stages. We have found interesting patterns of differentially expressed transcripts that are in concordance with a common hypothesis of metabolic shutdown during anhydrobiosis. This included down-regulation of several proteins of the DNA replication and translational machinery and protein degradation. Among others, heat shock proteins Hsp27 and Hsp30c were up-regulated in response to dehydration and rehydration. In addition, we observed up-regulation of ployubiquitin-B upon rehydration together with a higher expression level of several DNA repair proteins during rehydration than in the dehydration stage. Conclusions Most of the transcripts identified to be differentially expressed had distinct cellular function. Our data suggest a concerted molecular adaptation in M. tardigradum that permits extreme forms of ametabolic states such as anhydrobiosis. It is temping to surmise that the desiccation tolerance of tradigrades can be achieved by a constitutive cellular protection system, probably in conjunction with other mechanisms such as rehydration-induced cellular repair. PMID:24651535

RhMKK9, a rose MAP KINASE KINASE gene, is involved in rehydration-triggered ethylene production in rose gynoecia.

PubMed

Chen, Jiwei; Zhang, Qian; Wang, Qigang; Feng, Ming; Li, Yang; Meng, Yonglu; Zhang, Yi; Liu, Guoqin; Ma, Zhimin; Wu, Hongzhi; Gao, Junping; Ma, Nan

2017-02-23

Flower opening is an important process in the life cycle of flowering plants and is influenced by various endogenous and environmental factors. Our previous work demonstrated that rose (Rosa hybrida) flowers are highly sensitive to dehydration during flower opening and the water recovery process after dehydration induced ethylene production rapidly in flower gynoecia. In addition, this temporal- and spatial-specific ethylene production is attributed to a transient but robust activation of the rose MAP KINASE6-ACC SYNTHASE1 (RhMPK6-RhACS1) cascade in gynoecia. However, the upstream component of RhMPK6-RhACS1 is unknown, although RhMKK9 (MAP KINASE KINASE9), a rose homologue of Arabidopsis MKK9, could activate RhMPK6 in vitro. In this study, we monitored RhMKK2/4/5/9 expression, the potential upstream kinase to RhMPK6, in rose gynoecia during dehydration and rehydration. We found only RhMKK9 was rapidly and strongly induced by rehydration. Silencing of RhMKK9 significantly decreased rehydration-triggered ethylene production. Consistently, the expression of several ethylene-responsive genes was down regulated in the petals of RhMKK9-silenced flowers. Moreover, we detected the DNA methylation level in the promoter and gene body of RhMKK9 by Chop-PCR. The results showed that rehydration specifically elevated the DNA methylation level on the RhMKK9 gene body, whereas it resulted in hypomethylation in its promoter. Our results showed that RhMKK9 possibly acts as the upstream component of the RhMKK9-RhMPK6-RhACS1 cascade and is responsible for water recovery-triggered ethylene production in rose gynoecia, and epigenetic DNA methylation is involved in the regulation of RhMKK9 expression by rehydration.

Common oral complications of head and neck cancer radiation therapy: mucositis, infections, saliva change, fibrosis, sensory dysfunctions, dental caries, periodontal disease, and osteoradionecrosis.

PubMed

Sroussi, Herve Y; Epstein, Joel B; Bensadoun, Rene-Jean; Saunders, Deborah P; Lalla, Rajesh V; Migliorati, Cesar A; Heaivilin, Natalie; Zumsteg, Zachary S

2017-12-01

Patients undergoing radiation therapy for the head and neck are susceptible to a significant and often abrupt deterioration in their oral health. The oral morbidities of radiation therapy include but are not limited to an increased susceptibility to dental caries and periodontal disease. They also include profound and often permanent functional and sensory changes involving the oral soft tissue. These changes range from oral mucositis experienced during and soon after treatment, mucosal opportunistic infections, neurosensory disorders, and tissue fibrosis. Many of the oral soft tissue changes following radiation therapy are difficult challenges to the patients and their caregivers and require life-long strategies to alleviate their deleterious effect on basic life functions and on the quality of life. We discuss the presentation, prognosis, and management strategies of the dental structure and oral soft tissue morbidities resulting from the administration of therapeutic radiation in head and neck patient. A case for a collaborative and integrated multidisciplinary approach to the management of these patients is made, with specific recommendation to include knowledgeable and experienced oral health care professionals in the treatment team. © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Tomato is a highly effective vehicle for expression and oral immunization with Norwalk virus capsid protein.

PubMed

Zhang, Xiuren; Buehner, Norene A; Hutson, Anne M; Estes, Mary K; Mason, Hugh S

2006-07-01

Norwalk virus (NV) is an important agent of epidemic gastroenteritis, and an oral subunit vaccine shows potential for protection. Recombinant Norwalk virus (rNV) capsid protein expressed in plants assembles virus-like particles (VLPs) that are orally immunogenic in mice and humans. In this article we examine rNV expression in tomato and potato using a plant-optimized gene, and test the immunogenicity of dried tomato fruit and potato tuber fed to mice. The synthetic gene increased rNV expression fourfold in tomato and potato plants, which assembled VLP. Four doses of 0.4 g freeze-dried tomato fruit containing 64 microg rNV (40 microg VLPs) induced NV-specific serum IgG and mucosal IgA in > or = 80% of mice, while doses of 0.8 g elicited systemic and mucosal antibody responses in all mice. Feedings of 1 g freeze-dried potato tuber containing 120 microg rNV (90 microg VLPs) were required to produce 100% responsiveness. Oxidation of phenolic compounds upon rehydration of dried tuber caused significant VLP instability, thus decreasing immunogenicity. Air-dried tomato fruit stimulated stronger immune responses than freeze-dried fruit of the same mass, perhaps by limiting the destruction of plant cell matrix and membrane systems that occurs with freeze-drying. Thus, rNV in dried transgenic tomato fruit was a more potent immunogen than that in dried potato tubers, based on the total VLPs ingested. These findings support the use of stabilized, dried tomato fruit for oral delivery of subunit vaccines.

Targeting, Monitoring and Effect of Oral Iron Therapy on Haemoglobin Levels in Older Patients Discharged to Primary Care from Inpatient Rehabilitation: A Cohort Study Using Routinely Collected Data.

PubMed

Thomson, Zach; Hands, Katherine J; Witham, Miles D

2016-08-01

Oral iron is commonly prescribed to older patients with suspected or confirmed iron-deficiency anaemia; however, few studies have examined the effectiveness of oral iron therapy in the real world in this population. We therefore determined the prevalence of iron deficiency in older people prescribed oral iron, examined the response mounted to therapy and ascertained predictors of response to oral iron. We analysed a routinely collected, linked dataset from older patients who had undergone inpatient rehabilitation between 1999 and 2011. An initial analysis examined patients within this cohort who were prescribed iron after rehabilitation and derived three groups based upon their ferritin and transferrin indices: probably, possibly and not iron deficient. A second analysis compared pre- and post-treatment haemoglobin to determine the degree of response to iron therapy across each category of deficiency. Finally, patient demographics, linked biochemistry data and comorbid disease based on International Classification of Disease (ICD-10) codes from previous hospital admissions were used in regression modelling to evaluate factors affecting response to therapy. A total of 490 patients were prescribed oral iron within 90 days of rehabilitation discharge. Of these, 413 (84 %) had iron indices performed; 94 (23 %) were possibly deficient, 224 (54 %) were probably deficient, and 95 (23 %) were not deficient. Of the 490 patients, 360 had both pre- and post-treatment haemoglobin data and iron indices; probably deficient patients mounted a slightly greater response to oral iron (17 vs. 12 g/L for not deficient; p < 0.05). Only pre-treatment haemoglobin, mean cell volume and lower gastrointestinal pathology were significant predictors of a response to oral iron therapy. Notably, acid-suppressant use was not a predictor of response. We conclude that many older patients are exposed to oral iron without good evidence of either iron deficiency or a significant response to therapy.

Selective primary health care: an interim strategy for disease control in developing countries.

PubMed

Walsh, J A; Warren, K S

1979-11-01

Priorities among the infectious diseases affecting the three billion people in the less developed world have been based on prevalence, morbidity, mortality and feasibility of control. With these priorities in mind a program of selective primary health care is compared with other approaches and suggested as the most cost-effective form of medical intervention in the least developed countries. A flexible program delivered by either fixed or mobile units might include measles and diphtheria-pertussis-tetanus vaccination, treatment for febrile malaria and oral rehydration for diarrhea in children, and tetanus toxoid and encouragement of breast feeding in mothers. Other interventions might be added on the basis of regional needs and new developments. For major diseases for which control measures are inadequate, research is an inexpensive approach on the basis of cost per infected person per year.

Cardiovascular adaptation to spaceflight

NASA Technical Reports Server (NTRS)

Charles, John B.; Lathers, Claire M.

1991-01-01

Data are presented on the rate of adaptation of the human cardiovascular system to conditions of spaceflight, with particular attention given to data obtained during spaceflight in the U.S. Space Shuttle Program. It is pointed out that many of the cardiovascular changes that occurred during spaceflights that lasted from 2 to 11 days can be traced directly to changes in the body fluid volume. The beneficial effects of a fluid loading countermeasure (oral rehydration) and of the supine body position on the heart rate during the spaceflight are demonstrated. It is noted that, after hours or a few days of spaceflight, a state of adaptation is reached, in which the subject is well adapted and appropriately hydrated for the weightless environment. However, the return to the normal gravity of the earth leaves the individual especially sensitive to orthostatic stress.

Hyponatremia-associated rhabdomyolysis following exercise in an adolescent with cystic fibrosis.

PubMed

Kaskavage, Jillian; Sklansky, Daniel

2012-07-01

Adolescents with well-controlled cystic fibrosis, including good lung function and appropriate growth, commonly participate in competitive athletic activities. We present the case of an adolescent male with cystic fibrosis, hyponatremia, dehydration, and rhabdomyolysis after participating in football practice on a summer morning. The patient presented with severe myalgia and serum sodium of 129 mmol/L, chloride 90 mmol/L, and creatine phosphokinase 1146 U/L. Aggressive hydration with intravenous 0.9% saline resulted in clinical improvement with no renal or muscular sequelae. Health care providers need to educate patients with cystic fibrosis about maintaining adequate hydration and sodium repletion during exercise. Research is needed regarding the appropriate amount and composition of oral rehydration fluids in exercising individuals with cystic fibrosis, as the physiology encountered in these patients provides a unique challenge to maintaining electrolyte balance and stimulation of thirst.

Oral hypertonic saline causes transient fall of vasopressin in humans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Seckl, J.R.; Williams, D.M.; Lightman, S.L.

1986-08-01

After dehydration, oral rehydration causes a fall in plasma arginine vasopressin (AVP) that precedes changes in plasma osmolality. To investigate further the stimulus for this effect, its specificity, and association with thirst, six volunteers were deprived of water for 24 h and given a salt load on two separate occasions. On each study day they then drank rapidly 10 ml/kg of either tap water or hypertonic saline (360 mosmol/kg). There was a significant fall in plasma AVP from 2.0 +/- 0.3 to 1.2 +/- 0.4 pmol/l 5 min after drinking water and from 1.8 +/- 0.3 to 0.9 +/- 0.2more » pmol/l after hypertonic saline. Plasma osmolality fell 30-60 min after water and was unchanged after saline. Plasma renin activity, oxytocin, and total protein all remained unchanged. All subjects reported diminished thirst after hypertonic saline. Gargling with water reduced thirst but did not affect plasma AVP. There appears to be a drinking-mediated neuroendocrine reflex that decreases plasma AVP irrespective of the osmolality of the liquid consumed. The sensation of thirst did not correlate with plasma osmolality and was not always related to plasma AVP concentration. AVP was measured by radioimmunoassay.« less

Henricks rehydrates a food packet at the shuttle orbiter repackaged galley (SORG)

NASA Image and Video Library

1995-07-31

STS070-333-016 (13-22 JULY 1995) --- At the space shuttle Discovery?s galley on the middeck, astronaut Terence T. (Tom) Henricks, mission commander, prepares to rehydrate a package of broccoli au gratin. A packet of punch and another beverage pouch filled with lemonade can be seen temporarily stowed on locker exteriors nearby.

Treatment of disseminated granuloma annulare with oral vitamin E: 'primum nil nocere'.

PubMed

Poppe, Heiko; Poppe, Lidia M; Goebeler, Matthias; Trautmann, Axel

2013-01-01

Disseminated granuloma annulare (DGA) is a benign and usually asymptomatic skin disease. However, many patients feel aesthetically disfigured and ask for treatment. Until today, no standard therapy is recommended. To evaluate the safety and efficacy of oral vitamin E treatment compared to the natural course of DGA. This single-centre observational cohort study included 38 consecutive patients with histologically confirmed DGA. 21 patients underwent treatment with oral vitamin E, whereas 17 patients preferred a wait-and-see approach. Complete healing (40%) and improvement (30%) were frequently seen under oral vitamin E therapy. However, DGA also spontaneously disappeared in 31% and improved in 25% of untreated control patients. Vitamin E therapy was very well tolerated. Oral vitamin E treatment is a safe and probably effective therapy for DGA. As the natural course of DGA leads to complete healing or significant improvement in many cases, 'primum nil nocere' should be the maxim.

Generalized Pustular Psoriasis and Hepatic Dysfunction Associated with Oral Terbinafine Therapy

PubMed Central

Kim, Byung-Soo; Jwa, Seung-Wook; Jang, Bong-Seok; Kim, Moon-Bum; Oh, Chang-Keun; Kwon, Yoo-Wook; Kwon, Kyung-Sool

2007-01-01

We report a case of 61-yr-old man with stable psoriasis who progressively developed generalized pustular eruption, erythroderma, fever, and hepatic dysfunction following oral terbinafine. Skin biopsy was compatible with pustular psoriasis. After discontinuation of terbinafine and initiating topical corticosteroid and calcipotriol combination with narrow band ultraviolet B therapy, patient'S condition slowly improved until complete remission was reached 2 weeks later. The diagnosis of generalized pustular psoriasis (GPP) induced by oral terbinafine was made. To our knowledge, this is the first report of GPP accompanied by hepatic dysfunction associated with oral terbinafine therapy. PMID:17297275

Economic Burden of Chronic Lymphocytic Leukemia in the Era of Oral Targeted Therapies in the United States

PubMed Central

Chen, Qiushi; Jain, Nitin; Ayer, Turgay; Wierda, William G.; Flowers, Christopher R.; O’Brien, Susan M.; Keating, Michael J.; Kantarjian, Hagop M.

2017-01-01

Purpose Oral targeted therapies represent a significant advance for the treatment of patients with chronic lymphocytic leukemia (CLL); however, their high cost has raised concerns about affordability and the economic impact on society. Our objective was to project the future prevalence and cost burden of CLL in the era of oral targeted therapies in the United States. Methods We developed a simulation model that evaluated the evolving management of CLL from 2011 to 2025: chemoimmunotherapy (CIT) as the standard of care before 2014, oral targeted therapies for patients with del(17p) and relapsed CLL from 2014, and for first-line treatment from 2016 onward. A comparator scenario also was simulated where CIT remained the standard of care throughout. Disease progression and survival parameters for each therapy were based on published clinical trials. Results The number of people living with CLL in the United States is projected to increase from 128,000 in 2011 to 199,000 by 2025 (55% increase) due to improved survival; meanwhile, the annual cost of CLL management will increase from $0.74 billion to $5.13 billion (590% increase). The per-patient lifetime cost of CLL treatment will increase from $147,000 to $604,000 (310% increase) as oral targeted therapies become the first-line treatment. For patients enrolled in Medicare, the corresponding total out-of-pocket cost will increase from $9,200 to $57,000 (520% increase). Compared with the CIT scenario, oral targeted therapies resulted in an incremental cost-effectiveness ratio of $189,000 per quality-adjusted life-year. Conclusion The increased benefit and cost of oral targeted therapies is projected to enhance CLL survivorship but can impose a substantial financial burden on both patients and payers. More sustainable pricing strategies for targeted therapies are needed to avoid financial toxicity to patients. PMID:27870563

Ondansetron Oral Dissolve Tab vs. Oral Solution in Children Presenting to the Emergency Department with Gastroenteritis.

PubMed

Thompson, Graham C; Morrison, Ellen L; Chaulk, David; Wobma, Holly; Kwong, Simon; Johnson, David W

2016-11-01

Ondansetron is often used in the emergency department (ED) to promote oral rehydration in children with acute gastroenteritis (AGE), yet medication solutions administered orally may be poorly tolerated in this population. We compared the tolerability of ondansetron oral dissolve tab (ODT) to oral solution (OS) in children presenting to the ED with AGE. Using alternate-day controlled clinical trial design, children aged 3 months to 10 years received either ondansetron ODT or OS. Our primary outcome was early vomiting (within 15 min of drug administration). The secondary outcome was intravenous (i.v.) fluid administration. There were 462/534 eligible children who met study criteria. Demographics, severity, and duration of illness were similar between groups. Using intention-to-treat analysis, early vomiting occurred in 8/209 ODT vs. 19/253 OS children (3.8% vs. 7.5%; odds ratio [OR] 0.49; 95% confidence interval [CI] 0.18-1.21). Using as-treated analysis, 6/222 (2.7%) children receiving ODT experienced early vomiting, compared with 21/221 (9.5%) of the OS group (OR 0.26; 95% CI 0.09-0.70). The proportion of children discharged without i.v. fluids was not different (intention-to-treat: ODT = 91.4% (191/209), OS = 94.1% (238/253), OR 1.49, 95% CI 0.69-3.28; as-treated: ODT = 92.3% (205/222), OS = 93.2% (206/221), OR 0.88, 95% CI 0.40-1.93). Using a conservative intention-to-treat analysis, we found that children presenting to an ED with AGE did not have statistically less early vomiting with ondansetron ODT as compared with OS. However, our as-treated analysis demonstrates that children receiving ondansetron ODT experienced early vomiting approximately one-third as often as those receiving OS. The rate of i.v. fluid administration was no different between groups regardless of the type of analysis used. Copyright © 2016 Elsevier Inc. All rights reserved.

Anticoagulant and Antiplatelet Therapy in Patients with Atrial Fibrillation and Coronary Artery Disease

PubMed Central

Mischke, Karl; Knackstedt, Christian; Marx, Nikolaus

2012-01-01

Anticoagulation represents the mainstay of therapy for most patients with atrial fibrillation. Patients on oral anticoagulation often require concomitant antiplatelet therapy, mostly because of coronary artery disease. After coronary stent implantation, dual antiplatelet therapy is necessary. However, the combination of oral anticoagulation and antiplatelet therapy increases the bleeding risk. Risk scores such as the CHA2DS2-Vasc score and the HAS-BLED score help to identify both bleeding and stroke risk in individual patients. The guidelines of the European Society of Cardiology provide a rather detailed recommendation for patients on oral anticoagulation after coronary stent implantation. However, robust evidence is lacking for some of the recommendations, and especially for new oral anticoagulants and new antiplatelets few or no data are available. This review addresses some of the critical points of the guidelines and discusses potential advantages of new anticoagulants in patients with atrial fibrillation after stent implantation. PMID:22577538

Rehydration with soft drink-like beverages exacerbates dehydration and worsens dehydration-associated renal injury.

PubMed

García-Arroyo, Fernando E; Cristóbal, Magdalena; Arellano-Buendía, Abraham S; Osorio, Horacio; Tapia, Edilia; Soto, Virgilia; Madero, Magdalena; Lanaspa, Miguel A; Roncal-Jiménez, Carlos; Bankir, Lise; Johnson, Richard J; Sánchez-Lozada, Laura-Gabriela

2016-07-01

Recurrent dehydration, such as commonly occurs with manual labor in tropical environments, has been recently shown to result in chronic kidney injury, likely through the effects of hyperosmolarity to activate both vasopressin and aldose reductase-fructokinase pathways. The observation that the latter pathway can be directly engaged by simple sugars (glucose and fructose) leads to the hypothesis that soft drinks (which contain these sugars) might worsen rather than benefit dehydration associated kidney disease. Recurrent dehydration was induced in rats by exposure to heat (36°C) for 1 h/24 h followed by access for 2 h to plain water (W), a 11% fructose-glucose solution (FG, same composition as typical soft drinks), or water sweetened with noncaloric stevia (ST). After 4 wk plasma and urine samples were collected, and kidneys were examined for oxidative stress, inflammation, and injury. Recurrent heat-induced dehydration with ad libitum water repletion resulted in plasma and urinary hyperosmolarity with stimulation of the vasopressin (copeptin) levels and resulted in mild tubular injury and renal oxidative stress. Rehydration with 11% FG solution, despite larger total fluid intake, resulted in greater dehydration (higher osmolarity and copeptin levels) and worse renal injury, with activation of aldose reductase and fructokinase, whereas rehydration with stevia water had opposite effects. In animals that are dehydrated, rehydration acutely with soft drinks worsens dehydration and exacerbates dehydration associated renal damage. These studies emphasize the danger of drinking soft drink-like beverages as an attempt to rehydrate following dehydration. Copyright © 2016 the American Physiological Society.

Emergency department management of gastro-enteritis in Australia and New Zealand.

PubMed

Schutz, Jacquie; Babl, Franz E; Sheriff, Nisa; Borland, Meredith

2008-10-01

Comparison of clinical practice guideline (CPG) recommendations and reported physician management of gastro-enteritis at Paediatric Research in Emergency Departments International Collaborative (PREDICT) network sites as a baseline for further randomised controlled trials. Two part survey comprising: (i) review of CPGs from PREDICT sites for gastro-enteritis; and (ii) survey of senior emergency department physicians regarding the management of gastro-enteritis. All 11 PREDICT sites participated. Nine CPGs were available with three sites using a common CPG. For moderate dehydration, eight CPGs advocated nasogastric (NG) rehydration in preference to intravenous (IV) rehydration. The IV route was reserved for severe dehydration or failed NG rehydration. In the second component of the survey, 78 of 83 (94%) physicians responded. In moderate dehydration, 82% of respondents used NG rehydration. In severe dehydration, 86% used IV fluids; 12% used NG and 3% an initial IV bolus followed by NG fluid. Serum electrolytes were measured universally with IV fluid use and by 22% using NG rehydration. The IV fluid bolus was with normal saline (86%). Fifty-four per cent used anti-emetics 'rarely' or 'sometimes'. The commonest agents were ondansetron (60%) and metoclopramide (29%). CPG recommendations and physician practice for the management of gastro-enteritis were similar across PREDICT sites with a focus on NG for moderate dehydration and IV for severe dehydration. A variety of fluids and administration rates were used. Anti-emetics were used infrequently. The efficacy and safety of newer anti-emetics should be explored in collaborative studies. Collaborative development of new CPGs should be considered to simplify fluid regimens.

Activation of photosynthesis and resistance to photoinhibition in cyanobacteria within biological desert crust.

PubMed

Harel, Yariv; Ohad, Itzhak; Kaplan, Aaron

2004-10-01

Filamentous cyanobacteria are the main primary producers in biological desert sand crusts. The cells are exposed to extreme environmental conditions including temperature, light, and diurnal desiccation/rehydration cycles. We have studied the kinetics of activation of photosynthesis during rehydration of the cyanobacteria, primarily Microcoleus sp., within crust samples collected in the Negev desert, Israel. We also investigated their susceptibility to photoinhibition. Activation of the photosynthetic apparatus, measured by fluorescence kinetics, thermoluminescence, and low temperature fluorescence emission spectra, did not require de novo protein synthesis. Over 50% of the photosystem II (PSII) activity, assembled phycobilisomes, and photosystem I (PSI) antennae were detected within less than 5 min of rehydration. Energy transfer to PSII and PSI by the respective antennae was fully established within 10 to 20 min of rehydration. The activation of a fraction of PSII population (about 20%-30%) was light and temperature-dependent but did not require electron flow to plastoquinone [was not inhibited by 3-(3,4-dichlorophenyl)-1,1-dimethylurea]. The cyanobacteria within the crusts are remarkably resistant to photoinhibition even in the absence of protein synthesis. The rate of PSII repair increased with light intensity and with time of exposure. Consequently, the extent of photoinhibition in high-light-exposed crusts reached a constant, relatively low, level. This is in contrast to model organisms such as Synechocystis sp. strain PCC 6803 where PSII activity declined continuously over the entire exposure to high illumination. Ability of the crust's organisms to rapidly activate photosynthesis upon rehydration and withstand photoinhibition under high light intensity may partly explain their ability to survive in this ecosystem.

Effect of drink carbohydrate content on postexercise gastric emptying, rehydration, and the calculation of net fluid balance.

PubMed

Clayton, David J; Evans, Gethin H; James, Lewis J

2014-02-01

The purpose of this study was to examine the gastric emptying and rehydration effects of hypotonic and hypertonic glucose-electrolyte drinks after exercise-induced dehydration. Eight healthy males lost ~1.8% body mass by intermittent cycling and rehydrated (150% of body mass loss) with a hypotonic 2% (2% trial) or a hypertonic 10% (10% trial) glucose-electrolyte drink over 60 min. Blood and urine samples were taken at preexercise, postexercise, and 60, 120, 180, and 240 min postexercise. Gastric and test drink volume were determined 15, 30, 45, 60, 90, and 120 min postexercise. At the end of the gastric sampling period 0.3% (2% trial) and 42.1% (10% trial; p < .001) of the drinks remained in the stomach. Plasma volume was lower (p < .01) and serum osmolality was greater (p < .001) at 60 and 120 min during the 10% trial. At 240 min, 52% (2% trial) and 64% (10% trial; p < .001) of the drinks were retained. Net fluid balance was greater from 120 min during the 10% trial (p < .001). When net fluid balance was corrected for the volume of fluid in the stomach, it was greater at 60 and 120 min during the 2% trial (p < .001). These results suggest that the reduced urine output following ingestion of a hypertonic rehydration drink might be mediated by a slower rate of gastric emptying, but the slow gastric emptying of such solutions makes rehydration efficiency difficult to determine in the hours immediately after drinking, compromising the calculation of net fluid balance.

The impact of post-exercise hydration with deep-ocean mineral water on rehydration and exercise performance.

PubMed

Keen, Douglas A; Constantopoulos, Eleni; Konhilas, John P

2016-01-01

Dehydration caused by prolonged exercise impairs thermoregulation, endurance and exercise performance. Evidence from animal and human studies validates the potential of desalinated deep-ocean mineral water to positively impact physiological and pathophysiological conditions. Here, we hypothesize that deep-ocean mineral water drawn from a depth of 915 m off the Kona, HI coast enhances recovery of hydration and exercise performance following a dehydrating exercise protocol compared to mountain spring water and a carbohydrate-based sports drink. Subjects (n = 8) were exposed to an exercise-dehydration protocol (stationary biking) under warm conditions (30 °C) to achieve a body mass loss of 3 % (93.4 ± 21.7 total exercise time). During the post-exercise recovery period, subjects received deep-ocean mineral water (Kona), mountain spring water (Spring) or a carbohydrate-based sports drink (Sports) at a volume (in L) equivalent to body mass loss (in Kg). Salivary samples were collected at regular intervals during exercise and post-exercise rehydration. Additionally, each participant performed peak torque knee extension as a measure of lower body muscle performance. Subjects who received Kona during the rehydrating period showed a significantly more rapid return to pre-exercise (baseline) hydration state, measured as the rate of decline in peak to baseline salivary osmolality, compared to Sports and Spring groups. In addition, subjects demonstrated significantly improved recovery of lower body muscle performance following rehydration with Kona versus Sports or Spring groups. Deep-ocean mineral water shows promise as an optimal rehydrating source over spring water and/or sports drink.

Maternity, infant care needs remain unmet in sub-Saharan Africa.

PubMed

Otolorin, E O

1986-01-01

The results of a survey conducted by Family Health International of 55,000 deliveries in 23 health facilities in 10 countries of sub-Saharan Africa indicate the importance of prenatal care to pregnacy outcome. Infant of mothers who had received prental care were significantly more likely to survive the early neonatal period than infants whose mothers received no prenatal care. Moreover, chances of neonatal survival rose with increases in the number of prenatal visits. Prenatal care also reduced the number of complication of delivery, especially among women with 4 or more previous births. On the basis of these findings, it is suggested that the objective should be to provide at least some prenatal care to all pregnant women in this area and to build in a system for identifying and providing more intensive care to women at highest risk. Total coverage of the sub-Sahran region requires a team approach. The team should consist of physicians, nurses, midwives, community health assistants, and traditional birth attendants. Given the shortage of physicians and nurses in this region, the need to cooperate with and train traditional birth attendants is particularly important. Their training should include the identification of risk factors and danger signs, including anemia, sepsis, hemorrhage, obstructed labor, and eclampsia. Community outreach programs need to be designed to encourage women to use prenatal services, and health education programs (covering topics such as oral rehydration therapy, immunization, and breast feeding) should be organized on a continuous basis. The integration of family planning and primary health care services is also crucial.

The role of arginine and arginine-metabolizing enzymes during Giardia – host cell interactions in vitro

PubMed Central

2013-01-01

Background Arginine is a conditionally essential amino acid important in growing individuals and under non-homeostatic conditions/disease. Many pathogens interfere with arginine-utilization in host cells, especially nitric oxide (NO) production, by changing the expression of host enzymes involved in arginine metabolism. Here we used human intestinal epithelial cells (IEC) and three different isolates of the protozoan parasite Giardia intestinalis to investigate the role of arginine and arginine-metabolizing enzymes during intestinal protozoan infections. Results RNA expression analyses of major arginine-metabolizing enzymes revealed the arginine-utilizing pathways in human IECs (differentiated Caco-2 cells) grown in vitro. Most genes were constant or down-regulated (e.g. arginase 1 and 2) upon interaction with Giardia, whereas inducible NO synthase (iNOS) and ornithine decarboxylase (ODC) were up-regulated within 6 h of infection. Giardia was shown to suppress cytokine-induced iNOS expression, thus the parasite has both iNOS inducing and suppressive activities. Giardial arginine consumption suppresses NO production and the NO-degrading parasite protein flavohemoglobin is up-regulated in response to host NO. In addition, the secreted, arginine-consuming giardial enzyme arginine deiminase (GiADI) actively reduces T-cell proliferation in vitro. Interestingly, the effects on NO production and T cell proliferation could be reversed by addition of external arginine or citrulline. Conclusions Giardia affects the host’s arginine metabolism on many different levels. Many of the effects can be reversed by addition of arginine or citrulline, which could be a beneficial supplement in oral rehydration therapy. PMID:24228819

We won't repeat the mistakes of the past.

PubMed

Amanor, A

1991-09-01

The Planned Parenthood Association of Ghana and the country's Ministry of Health have seized on an innovative new method for promoting immunization coverage -- a baby contest. The event seeks to promote the benefits of good health habits, a sound environment, and immunization on a child's development. The contest is designed to determine whether the mother has understood the educational lessons concerning family planning and family health given at the immunization centers and welfare clinics. The prize for winning the contest consists of 3 plastic basins, bars of bath soap, and a white shirt. In order to take part in the baby contest, a mother has to demonstrate the following: that she took 2 doses of tetanus vaccine during pregnancy; that she is able to administer first aid and oral rehydration therapy; that she has a certain level of knowledge concerning family planning methods, environmental sanitation, and personal hygiene; and that she is able to prepare Weanimix, a local weaning food for children. The 1st baby contest was held in December 1989 in the 9 communities that form the Integrated Family Planning, Nutrition and Parasite Control Project (IP) area. This 1st competition succeeded in getting 513 mothers to complete their immunization schedules prior to the event. Because the initial contests took place in remote villages, they received little media coverage, which affected attendance. But as more contests were held and more people became involved, the media picked up the story, further increasing participation. Organizers indicate that the number of people taking part in the contests, as well as the number of children being immunized, has increased steadily every month.

Childhood diarrhoeal deaths in seven low- and middle-income countries

PubMed Central

Rahman, Ahmed Ehsanur; Moinuddin, Md; Molla, Mitike; Worku, Alemayehu; Hurt, Lisa; Kirkwood, Betty; Mohan, Sanjana Brahmawar; Mazumder, Sarmila; Bhutta, Zulfiqar; Raza, Farrukh; Mrema, Sigilbert; Masanja, Honorati; Kadobera, Daniel; Waiswa, Peter; Bahl, Rajiv; Zangenberg, Mike

2014-01-01

Abstract Objective To investigate the clinical characteristics of children who died from diarrhoea in low- and middle-income countries, such as the duration of diarrhoea, comorbid conditions, care-seeking behaviour and oral rehydration therapy use. Methods The study included verbal autopsy data on children who died from diarrhoea between 2000 and 2012 at seven sites in Bangladesh, Ethiopia, Ghana, India, Pakistan, Uganda and the United Republic of Tanzania, respectively. Data came from demographic surveillance sites, randomized trials and an extended Demographic and Health Survey. The type of diarrhoea was classified as acute watery, acute bloody or persistent and risk factors were identified. Deaths in children aged 1 to 11 months and 1 to 4 years were analysed separately. Findings The proportion of childhood deaths due to diarrhoea varied considerably across the seven sites from less than 3% to 30%. Among children aged 1–4 years, acute watery diarrhoea accounted for 31–69% of diarrhoeal deaths, acute bloody diarrhoea for 12–28%, and persistent diarrhoea for 12–56%. Among infants aged 1–11 months, persistent diarrhoea accounted for over 30% of diarrhoeal deaths in Ethiopia, India, Pakistan, Uganda and the United Republic of Tanzania. At most sites, more than 40% of children who died from persistent diarrhoea were malnourished. Conclusion Persistent diarrhoea remains an important cause of diarrhoeal death in young children in low- and middle-income countries. Research is needed on the public health burden of persistent diarrhoea and current treatment practices to understand why children are still dying from the condition. PMID:25378757

Theater dramatizes ORT message.

PubMed

White, K

1990-04-01

The Zambian Control of Diarrheal Diseases (CDD) Program sought the assistance of 2 popular theater groups to develop a play on diarrhea including messages on using oral rehydration therapy (ORT), breast feeding, continued feeding, and using fluids. This was a more appropriate channel for promoting ORT because only 30% of the population had access to a radio and even less to a television set. The groups performed their 35-40 minute plays, complete with dancing and singing, in the local language for 40 different high density communities in Lusaka 6 times/week for 3 months. Before each play, 1 group went door to door telling the occupants that they were going to perform a play about diarrhea management, specifically ORT. If no one could come, the group described ORT for the occupants. The other group held discussions after each performance to determine what learned and to correct any misconceptions about ORT. 1 group concentrated on bottle feeding as the cause of diarrhea while the other group concentrated on poor sanitation and personal hygiene. The groups always performed in locations convenient to mothers, such as markets, outside clinics, and schools, thereby reaching an estimated 10,000 people. Men also attended the plays which was good because fathers often decide whether or not to use ORT for a sick child. Several performances were recorded and aired on local language radio programs to increase awareness of ORT. The entire 1989 campaign of the CDD Program cost $3000 while radio spots for the same period cost the program $8000-10,000. Popular theater is now being used to publicize many other health messages, such as AIDS-prevention.

Water pumps

PubMed Central

Loo, Donald D F; Wright, Ernest M; Zeuthen, Thomas

2002-01-01

The transport of water across epithelia has remained an enigma ever since it was discovered over 100 years ago that water was transported across the isolated small intestine in the absence of osmotic and hydrostatic pressure gradients. While it is accepted that water transport is linked to solute transport, the actual mechanisms are not well understood. Current dogma holds that active ion transport sets up local osmotic gradients in the spaces between epithelial cells, the lateral intercellular spaces, and this in turn drives water transport by local osmosis. In the case of the small intestine, which in humans absorbs about 8 l of water a day, there is no direct evidence for either local osmosis or aquaporin gene expression in enterocytes. Intestinal water absorption is greatly enhanced by glucose, and this is the basis for oral rehydration therapy in patients with secretory diarrhoea. In our studies of the intestinal brush border Na+-glucose cotransporter we have obtained evidence that there is a direct link between the transport of Na+, glucose and water transport, i.e. there is cotransport of water along with Na+ and sugar, that will account for about 50 % of the total water transport across the human intestinal brush border membrane. In this short review we summarize the evidence for water cotransport and propose how this occurs during the enzymatic turnover of the transporter. This is a general property of cotransporters and so we expect that this may have wider implications in the transport of water and other small polar molecules across cell membranes in animals and plants. PMID:12096049

The Bangladesh paradox: exceptional health achievement despite economic poverty.

PubMed

Chowdhury, A Mushtaque R; Bhuiya, Abbas; Chowdhury, Mahbub Elahi; Rasheed, Sabrina; Hussain, Zakir; Chen, Lincoln C

2013-11-23

Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households. Government and non-governmental organisations have pioneered many innovations that have been scaled up nationally. However, these remarkable achievements in equity and coverage are counterbalanced by the persistence of child and maternal malnutrition and the low use of maternity-related services. The Bangladesh paradox shows the net outcome of successful direct health action in both positive and negative social determinants of health--ie, positives such as women's empowerment, widespread education, and mitigation of the effect of natural disasters; and negatives such as low gross domestic product, pervasive poverty, and the persistence of income inequality. Bangladesh offers lessons such as how gender equity can improve health outcomes, how health innovations can be scaled up, and how direct health interventions can partly overcome socioeconomic constraints. Copyright © 2013 Elsevier Ltd. All rights reserved.

Oral candidiasis following steroid therapy for oral lichen planus.

PubMed

Marable, D R; Bowers, L M; Stout, T L; Stewart, C M; Berg, K M; Sankar, V; DeRossi, S S; Thoppay, J R; Brennan, M T

2016-03-01

The purpose of this multicentre study was to determine the incidence of oral candidiasis in patients treated with topical steroids for oral lichen planus (OLP) and to determine whether the application of a concurrent antifungal therapy prevented the development of an oral candidiasis in these patients. Records of 315 patients with OLP seen at four Oral Medicine practices treated for at least 2 weeks with steroids with and without the use of an antifungal regimen were retrospectively reviewed. The overall incidence of oral fungal infection in those treated with steroid therapy for OLP was 13.6%. There was no statistically significant difference in the rate of oral candidiasis development in those treated with an antifungal regimen vs those not treated prophylactically (14.3% vs 12.6%) (P = 0.68). Despite the use of various regimens, none of the preventive antifungal strategies used in this study resulted in a significant difference in the rate of development of an oral candidiasis in patients with OLP treated with steroids. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Air-dried cells from the anhydrobiotic insect, Polypedilum vanderplanki, can survive long term preservation at room temperature and retain proliferation potential after rehydration.

PubMed

Watanabe, Kazuyo; Imanishi, Shigeo; Akiduki, Gaku; Cornette, Richard; Okuda, Takashi

2016-08-01

Pv11, a cell line derived from the anhydrobiotic insect, Polypedilum vanderplanki, was preserved in a dry form (only 6% residual moisture) at room temperature for up to 251 days and restarted proliferating after rehydration. A previous study already reported survival of Pv11 cells after desiccation, but without subsequent proliferation. Here, the protocol was improved to increase survival and achieve proliferation of Pv11 cells after dry storage. The method basically included preincubation, desiccation and rehydration processes and each step was investigated. So far, preincubation in a 600 mM trehalose solution for 48 h before dehydration was the most favourable preconditioning to achieve successful dry preservation of Pv11 cells, allowing about 16% of survival after rehydration and subsequent cell proliferation. Although the simple air-dry method established for Pv11 cells here was not applicable for successful dry-preservation of other insect cell lines, Pv11 is the first dry-preservable animal cell line and will surely contribute not only to basic but also applied sciences. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Food allergy therapy: is a cure within reach?

PubMed

Nowak-Węgrzyn, Anna; Muraro, Antonella

2011-04-01

There is an unmet medical need for an effective food allergy therapy; thus, development of therapeutic interventions for food allergy is a top research priority. The food allergen-nonspecific therapies for food-induced anaphylaxis include monoclonal anti-IgE antibodies and Chinese herbs. The food allergen-specific therapies include oral, sublingual, and epicutaneous immunotherapy with native food allergens and mutated recombinant proteins. Diet containing heated milk and egg may represent an alternative approach to oral immunomodulation. Oral food immunotherapy remains an investigational treatment to be further studied before advancing into clinical practice. Copyright © 2011 Elsevier Inc. All rights reserved.

Comparing sociocultural features of cholera in three endemic African settings

PubMed Central

2013-01-01

Background Cholera mainly affects developing countries where safe water supply and sanitation infrastructure are often rudimentary. Sub-Saharan Africa is a cholera hotspot. Effective cholera control requires not only a professional assessment, but also consideration of community-based priorities. The present work compares local sociocultural features of endemic cholera in urban and rural sites from three field studies in southeastern Democratic Republic of Congo (SE-DRC), western Kenya and Zanzibar. Methods A vignette-based semistructured interview was used in 2008 in Zanzibar to study sociocultural features of cholera-related illness among 356 men and women from urban and rural communities. Similar cross-sectional surveys were performed in western Kenya (n = 379) and in SE-DRC (n = 360) in 2010. Systematic comparison across all settings considered the following domains: illness identification; perceived seriousness, potential fatality and past household episodes; illness-related experience; meaning; knowledge of prevention; help-seeking behavior; and perceived vulnerability. Results Cholera is well known in all three settings and is understood to have a significant impact on people’s lives. Its social impact was mainly characterized by financial concerns. Problems with unsafe water, sanitation and dirty environments were the most common perceived causes across settings; nonetheless, non-biomedical explanations were widespread in rural areas of SE-DRC and Zanzibar. Safe food and water and vaccines were prioritized for prevention in SE-DRC. Safe water was prioritized in western Kenya along with sanitation and health education. The latter two were also prioritized in Zanzibar. Use of oral rehydration solutions and rehydration was a top priority everywhere; healthcare facilities were universally reported as a primary source of help. Respondents in SE-DRC and Zanzibar reported cholera as affecting almost everybody without differentiating much for gender, age and class. In contrast, in western Kenya, gender differentiation was pronounced, and children and the poor were regarded as most vulnerable to cholera. Conclusions This comprehensive review identified common and distinctive features of local understandings of cholera. Classical treatment (that is, rehydration) was highlighted as a priority for control in the three African study settings and is likely to be identified in the region beyond. Findings indicate the value of insight from community studies to guide local program planning for cholera control and elimination. PMID:24047241

Acute bacterial osteoarticular infections: eight-year analysis of C-reactive protein for oral step-down therapy.

PubMed

Arnold, John C; Cannavino, Christopher R; Ross, Mindy K; Westley, Ben; Miller, Thomas C; Riffenburgh, Robert H; Bradley, John

2012-10-01

One of the most important decisions in the treatment of osteoarticular infections is the time at which parenteral therapy can be changed to oral therapy. C-reactive protein (CRP) is an acute inflammatory indicator with a half-life of 19 hours and thus can be helpful in assessing the adequacy of therapy for bacterial infections. At our institution, a combination of CRP and clinical findings is used to determine the transition to oral therapy. A search of 8 years of electronic records identified children with osteoarticular infections. Only children with culture-positive acute bacterial arthritis (ABA) or acute bacterial osteomyelitis (ABO) were studied further. A primary chart review of demographic and clinical data was conducted, and a secondary chart review of complicated outcomes was performed. Of 194 total patients, complicated outcomes occurred in 40, of which 35 were prolonged therapy. Only 1 microbiologic failure occurred, presumably due to a retained intra-articular fragment of infected bone. CRP was highest initially among patients with simultaneous ABO + ABA and among those with complicated outcomes, and was lower at the transition to oral therapy in the complicated outcome group (1.5 vs 2.1 mg/dL; P = .012). The combination of clinical findings and CRP is a useful tool to transition children with osteoarticular infections to oral therapy. Complicated outcomes were associated with higher early CRP at diagnosis and lower CRP at the end of parenteral therapy, suggesting that clinicians were more conservative with prolonged initial parenteral therapy in this group.

Duration and route of antibiotic therapy in community-acquired pneumonia: switch and step-down therapy.

PubMed

Cassiere, H A; Fein, A M

1998-03-01

The treatment of hospitalized patients with community-acquired pneumonia (CAP) has traditional been with intravenous antibiotics. More recently, the focus of this antibiotic therapy has been empiric and based on the most likely pathogens in a given patient. The concept of when and how to approach the patient for conversion to oral therapy, known as switch therapy, is now the focus of controversy. Recently, several studies have emerged from the literature that shed some light on the subject of switch therapy for CAP. Although the data are limited at this time, it seems clear that switching to oral antibiotics in selected low-risk patients may be feasible and safe. In this article, we focus on the problem and help formulate a practical approach to switching patients from intravenous antibiotics to oral therapy for CAP.

The role of ferric carboxymaltose in the treatment of iron deficiency anemia in patients with gastrointestinal disease.

PubMed

Koduru, Pramoda; Abraham, Bincy P

2016-01-01

Iron deficiency anemia (IDA) is the most common form of nutritional anemia worldwide. Iron plays a pivotal role in vital functioning of almost every organ system. IDA affects both physical and psychological functioning of humans. Oral iron is considered as first-line therapy for the treatment of IDA due to low cost, good safety profile and ease of administration. However, the absorption of oral iron is affected by several factors and incidence of gastrointestinal side effects can lead to lack of adherence to therapy as well as poor efficacy. This has led to the emergence of intravenous iron therapy which is clearly superior to oral iron with higher increment of hemoglobin levels and rapid replenishment of iron stores. Ferric carboxymaltose (FCM) is a novel non-dextran intravenous iron form which has been approved for use in patients with iron deficiency who have had inadequate response to oral iron therapy, intolerance to oral iron, or nondialysis-dependent chronic kidney disease. The safety and efficacy of using FCM for the treatment of IDA has been demonstrated in several clinical trials. One dose can provide a large amount of iron and has a very short infusion time. It should be considered as first-line therapy in patients with active inflammation like inflammatory bowel disease when gastrointestinal absorption of oral iron may be compromised. It should also be given to patients who have inadequate response to oral iron therapy. It has been shown to be noninferior to other intravenous iron formulations with a good safety profile and produced fewer anaphylactic reactions.

Exchange transfusion as a life-saving intervention in three patients with different haematological malignancies with severe hyperleukocytosis where leukapheresis was not available.

PubMed

Barrett, Claire L; Louw, Vernon J; Webb, Michael J

2013-12-01

Hyperleukocytosis is a rare but potentially serious complication of haematological malignancies. It is usually treated with rehydration, prevention of tumour lysis syndrome and the administration of cytotoxic therapy. Leukapheresis may be life-saving in emergency cases. In this article we describe how, in a resource-limited setting where leukapheresis was not available, manual exchange transfusion was utilised as a life-saving intervention in three patients with different haematological malignancies complicated by hyperleukocytosis. Further we outline the procedure that was carried out and evaluated possible complications associated with this rarely used practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

Influence of ensiling, exogenous protease addition, and bacterial inoculation on fermentation profile, nitrogen fractions, and ruminal in vitro starch digestibility in rehydrated and high-moisture corn.

PubMed

Ferraretto, L F; Fredin, S M; Shaver, R D

2015-10-01

Exogenous protease addition may be an option to increase proteolysis of zein proteins and thus starch digestibility in rehydrated and high-moisture corn (HMC) ensiled for short periods. In addition, microbial inoculation may accelerate fermentation and increase acid production and thus increase solubilization of zein proteins. Four experiments were performed to evaluate the effect on fermentation profile, N fractions, and ruminal in vitro starch digestibility (ivSD) of the following: (1) rehydration and ensiling of dry ground corn; (2) exogenous protease addition to rehydrated un-ensiled and ensiled corn; (3) exogenous protease addition or inoculation in rehydrated ensiled corn; and (4) exogenous protease addition or inoculation in HMC. Experiments 1, 2, and 3 were performed with 7 treatments: dry ground corn (DGC); DGC rehydrated to a targeted dry matter content of 70% (REH); REH treated with exogenous protease (REH+); REH ensiled for 30 d (ENS); ENS treated with exogenous protease (ENS+); ENS treated with a microbial inoculant containing Lactobacillus plantarum, Lactobacillus casei, Enterococcus faecium, and Pediococcus sp. (ENSI); and ENS treated with exogenous protease and microbial inoculant (ENSI+). Experiment 1 compared DGC, REH, and ENS with ivSD being greater for ENS (64.9%) than DGC and REH (51.7% on average). Experiment 2 compared REH and ENS without or with exogenous protease addition (REH+ and ENS+, respectively). Ensiling and exogenous protease addition increased ivSD, but exogenous protease addition was more effective in ENS than REH (6.4 vs. 2.6 percentage unit increase). Experiment 3 compared the effects of exogenous protease addition and inoculation in ENS corn (ENS, ENS+, ENSI, and ENSI+). The addition of protease, but not inoculant, increased ivSD. Inoculation reduced pH and acetate, propionate, and ethanol concentrations, and increased lactate and total acid concentrations. In experiment 4, 8 treatments were a combination of HMC noninoculated or inoculated with 1 of 3 microbial inoculants and with or without exogenous protease addition. The inoculant treatments contained (1) Lactobacillus buchneri 40788 and Pediococcus pentosaceus, (2) L. buchneri 40788, and (3) a mixture of P. pentosaceus and Propionibacterium freudenreichii. Protease, but not inoculation, increased ivSD by 7.5 percentage units (44.4 vs. 51.9%). Protease addition increased ivSD in rehydrated corn and HMC. Microbial inoculation improved fermentation profiles but did not affect ivSD. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

[Contribution of Perioperative Oral Health Care and Management for Patients who Underwent General Thoracic Surgery].

PubMed

Saito, Hajime; Minamiya, Yoshihiro

2016-01-01

Due to the recent advances in radiological diagnostic technology, the role of video-assisted thoracoscopic surgery in thoracic disease has expanded, surgical indication extended to the elderly patients. Cancer patients receiving surgery, radiation therapy and/or chemotherapy may encounter complications in conjunction with the oral cavity such as aspiration pneumonia, surgical site infection and various type of infection. Recently, it is recognized that oral health care management is effective to prevent the postoperative infectious complications, especially pneumonia. Therefore, oral management should be scheduled before start of therapy to prevent these complications as supportive therapy of the cancer treatment. In this background, perioperative oral function management is highlighted in the remuneration for dental treatment revision of 2012,and the importance of oral care has been recognized in generally. In this manuscript, we introduce the several opinions and evidence based on the recent previous reports about the perioperative oral health care and management on thoracic surgery.

Cyclosporine therapy in inflammatory bowel disease: short-term and long-term results.

PubMed

Gurudu, S R; Griffel, L H; Gialanella, R J; Das, K M

1999-09-01

Intravenous cyclosporine therapy followed by oral cyclosporine therapy reduce the need for urgent surgery in steroid-refractory inflammatory bowel disease (IBD). Our objective is to report short- and long-term results of cyclosporine therapy in IBD patients. Thirteen patients with steroid-refractory IBD, seven patients with ulcerative colitis (UC), and six patients with Crohn's disease (CD) were treated with intravenous cyclosporine (4 mg/kg/day) for a mean period of 11.4+/-2.8 days (range, 4-15 days). Subsequently the patients were started on oral cyclosporine (8 mg/kg/day) and followed for a mean of 10.3+/-10 months (range, 1-30 months). Twelve patients responded to intravenous cyclosporine therapy. One patient with UC developed sepsis on the fourth day of intravenous cyclosporine therapy and needed urgent colectomy. Nine of 12 initial responders (6 patients with UC and 3 patients with CD) relapsed during follow-up despite oral cyclosporine and underwent elective surgery. One patient with CD relapsed 3 months after discontinuation of oral cyclosporine. Only two patients with CD are in long-term remission. There were no long-term side effects in any of the 13 treated patients. In conclusion, intravenous cyclosporine was effective in inducing remission or significant improvement in 12 of 13 patients with steroid-refractory IBD. However, with subsequent oral cyclosporine the remission could be maintained only for a short while. Each of the six patients with UC needed colectomy and three of the five patients with CD had intestinal resection within 12 months despite oral cyclosporine therapy.

The Effects of Rapid Weight Loss and Attempted Rehydration on Strength and Endurance of the Handgripping Muscles in College Wrestlers.

ERIC Educational Resources Information Center

Serfass, Robert C.; And Others

1984-01-01

Because of the continued prevalence of rapid weight reduction by wrestlers, this study attempted to determine if college wrestlers' strength and muscular endurance were affected by either rehydration or dehydration. Results showed that a loss of five percent of body weight over three days did not affect strength or endurance levels. (JMK)

Dehydration and Rehydration

DTIC Science & Technology

2012-01-01

ELEMENT NUMBER 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 6. AUTHOR(S) 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ...ability to perform .84 This chapter presents an overview of topics surrounding hydration, dehydration, and rehydration. The terms euhydration, hypohydration...environments, or illness, inability to maintain fluid balance can seriously jeopardize health and the ability to perform .84 This chapter presents an overview

Effects of rehydration on +Gz tolerance after 14-days' bed rest.

NASA Technical Reports Server (NTRS)

Greenleaf, J. E.; Van Beaumont, W.; Bernauer, E. M.; Haines, R. F.; Sandler, H.; Staley, R. W.; Young, H. L.; Yusken, J. W.

1973-01-01

Investigation of the magnitude of reduction in human tolerance to centrifugation following 2 weeks of bed rest with moderate daily exercise. The degree of hypovolemia associated with these exposures is assessed, and the possibility to improve or to return to control levels the tolerance to acceleration forces acting in the head-to-foot direction through rehydration prior to acceleration is explored.

Treatment of neonatal calf diarrhea with an oral electrolyte solution supplemented with psyllium mucilloid.

PubMed

Cebra, M L; Garry, F B; Cebra, C K; Adams, R; McCann, J P; Fettman, M J

1998-01-01

Dairy calves under 14 days of age with naturally occurring, uncomplicated diarrhea were treated for 3 days with a hypertonic oral electrolyte solution with (n = 15) or without (n = 12) psyllium. Clinical response and clinical pathology data were compared between the 2 groups. Glucose absorption was evaluated on days 1 and 3 by measurement of plasma glucose and lactate and serum insulin concentrations for 4 hours after formula administration. On day 1, glucose, lactate, and insulin concentrations were lower in psyllium-fed calves than in control calves, with significant differences noted in glucose and lactate concentrations at several time points (P < 0.05). Plasma lactate concentrations were higher at several times in both treatment groups on day 3 than on day 1 (P < 0.05). Fecal consistency was markedly different in psyllium-fed calves as compared with control calves within 24 hours of psyllium supplementation. Fecal percent dry matter content was lower in psyllium-fed calves than in control calves at least once a day during supplementation and on day 3 compared with day 0 in the psyllium-fed calves (P < 0.05). There were no significant differences in clinical performance scores, hydration status, arterial blood gas, serum anion gap, electrolyte, or total CO2 concentrations. Addition of psyllium to an oral electrolyte solution resulted in immediate alterations in glucose absorption without impairing rehydration in diarrheic calves, but differences were transient and did not affect clinical outcome.

Cholera Mortality during Urban Epidemic, Dar es Salaam, Tanzania, August 16, 2015–January 16, 20161

PubMed Central

Massay, Amani Elibariki; Narra, Rupa; Mghamba, Janneth; Mohamed, Ahmed Abade; Kishimba, Rogath Saika; Urio, Loveness John; Rusibayamila, Neema; Magembe, Grace; Bakari, Muhammud; Gibson, James J.; Eidex, Rachel Barwick; Quick, Robert E.

2017-01-01

In 2015, a cholera epidemic occurred in Tanzania; most cases and deaths occurred in Dar es Salaam early in the outbreak. We evaluated cholera mortality through passive surveillance, burial permits, and interviews conducted with decedents’ caretakers. Active case finding identified 101 suspected cholera deaths. Routine surveillance had captured only 48 (48%) of all cholera deaths, and burial permit assessments captured the remainder. We interviewed caregivers of 56 decedents to assess cholera management behaviors. Of 51 decedents receiving home care, 5 (10%) used oral rehydration solution after becoming ill. Caregivers reported that 51 (93%) of 55 decedents with known time of death sought care before death; 16 (29%) of 55 delayed seeking care for >6 h. Of the 33 (59%) community decedents, 20 (61%) were said to have been discharged from a health facility before death. Appropriate and early management of cholera cases can reduce the number of cholera deaths. PMID:29155665

Maternal understanding of diarrhoea-related dehydration and its influence on ORS use in Indonesia.

PubMed

MacDonald, S E; Moralejo, M N D G; Matthews, M K

2007-01-01

Dehydration resulting from diarrhoea remains a significant cause of death for young children in developing countries such as Indonesia. Although Oral Rehydration Solution (ORS) is effective in preventing and treating dehydration, its use in home treatment is not widespread. This study sought to assess whether mothers' understanding of diarrhoea-related dehydration influenced their use of ORS in home treatment. One hundred mothers of children under the age of five years in rural Indonesia were surveyed using a structured questionnaire, administered in an interview format in their homes. Only 38 (38%) of the mothers surveyed could identify two or more correct signs of dehydration. Significant relationship was found between maternal knowledge of correct signs of dehydration and the use of ORS in home treatment (OR 3.36, 95% CI 1.24, 10.63). Resulting recommendations include improved health education programming for mothers of young children, as well as future programme evaluation and intervention studies.

Cardiovascular deconditioning during space flight and the use of saline as a countermeasure to orthostatic intolerance

NASA Technical Reports Server (NTRS)

Bungo, M. W.; Charles, J. B.; Johnson, P. C., Jr.

1985-01-01

Results are reported of trials with oral hydration by astronauts before reentry of the Orbiter. The experiments were run to evaluate hydration as a means of offsetting the loss of lower body negative pressure experienced after several days in space. The rehydration was carried out by 17 astronauts who ingested salt tablets and water prior to the end of the first eight STS mission orbital phases; nine astronauts abstained. Pulse and blood pressure data were collected from 1-2 hr post landing. Measurements were also made of the extent of cardiac deconditioning and the response to orthostatic stress (standing). Ingestion of the salt tablets reduced the heart rate response to stress an average of 29 percent. The statistical significance of the difference has encouraged adoption of the salt tablet countermeasure as an operational procedure by Shuttle astronauts.

Dynamics of leaf hydraulic conductance with water status: quantification and analysis of species differences under steady state

PubMed Central

Scoffoni, Christine; McKown, Athena D.; Rawls, Michael; Sack, Lawren

2012-01-01

Leaf hydraulic conductance (Kleaf) is a major determinant of photosynthetic rate in well-watered and drought-stressed plants. Previous work assessed the decline of Kleaf with decreasing leaf water potential (Ψleaf), most typically using rehydration kinetics methods, and found that species varied in the shape of their vulnerability curve, and that hydraulic vulnerability correlated with other leaf functional traits and with drought sensitivity. These findings were tested and extended, using a new steady-state evaporative flux method under high irradiance, and the function for the vulnerability curve of each species was determined individually using maximum likelihood for 10 species varying strongly in drought tolerance. Additionally, the ability of excised leaves to recover in Kleaf with rehydration was assessed, and a new theoretical framework was developed to estimate how rehydration of measured leaves may affect estimation of hydraulic parameters. As hypothesized, species differed in their vulnerability function. Drought-tolerant species showed shallow linear declines and more negative Ψleaf at 80% loss of Kleaf (P80), whereas drought-sensitive species showed steeper, non-linear declines, and less negative P80. Across species, the maximum Kleaf was independent of hydraulic vulnerability. Recovery of Kleaf after 1 h rehydration of leaves dehydrated below their turgor loss point occurred only for four of 10 species. Across species without recovery, a more negative P80 correlated with the ability to maintain Kleaf through both dehydration and rehydration. These findings indicate that resistance to Kleaf decline is important not only in maintaining open stomata during the onset of drought, but also in enabling sustained function during drought recovery. PMID:22016424

An organ-specific role for ethylene in rose petal expansion during dehydration and rehydration

PubMed Central

Liu, Daofeng; Liu, Xiaojing; Meng, Yonglu; Sun, Cuihui; Tang, Hongshu; Jiang, Yudong; Khan, Muhammad Ali; Xue, Jingqi; Ma, Nan; Gao, Junping

2013-01-01

Dehydration is a major factor resulting in huge loss from cut flowers during transportation. In the present study, dehydration inhibited petal cell expansion and resulted in irregular flowers in cut roses, mimicking ethylene-treated flowers. Among the five floral organs, dehydration substantially elevated ethylene production in the sepals, whilst rehydration caused rapid and elevated ethylene levels in the gynoecia and sepals. Among the five ethylene biosynthetic enzyme genes (RhACS1–5), expression of RhACS1 and RhACS2 was induced by dehydration and rehydration in the two floral organs. Silencing both RhACS1 and RhACS2 significantly suppressed dehydration- and rehydration-induced ethylene in the sepals and gynoecia. This weakened the inhibitory effect of dehydration on petal cell expansion. β-glucuronidase activity driven by both the RhACS1 and RhACS2 promoters was dramatically induced in the sepals, pistil, and stamens, but not in the petals of transgenic Arabidopsis. This further supports the organ-specific induction of these two genes. Among the five rose ethylene receptor genes (RhETR1–5), expression of RhETR3 was predominantly induced by dehydration and rehydration in the petals. RhETR3 silencing clearly aggravated the inhibitory effect of dehydration on petal cell expansion. However, no significant difference in the effect between RhETR3-silenced flowers and RhETR-genes-silenced flowers was observed. Furthermore, RhETR-genes silencing extensively altered the expression of 21 cell expansion-related downstream genes in response to ethylene. These results suggest that induction of ethylene biosynthesis by dehydration proceeds in an organ-specific manner, indicating that ethylene can function as a mediator in dehydration-caused inhibition of cell expansion in rose petals. PMID:23599274

The effects of dehydration, moderate alcohol consumption, and rehydration on cognitive functions.

PubMed

Irwin, Christopher; Leveritt, Michael; Shum, David; Desbrow, Ben

2013-05-01

This study investigated the impact of mild-moderate dehydration on alcohol-induced deteriorations in cognitive functions. Sixteen healthy males participated in a single-blind, placebo-controlled cross-over design study involving 4 experimental trials (separated by ≥7 d). In each trial, participants were dehydrated by 2.5% body mass through exercise. After 1 h recovery in a thermo-neutral environment (22 ± 2 °C, 60-70% relative humidity) 4 tasks from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered to the participants (test 1). In two of the trials, participants were provided with water equivalent to either 50% or 150% body mass loss and given salt (NaCl) capsules (50 mmol/L). A set volume of alcohol or placebo was then consumed in each trial, incorporating the conditions: dehydration-placebo (DP), dehydration-alcohol (DA), partial rehydration-alcohol (PA), and full rehydration-alcohol (FA). The same 4 CANTAB tasks were then re-administered (test 2). Subjective ratings of mood and estimates of alcohol intoxication and driving impairment were also recorded in each trial. Alcohol consumption caused deterioration on 3 of the 4 CANTAB measures (viz., choice reaction time, executive function and response inhibition). This reduction in performance was exacerbated when participants were dehydrated compared to trials where full rehydration occurred. Subjective ratings of impairment and intoxication were not significantly different between any of the trials where alcohol was consumed; however ratings for alcohol trials were significantly higher than in the placebo trial. These findings suggest that rehydration after exercise that causes fluid loss can attenuate alcohol-related deterioration of cognitive functions. This may pose implications for post match fluid replacement if a moderate amount of alcohol is also consumed. Copyright © 2013 Elsevier Inc. All rights reserved.

Open sun drying of green bean: influence of pretreatments on drying kinetics, colour and rehydration capacity

NASA Astrophysics Data System (ADS)

İsmail, Osman; Kantürk Figen, Aysel; Pişkin, Sabriye

2017-04-01

Green bean ( Phaseolus Vulgaris L), classified under legume family, is a primary source of dietary protein in human diets especially in the agricultural countries. Green bean is susceptible to rapid deterioration because of their high moisture content and in order to prevent and present the green bean drying process is applied. In this study, effects of pretreatments on drying kinetics, colour and rehydration capacity of green bean were investigated. It was observed that the pretreatment affected the drying time. The shortest drying times were obtained from pretreated samples with blanched. Drying times were determined as 47, 41 and 29 h for natural, salted and blanch, respectively. The results showed that pretreatment and ambient temperature significantly ( P = 0.05) affected the drying rate and the drying time. The effective moisture diffusivity was determined by using Fick's second law and was found to be range between 3.15 × 10-10 and 1.2 × 10-10 m2/s for the pre-treated and natural green bean samples. The rehydration values were obtained 2.75, 2.71, 2.29 (g water/g dry matter) for the blanched, salted and natural samples. The effective diffusion coefficients were calculated using the data collected during the falling rate period and the experimental data are fitted to seven thin layer drying models which found in the literature. The Logarithmic model was found to best describe the drying behavior of fresh green beans under open air sun. Rehydration time and color parameters had been determined in order to improve the quality of dried green bean. Regarding with rehydration time and colour data, the best results were obtained at blanched drying conditions.

Effects of a moderate intake of beer on markers of hydration after exercise in the heat: a crossover study.

PubMed

Jiménez-Pavón, David; Cervantes-Borunda, Mónica Sofía; Díaz, Ligia Esperanza; Marcos, Ascensión; Castillo, Manuel J

2015-01-01

Exercise in the heat causes important water and electrolytes losses through perspiration. Optimal rehydration is crucial to facilitate the recuperation process after exercise. The aim of our study was to examine whether a moderate beer intake as part of the rehydration has any negative effect protocol after a short but dehydrating bout of exercise in the heat. Sixteen active male (VO2max, 56 ± 4 mL/kg/min), were included in a crossover study and performed a dehydrating exercise (≤1 h running, 60 %VO2max) twice and 3 weeks apart, in a hot laboratory setting (35 ± 1 °C, humidity 60 ± 2 %). During the two hours following the exercise bouts participants consumed either mineral water ad-libitum (W) or up to 660 ml regular beer followed by water ad-libitum (BW). Body composition, hematological and serum parameters, fluid balance and urine excretion were assessed before, after exercise and after rehydration. Body mass (BM) decreased (both ~ 2.4%) after exercise in both trials. After rehydration, BM and fat free mass significantly increased although BM did not return to baseline levels (BM, 72.6 ± 6.7 to 73.6 ± 6.9; fat free mass, 56.9 ± 4.7 to 57.5 ± 4.5, no differences BW vs W). Beer intake did not adversely affect any measured parameter. Fluid balance and urine excretion values did not differ between the rehydration strategies. After exercise and subsequent water losses, a moderate beer (regular) intake has no deleterious effects on markers of hydration in active individuals.

Non-invasive estimation of hydration status changes through tear fluid osmolarity during exercise and post-exercise rehydration.

PubMed

Ungaro, Corey T; Reimel, Adam J; Nuccio, Ryan P; Barnes, Kelly A; Pahnke, Matthew D; Baker, Lindsay B

2015-05-01

To determine if tear fluid osmolarity (Tosm) can track changes in hydration status during exercise and post-exercise rehydration. Nineteen male athletes (18-37 years, 74.6 ± 7.9 kg) completed two randomized, counterbalanced trials; cycling (~95 min) with water intake to replace fluid losses or water restriction to progressively dehydrate to 3 % body mass loss (BML). After exercise, subjects drank water to maintain body mass (water intake trials) or progressively rehydrate to pre-exercise body mass (water restriction trials) over a 90-min recovery period. Plasma osmolality (Posm) and Tosm measurements (mean of right and left eyes) were taken pre-exercise, during rest periods between exercise bouts corresponding to 1, 2, and 3 % BML, and rehydration at 2, 1, and 0 % BML. During exercise mean (± SD) Tosm was significantly higher in water restriction vs. water intake trials at 1 % BML (299 ± 9 vs. 293 ± 9 mmol/L), 2 % BML (301 ± 9 vs. 294 ± 9 mmol/L), and 3 % BML (302 ± 9 vs. 292 ± 8 mmol/L). Mean Tosm progressively decreased during post-exercise rehydration and was not different between trials at 1 % BML (291 ± 8 vs. 290 ± 7 mmol/L) and 0 % BML (288 ± 7 vs. 289 ± 8 mmol/L). Mean Tosm tracked changes in hydration status similar to that of mean Posm; however, the individual responses in Tosm to water restriction and water intake was considerably more variable than that of Posm. Tosm is a valid indicator of changes in hydration status when looking at the group mean; however, large differences among subjects in the Tosm response to hydration changes limit its validity for individual recommendations.

Effect of milk protein addition to a carbohydrate-electrolyte rehydration solution ingested after exercise in the heat.

PubMed

James, Lewis J; Clayton, David; Evans, Gethin H

2011-02-01

The present study examined the effects of milk protein on rehydration after exercise in the heat, via the comparison of energy- and electrolyte content-matched carbohydrate and carbohydrate-milk protein solutions. Eight male subjects lost 1·9 (SD 0·2) % of their body mass by intermittent exercise in the heat and rehydrated with 150% of their body mass loss with either a 65 g/l carbohydrate solution (trial C) or a 40 g/l carbohydrate, 25 g/l milk protein solution (trial CP). Urine samples were collected before and after exercise and for 4 h after rehydration. Total cumulative urine output after rehydration was greater for trial C (1212 (SD 310) ml) than for trial CP (931 (SD 254) ml) (P < 0·05), and total fluid retention over the study was greater after ingestion of drink CP (55 (SD 12) %) than that after ingestion of drink C (43 (SD 15) %) (P < 0·05). At the end of the study period, whole body net fluid balance (P < 0·05) was less negative for trial CP (-0·26 (SD 0·27) litres) than for trial C (-0·52 (SD 0·30) litres), and although net negative for both the trials, it was only significantly negative after ingestion of drink C (P < 0·05). The results of the present study suggest that when matched for energy density and fat content, as well as for Na and K concentration, and when ingested after exercise-induced dehydration, a carbohydrate-milk protein solution is better retained than a carbohydrate solution. These results suggest that gram-for-gram, milk protein is more effective at augmenting fluid retention than carbohydrate.

Effects of Post-Exercise Honey Drink Ingestion on Blood Glucose and Subsequent Running Performance in the Heat

PubMed Central

Ahmad, Nur Syamsina; Ooi, Foong Kiew; Saat Ismail, Mohammed; Mohamed, Mahaneem

2015-01-01

Background: Glycogen depletion and hypoglycemia have been associated with fatigue and decrement of performance during prolonged exercise Objectives: This study investigated the effectiveness of Acacia honey drink as a post-exercise recovery aid on glucose metabolism and subsequent running performance in the heat. Patients and Methods: Ten subjects participated in this randomized cross-over study. All subjects performed 2 trials. In each trial, all subjects went through a glycogen depletion phase (Run-1), 2-hour rehydration phase and time trial running phase (Run-2). In Run-1, subjects were required to run on a treadmill at 65% VO2max in the heat (31°C, 70% relative humidity) for 60 min. During 2-hour rehydration phase, subjects drank either plain water (PW) or honey drink (HD) with amount equivalent to 150% of body weight loss in 3 boluses (60%, 50% and 40% subsequently) at 0, 30 and 60 min. In Run-2, the longest distance covered in 20 min was recorded for determining running performance. Two-way repeated measured ANOVA and paired t-test were used for analysis. Results: Running distance in Run-2 covered by the subjects in the honey drink HD trial (3420 ± 350 m) was significantly (P < 0.01) longer compared to plain water PW trial (3120 ± 340 m). In general, plasma glucose, serum insulin and osmolality were significantly (P < 0.05) higher in HD compared to PW during the rehydration phase and Run-2. Conclusions: These findings indicate that rehydration with honey drink improves running performance and glucose metabolism compared to plain water in the heat. Thus, honey drink can be recommended for rehydration purpose for athletes who compete in the heat. PMID:26448850

Our experience using primary oral antibiotics in the management of orbital cellulitis in a tertiary referral centre.

PubMed

Cannon, P S; Mc Keag, D; Radford, R; Ataullah, S; Leatherbarrow, B

2009-03-01

Orbital cellulitis is conventionally managed by intravenous (i.v.) antibiotic therapy, followed by oral antibiotics once the infection shows signs of significant improvement. We report 4 years of experience using primary oral ciprofloxacin and clindamycin in cases of orbital cellulitis. Oral ciprofloxacin and clindamycin have a similar bioavailability to the i.v. preparations and provide an appropriate spectrum of antibiotic cover for the pathogens responsible for orbital cellulitis. A retrospective review was performed that identified all patients with orbital cellulitis and treated with primary oral antibiotic therapy admitted to the Manchester Royal Eye Hospital between March 2003 and March 2007. Age, stage of disease, surgical intervention, hospital duration, and complications were obtained. A comparison was made with patients admitted to our unit with orbital cellulitis and treated with primary i.v. antibiotics between March 2000 and March 2003. Nineteen patients were included in the review for the period March 2003 to March 2007, which comprised of 7 children and 12 adults. Five patients required surgical intervention. All patients responded to the oral regimen, 18 patients had no change to their oral antibiotic therapy. Mean hospital stay was 4.4 days. There were no complications. Empirical oral ciprofloxacin and clindamycin combination may be as safe and effective as i.v. therapy in the management of orbital cellulitis. Oral treatment can offer the advantages of rapid delivery of the first antibiotic dose, fewer interruptions in treatment, and simplified delivery of medication particularly in children.

[Drug-induced oral ulcerations].

PubMed

Madinier, I; Berry, N; Chichmanian, R M

2000-06-01

Different side effects of drugs have been described in the oral cavity, including oral ulcerations. Direct contact between drugs and oral mucosa may induce chemical burn or local hypersensitivity. Less frequently, these drug-induced oral ulcerations are part of a complex reaction with cutaneous or systemic manifestations. Sometimes, one or more oral ulcerations appear as the main side-effect of a drug, or exceptionally as solitary lesions. Solitary oral ulcerations usually appear after few weeks of treatment. In most of cases, these lesions resist to conventional treatments, with a rapid healing following the suppression of the responsible drug. This diagnosis is usually difficult, particularly with patients receiving multiple drug therapy. Besides, special attention must be paid to new drugs. Oral ulcerations following symptoms of burning mouth, metallic taste, dysgueusia or agueusia are strongly suggestive of a pharmacological origin. Most of the molecules able to induce solitary oral ulcerations are commonly prescribed in a) rheumatology: NSAI (diclofenac, flurbiprofen, indomethacin, naproxen), long-term rheumatoid arthritis therapy (azathioprine, methotrexate, penicillamine, gold compounds, tiopronin); b) cardiology: angiotensin-converting-enzyme inhibitors (captopril, enalapril), angiotensin 2-receptor antagonist (losartan), anti-angorous (nicorandil), c) psychiatry: antidepressants (fluoxetine, lithium), d) AIDS therapy (foscarnet, zalcitabine).

Patterned orocutaneous therapy improves sucking and oral feeding in preterm infants

PubMed Central

Poore, M; Zimmerman, E; Barlow, SM; Wang, J; Gu, F

2008-01-01

Aim To determine whether NTrainer patterned orocutaneous therapy affects preterm infants' non-nutritive suck and/or oral feeding success. Subjects Thirty-one preterm infants (mean gestational age 29.3 weeks) who demonstrated minimal non-nutritive suck output and delayed transition to oral feeds at 34 weeks post-menstrual age. Intervention NTrainer treatment was provided to 21 infants. The NTrainer promotes non-nutritive suck output by providing patterned orocutaneous stimulation through a silicone pacifier that mimics the temporal organization of suck. Method Infants' non-nutritive suck pressure signals were digitized in the NICU before and after NTrainer therapy and compared to matched controls. Non-nutritive suck motor pattern stability was calculated based on infants' time- and amplitude-normalized digital suck pressure signals, producing a single value termed the Non-Nutritive Suck Spatiotemporal Index. Percent oral feeding was the other outcome of interest, and revealed the NTrainer's ability to advance the infant from gavage to oral feeding. Results Multilevel regression analyses revealed that treated infants manifest a disproportionate increase in suck pattern stability and percent oral feeding, beyond that attributed to maturational effects alone. Conclusion The NTrainer patterned orocutaneous therapy effectively accelerates non-nutritive suck development and oral feeding success in preterm infants who are at risk for oromotor dysfunction. PMID:18462468

Outpatient management of oral vitamin K antagonist therapy: defining and measuring high-quality management.

PubMed

Phillips, Katherine W; Ansell, Jack

2008-01-01

Oral anticoagulation therapy with warfarin is the mainstay of prevention and treatment of thromboembolic disease. However, it remains one of the leading causes of harmful medication errors and medication-related adverse events. The beneficial outcomes of oral anticoagulation therapy are directly dependent upon the quality of dose and anticoagulation management, but the literature is not robust with regards to what constitutes such management. This review focuses on, and attempts to define, the parameters of high-quality anticoagulation management and identifies the appropriate outcome measures constituting high-quality management. Elements discussed include the most fundamental measure, time in therapeutic range, along with other parameters including therapy initiation, time to therapeutic range, dosing management when patients are not in therapeutic range, perioperative dosing management, patient education, and other important outcome measures. Healthcare providers who manage oral anticoagulation therapy should utilize these parameters as a measure of their performance in an effort to achieve high-quality anticoagulation management.

Comparison of Intravenous/Oral Ciprofloxacin Plus Metronidazole Versus Piperacillin/Tazobactam in the Treatment of Complicated Intraabdominal Infections

PubMed Central

Cohn, Stephen M.; Lipsett, Pamela A.; Buchman, Timothy G.; Cheadle, William G.; Milsom, Jeffery W.; O’Marro, Steven; Yellin, Albert E.; Jungerwirth, Steven; Rochefort, Estela V.; Haverstock, Daniel C.; Kowalsky, Steven F.

2000-01-01

Objective To compare the safety and efficacy of intravenous (IV) ciprofloxacin plus IV metronidazole (CIP+MET) with that of IV piperacillin/tazobactam (PIP/TAZO) in adults with complicated intraabdominal infections, and to compare the efficacy of sequential IV-to-oral CIP+MET therapy with that of the IV CIP-only regimen. Summary Background Data Treatment of intraabdominal infections remains a challenge, mainly because of their polymicrobial etiology and attendant death and complications. Antimicrobial regimens using sequential IV-to-oral therapy may reduce the length of hospital stay. Methods In this multicenter, randomized, double-blind trial involving 459 patients, clinically improved IV-treated patients were switched to oral therapy after 48 hours. Overall clinical response was the primary efficacy measurement. Results A total of 282 patients (151 CIP+MET, 131 PIP/TAZO) were valid for efficacy. Of these patients, 64% CIP+MET and 57% PIP/TAZO patients were considered candidates for oral therapy. Patients had a mean APACHE II score of 9.6. The most common diagnoses were appendicitis (33%), other intraabdominal infection (29%), and abscess (25%). Overall clinical resolution rates were statistically superior for CIP+MET (74%) compared with PIP/TAZO (63%). Corresponding rates in the subgroup suitable for oral therapy were 85% for CIP+MET and 70% for PIP/TAZO. Postsurgical wound infection rates were significantly lower in CIP+MET (11%) versus PIP/TAZO patients (19%). Mean length of stay was 14 days for CIP+MET and 17 days for PIP/TAZO patients. Conclusion CIP+MET, initially administered IV and followed by CIP+MET oral therapy, was clinically more effective than IV PIP/TAZO for the treatment of patients with complicated intraabdominal infections. PMID:10903605

Randomized controlled trial comparing oral amoxicillin-clavulanate and ofloxacin with intravenous ceftriaxone and amikacin as outpatient therapy in pediatric low-risk febrile neutropenia.

PubMed

Gupta, Ajay; Swaroop, Chetanya; Agarwala, Sandeep; Pandey, Ravindra Mohan; Bakhshi, Sameer

2009-09-01

Outpatient oral therapy is infrequently used in pediatric low-risk febrile neutropenia (LRFN) as there is insufficient data regarding its equivalence as compared with parenteral therapy. This is a single institutional, randomized control trial in pediatric LRFN aged 2 to 15 years, in which 123 episodes in 88 patients were randomized to outpatient oral ofloxacin 7.5 mg/kg 12 hourly and amoxycillin-clavulanate 12.5 mg/kg 8 hourly or outpatient intravenous (IV) ceftriaxone 75 mg/kg and amikacin 15 mg/kg once daily after blood cultures. Out of 119 evaluable episodes, one-third were leukemia patients in maintenance and rest were solid tumors. Success was achieved in 55/61 (90.16%) and 54/58 (93.1%) in oral and IV arms, respectively, (P=0.56). There were 3 hospitalizations but no mortality. Median days to resolution of fever, absolute neutrophil count >500/mm(3) and antibiotic use were 3, 5, and 6 days in both arms. There were 5 blood culture isolates (3 gram-positive and 2 gram-negative bacteria). Failure of outpatient therapy was associated with perianal infections, bacteremia, febrile neutropenia onset before day 9 of chemotherapy in solid tumors and Vincristine, actinomycin-D, and cyclophosphamide chemotherapy for rhabdomyosarcoma. All gram-positive isolates were successes, whereas both gram-negative isolates were failures. Diarrhea in IV arm and Vincristine, actinomycin-D, and cyclophosphamide chemotherapy in the oral arm predicted failure in subgroup analysis. Outpatient therapy is efficacious and safe in pediatric LRFN. There was no difference in outcome in oral versus IV outpatient therapy. Amoxycillin-clavulanate and ofloxacin may be the oral regimen of choice.

The effect of low level laser therapy in different wavelengths in the treatment of oral mucositis—proposal for extra-oral implementation

NASA Astrophysics Data System (ADS)

Moraes, J. J. C.; Queiroga, A. S.; de Biase, R. C. C. G.; Leite, E. P.; Cabral Júnior, C. R.; Limeira Júnior, F. A.

2009-09-01

The oral mucositis is the most frequent acute oral complication resulting from antineoplastic treatment and may worsen the clinical condition of the patient and interfere with his/her quality of life. This study aimed to comparatively evaluate, from a clinical point of view, the effect of Laser Therapy λ660 nm (wavelength of the red Laser) and λ830 nm (wavelength of the infrared Laser), at extra-oral points, in remission of severity of oral mucositis and pain associated with it in pediatric oncological patients undergoing chemotherapy with the anticancer drug methotrexate, noting which of the two wavelength is the most appropriate to this new technique. The sample consisted of 13 patients placed at random in each group and subjected to sessions of Low Level Laser Therapy, at pre-determined extra-oral points for five consecutive days, starting at the beginning of the observation of mucositis injuries. It became possible to note that from the group of patients in the group of Laser λ830 nm ( n = 6; 46.15%), four ( n = 4; 66.67%) of these patients had remission of injuries to grade 0 (WHO), and as for pain, five patients ( n = 5; 83.33%) showed no painful symptoms for mucositis injuries. In the Laser λ660 nm group ( n = 7; 53.85%), only two patients ( n = 2; 28.57%) achieved a regression of lesions to grade 0 (WHO), while four patients ( n = 4; 57.14%) had no pain. So, the extra-oral application of Laser Therapy was effective in treating injuries of oral mucositis in the patients treated; and Laser Therapy in the infrared spectrum (λ830 nm) was more effective in the treatment of oral mucositis injuries compared to the red spectrum (λ660 nm), which can be explained by the greater power of penetration of infrared rays, acting in a more expressive way in deeper places.

Influence of body mass loss on changes in heart rate during exercise in the heat: a systematic review.

PubMed

Adams, William M; Ferraro, Elizabeth M; Huggins, Robert A; Casa, Douglas J

2014-08-01

The purpose of this review was to compare the changes in heart rate (HR) for every 1% change in body mass loss (ΔBML) in individuals while exercising in the heat. PubMed, SPORTDiscus, ERIC, CINAHL, and Scopus were searched from the earliest entry to February 2013 using the search terms dehydration, heart rate, and exercise in various combinations. Original research articles that met the following criteria were included: (a) valid measure of HR, (b) exercise in the heat (>26.5° C [79.7 °F]), (c) the level of dehydration reached at least 2%, (d) a between-group comparison (a euhydrated group or a graded dehydration protocol) was evident, and (e) for rehydration protocols, only oral rehydration was considered for inclusion. Twenty articles were included in the final analysis. Mean values and SDs for HR and percentage of body mass loss immediately after exercise were used for this review. The mean change in HR for every 1% ΔBML was 3 b·min-1. In trials where subjects arrived euhydrated and hypohydrated, the mean change in HR for every 1% ΔBML was 3 and 3 b·min-1, respectively. Fixed intensity and variable intensity trials exhibited a mean HR change of 4 and 1 b·min-1, respectively. Exercising in the heat while hypohydrated (≥2%) resulted in an increased HR after exercise. This increase in HR for every 1% ΔBML exacerbates cardiovascular strain in exercising individuals, thus causing decrements in performance. It should be encouraged that individuals should maintain an adequate level of hydration to maximize performance, especially in the heat.

An Evaluation of Foods Processed in Tray Pack Versus Two Standard Food Service Containers. Part 2. Nutritional Analyses

DTIC Science & Technology

1986-02-01

glumate Salt Tomatoes, whole Tomato paste, 26% solids Starch* Flour Dehydrated onion pieces, rehydrated Sugar , white Cinnamon Stock...Margarine Hydrolyzed vegetable protein, Nestles 4BE Starch* Vinegar, cider, 40 grain Salt Monosodium glutamate Sugar , white Celery seed, ground...peppers Tomato paste, 26% solids Brown sugar Starch* Dehydrated onion pieces, rehydrated Cider vinegar, 40 grain Salt Monosodium glutamate Liquid

Proteome analysis of Physcomitrella patens exposed to progressive dehydration and rehydration.

PubMed

Cui, Suxia; Hu, Jia; Guo, Shilei; Wang, Jie; Cheng, Yali; Dang, Xinxing; Wu, Lili; He, Yikun

2012-01-01

Physcomitrella patens is an extremely dehydration-tolerant moss. However, the molecular basis of its responses to loss of cellular water remains unclear. A comprehensive proteomic analysis of dehydration- and rehydration-responsive proteins has been conducted using quantitative two-dimensional difference in-gel electrophoresis (2D-DIGE), and traditional 2-D gel electrophoresis (2-DE) combined with MALDI TOF/TOF MS. Of the 216 differentially-expressed protein spots, 112 and 104 were dehydration- and rehydration-responsive proteins, respectively. The functional categories of the most differentially-expressed proteins were seed maturation, defence, protein synthesis and quality control, and energy production. Strikingly, most of the late embryogenesis abundant (LEA) proteins were expressed at a basal level under control conditions and their synthesis was strongly enhanced by dehydration, a pattern that was confirmed by RT-PCR. Actinoporins, phosphatidylethanolamine-binding protein, arabinogalactan protein, and phospholipase are the likely dominant players in the defence system. In addition, 24 proteins of unknown function were identified as novel dehydration- or rehydration-responsive proteins. Our data indicate that Physcomitrella adopts a rapid protein response mechanism to cope with dehydration in its leafy-shoot and basal expression levels of desiccation-tolerant proteins are rapidly upgraded at high levels under stress. This mechanism appears similar to that seen in angiosperm seeds.

The transketolase gene family of the resurrection plant Craterostigma plantagineum: differential expression during the rehydration phase.

PubMed Central

Bernacchia, G; Schwall, G; Lottspeich, F; Salamini, F; Bartels, D

1995-01-01

Transketolases, key enzymes of the reductive and oxidative pentose phosphate pathways, are responsible for the synthesis of sugar phosphate intermediates. Here we report the first molecular analysis of transketolase genes from plants. Three distinct classes of transketolase-encoding cDNA clones were isolated from the desiccation-tolerant resurrection plant Craterostigma plantagineum. One class represented by the transcript tkt3 is constitutively expressed in leaves and roots under all physiological conditions tested. By biochemical analysis and protein sequencing of purified transketolase, it was shown that tkt3 is expressed in three enzymatically active isoforms. An intriguing discovery was that accumulation of the two other transketolase transcripts, tkt7 and tkt10, is preferentially associated with the rehydration process of the desiccated plant; whereas tkt10 is only expressed in leaves, tkt7 was detected in leaves and roots. This observation suggests a possible role for these transketolases in the conversion of sugars, which are a major phenomenon in the rehydration process. Despite an abundant level of tkt7 and tkt10 transcripts in rehydrating leaves, proteins could not be isolated. This is due in part to a translational control mechanism acting on the loading of mRNAs to polysomes. Images PMID:7859749

Water deprivation-induced sodium appetite: humoral and cardiovascular mediators and immediate early genes

NASA Technical Reports Server (NTRS)

De Luca, Laurival A Jr; Xu, Zhice; Schoorlemmer, Guus H M.; Thunhorst, Robert L.; Beltz, Terry G.; Menani, Jose V.; Johnson, Alan Kim

2002-01-01

Adult rats deprived of water for 24-30 h were allowed to rehydrate by ingesting only water for 1-2 h. Rats were then given access to both water and 1.8% NaCl. This procedure induced a sodium appetite defined by the operational criteria of a significant increase in 1.8% NaCl intake (3.8 +/- 0.8 ml/2 h; n = 6). Expression of Fos (as assessed by immunohistochemistry) was increased in the organum vasculosum of the lamina terminalis (OVLT), median preoptic nucleus (MnPO), subfornical organ (SFO), and supraoptic nucleus (SON) after water deprivation. After rehydration with water but before consumption of 1.8% NaCl, Fos expression in the SON disappeared and was partially reduced in the OVLT and MnPO. However, Fos expression did not change in the SFO. Water deprivation also 1) increased plasma renin activity (PRA), osmolality, and plasma Na+; 2) decreased blood volume; and 3) reduced total body Na+; but 4) did not alter arterial blood pressure. Rehydration with water alone caused only plasma osmolality and plasma Na+ concentration to revert to euhydrated levels. The changes in Fos expression and PRA are consistent with a proposed role for ANG II in the control of the sodium appetite produced by water deprivation followed by rehydration with only water.

Proteome analysis of Physcomitrella patens exposed to progressive dehydration and rehydration

PubMed Central

Cui, Suxia; Hu, Jia; Guo, Shilei; Wang, Jie; Cheng, Yali; Dang, Xinxing; Wu, Lili; He, Yikun

2012-01-01

Physcomitrella patens is an extremely dehydration-tolerant moss. However, the molecular basis of its responses to loss of cellular water remains unclear. A comprehensive proteomic analysis of dehydration- and rehydration-responsive proteins has been conducted using quantitative two-dimensional difference in-gel electrophoresis (2D-DIGE), and traditional 2-D gel electrophoresis (2-DE) combined with MALDI TOF/TOF MS. Of the 216 differentially-expressed protein spots, 112 and 104 were dehydration- and rehydration-responsive proteins, respectively. The functional categories of the most differentially-expressed proteins were seed maturation, defence, protein synthesis and quality control, and energy production. Strikingly, most of the late embryogenesis abundant (LEA) proteins were expressed at a basal level under control conditions and their synthesis was strongly enhanced by dehydration, a pattern that was confirmed by RT-PCR. Actinoporins, phosphatidylethanolamine-binding protein, arabinogalactan protein, and phospholipase are the likely dominant players in the defence system. In addition, 24 proteins of unknown function were identified as novel dehydration- or rehydration-responsive proteins. Our data indicate that Physcomitrella adopts a rapid protein response mechanism to cope with dehydration in its leafy-shoot and basal expression levels of desiccation-tolerant proteins are rapidly upgraded at high levels under stress. This mechanism appears similar to that seen in angiosperm seeds. PMID:21994173

Enhancement of drying and rehydration characteristics of okra by ultrasound pre-treatment application

NASA Astrophysics Data System (ADS)

Tüfekçi, Senem; Özkal, Sami Gökhan

2017-07-01

Effect of ultrasound application prior to hot air drying on drying and rehydration kinetics, rehydration ratio and microstructure of okra slices were investigated. For this purpose, the selected parameters are ultrasound pre-treatment time (10, 20 and 30 min), ultrasound amplitude (55 and 100%) and the temperature of drying air (60 and 70 °C). 5 mm thick cylindrical shaped okra slices were used in the experiments. The samples were immersed in water and ultrasonic pre-treatments were done in water with ultrasonic probe connected to an ultrasonic generator with 20 kHz frequency. Pre-treated samples were dried in a tray drier with a 0.3 m/s air velocity. Ultrasound pre-treatment affected the drying rate of the okra slices significantly. Drying time of okra slices was decreased by the application of ultrasound pre-treatment. Modified Page model found to be the most suitable model for describing the drying characteristics of okra slices. Improvements in rehydration properties of the dried samples were observed due to the ultrasound pre-treatment. The influence of the ultrasound pre-treatment on microstructure was clearly observed through scanning electron microscopy images of the dried samples. As the amplitude of ultrasound increased the changes in structure of the okra tissue increased.

The role of membrane fluidization in the gel-assisted formation of giant polymersomes

DOE PAGES

Greene, Adrienne C.; Henderson, Ian M.; Gomez, Andrew; ...

2016-07-13

Polymersomes are being widely explored as synthetic analogs of lipid vesicles based on their enhanced stability and potential uses in a wide variety of applications in (e.g., drug delivery, cell analogs, etc.). Controlled formation of giant polymersomes for use in membrane studies and cell mimetic systems, however, is currently limited by low-yield production methodologies. Here, we describe for the first time, how the size distribution of giant poly(ethylene glycol)-poly(butadiene) (PEO-PBD) polymersomes formed by gel-assisted rehydration may be controlled based on membrane fluidization. We first show that the average diameter and size distribution of PEO-PBD polymersomes may be readily increased bymore » increasing the temperature of the rehydration solution. Further, we describe a correlative relationship between polymersome size and membrane fluidization through the addition of sucrose during rehydration, enabling the formation of PEO-PBD polymersomes with a range of diameters, including giant-sized vesicles (>100 μm). This correlative relationship suggests that sucrose may function as a small molecule fluidizer during rehydration, enhancing polymer diffusivity during formation and increasing polymersome size. Altogether the ability to easily regulate the size of PEO-PBD polymersomes based on membrane fluidity, either through temperature or fluidizers, has broadly applicability in areas including targeted therapeutic delivery and synthetic biology.« less

Fermentation profile and identification of lactic acid bacteria and yeasts of rehydrated corn kernel silage.

PubMed

Carvalho, B F; Ávila, C L S; Bernardes, T F; Pereira, M N; Santos, C; Schwan, R F

2017-03-01

The aim of this study was to evaluate the chemical and microbiological characteristics and to identify the lactic acid bacteria (LAB) and yeasts involved in rehydrated corn kernel silage. Four replicates for each fermentation time: 5, 15, 30, 60, 90, 150, 210 and 280 days were prepared. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and PCR-based identification were utilized to identify LAB and yeasts. Eighteen bacteria and four yeast species were identified. The bacteria population reached maximum growth after 15 days and moulds were detected up to this time. The highest dry matter (DM) loss was 7·6% after 280 days. The low concentration of water-soluble carbohydrates (20 g kg -1 of DM) was not limiting for fermentation, although the reduction in pH and acid production occurred slowly. Storage of the rehydrated corn kernel silage increased digestibility up to day 280. This silage was dominated by LAB but showed a slow decrease in pH values. This technique of corn storage on farms increased the DM digestibility. This study was the first to evaluate the rehydrated corn kernel silage fermentation dynamics and our findings are relevant to optimization of this silage fermentation. © 2016 The Society for Applied Microbiology.

Oral ofloxacin therapy of Pseudomonas aeruginosa sepsis in mice after irradiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brook, I.; Ledney, G.D.

Death subsequent to whole-body irradiation is associated with gram-negative bacterial sepsis. The effect of oral therapy with the new quinolone ofloxacin for orally acquired Pseudomonas aeruginosa infection was tested in B6D2F1 mice exposed to 7.0 Gy of bilateral radiation from 60Co. A dose of 10(7) organisms was given orally 2 days after irradiation, and therapy was started 1 day later. Only 4 of 20 untreated mice (20%) survived for at least 30 days compared with 19 of 20 mice (95%) treated with ofloxacin (P less than 0.005). P. aeruginosa was isolated from the livers of 21 to 28 untreated micemore » (75%), compared with only 2 of 30 treated mice (P less than 0.005). Ofloxacin reduced colonization of the ileum by P. aeruginosa; 24 of 28 untreated mice (86%) harbored the organisms, compared with only 5 of 30 (17%) with ofloxacin (P less than 0.005). This experiment was replicated twice, and similar results were obtained. These data illustrate the efficacy of the quinolone ofloxacin for oral therapy of orally acquired P. aeruginosa infection in irradiated hosts.« less

Non-oral dopaminergic therapies for Parkinson’s disease: current treatments and the future

PubMed Central

Ray Chaudhuri, K; Qamar, Mubasher A; Rajah, Thadshani; Loehrer, Philipp; Sauerbier, Anna; Odin, Per; Jenner, Peter

2016-01-01

Dysfunction of the gastrointestinal tract has now been recognized to affect all stages of Parkinson’s disease (PD). The consequences lead to problems with absorption of oral medication, erratic treatment response, as well as silent aspiration, which is one of the key risk factors in developing pneumonia. The issue is further complicated by other gut abnormalities, such as small intestinal bacterial overgrowth (SIBO) and an altered gut microbiota, which occur in PD with variable frequency. Clinically, these gastrointestinal abnormalities might be associated with symptoms such as nausea, early-morning “off”, and frequent motor and non-motor fluctuations. Therefore, non-oral therapies that avoid the gastrointestinal system seem a rational option to overcome the problems of oral therapies in PD. Hence, several non-oral strategies have now been actively investigated and developed. The transdermal rotigotine patch, infusion therapies with apomorphine, intrajejunal levodopa, and the apomorphine pen strategy are currently in clinical use with a few others in development. In this review, we discuss and summarize the most recent developments in this field with a focus on non-oral dopaminergic strategies (excluding surgical interventions such as deep brain stimulation) in development or to be licensed for management of PD. PMID:28725704

Oral 5-Aminosalicylate, Mesalamine Suppository, and Mesalamine Enema as Initial Therapy for Ulcerative Proctitis in Clinical Practice with Quality of Care Implications.

PubMed

Richter, James M; Arshi, Nabeela K; Oster, Gerry

2016-01-01

Background. Ulcerative proctitis (UP) is typically treated initially with oral 5-aminosalicylate ("5-ASA"), mesalamine suppository, or mesalamine enema ("UP Rx"). Little is known about their effectiveness in practice. Methods. Using a US health insurance database, we identified new-onset UP patients between January 1, 2005, and December 31, 2007, based on the following: (1) initiation of UP Rx; (2) endoscopy in prior 30 days resulting in diagnosis of UP; and (3) no prior encounters for ulcerative colitis or Crohn's disease. We examined the incidence of therapy escalation and total costs in relation to initial UP Rx. Results. We identified 548 patients: 327 received mesalamine suppository, 138 received oral 5-ASA, and 83 received mesalamine enema, as initial UP Rx. One-third receiving oral 5-ASA experienced therapy escalation over 12 months, 21% for both mesalamine suppository and enema. Mean cumulative total cost of UP Rx over 12 months was $1552, $996, and $986 for patients beginning therapy with oral 5-ASA, mesalamine enema, and mesalamine suppository, respectively. Contrary to expert recommendations the treatments were often not continued prophylactically. Conclusions. Treatment escalation was common, and total costs of therapy were higher, in patients who initiated treatment with oral 5-ASA. Further study is necessary to assess the significance of these observations.

Oral 5-Aminosalicylate, Mesalamine Suppository, and Mesalamine Enema as Initial Therapy for Ulcerative Proctitis in Clinical Practice with Quality of Care Implications

PubMed Central

Richter, James M.; Arshi, Nabeela K.; Oster, Gerry

2016-01-01

Background. Ulcerative proctitis (UP) is typically treated initially with oral 5-aminosalicylate (“5-ASA”), mesalamine suppository, or mesalamine enema (“UP Rx”). Little is known about their effectiveness in practice. Methods. Using a US health insurance database, we identified new-onset UP patients between January 1, 2005, and December 31, 2007, based on the following: (1) initiation of UP Rx; (2) endoscopy in prior 30 days resulting in diagnosis of UP; and (3) no prior encounters for ulcerative colitis or Crohn's disease. We examined the incidence of therapy escalation and total costs in relation to initial UP Rx. Results. We identified 548 patients: 327 received mesalamine suppository, 138 received oral 5-ASA, and 83 received mesalamine enema, as initial UP Rx. One-third receiving oral 5-ASA experienced therapy escalation over 12 months, 21% for both mesalamine suppository and enema. Mean cumulative total cost of UP Rx over 12 months was $1552, $996, and $986 for patients beginning therapy with oral 5-ASA, mesalamine enema, and mesalamine suppository, respectively. Contrary to expert recommendations the treatments were often not continued prophylactically. Conclusions. Treatment escalation was common, and total costs of therapy were higher, in patients who initiated treatment with oral 5-ASA. Further study is necessary to assess the significance of these observations. PMID:27446860

Lacosamide: a review of its use as adjunctive therapy in the management of partial-onset seizures.

PubMed

Hoy, Sheridan M

2013-12-01

Lacosamide (Vimpat(®)) is a functionalized amino acid available orally (as a syrup or tablet) and as an intravenous infusion. It is believed to exert its antiepileptic effect by selectively enhancing the slow inactivation of voltage-gated sodium channels. Lacosamide is approved in several countries worldwide as an adjunctive therapy for the treatment of partial-onset seizures; however, prescribing regulations differ between countries. This article reviews the use of lacosamide as indicated in adults and adolescents (aged 16-18 years) in the EU, where it is approved in this patient population as an adjunctive therapy to other AEDs in the treatment of partial-onset seizures, with or without secondary generalization. In three randomized, double-blind, placebo-controlled, multicentre studies in adults and adolescents (aged 16-18 years) with partial-onset seizures, adjunctive therapy with oral lacosamide (administered for an initial titration period followed by 12 weeks' maintenance therapy) generally reduced the frequency of seizures to a significantly greater extent than placebo, with antiepileptic efficacy sustained following longer-term treatment (up to 8 years) in this patient population. Oral and intravenous lacosamide were generally well tolerated in clinical studies, with the majority of adverse events being mild or moderate in severity. Very common adverse reactions following adjunctive therapy with oral lacosamide included diplopia, dizziness, headache and nausea; the tolerability profile of intravenous lacosamide appeared consistent with that of oral lacosamide, although intravenous administration was associated with local adverse events, such as injection site discomfort or pain, irritation and erythema. Thus, oral and intravenous lacosamide as an adjunctive therapy to other AEDs provides a useful option in the treatment of patients with partial-onset seizures.

Long-acting injectable versus oral naltrexone maintenance therapy with psychosocial intervention for heroin dependence: a quasi-experiment.

PubMed

Brooks, Adam C; Comer, Sandra D; Sullivan, Maria A; Bisaga, Adam; Carpenter, Kenneth M; Raby, Wilfrid M; Yu, Elmer; O'Brien, Charles P; Nunes, Edward V

2010-10-01

To conduct a quasi-experimental comparison of early clinical outcomes between injectable, sustained-release, depot naltrexone formulation versus oral naltrexone maintenance therapy in individuals with opiate dependence. Early retention in treatment and urine-confirmed opiate use in the first 8 weeks postdetoxification were compared between patients (diagnosed as opiate-dependent according to DSM-IV criteria) participating in 2 concurrently run randomized clinical trials of oral (n = 69; patients treated from September 1999 to May 2002) and long-acting injectable (n = 42; patients treated from November 2000 to June 2003) naltrexone maintenance therapy with psychosocial therapy. Long-acting injectable naltrexone produced significantly better outcome than oral naltrexone on days retained in treatment (F(1,106) = 6.49, P = .012) and for 1 measure of opiate use (F(1,106) = 5.26, P = .024); other measures were not significantly different, but differences were in the same direction. In subanalyses, there were interaction effects between baseline heroin use severity and type of treatment. In subanalyses, heroin users with more severe baseline use showed better retention with oral naltrexone maintenance therapy combined with intensive psychotherapy (behavioral naltrexone therapy) as compared to retention shown by severe heroin users treated with long-acting naltrexone injections combined with standard cognitive-behavioral therapy (χ²(1)= 9.31, P = .002); less severe heroin users evidenced better outcomes when treated with long-acting injectable naltrexone. This quasi-experimental analysis provides tentative indications of superior outcomes for heroin-dependent patients treated with long-acting injectable naltrexone compared to oral naltrexone. The finding that heroin users with more severe baseline use achieved better outcomes with oral naltrexone is most probably attributable to the intensive nature of the psychosocial treatments provided and points to the opportunity for continued research in augmenting injectable naltrexone with psychosocial strategies to further improve outcome, especially in individuals with more severe use. The results should be considered exploratory given the quasi-experimental nature of the study. © Copyright 2010 Physicians Postgraduate Press, Inc.

Drugs for preventing red blood cell dehydration in people with sickle cell disease.

PubMed

Nagalla, Srikanth; Ballas, Samir K

2016-03-04

Sickle cell disease is an inherited disorder of hemoglobin, resulting in abnormal red blood cells. These are rigid and may block blood vessels leading to acute painful crises and other complications. Recent research has focused on therapies to rehydrate the sickled cells by reducing the loss of water and ions from them. Little is known about the effectiveness and safety of such drugs. This is an updated version of a previously published review. To assess the relative risks and benefits of drugs to rehydrate sickled red blood cells. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register.Last search of the Group's Trials Register: 28 November 2015. Randomized or quasi-randomized controlled trials of drugs to rehydrate sickled red blood cells compared to placebo or an alternative treatment. Both authors independently selected studies for inclusion, assessed study quality and extracted data. Of the 51 studies identified, three met the inclusion criteria. The first study tested the effectiveness of zinc sulphate to prevent sickle cell-related crises in a total of 145 participants and showed a significant reduction in painful crises over one and a half years, mean difference -2.83 (95% confidence interval -3.51 to -2.15). However, analysis was restricted due to limited statistical data. Changes to red cell parameters and blood counts were inconsistent. No serious adverse events were noted in the study.The second study was a Phase II dose-finding study of senicapoc (a Gardos channel blocker) compared to placebo. Compared to the placebo group the high dose senicapoc showed significant improvement in change in hemoglobin level, number and proportion of dense red blood cells, red blood cell count and indices and hematocrit. The results with low-dose senicapoc were similar to the high-dose senicapoc group but of lesser magnitude. There was no difference in the frequency of painful crises between the three groups. A subsequent Phase III study of senicapoc was terminated early since there was no difference observed between the treatment and control groups in the primary end point of painful crises. While the results of zinc for reducing sickle-related crises are encouraging, larger and longer-term multicenter studies are needed to evaluate the effectiveness of this therapy for people with sickle cell disease.While the Phase II and the prematurely terminated phase III studies of senicapoc showed that the drug improved red cell survival (depending on dose), this did not lead to fewer painful crises.We will continue to run searches to identify any potentially relevant trials; however, we do not plan to update other sections of the review until new trials are published.

Retrospective Audit: Does Prior Assessment by Oral and Maxillofacial Surgeons Reduce the Risk of Osteonecrosis of The Jaw in Patients Receiving Bone-Targeted Therapies for Metastatic Cancers to the Skeleton?--Part II.

PubMed

Turner, Bruce; Ali, Sacha; Pati, Jhumur; Nargund, Vinod; Ali, Enamul; Cheng, Leo; Wells, Paula

2016-01-01

Men who receive bone-targeted therapy for metastatic prostate cancer are at increased risk of osteonecrosis of the jaw (ONJ). Development of ONJ has been associated with the administration of bone-targeted therapies in association with other risk factors. ONJ can be distressing for a patient because it can cause pain, risk of jaw fracture, body image disturbance, difficultly eating, and difficulty maintaining good oral hygiene. The aim of this article is to report results of an audit of prior assessment by oral and maxillofacial surgeons (OMFS) before initiation of bone-targeted therapies and whether it may reduce the risk of ONJ in patients receiving bone-targeted therapies for advanced cancers.

Oral Mucositis Prevention By Low-Level Laser Therapy in Head-and-Neck Cancer Patients Undergoing Concurrent Chemoradiotherapy: A Phase III Randomized Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gouvea de Lima, Aline; Villar, Rosangela Correa; Castro, Gilberto de, E-mail: gilberto.castro@usp.br

Purpose: Oral mucositis is a major complication of concurrent chemoradiotherapy (CRT) in head-and-neck cancer patients. Low-level laser (LLL) therapy is a promising preventive therapy. We aimed to evaluate the efficacy of LLL therapy to decrease severe oral mucositis and its effect on RT interruptions. Methods and Materials: In the present randomized, double-blind, Phase III study, patients received either gallium-aluminum-arsenide LLL therapy 2.5 J/cm{sup 2} or placebo laser, before each radiation fraction. Eligible patients had to have been diagnosed with squamous cell carcinoma or undifferentiated carcinoma of the oral cavity, pharynx, larynx, or metastases to the neck with an unknown primarymore » site. They were treated with adjuvant or definitive CRT, consisting of conventional RT 60-70 Gy (range, 1.8-2.0 Gy/d, 5 times/wk) and concurrent cisplatin. The primary endpoints were the oral mucositis severity in Weeks 2, 4, and 6 and the number of RT interruptions because of mucositis. The secondary endpoints included patient-reported pain scores. To detect a decrease in the incidence of Grade 3 or 4 oral mucositis from 80% to 50%, we planned to enroll 74 patients. Results: A total of 75 patients were included, and 37 patients received preventive LLL therapy. The mean delivered radiation dose was greater in the patients treated with LLL (69.4 vs. 67.9 Gy, p = .03). During CRT, the number of patients diagnosed with Grade 3 or 4 oral mucositis treated with LLL vs. placebo was 4 vs. 5 (Week 2, p = 1.0), 4 vs. 12 (Week 4, p = .08), and 8 vs. 9 (Week 6, p = 1.0), respectively. More of the patients treated with placebo had RT interruptions because of mucositis (6 vs. 0, p = .02). No difference was detected between the treatment arms in the incidence of severe pain. Conclusions: LLL therapy was not effective in reducing severe oral mucositis, although a marginal benefit could not be excluded. It reduced RT interruptions in these head-and-neck cancer patients, which might translate into improved CRT efficacy.« less

Cost effectiveness of ciprofloxacin plus metronidazole versus imipenem-cilastatin in the treatment of intra-abdominal infections.

PubMed

Walters, D J; Solomkin, J S; Paladino, J A

1999-11-01

To compare the cost effectiveness of sequential intravenous (i.v.) to oral ciprofloxacin plus metronidazole (CIP/MTZ i.v./PO) with that of i.v. ciprofloxacin plus i.v. metronidazole (CIP/MTZ i.v.) and i.v. imipenem-cilastatin (IMI i.v.) in patients with intra-abdominal infections. Patients enrolled in a double-blind randomised clinical trial were eligible for inclusion into this cost-effectiveness analysis. Decision analysis was used to characterise the economic outcomes between groups and provide a structure upon which to base the sensitivity analyses. 1996 cost values were used throughout. The economic perspective of the analysis was that of a hospital provider. Among 446 economically evaluable patients, 176 could be switched from i.v. to oral administration. The 51 patients randomised to CIP/MTZ i.v./PO who received active oral therapy had a success rate of 98%, mean duration of therapy of 9.1 days and mean cost of $US7678. There were 125 patients randomized to either CIP/MTZ i.v. or IMI i.v. who received oral placebo while continuing on active i.v. antibacterials; their success rate was 94%, mean duration of therapy was 10.1 days and mean cost was $US8774 (p = 0.029 vs CIP/MTZ i.v./PO). Of the 270 patients who were unable to receive oral administration, 97 received IMI i.v. and had a success rate of 75%, mean duration of therapy of 13.8 days and a mean cost of $US12,418, and 173 received CIP/MTZ i.v. and had a success rate of 77%, mean duration of therapy of 13.4 days and mean cost of $US12,219 (p = 0.26 vs IMI i.v.). In patients able to receive oral therapy, sequential i.v. to oral treatment with ciprofloxacin plus metronidazole was cost effective compared with full i.v. courses of ciprofloxacin plus metronidazole or imipenem-cilastatin. In patients unable to receive oral therapy, no difference in mean cost was found between i.v. imipenem-cilastatin or i.v. ciprofloxacin plus i.v. metronidazole.

The oral and craniofacial relevance of chemically modified RNA therapeutics.

PubMed

Elangovan, Satheesh; Kormann, Michael S D; Khorsand, Behnoush; Salem, Aliasger K

2016-01-01

Several tissue engineering strategies in the form of protein therapy, gene therapy, cell therapy, and their combinations are currently being explored for oral and craniofacial regeneration and repair. Though each of these approaches has advantages, they all have common inherent drawbacks of being expensive and raising safety concerns. Using RNA (encoding therapeutic protein) has several advantages that have the potential to overcome these limitations. Chemically modifying the RNA improves its stability and mitigates immunogenicity allowing for the potential of RNA to become an alternative to protein and gene based therapies. This brief review article focuses on the potential of RNA therapeutics in the treatment of disorders in the oral and craniofacial regions.

The Oral and Craniofacial Relevance of Chemically Modified RNA Therapeutics

PubMed Central

Kormann, Michael S.D.; Khorsand, Behnoush

2016-01-01

Several tissue engineering strategies in the form of protein therapy, gene therapy, cell therapy and its combinations are currently being explored for oral and cranio-facial regeneration and repair. Though each of these approaches has advantages, they all have common inherent drawbacks of being expensive and raising safety concerns. Using RNA (encoding therapeutic protein) has several advantages that have the potential to overcome these limitations. Chemically modifying the RNA improves its stability and mitigates immunogenicity allowing for the potential of RNA to become an alternative to protein and gene based therapies. This brief review article focuses on the potential of RNA therapeutics in the treatment of disorders in the oral and craniofacial regions. PMID:26896600

Low level laser therapy in the treatment of oral mucositis in cancer patients: systematic review of literature

NASA Astrophysics Data System (ADS)

El-Sabbagh, Rula Fawzi; Selting, Wayne J.

2016-03-01

Oral mucositis is a debilitating and dose limiting side effect of oncotherapy in cancer patients. Low Level Laser Therapy (LLLT) is a promising new intervention for the treatment of oral mucositis. Aims and objectives: 1. Perform a systematic review of available literature on the therapeutic effect of LLLT on established oral mucositis. 2. Formulate recommendations for future studies based on results of review. Methods: Electronic search oflow level laser therapy in the treatment of oral mucositis was conducted and eligible studies reviewed. Results: Four studies met the inclusion criteria and were analyzed. A total of 109 patients were included, 59 of which received LLLT as a therapeutic measure. An overall success rate of 81.4% success rate was reported in regard to OM. Conclusion: The review demonstrated the positive therapeutic effect of LLLT on oral mucositis. However, the need for future studies with standardized reporting of parameters and methods is needed to increase the level of evidence of this intervention.

The effect of periodontal therapy on intra-oral halitosis: a case series.

PubMed

Erovic Ademovski, Seida; Mårtensson, Carina; Persson, G Rutger; Renvert, Stefan

2016-05-01

The aim of this study was to evaluate the effects of non-surgical periodontal therapy on intra-oral halitosis 3 months after therapy. Sixty-eight adults with intra-oral halitosis were included in a case series. Intra-oral halitosis was evaluated at baseline, and at 3 months after treatment using the organoleptic scores (OLS), Halimeter ® , and a gas chromatograph. Significant reductions for OLS (p < 0.01), total sum of volatile sulphur compounds (T-VSC) (p < 0.01) and methyl mercaptan (MM) (p < 0.05) values were found after treatment. Hydrogen sulphide (H 2 S) levels were not significantly reduced. The numbers of probing pockets 4 mm, 5 mm and 6 mm were significantly reduced as a result of therapy (p < 0.001). Bleeding on probing (BOP) and plaque indices were also significantly reduced (p < 0.001). For the 34 individuals with successful periodontal treatment (BOP<20% and a ≥50% reduction of total pocket depth) reductions in OLS (p < 0.01) and T-VSC scores (p < 0.01) were found. Eleven individuals were considered effectively treated for intra-oral halitosis presenting with a T-VSC value <160 ppb, a H 2 S value <112 ppb and a MM value <26 ppb. Non-surgical periodontal therapy resulted in reduction of OLS, MM and T-VSC values 3 months after therapy. Few individuals were considered as effectively treated for intra-oral halitosis. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Nanomedicine, an emerging therapeutic strategy for oral cancer therapy.

PubMed

Marcazzan, Sabrina; Varoni, Elena Maria; Blanco, Elvin; Lodi, Giovanni; Ferrari, Mauro

2018-01-01

Oral cavity and oropharyngeal carcinomas (oral cancer) represents a significant cause of morbidity and mortality. Despite efforts in improving early diagnosis and treatment, the 5-year survival rate of advanced stage of the disease is less than 63%. The field of nanomedicine has offered promising diagnostic and therapeutic advances in cancer. Indeed, several platforms have been clinically approved for cancer therapy, while other promising systems are undergoing exploration in clinical trials. With its ability to deliver drugs, nucleic acids, and MRI contrast agents with high efficiency, nanomedicine platforms offer the potential to improve drug efficacy and tolerability. The aim of the present mini-review is to summarize the current preclinical status of nanotechnology systems for oral cancer therapy. The nanoplatforms for delivery of chemopreventive agents presented herein resulted in significantly higher anti-tumor activity than free forms of the drug, even against a chemo-resistant cell line. Impressive results have also been obtained using nanoparticles to deliver chemotherapeutics, resulting in reduced toxicity both in vitro and in vivo. Nanoparticles have also led to improvements in efficacy of photodynamic therapies through the development of targeted magnetic nanoparticles. Finally, gene therapy using nanoparticles demonstrated promising results specifically with regards to inhibition of gene expression. Of the few in vivo studies that have been reported, many of these used animal models with several limitations, which will be discussed herein. Lastly, we will discuss several future perspectives in oral cancer nanoparticle-based therapy and the development of appropriate animal models, distinguishing between oral cavity and oropharyngeal carcinoma. Copyright © 2017 Elsevier Ltd. All rights reserved.

Split high-dose oral levothyroxine treatment as a successful therapy option in myxedema coma.

PubMed

Charoensri, Suranut; Sriphrapradang, Chutintorn; Nimitphong, Hataikarn

2017-10-01

High-dose intravenous thyroxine (T4) is the preferable treatment for myxedema coma. We describe the clinical course of a 69-year-old man who presented with myxedema coma and received oral levothyroxine (LT4) therapy (1 mg) in a split dose. This suggests split high-dose oral LT4 as a therapeutic option in myxedema coma.

A prospective 8 week trial of nasal interfaces vs. a novel oral interface (Oracle) for treatment of obstructive sleep apnea hypopnea syndrome.

PubMed

Khanna, Ritu; Kline, Lewis R

2003-07-01

To compare efficacy, compliance rates, and side effects of a new strapless oral interface, the Oracle, with available nasal masks over 8 weeks of use for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). A total of 38 patients with OSAHS (respiratory disturbance index (RDI) >/=15/h) were enrolled after the diagnostic polysomnogram for subsequent continuous positive airway pressure (CPAP) therapy. After randomization, therapeutic pressures during a titration study were determined for 21 patients in the oral group and 17 patients in the nasal group. Comparisons for nasal and oral interfaces were made for baseline patient characteristics, average hours of CPAP use, side effects from therapy, and among questionnaires evaluating patients' subjective responses to therapy at months 1 and 2. No significant difference was observed in the average hours of CPAP use between the oral (4.5+/-2.1; 5.5+/-2.6) and nasal groups (4.0+/-2.6; 4.8+/-2.5) for either month 1 or 2 (P>0.05). The dropout rates were similar for both groups after 8 weeks of therapy. However, patients in the nasal group had higher occurrences of side effects such as nasal congestion, dryness, and air leaks, whereas patients in the oral group experienced more oral dryness and gum pain. Oral delivery of CPAP with the Oracle is an effective and suitable alternative for patients with OSAHS.

Protection of dried probiotic bacteria from bile using bile adsorbent resins.

PubMed

Mahbubani, Krishnaa T; Slater, Nigel K H; Edwards, Alexander D

2014-01-25

Enteric coated oral tablets or capsules can deliver dried live cells directly into the intestine. Previously, we found that a live attenuated bacterial vaccine acquired sensitivity to intestinal bile when dried, raising the possibility that although gastric acid can be bypassed, significant loss of viability might occur on release from an enteric coated oral formulations. Here we demonstrate that some food-grade lyophilised preparations of Lactobacillus casei and Lactobacillus salivarius also show temporary bile sensitivity that can be rapidly reversed by rehydration. To protect dried bacterial cells from temporary bile sensitivity, we propose using bile acid adsorbing resins, such as cholestyramine, which are bile acid binding agents, historically used to lower cholesterol levels. Vcaps™ HPMC capsules alone provided up to 830-fold protection from bile. The inclusion of 50% w/w cholestyramine in Vcaps™ HPMC capsules resulted in release of up to 1700-fold more live Lactobacillus casei into simulated intestinal fluid containing 1% bile, when compared to dried cells added directly to bile. We conclude that delivery of dried live probiotic organisms to the intestine may be improved by providing protection from bile by addition of bile adsorbing resins and the use of HPMC capsules. Copyright © 2013 Elsevier B.V. All rights reserved.

Physico-chemical and thermochemical studies of the hydrolytic conversion of amorphous tricalcium phosphate into apatite

DOE Office of Scientific and Technical Information (OSTI.GOV)

Somrani, Saida; Banu, Mihai; Jemal, Mohamed

2005-05-15

The conversion of amorphous tricalcium phosphate with different hydration ratio into apatite in water at 25 deg. C has been studied by microcalorimetry and several physical-chemical methods. The hydrolytic transformation was dominated by two strong exothermic events. A fast, relatively weak, wetting process and a very slow but strong heat release assigned to a slow internal rehydration and the crystallization of the amorphous phase into an apatite. The exothermic phenomenon related to the rehydration exceeded the crystalline transformation enthalpy. Rehydration occurred before the conversion of the amorphous phase into apatite and determined the advancement of the hydrolytic reaction. The apatiticmore » phases formed evolved slightly with time after their formation. The crystallinity increased whereas the amount of HPO{sub 4}{sup 2-} ion decreased. These data allow a better understanding of the behavior of biomaterials involving amorphous phases such as hydroxyapatite plasma-sprayed coatings.« less

Laboratory measurements of electric properties of composite mine dump samples from Colorado and New Mexico

USGS Publications Warehouse

Anderson, Anita L.; Campbell, David L.; Beanland, Shay

2001-01-01

Individual mine waste samples were collected and combined to form one composite sample at each of eight mine dump sites in Colorado and New Mexico. The samples were air-dried and sieved to determine the geochemical composition of their <2mm size fraction. Splits of the samples were then rehydrated and their electrical properties were measured in the US Geological Survey Petrophysical Laboratory, Denver, Colorado (PetLab). The PetLab measurements were done twice: in 1999, using convenient amounts of rehydration water ranging from 5% to 8%; and in 2000, using carefully controlled rehydrations to 5% and 10% water. This report gives geochemical analyses of the <2mm size fraction of the composite samples (Appendix A), PetLab graphs of the 1999 measurements (Appendix B), Petlab graphs of the 2000 measurements (Appendix C), and Cole-Cole models of the PetLab data from the 2000 measurements (Appendix D).

Comparison of rehydration regimens for rehabilitation of firefighters performing heavy exercise in thermal protective clothing: A report from the Fireground Rehab Evaluation (FIRE) trial

PubMed Central

Hostler, David; Bednez, James C; Kerin, Sarah; Reis, Steven E; Kong, Pui Wah; Morley, Julia; Gallagher, Michael; Suyama, Joe

2010-01-01

Background: Fire suppression activities results in cardiovascular stress, hyperthermia, and hypohydration. Fireground rehabilitation (rehab) is recommended to blunt the deleterious effects of these conditions. Objective: We tested the hypothesis that three rehydration fluids provided after exercise in thermal protective clothing (TPC) would produce different heart rate or core temperature responses during a second bout of exercise in TPC. Methods: On three occasions, 18 euhydrated firefighters (16 males, 2 females) wearing TPC completed a standardized, 50-minute bout of upper and lower body exercise in a hot room that mimicked the National Fire Protection Association (NFPA) rehabilitation guidelines of “two cylinders before rehab” (20 min work, 10 min recovery, 20 min work). After an initial bout of exercise, subjects were randomly assigned water, sport drink, or an intravenous (IV) infusion of normal saline equal to the amount of body mass lost during exercise. After rehydration, the subject performed a second bout of exercise. Heart rate, core and skin temperature, and exercise duration were compared with a two-way ANOVA. Results: Subjects were firefighters aged 28.2±11.3 years with a VO2peak of 37.4±3.4 ml/kg/min. 527±302 mL of fluid were provided during the rehabilitation period. No subject could complete either the pre- or post-rehydration 50-minute bout of exercise. Mean (SD) time to exhaustion (min) was longer (p<0.001) in bout 1 (25.9±12.9 min. water, 28.0±14.1 min. sport drink, 27.4±13.8 min. IV) compared to bout 2 (15.6±9.6 min. water, 14.7±8.6 min. sport drink, 15.7±8.0 min. IV) for all groups but did not differ by intervention. All subjects approached age predicted maximum heart rate at the end of bout 1 (180±11 bpm) and bout 2 (176±13 bpm). Core temperature rose 1.1±0.7°C during bout 1 and 0.5±0.4°C during bout 2. Core temperature, heart rate, and exercise time during bout 2 did not differ between rehydration fluids. Conclusions: Performance during a second bout of exercise in TPC did not differ when firefighters were rehydrated with water, sport drink, or IV normal saline when full rehydration is provided. Of concern was the inability of all subjects to complete two consecutive periods of heavy exercise in TPC suggesting the NFPA “two cylinders before rehab” guideline may not be appropriate in continuous heavy work scenarios. PMID:20095824

Use of combined intracorporal injection and a phosphodiesterase-5 inhibitor therapy for men with a suboptimal response to sildenafil and/or vardenafil monotherapy after radical retropubic prostatectomy.

PubMed

Mydlo, Jack H; Viterbo, Rosalia; Crispen, Paul

2005-04-01

To report experience with combined therapy using intracorporal injection (ICI) of alprostadil and oral phosphodiesterase 5 (PDE-5) inhibitors for the minimally invasive treatment of erectile dysfunction (ED) after radical prostatectomy (RP), as PDE-5 inhibitors are effective but a few patients may have a suboptimal response. In a retrospective study, 34 men (aged 46-66 years) had a nerve-sparing retropubic RP and subsequent ED. Patients were titrated on sildenafil citrate or vardenafil to maximum doses. All had a suboptimal response after a maximum of eight doses of oral therapy and were then treated with ICI therapy using 15 or 20 microg alprostadil. Erectile function was assessed with the Sexual Health Inventory for Men (SHIM). Of the 32 patients who continued combined therapy, 22 (68%) had an improvement in erectile function after ICI therapy, as assessed by the SHIM score. On follow-up, 36% of these patients used ICI therapy only intermittently, instead of regularly, as they felt that this was adequate enough for good results. PDE-5 oral pharmacotherapy is the most commonly used effective therapy for ED but may not be as effective in patients who have radical surgery; the addition of testosterone patches may have side-effects or be considered a risk in patients with a history of prostate cancer. The use of ICI therapy as an adjunct or maintenance therapy to their oral medication may be another alternative in these patients.

Prospective evaluation of a shortened regimen of treatment for acute osteomyelitis and septic arthritis in children.

PubMed

Jagodzinski, Nikolas Alan; Kanwar, Rajeev; Graham, Kerr; Bache, Christopher Edward

2009-01-01

We present the findings of a prospective, bi-center study to establish the appropriate duration of antibiotic therapy for acute, uncomplicated bone and joint infections in children. Historically, patients have been treated with prolonged courses of intravenous and oral therapy. Our hypothesis was that children could be safely treated with 3 days of high-dose intravenous therapy followed by 3 weeks of oral therapy. We prospectively collected data from children presenting to Birmingham Children's Hospital and The Royal Children's Hospital, Melbourne who fitted our diagnostic criteria for septic arthritis and osteomyelitis over a 52-month period. Inclusion criteria for entry into the database were children

Oral health under use of continuous positive airway pressure and interest in alternative therapy in patients with obstructive sleep apnoea: a questionnaire-based survey.

PubMed

Tsuda, Hiroko; Moritsuchi, Yasutaka; Higuchi, Yoshinori; Tsuda, Toru

2016-09-01

Obstructive sleep apnoea (OSA) is associated with a variety of adverse health outcomes. Continuous positive airway pressure (CPAP) is considered first-line treatment for sleep apnoea patients, but there are few studies on oral health in patients with OSA who are using CPAP. This study aimed to estimate the prevalence of oral symptoms and interest in alternative treatments such as oral appliance (OA) therapy in CPAP users. A questionnaire was used to ascertain oral health including denture use, oral symptoms at present and since the start of CPAP, and interest in OA therapy. Relevant demographic and clinical data were collected from medical records. The 744 participants who completed the questionnaire had following characteristics (mean ± standard deviation): age (55.1 ± 12.9 years); apnoea-hypopnoea index (40.9 ± 23.2/h); body mass index (27.9 ± 5.2 kg/m(2) ) and length of CPAP usage (49.1 ± 30.7 months); halitosis (30.4%); and gingival bleeding (27.5%). Nearly half (44.6%) complained of dry mouth since beginning CPAP therapy. Patients with diabetes were older (57.8 ± 11.9 vs. 54.2 ± 12.8 years), had a higher rate of denture use (28.3 vs. 19.0%), more dental clinic visits (71.4 vs. 58.7%) and more oral symptoms (50.0 vs. 38.2%) than non-diabetes patients (p < 0.05). Thirty-eight per cent of subjects were interested in OA therapy. This study exhibited that almost 40% of CPAP users had oral symptoms. In particular, OSA patients with diabetes may be at high risk of oral disease. © 2015 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

An assessment of the current treatment landscape for rheumatology patients in Qatar: Recognising unmet needs and moving towards solutions.

PubMed

Emadi, Samar Al; Hammoudeh, Mohammed; Mounir, Mohamed; Mueller, Ruediger B; Wells, Alvin F; Sarakbi, Housam Aldeen

2017-04-01

Objective This study assessed the mode of application (oral, intravenous or subcutaneous (SC)) currently employed in the treatment of rheumatoid arthritis (RA) in patients from Qatar in comparison with patients' individual preferences for the mode of application of their treatment. Methods This study included 294 RA patients visiting three clinics at the main referral hospital in Qatar who were interviewed using a standard questionnaire to determine their preference of mode of application for their disease-modifying antirheumatic drug (DMARD) treatment in relation to their currently employed mode of application. Results The majority of patients were female (76%), and 93% of male patients and 61% of female patients in the study clinics were of a nationality other than Qatari. The highest patient preference recorded was for an oral therapy (69%), compared with injection (23%) and intravenous (8%) therapy. In total, 85% of patients expressed a preference to remain on oral therapy compared with 63% and 58% of intravenous and SC injection patients indicating a preference to remain on their current method of administration. Conclusions This high preference for oral therapies highlights the considerable need for incorporation of new oral targeted synthetic DMARD therapies into clinical practice within the region.

An assessment of the current treatment landscape for rheumatology patients in Qatar: Recognising unmet needs and moving towards solutions

PubMed Central

Hammoudeh, Mohammed; Mounir, Mohamed; Mueller, Ruediger B.; Wells, Alvin F.; Sarakbi, Housam Aldeen

2017-01-01

Objective This study assessed the mode of application (oral, intravenous or subcutaneous (SC)) currently employed in the treatment of rheumatoid arthritis (RA) in patients from Qatar in comparison with patients’ individual preferences for the mode of application of their treatment. Methods This study included 294 RA patients visiting three clinics at the main referral hospital in Qatar who were interviewed using a standard questionnaire to determine their preference of mode of application for their disease-modifying antirheumatic drug (DMARD) treatment in relation to their currently employed mode of application. Results The majority of patients were female (76%), and 93% of male patients and 61% of female patients in the study clinics were of a nationality other than Qatari. The highest patient preference recorded was for an oral therapy (69%), compared with injection (23%) and intravenous (8%) therapy. In total, 85% of patients expressed a preference to remain on oral therapy compared with 63% and 58% of intravenous and SC injection patients indicating a preference to remain on their current method of administration. Conclusions This high preference for oral therapies highlights the considerable need for incorporation of new oral targeted synthetic DMARD therapies into clinical practice within the region. PMID:28415924

The potential of positron emission tomography/computerized tomography (PET/CT) scanning as a detector of high-risk patients with oral infection during preoperative staging.

PubMed

Yamashiro, Keisuke; Nakano, Makoto; Sawaki, Koichi; Okazaki, Fumihiko; Hirata, Yasuhisa; Takashiba, Shogo

2016-08-01

It is sometimes difficult to determine during the preoperative period whether patients have oral infections; these patients need treatment to prevent oral infection-related complications from arising during medical therapies, such as cancer therapy and surgery. One of the reasons for this difficulty is that basic medical tests do not identify oral infections, including periodontitis and periapical periodontitis. In this report, we investigated the potential of positron emission tomography/computerized tomography (PET/CT) as a diagnostic tool in these patients. We evaluated eight patients during the preoperative period. All patients underwent PET/CT scanning and were identified as having the signs of oral infection, as evidenced by (18)F-fludeoxyglucose (FDG) localization in the oral regions. Periodontal examination and orthopantomogram evaluation showed severe infection or bone resorption in the oral regions. (18)F-FDG was localized in oral lesions, such as severe periodontitis, apical periodontitis, and pericoronitis of the third molar. The densities of (18)F-FDG were proportional to the degree of inflammation. PET/CT is a potential diagnostic tool for oral infections. It may be particularly useful in patients during preoperative staging, as they frequently undergo scanning at this time, and those identified as having oral infections at this time require treatment before cancer therapy or surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Towards microbiome transplant as a therapy for periodontitis: an exploratory study of periodontitis microbial signature contrasted by oral health, caries and edentulism.

PubMed

Pozhitkov, Alex E; Leroux, Brian G; Randolph, Timothy W; Beikler, Thomas; Flemmig, Thomas F; Noble, Peter A

2015-10-14

Conventional periodontal therapy aims at controlling supra- and subgingival biofilms. Although periodontal therapy was shown to improve periodontal health, it does not completely arrest the disease. Almost all subjects compliant with periodontal maintenance continue to experience progressive clinical attachment loss and a fraction of them loses teeth. An oral microbial transplant may be a new alternative for treating periodontitis (inspired by fecal transplant). First, it must be established that microbiomes of oral health and periodontitis are distinct. In that case, the health-associated microbiome could be introduced into the oral cavity of periodontitis patients. This relates to the goals of our study: (i) to assess if microbial communities of the entire oral cavity of subjects with periodontitis were different from or oral health contrasted by microbiotas of caries and edentulism patients; (ii) to test in vitro if safe concentration of sodium hypochlorite could be used for initial eradication of the original oral microbiota followed by a safe neutralization of the hypochlorite prior transplantation. Sixteen systemically healthy white adults with clinical signs of one of the following oral conditions were enrolled: periodontitis, established caries, edentulism, and oral health. Oral biofilm samples were collected from sub- and supra-gingival sites, and oral mucosae. DNA was extracted and 16S rRNA genes were amplified. Amplicons from the same patient were pooled, sequenced and quantified. Volunteer's oral plaque was treated with saline, 16 mM NaOCl and NaOCl neutralized by ascorbate buffer followed by plating on blood agar. Ordination plots of rRNA gene abundances revealed distinct groupings for the oral microbiomes of subjects with periodontitis, edentulism, or oral health. The oral microbiome in subjects with periodontitis showed the greatest diversity harboring 29 bacterial species at significantly higher abundance compared to subjects with the other assessed conditions. Healthy subjects had significantly higher abundance in 10 microbial species compared to the other conditions. NaOCl showed strong antimicrobial properties; nontoxic ascorbate was capable of neutralizing the hypochlorite. Distinct oral microbial signatures were found in subjects with periodontitis, edentulism, or oral health. This finding opens up a potential for a new therapy, whereby a health-related entire oral microbial community would be transplanted to the diseased patient.

Re-irradiation using proton beam therapy combined with weekly intra-arterial chemotherapy for recurrent oral cancer.

PubMed

Hayashi, Yuichiro; Nakamura, Tatsuya; Mitsudo, Kenji; Kimura, Kanako; Yamaguchi, Hisashi; Ono, Takashi; Azami, Yusuke; Takayama, Kanako; Hirose, Katsumi; Yabuuchi, Tomonori; Suzuki, Motohisa; Hatayama, Yoshiomi; Kikuchi, Yasuhiro; Wada, Hitoshi; Fuwa, Nobukazu; Hareyama, Masato; Tohnai, Iwai

2017-10-01

The purpose of this study was to clarify the efficacy and toxicities of re-irradiation using proton beam therapy combined with weekly intra-arterial chemotherapy for recurrent oral cancer. Between October 2009 and July 2014, 34 patients who had recurrent oral cancer were treated by proton beam therapy combined with intra-arterial infusion chemotherapy at the Southern Tohoku Proton Therapy Center, Japan. For all patients, the median follow-up was 25 months (range, 3-77 months). After treatment, 22 patients (65%) achieved a complete response, and 12 patients (35%) achieved a partial response at the primary tumor site. One-year and 2-year overall survival (OS) rates were 62% and 42%, respectively. One-year and 2-year LC rates were 77% and 60%, respectively. No treatment-related deaths were observed during the treatment and follow-up periods. Re-irradiation using proton beam therapy combined with weekly intra-arterial chemotherapy improved OS and local control rates compared with other treatment modalities and could become a new treatment modality for patients with recurrent oral cancer. © 2016 John Wiley & Sons Australia, Ltd.

Water content, speciation and isotopic composition in volcanic glass: an open window on magma degassing processes or paleoclimate?

NASA Astrophysics Data System (ADS)

Martin, Erwan; Bindeman, Ilya; Balan, Etienne; Palandri, Jim; Seligman, Angela; Villemant, Benoit

2016-04-01

The content, speciation and isotopic composition of water in volcanic glass have been used for decades as recorder of magma degassing or late glass rehydration processes. Magmatic or paleoclimate information are derived depending on the primary (magmatic) or meteoric (secondary) origin of water. In this study, we attempt to discriminate residual magmatic from secondary meteoric water in volcanic glass. Using samples from different geological settings and different climatic conditions, we show that the H-isotope composition and water content measured via a TC/EA-MAT253 system in volcanic glass alone are not always sufficient to provide clear distinction between magmatic and meteoric origin. However, it is quite easy to resolve δD evolution during post-deposit rehydration by meteoric water from magma degassing when volcanic glass have a δD <-100‰ or >-50‰ and [H2O]tot >1.5-2wt.%. Water speciation inferred from near-infrared spectroscopy also provides valuable information complementary to isotopic and total water measurements. During magma degassing (typically with [H2O]tot decreasing from 6wt.% to ~0wt.% water) H2O/OH is expected to decrease from 2 to close to 0. However, our dataset shows the opposite trend with an increase of H2O/OH from 2 to ~5. We interpret it as post deposit rehydration of the volcanic glass. Overall our results show that the discrimination of the water origin is essential to discuss magma degassing processes or paleoclimatic reconstitutions. The present study of hydrous glass supports the use of H-isotopes of volcanic glass to discuss paleoclimate reconstitution in a specific region. To this purpose, the volcanic glass has to be almost fully rehydrated in order to fingerprint the isotopic composition of the rehydration water. A sharp time constrain can be obtained if the full rehydration occurs quickly after the eruption. This is most likely to occur in meters thick volcanic pyroclast deposits that undergo slow cooling rates and thus can stay at few hundreds °C for a time long enough to ensure complete chemical reaction (few to hundreds of years) after the eruption but still short on a geological scale.

An amino acid-electrolyte beverage may increase cellular rehydration relative to carbohydrate-electrolyte and flavored water beverages.

PubMed

Tai, Chih-Yin; Joy, Jordan M; Falcone, Paul H; Carson, Laura R; Mosman, Matt M; Straight, Justen L; Oury, Susie L; Mendez, Carlos; Loveridge, Nick J; Kim, Michael P; Moon, Jordan R

2014-05-26

In cases of dehydration exceeding a 2% loss of body weight, athletic performance can be significantly compromised. Carbohydrate and/or electrolyte containing beverages have been effective for rehydration and recovery of performance, yet amino acid containing beverages remain unexamined. Therefore, the purpose of this study is to compare the rehydration capabilities of an electrolyte-carbohydrate (EC), electrolyte-branched chain amino acid (EA), and flavored water (FW) beverages. Twenty men (n = 10; 26.7 ± 4.8 years; 174.3 ± 6.4 cm; 74.2 ± 10.9 kg) and women (n = 10; 27.1 ± 4.7 years; 175.3 ± 7.9 cm; 71.0 ± 6.5 kg) participated in this crossover study. For each trial, subjects were dehydrated, provided one of three random beverages, and monitored for the following three hours. Measurements were collected prior to and immediately after dehydration and 4 hours after dehydration (3 hours after rehydration) (AE = -2.5 ± 0.55%; CE = -2.2 ± 0.43%; FW = -2.5 ± 0.62%). Measurements collected at each time point were urine volume, urine specific gravity, drink volume, and fluid retention. No significant differences (p > 0.05) existed between beverages for urine volume, drink volume, or fluid retention for any time-point. Treatment x time interactions existed for urine specific gravity (USG) (p < 0.05). Post hoc analysis revealed differences occurred between the FW and EA beverages (p = 0.003) and between the EC and EA beverages (p = 0.007) at 4 hours after rehydration. Wherein, EA USG returned to baseline at 4 hours post-dehydration (mean difference from pre to 4 hours post-dehydration = -0.0002; p > 0.05) while both EC (-0.0067) and FW (-0.0051) continued to produce dilute urine and failed to return to baseline at the same time-point (p < 0.05). Because no differences existed for fluid retention, urine or drink volume at any time point, yet USG returned to baseline during the EA trial, an EA supplement may enhance cellular rehydration rate compared to an EC or FW beverage in healthy men and women after acute dehydration of around 2% body mass loss.

Getting your message out with social marketing.

PubMed

Manoff, R K

1997-09-01

This article was based on a speech presented at a Plenary Session of the 1996 Annual Meeting of the American Society of Tropical Medicine and Hygiene. The address describes the nature of social marketing with examples and some lessons learned in developing countries. The earliest social marketers were Moses with the Ten Commandments of God and Indian religious authorities with fertility motifs inscribed on temple walls. Modern marketers of beer and snack food preempted the ancients and made social marketing more ingenious. The strategy shifted to supplying a product to satisfy a consumer want. Messages became a two-way process that minimized feedback shock. Focus groups were used to probe consumers' thoughts. Research must probe the total environment of the "problem." In Brazil, breast feeding promotions revealed that the perceived problem may not be the real problem, and there was no single magic solution. Most tropical disease prevention approaches do not rely on multistage strategies. The oral rehydration therapy (ORT) strategy became a world-wide model when strategists realized that the formula had to be easy to remember, diarrhea had to be recognized as a disease, and the function of ORT had to be clearly defined. The Bangladesh Social Marketing Campaign was successful in getting men to discuss family planning with their wives and establishing the family planning worker as a heroine. Effective messages must uncover points of resistance to the message. Public health advances in the 19th century were due to social policy to improve water supply, sanitation, and nutrition. The iodization of salt in Ecuador was possible with political will, public awareness, redirection of perception, and motivation of demand. Social marketing resources exist in all countries nowadays. Only medical and scientific professionals can promote concern about tropical diseases and raise the prevention priority on the public agenda.

Oral rehydration therapy in a rural area, northern Thailand.

PubMed

Varavithya, W; Sangshaisirisak, S; Ramaboot, S; Ruangkanchanasetr, S; Vivatwongkasem, C

1989-01-01

A cross-sectional sampling survey of mothers' practice of ORT in Amphoe Bunpotphesai in the northern part of Thailand included 1,619 children under five. Two hundred and six children were reported to have 223 diarrheal episodes. The incidence of diarrhea in children under five was 3.4 episodes per child per year. When children had diarrhea 65.5 per cent of mothers sought help from health providers, 25.2 per cent treated their children with drugs bought from stores, 2.3 per cent used herbal medicine and 6.1 per cent did not treat their children. 50.7 per cent of diarrheal episodes mother gave ORT, using ORS 19.7, commercial electrolytes mixture 16.6 and home available fluid 14.4 per cent. The accuracy of dilution of electrolytes powder from the packets was checked in 80 incidences. 31.8 and 27.8 per cent of mothers made correct dilution of ORS and commercial electrolytes products respectively. Health providers carried both ORS and commercial electrolytes packets. ORS added to a glass of water was found in 13.6 per cent which was 3 times concentrated. Commercial electrolytes products were too dilute in 72.2 per cent. 17.5 per cent of mothers divided electrolytes powder to add in one spoon of water to treat their children as one drug dose. Data showed that the ORT use rate was 50.7 per cent. Home available fluid was used by 14.4 per cent. ORT should be further promoted to control diarrheal diseases and health providers should give instructions to every mother or child minder on how to dispense ORS or electrolytes packets for appropriate dilution and use.

The rural market: a unique communication medium.

PubMed

Spain, P

1992-01-01

In January 1990, the Health Secretary asked the Technologies for Primary Health Care (PRITECH) project to facilitate access to the many small villages with 500 people in Mexico since PRITECH had assisted the diarrhea disease control program. 1st PRITECH had Ministry of Health staff train trainers which would eventually spread the information to the rural areas. This strategy was effective only for those people who did not live in remote areas. The same reasons for remote people being at high risk of disease also limited this strategy: isolation, lack of education, limited diets, lack of access to services, and limited fluency in Spanish. PRITECH hired a local consulting organization, CICLOPE, to develop a new strategy. CICLOPE limited its activities to the states of Hidalgo and Vera Cruz for 8 months. 1st CICLOPE staff provided proper diarrhea management training including emphasis on oral rehydration therapy (ORT) to rural health auxiliaries. They used a gourd painted to look like an infant with holes and other modifications to depict the workings and results of diarrheal dehydration. The staff then sent the auxiliaries to their own communities to use the gourd dolls to teach mothers about ORT and correct diarrhea management. The staff conducted follow-up activities to monitor the auxiliaries' progress. This training approach allowed the auxiliaries to realize the abilities of the mothers and their active role in learning. The auxiliaries conducted the training at markets where women living in remote areas came weekly. The local radio announced market day events in which the auxiliaries participated and aired dramas about diarrhea management. CICLOPE staff and the auxiliaries sat up a booth at these markets to promote proper diarrhea management. They used a flip chart, comic books, a lottery game, and entertainment to impart education messages.

Reducing infant mortality.

PubMed

Johnson, T R

1994-01-01

Public health and social policies at the population level (e.g., oral rehydration therapy and immunization) are responsible for the major reduction in infant mortality worldwide. The gap in infant mortality rates between developing and developed regions is much less than that in maternal mortality rates. This indicates that maternal and child health (MCH) programs and women's health care should be combined. Since 1950, 66% of infant deaths occur in the 1st 28 days, indicating adverse prenatal and intrapartum events (e.g., congenital malformation and birth injuries). Infection, especially pneumonia and diarrhea, and low birth weight are the major causes of infant mortality worldwide. An estimated US$25 billion are needed to secure the resources to control major childhood diseases, reduce malnutrition 50%, reduce child deaths by 4 million/year, provide potable water and sanitation to all communities, provide basic education, and make family planning available to all. This cost for saving children's lives is lower than current expenditures for cigarettes (US$50 billion in Europe/year). Vitamin A supplementation, breast feeding, and prenatal diagnosis of congenital malformations are low-cost strategies that can significantly affect infant well-being and reduce child mortality in many developing countries. The US has a higher infant mortality rate than have other developed countries. The American College of Obstetricians and Gynecologists and the US National Institutes of Health are focusing on prematurity, low birth weight, multiple pregnancy, violence, alcohol abuse, and poverty to reduce infant mortality. Obstetricians should be important members of MCH teams, which also include traditional birth attendants, community health workers, nurses, midwives, and medical officers. We have the financial resources to allocate resources to improve MCH care and to reduce infant mortality.

Antimicrobials & cholera: are we stranded?

PubMed Central

Ghosh, Amit; Ramamurthy, T.

2011-01-01

Antimicrobial resistance poses a major threat in the treatment of infectious diseases. Though significant progress in the management of diarrhoeal diseases has been achieved by improved hygiene, development of new antimicrobials and vaccines, the burden remains the same, especially in children below 5 yr of age. In the case of cholera, though oral rehydration treatment is the mainstay, antimicrobial therapy is mandatory at times to reduce the volume of stool and shorten the duration of the disease. Though for many pathogens, antimicrobial resistance emerged soon after the introduction of antibiotics, Vibrio cholerae remained sensitive to most of the antibiotics for quite a long period. However, the scenario changed over the years and today, V. cholerae strains isolated world over are resistant to multiple antibiotics. A myriad number of mechanisms underlie this phenomenon. These include production of extended-spectrum beta-lactamases, enhanced multi-drug efflux pump activity, plasmid-mediated quinolone and fluoroquinolone resistance, and chromosomal mutations. Horizontal transfer of resistance determinants with mobile genetic elements like integrons and the integrating conjugative elements (ICEs), SXTs help in the dissemination of drug resistance. Though all strains isolated are not resistant to all antibiotics and we are not as yet “stranded”, expanding spectrum of drug resistance is a definite cause for concern. Pipelines of discovery of new antibiotics are drying up as major pharmaceutical companies are losing interest in investing money in this endeavour, mainly due to the short shelf-life of the antibiotics and also due to the fast emergence of drug resistance. To address this issue, attempts are now being made to discover drugs which are pathogen specific and target their “virulence mechanisms”. It is expected that development of resistance against such antibiotics would take much longer. This review briefly focuses on all these issues. PMID:21415499

Antimicrobials & cholera: are we stranded?

PubMed

Ghosh, Amit; Ramamurthy, T

2011-02-01

Antimicrobial resistance poses a major threat in the treatment of infectious diseases. Though significant progress in the management of diarrhoeal diseases has been achieved by improved hygiene, development of new antimicrobials and vaccines, the burden remains the same, especially in children below 5 yr of age. In the case of cholera, though oral rehydration treatment is the mainstay, antimicrobial therapy is mandatory at times to reduce the volume of stool and shorten the duration of the disease. Though for many pathogens, antimicrobial resistance emerged soon after the introduction of antibiotics, Vibrio cholerae remained sensitive to most of the antibiotics for quite a long period. However, the scenario changed over the years and today, V. cholerae strains isolated world over are resistant to multiple antibiotics. A myriad number of mechanisms underlie this phenomenon. These include production of extended-spectrum beta-lactamases, enhanced multi-drug efflux pump activity, plasmid-mediated quinolone and fluoroquinolone resistance, and chromosomal mutations. Horizontal transfer of resistance determinants with mobile genetic elements like integrons and the integrating conjugative elements (ICEs), SXTs help in the dissemination of drug resistance. Though all strains isolated are not resistant to all antibiotics and we are not as yet "stranded", expanding spectrum of drug resistance is a definite cause for concern. Pipelines of discovery of new antibiotics are drying up as major pharmaceutical companies are losing interest in investing money in this endeavour, mainly due to the short shelf-life of the antibiotics and also due to the fast emergence of drug resistance. To address this issue, attempts are now being made to discover drugs which are pathogen specific and target their "virulence mechanisms". It is expected that development of resistance against such antibiotics would take much longer. This review briefly focuses on all these issues.

Integrated health programmes.

PubMed

Knowles, J

1995-04-01

Over a period of 10 years, a hospital in rural Africa slowly built an integrated primary and secondary health care program to the point where it has more than 40 elements. In its initial stage (1982-84), hospital staff and community participants were trained, the number of mobile clinics was increased, community participation was sought, and health education was emphasized. During 1985-86, 92 village health committees were organized with 70 trained Village Health Workers (VHWs). This led to a rapid increase in vaccination rates, the use of oral rehydration therapy, and training of traditional birth attendants. In 1987-88, 14 VHW were trained to use basic medical kits and distribute medicines. By 1990, 18,000 of the 72,000 outpatient treatments were administered by VHWs. In 1987, the hospital made a community diagnosis and increased the size of its advisory board (which became 60% female). Because the community identified food, water, and poverty as its priorities, the hospital took steps to improve the food supply, the water supply, and the financial position of the women. In 1989-90, the primary health care (PHC) project added the components of family planning, a weaning food production unit, food coupons, food for work, grain banks, a trust fund, literacy classes, health stamps, a mobile malnutrition clinic, subsidized fertilizer and seed, low-cost care for victims of AIDS, new malaria treatment schedules, and a housing association. The PHC program has resulted in a reduction in under-five deaths from the national average of 330/1000 to 145/1000 (other areas have reduced deaths to 270-300/1000. The program is also becoming increasingly cost-effective, costing about 6 pounds per capita over 10 years for a population of 50,000. Country-wide implementation of the PHC program would require only 30% of the present health budget.

Severe events in the first 6 months of life in a cohort of HIV-unexposed infants from South Africa: effects of low birthweight and breastfeeding status.

PubMed

Doherty, Tanya; Jackson, Debra; Swanevelder, Sonja; Lombard, Carl; Engebretsen, Ingunn M S; Tylleskär, Thorkild; Goga, Ameena; Ekström, Eva-Charlotte; Sanders, David

2014-10-01

To report on risk factors for severe events (hospitalisation or infant death) within the first half of infancy amongst HIV-unexposed infants in South Africa. South African data from the multisite community-based cluster-randomised trial PROMISE EBF promoting exclusive breastfeeding in three sub-Saharan countries from 2006 to 2008 were used. The South African sites were Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal. This analysis included 964 HIV-negative mother-infant pairs. Data on severe events and infant feeding practices were collected at 3, 6, 12 and 24 weeks post-partum. We used a stratified extended Cox model to examine the association between the time to the severe event and covariates including birthweight, with breastfeeding status as a time-dependent covariate. Seventy infants (7%) experienced a severe event. The median age at first hospitalisation was 8 weeks, and the two main reasons for hospitalisation were cough and difficult breathing followed by diarrhoea. Stopping breastfeeding before 6 months (HR 2.4; 95% CI 1.2-5.1) and low birthweight (HR 2.4; 95% CI 1.3-4.3) were found to increase the risk of a severe event, whilst maternal completion of high school education was protective (HR 0.3; 95% CI 0.1-0.7). A strengthened primary healthcare system incorporating promotion of breastfeeding and appropriate caring practices for low birthweight infants (such as kangaroo mother care) are critical. Given the leading reasons for hospitalisation, early administration of oral rehydration therapy and treatment of suspected pneumonia are key interventions needed to prevent hospitalisation in young infants. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

[Child health. Revolution in health care can save millions].

PubMed

1983-02-09

The conclusions of the 1982-83 UNICEF report on the world's children are summarized. Improved diarrhea treatment, better vaccines, a halt to formula-feeding, and the fight against the invisible problem of malnutrition could save 20,000 children per day. If no measures are taken, a 30% increase in the number of undernourished and sick children could result by the turn of the century. Oral rehydration therapy (ORT) is vital to combatting diarrhea, which claims the lives of 5 million children per year. ORT can be done at home by letting the child drink a mixture of sugar and salt in water. The distribution of cheap ORT salt packages should be promoted. A new, heat-resistant measles vaccine, requiring only cold storage instead of freezing, could save 1.5 million children who die of measles annually. In 35 countries, a campaign against the use and sale of baby formulas could also save scores of children who die from undernourishment or infections from unclean bottles. Breast-feeding should be encouraged. In the fight against malnutrition, a child development chart indicating normal growth phases should be used to alert mothers to slow development. In 60% of the malnutrition cases in the Philippines, mothers were not aware of the condition. In an experiment in Indonesia, 15,000 village mothers regularly weigh their children on open-market scales and record the results. The organizational input for this is relatively small, but could result in decreasing malnutrition and child mortality by 1/2 by the end of the century. In addition, there are indications that a decline in child mortality correlates with a decrease in birth rate. Paradoxically, saving 6-7 million children could prevent the birth of 12-20 million children per year.

Effects of immediate modified feeding on infantile gastroenteritis.

PubMed Central

Hoghton, M A; Mittal, N K; Sandhu, B K; Mahdi, G

1996-01-01

BACKGROUND: Standard treatment of infants who are dehydrated as a result of acute gastroenteritis is to administer oral rehydration therapy (ORT). Traditionally, food has been withdrawn for 24-48 h, but there is no conclusive evidence that this is of any real benefit to the patient. Immediate modified feeding, in which an infant on ORT is not starved but administered a limited diet, may have benefits in the treatment of gastroenteritis, especially in children who are nutritionally compromised before they develop the illness. AIM: A pilot study was carried out to investigate the effects of giving infants suffering from acute gastroenteritis a limited modified diet in conjunction with ORT. METHOD: Infants recruited into the study by their general practitioner or by a research doctor in the hospital casualty unit of Bristol Children's Hospital were randomly allocated to receive ORT with or without immediate modified feeding. The duration of diarrhoea, weight change, and incidence of vomiting and lactose intolerance were measured in both treatment groups, and the results were compared. RESULTS: Of the infants studied, 27 received ORT and immediate modified feeding, and 32 ORT alone. The duration of diarrhoea, and incidence of vomiting or lactose intolerance were no greater in the group receiving immediate modified feeding. Patients who received ORT and immediate modified feeding appeared to gain more weight than the infants who were starved for 24-48 h, but this difference was not statistically significant. CONCLUSION: Immediate modified feeding is safe and effective, and may have nutritional advantages over traditional ORT with starvation. A similar but multicentre study using unmodified diet, i.e. child's normal diet, is being carried out by a working group of The European Society of Paediatrics, Gastroenterology and Nutrition (ESPGAN). PMID:8731625

Improving the management of acute diarrhoea and dehydration in under-5 children in a paediatric referral facility in Lagos, Nigeria.

PubMed

Senbanjo, Idowu O; Ch'ng, Chin Lye; Allen, Stephen J

2017-02-01

Mortality from acute diarrhoea and dehydration (AD/D) in children is high despite existing management guidelines. The aim of this study was to identify deficiencies in the management of AD/D by health staff and assess changes in management after a training intervention in a paediatric referral facility in Lagos, Nigeria. In a retrospective review of case notes, the management of AD/D was assessed using WHO guidelines as the standard. An e-learning module was developed that directly addressed deficiencies and was used to train health staff. Changes in the management of AD/D were assessed by re-auditing case notes. There were learning needs among health staff in the management of AD/D. Altogether, 34 (97.1%) of 35 residents were trained. Training resulted in modest improvements in the number of children in whom nutritional status was assessed, use of oral rather than intravenous fluids for rehydration and reducing unnecessary laboratory tests. Training resulted in marked improvements in the correct volume of (pre- vs. post-training 6.3% vs. 94.1%, P<0.001) and follow-up of fluid therapy (8.1% vs. 98.0%; P<0.001), prescription of zinc (41.6% vs. 85.1%, P<0.001) and providing advice on when to return after discharge (77.6% vs. 96.0%, P<0.001). Although statistically significant, the minimal improvements in antibiotic use (43.8% vs. 56.6%, P = 0.03), re-starting feeds (10.6% vs. 38.6%, P<0.001) and counselling about feeding (11.8% vs. 33.7%, P<0.001) highlighted areas for further training. In low-resource countries, clinical auditing and training can significantly improve the management of illnesses that contribute to child deaths and identify areas where further training is required.

An investment in children's health, nutrition and education is the foundation stone for all national development.

PubMed

Kalra, S

1991-01-01

A medical student at the Christian Medical College in Ludhiana, India, won first place in the First Annual Dr. S.M. Gupta Memorial Essay Contest with this essay on investing in the health, nutrition, and education of India's children. The health, nutrition, and education condition of India's children is substandard. 10% of infants die before their first birthday. 15% of children die before age 5. Many Indian children suffer from diarrhea and acute respiratory infections. Investment in immunization, oral rehydration therapy, hygiene, and health education would prevent many of these deaths and illnesses. Illness and death cost parents time, energy, and money. Children suffering from malnutrition and sickness cannot concentrate on learning. The state of today's children foretells the state of tomorrow's adults, work force, and leaders. Poor nutrition and health contribute to India's substandard economic productivity. India has 14% of the world's population, but produces only 1.2% of its gross national product. Even though India was the first country to have a national family planning program, its fertility and population growth rates are high. Investment in children's health would show parents the benefits of planning their families. It would also improve India's poor performance in sports and war as well as national prestige and socioeconomic development. The considerable number of illiterates reflect India's failure to invest in education. Females have a lower literacy rate than males. Girls in India suffer much discrimination. They receive less food, less medical care, less opportunities for education, and less recreation. National development depends on the active participation of girls. Prevention is the key: nourish the children, educate them, and keep them healthy.

Effect of the aerated structure on selected properties of freeze-dried hydrocolloid gels

NASA Astrophysics Data System (ADS)

Ciurzyńska, Agnieszka; Lenart, Andrzej

2016-01-01

The ability to create diverse structures and studies on the effect of the aerated structure on selected properties with the use of freeze-dried gels may provide knowledge about the properties of dried foods. Such gels can be a basis for obtaining innovative food products. For the gel preparation, 3 types of hydrocolloids were used: low-methoxyl pectin, a mixture of xanthan gum and locust-bean gum, and a mixture of xanthan gum and guar gum. Gels were aerated for 3 and 7 min, frozen at a temperature of -45°C 2 h-1, and freeze-dried at a temperature of 30°C. For the samples obtained, structure, porosity, shrinkage, rehydration, and colour were investigated. It was shown that the type of the hydrocolloid and aeration time influence the structure of freeze-dried gels, which determines such properties of samples as porosity, shrinkage, density, rehydration, and colour. The bigger pores of low-methoxyl pectin gels undergo rehydration in the highest degree. The delicate and aerated structure of gels with the mixture of xanthan gum and locust-bean gum was damaged during freeze-drying and shrinkage exhibited the highest value. Small pores of samples with the mixture of xanthan gum and guar gum were responsible for the lower rehydration properties, but the highest porosity value contributed to the highest lightness value.

Impact of dehydration of purslane on retention of bioactive molecules and antioxidant activity.

PubMed

Shanker, Niharika; Debnath, Sukumar

2015-10-01

Purslane (Portulaca oleracea L.) has several health benefits, such as it reduces risk of CVD, obesity and diabetes. The objective of the study was to investigate the effect of different drying on retention of bioactive molecules, such as omega-3 fatty acids, total phenolic content and antiradical activity of purslane. Five different dehydration methods including microwave (100 MW, 5 min), tray, vacuum, low temperature low humidity, infrared were used at 55-60 °C for 5-7 h for dehydration of purslane. Three solvents, viz. water, ethanol and methanol were used for extraction of bioactive molecules from purslane. Total polyphenol content, antiradical activity and rehydration ratio of the bioactive molecules were determined. Results revealed that total PUFA, α-linolenic acid (ALA), total polyphenol content and antiradical activity were found to retain in the dried purslane in the range of (47.9-59.9 %), (42.5-50 %), (188-408GAE/100 g) and (33.0-88.8 mg/100 g) respectively. The highest values of ALA, total polyphenol content and antiradical activity were found to obtain in the vacuum dried sample. Rehydration ratio was found in the range of 3.2-4.3 and vacuum dried purslane showed maximum rehydration. It could be concluded that vacuum dehydration of purslane is an effective method for retention of bioactive molecules and good rehydration behaviour of dried purslane.

Comparison of selected physico-chemical properties of calcium alginate films prepared by two different methods.

PubMed

Crossingham, Yazmin J; Kerr, Philip G; Kennedy, Ross A

2014-10-01

Sodium alginate (SA) is a naturally occurring, non-toxic, polysaccharide that is able to form gels after exposure to calcium. These gels have been used in food and biomedical industries. This is the first direct comparison of two different methods of calcium alginate film production, namely interfacial gelation (IFG) and dry cast gelation (DCG). IFG films were significantly thicker than DCG films, and were more extensively rehydrated in water and 0.1M HCl than the DCG films. During rehydration in 0.1M HCl almost all calcium ions were lost. Under scanning electron microscopy, IFG films appeared less dense than DCG films. IFG films were mechanically weaker than DCG films, and both types of film were weaker after rehydration in 0.1M HCl compared with deionized water. Permeation of theophylline (TPL) was evaluated in-vitro; the diffusion coefficient (D) of the TPL was almost 90 times lower in DCG films than IFG films when both were rehydrated in water. Although the 0.1M HCl rendered both gels more permeable to TPL, D of TPL was still about five times lower in DCG compared to IFG films. The evaluation of selected physico-chemical properties of films is important, since this information may inform the choice of gelation technique used to produce calcium alginate coatings on pharmaceutical products. Copyright © 2014 Elsevier B.V. All rights reserved.

Effects of protectant and rehydration conditions on the survival rate and malolactic fermentation efficiency of freeze-dried Lactobacillus plantarum JH287.

PubMed

Lee, Sae-Byuk; Kim, Dong-Hwan; Park, Heui-Dong

2016-09-01

In this study, Lactobacillus plantarum JH287 was used as a malolactic fermentation starter in Campbell Early wine production. L. plantarum JH287 was first lyophilized, and the malolactic fermentation potential of freeze-dried L. plantarum JH287 was investigated. Different protective media and rehydration conditions were tested to improve the survival rate of freeze-dried L. plantarum JH287. Optimal protective medium contained 10 % sorbitol and 10 % skim milk. The optimal rehydration condition was a 1-h rehydration time conducted in the same protective media, and the combination of these two methods produced a survival rate of 86.37 %. In addition, a 77.71 % survival rate was achieved using freeze-dried samples that were stored at 4 °C for 2 months. Freeze-dried L. plantarum JH287 and Saccharomyces cerevisiae Fermivin were used to inoculate the Campbell Early grape must to decrease its malic acid content. Using this mixed-fermentation method, wine showed a decrease in malic acid content after 9 days of fermentation. GC-MS analysis detected 15 volatile ester compounds in the wine. A sensory evaluation showed that the taste and aroma of mix-fermented wine were better than those of the control that had not been inoculated with L. plantarum JH287.

Rehydration after exercise in the heat: a comparison of 4 commonly used drinks.

PubMed

Shirreffs, Susan M; Aragon-Vargas, Luis F; Keil, Mhairi; Love, Thomas D; Phillips, Sian

2007-06-01

To determine the effectiveness of 3 commonly used beverages in restoring fluid and electrolyte balance, 8 volunteers dehydrated by 1.94% +/- 0.17% of body mass by intermittent exercise in the heat, then ingested a carbohydrate-electrolyte solution (Gatorade), carbonated water/apple-juice mixture (Apfelschorle), and San Benedetto mineral water in a volume equal to 150% body-mass loss. These drinks are all are perceived to be effective rehydration solutions, and their effectiveness was compared with the rehydration effectiveness of Evian mineral water, which is not perceived in this way by athletes. Four hours after rehydration, the subjects were in a significantly lower hydration status than the pretrial situation on trials with Apfelschorle (-365 +/- 319 mL, P = 0.030), Evian (-529 +/- 319 mL, P < 0.0005), and San Benedetto (-401 +/- 353 mL, P = 0.016) but were in the same hydration status as before the dehydrating exercise on Gatorade (-201 +/- 388 mL, P = 0.549). Sodium balance was negative on all trials throughout the study; only with Apfelschorle did subjects remain in positive potassium balance. In this scenario, recovery of fluid balance can only be achieved when significant, albeit insufficient, quantities of sodium are ingested after exercise. There is a limited range of commercially available products that have a composition sufficient to achieve this, even though the public thinks that some of the traditional drinks are effective for this purpose.

Lyophilisation and concentration of chitosan/siRNA polyplexes: Influence of buffer composition, oligonucleotide sequence, and hyaluronic acid coating.

PubMed

Veilleux, Daniel; Gopalakrishna Panicker, Rajesh Krishnan; Chevrier, Anik; Biniecki, Kristof; Lavertu, Marc; Buschmann, Michael D

2018-02-15

Chitosan (CS)/siRNA polyplexes have great therapeutic potential for treating multiple diseases by gene silencing. However, clinical application of this technology requires the development of concentrated, hemocompatible, pH neutral formulations for safe and efficient administration. In this study we evaluate physicochemical properties of chitosan polyplexes in various buffers at increasing ionic strengths, to identify conditions for freeze-drying and rehydration at higher doses of uncoated or hyaluronic acid (HA)-coated polyplexes while maintaining physiological compatibility. Optimized formulations are used to evaluate the impact of the siRNA/oligonucleotide sequence on polyplex physicochemical properties, and to measure their in vitro silencing efficiency, cytotoxicity, and hemocompatibility. Specific oligonucleotide sequences influence polyplex physical properties at low N:P ratios, as well as their stability during freeze-drying. Nanoparticles display greater stability for oligodeoxynucleotides ODN vs siRNA; AT-rich vs GC-rich; and overhangs vs blunt ends. Using this knowledge, various CS/siRNA polyplexes are prepared with and without HA coating, freeze-dried and rehydrated at increased concentrations using reduced rehydration volumes. These polyplexes are non-cytotoxic and preserve silencing activity even after rehydration to 20-fold their initial concentration, while HA-coated polyplexes at pH∼7 also displayed increased hemocompatibility. These concentrated formulations represent a critical step towards clinical development of chitosan-based oligonucleotide intravenous delivery systems. Copyright © 2017 Elsevier Inc. All rights reserved.

Feed intake, forestomach fluid volume, dilution rate and mean retention of fluid in the forestomach during water deprivation and rehydration in camels (Camelus sp.).

PubMed

von Engelhardt, W; Haarmeyer, P; Lechner-Doll, M

2006-04-01

Camels were deprived of water for 11 days. Before and during water deprivation and during rehydration changes in body weight, feed and water intake were measured. Using the liquid marker Cr-EDTA forestomach fluid volume, mean fluid retention and fluid dilution in the forestomach were estimated. At the eleventh day of water deprivation hay intake had decreased to only 9.6% of controls, dilution rates had decreased to 31%, mean retention time of fluid in the forestomach had increased to 189%. At the end of dehydration flow of saliva of 2 l/h mainly contributed to the still rather high dilution rates. Thereby buffering capacity and flow of fluid into the forestomach for microbial digestion as well as the outflow from the forestomach were maintained. At the beginning of rehydration camels drank 97 l within a few minutes, and animals thereby replaced all the water lost. Following this first huge water intake water is rapidly absorbed from the forestomach, and forestomach volume decreased again to dehydration values. At the third day of rehydration control values were reached again. Although feed intake decreased dramatically during water deprivation, functions of the forestomach can be maintained sufficiently mainly due to saliva inflow. This explains the mostly rapid recovery of camels when water is available again.

Vasopressin Mediates the Renal Damage Induced by Limited Fructose Rehydration in Recurrently Dehydrated Rats.

PubMed

García-Arroyo, Fernando E; Tapia, Edilia; Blas-Marron, Mónica G; Gonzaga, Guillermo; Silverio, Octaviano; Cristóbal, Magdalena; Osorio, Horacio; Arellano-Buendía, Abraham S; Zazueta, Cecilia; Aparicio-Trejo, Omar Emiliano; Reyes-García, Juan G; Pedraza-Chaverri, José; Soto, Virgilia; Roncal-Jiménez, Carlos; Johnson, Richard J; Sánchez-Lozada, Laura G

2017-01-01

Recurrent dehydration and heat stress cause chronic kidney damage in experimental animals. The injury is exacerbated by rehydration with fructose-containing beverages. Fructose may amplify dehydration-induced injury by directly stimulating vasopressin release and also by acting as a substrate for the aldose reductase-fructokinase pathway, as both of these systems are active during dehydration. The role of vasopressin in heat stress associated injury has not to date been explored. Here we show that the amplification of renal damage mediated by fructose in thermal dehydration is mediated by vasopressin. Fructose rehydration markedly enhanced vasopressin (copeptin) levels and activation of the aldose reductase-fructokinase pathway in the kidney. Moreover, the amplification of the renal functional changes (decreased creatinine clearance and tubular injury with systemic inflammation, renal oxidative stress, and mitochondrial dysfunction) were prevented by the blockade of V1a and V2 vasopressin receptors with conivaptan. On the other hand, there are also other operative mechanisms when water is used as rehydration fluid that produce milder renal damage that is not fully corrected by vasopressin blockade. Therefore, we clearly showed evidence of the cross-talk between fructose, even at small doses, and vasopressin that interact to amplify the renal damage induced by dehydration. These data may be relevant for heat stress nephropathy as well as for other renal pathologies due to the current generalized consumption of fructose and deficient hydration habits.

Association of Oral Lichen Planus with Chronic C Hepatitis. Review of the Data in Literature

PubMed Central

GHEORGHE, Carmen; MIHAI, Lelia; PARLATESCU, Ioanina; TOVARU, Serban

2014-01-01

The relationship between chronic hepatitis C virus infection (HCV) and oral lichen planus (OLP) is a current topic in the field of oral medicine. Many studies of this association have been made over time. The geographic variation of the hepatitis C prevalence proved to be an important factor influencing the statistical results of the studies analyzing the association of the oral plan lichen with the hepatitis C virus. Approaching this issue is not to be neglected. Treatment outcomes in patients with oral lichen planus associated with chronic hepatitis C virus are often unsatisfactory compared to patients suffering from idiopathic oral lichen planus. Also, the evolution of oral lesions is often fluctuating, with repeated periods of relapse according to the degree of liver function decompensation. Background therapy for liver disease itself may influence lichen planus lesions. Thus, during therapy with interferon and ribavirin oral lesions may appear or become acute. PMID:25553136

Relapse after Oral Terbinafine Therapy in Dermatophytosis: A Clinical and Mycological Study.

PubMed

Majid, Imran; Sheikh, Gousia; Kanth, Farhath; Hakak, Rubeena

2016-01-01

The incidence of recurrent tinea infections after oral terbinafine therapy is on the rise. This study aims to identify the appearance of incomplete cure and relapse after 2-week oral terbinafine therapy in tinea corporis and/or tinea cruris. A total of 100 consecutive patients clinically and mycologically diagnosed to have tinea corporis and/or tinea cruris were included in the study. The enrolled patients were administered oral terbinafine 250 mg once daily for 2 weeks. All clinically cured patients were then followed up for 12 weeks to look for any relapse/cure. The common dermatophytes grown on culture were Trichophyton rubrum and Trichophyton tonsurans in 55% and 20% patients, respectively. At the end of 2-week oral terbinafine therapy, 30% patients showed a persistent disease on clinical examination while 35% patients showed a persistent positive fungal culture (persisters) at this time. These culture positive patients included all the clinically positive cases. Rest of the patients (65/100) demonstrated both clinical and mycological cure at this time (cured). Over the 12-week follow-up, clinical relapse was seen in 22 more patients (relapse) among those who had shown clinical and mycological cure at the end of terbinafine therapy. Thus, only 43% patients could achieve a long-term clinical and mycological cure after 2 weeks of oral terbinafine treatment. Majority of the relapses (16/22) were seen after 8 weeks of completion of treatment. There was no statistically significant difference in the body surface area involvement or the causative organism involved between the cured, persister, or relapse groups. Incomplete mycological cure as well as relapse is very common after standard (2-week) terbinafine therapy in our patients of tinea cruris/corporis.

Randomized, Double-Blind, Placebo-Controlled Trial of Shuanghua Baihe Tablets to Prevent Oral Mucositis in Patients With Nasopharyngeal Cancer Undergoing Chemoradiation Therapy.

PubMed

Zheng, Baomin; Zhu, Xiaodong; Liu, Mengzhong; Yang, Zhenzhou; Yang, Ling; Lang, Jinyi; Shi, Mei; Wu, Gang; He, Xia; Chen, Xiaozhong; Xi, Xuping; Zhao, Dan; Zhu, Guangying

2018-02-01

Oral mucositis is a common unpreventable complication associated with chemoradiation therapy. Shuanghua Baihe tablets have been approved by the Chinese Food and Drug Administration for treating recurrent oral mucosa ulceration. This study assessed whether Shuanghua Baihe tablets could prevent oral mucositis during chemoradiation therapy for locally advanced nasopharyngeal carcinoma. This multicenter, randomized, double-blind, placebo-controlled trial was conducted at 11 hospitals in China between January 22, 2014, and September 21, 2015. Eligible patients (N=240, 18-70 years old) with pathologically diagnosed locally advanced nasopharyngeal carcinoma were randomly assigned (computer-block randomization; 1:1) to receive Shuanghua Baihe tablets or a placebo (4 tablets, 3 times a day, for 7 weeks) at the initiation of chemoradiation therapy. Administration of Shuanghua Baihe tablets could be ended if grade 3 or higher oral mucositis developed and patients were unwilling to continue taking the drug. The primary endpoints were oral mucositis incidence and latency. The incidence of oral mucositis during this study was significantly lower in the Shuanghua Baihe group (85.0%; 95% confidence interval [CI], 78.6%-91.4%) than in the placebo group (96.6%; 95% CI, 93.4%-99.9%; P=.0028). The median latency period was 28 days in the Shuanghua Baihe group and 14 days in the placebo group (hazard ratio, 0.17; 95% CI, 0.12-0.23; P<.0001). Compared with placebo, Shuanghua Baihe tablets significantly reduced the oral mucositis severity scores recorded by the investigators (Oral Mucositis Score, 24.0 [range, 0.0-67.8] vs 57.5 [range, 0.0-98.0]; P<.0001), full-time nurses (Oral Assessment Guide score, 462.0 [range, 392.0-664.7] vs 520.4 [range, 392.0-714.0]; P<.0001), and patients (score for soreness of mouth and throat, 4.0 [range, 0-10] vs 6.0 [range, 0-10]; P<.0001). No serious adverse events were observed, and the incidence of mild or moderate gastrointestinal adverse events associated with Shuanghua Baihe tablets was 3.3%. The short-term response rate was similar in patients receiving Shuanghua Baihe tablets and those receiving placebo during chemoradiation therapy during this study. Shuanghua Baihe tablets reduced the occurrence, latency, and severity of oral mucositis in patients with nasopharyngeal cancer during chemoradiation therapy treatment. Copyright © 2017. Published by Elsevier Inc.

Advances in Oral Appliances for Obstructive Sleep Apnea.

PubMed

Jacobowitz, Ofer

2017-01-01

Oral appliances that advance the mandible are widely used as alternatives to positive airway pressure (PAP) devices or as primary therapy for obstructive sleep apnea (OSA) in adults. Although PAP is more efficacious at lowering the polysomnographic indices of OSA, the clinical effectiveness of PAP and oral appliances is similar, and patients are more likely to adhere to oral appliance therapy than to PAP treatment. Clinical examination is used to determine the candidacy of oral appliances and to select a particular appliance for a given patient. Endoscopic examination of the pharynx may be used to help assess the potential for efficacy. Otherwise, if available, titration of mandibular protrusion during sleep may be performed prior to appliance production in order to assess efficacy. Once a patient is fitted with a titratable oral appliance, further advancement is usually performed at home to resolve the clinical symptoms and signs of OSA. Clinical follow-up is needed to assess the outcome, side effects, and adherence, as the long-term adherence rate is approximately 50%. Recent advances in oral appliance therapy include the development of embedded temperature sensors for adherence monitoring and the production of thinner, lighter appliances via 3D printing techniques. © 2017 S. Karger AG, Basel.

Professional oral hygiene treatment and detailed oral hygiene instructions in patients affected by mucous membrane pemphigoid with specific gingival localization: a pilot study in 12 patients.

PubMed

Arduino, P G; Lopetuso, E; Carcieri, P; Giacometti, S; Carbone, M; Tanteri, C; Broccoletti, R

2012-05-01

The aim of this prospective case series was to assess the clinical efficiency of an oral hygiene protocol in patients affected by mucous membrane pemphigoid (MMP) with specific gingival localization, before starting any medical treatment. Patients received oral hygiene instruction followed by non-surgical periodontal therapy including oral hygiene instructions in a 3-week cohort study. Clinical outcome variables were recorded at baseline and 5 weeks after intervention and included, as periodontal parameters, full mouth plaque (FMPS) and bleeding (FMBS) scores and patient-related outcomes (visual analogue score of pain). A total of 12 patients were recruited. The mean age at presentation was 59.5 ± 14.52 years. Five weeks after finishing the oral hygiene and periodontal therapy protocol, a statistical significant reduction was observed for FMPS (P = 0.001), FMBS (P = 0.022) and reported pain (P = 0.0028). Professional oral hygiene procedures and non-surgical periodontal therapy are connected with improvement of gingival status and decrease in gingival-related pain, in female patients affected by MMP with specific gingival localization. © 2011 John Wiley & Sons A/S.

Colon-targeted delivery of live bacterial cell biotherapeutics including microencapsulated live bacterial cells

PubMed Central

Prakash, Satya; Malgorzata Urbanska, Aleksandra

2008-01-01

There has been an ample interest in delivery of therapeutic molecules using live cells. Oral delivery has been stipulated as best way to deliver live cells to humans for therapy. Colon, in particular, is a part of gastrointestinal (GI) tract that has been proposed to be an oral targeted site. The main objective of these oral therapy procedures is to deliver live cells not only to treat diseases like colorectal cancer, inflammatory bowel disease, and other GI tract diseases like intestinal obstruction and gastritis, but also to deliver therapeutic molecules for overall therapy in various diseases such as renal failure, coronary heart disease, hypertension, and others. This review provides a comprehensive summary of recent advancement in colon targeted live bacterial cell biotherapeutics. Current status of bacterial cell therapy, principles of artificial cells and its potentials in oral delivery of live bacterial cell biotherapeutics for clinical applications as well as biotherapeutic future perspectives are also discussed in our review. PMID:19707368

Treatment of chancroid, 1997.

PubMed

Schmid, G P

1999-01-01

Since the 1993 treatment guidelines for sexually transmitted diseases were published by the Centers for Disease Control and Prevention, experience has indicated that the regimens recommended then remain largely effective. The recommended therapies--with azithromycin (1 g orally, once), ceftriaxone (250 mg intramuscularly, once), or erythromycin (500 mg orally, four times a day for 7 days)--appear highly effective in the United States; limited data from Kenya suggest that the ceftriaxone regimen may not be as effective there as it once was. The alternative regimen of ciprofloxacin proposed in 1993 (500 mg orally, twice a day for 3 days) is as effective as the recommended therapies, but new information indicates that single-dose therapy with 500 mg orally is not as effective as the use of either larger single doses or more prolonged therapy. Persons who are infected with human immunodeficiency virus (HIV) do not respond as well as those who are not HIV-infected, and males who are uncircumcised appear not to respond as well as those who are circumcised.

Bamboo Nodes of Vocal Folds: A Description of 10 Cases and Review of the Literature.

PubMed

Todic, Jelena; Schweizer, Valérie; Leuchter, Igor

2018-05-30

Bamboo nodes are vocal fold lesions, mostly associated with autoimmune diseases. This is a retrospective clinical study including 10 patients with bamboo nodes. Data were collected regarding associated autoimmune disorder and type of treatment. A systematic review of the literature was conducted. All patients were women, with hoarseness as the most frequent symptom. There was in most cases an associated autoimmune disease: 3 patients with systemic lupus erythematosus; 3 with rheumatoid arthritis; 1 with Sjögren syndrome; 1 with Hashimoto disease; and 1 with mixed connective tissue disease. Four patients were treated with speech therapy, 3 with oral steroids, 1 with speech therapy and oral steroids combined, 1 with oral steroids and laryngeal steroid injections, and 1 had oral steroids, surgery, and speech therapy. Speech therapy was the first-line treatment. Bamboo nodes should be looked for in every patient with a diagnosis of autoimmune disease complaining of dysphonia. © 2018 S. Karger AG, Basel.

A review of the efficacy and safety of nanoparticle-based oral insulin delivery systems.

PubMed

Card, Jeffrey W; Magnuson, Bernadene A

2011-12-01

Nanotechnology is providing new and innovative means to detect, diagnose, and treat disease. In this regard, numerous nanoparticle-based approaches have been taken in an effort to develop an effective oral insulin therapy for the treatment of diabetes. This review summarizes efficacy data from studies that have evaluated oral insulin therapies in experimental models. Also provided here is an overview of the limited safety data that have been reported in these studies. To date, the most promising approaches for nanoparticle-based oral insulin therapy appear to involve the incorporation of insulin into complex multilayered nanoparticles that are mucoadhesive, biodegradable, biocompatible, and acid protected and into nanoparticles that are designed to take advantage of the vitamin B(12) uptake pathway. It is anticipated that the continued investigation and optimization of nanoparticle-based formulations for oral delivery of insulin will lead to a much sought-after noninvasive treatment for diabetes. Such investigations also may provide insight into the use of nanoparticle-based formulations for peptide- and protein-based oral treatment of other diseases and for various food-related purposes.

BioSentinel: Biosensors for Deep-Space Radiation Study

NASA Technical Reports Server (NTRS)

Lokugamage, Melissa P.; Santa Maria, Sergio R.; Marina, Diana B.; Bhattacharya, Sharmila

2016-01-01

The BioSentinel mission will be deployed on NASA's Exploration Mission 1 (EM-1) in 2018. We will use the budding yeast, Saccharomyces cerevisiae, as a biosensor to study the effect of deep-space radiation on living cells. The BioSentinel mission will be the first investigation of a biological response to space radiation outside Low Earth Orbit (LEO) in over 40 years. Radiation can cause damage such as double stand breaks (DSBs) on DNA. The yeast cell was chosen for this mission because it is genetically controllable, shares homology with human cells in its DNA repair pathways, and can be stored in a desiccated state for long durations. Three yeast strains will be stored dry in multiple microfluidic cards: a wild type control strain, a mutant defective strain that cannot repair DSBs, and a biosensor strain that can only grow if it gets DSB-and-repair events occurring near a specific gene. Growth and metabolic activity of each strain will be measured by a 3-color LED optical detection system. Parallel experiments will be done on the International Space Station and on Earth so that we can compare the results to that of deep space. One of our main objectives is to characterize the microfluidic card activation sequence before the mission. To increase the sensitivity of yeast cells as biosensors, desiccated yeast in each card will be resuspended in a rehydration buffer. After several weeks, the rehydration buffer will be exchanged with a growth medium in order to measure yeast growth and metabolic activity. We are currently working on a time-course experiment to better understand the effects of the rehydration buffer on the response to ionizing radiation. We will resuspend the dried yeast in our rehydration medium over a period of time; then each week, we will measure the viability and ionizing radiation sensitivity of different yeast strains taken from this rehydration buffer. The data obtained in this study will be useful in finalizing the card activation sequence for this mission.

Ground Testing of the EMCS Seed Cassette for Biocompatibility with the Tardigrade, Hypsibius dujardini

NASA Technical Reports Server (NTRS)

Reinsch, Sigrid; Myers, Zachary Alan; DeSimone, Julia Carol; Freeman, John L.; Steele, Marianne K.; Sun, Gwo-Shing; Heathcote, David

2014-01-01

The European Modular Cultivation System, EMCS, was developed by ESA for plant experiments. We performed ground testing to determine whether ARC EMCS seed cassettes could be adapted for use with tardigrades for future spaceflight experiments. Tardigrades (water bears) are small invertebrates that enter the tun state in response to desiccation or other environmental stresses. Tardigrade tuns have suspended metabolism and have been shown to be survive exposure to space vacuum, high pressure, temperature and other stresses. For spaceflight experiments using the EMCS, the organisms ideally must be able to survive desiccation and storage in the cassette at ambient temperature for several weeks prior to the initiation of the experiment by the infusion of water to the cassette during spaceflight. The ability of tardigrades to survive extremes by entering the tun state make them ideal candidates for growth experiments in the EMCS cassettes. The growth substratum in the cassettes is a gridded polyether sulfone (PES) membrane. A blotter beneath the PES membrane contains dried growth medium. The goals of our study were to (1) determine whether tardigrades survive and reproduce on PES membranes, (2) develop a consistent method for dehydration of the tardigrades with high recovery rates upon rehydration, (3) to determine an appropriate food source for the tardigrades that can also be dehydrated/rehydrated and (4) successful mock rehydration experiment in cassettes with appropriate food source. We present results that show successful multigenerational growth of tardigrades on PES membranes with a variety of wet food sources. We have successfully performed a mock rehydration with tardigrades and at least one candidate food, protonema of the moss Polytrichum, that supports multigenerational growth and whose spores germinate quickly enough to match tardigrade feeding patterns post rehydration. Our results indicate that experiments on the ISS using the tardigrade, Hypsibius dujardini and other similar species could successfully be performed in the flight verified hardware of the EMCS seed cassettes.

A comparative study of volatile contents of primitive arc bubble-bearing melt inclusions determined by Raman-spectroscopy and mass-balance versus experimental homogenization methods

NASA Astrophysics Data System (ADS)

Moore, L.; Mironov, N.; Portnyagin, M.; Gazel, E.; Bodnar, R. J.

2016-12-01

Primitive olivine-hosted melt inclusions (MI) are a useful means to estimate the pre-eruptive volatile contents of a volcanic melts but post-entrapment processes complicate this approach. In particular, crystallization of the host phase along the wall of the MI and diffusion of H+ through the host cause CO2 and potentially S or other volatiles to exsolve from the melt to a separate fluid bubble. Recently, experimental rehydration and Raman spectroscopy have become potential methods for restoring the volatile contents of MI by rehomogenization or through mass balance calculations respectively. In order to compare these two approaches, we have studied MI from a single suite of samples from Klyuchevsky volcano (Kamchatka Arc) that have been treated with both experimental rehydration and analyzed using Raman spectroscopy. The maximum MI CO2 contents are in agreement ( 4000 ppm) regardless of the method used to account for CO2 in the bubble, but there is significantly more scatter to lower values using the Raman method which can be attributed to uncertainty related to mass balance calculations and carbonate daughter minerals that have formed at the glass-bubble interface. The presence of S- and C-bearing daughter minerals on the surface of the bubble in unheated melt inclusions indicates that to obtain more confident results with Raman spectroscopy, naturally quenched MIs should be also shortly reheated to dissolve most or all the crystals at the glass-bubble interface. Concerning H2O, MI from the unheated tephra samples contain less H2O than rehydrated MI in lavas. Determining the original H2O content of rehydrated MI is difficult because the H2O concentration in the glass is controlled by the conditions during the rehydration experiment. Thus reconciling the initial H2O content in primitive arc MIs (and degree of H2O loss) still remains a challenging task.

Evaluation of an antibiotic intravenous to oral sequential therapy program.

PubMed

Pablos, Ana I; Escobar, Ismael; Albiñana, Sandra; Serrano, Olga; Ferrari, José M; Herreros de Tejada, Alberto

2005-01-01

This study was designed to analyse the drug consumption difference and economic impact of an antibiotic sequential therapy focused on quinolones. We studied the consumption of quinolones (ofloxacin/levofloxacin and ciprofloxacin) 6 months before and after the implementation of a sequential therapy program in hospitalised patients. It was calculated for each antibiotic, in its oral and intravenous forms, in defined daily dose (DDD/100 stays per day) and economical terms (drug acquisition cost). At the beginning of the program ofloxacin was replaced by levofloxacin and, since their clinical uses are similar, the consumption of both drugs was compared during the period. In economic terms, the consumption of intravenous quinolones decreased 60% whereas the consumption of oral quinolones increased 66%. In DDD/100 stays per day, intravenous forms consumption decreased 53% and oral forms consumption increased 36%. Focusing on quinolones, the implementation of a sequential therapy program based on promoting an early switch from intravenous to oral regimen has proved its capacity to alter the utilisation profile of these antibiotics. The program has permitted the hospital a global saving of 41420 dollars for these drugs during the period of time considered. Copyright (c) 2004 John Wiley & Sons, Ltd.

Cancer of the oral cavity.

PubMed

Montero, Pablo H; Patel, Snehal G

2015-07-01

Cancer of the oral cavity is one of the most common malignancies worldwide. Although early diagnosis is relatively easy, presentation with advanced disease is not uncommon. The standard of care is primary surgical resection with or without postoperative adjuvant therapy. Improvements in surgical techniques combined with the routine use of postoperative radiation or chemoradiation therapy have resulted in improved survival. Successful treatment is predicated on multidisciplinary treatment strategies to maximize oncologic control and minimize impact of therapy on form and function. Prevention of oral cancer requires better education about lifestyle-related risk factors, and improved awareness and tools for early diagnosis. Copyright © 2015 Elsevier Inc. All rights reserved.

Oral hygiene in patients with oral cancer undergoing chemotherapy and/or radiotherapy after prosthesis rehabilitation: protocol proposal.

PubMed

Rapone, B; Nardi, G M; DI Venere, D; Pettini, F; Grassi, F R; Corsalini, M

2016-01-01

This study was aimed at assessing the effectiveness and the importance of an oral hygiene (OH) protocol in patients undergoing radiation therapy and chemotherapy after prosthesis rehabilitation, in order to reduce or minimize oral complications. This study was carried out at the Department of Dental Science, at the University of Bari-Italy from December 2012 to December 2015 on 34 selected patients with primary oral cancer undergoing chemotherapy and radiotherapy after prosthesis rehabilitation. They were divided into 2 groups according to their age, sex and cancer therapy. Seventeen patients were assigned to the control group and seventeen in the experimental one. In the experimental group (Table 1), patients underwent an oral hygiene protocol whereas in the control group (Table 2) patients received the usual care provided within the clinical setting. All the patients gave written informed consent. It has been asked and obtained the authorisation from the Ethics Committee of the Dental Science and Surgery Department. Results show that in patients undergoing the oral hygiene protocol, the complications and the risks of infection and permanent dental problems have been minimized. Indeed, of the seventeen patients undergoing the OH protocol, 70% obtained positive results and were satisfied with the program outcome. The role of the health care providers is essential to educate patients to adhere to the prescribed treatments and reinforce their motivation in oral hygiene. The oral hygiene procedures prevent and ameliorate oral complications due to the radiation therapy and chemotherapy.

Lacosamide: A Review in Focal Seizures in Patients with Epilepsy.

PubMed

Scott, Lesley J

2015-12-01

Lacosamide (Vimpat(®)) is a functionalized amino acid available orally (as a solution or tablets) and as an intravenous infusion for use as monotherapy (only in the USA) or adjunctive therapy for the treatment of focal seizures in adult and adolescent (aged ≥17 years in the USA) patients with epilepsy. As adjunctive therapy to other antiepileptic drugs (AEDs), lacosamide provided effective seizure control and was generally well tolerated in adults and adolescents (aged ≥16 years) in randomized clinical trials and in the real-world setting. In clinical trials, adjunctive lacosamide provided significantly greater reductions in 28-day seizure rates than adjunctive placebo, with these benefits maintained after up to 8 years of therapy in open-label extension studies. Moreover, patients were effectively switched from oral to short-term intravenous adjunctive therapy at the same dosage, which may be particularly beneficial in situations where oral therapy is not suitable. Conversion to lacosamide monotherapy was superior to a historical-control cohort in patients with focal seizures converting from previous AED therapy. In the absence of head-to-head comparisons with other AEDs, the exact position of lacosamide relative to other AEDs remains to be fully determined. In the meantime, oral and intravenous lacosamide provides a useful option as monotherapy (only in the USA) or adjunctive therapy for the treatment of focal seizures in adult and adolescent (aged ≥17 years in the USA) patients with epilepsy.

Prescribing Habits for Androgenic Alopecia Among Dermatologists in Spain in 2017: A Cross-Sectional Study.

PubMed

Pindado-Ortega, C; Saceda-Corralo, D; Buendía-Castaño, D; Fernández-González, P; Moreno-Arrones, Ó M; Fonda-Pascual, P; Alegre-Sánchez, A; Rodrigues-Barata, A R; Vañó-Galván, S

2018-04-12

Topical minoxidil and oral finasteride are the only drugs approved for the treatment of androgenetic alopecia (AGA) in Spain. However, the management of this condition is highly variable because numerous treatments are used off-label. The main aim of this study was to describe the prescribing habits of dermatologists in Spain for male AGA (MAGA) and female AGA (FAGA). Descriptive cross-sectional study using online questionnaires completed by dermatologists working in Spain. The responses of 241 dermatologists were analyzed. The most common treatments prescribed for MAGA were minoxidil (98%), oral finasteride (96%), nutricosmetics (44%), topical finasteride (37%), oral dutasteride (33%), platelet-rich plasma (14%), and low-level laser therapy (8%). For premenopausal FAGA, the most common treatments were topical minoxidil (98%), oral contraceptives (81%), nutricosmetics (72%), cyproterone acetate (58%), oral finasteride (39%), topical finasteride (39%), spironolactone (27%), platelet-rich plasma (20%), oral dutasteride (20%), oral flutamide (18%), and low-level laser therapy (7%). Finally, for postmenopausal FAGA, the most common treatments prescribed were topical minoxidil (98%), oral finasteride (84%), nutricosmetics (68%), topical finasteride (50%), oral dutasteride (35%), platelet-rich plasma (21%), spironolactone (16%), cyproterone acetate (16%), oral flutamide (9%), and low-level laser therapy (9%). A limitation of our study is that we did not analyze novel AGA treatments such as oral minoxidil and dutasteride mesotherapy. The most common treatments prescribed for AGA by dermatologists in Spain are topical minoxidil, oral finasteride, and nutricosmetics for MAGA and postmenopausal FAGA and topical minoxidil, oral contraceptives, and nutricosmetics for premenopausal FAGA. Copyright © 2018 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.

[Photodrugtherapy of psoriasis with oral psoralen and black light therapy].

PubMed

Corrales Padilla, H

1975-01-01

Oral 4, 5', 8 trimethoxypsoralen (TMP) or 8-M-methoxypsoralen (8 MP) plus black light therapy of psoriasis produced disappearing of lesions in 6 out of 8 pacients treated with TMP and in 6 out of 7 treated with 8 MP. In three patients treated with the first drug, a paired comparision demonstrated that the ingestion of it, when followed of black exposure, is more effective than the exposure to conventional ultraviolet light. Parrish et al. have shown this for oral methoxalen and long wave ultraviolet light. Combined TMP or 8-MP and black light therapy inhibits epidermal DNA synthesis and this is the scientific base of its application in the therapy of psoriasis, disease in which an accelerated celular cicle and DNA synthesis has been postulated.

Diagnosis and indications for low-intensity laser therapy of the pathology of the oral cavity mucosa of patients with hematologic and gastroenteric diseases

NASA Astrophysics Data System (ADS)

Kunin, Anatoly A.; Minakov, E. V.; Sutscenko, A. V.; Vornovsky, V. A.; Dunaeva, S. V.; Stepanov, Nicolay N.; Shumilovitch, Bogdan R.

1996-11-01

In the recent years low intensity laser irradiation is made use of in stomatology with the view of treating numerous diseases of the oral cavity mucosa and parodontium. The oral cavity mucosa lesions caused by the internal organs diseases, especially those of blood and the gastroenteric tract, constitute a particular group. Such diseases are usually manifested by an inflammation, erosions, ulcers, hemorrhages. An abundant microflora of the oral cavity and diminished immunity of the patients contribute to the possibility of septicaemia development. Laser therapy of the oral cavity mucosa lesions according to strictly defined indications promotes rapid healing of ulcers, arresting the oral cavity mucosa inflammation, providing a reduction in bleeding and presents a safe prophylactic means of stomatogenic sepsis.

Comparison of survival between radiation therapy and trans-oral laser microsurgery for early glottic cancer patients; a retrospective cohort study.

PubMed

De Santis, R J; Poon, I; Lee, J; Karam, I; Enepekides, D J; Higgins, K M

2016-08-02

The literature reports various treatment methodologies, such as trans-oral laser microsurgery, radiation therapy, total/partial laryngectomies, and concurrent radiation chemotherapy for patients with early larynx cancer. However, at the forefront of early glottis treatment is trans-oral laser microsurgery and radiation therapy, likely due to better functional and survival outcomes. Here we conduct the largest Canadian head-to-head comparison of consecutive patients treated with either radiation therapy or trans-oral laser microsurgery. Additionally, we compare these two treatments and their 5-year survival rates post treatment to add to the existing literature. Charts of patients who were diagnosed with early glottic cancer between 2006 and 2013 were reviewed. Seventy-five patients were identified, and split into 2 groups based on their primary treatment, trans-oral laser microsurgery and radiation therapy. Kaplan-Meier survival curves, life-tables, and the log-rank statistic were reported to determine if there was a difference between the two treatment groups and their disease-specific survival, disease-free survival, and total laryngectomy-free survival. Additionally, each different survival analysis was stratified by potential confounding variables, to help conclude which treatment is more efficacious in this population. The 5-year disease-specific survival rate is 93.3 % σ = 0.063 and 90.8 % σ = 0.056 for patients treated with trans-oral laser microsurgery and radiation therapy, respectively (χ (2) < 0.001, p = 0.983). The disease free survival rate is 60.0 % (σ =0.121) for patients treated with trans-oral laser microsurgery, and 67.2 % (σ = 0.074) for those who received RT (χ (2) = 0.19, p = 0.663). Additionally, the total laryngectomy-free survival rate is 84.1 % (σ = 0.1) and 79.1 % (σ = 0.072) for patients' early glottic cancer treated by trans-oral laser microsurgery and radiation therapy, respectively (χ (2) = 0.235, p = 0.628). Chi-square analysis of age-group versus treatment group (χ (2) = 6.455, p = 0.04) and T-stage versus treatment group (χ (2) = 11.3, p = 0.001) revealed a statistically significant relationship, suggesting survival analysis should be stratified by these variables. However, after stratification, there was no statistically significant difference between the trans-oral laser microsurgery and radiation therapy groups in any of the survival analyses. No difference was demonstrated in the 5-year disease-specific survival, disease-free survival, and total laryngectomy-free survival, between the RT and TLM treatment groups. Additionally, both groups showed similar 5-year survival after stratifying by confounding variables.

[CHANGES IN THE ORGANS AND TISSUES OF THE ORAL CAVITY WITH DIGESTIVE SYSTEM DISEASES].

PubMed

Trukhan, D I; Goloshubina, V V; Trukhan, L Yu

2015-01-01

A substantial part of the pathology of organs and tissues of the oral cavity make common manifestations or systemic diseases. Accordingly, the dosage systemic therapy of these diseases can affect the condition of the eye. Changes in organs and tissues of the oral cavity and the appropriate advice a dentist can help the gastroenterologist in the diagnosis and adequate treatment of the patient. The article discusses possible changes in the organs and tissues of the oral cavity in diseases of the digestive system, as well as changes occurring under the influence of drug therapy of these diseases.

Duration of oral tetracycline-class antibiotic therapy and use of topical retinoids for the treatment of acne among general practitioners (GP): A retrospective cohort study.

PubMed

Barbieri, John S; Hoffstad, Ole; Margolis, David J

2016-12-01

Guidelines recommend limiting the duration of oral antibiotic therapy in acne to 3 to 6 months and prescribing concomitant topical retinoids for all patients. We sought to evaluate the duration of therapy with oral tetracyclines and the use of topical retinoids among patients with acne treated primarily by general practitioners in the United Kingdom. We conducted a retrospective cohort study using the Health Improvement Network database. The mean duration of therapy was 175.1 days. Of antibiotic courses, 62% were not associated with a topical retinoid; 29% exceeded 6 months in duration. If all regions were to achieve uses similar to the region with the shortest mean duration of therapy, approximately 3.3 million antibiotic days per year could be avoided in the United Kingdom. The Health Improvement Network does not include information on acne severity and clinical outcomes. Prescribing behavior for oral antibiotics in the treatment of acne among general practitioners is not aligned with current guideline recommendations. Increasing the use of topical retinoids and considering alternative agents to oral antibiotics when appropriate represent opportunities to reduce antibiotic exposure and associated complications such as antibiotic resistance and to improve outcomes in patients treated for acne. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Appetite and adverse effects associated with radiation therapy in patients with head and neck cancer.

PubMed

Ogama, Norimasa; Suzuki, Sumie; Umeshita, Koji; Kobayashi, Tamami; Kaneko, Shoko; Kato, Sakiko; Shimizu, Yasuko

2010-02-01

The relationship between radiation treatment and adverse effects resulting in changes in appetite was studied in patients with head and neck (H&N) cancer. Path analysis was used to evaluate the following factors in 117 patients receiving radiation therapy for H&N cancer: daily fluctuations in saliva production, analgesic use, frequency of oral care, subject characteristics, and appetite. At 20 Gy of radiation, appetite was affected by Brinkman index value, age, and sensitivity to taste (R2=0.48, p<0.001); at 30 Gy of radiation, appetite was affected by frequency of oral care, xerostomia symptoms, age, sensitivity to taste, and oral mucositis (R2=0.52, p<0.001); and at 50 Gy of radiation, appetite was affected by low saliva production in the morning, frequency of oral care, xerostomia symptoms, sensitivity to taste, analgesic use, and oral mucositis (R2=0.62, p<0.001). The results of this study suggest that care taken to avoid a decrease in appetite due to adverse effects of radiation therapy should differ according to the dosage and schedule of radiation therapy. These findings represent important data for health care professionals to understand and support appropriate dietary intake and improved quality of life for H&N cancer patients receiving radiation therapy. Copyright 2009 Elsevier Ltd. All rights reserved.

Cost-effectiveness of surgery in low- and middle-income countries: a systematic review.

PubMed

Grimes, Caris E; Henry, Jaymie Ang; Maraka, Jane; Mkandawire, Nyengo C; Cotton, Michael

2014-01-01

There is increasing interest in provision of essential surgical care as part of public health policy in low- and middle-income countries (LMIC). Relatively simple interventions have been shown to prevent death and disability. We reviewed the published literature to examine the cost-effectiveness of simple surgical interventions which could be made available at any district hospital, and compared these to standard public health interventions. PubMed and EMBASE were searched using single and combinations of the search terms "disability adjusted life year" (DALY), "quality adjusted life year," "cost-effectiveness," and "surgery." Articles were included if they detailed the cost-effectiveness of a surgical intervention of relevance to a LMIC, which could be made available at any district hospital. Suitable articles with both cost and effectiveness data were identified and, where possible, data were extrapolated to enable comparison across studies. Twenty-seven articles met our inclusion criteria, representing 64 LMIC over 16 years of study. Interventions that were found to be cost-effective included cataract surgery (cost/DALY averted range US$5.06-$106.00), elective inguinal hernia repair (cost/DALY averted range US$12.88-$78.18), male circumcision (cost/DALY averted range US$7.38-$319.29), emergency cesarean section (cost/DALY averted range US$18-$3,462.00), and cleft lip and palate repair (cost/DALY averted range US$15.44-$96.04). A small district hospital with basic surgical services was also found to be highly cost-effective (cost/DALY averted 1 US$0.93), as were larger hospitals offering emergency and trauma surgery (cost/DALY averted US$32.78-$223.00). This compares favorably with other standard public health interventions, such as oral rehydration therapy (US$1,062.00), vitamin A supplementation (US$6.00-$12.00), breast feeding promotion (US$930.00), and highly active anti-retroviral therapy for HIV (US$922.00). Simple surgical interventions that are life-saving and disability-preventing should be considered as part of public health policy in LMIC. We recommend an investment in surgical care and its integration with other public health measures at the district hospital level, rather than investment in single disease strategies.

Rapid enteric testing to permit targeted antimicrobial therapy, with and without Lactobacillus reuteri probiotics, for paediatric acute diarrhoeal disease in Botswana: A pilot, randomized, factorial, controlled trial.

PubMed

Pernica, Jeffrey M; Steenhoff, Andrew P; Mokomane, Margaret; Moorad, Banno; Lechiile, Kwana; Smieja, Marek; Mazhani, Loeto; Cheng, Ji; Kelly, Matthew S; Loeb, Mark; Stordal, Ketil; Goldfarb, David M

2017-01-01

Diarrhoeal disease is the second-leading cause of death in young children. Current guidelines recommend treating children with acute non-bloody diarrhea with oral rehydration solutions and zinc, but not antimicrobials. However, in many resource-limited settings, infections with treatable enteric bacterial and protozoan pathogens are common. Probiotics have shown promise as an adjunct treatment for diarrhoea but have not been studied in sub-Saharan Africa. We conducted a pilot, factorial, randomized, placebo-controlled trial of children aged 2-60 months hospitalized in Botswana for acute non-bloody diarrhoea. A rapid test-and-treat intervention, consisting of multiplex PCR testing of rectal swabs taken at enrolment, accompanied by targeted antimicrobial therapy if treatable pathogens were detected, was compared to the reference standard of no stool testing. Additionally, Lactobacillus reuteri DSM 17938 x 60 days was compared to placebo treatment. The main objective of this pilot study was to assess feasibility. The primary clinical outcome was the increase in age-standardized height (HAZ) at 60 days adjusted for baseline HAZ. Seventy-six patients were enrolled over a seven-month study period. We judged that the recruitment rate, lab processing times, communication protocols, provision of specific antimicrobials, and follow-up rates were acceptable. Compared to the reference arm (no stool testing and placebo treatment), the combination of the rapid test-and-treat strategy plus L. reuteri DSM 17938 was associated with an increase of 0.61 HAZ (95% CI 0.09-1.13) and 93% lower odds of recurrent diarrhoea (OR 0.07, 95%CI 0.01-0.61) at 60 days. We demonstrated that it was feasible to evaluate the study interventions in Botswana. Despite the small sample size, we observed a statistically significant increase in HAZ at 60 days and significantly lower odds of recurrent diarrhoea in children receiving both rapid test-and-treat and L. reuteri. There is sufficient evidence to warrant proceeding with a larger follow-up trial in a similar setting.

Pharmacists' interventions on intravenous to oral conversion for potassium.

PubMed

Charpiat, B; Bedouch, P; Conort, O; Juste, M; Rose, F X; Roubille, R; Allenet, B

2014-06-01

Guidelines recommend use of the oral route whenever possible to treat or prevent hypokalemia. Although a myriad of papers have been published regarding intravenous to oral (IV to PO) therapy conversion programs and about clinical pharmacy services provided in hospitals, little is known on the role of hospital pharmacists in promoting the oral route for potassium administration. The aim of this work was to describe the frequency of interventions related to IV to PO potassium therapy conversions performed by hospital pharmacists. Setting French hospitals recording pharmacist's interventions on the website tool of the French Society of Clinical Pharmacy. From the pharmacist's interventions (PI) dataset recorded we extracted all interventions related to potassium IV to PO conversion. We assessed the acceptance rate of these PI by prescribers. Additional free text information in the dataset was analysed. IV to PO potassium therapy conversions related to potassium chloride. From January 2007 to December 2010, 87 hospitals recorded 1,868 PIs concerning IV to PO therapy conversion. Among these, 16 (<1 %) concerned potassium chloride. They were recorded by four hospitals (4.6 %) with respectively 12, 2, 1 and 1 PIs. Six PIs were accepted by physicians and the prescriptions were modified. PIs to promote the administration of potassium by the oral route are extremely rare. Our results and scarce previously published data reveal that this field of practice remains almost unexplored. These findings highlight an important gap in the field of intravenous to oral therapy programs. This situation must be regarded as unsatisfactory and should lead to setting up more education and research programs.

Comparing clinical effects of photodynamic therapy as a novel method with topical corticosteroid for treatment of Oral Lichen Planus.

PubMed

Bakhtiari, Sedigheh; Azari-Marhabi, Saranaz; Mojahedi, Seyyed Masoud; Namdari, Mahshid; Rankohi, Zahra Elmi; Jafari, Soudeh

2017-12-01

Oral lichen planus is an autoimmune disorder with several challenges in treatment. Photodynamic therapy has been proposed as a new treatment option for the disease. The present study compared the clinical effects of photodynamic therapy to dexamethasone mouthwash in the treatment of oral lichen planus lesions. In this randomized clinical trial, 30 patients with oral lichen planus were included.15 patients were treated with 5% methylene blue mediated photodynamic therapy using Fotosan device for 30s (630nm wavelength and 7.2-14.4J/cm 2 dose) for 4 sessions in the days 1, 4, 7, 14. In another group, the treatment was done on 15 patients by 0.5mg tab dexamethasone solution in 5cc water, rinsed 4 times in a day within two weeks. The sign score, symptoms scores (pain), clinical severity and treatment efficacy were measured at the days 15, 30, 60, 90 after beginning of the treatment. The results were subjected to Mann-whitney U test in both groups. No significant difference existed between the two modalities regarding the treatment efficacy index, sign score, symptom score and clinical severity on the 15, 30, 60 and 90 post-treatment days. Decreases in patient's symptoms were statistically significant in both groups. Photodynamic therapy was as effective as the dexamethasone mouth wash in the treatment of oral lichen planus. It could be used as a safe modality in the treatment of oral lichen planus lesions without identified side effects. Copyright © 2017 Elsevier B.V. All rights reserved.

Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015

PubMed Central

Ramar, Kannan; Dort, Leslie C.; Katz, Sheri G.; Lettieri, Christopher J.; Harrod, Christopher G.; Thomas, Sherene M.; Chervin, Ronald D.

2015-01-01

Introduction: Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientific literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring. Methods: The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations. Recommendations: We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD) When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE) We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD) We suggest that qualified dentists provide oversight— rather than no follow-up—of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE) We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for patients fitted with oral appliances. (GUIDELINE) We suggest that sleep physicians and qualified dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic office visits— as opposed to no follow-up—with a qualified dentist and a sleep physician. (GUIDELINE) Conclusions: The AASM and AADSM expect these guidelines to have a positive impact on professional behavior, patient outcomes, and, possibly, health care costs. This guideline reflects the state of knowledge at the time of publication and will require updates if new evidence warrants significant changes to the current recommendations. Citation: Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med 2015;11(7):773–827. PMID:26094920

Treatment of primary hyperhidrosis with oral anticholinergic medications: a systematic review.

PubMed

Cruddas, L; Baker, D M

2017-06-01

Primary hyperhidrosis is a condition characterized by excessive sweating. Patients are treated off-license with oral anticholinergic medications and report adverse events associated with systemic anticholinergic interactions. This review assesses clinical evidence of efficacy, impact on quality of life and adverse events associated with oral anticholinergic therapy for primary hyperhidrosis. PRISMA guidelines were implemented to complete a systematic review (PROSPERO:CRD42016036326). MEDLINE, EMBASE and PubMed were searched from 1946 to 2015. Inclusion criteria included observational and experimental studies, anticholinergic medication use in primary hyperhidrosis, oral therapy and clear diagnostic and outcome measures. Twenty-three articles relevant to the inclusion criteria were analysed. Oxybutynin therapy improved symptoms in an average of 76.2% (range 60-97%) patients and improved QOL in 75.6% (range 57.6-100%) of patients. Methantheline bromide therapy was associated with a 41% reduction in axillary sweating, 16.4% reduction in palmar sweating, 25% decrease in HDSS score and 40.9% increase in DLQI score. Outcome measures of glycopyrrolate therapy were too variable to collate. Dry mouth was reported in 73.4% (range 43.3-100%) of participants taking oxybutynin 10 mg/day, 38.6% (range 27.8-63.2%) of patients taking glycopyrrolate and 68.8% of patients taking methantheline bromide. Nine studies reported that patients stopped therapy due to adverse events. In eight of these studies, a mean of 10.9% of total participants ceased treatment due to dry mouth. Evidence of oral anticholinergic therapy for hyperhidrosis is limited. However, its use is associated with improvement in quality of life and clinical symptoms but at the cost of considerable adverse events. © 2016 European Academy of Dermatology and Venereology.

Infants under two months of age with urinary tract infections are showing increasing resistance to empirical and oral antibiotics.

PubMed

Segal, Zvi; Cohen, Matan J; Engelhard, Dan; Tenenbaum, Ariel; Simckes, Ari M; Benenson, Shmuel; Stepensky, Polina; Averbuch, Diana

2016-04-01

Data on antimicrobial resistance in uropathogens in infants up to the age of three months are limited. This study characterised resistance patterns in Gram-negative uropathogens in infants up to the age of two months. Previously healthy young infants with urinary tract infections (UTIs) were studied retrospectively. Antimicrobial susceptibility was evaluated. Multidrug resistance (MDR) was defined as resistance to at least three antibiotic classes. Clinical, laboratory and outcome data were compared between infants with UTIs caused by bacteria sensitive and resistant to empirical and to oral therapy. We evaluated 306 UTI episodes with 314 pathogens. The following resistance rates were observed: ampicillin 73.7%, cefazoline 22.1%, ampicillin/clavulanate 21.8%, cefuroxime 7.8%, gentamicin 7%; MDR 11.8%; resistant to empirical treatment 7.3% and resistant to available oral antibiotics 8.6%. Our study showed that pathogens resistant to empirical and oral therapy were more frequently isolated in non-Jewish (Arab) infants and in those of ≥30 days of age. Resistance to empirical treatment and oral antibiotics also resulted in longer mean hospital stays. Resistance to antibiotics challenges empirical therapy and compromises oral treatment options in young infants with UTIs. Antimicrobial resistance patterns should be monitored in infants to determine appropriate empirical antibiotic therapy protocols. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

ANALYSIS OF FLOW THROUGH A HUMAN ORAL MODEL FOR USE IN INHALATION TOXICOLOGY AND AEROSOL THERAPY PROTOCOLS

EPA Science Inventory

RATIONALE
Understanding the transport and deposition of inhaled aerosols is of fundamental importance to inhalation toxicology and aerosol therapy. Herein, we focus on the development of a computer based oral morphology and related computational fluid dynamics (CFD) studi...

Topical Tacrolimus and Periodontal Therapy in the Management of a Case of Oral Chronic GVHD Characterized by Specific Gingival Localization

PubMed Central

Conrotto, Davide; Broccoletti, Roberto; Carcieri, Paola; Giaccone, Luisa; Arduino, Paolo G.

2014-01-01

Background. Chronic graft versus host disease (cGVHD) is a complication following bone marrow transplantation. The oral lesions are difficult to control with a systemic pharmacological therapy. Case Description. A 63-year-old female patient, who underwent an allogeniec transplantation for acute myeloid leukemia, developed a chronic oral and cutaneous GVHD. The patient was treated with topical tacrolimus 0.1%, twice daily for two months, and underwent a protocol of oral hygiene characterized by 3 appointments of scaling, root planning, and daily oral hygiene instructions. The patient showed marked resolution of gingival lesions and a significant improvement of related pain and gingival inflammatory indexes. Clinical Implications. This case report suggests that treatment with topical tacrolimus and professional oral hygiene may be helpful in the management of chronic oral GVHD with severe gingival involvement. PMID:24639902

Topical tacrolimus and periodontal therapy in the management of a case of oral chronic GVHD characterized by specific gingival localization.

PubMed

Conrotto, Davide; Broccoletti, Roberto; Carcieri, Paola; Giaccone, Luisa; Arduino, Paolo G

2014-01-01

Background. Chronic graft versus host disease (cGVHD) is a complication following bone marrow transplantation. The oral lesions are difficult to control with a systemic pharmacological therapy. Case Description. A 63-year-old female patient, who underwent an allogeniec transplantation for acute myeloid leukemia, developed a chronic oral and cutaneous GVHD. The patient was treated with topical tacrolimus 0.1%, twice daily for two months, and underwent a protocol of oral hygiene characterized by 3 appointments of scaling, root planning, and daily oral hygiene instructions. The patient showed marked resolution of gingival lesions and a significant improvement of related pain and gingival inflammatory indexes. Clinical Implications. This case report suggests that treatment with topical tacrolimus and professional oral hygiene may be helpful in the management of chronic oral GVHD with severe gingival involvement.

Peptide pills for brain diseases? Reality and future perspectives.

PubMed

Serrano Lopez, Dolores Remedios; Lalatsa, Aikaterini

2013-04-01

The peptide therapeutic market is one of the fastest growth areas of the pharmaceutical industry. Although few orally administered peptides are marketed and many are in different phases of clinical development, there is no marketed oral peptide therapeutic used for CNS disorders. The major challenges involved in orally delivering peptides to the brain relate to their enzymatic instability and inability to permeate across physiological barriers. The paucity of therapies for the treatment of brain diseases and the presence of the blood-brain barrier excluding 98% of therapeutic molecules necessitates parenteral administration. Various approaches have been applied to enhance oral peptide bioavailability, but only nanoparticulate strategies were able to deliver orally therapeutic peptides to the brain. Although industry may be reluctant to invest in developing oral peptide nanomedicines, the increasingly unmet clinical need and economic burden associated with brain diseases will fuel the development of the first marketed oral-to-brain peptide therapy.

A randomized, open-label, crossover study comparing the effects of oral versus transdermal estrogen therapy on serum androgens, thyroid hormones, and adrenal hormones in naturally menopausal women.

PubMed

Shifren, Jan L; Desindes, Sophie; McIlwain, Marilyn; Doros, Gheorghe; Mazer, Norman A

2007-01-01

To compare the changes induced by oral versus transdermal estrogen therapy on the total and free serum concentrations of testosterone (T), thyroxine (T4), and cortisol (C) and the concentrations of their serum binding globulins sex hormone-binding globulin, thyroxine-binding globulin, and cortisol-binding globulin in naturally menopausal women. Randomized, open-label, crossover. Interventions included a 6-week withdrawal from previous hormone therapy (baseline), followed in randomized order by 12 weeks of oral conjugated equine estrogens (CEE) (0.625 mg/d) and 12 weeks of transdermal estradiol (TD E2) (0.05 mg/d), with oral micronized progesterone (100 mg/d) given continuously during both transdermal estrogen therapy regimens. Twenty-seven women were enrolled in the study, and 25 completed both treatment periods. The mean(SD) percentage changes from baseline of sex hormone-binding globulin, total T, and free T with oral CEE were +132.1% (74.5%), +16.4% (43.8%), and -32.7% (25.9%), respectively, versus +12.0% (25.1%), +1.2% (43.7%), and +1.0% (45.0%) with TD E2. The mean (SD) percentage changes of thyroxine-binding globulin, total T4, and free T4 with oral CEE were +39.9% (20.1%), +28.4% (29.2%), and -10.4% (22.3%), respectively, versus +0.4% (11.1%), -0.7% (16.5%), and +0.2% (26.6%) with TD E2. The mean (SD) percentage changes of cortisol-binding globulin, total C, and free C with oral CEE were +18.0% (19.5%), +29.2% (46.3%), and +50.4% (126.5%), respectively, versus -2.2% (11.3%), -6.7% (30.8%), and +1.8% (77.1%) with TD E2. Concentrations of all hormones and binding globulins were significantly different (P < or = 0.003) during administration of oral versus transdermal estrogen therapy, except for free T4 and free C. Compared with oral CEE, TD E2 exerts minimal effects on the total and free concentrations of T, T4, and C and their binding proteins.

Candidiasis and other oral mucosal lesions during and after interferon therapy for HCV-related chronic liver diseases.

PubMed

Nagao, Yumiko; Hashimoto, Kouji; Sata, Michio

2012-11-02

Oral lichen planus (OLP) is seen frequently in patients with hepatitis C virus (HCV) infection. The aim of this study was to evaluate the occurrence of oral candidiasis, other mucosal lesions, and xerostomia during interferon (IFN) therapy for HCV infection. Of 124 patients with HCV-infected liver diseases treated with IFN therapy in our hospital, 14 (mean age 56.00 ± 12.94 years) who attended to receive administration of IFN once a week were identified and examined for Candida infection and other oral lesions and for the measurement of salivary flow. Serological assays also were carried out. Cultures of Candida from the tongue surfaces were positive in 7 (50.0%) of the 14 patients with HCV infection at least once during IFN therapy. C. albicans was the most common species isolated. The incidence of Candida during treatment with IFN did not increase above that before treatment. Additional oral mucosal lesions were observed in 50.0% (7/14) of patients: OLP in three (21.4%), angular cheilitis in three (21.4%) and recurrent aphthous stomatitis in one (7.1%). OLP occurred in one patient before treatment with IFN, in one during treatment and in one at the end of treatment. 85.7% of the oral lesions were treated with topical steroids. We compared the characteristics of the 7 patients in whom Candida was detected at least once during IFN therapy (group 1) and the 7 patients in whom Candida was not detected during IFN therapy (group 2). The prevalence of oral mucosal lesions (P=0.0075) and incidence of external use of steroids (P=0.0308) in group 1 were significantly higher than in group 2. The average body weight of group 1 decreased significantly compared to group 2 (P=0.0088). Salivary flow decreased in all subjects throughout the course of IFN treatment and returned at 6th months after the end of treatment. In group 1, the level of albumin at the beginning of the 6th month of IFN administration was lower than in group 2 (P=0.0550). According to multivariate analysis, one factor, the presence of oral mucosal lesions, was associated with the detection of Candida. The adjusted odds ratio for the factor was 36.00 (95% confidence interval 2.68-1485.94). We should pay more attention to oral candidiasis as well as other oral mucosal lesions, in patients with weight loss during IFN treatment.

Prevention of oral mucositis in children receiving cancer therapy: a systematic review and evidence-based analysis.

PubMed

Qutob, Akram F; Gue, Sumant; Revesz, Tamas; Logan, Richard M; Keefe, Dorothy

2013-02-01

This systematic review investigated, critically appraised, and rated the evidence on agents used to prevent oral mucositis in children. A comprehensive search of the relevant literature was performed up to December 2011. Articles were included according to the inclusion/exclusion criteria and were critically appraised for validation and quality assessment using a checklist consisting of 18 categories. Each article was then rated for its strength of evidence. 16,471 articles were retrieved from 19 different databases and then reduced to 27 articles that fit the inclusion criteria. Five articles on oral care protocols supported their use to prevent oral mucositis in children. Seven articles on chlorhexidine mouthwash and three on laser therapy had conflicting evidence of its use. The preventative agents that were supported by one or two articles included: benzydamine mouthwash, iseganan mouthwash, granulocyte-macrophage colony-stimulating factor (GM-CSF) mouthwash, oral/enteral glutamine, oral propantheline and cryotherapy, oral cryotherapy, oral sucralfate suspension, prostaglandin E2 tablets, and chewing gum. The reduction in the rates of occurrence of oral mucositis when using agents of fair (B) to good (A) evidence ranged from 22% to 52%. In conclusion, this review suggests the use of oral care protocols to prevent oral mucositis in children because of their strength of evidence (fair to good). The authors suggest avoiding agents with fair to good evidence against their use (oral sucralfate suspension, prostaglandin E2 tablets, and GM-CSF mouthwash). Agents with conflicting evidence (chlorhexidine mouthwash (used solely), laser therapy, and glutamine) should also be avoided until further research confirms their efficacy. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Withdrawal of long-term epoprostenol therapy in pulmonary arterial hypertension (PAH).

PubMed

Calcaianu, George; Calcaianu, Mihaela; Canuet, Matthieu; Enache, Irina; Kessler, Romain

2017-01-01

Once initiated for pulmonary arterial hypertension (PAH), epoprostenol treatment usually needs to be delivered for an indefinite duration. It is possible that some participants could be transitioned from epoprostenol to oral therapies. We retrospectively evaluated eight PAH participants transitioned from epoprostenol to PAH oral drugs. The criteria for epoprostenol withdrawal were: (1) persistent improvement of clinic and hemodynamic status; (2) stable dose of epoprostenol for the last three months; and (3) the participant's preference for oral therapy after evaluation of risk-benefit. We evaluated the clinical, functional, and hemodynamic status at baseline, at withdrawal, and after the transition to oral PAH therapy. The transition was completed in all eight participants. Four participants had a complete successful transition (CT) with a stable clinical and hemodynamic course and four participants had a partial successful transition (PT) remaining stable clinically, with a mild hemodynamic worsening, but without need to re-initiate epoprostenol therapy. The four CT participants were treated with epoprostenol for a shorter period of time (CT group: 35 ± 30 versus PT group: 79 ± 49 months, P = 0.08). Mean epoprostenol dosage was lower in the CT group (CT group: 15 ± 1.5 ng/kg/min versus PT group: 24 ± 11 ng/kg/min, P = 0.09). Safe withdrawal of epoprostenol treatment and transition to oral PAH therapy was possible in a small and highly selected group of participants. The majority of these participants had a porto-pulmonary PAH or PAH associated to HIV infection.

Access to Oral Osteoporosis Drugs among Female Medicare Part D Beneficiaries

PubMed Central

Lin, Chia-Wei; Karaca-Mandic, Pinar; McCullough, Jeffrey S.; Weaver, Lesley

2014-01-01

Background For women living with osteoporosis, high out-of-pocket drug costs may prevent drug therapy initiation. We investigate the association between oral osteoporosis out-of-pocket medication costs and female Medicare beneficiaries’ initiation of osteoporosis drug therapy. Methods We used 2007 and 2008 administrative claims and enrollment data for a 5% random sample of Medicare beneficiaries. Our study sample included age-qualified, female beneficiaries who had no prior history of osteoporosis but were diagnosed with osteoporosis in 2007 or 2008. Additionally, we only included beneficiaries continuously enrolled in standalone prescription drug plans. We excluded beneficiaries who had a chronic condition that was contraindicated with osteoporosis drug utilization. Our final sample included 25,069 beneficiaries. Logistic regression analysis was used to examine the association between the out-of-pocket costs and initiation of oral osteoporosis drug therapy during the year of diagnosis. Findings Twenty-six percent of female Medicare beneficiaries newly diagnosed with osteoporosis initiated oral osteoporosis drug therapy. Beneficiaries’ out-of-pocket costs were not associated with the initiation of drug therapy for osteoporosis. However, there were statistically significant racial disparities in beneficiaries’ initiation of drug therapy. African Americans were 3 percentage points less likely to initiate drug therapy than whites. In contrast, Asian/Pacific Islander and Hispanic beneficiaries were 8 and 18 percentage points respectively more likely to initiate drug therapy than whites. Additionally, institutionalized beneficiaries were 11 percentage points less likely to initiate drug therapy than other beneficiaries. Conclusions Access barriers for drug therapy initiation may be driven by factors other than patients’ out-of-pocket costs. These results suggest that improved osteoporosis treatment requires a more comprehensive approach that goes beyond payment policies. PMID:24837398

Aspirin desensitization in aspirin-sensitive asthma: failure to maintain a desensitized state during prolonged therapy.

PubMed

Dankner, R E; Wedner, H J

1983-11-01

A patient with a history of asthma induced by acetylsalicylic acid (ASA) was found to be ASA sensitive when orally challenged with ASA. She was successfully desensitized using incremental doses of ASA given orally and maintained on ASA or other nonsteroidal antiinflammatory (NSAI) agents for the treatment of arthritis. After 6 months of uninterrupted therapy the patient developed asthmatic symptoms that were related to ASA and NSAI drug therapy. Although desensitization may be achieved in patients with ASA-sensitive asthma, sensitivity may recur despite continuous therapy.

[Scintigraphic study of gastric emptying of rehydration drinks in athletes].

PubMed

Martínez Gonzálvez, A B; Nuño de la Rosa Y Pozuelo, J A; Sánchez Gascón, F; Villegas García, J A; Mulero Aniorte, F; Contreras Gutiérrez, J C

2005-01-01

This study aims to evaluate how rehydration beverage ingestion influences gastric emptying rate (in cycle ergometer) at rest and during exercise at 70 % of maximal oxygen consumption (VO2max). 26 well-trained cyclists performed a preliminary maximal test until exhaustion to evaluate their VO2max, and two submaximal exercise tests at 70 % of their mode-specific VO2max. Each test was separated by one week. During the two submaximal tests, cyclists consumed 200 ml of a 99mTc-DTPA labeled rehydration beverage (A or B) and scintigraphy determinations were performed at rest. After, exercise was initiated for 60 minutes with an intake rate of 200 ml every 15 minutes, making gastric serial scintigraphy determinations. The difference regarding chemical composition between A and B drinks resides in the fact that drink A contains a smaller load in carbohydrates (10.3 g/100 ml versus 15.2 g/100 ml of B), proteins in form of serum milk and antioxidants in form of fruit juice. Both contain ions and vitamins. at rest, gastric count number was significantly reduced (p > 0.000) from 0 to 25 minutes for both A and B beverage. At the end of exercise (60 min), there was greater gastric retention for B beverage than for A, this difference being statistically significant (p < 0.031). The A beverage, a rehydration drink on the market with protein and antioxidants with fruit juice content, has a faster gastric emptying rate than the B sport beverage.

Metronomic chemotherapy using orally active carboplatin/deoxycholate complex to maintain drug concentration within a tolerable range for effective cancer management.

PubMed

Mahmud, Foyez; Chung, Seung Woo; Alam, Farzana; Choi, Jeong Uk; Kim, Seong Who; Kim, In-San; Kim, Sang Yoon; Lee, Dong Soo; Byun, Youngro

2017-03-10

Metronomic chemotherapy has translated into favorable toxicity profile and capable of delaying tumor progression. Despite its promise, conventional injectable chemotherapeutics are not meaningful to use as metronomic due to the necessity of frequent administration for personalized therapy in long-term cancer treatments. This study aims to exploit the benefits of the oral application of carboplatin as metronomic therapy for non-small cell lung cancer (NSCLC). We developed an orally active carboplatin by physical complexation with a deoxycholic acid (DOCA). The X-ray diffraction (XRD) patterns showed the disappearance of crystalline peaks from carboplatin by forming the complex with DOCA. In vivo pharmacokinetic (PK) study confirmed the oral absorption of carboplatin/DOCA complex. The oral bioavailability of carboplatin/DOCA complex and native carboplatin were calculated as 24.33% and 1.16%, respectively, when a single 50mg/kg oral dose was administered. Further findings of oral bioavailability during a low-dose daily administration of the complex (10mg/kg) for 3weeks were showed 19.17% at day-0, 30.27% at day-7, 26.77% at day-14, and 22.48% at day-21, demonstrating its potential for metronomic chemotherapy. The dose dependent antitumor effects of oral carboplatin were evaluated in SCC7 and A549 tumor xenograft mice. It was found that the oral carboplatin complex exhibited potent anti-tumor activity at 10mg/kg (74.09% vs. control, P<0.01) and 20mg/kg dose (86.22% vs. control, P<0.01) in A549 tumor. The number of TUNEL positive cells in the tumor sections was also significantly increased during oral therapy (3.95% in control, whereas 21.37% and 32.39% in 10mg/kg and 20mg/kg dose, respectively; P<0.001). The enhanced anti-tumor efficacy of oral metronomic therapy was attributed with its antiangiogenic mechanism where new blood vessel formation was notably decreased. Finally, the safety of oral complex was confirmed by three weeks toxicity studies; there were no significant systemic or local abnormalities found in mice at 10mg/kg daily oral dose. Our study thus describes an effective and safe oral formulation of carboplatin as a metronomic chemotherapy. Copyright © 2017 Elsevier B.V. All rights reserved.

Effects of tetrahydrouridine on pharmacokinetics and pharmacodynamics of oral decitabine

PubMed Central

Lavelle, Donald; Vaitkus, Kestis; Ling, Yonghua; Ruiz, Maria A.; Mahfouz, Reda; Ng, Kwok Peng; Negrotto, Soledad; Smith, Nicola; Terse, Pramod; Engelke, Kory J.; Covey, Joseph; Chan, Kenneth K.; DeSimone, Joseph

2012-01-01

The deoxycytidine analog decitabine (DAC) can deplete DNA methyl-transferase 1 (DNMT1) and thereby modify cellular epigenetics, gene expression, and differentiation. However, a barrier to efficacious and accessible DNMT1-targeted therapy is cytidine deaminase, an enzyme highly expressed in the intestine and liver that rapidly metabolizes DAC into inactive uridine counterparts, severely limiting exposure time and oral bioavailability. In the present study, the effects of tetrahydrouridine (THU), a competitive inhibitor of cytidine deaminase, on the pharmacokinetics and pharmacodynamics of oral DAC were evaluated in mice and nonhuman primates. Oral administration of THU before oral DAC extended DAC absorption time and widened the concentration-time profile, increasing the exposure time for S-phase–specific depletion of DNMT1 without the high peak DAC levels that can cause DNA damage and cytotoxicity. THU also decreased interindividual variability in pharmacokinetics seen with DAC alone. One potential clinical application of DNMT1-targeted therapy is to increase fetal hemoglobin and treat hemoglobinopathy. Oral THU-DAC at a dose that would produce peak DAC concentrations of less than 0.2μM administered 2×/wk for 8 weeks to nonhuman primates was not myelotoxic, hypomethylated DNA in the γ-globin gene promoter, and produced large cumulative increases in fetal hemoglobin. Combining oral THU with oral DAC changes DAC pharmacology in a manner that may facilitate accessible noncytotoxic DNMT1-targeted therapy. PMID:22160381

Oral Health in Electroconvulsive Therapy: A Neglected Topic.

PubMed

Muzyka, Brian C; Glass, Magdalena; Glass, Oliver M

2017-03-01

Psychiatric medications may have serious and untoward adverse effects such as blurred vision, restlessness, agranulocytosis, muscle rigidity, and tremors. When compared to medications, electroconvulsive therapy (ECT) is becoming a more acceptable treatment due to its efficacy, tolerability, and minimal adverse effect profile. Oral trauma can be an ECT-related adverse effect. We reviewed the published literature on oral health and dental protection in patients undergoing ECT, and found that there are deficits in all guidelines on dental protection during ECT. Dental assessment and treatment before and after ECT is warranted. Given the increased risk of poor oral health in psychiatric patients, and the continued evolution of ECT as a mainstay treatment, it is important that studies be conducted to determine the optimal method of oral protection. If adequate care can be ensured, the risks of ECT-induced oral trauma will be minimized.

Boron neutron capture therapy for oral precancer: proof of principle in an experimental animal model

DOE Office of Scientific and Technical Information (OSTI.GOV)

A. Monti Hughes; ECC Pozzi; S. Thorp

Field-cancerized tissue can give rise to second primary tumours, causing therapeutic failure. Boron neutron capture therapy (BNCT) is based on biological targeting and would serve to treat undetectable foci of malignant transformation. The aim of this study was to optimize BNCT for the integral treatment for oral cancer, with particular emphasis on the inhibitory effect on tumour development originating in precancerous conditions, and radiotoxicity of different BNCT protocols in a hamster cheek pouch oral precancer model.

Oral histoplasmosis after radiation therapy for laryngeal squamous cell carcinoma.

PubMed

Ezzedine, Khaled; Accoceberry, Isabelle; Malvy, Denis

2007-05-01

Histoplasmosis is a usually asymptomatic deep fungal infection of tropical origin with respiratory entry and possible oral, pharyngeal, or metastatic localization. The condition represents an important imported systemic mycosis with oral involvement. We report the case of a patient who developed an oropharyngeal reactivation of a latent Histoplasma infection after receiving local antitumoral radiation therapy of the neck. H capsulatum was shown to be present in the lesion by both histopathology and staining, and was deduced to be the causative organism of the disease.