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3195.Anonymous. Case records of the Massachusetts General Hospital. Weekly  clinicopathological exercises. Case 23-2001. An 18-month-old girl with persistent diarrhea and malnutrition. New England Journal of Medicine.  345(4):276-81, 2001 Jul 26.

3196.Antinori S.  Galimberti L.  Parente F. Intestinal tuberculosis as a cause of chronic diarrhoea among patients with human immunodeficiency virus infection: report of two cases. Digestive & Liver Disease.  33(1):63-7, 2001 Jan-Feb.


  In Western countries human immunodeficiency virus infection is considered the main risk factor of tuberculous disease, its incidence being 500 times higher in HIV-infected patients than in the general population. Despite the disease frequently present in these patients with extraintestinal manifestations, intestinal localization is rarely observed and often as a consequence of complications such as acute gastrointestinal bleeding or perforation. The diagnosis of intestinal tuberculosis is difficult and is often delayed due to the lack of specific signs and symptoms as well as the low sensitivity of routine methods. A review of the literature is made and personal experience in the diagnosis of two cases is reported.



3197. Bhave SY. Approach to recurrent respiratory infections. Indian Journal of Pediatrics.  68  Suppl 2:S26-32, 2001 Apr.



  Rational approach to diagnosis and management of recurrent respiratory infections is needed, or else the child is subjected to unnecessary investigations and multiple drugs. Repeated respiratory symptoms do not mean a respiratory infection. A diagnosis of viral infection does not justify prescription of an antibiotic. Recurrent viral infections are part of the growing up process of any child. Giving antibiotics at every episode to cover "so-called superadded bacterial infections" will lead to "recurrent antibiotics" and adverse effects on growth. Systematic approach should be used to find the underlying cause. An otoscopic examination of a child should form part of a pediatric examination in all cases of respiratory infections. Antibiotics should be judiciously chosen depending on age, socioeconomic status, severity of infection and the type of organism expected and always given in adequate doses and proper duration. Treatment should be specific and symptomatic. Adequate drainage of the sinuses is an important adjuvant therapy. Use of cough syrups with various combinations should be avoided. Efforts should be made to diagnose and treat manifestations of hyperactive airway or allergy, role of CEA (cough equivalent asthma) and WLRI (Wheeze associated lower respiratory infections). Investigations are needed in recent lower respiratory infections and adverse effect on growth, school performance, abnormal physical findings. CBC, CRP, ESR, nasal smear, appropriate cultures, tests for TB, X-Rays, barium studies, milk scan, ultra sound, CT, MRI, bronchoscopy in selected cases.




3198. Bonilla-Musoles F.  Machado LE.  Bailao LA.  Osborne NG.  Raga F.Abdominal wall defects: two- versus three-dimensional ultrasonographic diagnosis. Journal of Ultrasound in Medicine.  20(4):379-89, 2001 Apr.


  We diagnosed 12 cases of abdominal wall defects. The cases diagnosed occurred in 6 fetuses with omphalocele, 3 with gastroschisis, 2 with prune-belly syndrome, and 1 with pentalogy of Cantrell. Except for 1 case of gastroschisis first diagnosed on the basis of three-dimensional ultrasonography at 14 weeks' gestation, all cases were first detected by two-dimensional transabdominal ultrasonography and then reevaluated with three-dimensional ultrasonography using multiplanar and orthogonal plane modes. Although the original diagnosis was accurate on the basis of two-dimensional ultrasonography in 11 of 12 cases, additional information was obtained by three-dimensional scanning in all cases. Our experience suggests that in cases in which abdominal wall defects are first detected by two-dimensional ultrasonographic scanning, the additional information gained by complementary three-dimensional ultrasonographic scanning can be useful for more-efficient counseling and postnatal therapeutic planning.


3199. Boudeau J.  Barnich N.  Darfeuille-Michaud A. Type 1 pili-mediated adherence of Escherichia coli strain LF82 isolated from Crohn's disease is involved in bacterial invasion of intestinal epithelial cells. Molecular Microbiology.  39(5):1272-84, 2001 Mar.


  We previously characterized the invasive ability of Escherichia coli strain LF82, isolated from an ileal biopsy of a patient with Crohn's disease. In the present study, we performed TnphoA insertion mutagenesis to identify genes involved in LF82 invasion of intestinal epithelial cells. Most of the non-invasive mutants had an insertion mutation within the type 1 pili-encoding operon. Two non-invasive fim mutants, which harboured an insertion within the fimI and fimF genes, still adhered but had lost the ability to induce host cell membrane elongations at the sites of contact with the epithelial cells. Transcomplementation experiments with a fim operon cloned from E. coli K-12 restored both invasive ability and the ability to induce host cell membrane elongations. Expression of the cloned LF82 or K-12 fim operon into the non-invasive laboratory strain JM109 did not confer invasive properties. Thus, these findings showed that: (i) type 1 pili-mediated adherence is involved in LF82-induced perturbation of host cell signalling responsible for membrane elongations; (ii) native shafts are required for type 1 pilus-mediated induction of membrane elongations; (iii) this active phenomenon is a key step in the establishment of the invasive process; and (iv) type 1 pili alone are not sufficient to trigger bacterial internalization.


3200. Carvalho AC.  Ruiz-Palacios GM.  Ramos-Cervantes P.  Cervantes LE.  Jiang X.  Pickering LK. Molecular characterization of invasive and noninvasive Campylobacter jejuni and Campylobacter coli isolates. Journal of Clinical Microbiology.  39(4):1353-9, 2001 Apr.


Campylobacter jejuni is one of the most common causes of bacterial diarrhea worldwide and is the primary bacterial cause of food-borne illness. Adherence to and invasion of epithelial cells are the most important pathogenic mechanisms of Campylobacter diarrhea. Molecular characterization of invasive and noninvasive Campylobacter isolates from children with diarrhea and symptom-free children was performed by random amplified polymorphic DNA techniques (RAPD). A distinct RAPD profile with a DNA band of 1.6 kb was observed significantly more frequently among invasive (63%) than among noninvasive (16%) Campylobacter isolates (P = 0.000005). The 1.6-kb band was named the invasion-associated marker (IAM). Using specifically designed primers, a fragment of 518 bp of the iam locus was amplified in 85% of invasive and 20% of noninvasive strains (P = 0.0000000). Molecular typing with a PCR-restriction fragment length polymorphism assay which amplified the entire iam locus showed a HindIII restriction fragment polymorphism pattern associated mainly with invasive strains. Although cluster analysis of the RAPD fingerprinting showed genetic diversity among strains, two main clusters were identified. Cluster I comprised significantly more pathogenic and invasive isolates, while cluster II grouped the majority of nonpathogenic, noninvasive isolates. These data indicate that most of the invasive Campylobacter strains could be differentiated from noninvasive isolates by RAPD analysis and PCR using specific primers that amplify a fragment of the iam locus.



3201.Chen CP. Ultrasound-guided needle aspiration of a fetal choledochal cyst.Ultrasound in Obstetrics & Gynecology.  17(2):175-6, 2001 Feb.


3202. Cohen J.Medicine. Rethinking a vaccine's risk. Science.  293(5535):1576-7, 2001 Aug 31.


3203. Crane JK.  McNamara BP.  Donnenberg MS. Role of EspF in host cell death induced by enteropathogenic Escherichia coli. Cellular Microbiology.  3(4):197-211, 2001 Apr.


  Enteropathogenic Escherichia coli (EPEC) causes diarrhoea in children in developing countries. Many EPEC genes involved in virulence are contained within the locus of enterocyte effacement (LEE), a large pathogenicity island. One of the genes at the far righthand end of the LEE encodes EspF, an EPEC secreted protein of unknown function. EspF, like the other Esps, is a substrate for secretion by the type III secretory system. Previous studies found that an espF mutant behaved as wild type in assays of adherence, invasion, actin condensation and tyrosine phosphorylation. As EPEC can kill host cells, we tested esp gene mutants for host cell killing ability. The espF mutant was deficient in host cell killing despite having normal adherence. The addition of purified EspF to tissue culture medium did not cause any damage to host cells, but expression of espF in COS or HeLa cells caused cell death. The mode of cell death in cells transfected with espF appeared to be pure apoptosis. EspF appears to be an effector of host cell death in epithelial cells; its proline-rich structure suggests that it may act by binding to SH3 domains or EVH1 domains of host cell signalling proteins.


3204. Crivelli C.  Demarta A.  Peduzzi R.Intestinal secretory immunoglobulin A (sIgA) response to Aeromonas exoproteins in patients with naturally acquired Aeromonas diarrhea.  FEMS Immunology & Medical Microbiology.  30(1):31-5, 2001 Feb.


  The secretory immunoglobulin A (sIgA) response at the intestinal mucosa is one of the primary defense mechanisms protecting against enteric infections and may therefore be used as an indicator of bacterial enteropathogenicity. In order to understand the role played by Aeromonas strains as gastrointestinal infectious agents, the sIgA response in fecal specimens obtained from patients with naturally acquired Aeromonas diarrhea was examined. Our results demonstrated a specific sIgA response which was directed against the exoproteins produced by Aeromonas strains. The specific Aeromonas sIgA reacted with extracellular products showing molecular masses similar to those of the Aeromonas hemolytic toxins such as aerolysin and AHH1. Some reactions were directed against other proteins that are known to be important factors in the pathogenicity of Aeromonas. The specific responses highlighted are in support of the view that one should consider at least certain biotypes of Aeromonas enteropathogenic.




3205. Cubert R.  Cheng EY.  Mack S.  Pepin MG.  Byers PH. Osteogenesis imperfecta: mode of delivery and neonatal outcome. Obstetrics & Gynecology.  97(1):66-9, 2001 Jan.


  OBJECTIVE: To evaluate the pregnancy characteristics, methods of delivery, and neonatal outcomes of fetuses affected by osteogenesis imperfecta. METHODS: We reviewed medical records of 1016 individuals whose cells were sent to the University of Washington Collagen Diagnostic Laboratory between 1987 and 1994 for confirmation of diagnoses of osteogenesis imperfecta. Information and neonatal records were available for 167 of those pregnancies. From those we identified method(s) of prenatal detection, delivery method, and neonatal complications, including survival and acquisition of new fractures, and related them to type of delivery. RESULTS: The cesarean delivery rate was 54%, most of them (53%) for nonvertex presentation and fewer than 15% because of an antenatal diagnoses of osteogenesis imperfecta. There was an unusually high rate of breech presentation at term (37%). In infants with nonlethal forms of osteogenesis imperfecta, 24 of 59 (40%) delivered by cesarean and 17 of 53 (32%) delivered vaginally had new fractures (chi(2) =.89; P =.3). Among 55 infants with the most severe form, 24 of 31 delivered by cesarean and 21 of 24 delivered vaginally died within 2 weeks of birth. CONCLUSION: Cesarean delivery did not decrease fracture rates at birth in infants with nonlethal forms of osteogenesis imperfecta nor did it prolong survival for those with lethal forms. Prenatal diagnosis did not influence mode of delivery in most instances. Most cesarean deliveries were done for usual obstetric indications.



3206. Cuckle H. Integrating antenatal Down's syndrome screening. [Review] [30 refs] Current Opinion in Obstetrics & Gynecology.  13(2):175-81, 2001 Apr.


  Statistical modelling is used to predict screening detection and false-positive rates for policies using different marker combinations and screening modalities. Parameters are derived wherever possible from meta-analyses. Screening with four serum markers yields a similar detection rate in the first trimester as it does in the second, and both have a similar detection rate to that of ultrasound nuchal translucency screening. Ultrasound anomaly screening has a low detection rate. The integration of the different screening modalities can yield very high detection rates. Some methods of integration are preferable to others. The concurrent use of first trimester serum markers and ultrasound nuchal translucency is the most practical. The combination of three modalities with nondisclosure of the intermediate results is more efficient, but the gain in detection is too small to warrant the wait for up to 4 weeks for results. The sequential use of modalities with intermediate disclosure is more practical but will generate higher false-positive rates. [References: 30]



3207. Cuillerier E.  Landi B.  Cellier C. Is push enteroscopy useful in patients with malabsorption of unclear origin?. American Journal of Gastroenterology.  96(7):2103-6, 2001 Jul.


  OBJECTIVE: The aim of this study was to determine the diagnostic value of push enteroscopy in patients with chronic diarrhea and malabsorption of unclear origin. METHODS: From January, 1997, to September, 1999, 16 consecutive patients with chronic diarrhea and biological signs of intestinal malabsorption but no evidence of celiac disease were explored by push enteroscopy. Previous duodenal histological findings had been normal in seven patients and abnormal but inconclusive in nine patients. Endoscopic and histological findings in the duodenum and in the jejunum were compared. RESULTS: Push enteroscopy with jejunal biopsy yielded a diagnosis in comparison with duodenal biopsy in two of 16 (12%) patients, respectively, in two of the nine (22%) patients with abnormal but inconclusive findings on duodenal biopsy, and none of the seven patients with normal duodenal histology. In the two patients in whom jejunal biopsy had diagnostic value but duodenal biopsy did not, the final diagnoses were invasive intestinal lymphoma and microsporidiosis. CONCLUSION: Push enteroscopy had diagnostic value in only 12% of patients with malabsorption of unclear origin, all of whom had had abnormal but inconclusive duodenal histological findings. Push enteroscopy with jejunal biopsy appears to have limited diagnostic value in patients with chronic diarrhea and malabsorption, especially when duodenal biopsies are histologically normal.


3208. Daniell SJ.  Delahay RM.  Shaw RK.  Hartland EL.  Pallen MJ.  Booy F.  Ebel F.  Knutton S.  Frankel G. Coiled-coil domain of enteropathogenic Escherichia coli type III secreted protein EspD is involved in EspA filament-mediated cell attachment and hemolysis. Infection & Immunity.  69(6):4055-64, 2001 Jun.


  Many animal and plant pathogens use type III secretion systems to secrete key virulence factors, some directly into the host cell cytosol. However, the basis for such protein translocation has yet to be fully elucidated for any type III secretion system. We have previously shown that in enteropathogenic and enterohemorrhagic Escherichia coli the type III secreted protein EspA is assembled into a filamentous organelle that attaches the bacterium to the plasma membrane of the host cell. Formation of EspA filaments is dependent on expression of another type III secreted protein, EspD. The carboxy terminus of EspD, a protein involved in formation of the translocation pore in the host cell membrane, is predicted to adopt a coiled-coil conformation with 99% probability. Here, we demonstrate EspD-EspD protein interaction using the yeast two-hybrid system and column overlays. Nonconservative triple amino acid substitutions of specific EspD carboxy-terminal residues generated an enteropathogenic E. coli mutant that was attenuated in its ability to induce attaching and effacing lesions on HEp-2 cells. Although the mutation had no effect on EspA filament biosynthesis, it also resulted in reduced binding to and reduced hemolysis of red blood cells. These results segregate, for the first time, functional domains of EspD that control EspA filament length from EspD-mediated cell attachment and pore formation.


3209. De Ponti F.  Tonini M.Irritable bowel syndrome: new agents targeting serotonin receptor subtypes. [Review] [138 refs] Drugs.  61(3):317-32, 2001.


  Although the past few years have seen an exponential growth of compounds of potential interest for the treatment of functional gastrointestinal (GI) tract disorders, the gap that still exists between basic and clinical research is easily noticed if one considers the relative paucity of drugs that have received marketing authorisation for the treatment of irritable bowel syndrome (IBS). Traditional efficacy outcomes in drug development for IBS include the ability of the compound to affect GI tract motility (i.e. to exert a prokinetic or an antispasmodic effect), which is thought to be of importance if a motor disorder is the underlying pathophysiological mechanism. More recently, altered visceral sensitivity to a distending stimulus has been suggested to be a key pathophysiological feature, at least in some patients, and has become a target for therapeutic interventions. However, there is now growing consensus that the primary outcome measure in the treatment of functional disorders are those that reflect overall control of the patient's symptoms (pain, diarrhoea, constipation) in everyday situations such as the clinical global improvement scales. Although, in general, guidelines on the design of treatment trials for functional GI tract disorders advise against subcategorisation of patients according to the main symptom (because of symptom instability), subcategorisation indeed makes sense especially in IBS (constipation- or diarrhoea-predominant). Compounds with a specific indication for each subpopulation of patients are now emerging. The rationale for investigations on serotonin (5-hydroxytryptamine; 5-HT) receptor ligands in IBS rests mainly on the fact that serotonin, which may be released by enterochromaffin-like cells in the GI tract as well as from other sources, has a number of well documented motor effects on the GI tract and can produce hyperalgesia in several experimental models. Serotonin receptors belonging to the 5-HT3 and 5-HT4 subtype are the most extensively studied in gastroenterology, although hitherto 'orphan' receptor subtypes, such as the 5-HT7 and the 5-HT(1B/D) receptors, are now emerging. Among 5-HT3 receptor antagonists, alosetron was recently approved for the treatment of diarrhoea-predominant IBS and is an example of a compound that, at least theoretically, may act at multiple levels: by inhibiting visceral sensitivity, by increasing compliance, and by inhibiting excitatory 5-HT3 receptors located on both ascending and descending neuronal pathways involved in peristalsis. For this reason, 5-HT3 receptor antagonists may slow transit, hence the specific indication of alosetron in diarrhoea-predominant IBS. However, alosetron has been recently withdrawn by the manufacturer because of safety concerns. Hypomotility remains an attractive therapeutic target in IBS and the new generation of prokinetics includes several partial agonists at the 5-HT4 receptor, such as tegaserod (HTF-919) and prucalopride (R0-93877). In addition, preliminary evidence suggests that 5-HT4 receptors may also be involved in the modulation of visceral sensitivity. Second-generation 5-HT4 receptor agonists seem to be devoid of the QT-prolonging effects observed in some clinical circumstances with cisapride and may be more active at the colonic level. Piboserod (SB-207266A) is a 5-HT4 receptor antagonist under development for the treatment of diarrhoea-predominant IBS. Finally, interest in 5-HT7 and 5-HT(1B/D) receptor subtypes stems from the observation that the former receptors mediate smooth muscle relaxation (at least in the human colon), whereas sumatriptan (a 5-HT(1B/D) receptor agonist) can affect GI tract motility and visceral sensitivity. [References: 138]



3210. De Sutter AI.  De Meyere MJ.  De Maeseneer JM.  Peersman WP. Antibiotic prescribing in acute infections of the nose or sinuses: a matter of personal habit?. Family Practice.  18(2):209-13, 2001 Apr.


  BACKGROUND: A proper understanding of how and why GPs prescribe antibiotics in general practice is essential for the design of strategies aimed at making prescribing more rational. OBJECTIVE: The intention of this study is to contribute to such understanding by investigating which elements are important in the GP's decision to prescribe antibiotics for patients with acute infectious complaints of the nose and/or sinuses. METHODS: During their training in general practice, students observed the following elements while attending encounters between their trainer-GP and patients with a runny nose, blocked nose or cough: patient characteristics, contact characteristics, signs and symptoms, diagnosis and prescriptions. Information on practice characteristics and characteristics of the trainer-GP were collected. Data were analysed using multiple logistic regression and multiple linear regression. RESULTS: A total of 722 cases were analysed with the following results: the best independent predictor of an antibiotic prescription is the individual antibiotic prescribing rate (IAPR), which expresses the personal habit of the GP in prescribing antibiotics [adjusted odds ratio (OR) 5.27, 95% confidence interval (CI) 3.22-8.62]. Others are the diagnostic labels "sinusitis" (adjusted OR 2.80, 95% CI 1.2-6.49) and "flu-like syndrome" (adjusted OR 0.08, 95% CI 0.01-0.45), and the sign "sinus tenderness" (adjusted OR 4.37, CI 2.15-8.89). The antibiotic prescribing behaviour intensifies with an increasing tendency to prescribe medication in general (beta = 0.46, P: < 0.00) and with an increasing defensive attitude (beta = 0.22, P: < 0.05). CONCLUSIONS: Whether or not a patient with an acute infection of the nose and/or sinuses will be handed an antibiotic prescription seems to depend more on the attending doctor's prescribing behaviour than on the clinical picture. Further qualitative research into attitudes which may be related to a high tendency to prescribe antibiotics consequently is of the utmost importance.



3211. Dutta S.  Chatterjee A.  Dutta P.  Rajendran K.  Roy S.  Pramanik KC.  Bhattacharya SK.Sensitivity and performance characteristics of a direct PCR with stool samples in comparison to conventional techniques for diagnosis of Shigella and enteroinvasive Escherichia coli infection in children with acute diarrhoea in Calcutta, India. Journal of Medical Microbiology.  50(8):667-74, 2001 Aug.


  As the sensitivity of the conventional techniques for identifying Shigella spp. and enteroinvasive Escherichia coli (EIEC) causing dysentery cases is low, a PCR assay was evaluated in this study. Analytical sensitivity (2 x 10(2) cfu) of the PCR technique was obtained by artificially spiking negative stool samples with a standard strain of S. flexneri type 2, then determining the detection limit. Specificity (100%) of the method was determined by testing a number of known Shigella and EIEC strains and organisms other than Shigella spp. A total of 300 stool samples collected from children with acute diarrhoea was plated on to two selective agar media after enrichment in Luria broth. Shigella spp. were isolated from 7.7% (23 of 300) and EIEC from 1% (3 of 300) patients. All enriched stool samples were subjected to PCR to amplify the target sequence of invasive plasmid antigen (ipa)H locus, a multicopy element found on the chromosome and invasion plasmid. The stool PCR was positive in 24 of the 26 culture-positive and in 22 culture-negative stools, thus detecting the presence of Shigella spp. or EIEC in 15.3% (46 of 300) of diarrhoea cases. When an ial probe was used for colony hybridistion with enriched stool cultures blotted on to membranes, 9.6% (29 of 300) of dysentery cases were identified as being caused by Shigella spp. or EIEC. Thus the sensitivity of enriched stool culture, colony hybridisation and enriched stool PCR was found to be 54%, 60% and 96%, respectively, when each of the methods was compared to the total microbiologically confirmed cases of dysentery. It was also observed that only 38% (48 of 126) of acute bloody dysentery cases actually had shigella or EIEC infection, as confirmed by laboratory methods. Moreover, this PCR assay could identify a number of untypable Shigella strains (Sh OUT), which would have remained undiagnosed had this assay not been used.



3212. Egloff N.  Oehler T.  Rossi M.  Nguyen XM.  Furrer H.Chronic watery diarrhea due to co-infection with Cryptosporidium spp and Cyclospora cayetanensis in a Swiss AIDS patient traveling in Thailand. Journal of Travel Medicine.  8(3):143-5, 2001 May-Jun.


3213. Elliott SJ.  Krejany EO.  Mellies JL.  Robins-Browne RM.  Sasakawa C.  Kaper JB.

EspG, a novel type III system-secreted protein from enteropathogenic Escherichia coli with similarities to VirA of Shigella flexneri. Infection & Immunity.  69(6):4027-33, 2001 Jun.


  The function of the rorf2 gene located on the locus of enterocyte effacement (LEE) pathogenicity island of enteropathogenic Escherichia coli (EPEC) has not been described. We report that rorf2 encodes a novel protein, named EspG, which is secreted by the type III secretory system and which is translocated into host epithelial cells. EspG is homologous with Shigella flexneri protein VirA, and the cloned espG (rorf2) gene can rescue invasion in a Shigella virA mutant, indicating that these proteins are functionally equivalent in Shigella. An EPEC espG mutant had no apparent defects in in vitro assays of virulence phenotypes, but a rabbit diarrheagenic E. coli strain carrying a mutant espG showed diminished intestinal colonization and yet diarrheal attack rates similar to those of the wild type. A second EspG homolog, Orf3, is encoded on the EspC pathogenicity islet. The cloned orf3 gene could also rescue invasion in a Shigella virA mutant, but an EPEC espG orf3 double mutant was not diminished in any tested in vitro assays for EPEC virulence factors. Our results indicate that EspG plays an accessory but as yet undefined role in EPEC virulence that may involve intestinal colonization.



3214. Farrell PM.  Kosorok MR.  Rock MJ.  Laxova A.  Zeng L.  Lai HC.  Hoffman G.  Laessig RH.  Splaingard ML. Early diagnosis of cystic fibrosis through neonatal screening prevents severe malnutrition and improves long-term growth. Wisconsin Cystic Fibrosis Neonatal Screening Study Group. Pediatrics.  107(1):1-13, 2001 Jan.


  OBJECTIVE: Despite its relative frequency among autosomal recessive diseases and the availability of the sweat test, cystic fibrosis (CF) has been difficult to diagnose in early childhood, and delays can lead to severe malnutrition, lung disease, or even death. The Wisconsin CF Neonatal Screening Project was designed as a randomized clinical trial to assess the benefits and risks of early diagnosis through screening. In addition, the incidence of CF was determined, and the validity of our randomization method assessed by comparing 16 demographic variables. METHODOLOGY: Immunoreactive trypsinogen analysis was applied to dried newborn blood specimens for recognition of CF risk from 1985 to 1991 and was coupled to DNA-based detection of the DeltaF508 mutation from 1991 to 1994. Randomization of 650 341 newborns occurred when their blood specimens reached the Wisconsin screening laboratory. This created 2 groups-an early diagnosis, screened cohort and a standard diagnosis or control group. To avoid selection bias, we devised a unique unblinding method with a surveillance program to completely identify the control subjects. Because sequential analysis of nutritional outcome measures revealed significantly better growth in screened patients during 1996, we accelerated the unblinding and completely identified the control group by April 1998. Having each member of this cohort enrolled and evaluated for at least 1 year and having completed a comprehensive surveillance program, we performed another statistical analysis of anthropometric evaluated indices that includes all CF patients without meconium ileus. RESULTS: The incidence of classical CF, ie, patients diagnosed in this trial with a sweat chloride of 60 mEq/L greater, was 1:4189. By incorporating other CF patients born during the randomization period, including 2 autopsy diagnosed patients and 8 probable patients, we calculate a maximum incidence of 1:3938 (95% confidence interval: 3402-4611). Although there were group differences in the proportion of patients with DeltaF508 genotypes and with pancreatic insufficiency, validity of the randomization plan was demonstrated by analyzing 16 demographic variables and finding no significant difference after adjustment for multiple comparisons. Focusing on patients without meconium ileus, we found a marked difference in the mean +/- standard deviation age of diagnosis for screened patients (13 +/- 37 weeks), compared with the standard diagnosis group (100 +/- 117). Anthropometric indices of nutritional status were significantly higher at diagnosis in the screened group, including length/height, weight, and head circumference. During 13 years of study, despite similar nutritional therapy and the inherently better pancreatic status of the control group, analysis of nutritional outcomes revealed significantly greater growth associated with early diagnosis. Most impressively, the screened group had a much lower proportion of patients with weight and height data below the 10th percentile throughout childhood. CONCLUSIONS: Although the screened group had a higher proportion of patients with pancreatic insufficiency, their growth indices were significantly better than those of the control group during the 13-year follow-up evaluation and, therefore, this randomized clinical trial of early CF diagnosis must be interpreted as unequivocally positive. Our conclusions did not change when the height and weight data before 4 years of age for the controls detected by unblinding were included in the analysis. Also, comparison of growth outcomes after 4 years of age in all subjects showed persistence of the significant differences. Therefore, selection bias has been eliminated as a potential explanation. In addition, the results show that severe malnutrition persists after delayed diagnosis of CF and that catch-up may not be possible. We conclude that early diagnosis of CF through neonatal screening combined with aggressive nutritional therapy can result


3215. Ghoshal UC.  Chetri K.  Banerjee PK.  Choudhuri G.  Pal BB.  Dabadghao S.  Dhar K.  Naik S.  Naik SR. Is immunoproliferative small intestinal disease uncommon in India?. Tropical Gastroenterology.  22(1):14-7, 2001 Jan-Mar.


  Till date only three series of immunoproliferative small intestinal disease (IPSID) describing 22 patients have been reported from India. Seven patients with IPSID in two tertiary referral centers in India are included in the study. Diagnosis was based on typical clinical features [diarrhoea (7/7), weight loss (7/7), clubbing (6/7), fever (3/7), abdominal pain and lump (3/7)], biochemical evidence of malabsorption and duodenal biopsy findings. All patients were young males (mean age 29.8 +/- 11.8 years, range 17-53). Atypical features included gastric involvement (1/7), colonic involvement (1/7) and appearance of pigmented nails following anti-cancer chemotherapy (1/7) which disappeared six months after omitting doxorubin from chemotherapy regimen. Parasitic infestation was common. Ascaris lumbricoides (1/7), Giardia lamblia and hookworm (1/7), Strongyloides stercoralis and Trichuris trichura (1/7). In the latter patient S. stercoralis became disseminated after anti-malignant chemotherapy. One patient had gastric H. pylori infection. Four of the seven patients who were misdiagnosed as tropical sprue were treated with tetracycline. This raises doubt on efficacy of tetracycline alone in treatment of IPSID. One other patient was misdiagnosed and treated as intestinal tuberculosis. Early diagnosis and administration of chemotherapy may improve survival in this disease.


3216. Gisbert JP.  Marcos S.  Gisbert JL.  Pajares JM. High efficacy of ranitidine bismuth citrate, amoxicillin, clarithromycin and metronidazole twice daily for only five days in Helicobacter pylori Eradication. [see comments]. Helicobacter.  6(2):157-62, 2001 Jun.


  AIM: The combination of a proton pump inhibitor (PPI) or ranitidine-bismuth-citrate (Rbc) and two antibiotics for 7-10 days are, at present, the preferred treatments in Helicobacter pylori eradication. However, therapies for fewer than 7 days have been scarcely evaluated and it is unknown whether the length of treatment can be shortened, without a lost of efficacy, if three instead of two antibiotics are used. The aim of our study was to evaluate the efficacy of Rbc plus three antibiotics for only 5 days in H. pylori eradication. METHODS: We prospectively studied 80 patients (34% duodenal ulcer, 66% functional dyspepsia) infected by H. pylori. At endoscopy, biopsies were obtained for histological study and rapid urease test, and a 13C-urea breath test was carried out. Urea breath test was repeated 4 weeks after completing eradication treatment with Rbc [400 mg twice a day (bid)], amoxicillin (1 g bid), clarithromycin (500 mg bid) and metronidazole (500 mg bid). All drugs were administered together after breakfast and dinner for 5 days only, and no treatment was administered thereafter. Compliance with therapy was determined from the interrogatory and the recovery of empty envelopes of medications. RESULTS: In 79 out of the 80 patients, H. pylori eradication success or failure was assessed after therapy (one patient was lost from follow-up). All but one of these 79 patients took all the medications (one patient stopped treatment on the day 3 due to nausea/vomiting). Per protocol eradication was achieved in 72/78 (92%; 95% CI, 84-96%) and in 72/80 (90%; 81-95%) by intention-to-treat. Therapy was more effective in patients with duodenal ulcer than in those with functional dyspepsia [100% (87-100%) vs. 85% (73-92%) by intention-to-treat; p <.05]. Adverse effects were described in ten patients (12%), and included the perception of a metallic taste (eight patients), nausea/vomiting (two patients, one of them abandoned the treatment due to this), and diarrhea (two patients). CONCLUSION: The combination of Rbc, amoxicillin, clarithromycin and metronidazole for only 5 days represents a promising therapy for H. pylori infection, due to its high efficacy, simple posology, low cost and excellent tolerance.



3217. Grandi G. Antibacterial vaccine design using genomics and proteomics. [Review] [49 refs] Ophthalmic Genetics.  19(5):181-8, 2001 May.


  After 200 years of practice, vaccinology has proved to be very effective in preventing infectious diseases. However, several human and animal pathogens exist for which vaccines have not yet been discovered. As for other fields of medical sciences, it is expected that vaccinology will greatly benefit from the emerging genomics technologies such as bioinformatics, proteomics and DNA microarrays. In this article the potential of these technologies applied to bacterial pathogens is analyzed, taking into account the few existing examples of their application in vaccine discovery. [References: 49]


3218. Hart A.  Nowicki BJ.  Reisner B.  Pawelczyk E.  Goluszko P.  Urvil P.  Anderson G.  Nowicki S. Ampicillin-Resistant Escherichia coli in Gestational Pyelonephritis: Increased Occurrence and Association with the Colonization Factor Dr Adhesin. Journal of Infectious Diseases.  183(10):1526-9, 2001 May 15.


  The pattern of ampicillin resistance and possible association with virulence factors of 78 Escherichia coli isolates taken from 78 pregnant women with pyelonephritis were evaluated. The current incidence of ampicillin resistance among pyelonephritis isolates (46%) was significantly higher than that reported in 1985 (22%). Resistance was found more frequently during the first (60%) and third (53%) trimesters than during the second trimester (33%). Of all dra(+) E. coli isolates, 75% were ampicillin resistant, whereas dra(+) isolates of O75 serotype E. coli accounted for 87% of ampicillin-resistant strains. The significant increase of ampicillin resistance among gestational pyelonephritis E. coli and the association with the dra gene cluster encoding colonization and invasive capacity may warrant further study involving obstetric and neonate wards, with the latter being at the higher risk for potential problems.


3219. Heczko U.  Carthy CM.  O'Brien BA.  Finlay BB. Decreased apoptosis in the ileum and ileal Peyer's patches: a feature after infection with rabbit enteropathogenic Escherichia coli O103. Infection & Immunity.  69(7):4580-9, 2001 Jul.


  Significant changes occur in intestinal epithelial cells after infection with enteropathogenic Escherichia coli (EPEC). However, it is unclear whether this pathogen alters rates of apoptosis. By using a naturally occurring weaned rabbit infection model, we determined physiological levels of apoptosis in rabbit ileum and ileal Peyer's patches (PP) and compared them to those found after infection with adherent rabbit EPEC (REPEC O103). Various REPEC O103 strains were first tested in vitro for characteristic virulence features. Rabbits were then inoculated with the REPEC O103 strains that infected cultured cells the most efficiently. After experimental infection, intestinal samples were examined by light and electron microscopy. Simultaneously, ileal apoptosis was assessed by using terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling (TUNEL) and caspase 3 assays and by apoptotic cell counts based on morphology (hematoxylin-and-eosin staining). The highest physiological apoptotic indices were measured in PP germinal centers (median = 14.7%), followed by PP domed villi (8.1%), tips of absorptive villi (3.8%), and ileal crypt regions (0.5%). Severe infection with REPEC O103 resulted in a significant decrease in apoptosis in PP germinal centers (determined by TUNEL assay; P = 0.01), in the tips of ileal absorptive villi (determined by H&E staining; P = 0.04), and in whole ileal cell lysates (determined by caspase 3 assay; P = 0.001). We concluded that REPEC O103 does not promote apoptosis. Furthermore, we cannot rule out the possibility that REPEC O103, in fact, decreases apoptotic levels in the rabbit ileum.


3220.Lamb EJ.  Muller AF.  Flynn MD.  An unusual case of diarrhoea and weight loss. Postgraduate Medical Journal.  77(908):411, 421-2, 2001 Jun.


3221. Leclercq A.  Lambert B.  Pierard D.  Mahillon J. Particular biochemical profiles for enterohemorrhagic Escherichia coli O157:H7 isolates on the ID 32E system.  Journal of Clinical Microbiology.  39(3):1161-4, 2001 Mar.


  The ability of the ID 32E system to identify and discriminate 74 Escherichia coli O157 isolates among 106 E. coli non-O157 isolates was evaluated. The results showed atypical biochemical reactions but accurate identification at the species level and no unique biochemical profile numbers for E. coli O157, although these numbers were distinct from those of other serotypes.


3222.Lloyd DC.  Scrivener G.  Prescribing at the Primary Care Group level: census data and prescribing indicators.  Journal of Clinical Pharmacy & Therapeutics.  26(2):93-101, 2001 Apr.


  OBJECTIVE: To examine the relationship between prescribing and morbidity, mortality and deprivation for the 481 Primary Care groups set up on 1 April 1999, by examining the prescribing of their constituent practices in the year 1998/99, i.e. the year before. DESIGN: Cross-sectional study. OUTCOME MEASURES: Set of 11 prescribing indicators taken from the Prescription Pricing Authority 'Toolkit' system; census measures of morbidity and deprivation and Standardized Mortality Ratio for those aged 75 and under. SETTING: All practices in England belonging to a Primary Care Group. RESULTS: Several of the indicators showed strong correlation with morbidity, mortality and, to a weaker extent, with deprivation. There was a negative correlation between the census-based measures and choice of more expensive alternatives or greater duration prescriptions for antibiotic prescribing and with the use of hormone replacement therapy (HRT). Conversely, there was a positive correlation with use of premium products and drugs of limited therapeutic value. CONCLUSION: Practices in areas of greater need (as measured by permanent sickness and Standardized Mortality Ratio) seem to be trying to hold down costs by the way they prescribe antibiotics. Conversely, their use of premium price products pushes up their costs in the absence of clear evidence concerning compliance. The use of HRT is low in areas of high overall need.


3223. Lozniewski A.  Rabaud C.  Dotto E.  Weber M.  Mory F.  Laboratory diagnosis of Clostridium difficile-associated diarrhea and colitis: usefulness of Premier Cytoclone A+B enzyme immunoassay for combined detection of stool toxins and toxigenic C. difficile strains.  Journal of Clinical Microbiology.  39(5):1996-8, 2001 May.


  Detection of Clostridium difficile toxins A and B in stools by Premier Cytoclone A+B enzyme immunoassay (EIA) was compared with detection by stool culture for C. difficile followed by detection of toxigenic isolates using the same EIA. Chart reviews were performed to evaluate the likelihood of C. difficile-associated diarrhea and colitis (CADC) for all patients with at least one positive toxin assay. While the toxins were detected in 58 of 85 consecutive CADC patients by both assays, CADC in 5 patients was detected only by stool toxin assay, and in 22 patients CADC was detected only by toxigenic culture. Our results suggest that for laboratories using a rapid toxin A+B EIA, direct toxin detection in stools should be combined with toxigenic culture in cases in which there is a negative stool toxin assay.


3224. Niyogi S K, Pal A, Mitra U, Dutta P: Enteroaggregative klebsiella pneumoniae in association with childhood diarrhoea. Indian J med Res 2000, 112(Oct), 133-4.


Ninteen strains of Klebsiella pneumoniae isolated as sole pathogen from children with diarrhoea were used to study there virulence mechanism using different assays. Eight strains of K. pneumoniae exhibited aggregative adherence that was distinct from the stacked brick enteroaggregative pattern  shown by Escherichia coli. The study suggests the presence of a new virulence mechanism in the pathogenesis of  Klebsiella-associated diarrhoea.


3225.Miller FH.  Ma JJ.  Scholz FJ. Imaging features of enterohemorrhagic Escherichia coli colitis. AJR. American Journal of Roentgenology.  177(3):619-23, 2001 Sep.


  OBJECTIVE: The purpose of this article is to define and illustrate the radiologic findings in patients with enterohemorrhagic Escherichia coli colitis. CONCLUSION: Although not definitive, imaging studies in conjunction with an appropriate clinical history can aid in the early diagnosis of E. coli colitis and exclude surgical conditions. CT is more sensitive than conventional radiography for detection. Contiguous involvement, including the transverse colon, was seen in all patients. Because CT is becoming routine in the initial workup of patients with acute abdominal pain, it is important for the radiologist to suggest E. coli colitis in the proper setting.

3226. Park S.  Worobo RW.  Durst RA. Escherichia coli O157:H7 as an emerging foodborne pathogen: a literature review. [Review] [173 refs] Critical Reviews in Biotechnology.  21(1):27-48, 2001.

3227. Shah MK. Sebti A.  Kiehn TE.  Massarella SA.  Sepkowitz KA.   Mycobacterium haemophilum in immunocompromised patients.  Clinical Infectious Diseases.  33(3):330-7, 2001 Aug 1.


  Mycobacterium haemophilum, a recently described pathogen, can cause an array of symptoms in immunocompromised patients. To date, 90 patients with this infection have been described worldwide. We report our institution's experience with 23 patients who were treated from 1990 through 2000. Fourteen patients had undergone bone marrow transplantation, 5 were infected with human immunodeficiency virus, 3 had hematologic malignancies, and 1 had no known underlying immunosuppression. Clinical syndromes on presentation included skin lesions alone in 13 patients, arthritis or osteomyelitis in 4 patients, and lung disease in 6 patients. Although patients with skin or joint involvement had favorable outcomes, 5 of 7 patients with lung infection died. Prolonged courses of multidrug therapy are required for treatment. A diagnosis of M. haemophilum infection must be considered for any immunocompromised patient for whom acid-fast bacilli are identified in a cutaneous, synovial fluid or respiratory sample or for whom granulomas are identified in any pathological specimen.


3228. Shankar A: Comparative evaluation of norfloxacin tinidazole combination as compared to norfloxacin-metronidazole combination and nalidixic acid metronidazol combination in management of pediatric diarrhoea. Antiseptic,  Maduri  2000,97(10), 357-60. (16 May 2024).


Diarrhoea, the commonest pediatric infection deserves prompt medicare to pevent morbidity and mortality. Comparative clinical evaluation of Norfloxacin- Tinidazole (Norfloxacin 20mg/ml and Tinidazole 30mg/ml) in dose of ½ ml /kg every 12 hours proves at par with metronidazole- nalidixic acid combination (Metronidazole 20mg/kg and nalidixic acid 50mg/kg) in 6 hourly divided dose except dose-encumbrance leading to drug default, and superior to metronidazole-norfloxacin combination of varied biological half life constituents. No untoward effect was noted with norfloxacin-tinidazole therapy though fungal superinfection was common among patients taking norfloxacin-metronidazole.


3229.Stanworth SJ.  Hackett GA.  Williamson LM. Fetomaternal alloimmune  thrombocytopenia presenting antenatally as hydrops fetalis.  Prenatal Diagnosis.  21(5):423-4, 2001 May.

3230.Szakal D.  Gado I.  Pal T.  A colony blot immunoassay to detect enteroinvasive Escherichia coli and Shigella in water samples. Journal of Applied Microbiology.  90(2):229-36, 2001 Feb.


  AIMS: The aim of the study was to develop a colony blot immunoassay to detect Shigella and enteroinvasive Escherichia coli (EIEC) in water. METHODS AND RESULTS: Spiked samples were filtered through nitrocellulose membranes. Colony prints on the filters were tested with a monoclonal antibody specific to IpaC, an antigen coded by the invasion plasmid of Shigella and EIEC. Invasive pathogens could be successfully detected with the technique, even in the presence of a large number of non-pathogenic bacterial cells. The method was significantly more sensitive in identifying pathogen-containing samples then the traditional culture-based approach. CONCLUSION: The IpaC-specific colony blot immunoassay is an inexpensive method for identifying the aetiological agents of bacillary dysentery in water samples. SIGNIFICANCE AND IMPACT OF THE STUDY: The technique could be particularly useful in detecting enteroinvasive E. coli which often remains undetected by bio- and serotyping.


3231.Woodford N.  Soltani M.  Hardy KJ.  Frequency of esp in Enterococcus faecium isolates.  Lancet.  358(9281):584, 2001 Aug 18.


3232. No Abstract

Apr 02


4005.Chakraborty S, Garg P, Ramamurthy T, Thungapathra M, Gautam JK, Kumar C, Maiti S, Yamasaki S, Shimada T, Takeda Y, Ghosh A, Nair GB. Comparison of antibiogram, virulence genes, ribotypes and DNA fingerprints of Vibrio cholerae of matching serogroups isolated from hospitalised diarrhoea cases and from the environment during 1997-1998 in Calcutta, India. J Med Microbiol  2001 Oct;50(10):879-88


This study identified 17 matching serogroups of Vibrio cholerae belonging to serogroups other than O1 and O139 isolated from human cases and from the environment during a concurrent clinical and environmental study conducted in Calcutta, a cholera endemic area. Isolates within these matching serogroups were compared by various phenotypic and genotypic traits to determine if the environment was the source of the organisms associated with the disease. Clinical strains of V. cholerae were resistant to a greater number of drugs and exhibited multi-drug resistance compared with their environmental counterparts. Except for the presence of the genes for the El Tor haemolysin and the regulatory element ToxR in most of the strains of V. cholerae examined, non-O1, non-O139 V. cholerae strains lacked most of the other known virulence traits associated with toxigenic V. cholerae O1 or O139. Restriction fragment-length polymorphism of virulence-associated genes, ribotypes and DNA fingerprints of strains of matched serogroups showed considerable diversity, although some gene polymorphisms and ribotypes of a few strains of different serogroups were similar. It is concluded that despite sharing the same serogroup, environmental and clinical isolates were genetically heterogeneous and were of different lineages.


4006.DuPont HL, Jiang ZD, Ericsson CD, Adachi JA, Mathewson JJ, DuPont MW, Palazzini E, Riopel LM, Ashley D, Martinez-Sandoval F. Rifaximin versus ciprofloxacin for the treatment of traveler's diarrhea: a randomized, double-blind clinical trial. Clin Infect Dis  2001 Dec 1;33(11):1807-15


Rifaximin is a poorly absorbed rifamycin derivative under investigation for treatment of infectious diarrhea. Adult students from the United States in Mexico and international tourists in Jamaica were randomized to receive either rifaximin (400 mg twice per day) or ciprofloxacin (500 mg twice per day) for 3 days, following a double-blinded model, from June 1997 to September 1998. A total of 187 subjects with diarrhea were studied. Time from initiation of therapy to passage of last unformed stool was comparable for those receiving rifaximin or ciprofloxacin (median, 25.7 hours versus 25.0 hours, respectively). There was no significant difference in the proportion of subjects in the 2 groups with respect to clinical improvement during the first 24 hours (P=.199), failure to respond to treatment (P=.411), or microbiological cure (P=.222). The incidence of adverse events was low and similar in each group. Rifaximin is a safe and effective alternative to ciprofloxacin in the treatment of traveler's diarrhea.

4007.Hirst TR. Cholera. A toxin with emerging therapeutic potential. Lancet  2001 Dec;358 Suppl:S7 No abstract.

4008.Krause R, Schwab E, Bachhiesl D, Daxbock F, Wenisch C, Krejs GJ, Reisinger EC. Role of Candida in antibiotic-associated diarrhea. J Infect Dis  2001 Oct 15;184(8):1065-9


To quantitatively assess the role of Candida species in antibiotic-associated diarrhea (AAD), stool samples from a total of 395 patients and control subjects were cultured in differential isolation medium: 98 patients had AAD, 93 patients were taking antibiotics but did not have diarrhea (A(+)D(-)), 97 patients were not taking antibiotics but had diarrhea (A(-)D(+)), and 107 patients were control subjects (A(-)D(-)). In addition, secreted aspartyl proteinase (Sap) production was tested. In AAD patients, Candida positivity (77/98) and Candida overgrowth (62/98) were not different from that among A(+)D(-) patients (75/93 [P= .860] and 52/93 [P= .375], respectively). Candida overgrowth among A(-)D(+) patients (40/97, P= .003) was less frequent than among AAD patients, but Candida positivity was not different (80/97, P= .612). In control subjects, Candida positivity and overgrowth were less common than in all other groups. Production of Sap did not differ between patients with AAD and control subjects (P= .568 and P= .590, respectively). Data indicate that elevated Candida counts are a result of antibiotic treatment or diarrhea rather than a cause of AAD.


4009.   Kunches LM, Reinhalter NE, Marquis A, Coakley E, Cohen C, Morris AB, Mazzullo JM. Tolerability of enteric-coated didanosine capsules compared with didanosine tablets in adults with HIV infection. J Acquir Immune Defic Syndr  2001 Oct 1;28(2):150-3


BACKGROUND: A new enteric-coated (EC) didanosine (ddI) formulation (Videx EC; Bristol-Myers Squibb, Princeton, NJ, U.S.A.) may be better tolerated than the tablet form because it lacks the buffer component thought to be responsible for diarrhea and other gastrointestinal (GI) side effects. OBJECTIVE: To evaluate the frequency and magnitude of GI side effects (nausea, bloating, GI upset, diarrhea, abdominal cramps, gas [flatus]) before and after switching the formulation of ddI, in study subjects who were experiencing one or more GI symptom(s) of at least moderate severity. METHODS: A 6-week open label crossover study of current didanosine tablet users comparing daily symptom scores (7 point scale, 0 = absent to 6 = very severe) during weeks 1 to 2 (on tablets) to weeks 4 and 6 (on EC capsules). Formulation palatability and preference, lifestyle effects, and use of antidiarrheals or other medications for symptom relief were also assessed. RESULTS: GI symptom scores (7-day means) on tablets were diarrhea 2.11, gas 2.00, bloating 1.23, abdominal cramps 0.74, GI upset 0.69, nausea 0.66. After switching to EC (week 4 and week 6), mean scores decreased for diarrhea (mean scores 0.99 week 4, 0.79 week 6), gas (0.95, 0.79), bloating (0.49, 0.32), abdominal cramps (0.21, 0.05), GI upset (0.16, 0.14), and nausea (0.32, 0.22). Severity of all GI symptoms was significantly reduced after 4 weeks on EC capsules ( p <.01 by paired t- test). Negative impact of side effects on routine activities was significantly reduced (41% on tablet vs. 7% on EC; p <.01). All 42 study subjects preferred the EC form. CONCLUSIONS: According to patients' diary scores, switching to ddI in EC form significantly reduces nausea, bloating, GI upset, diarrhea, abdominal cramps, and gas for individuals who experienced GI side effects while taking the buffered tablet form. The striking tolerability advantages appear to support routine switching to EC for such patients and may suggest that widespread preferential selection of the EC form is appropriate to enhance didanosine tolerability and promote treatment adherence.

4010.Lacourciere Y, Tytus R, O'Keefe D, Lenis J, Orchard R, Martin K. Efficacy and tolerability of a fixed-dose combination of telmisartan plus hydrochlorothiazide in patients uncontrolled with telmisartan monotherapy. J Hum Hypertens  2001 Nov;15(11):763-70


The antihypertensive effects of a telmisartan 80 mg/hydrochlorothiazide (HCTZ) 12.5 mg fixed-dose combination and telmisartan 80 mg monotherapy were compared in patients with a history of mild-to-moderate essential hypertension and inadequate BP control (DBP > or = 90 mm Hg) following 8 weeks of telmisartan monotherapy. At the end of this period, 491 patients (62.9% men; mean age 55.3 years) whose DBP was > or = 90 mm Hg were double-blind randomised to once-daily telmisartan 80 mg/HCTZ 12.5 mg (n = 246) or telmisartan 80 mg (n = 245). Trough (24 h post-dose) clinic BP was measured after 4 and 8 weeks of double-blind therapy. At the end of double-blind treatment, patients receiving telmisartan 80 mg/HCTZ 12.5 mg had significant additional decrements in clinic SBP/DBP over telmisartan 80 mg of -5.7/-3.1 mm Hg (P < 0.01). Most of the additional effect occurred during the first 4 weeks of treatment. The proportion of patients with normalised BP (SBP < 140 mm Hg and DBP < 90 mm Hg) was significantly greater in the telmisartan 80 mg/HCTZ 12.5 mg group than the telmisartan 80 mg group (41.5%vs 26.1%;P < 0.05). Both treatments were well tolerated. The incidence of adverse events was similar except for diarrhoea, which occurred more frequently in the telmisartan 80 mg/HCTZ 12.5 mg group, and oedema, which occurred more frequently in the telmisartan group. Our results indicate that a telmisartan 80 mg/HCTZ 12.5 mg fixed-dose combination confers significant additional BP reductions compared with continuation of telmisartan monotherapy in non-responders.


4011.Mitra AK, Hernandez CD, Hernandez CA, Siddiq Z. Management of diarrhoea in HIV infected patients. Int J STD AIDS  2001 Oct;12(10):630-9


Human immunodeficiency virus (HIV) infection can weaken the immune system causing its inability to combat opportunistic infections. Managing the complexity of these opportunistic infections has created a challenge for healthcare professionals. Our knowledge on the aetiological agents causing opportunistic infections in immunocompromised hosts has increased over the last decade. Diarrhoeal diseases are frequent complications associated with HIV-infected patients. For most of the causes of diarrhoea, the clinical signs are non-specific, and the laboratory diagnostic workup is neither easy nor fast. This review provides data on aetiological approaches of common diarrhoeal diseases including viral, microbacterial, parasitic, bacterial and fungal infections, and HIV enteropathy; diagnostic evaluation; and treatment of diarrhoea in HIV-infected patients. This article will be helpful for those who are in the practice of managing diarrhoea in such patients.


4012.Mittal SK, Mathew JL. Regulating the use of drugs in diarrhea. J Pediatr Gastroenterol Nutr  2001 Oct;33 Suppl 2:S26-30 No abstract.

4013.Nuyttens JJ, Robertson JM, Yan D, Martinez A. The position and volume of the small bowel during adjuvant radiation therapy for rectal cancer. Int J Radiat Oncol Biol Phys  2001 Dec 1;51(5):1271-80


PURPOSE: The rate of small bowel toxicity from adjuvant pelvic radiation therapy (RT) for rectal cancer has been reported to be lower for patients treated preoperatively (Preop). This was probably due to a lesser volume of irradiated small bowel; however, studies of postoperative treatment reported that patients with an abdominoperineal resection (APR), who likely have the largest volume of small bowel in the pelvis, had less acute and chronic toxicity than those with a low anterior resection (LAR). In this study, three-dimensional treatment planning techniques were used to characterize the position and volume of small bowel in the pelvis and compare these to repeat studies obtained during the typical 5-week course of treatment to attempt to explain the above observations. METHODS AND MATERIALS: Treatment planning CT scans were obtained in 30 patients with rectal cancer (10 Preop, 10 LAR, 10 APR), including 12 patients with weekly CT scans during RT (65 scans). The position of the small bowel was measured by the distance to the nearest small bowel from the bones of the posterior pelvis and by the volume of small bowel within four anatomically defined regions of the pelvis. The motion of the small bowel was expressed as the standard deviation of the small bowel position measured with both the distance and the volume in the 12 patients with repeat studies. RESULTS: Contrast-containing small bowel was found an average 2.9 cm more anterior than small bowel without contrast below the sacral promontory. The position of the small bowel in Preop patients was significantly more anterior (p < or = 0.01) with less volume (p < or = 0.04) in the pelvis than postoperatively treated patients. The small bowel was also more anterior for patients with an LAR vs. APR (p < or = 0.03) but with similar volume in all pelvic regions. Small bowel motion, expressed as the standard deviation of the distance from the bones of the posterior pelvis to the closest small bowel, was 2.9 cm, 1.4 cm, and 0.2 cm for the Preop, LAR, and APR group, respectively. The LAR group had a considerable degree of motion in the posterior pelvis. Increased bladder volume was associated with reduced small bowel volumes, although this benefit decreased during treatment. CONCLUSION: Because treatment planning CT scans can detect small bowel that does not contain contrast, they may be more accurate than the traditional small bowel series. The Preop patients had significantly less pelvic small bowel supporting the clinical observation of better tolerance to therapy. The higher small bowel toxicity reported for LAR vs. APR patients may be explained by the greater variability of both the position and volume of the small bowel in the posterior pelvis for LAR patients. This finding suggests that a single planning study may not be accurate for the block design used for boost treatment of LAR patients. Bladder-filling techniques were useful for Preop and LAR but not APR patients, and decreased in benefit over time. This study suggested that treatment planning CT scans were more useful than a small bowel series and that more than one treatment planning CT may be obtained in any patient receiving > 45 Gy for rectal cancer. However, further research will be necessary to determine the optimal timing and total number of repeat studies.


4014.Passaro DJ, Taylor DN, Meza R, Cabrera L, Gilman RH, Parsonnet J. Acute Helicobacter pylori infection is followed by an increase in diarrheal disease among Peruvian children. Pediatrics  2001 Nov;108(5):E87


BACKGROUND: Cohort and case-crossover studies were conducted to evaluate whether new Helicobacter pylori infections are followed by increased diarrhea. METHODS: Participants were 6-month-old to 12-year-old shantytown residents living near Lima, Peru. Baseline data were collected from community households. Health interviews were completed daily, and sera, drawn every 4 months, were tested for H pylori immunoglobulin G. Diarrhea rates among newly H pylori-infected (seroconverting) children were compared with rates among persistently uninfected and infected children using cohort and case-crossover analyses. RESULTS: Sera were obtained from 345 children from January 1, 1995, through September 1, 1997. H pylori incidence was 12% per year (36 H pylori infections in 109 866 seronegative days). In adjusted cohort analyses, seroconverters had more diarrhea days (rate ratio: 2.0; 95% confidence interval: 1.6-2.4), episodes, and sick days in the year after infection than did uninfected children; and more diarrhea days and sick days than did persistently infected children. This effect was strongest in the first 2 months. Case-crossover analyses supported these findings. CONCLUSION: Preventing H pylori infection may help reduce pediatric diarrheal disease.

4015.Sandhu BK;  European Society of Pediatric Gastroenterology, Hepatology and Nutrition Working Group on Acute Diarrhoea. Practical guidelines for the management of gastroenteritis in children. J Pediatr Gastroenterol Nutr  2001 Oct;33 Suppl 2:S36-9  No abstract.

4016.Stevenson JP, Redlinger M, Kluijtmans LA, Sun W, Algazy K, Giantonio B, Haller DG, Hardy C, Whitehead AS, O'Dwyer PJ. Phase I clinical and pharmacogenetic trial of irinotecan and raltitrexed administered every 21 days to patients with cancer. J Clin Oncol  2001 Oct 15;19(20):4081-7


PURPOSE: Irinotecan and raltitrexed display schedule-dependent synergy in vitro, which supports the clinical investigation of the combination. Functional polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene result in intracellular redistribution of folate derivatives, which may affect raltitrexed-associated cytotoxicity. PATIENTS AND METHODS: Patients with a range of solid cancers and good performance status received irinotecan as a 90-minute infusion on day 1 and raltitrexed as a 15-minute infusion on day 2, repeated every 21 days. Samples were collected for MTHFR C677T genotyping and fasting plasma homocysteine during the first cycle. RESULTS: Thirty-nine assessable patients received 127 cycles of therapy. Irinotecan doses ranged from 100 to 350 mg/m(2), and raltitrexed, 1.0 to 4.0 mg/m(2). Raltitrexed doses of more than 3.0 mg/m(2) were not tolerated and were associated with dose-limiting asthenia, diarrhea, and AST/ALT elevation. Irinotecan/raltitrexed doses of 350/3.0 mg/m(2) were well-tolerated; principal toxicities included neutropenia, diarrhea, and fatigue. Two partial responses were observed in patients with retreated gastroesophageal cancers. Homozygotes with the MTHFR 677 TT  lymorphism

incurred significantly less raltitrexed-associated toxicity than those with either wild-type or heterozygous genotypes (P = .05). No significant differences were noted in plasma homocysteine values between the genotypic subtypes, and plasma homocysteine levels did not predict the risk of toxicity. CONCLUSION: Irinotecan and raltitrexed doses of 350 and 3.0 mg/m(2) are recommended for further study on a day 1, 2 schedule every 21 days. Efficacy results suggest that trials in upper and lower gastrointestinal malignancies are warranted. MTHFR C677T genotypes may be predictive of clinical raltitrexed toxicity.


4017.Szajewska H, Mrukowicz JZ. Probiotics in the treatment and prevention of acute infectious diarrhea in infants and children: a systematic review of published randomized, double-blind, placebo-controlled trials. J Pediatr Gastroenterol Nutr  2001 Oct;33 Suppl 2:S17-25


BACKGROUND: This review was designed to assess the evidence from randomized controlled trials on effects of probiotics in the treatment and prevention of acute infectious diarrhea in infants and children. METHODS: A systematic review of published, randomized, double-blind, placebo-controlled trials on probiotics in the treatment or prevention of acute diarrhea defined as >3 loose or watery stools per 24 hours in infants and children. RESULTS: The use of probiotics as compared with placebo was associated with a significantly reduced risk of diarrhea lasting >3 days. The pooled estimate risk was 0.43 (95% CI, 0.34-0.53) with a fixed-effect model, and remained significant in a random-effect model (0.40; 95% CI, 0.28-0.57). Only Lactobacillus GG showed a consistent effect. Probiotics significantly reduced the duration of diarrhea when compared with placebo, particularly in rotaviral gastroenteritis-the pooled, weighted, mean difference (WMD) assuming the random-effect model was -20.1 hours (95% CI, -26.1 to -14.2) and -24.8 (95% CI, -31.8 to -17.9) respectively. A meta-analysis of the prevention studies was not feasible because of significant clinical and statistical heterogeneity. CONCLUSIONS: There is evidence of a clinically significant benefit of probiotics in the treatment of acute infectious diarrhea in infants and children, particularly in rotaviral gastroenteritis. Lactobacillus GG showed the most consistent effect, although other probiotic strains may also be effective. Further research is needed. Clinical and statistical heterogeneity of the prophylactic interventions preclude drawing firm conclusions about the efficacy of probiotics in preventing acute gastroenteritis.


4018.Travis SP, Czajkowski M, McGovern DP, Watson RG, Bell AL. Treatment of intestinal Behcet's syndrome with chimeric tumour necrosis factor alpha antibody. Gut  2001 Nov;49(5):725-8


Few patients with Behcet's syndrome have gastrointestinal ulceration. Such patients are difficult to treat and have a higher mortality. Faced with refractory symptoms in two patients with intestinal Behcet's, we used the tumour necrosis factor alpha (TNF-alpha) monoclonal antibody infliximab to induce remission. Both women (one aged 27 years, the other 30 years) presented with orogenital ulceration, pustular rash, abdominal pain, bloody diarrhoea due to colonic ulceration, weight loss, and synovitis. One had thrombophlebitis, digital vasculitis, perianal fistula, and paracolic abscess; the other had conjunctivitis and an ulcer in the natal cleft. Treatment with prednisolone, methyl prednisolone, and thalidomide in one and prednisolone, colchicine, and cyclosporin in the other was ineffective. After full discussion, infliximab (3 mg/kg, dose reduced because of recent sepsis in one, and 5 mg/kg in the other) was administered. Within 10 days the ulcers healed, with resolution of bloody diarrhoea and all extraintestinal manifestations. A second infusion of infliximab was necessary eight weeks later in one case, followed by sustained (>15 months) remission on low dose thalidomide. Remission was initially sustained for 12 months in the other but thalidomide had to be stopped due to intolerance, and a good response to retreatment lasted only 12 weeks without immunosuppression, before a third infusion. The cause of Behcet's syndrome is unknown but peripheral blood CD45 gammadelta T cells in Behcet's produce >50-fold more TNF-alpha than controls when stimulated with phorbol myristate acetate and anti-CD3. Infliximab could have a role for inducing remission in Behcet's syndrome.

4019.Walz SE, Baqar S, Beecham HJ, Echeverria P, Lebron C, McCarthy M, Kuschner R, Bowling S, Bourgeois AL, Scott DA. Pre-exposure anti-Campylobacter jejuni immunoglobulin a levels associated with reduced risk of Campylobacter diarrhea in adults traveling to Thailand. Am J Trop Med Hyg  2001 Nov;65(5):652-6


Diarrhea history questionnaires were administered to 369 U.S. military volunteers before and after deployment to Thailand. Additionally, blood samples obtained from a subset of 221 volunteers 1-3 weeks previously and 3-4 weeks after their deployment were tested by enzyme-linked immunosorbent assay for immunoglobulin A to Campylobacter jejuni. Stool samples from personnel (including volunteers) contracting diarrhea in Thailand were cultured for enteric pathogens. Overall, 35.2% (130 of 369) of questionnaire respondents reported one or more diarrhea episodes during their trip. Volunteers with pretravel anti-C. jejuni reciprocal titers < or = 450 were 1.6 times as likely to have had diarrhea during their stay in Thailand compared with those with pretravel titers > 450 (39.7% versus 25.3%; P = 0.05). The symptomatic seroconversion, or attributable Campylobacter diarrhea attack rate, for the 1-month exercise was 12.7% (28 of 221). The symptomatic seroconversion rate in nonimmune (titer < or = 450) volunteers was 17.1%, whereas that in immune volunteers was only 4.0% (P = 0.002). Campylobacter jejuni or C. coli were recovered from 32.9% (56 of 170) of stool samples cultured and were the most commonly identified enteropathogens. Campylobacter diarrhea was associated with elevated temperatures, fecal red cells, and fecal white blood cells. The results of this study show that Campylobacter continues to represent a significant health threat to Western travelers to Thailand, but many of these travelers have preexisting Campylobacter immunity that protects them from clinically significant Campylobacter enteritis.



July 02


4546.      Abrol P; Mehta U; Lal H. Pt. B.D. Vitamin A status in children with diarrhoea Indian Journal of Clinical Biochemistry 2002 Jan; 17(1): 64-8


ABSTRACT: Vitamin A status was measured in 50 pre-school children with acute and persistent diarrhoea. It was measured by (a) Fluorometric micromethod and (b) Conjunctival impression cytology (CIC). The results were compared with 25 normal children. Vitamin A status was lower in children with persistent diarrhoea whereas the results were comparable between the children with acute diarrhoea and control subject.


4547.      Adah MI, Wade A, Oseto M, Kuzuya M, Taniguchi K. Detection of human group C rotaviruses in Nigeria and sequence analysis of their genes encoding VP4, VP6, and VP7 proteins. J Med Virol. 2002 Feb;66(2):269-75.


In a survey on the etiology of acute gastroenteritis in infants and young children in Nigeria, group C human rotaviruses were detected in two of 112 rotavirus positive stool specimens collected between 1999 and 2000. The VP7, VP6, and VP4 genes of the two Nigerian human group C rotavirus strains (Jajeri and Moduganari) were sequenced in this study. Comparative sequence analysis with other published human group C rotaviruses showed that the genes encoding the three structural proteins were remarkably conserved in primary structure with few mutations. The VP4 and VP7 genes from the two Nigerian strains were related more closely to each other than to those of other published strains, and formed a separate cluster on the phylogenetic tree. In contrast, it was of note that VP6 gene of strain Moduganari was related more closely to the Brazilian strain Belem than to the other Nigerian strain Jajeri. This is the first report of identification of human group C rotavirus in Nigeria and constitutes the first sequence data of human group C rotaviruses in the African continent. Copyright 2002 Wiley-Liss, Inc.


4548.      Bartlett JG. Clinical practice. Antibiotic-associated diarrhea. N Engl J Med. 2002 Jan 31;346(5):334-9. Review.  No abstract.

4549.      Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet. 2002 Feb 16;359(9306):564-71.


BACKGROUND: Chronic malnutrition during infancy, marked by stunting, has been associated with poor cognitive function. We assessed the effect of stunting, diarrhoeal disease, and parasitic infections during infancy on cognitive function in late childhood. METHODS: We followed up from birth to 2 years, a cohort of 239 Peruvian children for anthropometrics, stool samples, and diarrhoeal status. At 9 years of age, we assessed cognitive function in 143 (69%) with the full-scale intelligence quotient of the Wechsler intelligence scale for children-revised (WISC-R).Findings All findings were adjusted for socioeconomic status and schooling; in addition, findings related to diarrhoea prevalence, Giardia lamblia, and Cryptosporidium parvum were adjusted for severe stunting. During the first 2 years of life, 46 (32%) of 143 children were stunted. Children with severe stunting in the second year of life scored 10 points lower on the WISC-R test (95% CI 2.4--17.5) than children without severe stunting. Children with more than one episode of G lamblia per year scored 4.1 points (0.2--8.0) lower than children with one episode or fewer per year. Neither diarrhoea prevalence nor Cparvum infection was associated with WISC-R scores. INTERPRETATION: Malnutrition in early childhood, indexed by stunting, and potentially G lamblia, are associated with poor cognitive function at age 9 years. If the observed associations are causal, then intervention programmes designed to prevent malnutrition and G lamblia early in life could lead to significant improvement in cognitive function of children in similar lower-income communities throughout the less-developed world.


4550.      Friedrich AW, Bielaszewska M, Zhang WL, Pulz M, Kuczius T, Ammon A, Karch H.  Escherichia coli harboring Shiga toxin 2 gene variants: frequency and association with clinical symptoms. J Infect Dis. 2002 Jan 1;185(1):74-84.


Shiga toxin (Stx)-producing Escherichia coli (STEC) from patients with hemolytic-uremic syndrome (HUS), patients with diarrhea without HUS, or asymptomatic subjects were genotyped to assess associations between stx2 variants and clinical manifestations of infection. Neither stx2d nor stx2e was found in 268 STEC isolates from patients with HUS. Of 262 STEC isolates from patients with diarrhea, stx(2d) was found in 41 (15.6%; P<.000001), and stx2e was found in 12 (4.6%; P=.0004). The stx2c genotype frequency was similar among isolates from patients with HUS (3.7%) and diarrhea (5.0%). The frequencies of stx2c, stx2d, and stx2e among 96 STEC isolates from asymptomatic subjects were comparable to those among isolates from patients with diarrhea. None of the 626 STEC isolates contained stx2f. All stx2d-positive or stx2e-positive STEC isolates were eae negative and originated from subjects older than those with STEC isolates with stx2c. stx2c-positive STEC isolates can cause HUS, but the presence of stx2d or stx2e may predict a milder disease with a minimal risk of HUS.


4551.      Godbole P, Margabanthu G, Crabbe DC, Thomas A, Puntis JW, Abel G, Arthur RJ, Stringer MD.  Limitations and uses of gastrojejunal feeding tubes. Arch Dis Child. 2002 Feb;86(2):134-7.


BACKGROUND: Gastrostomy feeding is a well established alternative method to long term nasogastric tube feeding. Many such patients have gastro-oesophageal reflux (GOR) and require a fundoplication. A transgastric jejunal tube is an alternative when antireflux surgery fails, or is hazardous or inappropriate. AIMS: To review experience of gastrojejunal (G-J) feeding over six years in two regional centres in the UK. METHODS: Retrospective review of all children who underwent insertion of a G-J feeding tube. RESULTS: There were 18 children, 12 of whom were neurologically impaired. G-J tubes were inserted at a median age of 3.1 years (range 0.6-14.7) because of persistent symptoms after Nissen fundoplication (n = 8) or symptomatic GOR where fundoplication was inappropriate. Four underwent primary endoscopic insertion of the G-J tube; the remainder had the tube inserted via a previous gastrostomy track. Seventeen showed good weight gain. There was one insertion related complication. During a median follow up of 10 months (range 1-60), four experienced recurrent aspiration, bilious aspirates, and/or diarrhoea. There were 65 tube related complications in 14 patients, necessitating change of the tube at a median of 74 days. Jejunal tube migration was the commonest problem. Five died from complications of their underlying disease. CONCLUSIONS: Although G-J feeding tubes were inserted safely and improved nutritional status, their use was associated with a high rate of morbidity. Surgical alternatives such as an Roux-en-Y jejunostomy may be preferable.


4552.      Guarino A, Albano F, Canani RB, Bruzzese E. HIV, fatal rotavirus infection, and treatment options. Lancet. 2002 Jan 5;359(9300):74. No abstract.

4553.      Mangala S, Gopinath D, Narasimhamurthy NS, Shivaram C. Impact of educational intervention on knowledge of mothers regarding home management of diarrhoea. Indian J Pediat 2001, 68(5), 393-7.


Abstract : Pre and post comparison study was carried out in the field practice area of M.S. Ramaiah Medical College, Bangalore, Karnataka to assess the impact of educational intervention on the knowledge  of mothers of underfive children on home management of diarrhoeal diseases. Sample of 225 mothers were included in the study. The study was conducted in 3 stages. Stage I - initial knowledge, attitude and practice of mothers was assessed. Stage II - one to one educational intervention was conducted and supported by audiovisual aids and live demonstration. Stage III - included post intervention knowledge, attitude and practice after 2 months and 2 years. After the educational intervention, there was significant improvement on knowledge of mothers regarding definition of diarrhoea (P<0.001), signs of dehydration (P<0.001), awareness of ORS solution (P<0.001), correct preparation of ORS solution (P<0.001), shelf-life of ORS solution (P<0.001), seeking health care (P<0.001) and rational drug therapy during diarrhoea (P<0.001). McNemar test was used to find out the change in knowledge before and after the educational intervention. The overall knowledge scores improved significantly after 2 months (P<0.001) as well as 2 years (P<0.001) of the educational intervention. Though the proportion of mothers retaining the knowledge at the end of 2 years dropped. 18 ref.


4554.      Narayani RI, Burton MP, Young GS. Resolution of collagenous colitis after treatment for Helicobacter pylori. Am J Gastroenterol. 2002 Feb;97(2):498-9. No abstract.

4555.      Perlstein PH, Lichtenstein P, Cohen MB, Ruddy R, Schoettker PJ, Atherton HD, Kotagal U. Implementing an evidence-based acute gastroenteritis guideline at a children's hospital. Jt Comm J Qual Improv. 2002 Jan;28(1):20-30.


BACKGROUND: Guidelines for preventing and treating acute gastroenteritis (AGE) have generally not been incorporated into medical practice. An evidence-based clinical practice guideline was adapted from national guidelines to meet the practice styles characterizing care in southwestern Ohio and implemented at the Children's Hospital Medical Center (Cincinnati). Its efficacy was assessed in terms of emergency department (ED) encounters and admissions, mean and total hospital costs, and mean length of hospitalization. METHODS: Comparisons were made between patients seen during peak gastroenteritis months (December-May) before (fiscal year [FYs] 1994-1997) and after (FYs 1998 and 1999) guideline implementation. Data were extracted from hospital charts, clinical databases, and billing records. RESULTS: Following implementation, mean yearly ED encounters for AGE decreased 22% and mean yearly admissions decreased 33%. The percentage of admitted children with minor illness decreased (p = 0.002). Mean length of stay decreased 21% for children with minor illness (p = 0.0001) and 5% for others. Hydration status was noted in only 15% of ED charts examined but increased to 63% in FY 1998 and 86% in FY 1999 (p < 0.001). The proportion of admitted patients who advanced to a regular diet by discharge increased from 4.9% (FY 1997) to 23% (FY 1998) and 76% (FY 1999; p < 0.0001). Total inpatient days/year decreased by 43%. Mean hospital costs did not change significantly. DISCUSSION: Following implementation, fewer patients with AGE were seen in the ED and fewer were admitted to the hospital for care. Hospital stays were shorter, and children were more likely to resume their diets before discharge.


4556.      Rao SB; Fonseca M; Ajmera S; Dhananjayan B; Badhwar VR. Is oral misoprostol a promising alternative to standard oxytocics in the third stage of labour? Bombay Hospital Journal 2002 Jan; 44(1): 30-5


ABSTRACT: Misoprostol (Cytotec, Searle) is a prostaglandin E1 analogue. Oral misoprostol is rapidly absorbed within two minutes into circulation. It has a rapid onset of action with a uterotonic effect on the postpartum uterus. A single blind non randomised study was conducted in a tertiary hospital to compare oral misoprostol versus standard oxytocics in the third stage of labour including oxytocin, methergin and prostaglandin F2 alpha. The primary outcome was measure in terms of fall in haemoglobin levels postpartum in each of the four study groups. The secondary outcomes evaluated included analysis of the mean duration of third stage, amount of postpartum haemorrhage, and the need for additional oxytocics. A profile of symptomatology in each study group included assessment for nausea, vomiting, diarrhoea, headache and shivering. This study concludes that misoprostol has the potential of an effective, stable oral oxytocic with a rapid onset of action. It has predictable side effects and a good safety profile. It is as effective as standard oxytocic drugs in preventing atonic post partum haemorrhage.


4557.      Rasool NB, Monroe SS, Glass RI. Determination of a universal nucleic acid extraction procedure for PCR detection of gastroenteritis viruses in faecal specimens. J Virol Methods. 2002 Feb;100(1-2):1-16.


Four nucleic acid extraction protocols were examined for their suitability for extraction of the ssRNA, dsRNA and dsDNA genomes of gastroenteritis viruses, for PCR detection. Protocol (A), employed specimen lysis with guanidinium thiocyanate, extraction with phenol-chloroform-isoamyl alcohol and nucleic acid purification by size-fractionated silica particles. Protocol (B), utilised specimen lysis with guanidinium thiocyanate and nucleic acid purification by silica, followed by phenol-chloroform-isoamyl alcohol extraction. Protocol (C), employed specimen lysis with guanidinium thiocyanate and nucleic acid purification by RNAID glass powder. Protocol (D), employed specimen lysis with sodium dodecyl sulphate, proteinase K digestion and extraction with phenol-chloroform-isoamyl alcohol. Of the four protocols, (B) appeared to be a suitable candidate 'universal' nucleic acid extraction procedure for PCR detection of different viral agents of gastroenteritis in a single nucleic acid extract of a faecal specimen, irrespective of genome composition. Omission of the phenol-chloroform extraction step did not affect negatively the ability of protocol (B) to allow PCR detection of gastroenteritis viruses in faecal specimens. PCR detection of NLVs, astroviruses, rotaviruses and adenoviruses, in single nucleic acid extracts of faecal specimens obtained from the field, confirmed the universality of the modified protocol (B). We propose the modified protocol (B) as a 'universal' nucleic acid extraction procedure, for monoplex PCR detection of gastroenteritis viruses in single nucleic acid extracts of faecal specimens and for development of multiplex PCR for their simultaneous detection.


4558.      Rubio CA, Lindholm J. Cryptal lymphocytic coloproctitis: a new phenotype of lymphocytic colitis? J Clin Pathol. 2002 Feb;55(2):138-40.


BACKGROUND/AIMS: Lymphocytic colitis is a clinicopathological entity characterised by protracted watery diarrhoea and an increased number of intraepithelial lymphocytes (IELs) in the surface epithelium of the colonic mucosa. This report describes two patients with symptoms similar to those of lymphocytic colitis and an increased number of IELs, but within the cryptal epithelium. METHODS: The numbers of IELs were assessed in colorectal biopsies from the two patients. Sections were stained immunohistochemically for CD3, CD8,CD20, and TIA1. RESULTS: The colorectal biopsies had an abnormally high number of IELs in the epithelium of the crypts but not in the surface epithelium. The IELs in the crypts were CD3+++, CD8+, TIA1+, and CD20-. CONCLUSIONS: The histological diagnosis in these two patients was cryptal lymphocytic coloproctitis. Patients with similar symptoms and an increased number of IELs in the surface epithelium are now filed at this department as having surface lymphocytic coloproctitis. Immunohistochemistry showed that the cryptal IELs were cytotoxic suppressor T cells. Interestingly, a case of cryptal lymphocytic colitis was recently recorded in a non-human primate dying after years of protracted chronic diarrhoea. It is possible that antigens present in the lumen of the crypts elicit a lymphocytic reaction within the cryptal cells.


4559.      Sanossian N, Haut S. Chronic diarrhea associated with vagal nerve stimulation. Neurology. 2002 Jan 22;58(2):330.  No abstract.

4560.      Soares CC, Volotao EM, Albuquerque MC, da Silva FM, de Carvalho TR, Nozawa CM, Linhares RE, Santos N. Prevalence of enteric adenoviruses among children with diarrhea in four Brazilian cities. J Clin Virol. 2002 Jan;23(3):171-7.


BACKGROUND: Enteric adenoviruses are related to child diarrhea and appear to be spread worldwide. OBJECTIVES: The aim of the present study was to determine the prevalence of enteric adenovirus infection among children in four Brazilian cities. STUDY DESIGN: stool specimens were collected from children under 5 years of age with acute diarrhea. RESULTS AND CONCLUSIONS: Enteric adenoviruses were detected in 1.55% (n=1420) of the samples analyzed indicating the circulation of these viruses among Brazilian children in association to diarrheal disease. These agents were isolated throughout the year demonstrating no specific seasonal distribution. Also, no pattern of serotype distribution between the cities was observed.

4561.      Terrin G, Borrelli O, Di Nardo G, Pacchiarotti C, Cucchiara S. A child with aphthae and diarrhoea. Lancet. 2002 Jan 26;359(9303):316. No abstract.

4562.Villamor E, Mbise R, Spiegelman D, Hertzmark E, Fataki M, Peterson KE, Ndossi G, Fawzi WW. Vitamin A supplements ameliorate the adverse effect of HIV-1, malaria, and diarrheal infections on child growth. Pediatrics. 2002 Jan;109(1):E6.


OBJECTIVE: Evidence from animal experiments and observational studies in humans suggests that vitamin A plays a fundamental role in physical growth. However, results from vitamin A supplementation trials in children are inconsistent; whereas some did not find an overall effect on growth, others found benefits only among specific groups, including children with low concentrations of serum retinol or short duration of breastfeeding. The apparent lack of an overall effect of vitamin A on growth could be attributed to context-specific distribution of conditions that affect both growth and the response to supplementation, eg, baseline vitamin A status, deficiency of other nutrients (fat, zinc), and the presence of infectious diseases. Human immunodeficiency virus (HIV) infection, malaria, and diarrheal disease adversely affect growth and are associated with increased prevalence of vitamin A deficiency. We  hypothesize that vitamin A supplementation could ameliorate the adverse effect of these infections on child growth. METHODS: We conducted a randomized, clinical trial among 687 Tanzanian children who were 6 to 60 months of age and admitted to the hospital with pneumonia. Children were assigned to oral doses of 200 000 IU vitamin A (half that dose if <12 months) or placebo on the day of admission, a second dose on the following day, and third and fourth doses at 4 and 8 months after discharge from the hospital, respectively. Anthropometric measurements were obtained at baseline and at monthly visits to the study clinics during 12 months after the initial hospitalization. Surveillance on the incidence and severity of diarrhea and respiratory infections was conducted during biweekly visits, alternately at a study clinic and the child's home, using a pictorial diary that the mothers were trained to use. A blood specimen was drawn at baseline for determination of HIV status, malaria infection, and hemoglobin levels. We used mixed effects models to compare estimated total weight and height increases after 1 year of follow-up between treatment arms, overall and within levels of HIV status, malaria, and other possible baseline effect modifiers. We also assessed the potential modulating effect of vitamin A on the risk of stunting (height-for-age <-2 standard deviations of the gender-specific National Center for Health Statistics median reference) attributable to diarrheal and respiratory infections during follow-up, in the subset of children who were not stunted at baseline. A similar approach was followed for wasting (weight-for-height <-2 standard deviations of the reference median). Cox regression models were used to estimate relative risks and 95% confidence intervals (CI), treating episodes of infection as time-dependent covariates. RESULTS: A total of 554 children had at least 2 follow-up measurements of height or weight and constituted the study base. Baseline characteristics did not differ significantly by treatment arm. Seventy-three percent of the children were <2 years of age, and 37% were <12 months; 31% were stunted at baseline and 9% were wasted. Malaria (Plasmodium falciparum) and HIV infection were found in 24% and 9% of the children, respectively. Median duration of follow-up was 351 days, with 10 measurements/child, on average, irrespectively of treatment assignment. Supplementation with vitamin A among children who had HIV infection and were <18 months of age resulted in a significant length increase. Four months after the first dose, infants who were HIV positive in the vitamin A arm had gained, on average, 2.8 cm (95% CI:1.0-4.6) more than children who received placebo, whereas no effect was observed among infants who were HIV negative (difference at 4 months: -0.2 cm; 95% CI: -0.8-0.5). Children who were <12 months of age and had malaria at enrollment experienced a 747-g (95% CI: 71-1423) higher yearly weight gain attributable to vitamin A; among children without malaria, however, the supplements did not have a significant effect (-57 g; 95% CI: -461-348). These results remained unchanged after controlling for indicators of the socioeconomic and nutritional status at baseline. Linear growth was also improved by vitamin A among children from households with poor water supply (0.8 cm/year; 95% CI: 0-1.5) but not in children with tap water in the house or compound (-1.0 cm/year; 95% CI: -1.9-0). Weight gain was greater among children with mid-upper arm circumference below the 25th percentile of the age-specific distribution at baseline (458 g/year; 95% CI: 1-905), but no benefit was evident among children with higher mid-upper arm circumference. The risk of stunting associated with episodes of persistent diarrhea (lasting 14 or more days) during follow-up was virtually eliminated by vitamin A supplements. Among children in the placebo group, the average risk of stunting associated with 1 or more episodes of persistent diarrhea between 2 consecutive visits was 5.2 times higher (95% CI: 2.4-11.2) than that of children without diarrhea or with acute episodes. In contrast, among children who received vitamin A, there was virtually no risk of stunting associated with persistent diarrhea (relative risk: 1.0; 95% CI: 0.3-1.3). This effect was slightly attenuated after controlling for the number of household possessions, gender, baseline low arm circumference, HIV infection, and presence of malaria parasites in blood. Vitamin A supplements did not modify the associations between respiratory infections and the risk of stunting or wasting. CONCLUSIONS: Vitamin A supplementation improves linear and ponderal growth in infants who are infected with HIV and malaria, respectively, and decreases the risk of stunting associated with persistent diarrhea. Supplementation could constitute a low-cost, effective intervention to decrease the burden of growth retardation in

settings where infectious diseases are highly prevalent.


4563.      Watson AJ, Johnston AT, Barker PM, Youngson GG, Bisset WM, Mahomed AA.  The presentation and management of juvenile-onset chronic inflammatory bowel disease in Northeastern Scotland. J Pediatr Surg. 2002 Jan;37(1):83-6.


PURPOSE: This study reviews the presentation and management of juvenile onset chronic inflammatory bowel disease and identifies changes in incidence of the disease over a 20-year period. METHODS: This was a retrospective study of all patients aged 16 and under with chronic inflammatory bowel disease diagnosed in 1 health region between 1980 and 1999. The patients were identified from computer records and the following variables studied: age, sex, mode of presentation, medical and surgical management, and length of follow-up. RESULTS: One hundred seven patients were identified: 77 with Crohn's disease and 30 with ulcerative colitis. The incidence of ulcerative colitis and Crohn's disease has risen from 0.7 in 100,000 and 2.2 in 100,000, respectively, in the years 1980 through 1989 to 1.5 in 100,000 and 4.4 in 100,000 in the period 1990 through 1999. The median age at presentation was 10.1 years for ulcerative colitis and 10.8 years for Crohn's disease. The majority of disease was diagnosed within 1 year of the onset of symptoms, which were principally abdominal pain, diarrhea, and rectal bleeding. The average length of follow-up was 6.9 years. Analysis of the surgical management of Crohn's patients has shown a low rate of surgical intervention. CONCLUSIONS: This study has shown an increasing incidence of chronic inflammatory bowel disease in the Grampian region of Scotland coupled with a low rate of surgical intervention in Crohn's disease. These findings could be the result of early referral and diagnosis, with the disease being documented earlier in its course or more aggressive preemptive medical therapy.

4564.      Wong RS, Chow AW. Identification of enteric pathogens by heat shock protein 60 kDa (HSP60) gene sequences. FEMS Microbiol Lett. 2002 Jan 2;206(1):107-13.


A highly specific and reproducible approach for the simultaneous detection of enteric pathogenic bacteria was developed using bacterial hsp60 gene and molecular biological tools. A single pair of universal primers was derived from the highly conserved sequence of hsp60 genes encompassing a 600-bp hypervariable region. PCR amplification followed by either dot blot hybridization or restriction enzyme digestion performed on 38 enteric bacteria indicated that this approach could differentiate not only different genera such as Campylobacter, Yersinia and Vibrio, but also species that are closely related genetically, such as between C. jejuni and C. coli, or between Salmonella and Shigella or Escherichia coli.


4565.      Yatsuyanagi J, Saito S, Sato H, Miyajima Y, Amano K, Enomoto K.  Characterization of enteropathogenic and enteroaggregative Escherichia coli isolated from diarrheal outbreaks. J Clin Microbiol. 2002 Jan;40(1):294-7.


Virulence characteristics of diarrheal outbreak-associated Escherichia coli O55:NM, O126:NM, and O111:NM were examined. The E. coli O55:NM strains were atypical enteropathogenic E. coli (EPEC), while the E. coli O126:NM and O111:NM strains should be classified as enteroaggregative E. coli (EAggEC). The contributions of EPEC and EAggEC to the human disease burden in Japan might be significantly greater than is currently appreciated.

4566.      Younes JS, Simon MR, Moore EC, Bahrainwala AH. Recurrent periorbital cellulitis and otitis media in an asthmatic child with chronic diarrhea and short stature. Ann Allergy Asthma Immunol. 2002 Feb;88(2):164-9. No abstract.


Oct 2002

5233.      Alsaigh N, Fogt F. Ileal subepithelial collagen thickening in an HIV+ patient presenting with diarrhoea with no evidence of collagenous colitis. Histopathology. 2002 Apr;40(4):394-5.  No abstract.

5234.      Castello AA, Arguelles MH, Villegas GA, Olthoff A, Glikmann G. Incidence and prevalence of human group C rotavirus infections in Argentina. J Med Virol. 2002 May;67(1):106-12.


The incidence of human group C rotavirus infections among children and adults in Buenos Aires was evaluated by enzyme linked immunosorbent assays (ELISA) based on recombinant group C VP6 protein (Cowden strain). A total of 976 stool samples taken from patients (ages 6 months to 15 years) with acute diarrhea were tested for the presence of group C rotavirus. Among these, only 10 (1.02%) were group C rotavirus positive by enzyme-linked immunosorbent assay (ELISA) confirmed by absorption with group C VP6 antibodies and by RT-PCR for both VP6 and VP7 genes. The average age (5.86 years) was significantly superior to that in group A-infected patients (1.63 years). Previous exposure to this virus was assessed by detecting specific IgG in sera taken from healthy individuals grouped by age. Of 844 sera tested, 425 (50.3%) were group C IgG positive by ELISA, confirmed by Western blot analysis. The rates of IgG positivity for group A and C rotaviruses during the first years of life indicated that infections with group C are frequent in older children (3-5 years), whereas group A infections are prevalent in infants and young children (6-18 months). This study shows that group C rotavirus infections in Argentine children occur later in life than group A and are relatively common in spite of the low detection rate of this virus. Copyright 2002 Wiley-Liss, Inc.

5235.      Coluchi N, Munford V, Manzur J, Vazquez C, Escobar M, Weber E, Marmol P, Racz ML. Detection, subgroup specificity, and genotype diversity of rotavirus strains in children with acute diarrhea in Paraguay. J Clin Microbiol. 2002 May;40(5):1709-14.


Of a total of 220 stool specimens from children with acute diarrhea, mostly under the age of 3 years, collected in Paraguay between January 1999 and March 2000, 70 (31.8%) were found positive for rotaviruses (RV). Positive samples were characterized by electropherotyping and subgrouping. Sixty-one (87.1%) were classified as group A, subgroup II; one (1.4%) was classified as group A, subgroup I; six (8.6%) were group A, non-I non-II; and two (2.9%) were not tested. RV strains were G and P genotyped by reverse transcription-PCR. The following G types were detected: G4 (34.3%), G1 (21.4%), G2 (1.4%), and G9 (5.7%). Mixtures of human and animal genotypes were detected in 15 (21.4%) samples, and 11 samples (15.7%) were nontypeable. The following P types were detected: P[8] (48.6%), P[4] (1.4%), and P[1] (1.4%). A mixed type was found in 10% of samples, and an unexpectedly high percentage (38.6%) of nontypeable samples was found. The common human G- and P-type combinations P[8], G4 (15.7%) and P[8], G1 (14.2%) were detected. Mixed human and animal genotypes were observed as the following combinations: G4 + G5, G4 + G5 + G10, and G1 + G10 for G types and P[8]-P[1] for P types. The emerging G9 genotype was detected in four samples. These results show for the first time the diversity of RV circulating among children in Paraguay and contribute to the knowledge of this pathogen required to devise strategies to prevent diarrheal illness in this country. The finding of mixed genotypes may indicate interspecies transmission of RV between humans and animals.


5236.      Dossa RA, Ategbo EA, van Raaij JM, de Graaf C, Hautvast JG. An appropriate tool for appetite testing and evaluation in young children in Benin. Appetite. 2002 Apr;38(2):99-109.


Appetite measurements were performed in 109 Beninese children aged 18-30 months to develop a tool for appetite evaluation in young children in nutritional intervention programmes. Two test foods were identified as appropriate for these children: a maize porridge (aklui) and rice (riz-au-gras). Ad libitum intakes of the foods served after an overnight fast according to a standardized offering procedure were measured on 3 days. The children's habitual intakes were measured during 3 consecutive days not overlapping with the days when the test meals were provided. Energy intake from the test foods was comparable to breakfast energy intake which was 0.8-1.0 MJ, representing 21% of total daily energy intake. Energy intake from aklui was significantly correlated with daily intake (r=0.41, n=38, p<0.05) and with energy intake from breakfast (r=0.52, p<0.01). Correlations concerning riz-au-gras were less pronounced and non-significant. Reproducibility (as coefficient of variation) of the appetite test as calculated from the triplicate measurements was 40% for aklui and 25% for riz-au-gras. This reproducibility is better than that of the habitual breakfast intake (43-45%). In conclusion, the appetite test used in our studies can be considered as an appropriate tool in appetite evaluations. Copyright 2002 Elseiver Science Ltd.

5237.    D'Souza AL, Rajkumar C, Cooke J, Bulpitt CJ. Probiotics in prevention of antibiotic associated diarrhoea: meta-analysis. BMJ. 2002 Jun 8;324(7350):1361. Review.
OBJECTIVE: To evaluate efficacy of probiotics in prevention and treatment of diarrhoea associated with the use of antibiotics. DESIGN: Meta-analysis; outcome data (proportion of patients not getting diarrhoea) were analysed, pooled, and compared to determine odds ratios in treated and control groups. IDENTIFICATION: Studies identified by searching Medline between 1966 and 2000 and the Cochrane Library. Studies reviewed Nine randomised, double blind, placebo controlled trials of probiotics. RESULTS: Two of the nine studies investigated the effects of probiotics in children. Four trials used a yeast (Saccharomyces boulardii), four used lactobacilli, and one used a strain of enterococcus that produced lactic acid. Three trials used a combination of probiotic strains of bacteria. In all nine trials, the probiotics were given in combination with antibiotics and the control groups received placebo and antibiotics. The odds ratio in favour of active treatment over placebo in preventing diarrhoea associated with antibiotics was 0.39 (95% confidence interval 0.25 to 0.62; P<0.001) for the yeast and 0.34 (0.19 to 0.61; P<0.01 for lactobacilli. The combined odds ratio was 0.37 (0.26 to 0.53; P<0.001) in favour of active treatment over placebo. CONCLUSIONS: The meta-analysis suggests that probiotics can be used to prevent antibiotic associated diarrhoea and that S boulardii and lactobacilli have the potential to be used in this situation. The efficacy of probiotics in treating antibiotic associated diarrhoea remains to be proved. A further large trial in which probiotics are used as preventive agents should look at the costs of and need for routine use of these agents.

5238.    Dubey S, Sharda R. Prevalence, serotypes and pathogenicity of Escherichia coli associated with diarrhoea in goats. Indian J Anim Sci. 2000, 71(2), 92-4.
Strains (92) of Excherichia coll were islated from 200 rectal swabs collected from diarrhoeic goats belonging to different   to different age groups; the highest incidence (50%) was recorded in 1-week old kids. The isolates were characterised on the basis of morphological, culture and biochemical characteristics. Few atypical strains showing variation in biochemical and sugar were also recovered. Out of 92 isolates, 80 were typable into 19 ‘0’ serogroups, while 12 were untypable. The serotypes isolated were: 0149, 050, 08, 086, 0116, 0105, 036, 061, 039, 041, 01202, 0170, 022, 043, 058, 0101, 0109, 0163, and 0168 in decreasing order of frequency. The selected strains of group 08, 022, 041, 061, 0101, 0149 and 0169 and 9 untypable strains were found pathogenic to mice on intraperitoneal inoculation . Epidemiology of enteric colibacillosis is discussed. 15 ref. 


5239.    Fasano A. Toxins and the gut: role in human disease. Gut. 2002 May;50 Suppl 3:III9-14. Review.
Bacterial enteric infections exact a heavy toll on the human population, particularly among children. Despite the explosion of knowledge on the pathogenesis of enteric diseases experienced during the past decade, the number of diarrhoeal episodes and human deaths reported worldwide remains of apocalyptic dimensions. However, our better understanding of the pathogenic mechanisms involved in the onset of diarrhoea is finally leading to preventive interventions, such as the development of enteric vaccines, that may have a significant impact on the magnitude of this human plague. The application of a multidisciplinary approach to study bacterial pathogenesis, along with the recent sequencing of entire microbial genomes, have made possible discoveries that are changing the way scientists view the bacterium-host interaction. Today, research on the molecular basis of the pathogenesis of infective diarrhoeal diseases of necessity transcends established boundaries between microbiology, cell biology, intestinal pathophysiology, and immunology. This review focuses on the most recent outcomes of this multidisciplinary effort.

5240.    Gupta V, Ray P. Sharma M. Antimicrobial resistance pattern of Shigella and non-typhi Salmonella isolated from patients with diarrhoea. Indian J med Res 1999 Feb; 109: 43-5 
Total of 3500 stool samples from patients with diarrhoea were evaluated for isolation of Shigella and non-typhi Salmonella organisms and their antimicrobial resistance pattern from January 1994 to January 1998. The isolated strains included S. typhimurium (99), S. senftenberg (35), S. enteritidis (1), Salmonella groups B and C (1,2) and Sh, dysenteriae (II) (1,2); and Sh. Flexneri (13), Sh. Boydii (2) and Sh. Sonnei (1). Amongst the Shigella species, very few strains showed resistance to the routinely used antimicrobial agents like furazolidone, nalidixic acid, gentamicin, chloramphenicol, norfloxacin etc. On the contrary, most of the Salmonella strains were resistant to these agents. S. senftenberg showed resistance to ciprpfloxacin, which has earlier not been  reported in the literature; 100 per cent sensitivity was shown only to amikacin. The emergence of resistance to ciprofloxacin in s matter of concern and can be checked by limiting the use of the drug to multi-drug resistant strains of Shegella and Salmonella rather than indiscriminately using it for all patients with diarrhoea.   

5241.    Hahn S, Kim Y, Garner P. Reduced osmolarity oral rehydration solution of treating dehydration due to diarrhoea in children: systematic review.  Selection BMJ- South Asian Edn. 2001; 17(8), 699-703.
ompares reduced osmolarity oral rehydration solution with standard World Health Organisation oral rehydration solution in children in acute diarrhoea. In a meta-analysis of nine trials for the primary outcomes, reduced osmolarity rehydration solution was associated with fewer unscheduled intravenous infusion compared with standard WHO rehydration solution (odds ratio 0.61, 95%) confidence interval 0.47 to 0.81). Three trials reported that no patients required unscheduled intravenous infusion. Trials reporting  secondary outcomes suggested stool output was lower (standardised mean difference in log scale – 0.214 (95% confidence interval – 0.305 to 0.123; 13 trials) and vomiting was less frequent (odds ratio 0.71, 0.55 to 0.92; six trials). Six trials sought presence of hyponatraemia, with events in three studies, but no significant difference between the two arms.


5242.      Kang G, Ramakrishna BS, Daniel J, Mathan M, Mathan VI. Epidemiological and laboratory investigations of outbreaks of diarrhoea in rural south India. Implications for control of disease. epidemiology Infection. 2001; 127(1), 107-12.
Two epidemics of acute, watery diarrhoea in villages in North Arcot district, India, were investigated. The attack rates were 10.03 and 15.53 per 100 populations, the medium duration was 5 days and enteric pathogens were present in 56.8% and 60.3% of specimens from the two villages, but no predominant pathogens was identified. Examination of stools from a 20% age-stratified random sample of the population of one of the villages after the epidemic found 22.9% of asymptomatic subject excreted bacterial enteric pathogens. Despite the high background of enteric pathogen carriage, the isolation rates for shigellae, enteropathogenic Escherichia coli and Shiga-toxin producingE. Coli were significantly higher (P 0.001,  P 0.02, P 0.05) during the epidemic. The epidemics may have been caused by faecal contamination  of well water following rain, Point-of-use techniques for water disinfection may be most effective for preventing such outbreaks, but further research into the development of appropriate technology is required. 17 ref.

5243.    Khurana B, Pandey R. Evidence of bovine non-group a rotavirus in diarrhoeic neonatal calves in India. Vet Rec. 2001; 149(12), 364-5. No Abstract

5244.    Lele M, Kar A. Home management of diarrhoea by women of a slum community in Pune city. Indian J. prev soc Med. 2003; 31(3-4), 78-82. Abstract:  Home management of diarrhoeal episodes by women of a slum community in Pune city was investigated. The primary findings of this study were as follows : Immediate alteration of diet was practiced by majority of the respondents ; absence of knowledge regarding relevance of additional fluid intake during diarrhoeal episodes; while breast-feeding was withheld when the mother suffered from diarrhoea. Knowledge regarding ORS was as low as 21% , with 8% of these respondents not giving ORS due to various reasons. Knowledge regarding prevention of diarrhoea  was almost non-existent. The study emphasizes the need to increase the awareness of communities regarding preventive measures and regarding the proper management of diarrhoea.


5245.      Libbrecht L, Croes R, Ectors N, Staels F, Geboes K. Microscopic colitis with giant cells. Histopathology. 2002 Apr;40(4):335-8.


AIMS: Collagenous colitis and lymphocytic colitis are the two types of microscopic colitis with specific morphological features. In this report we describe a new histopathological subtype of microscopic colitis. METHODS AND RESULTS: Colonoscopy in four patients with chronic watery diarrhoea showed no macroscopic abnormalities. The random biopsies from the colon showed subepithelial multinucleated giant cells in combination with the features of collagenous colitis in three patients and lymphocytic colitis in one patient. These multinucleated giant cells were positive for CD68. The density of macrophages was highest in the most superficial part of the lamina propria. In one patient, a previous biopsy showed features consistent with collagenous colitis without multinucleated giant cells. Treatment with budesonide led to the disappearance of diarrhoea in all four patients. CONCLUSIONS: The clinical and histopathological features of the four presented patients indicate that there exists a histopathological subtype of microscopic colitis characterized by the presence of subepithelial multinucleated giant cells, which probably arise from fusion of subepithelial macrophages. Analysis of more patients with this histopathological subtype of microscopic colitis is necessary to determine whether they also form a clinically distinct group.


5246.      Mascarenhas JD, Leite JP, Gabbay YB, Freitas RB, Oliveira CS, Monteiro TA, Linhares AC.  Rotavirus G serotypes and p[],G genotypes identified in cases of reinfection among children participating in a trial with rhesus-human reassortant tetravalent vaccine (RRV-TV) in Belem, Brazil. J Trop Pediatr. 2002 Apr;48(2):93-7. Abstract: Group A rotaviruses are the most important agents of severe diarrhea in children and infants worldwide. The aim of present study was to identify rotavirus G serotypes and P[],G genotypes in cases of reinfection among children who participated in a vaccine trial with the tetravalent rhesus-human reassortant rotavirus vaccine (RRV-TV 4 x 10(4) pfu/dose) in Belem, Brazil. From July 1990 to June 1992, 540 children received, at their first, third and fifth months of life, oral doses of either vaccine or placebo. A total of 90 rotavirus diarrheal episodes among children who completed the three-dose vaccination schedule were recorded. We studied 11 reinfection rotavirus cases among five children (three female and two male). Fecal specimens were tested by using a enzyme immunoassay (IDEIA Rotavirus), followed by EIA with monoclonal antibodies to determine infecting serotypes Gl, G2, G3 and G4 and subgroups I and II. The viral dsRNA was extracted and electrophoresed through polyacrylamide gel and then subjected to reverse-transcription-polymerase chain reaction and nested-PCR for the determination of Gl, G2, G3, G4, G5 and G9 and P[4], P[6], P[8] and P[9] rotavirus genotypes. A total of 11 cases of reinfection (12 per cent) occurred among five children, three from the placebo group and two from the vaccine group. In four of the cases of reinfection G serotypes and P[],G genotypes were as follows: for the first and second infections, respectively: (1) G2/P[4],G2 and Gl/P[4],G1; (2) G2/P[4],G2 and G2/P[6],G5; (3) G2/P[4],G2 and G1/P[8],G1; and (4) G2/P[8],G1 and G1/P[8],G1. A fifth child had three successive infections caused by serotypes/genotypes G1/P[8],G1, in the first and second infections, and G2/P[4],G2 in the third infection. The common genotypes and unusual genotypes were detected in 8 (73 per cent) and 3 (27 per cent) of the isolates, respectively. With regards to the clinical severity, in two children a score indicated moderate/severe disease in both first and second infections. One child had three successive infections; the first episode was moderate/severe, the second very severe and the third was not available. In contrast, in two other children, the first episode was very severe, and the second episode was moderate/severe in one child and data was not available for the other child. The results obtained in the present investigation underscore the need to broaden our knowledge of the immunity in rotavirus reinfection. This should be useful regarding future rotavirus vaccination strategies in Brazil.

5247.      Mukhopadhya A, Ramakrishna BS, Kang G, Pulmood AB, Mathan MM, Zachariah A, Mathai DC. Enteric pathogens in southern Indian HIV-infected patients with and without diarrhoea. Indian J. med Res. 1999; 109(March), 85-9. Abstract: Indian Institute of Technology, Kharagpur developed a prototype telemedicine system for the treatment of tropical disease. Keeping in view the available infrasturcture in the country, designed the system in such a way, so that it can function even at a very low bit rate data communication channel (telephone line). The domain of discourse is chronic tropical diseases which are endemic in the eastern India. To start with , it selected leprosy and dermatological disorfers. In the proposed system, it adopted a store and forward approach. The bulk of the patient  information such as patient’s history, signs and symptoms, old prescription’s diagnostic test reports and images etc are transferred before doctors at two ends start discussion about the patient. The physicians at the referral end could browse through the patient-data and advise accordingly. During online conferencing, the physicians at the two ends could converse with each other  and discuss with respect to  a test report and image by annotations, diagram, texts etc. the system has also the back-end database support for storage and retrieval of patients data. Presently a prototype a system has been developed and installed at the School of Tropical Medicine (STM), Calcutta for in-house testing and training of the doctors. Briefly presents different features of this system with respect to the treatment and diagnosis of leprosy. A few experimental sessions were carried out between Calcutta and Kharagpur.


5248.      Prasanna Lakshmi NC, Sharma NK, Shailaja Vani B, Tiwari S. Clinical evaluation of new diarex in acute and chronic diarrhoea. Antiseptic,  Madurai. 2001; 98(10), 3712-2.  Polyherbal formulation New Diarex was tested in 50 patients with acute and chromic diarrhoea. A dose of 2 tablets thrice daily for 2 days was administered in acute diarrhoea. Chronic diarrhoea patients were given 2 tablets thrice daily for 10 days. There was significant reduction in frequency of stools in acute  as well as chronic diarrhoea. The associated symptoms were also controlled.

5249.      Ramsey SD, Berry K, Moinpour C, Giedzinska A, Andersen MR. Quality of life in long term survivors of colorectal cancer. Am J Gastroenterol. 2002 May;97(5):1228-34.


OBJECTIVES: We aimed to determine the quality of life (QOL) for long term survivors of colorectal cancer. METHODS: Persons with colorectal cancer who had survived at least 5 yr from diagnosis were recruited from a local cancer registry to answer questions about general QOL and colon cancer-specific issues. Before the general survey, focus group interviews with long term survivors were conducted to select survey questions from a pool of general and cancer-specific QOL questionnaires. The survey included the Health Utilities Index, the Center for Epidemiological Studies Depression Scale, and questions from the Short Form 36 and Functional Assessment of Cancer Therapy-Colorectal Cancer. After permission was obtained from their primary physicians, long term survivors from the registry were mailed invitation letters, then telephoned. Those agreeing were mailed self-administered questionnaires with stamped return envelopes. RESULTS: Two hundred twenty-seven respondents (average age = 74 yr, 46% female) completed the survey. Survivors reported a relatively uniform and high QOL, irrespective of stage at diagnosis and time from diagnosis. Non-cancer related comorbid conditions and low income status had more influence on overall QOL than initial stage of colorectal cancer or time since diagnosis. Compared to age-matched populations, long term survivors reported higher overall QOL, but had higher rates of depression. Sixteen percent reported three or more bowel movements a day; 49% reported chronic recurrent diarrhea. CONCLUSIONS: Those who achieve long term remission from colorectal cancer may experience a relatively high QOL, although physical symptoms such as diarrhea and depressive symptoms remain a problem.

5250.      Ramsook C, Sahagun-Carreon I, Kozinetz CA, Moro-Sutherland D. A randomized clinical trial comparing oral ondansetron with placebo in children with vomiting from acute gastroenteritis. Ann Emerg Med. 2002 Apr;39(4):397-403.


STUDY OBJECTIVE: Vomiting in children suffering from acute gastroenteritis interferes with the oral rehydration process and equally frustrates parents and health care providers. Adjuncts such as promethazine and metoclopramide are less than optimally effective and are associated with side effects. Ondansetron, a 5-HT3 receptor antagonist marketed as Zofran, is a safe and effective antiemetic used extensively in oncology and postoperative patients. We evaluate the effect of the antiemetic ondansetron versus placebo on the clinical outcome of patients with vomiting from gastroenteritis in a pediatric emergency department. METHODS: This was a randomized, prospective, double-blind clinical trial in a university-affiliated children's hospital ED. Children between the ages of 6 months and 12 years who had vomited at least 5 times during the preceding 24 hours were randomized to receive either oral ondansetron or a taste- and color-matched placebo. Oral rehydration was commenced 15 minutes later at 5 mL/min per standard oral rehydration protocols. Patients were discharged after they voided and continued standard oral rehydration at home with the introduction of a bananas, rice, applesauce, and toast (BRAT) diet after the first 24 hours. Any patient requiring admission was considered a treatment failure, and no further doses were given. Discharged patients were given 5 additional doses to be used every 8 hours, and they were contacted by telephone 24 and 48 hours after discharge to record the number of episodes of vomiting and diarrhea. The parents were also required to complete a diary of the same information, which was mailed to the investigators for confirmation of the telephone data. RESULTS: One hundred forty-five patients were enrolled, of whom 51% (n=74) were randomized to ondansetron. At baseline, age distribution, sex, and severity of illness did not differ between the ondansetron and placebo groups. During the observation period in the ED, the median number of episodes of vomiting was 0 in both groups, but the rank sum of vomiting episodes was significantly lower in the ondansetron group (P =.001). The number of episodes of emesis in the ED after enrollment ranged from 0 to 7 in the placebo group and 0 to 2 in the ondansetron group. During the 48 hours of follow-up, the median number of episodes of vomiting remained 0, with no statistically significant difference between the groups. There was no statistically significant difference in the rank sum of episodes of diarrhea in the ED between the groups (P =.622); however, during the next 48 hours, the patients in the ondansetron group had significantly more diarrhea than the placebo group. A lower proportion of patients receiving ondansetron compared with placebo required intravenous fluid therapy (P =.015). The admission rate was also lower in patients receiving ondansetron (P =.007). The revisit rate was higher in the ondansetron group compared with the placebo group (P =.047). CONCLUSION: Ondansetron was effective in reducing the emesis from gastroenteritis during the ED phase of oral rehydration and in lowering the rates of intravenous fluid administration and hospital admission.

5251.      Sethi NK, Sethi SK. Vibrio cholerae diarrhoea in a three-day-old. Indian J Pediat. 2001; 68(8), 791-2. Abstract: Confirmed case of cholera in a 3-day-old neonate is being reported. Possible source of infection could be by holy water (charnamrit) given to the baby, which is common ritual in India. Mother’s milk has never been reported to transmit cholera, even though mother herself may be suffering from cholera. Contaminated water can transmit the disease as there is no maternally transmitted immunity.

5252.      Tursi A. Irritable bowel syndrome and coeliac disease. Lancet. 2002 Apr 13;359(9314):1347. No abstract.

5253.      Vila J, Vargas M, Ruiz J, Espasa M, Pujol M, Corachan M, De Anta MTJ, Gascon J. Susceptibility patterns of enteroaggregative Escherichia coli associated with traveller’s diarrhoea: emergence of quinolone resistance. J Med Microbiol. 2001; 50(11), 996-1000.  Enteroaggregative Escherichia coli (EaggEC) isolates were identified as a cause of traveller’s diarrhoea in 50 (9%) of 517 patients and their antimicrobial susceptibility was determined. Molecular epidemiological susceptibility was determined. Molecular epidemiological characterisation and investigation of the mechanisms of acquisition of quinolone resistance among nalidixic acid-resistant EaggEC strains was performed. Seventeen (34%) of 50 patients needed antimicrobial therapy, because of persistence of symptoms in eight cased. Ampicillin and tetracycline resistance was high, whereas chloramphenicol and co-trimoxazole showed moderate activity and amoxicillin plus clavulanic acid, nalidixic acid and ciprofloxacin showed very good activity. Resistance to nalidixic acid was in three isolates, two from patients who had travelled to India. In all three strains the resistance was linked to mutations in the gyrA gene alone or in the both gyrA and ParC genes. Although ciprofloxacin shows excellent in-vitro activity and could be useful in the treatment of traveller’s diarrhoea in patients travelled abroad, it may not be useful in patients who have journeyed to India or Mecico. 37 ref.  


5254.      Adachi JA, Ericsson CD, Jiang ZD, DuPont MW, Pallegar SR, DuPont HL. Natural history of enteroaggregative and enterotoxigenic Escherichia coli infection among US travelers to Guadalajara, Mexico. J Infect Dis. 2002 Jun 1;185(11):1681-3.


The natural history of enteroaggregative Escherichia coli (EAEC) and enterotoxigenic E. coli (ETEC) infection was studied among 40 US travelers who provided weekly stool samples for 4 weeks after arrival in Mexico. At enrollment, 5 subjects were colonized by EAEC and 3 by ETEC. During the first 2 weeks after enrollment, 12 developed EAEC diarrhea, 7 developed ETEC diarrhea (5 with mixed EAEC/ETEC diarrhea), 13 had EAEC colonization, and 7 had ETEC colonization. During the third and fourth weeks, 4 experienced EAEC diarrhea, 2 experienced ETEC diarrhea (1 with mixed EAEC/ETEC diarrhea), 31 had EAEC colonization, and none had ETEC colonization. Plasmid DNA analysis showed a high degree of heterogeneity among EAEC isolates. Symptomatic EAEC infection occurred early after arrival in Guadalajara, Mexico, and was as common as ETEC infection. Asymptomatic EAEC infection was recurrent.


5255.      Adwan K, Abu-Hasan N, Essawi T, Bdir M. Isolation and characterisation of Shiga toxigenic Escherichia coli strains from northern Palestine. J Med Microbiol. 2002 Apr;51(4):332-5.


Shiga toxigenic Escherichia coli (STEC) isolates from symptomatic and asymptomatic patients in northern Palestine in 1999 were screened for serotype O157 and characterised for virulence genes by multiplex PCR assay. Of the 176 STEC isolates, 124 (70.5%) were of serotype O157. All these isolates carried the gene for Shiga toxin type 1 (stx,) and 112 (90.3%) carried stx2. The intimin encoding gene locus eae was detected in 16 isolates (12.9%) and the enterohaemolysin encoding gene, hlyA, in 18 (14.5%). Statistical analysis showed a significant association between the presence of eaeA and hlyA, either alone or combined with stx1 and stx2 genes in O157 isolates from symptomatic infection. ERIC-PCR analysis of DNA from 80 serotype O157 isolates revealed three major clonal populations.

5256.      Anidi I, Bazargan M, James FW. Knowledge and management of diarrhea among underserved minority parents/caregivers. Ambul Pediatr. 2002 May-Jun;2(3):201-6.


OBJECTIVE: Dehydration resulting from diarrhea continues to be a cause of morbidity, mortality, and increased health care costs in the United States. This study assesses parental knowledge of the causes and signs of diarrhea and dehydration. It also examines parental-care practices during an episode of diarrhea. METHODS: A survey was given to 219 parents/caregivers of children less than 5 years of age who presented to a pediatric continuity clinic. A bilingual interviewer was used to administer the surveys to participants for assessing knowledge of causes, signs, and treatment of diarrhea; signs of dehydration; and care practices during an episode of diarrhea. RESULTS: A wide variation in the level of awareness of signs, causes, and treatment of diarrhea was detected. General knowledge of diarrhea was related positively to accessibility of health information, level of education, ethnicity, and experience with dehydration. General knowledge of diarrhea, adjusted for level of education, was higher in African Americans than in Hispanics. CONCLUSIONS: In children, dehydration from diarrhea may be prevented by increasing parents'/caregivers' general knowledge of diarrhea and dehydration and the appropriate usage of oral rehydration solutions. Intervention programs designed to increase parents'/caregivers' knowledge must be culturally sensitive and appropriate for diverse educational backgrounds and must assist in improving access to health-related information.

5257.      Barbut F, Meynard JL. Managing antibiotic associated diarrhoea. BMJ. 2002 Jun 8;324(7350):1345-6.  No abstract.

5258.      Chhotray GP, Pal BB, Khuntia HK, Chowdhury NR, Chakraborty S, Yamasaki S, Ramamurthy T, Takeda Y, Bhattacharya SK, Nair GB. Incidence and molecular analysis of Vibrio cholerae associated with cholera outbreak subsequent to the super cyclone in Orissa, India. Epidemiol Infect. 2002 Apr;128(2):131-8.


An epidemiological study was carried out to find out the aetiological agent for diarrhoeal disorders in the cyclone and flood affected areas of Orissa, India. Rectal swabs collected from 107 hospitalized diarrhoea patients were bacteriologically analysed to isolate and identify the various enteropathogens. Detection of toxic genes among E. coli and V. cholerae was carried out by polymerase chain reaction (PCR) assay. Of the 107 rectal swabs analysed, 72.3% were positive for V. cholerae O1 Ogawa, 7.2% for V. cholerae O139, 1.2% for E. coli (EAggEC) and 1.2% for Shigella flexneri type 6. Using multiplex PCR assay it was found that all V. cholerae isolates were ctxA positive and El Tor biotype. Strains of V. cholerae O1 were observed to be resistant to nalidixic acid, furazolidone, streptomycin, co-trimoxazole and ampicillin. Except for nalidixic acid, the resistance pattern for O139 was identical to that of O1 strains. Representative strains of V. cholerae were further characterized by randomly amplified polymorphic DNA (RAPD) analysis and ribotyping. Both O1 and O139 V. cholerae strains exhibited the R3 pattern of ribotype and belonged to a similar pattern of RAPD compared with that of Calcutta strains. Early bacteriological and epidemiological investigations have revealed the dominance of V. cholerae O1 among the hospitalized patients in cyclone affected areas of Orissa. Drinking water scarcity and poor sanitation were thought to be responsible for these diarrhoeal outbreaks. Timely reporting and implementation of appropriate control measures could contain a vital epidemic in this area.

5259.      Dejong CH, Parks RW, Currie E, Piris J, Redhead DN, Garden OJ. Treatment of hepatic metastases of neuroendocrine malignancies: a 10-year experience. J R Coll Surg Edinb. 2002 Apr;47(2):495-9.


BACKGROUND: Liver metastases from neuroendocrine tumours may give rise to symptoms due to hormone production or mass effect. Accepted management options include administration of somatostatin-analogues, selective chemoembolisation or hepatic resection. The aim of this study was to review the management of hepatic neuroendocrine metastases in our unit. METHODS: Patients with neuroendocrine tumours presenting between 1989 and 1999 were identified from pathology, radiology and surgical databases. Case notes were retrospectively reviewed for demographic data, treatment modality and outcome. Response to treatment was based on biochemistry, radiology or symptoms, and response rates were defined accordingly. RESULTS: Thirty patients with a mean age of 55 years presented with, or later developed liver metastases. The most frequent presenting symptoms were abdominal pain (63%), diarrhoea (40%), weight loss (33%) and flushing (13%). Five patients underwent liver resection with complete symptomatic response, nine underwent chemoembolisation with a 75% response rate (either biochemically, radiologically or symptomatic) and fifteen were treated with a somatostatin-analogue, with a response rate of 86%. Median survival from detection of metastases was 45 months. CONCLUSIONS: Liver resection provides good symptomatic relief, but it is only indicated in a small proportion of patients with metastatic neuroendocrine tumours. Both chemoembolisation and somatostatin-analogues offer useful symptomatic control for these patients with good survival prospects.

5260.      D'Souza RM, D'Souza R. Vitamin A for preventing secondary infections in children with measles—a systematic review. J Trop Pediatr. 2002 Apr;48(2):72-7. Review.


The objective of the present study was to determine whether vitamin A prevents pneumonia, diarrhoea and other infections in children with measles. A meta-analysis was carried out of randomized controlled trials identified through a systematic search of the medical literature for studies that used vitamin A to treat measles. A total of 492 children, aged from 6 months to 13 years, were supplemented with vitamin A, and 536 children were given placebo in six trials, five of which were conducted in hospitals and one in a community setting. The main outcome measures were: incidence of pneumonia, diarrhoea, croup, and otitis media; and duration of pneumonia, diarrhoea, fever and hospitalization. There was no significant reduction in the incidence of pneumonia or diarrhoea but there was a 47 per cent reduction in the incidence of croup (RR = 0.53; 95 per cent CI = 0.29-0.89) in children who were treated with 200 000 IU of vitamin A on 2 consecutive days. Only one study reported a 74 per cent reduction in the incidence of otitis media (RR = 0.26 95 per cent CI = 0.05-0.92). There was a statistically significant decrease in the duration of diarrhoea, pneumonia, hospital stay and fever in individual studies. It was concluded that vitamin A does have a beneficial effect on morbidity associated with measles and should be used as a treatment for hospitalized measles cases.


5261.      Farthing MJ. Novel targets for the control of secretory diarrhoea. Gut. 2002 May;50 Suppl 3:III15-8. Review.


Secretory diarrhoea continues to be a major clinical problem worldwide. It is now recognised that the enteric nervous system plays an important role in the pathogenesis of enterotoxin mediated intestinal secretion, which has resulted in the identification of novel therapeutic targets for the treatment of acute watery diarrhoea.


5262.      Greenberg DE, Jiang ZD, Steffen R, Verenker MP, DuPont HL. Markers of inflammation in bacterial diarrhea among travelers, with a focus on enteroaggregative Escherichia coli pathogenicity. J Infect Dis. 2002 Apr 1;185(7):944-9.


The intestinal inflammatory response of traveler's diarrhea acquired in Goa, India, and Guadalajara, Mexico, was studied. Fecal lactoferrin was found in stool samples in which enteroaggregative Escherichia coli (EAEC), enterotoxigenic E. coli, or Salmonella or Shigella species were isolated, with Shigella-positive cases showing the highest level. Samples from cases of Shigella-associated diarrhea had the highest concentrations of fecal cytokines. Travelers to India who had EAEC-associated diarrhea showed elevated levels of interleukin (IL)-8 (median, 341.15 pg/mL) and IL-1beta (median, 749.90 pg/mL). Although 15 travelers to Mexico who had EAEC-associated diarrhea had a median concentration of 0 pg/mL for both IL-8 and IL-1beta, 2 had high levels of IL-8 (1853 and 11,786 pg/mL), and 5 showed elevated levels of IL-1beta (1-1240 pg/mL). Samples from patients in India who had pathogen-negative diarrhea or from patients in Mexico who had asymptomatic EAEC infection were negative for cytokines. Bacterial pathogens causing traveler's diarrhea commonly produce intestinal inflammation, although a subset of patients with EAEC-associated diarrhea fail to develop an inflammatory response.


5263.      Highleyman L. Managing nausea, vomiting, and diarrhea. BETA. 2002 Spring;15(2):29-39. No abstract.

5264.      Hopkins MJ, Macfarlane GT. Changes in predominant bacterial populations in human faeces with age and with Clostridium difficile infection. J Med Microbiol. 2002 May;51(5):448-54.


The bacterial composition of human faeces can vary greatly with factors such as age and disease, although relatively few studies have monitored these events, particularly at species level. In this investigation, bacteria were isolated from faecal samples from healthy young adults and elderly subjects, and elderly patients with Clostridium difficile-associated diarrhoea (CDAD). The organisms were identified to species level on the basis of their cellular fatty acid profiles with the MIDI system. In some groups of bacteria, species diversity was found to change with age despite the overall numbers of organisms being similar at genus level. Bacteroides thetaiotaomicron, B. ovatus and Prevotella tannerae were common gram-negative anaerobes isolated from young adults. Bacteroides species diversity increased in the faeces of healthy elderly people. Bifidobacterial species diversity decreased with age, with Bifidobacterium adolescentis and Bif. angulatum being the most common isolates. CDAD patients were characterised by greater diversity of facultative species, lactobacilli and clostridia, but greatly reduced numbers of bacteroides, prevotella and bifidobacteria. Such bacterial population changes in the normal microbiota could result in metabolic conditions favourable for the establishment of pathogenic micro-organisms, such as clostridia, and would have considerable effects on the biochemical capacity of the large intestine as a whole. Alterations in the community structure of bifidobacteria and lactobacilli have relevance for dietary and therapeutic interventions such as the use of pre- or probiotics that aim to modify the composition or metabolic activities of the intestinal microflora in a beneficial way, particularly in elderly people or individuals at risk of CDAD.

5265.      Jolobe O. Recurrent diarrhoea and weight loss associated with cessation of smoking in undiagnosed coeliac disease. Gut. 2002 Apr;50(4):582; discussion 582. No abstract.

5266.      Kang G, Green J, Gallimore CI, Brown DW. Molecular epidemiology of rotaviral infection in South Indian children with acute diarrhea from 1995-1996 to 1998-1999. J Med Virol. 2002 May;67(1):101-5.


The distribution of VP7 (G-) and VP4 (P-) genotypes among 126 rotavirus strains from South Indian children, < 5 years of age and with acute diarrhoea, presenting to a single hospital during the months to November and December, from 1995 to 1998, was studied. Multiplex hemi-nested G- and P-typing polymerase chain reactions determined 101 (80%) G types and 78 (61%) P types, respectively. In order of frequency, the commonest G types were G1, G4, G2, G9, G3, and G8, and P types were P1B[4], P1A[8], and P2A[6] and the most common G:P combinations were G1:P1A[8], G1:P1B[4], G2P1B[4] and G4:P1A[8]. G1, G2, and G4 types were seen in all years. The single G3 isolate was seen in 1998. The single G8 isolate and the 5 G9 isolates were seen in 1997, after a period of heavy rain. Sequence analysis showed that the G8 isolate was related most closely to the bovine strain A5, and the G9 strains were distinct from the nonpathogenic Indian isolate 116E and similar to G9s isolated in Mysore and the United Kingdom described previously. Copyright 2002 Wiley-Liss, Inc.

5267.      Lee J, Koh D, Andijani M, Saw SM, Munoz C, Chia SE, Wong ML, Hong CY, Ong CN. Effluents from a pulp and paper mill: a skin and health survey of children living in upstream and downstream villages. Occup Environ Med. 2002 Jun;59(6):373-9.


OBJECTIVES: A health survey of three villages (upstream village Rantau Baru and two downstream villages, Sering and Pelalawan) in the vicinity of a pulp and paper mill along the Kampar river in the province of Riau, Indonesia was conducted to find whether exposure to the effluents from the mill was related to skin conditions and ill health. METHODS: A cross sectional survey was carried out of children living in the three villages. RESULTS: Common skin conditions such as dermatitis, fungal infections, insect bites, and miliaria were found. No significantly increased risk of dermatitis or any illness in general was found with increasing levels of exposure to river water for downstream villages when compared with the upstream village. However, there was an increased risk of diarrhoea in Sering especially with drinking water directly from the river (prevalence rate ratio (PRR) 4.9, 95% confidence interval (95% CI) 0.4 to 63.9). An increased risk was also found within the upstream village Rantau Baru (PRR 2.3, 95% CI 0.9 to 5.8) and downstream village Sering (PRR 1.4, 95% CI 0.4 to 5.2) when children who drank water directly from the river were compared with those who never did. Analysis of the river water also showed physical and chemical variables within the acceptable range except for faecal coliforms (6 MPN/100 ml) found in the sample taken from Sering. CONCLUSIONS: The effluent from the mill is unlikely to be causing skin conditions and ill health. Diarrhoea may be due to faecal coliform contamination of the water because all raw sewerage is deposited in the river. Community health outreach programmes are being implemented based on these findings.


5268.      McEligot AJ, Gilpin EA, Rock CL, Newman V, Hollenbach KA, Thomson CA, Pierce JP. High dietary fiber consumption is not associated with gastrointestinal discomfort in a diet intervention trial. J Am Diet Assoc. 2002 Apr;102(4):549-51. No abstract.

5269.      Nager AL, Wang VJ. Comparison of nasogastric and intravenous methods of rehydration in pediatric patients with acute dehydration. Pediatrics. 2002 Apr;109(4):566-72.


OBJECTIVE: To assess the safety, efficacy, and cost-effectiveness of rapid nasogastric hydration (RNG) and rapid intravenous hydration (RIV) administered in the emergency department (ED) to young children suffering with uncomplicated, acute moderate dehydration. METHODS: Ninety-six children aged 3 to 36 months, who presented with signs and symptoms of uncomplicated, acute moderate dehydration caused by vomiting and/or diarrhea, presumed to be caused by viral gastroenteritis, were randomly assigned to receive either RNG with a standard oral rehydration solution or RIV with normal saline. Each solution was administered at a rate of 50 mL/kg of body weight, delivered over a 3-hour period in our urban pediatric ED. All participants were weighed pretreatment and posttreatment and underwent initial and final measurements of their serum electrolytes, blood urea nitrogen, creatinine, and glucose levels, along with urine chemistry and urine specific gravity. Telephone follow-up by completion of a standardized questionnaire was obtained approximately 24 hours after discharge from the ED. RESULTS: Ninety-two of 96 enrolled patients completed the study. Three patients failed treatment (2 RIV and 1 RNG) and were excluded and hospitalized because of severe, intractable vomiting, and 1 patient was withdrawn secondary to an intussusception. Among 92 evaluable patients, 2 were found to be severely dehydrated (>10% change in body weight) and were excluded from analysis, leaving 90 patients (RNG: N = 46 and RIV: N = 44), who completed the study. Both RNG and RIV were found to be a safe and efficacious means of treating uncomplicated, acute moderate dehydration in the ED. Determinations of electrolytes, blood urea nitrogen, creatinine, or glucose were not found to be of value on an intent-to-treat basis in the care of these patients. The urine specific gravity and incidence of ketonuria declined from levels commensurate with moderate dehydration in the RNG group, but not as consistently so in the RIV group. Both RNG and RIV were substantially less expensive to administer than standard care with intravenous fluid deficit therapy in-hospital, and RNG was more cost-effective to administer over RIV in the outpatient setting. CONCLUSION: RNG and RIV administered in the ED are safe, efficacious, and cost-effective alternatives to the standard treatment for uncomplicated, acute moderate dehydration in young children. RNG is as efficacious as RIV, is no more labor intensive than RIV, and is associated with fewer complications. In addition, we found that most routine laboratory testing is of little value in these patients and should be avoided, except when clearly clinically indicated.


5270.      Park SF. The physiology of Campylobacter species and its relevance to their role as foodborne pathogens. Int J Food Microbiol. 2002 Apr 5;74(3):177-88. Review.


Campylobacter jejuni and C. coli are recognised as the leading causes of bacterial foodborne diarrhoeal disease throughout the development world. While most foodborne bacterial pathogens are considered to be relatively robust organisms, as a consequence of the necessity to survive the inimical conditions imposed by food processing and preservation, Campylobacter species have uniquely fastidious growth requirements and an unusual sensitivity to environmental stress. Campylobacters also lack many of the well characterised adaptive responses that can be collated with resistance to stress in other bacteria. The aim of this review is to outline the unusual physiology of campylobacters (C. jejuni and C. coli) and to describe how this influences their role as foodborne pathogens.

5271.      Resta-Lenert S, Barrett KE. Enteroinvasive bacteria alter barrier and transport properties of human intestinal epithelium: role of iNOS and COX-2. Gastroenterology. 2002 Apr;122(4):1070-87.


BACKGROUND & AIMS: Various invasive pathogens cause diarrhea, but the mechanism(s) are poorly understood. We hypothesized that nitric oxide and prostaglandins might modulate chloride secretory and barrier properties of the infected intestinal epithelium and that diarrhea is caused, in part, by altered expression of inducible NO synthase (iNOS) and cyclooxygenase 2 (COX-2). METHODS: Studies were conducted in human intestinal epithelial cell lines (HT29/cl.19A, Caco-2, and T84). Cells were infected with enteroinvasive Escherichia coli (EIEC 029:NM) or Salmonella dublin (SD), or nonpathogenic, noninvasive bacteria (Streptococcus thermophilus [ST] and Lactobacillus acidophilus [LA]). Infected cells and controls were tested for transepithelial resistance, chloride secretion, prostaglandin E2, guanosine 3',5'-cyclic monophosphate and adenosine 3',5'-cyclic monophosphate, and protein expression. RESULTS: Cells infected with EIEC or SD, but not uninfected controls or ST/LA-exposed monolayers, showed a progressive reduction in transepithelial resistance starting at 6-12 hours. Infected HT29/cl.19A and Caco-2 cells, but not T84 cells, also showed an increase in total nitrite. Expression of iNOS, and consequently COX-2, was also increased, followed by increased production of prostaglandins and cyclic nucleotides. Furthermore, basal and stimulated chloride secretory responses to various agonists were enhanced in HT29/cl.19A and Caco-2 cells after infection with enteroinvasive bacteria, and this effect was reversed for some agonists by iNOS or COX-2 inhibitors. Increased expression of cystic fibrosis transmembrane conductance regulator and NKCC1 was also observed in EIEC or SD-infected cells vs. controls, secondary to NO synthase activity. CONCLUSIONS: Up-regulation of iNOS and COX-2 by enteroinvasive bacteria can modulate chloride secretion and barrier function in intestinal epithelial cells. Thus, these enzymes represent possible therapeutic targets in infectious diarrhea.

5272.      Robins-Browne RM, Hartland EL. Escherichia coli as a cause of diarrhea. J Gastroenterol Hepatol. 2002 Apr;17(4):467-75. Review.


Escherichia coli is the best-known member of the normal microbiota of the human intestine and a versatile gastrointestinal pathogen. The varieties of E. coli that cause diarrhea are classified into named pathotypes, including enterotoxigenic, enteroinvasive, enteropathogenic and enterohemorrhagic E. coli. Individual strains of each pathotype possess a distinct set of virulence-associated characteristics that determine the clinical, pathological and epidemiological features of the diseases they cause. In the present brief review, we summarize the key distinguishing features of the major pathotypes of diarrheagenic E. coli. Knowledge of the pathogenic mechanisms of these bacteria has led to the development of rational interventions for the treatment and prevention of E. coli-induced diarrhea. In addition, investigations into E. coli virulence are providing useful insights into the origins and evolution of bacterial pathogens more generally. Copyright 2002 Blackwell Publishing Asia Pty


5273.      Shifrin Y, Kirschner J, Geiger B, Rosenshine I. Enteropathogenic Escherichia coli induces modification of the focal adhesions of infected host cells. Cell Microbiol. 2002 Apr;4(4):235-43.


Enteropathogenic Escherichia coli (EPEC) is a human-specific pathogen that causes severe diarrhoea in young children. The disease involves intimate interaction between the pathogen and the brush border of enterocytes. During infection, EPEC uses a type III secretion system (TTSS) to inject several proteins into the infected cells, and these effector proteins modify specific processes in the host cell. We show that, upon infection, EPEC induces detachment of the infected host cells from the substratum, modification of focal adhesions (FA) in the infected cells and specific dephosphorylation of focal adhesion kinase (FAK). We also show that EPEC-induced cell detachment is dependent on FAK expression by the infected cells. Finally, we demonstrate that cell detachment, FA modification and FAK dephosphorylation are dependent on functional TTSS in the infecting EPEC. These results suggest that EPEC is using its TTSS to inject protein(s) into the infected cells, which can induce FAK dephosphorylation, as well as FAK-dependent FA modification and cell detachment. These processes are specific and probably play an important role in EPEC virulence.


5274.      Storey DM, Lee A, Zumbe A. The comparative gastrointestinal response of young children to the ingestion of 25 g sweets containing sucrose or isomalt. Br J Nutr. 2002 Apr;87(4):291-7.


Sugar-free confectionery products containing the low-energy, non-cariogenic sweetener isomalt are widely available in the market place and increasingly aimed at children. However, over-consumption of such products may lead to gastrointestinal symptoms and/or osmotic diarrhoea. Little is known about the gastrointestinal tolerance of children following consumption of isomalt. The aim of the present study was to assess gastrointestinal symptoms in children following consumption of sugar-free confectionery containing isomalt compared with sweets containing sucrose. In a double-blind, randomised, controlled, crossover study, sixty-seven children aged 6-9 years ingested 25 g hard-boiled sweets containing either sucrose or isomalt on two consecutive test days. Isomalt sweets were received as enthusiastically as sucrose sweets and, when given the choice, 97 % of children asked to be given the isomalt or the sucrose sweets on the second test day. Most children did not report multiple symptoms and few experienced symptoms on both days of isomalt consumption. However, significantly more children reported stomach-ache (P<0.01), abdominal rumbling (P<0.025) and passing watery faeces (P<0.001) following consumption of isomalt sweets compared with sucrose sweets. Consumption of 25 g isomalt-containing sweets by children is not associated with significant gastrointestinal effects graded as 'considerably more than usual' or multiple symptoms, but is associated with a laxative effect and increase in symptoms graded as 'slightly more than usual'. For the majority of children in the present study, 25 g isomalt-containing sweets represents an acceptable level of consumption, although some children are sensitive to the effects of isomalt ingestion.

5275.      Weizman Z, Binsztok M, Fraser D, Deckelbaum RJ, Granot E. Intestinal protein loss in acute and persistent diarrhea of early childhood. J Clin Gastroenterol. 2002 Apr;34(4):427-9.


GOALS: To determine fecal protein loss in children with acute and persistent diarrhea. BACKGROUND: In children with diarrhea, ongoing losses of endogenous proteins have been suggested as contributing to impairment of nutritional and immunologic status. However, there is a paucity of information and inconclusive data in the literature. STUDY: Fecal protein loss was assessed prospectively in children (<3 years of age) with acute diarrhea (<7 days' duration) or persistent diarrhea (>14 days) and in controls using alpha-1-antitrypsin determination; fecal protein loss then was correlated with age, duration of diarrhea, nutritional status, plasma proteins, and stool pathogens. RESULTS: Children with acute diarrhea (n = 43) and those with persistent diarrhea (n = 41) had significantly higher fecal alpha-1-antitrypsin levels compared with controls (n = 14) (2.26 +/- 1.71 and 2.25 +/- 1.51, respectively, vs. 1.02 +/- 0.73 mg/g stools; p = 0.002). However, there was no significant decrease of plasma albumin, globulin, or immunoglobulins. Fecal protein loss did not differ significantly among stool pathogens (bacterial, viral, and parasitic) and demonstrated no significant correlation with age, duration of diarrhea, or nutritional status (mild malnutrition). CONCLUSIONS: Enhanced fecal protein loss was observed in more than 50% of children with acute and persistent diarrhea caused by various pathogens. This did not correlate with age, duration of diarrhea, or nutritional status and did not result in significant decrease of plasma proteins or immunoglobulins. This protein-losing enteropathy does not appear to have a causal role in perpetuation of diarrheal episodes in children with mild malnutrition.


5276.      Jiang B, Gentsch JR, Glass RI. The role of serum antibodies in the protection against rotavirus disease: an overview. Clin Infect Dis  2002 May 15;34(10):1351-61


A critical observation in understanding immunity to rotavirus is that children infected with wild virus or vaccinated with oral live vaccines develop a humoral immune response and are protected against severe disease upon reinfection. Nevertheless, much controversy exists as to whether these serum antibodies are directly involved in protection or merely reflect recent infection, leaving the protective role to mucosal or cell-mediated immunity or to other as-yet-undefined mechanisms. We have reviewed data from a variety of studies in humans, including challenge experiments in adult volunteers, longitudinal studies of rotavirus infection in young children, and clinical trials of animal and animal-human reassortant rotavirus vaccines in infants. These data suggest that serum antibodies, if present at critical levels, are either protective themselves or are an important and powerful correlate of protection against rotavirus disease, even though other host effectors may play an important role as well.



5277.      Strand TA, Chandyo RK, Bahl R, Sharma PR, Adhikari RK, Bhandari N, Ulvik RJ, Molbak K, Bhan MK, Sommerfelt H. Effectiveness and efficacy of zinc for the treatment of acute diarrhea in young children. Pediatrics  2002 May;109(5):898-903


Intervention trials have shown that zinc is efficacious in treating acute diarrhea in children of developing countries. In a randomized, placebo-controlled trial, we assessed the effectiveness and efficacy of giving 3 Recommended Daily Allowances of elemental zinc to 6- to 35-month-old children with acute diarrhea. METHODS: Seventeen hundred ninety-two cases of acute diarrhea in Nepalese children were randomized to 4 study groups. Three groups were blinded and the children supplemented daily by field workers with placebo syrup, zinc syrup, or zinc syrup and a massive dose of vitamin A at enrollment. The fourth group was open and the caretaker gave the children zinc syrup daily. Day-wise information on morbidity was obtained by household visits every fifth day. RESULTS: The relative hazards for termination of diarrhea were 26% (95% confidence interval [CI]: 8%, 46%), 21% (95% CI: 4%, 38%), and 19% (95% CI: 2%, 40%) higher in the zinc, zinc-vitamin A, and zinc-caretaker groups, respectively, than in the placebo group. The relative risks of prolonged diarrhea (duration >7 days) in these groups were 0.57 (95% CI: 0.38, 0.86), 0.53 (95% CI: 0.35, 0.81), and 0.55 (0.37, 0.84); zinc accordingly reduced the risk of prolonged diarrhea with 43% to 47%. Five percent and 5.1% of all syrup administrations were followed by regurgitation in the zinc and zinc-vitamin A group, respectively, whereas this occurred after only 1.3% of placebo administrations. Vomiting during diarrhea was also more common in children receiving zinc. CONCLUSIONS: Three Recommended Daily Allowances of zinc given daily by caretakers or by field workers substantially reduced the duration of diarrhea. The effect of zinc was not dependent on or enhanced by concomitant vitamin A administration.




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