Oral Zinc Therapy Research Articles

Mobile phone call reminders to improve oral rehydration salt and zinc adherence for acute diarrhea in children: a single-center, randomized controlled trial

BackgroundLow-osmolarity oral rehydration salt (ORS) and zinc therapy effectively manage diarrhea in children under five years of age, offering both short- and long-term benefits. Despite this, caregivers’ adherence to ORS and zinc is often unsatisfactory due to factors such as forgetfulness, resolution of symptoms, and underestimation of the disease’s severity. This study assessed the effect of mobile call reminders on ORS and zinc tablet adherence among children with acute diarrhea in a secondary-level health facility in Kwara State, Nigeria.MethodsUsing an open-label, randomized controlled trial design, this study compared caregiver-child pairs with acute diarrhea aged 6–59 months who received standard instructions (SI) alone (control group) and an intervention group (IG) who received SI plus phone call reminders on days three and seven of zinc sulfate therapy. All participants used a pictorial diary to track loose/watery stools and ORS and zinc tablet treatments for ten days. The primary outcome measures were independent and combined adherence to ORS and zinc therapy. The secondary outcomes were independent and combined adherence scores, defined as the percentage of times the ORS was given post-diarrhea and the percentage of prescribed zinc tablets administered out of ten.ResultsA total of 364/400 mother–child pairs completed the study. The percentage of mothers with full adherence in the intervention group was 82.5% for ORS, 72.1% for zinc, and 58.5% for combined use, compared to 78.8%, 60.8%, and 43.6%, respectively, in the control group. The odds of full adherence to ORS and zinc were 1.6 and 1.7 times higher among intervention mothers [ORS: OR = 1.561, 95% CI = 0.939–2.598, P = 0.085; zinc: OR = 1.671, 95% CI = 1.076–2.593, P = 0.022], and 1.8 times higher for combined use according to WHO guidelines [OR = 1.818, 95% CI = 1.200–2.754, P = 0.005]. The mean adherence scores for the intervention group were higher than those for the control group by 4.1% (95% CI = 0.60–7.60) for ORS, 7.3% (95% CI = 3.74–10.86) for zinc, and 5.7% (95% CI = 3.23–8.17) for the combined treatment.ConclusionPhone reminders can effectively improve consistency of home treatment administered by caregivers for children under five years old.Trial RegistrationThe study was registered retrospectively (17/3/2023) with the Pan African Clinical Trial Registry (PACTR202301560735856).

Effectiveness of Oral Zinc Therapy as an Adjunct to Intralesional Measles, Mumps, and Rubella Vaccine in Patients of Verruca Vulgaris

Abstract Background: Verruca vulgaris (VV) is caused by human papillomavirus affecting both keratinized and nonkeratinized epithelium. Different treatment modalities are available leading to scarring, pain, and ineffectiveness. Injection of measles, mumps, and rubella (MMR) not only clears treated warts but also distant warts by stimulating cell-mediated immunity. Objectives: The objective of this study was to study the efficacy of adjuvant zinc with injectable MMR vaccine in treatment with side effects of treatments, the pattern of regression, the number of injections required for clearance, and the recurrence of verruca. Materials and Methods: Fifty patients having verruca were divided into groups A and B with 25 patients each. Group A received an injection of MMR and tablet of zinc whereas group B only injection MMR. A total of five injections were given in the largest wart at intervals of 2 weeks i.e., 0, 2, 4, 6, and 8 weeks. Follow-up was done at 3rd month and 6th months following 1st dose. Improvement in warts and patient satisfaction were assessed using visual analog scale and Likert scale, respectively. Results: Mean age of patients in groups A and B was 30.36 and 32.68 with male-to-female ratio 5.28:1 (21:4) and 1.77:1 (16:9), respectively. Mean numbers and size of lesions in group A and B were 2.24 (±1.59), 1.84 (±1.40) and 5.52 mm, 5.08 mm, respectively. Eighty-four percentage of patients in both groups needed five injections for complete clearance. Pain was the most common side effect in all patients of both groups whereas gastritis, fever, and lymphadenopathy were observed only in one patient of Group A. Patients in both groups were strongly satisfied on Likert’s scale. Conclusion: Oral zinc as an adjuvant with MMR vaccine for the treatment of VV was equally safe but did not prove to be of higher efficacy in our study.

Compare the Effect of Zinc–Probiotic versus Zinc Therapy in Acute Watery Diarrhea in Children

Background: Acute watery diarrhea still remains a major health problem among under 5 children worldwide. Apart from oral rehydration solution, continued feeding and oral zinc therapy the administration of adequate amounts of probiotics seems beneficial for acute diarrheal episodes in children in the developing world. Objective: To compare the efficacy of zinc-probiotic combination therapy versus zinc-only therapy in children with acute watery diarrhea. Materials and Methods: This was a hospital based randomized controlled clinical trial (RCT) conducted from July 2019 to June 2021 in the Department of Pediatrics, Khwaja Yunus Ali Medical College & Hospital. Total 70 children aged 6 months to 5 years admitted in hospital with acute watery diarrhea (AWD) with severe dehydration or some dehydration with intractable vomiting were included in this study. Patients were equally divided into 2 groups. Group A received oral zinc sulfate 20 mg/day for 10 days combined with oral Bacillus clausii probiotic 4million spores/day for 5 days. Group B received only oral zinc sulfate at the same dosage as group A. We also studied the relationship between mother`s education, knowledge of ORS preparation and child’s feeding practices and nutritional status with the occurrence of diarrhea in children. Results: Frequency of diarrhoea was significantly higher in group B (Zinc only) in comparison to group A (Zinc and probiotic). Mean frequency of diarrhea, Mean duration of diarrhea and Mean length of hospital stay was significantly higher in group B (Zinc) than group A (Zinc+Probiotic). Conclusion: Compared to oral Zinc therapy only; the combination of oral zinc and probiotic therapy is clinically more effective in reducing the frequency of acute watery diarrhea in under 5 years children. KYAMC Journal Vol. 13, No. 04, January 2023: 218-222

Clinical Outcomes of Oral Zinc Therapy in Hepatic Encephalopathy Treatment.

Additional therapies for hepatic encephalopathy (HE) treatment are warranted. There are data evaluating the use of zinc for HE; however, clinical outcomes, specifically in the United States, are unknown. To compare 30-day and 1-year all-cause readmission rates in patients with cirrhosis complicated by HE on lactulose and rifaximin to those on lactulose, rifaximin, and zinc. This retrospective study included patients admitted with documented cirrhosis and home medications of lactulose and rifaximin, with or without zinc. Patients were stratified into 2 groups: those receiving lactulose and rifaximin for HE (control) and those receiving lactulose, rifaximin, and zinc for HE (treatment). The primary outcomes were 30-day and 1-year all-cause readmission rates. One-hundred fifty-seven patients were included (102 in control group, 55 in treatment group). Regarding 30-day and 1-year all-cause readmission rates, there was no difference between the control and treatment groups. This is the first study conducted in the United States evaluating zinc for HE treatment. Zinc did not impact 30-day or 1-year all-cause readmission rates. Further studies are warranted to evaluate the potential benefit of zinc for HE, possibly in correlation with Model for End-stage Liver Disease-Sodium (MELD-Na) scores.

Elevated Glucagon in a Patient with Necrolytic Acral Erythema: A Case Report and Review of the Literature

Necrolytic acral erythema (NAE) is a relatively newly described dermatologic disease that is often associated with hepatitis C virus (HCV). Oral zinc therapy is a successful treatment; however, therapy is often delayed due to misdiagnosis. There are limited reports of NAE in the literature. This paper presents a case of NAE in a 68-year-old male with untreated HCV, whose NAE was diagnosed and treated as recurrent cellulitis for 12 years. He had low serum zinc and elevated serum glucagon levels. Elevated glucagon is not often reported in NAE, but the patient’s CT abdomen was negative, ruling out glucagonoma and necrolytic migratory erythema. He improved with oral zinc replacement and was referred to the hepatology department for HCV treatment. This paper additionally presents a review of the literature for NAE cases.

Evaluating efficacy of oral zinc as adjuvant therapy in acute diarrhea in children.

Objectives: To evaluate the efficacy of oral zinc as adjuvant therapy in acute diarrhea comparing frequency and volume of stool and duration of diarrhea in children. Study Design: Case Control study. Setting: Department of Paediatrics, Shaheed Muhtrama Benazir Bhutto Medical College Layari General Hospital, Karachi. Period: September 2017 to August 2018. Material & Methods: A sample of 200 children, age 5- 15 years, suffering from acute diarrhea was divided into control and cases (study group). Oral zinc therapy (20 mg once daily) was given 14 days and its efficacy was observed in terms of stool frequency, stool volume and duration of diarrhea. Variables were noted at 24 hours and 48 hours and on 7th day of hospitalization. Data was analyzed on SPSS statistical software (version 22.0) at 95% confidence interval (P≤ 0.05). Results: Mean ± SD age in control and study group was noted as 9.1± 5.43 years and 9.5±6.02 years respectively (P=0.053). 89% of children of study group were discharged on 3rd day of hospitalization compared to only 45% from control group. Zinc treated study group shows significant decrease in frequency of loose stools, stool volume and lesser duration of hospital stay. Conclusion: Oral zinc therapy was effective in decreasing the frequency of loose stools and volume and lesser duration of hospital stay in children.

Necrolytic Acral Erythema: Current Insights.

Necrolytic acral erythema (NAE) is now considered as a distinct clinical entity. It clinically presents as well demarcated hyperpigmented papules and plaques with thick adherent scales distributed symmetrically over dorsum of feet. It usually develops in patients with Hepatitis C virus (HCV) infection. Cases of NAE have been reported in patients without HCV infection. Hepatic dysfunction resulting in metabolic alterations like hypoalbuminemia, hypoaminoacidemia, hyperglucagonemia and transient zinc deficiency has been proposed as underlying pathogenic mechanism of NAE. Clinically, NAE resembles other necrolytic erythemas like necrolytic migratory erythema (NME), acrodermatitis enteropathica (AE) and pellagra. Better understanding of etiopathogenesis and histopathological features is important to distinguish NAE from other necrolytic erythemas. The disease runs a natural course of exacerbations and remissions. Non-invasive diagnostic tools like dermoscopy can be used in differential diagnosis of NAE. Oral zinc therapy is the most effective treatment of NAE reported in most of the cases irrespective of HCV status or serum zinc levels.

A Comparative Evaluation on the Effect of Oral Zinc 50 mg with or without 0.1% Triamcinolone Orabase on Oral Lichen Planus.

Background:Lichen planus is a T-cell-mediated autoimmune disease, in which CD8+ T-cells releases the cytokines such as tumor necrosis factor-alpha and interleukin-12 disrupting basement membrane integrity. Treatment modalities were directed toward the relief in signs and symptoms and preventing recurrences. Zinc activates caspase-3 and DNA fragmentation, resulting in the apoptosis of keratinocytes. Prevention of matrix metalloproteinases1 (MMP1) activation, inhibits the Tcell accumulation in oral lichen planus (OLP) and by inhibiting MMP9, prevents the cleavage of collagen resulting in maintaining the integrity of the basement membrane.Objectives:The main objective of the study is to compare the efficacy of oral zinc 50 mg and 0.1% triamcinolone Orabase with 0.1% triamcinolone Orabase alone on the healing process of symptomatic OLP.Materials and Methods:A total of forty participants were randomly categorized into two groups: Group A and Group B with 20 patients with OLP and having symptoms of burning sensation. Group A patients had received 0.1% triamcinolone Orabase twice daily application. Group B patients had provided with oral zinc 50 mg and 0.1% triamcinolone Orabase twice daily for 8 weeks. The follow-up period for both the groups was 6 months. Lesional size was measured by Thongprasom scale and burning sensation was assessed by visual analog scale at each visit till the cessation of treatment.Results:There was decrease in the burning sensation and lesional size from the first visit to follow-up period which was statistically significant in both groups (P = 0.000).Conclusion:Oral zinc therapy was adjunctive in reducing the burning sensation and lesional size in the symptomatic OLP.

A case of acrodermatitis enteropathica misdiagnosed as staphylococcal scalded skin syndrome

Acrodermatitis enteropathica (AE) is a rare genetic autosomal recessive disorder, characterized by periorificial dermatitis, alopecia, and diarrhea due to zinc deficiency. We report a case of a 9-month-old baby boy with hair loss for 2 months, diarrhea for 1.5 months, skin peeling starting around mouth, nose, anus, gradually spreading all over body over 1 month, and fever for 10 days. Due to superadded bacterial infections and altered clinical picture, he was diagnosed as a case of staphylococcal scalded skin syndrome. With low serum zinc levels and improvement of skin lesions and diarrhea within 8 days of starting oral zinc therapy, it was confirmed to be a case of acrodermatitis enteropathica. It is important to consider AE as one of the differential diagnoses in pediatric chronic diarrhea cases with acral and/or periorificial skin lesions to prevent delay in the zinc supplementation treatment and mortality.

A comparative study between oral zinc therapy with or without steroid application in symptomatic oral lichen planus: a randomized controlled trial

Objectives Lichen planus is an autoimmune inflammatory disease affecting the buccal mucosa, tongue, and gingiva. As a result of its effect on matrix metalloproteinase, zinc is useful for treating the lesions and preventing their recurrences. This study aimed to compare the efficacy of a combination of oral zinc acetate 50 mg tablets and the 0.1% triamcinolone acetonide Orabase with Orabase alone in the healing process of symptomatic oral lichen planus (OLP). Study Design Forty patients attending the Department of Oral Medicine were randomly included in the study and were categorized into 2 groups, group A and group B. Group A (control group) and group B (case group) each comprised 20 patients with clinically and histopathologically confirmed OLP and symptoms of burning sensation. Group A received the 0.1% triamcinolone acetonide Orabase 2 times daily. Group B received 50 mg zinc acetate tablets plus Ora-base 2 times daily for 8 weeks. Orabase was discontinued after 1 week of application in the case group, whereas zinc acetate tablets were continued throughout the treatment period. The follow-up period was 2 months. Lesion size and burning sensation were measured by using the Thongprasom scale and the visual analogue scale (VAS) at initial and weekly visits till cessation of treatment. Results A decrease in pain intensity from the first visit to the follow-up visit was statistically significant in both groups (P = .000). Group B showed higher mean pain intensity from the initial visit to the follow-up visit compared with group A. Mean difference between the first and follow-up visits in the study group showed that there was a gradual decrease in pain intensity, whereas the control group showed minimal difference compared with the study group; the difference was not statistically significant (P = .498). There was statistically significant gradual decrease in lesion size till the follow-up period in both groups (P = .000). Conclusions Oral zinc therapy was found to be an adjunct in reducing burning sensation and lesion size in symptomatic OLP. Lichen planus is an autoimmune inflammatory disease affecting the buccal mucosa, tongue, and gingiva. As a result of its effect on matrix metalloproteinase, zinc is useful for treating the lesions and preventing their recurrences. This study aimed to compare the efficacy of a combination of oral zinc acetate 50 mg tablets and the 0.1% triamcinolone acetonide Orabase with Orabase alone in the healing process of symptomatic oral lichen planus (OLP). Forty patients attending the Department of Oral Medicine were randomly included in the study and were categorized into 2 groups, group A and group B. Group A (control group) and group B (case group) each comprised 20 patients with clinically and histopathologically confirmed OLP and symptoms of burning sensation. Group A received the 0.1% triamcinolone acetonide Orabase 2 times daily. Group B received 50 mg zinc acetate tablets plus Ora-base 2 times daily for 8 weeks. Orabase was discontinued after 1 week of application in the case group, whereas zinc acetate tablets were continued throughout the treatment period. The follow-up period was 2 months. Lesion size and burning sensation were measured by using the Thongprasom scale and the visual analogue scale (VAS) at initial and weekly visits till cessation of treatment. A decrease in pain intensity from the first visit to the follow-up visit was statistically significant in both groups (P = .000). Group B showed higher mean pain intensity from the initial visit to the follow-up visit compared with group A. Mean difference between the first and follow-up visits in the study group showed that there was a gradual decrease in pain intensity, whereas the control group showed minimal difference compared with the study group; the difference was not statistically significant (P = .498). There was statistically significant gradual decrease in lesion size till the follow-up period in both groups (P = .000). Oral zinc therapy was found to be an adjunct in reducing burning sensation and lesion size in symptomatic OLP.

Single dose oral zinc as adjuvant therapy in children admitted with severe pneumonia: A randomized, placebo-controlled study

Background: Childhood pneumonia is one of the major causes of under-five mortality in developing countries. Any interventions which can reduce the mortality and morbidity of pneumonia are of great importance. Adjuvant zinc therapy is one such intervention studied in various parts of the world with inconclusive results. Objective: We aim to study the impact of a single dose of zinc therapy on the outcome of childhood severe pneumonia. Material and Methods: Randomized, placebo-controlled study of young children between2 and 24 months was conducted to study the impact of single dose zinc administration on time to resolution of severe pneumonia. The subjects were assigned two groups, zinc group and non-zinc group, by stratified randomization. The zinc group received unlabeled oral zinc syrup 20 mg of elemental zinc as single dose for children >6 months of age and 10 mg of elemental zinc as single dose for children <6 months. The non-zinc group children were administered unlabeled non-zinc containing placebo as single dose. Results: From April2011 to December 2011, 1284 children screened for pneumonia as per Integrated Management of Neonatal and Childhood Illnesses guidelines and 126 children were included in the study. Of these 126 children, 63 were randomized to receive zinc and 63 to receive placebo. The mean duration of respiratory distress before hospitalization was 1.4±0.5 days in zinc group as compared to 1.1±0.5 days in non-zinc group (p=0.001). The mean duration of resolution of distress was 52.47±33.99 h in zinc group as compared to 74.17±37.76 h inthe non-zinc group (p=0.05). Similarly, the mean duration for resolution of symptoms was 65.52±36.03 h in zinc group as compared to 88.00±37.97 in non-zinc group (p=0.05). The 23% of the children in non-zinc group had treatment failure (p=0.03). Conclusion: Single dose of adjuvant oral zinc therapy in severe pneumonia, reduces the duration of respiratory distress, resolves the symptoms early and decreases the incidence of treatment failure. However, the total duration of hospitalization was not affected by zinc therapy.

A Case of Acrodermatitis Enteropathica

Clinicians should be mindful of all paediatric skin diseases, which present in a similar manner during the first months of life. Acrodermatitis enteropathica (AE) is a rare, bullous disorder that has a significant impact on the child’s quality of life and is fatal if untreated. AE is either a recessively inherited or a transiently acquired disorder. The hereditary form is caused by a genetic mutation in intestinal zinc absorption whereas the acquired form is caused by low nutritional intake or decreased peripheral release of zinc from the blood. This case report describes AE which manifested in a similar way to other blistering skin disorders, but showed a dramatic clinical improvement to oral zinc therapy. AE is characterised by a triad of periorificial and acral dermatitis, diarrhoea and alopecia. Both forms of AE affect males and females equally. The cutaneous lesions are annular, erythematous, scaly, crusted plaques, which are well demarcated. As the disease progresses these plaques become vesicobullous, pustular and erosive. The lesions are distributed symmetrically, around body openings such as the mouth anus, eyes and skin of the elbows, knees, hands and feet. The alopecia diffusely affects the eyelashes, eyebrows and scalp. As described in the case, secondary infection by candida albicans or staphylococcus aureus may complicate the disease. Classically the disease presented after the child was making the transition from breast milk to solid foods. Breast milk has comparatively higher zinc content and absorbability compared to infant formulas, cow’s milk or solid foods. This case emphasises the need for an open mind when treating childhood skin disorders. Once bullous skin disorders are suspected the case should be referred promptly to a specialist. An early diagnosis and prompt treatment of AE reduces mortality and prevents the long-term consequences of zinc deficiency.

Early Zinc Supplementation and Enhanced Growth of the Low-Birth Weight Neonate.

BACKGROUND:Nutritional deficits are almost universal in Low-Birth Weight babies. Zinc is essential for normal infant growth and its supplementation assists growth probably through insulin-like growth factor-1.AIM:This double-blind randomized-controlled trial aimed at evaluating the role of zinc in catch-up growth of low-birth-weight infants and investigating its proposed mediator.MATERIAL AND METHODS:The study was conducted in Ain Shams University Maternity Hospital. Two hundred low-birth-weight neonates were simply randomized to either oral zinc therapy or placebo. Anthropometric measurements were recorded at birth, 3, 6, and 12 months; including weight, recumbent length, head, waist, chest, and mid-upper arm circumferences, and triceps and sub-scapular skin fold thickness.RESULTS:We found that initial and 3-months measurements, except weight, were comparable in the 2 groups. All measurements at 6- and 12-months, except sub-scapular skin-fold-thickness, were significantly higher in zinc group than placebo. Catch-up growth, at 12-months, was significant in zinc group and was significantly higher in appropriate-for-gestational-age vs. small-for-gestational-age, in preterm vs. term, and in male vs. female infants. The median 6-months insulin-like growth factor-1 levels were significantly higher in zinc group.CONCLUSION:We conclude that early start of oral zinc supplementation in low-birth-weight neonates assists catch-up growth, probably through rise of insulin-like growth factor-1.

Evaluation of the role of zinc supplementation in treatment of diarrhoea in paediatric patients: a randomized open-label study

Background Zinc deficiency has been associated with an increased risk of gastrointestinal infections, adverse effects on the structure and function of the gastrointestinal tract, and impaired immune function. Recently, oral zinc therapy has been added to the standard treatment of diarrhoea by the World Health Organization, as it can improve outcomes in paediatric patients with diarrhoea, especially those in developing countries.

O-087 Role Of Zinc In Catch-up Growth Of Low-birth Weight Neonates

Low-birth-weight is a challenging public health problem. <h3>Aim</h3> To clarify role of zinc on enhancing fasting catch-up growth of Low-birth-weight and find out a proposed relationship between zinc effect on growth and the main growth hormone mediator, IGF-1. <h3>Methods</h3> Study is a double-blind-randomised-placebo-controlled trial conducted on Low-birth-weight-neonates delivered at Ain Shams University Maternity Hospital. It comprised 200 Low-birth-weight-neonates selected from those admitted to NICU. Neonates were randomly allocated into one of the following two groups: group I: Low-birth-weight; AGA or SGA on oral zinc therapy at dose of 10 mg/day; group II: Low-birth-weight; AGA or SGA on placebo at 10 mg/day placebo. Anthropometric measurements were taken including birth weight, length; head, waist, chest, mid-upper arm circumferences, triceps and sub-scapular skin-fold thicknesses. <h3>Results</h3> At 12-month-old follow-up visit, mean weight, Length; head (HC), waist, chest, mid-upper arm circumferences and triceps; also, infant’s proportions had values ≥ 10 th% for weight, length and HC were significantly higher among infants of group I when compared to those of group II. Oral zinc therapy was associated with 24.88%, 25.98% and 19.6% higher proportion of values ≥ 10 th% regarding weight, length and HC at 12-month-old visit, respectively [NNT = 4, 4 and 5, respectively]. Median IGF-1 levels measured at 6 months were significantly higher in group I compared to group II [median (range): 90 (19–130) ng/ml vs. 74 (21–130) ng/ml), respectively, p = 0.023]. <h3>Conclusion</h3> Oral zinc therapy in low-birth-weight neonates was associated with significantly more catch-up growth at 12-months-old and significantly higher serum IGF-1 at 6-month-old.

Efficacy of oral zinc therapy in epidermodysplasia verruciformis with squamous cell carcinoma

Epidermodysplasia verruciformis (EV) is a rare, inherited disorder that predisposes patients to widespread human papillomavirus (HPV) infection and cutaneous squamous cell carcinomas. There is still no definitive therapeutic modality for EV. A 24 year old male patient with EV was treated with oral zinc sulphate, one of the cheapest and safe immuno-modulator available as therapeutic agent with satisfactory result.

Dietary management of childhood diarrhea in low- and middle-income countries: a systematic review

BackgroundCurrent WHO guidelines on the management and treatment of diarrhea in children strongly recommend continued feeding alongside the administration of oral rehydration solution and zinc therapy, but there remains some debate regarding the optimal diet or dietary ingredients for feeding children with diarrhea.MethodsWe conducted a systematic search for all published randomized controlled trials evaluating food-based interventions among children under five years old with diarrhea in low- and middle-income countries. We classified 29 eligible studies into one or more comparisons: reduced versus regular lactose liquid feeds, lactose-free versus lactose-containing liquid feeds, lactose-free liquid feeds versus lactose-containing mixed diets, and commercial/specialized ingredients versus home-available ingredients. We used all available outcome data to conduct random-effects meta-analyses to estimate the average effect of each intervention on diarrhea duration, stool output, weight gain and treatment failure risk for studies on acute and persistent diarrhea separately.ResultsEvidence of low-to-moderate quality suggests that among children with acute diarrhea, diluting or fermenting lactose-containing liquid feeds does not affect any outcome when compared with an ordinary lactose-containing liquid feeds. In contrast, moderate quality evidence suggests that lactose-free liquid feeds reduce duration and the risk of treatment failure compared to lactose-containing liquid feeds in acute diarrhea. Only limited evidence of low quality was available to assess either of these two approaches in persistent diarrhea, or to assess lactose-free liquid feeds compared to lactose-containing mixed diets in either acute or persistent diarrhea. For commercially prepared or specialized ingredients compared to home-available ingredients, we found low-to-moderate quality evidence of no effect on any outcome in either acute or persistent diarrhea, though when we restricted these analyses to studies where both intervention and control diets were lactose-free, weight gain in children with acute diarrhea was shown to be greater among those fed with a home-available diet.ConclusionsAmong children in low- and middle-income countries, where the dual burden of diarrhea and malnutrition is greatest and where access to proprietary formulas and specialized ingredients is limited, the use of locally available age-appropriate foods should be promoted for the majority of acute diarrhea cases. Lactose intolerance is an important complication in some cases, but even among those children for whom lactose avoidance may be necessary, nutritionally complete diets comprised of locally available ingredients can be used at least as effectively as commercial preparations or specialized ingredients. These same conclusions may also apply to the dietary management of children with persistent diarrhea, but the evidence remains limited.

A study on efficacy of oral zinc therapy for treatment of acrodermatitis enteropathica

Introduction: Acrodermatitis enteropathica (AE) is a disorder of zinc metabolism that occurs in one of two forms: an inborn (congenital) form and an acquired form. The inborn form of AE is a rare genetic disorder characterized by intestinal abnormalities that leads to inability to absorb zinc from the intestine. The lack of zinc presents, characteristically, as skin inflammation with pustules occurring around the mouth and/or anus, diarrhea. Aims: To study the efficacy of oral zinc therapy on thirty patients of acrodermatitis enteropathica. Methods: Thirty clinically diagnosed patients of acrodermatitis enteropathica were taken for the study. The criterion of diagnosis of this condition was the clinical picture of symmetrical vesiculo-pustular dermatitis, in upper and lower limbs and periorificial regions . Results and Discussion: In our study maximum (50%) patients were below 1 year of age, 33.3% patients were between 13-24 months of age, 6.66% patients were between 25- 36 months and 37- 48 months each and 3.33% patients were between 49- 60 months of age. Nail changes were seen in 60% children. Also, it was seen that perioral area was the commonest (86.6%) site involved, followed by anogenital area in 80% patients, palms and soles were involved in 66.6% patients, arms in 46.6% patients and legs were seen in 40% patients. Regarding clinical features, dermatitis was seen in 100%patients, alopecia was seen in 40% patients, diarrhea in 60% patients and mental disturbances were seen in 30 % patients.

Comment: A study on efficacy of oral zinc therapy for treatment of acrodermatitis enteropathica

comment: A study on efficacy of oral zinc therapy for treatment of acrodermatitis enteropathica

Necrolytic acral erythema

Necrolytic acral erythema is a rare, cutaneous manifestation of hepatitis C virus infection that is characterized by erythematous, violaceous or dusky papules, blisters, and/or erosions in the early stages and by well-demarcated, hyperkeratotic, targetoid plaques with a peripheral rim of macular erythema, secondary lichenification and hyperpigmentation, and overlying fine micaceous or necrotic-appearing scale in the later stages. Because most topical modalities prove ineffective, treatment of the underlying viral infection or therapeutic zinc supplementation are required for clinical improvement.