Rehydration Solution Research Articles

Comparative, randomized-controlled trial on efficacy and safety of Lactobacillus rhamnosus GG and Saccharomyces boulardii in treatment of acute diarrhea in Indian children (COMPARE-GG trial)

Background: Probiotics are routinely prescribed to boost gut health and reduce severity of diarrhea. This study aimed to compare the efficacy and safety of Lactobacillus rhamnosus GG (LrGG) and Saccharomyces boulardii as an adjunct treatment for acute diarrhea in Indian children aged 6–36 months. Methods: In this single-center, open label, comparative, randomized controlled study, children were randomized into three groups (n=35, each) and provided either low osmolarity oral rehydration solution (ORS) and zinc (20 mg/day) alone or ORS+Zinc supplemented with one of the two probiotic preparations, LrGG ATCC 53103 or S. boulardii CNCM 1-745. Children were monitored every 8 hours after admission and the duration of diarrhea and hospital stay, and stool frequency were evaluated. Results: Of the total 105 children enrolled in the study, majority were aged between 13–24 months (40%). LrGG significantly reduced the mean duration of diarrhea by nearly 19 hours, when compared to the control group (p=0.003), while reduction by S. boulardii was not significant. The mean hospital stay duration for control group was about 6 days, which was significantly reduced (p=0.0001) by nearly 23 hours by LrGG, and non-significantly by S. boulardii. On day 2, LrGG significantly reduced stool frequency by 32.31%, as compared to 27.44% reduction in control group. S. boulardii reduced stool frequency by 31.76%, which was not statistically significant compared to that in control group. Conclusions: LrGG showed statistically significant reduction in duration of diarrhea and hospital stay, when compared against the group receiving ORS+zinc either alone or with S. boulardii.

Nutritional Profiles and Zinc Supplementation among Children with Diarrhea in Bangladesh.

Zinc supplementation is an added intervention with oral rehydration solution (ORS) for treating childhood diarrhea as per World Health Organization recommendations. Our study aimed to determine the prevalence of zinc administration in addition to ORS for childhood diarrhea before hospitalization and the nutritional profile of those children admitted to the outpatient department of the largest diarrheal facility in Bangladesh. This study used a screening dataset of a clinical trial (www.clinicaltrials.gov; NCT04039828) on zinc supplementation at a Dhaka hospital (International Centre for Diarrhoeal Disease Research, Bangladesh) between September 2019 and March 2020. A total of 1,399 children aged 3-59 months were included in our study. Children were divided into two groups (one group received zinc and another did not) and were analyzed accordingly; 39.24% (n = 549) children received zinc along with ORS for the current diarrheal episode prior to hospitalization. Percentages of underweight (weight-for-age z-score < -2 SD), stunting (length/height-for-age z-score < -2 SD), wasting (weight-for-length/height z-score < -2 SD), and overweight (weight-for-age z-score > +2 SD) among these children were 13.87% (n = 194), 14.22% (n = 199), 12.08% (n = 169), and 3.43% (n = 48), respectively. In logistic regression after adjusting age, sex, and nutritional status (underweight, stunting, wasting, and overweight), association of dehydration (adjusted odds ratio [aOR]: 0.06; 95% CI: 0.03-0.11; P < 0.01), bloody diarrhea (aOR: 0.18; 95% CI: 0.11-0.92; P < 0.01), and fever (aOR: 0.27; 95% CI: 0.18-0.41; P < 0.01) were less with children who received zinc at home. Bangladesh is one of the leading zinc coverage areas globally but lags behind the target for zinc coverage in diarrheal illness among under-five children. Policymakers should scale up and formulate guidelines with sustainable strategies to encourage zinc supplementation in diarrheal episodes in Bangladesh and elsewhere.

Evaluation of knowledge and Satisfaction among service recipient of (Integrated Management of Neonatal and Child Health Program) in Primary Health Care Centers in Baquba City

Background: Integrated Management of Neonatal and Child Health Program (IMNCH) is an approach to offering solid evidence. It is used as a strategy to draw national and international investment into many initiatives to improve child health because it is diagnostically superior to conventional routine practice.&#x0D; Objective: To assess the knowledge and satisfaction rate among Integrated Management of Neonatal and Child Health Program care takers.&#x0D; Patients and Methods: A cross sectional study was conducted in two sectors (The health care sector in baqubah first and second) that offers health services in Baquba city from 15th December 2015 to 1st of June 2016. A convenient sample of 150 cases were included in the study from the age of two month to five years. Data collected by special designed questionnaire that adopted from world health organization.&#x0D; Results: The result showed that 87.3 % of health providers prescribed oral medicine for child out of them 86.3% of service recipient know how many times day that should be given while 25.2% of them know how many days that should be given. oral rehydration solution was prescribed 31.3% of children majority of health takers 87.2% known quantity of water to maxed with one sachet of ORS Showed that 24.7% of service recipients bring back the child immediately to primary health care center when the child unable to drink or breast feed and 23% of service recipients bring back the child immediately when the child becomes sicker or develop fever or difficult breathing and 30%when the child breathing is fast or difficult breathing and 18% of service recipient were satisfied about care that provided for children while 82% of service recipients were not satisfied.&#x0D; Conclusion: The satisfaction rate of service recipients about the service that provided in primary heath care center in Baquba city were poor.

Evaluation of knowledge and Satisfaction among service recipient of (Integrated Management of Neonatal and Child Health Program) in Primary Health Care Centers in Baquba City

Background: Integrated Management of Neonatal and Child Health Program (IMNCH) is an approach to offering solid evidence. It is used as a strategy to draw national and international investment into many initiatives to improve child health because it is diagnostically superior to conventional routine practice. Objective: To assess the knowledge and satisfaction rate among Integrated Management of Neonatal and Child Health Program care takers. Patients and Methods: A cross sectional study was conducted in two sectors (The health care sector in baqubah first and second) that offers health services in Baquba city from 15th December 2015 to 1st of June 2016. A convenient sample of 150 cases were included in the study from the age of two month to five years. Data collected by special designed questionnaire that adopted from world health organization. Results: The result showed that 87.3 % of health providers prescribed oral medicine for child out of them 86.3% of service recipient know how many times day that should be given while 25.2% of them know how many days that should be given. oral rehydration solution was prescribed 31.3% of children majority of health takers 87.2% known quantity of water to maxed with one sachet of ORS Showed that 24.7% of service recipients bring back the child immediately to primary health care center when the child unable to drink or breast feed and 23% of service recipients bring back the child immediately when the child becomes sicker or develop fever or difficult breathing and 30%when the child breathing is fast or difficult breathing and 18% of service recipient were satisfied about care that provided for children while 82% of service recipients were not satisfied. Conclusion: The satisfaction rate of service recipients about the service that provided in primary heath care center in Baquba city were poor.

Reducing Ileostomy Readmissions: Using Implementation Science to Evaluate the Adoption of a Quality Improvement Initiative.

Translating empirical evidence into clinical practice remains challenging. Prevention of morbidity from new ileostomies may serve as an example. Despite evidence demonstrating improvements in electrolyte levels, kidney function markers, and hospital readmissions, widespread adoption of oral rehydration solutions among patients with new ileostomies has not occurred. The causes of low uptake are unknown and likely multifactorial. We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance implementation science framework to identify barriers and facilitators in the adoption of a quality improvement initiative aimed at decreasing emergency department visits and hospital readmissions because of dehydration among patients with new ileostomies using oral rehydration solutions. Qualitative interviews were conducted with stakeholders based on the domains of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Participating community and academic hospitals across Michigan (n = 12). Convenience sampling was used to recruit 25 key stakeholders, including wound, ostomy, and continence nurses; registered nurses; nurse practitioners; nurse managers; colorectal surgeons; surgery residents; physician assistants; and data abstractors (1-4 participants per site). Through qualitative content analysis, we located, analyzed, and identified patterns using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We identified the following factors to increase the adoption of quality improvement initiatives at the provider level: 1) selection and coaching of champions, 2) broadening of multidisciplinary teams, 3) performing structured patient follow-up, and 4) addressing long-term sustainability concerns regarding cost and equity. Limited to high-volume ileostomy surgery hospitals, did not include in-person site visits to each hospital before and after implementation, and did not consider the hospital- and patient-level factors that impact the widespread adoption of quality improvement initiatives. Integrating implementation science frameworks to rigorously study quality improvement initiatives may reveal the determinants of the widespread adoption of evidence-based practices. ANTECEDENTES:Traducir la evidencia empírica a la práctica clínica sigue siendo un desafío. La prevención de la morbilidad por nuevas ileostomías puede servir como ejemplo. A pesar de la evidencia que demuestra mejoras en los niveles de electrolitos, marcadores de función renal y reingresos hospitalarios, no se ha producido una adopción generalizada de soluciones de rehidratación oral entre pacientes con nuevas ileostomías. Las causas de la baja captación son desconocidas y probablemente multifactoriales.OBJETIVO:Empleamos Alcance, Eficacia, Adopción, Implementación y Mantenimiento, un marco de las ciencias de implementación, para identificar barreras y facilitadores en la adopción de una iniciativa de mejora de la calidad destinada a disminuir las visitas al departamento de emergencias y los reingresos hospitalarios debido a la deshidratación entre los pacientes con nuevos ileostomías utilizando soluciones de rehidratación oral.DISEÑO:Se realizaron entrevistas cualitativas con las partes interesadas basadas en los dominios del marco de Alcance, Efectividad, Adopción, Implementación y Mantenimiento.CONFIGURACIÓN:Hospitales académicos y comunitarios participantes a través de Michigan (n = 12).PARTICIPANTES:Se utilizó un muestreo por conveniencia para reclutar a 25 partes interesadas clave, incluyendo enfermeras de heridas, ostomía y continencia; enfermeras registradas; enfermeras practicantes; gerentes de enfermera; cirujanos colorrectales; residentes de cirugía; asistentes médicos; y extractores de datos (1-4 participantes por sitio).PRINCIPALES MEDIDAS DE RESULTADO:A través del análisis de contenido cualitativo, localizamos, analizamos e identificamos patrones utilizando el marco de Alcance, Eficacia, Adopción, Implementación y Mantenimiento.RESULTADOS:Identificamos los siguientes factores para aumentar la adopción de iniciativas de mejora de la calidad a nivel de proveedores: 1) selección y entrenamiento de campeones, 2) ampliación de equipos multidisciplinarios, 3) seguimiento estructurado de pacientes y 4) abordaje a largo plazo. preocupaciones de sostenibilidad con respecto al costo y la equidad.LIMITACIONES:Limitado a hospitales de cirugía de ileostomía de alto volumen, incapaz de realizar visitas en persona a cada hospital antes y después de la implementación, no considera los factores a nivel del hospital y del paciente que afectan la adopción generalizada de iniciativas de mejora de la calidad.CONCLUSIONES:La integración de marcos científicos de implementación para estudiar rigurosamente las iniciativas de mejora de la calidad puede revelar los determinantes de la adopción generalizada de prácticas basadas en la evidencia. (Traducción-Dr. Aurian Garcia Gonzalez ).

Case Report: Effect of Oral Rehydration Solutions Added to the Conventional ‎Treatment Protocol for the Treatment of Parvoviral Enteritis

Case Report: Effect of Oral Rehydration Solutions Added to the Conventional ‎Treatment Protocol for the Treatment of Parvoviral Enteritis

On the Politics of Viruses and Visibility

On the Politics of Viruses and Visibility

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 &amp; 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

A Descriptive Study to Assess Child Nutrition and Health Information Related Knowledge among Mothers of Under Six Years Children in Selected Areas of Dadra &amp; Nagar Haveli

Background: The Health of a country depends on healthy citizens. Healthy children grow up to be healthy adults. Young children, especially those under the age of six are in a vulnerable stage of physical development. Malnutrition during this time can have long-term and irreversible consequences. Mothers have to be made more aware about feeding practices and health-care practices only then it can go a long away in reducing the severity of malnutrition. As per ICDS guidelines on convergence initiatives for improved nutrition, Knowledge of mothers regarding child Nutrition and Health information can be assessed based on five key Nutrition and Health information as follows: (i) importance of colostrum; (ii) continued breastfeeding; (iii) diarrhea prevention and treatment using oral rehydration solution (ORS); (iv) child immunization and (v) family planning. Aim: To assess knowledge regarding child nutrition and health information among mothers of under six year children in selected areas of Dadra and Nagar Haveli. Methodology: A descriptive survey design was used to collect data with structured interview method from 200 mothers which were selected from non-probability convenient sampling technique. Result: Out of 200 mothers whosever taken part in study, 24.50 % had inadequate knowledge, 64.50 % had moderate knowledge and 11.0 % had adequate knowledge. Age, education of mothers and family monthly income were having significant association with knowledge score at 0.05 level of significance. Conclusion: This study concluded that mothers were having moderate knowledge which is affected by mainly age and education of mothers, hence improving knowledge level of mothers can positively impact growth and development of children.

The Safety of Oral Rehydration Solution Jelly for Water and Electrolyte Intake in Patients with Dysphagia.

Oral rehydration solutions (ORSs) are effective in replacing fluids and electrolytes and are widely used. OS-1 Jelly (Otsuka Pharmaceutical Factory, Tokushima, Japan) is a jelly drink corresponding to code 2-1 of the 2021 Japanese Dysphagia Diet. Although jelly drinks are less likely to be aspirated than liquids, their physical properties vary depending on the product. Therefore, the severity of dysphagia may affect intake status. This study aimed to investigate the association between the intake status of ORS jelly and swallowing function. Thirty-six patients with dysphagia who required videoendoscopic swallowing evaluation at our university hospital were enrolled. Videoendoscopic swallowing evaluation was performed, and each participant swallowed 5 mL of OS-1 Jelly or thickened water modified to International Dysphagia Diet Standardization Initiative (IDDSI) level 2 three times. Statistical analysis was performed to determine the difference in the number of swallows, time until the swallowing reflex, position for inducing the swallowing reflex, presence of pharyngeal residue, penetration, or aspiration between ORS jelly and thickened water. The time until the swallowing reflex was induced and the position of the swallowing reflex triggered were significantly earlier for ORS jelly (p=0.012, p=0.001). The incidence of pharyngeal residue was significantly lower with ORS jelly (p=0.002). The Penetration-Aspiration Scale score was similar for both samples (p=0.062), and no aspiration was observed in either sample. Patients with dysphagia who can swallow thickened water modified to IDDSI level 2 can consume ORS jelly. ORS jelly, which requires no thickening and can be easily and safely consumed, is effective for water and electrolyte intake in patients with dysphagia.

Recent surge in cholera outbreaks globally during the COVID-19 pandemic era: a potential threat to the African continent and salient counteracting strategies.

Recent surge in cholera outbreaks globally during the COVID-19 pandemic era: a potential threat to the African continent and salient counteracting strategies.

Home Management Practices of Acute Respiratory Infections and Acute Diarrhea of Children in Sana’a, Yemen

Introduction: Acute Respiratory Infections, (ARI), and diarrhea represent major leading cause to under five morbidity and mortality all over the world. Majority of these cases occur in the poorest communities. This study aimed to assess different home management practices of pneumonia and diarrhea in Sana’a. Methods: This is a hospital-based cross-sectional study with direct interview of Mothers recruited from major hospitals in Sana’a between January and May 2020. Results Two hundred and six mothers were enrolled in this study. Hundred and sixty-six (80.6%) of mothers in this study used over-the-counter anti-cough preparations. The study reported 58.7% of mothers did not give their children Oral Rehydration Solution (ORS), during diarrhea. We found 45.1% and 35% gave antibiotics without prescription during ARI and acute diarrhea respectively. Majority of mothers continued breastfeeding. No association was detected between practices and demographic features or educational level of mothers. Conclusion: Inappropriate self-medication practices regarding the management of acute diarrhea and ARI and under use of ORS for acute diarrhea were common home practices. There is a great need to increase awareness of mothers about home management through health education programs.

Upaya Peningkatan Pengetahuan, Sikap dan Perilaku dengan Kejadian Muntaber melalui Perilaku Hidup Bersih dan Sehat

Clean and healthy living behavior in the household is one of the efforts so that the community is in a clean and healthy environment so that it can reduce the incidence of infectious and non-communicable diseases. This is in accordance with one of the themes of the sustainable development goals, namely a healthy and prosperous life. One of the diseases that often arise in the community is diarrhea. Data from the Cimanggung Community Health Center showed that 9.59% of people with vomiting and defecation occurred in Sindanggalih Village. The implementation of community service was carried out in August 2022 by lecturers and students of Bhakti Kencana University. The target of the activity is RW 1-10 cadres, totalling 37 people. Providing health promotion about vomiting and defecation, drug self-medication and Oral rehydration solution demonstration. The community was given a pre-test and post-test in the form of a knowledge, attitude and action questionnaire to measure the achievement of activities. The results show that the average pre-test knowledge is 8.13 and the post-test average is 8.83; the average attitude of the pre-test was 16.32 and the post-test was 16.70 and the mean of the pre-test was 16.35 and the post-test was 16.97. This shows that there is an increase in knowledge of 0.7, attitude of 0.38 and action of 0.62.

Breastfeeding practices among mothers attending a tertiary care hospital in Kashmir

Background: According to world health organization (WHO), exclusive breastfeeding (EBF) for the first 6 months of life is vital for optimal growth and development of a child. During this period, other liquids or breastfeeding substitutes should not be given to infants except for medicine or oral rehydration solution. Methods: This cross-sectional study was conducted in the child health clinic of the department of community medicine, SKIMS. The study participants were mothers accompanying their infants coming for immunisation at the child health centre. A semi-structured, questionnaire was used to interview the mothers regarding breast feeding practices of their infants. The data was entered in Microsoft excel 2010 and analysed using SPSS Version 20. Results: The prevalence of EBF was 38.7%. Mixed feeding was received by 54% and 7.3% were formula-fed. Variables that were significantly associated with EBF include residence and mother’s education. Infants from rural area were more likely to be exclusively breastfed compared to those from urban area (OR=0.365; 95% CI=0.166-0.802; p=0.012). Mothers with up to 9 years of formal education were more likely to exclusively breastfed their children than those with more than 9 years of formal education (OR=0.300;95% CI=0.121-0.744, p=0.009). Conclusions: To ensure that the rate of EBF among the mothers is increased, all the stakeholders (spouse, family and government) as well as the people at work place must play their part to the best extent.

A single dose of ciprofloxacin reduces the duration of diarrhea among service members deployed in Africa

ObjectivesTo assess the effectiveness of the adjunction of a one-gram single dose of ciprofloxacin to a symptomatic treatment for the early treatment of uncomplicated diarrhea during military operations of the French service members in Africa. Patients and methodsThis phase IV, multicentric, randomized, open-label, controlled trial was conducted in Chad, Mali, and in Central African Republic. A total of 267 French service members having at least one loose stool in the previous 24 hours were enrolled from May 2015 to June 2016. Participants were randomized to receive ciprofloxacin 1 g and a symptomatic treatment (racecadotril 100 mg three times a day and ad libidum oral rehydration solution) or a symptomatic treatment alone. The primary outcome was the duration of the diarrhea. Secondary outcomes were evaluated at the 72-hour endpoint and included recovery status, number of loose stools, frequency and duration of associated symptoms and safety of treatments. ResultsAmong 267 participants, 242 completed the trial. Participants receiving ciprofloxacin and a symptomatic treatment (n = 124) were significantly more likely to be cured at the endpoint than those who only received a symptomatic treatment (118): 94.4 % versus 74.6 % (OR = 5.7; 95 %CI: [2.4–13.6]; p < 10-3). The antibiotic therapy reduced the average diarrhea duration by 30 % (p = 10-4). Fever at inclusion was associated with a longer episode (HR = 0.61; 95 %CI: [0.41–0.89]; p = 0.012). No adverse event of medications was reported. ConclusionA single dose of ciprofloxacin was effective and safe in treating uncomplicated diarrhea among service members in Africa.

Assessment of Home-Based Care for Young Child (HBYC) Program in Aspirational Districts of Madhya Pradesh, India: A Cross-Sectional Study.

In 2018, Government of India initiated Home-Based Care for Young Child (HBYC) program having five quarterly structured home visits for children age 3 to 15 months to promote early childhood development. Assess knowledge and practices of Accredited Social Health Activist (ASHAs), other health functionaries, and mothers related to HBYC. Cross-sectional evaluation design with ASHAs, AWWs, ANMs, ASHA, and mothers of 3 to 15 month's children as participants. Knowledge and practices of 801 ASHAs, 200 other health functionaries, and 787 mothers were assessed on exclusive breastfeeding, complementary feeding, hand washing, iron folic acid (IFA) and oral rehydration solution (ORS) supplementation, danger referral signs in eight aspirational districts of Madhya Pradesh. 88% ASHAs had correct knowledge on ORS, 85% on complementary feeding, 85% on adequacy of IFA, and 47% on danger signs which required child referral. Similarly, 85% of mothers had knowledge on exclusive breastfeeding, 40% mothers knew about complementary feeding, and only 18% knew correct ORS preparation. Statistically significant association was observed between ASHAs home visits and availability of ORS with mothers and their knowledge on correct Initiation of IFA (p < 0.001). Findings of study confirmed majority of health functionaries were aware about roles, responsibilities, and key tasks under HBYC. However, there observed a gap in knowledge transfer by health functionaries and thus inadequate translation of knowledge into practices among mothers on HBYC. This necessitates the need of appropriate actions from health system strengthening to capacity building to accelerate uptake of HBYC program.

MCQ corner

1. Selenocysteine is coded by UGA UAG UAA AUG Ans: A. UGA Explanation Selenocysteine (SeCys/SeC) is the 21st amino acid and is found in thioredoxin reductase, glutathione peroxidase, 5’-deiodinase, and selenoprotein P. It is an exceptional case where a stop codon codes for an amino acid. The other stop codons are UAA and UAG. The ability of the protein synthetic apparatus to identify a selenocysteine-specific UGA codon involves the selenocysteine insertion element, a stem-loop structure in the untranslated region of the mRNA.[1] 2. A child with diarrhea for 2 days came to your out-patient department (OPD). On examination, the signs of dehydration were marked and the child was treated with oral rehydration solution (ORS). Glucose absorption was facilitated by which receptors? SGLT1 SGLT2 GLUT4 Sodium–hydrogen antiporter Ans: A. SGLT1 Explanation Absorption of glucose from the intestinal lumen to intestinal cells is by the cotransport mechanism. It is an active transport system and can transport against the concentration gradient.[2] 3. Skeletal derivative of the second pharyngeal arch is Malleus Incus Stapes Maxilla Ans: C. Stapes Explanation Maxilla, malleus, and incus are derived from the first arch.[3] 4. Blastocyst makes contact with a uterus on <3 days 5–7 days 8–11 days 15–16 days Ans: B. 5–7 days Explanation Contact of the blastocyst with endometrium occurs at the time of implantation. Implantation occurs at around 5-7 days.[4] 5. The father of antiseptic surgery is Louis Pasteur Robert Koch Julius Petri Joseph Lister Ans. D. Joseph Lister Explanation Louis Pasteur – the father of microbiology, Robert Koch – the father of microbiology (with Louis Pasteur), and the father of medical bacteriology, Julius Petri – invented the Petri dish.[5] 6. Following were the findings in a Glucose tolerance test (GTT). Fasting blood glucose <75 mg/dl; all blood samples show low blood glucose; urine glucose – nil. The possible diagnosis is Alimentary glycosuria Diabetes mellitus Hypopituitarism Diabetes insipidus Ans. C. Hypopituitarism Explanation In alimentary glycosuria, there will be a peak in the first sample after glucose load and sugar will appear in urine. In diabetes mellitus, fasting and the next two samples will show higher values than the normal reference range and the sample does not return to baseline at the end of the test. In hypopituitarism, there is hypoglycemia and the patient feels fatigued and stressed. In diabetes insipidus, GTT is mostly unaffected.[6] 7. A 10-year-old boy with a history of atopy presented with seasonal recurrent bilateral conjunctivitis and complained of blurred vision for the past 1 week. On lid eversion, giant papillae were seen. All of the following could be seen by slit-lamp examination except: Vascular pannus and punctate epithelial erosions involving the superior cornea. An oval epithelial ulceration with underlying stromal opacification in the central cornea Limbal follicles Conjunctival symblepharon Ans. D. Conjunctival symblepharon Explanation A conjunctival symblepharon is seen in the case of autoimmune disorders such as Sjogren’s syndrome, sarcoidosis, lichen planus, granulomatosis with polyangiitis, etc.[7] 8. Which of the following breast lesion is a noninvasive malignancy? Tubular carcinoma and mucinous carcinoma Intraductal carcinoma of the comedo type Infiltrating ductal carcinoma and lobular carcinoma Medullary carcinoma, including atypical medullary lesions Ans. B. Intraductal carcinoma of the comedo type Explanation A comedo-type ductal carcinoma in situ (DCIS), also known as comedocarcinoma insitu, is the high-grade subtype of DCIS. It completely fills and dilates the ducts and lobules in terminal duct lobular units with plugs of high-grade tumor cells with central necrosis “comedonecrosis.”[8] 9. In patients who develop a documented episode of deep-vein thrombosis, the most significant long-term sequelae are: Claudication Recurrent foot infections Development of stasis ulcer Pulmonary embolization Ans. C-Development of stasis ulcer Explanation Chronic symptoms may occur after 6 weeks or beyond. Pulmonary embolization is the most common complication but is seen as an acute complication.[9] 10. Identify the test from the diagram. Rothera’s test Benedict’s test Barfoed’s test Seliwanoff’s test Ans. A. Rothera’s testFigure 1: Purple permanganate coloured ring [Ferro-penta cyanine complex] at the junction of two fluidsExplanation Rothera’s test was done to identify the presence of ketone bodies in a urine sample. Benedict’s test will contain a green/yellow/orange/brick red precipitate at the bottom. Barfoed’s test has a red scum at the top of the fluid and a little red precipitate at the bottom. Seliwanoff’s test will have a cherry red color.[10] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Capacity and quality of maternal and child health services delivery at the subnational primary healthcare level in relation to intermediate health outputs: a cross-sectional study of 12 low-income and middle-income countries

ObjectivesTo examine the capacity and quality of maternal and child health (MCH) services at the subnational primary healthcare (PHC) level in 12 low-income and middle-income countries (LMICs) and its association...

Assessment of Maternal Knowledge and Practices Regarding Acute Diarrheal Illnesses in Children in Saudi Arabia: A Tertiary Care Center Survey.

Background Diarrheal illness remains one of the most common causes of death among children specifically those who live in developing countries. Appropriate mothers' knowledge and practice regarding acute diarrhea illness in children can considerably reduce diarrhea-related morbidity and mortality. So, the aim of this study was to evaluate mothers' knowledge and practice regarding acute diarrheal illness in children. Method This cross-sectional study was conducted in a tertiary hospital in Riyadh, Saudi Arabia using a newly developed questionnaire that was distributed to King Abdullah Specialist Children. The calculated sample size was 375. Results A total of 375 mothers were included in this study and the majority of them(99%) were Saudis. More than half of the participants (61%) were university graduates.The majority(96.5%) choseprevious experience as the main source of information about diarrhea while(40%) chose physician. Most of the mothers(69.6%) believed that teething is the leading cause of diarrheal illness in children. Regarding the treatment, fluid was recognized to be the major treatmentfor diarrhea as chosen by the mothers. Around (42.7%) of the respondents thought intravenous fluid is more effective than oral rehydration solution (ORS) in treating dehydration associated withdiarrheal episodes. ORS was the main type of fluid (74.1%) which was selected by the mothers to be given during the diarrheal episode. Conclusion Mothers showed good knowledge and practice overall in regard to acute diarrheal illness in children. However, this study revealed some misconceptions among the caregivers which necessitates more educational sessions to be conducted in the community and during the hospital visit.

An insight into the commercial piglet’s microbial gut colonization: from birth towards weaning

BackgroundThe establishment of the gut microbiota can be influenced by several perinatal factors, including, most importantly, the maternal microbiota. Moreover, early-life environmental variation affects gut microbial colonization and the intestinal health of offspring throughout life. The present study aimed to explore the development of piglet gut microbiota from birth to weaning in the commercial practice and also to assess how different farm environments could condition this process. Although it is possible to find in the literature other studies with similar objectives this work probably represents one of the few studies that make a systematic evaluation of such differential factors under a real scenario. To achieve this objective, we performed two trials. In a first Trial, we selected 2 farms in which we performed an intensive sampling (5 samples /animal) to characterize the gut colonization pattern during the first days of life and to identify the time window with the greatest impact. Both farms differed in their health status and the use of antimicrobials in the piglets. In a second Trial, we selected 4 additional farms with variable rearing conditions and a distinctive use of antimicrobials in the sows with a simplified sampling pattern (2 samples/animal). Faecal samples were obtained with swabs and DNA was extracted by using the PSP® Spin Stool DNA Kit and sequencing of the 16S rRNA gene (V3-V4 region) performed by Illumina MiSeq Platform.ResultsThe present study contributes to a better understanding of microbiome development during the transition from birth to weaning in commercial conditions. Alpha diversity was strongly affected by age, with an increased richness of species through time. Beta diversity decreased after weaning, suggesting a convergent evolvement among individuals. We pinpointed the early intestinal colonizers belonging to Bacteroides, Escherichia-Shigella, Clostridium sensu stricto 1, and Fusobacterium genera. During lactation(d7-d21 of life), the higher relative abundances of Bacteroides and Lactobacillus genera were correlated with a milk-oriented microbiome. As the piglets aged and after weaning (d36 of life), increasing abundances of genera such as Prevotella, Butyricimonas, Christensenellaceae R-7 group, Dorea, Phascolarctobacterium, Rikenellaceae RC9 gut group, Subdoligranulum, and Ruminococcaceae UCG-002 were observed. These changes indicate the adaptation of the piglets to a cereal-based diet rich in oligosaccharides and starch. Our results also show that the farm can have a significant impact in such a process, evidencing the influence of different environments and rearing systems on the gut microbiota development of the young piglet. Differences between farms were more noticeable after weaning than during lactation with changes in alpha and beta biodiversity and specific taxa. The analysis of such differences suggests that piglets receiving intramuscular amoxicillin (days 2–5 of life) and being offered an acidifying rehydrating solution (Alpha farm in Trial 1) have a greater alpha diversity and more abundant Lactobacillus population. Moreover, the only farm that did not offer any rehydrating solution (Foxtrot farm in Trial 2) showed a lower alpha diversity (day 2 of life) and increased abundance of Enterobacteriaceae (both at 2 and 21 days). The use of in-feed antibiotics in the sows was also associated with structural changes in the piglets’ gut ecosystem although without changes in richness or diversity. Significant shifts could be registered in different microbial groups, particularly lower abundances of Fusobacterium in those piglets from medicated sows.ConclusionsIn conclusion, during the first weeks of life, the pig microbiota showed a relevant succession of microbial groups towards a more homogeneous and stable ecosystem better adapted to the solid dry feed. In this relevant early-age process, the rearing conditions, the farm environment, and particularly the antimicrobial use in piglets and mothers determine changes that could have a relevant impact on gut microbiota maturation. More research is needed to elucidate the relative impact of these farm-induced early life-long changes in the growing pig.