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Copyright of Al-Qadisiyah Journal of Pure Science is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The latest studies indicate that probiotics can help with colic, eczema, and certain types of diarrhea. They may also help with upper respiratory infections and IBS pain. [ABSTRACT FROM AUTHOR]

Aim: Implementing international guidelines guarantees high standards of clinical care. A group of experts developed an algorithm to drive the management of common gastrointestinal symptoms in infancy by paediatricians and general practitioners.Methods: The algorithm started from the evidence-based recommendations of the European Society of Gastroenterology, Hepatology and Nutrition and the European Society of Pediatric Infectious Diseases and an updated review of the literature. We used the structured quantitative method of nominal group technique to reach a consensus.Results: A practical algorithm for the management of infants with acute diarrhoea was designed based on the consensus reached for each statement. The management of an infant with acute diarrhoea should include a sequence of actions: (i) a semiquantitative estimate of infant dehydration through validated clinical scores, (ii) rehydration therapy and early refeeding with breast milk or regular formula and (iii) effective agents to reduce the severity and duration of the diarrhoea. Finally, in children with prolonged diarrhoea, the search for aetiology should include persistent infections or reinfections, cows' milk protein allergy and coeliac diseases. Lactose should always be withdrawn.Conclusion: This algorithm provides an evidence-based sequence of interventions to optimise the management of infants with acute diarrhoea. [ABSTRACT FROM AUTHOR]

Background: Exclusive Breast Feeding (EBF), the best feeding practice for infants aged from birth to six (6) months has faced challenges of adherence, exposes infants to infections such as diarrhoea, despite information on its importance being given to mothers. The main objective of this study was to establish levels of EBF practice among breast feeding mothers who had infants aged from birth to six months, factors influencing the practices and support required for mothers in Luangwa district. Methods: A descriptive cross section study design was used and a total sample of 171 breast feeding mothers with infants aged from birth to six months were selected using systematic sampling method. The study was conducted in five randomly selected health facilities. The respondents were interviewed using a pretested semi-structured interview schedule and five focus group discussions each group with seven participants, were conducted using a focus group discussion guide at study sites. Quantitative data was analysed using SPSS computer software package and Fishers Exact test was used to test the association between the dependent and independent variables. Qualitative data from the focus group discussions was analysed using content analysis with the help of qualitative research computer software Nvivo. Results: The prevalence of exclusive breast feeding practice was at 61%. The factors that were found to be statistically significant to exclusive breast feeding were age of infant and support breast feeding mothers received. The others factors were found not to be statistically significant to exclusive breast feeding and these were educational level of the mother, knowledge on benefits of breast feeding and support from spouse. The study revealed that mothers found it difficult to practice Exclusive Breast Feeding because of the amount of work at home and spouses found it difficult to help with house chores because culturally it was a woman's work. Conclusion: Though exclusive breast feeding practice had improved in the district, there was still need to strengthen the practice in the district through education of spouses, family and the community on infant feeding for them to support breast feeding mothers. With the support, mothers will have time to exclusively breast feed their infants. [ABSTRACT FROM AUTHOR]

BACKGROUND: Pyometra, an accumulation of pus in the uterine cavity, occurs rarely in children but should be considered in the differential diagnosis of an intraabdominal or pelvic abscess. CASE: A 10-month-old infant presented with an increasing abdominal mass. She had previous respiratory and diarrheal illnesses. She was underweight, febrile, and tachycardic with an 836-cm mobile tender mass in her lower abdomen. Investigations demonstrated leukocytosis and ultrasonogram confirmed a cystic mass. At laparotomy a pyometra was found. Needle aspiration and washout of the uterine cavity were performed but a second procedure was required to place a drain into the cavity. CONCLUSION: Pyometra occurs rarely in childhood. A review of cases associates a hypoestrogenized endometrium exposed to transient bacteremia with obstruction to uterine drainage. Treatment should include continuous drainage of the uterus. [ABSTRACT FROM AUTHOR]

Objective To verify the validity and practicality of the implementation of new standardized treatment of diarrhea in children in the people's hospital of Funing. Methods Three hundred and thirteen cases of infantile diarrhea were selected as the observation group from August 1, 2013 to July 31, 2014, and were treated by new standardized program. The other 313 cases of infantile diarrhea were randomly selected as the control group from July 1, 2010 to July 31, 2013, and were treated by the original therapeutic protocol. We compared the therapeutic effect, cure rate, satisfaction and knowledge awareness of parents of children patients between observation group and control group with t-student test and chi square test. Results There were significant differences between observation group and control groups, in the therapeutic effect, cure rate, satisfaction and knowledge awareness of parents of children. The therapeutic effect in the observation group was significantly better than the control group (P < 0.01). Conclusion The validity and practicability of new rural standardized treatment of diarrhea in children is significantly better than the original therapeutic protocol. [ABSTRACT FROM AUTHOR]

Background In endemic settings, Helicobacter pylori infection can occur shortly after birth and may be associated with a reduction in childhood growth. Materials and Methods This study investigated what factors promote earlier age of first H. pylori infection and evaluated the role of H. pylori infection in infancy (6-11 months) versus early childhood (12-23 months) on height. We included 183 children near birth from a peri-urban shanty town outside of Lima, Peru. Field-workers collected data on socioeconomic status ( SES), daily diarrheal and breast-feeding history, antibiotic use, anthropometrics, and H. pylori status via carbon 13-labeled urea breath test up to 24 months after birth. We used a proportional hazards model to assess risk factors for earlier age at first detected infection and linear mixed-effects models to evaluate the association of first detected H. pylori infection during infancy on attained height. Results One hundred and forty (77%) were infected before 12 months of age. Lower SES was associated with earlier age at first detected H. pylori infection (low vs middle-to-high SES Hazard ratio ( HR) 1.59, 95% CI 1.16, 2.19; p = .004), and greater exclusive breast-feeding was associated with reduced likelihood ( HR 0.63, 95% CI 0.40, 0.98, p = .04). H. pylori infection in infancy was not independently associated with growth deficits ( p = .58). However, children who had their first detected H. pylori infection in infancy (6-11 months) versus early childhood (12-23 months) and who had an average number of diarrhea episodes per year (3.4) were significantly shorter at 24 months (−0.37 cm, 95% CI, −0.60, −0.15 cm; p = .001). Discussion Lower SES was associated with a higher risk of first detected H. pylori infection during infancy, which in turn augmented the adverse association of diarrheal disease on linear growth. [ABSTRACT FROM AUTHOR]

This paper collects information on artificial infant feeding published before 1860, the year when commercial formula became available. We have extensive artifactual evidence of thousands of feeding vessels since the Bronze Age. Special museum collections can be found in London, Paris, Cologne, Fécamp, Toronto, New Mexico, and elsewhere. The literature on the use of animal milk for infant feeding begins with Soranus in the 2nd century CE. Literature evidence from the very first printed books in the 15th century proves that physicians, surgeons, midwives, and the laity were aware of the opportunities and risks of artificial infant feeding. Most 17th to 19th century books on infant care contained detailed recipes for one or several of the following infant foods: pap, a semisolid food made of flour or bread crumbs cooked in water with or without milk; gruel, a thin porridge resulting from boiling cereal in water or milk, and panada, a preparation of various cereals or bread cooked in broth. During the 18th century, the published opinion on artificial feeding evolved from health concerns to a moral ideology. This view ignored the social and economic pressures which forced many mothers to forego or shorten breast-feeding. Bottle-feeding has been common practice throughout history. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This study investigated the effect of breast-feeding in protection against protozoan infection in infants with persistent diarrhea. Infants were classified into 2 groups; 161 breast-fed infants and the same number of non-breast-fed infants. Microscopic examinations of stool were done for detection of parasites and measuring the intensity of infection. Moreover, serum levels of IgE and TNF-α were measured by ELISA. Cryptosporidium spp., Entamoeba histolytica/Entamoeba dispar, Giardia lamblia, and Blastocystis sp. were demonstrated in infants with persistent diarrhea. The percentage of protozoan infections was significantly lower in breast-fed infants than that in the non-breast-fed infants. The levels of IgE and TNF-α were significantly lower in the breast-fed group than in the non-breast-fed group. There were significant positive associations between the serum levels of IgE and TNF-α and the intensity of parasite infection in the breast-fed group. It is suggested that breast-feeding has an attenuating effect on the rate and intensity of parasite infection. [ABSTRACT FROM AUTHOR]

Justification: Diarrhea that lasts for more than two weeks is a common cause of mortality and morbidity in infants and children. There is a need to update the information available on this subject in Indian context. Process: This review has analyzed the available published data on the subject with particular focus on developing countries. It has also outlined the current diagnostic and management practices in India based on the experience of the participants from major hospitals in different parts of the country. Objectives: Problem areas in both persistent and chronic diarrhea have been identified and remedial measures relevant to India are presented. Recommendations: Micronutrient supplementation, algorithm based diet regimens, and good supportive care are sufficient in most children above 6 months of age with persistent diarrhea. Paucity of diagnostic facilities limits evaluation of chronic diarrhea in most parts of the country and regional laboratories need to be set up urgently. Lack of awareness regarding cow's milk protein allergy, celiac disease and immunodeficiency associated diarrhea is of particular concern. [ABSTRACT FROM AUTHOR]

Malnutrition continues to be a major public health problem in Nigeria, and this contributes substantially to childhood mortality. Culturally related food restriction and reduction in feeding frequency during common childhood illnesses such as diarrhoeal diseases further contributes to the burden of malnutrition and thus to childhood morbidity and mortality. This study was designed to determine the knowledge, attitudes and practices of nursing mothers with respect to food restriction during acute diarrhoea in Ibadan, South West Nigeria. This single round cross-sectional study adopted a purposive sampling procedure to select 250 nursing mothers aged between 17 and 45 years from the sick-baby and immunization clinics of two health facilities in Ibadan, between November 2003 and February 2004. Information on nutritional management of acute diarrhoea was collected with a structured intervieweradministered questionnaire and two focus group discussions exploring food withdrawal practices during acute diarrhoea. Data analysis was done using SPSS 11.0. Descriptive and inferential statistics were generated to test for associations. About half (46.8%) of the respondents had secondary education. Only 6.0% had knowledge of nutritional management of diarrhoea while 54.8% had knowledge of oral rehydration therapy. Seventy-one percent of respondents reported food withdrawal during acute diarrhoea in infants, 44% also reported reduction in breastfeeding frequency during acute diarrhoea and more than two-thirds of these (71.2%) cited cultural reasons for withholding breastfeeding. Mothers' educational level had no significant effect on their knowledge of nutritional management of acute diarrhoea in infants (p =0.610). Mothers' knowledge of nutritional management of acute diarrhoea had a significant effect on their attitude (p = 0.03) but not on their practice (p = 0.257). Relatives and health care providers were the sources of advice on food restriction/withdrawal during acute diarrhoea. Appropriate nutritional management during acute illness is important, and this has been found to be deficient among caregivers in the family setting. Targeting appropriate health and nutrition education to caregivers particularly mother would reduce morbidity and mortality commonly associated with childhood diarrhoea. [ABSTRACT FROM AUTHOR]

Identifying the underlying cause of congenital hypotonia remains difficult, despite advances in diagnostic laboratory and imaging techniques. Clinical evaluation strategies and standardized developmental tests can assist in differentiating hypotonia resulting from primary involvement of the upper motoneuron (central hypotonia) versus that involving the lower motoneuron and motor unit (peripheral hypotonia). This is especially important in infants with idiopathic hypotonia. This review outlines and describes the components of the clinical assessment: detailed infant and family history, clinical techniques and characteristics for differentiating hypotonia of central versus peripheral origin, and clinical evaluation (muscle tone, primitive reflexes, deep tendon reflexes, etc). Recent research that has contributed to the differential diagnosis of congenital hypotonia is reviewed and directions for future research are provided. Ideally, the assessment of infants with congenital hypotonia is best accomplished by an interdisciplinary team of developmental specialists including pediatricians, medical geneticists, child neurologists, and physical or occupational therapists. [ABSTRACT FROM AUTHOR]

Atypical enteropathogenic Escherichia coli (aEPEC) strains are frequently implicated in infant diarrhoea in developing countries. Not much is known about the adherence properties of aEPEC; however, it has been shown that these strains can adhere to tissue-cultured cells. A chromosomal region designated the locus for diffuse adherence (LDA) confers aEPEC strain 22 the ability to adhere to culture cells. LDA is an afimbrial adhesin that contains a major subunit, LdaG, whose expression is induced on MacConkey agar at 37°C. We hypothesized that the bile salts found in this culture media induce the expression of LdaG. Strain 22 and the LdaG mutant were grown in Luria–Bertani (LB) media in the presence or absence of bile salts and heat-extracted surface-expressed proteins were separated by SDS-PAGE to determine whether expression of the 25 kDa LdaG protein was induced. Western blot analysis with anti-LdaG confirmed that bile salts enhance LdaG expression at 37°C. Adhesion assays on HeLa cells revealed that adhesion in a diffuse pattern of strain 22 increased in the presence of bile salts. We also confirmed that expression of the localized adherence pattern observed in the ldaG mutant required the presence of a large cryptic plasmid found in strain 22 and that this phenotype was not induced by bile salts. At the transcriptional level, the ldaG-lacZ promoter fusion displayed maximum beta-galactosidase activity when the parent strain was grown in LB supplemented with bile salts. Fluorescence Activated Cell Sorting analysis, immunogold labelling electron microscopy and immunofluorescence using anti-LdaG sera confirmed that LDA is a bile salts-inducible surface-expressed afimbrial adhesin. Finally, LdaG expression was induced in presence of individual bile salts but not by other detergents. We concluded that bile salts increase expression of LDA, conferring a diffuse adherence pattern and having an impact on the adhesion properties of this aEPEC strain. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease is uncommon in infants. We present the clinical, endoscopic and pathologic findings for two exclusively breast-fed infants with a diagnosis of inflammatory bowel disease. We emphasize that although inflammatory bowel disease is rare in infants, chronic bloody diarrhea must be a sufficiently alarming symptom to consider a differential diagnosis of inflammatory bowel disease in young infants is considered, even when they are exclusively breast-fed. [ABSTRACT FROM AUTHOR]

Summary Background Pneumonia and diarrhea cause much morbidity and mortality in children younger than 5 years. Most deaths occur during infancy and in developing countries. Daily regimens of zinc have been reported to prevent acute lower respiratory tract infection and diarrhea, and to reduce child mortality. We aimed to examine whether giving zinc weekly could prevent clinical pneumonia and diarrhea in children younger than 2 years. Methods 1665 poor, urban children aged 60 days to 12 months were randomly assigned zinc (70 mg) or placebo orally once weekly for 12 months. Children were assessed every week by field research assistants. Our primary outcomes were the rate of pneumonia and diarrhea. The rates of other respiratory tract infections were the secondary outcomes. Growth, final serum copper, and final haemoglobin were also measured. Analysis was by intention to treat. Findings 34 children were excluded before random assignment to treatment group because they had tuberculosis. 809 children were assigned zinc, and 812 placebo. After treatment assignment, 103 children in the treatment group and 44 in the control group withdrew. There were significantly fewer incidents of pneumonia in the zinc group than the control group (199 vs 286; relative risk 0·83, 95% CI 0·73-0·95), and a small but significant effect on incidence of diarrhea (1881 cases vs 2407; 0·94, 0·88-0·99). There were two deaths in the zinc group and 14 in the placebo group (p=0·013). There were no pneumonia-related deaths in the zinc group, but ten in the placebo group (p=0·013). The zinc group had a small gain in height, but not weight at 10 months compared with the placebo group. Serum copper and haemoglobin concentrations were not adversely affected after 10 months of zinc supplementation. Interpretation 70 mg of zinc weekly reduces pneumonia and mortality in young children. However, compliance with weekly intake might be problematic outside a research program. [ABSTRACT FROM AUTHOR]

Objective. Investigating the secretory immune response during the acute phase of diarrhoeal disease is hampered by difficulty in collecting suitable control specimens. This is particularly the case in infants, as they are the most severely affected by this disease. In this study we examined the mucosal immunoglobulin response during the acute phase of diarrhoeal disease in infants. Material and methods. The intestinal outputs of secretory immunoglobulins (IgA, IgM) and non-secretory proteins (IgG, albumin, Al AT, eosinophil cationic protein (ECP)) were measured in 14 African children with acute watery diarrhoea (less than 3 days). These data were compared with those of 38 controls from the same area who had undergone whole-gut lavage (WGL) (inducing non-pathogenic watery diarrhoea) in a previous study of intestinal immunity and inflammation. Intestinal secretion rates were measured by multiplying the concentration of the substances by the rate of administration of WGL fluid (equal to the output) or by the output of diarrhoea. Statistical comparison was made using the Mann-Whitney U-test. Results. IgA output in subjects with diarrhoea was 1.8-fold greater (80.7 versus 45.6 mg/kg/day, p = 0.03), whereas IgM output was 10-fold greater (21 versus 2.1 mg/kg/day, p =0.0001). Albumin, A1AT and IgG were all also greater to varying degrees (2.5-6.8-fold). ECP was unchanged. Increases in the non-secretory proteins would suggest increased permeability of the gastrointestinal tract but transudation of serum was insufficient to explain the rise in immunoglobulin output. Conclusions. The 10-fold increase in IgM secretion compared with a smaller relative increase in IgA suggests that this is the primary mucosal immune response in acute diarrhoeal disease. [ABSTRACT FROM AUTHOR]

In order to assess the effects of juice feedings during acute diarrhea a double-blind, randomized study was performed in 90 children, mean age of 10 ± 4.28 months. Thirty patients with acute diarrhea were fed twice-daily 15 ml/kg of Apple Juice (AJ), 30 received White Grape Juice (WGJ), and 30 were given colored and flavored water (WA) as part of their age appropriate dietary intake. The duration and severity of diarrhea were the main endpoint variables of the study performed in a metabolic unit. The patients were similar among the 3 groups, had diarrhea for 50-64 hours prior to admission, and were dehydrated when admitted to the unit for study. Half of the patients in each group were well nourished and the others had mild to moderate degrees of malnutrition. Rotavirus infection was the agent causing the illness in 63% of the patients. The infants fed juice ingested 14-17% more calories than those given WA, (those receiving AJ and WGJ ingested 95 and 98 Calories/Kg/d respectively) whereas those receiving WA consumed 81 cal/kg/d). The increased energy intake was not at the expense of other foods or milk formula. The mean body weight gain was greater among patients receiving WGJ (+ 50.7 gm) as compared with the patients in the AJ group (+ 18.3 gm) or the patients fed WA (- 0.7 gm) (p = 0.08). The duration of the illness was longer in the infants fed juice as compared with those given WA (p = 0.006), the mean +/- SD duration in hours was 49.4 ± 32.6, 47.5 ± 38.9 and 26.5 ± 27.4 in patients fed AJ, WGJ and WA respectively. All patients improved while ingesting juice and none of them developed persistent diarrhea; most recovered within 50 hours of the beginning of treatment and less than one fourth had diarrhea longer than 96 hours in the unit. The fecal losses were also increased among the juice fed patients (p = 0.001); the mean ± SD fecal excretion in g/kg/h was 3.94 ± 2.35, 3.59 ± 2.35, and 2.19 ± 1.63 in AJ, WGJ and WA respectively. The stool output was highest during the first day of treatment among all the patients, though those fed AJ had the highest volume of fecal losses and those who received WA had the lowest stool excretion. After the first day of treatment the differences in fecal excretion were not significant. The ability to tolerate carbohydrates during the illness and immediately after recovery was similar among the 3 groups of patients. Intake of juices with different fructose/glucose ratios and osmolarities resulted in more fecal losses and more prolonged diarrhea as compared with water feedings, but the patients given juice ingested more calories and gained more weight, particularly among those being fed the juice with equimolar concentrations of fructose and glucose. [ABSTRACT FROM AUTHOR]

Background: Phytate decreases iron and zinc bioavailability and contributes to deficiencies of iron and zinc, potentially causing anaemia, poor psychomotor development, impaired growth and increased risk of diarrhoea and respiratory infections.Aim: To investigate whether a reduced dietary intake of phytate, either via extensively phytate-reduced infant cereals [milk cereal drinks (MCDs) and porridge] or a milk-based infant formula, would improve growth and development and reduce morbidity in infants.Design: Infants (n = 300) were, in a double-blind design, randomized to three diet intervention groups from 6 to 12 mo of age-commercial MCD and porridge (CC group), phytate-reduced MCD and phytate-reduced porridge (PR group), or milkbased infant formula and porridge with regular phytate content (IF group)-then followed until 18 mo. Dietary intake, anthropometry, development (Bayley Scales of Infant Development) and episodes of infectious diseases were registered.Results: There were no significant differences between study groups in growth, development or morbidity until 12 mo of age. The IF group had a 77% higher risk (95% CI: 1.05-2.97) of diarrhoea compared to the PR group during the 12-17-mo period. Infants with haemoglobin concentration (Hb) < 110 g/l at 12 mo had lower attained weight at 18 mo (11.14 kg vs 11.73 kg, p = 0.012). Infants with serum zinc (S-Zn) <10.7 pmol/l at 12 mo had higher risk of respiratory infections (RR = 1.74, 95% CI: 1.19-2.56) compared to controls.Conclusion: Phytate reduction had no effect on growth, development or incidence of diarrhoeal or respiratory infections. Infants with low Hb or low S-Zn may be at higher risk of poor growth and respiratory infections, even in this high-income population. [ABSTRACT FROM AUTHOR]

Background. Persistent diarrhea (PD) of infancy has incurred high morbidity and lethality. However, decrease in its prevalence, morbidity, and lethality appeared to occur progressively throughout the last decade of the twentieth century. Our objective in this study was to compare prevalence, lethality, and morbidity of infants and children with PD managed in a pediatric referral hospital.Methods. We conducted a comparative cross-sectional study. A total of 546 patients with PD managed during three different periods (1988–1991, 1993–1994, and 1997–1999) were described and analyzed. Prevalence×100 admissions, prevalence rates of nutritional status, sepsis, pneumatosis intestinalis, carbohydrate and protein intolerance, and lethality were calculated. We used Student t and χ2 tests (α = 0.05).Results. Mean age on admission was 13.8±24.3 months; 296 (54.2%) patients were males. Prevalence of admissions for PD decreased gradually from 31.7 to 13.8%; rates of lethality and mortality remained unchanged. Malnutrition had high prevalence throughout the three periods evaluated. Rate of carbohydrate intolerance diminished but protein intolerance increased; proportion of pneumatosis intestinalis and bowel perforation did not change. Isolation of Salmonella spp. and small bowel bacterial overgrowth decreased significantly from the 1988–1991 series when compared with later series.Conclusions. Although these observations were made at a pediatric referral hospital, they may suggest that prevalence of PD is diminishing. However, its lethality and mortality rates remain unchanged. Malnutrition persists as a relevant associated factor. Decrease of carbohydrate intolerance and increase in protein intolerance rates resemble rates of children with PD of developed countries. These observations may reflect an epidemiologic transition of PD in Mexico. [Copyright &y& Elsevier]

Unlabelled: We observed an association between rotavirus diarrhoea and hypocalcaemia in several patients and therefore started a prospective evaluation with measurement of calcium levels in all patients with rotavirus infection during a period of 8 months. We report on 54 infants with rotavirus gastro-enteritis. Serum concentrations of sodium, potassium, and total and ionized calcium were measured on admission. If hypocalcaemia was detected, total and ionized calcium were measured every day until recovery. Calcium was supplemented as calcium gluconate which was added to milk. Out of 54 newborns with rotavirus gastro-enteritis, 20 developed hypocalcaemia. All these newborns had severe diarrhoea. Seven infants were admitted because of convulsions, but EEG and ultrasonographic examination of the brain revealed no abnormalities. Once the infants' clinical condition and the consistency and frequency of the stool had improved, calcium concentrations increased and remained within the reference range without supplementation.Conclusion: Rotavirus gastro-enteritis seems to be a cause of neonatal hypocalcaemia. [ABSTRACT FROM AUTHOR]

Abstract. Thirty infants with intractable diarrhea of infancy (IDI) underwent small bowel biopsies in order to determine the extent and duration of small intestinal mucosal injury. The onset of the persistent diarrhea occurred prior to 3 months of age and continued for an average of 48 days prior to investigation. In 18 cases, no associated entities were found. Mucosal injury was invariably found in all 30 infants: grade IV injury in 11, grade III in eight, grade II in nine, and grade I atrophy in one. Disaccharidase activities were diminished and corresponded to the degree of atrophy. Lactase activity was diminished to a greater extent than sucrase and maltase. Significant, persistent mucosal injury existed for an average of six months in 16 of the 23 (70%) repeat biopsies. All infants were given an elemental diet (ED). Twelve of the 30 infants required parenteral nutrition (PN). These infants were gradually advanced to an oral elemental diet and maintained on this diet until histologic findings and disaccharidase levels were normal. Eighteen infants were fed and maintained on an elemental diet by mouth from time of admission until normal histologic findings and disaccharidases were found. No mortality occurred during management and follow-up. Twenty-two of the 28 infants in whom follow-up growth data were available excelled in weight and height velocity. The data suggest that prolonged injury to the small intestinal mucosa is a common finding in many cases of intractable diarrhea of infancy. Elemental diets should be started early in the course of protracted diarrhea in young infants, and may need to be continued for several months since histologic and enzymatic changes of the small intestine may persist for extended periods. Pediatrics 66:730-735, 1980. [ABSTRACT FROM AUTHOR]

Abstract. The case of an infant who developed refractory watery diarrhea at the age of 2 weeks is described. Diarrhea was secretory in type, stool weight on no oral intake was 400 to 600 gm daily. A vasoactive intestinal peptide (VIP)-producing tumor was suspected. At the age of 7 1/2 months an exploratory laparotomy revealed nonbeta islet cell hyperplasia of the pancreas. VIP levels were elevated in plasma and pancreatic tissue. After 95% pancreatectomy, plasma VIP level dropped to normal. Hypokalemia, described in adult patients with VIP-producing pancreatic tumors and refractory watery diarrhea, was not a significant problem in this infant. This is the first report on the association of refractory watery diarrhea with elevated levels of plasma VIP and pancreatic islet nonbeta cell hyperplasia in the pediatric age group. Pediatrics 64:46-49, 1978; infant, chronic diarrhea, pancreas, vasoactive intestinal peptide. [ABSTRACT FROM AUTHOR]

Investigates the effects of weaning foods and products used in preparing weaning foods on colonization and proliferation of bacteria pathogens in young children. Study in Ile-Ife, Oyo-State, Nigeria; Higher recovery rate of enteric pathogens from the stools of children who were fed weaning foods than from their counterparts who were breastfed exclusively; Unhygienic preparation of the weaning foods; Lack of potable water.

Describes the case of three infants who presented with chronic diarrhea associated with Salmonella Group C infections. Administration of intravenous fluids for mild dehydration and a five-day course of intramuscular Kanamycin to an eight-week-old male infant with mild diarrhea and failure to thrive since three days of age; Inclusion of the possibility of chronic salmonellosis in the differential diagnosis of infants with chronic diarrhea and failure to thrive even though signs of infection are obscure; Clinical features of the infants' illnesses.

Twenty infants with intractable diarrhea, whose onset was before 3 months of age, were analyzed. Twelve had identifiable pathological entities sufficient to explain their protracted diarrhea. A systematic diagnostic scheme for such babies is presented. Eight of the 20 infants had no identifiable cause for diarrhea of such severity and refractoriness, and these babies were termed non-specific enterocolitis. Six of these latter eight babies died and at autopsy had widespread enterocolitis with destruction of the mucosa and inflammatory infiltration. The authors believe that in these latter cases, regardless of the initial cause of the diarrhea, certain vicious cycles came into play which perpetuated the diarrhea. Preliminary evidence suggests that colostomy and perhaps adrenal corticosteroids, may be useful in the therapy of refractory enterocolitis, particularly if applied before the terminal stages of the disease. Pediatrics, 41:712, 1968, DIARRHEA, ENTEROCOLITIS, COLOSTOMY, STEROIDS, MARASMUS [ABSTRACT FROM AUTHOR]

A study of methemoglobin levels in infants from birth through six months showed that even healthy babies not exposed to excessive nitrate levels in diets have higher levels when young. Babies with diarrhea or respiratory illness had the highest levels in this population. Ingestion of water or formula high in nitrates appears to increase the frequency of elevated methemoglobin. More than 60% of formulae showed bacterial contamination. Long-term consequences should be investigated. [ABSTRACT FROM AUTHOR]

In a cohort of 1,863 Filipinos, diarrhea, fever, and unsanitary conditions in infancy were associated with a decreased body mass index in adulthood; upper respiratory tract infection was associated with an increased body mass index. These finding support the hypothesis that infections early in life play a role in body habitus in adulthood. [ABSTRACT FROM AUTHOR]

Describes cases involving infants with classic varicella exanthemata who concomitantly developed diarrhea, hypoproteinemia and edema. Etiology of hypoproteinemia; Explanation for the presence of hypoproteinemia and edema in the patients; Link between varicella and protein losing enteropathy.

Describes the case of a one-month-old girl with vertebral osteomyelitis. Hospitalization of the infant because of gastroenteritis with severe hydration and acidosis; Deterioration of her condition with spiking fever, severe diarrhea, pneumonia, oral moniliasis, acute bilateral otitis media, anemia and leukocytosis; Administration of gentamycin and carbenicillin to the patient.

Presents an abstract of the article `Early Initiation of Breastfeeding and the Risk of Infant Diarrhea in Rural Egypt,' by John Clemens, et al., from the online information service of the `Pediatric' journal.

Enteroaggregative Escherichia coli (EAEC) is a pathogen implicated in several infant diarrhea or diarrheal outbreaks in areas of endemicity. Although multiple genes involved in EAEC pathogenesis have been identified, the overall mechanism of virulence is not well understood. Recently, a novel secretion system, called type VI secretion (T6S) system (T6SS), has been identified in EAEC and most animal or plant gram-negative pathogens. T6SSs are multicomponent cell envelope machines responsible for the secretion of at least two putative substrates, Hcp and VgrG. In EAEC, two copies of T6S gene clusters, called sci-1 and sci-2, are present on the pheU pathogenicity island. In this study, we focused our work on the sci-1 gene cluster. The Sci-1 apparatus is probably composed of all, or a subset of, the 21 gene products encoded on the cluster. Among these subunits, some are shared by all T6SSs identified to date, including a ClpV-type AAA+ ATPase (SciG) and an IcmF (SciS) and an IcmH (SciP) homologue, as well as a putative lipoprotein (SciN). In this study, we demonstrate that sciN is a critical gene necessary for T6S-dependent secretion of the Hcp-like SciD protein and for biofilm formation. We further show that SciN is a lipoprotein, as shown by the inhibition of its processing by globomycin and in vivo labeling with [3H]palmitic acid. SciN is tethered to the outer membrane and exposed in the periplasm. Sequestration of SciN at the inner membrane by targeting the +2 residue responsible for lipoprotein localization (Gly2Asp) fails to complement an sciN mutant for SciD secretion and biofilm formation. Together, these results support a model in which SciN is an outer membrane lipoprotein exposed in the periplasm and essential for the Sci-1 apparatus function. [ABSTRACT FROM AUTHOR]

Aims To examine the associations between post-natal depression in mothers and diarrhoeal illness in their infants in the first year of life in a low-income country. Methods Using a prospective cohort design, 265 infants ( n = 130 of mothers having a depressive episode according to the International Classification of Diseases, 10th revision, at 3 months post-natal and n = 135 of psychologically well mothers), living in rural Rawalpindi, Pakistan, were followed up for 1 year. Frequency of diarrhoeal episodes was measured fortnightly by health workers using a standard questionnaire. Results Infants of depressed mothers had significantly more diarrhoeal episodes per year than those of controls (mean 5.5 vs. 4.0; 95% CI 0.9–2.0). The relative risk of having ≥5 diarrhoeal episodes per year in infants of depressed mothers was 2.3 (95% CI 1.6–3.1). The association remained significant after adjustment for other risk factors by multivariate analysis. Conclusions Maternal depression is associated with infant diarrhoeal morbidity in a low-income community setting. It is independent of the effects of known factors such as under-nutrition, socio-economic status and parental education. Preventive child health programmes targeting mothers must consider their mental health. [ABSTRACT FROM AUTHOR]

Presents information on the suggestions made by the late medical writer Simon de Vallambert concerning the treatment of diarrhea in infants. Information on his book `Cinq Livres de la Maniere de Nourrir et Gouverner les Enfans des Leur Naissance'; Therapeutic use of powdered rhubarb with syrup of dried roses; Use of starch in the form of broth and lettuce cooked in vinegar and water;

Points out that a major effort by public health education at the community level may be the most important strategy for preventing infantile infectious diarrhea. Presence of bacteria in weaning foods used either as supplements to breast feeding or as the sole feeding diet; Close relationship between diarrhea and malnutrition; Sociological impact of living practices of more affluent societies on poorer countries.

Focuses on the usability of mixtures of carbohydrate and electrolytes in solution in the home treatment of infants with mild diarrhea. Results on the feeding of infants with electrolyte mixtures which are not sufficiently hypotonic; Composition of lytren; Significance of following instructions properly regarding the administration of salt packets to infants.