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DiscussionThis study provides a clear relation between the mortality rate after recovery from diarrhoea and the nutritional state. Severely malnourished children had a 14 times greater risk of death than their nutritionally better off counterparts. More of the excess deaths occurred within three months after discharge from hospital. Chen et al, in their study of children aged 13 to 23 months followed up for two years in a similar rural community, also found a relation between anthropometric measurernents and subsequent mortality.3Interestingly, in our study the excess deaths were confined to the 2 year age group. In children aged less than 2 years there were no excess deaths, nor was mortality affected by nutritional state. By contrast, in the 2 year age group all the deaths occurred in lower nutritional categories. An explanation for these differences might be that nutrition in children aged Linder 2 years is related to birth weight, whereas malnutrition in children aged 2 years and over is related to food. Also breast feeding is universal and prolonged in this area, 7 which might have protected the children aged under 2 years against reinfection and contributed to nutritional rehabilitation. Children aged 2 years or more are dependent on other types of food and are neither protected against reinfection nor have sufficient or appropriate food to be rehabilitated nutritionally. Therefore, when a population is universally breast fed, classification of children by single years or even half a year will be methodologically better for nutritional studies.Another finding, based on lay reporting of causes of death, shows that even in severely malnourished children death occurs after a prolonged illness, mostly of an enteric nature. This would allow enough time for treatment of the disease as well as for nutritional rehabilitation to prevent such deaths.Our findings indicate a need to integrate diarrhoeal treatment with nutritional rehabilitation and home follow up care for children aged 2 years and severely malnourished. Since death is not immediate, the programme should be implemented easily and successfully.

Sulphasalazine is being used increasingly to treat rheumatoid arthritis, though its long term safety profile has not been established in this condition. The incidence and nature of adverse effects occurrmng in 774 patients with rheumatoid arthritis treated with sulphasalazine for periods ranging from one to 11 years were therefore noted. Altogether 205 of the patients stopped treatment permanently due to an adverse effect. One hundred and fifty six (76%) of these events occurred within three months and few beyond the first year. Most events were trivial and were self limiting after withdrawal of the drug; of the potentially more serious adverse effects, 33 (66%) occurred within three months-of treatment. None of the patients died or suffered lasting ill effects.It is concluded that adverse effects of treatment with sulphasalazine are generally seen within three months; though regular monitoring is desirable during that period, thereafter few worrying problems occur.

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The ability of fresh sera to resist attack by peroxyl radicals (TRAP) was found to be significantly lower in 20 patients with rheumatoid arthritis (RA)

In this study we examined the incidence, timing, and reasons for treatment termination in patients with RA treated with gold, penicillamine, or SAS for up to five years.

We have discussed previously the use of sequential measurements of serum C-reactive protein (CRP) and haptoglobin (Hp) and of the erythrocyte sedimentation rate (ESR) in the management of patients with rheumatoid arthritis (RA) and the desirability of developing drugs with the capacity for lowering values of these measurements (McConkey et al., 1972;McConkey et al., 1973;Constable et al., 1975;McConkey, 1976;Amos et al., 1977). The magnitude of the effect of a drug on serum CRP, Hp, and the ESR can be regarded as a measure of its efficacy in a particular sense. The information provides a guide to how well the disease rather than just symptoms is controlled. The purpose of the present investigation was to study and compare the effects of treatment with gold, dapsone, or prednisone. We describe a method of