Background: Racecadotril, an enkephalinase inhibitor with antisecretory action is a safe and effective treatment for acute diarrhea for children and adults. As an adjunct to oral rehydration therapy (ORT) in Indian children, its efficacy and safety data are scarce. Methods: A total of 117 children with acute watery diarrhea for not more than 7 days were randomized into two groups. Group A (control group) received ORT and zinc only while Group B (study group) received a combination of racecadotril (1.5 mg/kg q8 h), zinc and ORT. Primary end point was the number of loose stools during first 48 h of treatment. Time to cure as well as total volumeof oral rehydration solution (ORS) consumed was also measured. Results: Baseline characteristics were not significantly different between the groups. Mean 48 h stool frequency in the study group was 10.47±3.2 episodes and that in control group was 15.87±4.6 episodes indicating a significant reduction of 34.1% with racecadotril (p=0.00016). The mean time for recovery in the study group was 37.98±6.1 h and 51.02±9.4 h in control group indicating a significant reduction of 25.6% with racecadotril (p=0.002). The mean volume of ORS consumed before recovery in the study group was 162.72 ml as compared to 232.68 ml in control grouppointing to a significant reduction of 30.1% in the study group. Conclusions: Racecadotril is effective as an adjunct to ORT and early continued feeding in infants and children with acute watery diarrhea.
Objective. The present study was carried out with an aim to study the nutritional status of patients undergoing emergency ileostomy using simple bedside tools in a developing country. Methods. Nutritional assessment (anthropometry, biochemical, immunological, and dietary) was done within 24-36 hours of admission and 6 weeks postoperatively. Primary endpoint was the study of the nutritional status of the patients with ileostomy. Results. N = 58, 47 males with mean age 32 years. Postoperatively 50 (86.2%) patients experienced some complications including those related to ileostomy. Malnutrition varied from 7 (12.1%) using BMI to 54 (93.1%) by triceps skinfold thickness. At 6 weeks, despite adequate nutritional intake, there was a significant decrease in almost all nutritional parameters except serum albumin which was normal in most patients. Factors contributing to weight loss in 41 (70.7%) patients were decreased length of proximal bowel left (P = 0.001), increased ileostomy output (P = 0.001), delayed surgery (P = 0.004), and increased disease severity score (P = 0.005). Conclusion. Majority of patients undergoing emergency ileostomy were malnourished and had significant nutritional depletion despite adequate nutritional support. Serial assessment helps to assess nutritional recovery in these patients.
alnutrition is a general term and it most often refers to undernutrition resulting from inadequate consumption, poor absorption or excessive loss of nutrients but the term also encompasses overnutrition, resulting from excessive intake of specific nutrients. Malnutrition in children is widely prevalent in developing countries including India. More than 33% of deaths in 0-5 years are associated with malnutrition [1,2]. Severe acute malnutrition (SAM) is defined by very low weightfor-height/length (z score below −3SD of the median WHO child growth standards), or a mid-upper arm circumference <115 mm, or by the presence of nutritional edema. SAM is both medical and social disorder. The medical problem is due to social problems at home. Lack of exclusive breastfeeding, late introduction of complementary feeds, feeding diluted feeds containing less amount of nutrients, repeated enteric and repeated respiratory tract infections, ignorance, and poverty are some of the factors responsible for SAM [1].Children with SAM are in danger of death from hypoglycemia, hypothermia, fluid overload, electrolyte mismanagement, and undetected infections. They cannot be treated like other children. Their feeds, fluids, and micronutrients must be carefully controlled to avoid complications during management [2]. Hence, biochemical and nutritional indicators in these children are important for management. They guide us to prevent mishappenings in the management of SAM children in causality and especially in nutrition rehabilitation centers (NRC) and help in giving proper correction of micronutrients [3,4]. Our study tried to find out the nutritional indicators at admission and also variations in the biochemical markers in these children at admission. This would help in further holistic management of these children. METHODS Thishospital based, prospective observational study, was conducted in Tertiary Care Institution of South India after obtaining approval from the Institutional Ethics Committee. Children aged 6-59 months admitted at NRC of Vanivilas Children hospital and Bowring and Lady Curzon Hospital attached to Bangalore Medical College and Research institute were enrolled. After obtaining informed consent from parents or legal guardians, 100 consecutive SAM children admitted during
Background: Several inflammatory markers have failed to meet the requirements for an early diagnosis of sepsis in children. Study results and trends show that measurement of the combination of biochemical markers offers the best prospects for research on early diagnosis of sepsis. Objectives: To evaluate the serum levels of C-reactive protein (CRP) and procalcitonin (PCT) as markers of early sepsis in pediatric patients. Methods: All the hospitalized children aged more than 28 days with clinically suspected sepsis, as per the definition given by International Pediatric Sepsis Consensus Conference, were selected. The patients were divided into two groups; one with culture proven sepsis and the other with culture negative sepsis. CRP and PCT levels were measured at the time of admission and 48 h after admission. Results: A 40 patients were studied, out of that 15 had culture positive and 25 had culture negative sepsis. The mean PCT level was significantly higher at admission than at 48 h after admission, and the mean CRP level was significantly lower at admission than at 48 h after admission indicating PCT as early marker of sepsis. Conclusion: CRP and PCT levels have favorable test performance in differentiating between culture positive and culture negative sepsis. PCT is earlier to rise compared to CRP and PCT is best in predicting the severity followed by CRP.
INTRODUCTION:Two-port mini laparoscopic cholecystectomy (LC) has been proposed as a safe and feasible technique. However, there are limited studies to evaluate the effectiveness of the procedure. This study is a prospective randomised trial to compare the standard four-port LC with two-port mini LC.MATERIALS AND METHODS:A total of 116 consecutive patients undergoing LC were randomised to four-port/two-port mini LC. In two-port mini LC, a 10-mm umbilical and a 5-mm epigastric port were used. Outcomes measured were duration and difficulty of operation, post-operative pain, analgesia requirements, post-operative stay, complications and cosmetic score at 30 days.RESULTS:Out of 116 patients, the ratio of M:F was 11:92, with mean age 40.79 ± 12.6 years. Twelve patients (nine in four-port group and three in two-port group) were lost to follow-up. The mean operative time were similar (P = 0.727). Post-operative pain was significantly low in the two-port group at up to 24 hrs (P = 0.023). The overall analgesia requirements (P = 0.003) and return to daily activity (P = 0.00) were significantly lower in two-port group. The cosmesis score of the two-port group was better than four-port group (P = 0.00). However, the length of hospital stay (P = 0.760) and complications (P = 0.247) were similar between the two groups.CONCLUSION:Two-port mini LC resulted in reduced pain, need for analgesia, and improved cosmesis without increasing the operative time and complication rates compared to that in four-port LC. Thus, it can be recommended in selected patients.
Background: Pain abdomen accounts for about 14.2% of all emergency hospitalization. Many patients remain undiagnosed even after excluding the common disorders by meticulous investigations. In case of diagnostic uncertainty, laparoscopy may help to avoid unnecessary laparotomy, provide accurate diagnosis. The current study aimed at comparing the role of laparoscopy in management of surgical causes of acute and chronic pain abdomen.Methods: A prospective study was done in 168 adult patients attending tertiary care hospital, selected by convenience sampling method. After clinical examination and relevant investigation, patients in need of diagnostic and therapeutic laparoscopic management were included in study. Laparoscopic findings and postoperative status of patients, with acute and chronic pain abdomen were compared with relevant statistical tests.Results: Mean age of patients was 35.8 years. Majority of the patients were females (58.3%). 41.1% and 58.9% patients had acute and chronic pain abdomen, respectively. Though more patients with chronic pain abdomen (58.9%) underwent laparoscopy when compared with acute pain abdomen (41.1%) it was not statistically significant, also post-operative status though found to be better in patients with chronic pain abdomen was not statistically significant.Conclusions: Though prevalence of laparoscopic intervention and better outcome was found more in patients with chronic abdominal pain in the present study it was not statistically significant.
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