The aetiology of acute diarrhoea was investigated in 245 children less than 3 years old in a paediatric outpatient clinic in southern India. In 55% of the children organisms were found in the stools, and one quarter were infected with multiple organisms. Viruses, enteropathogenic E. coli, shigella and campylobacter species accounted for 75% of all isolates. Cholera and helminthiasis were rare, and no child had amoebiasis. Clinical findings were useful in the diagnosis of shigella and rotavirus infection only. Children with shigellosis had classical dysentery, and a greater number of stools; they were unlikely to be breast-fed, to be less than 6 months old, or to have watery stools. Rotavirus infections were characterized by vomiting. Only 20% of the 245 children had an infection which could be treated effectively with antimicrobials.
arterial pressure, causing natriuresis, which leads to depletion of sodium and further raises the angiotensin II concentration.5 Given that the blood pressure of patients with the hyponatraemic hypertensive syndrome is renin dependent, our patients' pronounced hypotensive response to atenolol is not surprising.The correct management of patients with this syndrome is unclear. It is not known whether blood pressure falls precipitously in all patients who take 3 blockers or how far the risk of hypotension extends to those who take other classes of drugs. Bethanidine and captopril have been reported as causing serious hypotension,' 5and we recommend that they be avoided as initial treatment.We conclude that patients with malignant hypertension and hypokalaemia or hyponatraemia should be treated with low doses of (i blockers that can be raised according to the response of the blood pressure. Any precipitous fall in blood pressure can be reversed by a prompt infusion of saline, although temporary inotropic support may also be required. however, the proportion who became positive for antibody to H antigen was significantly higher than the proportion who became positive for 0 antigen (x2> 15, p<0-001). The proportion who became positive for antibody to 0 or H antigen among infants, 1 year olds, and 2-4 year olds by each route was not significantly different (p>0 05).The geometric mean titres of antibodies to H antigen after intradermal or subcutaneous vaccination were significantly higher than those of antibodies to O antigen (p005) or in the titres among infants, 1 year olds, and 2-4 year olds (p>0 05).
CommentOverall the immune response of infants and preschool children to the heat inactivated typhoid vaccine given subcutaneously or intradermally 162 BMJ VOLUME 298 21 JANUARY 1989
Peer Effects, Fast Food Consumption and Adolescent Weight Gain *This paper aims at opening the black box of peer effects in adolescent weight gain. Using Add Health data on secondary schools in the U.S., we investigate whether these partly flow through the eating habits channel. Adolescents are assumed to interact through a friendship social network. We propose a two-equation model. The first equation provides a social interaction model of fast food consumption. To estimate this equation we use a quasi maximum likelihood approach that allows us to control for common environment at the network level and to solve the simultaneity (reflection) problem. Our second equation is a panel dynamic weight production function relating an individual's Body Mass Index z-score (zBMI) to his fast food consumption and his lagged zBMI, and allowing for irregular intervals in the data. Results show that there are positive but small peer effects in fast food consumption among adolescents belonging to a same friendship school network. Based on our preferred specification, the estimated social multiplier is 1.15. Our results also suggest that, in the long run, an extra day of weekly fast food restaurant visits increases zBMI by 4.45% when ignoring peer effects and by 5.11%, when they are taken into account.
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