Impact of the Hajj on pneumococcal transmission.

Over two million Muslim pilgrims assemble annually in Mecca and Medina, Saudi Arabia, to complete the Hajj. The large number of people in a crowded environment increases the potential for pneumococcal carriage amplification. We evaluated pneumococcal carriage prevalence with four cross-sectional studies conducted at beginning-Hajj (Mecca) and end-Hajj (Mina) during 2011 and 2012. A questionnaire was administered and a nasopharyngeal swab was collected. The swab was tested for pneumococcus, serotype and antibiotic resistance. A total of 3203 subjects (1590 at beginning-Hajj and 1613 at end-Hajj) originating from 18 countries in Africa or Asia were enrolled. The overall pneumococcal carriage prevalence was 6.0%. There was an increase in carriage between beginning-Hajj and end-Hajj cohorts for: overall carriage (4.4% versus 7.5%, prevalence ratio (PR) 1.7, 95% CI 1.3-2.3), and carriage of 23-valent pneumococcal polysaccharide vaccine serotypes (2.3% versus 4.1%, PR 1.8, 95% CI 1.2-2.7), 13-valent pneumococcal conjugate vaccine (PCV) serotypes (1.1% versus 3.6%, PR 3.2, 95% CI 1.9-5.6), 10-valent PCV serotypes (0.6% versus 1.6%, PR 2.6, 95% CI 1.2-5.3), antibiotic non-susceptible isolates (2.5% versus 6.1%, PR 2.5, 95% CI 1.7-3.6) and multiple non-susceptible isolates (0.6% versus 2.2%, PR 3.8, 95% CI 1.8-7.9). Fifty-two different serotypes were identified, most commonly serotypes 3 (17%), 19F (5%) and 34 (5%). These results suggest that the Hajj may increase pneumococcal carriage-particularly conjugate vaccine serotypes and antibiotic non-susceptible strains, although the exact mechanism remains unknown. The Hajj may therefore provide a mechanism for the global distribution of pneumococci.

Shotgun slug injuries: case report and literature review.

Shotguns are usually used to fire multiple pellets; however, they are capable of firing a single projectile in the form of a slug. Although rare, shotgun slug injuries are severe, producing wounds comparable to those inflicted by high-velocity weapons with the potential for even more tissue destruction because of the slug's size and mass. We report the first survivor of a close range shotgun slug injury, with a review of this weapon's unique projectile ballistics and the relevant literature.

Is a low-osmolarity ORS solution more efficacious than standard WHO ORS solution?

The clinical efficacy of a diluted oral rehydration salts (ORS) solution was compared in a pilot study with that of intravenous (i.v.) therapy and of standard World Health Organization (WHO)/United Nations Childrens Fund (UNICEF) ORS solution in children with acute diarrhea. Sixty-one boys aged 3 to 24 months, admitted to hospital with acute diarrhea and signs of dehydration, were randomly assigned to groups receiving standard ORS solution, diluted ORS solution, or i.v. therapy. In children treated with standard ORS solution and small amounts of plain water, the total fluid intake was 25-39% greater, the stool output was 58-77% greater (p < 0.01), and the duration of diarrhea was 30-55% greater than in the other treatment groups. Intake of plain water, taken separately or added to the ORS solution, was greater in children given diluted ORS solution (73 +/- 23 ml/kg) than in those given standard ORS solution (21 +/- 32 ml/kg) (p < 0.001). The mean serum sodium concentration increased by 2.2 mEq/L in children given standard ORS solution, whereas it decreased by 2.9 mEq/L in those given diluted ORS solution. This study shows that some children develop worsening diarrhea and increasing serum sodium concentrations when treated with standard ORS solution and given only small amounts of plain water. This is probably caused by the slight hypertonicity of standard ORS solution combined with transient partial glucose malabsorption. This can be avoided if water, breast milk, or another low-solute drink is given liberally during maintenance therapy with ORS solution, as recommended by the WHO.

Controlled clinical trial on the efficacy of rice powder-based oral rehydration solution on the outcome of acute diarrhea in infants.

We report a controlled clinical trial of rice powder-based oral rehydration solution (ORS) versus glucose ORS on the outcome of acute diarrhea in infants. The rice ORS group (n = 30) received ORS containing 50 g rice powder instead of standard WHO solution (20 g glucose, n = 30). Formula-fed male infants were enrolled to enable calculation of milk intake and excretion of urine. Patient allocation to either group depended on the method of random permuted blocks. Both groups were comparable regarding age (4-18 months), duration of diarrhea, number of bowel movements or vomiting per 24 h, rectal temperature, dehydration score, and nutritional status. Results revealed that the rice ORS group had a shorter duration of diarrhea (28.4 +/- 5.1 vs 34.3 +/- 2.3 h) and greater mean weight gain in the first 24 h as percentage of recovery weight (5.7 +/- 0.5% vs 4.1 +/- 0.6%). Furthermore, the mean amount of ORS intake, mean stool output, and mean number of episodes of vomiting were lower in the rice-ORS group as compared with the glucose ORS group. All differences were statistically significant. Due to its observed superiority and low cost, the widespread use of rice ORS should be considered for treatment of acute diarrhea.

Accuracy of mixing oral rehydration solution at home by Egyptian mothers.

PIP: The study was conducted by the Rehydration Unit of Bab El-Sha'reya Hospital, Cairo to determine the impact on the mixing accuracy of oral rehydration solution (ORS) of a group of mothers of infants suffering from acute diarrhea. 1 group received a special 200 ml cup and brief verbal instructions; a control group received neither the cup nor instructions. The mothers were illiterate and of a low socioeconomic class. Results show that the median capacity of home containers used was 160ml/L. The mean ORS sodium concentration (98mmol/L) for the group supplied with the specified container was significantly lower than the ORS sodium concentration (123 mmol/L) of the group that used home containers (p 0.02). All mothers who received the 200 ml cup from the medical unit used it. 96% of mothers in both groups were ready to use ORS in the future. The present study showed that mothers mixing premarked ORS containers along with brief instructions and the 200 ml cups dispensed with the ORS container were more accurate because the standard container was provided. There is no financial obstacle to providing such containers since the cost in Egypt is US$0.1. Such containers could be provided free if Egyptian companies producing pediatric medicines would agree to such containers away as promotional tools.^ieng

Lactose tolerance in normal Egyptian infants and children and in protein calorie malnutrition.

Oral lactose tolerance test was performed on a total of 100 cases of normal Egyptian infants and children aged 6 months to 12 years. The same test was performed on 30 cases of protein calorie malnutrition (15 cases of marasmus and 15 cases of kwashiorkor). Detection of sugar and determination of pH were also carried out on all stools passed after the test. Lactose intolerance, as judged by a maximal blood glucose rise of 20 mg. or less and/or stools positive for sugar with a pH less than 6 following lactose ingestion, was observed as follows in normal cases: 12% in the age group 6 months to 2 years, 32% in the age group 2 to 5 years, 32% in the age group 5 to 9 years, and 80% in the age group 9 to 12 years. On the other hand, lactose intolerance was demonstrated in 73.3% of cases suffering from protein malnutrition. The aetiology and practical implications of the present findings of lactose intolerance on normal and malnourished children are discussed.