Valor de la vena digital para el diagnóstico tradicional y pronóstico de las diarreas en una lactante / Value of the digital vein for the traditional diagnosis and prognosis of diarrheas in an infant

Se presenta el caso clínico de una lactante de 8 meses de edad, de procedencia rural, quien ingresa en el Hospital Docente Infantil Norte de Santiago de Cuba por presentar fiebre, vómitos y diarreas. Se le realizó examen físico y observación de la vena digital, cuyo resultado desde el punto de vista de la medicina tradicional fue diarrea por frío-humedad, para lo cual se orientó una estrategia terapéutica que favoreció la mejoría del cuadro diarreico y emético, sin el empleo de medicamentos

The case report of an 8 months infant is presented. She had rural origin and is admitted to the Northern Teaching Children Hospital in Santiago de Cuba due to fever, vomits and diarrheas. Physical examination and observation of the digital vein was carried out whose result from the traditional medicine point of view was diarrhea due to cold-humidity, for which a therapeutic strategy was guided that favored the improvement of the diarrheal and emetic pattern, without using medication

Costos de la rehidratación oral y nasogástrica comparadas con la rehidratación endovenosa en niños con diarrea en Colombia / Costs of oral and nasogastric rehydration compared to intravenous rehydration in children under 5 years of age with diarrhea in Colombia

RESUMEN Objetivo Evaluar los costos de las terapias de rehidratación oral (TRO) y de rehidratación nasogástrica (TRN) comparadas con la terapia de rehidratación endovenosa (TRE) para corregir la deshidratación por diarrea en niños. Metodología Análisis de minimización de costos desde la perspectiva del Sistema de Salud colombiano comparando TRO (seguida de TRN ante falla de la TRO), con la TRE. El horizonte temporal fue la duración de la rehidratación. La medida de efectividad se extrajo de una revisión sistemática de literatura. Para determinar costos, se construyó un caso típico y un árbol de decisiones, a partir de revisión de guías e historias clínicas, validado con expertos. Los costos unitarios se obtuvieron de bases de datos colombianas. Costos fueron calculados en pesos colombianos (COP) y dólares americanos (USD). Se realizaron análisis de sensibilidad de una y dos vías. Resultados La TRO y la TRE son similares en efectividad para prevenir hospitalización y lograr rehidratación. En el caso base, el costo de la TRO fue $91,221COP (40.5 USD) y para TRE $112,944COP (50.14USD), es decir, un ahorro de $21,723 COP (9.64 USD). En los análisis de sensibilidad por regímenes de aseguramiento y complejidad del hospital, la TRO suele ser la estrategia menos costosa. Discusión Ambas intervenciones son similares en efectividad, pero la TRO, seguida de TRN ante falla de la primera resulta menos costosa que la TRE. La TRO es recomendable como primera opción para corregir la deshidratación. Deberían continuarse esfuerzos por implementar TRO y TRN en los servicios de salud en Colombia.(AU)

ABSTRACT Objective To evaluate the costs of oral rehydration therapy (ORT) and nasogastric rehydration therapy (NRT) compared with intravenous rehydration therapy (IRT) to treat dehydration in children under 5 years of age with diarrhea. Methodology Cost-minimization analysis from the perspective of the Colombian Health System, comparing ORT, (followed by NRT when ORT fails), with IRT. The time horizon was the duration of rehydration. The effectiveness measure was obtained from a systematic review of the literature. To determine costs, a typical case was created based on current guidelines and medical records; this case was validated by experts. Unit costs were obtained from Colombian databases and were provided in Colombian pesos (COP) and US dollars (USD) for 2010. One- and two-way sensitivity analyzes were performed. Results ORT and ERT are similarly effective to prevent hospitalization and to achieve rehydration. In the base case, the expected cost of ORT was $91,221 COP (40.5 USD) and for IRT was $112,944 COP ($50.14 USD), saving $21,723 COP ($9.64 USD) per case. In the sensitivity analyzes by health insurance and hospital level, ORT is often the least costly strategy. Discussion Both interventions are similarly effective, but ORT, followed by NRT when ORT fails, is less costly than IRT. ORT is recommended as the first option to treat dehydration since it is effective and less expensive. Efforts should be continued to implement TRO and NRT in the health services of Colombia.(AU)

Poor utilization and wrong preparation of oral rehydration salt solution during childhood diarrhea in Ilesa, Nigeria

Background and Aim: Diarrheal deaths are largely preventable with the use of oral rehydration salt (ORS) solution. The aim of this study was to investigate the preparation and use of ORS for the treatment of childhood diarrhea in Ilesa, Nigeria. Materials and Methods: The characteristics of the present diarrheal illness as well as biodata, social class, use of ORS solution, and the method of preparation were documented in 250 children with diarrhea at the Wesley Guild Hospital, Ilesa, Nigeria. Data were analyzed using the statistical program for the social sciences (SPSS) version 16.0. Results: A total of 151 (60.4%) of the children had been given ORS before the presentation. The ORS was correctly prepared in 38 (25.2%) of them, whereas hypertonic ORS solution was mostly given to the others. A significantly higher proportion (66.7%) of those from high social class had their ORS correctly prepared, compared with 16.1% of those from low social class (P = 0.000). The use of ORS was more prevalent among children with longer duration of diarrhea (P = 0.004). A significantly higher proportion of children who were still breastfeeding were given ORS, compared with those who had stopped breastfeeding (P = 0.007). Conclusion: Teachings on the use and correct preparation of ORS should not be limited to diarrhea treatment units, but should rather be included in the routine health talks given to mothers at antenatal and immunization clinics. The provision of a 1 L measure to be used for measuring water for ORS preparation should be seriously considered to combat the problem of hypertonic ORS preparations

Diagnosis and clinical observation of lactose-free milk powder on treatment of neonatal diarrhea

Neonatal lactose intolerance syndrome is a series of digestive system symptoms caused by the lack of lactase, and could not fully digest the lactose in breast milk or cow milk. Lactose is one of the disaccharides mainly existed in mammalian milk. Lactose content in breast milk is 7.2g/100ml, cow milk is 4.7g/100ml. Dairy products are the main energy sources for the newborn, and lactose provides 20% energy for infants. During the growth of the newborn, lactose not only play an significant role in energy supply, but also involve in the development of the brain growing. This study mainly studied the lactose development features, the reasons for lactose intolerance, and the measures to treat lactose deficiency

Lactobacillus reuteri DSM 17938 shortens acute infectious diarrhea in a pediatric outpatient setting / O Lactobacillus reuteri DSM 17938 reduz a diarreia infecciosa aguda no cuidado pediátrico ambulatorial

OBJECTIVE: Two randomized controlled clinical trials have shown thatLactobacillus (L) reuteri DSM 17938 reduces the duration of diarrhea in children hospitalized due to acute infectious diarrhea. This was the first trial evaluating the efficacy of L. reuteri DSM 17938 in outpatient children with acute infectious diarrhea.METHODS: This was a multicenter, randomized, single-blinded, case control clinical trial in children with acute watery diarrhea. A total of 64 children who presented at outpatient clinics were enrolled. The probiotic group received 1 × 108 CFU L. reuteri DSM 17938 for five days in addition to oral rehydration solution (ORS) and the second group was treated with ORS only. The primary endpoint was the duration of diarrhea (in hours). The secondary endpoint was the number of children with diarrhea at each day of the five days of intervention. Adverse events were also recorded.RESULTS: The mean duration of diarrhea was significantly reduced in the L. reuteri group compared to the control group (approximately 15 h, 60.4 ± 24.5 h [95% CI: 51.0-69.7 h] vs. 74.3 ± 15.3 h [95% CI: 68.7-79.9 h], p < 0.05). The percentage of children with diarrhea was lower in the L. reuteri group (13/29; 44.8%) after 48 h than the control group (27/31; 87%; RR: 0.51; 95% CI: 0.34-0.79,p < 0.01). From the 72nd hour of intervention onwards, there was no difference between the two groups in the percentage of children with diarrhea. No adverse effects related to L. reuteri were noted.CONCLUSION:L. reuteri DSM 17938 is effective, safe, and well-tolerated in outpatient children with acute infectious diarrhea.

OBJETIVO: Dois ensaios clínicos randomizados controlados demonstraram que oLactobacillus (L) reuteri DSM 17938 reduz a duração de diarreia em crianças hospitalizadas devido a diarreia infecciosa aguda. Este é o primeiro ensaio que avalia a eficácia do L. reuteri DSM 17938 em crianças com diarreia infecciosa aguda no ambulatório.MÉTODOS: Ensaio clínico multicêntrico, randomizado, único cego, com grupos paralelos e controlado em crianças com diarreia aguda. Foram inscritas 64 crianças internadas na clínica ambulatorial. O grupo probiótico recebeu 1 × 108 CFU L. reuteri DSM 17938 por cinco dias, além de uma solução de reidratação oral (SRO), e o segundo grupo foi tratado apenas com SRO. O desfecho principal foi a duração da diarreia (em horas). O desfecho secundário foi o número de crianças com diarreia em cada um dos cinco dias da intervenção. Os eventos adversos também foram registrados.RESULTADOS: A duração média da diarreia foi significativamente reduzida no grupoL. reuteri em comparação com o grupo de controle (aproximadamente 15 horas; 60,4 ± 24,5 horas [51,0-69,7 horas, IC de 95%] em comparação com 74,3 ± 15,3 horas [68,7-79,9 horas, IC de 95%], p < 0,05). O percentual de crianças com diarreia foi menor no grupo L. reuteri (13/29; 44,8%) após 48 horas do que no grupo de controle (27/31; 87%) (RR: 0,51; 0,34-0,79; IC de 95%, < 0,01). A partir da 72a hora de intervenção, não havia diferença entre os dois grupos no percentual de crianças com diarreia. Nenhum efeito adverso com relação ao L. reuteri foi observado.CONCLUSÃO: O L. reuteri DSM 17938 é eficaz, seguro e bem tolerado por crianças com diarreia infecciosa aguda no ambulatório.

Impacto de cursos cortos de suplementación con zinc en la morbilidad asociada a la diarrea en niños del distrito de Carmen Alto. Ayacucho-Perú (2011-2013) / Impact of short courses of supplementation with zinc in the morbidity associated with diarrhea in children from the District of Carmen Alto. Ayacucho-Peru (2011-2013)

Antecedentes: La suplementación con Zinc durante un episodio de diarrea reduce la incidencia y la severidad de la misma. El estudio plantea comparar la incidencia de episodios subsecuentes de diarrea entre niños con diarrea aguda y deshidratación moderada que reciben cursos cortos de suplementación oral con Zinc adicional al SRO (Suero de Rehidratación Oral) y quienes reciben sólo el SRO de rutina. Métodos: Fueron reclutados todos los niños mayores de 30 días y menores de 5 años que fueron admitidos al Servicio de urgencias con diarrea aguda y deshidratación moderada en el Centro de Salud Carmen Alto de la Provincia de Huamanga (Ayacucho) - Perú en el 2011. Se indicó suplementación con Zinc en todos los casos. Después de la aplicación de los criterios de inclusión y exclusión, los pacientes fueron aleatoriamente separados en dos grupos: un grupo que completó el tratamiento de suplementación con zinc adicional al SRO (Suero de Rehidratación Oral) y otro que no inició o no completó el tratamiento con Zinc y sólo recibió SRO. Todos los pacientes fueron rehidratados usando SRO y recibieron el SRO para reponer las pérdidas (10mL/kg después de cada deposición). Adicionalmente el grupo que tuvo el tratamiento completo, recibió la suplementación con zinc: los niños menores de 6 meses de edad, 1/2 tableta una vez al día durante 10/14 días, y los niños de 6 meses a más recibieron 1 tableta por día durante 10/14 días (Recomendación basada en tabletas de 20 mg). Un cuestionario detallado fue realizado por el personal de Enfermería capacitado del Centro de Salud para cada paciente, este contiene las características demográficas, estado de hidratación y nutrición, condición de higiene y salubridad. Se realizó una visita domiciliaria al cabo de un mes de haber recibido el tratamiento. Los resultados primarios (episodios de diarrea subsecuentes) y secundarios (episodios de infecciones respiratorias agudas, crecimiento y anemia) fueron comparados en ambos grupos. Resultados...

Background: Zinc supplementation during diarrhea substantially reduces the incidence and severity of diarrhea. To assess the therapeutic effects of oral zinc supplementation on acute watery diarrhea of children with moderate dehydration. Methods: All 1-month to 5-year-old children who were admitted with acute watery diarrhea and moderate dehydration to the Children Central Care of Carmen Alto, Ayacucho, Peru in 2011 were recruited. All patients were indicated of zinc supplementation. After the application of the inclusion and exclusion criteria, the patients were randomly allocated to two groups: one group to complete zinc plus oral rehydration solution (ORS) and the other one to not complete zinc supplement and receive only ORS. All the patients were rehydrated using ORS and then receiving ORS for ongoing loss (10 ml/kg after every defecation). Additionally, the patients in the intervention group received zinc (1 mg/kg/day) for 10/14 days. A detailed questionnaire was filled daily for each patient by trained nurses; it contained required demographic characteristics, nutrition and hydration status, and disease progression. The primary outcome (frequency new episodes of diarrhea) and the secondary outcomes (frequency of tract respiratory infection, grown, anemia) were compared between the two groups. Results: Treatment of additional administration of Zinc induces significant changes in the subsequent reduction in episodes of acute diarrhea in children with diarrhea and moderate (McNemar test, with a p- value of 0.034, with a significance level of 0.05). While the average initial hemoglobin was 11.5 mg/dL (SD=1.9279), and the final average hemoglobin was 11.8 mg/dL (SD=1.9279), no significant difference in effect of zinc supplementation on hemoglobin found between the two groups (t-test - Student=0.460, P-value of 0.072, a=0.05). Regarding weight statistical association was demonstrated in the group receiving zinc supplementation, increasing the final weight of...

Perceptions regarding oral rehydration solutions for the management of diarrhea in Guatemalan children: implications for diarrheal management in the Americas / Ideas con respecto a las soluciones de rehidratación oral en el tratamiento de la diarrea de los niños guatemaltecos: repercusiones sobre el tratamiento de la diarrea en las Américas

OBJECTIVE: To describe knowledge and perceptions regarding the use of oral rehydration solution (ORS) for the management of diarrheal diseases among formal and informal health care providers and community caregivers in the Guatemalan department of Santa Rosa, and to recommend strategies to increase ORS use for management of diarrhea in children. METHODS: From July to September 2008, in-depth, semi-structured interviews were conducted with formal health care providers; open-ended interviews were conducted with informal health care providers; and focus group discussions and pile sorting were carried out with community caregivers. RESULT: The study participants attributed episodes of diarrhea in children to culturally recognized or folk ailments (empacho, cuajo, and varillas) that are primarily treated by traditional healers. There were knowledge deficits about 1) dehydration as a manifestation of diarrhea, and 2) management of dehydration, including the use of ORS and the need to continue feedings during diarrheal episodes. Caregivers perceived bottled/ready-made ORS products and the more expensive over-the-counter antidiarrheal medications as superior to ORS packets in the treatment of diarrhea. CONCLUSIONS: In Guatemala, folk etiologies of disease differ from those of the biomedical establishment and influence the decisions made by caregivers when treating ill children, including those related to the use of ORS. Public health campaigns addressing the treatment and management of diarrheal diseases in Santa Rosa should recognize the ailments known as empacho, cuajo, and varillas and target them for ORS use by community caregivers as well as health care providers in both the formal and informal health sectors.

OBJETIVO: Describir los conocimientos y las ideas que tienen las personas que prestan atención de salud en el sector convencional, el sector no convencional y los cuidadores de la comunidad con respecto al uso de las soluciones de rehidratación oral en el tratamiento de las enfermedades diarreicas, en el departamento guatemalteco de Santa Rosa y recomendar estrategias encaminadas a aumentar la utilización de estas soluciones en el tratamiento de la diarrea en los niños. MÉTODOS: De julio a septiembre del 2008 se llevaron a cabo entrevistas exhaustivas semiestructuradas a los profesionales de salud y entrevistas con preguntas abiertas a los proveedores no convencionales de atención sanitaria y se organizaron debates en grupos de opinión y ejercicios de ordenamiento de tarjetas con los cuidadores de la comunidad. RESULTADOS: Los participantes en el estudio atribuyeron la causa de los episodios de diarrea en los niños a dolencias culturalmente aceptadas o populares (empacho, cuajo y varillas), que tratan principalmente los curanderos. Se observaron deficiencias en los conocimientos acerca de 1) la deshidratación como una manifestación de la diarrea y 2) el tratamiento de la deshidratación, incluido el uso de las soluciones de rehidratación oral y la necesidad de continuar la alimentación durante los episodios diarreicos. Los cuidadores consideraron las soluciones de rehidratación embotelladas o preparadas y los medicamentos antidiarreicos de venta libre, que son más costosos, como mejores opciones para el tratamiento de la diarrea que las soluciones de rehidratación oral. CONCLUSIONES: En Guatemala, el concepto popular y el de las instituciones biomédicas sobre la causa de las enfermedades es diferente e influye sobre las decisiones que toman los cuidadores al tratar a los niños enfermos, por ejemplo, las relacionadas con el uso de soluciones de rehidratación oral. Las campañas de salud pública que abordan el tratamiento y el manejo de las enfermedades diarreicas en Santa Rosa deben incorporar las dolencias conocidas como empacho, cuajo y varillas y fomentar el uso de las soluciones de rehidratación oral en estos casos, por parte de los cuidadores de la comunidad, los profesionales de salud del sector convencional y los proveedores de atención del sector no convencional.

Habilidades maternas para prevenção e manejo da diarreia infantil / Habilidades maternas para prevención y manejo de la diarrea infantil / Maternal abilities in the prevention and handling of infantile diarrea

Objetivo: Identificar as habilidades maternas na prevenção e manejo da diarreia infantil. Materiale e método: Estudo transversal, quantitativo, realizado com 448 mães de crianças menores de 5 anos residentes em Fortaleza-CE. A coleta de dados ocorreu por meio de entrevista, utilizando-se um formulário abordando características sociodemográfIcas e aspectos relacionados ao cuidado materno para prevenção e manejo da diarreia em seus filhos. Resultados: As mães tinham em média 28,34 anos e 9,1 anos de estudo. A mediana da renda per capta foi R$150. A maioria possuía companheiro, trabalhava em casa e morava há mais de cinco anos na mesma residência. Verificou-se correlação estatisticamente significante entre a realização de receita caseira e idade materna (p=0,027); entre oferta de solução de reidratação oral para a criança e anos de estudo da mãe (p=0,013), bem como com renda familiar (p<0,001). A mãe ter recebido informação anterior sobre prevenção de diarreia infantil mostrou associação estatística com idade materna (p<0,001). Conclusão: As mães apresentaram como principais habilidades para prevenir e manejar a diarreia infantil o encaminhamento da criança a um servicio de saúde, o uso de receitas caseiras e a inmunizaçao contra rotavirus, evidenciando que estas são situaçõnes nas quais os enfermeiros são capazes de intervir.

Aim: To identify the maternal abilities in the prevention and handling of infantile diarrhea. Method: Transversal, quantitative study, carried out with 448 mothers of children under 5 years old, resident in Fortaleza-CE. Data were collected through interviews, using a form containing socio demographical characteristics and aspects related to maternal care for prevention and handling of infantile diarrhea. Results: The mothers had an average age of 28.34 years and 9.1 years of study. The medium income per capita was R$150. Most of the women had a couple and worked at home. Significant statistical correlation was observed between the realization of a homemade recipe and maternal age (p=0,027); and between the availability of oral rehydration solutions for the child and schooling of the mother (p=0,013). The previous act of receiving the information on prevention of infantile diarrhea showed statistical association with maternal age (p< 0.001). Conclusion: The mothers has as main hability to prevent and handle infantile diarrhea the referal of the child to a health service, the use of homemade recipes and inmunization against rotavirus, showing that these are situations in which nurses are able to intervene.

Objetivo: Identificar las habilidades maternas en la prevención y manejo de la diarrea infantil. Método: Estudio transversal, cuantitativo, realizado con 448 madres de niños menores de 5 años, en Fortaleza. Los datos fueron recolectados a través de entrevistas, utilizando un formulario que contenía datos sociodemográficos y aspectos relacionados a la atención materna para la prevención y manejo de la diarrea infantil. Resultados: Las madres tuvieron un promedio de 28,34 años y 9,1 años de estudio. La mediana de la renta per cápita fue de R$150. La mayoría tenía una pareja, trabajaba en casa y vivía hacía más de cinco años en la misma residencia. Hubo una correlación estadísticamente significativa entre la realización de medicinas caseras y la edad materna (p = 0,027); entre la oferta de solución de rehidratación oral para el niño y los años de estudio de la madre (p = 0,013), así como con el ingreso familiar (p<0,001). La madre que había recibido información previa sobre la prevención de la diarrea infantil mostró asociación estadística con la edad (p <0,001).La información previa recibida acerca de la prevención de la diarrea infantil mostró asociación estadística con la edad materna (p <0,001). Conclusión: Las madres tuvieron como principales habilidades para prevenir y manejar la diarrea infantil derivación del niño a un servicio de salud, el uso de recetas caseras y la inmunización contra el rotavirus, que demuestra que se trata de situaciones en las que las enfermeras pueden intervenir.

Observación inicial del impacto de la vacuna antirotavirus sobre la morbi-mortalidad por diarreas en Venezuela 2002-2010 / Initial observation of the impact of rotavirus vaccine on diarrhea morbidity and mortality in Venezuela 2002-2010

Estudiar el impacto de la introducción de la vacuna antirrotavirus en el plan nacional de inmunización sobre morbi-mortalidad por diarreas en <1 año, 1-4 y >5 2002-2010. Fuente: Boletines epidemiológicos, Informes de inmunizaciones y Anuarios de Mortalidad de MInSalud/INE. Se analizaron datos en números absolutos y porcentuales. Se calcularon la tasa general y las específicas de <1 año, 1-4 y > 5, promedios y razones, aplicando T independiente con I.C 95% Excel2010® y Epidat3®. La morbilidad general por diarreas se mantiene estbale, alcanzando una tasa de 6,45 x 10 5 hab y la mortalidad desciendole desde 6,79 (2002), a 3,94 (2008). La cobertura vacunal inicial (2006) fue de 26%, ascendiendo a 60% (2010). Las tasas de morbilidad y mortalidad en <5 años son 7 y 10 veces mayores, respectivamente, que en >5. Para todos, existe tendencia al descenso en mortalidad y estabilidad en morbilidad. Comparando tasas promediales antes y después de la vacunación, la disminución de la tasa de mortalidad en >5 años es estadísticamente significativa(T=2,68/P=0,04); para >5 años, no lo es. La enfermedad diarreica es un problema de salud pública. Después de introducir la vacuna al PAI se evidencia disminución en la mortalidad en > de 5 años, sin cambios en los > de 5 años. Debe mantenerse bajo vigilancia.

To study the impact of the introduction of rotavirus vaccine in national immunization plan over morbidity and mortalily from diarrhea in <1, 1-4 and > 5 years old patients, 2002-2010. Source: Epidemiological Bulletin, Immunization Reports and Yearbooks of Mortality MINSALUD/INE. Data were analyzed in absolute numbers and percentages. We calculated general and specific rates of < 1, 1-4 and > 5 years old children, averages and ratios by using T-independent IC 95%, Epidat3® and Excel2010®. The overall morbidity from diarrhea remains stable, reaching a rate of 6.45 x 10 5 hab. and mortality declined from 6.79 (2002) to 3.94 (2008). The initial vaccine coverage (2006) was 26%, reaching 60% (2010). The morbidity and morlality in >5 years old patients are 7 and 10 times higher, respectively, than in > 5 years old patients. For all, there is a downward trend in mortality and morbidity seems to be stable. Comparing mean rates before and after vaccination, the decline in mortality rate in < 5 years old patients is statistically significant (T=2.68/P=0.04), but for > 5 years old patients, it is not. Diarrheal disease is a public health problem. After introducing the vaccine into the EPI there is an evident decline in mortality in < 5 years old patients, with no changes in those > 5 years old. Surveillance plans should be kept.

Concentração de sódio e glicose em soro de reidratação oral preparado por Agentes Comunitários de Saúde / Sodium and glucose concentration in therapeutical solution for oral rehydration prepared by Community Health Agents

A diarreia infantil é importante causa de morbimortalidade, sendo indicativo para terapia de reidratação oral (TRO). Este estudo objetivou avaliar o teor de sódio e glicose em soro de reidratação oral preparado por Agentes Comunitários de Saúde (ACS) que atuam em Unidades Básicas de Saúde (UBS), caracterizando o perfil e o conhecimento destes sobre a TRO. Após responderem questionário com informações profissionais e sobre a TRO, os ACS a prepararam por três métodos. O teor de glicose e de sódio das TRO foi determinado e comparado ao proposto pela OMS. Na análise estatística foram utilizados ANOVA, Tukey e odds ratio. Participaram do estudo 52 ACS, majoritariamente mulheres e com ensino médio completo (90,4 por cento). A adequação da TRO foi de 3,9; 9,8 e 28,9 por cento para a colher caseira, colher medida e punhado pitada, respectivamente. O preparo da TRO com a colher caseira resultou em 88,0 por cento das amostras com teor de sódio perigoso à saúde (>101 mmol/L). Entre os ACS, 38,5 por cento tinham menos de 2 anos de trabalho, com risco 4,8 vezes maior de preparar TRO inadequada em sódio. Os ACS referiram indicar a TRO no tratamento da diarreia infantil, desconhecendo efeitos colaterais do preparo inadequado. A composição da TRO produzida pelos ACS foi inadequada em todos os métodos. É recomendável treinamento dos ACS no preparo da TRO.

Infant Diarrhea is a major cause of morbidity and mortality in children and oral rehydration therapy (ORT) is required. This study evaluates the composition of ORT prepared by Community Health Agents (CHAs) working in Basic Health Units, assessing their profile and knowledge about ORT. After the CHAs answer specific questions, they are invited to prepare ORT using three methods. Glucose and sodium levels were then quantified and compared with WHO recommendations. ANOVA, Tukey and odds ratio were used for statistical analysis. 52 CHAs participated, mainly females, and 90.4 percent with full high school education. The adequacy of the ORT was 3.9; 9.8 and 28.9 percent for table spoon, measuring spoon and pinch and scoop, respectively. The ORT preparation by table spoon resulted in 88 percent of samples with dangerous levels of sodium (>101mmol/L). 38.5 percent of the CHAs had less than 2 years experience, leading to a 4.8 times greater risk of preparing ORT with high sodium. The CHAs indicated ORT as a treatment for diarrhea, though they were unaware of the side effects of inadequate preparation. The composition of the ORT produced by the CHAs was inadequate in all methods tested. The CHAs revealed a lack of knowledge of the side effects iof ORT with inadequate salt levels. The recommendation is to train the CHAs in ORT preparation.

Cost-effectiveness of improving pediatric hospital care in Nicaragua / Costo-eficacia de la mejora de la atención hospitalaria pediátrica en Nicaragua

OBJECTIVE: To determine the costs and cost-effectiveness of an intervention to improve quality of care for children with diarrhea or pneumonia in 14 hospitals in Nicaragua, based on expenditure data and impact measures. METHODS: Hospital length of stay (LOS) and deaths were abstracted from a random sample of 1294 clinical records completed at seven of the 14 participating hospitals before the intervention (2003) and 1505 records completed after two years of intervention implementation ("post-intervention"; 2006). Disability-adjusted life years (DALYs) were derived from outcome data. Hospitalization costs were calculated based on hospital and Ministry of Health records and private sector data. Intervention costs came from project accounting records. Decision-tree analysis was used to calculate incremental cost-effectiveness. RESULTS: Average LOS decreased from 3.87 and 4.23 days pre-intervention to 3.55 and 3.94 days post-intervention for diarrhea (P = 0.078) and pneumonia (P = 0.055), respectively. Case fatalities decreased from 45/10 000 and 34/10 000 pre-intervention to 30/10 000 and 27/10 000 post-intervention for diarrhea (P = 0.062) and pneumonia (P = 0.37), respectively. Average total hospitalization and antibiotic costs for both diagnoses were US$ 451 (95 percent credibility interval [CI]: US$ 419-US$ 482) pre-intervention and US$ 437 (95 percent CI: US$ 402-US$ 464) post-intervention. The intervention was cost-saving in terms of DALYs (95 percent CI: -US$ 522- US$ 32 per DALY averted) and cost US$ 21 per hospital day averted (95 percent CI: -US$ 45- US$ 204). CONCLUSIONS: After two years of intervention implementation, LOS and deaths for diarrhea decreased, along with LOS for pneumonia, with no increase in hospitalization costs. If these changes were entirely attributable to the intervention, it would be cost-saving.

OBJETIVO: Determinar el costo y la eficacia en función del costo de una intervención para mejorar la calidad de la atención de ni±os con diarrea o neumonía en 14 hospitales de Nicaragua, sobre la base de la información sobre gastos y la medición de las repercusiones. MÉTODOS: Se compilaron datos sobre la duración de la hospitalización y la mortalidad de una muestra aleatoria de 1 294 historias clínicas compiladas en 7 de los 14 hospitales participantes antes de la intervención (2003) y 1 505 historias clínicas compiladas después de dos a±os de ejecución de la intervención ("postintervención", 2006). Los a±os de vida ajustados en función de la discapacidad (AVAD) se obtuvieron de los resultados asistenciales. Se calcularon los costos de hospitalización según los registros de los hospitales y del Ministerio de Salud, y datos del sector privado. Los costos de la intervención se obtuvieron de los registros contables del proyecto. Para calcular la relación costo-eficacia incremental se usó un anßlisis de ßrbol de decisiones. RESULTADOS: La duración promedio de la hospitalización disminuyó de 3,87 y 4,23 días antes de la intervención a 3,55 y 3,94 días después de la intervención para la diarrea (P = 0,078) y la neumonía (P = 0,055), respectivamente. La letalidad disminuyó de 45/10 000 y 34/10 000 antes de la intervención a 30/10 000 y 27/10 000 después de la intervención para la diarrea (P = 0,062) y la neumonía (P = 0,37), respectivamente. Los costos totales promedio de la hospitalización y de los antibióticos para ambos diagnósticos fueron de US$ 451 (intervalo de confianza [IC] de 95 por ciento: US$ 419 a US$ 482) antes de la intervención y US$ 437 (IC 95 por ciento: US$ 402-US$ 464) después. La intervención representó un ahorro de costos en cuanto a los AVAD (IC 95 por ciento: -US$ 522 a US$ 32 por cada AVAD evitado) y costó US$ 21 por cada día de hospitalización evitado (IC 95 por ciento: -US$ 45 a US$2 04). CONCLUSIONES: Después de dos...

Actualización en el manejo nutricional de la diarrea infantil / Update on nutritional management of infant diarrhea

Los niños con enfermedad diarreica (ED) continúan siendo un problema de salud pública en los países en vía de desarrollo como el nuestro. Es necesario definir una serie de términos que ayudan al mejor entendimiento en el manejo de la ED como son su etiología, la manera de hidratar, las intolerancias, las fórmulas infantiles, y la dieta absorbente o astringente. Sigue siendo válido en el manejo de la ED, el concepto “primero hidratar, para luego alimentar”. El tratamiento incluye desde lactancia materna, fórmulas infantiles especiales, dieta absorbente o astringente, zinc, probióticos, antibióticos y en casos extremos hasta de nutrición parenteral.

Children with diarrheal disease (DD) remains a public health problem in developing countries like ours. It isnecessary to define a set of terms that help the better understanding of the management of DD, such as theircauses, how to hydrate, intolerance, infant formulas, and diet absorbent or astringent. Remains valid in the management of DD, the term "hydrate first, then feed." Treatment ranges from breastfeeding, special infantformulas, diet absorbent and astringent, zinc, probiotics, antibiotics, andinextremecasesof parenteral nutrition.

Probióticos e prebióticos na prevenção e no tratamento de doenças em lactentes e crianças / Probiotics and prebiotics in prevention and treatment of diseases in infants and children

OBJETIVO: Avaliar o impacto do uso de probióticos e prebióticos na saúde das crianças. FONTES DOS DADOS: Foram pesquisados os bancos de dados MEDLINE e LILACS, selecionando-se artigos relevantes em inglês e francês. SÍNTESE DOS DADOS: O leite humano é rico em oligossacarídeos prebióticos e pode conter probióticos. Não existem dados sugerindo que a adição de probióticos a fórmulas para lactentes possa ser prejudicial, mas as evidências de sua eficácia são insuficientes para que seja recomendada. Visto que dados sugerem que a adição de oligossacarídeos prebióticos específicos pode reduzir infecções e atopia em lactentes saudáveis, sua adição parece razoável. Os benefícios a longo prazo dos pro e prebióticos para o sistema imunológico em desenvolvimento ainda precisam ser comprovados. Probióticos selecionados reduzem a duração da diarreia infecciosa em 1 dia, mas faltam evidências quanto à prevenção, exceto na diarreia associada a antibióticos. Alguns probióticos específicos previnem a enterocolite necrosante, e outros micro-organismos podem ser benéficos nos casos de gastrite por Helicobacter pylori e de cólica do lactente. Não há evidências suficientes para recomendar o uso de probióticos na prevenção e no tratamento da dermatite atópica. A utilização de probióticos nos casos de constipação, síndrome do intestino irritável, doença inflamatória intestinal e infecções extraintestinais requer mais estudos. CONCLUSÕES: A duração da administração, a dosagem microbiana e as espécies utilizadas necessitam de maior validação, tanto para probióticos quanto para prebióticos. Alegações de saúde injustificadas são uma grande ameaça ao conceito de pro e prebióticos.

OBJECTIVE: To evaluate the impact of probiotics and prebiotics on the health of children. SOURCES: MEDLINE and LILACS were searched for relevant English and French-language articles. SUMMARY OF THE FINDINGS: Human milk is rich in prebiotic oligosaccharides and may contain some probiotics. No data suggest that addition of probiotics to infant formula may be harmful, but evidence of its efficacy is insufficient for its recommendation. Since data suggest that addition of specific prebiotic oligosaccharides may reduce infections and atopy in healthy infants, their addition to infant formula seems reasonable. Long-term health benefits of pro- and prebiotics on the developing immune system remain to be proven. Selected probiotics reduce the duration of infectious diarrhea by 1 day, but evidence in prevention is lacking, except in antibiotic-associated diarrhea. Some specific probiotics prevent necrotizing enterocolitis, and other microorganisms may be beneficial in Helicobacter pylori gastritis and in infantile colic. Evidence is insufficient to recommend probiotics in prevention and treatment of atopic dermatitis. The use of probiotics in constipation, irritable bowel syndrome, inflammatory bowel disease, and extra-intestinal infections requires more studies. CONCLUSIONS: Duration of administration, microbial dosage, and species used need further validation for both pro- and prebiotics. Unjustified health claims are a major threat for the pro- and prebiotic concept.

Males diarreicos en la costa ecuatoriana: cambios socioambientales y concepciones de salud / Diarrheal illnesses on the Ecuadorian coast: socio-environmental changes and health concepts

Presentamos una etnoepidemiologia de las enfermedades diarreicas en 21 pueblos de la costa norte del Ecuador, zona en la cual hay muchos cambios sociales y ambientales desde 2001 por la presencia de una nueva carretera. Con percepciones de que la misma naturaleza esta cambiando, vienen cambios en interpretaciones de lo que es salud y enfermedad, que presentamos en forma de una taxonomia de males diarreicos. Ante la fuerte incidencia de las enfermedades diarreicas, existen concepciones alternativas a la biomedicina en cuanto a sus causas, sintomas y tratamientos. Hay superposiciones entre sistemas no-biomedicas y biomedicos, en donde hay mezclas de coexistencia y resistencia. Reconocer esto es entender una serie de desafios para el sistema de salud oficial, incluyendo el uso indiscriminado de antibioticos, el no uso de servicios de salud para algunos males, y relaciones percibidas entre contaminacion ambiental y la eficacia de las medicinas moderna y tradicional.

The authors present an ethnoepidemiological study of diarrheal illnesses in 21 communities on the northern coast of Ecuador, where numerous social and environmental changes have taken place since 2001 due to a new highway. As communities realize that nature itself is changing, changes occur in their interpretations of health and disease, which the authors present through a taxonomic classification of diarrheal illnesses. Given the high incidence of diarrheal diseases, alternative concepts have emerged (as compared to those of biomedicine) in relation to causes, symptoms, and treatments. The non-biomedical and biomedical systems overlap, with mixtures of coexistence and resistance. Recognizing this reality means understanding a series of challenges for the official health system, including the indiscriminate use of antibiotics, non-use of health services for some diseases, and perceived relations between environmental contamination and the efficacy of modern and traditional medicines.

Acute salt poisoning due to different oral rehydration solution (ORS) packet sizes.

The packing and composition of ORS has undergone a change since its introduction. In India, some companies are manufacturing smaller pouches (4.2 g) to be dissolved in 200 ml of water. Therefore, out of confusion some prescribers routinely advise the patients to dissolve the standard formulation ORS pouch (21 g) in a glass (200 ml) of water. Two cases are discussed. First patient developed salt poisoning due to improper dilution and recovered after rapid correction. In the second patient improper reconstitution led to hypernatremia and death.

Indicação da Terapia de Reidratação Oral no setor de emergência: decisão baseada na clínica: [revisão] / Use of Oral Rehydration Therapy in the emergency unit: a clinical-based decision: [review]

OBJETIVO: Revisar a literatura acerca da indicação da terapia de reidratação oral (TRO) no contexto do Setor de Emergência, buscando fatores inerentes à formação do médico, à atitude do cuidador e, finalmente, à dinâmica do próprio serviço como determinantes à sua aplicação. FONTES DE DADOS: Revisão não-sistemática da literatura incluindo artigos originais e meta-análises, nos idiomas inglês, português e espanhol, a partir das bases de dados Pubmed/Medline, Cochrane Collaboration, Lilacs e SciELO, no período de 1990 a 2008. Foram utilizados os termos "oral rehydration therapy", "diarrhea case management", "emergency department" e palavras relacionadas. SÍNTESE DOS DADOS: Realizada em local apropriado, a TRO mostrou eficácia semelhante à terapia venosa no restabelecimento do nível de hidratação em crianças com diarreia aguda no Setor de Emergência. O tempo de formado e a experiência profissional, o conhecimento e o treinamento no manejo da diarreia aguda mostraram associação à utilização da TRO. Entretanto, relatos de inconveniência de sua administração no Setor de Emergência incluem falta de espaço físico e pressão assistencial, sugerindo, ao mesmo tempo, inadequação estrutural e uso inapropriado do serviço nesses casos. A relação com o cuidador também influencia na decisão médica, com o relato de desconfiança deste quanto à eficácia da terapia sendo citado como barreira à sua indicação. CONCLUSÕES: A subutilização da TRO no Setor de Emergência está associada a fatores extrínsecos à formação médica, como questões estruturais e fatores inerentes à relação com o cuidador diante das suas expectativas quanto à terapia.

OBJECTIVE: To review the literature about indication of oral rehydration therapy (ORT) for children in the emergency unit, seeking factors related to medical training, caregiver's attitude and units' conditions as determinants for that practice. DATA SOURCES: Non-systematic literature review including original articles and meta-analysis in English, Portuguese and Spanish, identified via Pubmed/Medline, Cochrane Collaboration, Lilacs and SciELO, published between 1990 and 2008, using the terms "oral rehydration therapy", "diarrhea case management", "emergency department" and related words. DATA SYNTHESIS: When carried out in appropriate rooms, ORT treatment is as effective as intravenous therapy in restoring the level of hydration in children with acute diarrhea in the emergency unit. Time of graduation and professional experience, knowledge and training on acute diarrhea case management showed an association with ORT use. However, reports of inconvenience of its administration in the emergency unit include lack of physical space and pressure care, while simultaneously suggesting structural inadequacy and improper use of the service in these cases. Reports of caregivers' suspicion about the effectiveness of this therapy are cited as a barrier for prescription. CONCLUSIONS: Subuse of ORT in the emergency unit is associated with factors beyond medical training and expertise, such as structural problems and caregivers' expectations about the therapy.

Terapia de rehidratación oral: [revisión] / Oral rehidratation therapy: [review]

La deshidratación producida por la perdida de líquidos y electrolitos en pacientes con diarrea aguda continua siendo causa frecuente de muerte infantil, el desarrollo de la terapia de rehidratación oral ha convertido a la diarrea aguda en la causa de mortalidad infantil más sencilla de prevenir. Las SRO y la terapia de rehidratación oral (TRO) propuesta por UNICEF y OMS a finales de los años 70, han permitido manejar con eficacia la diarrea aguda. En la década de los 90 a nivel mundial fue posible evitar mas de un millón de muertes anuales de niñas y niños menores de 5 años relacionadas con esta enfermedad. La TRO esta indicada para prevenir la deshidratación, rehidratar y mantener el estado de hidratación independientemente de la edad del paciente, del agente etiológico o los valores iniciales de sodio sérico, a través de la administración por vía oral de mezclas estandarizadas de sales y carbohidratos disueltos en agua. A través del tiempo muchos investigadores han estudiado diferentes transportadores tratando de encontrar la solución ideal para la terapia de rehidratación oral, tomando en cuenta la absorción intestinal de nutrientes, líquidos y electrólitos, considerando que la absorción asociada de glucosa y sodio, favorece a su vez la absorción de agua, lo que permite obtener balances hídricos positivos de tal magnitud que posibilitan la corrección de la deshidratación en las primeras 4 a 6 hrs. de iniciada su administración en más del 90% de los niños deshidratados por diarrea aguda. Lo anterior fue considerado por Lancet como el descubrimiento médico más importante del siglo XX.

The dehydration produced by the loss of liquids and electrolytes in patients with sharp (acute) constant diarrhea being a frequent reason of infantile death, the development of the therapy of oral rehydration has turned to the acute diarrhea in the reason of the simplest infant mortality to anticipate. The SRO and the therapy of oral rehydration (TRO) proposed by UNICEF and WHO at the end of the 70s, have allowed to handle with efficiency the acute diarrhea. In the decade of the 90 worldwide it was possible to avoid more of a million annual deaths of children and 5-year-old minor related to this disease. The TRO indicated to anticipate the dehydration, to re-hydrate and to support the condition of hydration independently of the age of the patient, of the agent etiological or the initial values of sodium, across the administration for oral route of mixtures standardized of salts, carbohydrates dissolved in water. Across the time many investigators have studied different carriers trying to find the ideal solution for the therapy of oral rehydration, taking in counts the intestinal absorption of nutrients, liquids and electrolytes, considering that the associate absorption of glucose and sodium, favors in turn the water absorption, which allows to obtain water positive balances of such a magnitude that make the alteration of the dehydration possible in the first ones 4 to 6 hrs. of initiated his administration in more than 90% of the children dehydrated by acute diarrhea. The previous thing was considered by Lancet as the discovery medicate more importantly of the 20th century.

Ausência de efeito do Lactobacillus delbrueckii H2B20 na prevenção de díarréia em crianças hospitalizadas por curto período / Lack of effect of Lactobacillus delbrueckii H2B20 in the prevention of diarrhea in children hospitalized for short period

Objetivo: Avaliar o uso do Lactobacillus delbruechii UFV H2B20 na prevenção de diarréia em crianças hospitalizadas. Método: Trata-se de estudo prospectivo, randomizado e duplo cego, no qual foram incluidas 139 crianças hospitalizadas com idades de 1 a 36 meses em enfermaria geral do Hospital Infantil João Paulo II/FHEMIG, em Belo Horizonte, no período de agosto de 2004 a julho de 2006...

Objectives: The objective of this trial was to evaluate the use of lactobacillus delbrueckii UFV H2B20 in the prevention of diarrhea in hospitalized children. Methods: It is a prospective, randomized and double blind trial in which were included 139 children from 1 to 36 months old who were hospitalized in the João Paulo II/FHEMIG children's Hospital, in Belo Horizonte, from August 2004 to July 2006...

Manejo terapéutico de las Enfermedades Diarreicas Agudas (EDA) desde la perspectiva de la medicina tradicional en menores de 5 años en la comunidad de Pocanche Provincia Ayopaya - Independencia, en el año 2008 / Therapeutic management of acute diarrheal diseases (ADD) from the perspective of traditional medicine in children under 5 years in the community of Pocanche Province Ayopaya - Independence, in 2008

Las enfermedades diarreicas agudas producen desórdenes hidroelectrolíticos en el organismo de los niños produciendo complicaciones como la deshidratación y por ende la muerte. Para el tratamiento de esta enfermedad se establecen estrategias por parte de la medicina occidental, pero de igual manera la medicina tradicional se introduce al manejo de estas enfermedades.Con el presente trabajo, se realizó un análisis del manejo terapéutico que los médicos tradicionales emplean en caso de EDA en niños menores de 5 años en la comunidad de Pocanche (provincia Ayopaya) utilizando guías de entrevistas personales.El estudio tiene enfoque cualitativo, etnográfico, longitudinal y descriptivo.Se utilizó guías de entrevista estructuradas; la información fue narrada, analizada con una reflexión profunda, obteniendo como resultado que la medicina tradicional es más empleada por la población siendo así que reconocen a la enfermedad desde una perspectiva mítica y desconocen métodos de diagnóstico, así como los planes de tratamiento para la EDA; razón por la cuál existe la necesidad de incorporar personal con conocimiento de la medicina tradicional a los servicios de salud. Se elaboró una propuesta para incorporar el personal tradicional a los servicios de salud con bases reales para así coadyuvar en la disminución de morbi-mortalidad por deshidratación por causa de EDA.

Composición de las soluciones caseras usadas en ninos con diarrea sin deshidratación: Mérida-Venezuela: [revisión] / Composition of home made solutions used in children with diarrhea without dehydration: [review]

La diarrea es una causa principal de morbi-mortalidad en niños y el uso de la terapia de rehidratación oral (uso de suero oral más líquidos caseros) puede prevenir la deshidratación. Identificar las soluciones caseras utilizadas en los niños con diarrea sin deshidratación, analizar su composición bioquímica y proponer las más adecuadas. Se entrevistaron 167 madres, en consultas pediátricas, seleccionadas al azar, durante los años 2004-2006, en Mérida-Venezuela; es un estudio epidemiológico, analítico, prospectivo y concurrente. Se identificaron cinco grupos de soluciones caseras: agua de arroz, sopa de plátano, sopa de cambur (banana), infusiones de hierbas y jugos de frutas. El análisis bioquímico se realizó mediante un pH metro, espectroscopia de absorción atómica (Na y K), argentometría (Cl), osmómetro (osmolaridad), glucosa peroxidasa (glucosa), hidrovolumetría por neutralización (bicarbonato) y bandas de absorción (citrato), procesadas en la Facultad de Ciencias de la Universidad de Los Andes. Todas las soluciones estudiadas tienen un pH ácido, con excepción del suero casero con bicarbonato. las concentraciones de electrolitos fueron mínimas en el agua de arroz, las infusiones de hierbas y los jugos de frutas, mientras que fueron más elevadas en las sopas de plátano y banana. (Na y Cl más elevado). Las osmolaridad fue baja en todas las soluciones y alta en los jugos de frutas. Ninguna de las soluciones reúne las concentraciones planteadas por la OMS, aunque en el niño con diarrea sin deshidratación la sopas de plátano y banana pueden ser utilizadas debido a la buena aceptación y al bajo costo. No se recomiendan los jugos de fruta por su alta osmolaridad.

Diarrhoea continues to be one the main causes of morbidity-mortality in latin american countries due to dehydration. this is why the most important strategy to avoid deaths due to dehydration is oral rehydration therapy (oral rehydration solution plus homemade solutions) which may vary according to each region of the country. To identify the most frequently used homemade solutions for preventing dehydration in children with acute diarrhoea within the community in Mérida, Venezuela; to analyze the biochemical composition of these solutions; to propose the use of the most adequate ones. By means o an epidemiological, analytical, prospective and concurrent study 167 inquiries were performed to mothers who sought medical help in the main assistance centers of the city. these mothers were selected randomly during 2004-2006. five groups of homemade solutions were identified: rice water (golden rice in esther grain or flour), plantain soup with or without chicken, banana soup, herbal infusions and fruit juices. Biochemical analysis was performed by means of: ohmmeters (pH), spectroscopy of atomic absorption (Na and K), argentometry (Cl), osmometer (osmolarity), glucose peroxidase (glucose), hidrovolumetry by neutralization (bicarbonate) and absorption bands (citrate) processed at the Science Faculty of the Universidad de Los Andes. All the homemade liquids have an acidic pH, except solutions with added bicarbonate. electrolytes concentrations were minimum except for the plantain and banana soups, which have a higher sodium and chloride concentration. The osmolarity of most solutions was low, with exception of fruit juices (orange and guava). Conclusions: none of the homemade solutions meet the requirements established by the World Health Organization as an ideal rehydration solution. However, plantain and banana soup may be used in children with diarrhea without dehydration due to their high availability.