Risk factors associated with antineoplastic chemotherapy-induced nausea and vomiting / Fatores de risco associados a náuseas e vômitos induzidos por quimioterapia antineoplásica

ABSTRACT OBJECTIVE: To estimate the incidence and to evaluate risk factors for antineoplastic nausea and vomiting with high and moderate emetogenic chemotherapy in adult patients in the first treatment cycle. METHODS: Prospective cohort study with follow-up of 269 adults during the first cycle of antineoplastic chemotherapy. The incidence of nausea and vomiting was evaluated in the acute phase (0-24 hours), in the late phase (24 hours-5th day) and in the total phase (0-5th day). RESULTS: In total, 152 patients underwent high emetogenic chemotherapy and 117 moderate emetogenic chemotherapy. The relative frequency of nausea was higher when compared with vomiting in the acute phase (p < 0.001) and in the late phase (p < 0.001). The risk factors identified were: age group ≤ 49 years (odds ratio = 0.47; 95%CI 0.23-0.95) and 50-64 years (odds ratio = 0.45; 95%CI 0.23-0.87), tobacco use (odds ratio = 0.35; 95%CI 0.14-0.88), and high emetogenic chemotherapy (odds ratio 0.55; 95%CI 0.31-0.95). CONCLUSION: The incidence of nausea was higher than that of vomiting, and adverse effects were more frequent in the late phase. The results suggest the risk factors for chemotherapy-induced nausea and vomiting are tobacco, age (young adults), and high emetogenic chemotherapy.

RESUMO OBJETIVO: Estimar a incidência e avaliar os fatores de risco para náuseas e vômitos induzidos por antineoplásicos com alto e moderado potencial emético em pacientes adultos, no primeiro ciclo de tratamento. MÉTODOS: Estudo de coorte prospectiva, com 269 adultos acompanhados durante o primeiro ciclo de quimioterapia antineoplásica. A incidência de náuseas e vômitos foi avaliada na fase aguda (0-24 horas), na fase tardia (24 horas-5° dia) e na fase total (0-5° dia). RESULTADOS: 152 pacientes foram submetidos a quimioterápico com alto potencial emético e 117 a moderado potencial emético. A frequência relativa de náuseas foi maior quando comparada à de vômitos na fase aguda (p < 0,001) e na fase tardia (p < 0,001). Os fatores de risco identificados foram: faixa etária ≤ 49 anos (odds ratio = 0,47; IC95% 0,23-0,95) e 50-64 anos (odds ratio = 0,45; IC95% 0,23-0,87), uso de tabaco (odds ratio = 0,35; IC95% 0,14-0,88) e alto potencial emético dos quimioterápicos (odds ratio 0,55; IC95% 0,31-0,95). CONCLUSÃO: A incidência de náuseas foi maior do que a de vômitos, e na fase tardia os efeitos adversos foram mais frequentes. Os resultados sugerem que os fatores de risco para náuseas e vômitos induzidos por quimioterapia são o tabaco, a idade (adultos jovens) e o alto potencial emético do quimioterápico.

Estado nutricional, imagem corporal e associação com comportamentos extremos para controle de peso em adolescentes brasileiros, Pesquisa Nacional de Saúde do Escolar de 2015 / Nutritional status, body image, and their association with extreme weight control behaviors among Brazilian adolescents, National Adolescent Student Health Survey 2015

RESUMO: Introdução: Este estudo objetivou analisar a associação entre estado nutricional, percepção da imagem corporal e comportamentos extremos para controle de peso nos adolescentes. Metodologia: Estudo transversal analítico, realizado no Brasil a partir da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2015, com adolescentes de 13 a 17 anos. Estado nutricional e percepção da imagem corporal foram as variáveis independentes. As dependentes foram vômito ou uso de laxantes e uso de remédios e outras fórmulas para controle de peso nos últimos 30 dias. Modelos de regressão de Poisson foram empregados para associação, com uso de variáveis demográficas para controle. Resultados: 7,4% dos adolescentes (IC95% 6,7 - 8,2) relataram vômito ou uso de laxantes, sem diferença entre os sexos. A prevalência de uso de remédio e fórmulas foi maior entre meninos (7,8%; IC95% 6,6 - 8,9). A associação entre estado nutricional e comportamentos extremos não foi significativa; entretanto, a prevalência de vômito ou uso de laxantes foi 2,3 (IC95% 1,1 - 4,7) vezes maior em meninos e 5,3 (IC95% 3,3 - 8,6) vezes maior em meninas que se sentiam muito gordos(as), ao passo que uso de remédios e fórmulas foi 4,0 vezes (IC95% 2,3 - 7,1) maior em meninas que sentiam muito gordas. Conclusão: A percepção da imagem corporal parece ter maior influência na prática dos comportamentos extremos do que o estado nutricional. Estratégias envolvendo serviços de saúde e escolas têm grande potencialidade para ações que impactem positivamente na autoestima e na saúde dos estudantes.

ABSTRACT: Introduction: This study aimed to analyze the association between nutritional status, body image perception, and extreme weight control behaviors among adolescents. Methods: This is an analytical cross-sectional study conducted in Brazil based on the National Adolescent Student Health Survey (Pesquisa Nacional de Saúde do Escolar - PeNSE) of 2015, with adolescents aged 13 to 17 years. Nutritional status and body image perception were the independent variables. The two dependent variables were vomiting or laxative use and use of medicines and other formulas for weight control in the 30 days prior to data collection. We used Poisson regression models for association, with demographic variables for control. Results: 7.4% of adolescents (95%CI 6.7 - 8.2) reported vomiting or using laxatives, with no difference between genders. The prevalence of use of medicines and formulas was higher among boys (7.8%; 95%CI 6.6 - 8.9). The association between nutritional status and extreme behaviors was not significant. However, the prevalence of vomiting or laxative use for adolescents who considered themselves very fat was 2.3 (95%CI 1.1 - 4.7) times higher for boys and 5.3 (95%CI 3.3 - 8.6) times higher for girls, while the use of medicines and formulas was 4.0 (95%CI 2.3 - 7.1) times higher for girls who considered themselves very fat. Conclusion: Body image perception seems to have a greater influence on extreme behaviors than nutritional status. Strategies involving health services and schools have great potential to impact the self-esteem and health of students positively.

Frecuencia y características del cáncer de vesícula biliar en un hospital de referencia al sur del Perú, 2009-2014: estudio descriptivo / Frequency and characteristics of gallbladder cancer at a referral hospital in southern Peru, 2009-2014: a descriptive study

INTRODUCCIÓN: El cáncer de vesícula biliar es una neoplasia poco común, y su frecuencia es variable en las regiones de Perú. OBJETIVO: Determinar la frecuencia y describir las características clínicas del cáncer de vesícula biliar en un hospital de referencia al sur de Perú. MÉTODOS: Estudiamos los informes de todas las muestras de colecistectomías realizadas entre los años 2009 y 2014, en el servicio de anatomía patológica del Hospital Regional Honorio Delgado. Además, revisamos las historias clínicas de los pacientes que tuvieran algún resultado compatible con cáncer de vesícula biliar. RESULTADOS: De 2991 colecistectomías, 75 (2,5%) tuvieron cáncer de vesícula biliar. El síntoma más frecuente en ambos grupos fue el dolor (96,7%), seguido de náusea (87,5%) y vómitos (65,0%). La mayoría de pacientes fueron mujeres (83,3%) mayores de 60 años (65,0%). El tipo histológico más frecuente fue el adenocarcinoma (80,0%). CONCLUSIÓN: La frecuencia de cáncer de vesícula biliar en un hospital de referencia del sur de Perú, es de 2,5% mayor a la reportada en otros estudios en las regiones centro y norte del país.

INTRODUCTION: Gallbladder cancer is a rare neoplasm, its frequency is variable in the regions of Peru. OBJECTIVE: To determine the frequency and describe the clinical characteristics of gallbladder cancer in southern Peru. METHODS: The reports of the anatomopathological department of the Honorio Delgado Regional Hospital were selected from all samples of cholecystectomies performed between 2009 and 2014 and those that had some result compatible with gallbladder cancer were looked for. Subsequently, the clinical histories were searched to obtain the characteristics of these patients. RESULTS: Of 2991 cholecystectomies, 75 (2.5%) had gall bladder cancer. The most frequent symptom in both groups was pain (96.7%), followed by nausea (87.5%) and vomiting (65.0%). The majority of patients were women (83.3%) older than 60 years (65.0%). The most frequent histological type was the adenocarcinoma (80.0%). CONCLUSION: The frequency of gallbladder cancer in a reference hospital in southern Peru is 2.51%, higher than that reported in other studies in the central and northern regions of Peru.

Características clínicas y manejo de lactantes menores de 1 año con sospecha de alergia a proteína de leche de vaca / Clinical characteristics and management of infants less than 1-year-old suspected with allergy to cow's milk protein

Introducción: La alergia a proteína de leche de vaca (APLV) es frecuente en lactantes (2-5% en < 1 año). Tiene múltiples formas de presentación y un amplio diagnóstico diferencial, por lo que es relevante confirmar el diagnóstico. El estándar de oro del diagnóstico es el test de provocación oral (TPO), que en la práctica no siempre se realiza. En Chile hay escasa literatura respecto a esta entidad. Objetivo: Describir características demográficas, clínicas y manejo de lactantes < 1 año con sospecha de APLV. Pacientes y Método: Estudio retrospectivo en menores de 1 año atendidos por sospecha de APLV entre 2009-2011. Se registraron datos demográficos, historia perinatal, antecedentes de atopia, alimentación al momento del diagnóstico, síntomas de sospecha de APLV, estudios realizados para su confirmación, y respuesta a tratamiento. Se consideró como estándar de diagnóstico la respuesta a la dieta y la contraprueba. Se definió como respuesta a la dieta la ausencia de los síntomas atribuidos a la APLV al menos 4 semanas desde el cambio de leche. Se realizó estadística descriptiva mediante programa Epiinfo™. Resultados: Se incluyeron 106 lactantes, 51% varones, 80% recién nacidos de término, 74% con al menos un progenitor atópico, 34% con alguno de los padres o algún hermano con alergia alimentaria. La mediana de edad al inicio fue 1,5 meses (rango: 1,5-2 m). El 15% recibió fórmula desde el período neonatal y el 50% antes del tercer mes. Los síntomas más frecuentes fueron: vómitos (63%), cólicos (50%) y rectorragia (40%); el 61% presentó ≥ 2 síntomas al comienzo. Solo en el 34% se hizo TPO, en el resto se evaluó la respuesta a la dieta de exclusión y se realizaron exámenes. La realización de exámenes no cambió la conducta. Tratamiento: 43% lactancia materna con dieta de exclusión, 24% solo fórmula extensamente hidrolizada, 26% solo fórmula aminoacídica y 7% otros. Conclusión: Las características demográficas y antecedentes de los pacientes concuerdan con lo descrito en la literatura extranjera. El inicio clínico fue precoz, predominando los síntomas digestivos. Se realizaron exámenes en una proporción alta de pacientes, sin contribuir a un cambio de conducta; el TPO fue subutilizado como herramienta diagnóstica.

Introduction: Cow's milk protein allergy (CMPA) is highly prevalent in infants (2-5%). It has a wide clinical spectrum, and confirmation through an oral food challenge (OFC) is relevant for its differential diagnosis. Information on this topic is scarce in Chile. Objective: To describe the demographic and clinical features of infants with suspected CMPA. Patients and Method: A retrospective study of patients < 1 year-old, treated for suspected CMPA between 2009 and 2011. Demographic data, symptoms of atopy, nutrition at the time of diagnosis, CMPA symptoms, diagnostic studies, and response to treatment were recorded. Diet response at least 4 weeks after milk modification, and clinical behavior when suspected foods were added back to the diet were considered standard diagnostic criteria. Descriptive statistics were performed using Epiinfo ™ software. Results: The study included 106 infants, of whom, 51% male, 80% term newborns, 74% with ≥ 1 atopic parent, and 34% with ≥ 1 parent/sibling with food allergy. The median age at onset of symptoms was 1.5 months (range 1.5-2 m). Almost half (46%) were breast-feeding ≥ 6 m, with 15% receiving formula milk since the neonatal period, and 49% before the third month. Common symptoms were: vomiting (63%), colic (49%), and bleeding on passing stools (41%). No anaphylaxis was identified, and 61% had ≥ 2 symptoms at debut. Only 34% were subjected to OFC. The most frequently requested tests were, test patch (43%), prick test (40%), and blood in stools (37%). Treatment: 43% breast feeding with exclusion diet, 24% extensively hydrolysed formula, 26% amino acid formula, and 7% others. Conclusion: Demographic characteristics and risk factors were similar to those previously described in international literature. Clinical presentation was early in life, and digestive symptoms predominated. OFC was underused for diagnosis, and most of the tests requested did not change management.

A comparison of two different doses of morphine added to spinal bupivacaine for inguinal hernia repair / Comparação de duas doses diferentes de morfina adicionadas à bupivacaína em raquianestesia para herniorrafia inguinal

ABSTRACT BACKGROUND AND OBJECTIVES: The aim of this study was to compare the effects of two different doses of intrathecal morphine on postoperative analgesia, postoperative first mobilization and urination times and the severity of side effects. METHODS: After Institutional Ethical Committee approval, 48 ASA I-II patients were enrolled in this randomized double-blinded study. Spinal anesthesia was performed with 0.1 mg (Group I, n = 22) or 0.4 mg (Group II, n = 26) ITM in addition to 7.5 mg heavy bupivacaine. The first analgesic requirement, first mobilization and voiding times, and postoperative side effects were recorded. Statistical analyses were performed using SPSS 15.0 and p < 0.05 was considered as statistically significant. The numeric data were analyzed by thet-test and presented as mean ± SD. Categorical data were analyzed with the chi-square test and expressed as number of patients and percentage. RESULTS: Demographic data were similar among groups. There were no differences related to postoperative pain, first analgesic requirements, and first mobilization and first voiding times. The only difference between two groups was the vomiting incidence. In Group II 23% (n = 6) of the patients had vomiting during the first postoperative 24 h compared to 0% in Group I (p = 0.025). CONCLUSION: For inguinal hernia repairs, the dose of 0.1 mg of ITM provides comparable postoperative analgesia with a dose of 0.4 mg, with significantly lower vomiting incidence when combined with low dose heavy bupivacaine.

RESUMO JUSTIFICATIVA E OBJETIVOS: Comparar os efeitos de duas doses diferentes de morfina intratecal (MIT) sobre a analgesia no pós-operatório, os tempos até a primeira mobilização e micção no pós-operatório e a gravidade dos efeitos colaterais. MÉTODOS: Após a aprovação do Comitê de Ética Institucional, 48 pacientes com estado físico ASA I-II foram incluídos neste estudo randômico e duplo-cego. A raquianestesia foi feita com 0,1 mg (Grupo I, n = 22) ou 0,4 mg (Grupo II, n = 26) de MIT adicionados a 7,5 mg de bupivacaína hiperbárica. Os tempos até a primeira necessidade de analgésico, mobilização e micção e os efeitos colaterais no pós-operatório foram registrados. As análises estatísticas foram feitas com o programa SPSS 15.0 e p < 0,05 foi considerado estatisticamente significativo. Os dados numéricos foram analisados com o teste t e expressos como média ± DP. Os dados categóricos foram analisados com o teste do qui-quadrado e expressos como número de pacientes e porcentagem. RESULTADOS: Os dados demográficos foram semelhantes entre os grupos. Não houve diferenças em relação à dor, aos tempos até a primeira necessidade de analgésicos, à primeira mobilização e primeira micção. A única diferença entre os dois grupos foi a incidência vômito. No Grupo II, 23% (n = 6) das pacientes apresentaram vômito durante as primeiras 24 horas de pós-operatório, em comparação com 0% no Grupo I (p = 0,025). CONCLUSÃO: Para herniorrafia inguinal, a dose de 0,1 mg de MIT fornece analgesia comparável à dose de 0,4 mg, com uma incidência de vômito significativamente menor quando combinada com uma dose baixa de bupivacaína hiperbárica.

Incidence and management of chemotherapy-induced nausea and vomiting in women with breast cancer / Incidencia y gestión de náuseas y vómitos en tratamiento quimioterapico en mujeres con cáncer de mama / Ocorrência e manejo de náusea e vômito no tratamento quimioterápico em mulheres com câncer de mama

The objective of this study was to analyze the incidence of chemotherapy-induced nausea and vomiting in women with breast cancer and identify strategies used by them to control these signs and symptoms. Data for this cross-sectional study were collected through interviews during the last cycle of chemotherapy, between August 2011 and March 2012, in a university hospital in the State of São Paulo. The sample consisted of 22 women between the ages of 31 and 70, of whom 77.3% reported nausea and 50% vomiting during treatment. Regarding symptom management, 82% of the women reported having received some information centered on the use of prescribed medication. However, 27.3% did not know what medication they had taken. We concluded that there is a lack of systematic care and institutional protocol to guide professionals in providing standardized information to women so they can better control nausea and vomiting.

Este estudio objetivó analizar la incidencia de náuseas y vómitos en mujeres con cáncer de mama durante la quimioterapia, identificar el manejo utilizado para controlar estos signos y síntomas. Estudio transversal, cuyos datos fueron recolectados por medio de entrevistas en el último ciclo de quimioterapia entre agosto 2011 y marzo 2012 en un hospital universitario en el Estado de São Paulo. La muestra consistió de 22 mujeres, con edades entre 31 y 70 años, que el 77,3% reportó náuseas y el 50% vómitos durante el tratamiento. Cuanto al manejo, el 82% afirmó que habían recibido algún tipo de información centrada en el uso de la medicación prescrita, sin embargo, el 27,3% no supo responder cuál medicación fue utilizada. Se concluye que falta de sistematización de la atención y protocolo institucional para orientar profesionales para ofrecer información estandarizada, posibilitando el seguimiento de las mujeres para tener un mejor control de náuseas y vómitos.

Objetivou-se analisar a ocorrência de náusea e vômito em mulheres com câncer de mama durante a quimioterapia, e identificar o manejo utilizado para o controle desses sinais e sintomas. Pesquisa transversal, cujos dados foram coletados por meio de entrevista, no último ciclo de quimioterapia, entre agosto de 2011 e março de 2012 em um hospital universitário no interior do Estado de São Paulo. A amostra foi composta por 22 mulheres, com idade entre 31 e 70 anos, e 77,3% relataram náusea e 50% vômito, durante o tratamento. Quanto ao manejo, 82% delas afirmaram ter recebido algum tipo de informação que ficou centrada no uso da medicamento prescrito, entretanto, 27,3% não souberam responder qual medicamento usaram. Concluiu-se que há falta de sistematização da assistência e protocolo institucional que norteiem os profissionais a fornecer informações padronizadas, possibilitando o seguimento das mulheres, a fim de terem controle mais adequado da náusea e vômito.

Comparison of weight loss, food consumption and frequency of vomiting among Roux-en-Y gastric bypass patients with or without constriction ring / Comparação da perda de peso, consumo alimentar e frequência de vômitos entre pacientes do bypass gástrico em Y-de-Roux com e sem colocação de anel de contenção

BACKGROUND: After Roux-en-Y gastric bypass to avoid rapid gastric emptying, dumping syndrome and regained weight due to possible dilation of the gastric pouch, was proposed to place a ring around the gastric pouch. AIM: To compare weight loss, consumption of macronutrients and the frequency of vomiting among patients who underwent Roux-en-Y gastric bypass with and without the placement of a constriction ring around the pouch. METHOD: A retrospective study, in which an analysis of medical records was carried out, collecting data of two groups of patients: those who underwent the operation with the placement of a constriction ring (Ring Group) and those who underwent without the placement of a ring (No-Ring Group). The food intake data were analyzed using three 24-hour recalls collected randomly in postoperative nutritional accompaniment. Data on the percentage of excess weight loss and the occurrence of vomiting were collected using the weight corresponding to the most recent report at the time of data collection. RESULTS: Medical records of 60 patients were analyzed: 30 from the Ring Group (women: 80%) and 30 from the No-Ring Group (women: 87%). The average time since the Ring Group underwent the operation was 88±17.50 months, and for the No-Ring Group 51±15.3 months. The percentage of excess weight loss did not differ between the groups. The consumption of protein (g), protein/kg of weight, %protein and fiber (g) were higher in the No-Ring Group. The consumption of lipids (g) was statistically higher in the Ring Group. The percentage of patients who never reported any occurrence was statistically higher in the No-Ring Group (80%vs.46%). The percentage who frequently reported the occurrence was statistically higher in the Ring Group (25%vs.0%). CONCLUSION: The placement of a ring seems to have no advantages in weight loss, favoring a lower intake of protein and fiber and a higher incidence of vomiting, factors ...

RACIONAL: Após bypass gástrico em Y-de-Roux e a fim de evitar o rápido esvaziamento gástrico, amenizar a síndrome de dumping e evitar o reganho de peso devido à possível dilatação da anastomose gastrojejunal, foi idealizada a colocação de um anel ao redor do reservatório gástrico. OBJETIVO: Comparar a perda de peso, o consumo de macronutrientes e a frequência de vômitos entre pacientes que realizaram o bypass gástrico em Y-de-Roux com e sem a colocação do anel de contenção. MÉTODOS: Estudo retrospectivo na análise de prontuários para a coleta dos dados de dois grupos de pacientes: os que realizaram o bypass gástrico em Y-de-Roux com a colocação do anel de contenção ao redor da bolsa gástrica (grupo com anel) e sem a colocação do anel (grupo sem anel). Os dados de consumo alimentar foram analisados através de três recordatórios de 24 horas coletados aleatoriamente nos atendimentos nutricionais do pós-operatório. Os dados quanto à porcentagem de perda do excesso de peso e ocorrência de vômitos foram coletados utilizando o peso e o relato mais recente em relação ao período da coleta. RESULTADOS: Analisaram-se prontuários de 60 pacientes: 30 do grupo com anel e 30 do grupo sem anel. A média do tempo de operado do grupo com anel foi de 88±17,5 meses, e do grupo sem anel 51±15,3 meses. A porcentagem de perda do excesso de peso não diferiu entre os grupos. O consumo de proteína (g), proteína/kg de peso, %proteína e fibras (g) foi estatisticamente superior no grupo sem anel. O consumo de lipídios (g) foi estatisticamente superior no grupo com anel. A porcentagem de pacientes que nunca relataram a ocorrência foi estatisticamente superior no grupo sem anel (80%vs46%). A porcentagem ...

[Vomiting in the different stages of childhood]

To determine the incidence, risk factors and diagnostic criteria of pyloric stenosis among infants suffering from refractory vomiting admitted in children's hospital of Damascus University. This study included every infant admitted in children's hospital complaining of any kind of vomiting between 2009 and 2010. Prospective descriptive study held on the study population, included illness history, physical examination, laboratory study, and imaging. Thirty two confirmed pyloric stenosis out of 460 cases admitted for vomiting were found in the study period [6.95%]. Male/female prevalence was 3/1. Six percent was premature infants. Positive family history found in 6.2% of cases. Infant of prime gravida contributed one third of all cases. Main mother age group was 21-25 year, no clear relation was noted with father's age group. On physical exam, pyloric olive palpation was positive in 40.6% [n=13], mild to moderate dehydration was present in 68.7% [n=22], failure to thrive in 78.12% [n=25] and accompanying congenital malformation noted in 6% [n=2] of cases. Diagnosis was made according to abdominal ultrasound done with a well experienced radiologist in 84% [n=27] of cases, while in 16% [n=5] of cases the diagnosis was made by upper gastrointestinal radio-opaque X-ray. The incidence of pyloric stenosis in this study is considered to be slightly higher than that found in international studies. Risk factors among pyloric stenosis cases were late admission, electrolyte disturbance, dehydration, failure to thrive and acid base imbalance. Ultrasound study is considered sensitive and specific way for pyloric stenosis diagnosis, and UGI opaque X-ray is good alternative

Concomitant Functional Gastrointestinal Symptoms Influence Psychological Status in Korean Migraine Patients

BACKGROUND/AIMS: Migraine is frequently accompanied by symptoms consistent with functional gastrointestinal disorders (FGIDs). This study evaluated the prevalence of functional gastrointestinal symptoms and assessed the symptoms' relationship with the concomitant functional symptoms of anxiety, depression, and headache-related disability. METHODS: This prospective study included 109 patients with migraine who were recruited from a headache clinic at a teaching hospital. The participants completed a self-administered survey that collected information on headache characteristics, functional gastrointestinal symptoms (using Rome III criteria to classify FGID), anxiety, depression, and headache-related disability. RESULTS: In total, 71% of patients met the Rome III criteria for at least one FGID. In patients with FGID, irritable bowel syndrome was the most common symptom (40.4%), followed by nausea and vomiting syndrome (24.8%) and functional dyspepsia (23.9%). Depression and anxiety scores were significantly higher in patients meeting the criteria for any FGID. The number of the symptoms consistent with FGID in individual patients correlated positively with depression and anxiety. CONCLUSIONS: FGID symptoms defined by the Rome III criteria are highly prevalent in migraine. These symptoms correlate with psychological comorbidities, such as depression and anxiety.

Clinical and etiological profile of acute febrile encephalopathy in eastern Nepal.

Objective. To investigate the clinical and etiological profile of acute febrile encephalopathy in children presenting to a tertiary care referral center of Eastern Nepal. Methods. 107 children (aged 1 month to 14 yr) presenting to the emergency with fever (> 380 C) of less than 2 wk duration with altered sensorium with/ or without seizure were prospectively investigated for etiological cause. The investigations included blood and CSF counts, blood and CSF cultures, peripheral smear and serology for malarial parasite, and serology for Japanese encephalitis (JE) virus. Other investigations included EEG and CT or MRI wherever indicated. Results. The most common presenting complaints apart from fever and altered sensorium were headache and vomiting. Convulsions, neck rigidity, hypertonia, brisk deep tendon reflexes, extensor plantar response and focal neurological deficits were seen in 50%, 57%, 22.4%, 28%, 39.3% and 9.3% of the subjects, respectively. The diagnoses based on clinical presentation and laboratory findings were pyogenic meningitis in 45 (42%), non JE viral encephalitis in 26 (25%), JE in 19 (18%), cerebral malaria in 8 (7%), herpes encephalitis and tubercular meningitis in 4 (4%) each, and typhoid encephalopathy in 1 case. Conclusion. Pyogenic meningitis and viral encephalitis including JE are the most common causes of acute presentation with fever and encephalopathy. Preventive strategies must be directed keeping these causes in mind.

The Prevalence of Gastrointestinal Symptoms in Patients with Non-Insulin Dependent Diabetes Mellitus

BACKGROUND/AIMS: Gastrointestinal (GI) symptoms are common among patients with non-insulin dependent diabetes mellitus (NIDDM). Our aim was to investigate the frequency of chronic GI symptoms in Korean patients with NIDDM. METHODS: A cross-sectional survey, using a reliable and valid questionnaire, was performed in diabetes clinics from seven hospitals of the Catholic University of Korea. RESULTS: A total of 608 patients (249 males and 359 females, mean age 53.7+/-10.9 years) were investigated. The frequencies of weekly heartburn and acid regurgitation (esophageal symptoms) were 7.1% (95% confidence interval [CI], 5.0 to 9.2) and 4.4% (95% CI, 2.8 to 6.1), respectively. The frequency of dyspepsia was 13.2% (95% CI, 10.5 to 15.8). The frequencies of constipation and diarrhea were 15.0% (95% CI, 12.2 to 18.0) and 5.3% (95% CI, 3.5 to 7.1), respectively. Nausea and the use of manual maneuvers to facilitate defecation were more prevalent in women than in men. Constipation and fecal incontinence were more common in diabetes patients with long duration (>10 years). Fecal incontinence and using laxatives were more frequent in the complicated diabetes group. Using laxatives was more frequent in the uncontrolled diabetes group. CONCLUSIONS: Two-thirds of diabetic patients experienced GI symptoms. The prevalence of GI symptoms was more common in patients who had diabetic complications and a long duration of diabetes.

Frequency and severity of Nausea and vomiting in pregnancy and the related factors among pregnant women

Nausea and vomiting are the most common problems in early pregnancies which 50% to 80% of the women have experienced them in different degrees. This problem leads to physical and psychological disordes and may damage family relations and social functions of pregnant women. Although, the etiology of the problem is not known but some risk factors influence on this situation. Therefore, the objective of this study was to assess the frequency and severity of nausea and vomiting in pregnancy and the related factors among pregnant women. The design of the study was a cross-sectional study. The study population was all the pregnant women attending to health centers in Hamedan. The sample size was 700 pregnant women with gestational age of 6 to 16 weeks. The sampling method, was multistage sampling and the study setting was the prenatal clinics in health centers in Hamedan. The data collection was a questionnaire. The study results showed that, the frequency of nausea and vomiting was%69.7 with the categorization of mild, moderate and severe [%37.4,%46.7 and%16] respectively. Also, according to the logistic regression analysis, there were significant relationships between nausea vomiting and motion sickness [P=0.000], smelling an odor [P=0.000], premenstrual syndrome [P=0.000] and unwanted pregnancy as influencing factors on inducing nausea and vomiting. Besides, multiple regression analysis test indicated significant independent correlations between severity of nausea-vomiting and migraine headache [P=0.000], motion sickness [P=0.001], smelling an odor [P=0.001], age of menarche [P=0.000], premenstrual syndrome [P=0.000] and social support [P=0.000]. According to the study results, the frequency of nausea and vomithing was considerable and special care and attention is needed to control the related factors of nausea and vomiting in pregnant women

Initiation of zinc treatment for acute childhood diarrhoea and risk for vomiting or regurgitation: a randomized, double-blind, placebo-controlled trial.

The childhood diarrhoea-management guidelines of the World Health Organization/United Nations Children's Fund (WHO/UNICEF) now include zinc treatment, 20 mg per day for 10 days. To determine if a dispersible zinc sulphate tablet formulation is associated with increased risk of vomiting or regurgitation following the initial, first treatment dose, a double-blind, placebo-controlled randomized clinical trial was carried out in the Dhaka hospital of ICDDR,B: Centre for Health and Population Research (n=800) and in an adjacent NGO outpatient clinic (n=800). Children were randomized to one of three groups: no treatment, placebo, or zinc sulphate tablet (20 mg). They were then observed for 60 minutes, and all vomiting or regurgitation episodes were recorded. When compared with placebo, zinc treatment resulted in an attributable risk increase of 14% for vomiting and 5.2% for regurgitation. The median time to vomiting among those receiving zinc was 9.6 minutes and was limited to one episode in 91.2% of the cases. Overall, the proportion of 60-minute post-treatment vomiting attributable to zinc, placebo, and the illness episode was estimated to be 40%, 26%, and 34% respectively. The dispersible zinc sulphate tablet formulation at a dose of 20 mg is associated with increased risks of vomiting and regurgitation. Both are transient side-effects.

Vomiting, abdominal distention and early feeding of banana (Musa paradisiaca) in neonates.

The objective of this cohort study was to assess the relationship between banana given as early solid food with the symptoms of intestinal obstruction (SIO) among neonates, in a rural community in West Lombok District, West Nusa Tenggara Province, Indonesia. Mothers having newborn infants were interviewed and 3,420 neonates were followed for 28 days. Compared with infants who were not given solid food, the relative risk (RR) for infants given food other than banana as early solid food was 1.87, 95% CI 0.48-8.24, p=0.4, while for infants given banana only as early solid food the RR was 9.15, 95% CI 1.96-42.58, p 0.0005. After adjustment for birthweight, colostrum, and breastfeeding, the odds ratio for infants given banana and the appearance of SIO was 2.99, 95% CI 2.65-5.14; p=0.0012. These data indicate that banana given as early solid food is an important risk factor for the appearance of SIO in neonates.

An epidemic of dengue hemorrhagic fever and dengue shock syndrome in children in Delhi.

OBJECTIVE: To study clinical profiles and outcome of children of dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) during 1996 Delhi epidemic. DESIGN: Retrospective study. SETTING: Hospital based study. METHODS: Children hospitalized from September to November 1996 were studied. All patients were diagnosed, managed and monitored according to a standard protocol. RESULTS: One hundred and thirty four children (80 (60%) males and 54 (40%) females) were studied. Sixty (45%) children were less than 6 years of age of which 12 presented during infancy. There were 92 (67%) cases of DHF and 42 (33%) cases of DSS. Common symptoms were fever (93%), abdominal pain (49%) and vomiting (68%). The commonest hemorrhagic manifestation was hematemesis (39%) followed by epistaxis (36%) and skin bleeds (33%). Hepatomegaly was observed in 97 (72%) cases and splenomegaly in 25 (19%). Serology was positive (IgM hemaglutination antibody titres > 1: 160) for dengue type 2 in 31 (80%) of 39 patients in whom sera was tested during the acute phase of illness. Mortality was 6%. Hematocrit > 40% was observed in only 25 (18%) patients and hence the management protocol was based on clinical signs and symptoms and not on hematocrit. CONCLUSIONS: A management protocol of DHF/DSS in which fluid therapy is not based on haematocrit values needs to be formulated.

Prophylactic metoclopramide administered immediately after the induction of anesthesia has no effect on the incidence of postoperative emesis after strabismus surgery.

OBJECTIVE: To evaluate the efficacy of metoclopramide (0.25 mg/kg) administered IV immediately after induction of general anesthesia for the prevention of postoperative emesis in children undergoing, elective strabismus surgery. DESIGN: Double blind, randomized. SETTING: Operation-theater. SUBJECTS AND INTERVENTIONS: Seventy six non premedicated children of ASA class 1 and 2 were randomly allocated to receive either normal saline or metoclopramide immediately after the induction of general anesthesia. All children received a standardized similar anesthetic technique. Postoperative analgesia consisted of oral indomethacin. RESULTS: The incidence of postoperative emesis in the metoclopramide group was 60% versus 71% in a placebo group (p < 0.05). The incidence of severe emesis (2 or > 2 vomiting) was similar in the placebo group (34.20%) and metoclopramide group (21.05%). There were no adverse reactions like excessive sedation, extrapyramidal signs and hemodynamic depression in either placebo or metoclopramide group. CONCLUSIONS: Metoclopramide in a dose of 0.25 mg/kg administered intravenously prior to manipulation of eyeball is devoid of the effects but is not effective in preventing postoperative emesis in children undergoing strabismus surgery.

Efficacy of prophylactic ondansetron in Thai patients undergoing gastrointestinal tract surgery.

Postoperative nausea and vomiting (PONV) although frequently is considered a minor postoperative complication, it may be greatly trouble some especially in ambulatory surgical patients. This study was performed to compare the efficacy and safety of a single intravenous bolus dose of ondansetron 4 mg with the placebo in the prevention of PONV and to assess the safety and tolerability in Thai patients. By using the randomized, double-blind, placebo controlled study design, we enrolled 82 Thai male and female patients, ASA physical status I or II, between the ages of 12 and 75 year undergoing gastrointestinal tract surgery with general anesthesia in the study. A single intravenous bolus dose of ondansetron 4 mg or a single dose of placebo was administered immediately prior to the induction of the anesthesia. The patients were followed for 24 hours to assess PONV and adverse events. We found that intravenous ondansetron 4 mg seemed to be effective and safe in the prevention of PONV especially in female patients (P = 0.037) based on clinical observation. However there was no statistical significance between groups. None of the patients in both groups had any adverse events. In addition, there was no significant difference between preoperative and postoperative abnormalities of liver enzymes. Also we had found no difference in patient satisfaction between two groups.

Postoperative nausea vomiting (PONV): influence of bowel manipulation during intraabdominal surgery.

This study does not confirm the hypothesis that "bowel manipulation during intraabdominal surgery may release 5 HT3 to stimulate the vomiting center via the vagus nerve". Thus routine prophylactic use of 5 HT3 receptor antagonist is probably not necessary, especially in Thai patients whose PONV is not distinct both in incidence and intensity of emesis.

Frecuencia de vómitos en niños con diarrea hidratados por vía oral / Frequency of vomitings in children with diarrhea hydrated by oral administration

Se estudiaron 376 niños con diarrea y deshidratación a quienes se indicó terapia de hidratación oral (THO). La mayor parte de ellos (80.9%) había presentado vómito en las 24 horas previas a su ingreso; durante la hidratación sólo 22.9% de los pacientes tuvieron uno o más vómitos. Se observó correlación entre la frecuencia de vómitos durante la THO y el número de vómitos en las 24 horas previas. Así, presentaron uno o más vómitos durante la hidratación oral: 32% de los niños con más de 5 vómitos en las 24 horas previas, 20% de los que tuvieron entre uno y 5 vómitos previamente y 12.5% de los que tuvieron antecedentes de vómitos. En todos los casos se observó disminución de la frecuencia de vómitos después de la cuarta toma del suero oral (SO). En 33 niños fue necesario instalar gastroclisis para administrar el SO, aunque en sólo cinco casos ésta se indicó por la presencia de vómitos persistentes. Trescientos cincuenta y ocho (95.2%) niños fueron hidratados satisfactoriamente por vía oral. De los 18 niños (4.8% del total) a los que se indicó venoclisis, sólo en un caso se debió a la presencia de vómitos persistentes