High-dose intravenous dexamethasone in the management of diarrheal patients with enteric fever and encephalopathy.

We conducted a retrospective chart analysis of diarrheal patients with enteric fever and encephalopathy (among survivors and non-survivors) to examine the role of high-dose, intravenous dexamethasone as an adjunct to appropriate antimicrobial therapy in their management. We studied all patients admitted to the Special Care Ward (SCW) of Dhaka Hospital between October 2006 and October 2007 with a diagnosis of encephalopathy in association with enteric fever. Twenty-three cases were identified with three mortalities. All bacterial isolates (Salmonella Typhi and Salmonella Paratyphi) were multi-drug resistant. Survivors were significantly more likely to have received high dose dexamethasone (100% vs 00%; p < 0.001) and had hypoglycemia less often (6% vs 67%; p = 0.045) compared to those who died. The results suggest high dose intravenous dexamethasone, as an adjunct to appropriate antimicrobial therapy, substantially reduces mortality among diarrheal patients presenting with enteric encephalopathy.

Micronutrients and anaemia.

Micronutrient deficiencies and anaemia remain as major health concerns for children in Bangladesh. Among the micronutrient interventions, supplementation with vitamin A to children aged less than five years has been the most successful, especially after distribution of vitamin A was combined with National Immunization Days. Although salt sold in Bangladesh is intended to contain iodine, much of the salt does not contain iodine, and iodine deficiency continues to be common. Anaemia similarly is common among all population groups and has shown no sign of improvement even when iron-supplementation programmes have been attempted. It appears that many other causes contribute to anaemia in addition to iron deficiency. Zinc deficiency is a key micronutrient deficiency and is covered in a separate paper because of its importance among new child-health interventions.

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.