[Effect of a new amino acid solution in the oral hydration of nursing infants with acute diarrhea. A prospective study]. / Efecto de una nueva solución con aminoácidos en la hidratación oral de lactantes con diarrea aguda. Un estudio prospectivo.

Thirty-two one- to 12-month-old male infants with diarrheal dehydration treated with either the oral rehydration solution recommended by the World Health Organization (WHO), or the same solution modified by the addition of glycerine (60 mmol/L) and glycil-glycine (30 mmol/L), with a total osmolality of 379 mOsm/kg. The patients belonging to the latter group exhibited greater stool losses (10.3 +/- 8.3 vs 8.0 +/- 6.4 mL/kg/hour) and a greater urine volume (10.4 +/- 14.2 vs 4.6 +/- 4.0 mL/kg/6 hours), during the first four to six hours of the rehydration period. The results of this study show, that in contrast with those of other series, the addition of glycine and glycil-glycine to the WHO solution, at the concentrations used in the study, produces greater fecal water losses in children with dehydration due to acute diarrhea.

[Arterial hypertension in children]. / Hipertensión arterial en niños.

It is considered hypertension in children, the persistent increase of the blood pressure values above percentile 95 for age and sex, in no less than three determinations, with adequate register techniques. Blood pressure is maintained mainly by the regulation of metabolism of sodium and water in the intravascular space, through the adequate balance of intake, filtration, reabsorption and renal throughout. It is also regulated by hormonal factors. Weight gain control in teen-agers could be useful to prevent high blood pressure in adults. In children, it is generally secondary to renal, reno-vascular, endocrinological or tumoral diseases. Clinical manifestations and the recommended diagnostic procedures are analysed to detect the most frequent causes of hypertension at different ages. Most cases response with antihypertensive drugs in combination with hyposodic diet. For the hypertensive crisis, asa diuretics and powerful antihypertensive drugs may be employed. Patients with chronic renal insufficiency could also need dialytic treatments. Renovascular diseases require almost always invasive treatments. Better prognosis in children with severe high blood pressure is related with recent diagnostic procedures, surgical techniques and antihypertensive drugs improvements.

[Strategies to reduce morbidity and mortality caused by acute diarrhea in Latin America]. / Estrategias para la disminución de la morbi-mortalidad por diarreas agudas en América Latina.

Following the World Health Organization guidelines, the Latin American Diarrheal Disease Control Programs have directed its efforts towards the promotion of Oral Hydration Therapy (OHT) and appropriate dietary management during the diarrheal episode and convalescent period, aimed at diminishing the mortality secondary to diarrhea. In developing countries, OHT is preventing, annually, one million of childhood deaths due to dehydration. Yet, only one fourth of the total population of children suffering diarrhea are being treated with this therapy. Among the strategies to decrease diarrhea morbidity, breast-feeding and hand washing are top priorities. The fundamental strategy has been to promote educational programs to train health personnel and community members. To continue these actions, we suggested the creation of more secondary and tertiary level hospitals and the installation of community units of OHT. They should become self-sufficient and self-manageable and include other programs of primary health care, such as immunization, growth and development surveillance, family planning and pregnancy control.

[Oral rehydration at a third-level service]. / Hidratación oral en un servicio de tercer nivel.

Oral rehydration therapy (ORT) has been shown to be useful in decreasing mortality, reducing treatment costs and diminishing the frequency of complications in children under the age of five with acute diarrhea. The current concept of ORT includes not only the increase in the intake of fluids and the administering of oral solution in order to prevent or treat dehydration, but also the continuance of everyday feeding, the teaching of the child's mother to detect signs of dehydration and other alarming changes, as well as the non-administering of medication, especially those considered as anti-diarrheal or anti-vomiting, and limiting the use of antimicrobials, only to be used in special cases. The theoretical know-how of these concepts has been seen to be insufficient in order to increase the use of community-wide Oral Rehydration Therapy, being this the main purpose for the establishment of the Oral Rehydration Ward in teaching hospitals of second and third level, where the majority of its' personnel must come into contact with and share the responsibility of treating children with diarrhea. Within these wards students obtain information, ability and assurance in the effective actual management of children with diarrhea, including the correction of the state of dehydration through the administering of oral solutions. Another complementary benefit from the coming about of this ward is the decrease in the need to hospitalize the majority of the patient with diarrhea therefore reducing costs and any related complications. Oral rehydration therapy; diarrhea; dehydration; oral solutions.

[Treatment of children with acute diarrheal disease. Knowledge and attitudes of the health personnel]. / Tratamiento de niños con enfermedad diarreica aguda. Conocimiento y actitudes del personal de salud.

Diarrheal diseases are still one of the most frequent causes of death due to dehydration in children; lack of information regarding the adequate treatment of diarrhea is the main cause. The results of an inquire sent to 620 physicians and nurses were analyzed to determine the knowledge and attitudes of the health care workers that reside in different diarrheal mortality areas in Mexico. The less professional experience time was correlated with more knowledge in etiology of diarrhea. More physicians than nurses had correct answers regarding the place of diarrheal diseases in child mortality and the correct use of antimicrobial, and other drugs and liquids to prevent and treat dehydration. Most workers did not know the inconvenience of hypertonic solutions to prevent dehydration and the importance of the oral solution flavor. This results suggest that nurses will, be included in clinical training by means of seminars in oral hydration therapy. Furthermore it seems convenient to increase the access to oral hydration solutions as well as the diffusion of its advantages.

[Cholera in pediatrics]. / Cólera en pediatría.

Cholerae is a grave and acute bacterial intestine infection which is caused by a bacilo, V. cholerae 01, that produces toxic products. Its clinical symptoms range from abundant liquid diarrhoea combined with vomiting and rapid dehydration. It is highly lethal when right treatment is not applied. There are also cases of cholera where victims do not show any symptoms of it, that is asymptomatic carriers. Any clinical suspicion of cholerae has to be corroborated by epidemiological data and its diagnostic confirmation should be done by isolating the bacteria, V. cholerae. When beginning the treatment, it is not necessary to confirm the diagnostic and this is based on the restitution of the liquids lost through vomiting and facing using any methods that are recommended for any other type of diarrhoea. The antimicrobial treatment is used only for grave cases. This present revision includes recent knowledge about cholerae emphasising on the effective management of cases through an adequate use of right treatment methods and also using the principal prevention measures against dissemination of this disease.

[Renal failure and rickets]. / Insuficiencia renal y raquitismo.

Acute renal failure secondary to interstitial nephritis caused by therapeutic ingestion of sodium diphenylhydantoins has been reported recently. The interference of sodium diphenylhydantoins on Vitamin D metabolism causing or aggravating ricketts has also been reported. This communication deals with an infant girl who was admitted to the hospital due to seizures. Four months before, she had convulsions and she was treated with diphenylhydantoins until admission. She was found to have renal failure and ricketts. Histological diagnosis of interstitial nephritis was established by means of percutaneous renal biopsy. Clinical and radiological improvement of ricketts was observed after dehydrotachysterol treatment. Clinical and biochemical alterations of renal failure slowly subsided. She had a clear-cut history of vitamin D defficiency ricketts. Seizures were due to hypocalcemia tetany but was erroneusly treated as "grand mal" epilepsy, with diphenylhydantoins. Interstitial nephritis complicated with acute renal failure was probably caused by diphenylhydantoins administration.

Hematuria in children.

Hematuria is the most common sign of renal lesions in childhood. Most common renal causes are glomerulonephritis, Alport's syndrome and IgA mesangiopathy. Urological and systemic causes are less frequently seen. Diagnostic approach focuses on the clinical presentation of hematuria: gross or microscopic, and accompanying signs or symptoms. Monosymptomatic hematuria causes are variable in each age group. Prognosis of cases with hematuria depends upon the cause.

Predictive value of fractional excretion of filtered sodium for hypertension in acute post-streptococcal glomerulonephritis.

The course of acute post-streptococcal glomerulonephritis was followed in 81 children, 66 of whom were hypertensive on admission. Sixty-one hypertensive patients were available for follow-up; in seven (11.5%), hypertension recurred 1 to 9 days after initial blood pressure elevation had returned to normal. Thirteen initially normotensive patients were available for follow-up; six (46%) developed hypertension 1 to 9 days after admission. Initial FENa was less than or equal to 0.5 in all 13 patients with recurrence of initial hypertension or who developed initial hypertension while under observation, and in another 25 patients who did not have this course. On the other hand, FENa was greater than 0.5 in 36 patients, none of whom had recurrence of initial hypertension or developed hypertension while under observation. Therefore, an admission FENa less than or equal to 0.5 seems to be an accurate predictor for development of hypertensive episodes.

[Nephrotoxicity caused by amphotericin B]. / Nefrotoxicidad por anfotericina B.

A six-year-old child with coccidioidomycosis is reported. The patient was given amphotericin B, that brought about disturbances in renal function with renal failure, which turned reversible on discontinuance of treatment. The earliest manifestations of nephrotoxicity were observed following administration of a total dose of 1,000 mgs. The findings were: glycosuria, cylindruria, high urinary pH followed by metabolic acidosis, hypokalemia, decreased capacity of renal concentration and clearance of endogenous creatinine. Oral administration of postassium bicarbonate and interruption of amphotericin B were followed by reversal of kidney lesion manifestations.

[Sodium concentrations in solutions for oral rehydration in children with diarrhea]. / Concentración de sodio en las soluciones para hidratación oral en niños con diarrea.

Using the appropriate treatment for dehydration due to diarrhea, over a million deaths a year in children under five are being prevented. After analyzing the information related to the concentration of sodium in solutions used for oral rehydration, the following conclusions can be made: 1. Solutions with high glucose content, as well as hyperosmolar foods, favor the development of hypernatremia. Not so, sodium concentrations of up to 90 mmol/L, with glucose under 2.5%. 2. There are other factors which correlate with the presence of hypernatremia: abundant watery diarrhea, a good state of nutrition, under six months of age and the administration of solute loads, orally (boiled milk) as well as intravenously. 3. The WHO oral rehydration solution which contains, in mmol/L: sodium 90, glucose 111 (2%), chloride 80, potassium 20 and citrate 10, with a total osmolarity of 311 or 331 mOsm/L, is the one which more closely resembles the ideal concentration and has shown to be effective, not only in the treatment of dehydration due to diarrhea, but has also been to be useful in the prevention and maintenance of rehydration, independently from the etiology, the patient's age or the state of nutrition. 4. The use of oral serum with a sodium concentration of 90 mmol/L, reduces the natremia more slowly, therefore protecting the patient with hypernatremic dehydration from developing convulsions during treatment. This sodium concentration is also the best for cases of hyponatremic dehydration. 5. Using the recommended norms in cases of children with diarrhea, including continuing regular feeding habits and the adding of complementary liquids, no cases of hypernatremia have been recorded.(ABSTRACT TRUNCATED AT 250 WORDS)

[Immunopathology of nephropathy secondary to anaphylactoid purpura]. / Inmunopatología de la nefropatía secundaria a púrpura anafilactoide (NPA)

With the purpose of contributing to the study of the pathogenesis of the nephropathy of anaphylactoid purpura (NPA), investigation was made of the presence and extension of immunoglobuline deposits, complement factors and fibrinogen in renal biopsies of 15 patients with NPA, correlating the findings with glomerular lesions seen at the light microscope. Fibrin and IgA deposits were found in all biopsies in mesangium, while C3 was detected only in 5 cases with potentially progressive lesions: 3 with PEEF, one with PEED and one with MP, being negative in PSF and PE cases, which are potentially reversible. The extension of deposits was diffuse or segmentary, without the existence of a precise correlation with the different morphological types. It is concluded that the immunopathologic pattern found in NPA is quite characteristics, different from that of postinfectious acute glomerulonephritis and that there seems to exist relation between findings of C3 with progression of the glomerular lesion.

Glomerular lesions and final outcome in children with glomerulonephritis of acute onset.

131 children with nephritic syndrome of acute onset were studied by renal biopsy and were followed clinically from 2 to 13 years. 87 patients (66%) with proliferative endocapillary glomerulonephritis all recovered. 21 (16%) had focal extracapillary and diffuse endocapillary glomerulonephritis. Eleven (52%) of these recovered. Six patients (5%) had diffuse extra and endocapillary glomerulonephritis, 13 (10%) had membrano-proliferative glomerulonephritis and four had diffuse glomerular fibrosis. All 23 patients of the latter groups progressed to renal insufficiency. A correlation between morphology and prognosis was apparent in this study.

[Pyelonephritis and bacterial tubulointerstitial nephritis]. / Pielonefritis y nefritis tubulointersticial bacteriana

With the purpose of establishing the clinicopathologic correlation in pyelonephritis and to discard other interstitial nephrites, with present day morphologic criteria we analysed 63 casos that had been diagnosed as pyelonephritis, following Weiss and Parker's histologic criterion. The clinicopathologic diagnosis of pyelonephritis was confirmed in 12 cases; all of them showed obstructive uropathy and in most of them, there was chronic renal failure. Interstitial nephritis was established in 27 cases, all of them showing septicemia and almost half of the cases showed acute renal failure. Other 20 cases showed tubulointerstitial nephritis secondary to different types of glomerulopathies, fetal glomerulosclerosis, dysplasias, nephrophthisis, radiation nephritis and renal infarct. In 4 cases, the study of sections finer than the original, showed absence of histopathologic lesions. The results of the present study point out the main causes of confusion with the pathological diagnosis of pyelonephritis, the necessity to investigate predisposing uropathy in patients with urinary infection and stresses the importance to establish correlation with clinical and laboratory findings in cases with tubulointerstitial lesions.

Costs of treating diarrhoea in a children's hospital in Mexico City.

The treatment received by children aged under 5 years with diarrhoea was studied in the Hospital Infantil de México (Federico Goméz), Mexico City. The costs of treatment were calculated and estimates were made of how these had changed since the establishment of an oral rehydration unit in the hospital in 1985. The results indicate that drug treatment of outpatients was generally appropriate and inexpensive. In contrast, the cost of drugs for inpatients was considerably higher. The seriousness of the cases justified much of this additional expense for inpatients, but there is evidence that the costs could be reduced further without jeopardizing the quality of the care. Diagnostic tests were relatively expensive, frequently failed to identify diarrhoeal etiology, and their results correlated poorly with the treatment prescribed. The oral rehydration unit resulted in significant savings by causing a 25% fall in the number of inpatients with diarrhoea.

PIP: Treatments of diarrhea in children under 5 by the Hospital Infantil de Mexico (Federico Gomez), Mexico City, in 1983-84 versus 1986 were compared with respect to drugs and laboratory tests, and costs were estimated. An outpatient oral rehydration unit was opened in the emergency room, reducing by 25% numbers of inpatients with diarrhea. Other than increased use of ORS, no changes in hospitalized patients were evident except a trend toward more laboratory tests, and prescription of amoxicillin and chloramphenicol over amikacin. There was little evidence that laboratory tests or antibiotic prescriptions were appropriate in most cases. Only 1 patient had a positive Shigella culture, and those with negative fecal cultures received more antibiotics than those with no cultures taken. Intravenous solutions were used in 85%, while only 17% were dehydrated and 22% had electrolyte imbalances, possibly because as a method of rehydration they require less nursing time than oral solutions. The average patient costs were 1200 pesos for lab tests and 180 pesos for drugs. In addition, prior to hospitalization, many patients had received ineffective or dangerous drugs such as Kaopectate-antibiotic mixtures, intestinal motility agents such as loperamide, Lactobacillus cultures, and iodochlorohydroxyquinoline.