Mortality associated with acute watery diarrhea, dysentery and persistent diarrhea in rural North India

Mortality associated with diarrhea was investigated in a longitudinally followed cohort of children under six years of age in rural North India. During the follow-up, 1663 episodes of diarrhea and 23 diarrhea related deaths were recorded in 1467 children followed up for 20 months. The case fatality rate was 0.56% for acute watery diarrhea, 4.27% for dysentery and 11.94% for non-dysenteric persistent diarrhea. Most of the episodes lasted less than a week; 5.2% became persistent (duration > 14 days). The case fatality rate was similar in episodes of one and two weeks'duration (0.64% and 0.8%) and increased to 13.95% for persistent episodes. Of the total 86 persistent episodes, 22.1% were dysenteric; the case fatality rate for such dysenteric persistent episodes was 21.1% and for watery persistent diarrhea 11.4%. Diarrheal attack rates were similar among different nutritional groups, but diarrheal case fatality rates progressively increased with increasing severity of malnutrition, these were 24 times higher in children with severe malnutrition (7.48%) compared to those normally nourished (0.31%). With availability and use of oral rehydration therapy, dysentery and persistent diarrhea emerge as major causes of diarrhea related mortality, with underlying malnutrition as a key associated factor.     

Type of milk feeding during acute diarrhoea and the risk of persistent diarrhoea: a case control study

The role of feeding breast milk, unmodified bovine milk or adapted infant formula during acute diarrhoea in protecting against or causing persistence of the episodes was investigated in a population-based case control study in an urban area of north India. After adjustment for confounding variables, exclusive breast-feeding was associated with an odds ratio of 0.06 (95% CI 0.002-2.1), a 16.5 times lower odds in favour of developing persistence of an episode. Infants fed unmodified bovine milk in addition to breast milk had an odds of 2.5 times (95% CI 1.0-9.9) in favour of developing persistence of acute diarrhoea ( p = 0.04). In infants receiving unmodified bovine milk and no breast milk, this odds ratio was 11.1 (95% CI 1.0-228.8) ( p = 0.05). This study indicates that promoting exclusive breastfeeding may reduce the persistence of diarrhoea over and above its effect in decreasing the incidence of acute diarrhoea. In urban areas of the developing countries where working mothers often use milk supplementation beyond the age of three months, our findings suggest that use of adapted spray dried formula may be safer than unmodified bovine milk with respect to the risk of developing persistent diarrhoea.     

Regional differences of physiological functions and cancer susceptibility in the human large intestine

Regional differences in function, metabolism and morphology between proximal colon, distal colon and rectum may be important in the pathogenesis and biologic behaviour of tumours originating from these segments. Thus, the effect of primary prevention of colorectal cancer may also differ from one large bowel segment to another. Therefore, this review underscores that one should be careful extrapolating results obtained in a short segment of the large bowel to the entire colorectum. Obviously, future studies concerning the pathogenesis and possibilities for prevention of large bowel cancer should certainly examine results by subsite as a routine procedure.     

EPIDEMIOLOGY OF UPPER AERODIGESTIVE CANCERS AMONG ARMED FORCES PERSONNEL AND THEIR FAMILIES

Cancers of the oral cavity, pharynx, and esophagus are now suspected to have common etiologic factors and have been grouped together as “upper aerodigestive” cancers. Since this grouping is of relatively recent origin there have been no epidemiological studies on this group among Armed Forces personnel. 114 cases of upper aerodigestive cancers and an equal number of controls were studied. The largest number of cases were in the age group of 40–49 years with male preponderance. Lower level of education, smoking, quid chewing, and alcohol use were found to be the major risk factors for these cancers. A dose response relationship was observed for smoking, quid chewing and alcohol intake.KEY WORDS: Neoplasms, Smoking, Quid chewing, Alcohol