COBALAMIN DEFICIENCY and SMALL BOWEL BACTERIAL OVERGROWTH: A COMMON ASSOCIATION

Background  Bacterial overgrowth may cause cobalamin deficiency through competition for dietary cobalamin in the small intestine. The objective of this study was to prospectively determine the prevalence of small bowel bacterial overgrowth in patients with documented cobalamin deficiency in a tertiary referral centre.
Methods  Patients identified with cobalamin deficiency underwent diagnostic investigations including: Endoscopy (with gastric antrum, gastric body and duodenal biopsies and duodenal aspirate), ¹⁴C-D-Xylose breath test, intrinsic factor antibody, anti-endomysial antibody and red cell folate level. 'Definite' small bowel bacterial overgrowth was defined as either a positive ¹⁴C-D-Xylose breath test or > 100 000 CFU/mL of culture of duodenal aspirate. 'Suspected' small bowel bacterial overgrowth was defined as an elevated red cell folate in the absence of supplemental folate therapy.
Results  Over a 2-year period, 62 patients with cobalamin deficiency were identified, of whom, 26 (42%) had 'definite' small bowel bacterial overgrowth, whilst a further nine (15%) had 'suspected' small bowel bacterial overgrowth. Nineteen (31%) had pernicious anaemia, and no cause for cobalamin deficiency could be found in eight (13%) patients. The diagnosis found in the remaining patients included coeliac disease (4), Crohn's Disease (1), gastric resection (2), vegan (2), homozygotes of the MTHFR gene (C677T) mutation (2), and one had enteropathy associated with common variable immunodeficiency (CVID). 'Definite' small bowel bacterial overgrowth was found to coexist with nine of the 19 cases of pernicious anaemia, two coeliac subjects, one CVID enteropathy and one patient with the MTHFR gene mutation.
Conclusion  Small bowel bacterial overgrowth is commonly associated with cobalamin deficiency.     

A rapid microagglutination test for the diagnosis of Legionella pneumophila (serogroup 1) infection

A rapid microagglutination test has been developed which can be performed in 30 minutes. Ninety-seven percent of 96 patients diagnosed as having Legionella pneumophila (serogroup 1) infection by indirect immunofluorescence were also detected by the rapid microagglutination test.     

Risk factors for development of dehydration in young children with acute watery diarrhoea: a case-control study

In a case-control study to understand the risk factors for development of life-threatening dehydration, a total of 379 children comprising 243 cases (moderate or severe dehydration) and 136 controls (non or mild dehydration) up to 2 years of age suffering from acute watery diarrhoea were studied. By univariate analysis, the presence of vibrios in stool, withdrawal of breast feeding during diarrhoea, not giving fluids, including oral rehydration solution (ORS), during diarrhoea, frequent purging (> 8/ day), vomiting (> 2/day) and undernutrition were identified as risk factors. However, by multivariate analysis after controlling for confounders, withdrawal of breast feeding during diarrhoea (odds ratio (OR) = 6.8, p < 0.00001) and not giving ORS during diarrhoea (OR = 2.1, p < 0.006) were identified as significant risk factors. The confounding variables which also contributed significantly to increasing the risk were age (≤ 12 months; OR = 2.7, p = 0.001), frequent purging (> 8/day; OR = 4.1, p < 0.00001), vomiting (> 2/day; OR = 2.4, p = 0.001) and severe undernutrition (%median <60 weight-for-age of Indian Academy of Paediatrics classification; OR = 3.1, p = 0.001). We feel that these findings will be useful for Global and National Diarrhoeal Diseases Control Programmes for formulating intervention strategies for preventing death due to diarrhoeal dehydration.     

Flunoxaprofen pharmacokinetics in elderly subjects

Plasma kinetics and 24 h urinary elimination of flunoxaprofen, a nonsteroidal antiinflammatory drug, were studied in 23 elderly patients (mean age 69.9 years) and compared with the data obtained in four young volunteers. The drug was administered as a single oral 100 mg tablet and its plasma and urine concentrations were assayed by a high performance liquid chromatography method. Plasma kinetics fitted a 3-exponential equation with a mean half-life of 7.9 +/- 2.17 hours and a mean peak plasma of 8.5 +/- 2.97 micrograms/ml, which was observed at about the second hour. The values of the areas under the curves (AUC) and the values of total clearance (multiplied by the bioavailability) showed great variability, due to the large differences in the patients body weights; in fact the value of AUC was linearly correlated to the dose divided by the body weight. The mean residence time (MRT) of the drug in plasma was equal to 12.81 h. Low amounts of unmodified drug (about 10%) were found in 24 h urine sample, indicating a high degree of biotransformation. Small differences only were found in plasma kinetics of flunoxaprofen among the present group of elderly patients and the group of four young volunteers; the main difference corresponded to a slower rate of gastrointestinal absorption and to a longer mean residence time.     

Pseudomembranes in reflux esophagitis

Three cases are presented in which double-contrast esophagograms revealed one or more plaquelike lesions in the distal esophagus, representing pseudomembrane formation in patients with severe reflux esophagitis. Although to our knowledge this finding has not been reported previously in the radiologic literature, pseudomembranes have been documented endoscopically in patients with reflux esophagitis and biopsy-proved Barrett esophagus. Radiologists should be aware of this finding, since these pseudomembranes may be indistinguishable radiographically from plaquelike carcinomas arising in Barrett esophagus.