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.     

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.     

Diagnostic difficulties and errors in early stomach cancer]

Difficulties that occur in the diagnosis of early gastric carcinoma (EGC) were studied on a material of 1617 prophylactic endoscopic examinations of persons who did not make any complaints of the alimentary organs and 2158 primary gastroscopies performed in accordance with the patients' complaints, results of the dispensary follow-up of 811 patients who made up a risk group, and an analysis of case reports of 183 patients in whom EGC was confirmed by surgery. The authors emphasize a high percentage of errors determined by the lack of the pathognomonic symptomatology, difficulties of interpreting the endoscopic appearance and histologic confirmation of carcinoma. To improve early diagnosis of gastric carcinoma (GC), it is recommended that every endoscopic investigation be performed with oncological apprehension, paying attention even to the minimum focal changes in the gastric mucosa and making spot biopsy of those changes. It is also advisable that a more strict approach should be exercised to the formation of risk groups, restricting them to the patients at greater risk for GC or with unrecognized GC (first revealed and poorly healing ulcers, polyps measuring over 2 cm in diameter, grade III dysplasia discovered in gastric biopsy specimens). Such patients should be placed under dispensary observation including endoscopy which is to be made in the first stage after 1, 3 and 6 months.     

Liquidation wahlärztlicher Leistungen

Ohne Zusammenfassung     

Kosten einer Bioresonanztherapie bei Asthma bronchiale und Allergien

Abstrakt 1. Hinsichtlich der Frage der Anerkennung einer Heilmethode kommt es nicht darauf an, ob eine Methode von der überwiegenden Mehrheit der sogenannten Schulmediziner anerkannt wird, aber auch nicht, ob die betreffende Methode „therapieimmanent“, also von denjenigen, die diese Methode entwickelt haben oder sie anwenden, als wirksam eingesch?tzt wird. Entscheidend ist vielmehr auf die Anerkennung derjenigen Personen abzustellen, die sich von dritter Seite als Wissenschaftler in einem wissenschaftlichen Verfahren mit der Frage der Wirksamkeit der betreffenden Methode auseinandergesetzt haben. 2. Der Wirkmechanismus der Bioresonanztherapie ist nach strengen naturwissenschaftlichen Untersuchungen nicht zu erkl?ren. Diese Methode ist jedoch von der Hufelandgesellschaft, die sich aus 25 ?rztegesellschaften zusammensetzt, die allesamt auch Naturheilverfahren betreiben, anerkannt. (Leits?tze des Bearbeiters)     

Pathophysiologic mechanisms of psychopathologic phenomena and psychopharmacotherapy]

The paper is concerned with the questions of genesis of psychopathological symptomatics in terms of the theory of Academician G. N. Kryzhanovsky of determinant structures and generator activity. The complexity of experimental modelling of severe psychopathological disorders is indicated since not all psychopathological phenomena possess objective characteristics. It should be keep in mind that the psychopathological method itself is a subjective one. The stability of clinical manifestations of psychoses, e.g. schizophrenia, and reactions to the psychopharmacotherapy in an individual over a long period of time suggests the involvement in pathological process of determinant structures. Variety of clinical manifestations of schizophrenia is predetermined by unequal involvement of the brain hemispheres. In connection with this one may think about the determinant structures and generator mechanisms predominating in either hemisphere. Quantitative EEG investigation in schizophrenia patients with hallucinatory-paranoid and schizoaffective symptomatics showed that in the former group after a week long therapy using stelazine the activation of the left hemisphere prevailed, and in the latter group--of the right one. Stelazine predominantly blocks the hemisphere in which generator processes are weaker (the right one in the case of hallucinatory-paranoid syndrome, and the left hemisphere with the schizoaffective one). This accounts for a great probability of development of postpsychotic depression in the patients with the schizoaffective syndrome after administration of neuroleptic therapy. Phenomenologically similar psychopathological symptomatics, in particular a depressive one, can occur as a result of the activities of various determinant structures. Anxiety, unlike other psychopathological phenomena, is responsive to practically all types of psychotropic compounds with different mechanisms of action.(ABSTRACT TRUNCATED AT 250 WORDS)