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Objective: To study the association between analfissures and cow's milk allergy (CMA) in infants. METHODS AND METHOD: In a prospective study, 72 confirmed cases of CMA in infants were examined for anal fissure by pediatricians with five years' experience. A positive finding was defined as when an anal fissure was detected by at least two out of three examiners., Results: Of infants with CMA with and without gastrointestinal GI symptoms, 79% and 83% had anal fissures, respectively The prevalence of anal fissure in these infants is significantly higher than in normal infants., Conclusion: Anal fissure may be a pathognomonic sign of cow's milk allergy in infants.

Objective: To study the prevalence of atopic dermatitis in exclusively breast-fed infants of allergic mothers who were placed either on liberal diets or on dairy-product-restricted diets., Material and Method: Infants aged 0 to 4 months old, who were exclusively breast-fed and whose mothers had a history of allergic disease, were the subjects of the present study. The mothers were randomized into two groups; mothers in a control group were on liberal diets, while mothers in an intervened group were on dairy product-restricted diets. Infants of both groups were examined for atopic dermatitis at seven days, one month, and four months of age., Results: There were 32 and 30 infants in the control and intervened groups, respectively. Eight infants in the control group and two infants in the intervened group developed atopic dermatitis by the age of four months. The prevalence of atopic dermatitis in the intervened group was significantly lower than that in the control group (6.67% vs. 25%, p < 0.05)., Conclusion: Dairy product restriction in allergic mothers results in decreasing prevalence of atopic dermatitis in 4-month-old infants who were exclusively breast-fed.

Background: The recommended formulas for treatments of cow's milk allergy (CMA) in infants are hydrolyzed protein-based and amino acid-based formulas. However they are not always affordable. Furthermore, some patients are still allergic to these formulas. Therefore, chicken-based formula has been innovated and used as an alternative formula to treat CMA in these infants., Objective: To assess the growth of infants with CMA who consumed chicken-based formula compared to normal infants., Material and Method: A prospective study was performed in 34 infants aged 3 to 24 months diagnosed as CMA at Siriraj Hospital. All subjects consumed the chicken-based formula for at least three months. The growth parameters were recorded., Results: Manifestations occurred in dermatological (78.60%), respiratory (67.9%), and gastrointestinal (53.6%) systems. Mean (+/-SD) chicken-based formula intake was 77 (+/-39.6) kcal/kg/d Weight gains are higher (35.7%), equal (10.8%), and lower (53.5%) than those of normal infants. In addition, length gains were higher (38%), equal (5%), and lower (57%) than those of normal infants. However, the difference of weight and length in chicken-basedfed, cow s milk-allergic infants, and normal infants were not statistically significant (p = 0.141, p = 0.192). None of these infants had severe complications., Conclusion: Growth parameters of infants fed with chicken-based formula are not diferent from those of normal infants.

Background: Malnutrition and malabsorption are common consequences in pediatric human immunodeficiency virus (HIV) infection. The gastrointestinal tract is a major site affected by HIV Rapid gastrointestinal transit time may contribute to malabsorption., Objective: To determine whether the whole gastrointestinal transit time (WGTT) correlates with disease stages or degrees of malnutrition in HIV-infected children., Material and Method: Forty HIV-seropositive children, at various stages of disease, and thirty seronegative age-matched controls, aged between 1 mo and 3 yr, were enrolled in the present study. The body weight, length, or height and the WGTT were assessed Then the WGTT of children in different stages of HIV disease and in different degrees of malnutrition were compared with those of the control group., Results: The mean ages were 15.5 and 14.3 mo in HIV-infected and control groups respectively. A greater degree of malnutrition was found in HIV-infected children with more advances HIV clinical symptoms. Compared to controls, WGTT was most rapid in severely symptomatic acquired immunodeficiency syndrome (AIDS) patients (Category C) (14.32 +/- 3.88 versus 7.22 +/- 3.17 h; p < 0.01) but not in asymptomatic, mildly and moderately symptomatic children. Accelerated WGTT in HIV-infected children was also significantly associated with a higher degree of malnutrition., Conclusion: Malnutrition is clearly related to the progression ofHIV disease. Accelerated WGTT is associated with HIV seropositivity, severe clinical symptoms, and higher degrees of malnutrition.

Background: DHA contents in breast milk varied upon maternal dietary intakes., Objective: To study DHA contents in breast milk in Thai lactating women from four diferent regions of Thailand., Material and Method: 20 mL of hind milk from 40 lactating women from Bangkok, Chantaburi, Tak, and Surin were collected and analyzed for fatty acids contents by gas chromatography Dietary intake of lactating women after delivery until the present study was assessed by a food frequency questionnaire. Then, the average DHA intake was estimated from the diets by using the reference data., Results: DHA contents in breast milk of mothers from Surin were higher than those from other areas. There were no correlations between history of DHA intake and DHA contents in breast milk., Conclusion: DHA contents in breast milk vary from region to region of the country. Local dietary intake and genetics might explain this contrast.

The authors carried out a retrospectively study of bodyweights of primary-school children from Grade I to Grade VI in 4 schools from Bangkok, one school from Saraburi and data of school children from a district in Sakolnakorn with a six year follow-up period. In the cohort there were 437 children from Bangkok, 225 children from Saraburi and 633 children from Sakolnakorn. Initial data show that prevalence of obesity at grade I in schools from Bangkok, Saraburi and Sakolnakorn were 16%, 23% and 4%, respectively. However, when these children were in grade VI, the prevalence of obesity increased to 31%, 30% and 9%, respectively. Relative risks of becoming obese at grade VI in children who were overweight and obese at grade I are 3 and 5 fold in Bangkok, 2 and 3 fold in Saraburi, 6 and 12 fold in Sakolnakorn, respectively. The present study shows that prevalence of obesity increased at quite dramatic rates during the primary school period in these study groups.

The authors carried out a longitudinal study of bodyweights of secondary-school children from Grade VII to Grade XII. Initial data of weight for height at Grade VII showed that the prevalences of overweight boys and girls were 13.6% and 9.9% and of obesity of boys and girls 26.8% and 13.5%, respectively. However, when these children were at Grade XII the prevalences of overweight of boys and girls were 14.0% and 10.5% and of obesity of boys and girls were 15.0% and 10.8%, respectively. The relative risks of becoming overweight of boys and girls at Grade XII who were already overweight at Grade VII were 1.5 and 4.0 respectively, and the relative risks of obesity in boys and girls at Grade XII who were already obese at Grade VII were 1.4 and 4.6, respectively. The present study showed that without any nutritional intervention those children, especially girls who were overweight and obese were more likely to maintain their bodyweights throughout the 6-year period in secondary school.

Lactose intolerance is common in Thai adults who ingest cow's milk but its incidence has not been clearly defined The authors evaluated 45 volunteers (15 males, 35 females), aged 21-31 yrs old, who drank one 240-ml box of milk daily. A Lactose tolerance test was performed using a breath-hydrogen test (BHT) after oral intake of 25 g of lactose dissolved in 250 ml of water The presence of gastrointestinal symptoms of lactose intolerance, flatulence, abdominal pain and diarrhea, were recorded Twenty-one subjects (47%) were categorized as lactose malabsorbers and intolerant, two subjects (4%) were malabsorbers but tolerant, and 22 of 45 (49%) were absorbers and tolerant. The incidence of lactose malabsorption was, thus, 51%; symptoms of intolerance were found in 21 of the 23 malabsorbers, making the incidence of lactose intolerance 47%. In the lactose malabsorbant and intolerant group, the more breath-hydrogen (H) the more symptoms observed All subjects who had a negative breath-H2 test had no symptoms. The breath-H2 test should be used as a standard method to evaluate lactose absorption and lactose tolerance. The incidence of lactose intolerance has decreased from the past and the symptoms are not so severe that the people limit the consumption of milk since it is a major source of food containing good quality of protein and calcium.

Background: The authors proposed that ketogenic diets will produce an increase in the ratio of branched chain amino acids (BCAAs) and aromatic amino acids (BCAAs) in plasma of children who are on the diets., Subjects and Method: A sample of plasma amino acids sample before initiation of fasting and on day 10 of the dietary treatment was obtained in patients with refractory epilepsy who were newly admitted for initiation of ketogenic diet. Plasma amino acids were determined by high performance liquid chromatography equipment., Results: There are 20 patients with refractory epilepsy participating in this study. Outcomes of ketogenic diet therapy were satisfactory. Nineteen cases out of 20 cases had a significantly higher ratio of plasma BCAAs:ARAAs during ketogenic diets than before the diet (P < 0.001)., Conclusion: The ketogenic diets produced an increased ratio of plasma BCAAs:ARAAs. Whether the increased ratio of plasma BCAAs:ARAAs plays an important role in controlling epilepsy is yet to be elucidated.

Objective: To compare the types and quantities of carbohydrate, electrolytes, pH and osmolarity of fresh fruit juices and commercial fruit juices., Material and Method: Forty kinds of fresh fruits available in Thai markets were analyzed for types and quantities of carbohydrate, electrolyte, pH and osmolarity and compared with previously obtained data for commercial fruit juices., Results: Most fresh fruit juices did not contain sucrose, whereas, commercial fruit juices mostly have sucrose in the range of 3-112 g/L. Although both fruit juices were acidic (pH varied from 3.6-6.7 and 3.2-5.8 of fresh juice and commercial juice), fresh fruit juices had a more neutral pH than commercial fruit juices. Apple, guava, orange, pear, and pineapple juices from commercial fruit juices had a high osmolarity compared with fresh fruit juices. All types of fresh fruit juices contained less sodium than commercial ones, whereas, most fresh fruit juices contained more potassium, phosphorus, and magnesium than commercial fluids., Conclusion: The nutrient content of fresh fruit juices and commercial fruit juices from the same kinds of fruits are not the same, possibly due to the manufacturing process. Therefore, physicians should know the composition of fruit juices in order to advise patients properly.

Probiotics administration has been claimed to prevent antibiotic-associated diarrhea. The investigators thus conducted a double blind, placebo controlled study of providing probiotics to infants and children with severe bacterial infections and receiving broad spechum antibiotics. The results of the study showed that the group receiving probiotics had fewer diarrheal episodes (37.5%) than the control group (80%), although the numbers were too small for statistical analysis. In conclusion, probiotics administration to patients receiving high doses of broad spectrum antibiotics may prevent the occurrence of antibiotic-associated diarrhea. A further study with a larger number is required.

Forty kinds of commercial fruit juices sold in Thailand were analyzed for types and contents of carbohydrates, electrolytes as well as osmolarity and pH. Each juice was analyzed three times and the results were averaged. A few kinds of fruit juices have high sorbitol contents (> 10 g/L). There are some juices which have a high fructose to glucose ratio (> 1.5:1). Sodium contents in juices ranged from 19 to 1405 mg/L. The osmolarity of the juices ranged from 500 to 1200 mOsmol/L. Most juices have acid pH which ranged between 2.8 and 5.0. It is concluded that each fruit juice has a unique set of properties. Consumers should know the properties of each juice because chronic intake and large amount intake of the juice could have detrimental effects on the health of the consumer.

Rationale: The aim of this study was to establish the first ketogenic diet treatment program for refractory epilepsy in Thailand and to assess its feasibility as well as its efficacy., Method: Children with refractory epilepsy were enrolled in the study. This was a prospective open trial study with 35 children (16 boys and 19 girls). Not all patients started on the diet at the same time. Each patient was cumulatively enrolled in this study over the period of 4 years. The mean age on diet was 5.37 +/- 3.57 years (2 months-13 years), mean age of onset of seizures was 19.2 +/- 27.47 months (1 days-8 years), and an average duration on ketogenic diet was 7.67 months (6 days to 29 months). The classic "4:1" formula ketogenic diet was used with some modification. The patient's parents were allowed to improvise and use any fatty diets available in the market such as coconut milk if needed. Parents were closely supervised and instructed on how to prepare the patient's own meals while in the hospital and continued to attend neurology and nutrition clinics. The seizure outcome and side effects were monitored as well as a daily test for urine ketone., Results: At 1 month, 3 months, 6 months, and 12 months duration on the diet, 90 per cent seizure reductions were achieved in 62.5 per cent, 68.18 per cent, 75 per cent, and 66.67 per cent of patients remaining on the diet, respectively. The number of antiepileptic drugs (AEDs) used by each patient also decreased as a result of better seizure control., Conclusion: Ketogenic diet can be tried as a management option for refractory epilepsy. It is not difficult to implement even in a developing country like Thailand where resources are limited. It may also help reduce the cost of treatment especially in view of the high prices of the new AEDs.

A total of 15 infants aged between 4-12 months with sleeping difficulty were enrolled in the study. All participants were given a test follow-on formula (cow's milk based), with added rice starch. The test formula was advised to be given at night-time for a 7-day period. Sleeping patterns were recorded 2 days prior to the study and during the 7-day study period. It was shown than 11 out of 15 cases (73.3%) had satisfactory results. Two cases (13.3%) were withdrawn from the study by their parents due to vomiting after taking the formula. We found that both cases developed concomitant respiratory tract infection one day after starting the study, and 2 cases (13.3%) were lost to follow-up. In conclusion, the majority of cases showed satisfactory results in terms of night sleeping pattern after switching to the rice starch added follow--on formula.

The investigators studied the height of adolescents in the age range of 12 to 18 years from 2 schools in Bangkok. Questionnaires asking their rates of organised exercise per week, of milk intake per day and their parental heights were given to a total of 545 male and 615 female students. The completed questionnaires were analyzed. We could categorize these subjects into 3 groups according to their heights which were Group I (height > 97th%-ile), Group II (height between 50-97th%-ile) and Group III (height < 50th%-ile). Those in Group I had parents, whose height was significantly greater than those of the other groups. There was no difference in organized exercise among the 3 groups. Milk intake of female adolescents from Group I was significantly more than the other groups. It is concluded that parents' height in both males and females and milk intake in females contribute to a greater adolescent height.

An oral electrolyte solution made with rice syrup solids was found to reduce fecal output more effectively than a comparable glucose-based solution in the early hours of treatment of infantile diarrhea. Administration of the rice syrup solids solution was also more effective in promoting absorption of fluid, sodium, and potassium. In some infants, the rapid, effective rehydration offered by this solution may prevent the need for hospitalization.

The results of a 4-week summer camp for childhood obesity were reported. Twenty-one children with moderate to severe obesity, aged between 8-13 years, joined the program. Dietary restriction during the official hours and dietary self-control at home were implemented throughout the program. Exercise, swimming and group therapy were also implemented throughout the program. Weekly sight-seeing outside the camp was very interesting for the participants. After the program, all participants had lost weight which was about 5 per cent of their initial weight. Most of the weight loss was due to loss of body fat but not lean body mass. No complications occurred during the program. The 4-week summer camp is then practical for initiating weight loss for obese children. Long-term follow-up which is underway will be reported later.

Ten obese children aged 8-13 years participated in a 4-week program of weight reduction. Dietary restriction of 800 kcal/day and mild exercise were the two features of the program. With this regimen the investigators expected that their lean body mass would be preserved while body fat would decrease. After the 4-week program, we found that those who were mildly and moderately obese lost more than 5 per cent of their body fat but less than 1 per cent of lean body mass. Those children with morbid obesity lost more than 5 per cent of body fat and lean body mass. It is concluded that the regimen is suitable for mild and moderate obesity, but for morbid obesity, a new regimen with higher energy and higher protein in the diet may be more suitable than the current one.

The correlation between osmolality and specific gravity of parenteral nutrition solutions containing various concentrations of amino acid and glucose were studied. There is good correlation between osmolality and specific gravity up to 1,000 mOsmol/kg H2O and 1.050, respectively. There are strong correlations between osmolality and amino acid concentration at each concentration of glucose. An equation which can be applied for quick calculation of osmolality of the solution from amino acid and glucose concentrations is: Osmolality (mOsmol/kg H2O) = 74.36 G + 163.91 A - 36.56. The results of this study can be adopted by all physicians for quick assessment of the osmolality of the PNS before administration to patients.

Gastric emptying of milk from the stomach of Thai infants shows a biphasic pattern. At 40 minutes the amount of stomach contents is more than at 20 minutes. At 100 minutes, only 16 per cent of the initial amount was recovered. The results of our study can be used as a standard reference for further study in infants with other diseases.

Parenteral nutrition admixtures prepared in the incubator for sick newborn infants from three wards were cultured for bacteria and fungi. Of the total samples of parenteral nutrition solution being studied, 4.7 per cent had fungi and 14.1 per cent had bacteria. Solutions prepared in the intensive care unit, in the ward for sick newborn, and in the ward for sick preterm revealed fungal contaminations at about 11.1, 5.8 and 0.0 per cent respectively. Bacterial contaminations were higher and had a percentage of 11.1 from the intensive care unit, 23.5 from the ward for sick newborn and 10.3 from the ward for sick preterm. It was concluded that another more sterilized technique should be implemented for reduction of such a high rate of bacterial and fungal contaminations in the parenteral nutrition admixtures.

Massive chemotherapy and autologous bone marrow transplantation (ABMT) have been successfully used for the treatment of Burkitt's lymphoma. We report our first success with such treatment in two children with Burkitt's lymphoma in Thailand. Both patients had massive abdominal tumors with ascites and minimal bone marrow metastasis at the first presentation. They received induction chemotherapy and intensive treatment including central nervous system prophylaxis with cranial irradiation and intrathecal methotrexate until being in complete remission before starting massive chemotherapy, comprising the combination of BCNU, cytosine arabinoside, cyclophosphamide and 6-thioguanine followed by ABMT. Both patients recovered completely following intensive supportive treatments post ABMT and are still good health without evidence of the disease for 18 and 8 months after transplantation respectively. The role of massive chemotherapy and ABMT for the treatment of non-Hodgkin's lymphoma especially Burkitt's lymphoma was discussed.