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Diarrhea is still a major cause of illness and death in developing countries in spite of advances in the use of oral rehydration therapy, in which a mixture of sugar and salts is used to improve the water balance in affected children. More than one-third of deaths associated with diarrhea are related to persistent diarrhea (PD), which lasts more than two weeks and usually causes weight loss. Children with malnutrition may be susceptible to PD, and the two conditions almost always coexist in children in developing countries. Nutritional rehabilitation is thought by many to be important in treating PD, but the best methods have not yet been established. Enteral feeding (by mouth) has many advantages including safety, low cost, and faster recovery; these diets have included cow's milk, soy, or protein formulas that are hydrolyzed (broken down to easily digested constituents). These are expensive in countries such as Pakistan; it is more effective to use inexpensive, culturally acceptable, and locally available diets in developing countries. Studies have shown that rice and lentils are effective sources of sugar for use in oral rehydration solutions, and yogurt, used as a supplement in Pakistan, does not harm absorption of nutrients. The effects of these foods have not been previously systematically assessed. The effect of khitchri, a traditional diet of rice, lentils, oil, and yogurt, in treating 102 boys with PD was evaluated and compared with that of soy formula. Of these children, 73 completed the study of the khitchri-yogurt (KY) diet. The KY group had a lower volume and frequency of stools and gained significantly more weight. Children in the KY group recovered significantly faster, which occurred even in children with advanced malnutrition. Five of 36 children in the soy group and 2 of 37 in the KY group failed the treatments, with continued frequent bowel movements; these children were under 15 months old. The study indicates that a KY diet, which is inexpensive and traditionally used in Pakistan, is safe and effective in treating children with PD. (Consumer Summary produced by Reliance Medical Information, Inc.)

Rice based oral rehydration therapy (ORT) solutions have been shown to be superior to glucose oral rehydration salts (World Health Organisation (WHO) ORS) in reducing stool volume and duration of diarrhoea in children and adults. Rice based ORT has been used only sparingly in young infants, however, because of theoretical concerns about digestibility. A randomised controlled trial of rice based ORT (50 g rice and electrolytes identical to WHO ORS) and WHO ORS was carried out in 52 male infants less than 6 months old with moderately severe acute diarrhoea to evaluate efficacy and digestibility. Nineteen (70%) of 27 children who received rice based ORT and 18 (72%) of 25 children who received WHO ORS were treated successfully. The mean (SD) diarrhoeal stool output for the first 24 hours of treatment was significantly lower in the infants receiving the rice based ORT than in those receiving WHO ORS (101.0 (60.5) v 137.1 (74.6) g/kg). The stool output was also significantly less in the rice based ORT group in the second 24 hours. Infants in the rice based ORT group drank significantly less rehydration solution than infants in the WHO ORS group (mean (SD) 165.4 (77.4) v 217.9 (86.1) during the first 24 hours of treatment. There was no difference in the duration of diarrhoea between the groups. The volume of breast and formula feeding was similar in the two groups. No difference was seen in the frequency of finding reducing substances or acid pH in the stools of either group of children. The results suggest that rice based ORT is as effective as WHO ORS in infants with moderately severe diarrhoea and that rice based ORT is as well tolerated as WHO ORS in infants. [ABSTRACT FROM AUTHOR]

Objective: To describe the presentations, complications and to look at the subtypes of children with osteopetrosis., Design: A case series., Place and Duration of Study: This study was conducted at the National Institute of Child Health (NICH) from July 2002 to December 2003., Subjects and Methods: All children presenting as outpatients or inpatients with anemia, thrombocytopenia, and hepatosplenomegaly were evaluated. Those suspected of the disorder (n=126) were screened by X-rays of long bones., Results: Eighteen children including 10 girls and 8 boys in 16 families were diagnosed as having osteopetrosis over a period of 18 months. Fifteen had isolated autosomal recessive osteopetrosis. The mean age at diagnosis was 33 months. Parental consanguinity was high (83.3%). Anemia, hepatosplenomegaly, failure to thrive, recurrent infections and neurological manifestations were common. A high mortality (33.3%) owing to infection was noted., Conclusion: Osteopetrosis should be considered in children presenting with unexplained anemia and hepatosplenomegaly. Once diagnosed, these children should then be monitored for the complications that occur with high frequency in the disorder. Early diagnosis and treatment of the disorder improves the outcome.

Objective: To review the clinical spectrum and etiology of chronic liver disease in children at National Institute of Child Health, Karachi., Methods: Prospective study in children aged 1 to 14 years with suspected chronic liver disease. Complete blood count, LFT's, prothrombin time, serum albumin and ultrasound of abdomen were done in all patients. Liver biopsy was done in majority of the cases. Viral markers included HBsAg, anti HCV and ANA to determine etiology. Those who were negative for hepatitis B, C and autoimmune disease, were subjected to slit lamp examination of eyes and 24 hours urinary copper estimation for Wilson's disease. Alpha-1-antitrypsin levels were done in selected patients., Results: A total of 55 cases were studied. The common presenting features were edema, ascites (44 patients), jaundice (27), variceal bleeding (23) and fever (22). On examination anemia was present in 52 patients, edema in 46, jaundice in 37, splenomegaly in 42 and hepatomegaly in 35 patients. Fortynine patients had hypoalbuminemia (< 2.5 gm%), 45 raised ALT (> 80 IU/L) and 49 prolonged PT (> 4 sec of control). Ultrasonography showed a dilated portal vein in 34 patients and esophageal varices were seen in 46 patients on endoscopy. Thirteen (24%) had chronic hepatitis B, 9(16%) autoimmune disease, 9 (16%) Wilson's disease and all were anti HCV negative. Etiology remained uncertain in 24 (44%) cases., Conclusion: Hepatitis B was the leading cause of chronic liver disease in children followed by Wilson's disease and autoimmune liver disease. None of the patients had hepatitis C in this study.

In a prospective study we randomized 102 male children (age 6-36 months) with persistent diarrhea to receive a traditional rice-lentil (Khitchri) diet and yogurt (K-Y) or a soy formula (alone for seven days and then in combination with K-Y for seven days). Of 73 children satisfying the study criteria, 66 were successfully treated and there were 7 treatment failures. There was poor concordance between parental accounts of severity of diarrhea or vomiting and that observed after admission. Significant risk factors associated with treatment failure included younger age (p < 0.005) and vomiting at presentation (p < 0.02). The greatest number of risk factors associated with delayed recovery (> 10 days) were identified during an initial evaluation period (the first 8 h after admission). These included greater severity of watery diarrhoea (p < 0.01) and increased ORS intake (p < 0.02). Our data suggest that an initial evaluation period, including objective observations, may identify children with persistent diarrhea who are at greatest need of hospitalization.