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Biomedical subjects

M Araya

Publications and source records attributed to M Araya.

At least 55 records · Page 3Linked to original sources

Hygiene habits and carriers in families with a child who has had typhoid fever.

The relationship between asymptomatic shedding of bacterial enteropathogens and the hygiene habits of families who have had a child with typhoid fever (TF) are investigated. The sample was made up of 80 families: 40 families in which one child had had TF (Group A) and 40 in which no children or either of the parents had had a history of TF (Group B). In each group 20 families belonged to a low socioeconomic status (SES) and 20 to a high SES. A structured interview was used to evaluate the SES and the hygiene habits of the child; observations were made to measure the hygiene habits of the family (toilet, kitchen and food preparation) and bacteriological studies (fecal samples and hand markers). Results show that carriers were more frequent in Group A than in Group B. The bacterial species found were significantly more numerous in Group A than in Group B (fecal samples: E. coli, the classic serotypes, Shigella ssp, and hand markers: E. coli). Families of Group A had higher carriage rates than those of Group B. Finally there exists a significantly higher association between inadequate hygiene habits and carrier families. These results show the need to teach specific habits of proper hygiene to the entire population, because the fact of belonging to the high SES does not in itself preclude inadequate hygiene habits.

Adolescent↗

[Application of a model for predicting morbidity in children from a low socioeconomic level].

An instrument to be used at a primary health care level was built on the basis of a predictive model for diarrhea obtained during a previous study. The instrument was applied to 720 mothers or caregivers of infants living in the Southeastern area of Santiago. 83 infants who fulfilled the requisites of the instrument were surveyed during July-August 1989 and compared to age, nutritional and socioeconomic status matched children not fulfilling the same requisites. Infants selected by the predictive instrument suffered 4 times more morbid episodes and respiratory infections and 5 times more diarrheal episodes than controls. Symptoms were present in them during 50% of the survey period as opposed to 14% in controls. Mothers of children at risk had inadequate behaviors in respect to health care of their children and did not follow many of the National Health programs available for their families. The predictive instrument tested may be useful to identify children at high risk of morbidity, creating the possibility for special interventions in them.

Child Welfare↗

Persistent diarrhoea in the community. Characteristics and risk factors.

In 58 previously well-nourished patients who were fed cow's milk and who later developed persistent diarrhoea (greater than or equal to 15 days), data obtained during the first 8 days of acute diarrhoea were compared with those of patients whose episodes lasted less than or equal to 8 days. Children with persistent diarrhoea weighted less at birth, passed greater than or equal to 6 stools/day during the first 48 hours, received early treatment with antibiotics. Their milk feedings were stopped during the first 48 hours, they had a past history of digestive diseases and hospitalizations, they were brought in for consultation after 5 days of symptoms and their nutritional status deteriorated more (p less than 0.003, p less than 0.03, p less than 0.0001, p less than 0.0001, p less than 0.0001, p less than 0.002, p less than 0.0001, and p less than 0.03, respectively). Their mothers were significantly younger (p less than 0.0013), had better schooling (p less than 0.037), and fewer children (p less than 0.044), and were separated from the index child during the day more often (p less than 0.056). After persistent diarrhoea was diagnosed, enteropathogens in stools or lactose intolerance or both were demonstrated in 75.9%. Treatment induced remission in all cases. Using logistic regression a predictive model was established which enables us to identify, among patients with acute diarrhoea, those at risk of prolonging their illness.

Acute Disease↗

Developmental changes in pleural liquid protein concentration in sheep.

The source of normal pleural liquid is thought to be the systemic circulation of the pleural membranes rather than the pulmonary circulation of the nearby lung. Evidence for a systemic origin comes from the low protein concentration of pleural liquid in adult sheep, which is consistent with protein sieving from a high-pressure circulation. During normal development from fetal to adult life, systemic vascular pressure increases. We therefore reasoned that if pleural liquid comes from the systemic circulation, pleural liquid protein concentration relative to plasma protein concentration should decrease during normal development. To test this hypothesis we did thoracotomies on 14 fetal, 9 newborn, and 15 adult sheep and collected pleural liquid and plasma for measurement of total protein and albumin concentrations. In separate experiments we measured steady-state systemic and pulmonary vascular pressures in age-matched chronically instrumented fetal, newborn, and adult sheep. The protein concentration in pleural liquid relative to that in plasma (pleural liquid/plasma) decreased progressively with age (fetuses, 0.50 +/- 0.15 [SD]; newborns, 0.27 +/- 0.08; adult, 0.15 +/- 0.05); the trend was similar for pleural liquid/plasma albumin ratios as a function of age. Systemic arterial pressure increased progressively during development, whereas pulmonary arterial pressure decreased from the fetus to the adult sheep. These observations support the hypothesis that normal pleural liquid originates from a systemic circulation.

Aging↗

Typhoid fever in children of low and high socioeconomic strata: comparison of hygiene habits.

The relationship between the hygienic habits of children who had typhoid fever (TF) who had recently begun attending school and their family group, is assessed. It is supposed that children, independently of their SES, acquired TF because of inadequate habits which facilitated the oral-fecal cycle. The sample was formed of 40 child-mother dyads: 20 of low SES (group A) and 20 of high SES (group B), the child of each of which had had TF. Results showed that the hygienic habits of children with respect to the oral-fecal cycle, their perception of school toilet cleanliness as well as the mothers' explanation of their children's hygienic habits is very similar in the two groups. The importance of these results is that the SES is seem to be irrelevant in the case of TF but that the hygienic habits of the children are of importance. Public health policy should be modified to include the teaching of proper hygienic habits (oral-fecal cycle).

Child↗

Effect of an acidified milk on diarrhoea and the carrier state in infants of low socio-economic stratum.

The effect on diarrhoeal disease of an acidified, modified powdered cow's milk infant formula (Pelargon) was evaluated in 82 infants (Group I) for six months; 104 infants who received the same formula but non acidified, served as controls (Group II). Nutritional status remained satisfactory in both groups throughout the observation period. Some children rejected the taste of the acidified milk. The incidence of diarrhoea was lower in Group I (p less than 0.001). The proportion of days in which the children suffered from acute diarrhoea, and the duration of the episodes were also lower in the children given the acidified milk (p less than 0.001). The rate of detection of enteropathogens and the species identified were comparable in both groups. Carrier rates for bacterial enteropathogens fell over time in Group I while they rose in Group II (p less than 0.001). Carrier rates for enteric parasites were comparable to those expected in our setting for this age group. These results suggest that acidified milk exerts a protective effect against diarrhoeal disease.

Animals↗

Faecal excretion of rotavirus and other enteropathogens in newborns of the high and low socio-economic stratum in Santiago, Chile.

Faecal excretion of enteropathogens was studied in newborns in their first week of life. Rotavirus was investigated in 225 neonates, of whom 107 belonged to the low socio-economic stratum (SES) and 118 to the high SES. Half of each group were delivered by caesarean section. Rotavirus was detected in 10 infants (4.4%). Eight of them had been in the same ward and excreted the same viral electrophoretype. Enteropathogenic bacteria were isolated from 8 out of 57 (14.0%) newborns. Positive cultures were equally distributed by SES and route of delivery. Giardia lamblia was the only parasite detected, in one infant (2.6%) of the high SES. None of the children developed symptoms. Faecal excretion of enteropathogens ended spontaneously within a week in all cases. It is suggested that the lack of symptomatology and the spontaneous termination of the faecal excretion are related to immaturity of the small intestinal mucosa, that does not allow the completion of the steps that must take place during a successful infectious event.

Chile↗

Effect of structured dietary fiber on bioavailability of amoxicillin.

The effect of structured dietary fiber on the bioavailability of amoxicillin (AMX) was evaluated. Ten healthy volunteers ingested one of two isocaloric, isonitrogenous diets providing 7.8 gm/day (diet I) and 36.2 gm/day (diet II) of structured fiber for 3 days. Then they ingested one tablet (500 mg) AMX after breakfast. The other diet was administered for an additional 3 days and the study was repeated. Plasma and urinary AMX concentrations were measured at 9 and 24 hours, respectively, by a microbiologic technique. An open one-compartment model was used for pharmacokinetic analysis. AMX was absorbed more slowly when ingested with diet I than with diet II: the absorption rate constant was 1.04 +/- 0.37 and 1.75 +/- 0.75 (P less than 0.05); lag time for absorption was 0.34 +/- 0.13 hours and 0.29 +/- 0.11 hours (P less than 0.05). The first-order rate constant and elimination half-life were similar. Bioavailability was higher with diet I: the AUC was 12.17 +/- 3.04 vs. 9.65 +/- 2.64 micrograms/ml/hr with diet II (P less than 0.05). A higher content of dietary fiber increased AMX absorption rate and decreased the amount of drug absorbed.

Absorption↗

Chronic environmental enteropathy in a temperate climate.

Forty-three apparently healthy young adult male volunteers underwent an evaluation of their nutritional status, blood chemistry and faecal excretion of enteropathogens, which did not reveal current malnutrition or illnesses. Ten of them were further studied for small intestinal histology, culture of aerobic and anaerobic bacteria in the duodenal juice, disaccharidase activities, glucose absorption and faecal excretion of fat and nitrogen. The study revealed mild morphological changes associated with the appearance of anaerobic bacteria in the upper intestine, decreased glucose transport and increased faecal losses of nitrogen. Although all these changes were rather mild, they may be significant for people whose diet is of borderline nutritional quality.

Adult↗

Acute diarrhoea and asymptomatic infection in Chilean preschoolers of low and high socio-economic strata.

Preschoolers who belonged to the high (Group I, n = 112) or the low (Group II, n = 90) socio-economic stratum were followed prospectively for six months. Mean monthly incidence of diarrhoea was 3 and 7 episodes per 100 children for Group I and Group II respectively (p less than 0.001). Episodes were shorter and affected a smaller proportion of children in Group I (p less than 0.002 and p less than 0.05), respectively). Bacterial enteropathogens were recovered in 12.6% and 13.5% of the episodes in Group I and Group II and parasites in 15.4% and 62.8%, respectively. Rotavirus was detected once in each group. Asymptomatic carrier rates for enteropathogenic bacteria were 12.0% in Group I and 7.2% in Group II. The corresponding figures for parasites were 28.2% and 62.8% (p less than 0.001). Nutritional status was normal in all children. These results suggest that socio-economic stratum plays an important role in the characteristics of diarrhoeal illness in the groups which conform the population of the less developed countries. Acute diarrhoea is less frequent in preschoolers living in Santiago than in other developing areas. Rates of asymptomatic infection are high.

Acute Disease↗

Acute diarrhoeal disease in children under 7 years of age in a peri-urban slum of Santiago, Chile.

A group of 168 families who lived in a peri-urban slum in Santiago were surveyed for 9 months. All of them had a child under 7 years of age. Medical activities and data collection were carried out at a Field Station and by means of twice-weekly visits to each home, at which time cases of diarrhoea were recorded and investigated. Faecal samples for bacteriological, parasitological and rotavirus studies were obtained during each episode. The characteristics of clinical course, hygienic practices in the family, and monthly anthropometric measurements of infants and toddlers were also recorded. The mean monthly incidence of diarrhoea was 7.1 episodes per 100 children. Of the episodes, 44.2% were associated with pathogenic bacteria, 14.4% with rotavirus, 38.4% with parasites and in 27.9% no enteropathogens were identified. It was found that adequate hygienic habits were not associated with a decreased risk of developing diarrhoea and that about 60% of children did not have diarrhoea throughout the study period. The nutritional status was adequate in most cases: weight-for-age was below the 5th percentile in 11.5% of subjects and the height-for-age was normal in all. No moderate or severe cases of malnutrition were detected.

Age Factors↗

Enteropathogen carriage by healthy individuals living in an area with poor sanitation.

Faecal carriage of bacterial enteropathogens (enteropathogenic Escherichia coli (EPEC), shigellae and salmonellae) was studied in 265 individuals: 65 infants 3-6 months of age (50 bottle-fed and 15 breast-fed), 100 school-age children 8-10 years of age and 100 adults 21-50 years of age. All were apparently healthy, did not have gastrointestinal symptoms, had not received antibiotics in the preceding fortnight and were not malnourished. Enteropathogens were isolated from the faeces of 24 individuals (9.1%). Cultures were positive for enteropathogens in 20% of the infants (both breast- and bottle-fed), 8% of school-age children and 3% of the adults. EPEC was the most frequent isolate. Twelve different serotypes were detected. The highest recoveries were E. coli 026:K60 and 044 . K74. Shigella was detected only in school-age children (2%) and salmonella only in adults (1%). Campylobacter jejuni and Yersinia enterocolitica were studied only in the school-age children: there was one isolate of each of them. Most enteropathogens isolated were susceptible to the majority of the antibiotics tested. Only four E. coli strains, isolated from bottle-fed infants, could be considered multi-resistant. Two of the strains wer E. coli 044:K74 and 020a020c:K61. The remainder were E. coli 0111:K58 and wee capable of transferring some of their antibiotic resistance traits to a recipient strain.

Adult↗

Characteristics and analysis of electropherotypes of human rotavirus isolated in Chile.

Electropherotypes of human rotavirus from stool samples of hospitalized and ambulatory infants with acute diarrhea were analysed. Thirty-two different electropherotypes were observed in 142 cases in which the viral genome RNA was characterized. The seasonal distribution of the electropherotypes, from 1979 to 1981, showed that the same electropherotypes were detected throughout the period of study while others were found only occasionally. Electropherotypes were also analyzed depending on whether the patient from whom they had been obtained required hospitalization or was treated at home. The analysis shows that the electropherotypes were equally distributed in both groups of patients.

Acute Disease↗

Fine structure of the small intestinal mucosa in infantile marasmic malnutrition.

The jejunal mucosa was studied in infantile marasmic malnutrition in the early phase after treatment was begun and before the onset of significant weight gain. In 7 infants light microscopy before recovery showed that the mucosa was normal or mildly abnormal in 4, and moderately abnormal in 3 cases. The electron microscope disclosed abnormalities of the brush border, large autophagosomes and residual bodies, and the deposition of collagen, filaments, and a dense, finely granular material below the basal lamella. Three of the infants were studied again during recovery. Although the histology remained unchanged, electron microscopy revealed improvement of the brush border, disappearance of the autophagosomes, and smaller and fewer residual bodies. The dense material below the basal lamella was absent whereas the fibrillar components remained. It is postulated that the fine structural lesions observed may be due to the derangements in cell metabolism caused by the severe, prolonged restriction of protein and caloric intake.

Cell Membrane↗

Bood vitamin levels in children with gastroenteritis.

Clinical evaluation and estimation of blood levels of vitamins A, E, C, B1, B2, B6 and of total carotenoids were carried out in 52 consecutive children admitted to the Royal Alexandra Hospital for Children in Sydney during the winter epidemic of diarrhoea. The children included 37 Europeans and 15 Aboriginals, who were previously apparently healthy. Of these, 19 Europeans and ten Abororigines were studied also after recovery. The anthropometric, clinical, microbiological and biochemical data for each child is presented. Vitamin treatment, duration of symptoms, severity of diarrhoea, stool microbiology and the role of secondary malabsorption as a main cause of the depressed plasma vitamin levels found is discussed.

Acute Disease↗