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Biomedical subjects

N Bhandari

Publications and source records attributed to N Bhandari.

At least 55 records · Page 3Linked to original sources
PubMed1992

Mortality associated with acute watery diarrhea, dysentery and persistent diarrhea in rural North India.

Mortality associated with diarrhea was investigated in a longitudinally followed cohort of children under 6 years of age in rural North India. During the followup, 1663 episodes of diarrhea and 23 diarrhea-related deaths were recorded in 1467 children followed up for 20 months. The case fatality rate was 0.56% for acute watery diarrhea, 4.27% for dysentery, and 11.94% for non-dysenteric persistent diarrhea. Most of the episodes lasted less than a week; 5.2% became persistent (duration 14 days). The case fatality rate was similar in episodes of 1 and 2 weeks duration (0.64% and 0.8%) and increased to 13.95% for persistent episodes. Of the total 86 persistent episodes, 22.1% were dysenteric; the case fatality rate for such dysenteric persistent episodes was 21.1% and for watery persistent diarrhea 11.4%. Diarrheal attack rates were similar among different nutritional groups, but diarrheal case fatality rates progressively increased with increasing severity of malnutrition; these were 24 times higher in children with severe malnutrition (7.48%) compared to those normally nourished (0.31%). With availability and use of oral rehydration therapy, dysentery and persistent diarrhea emerge as major causes of diarrhea-related mortality, with underlying malnutrition as a key associated factor.

Asia↗
PubMed1992

Mortality associated with acute watery diarrhea, dysentery and persistent diarrhea in rural north India.

Mortality associated with diarrhea was investigated in a longitudinally followed cohort of children under six years of age in rural North India. During the follow-up, 1663 episodes of diarrhea and 23 diarrhea related deaths were recorded in 1467 children followed up for 20 months. The case fatality rate was 0.56% for acute watery diarrhea, 4.27% for dysentery and 11.94% for non-dysenteric persistent diarrhea. Most of the episodes lasted less than a week; 5.2% became persistent (duration > 14 days). The case fatality rate was similar in episodes of one and two weeks' duration (0.64% and 0.8%) and increased to 13.95% for persistent episodes. Of the total 86 persistent episodes, 22.1% were dysenteric; the case fatality rate for such dysenteric persistent episodes was 21.1% and for watery persistent diarrhea 11.4%. Diarrheal attack rates were similar among different nutritional groups, but diarrheal case fatality rates progressively increased with increasing severity of malnutrition, these were 24 times higher in children with severe malnutrition (7.48%) compared to those normally nourished (0.31%). With availability and use of oral rehydration therapy, dysentery and persistent diarrhea emerge as major causes of diarrhea related mortality, with underlying malnutrition as a key associated factor.

Acute Disease↗
PubMed1991

Evidence for recent diarrhoeal morbidity as a risk factor for persistent diarrhoea: a case-control study.

The association between persistent diarrhoea and 'recent morbidity' defined as that occurring within the two-month period immediately preceding the onset of persistent diarrhoea was investigated in a population-based case-control study in rural North India. In two separate matched case-control analyses children with persistent diarrhoea (cases) were compared to population controls (five controls matched to each case) and acute diarrhoeal controls (three controls matched to each case). After correcting for possible confounding variables, comparing children with persistent diarrhoea and matched population controls, presence of a recent diarrhoeal illness was significantly associated with persistent diarrhoea with an odds ratio (OR) 2.6 (95%) confidence interval (CI): 1.1-7.1; p less than 0.05); during infancy this OR was 5.2 (95% CI: 1.0-31.9; p less than 0.01). Comparing children with persistent diarrhoea to matched acute diarrhoeal controls, presence of recent diarrhoeal illness was associated with an OR of 5.1 (95% CI: 1.3-20.3) in favour of the episode becoming persistent; in infants this OR was 10.4 (95% CI: 1.1-132.4; p less than 0.001).

Acute Disease↗
PubMed1990

Rotavirus-specific antibody response in saliva of infants with rotavirus diarrhea.

The reliability of saliva as an indicator of rotavirus infection was assessed among 15 infants (3-12 months) with rotaviral and 15 with nonrotaviral diarrhea. Paired salivary samples collected during acute and convalescent phases were tested for rotavirus-specific IgA and IgM by an ELISA. The sensitivity of IgA or IgM alone to predict infection was 53.3% and 46.6%, respectively; used in conjunction, the sensitivity rose to 80%. It seems that infants with rotaviral diarrhea mount mucosal antibody responses as reflected in their saliva; possibly salivary antibodies could be used to evaluate vaccine "take" in rotavirus vaccine trials.

Antibodies, Viral↗
PubMed1990

Glycine, glycyl-glycine and maltodextrin based oral rehydration solution. Assessment of efficacy and safety in comparison to standard ORS.

We evaluated the efficacy and safety of an oral rehydration solution containing glycyl-glycine, glycine, and maltodextrin (GGG-ORS), in comparison to the glucose based ORS (standard ORS). The osmolality of the GGG-ORS (305 mOsm/l) and standard ORS (311 mOsm/l) was similar. Ninety-two children presenting with acute gastroenteritis and moderate dehydration, aged 3 months to 3 years, were randomly assigned to receive standard ORS or GGG-ORS. All the patients were successfully rehydrated orally. The two groups were comparable for baseline characteristics including the microbial etiology. Rotavirus (49%, 36%), ETEC (11%, 18%) or a combination of rotavirus and ETEC (15%, 9%) were the main stool pathogens isolated. There was no significant difference in the mean stool output or duration of diarrhoea between the two groups. Patients in the GGG-ORS group had higher urine output (p less than 0.01) and weight gain (p less than 0.05) in the initial 6 hours when feeding was withheld, but no such differences were observed beyond this period. Hypernatremia did not develop in any patient during the study. We conclude that glycine and glycyl-glycine supplemented oral rehydration solution does not have any therapeutic advantage in the treatment of acute gastroenteritis with moderate dehydration caused predominantly by rotavirus.

Acute Disease↗
PubMed1990

Intestinal glucoamylase & other disaccharidases in children with protracted diarrhoea.

Brush border lactase, sucrase and glucoamylase activities were assessed in jejunal mucosal biopsy specimens from 34 children (median age 11 months; range 1.5-38) having protracted diarrhoea with failure to thrive and 8 well nourished children with normal jejunal mucosal histology (median age 10.2 months; range 2-37). All enzymes showed progressive decrease in activity which was directly in relation to increasing degree of mucosal injury (P less than 0.002). Lactase was significantly reduced even in patients with protracted diarrhoea and normal mucosa (P less than 0.05). Glucoamylase and sucrase were significantly reduced only in the presence of mucosal injury (P less than 0.01). Our data suggest that most children with protracted diarrhoea may not tolerate lactose containing feeds and may need lactose-free diets preferably based on starch. A small number of children with protracted diarrhoea, who have severe mucosal injury may not be able to handle even starch and may require diets based on short chain glucose polymers. The findings of this study, need to be corroborated with well-controlled metabolic balance studies.

Child, Preschool↗
PubMed1990

Human enterocyte adhesion of enteroadherent Escherichia coli.

Esch. coli strains manifesting localised (17), diffuse (8) or aggregative (17) phenotypes of adherence to HEp-2 cells were tested for their ability to adhere to human enterocytes isolated from duodenal biopsies of adult volunteers to obtain further evidence of their enteropathogenecity. Esch. coli strains H10407+; CFAI+ and LT+ STp+ STh+, F 294 B; a localised adherent strain positive with entero-adherent factor probe reported previously to attach to small intestinal enterocytes and F 582 C; LT- STp+ STh+ were the positive controls: H10407P (CFAI- mutant of H10407+) and K12 served as negative control strains. Adherence of variable degree was seen with 35.3 per cent of enteroaggregative Esch. coli (EAggEc) and with 58.8 per cent of enteroadherent Esch. coli localised (EAEC-L); EAEC-diffuse (EAEC-D) did not adhere to the human enterocytes. The possibility that EAgg EC and diffuse phenotypes may adhere better to lower small intestine or the large intestine, needs to be investigated.

Adult↗
PubMed1989

Association of antecedent malnutrition with persistent diarrhoea: a case-control study.

To determine the effect of nutritional state on persistent diarrhoea a case-control study was carried out on 756 children followed up prospectively for 18 months. Children who developed persistent diarrhoea were compared with population controls and controls with acute diarrhoea. The mean weight for age in the children with persistent diarrhoea (69.9%) was significantly lower than that in the population controls (77.0%) and the diarrhoeal controls (76.2%). Weight for age of less than or equal to 70% was associated with persistent diarrhoea in both case-control analyses (population controls, matched odds ratio 3.25; diarrhoeal controls, matched odds ratio 2.46). The corrected odds (multiple logistic regression) in the two analyses were 3.2 (95% confidence interval 1.3 to 8.1) and 3.4 (1.2 to 9.1). Weight for age of less than or equal to 70% increases the risk of persistent diarrhoea. In an underweight child there is a higher risk of diarrhoea becoming persistent. Prevention of malnutrition and intensive management of acute diarrhoea in malnourished children should help reduce the risk of the diarrhoea persisting.

Age Factors↗
PubMed1989

Enteroaggregative Escherichia coli associated with persistent diarrhea in a cohort of rural children in India.

A cohort of 452 rural children was followed longitudinally for 13 mo to ascertain the role of HEp-2 cell adherent Escherichia coli and other pathogens in causing acute (less than or equal to 14 d) and persistent (greater than 14 d) diarrhea. Aeromonas, Campylobacter jejuni, E. coli manifesting localized adherence to HEp-2 cells and enterotoxigenic E. coli were significantly associated with acute diarrhea. E. coli strains that exhibit aggregative adherence, so-called enteroaggregative E. coli, a newly-described category of diarrheagenic E. coli distinct from enterotoxigenic, enteroinvasive, enterohemorrhagic, and enteropathogenic E. coli, were found significantly more often in patients with persistent diarrhea (29.5%) than with acute diarrhea (12.8%) (P = .0052) or controls (9.9%) (P = .0006).

Acute Disease↗
PubMed1989

Electrophoretic study of the genome of human rotavirus in rural Indian community.

A rural cohort of 507 children, less than 3 yr of age was kept under weekly surveillance for 12 months, for morbidity due to diarrhoea. Stool specimens for rotavirus detection were obtained in 346 of the 360 diarrheal episodes occurring in 354 children and in 211 children without diarrhoeal symptoms. Rotavirus was detected by an ELISA test in 4 per cent of children with diarrhoea and 6.6 per cent of control subjects. Viral genome RNA was extracted by phenol chloroform method from all the positive samples and analysed by polyacrylamide gel electrophoresis followed by silver staining. All the strains isolated, exhibited the same electropherotype with a 'long' RNA migration pattern. This result contrasts with the genomic variability amongst rotavirus strains usually observed in different settings.

Child, Preschool↗
PubMed1989

Evaluation of a new latex agglutination kit for detection of human rotavirus in faecal specimens.

A commercial latex agglutination (LA) test was compared with ELISA and direct electron microscopy (EM) for detection of rotavirus antigen in 93 stool specimens obtained from as many children with acute gastroenteritis. Seventy one specimens (76.3%) were either positive or negative with all the three techniques, while 22 (23.7%) gave contradictory results. Only 1 sample was positive by LA test but not with ELISA or EM. The sensitivity of LA test and EM was 62.5 per cent (30 of 48) and 75 per cent (36 of 48); the corresponding specificity being 97.7 per cent (44 of 45) and 100 per cent (45 of 45) respectively. ELISA was more sensitive than the LA test and EM for detection of rotavirus antigen. LA test which is highly specific and a rapid method, may be useful in certain situations but its low sensitivity makes it unsuitable for use in routine clinical practice.

Enzyme-Linked Immunosorbent Assay↗
PubMed1989

Efficacy of nalidixic acid in the treatment of acute bloody diarrhea.

Of sixty four children (mean age 20.1 +/- 1.2 mo) with acute bloody diarrhea and high fever, 47 had infection with non-typhoidal Salmonella (NTS) (20), Shigella (15) and enteropathogenic E. coli (EPEC) (12) and were treated with nalidixic acid (NA). The mean duration (h) of presence of macroscopic blood in the stool following institution of treatment was significantly shorter (p less than 0.05) in those with EPEC (11.5 +/- 4.9) as compared to NTS (30.4 +/- 15.4) or Shigella groups (22.9 +/- 15.6). The number of children having less than or equal to 50% reduction in stool frequency within 72 h was: NTS (17); Shigella (14); EPEC (10). Negative stool cultures on day 5 were obtained in all patients with Shigella and EPEC and 16 (80%) of those with NTS. Two patients with NTS and one with EPEC failed to respond to NA.

Acute Disease↗
PubMed1989

Descriptive epidemiology of persistent diarrhoea among young children in rural northern India.

In order to determine the descriptive epidemiology of persistent diarrhoea in rural northern India, a cohort of 963 children aged 0-71 months was followed prospectively for 12 months through weekly household visits. The incidence of persistent diarrhoea was 6.3 per 100 child-years among those aged 0-71 months, and was highest (31 per 100 child-years) among those aged 0-11 months. There were no significant sex-related differences in the incidence of the disease, and the overall seasonal distribution of acute and persistent diarrhoea was similar. The persistence of diarrhoeal symptoms was significantly correlated with a higher initial mean stool frequency (P less than 0.01) and passage of gross blood with stools (P less than 0.001). Persistent diarrhoea was an important problem among children during the first 2 years of life. Established enteric pathogens were isolated during the initial illness in 46.4% of persistent and 55.4% of acute episodes. Pathogens isolated during persistent episodes included enterotoxigenic Escherichia coli (ETEC 9.3%), Salmonella spp. (4.7%), as well as campylobacter (4.7%), Shigella spp. (2.3%), Entamoeba histolytica (2.3%), and rotavirus (2.3%). Similar proportions of these pathogens were isolated also during episodes of acute diarrhoea. Multiple pathogens were isolated in 7% of the persistent and 5% of the acute episodes. E. coli that manifested aggregative adherence (EAEC-A) was more common (34.9% versus 12.3%) in persistent than acute episodes (P less than 0.01), and initial faecal excretion of EAEC-A was significantly associated with the persistence of a diarrhoeal episode.

Child↗
PubMed1989

Quantitation and properties of fecal and upper small intestinal aerobic microflora in infants and young children with persistent diarrhea.

The duodenal juice and fecal aerobic microflora was investigated in 54 patients with persistent diarrhea (age less than or equal to 2 years). The duodenal aspirates yielded increased aerobic bacteria (greater than 10(5) organisms/ml) in 28 (51.9%) of the patients. Established enteric pathogens were isolated from the duodenal aspirates of 12 (22.2%) of the 54 patients, viz., enteroadherent Escherichia coli (EAEC) (5), enterotoxigenic E. coli (ETEC) (3), enteropathogenic E. coli (EPEC) (1), nontyphoidal Salmonella (1), and Giardia lamblia (2). The total aerobic bacterial count was greater than 10(5) in all 12 patients positive for specific pathogens apart from one case in whom E. coli showing diffuse adherence to HEp-2 cells were identified. Among the remaining 42 specific pathogen-negative patients, 19 (45.2%) also had greater than 10(5) aerobic organisms/ml in the small bowel. Eight strains of Klebsiella from four of the patients were negative for enterotoxin production in a rabbit ileal loop assay and for adherence to HEp-2 cells. In contrast, 28/54 (51.9%) of the same patients had known enteric pathogens in their stools, viz., nontyphoidal Salmonella (8 or 14.8%), Shigella (2 or 3.7%), Campylobacter (1 or 1.9%), ETEC (4 or 7.4%), EPEC (2 or 3.7%), EAEC (7 or 13.0%), and G. lamblia and Entameba histolytica (3 or 5.6%). Further search for potential virulence factors among aerobic bacteria colonizing the upper small intestine in persistent diarrhea is warranted.

Aerobiosis↗
PubMed1988

Protection against neonatal rotavirus infection by breast milk antibodies and trypsin inhibitors.

The role of breast milk antirotavirus immunoglobulin A (IgA) and trypsin inhibitors in limiting the acquisition of rotavirus infection during the initial 5 days of life was evaluated among 42 exclusively breast-fed hospital-born infants, 22 of whom experienced rotavirus infection. The mean concentrations of antirotavirus IgA (ELISA Units) in the breast milk of mothers of the 22 rotavirus-infected neonates was 130.4 +/- 46.4; the corresponding value in 20 noninfected neonates was 384.3 +/- 328.3 (P less than 0.001). Similarly, the trypsin inhibitory capacity (mumols/mt/ml) of breast milk in the rotavirus-infected group was significantly lower (0.109 +/- 0.095) than that in the noninfected group (0.376 +/- 0.191; P less than 0.001). The trypsin inhibitory capacity of milk showed an inverse correlation with infant stool tryptic activity (P less than 0.01). Our results indicate that the acquisition of rotavirus infection during the early neonatal period depends on the concentrations of antirotavirus IgA and trypsin inhibitors in human milk and that protection is mediated by high levels of these antiviral factors.

Antibodies, Viral↗
PubMed1988

Role of enteric adenoviruses and rotaviruses in mild and severe acute enteritis.

The role of enteric-type adenoviruses and rotaviruses in mild and severe acute gastroenteritis was investigated among children younger than 5 years of age seeking treatment at an urban hospital (UH) and at a rural health center (RHC) in India. There were 330 children at the UH and 340 at the RHC; 319 and 315 age matched nondiarrheal children served as controls for the respective groups. Rotavirus was detected in 15.2% of 330 cases and 1.9% of 319 controls at the UH (P less than 0.001) and in 16.5% of 340 cases and 2.9% of 315 controls at the RHC (P less than 0.001). RV excretion was 3- to 5-fold more common in severe compared with mild diarrhea at the UH and at the RHC (P less than 0.001). The detection rate for enteric-type adenoviruses was similar in patients and controls, respectively, at the UH (0.9%; 2.5%) and RHC (3.8%; 2.5%). At the RHC adenovirus types other than 40 and 41 were excreted by 8.8% of the patients and by only 1.0% of the controls (P less than 0.001). It is possible that the diarrheagenic role of adenoviruses may not be restricted to types 40 and 41.

Adenoviruses, Human↗
PubMed1988

Neonatal rotavirus infection and its relation to cord blood antibodies.

Among 274 neonates born at the maternity services of an urban hospital in India, 36.1% of the infants shed rotavirus in feces (as detected by ELISA) by 72 h of life. The excretion rate increased to 70.3% among the 120 infants who stayed for 5 days or more at the hospital. Diarrhoeal symptoms of mild and self-limited nature were observed only in 19.2% of the rotavirus excretors, the remaining being asymptomatic. Among the 98 infants who received supplement feeds, 49% acquired rotavirus infection as against 24.7% of the 150 exclusively breast fed infants (p less than 0.001). Viral RNA in the feces of all rota positive infants showed the same electropherotype, indicating infection from a common source. The mean percentage rotavirus inhibitory activity of cord sera in the infected and non-infected infants was 50.2 +/- 21.7 and 56.6 +/- 19.2 respectively (p greater than 0.05), suggesting that cord blood antibodies do not offer significant protection against neonatal rotavirus infection.

Antibodies, Viral↗