Zinc deficiency is widespread in developing countries and increases children's risk of illness and death from infectious diseases like diarrhea, pneumonia, and malaria. Randomized controlled trials show that zinc supplementation significantly reduces the incidence of diarrhea by 18% and pneumonia by 41% in children. A recent study found that zinc supplementation reduced mortality in small-for-gestational-age infants by 68%. Zinc supplementation also provides therapeutic benefits for acute and persistent diarrhea by reducing episode duration and severity. Ongoing large trials are evaluating whether zinc supplementation can reduce child mortality from infectious diseases.
International Journal of Engineering Research and Applications (IJERA) is an open access online peer reviewed international journal that publishes research and review articles in the fields of Computer Science, Neural Networks, Electrical Engineering, Software Engineering, Information Technology, Mechanical Engineering, Chemical Engineering, Plastic Engineering, Food Technology, Textile Engineering, Nano Technology & science, Power Electronics, Electronics & Communication Engineering, Computational mathematics, Image processing, Civil Engineering, Structural Engineering, Environmental Engineering, VLSI Testing & Low Power VLSI Design etc.
Emergency room visit for respiratory conditions in children increased after G...ISAMI1
Emergency room visit for respiratory conditions in children increased after Guagua Pichincha Volcanic eruptions in April 200 in Quito, Ecuador Observational Study: Time Series Analysis
International Journal of Engineering Research and Applications (IJERA) is an open access online peer reviewed international journal that publishes research and review articles in the fields of Computer Science, Neural Networks, Electrical Engineering, Software Engineering, Information Technology, Mechanical Engineering, Chemical Engineering, Plastic Engineering, Food Technology, Textile Engineering, Nano Technology & science, Power Electronics, Electronics & Communication Engineering, Computational mathematics, Image processing, Civil Engineering, Structural Engineering, Environmental Engineering, VLSI Testing & Low Power VLSI Design etc.
Emergency room visit for respiratory conditions in children increased after G...ISAMI1
Emergency room visit for respiratory conditions in children increased after Guagua Pichincha Volcanic eruptions in April 200 in Quito, Ecuador Observational Study: Time Series Analysis
Napa County Public Health is holding a tabletop exercise on 10/28/13 to discuss the response to an e. Coli outbreak. This is in conjunction with the CA Dept of Public Health and anticipation of the upcoming statewide functional exercise. Slides prepared by The Abaris Group
A Study of Anemia Among children in Mansoura University Children's Hospital; ...Kareem Alnakeeb
A "Study of Anemia" Among children in Mansoura University Children's Hospital. It involved 30 male and female children aged from 5 to 120 months old, who were hospitalized in Mansoura University Children's Hospital. The study was performed in the period between 19 March 2018 and 18 April 2018.
El Tratamiento de bacteriuria asintomatica se asocia con alta prevalencia de ...Alex Castañeda-Sabogal
El Tratamiento de la bacteriuria asintomática con antibióticos está asociado con aparición de cepas resistentes a antibióticos!!!! Publicado el 4 de setiembre del 2015 en Clinical Infectious Diseases
Antibiotic exposure and the development of coeliac disease: a nationwide case...Enrique Moreno Gonzalez
The intestinal microbiota has been proposed to play a pathogenic role in coeliac disease (CD). Although antibiotics are common environmental factors with a profound impact on intestinal microbiota, data on antibiotic use as a risk factor for subsequent CD development are scarce.
Study Of Prevalence Of Malnutrition In HIV Positive Children And Its Correlat...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Resurge - The Godzilla Of Offers - Resurge weight loss.Med Gaith
Resurge- The Godzilla Offers is a blend of natural products that are helpful to losing weight, boosting the immune system, increasing metabolism, and relieving stress. it is effective against problems that in one way or another are related to weight gain. It is made in the USA and approved by the Food and Drug Administration (FDA).
Polycystic ovary syndrome PCOS is a common endocrine and metabolic disorder in premenopausal women. Heterogeneous by its nature, PCOS is defined as combination of signs and symptoms of androgen excess and ovarian dysfunction in the absence of other specific diagnoses. The etiology of the syndrome remains unknown, but evidence suggests that PCOS might be a complex multigenic disorder with strong epigenetic and environmental influences, including diet and lifestyle factors. It affects 8 to 13 of reproductive aged women. Polycystic ovary syndrome PCOS is associated with hormonal, biochemical disturbance and adverse cosmetic, reproductive, metabolic, and psychological consequences, resulting in reduced health related quality of life HRQoL . The most recent international guidelines set lifestyle management as the cornerstone of the PCOS treatment. Hridyanshi | R. K. Patil | Lovish Kansal "Polycystic Ovary Syndrome: A Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd41134.pdf Paper URL: https://www.ijtsrd.commedicine/gynecology/41134/polycystic-ovary-syndrome-a-review/hridyanshi
Napa County Public Health is holding a tabletop exercise on 10/28/13 to discuss the response to an e. Coli outbreak. This is in conjunction with the CA Dept of Public Health and anticipation of the upcoming statewide functional exercise. Slides prepared by The Abaris Group
A Study of Anemia Among children in Mansoura University Children's Hospital; ...Kareem Alnakeeb
A "Study of Anemia" Among children in Mansoura University Children's Hospital. It involved 30 male and female children aged from 5 to 120 months old, who were hospitalized in Mansoura University Children's Hospital. The study was performed in the period between 19 March 2018 and 18 April 2018.
El Tratamiento de bacteriuria asintomatica se asocia con alta prevalencia de ...Alex Castañeda-Sabogal
El Tratamiento de la bacteriuria asintomática con antibióticos está asociado con aparición de cepas resistentes a antibióticos!!!! Publicado el 4 de setiembre del 2015 en Clinical Infectious Diseases
Antibiotic exposure and the development of coeliac disease: a nationwide case...Enrique Moreno Gonzalez
The intestinal microbiota has been proposed to play a pathogenic role in coeliac disease (CD). Although antibiotics are common environmental factors with a profound impact on intestinal microbiota, data on antibiotic use as a risk factor for subsequent CD development are scarce.
Study Of Prevalence Of Malnutrition In HIV Positive Children And Its Correlat...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Resurge - The Godzilla Of Offers - Resurge weight loss.Med Gaith
Resurge- The Godzilla Offers is a blend of natural products that are helpful to losing weight, boosting the immune system, increasing metabolism, and relieving stress. it is effective against problems that in one way or another are related to weight gain. It is made in the USA and approved by the Food and Drug Administration (FDA).
Polycystic ovary syndrome PCOS is a common endocrine and metabolic disorder in premenopausal women. Heterogeneous by its nature, PCOS is defined as combination of signs and symptoms of androgen excess and ovarian dysfunction in the absence of other specific diagnoses. The etiology of the syndrome remains unknown, but evidence suggests that PCOS might be a complex multigenic disorder with strong epigenetic and environmental influences, including diet and lifestyle factors. It affects 8 to 13 of reproductive aged women. Polycystic ovary syndrome PCOS is associated with hormonal, biochemical disturbance and adverse cosmetic, reproductive, metabolic, and psychological consequences, resulting in reduced health related quality of life HRQoL . The most recent international guidelines set lifestyle management as the cornerstone of the PCOS treatment. Hridyanshi | R. K. Patil | Lovish Kansal "Polycystic Ovary Syndrome: A Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-4 , June 2021, URL: https://www.ijtsrd.compapers/ijtsrd41134.pdf Paper URL: https://www.ijtsrd.commedicine/gynecology/41134/polycystic-ovary-syndrome-a-review/hridyanshi
Kathryn Maitland describes the challenges faced with oxygen therapy as an emergency intervention in critical illness in African children.
Where Kathryn works, in East Africa, there is no access to intensive care. Caring for critically ill children is all done in the Emergency Department.
70% of the global burden of disease and deaths from pneumonia occurs in Southeast Asia and Sub-Saharan Africa. The WHO has published guidelines as to what classifies as pneumonia, severe pneumonia, and very severe pneumonia.
These classifications rely on clinical signs. However, Kathryn in her research has discovered that these classifications are rarely correlated with the actual underlying disease process.
Clinical signs are non-specific for the diagnosis of pneumonia. Oxygen is recommended for severe and very severe pneumonia.
This has led to calls to prioritise oxygen delivery in African hospitals. However, it has not led to change from a health department or funding viewpoint.
There are also oxygen delivery practicalities to consider. Often there is only one source of oxygen on a ward (if at all) with patients clustered around it.
The production of Oxygen may only happen in a few places.
Poor cylinder quality leads to leaks and therefore, low supply.
Concentrators are useful however they need regular servicing. They also rely on power, and in a region that experiences regular power outages, this can be problematic. When the power goes off, there is no oxygen available.
Kathryn asks – do all children actually need oxygen? There is still however a hidden burden of hypoxia.
Outside of Africa, Kathryn discusses the current state of equipoise on oxygen therapy.
Moreover, oxygen can be harmful if given inappropriately. This leads to concerns more broadly on the harms of oxygen therapy.
Kathryn concludes her talk by looking to the future. She discusses ongoing research and the implications for future practice in resource poor settings, and indeed the world.
A Meta-analysis of the Effects of Oral Zinc in thefranklinaranda
Articulo publicado en el PEDIATRICS por Marek Lukacik, MDa, Ronald L. Thomas, PhDb, Jacob V. Aranda, MD, PhDb. sobre el uso de zinc en la diarrea aguda y persistente, donde se verifica que acorta la duracion de la enfermedad.
A Prospective Observational Study of Zinc As Adjunct Therapy In Pediatric Pop...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Effects of moderate doses of vitamin A as an adjunct to the treatment of pneu...ISAMI1
Effects of moderate doses of vitamin A as an adjunct to the treatment of pneumonia in underweight and normal-weight children: a randomized, double-blind, placebo-controlled trial
Influence of Micronutrient Deficiency on the Prevalence of Respiratory Diseas...iosrjce
The study entitled “Influence of micronutrient deficiency on the prevalence of respiratory diseases
among children 6-12 years” was conducted to assess the nutritional status of the children. Majority of the socio
economic variables such as age, area of residence, family income are found to have an impact on the nutritional
status of the children with respiratory diseases.
Method: In this study anthropometric, bio-chemical, clinical and nutritional assessment was done for 100
children with respiratory diseases from thiruvananthapuram district of Kerala. The data regarding the socio
economic status, nutritional status and health status were collected using suitably structured schedule. The
nutrient intake was assessed by 24 hour recall method. The hemoglobin levels and calcium levels of the
subsamples were analyzed biochemically. The results were statistically analyzed.
Result: Nutritional anthropometry of the children with respiratory diseases indicates that 77% of the children
were underweight. The biochemical analysis of blood samples indicates that 75% were having iron deficiency
anemia. Mean nutrient intake of both male and female children with respiratory diseases indicates that both of
them are deficient in all nutrient s consumption with respect to RDA.The statistical analysis by t-test reveals that
for males fat consumption and riboflavin consumption were significant at 0.01 levels. For the females it was
found that t-test analysis shows protein, fat, iron, vitamin C and riboflavin consumption were significant at 0.01
levels.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Aborda un tema muy frecuente en pediatría...la inapetencia y sus maneras de abordarlo, educación alimentaria, perspectivas de tratamiento, abordaje de la inapetencia en adolescente.
La estimación de
la edad ósea (EO)
refleja la edad biológica,
correlacionándose mejor
con muchos parámetros
que la edad cronológica
(EC).
En la determinación
de la EO, los distintos
centros de osificación
no tienen el mismo valor
predictivo.
La EO tiene
limitaciones en niños
con displasias óseas,
así como en predecir
la talla adulta en niños
con pubertad precoz o
pequeños para la edad
gestacional.
La EO es necesaria
para confirmar el
diagnóstico de variantes
normales del crecimiento,
condiciones patológicas,
inicio y cese de
tratamientos, estimación de
la edad de niños con fecha
de nacimiento desconocida
y de talla adulta.
201 violenvia contra trabajadores ops v38n4a7p307 315Roger Zapata
Se determinar la frecuencia de agresiones al personal sanitario en una red social de profesionales de la salud y se caracterizan aspectos que profundicen su comprensión y el desarrollo de estrategias que ayuden a prevenirlos.
de estrategias de prevención.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
2003 deficiencia de zinc y mortalidad
1. Trace Element Undernutrition: Biology to Interventions
Zinc Deficiency, Infectious Disease and Mortality in the
Developing World1,2
Robert E. Black3
Department of International Health, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD 21205
ABSTRACT Zinc deficiency places children in many low-income countries at increased risk of illness and death
from infectious diseases. Randomized controlled trials of zinc supplementation provide the best estimate of this risk
through demonstrated preventive benefits. In six of nine trials that evaluated prevention of diarrhea, significantly
lower incidence of diarrhea occurred in the zinc group than in the controls; a pooled analysis demonstrated 18%
(95% confidence interval, 7–28%) less diarrhea. In five trials, a lower rate of pneumonia infection was found in the
zinc-supplemented groups, and there was some indication of a preventive effect in three trials with a clinical malaria
outcome. Zinc was also found to have a therapeutic benefit in seven trials of acute diarrhea and five of persistent
diarrhea. Studies to evaluate the effect of zinc supplementation on mortality are under way, but a recently published
study from India identified a 68% reduction in mortality in small-for-gestational-age term infants that were
supplemented with zinc from 1 to 9 mo of age. The important effects of zinc deficiency are now clear, and nutrition
programs should address this prevalent problem. J. Nutr. 133: 1485S–1489S, 2003.
KEY WORDS: child nutrition diarrhea malaria pneumonia zinc
Zinc deficiency, which appears to be widespread in de-
veloping countries, has long been recognized to impair growth
and immune function (1,2). Although effects on the immune
system are known to occur with even mild zinc deficiency (3),
the importance of this with regard to the risk of childhood
infectious diseases has only recently become better understood
(4). Observational studies provide some evidence of a relation-
ship between low plasma-zinc concentration in children and
higher risk of infectious diseases (5), but inferences from these
studies are limited owing to a lack of adequate zinc-deficiency
indicators at the individual level.
Randomized, controlled trials of zinc supplementation
provide the best evidence for the roles of zinc in infectious
diseases, which are presumably mediated through alterations in
host defenses including epithelial barriers and immune
responses. Results of these trials are reviewed and summarized
with regard to effects on diarrhea, pneumonia and malaria
incidence as well as on total child mortality. In addition to these
preventive trials in which zinc was given on a routine, usually
daily, basis for an extended period of time, there are other trials
in which zinc was provided as an adjunct to therapy for acute or
persistent diarrhea. This review is limited to published trials.
Prevention of infectious disease morbidity
The effects of zinc supplements on rates of diarrhea and
pneumonia incidence have been well studied, and there is also
some information on malaria incidence. In total, 11 trials are
available for inclusion in this review (6–17). Ten of these trials
assess the effect of zinc supplementation on the incidence of
diarrhea, five on the incidence of pneumonia and three on the
incidence of malaria (Table 1). These trials were performed
with preschool children who reside in typical developing
country settings. Although the settings of these trials might
be expected to include a substantial prevalence of zinc
deficiency as would be expected in most developing countries,
the populations of children were not preselected on the basis of
zinc deficiency. Six of the trials were performed with all
children in the targeted age group, whereas five of the trials had
some enrollment restrictions (Table 1). Two of these trials
employed children that were selected with at least a moderate
degree of undernutrition, whereas one trial stratified the
enrollment based on individuals who were or were not stunted.
1
Published in a supplement to The Journal of Nutrition. Presented as part of the
11th meeting of the international organization, ‘‘Trace Elements in Man and Animals
(TEMA),’’ in Berkeley, California, June 2–6, 2002. This meeting was supported by
grants from the National Institutes of Health and the U.S. Department of Agriculture
and by donations from Akzo Nobel Chemicals, Singapore; California Dried Plum
Board, California; Cattlemen’s Beef Board and National Cattlemen’s Beef
Association, Colorado; GlaxoSmithKline, New Jersey; International Atomic Energy
Agency, Austria; International Copper Association, New York; International Life
Sciences Institute Research Foundation, Washington, D.C.; International Zinc
Association, Belgium; Mead Johnson Nutritionals, Indiana; Minute Maid Company,
Texas; Perrier Vittel Water Institute, France; U.S. Borax, Inc., California; USDA/ARS
Western Human Nutrition Research Center, California and Wyeth-Ayerst Global
Pharmaceuticals, Pennsylvania. Guest editors for the supplement publication
were Janet C. King, USDA/ARS WHNRC and the University of California at Davis;
Lindsay H. Allen, University of California at Davis; James R. Coughlin, Coughlin
Associates, Newport Coast, California; K. Michael Hambidge, University of
Colorado, Denver; Carl L. Keen, University of California at Davis; Bo L. Lo¨nnerdal,
University of California at Davis and Robert B. Rucker, University of California at
Davis.
2
This work is funded in part by the Johns Hopkins Family Health and Child
Survival Cooperative Agreement with the U.S. Agency for International
Development.
3
To whom correspondence should be addressed. E-mail: rblack@jhsph.edu.
0022-3166/03 $3.00 Ó 2003 American Society for Nutritional Sciences.
1485S
byguestonMay10,2015jn.nutrition.orgDownloadedfrom
2. Two of the trials enrolled children after they had recovered
from either acute or persistent diarrhea. Taken collectively, the
studies were done in settings that represent a wide range of
conditions with regard to nutritional status and risk of
infectious diseases.
These trials are consistent in showing that zinc-supple-
mented children have lower rates of diarrhea than control
children (Table 2). Six of the nine studies had statistically
significant differences between the zinc and control groups. A
pooled analysis that includes most of these studies reveals the
overall incidence of diarrhea in zinc-supplemented children to
be 18% [95% confidence interval (CI), 7–28%] less than in
children who did not receive zinc (18). This analysis shows
trends (not statistically significant) that children with lower
plasma zinc concentrations or wasting, or were female or in
their second or later year of life (versus infants) have greater
effects of zinc supplementation.
The five studies with available information are also
consistent in showing that zinc-supplemented children have
a lower incidence of pneumonia than control children (Table
2). In the pooled analysis, there was a 41% (95% CI, 17–59%)
lower rate of pneumonia in zinc-supplemented children (18). A
study that was more recently completed shows a statistically
significant 26% reduction in the incidence of pneumonia as
diagnosed by clinical examination by two physicians using
specific predefined clinical criteria (17).
The information regarding the effects of zinc supplementa-
tion on malaria is more limited. Studies in the Gambia and
Papua New Guinea reveal reductions of about one-third in
the rate of visits to health facilities for a clinical syndrome
consistent with malaria and confirmed by parasitologic ex-
amination of the blood. Given the extremely high rate of
malaria parasitemia in some endemic populations, visits to
health facilities with confirmed malaria are generally considered
to be the most valid measure of malaria incidence and have
been used by the World Health Organization (WHO) to
estimate the malaria burden of disease (19). The third trial of
zinc supplementation that examined an effect on malaria was
done in Burkina Faso. This trial had only community-based
surveillance of malaria and did not ascertain health-facility
visits. The study found no effect of zinc supplementation on
rates of fever as ascertained from household visits 6 d/wk. This
may not be surprising in that the study in Papua New Guinea
did not find an effect of zinc supplementation on ‘‘malaria’’ as
ascertained from community-based surveillance but did find
a significant benefit with regard to malaria visits to the health
facilities (12).
Therapeutic effects for diarrhea
There are currently 12 published trials of zinc supplemen-
tation in the therapy of acute or persistent diarrhea that are
available for review (20–30). Seven of these trials are for acute
diarrhea (Table 3). The five trials on persistent diarrhea are
likely the only ones that will be available, because WHO has
recommended that zinc be used in the treatment of persistent
diarrhea, which makes controlled trials no longer appropriate.
Five additional trials of zinc supplementation for acute diarrhea
have been conducted. Although these are as-yet unpublished,
they were reviewed in a recently published meeting report (31).
Most find beneficial effects of zinc supplementation as do the
published trials.
The trials on persistent diarrhea, i.e., episodes lasting $14 d,
demonstrate overall benefits of zinc supplementation (Table 4).
Generally, the zinc-supplemented children have shorter-
duration episodes, lower stool frequency or stool volume and
importantly, in three of the four studies, a reduction in
treatment failure or death. A meta-analysis of these five trials
yields a statistically significant summary effect (32). Overall, in
this analysis there is a 42% (95% CI, 10–63%) reduced rate of
treatment failure or death. In a pooled analysis of these trials,
TABLE 1
Trials evaluating effects of zinc supplementation on preventing morbidity in children
Country Ref.
Zinc supplement
(mg) and type Duration (wk)
No. of children in
zinc/control group
Age
(mo) Enrollment restriction1
The Gambia (6) 70, acetate 60 55/54 6–28 —
Vietnam (7) 10, sulfate 22 73/73 4–36 W/A and H/A , ÿ2z
India (8,9) 10, gluconate 26 286/293 6–35 Recovered from acute diarrhea
Mexico (10) 20, methionate 54 97/97 18–36 —
Guatemala (11) 10, sulfate 28 45/44 6–9 —
Papua New Guinea (12) 10, gluconate 46 136/138 6–60 —
Jamaica (13) 5, sulfate 12 31/30 6–24 W/H , ÿ2z
Peru (14) 10, gluconate 26 80/79 6–35 Recovered from persistent diarrhea
Ethiopia (15) 10, sulfate 26 92/92 6–12 Stratified on H/A , ÿ2z
Burkina Faso (16) 12.5, sulfate 26 356/353 6–31 —
India (17) 10/20, gluconate 16 1,241/1,241 6–35 —
1 W/A, weight for age; H/A, height for age; W/H, weight for height.
TABLE 2
Effects of zinc in prevention of diarrhea, pneumonia, malaria
and mortality in children
Country Ref.
Diarrhea
incidence
(% lower)
Pneumonia
incidence
(% lower)
Malaria
incidence
(% lower)
Mortality
(% lower)
The Gambia (6) — — 32 —
Vietnam (7) 441
441
— —
India (8,9) 8 431
— 681
Mexico (10) 371
— — —
Guatemala (11) 181
— — —
Papua New Guinea (12) 12 — 381
—
Jamaica (13) 8 88 — —
Peru (14) 121
15 — —
Ethiopia (15) 551
— — —
Burkina Faso (16) 161
— 2 58
India (17) N/A2
261
— —
1 Statistically significant, i.e., P , 0.05.
2 N/A, not available.
1486S SUPPLEMENT
byguestonMay10,2015jn.nutrition.orgDownloadedfrom
3. the subgroups of children who are , 12 mo of age, wasted or
male have statistically significant effects of zinc supplementa-
tion. The corresponding alternative groups have smaller
beneficial effects that are not statistically significant (Table 4).
Of the seven trials on acute diarrhea, all find that the episode
duration is shorter in zinc-supplemented children, and four of
these trials are individually statistically significant. Likewise, all
of the five trials that measure an effect on diarrhea severity find
that zinc-supplemented children have less diarrheal stool
output than controls; three of these trials find statistically
significant benefits. In a pooled analysis with original data from
three of these trials, within subgroups by age (, 12 mo versus $
12 mo), wasting (, 22z versus $ 22z weight per height) and
sex, each subgroup has significant benefits of zinc supplemen-
tation. In subgroups of children with lower or higher initial
plasma zinc concentrations, there are significant pooled effects
in both groups, although the effects tend to be greater in the
subgroup with lower plasma zinc concentration.
Effects on child mortality
Diarrhea, pneumonia and malaria are the most common
causes of death among children in developing countries. The
consistent and sizeable effects of zinc supplementation on the
incidence and severity of these infectious diseases logically
leads to the hypothesis that there will be a reduction in child
mortality with zinc supplementation. One recent study in India
provides preliminary evidence that this is correct (33). A
randomized, double-blind, controlled trial enrolled 1,154 full-
term small-for-gestational-age infants to receive one of the
following supplements: riboflavin; riboflavin and zinc (5 mg as
sulfate); riboflavin, calcium, phosphorus, folate and iron; or
riboflavin, zinc, calcium, phosphorus, folate and iron. Children
were supplemented between 30 and 284 d of age and visited 6
d/wk to provide the supplement and conduct surveillance for
illness and death. When the main effects of the zinc or the
other micronutrients are examined by survival analysis, it is
found that zinc supplementation is associated with a signifi-
cantly lower mortality with a ratio of 0.32 (95 CI, 0.12–0.89).
Calcium, phosphorus, folate and iron supplementation are not
associated with a reduction in mortality.
The widespread demonstration that zinc supplements
reduce the incidence of diarrhea and the two-thirds reduction
in mortality that was found in the Indian study have led to the
initiation of three large trials of zinc supplementation in India,
Nepal and Zanzibar. All trials will evaluate the effect of zinc on
child mortality, and the studies in India and Zanzibar will also
assess the effects on hospitalizations from infectious diseases
(diarrhea and pneumonia in both and malaria also in Zanzibar).
Results are expected by 2004.
TABLE 3
Trials evaluating therapeutic effects of zinc in diarrhea
Country Ref.
Zinc supplement
and type
No. of children in
zinc/control group
Age
(mo) Enrollment restriction1
Type of
diarrhea
India (20) 20 mg, sulfate 25/25 6–18 Exclude moderate-severe malnutrition Acute
India (21) 20 mg, sulfate 20/20 6–18 Exclude moderate-severe malnutrition Persistent
India (22) 20 mg, gluconate 456/481 6–35 Exclude severe malnutrition Acute
Bangladesh (23) 20 mg, acetate 57/54 3–24 Include W/A , 76th percentile Acute
Bangladesh (24) 20 mg, acetate 95/95 3–24 — Persistent
Indonesia (25) 4–5 mg/kg, acetate 739/659 3–25 — Acute
Peru (14) 20 mg, gluconate 139/136 6–35 — Persistent
Pakistan (26) 3 mg/kg, sulfate 43/44 6–36 Include W/A , ÿ2z Persistent
Bangladesh (27) 14/40 mg, acetate 343/341 6–23 Exclude severe malnutrition Acute
India (28) 40 mg, sulfate 44/36 3–24 Include W/A , 80% Acute
Bangladesh (29) 20 mg, acetate 44/44 6–24 Include W/A , ÿ2z Persistent
Nepal (30) 15/30 mg, gluconate 445/449 6–35 — Acute
1 W/A, weight for age.
TABLE 4
Effects of zinc in therapy of acute and persistent diarrhea
Country Ref. Episode duration Severity
Treatment
failure/death
India (20) 9% Shorter duration 18% Less stool frequency —
India (21) 19% Shorter duration 21% Less stool frequency —
India (22) 21% Reduced probability of continuing diarrhea1
39% Less stool frequency1
—
Bangladesh (23) 14% Reduced probability of continuing diarrhea 28% Lower stool output —
Bangladesh (24) 15% Reduced probability of continuing diarrhea — 63% Less1
Indonesia (25) 11% Reduced probability of continuing diarrhea1
— —
Peru (14) 18% Reduced probability of continuing diarrhea1
— 19% Less
Pakistan (26) 2% Reduced probability of continuing diarrhea1
No effect 58% More
Bangladesh (27) 20% Reduced probability of continuing diarrhea — —
India (28) 32% Shorter duration1
38% Lower stool output1
—
Bangladesh (29) 55% Reduced probability of continuing diarrhea1
— 75% Less1
Nepal (30) 26% Reduced probability of continuing diarrhea1
8% Less stool frequency1
—
1 Statistically significant, i.e., P , 0.05.
1487SZINC DEFICIENCY, INFECTIOUS DISEASE AND MORTALITY
byguestonMay10,2015jn.nutrition.orgDownloadedfrom
4. DISCUSSION
The substantial prevalence of zinc deficiency in children in
developing countries and its important consequences for higher
rates of illness and death from infectious diseases in children in
developing countries leads to the conclusion that the global
burden of disease due to this nutritional problem is very large.
This unnecessary burden can be reduced by existing means of
improving the available zinc in the diet (34). Although this may
be possible in some settings by using dietary modification, e.g.,
consumption of additional animal products or reduction in the
consumption of foods that interfere with zinc absorption (35),
in other settings such as in poor, vegetarian populations, this
may prove difficult. Additional dietary approaches particularly
including fortification are needed to address the problem of
dietary inadequacy of zinc and other micronutrients such as
iron (34). Supplements may play a role as well, and there is
a need to understand more about the interactions of iron and
other micronutrients when given together (36).
The efficacy of zinc in treating both persistent and acute
diarrhea is now clear. Recommendations have already been
made by WHO for its use in the treatment of persistent
diarrhea. Furthermore, a WHO meeting in 2001 reviewed the
studies presented here along with five as-yet unpublished
studies (31). These unpublished studies reveal benefits that are
consistent with those reported here and are briefly summarized
in the meeting report. The report concludes that ‘‘there is now
enough evidence demonstrating the efficacy of zinc supple-
mentation on the clinical course of acute diarrhea.’’ Although
there is encouraging information from several large-scale,
community-based studies that use zinc supplements to treat
diarrhea, more information is needed on this in different
settings. In particular, there is a need to understand how to
promote zinc supplements to treat diarrhea without interfering
with oral rehydration therapy, which will remain the mainstay
of treatment. The meeting concludes that future studies should
‘‘investigate the feasibility, sustainability, and cost-effectiveness
of different zinc delivery mechanisms and monitor variables,
such as consumption of ORS (oral rehydration therapy),
antibiotic use rate, non-diarrheal morbidity and overall
mortality.’’ It also indicates that it is important to determine
the best formulation of zinc to minimize side effects and
maximize adherence to therapy.
The important role of zinc deficiency in childhood infectious
diseases is now clear. The challenge is to develop the public
health response to address this deficiency and thereby improve
child health.
LITERATURE CITED
1. Aggett, P. (1989) Severe zinc deficiency. In: Zinc in Human Biology
(Mills, C., ed.), pp. 259–279. Springer-Verlag, London, U.K.
2. Brown, K., Peerson, J. Allen, L. (1998) Effect of zinc supplementa-
tion on children’s growth: a meta-analysis of intervention trials. Bibl. Nutr. Dieta. 54:
76–83.
3. Shankar, A. H. Prasad, A. S. (1998) Zinc and immune function: the
biological basis of altered resistance to infection. Am. J. Clin. Nutr. 68 (suppl. 2):
447S–463S.
4. Black, R. E. (2001) Zinc deficiency, immune function, and morbidity
and mortality from infectious disease among children in developing countries. Food
Nutr. Bull. 22: 155–162.
5. Bahl, R., Bhandari, N., Hambidge, K. M. Bhan, M. K. (1998) Plasma
zinc as a predictor of diarrhea and respiratory morbidity in children in an urban
slum setting. Am. J. Clin. Nutr. 68 (suppl. 2): 414S–417S.
6. Bates, C. J., Evans, P. H., Dardeene, M., Prentice, A., Lunn, P. G.,
Northrop-Clewes, C. A., Hoare, S., Cole, T. J., Horan, S. J. Longman, S. C.
(1993) A trial of zinc-supplementation in young rural Gambian children. Br. J. Nutr.
69: 243–255.
7. Ninh, X., Thissen, P., Collette, L., Gerard, G., Khoi, H. Keteislegers, M.
(1996) Zinc supplementation increases growth and circulating insulin-like growth
factor 1 (IGR-1) in growth retarded Vietnamese children. Am. J. Clin. Nutr. 63:
413–418.
8. Sazawal, S., Black, R., Bhan, M., Jalla, S., Sinha, A. Bhandari, N.
(1997) Efficacy of zinc supplementation in reducing the incidence and prevalence
of acute diarrhea—a community-based, double-blind, controlled trial. Am. J. Clin.
Nutr. 66: 413–418.
9. Sazawal, S., Black, R., Jalla, S., Mazumdar, S., Sinha, A. Bhan, M.
(1998) Zinc supplementation reduces the incidence of acute lower respiratory
infections in infants and preschool children. A double-blind, controlled trial.
Pediatrics 102: 1–5.
10. Rosado, J., Lopez, P., Monoz, E., Martinez, H. Allen, L. H.
(1997) Zinc supplementation reduced morbidity, but neither zinc nor iron
supplementation affected growth or body composition of Mexican preschoolers.
Am. J. Clin. Nutr. 65: 13–19.
11. Ruel, M., Rivera, J., Santizo, M., Lonnerdal, B. Brown, K. (1997) The
impact of zinc supplementation on morbidity from diarrhea and respiratory
infections among young rural Guatemalan children. Pediatrics 99: 808–813.
12. Shankar, A. H., Genton, B., Baisor, M., Paino, J., Tamja, S., Adiguma, T.,
Wu, L., Rare, L., Bannon, D., Tielsch, J. M., West, K. P., JR. Aleprs, M. P.
(2000) The influence of zinc supplementation on morbidity due to Plasmodium
falciparum: a randomized trial in preschool children in Papua New Guinea. Am. J.
Trop. Med. Hyg. 62: 663–669.
13. Meeks-Gardner, J., Witter, M. Ramdath, D. (1998) Zinc supplemen-
tation effects on the growth and morbidity of undernourished Jamaican children.
Eur. J. Clin. Nutr. 52: 34–39.
14. Penny, M. E., Peerson, J. M., Marin, R. M., Duran, A., Lanata, C. F.,
Lo¨nnerdal, B., Black, R. E. Brown, K. H. (1999) Randomized community-
based trial of the effect of zinc supplementation, with or without other micro-
nutrients, on the duration of persistent diarrhea in Lima, Peru. J. Pediatr. 135:
208–217.
15. Umeta, M., West, C. E., Haider, J., Deurenberg, P. Hautvast, J. G.
(2000) Zinc supplementation and stunted infants in Ethiopia: a randomized
controlled trial. Lancet 355: 2021–2026.
16. Muller, O., Becher, H., van Zweeden, A. B., Ye, Y., Diallo, D. A., Konate,
A. T., Gbangou, A., Kouate, B. Gareene, M. (2001) Effect of zinc
supplementation on malaria and other causes of morbidity in west African children:
randomized double blind placebo controlled trial. BMJ 322: 1567–1573.
17. Bhandari, N., Bahl, R., Taneja, S., Strand, T., Molbak, K., Ulvik, R. J.,
Sommerfelt, H. Bhan, M. K. (2002) Routine zinc supplementation prevents
pneumonia in children 6 months to 3 years of age: a randomized controlled trail in
an urban slum. BMJ 324: 1358–1360.
18. Zinc Investigators’ Collaborative Group: Bhutta, Z. A., Black, R. E., Brown,
K. H., Meeks-Gardner, J., Gore, S., Hidayat, A., Khatun, F., Martorell, R., Ninh,
N. X., Penny, M. E., Rosado, J. L., Roy, S. K., Ruel, M., Sazawal, S. Shankar,
A. (1999) Prevention of diarrhea and pneumonia by zinc supplementation in
children in developing countries: pooled analysis of randomized controlled trials.
J. Pediatr. 135: 689–697.
19. Snow, R. W., Craig, M., Deichmann, U. Marsh, K. (1999) Estimating
mortality, morbidity and disability due to malaria among Africa’s non-pregnant
population. Bull. World Health Organ. 77: 624–640.
20. Sachdev, H. P. S., Mittal, N. K., Mittal, S. K. Yadav, H. S. (1998) A
controlled trial on utility of oral zinc supplementation in acute dehydrating diarrhea
in infants. J. Pediatr. Gastroenterol. Nutr. 7: 877–878.
21. Sachdev, H. P. S., Mittal, N. K. Yadav, H. S. (1990) Oral zinc
supplementation in persistent diarrhoea in infants. Ann. Trop. Paediatr. 10: 63–69.
22. Sazawal, S., Black, R. E., Bhan, M. K., Ghandari, N., Sinha, A. Jalla,
S. (1995) Zinc supplementation in young children with acute diarrhea in India.
N. Engl. J. Med. 333: 839–844.
23. Roy, S. K., Tomkins, A. M., Akramuzzaman, S. M., Behrens, R. H., Haider,
R., Mahalanabis, D. Fuchs, G. (1997) Randomised controlled trial of zinc
supplementation in malnourished Bangladeshi children with acute diarrhoea. Arch.
Dis. Child. 77: 196–200.
24. Roy, S. K., Tomkins, A. M., Mahalanabis, D., Akramuzzaman, S. M.,
Haider, R., Behrens, R. H. Fuchs, G. (1998) Impact of zinc supplementation
on persistent diarrhoea in malnourished Bangladeshi children. Acta Paediatr. 87:
1235–1239.
25. Hidayat, A., Achadi, A., Sunoto Soedarmo, S. P. (1998) The effect of
zinc supplementation in children under three years of age with acute diarrhea in
Indonesia. Med. J. Indonesia 7: 237–241.
26. Bhutta, Z. A., Nizami, S. Q. Isani, Z. (1999) Zinc supplementation in
malnourished children with persistent diarrhea in Pakistan. Pediatrics 103: 1–9.
27. Faruque, A. S. G., Mahalanabis, D., Haque, S. S., Fuchs, G. J. Habte, D.
(1999) Double-blind, randomized, controlled trial of zinc or vitamin A supplemen-
tation in young children with acute diarrhoea. Acta Paediatr. 88: 54–60.
28. Dutta, P., Mitra, U., Datta, A., Niyogi, S. K., Dutta, S., Manna, B., Basak,
M., Mahapatra, T. S. Bhattacharya, S. K. (2000) Impact of zinc supplemen-
tation in malnourished children with acute watery diarrhoea. J. Trop. Pediatr. 46:
259–263.
29. Khatun, U. H. F. (1998) Impact of Zinc and Vitamin A Supplementation
in Malnourished Hospitalized Children Suffering from Persistent Diarrhoea.
Doctoral thesis, University of Dhaka, Institute of Nutrition and Food Science,
Dhaka, Bangladesh.
30. Strand, T. A., Chandyo, R. K., Bahl, R., Sharma, P. R., Adhikari, R. K.,
Bhandari, N., Ulvik, R. J., Molbak, K., Bhan, M. K. Sommerfelt, H. (2002) Ef-
fectiveness and efficacy of zinc for the treatment of acute diarrhea in young
children. Pediatrics 109: 898–903.
1488S SUPPLEMENT
byguestonMay10,2015jn.nutrition.orgDownloadedfrom
5. 31. Fontaine, O. (2001) Report of a meeting, New Delhi, 7–8 May 2001.
Effect of zinc supplementation on clinical course of acute diarrhoea. J. Health
Popul. Nutr. 19: 338–346.
32. Zinc Investigators’ Collaborative Group: Bhutta, Z. A., Bird, S. M., Black,
R. E., Brown, K. H., Gardner, J. M., Hidayat, A., Khatun, F., Martorell, R., Ninh, N. X.,
Penny, M. E., Rosado, J. L., Roy, S. K., Ruel, M., Sazawal, S. Shankar, A.
(2000) Therapeutic effects of oral zinc in acute and persistent diarrhea in children
in developing countries: pooled analysis of randomized controlled trials. Am. J.
Clin. Nutr. 72: 1516–1522.
33. Sazawal, S., Black, R. E., Menon, V. P., Dinghra, P., Caulfield, L. E.,
Dhingra, U. Bagati, A. (2001) Zinc supplementation in infants born small for
gestational age reduces mortality: a prospective, randomized, controlled trial.
Pediatrics 108: 1280–1286.
34. Black, R. E. (2002) Consequences of zinc deficiency on human health
and alternatives for programmatic intervention. In: Public Health Issues in Infant
and Child Nutrition. Nestle Nutrition Workshop Series, Pediatric Program, vol. 48,
pp. 97–110. Nestec Ltd., Vevey, Switzerland.
35. Gibson, R. S., Yeudall, F., Drost, N., Mtitimuni, B. Cullinan, T.
(1998) Dietary interventions to prevent zinc deficiency. Am. J. Clin. Nutr.
68(suppl. 2.): 484S–487S.
36. Allen, L. H. (1998) Zinc and micronutrient supplements for children.
Am. J. Clin. Nutr. 68 (suppl. 2): 495S–498S.
1489SZINC DEFICIENCY, INFECTIOUS DISEASE AND MORTALITY
byguestonMay10,2015jn.nutrition.orgDownloadedfrom