Serum zinc and copper levels in southeastern Turkish children with giardiasis or amebiasis

Alterations of serum zinc (Zn) and copper (Cu) concentrations are commonly found in patients suffering from gastrointestinal infections and with hepatic, renal, cardiovascular, and malignant diseases. In this study, the serum Zn and Cu levels in 20 children with giardiasis and in 40 children with amebiasis were evaluated. The serum Zn levels showed a significant decrease when compared to controls (p<0.001). After metronidazole therapy, a significant increase in Zn levels was observed (p<0.001). There was no significant difference in serum Cu levels between patients and controls before therapy. Before therapy, the serum Cu/Zn ratio in children with either giardiasis or amebiasis was significantly higher than that of the control group. After therapy, the Cu/Zn ratio was found to be back to normal. There were no significant differences in serum Zn levels and Cu/Zn ratios between children with and without diarrhea and there was no significant difference in children with or without failure to thrive. We concluded that Zn deficiency and elevated Cu/Zn ratio could be acute-phase responses to parasitic infections in children with giardiasis or amebiasis and that a successful treatment of the primary disorder will lead to complete recovery. Further studies are in progress to confirm the benefit of Zn supplementation during the acute phase of the disease, particularly in zinc-deficient regions of the world, such as in the case of Turkey.     

Village-Randomized Clinical Trial of Home Distribution of Zinc for Treatment of Childhood Diarrhea in Rural Western Kenya

Background

Zinc treatment shortens diarrhea episodes and can prevent future episodes. In rural Africa, most children with diarrhea are not brought to health facilities. In a village-randomized trial in rural Kenya, we assessed if zinc treatment might have a community-level preventive effect on diarrhea incidence if available at home versus only at health facilities.

Methods

We randomized 16 Kenyan villages (1,903 eligible children) to receive a 10-day course of zinc and two oral rehydration solution (ORS) sachets every two months at home and 17 villages (2,241 eligible children) to receive ORS at home, but zinc at the health–facility only. Children’s caretakers were educated in zinc/ORS use by village workers, both unblinded to intervention arm. We evaluated whether incidence of diarrhea and acute lower respiratory illness (ALRI) reported at biweekly home visits and presenting to clinic were lower in zinc villages, using poisson regression adjusting for baseline disease rates, distance to clinic, and children’s age.

Results

There were no differences between village groups in diarrhea incidence either reported at the home or presenting to clinic. In zinc villages (1,440 children analyzed), 61.2% of diarrheal episodes were treated with zinc, compared to 5.4% in comparison villages (1,584 children analyzed, p<0.0001). There were no differences in ORS use between zinc (59.6%) and comparison villages (58.8%). Among children with fever or cough without diarrhea, zinc use was low (<0.5%). There was a lower incidence of reported ALRI in zinc villages (adjusted RR 0.68, 95% CI 0.46–0.99), but not presenting at clinic.

Conclusions

In this study, home zinc use to treat diarrhea did not decrease disease rates in the community. However, with proper training, availability of zinc at home could lead to more episodes of pediatric diarrhea being treated with zinc in parts of rural Africa where healthcare utilization is low.

Trial Registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00530829","term_id":"NCT00530829"}}NCT00530829     

Impact of <Emphasis Type="Italic">Giardia lamblia</Emphasis> on Growth,Serum Levels of Zinc,Copper, and Iron in Egyptian Children

The aim of this study is to evaluate the serological levels of zinc, copper and iron in Giardia lamblia-infected children and to study the effect of giardiasis on their weight compared to controls. We studied 30 children, 1–10 years old, who attended the outpatient clinics of Cairo university pediatric hospital, with gastrointestinal complaints and diagnosed as having giardiasis by stools examination, they were enrolled as a study group. The control group consisted of 30 age- and sex-matched healthy children, free of gastrointestinal complaints and free of giardiasis. Serological levels of zinc, copper, and iron were measured by atomic absorption spectrophotometer. The infected group had significantly lower weight, serum iron, and zinc than controls (P = 0.035, <0.001, and <0.001 respectively) and 63.3% of patients infected with giardiasis were 1–5 years old. In the infected cases, 60% suffered from of abdominal pain, 50% from weight loss, and 40% had intermittent diarrhea. Infected cases with weight percentiles below the fifth had significantly lower serum iron than those with normal percentiles (>5th). In conclusion, most giardiasis-infected children were between 1 and 5 years, with significant affection of weight, abdominal pain, and/or intermittent diarrhea. Serum zinc and iron levels were significantly decreased in the infected group compared to control (P < 0.001).     

The Association between Provider Practice and Knowledge of ORS and Zinc Supplementation for the Treatment of Childhood Diarrhea in Bihar,Gujarat and Uttar Pradesh,India: A Multi-Site Cross-Sectional Study

Introduction

Programs aimed at reducing the burden of diarrhea among children under-five in low-resource settings typically allocate resources to training community-level health workers, but studies have suggested that provider knowledge does not necessarily translate into adequate practice. A diarrhea management program implemented in Bihar, Gujarat and Uttar Pradesh, India trained private sector rural medical practitioners (RMPs) and public sector Accredited Social Health Activists (ASHAs) and Anganwadi workers (AWWs) in adequate treatment of childhood diarrhea with oral rehydration salts (ORS) and zinc. We used cross-sectional program evaluation data to determine the association between observed diarrhea treatment practices and reported knowledge of ORS and zinc among each provider cadre.

Methods

We conducted principal components analysis on providers’ responses to diarrhea treatment questions in order to generate a novel scale assessing ORS/zinc knowledge. We subsequently regressed a binary indicator of whether ORS/zinc was prescribed during direct observation onto the resulting knowledge scores, controlling for other relevant knowledge predictors.

Results

There was a positive association between ORS/zinc knowledge score and prescribing ORS and zinc to young children with diarrhea among private sector RMPs (aOR: 2.32; 95% CI: 1.29-4.17) and public sector ASHAs and AWWs (aOR 2.48; 95% CI: 1.90-3.24). Controlling for knowledge score, receipt of training in the preceding 6 months was a good predictor of adequate prescribing in the public but not the private sector. In the public sector, direct access to ORS and zinc supplies was also highly associated with prescribing.

Conclusions

To enhance the management of childhood diarrhea in India, programmatic activities should center on increasing knowledge of ORS and zinc among public and private sector providers through biannual trainings but should also focus on ensuring sustained access to an adequate supply chain.     

Therapeutic Value of Zinc Supplementation in Acute and Persistent Diarrhea: A Systematic Review

Background

For over a decade, the importance of zinc in the treatment of acute and persistent diarrhea has been recognized. In spite of recently published reviews, there remain several unanswered questions about the role of zinc supplementation in childhood diarrhea in the developing countries. Our study aimed to assess the therapeutic benefits of zinc supplementation in the treatment of acute or persistent diarrhea in children, and to examine the causes of any heterogeneity of response to zinc supplementation.

Methods and Findings

EMBASE®, MEDLINE ® and CINAHL® databases were searched for published reviews and meta-analyses on the use of zinc supplementation for the prevention and treatment of childhood diarrhea. Additional RCTs published following the meta-analyses were also sought. The reviews and published RCTs were qualitatively mapped followed by updated random-effects meta-analyses, subgroup meta-analyses and meta-regression to quantify and characterize the role of zinc supplementation with diarrhea-related outcomes. We found that although there was evidence to support the use of zinc to treat diarrhea in children, there was significant unexplained heterogeneity across the studies for the effect of zinc supplementation in reducing important diarrhea outcomes. Zinc supplementation reduced the mean duration of diarrhea by 19.7% but had no effect on stool frequency or stool output, and increased the risk of vomiting. Our subgroup meta-analyses and meta-regression showed that age, stunting, breast-feeding and baseline zinc levels could not explain the heterogeneity associated with differential reduction in the mean diarrheal duration. However, the baseline zinc levels may not be representative of the existing zinc deficiency state.

Conclusions

Understanding the predictors of zinc efficacy including the role of diarrheal disease etiology on the response to zinc would help to identify the populations most likely to benefit from supplementation. To improve the programmatic use of zinc, further evaluations of the zinc salts used, the dose, the frequency and duration of supplementation, and its acceptability are required. The significant heterogeneity of responses to zinc suggests the need to revisit the strategy of universal zinc supplementation in the treatment children with acute diarrhea in developing countries.     

A randomized controlled trial of glucose versus amylase resistant starch hypo-osmolar oral rehydration solution for adult acute dehydrating diarrhea

Background

Reduction of gross diarrhea rate in excess of that seen over time with intravenous therapy and appropriate antibiotics is not usually achieved by oral glucose-electrolyte rehydration therapy for cholera and cholera-like diarrheas.

Methodology and Principal Findings

This prospective randomized clinical trial at a tertiary referral hospital in southern India was undertaken to determine whether amylase resistant starch, substituting for glucose in hypo-osmolar oral rehydration solution, would reduce diarrhea duration and weight in adults with acute severe dehydrating diarrhea. 50 adult males with severe watery diarrhea of less than three days'' duration and moderate to severe dehydration were randomized to receive hypo-osmolar ORS (HO-ORS) or HO-ORS in which amylase resistant high amylose maize starch 50g/L substituted for glucose (HAMS-ORS). All remaining therapy followed standard protocol. Duration of diarrhea (ORS commencement to first formed stool) in hours was significantly shorter with HAMS-ORS (median 19, IQR 10-28) compared to HO-ORS (median 42, IQR 24-50) (Bonferroni adjusted P, P_adj<0.001). Survival analysis (Kaplan-Meier) showed faster recovery from diarrhea in the HAMS-ORS group (P<0.001, log rank test). Total diarrhea fecal weight in grams (median, IQR) was not significantly lower in the HAMS-ORS group (2190, 1160-5635) compared to HO-ORS (5210, 2095-12190) (P_adj = 0.08). However, stool weight at 13-24 hours (280, 0-965 vs. 1360, 405-2985) and 25–48 hours (0, 0-360 vs. 1080, 55-3485) were significantly lower in HAMS-ORS compared to HO-ORS group (P_adj = 0.048 and P = 0.012, respectively). ORS intake after first 24 hours was lower in the HAMS-ORS group. Subgroup analysis of patients with culture isolates of Vibrio cholerae indicated similar significant differences between the treatment groups.

Conclusions

Compared to HO-ORS, HAMS-ORS reduced diarrhea duration by 55% and significantly reduced fecal weight after the first 12 hours of ORS therapy in adults with cholera-like diarrhea.

Trial Registration

Current Controlled Trials ISRCTN72841333     

Acquisition of Visuomotor Abilities and Intellectual Quotient in Children Aged 4–10 Years: Relationship with Micronutrient Nutritional Status

Lethargy, poor attention, and the high rate and severity of infections in malnourished children affect their educational achievement. We therefore studied the association between visuomotor abilities and intelligence quotient (IQ) and their relationship with iron, zinc, and copper. A cross-sectional study was carried out on a sample of 89 healthy children (age range, 4-10 years). Evaluations of visuomotor ability and IQ were performed with the Developmental Test of Visual Motor Integration (VMI) and the Scale for Measurement of Intelligence for children aged 3-18 years, respectively. Nutritional status was assessed using anthropometry and biochemical assessments, which included serum ferritin, zinc and copper levels, and Hb. The sample was classified as having low or normal VMI scores: 47 children (52.8%, mean age 7 +/- 1.5 years) had low VMI, and 42 (47.2%, mean age 7 +/- 2.06 years) had normal VMI. There were no statistically significant differences in socioeconomic and cultural condition between both groups. We found significantly higher serum copper and ferritin levels in normal as compared to low VMI, but we did not find any differences with zinc. IQ was significantly higher in normal vs low VMI children. The fact that children with abnormal VMI presented low mean serum copper and ferritin concentrations could indicate that copper and iron deficiencies in this sample could be related with visuomotor abilities.     

Biochemical, Histological, and Memory Impairment Effects of Chronic Copper Toxicity: A Model for Non-Wilsonian Brain Copper Toxicosis in Wistar Rat

Animal models of copper toxicosis rarely exhibit neurological impairments and increased brain copper accumulation impeding the development of novel therapeutic approaches to treat neurodegenerative diseases having high brain Cu content. The aim of this study was to investigate the effects of intraperitoneally injected copper lactate (0.15 mg Cu/100 g body weight) daily for 90 days on copper and zinc levels in the liver and hippocampus, on biochemical parameters, and on neurobehavioral functions (by Morris water maze) of male Wistar rats. Copper-administered animals exhibited significantly decreased serum acetylcholinesterase (AChE) activity and impaired neuromuscular coordination and spatial memory compared to control rats. Copper-intoxicated rats showed significant increase in liver and hippocampus copper content (99.1 and 73 % increase, respectively), 40.7 % reduction in hepatic zinc content, and interestingly, 77.1 % increase in hippocampus zinc content with concomitant increase in copper and zinc levels in serum and urine compared to control rats. Massive grade 4 copper depositions and grade 1 copper-associated protein in hepatocytes of copper-intoxicated rats were substantiated by rhodanine and orcein stains, respectively. Copper-intoxicated rats demonstrated swelling and increase in the number of astrocytes and copper deposition in the choroid plexus, with degenerated neurons showing pyknotic nuclei and dense eosinophilic cytoplasm. In conclusion, the present study shows the first evidence in vivo that chronic copper toxicity causes impaired spatial memory and neuromuscular coordination, swelling of astrocytes, decreased serum AChE activity, copper deposition in the choroid plexus, neuronal degeneration, and augmented levels of copper and zinc in the hippocampus of male Wistar rats.     

Oral zinc and common childhood infections—An update

Zinc is an essential micronutrient important for growth and for normal function of the immune system. Many children in developing countries have inadequate zinc nutrition. Routine zinc supplementation reduces the risk of respiratory infections and diarrhea, the two leading causes of morbidity and mortality in young children worldwide. In childhood diarrhea oral zinc also reduces illness duration and risk of persistent episodes. Oral zinc is therefore recommended for the treatment of acute diarrhea in young children. The results from the studies that have measured the therapeutic effect of zinc on acute respiratory infections, however, are conflicting. Moreover, the results of therapeutic zinc for childhood malaria also are so far not promising.This paper gives a brief outline of the current evidence from clinical trials on therapeutic effect of oral zinc on childhood respiratory infections, pneumonia and malaria and also of new evidence of the effect on serious bacterial illness in young infants.     

Zinc and copper in Indian patients of tuberculosis

The effectiveness and success of antitubercular therapy is mainly measured by identifying the organism in sputum. In certain patients, especially in geriatric patients, available tuberculosis tests are not satisfactory and do not provide enough information on the effectiveness of antitubercular therapy, as the symptoms might be confused with the existing symptoms of ongoing diseases. Therefore, 60 diagnosed and randomly selected patients with tuberculosis were included into this study. The patients with other associated diseases likely to influence serum copper and zinc were not included in the study. The estimations of serum copper and zinc were done in healthy volunteers and in tubercular patients before the start of treatment and after 4 wk of antitubercular treatment. The average plasma concentration of serum copper and zinc in healthy volunteers were 102±20 μg/dL and 96±18 μg/dL respectively. In tuberculosis patients, serum copper and zinc levels were 123.65±9.98 μg/dL and 64.14±3.97 μg/dL, respectively, before the start of treatment, which came down to 116.23±4.27 μg/dL and 74.31±3.60 μg/dL, respectively, after 4 wk of antitubercular treatment.     

Metabolic and endocrinologic complications in beta-thalassemia major: a multicenter study in Tehran

ABSTRACT : BACKGROUND : The combination of transfusion and chelation therapy has dramatically extended the life expectancy of thalassemic patients. The main objective of this study is to determine the prevalence of prominent thalassemia complications. METHODS : Two hundred twenty patients entered the study. Physicians collected demographic and anthropometric data and the history of therapies as well as menstrual histories. Patients have been examined to determine their pubertal status. Serum levels of 25(OH) D, calcium, phosphate, iPTH were measured. Thyroid function was assessed by T3, T4 and TSH. Zinc and copper in serum were determined by flame atomic absorption spectrophotometry. Bone mineral density (BMD) measurements at lumbar and femoral regions have been done using dual x-ray absorptiometry. The dietary calcium, zinc and copper intakes were estimated by food-frequency questionnaires. RESULTS : Short stature was seen in 39.3% of our patients. Hypogonadism was seen in 22.9% of boys and 12.2% of girls. Hypoparathyroidism and primary hypothyroidism was present in 7.6% and 7.7% of the patients. About 13 % of patients had more than one endocrine complication with mean serum ferritin of 1678 +/- 955 micrograms/lit. Prevalence of lumbar osteoporosis and osteopenia were 50.7% and 39.4%. Femoral osteoporosis and osteopenia were present in 10.8% and 36.9% of the patients. Lumbar BMD abnormalities were associated with duration of chelation therapy. Low serum zinc and copper was observed in 79.6% and 68% of the study population respectively. Serum zinc showed significant association with lumbar but not femoral BMD. In 37.2% of patients serum levels of 25(OH) D below 23 nmol/l were detected. CONCLUSION : High prevalence of complications among our thalassemics signifies the importance of more detailed studies along with therapeutic interventions.     

The Effect of a Yeast Probiotic on Acute Diarrhea in Children

A probiotic is a living micro-organism administered to promote the health of the host by treating or preventing infections owing to strains of pathogens. Saccharomyces boulardii is a nonpathogen yeast that has a direct inhibitory effect on the growth of many pathogens, an anti-secretory effect and a trophic effect on enterocytes. The aim of this study was to determine the effect of S. boulardii on diarrhea in children. The children from 6 months to 6 years of age with acute watery diarrhea admitted in pediatric clinic in Kashan in 2012 were included in this trial. Exclusion criteria were high fever (T > 38.5 °C), severe dehydration, bloody diarrhea, severe malnutrition, using of antibiotics, anti-diarrheal or antifungal drugs and children with more than one complain. Two hundred patients were assigned into two groups: A total of 100 patients were treated with S. boulardii in addition to ORS (case group) and 100 patients were given placebo in addition to ORS (control group). The duration of diarrhea and frequency of stools were recorded by asking the mothers of the children every day. The results showed that the defecation frequency after second day of treatment in the case group was significantly less than the control group (P = 0.001) and the mean numbers of days of diarrhea was significantly lower in the case group (P = 0.001). The result of this study confirms that S. boulardii reduces the frequency of stool and duration of illness in children.     

Copper, Iron, and Zinc Status in Children with Moderate and Severe Acute Malnutrition Recovered Following WHO Protocols

INTRODUCTION: The prevalence of copper, iron, and zinc deficiencies in malnutrition and the amounts of micronutrients that should be provided for nutritional recovery are unclear. OBJECTIVE: This study aims to measure (1) the frequency of Cu, Fe, and Zn deficiencies in children with acute malnutrition on day 1 and after 15- and 30-day treatments with F100 plus vitamins/minerals mix, and (2) anthropometric recovery after 30 d feeding ad libitum. METHODS: In Cochabamba, Bolivia, 12 hospitalized children with severe acute malnutrition (HSM) and 17 (hospitalized) with moderate acute malnutrition (HMM), 3-33 months, received F100 ad libitum for 1 month. Children received FeSO4 after infection subsided. On days 1, 15, and 30 weight, length, hemoglobin, serum ferritin, iron, copper, zinc, and ceruloplasmin were measured. Comparison group were 17 ambulatory moderately malnourished (AMM) and 34 well-nourished children, measured once. RESULTS: Deficiencies were highly prevalent in hospitalized groups. Serum copper and zinc became normal on D15 and D30, respectively. Mean daily energy intake of 160 kcal and 4 g prot//kg/d/1 mo led children to gain (mean) 5 g/kg/day, both on D15 and D30. CONCLUSIONS: Micronutrient deficiencies were highly prevalent in HSM and HMM and recovered similarly. Application of WHO protocols induced satisfactory copper status recovery, but improvement of zinc was slower.     

Lead, copper, zinc, and magnesium content in hair of children and young people with some neurological diseases

The lead, copper, zinc, and magnesium levels of scalp hair taken from 153 children aged 1–15 yr and young people (16–18 yr) with selected neurological disorders (hyperexcibility, loss of consciousness, and epileptiform convulsions of an unknown origin, etc.), were measured using the atomic absorption spectrometry method and then compared with a control group of healthy children (n=108). The research indicated significantly reduced mean levels of magnesium in the hair of children suffering from selected neurological diseases (in children aged 11–15 yr of age, above 30%; up to 5 yr of age, nearly 30%; the differences were statistically significant at p<0.05) and slightly decreased mean levels of copper (differences statistically significant at p<0.05, particularly in the 11 to 15-yr category). Differences in zinc levels in hair were inconsiderable (not statistically significant in any age groups). The lead level in the hair of the above-mentioned group of children was exceeded in relation to the control group (a statistically significant difference at p<0.05 for the total group). A more than twofold decrease in the mean value of the Mg/Pb ratio (and a nearly 30% decrease in the value of the Mg/Zn ratio) in the hair of children suffering from neurological diseases suggests that the high toxicity of lead accompanying, among other things, magnesium deficiencies might be a cause of the observed disorders in children.     

Etiology of acute diarrheas in children from the Lodz region. I. Occurrence of etiologic agents

The aim of this study was determination of the etiologic agents (bacterial, fungal or viral) of acute diarrheas in children from the ?ód? region, suffering from acute diarrhoea during the period from October 1998 to February 2001. Rotaviruses were detected by the latex test. Other microorganisms belonging to the Enterobacteriaceae, Pseudomonadaceae and Vibrionaceae families, as well as the genera Listeria, Campylobacter, Candida, Staphylococcus were cultured on standard or selective culture media according to the NDH recommendations and identification by means of API system. Acute diarrhea in 155 small children below 6 years of age from the ?ód? region were caused by rotaviruses (n = 42; 27%). Enteropathogenic strains of Escherichia coli (n = 25; 16.1%) occupied the third place after Salmonella bacteria (n = 30; 19.3%--second place). Among bacterial etiologic factors of diarrhea Campylobacter bacteria showed high frequency of occurrence (n = 22; 14.1%). The investigations enabled identification both the mixed infections (n = 25; 16.1%) and more rare etiologic agents of diarrhea. CONCLUSIONS: 1. Acute diarrhea in children from the region ?ód? were most frequently caused by rotaviruses; 2. Modern microbiological diagnostics of acute diarrhea in children should be multilateral, taking account of the mixed infections and expanding the routine search for bacteria of the genus Campylobacter.     

Serum and hair levels of zinc, selenium, iron, and copper in children with iron-deficiency anemia

In the present study, the serum and hair levels of zinc, selenium, and copper were determined in children with iron-deficiency anemia (IDA). A total of 52 anemic children aged 1–4 yr constituted the study group. Fortysix healthy children acted as controls. The copper and zinc levels were measured with an atomic absorption spectrophometer. Serum and hair selenium was determined by a spectroflourometric method. The serum zinc and selenium concentrations in the IDA group were found to be significantly lower and serum copper significantly higher than those in the controls (p<0.05). Lower iron, zinc, and selenium concentrations (p<0.001) but not copper were found in hair (p>0.05).     

The possible role of zinc and metallothionein in the liver on the therapeutic effect of IFN-α to hepatitis C patients

We have studied zinc deficiency in hepatitis C patients (complete responder [C,R] 22, nonresponder [NR] 25) with relation to the therapeutic effect of interferon-α (IFN-α). Circadian variations in serum zinc levels were high in the morning (basal level) and then gradually decreased during the day in both chronic hepatitis C patients and healthy controls. Basal zinc levels in serum were significantly lower in chronic hepatitis C patients (73±3 μg/dL,n=12) than in controls (93±5 μg/dL). An injection of 10 MU of IFN-α to hepatitis C patients augmented the serum zinc reductions, up to 40% in 8 h. Serum cortisol levels were significantly elevated 8 h (25.6±2.3 μg/dL) after IFN-α dose. Forty-seven chronic hepatitis C patients were treated with IFN-α for 24 wk, and serum zinc and copper levels were determined 12 and 24 wk during and after the completion of IFN-α therapy. Serum zinc levels and zinc/copper ratio were higher in CRs than in NRs to IFN therapy at each time-point. Hepatic metallothionein staining became prominent after IFN therapy in most of CRs, whereas it diminished NRs. These data suggest that nutritional status of zinc influences the effect of IFN on hepatitis C patients.     

Impact Monitoring of the National Scale Up of Zinc Treatment for Childhood Diarrhea in Bangladesh: Repeat Ecologic Surveys

Background

Zinc treatment of childhood diarrhea has the potential to save 400,000 under-five lives per year in lesser developed countries. In 2004 the World Health Organization (WHO)/UNICEF revised their clinical management of childhood diarrhea guidelines to include zinc. The aim of this study was to monitor the impact of the first national campaign to scale up zinc treatment of childhood diarrhea in Bangladesh.

Methods/Findings

Between September 2006 to October 2008 seven repeated ecologic surveys were carried out in four representative population strata: mega-city urban slum and urban nonslum, municipal, and rural. Households of approximately 3,200 children with an active or recent case of diarrhea were enrolled in each survey round. Caretaker awareness of zinc as a treatment for childhood diarrhea by 10 mo following the mass media launch was attained in 90%, 74%, 66%, and 50% of urban nonslum, municipal, urban slum, and rural populations, respectively. By 23 mo into the campaign, approximately 25% of urban nonslum, 20% of municipal and urban slum, and 10% of rural under-five children were receiving zinc for the treatment of diarrhea. The scale-up campaign had no adverse effect on the use of oral rehydration salt (ORS).

Conclusions

Long-term monitoring of scale-up programs identifies important gaps in coverage and provides the information necessary to document that intended outcomes are being attained and unintended consequences avoided. The scale-up of zinc treatment of childhood diarrhea rapidly attained widespread awareness, but actual use has lagged behind. Disparities in zinc coverage favoring higher income, urban households were identified, but these were gradually diminished over the two years of follow-up monitoring. The scale up campaign has not had any adverse effect on the use of ORS. Please see later in the article for the Editors'' Summary     

Classification and prognostic value of serum copper/zinc ratio in hodgkin’s disease

The serum copper and zinc levels were determined by atomic absorption spectrometry in 135 Hodgkin's disease (HD) patients and in 100 healthy controls. These values were used to explore the application value of the serum copper/zinc ratio in the histologic classification and prognosis in this illness. The resuls show that serum copper and the copper/zinc ratio were higher and the serum zinc level was lower in the HD patients when compared to the healthy individuals (p < 0.01, 0.001, and 0.01, respectively). The serum copper and copper/zinc ratio were significantly higher in the lymphocyte-depleted type of HD than in the patients with the mixed-cellular type of HD. These values were also higher and the serum zinc was lower in the patients with mixed-cellular HD when compared to the nodular-sclerosis and the lymphocyte-predominant types of the disease (p < 0.01 and 0.001, respectively). It was also shown that as the disease progresses, the serum copper level and copper/zinc ratio rises with the concomitant decrease of the corresponding serum zinc level. These trends are reversed in cases where the disease is in remission. Both the serum copper level and the copper/zinc ratio were strongly correlated to histopathological changes, clinical stage, and prognosis of Hodgkin's disease.     

Synthesis of rat hepatic zinc thionein in response to the stress of sham operation

Following sham operation for adrenalectomy, a dramatic 30-fold increase in rat hepatic zinc thionein occurs, peaking at 18 hours after surgery. Hepatic cytosolic and serum zinc levels rise concomitantly with zinc thionein. Copper in hepatic thionein and cytosol rises only slightly and serum copper not at all during the period of observation. In the period 18 to 48 hours after surgery the content of hepatic zinc thionein decreases with a $\text{t}\text{1}\text{2}$ of 16.4 hours.Pretreatment with cycloheximide (1 mg/kg b.w.) two hours before surgery inhibits the rise in zinc thionein by 52%, the rise in cytosolic zinc by 56%, and actually causes a decrease in serum zinc by 33%. Pretreatment with the α-adrenergic receptor blocker, phetolamine (10 mg/kg b.w.), or the β-adrenergic receptor blocker, propranolol (10 mg/kg b.w.), 30 minutes before surgery also inhibited the rise in zinc thionein (82% and 60%, respectively) and cytosolic zinc (75% and 47%, respectively), and decreased serum zinc (38% and 44%, respectively) 19 hours after surgery.Treatment with corticosterone (40 mg/kg b.w.) alone or epinephrine (1–20 μg/kg b.w.) alone did not alter hepatic zinc thionein levels 18 hours late, although they each caused hypozincemia and epinephrine raised cytosolic zinc levels. Treatment with corticosterone and epinephrine together did, however, raise zinc thionein levels 3.2-fold (P<0.02).These experiments are consistent with the hypothesis that adrenal hormones are involved in the regulation of zinc metabolism, and, hence, zinc thionein in levels in rat liver following the stress of sham operation.