***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: The study compared the safety and efficacy of an oral rehydration salts ( ORS ) solution , containing 75 mmol/L of sodium and glucose each , with the st and ard World Health Organization (WHO)-ORS solution in the management of ongoing fluid losses , after initial intravenous rehydration to correct dehydration . The study was conducted among patients aged 12 - 60 years hospitalized with diarrhoea due to cholera . One hundred seventy-six patients who were hospitalized with acute diarrhoea and signs of severe dehydration were rehydrated intravenously and then r and omly assigned to receive either st and ard ORS solution ( 311 mmol/L ) or reduced-osmolarity ORS solution ( 245 mmol/L ) . Intakes and outputs were measured every six hours until the cessation of diarrhoea . During maintenance therapy , stool output , intake of ORS solution , duration of diarrhoea , and the need for unscheduled administration of intravenous fluids were similar in the two treatment groups . The type of ORS solution that the patients received did not affect the mean serum sodium concentration at 24 hours after r and omization and the relative risk of development of hyponatraemia . However , patients treated with reduced-osmolarity ORS solution had a significantly lower volume of vomiting and significantly higher urine output than those treated with st and ard WHO-ORS solution . Reduced-osmolarity ORS solution  was as efficacious as st and ard WHO-ORS solution in the management of cholera patients . The results indicate that reduced-osmolarity ORS solution is also as safe as st and ard WHO-ORS solution . However , because of the limited sample size in the study , the results will have to be confirmed in trials , involving a larger number of patients AIMS To compare the clinical efficacy of hypo-osmolar oral rehydration salt ( ORS ) solution ( 224 mmol/l ) and st and ard ORS solution ( 311 mmol/l ) in severely malnourished ( marasmic ) children having less than 60 % Harvard st and ard weight for age with dehydrating acute watery diarrhoea . METHODS In a double blind , r and omised , controlled trial , 64 children aged 6–48 months were r and omly assigned st and ard ( n = 32 ) or hypo-osmolar ORS ( n = 32 ) . RESULTS Stool output ( 52.3v 96.6 g/kg/day ) , duration of diarrhoea ( 41.5 v 66.4 hours ) , intake of ORS  ( 111.5v 168.9 ml/kg/day ) , and fluid intake ( 214.6v 278.3 ml/kg/day ) were significantly less in the hypo-osmolar group than in the st and ard ORS group . Percentage of weight gain on recovery in the hypo-osmolar group was also significantly less ( 4.3 v 5.4 % of admission weight ) than in the st and ard ORS group . A total of 29 ( 91 % ) children in the st and ard ORS group and 32 ( 100 % ) children in the hypo-osmolar group recovered within five days of initiation of therapy . Mean serum sodium and potassium concentrations on recovery were within the normal range in both groups . CONCLUSION Our findings suggest that hypo-osmolar ORS has beneficial effects on the clinical course of dehydrating acute watery diarrhoea in severely malnourished ( marasmic ) children . Furthermore , children did not become hyponatraemic after receiving hypo-osmolar ORS CONTEXT In May 2002 , the World Health Organization and the United Nations Children 's Fund recommended that the formulation of oral rehydration solution ( ORS ) for treatment of patients with diarrhea be changed to one with a reduced osmolarity and that safety of the new formulation , particularly development of symptomatic hyponatremia , be monitored . OBJECTIVE To measure the rates of symptomatic hyponatremia during treatment of patients with diarrhea with reduced osmolarity ORS .  DESIGN , SETTING S , AND PATIENTS A phase 4 trial conducted at the Dhaka hospital ( December 1 , 2002-November 30 , 2003 ) and Matlab hospital ( February 2 , 2003-January 31 , 2004 ) of the International Centre for Diarrhoeal Disease Research Bangladesh : Centre for Health and Population Research , Dhaka , Bangladesh . All patients admitted with uncomplicated watery diarrhea were treated with the newly recommended ORS and monitored . Patients developing neurological symptoms ( seizure or altered consciousness ) were transferred to the special care ward for treatment and investigated to identify the cause of the symptoms . Patient records of the Dhaka hospital were review ed during the previous year when the old ORS formulation was used . INTERVENTION Reduced osmolarity ORS . MAIN OUTCOME MEASURE Incidence rate of symptomatic hyponatremia in a 1-year period . RESULTS A total of 53,280 patients , including 22,536 children younger than 60 months , were monitored at the Dhaka and Matlab hospitals . Twenty-four patients , none older than 36 months , developed seizures or altered consciousness associated with hyponatremia , with an overall incidence rate of 0.05 % ( 95 % confidence interval [ CI ] , 0.03%-0.07 % ) at the Dhaka hospital and 0.03 % ( 95 % CI , 0.01%-0.09 % ) at the Matlab hospital . During the previous year , 47 patients at the Dhaka hospital had symptoms associated with hyponatremia , for an estimated incidence rate of 0.10 % ( 95 % CI , 0.07%-0.13 % ) . The reduction in the rates was statistically significant ( odds ratio , 0.50 ; 95 % CI , 0.29 - 0.85 ; P = .009 ) . CONCLUSION The risk of symptoms associated with hyponatremia in patients treated with the reduced osmolarity ORS  is minimal and did not increase with the change in formulation OBJECTIVE To assess the efficacy and safety of reduced osmolarity oral rehydration salts ( ROORS ) in treatment of mild to moderate dehydration caused by acute diarrhea in children . METHODS A multicenter , r and omized , double-blind , positive drug controlled clinical trial was conducted in 125 cases aged 1 to 17 years . These children with acute diarrhea and signs of dehydration were r and omly assigned to receive either ROORS ( trial group , n = 62 ) or oral rehydration salts II ( ORS II ) ( control group , n = 63 ) . The volume of intravenous infusion were recorded . The improvements of systemic symtoms and signs , diarrhea , dehydration and total scores were compared between the two groups . The adverse events and changes of electrolyte and other laboratory tests during treatment were also observed and analyzed . RESULTS The overall effective rates in trial group and control group were 96.8 % and 96.8 % , respectively . The recovery of systemic symptoms , dehydration signs and diarrhea occurred in 96 % , 97 % and 78 % patients in trial groups , and 96 % , 98 % and 85 % patients in control group . The scores of symptoms and signs in both groups decreased significantly after treatment . All the above parameters and the number of cases who needed intravenous infusion ( 41 vs. 39 ) were not statistically different between two groups . However , the average volume of intravenously infused fluids in trial group was ( 450.98 + /- 183.07 ) ml , 24.5 % less than that in the control group ( 597.30 + /- 343.37 ) ml ( P < 0.05 ) . The mean serum Na(+ ) concentration elevated from ( 137.48 + /- 4.55 ) mmol/L to ( 139.52 + /- 3.25 ) mmol/L ( P < 0.01 ) in control group after treatment , but the change was not statistically significant in trail group . Serum K(+ ) , Cl(- ) , HCO(3)(- ) and other laboratory result did not change significantly after treatment . The total scores in both groups decreased obviously after treatment , but no significant difference was demonstrated between two groups ( P > 0.05 ) . A case in trial group had mild abdominal distention and recovered spontaneously . CONCLUSION ROORS was shown to be effective and safe in the treatment of mild and moderate dehydration induced by acute diarrhea . Compared to ORS II , ROORS could decrease the intravenous supplement of fluid and lower the risk of hypernatremia BACKGROUND Recent animal experiments and clinical trials have shown that both osmolarity and rice as the organic components are important factors for net intestinal absorption of an oral rehydration salt solution . METHODS In a controlled clinical trial 123 male adult patients with severe cholera , after initial rehydration with intravenous Ringer 's lactate solution , were r and omly assigned to receive one of the four oral rehydration salt solutions : WHO ORS , ORS containing 70 mmol/l Na+ and 16.2 g/l glucose , rice ORS containing 50 g/l rice and 90 mmol/l Na+ , and rice ORS containing 50 g/l rice and 70 mmol/l Na+ . All patients received 300 mg of doxycycline as a single dose . RESULTS Patients who received rice-low-sodium ORS subsequently had lower ( P < 0.05 ) stool output , ORS consumption , and diarrhoea duration than the other three ORS groups . CONCLUSIONS We conclude that rice-based low-sodium ORS is superior for treating adult cholera In a controlled clinical trial conducted in 34 adults with severe cholera diarrhoea , the use of a relatively dilute oral rehydration salt ( ORS ) solution ( sodium 67 , potassium 20 , chloride 66 , citrate 7 , glucose 89 mmol/l , osmolality 249 mOsmol/kg ) caused a 29 % ( p=0.003 ) reduction in stool output over the first 24 h and a 37 % ( p=0.001 ) reduction over the first 48 h compared with 29 controls who received the hyperosmolar WHO/UNICEF ORS . No controls but 3 study -group patients had marked but asymptomatic hyponatraemia ( sodium < 125 mmol/l ) at 24 h. Twenty-four % of controls and 12 % of patients receiving the dilute ORS needed unscheduled intravenous therapy for recurrence of dehydration . The ORS intake was twice the 48 h stool volume in controls and 3 times in the study group . The test ORS with a reduced glucose and sodium concentration is more efficient than the WHO/UNICEF ORS in preserving net intestinal fluid balance in severe cholera This study was conducted in Calcutta India during the cholera season April-July 1970 to evaluate the use of an oral glucose-electrolyte solution and to define the practical problems involved in carrying out such treatment in infants and children . 15 children were treated by st and ard intravenous methods and 17 by a combination of intravenous and oral glucose-electrolyte fluids .  Results from the study suggested that oral fluid therapy will be uniformly successful only after initial fluid and electrolyte losses have been corrected intravenously . Since lack of intravenous fluid and lack of trained personnel are major h and icaps to successful cholera therapy in India oral therapy can be a marked improvement since it decreases the need for intravenous fluids thereby reducing need for trained personnel to administer therapy under difficult field conditions OBJECTIVE To compare the safety and efficacy of a hyposmolar oral rehydration solution ( H-ORS ) ( 245 mmol/liter ) with the World Health Organization oral rehydration solution ( WHO ORS ) in cholera and acute non-cholera diarrhea . DESIGN Controlled clinical trial . SETTING Diarrhea training and treatment unit . METHODS Thirty-five culture proven cholera and 135 acute non-cholera diarrheal patients r and omly received  H-ORS or WHO-ORS . Intake and output were measured every 4 hours . RESULTS Analysis of the total cases revealed rehydration phase ( p=0.048 , 95 % CI 0.64 - 0.99 ) and overall ( p=0.046 , 95 % CI 0.70 - 0.99 ) frequency of stools to be significantly less in the H-ORS group . In the severely malnourished , the rehydration phase ( p=0.032 , 95 % CI 0.55 - 97 ) , maintenance phase ( p=0.035 , 95 % CI 0.51 - 0.97 ) and overall ( p=0.011 ; 0.95 % CI 0.55 - 0.93 ) stool frequency were significantly decreased in the H-ORS group . The amount of ORS consumed in the maintenance phase of the cholera cases was significantly ( p=0.04 , 95 % CI 0.44 - 0.98 ) less in the H-ORS group . All other parameters , despite showing a decreasing trend , were statistically comparable in the 
    Output:
    
In people with cholera , ORS ≤ 270 is associated with biochemical hyponatraemia when compared with ORS ≥ 310 , but there are no differences in terms of other outcomes .