***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Glutamine has been demonstrated to be an important source of fuel for the gut . The purpose of this study was to evaluate the effect of glutamine-supplemented hyperalimentation on gut immune function .  Thirty-six female Fischer rats were r and omized into three groups : group 1 ( chow ) was fed rat chow and water ad libitum , group 2 ( total parenteral nutrition ) received a st and ard hyperalimentation formula , and group 3 ( total parenteral nutrition-glutamine ) received a hyperalimentation solution that contained 2 % glutamine . Animals were maintained on their respective diets for 2 weeks and then killed . Mesenteric lymph nodes were harvested for culture , bile was assayed for secretory IgA , and bowel was excised to assay bacterial adherence . Results indicated that glutamine-supplemented total parenteral nutrition protects against bacterial translocation from the gut seen with st and ard formulas . This effect may be mediated by the secretory IgA immune system A r and omized clinical trial was carried out to compare a packaged ready‐to‐mix rice oral rehydration solution ( ORS ) to the st and ard glucose ORS for the treatment of childhood diarrhoea . Children were of either gender , aged 3–35 months , presenting with a history of watery diarrhoea for 72 h or less . The main outcomes examined were stool output , ORS intake , duration of diarrhoea and nutritional recovery during follow‐up at 16 d of illness . Stool output in the first 24 h ( 106 vs 107 g kg‐1 ) ,  ORS intake in clinic ( 93 vs 102 ml per motion ) and duration of diarrhoea ( 88 h vs 81 h ) were similar in the two treatment groups . The few episodes that became persistent were similar ( 2 % ) in the two groups . The weight gain during follow‐up was similar in the two ORS groups Twenty male infants less than 1 year of age with acute diarrhea and dehydration were r and omly assigned to a study group and studied in blind fashion in a metabolic unit to assess the efficacy of the addition of 30 mmol/L alanine to the st and ard World Health Organization ( WHO ) oral rehydration solution ( ORS ) . Patients were exclusively rehydrated with one of two types of ORS during the first 24 hours of treatment . On the second day , oral feedings were started with a lactose-free formula , and ORS was given to replace stool losses . Body weight , ORS , food intake , vomitus , stool , and urine output were recorded at 6-hour intervals . Blood was drawn at the time of admission , after rehydration , and at 24 and 48 hours of hospitalization to monitor blood gases and electrolytes . Rehydration was satisfactory in both groups of patients . ORS that contained alanine did not reduce the purging rates of the infants compared with those who received st and ard ORS . Clinical ly no adverse effect of the alanine-based ORS was observed during hospitalization . None of the patients had significant hypernatremia or hyponatremia , and serum amino acid levels were not altered . These data show that the addition of 30 mmol/L alanine to the st and ard WHO-ORS produces no further improvement in the outcome of the infants with acute diarrhea compared with those fed the st and ard WHO-ORS In a double‐blind r and omized controlled clinical trial , moderately malnourished Bangladeshi children ( 61–75 % of the median weight/age ) were studied for the effect of zinc and /or vitamin A supplementation on the clinical outcome of persistent diarrhea . Children 6 mo to 2 y of age with diarrhea for more than 14 d were r and omly allocated into 4 groups of 24 receiving a multivitamin syrup and ( i ) zinc ( 20 mg elemental ) , ( ii ) vitamin A , ( iii ) both zinc and vitamin A , or ( iv ) neither , in 2 doses daily for 7 d. Clinical data on recovery and on stool output , consistency and frequency were recorded for 7 d , and weight change from day 1 to day 7 was assessed . The baseline characteristics of the four study groups were comparable . The mean daily stool outputs from days 2 to 7 of therapy were significantly less in the zinc and zinc plus vitamin A groups , but not in the vitamin A group , in comparison with the control group . In children receiving zinc , the cumulative stool weight in the 7 d was 39 % less than in the control group ( p < 0.001 ) and 32 % less than in the vitamin A group ( p= 0.006 ) . The cumulative stool weight in the zinc plus vitamin A group was 24 % less than in the control group ( p < 0.001 ) , but the 14 % lower output than in the vitamin A group was not statistically different The change in body weight over the 7d study period was significantly different between the group receiving zinc and the control group ( + 111 g vs –90 g , p = 0.045 ) . The rate of clinical recovery of children within 7 d was significantly greater in the zinc group ( 88 % ) compared with the control group ( 46 % , p= 0.002 ) or vitamin A group ( 50 % , p= 0 005 ) , but not statistically different from the zinc plus vitamin A group ( 67 % , p= 0.086 ) BACKGROUND Probiotics have a possible role in the treatment of pediatric acute gastroenteritis . We report the effect of the probiotic Lactobacillus rhamnosus GG ( LGG ) on intestinal function , immune response , and clinical outcomes in Indian children with cryptosporidial or rotavirus diarrhea . METHODS Children with gastroenteritis aged 6 months to 5 years , testing positive for either rotavirus or Cryptosporidium species in stool ( coinfections were excluded ) , were r and omized to LGG ( ATCC 53103 ) or placebo , once daily for 4 weeks . Baseline demographic and clinical details were obtained . Sera were tested for immunoglobulin G ( IgG ) and immunoglobulin A ( IgA ) antibodies to Cryptosporidium and rotavirus , and the lactulose to mannitol ratio for intestinal permeability was determined at baseline and at the end of follow-up . RESULTS Of the 124 children enrolled , 82 and 42 had rotavirus and cryptosporidial diarrhea , respectively . Median diarrheal duration was 4 days ; one-third of the children had severe diarrhea . Baseline and clinical parameters were comparable between children receiving LGG and placebo . At the end of follow-up , fewer children with rotavirus diarrhea on LGG had repeated diarrheal episodes ( 25 % vs 46 % ; P = .048 ) and impaired intestinal function ( 48 % vs 72 % ; P = .027 ) . Significant increase in IgG levels postintervention ( 456 vs 2215 EU ; P = .003 ) was observed in children with rotavirus diarrhea receiving LGG . Among children with cryptosporidial diarrhea , those receiving LGG showed significant improvement in intestinal permeability . CONCLUSIONS LGG has a positive immunomodulatory effect and may be useful in decreasing repeated episodes of rotavirus diarrhea . Improvement in intestinal function in children with rotavirus and cryptosporidial gastroenteritis emphasizes the role of probiotics in treating intestinal impairment after infection . CLINICAL TRIALS REGISTRATION CTRI/2010/091/000339 Introduction Diarrhoeal disease is the second-leading cause of death in young children . Current guidelines recommend treating children with acute non-bloody diarrhea with oral rehydration solutions and zinc , but not antimicrobials . However , in many re source -limited setting s , infections with treatable enteric bacterial and protozoan pathogens are common . Probiotics have shown promise as an adjunct treatment for diarrhoea but have not been studied in sub-Saharan Africa . Methods We conducted a pilot , factorial , r and omized , placebo-controlled trial of children aged 2–60 months hospitalized in Botswana for acute non-bloody diarrhoea . A rapid test- and -treat intervention , consisting of multiplex PCR testing of rectal swabs taken at enrolment , accompanied by targeted antimicrobial therapy if treatable pathogens were detected , was compared to the reference st and ard of no stool testing . Additionally , Lactobacillus reuteri DSM 17938 x 60 days was compared to placebo treatment . The main objective of this pilot study was to assess feasibility . The primary clinical outcome was the increase in age-st and ardized height ( HAZ ) at 60 days adjusted for baseline HAZ . Results Seventy-six patients were enrolled over a seven-month study period . We judged that the recruitment rate , lab processing times , communication protocol s , provision of specific antimicrobials , and follow-up rates were acceptable . Compared to the reference arm ( no stool testing and placebo treatment ) , the combination of the rapid test- and -treat strategy plus L. reuteri DSM 17938 was associated with an increase of 0.61 HAZ ( 95 % CI 0.09–1.13 ) and 93 % lower odds of recurrent diarrhoea ( OR 0.07 , 95%CI 0.01–0.61 ) at 60 days . Discussion We demonstrated that it was feasible to evaluate the study interventions in Botswana . Despite the small sample size , we observed a statistically significant increase in HAZ at 60 days and significantly lower odds of recurrent diarrhoea in children receiving both rapid test- and -treat and L. reuteri . There is sufficient evidence to warrant proceeding with a larger follow-up trial in a similar setting BACKGROUND Uncontrolled hospital-based studies in developing countries have reported promising results of dietary rehabilitation of children with persistent diarrhea . OBJECTIVE The objective was to determine the immediate and long-term effects of a dietary supplement and micronutrients given to children with persistent diarrhea during the episode and for 1 wk during convalescence . DESIGN The study was open , controlled , and community-based and was conducted in a periurban area in Guinea-BISSAU : Children <3 y of age with persistent diarrhea were identified during weekly household visits . The children r and omly assigned to the treatment and control groups were examined by a physician and all medical conditions were treated . The children in the treatment group were offered home-based dietary treatment consisting of locally available foods and micronutrient supplements . RESULTS There were 141 episodes of persistent diarrhea during the study : 70 in the treatment group ( in 58 children ) and 71 in the control group ( in 62 children ) . During the intervention period ( median : 17 d ) , weight gain in the treatment group exceeded that of the control group by 61.5 g/wk ( 95 % CI : 49.2 , 73.8 ) , whereas there was no significant difference in linear growth on the basis of knee-heel length . At a median follow-up period of 6.6 mo after the intervention was stopped , weight gain in the treatment group exceeded that of the control group by 12.5 g/wk ( 95 % CI : 7.7 , 17.3 ) ; knee-heel length was 7.5 mm/y ( 4.8 , 10.2 ) greater and total length was 0.65 cm/y ( 0.11 , 1.19 ) greater in the treatment group . CONCLUSION Therapeutic feeding and micronutrient supplementation had an immediate and sustained beneficial effect on growth in children with persistent diarrhea In a controlled clinical trial , we examined the effect of the short-term feeding of an energy-dense milk cereal formula in malnourished children with clinical ly severe dysentery due to acute shigellosis . Seventy-five malnourished children , aged 12 - 48 mo , passing blood or blood with mucous in the stool for < or = 96 h , were offered a hospital diet . In addition , study children ( n = 36 ) were offered a milk-cereal formula with an energy of 5 kJ/g ( an 11 % protein diet ) ; similarly , control children ( n = 39 ) were offered a  milk-cereal formula with an  energy content of 2.5  kJ/g ( an 11 % protein diet ) . Patients were admitted to the metabolic ward of the Clinical Research and Service Centre , Dhaka , at the International Centre for Diarrhoeal Disease Research , Bangladesh . Patients were studied for 10 hospital days and were then followed up at home after 30 d. After 10 d of dietary intervention , children in the study group had a significantly greater increase vs. controls in weight-for-age ( 6 vs. 3 % , P < 0.001 ) and in weight-for-height ( 7 vs. 3 % , P < 0.001 ) . Serum prealbumin concentrations were significantly higher ( study vs. control ) after 5 d ( 0.214 vs. 0.170 g/L , P = 0.01 ) and after 10 d ( 0.244 vs. 0.193 g/L , P = 0.006 ) of the study . Greater weight-for-age was sustained at home 1 mo after discharge ( 8 vs. 5 % , P = 0.005 ) 
    Output:
    
There were mixed results for dietary interventions affecting growth and diarrhea outcomes in the post-acute period .