human
***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: Objective To investigate the impact of zinc supplementation in children with cholera . Design Double blind , r and omised , placebo controlled trial . Setting Dhaka Hospital , Bangladesh . Participants 179 children aged 3 - 14 years with watery diarrhoea and stool dark field examination positive for Vibrio cholerae and confirmed by stool culture . Intervention Children were r and omised to receive 30 mg elemental zinc per day ( n=90 ) or placebo ( n=89 ) until recovery . All children received erythromycin suspension orally in a dose of 12.5 mg/kg every six hours for three days . Main outcome measures Duration of diarrhoea and stool output . Results 82 children in each group completed the study . More patients in the zinc group than in the control group recovered by two days ( 49 % v 32 % , P=0.032 ) and by three days ( 81 % v 68 % , P=0.03 ) . Zinc supplemented patients had 12 % shorter duration of diarrhoea than control patients ( 64.1 v 72.8 h , P=0.028 ) and 11 % less stool output ( 1.6 v 1.8 kg/day , P=0.039 ) . Conclusion Zinc supplementation significantly reduced the duration of diarrhoea and stool output in children with cholera . Children with cholera should be supplemented with zinc to reduce its duration and severity . Trial registration Clinical trials NCT00226616 OBJECTIVE To evaluate the efficacy and safety of zinc in the treatment of acute gastroenteritis ( AGE ) in children in Pol and . STUDY DESIGN Children aged 3 to 48 months with AGE were enrolled in a r and omized , double-blind , placebo-controlled trial in which they received zinc sulfate ( 10 or 20 mg/day depending on age ) or placebo for 10 days . A total of 141 of 160 children recruited were available for intention-to-treat analysis . The primary outcome was the duration of diarrhea . RESULTS In the experimental group ( n = 69 ) compared with the control group ( n = 72 ) , there was no significant difference in the duration of diarrhea ( P > .05 ) . Similarly , there was no significant difference in the groups in secondary outcome measures such as stool frequency on days 1 , 2 , and 3 , vomiting frequency , intravenous fluid intake , and the number of children with diarrhea lasting > 7 days . CONCLUSION Children living in a country where zinc deficiency is rare do not appear to benefit from the use of zinc in the treatment of AGE OBJECTIVE To compare the clinical efficacy of supplementation of zinc , zinc plus vitamin A , and zinc plus combination of micronutrients and vitamins ( iron , copper , selenium , vitamin B(12 ) , folate , and vitamin A ) on acute diarrhea in children . STUDY DESIGN This was a double-blind , r and omized , placebo-controlled trial . Children aged 6 to 24 months with diarrhea and moderate dehydration were r and omized to receive zinc plus placebo vitamin A ( group 1 ) , zinc plus other micronutrients plus vitamin A ( group 2 ) , zinc plus vitamin A ( group 3 ) , or placebo ( group 4 ) as an adjunct to oral rehydration solution .  Duration , volume of diarrhea , and consumption of oral rehydration solution were compared as outcome variables within the supplemented groups and with the placebo group . RESULTS The 167 study subjects included 41 in group 1 , 39 in group 2 , 44 in group 3 , and 43 in group 4 . All 3 supplemented groups demonstrated a significant reduction in outcome variables ( P < .0001 ) compared with the placebo group . Group 3 had the lowest reduction of outcome variables and group 2 had a speedy recovery , but differences among the supplemented groups were not statistically significant . CONCLUSIONS Supplementation with a combination of micronutrients and vitamins was not superior to zinc alone , confirming the clinical benefit of zinc in children with diarrhea Background Diarrhea causes an estimated 2.5 million child deaths in developing countries each year , 35 % of which are due to acute diarrhea . Zinc and copper stores in the body are known to be depleted during acute diarrhea . Our objectives were to evaluate the efficacy of zinc and copper supplementation when given with st and ard treatment to children with acute watery or bloody diarrhea . Methods We conducted a double-blind r and omized controlled clinical trial in the Department of Pediatrics at Indira G and hi Government Medical College Nagpur , India . Eight hundred and eight children aged 6 months to 59 months with acute diarrhea were individually r and omized to placebo ( Pl ) , zinc ( Zn ) only , and zinc and copper ( Zn+Cu ) together with st and ard treatment for acute diarrhea . Results The mean duration of diarrhea from enrolment and the mean stool weight during hospital stay were 63.7 hours and 940 grams , respectively , and there were no significant differences in the adjusted means across treatment groups . Similarly , the adjusted means of the amount of oral rehydration solution or intravenous fluids used , the proportion of participants with diarrhea more than 7 days from onset , and the severity of diarrhea indicated by more than three episodes of some dehydration or any episode of severe dehydration after enrolment , did not differ across the three groups . Conclusion The expected beneficial effects of zinc supplementation for acute diarrhea were not observed . Therapeutic Zn or Zn and Cu supplementation may not have a universal beneficial impact on the duration of acute diarrhea in children . Trial registration The study was registered as an International St and ard R and omized Controlled Trial ( IS RCT N85071383 ) OBJECTIVE To evaluate the impact of zinc supplementation on the clinical course , stool weight , duration of diarrhoea , changes in serum zinc , and body weight gain of children with acute diarrhoea . DESIGN R and omised double blind controlled trial . Children were assigned to receive zinc ( 20 mg elemental zinc per day ) containing multivitamins or control group ( zinc-free multivitamins ) daily in three divided doses for two weeks . SETTING A diarrhoeal disease hospital in Dhaka , Bangladesh . PATIENTS 111 children , 3 to 24 months old , below 76 % median weight for age of the National Center for Health Statistics st and ard with acute diarrhoea . Children with severe infection and /or oedema were excluded . MAIN OUTCOME MEASURES Total diarrhoeal stool output , duration of diarrhoea , rate of weight gain , and changes in serum zinc levels after supplementation . RESULTS Stool output was 28 % less and duration 14 % shorter in the zinc supplemented group than placebo ( p = 0.06 ) . There were reductions in median total diarrhoeal stool output among zinc supplemented subjects who were shorter ( less than 95 % height for age ) , 239 v 326 g/kg ( p < 0.04 ) , and who had a lower initial serum zinc ( < 14 mmol/l ) , 279 v 329 g/kg ( p < 0.05 ) ; a shortening of mean time to recovery occurred ( 4.7v 6.2 days , p < 0.04 ) in those with lower serum zinc . There was an increase in mean serum zinc in the zinc supplemented group ( + 2.4 v −0.3 μmol/l , p < 0.001 ) during two weeks of supplementation , and better mean weight gain ( 120 v 30 g , p < 0.03 ) at the time of discharge from hospital . CONCLUSIONS Zinc supplementation is a simple , acceptable , and affordable strategy which should be considered in the management of acute diarrhoea and in prevention of growth faltering in children specially those who are malnourished . Key messages 20 mg of daily zinc supplementation reduced diarrhoeal stool in shorter children Zinc reduced diarrhoeal stool in those with low serum zinc Zinc reduced duration of diarrhoea in children with low serum zinc Zinc increased body weight of children during acute diarrhoeal episode Malnourished children are likely to benefit more from zinc Background and Aim : The World Health Organization recommends oral zinc ( tablets or syrups ) as adjunct therapy with oral rehydration solution ( ORS ) for acute childhood diarrhea . Mixing zinc with ORS can be an attractive approach for simultaneous provision of these 2 effective interventions . This double-masked r and omized controlled trial evaluated the efficacy of ORS containing 40 mg/L elemental zinc per liter ( zinc-ORS ) in reducing stool weight and duration of diarrhea . Patients and Methods : Five hundred northern Indian children ages 1 to 35 months with diarrhea < 7 days ’ duration were r and omized to zinc-ORS or ORS . The primary outcomes were total stool output and time to recovery . Results : The median total stool output was 2.12 g · kg−1 · h−1 ( interquartile range [ IQR ] 0.9–3.76 ) in the zinc-ORS group compared with 1.78 g · kg−1 · h−1 ( IQR 0.83–3.45 ) in the ORS group . The time to recovery was also similar in the 2 groups ( hazard ratio 1.06 [ 95 % confidence interval 0.88–1.27 ] ) . In subjects who received zinc-ORS , the median ( IQR ) zinc intakes were 27 ( 16–46 ) mg on day 1 , 15 ( 6–27 ) mg on day 2 , and negligible thereafter . Conclusions : The World Health Organization – recommended daily dose of zinc for diarrhea was not achieved in most children beyond the first day of treatment . This is the likely explanation for the lack of improvement in outcomes from zinc-ORS when compared with ORS alone . Our findings do not support a change from using zinc syrup or dispersible tablets for treatment of acute diarrhea in children In a community-based double-blind r and omized trial in children aged 6–35 months , both intervention and control groups received a multi-vitamin syrup containing vitamin A , while the intervention group had zinc gluconate ( equivalent to 10 mg of elemental zinc ) additional in the syrup . There was a significant decrease in diarrhoea and pneumonia in the intervention group . This study was undertaken to investigate if addition of zinc to vitamin A had improved plasma retinol levels , which , in turn , was responsible for the effects observed in the intervention group . In a r and omly-selected sub sample of 200 children—100 each from the intervention and the control group , plasma retinol levels after 120 days of supplementation were measured . There was no difference in the mean plasma retinol levels [ the difference in the mean 0.46 μg/dL ( 95 % confidence interval -1.42–2.36 ) ] between the two groups following supplementation . No difference in plasma retinol levels was observed in the subgroups based on baseline nutritional status and plasma zinc levels . Addition of zinc to low-dose vitamin A in this study did not improve the vitamin A status of children and can not explain morbidity effects of the intervention Objective . To evaluate the potential benefit of dietary supplementation of a rice-lentil ( Khitchri ) and yogurt diet with 3 mg/kg/d of elemental zinc ( as zinc sulfate ) in hospitalized malnourished children ( age 6–36 months ) with persistent diarrhea for 14 days . Methodology . R and omized , double-blind placebo-controlled trial . Setting . Nutrition Research Ward at the National Institute of Child Health , Karachi , Pakistan , where children were admitted for 14 days of inpatient supervised rehabilitation . Main Outcome Measures . Primary outcome : overall weight gain by day 14 . Secondary outcomes : overall energy intake , stool output , time to diarrheal recovery and weight gain ( ≥3 days ) , plasma zinc , copper , prealbumin , and insulin-like growth factor-1 . Results . Of 87 children r and omized for supplementation with either zinc or placebo , the two groups were comparable at admission in terms of severity and duration of diarrhea , as well as nutritional and anthropometric parameters . The overall weight gain , stool volume , stool frequency , as well as the time taken for diarrheal recovery or steady weight gain , were comparable for both supplemented children and controls . Supplemented children had a significant improvement in plasma zinc levels and serum alkaline phosphatase by day 14 of therapy in comparison with controls . Plasma copper levels were low in both groups at admission and although an increase was seen in control children , levels decreased further after zinc supplementation . There was no significant difference between the two groups for hemoglobin , serum albumin , prealbumin , and plasma insulin-like growth factor-1 increments during the course of therapy . Evaluation of primary and secondary outcome criteria among the subset of children with plasma zinc levels < 60 μg/d at admission did not reveal any significant differences . Conclusions . Although there was satisfactory recovery in malnourished children with persistent diarrhea receiving the Khitchri-yogurt diet , there was no evidence of improved weight gain or acceleration of recovery from diarrhea with zinc supplementation . In contrast , the reduction in plasma copper levels in zinc-supplemented malnour 
    Output:
    
agent
Diarrhea prevalence on days 3 , 5 , and 7 was lower in the zinc group .
The incidence of vomiting was significantly greater in the group that received zinc than in the control group .
CONCLUSIONS Oral zinc supplementation significantly decreases diarrhea duration and has a greater effect on malnourished children .
***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: Objective To investigate the impact of zinc supplementation in children with cholera . Design Double blind , r and omised , placebo controlled trial . Setting Dhaka Hospital , Bangladesh . Participants 179 children aged 3 - 14 years with watery diarrhoea and stool dark field examination positive for Vibrio cholerae and confirmed by stool culture . Intervention Children were r and omised to receive 30 mg elemental zinc per day ( n=90 ) or placebo ( n=89 ) until recovery . All children received erythromycin suspension orally in a dose of 12.5 mg/kg every six hours for three days . Main outcome measures Duration of diarrhoea and stool output . Results 82 children in each group completed the study . More patients in the zinc group than in the control group recovered by two days ( 49 % v 32 % , P=0.032 ) and by three days ( 81 % v 68 % , P=0.03 ) . Zinc supplemented patients had 12 % shorter duration of diarrhoea than control patients ( 64.1 v 72.8 h , P=0.028 ) and 11 % less stool output ( 1.6 v 1.8 kg/day , P=0.039 ) . Conclusion Zinc supplementation significantly reduced the duration of diarrhoea and stool output in children with cholera . Children with cholera should be supplemented with zinc to reduce its duration and severity . Trial registration Clinical trials NCT00226616 OBJECTIVE To evaluate the efficacy and safety of zinc in the treatment of acute gastroenteritis ( AGE ) in children in Pol and . STUDY DESIGN Children aged 3 to 48 months with AGE were enrolled in a r and omized , double-blind , placebo-controlled trial in which they received zinc sulfate ( 10 or 20 mg/day depending on age ) or placebo for 10 days . A total of 141 of 160 children recruited were available for intention-to-treat analysis . The primary outcome was the duration of diarrhea . RESULTS In the experimental group ( n = 69 ) compared with the control group ( n = 72 ) , there was no significant difference in the duration of diarrhea ( P > .05 ) . Similarly , there was no significant difference in the groups in secondary outcome measures such as stool frequency on days 1 , 2 , and 3 , vomiting frequency , intravenous fluid intake , and the number of children with diarrhea lasting > 7 days . CONCLUSION Children living in a country where zinc deficiency is rare do not appear to benefit from the use of zinc in the treatment of AGE OBJECTIVE To compare the clinical efficacy of supplementation of zinc , zinc plus vitamin A , and zinc plus combination of micronutrients and vitamins ( iron , copper , selenium , vitamin B(12 ) , folate , and vitamin A ) on acute diarrhea in children . STUDY DESIGN This was a double-blind , r and omized , placebo-controlled trial . Children aged 6 to 24 months with diarrhea and moderate dehydration were r and omized to receive zinc plus placebo vitamin A ( group 1 ) , zinc plus other micronutrients plus vitamin A ( group 2 ) , zinc plus vitamin A ( group 3 ) , or placebo ( group 4 ) as an adjunct to oral rehydration solution .  Duration , volume of diarrhea , and consumption of oral rehydration solution were compared as outcome variables within the supplemented groups and with the placebo group . RESULTS The 167 study subjects included 41 in group 1 , 39 in group 2 , 44 in group 3 , and 43 in group 4 . All 3 supplemented groups demonstrated a significant reduction in outcome variables ( P < .0001 ) compared with the placebo group . Group 3 had the lowest reduction of outcome variables and group 2 had a speedy recovery , but differences among the supplemented groups were not statistically significant . CONCLUSIONS Supplementation with a combination of micronutrients and vitamins was not superior to zinc alone , confirming the clinical benefit of zinc in children with diarrhea Background Diarrhea causes an estimated 2.5 million child deaths in developing countries each year , 35 % of which are due to acute diarrhea . Zinc and copper stores in the body are known to be depleted during acute diarrhea . Our objectives were to evaluate the efficacy of zinc and copper supplementation when given with st and ard treatment to children with acute watery or bloody diarrhea . Methods We conducted a double-blind r and omized controlled clinical trial in the Department of Pediatrics at Indira G and hi Government Medical College Nagpur , India . Eight hundred and eight children aged 6 months to 59 months with acute diarrhea were individually r and omized to placebo ( Pl ) , zinc ( Zn ) only , and zinc and copper ( Zn+Cu ) together with st and ard treatment for acute diarrhea . Results The mean duration of diarrhea from enrolment and the mean stool weight during hospital stay were 63.7 hours and 940 grams , respectively , and there were no significant differences in the adjusted means across treatment groups . Similarly , the adjusted means of the amount of oral rehydration solution or intravenous fluids used , the proportion of participants with diarrhea more than 7 days from onset , and the severity of diarrhea indicated by more than three episodes of some dehydration or any episode of severe dehydration after enrolment , did not differ across the three groups . Conclusion The expected beneficial effects of zinc supplementation for acute diarrhea were not observed . Therapeutic Zn or Zn and Cu supplementation may not have a universal beneficial impact on the duration of acute diarrhea in children . Trial registration The study was registered as an International St and ard R and omized Controlled Trial ( IS RCT N85071383 ) OBJECTIVE To evaluate the impact of zinc supplementation on the clinical course , stool weight , duration of diarrhoea , changes in serum zinc , and body weight gain of children with acute diarrhoea . DESIGN R and omised double blind controlled trial . Children were assigned to receive zinc ( 20 mg elemental zinc per day ) containing multivitamins or control group ( zinc-free multivitamins ) daily in three divided doses for two weeks . SETTING A diarrhoeal disease hospital in Dhaka , Bangladesh . PATIENTS 111 children , 3 to 24 months old , below 76 % median weight for age of the National Center for Health Statistics st and ard with acute diarrhoea . Children with severe infection and /or oedema were excluded . MAIN OUTCOME MEASURES Total diarrhoeal stool output , duration of diarrhoea , rate of weight gain , and changes in serum zinc levels after supplementation . RESULTS Stool output was 28 % less and duration 14 % shorter in the zinc supplemented group than placebo ( p = 0.06 ) . There were reductions in median total diarrhoeal stool output among zinc supplemented subjects who were shorter ( less than 95 % height for age ) , 239 v 326 g/kg ( p < 0.04 ) , and who had a lower initial serum zinc ( < 14 mmol/l ) , 279 v 329 g/kg ( p < 0.05 ) ; a shortening of mean time to recovery occurred ( 4.7v 6.2 days , p < 0.04 ) in those with lower serum zinc . There was an increase in mean serum zinc in the zinc supplemented group ( + 2.4 v −0.3 μmol/l , p < 0.001 ) during two weeks of supplementation , and better mean weight gain ( 120 v 30 g , p < 0.03 ) at the time of discharge from hospital . CONCLUSIONS Zinc supplementation is a simple , acceptable , and affordable strategy which should be considered in the management of acute diarrhoea and in prevention of growth faltering in children specially those who are malnourished . Key messages 20 mg of daily zinc supplementation reduced diarrhoeal stool in shorter children Zinc reduced diarrhoeal stool in those with low serum zinc Zinc reduced duration of diarrhoea in children with low serum zinc Zinc increased body weight of children during acute diarrhoeal episode Malnourished children are likely to benefit more from zinc Background and Aim : The World Health Organization recommends oral zinc ( tablets or syrups ) as adjunct therapy with oral rehydration solution ( ORS ) for acute childhood diarrhea . Mixing zinc with ORS can be an attractive approach for simultaneous provision of these 2 effective interventions . This double-masked r and omized controlled trial evaluated the efficacy of ORS containing 40 mg/L elemental zinc per liter ( zinc-ORS ) in reducing stool weight and duration of diarrhea . Patients and Methods : Five hundred northern Indian children ages 1 to 35 months with diarrhea < 7 days ’ duration were r and omized to zinc-ORS or ORS . The primary outcomes were total stool output and time to recovery . Results : The median total stool output was 2.12 g · kg−1 · h−1 ( interquartile range [ IQR ] 0.9–3.76 ) in the zinc-ORS group compared with 1.78 g · kg−1 · h−1 ( IQR 0.83–3.45 ) in the ORS group . The time to recovery was also similar in the 2 groups ( hazard ratio 1.06 [ 95 % confidence interval 0.88–1.27 ] ) . In subjects who received zinc-ORS , the median ( IQR ) zinc intakes were 27 ( 16–46 ) mg on day 1 , 15 ( 6–27 ) mg on day 2 , and negligible thereafter . Conclusions : The World Health Organization – recommended daily dose of zinc for diarrhea was not achieved in most children beyond the first day of treatment . This is the likely explanation for the lack of improvement in outcomes from zinc-ORS when compared with ORS alone . Our findings do not support a change from using zinc syrup or dispersible tablets for treatment of acute diarrhea in children In a community-based double-blind r and omized trial in children aged 6–35 months , both intervention and control groups received a multi-vitamin syrup containing vitamin A , while the intervention group had zinc gluconate ( equivalent to 10 mg of elemental zinc ) additional in the syrup . There was a significant decrease in diarrhoea and pneumonia in the intervention group . This study was undertaken to investigate if addition of zinc to vitamin A had improved plasma retinol levels , which , in turn , was responsible for the effects observed in the intervention group . In a r and omly-selected sub sample of 200 children—100 each from the intervention and the control group , plasma retinol levels after 120 days of supplementation were measured . There was no difference in the mean plasma retinol levels [ the difference in the mean 0.46 μg/dL ( 95 % confidence interval -1.42–2.36 ) ] between the two groups following supplementation . No difference in plasma retinol levels was observed in the subgroups based on baseline nutritional status and plasma zinc levels . Addition of zinc to low-dose vitamin A in this study did not improve the vitamin A status of children and can not explain morbidity effects of the intervention Objective . To evaluate the potential benefit of dietary supplementation of a rice-lentil ( Khitchri ) and yogurt diet with 3 mg/kg/d of elemental zinc ( as zinc sulfate ) in hospitalized malnourished children ( age 6–36 months ) with persistent diarrhea for 14 days . Methodology . R and omized , double-blind placebo-controlled trial . Setting . Nutrition Research Ward at the National Institute of Child Health , Karachi , Pakistan , where children were admitted for 14 days of inpatient supervised rehabilitation . Main Outcome Measures . Primary outcome : overall weight gain by day 14 . Secondary outcomes : overall energy intake , stool output , time to diarrheal recovery and weight gain ( ≥3 days ) , plasma zinc , copper , prealbumin , and insulin-like growth factor-1 . Results . Of 87 children r and omized for supplementation with either zinc or placebo , the two groups were comparable at admission in terms of severity and duration of diarrhea , as well as nutritional and anthropometric parameters . The overall weight gain , stool volume , stool frequency , as well as the time taken for diarrheal recovery or steady weight gain , were comparable for both supplemented children and controls . Supplemented children had a significant improvement in plasma zinc levels and serum alkaline phosphatase by day 14 of therapy in comparison with controls . Plasma copper levels were low in both groups at admission and although an increase was seen in control children , levels decreased further after zinc supplementation . There was no significant difference between the two groups for hemoglobin , serum albumin , prealbumin , and plasma insulin-like growth factor-1 increments during the course of therapy . Evaluation of primary and secondary outcome criteria among the subset of children with plasma zinc levels < 60 μg/d at admission did not reveal any significant differences . Conclusions . Although there was satisfactory recovery in malnourished children with persistent diarrhea receiving the Khitchri-yogurt diet , there was no evidence of improved weight gain or acceleration of recovery from diarrhea with zinc supplementation . In contrast , the reduction in plasma copper levels in zinc-supplemented malnour 
    Output:
    