You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
Double blind, randomised controlled clinical trial of hypo-osmolar oral rehydration salt solution in dehydrating acute diarrhoea in severely malnourished (marasmic) children
Abstract 1:
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


Title 2:
Efficacy of oral hyposmolar glucose-based and rice-based oral rehydration salt solutions in the treatment of cholera in adults.
Abstract 2:
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


Title 3:
Reduced osmolarity oral rehydration salt in Cholera.
Abstract 3:
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


Title 4:
Use of an oral glucose-electrolyte solution in the treatment of paediatric cholera--a controlled study.
Abstract 4:
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


Title 5:
Controlled trial of hypo-osmalar versus World Health Organization oral rehydration solution.
Abstract 5:
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 cholera , non-cholera and total cases . The amount of intravenous fluid needed was significantly more in the noncholera and total cases on H-ORS . In the non-breastfed cases , under two years of age , the total duration of diarrhea was significantly decreased ( p=0.03 ; 95 % CI 11.07 - 11.45 ) but the need for intravenous fluids significantly increased ( p=0.02 ; 95 % CI 109.8 - 112.1 ) in the H-ORS group . The proportion of children vomiting , the weight gain , urine passed in 24 hours , serum sodium , caloric intake and failure rate were comparable . CONCLUSIONS H-ORS is as safe and effective as the WHO-ORS and may have some additional benefits in malnourished children


Title 6:
Evaluation of oral hypo‐osmolar glucose‐based and rice‐based oral rehydration solutions in the treatment of cholera in children
Abstract 6:
In a r and omized controlled clinical trial , the efficacy of a low‐sodium low‐glucose oral rehydration solution ( ORS ) and a low‐sodium rice‐based ORS was compared with st and ard WHO glucose ORS in the treatment of severe cholera in children aged 2‐10 y. In total , 120 children were evaluated for the study , of whom 58 patients were positive for Vibrio cholerae and were included in the study . Of these 58 cases , 19 received rice‐based hypo‐osmolar ORS , 20 received WHO‐ORS and 19 received glucose‐based hypo‐osmolar ORS . The clinical characteristics ( age , preadmission duration of diarrhoea , frequency of stool before admission , incidence of vomiting , body weight and volume of initial fluid requirement ) were comparable in the three treatment groups . All patients received tetracycline in a dose of 50 mg/kg/d of body weight in 4 divided doses for 3
We found no statistically significant difference in the need for unscheduled intravenous infusion .
REVIEW ERS ' CONCLUSIONS In people with cholera , reduced osmolarity ORS is associated with biochemical hyponatremia when compared with st and ard ORS , although there are similar benefits in terms of other outcomes .