Common Gastrointestinal Illness Research Articles

Fighting Salmonella Infantis: bacteriophage-driven cleaning and disinfection strategies for broiler farms.

Salmonella is a bacterium that can cause food-borne infections and is responsible for the most common gastrointestinal illnesses. The emergence of multi-drug resistant (MDR) strains worldwide is a major threat, representing a major challenge in public health. To reduce its incidence, the One Health approach is required, and the development of new biocontrol protocols will help prevent or eliminate the spread of Salmonella. Prevention measures, such as on-farm cleaning and disinfection protocols, are a crucial step in reducing infection to new flocks and eliminating bacteria that remain in the facilities. However, MDR Salmonella species, such as S. Infantis, are highly resistant to conventional cleaning and disinfection protocols, with an increased ability to persist in the broiler farm environment. The need for alternative biocontrol methods has led to the use of bacteriophages or phages, viruses that target bacteria, as promising tools. Thus, the aim of this study was to evaluate the efficacy of phages as a biocide against S. Infantis isolates in combination with cleaning and disinfection protocols in 10 commercial poultry farms. All commercial farms selected in this study had persistent Salmonella, even after the routinely used cleaning and disinfection procedures. In addition, Salmonella isolated before treatment were phenotypically characterized by antimicrobial resistance patterns. The results showed that 100% of S. Infantis were resistant to at least one antibiotic, and > 70% were MDR. Phages were then isolated against the in-farm bacteria, purified, and multiplied for each poultry farm. The cleaning and disinfection protocols included the application of the lytic phages (vB_Si_CECAV_FGS009; vB_Si_CECAV_FGS017; vB_Si_CECAV_FGS029 and vB_Si_CECAV _FGS030) twice at 24-h intervals between cleaning and disinfection. Following the cleaning and disinfection procedures, Salmonella detection was reduced from 100% after cleaning to 36% after applying the phages and dropped to 0% after the final step of disinfection, thus eliminating Salmonella from the farm facilities. This study demonstrates that bacteriophage application after cleaning and before disinfection enhances the removal of MDR Salmonella Infantis in commercial broiler farms, suggesting their use as biocontrol agents to reduce Salmonella, a major public health concern.

Prevalence of Helicobacter pylori infection and effectiveness of first-line triple eradication therapy among dyspeptic patients at hospitals in Hawassa City, Ethiopia: a cross-sectional follow-up study

BackgroundDyspepsia is a common gastrointestinal illness sometimes associated with Helicobacter pylori (H. pylori) infection. Screening and eradicating the bacterium reduces the risk of infection-related complications. The aim of this study was to determine the magnitude of H. pylori infection among dyspeptic patients and the effectiveness of triple eradication therapy at hospitals in Hawassa city, Ethiopia.ResultsThe prevalence of H. pylori infection was 48.5%. The H. pylori eradication rate using first-line triple therapy was 83.8%. Eradication therapy failure is associated with previous exposure compared to no exposure (AOR: 4.8, 95% CI: 1.37–10.97), a regimen for 10-days compared to 14-days (AOR: 4.05, 95% CI: 1.42–11.55), and self-reported side effects compared to no report (AOR: 2.5, 95% CI: 1.12–5.97). Based on Morisky-eight scale 230 (79.0%) patients were adherent to their triple therapy. Participants with no reports of adverse effects showed increased odds of adherence to triple therapy compared to those who had reports (AOR = 2.45, 95% CI: 1.29–4.62).ConclusionsThis study demonstrated that about half of adult dyspeptic patients were infected with H. pylori, and moderate eradication was observed. Factors such as previous history of eradication therapy, duration of the eradication regimen, and perception of potential adverse effects are associated with eradication rate and should be considered during the initiation of eradication therapy.

Aloe vera gel confers therapeutic effect by reducing pyroptosis in ethanol-induced gastric ulcer rat model: Role of NLRP3/GSDMD signaling pathway

BackgroundGastric ulcer (GU) is a common gastrointestinal tract illness. Aloe vera has anti-inflammatory, antioxidant, and healing characteristics. This research sought to explore the therapeutic impact of Aloe vera gel on ethanol-provoked GU in rats and to elucidate the underlying mechanisms involved.MethodsAn ethanol-induced GU rat model was constructed using forty male Wistar rats distributed at random into four groups: control, ulcer, pantoprazole, and Aloe vera. Gross evaluation of the stomach, ulcer index (UI), inhibition index, and gastric pH estimation were analyzed. Gastric malondialdehyde (MDA) and reduced glutathione (GSH) were determined using the spectrophotometric method, and serum gastrin level was measured by an enzyme-linked immunosorbent assay. Gastric nucleotide-binding domain, leucine-rich repeat, and pyrin domain PYD containing protein 3 (NLRP3) and gasdermin D (GSDMD) mRNA expression levels were estimated by quantitative real-time PCR. Finally, the histopathological examination of the glandular part of stomach tissue was done.ResultsThe ulcer group revealed a significant increase in MDA, gastrin, NLRP3, and GSDMD and a decrease in gastric pH and GSH compared to the control group. Gross investigations of the ulcer group revealed a hemorrhagic lesion in the stomach and an increase in UI. Also, histopathological results for this group showed severe epithelial loss, haemorrhage, inflammatory cell infiltration, and blood vessel congestion. However, Aloe vera treatment improved the gross, biochemical, molecular, and histopathological alterations induced by ethanol when compared to the ulcer group.ConclusionsAloe vera exerted antiulcer activities through modulation of oxidant/antioxidant status, anti-secretory properties, and mitigation of pyroptosis.

Travel-related giardiasis: Incidence and time trends for various destination countries.

Giardiasis is a common gastrointestinal illness in travellers. Data on the actual giardiasis risk of travellers to different travel destinations is scarce. We aim to estimate the risk of giardiasis in travellers from Germany by destination country and region. We analysed travel-related giardiasis cases, their countries and regions of exposure and the age and sex distribution of cases reported in 2014-2019 in Germany. We defined a travel-related giardiasis case as a laboratory-confirmed (i.e. positive microscopy, antigen test or nucleic acid test) symptomatic individual with outbound travel abroad within 3-25days before symptom onset. Based on the number of reported cases per exposure country and UNWTO travel data for Germany, we calculated the number of travel-related giardiasis cases per 100 000 travellers and compared the incidence in 2014-2016 and 2017-2019 to identify potential trends. In 2014-2019, 21 172 giardiasis cases were reported in Germany, corresponding to an overall incidence of 4.3 per 100 000 population. Of all cases, 6879 (32%) were travel-related with a median age of 34 (interquartile range (IQR): 25-50), 51% were male. Southern Asia was the most frequently reported exposure region and had the highest incidence in travellers (64.1 per 100 000 returning travellers) in 2017-2019, followed by Latin America (19.2) and Sub-Saharan Africa (12.9). We observed statistically significant decreasing trends for Southern Asia and Sub-Saharan Africa. Latin America was the only region with a statistically significant increasing trend. Almost one-third of recent giardiasis cases in Germany were travel-related. Giardiasis incidence in travellers differs greatly depending on the destination region. Decreasing trends in many regions might be due to improvements in food hygiene or travel conditions. Our results may inform medical consultation pre and post patient's travel.

Relationship between psychological stress with functional constipation in children: a systematic review.

constipation affects up to 29.6% of children worldwide, making it one of the most common gastrointestinal illnesses in the pediatric population. As a functional disorder, the development of constipation is mostly influenced by a child´s psychosocial condition, even considered as one of important contributing factors. This systematic review aims to evaluate the relationship between psychological stress with constipation in the pediatric population. three online databases were searched as study sources, including PubMed, the Cochrane Library, and Google Scholar. Study selection was carried out using the PRISMA diagram. Studies that met the eligibility criteria were then included in the data extraction and synthesis. The study quality assessment was done using the Joanna Briggs Institute's (JBI) critical appraisal checklist. eleven studies are included in this systematic review, consisting of four cross sectional studies, four case control studies and three cohort studies. The included studies have good quality based on the assessment. Majority of the studies showed a significant relationship between psychological stress and constipation in children. Psychological stress in children can be classified into family-related stressors, school-related stressors, exposure to stressful life events, stress related to psychological disorders, and other factors. psychological stress and burden are associated to constipation in children. To overcome functional constipation in children, a collaborative effort is required between parents, children, and the healthcare professional.

Prospective study of predictive factors for conversion of laparoscopic cholecystectomy to open surgery

Background: Gallstone diseases are a common gastrointestinal illness in the general population that frequently requires hospitalization with a prevalence of around 11% to 36% The goal of this study was to determine the conversion rate and identify the factors responsible for the conversion of laparoscopic cholecystectomy (LC) to open cholecystectomy (OC).This study intends to evaluate the causes of conversion from LC to OC and to establish the efficacy and safety of the procedure. Methods: This case series was conducted in the department of general surgery at Gujarat Adani institute of medical science, Bhuj, Gujarat from October 2018 to July 2020. Patients more than 18 years of age presenting with OPD with symptomatic gallstones and patients with acalculous cholecystitis were included in the study. Patients with dilated CBD (>8 mm in diameter), jaundice, gallbladder malignancy, and perforated gallbladder were excluded. Results: A total of 100 patients were included in the study; 68 were females and 32 were males. Eleven (11%) patients were converted to OC. The most common cause of conversion was dense adhesions followed by obscure anatomy at Calot's triangle. Other common causes were bleeding, bile leakage, visceral injuries, and instrument failure Conclusions: Most common cause of conversion from LC to OC was dense adhesions causing obscure anatomy at Calot's triangle followed by bleeding and CBD injury.

Association of histo-blood group antigens and predisposition to gastrointestinal diseases.

Infectious gastroenteritis is a common illness afflicting people worldwide. The two most common etiological agents of viral gastroenteritis, rotavirus and norovirus are known to recognize histo-blood group antigens (HBGAs) as attachment receptors. ABO, Lewis, and secretor HBGAs are distributed abundantly on mucosal epithelia, red blood cell membranes, and also secreted in biological fluids, such as saliva, intestinal content, milk, and blood. HBGAs are fucosylated glycans that have been implicated in the attachment of some enteric pathogens such as bacteria, parasites, and viruses. Single nucleotide polymorphisms in the genes encoding ABO (H), fucosyltransferase gene FUT2 (Secretor/Se), FUT3 (Lewis/Le) have been associated with changes in enzyme expression and HBGAs production. The highly polymorphic HBGAs among different populations and races influence genotype-specific susceptibility or resistance to enteric pathogens and its epidemiology, and vaccination seroconversion. Therefore, there is an urgent need to conduct population-based investigations to understand predisposition to enteric infections and gastrointestinal diseases. This review focuses on the relationship between HBGAs and predisposition to common human gastrointestinal illnesses caused by viral, bacterial, and parasitic agents.

Knockdown of TRPM7 attenuates apoptosis and inflammation in neonatal necrotizing enterocolitis model cell IEC-6 via modulating TLR4/NF-κB and MEK/ERK pathways.

Objective(s):Neonatal necrotizing enterocolitis (NEC) is the most common gastrointestinal critical illness in neonatal infants. TRPM7 reportedly plays a role in human inflammatory bowel disease (IBD) and colorectal cancer, but the role of TRPM7 in the pathogenesis of NEC remains vague.Materials and Methods:The expression of TRPM7 was determined in intestinal tissues of NEC patients and lipopolysaccharide (LPS)-induced IEC-6 cells. Subsequently, a loss-of-function assay was performed to assess the effects of TRPM7 on cell apoptosis and inflammatory response in IEC-6 cells after LPS induction. Furthermore, the modulation of TRPM7 on TLR4/NF-κB and MEK/ERK signaling pathways was validated.Results:The expression of TRPM7 was higher in the intestinal tissues of NEC patients compared with the normal human intestinal tissues. Moreover, the expression level of TRPM7 was elevated in LPS stimulation IEC-6 cells. Knockdown of TRPM7 enhanced cell viability and suppressed apoptosis, accompanied by the decreased Bax/Bcl-1 ratio and cleaved-caspase3 expression in LPS-induced IEC-6 cells. Additionally, TRPM7 silencing attenuated LPS-induced expressions and secretions of proinflammatory cytokines. Mechanistically, TRPM7 knockdown inhibited the TLR4/NF-κB activation, while enhancing the MEK/ERK activation in LPS-treated IEC-6 cells. Overexpression of TLR4 or inhibition of MEK attenuated the inhibitory effects of TRPM7 knockdown on LPS-induced apoptosis and inflammation in IEC-6 cells.Conclusion:Knockdown of TRPM7 attenuated LPS-induced IEC-6 cell apoptosis and inflammation by modulating TLR4/NF-κB and MEK/ERK pathways.

A study of factors associated with conversion of laparoscopic cholecystectomy to open cholecystectomy

Background: Gall stones are among the most common gastrointestinal illness requiring hospitalization. Laparoscopic cholecystectomy is the procedure of choice for majority of patients. Factors responsible for conversion to open cholecystectomy are adhesions, obscure anatomy at calot’s triangle, CBD injury etc. Aim was to study patients admitted in surgery department and undergoing laparoscopic cholecystectomy in GMCH, Udaipur. Primary objective was to determine factors of conversion of laparoscopic to open cholecystectomy in tertiary care center Secondary objectives were to evaluate the age, sex and etiological factors of cholelithiasis.Methods: It is a prospective observational study done in 1oo patients admitted in GMCH during January 2020 to June 2021 after informed consent and ethical clearance approval from IRRC. Patients having cholelithiasis were diagnosed with USG, MRCP and/ or ERCP and laparoscopic cholecystectomy was planned. Factors associated for conversion from laparoscopic to open cholecystectomy were studied.Results: Out of 100 patient 9 were converted to open, adhesion was the most common (8%), (2%) CBD injury, bleed of cystic artery, (1%) bowel injury, (3%) presence of unclear anatomy.Conclusions: Laparoscopic cholecystectomy is a safe and minimally invasive technique, with only low conversion rate and the commonest cause of conversion in this study was the presence of dense adhesions at Calot's triangle.

Improving Patient Adherence to Lifestyle Changes for the Management of Gastroesophageal Reflux

Gastroesophageal reflux disease (GERD) is a common gastrointestinal illness with symptoms of heartburn, chest pain, and regurgitation. Management of GERD can involve medication use, lifestyle modification (eg, dietary modification), and surgical intervention depending on the individual patient and disease severity. Poor adherence to medication and recommended lifestyle changes may result in increased symptom severity and decreased quality of life. This paper aimed to systematically review the literature on lifestyle modification for the management of GERD. Fourteen articles were included based on search criteria. Following review and analysis, three types of lifestyle modifications were present in the literature and include medication use, dietary recommendations, and sleep recommendations. Despite being a pharmacological treatment, medication adherence was included in the review, as health behavior change can be used to improve adherence. Overall, the factors associated with adherence to modifications varied in terms of impact and directionality, depending on the type of lifestyle modification. Symptom severity emerged as important across all lifestyle modifications, and is associated with increased adherence to medication use, but decreased adherence to dietary guidelines. While patient–provider communication appeared to improve patient knowledge, it is unclear if increased knowledge translates to improved adherence. The review also demonstrated a lack of clear and standardized guidelines across lifestyle modifications, which may have an influence on adherence and adherence reporting. Future research in GERD treatment adherence would benefit from the use of validated measures to assess adherence. Specific recommendations to improving patient adherence are discussed.

IS THERE STILL A DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY? — AN EXPLORATIVE AND DESCRIPTIVE STUDY TO IDENTIFY RISK FACTORS AND TO ESTABLISH A SCORING SYSTEM FOR DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY.

Background: Gallstone disease is among the most common gastrointestinal illness requiring hospitalization. Laparoscopic cholecystectomy is now the preferred approach to its treatment. When performing laparoscopic cholecystectomy, the surgeon should have the low threshold for open conversion in case of difculty. The aim of the study was Pre-operative prediction of difcult laparoscopic cholecystectomy using clinical, ultrasonographic and intraoperative parameters. Methods:This study was done on 200 patients presenting with symptomatic cholelithiasis who underwent laparoscopic cholecystectomy. A prospective analysis of parameters including the patient demographics, laboratory values, radiologic data and intraoperative parameters was performed. Results: The factors which were considered a difculty parameter were males, age>60years, preoperative ERCP, rised amylase, sonographic features of contracted or distended gallbladder and pericholecystic collection. Intraoperative parameters were adhesions around gallbladder, contracted or distended gallbladder inamed gallbladder. Conclusions: The above mentioned factors must be adequately studied and the surgeon and the patient should be prepared for difcult laparoscopic cholecystectomy.

Examination of Australian backyard poultry for Salmonella, Campylobacter and Shigella spp., and related risk factors.

Worldwide, foodborne illness is a significant public health issue in both developed and developing countries. Salmonellosis, campylobacteriosis and shigellosis are common foodborne gastrointestinal illnesses caused by the bacteria Salmonella spp., Campylobacter spp. and Shigella spp. respectively. These zoonotic diseases are frequently linked to eggs and poultry products. The aim of this study was to investigate the presence of these pathogens in Australian backyard poultry flocks and to determine risk factors for these pathogens. Poultry faeces samples were collected from 82 backyards and screened for Salmonella spp., Campylobacter spp. and Shigella spp. using qPCR. A questionnaire was administered to the backyard poultry owners to assess their knowledge regarding management of poultry and eggs and to identify potential risk factors that may contribute to the presence of zoonotic pathogens in the flocks. One composite faecal sample was collected from each backyard (82 samples). Composite sampling here means taking one or more grab samples from a backyard to make up approximately 10 grams. Four per cent of samples, that is 4% backyards tested, were positive for Salmonella spp., 10% were positive for Campylobacter spp. and none were positive for Shigella spp. A higher infection rate was seen in multi-aged flocks (24%) compared with the single-aged flocks (3%). The survey found that many participants were engaging in risky food safety behaviours with 46% of participants responding that they washed their eggs with running water or still water instead of wiping the dirt off with a damp cloth to clean the eggs and 19% stored their eggs at room temperature. This study demonstrated that backyard poultry may pose a potential risk for salmonellosis and campylobacteriosis. Additionally, Australian public health and food safety regulations should be modified and effectively implemented to address the risks associated with backyard poultry husbandry.

A Cross-sectional Study to Estimate the Prevalence of Dyslipidaemia in Patients with Cholelithiasis

Introduction: Gallstones are one among the common gastrointestinal illness requiring hospitalisation and frequently occur in middle- aged otherwise healthy people with a prevalence of 10 to 15%. Women are more frequently affected than men. Most patients remain asymptomatic from their gallstones and remain silent throughout life. One major factor contributing to cholesterol stone formation is high concentration of cholesterol and lipids in bile secretion from liver. Changes in human behaviour and lifestyle over the last few decades have resulted in a dramatic increase in the incidence of dyslipidaemia and gallstone disease worldwide. Aim: To estimate the prevalence of dyslipidaemia in patients with gallstones. Materials and Methods: A cross-sectional study was done on 82 patients who were admitted in a tertiary care centre with gall stone confirmed by ultrasound abdomen, during the period between November 2016 to October 2017. Patients with dyslipidaemia taking medicine were excluded. Data were entered in structured data sheet which includes all the variables and results were expressed in frequency and percentage. Results: Forty-two patients were found to have dyslipidaemia and the prevalence was found to be 51.2%. Maximum prevalence of cholelithiasis was found in the 41-50 years age group (58.5%). Fifty-six were females (68.3%). Twenty-four patients had very high Serum Low Density Lipoprotiens (LDL) levels. Twenty-three had high levels of Triglycerides (TG) (28%). Six had very low High Density Lipoprotein (HDL) level (7.3%). Conclusion: The prevalence of dyslipidaemia estimated was 51.2%. Of the fractions of serum lipids, the LDL and triglycerides level elevations was more commonly detected in patients with gall stone.

The effects of diabetes mellitus on clinical outcomes of hospitalized patients with acute diverticulitis.

Acute diverticulitis is a common gastrointestinal illness due to diverticular inflammation and focal necrosis. Diabetes mellitus has been reported to influence the outcomes of patients with diverticular disease. Our study aimed to examine the inpatient outcomes and complications of patients with acute diverticulitis and coexisting diabetes mellitus. The Nationwide Inpatient Sample was used to identify adult patients in 2014 admitted for acute diverticulitis. Primary outcomes were mortality, length of stay (LOS), and total hospitalization charges. Secondary outcomes were complications of acute diverticulitis and interventions. In total, 44 330 of patients with acute diverticulitis and diabetes mellitus were included in the analysis. Acute diverticulitis patients with diabetes mellitus had a higher rate of diverticular bleeding (P < 0.0001), but lower rates of abscess (P < 0.0001), obstruction (P < 0.0001) and colectomy (P < 0.0001) when compared to acute diverticulitis patients without diabetes mellitus. Complicated diabetes mellitus was associated with a longer LOS (P = 0.00003) and greater total hospitalization charges (P = 0.0021) compared to uncomplicated diabetes mellitus when coexisting with acute diverticulitis. Acute diverticulitis with diabetes mellitus is associated with a higher rate of diverticular bleeding, lower rates of abscess, obstruction, and colectomy compared to acute diverticulitis without diabetes mellitus. When coexisting with acute diverticulitis, complicated diabetes mellitus is not associated with higher rates of mortality or diverticulitis-related complications compared to uncomplicated diabetes mellitus.

A107 PATIENT PERSPECTIVES ON THE LONG-TERM MANAGEMENT OF CELIAC DISEASE

Abstract Background Celiac disease (CD) is a common chronic gastrointestinal illness with a range of manifestations. The only available treatment is strict gluten avoidance, therefore patients are effectively self-managed. Despite the critical role patients play in their treatment, patient perspectives on long-term CD care have not been formally assessed and are therefore not represented in current clinical guidelines. Aims To determine the opinions of CD patients on the need for long-term CD follow-up, the utility of various aspects of CD follow-up, and the areas in which further information is desired. Methods The Manitoba Celiac Disease Cohort includes newly diagnosed adults with elevated TTG and/or EMA antibodies and Marsh III histology. At the 24-month follow-up visit, participants were asked to rate the utility of various aspects of CD care from 1–5 (low-high) and their desire for further information on CD-related issues from 1–6 (low-high). Results A total of 213 patients were recruited and 137 participants completed the online survey (median age 41 [interquartile range 29–57] years; 68% female). Adherence to a gluten free diet was variable, with 29% of patients having TTG antibodies above the upper limit of normal. Two-thirds of participants felt they should be seen regularly for their celiac disease, while 79.8% of those who wished to be followed felt they should be seen every 6–12 months. Blood tests were the most highly rated component of CD care (scored ≥4 by 78% of respondents). Celiac symptom review, information on research in celiac disease, and the opportunity to ask questions about vitamins and supplements were also positively regarded. Diet review was not generally considered helpful. 79% of patients desired further information on research in CD, while approximately 60% desired information on the long-term complications of CD and the risk of nutritional deficiencies. Conclusions The majority of CD patients find regular specialist follow-up helpful, particularly for biochemical assessment of disease activity and its complications. Further information on CD research and the long-term complications of CD should be addressed in follow-up visits. These aspects of follow-up care should be reflected in future guidelines. Funding Agencies None

Colitis: Infectious, Ischemic, and Toxic Megacolon

Colitis is a common gastrointestinal illness that carries high morbidity and mortality in critically ill patients admitted to the intensive care unit. In critically ill patients, colitis can be a primary process or secondary result from their presenting illness. The etiology of the colitis ranges from infectious (bacterial, viral, and the most common gastrointestinal infection hospitalized patients Clostridium difficile), ischemic insult (both occlusive and nonocclusive disease), and finally inflammatory bowel disease. This chapter goes over the background, work-up and diagnosis, and finally treatment options and strategies for the most common etiologies that afflict this population of severely ill patients. This review contains 3 figures, 6 tables, and 79 references. Keywords:colectomy, colitis, diarrhea, fecal transplant, hematochezia, ischemia, inflammation, vancomycin, Clostridium difficile

Resistance towards metronidazole in Blastocystis sp.: A pathogenic consequence.

Blastocsytis sp. is a protozoan parasite that has been linked to common gastrointestinal illnesses. Metronidazole, the first line therapy, was reported to show frequent inefficacy. Previously, Blastocystis sp. isolated from different population showed varying metronidazole resistance. However, the effect of metronidazole treatment on pathogenic potentials of Blastocystis sp. isolated from different populations, which is known to have different gut environment, is unclear. This study investigates the in vitro effect of metronidazole on the pathogenic potentials of Blastocystis sp. isolated from urban and orang asli individuals. Blastocystis sp. ST 3 isolated from symptomatic and asymptomatic individuals were treated with a range of metronidazole concentration. The parasites’ growth characteristics, apoptotic rate, specific protease activity and the ability to proliferate cancer cells were analyzed upon treatment with 0.001 mg/l metronidazole. The study demonstrates that Blastocystis sp. isolates showed increase in the parasite numbers especially the amoebic forms (only in urban isolates) after treating with metronidazole at the concentration of 0.001 mg/ml. High number of cells in post-treated isolates coincided with increase of apoptosis. There was a significant increase in cysteine protease of Blastocystis sp. isolates upon treatment despite the initial predominance of serine protease in asymptomatic isolates. Metronidazole resistant Blastocystis sp. also showed significant increase in cancer cell proliferation. Resistance to metronidazole did not show significant different influence on the pathogenicity between Blastocystis sp. isolated from urban and orang asli individual. However, an increase in parasite numbers, higher amoebic forms, cysteine protease and ability to proliferate cancer cells implicates a pathogenic role. The study provides evidence for the first time, the effect of metronidazole towards enhancing pathogenic potentials in Blastocystis sp. when isolated from different gut environment. This necessitates the need for reassessment of metronidazole treatment modalities.

English

Indomethacin is commonly used as an anti-inflammatory and pain relieving medication; however, it has the side effect of gastric ulcer formation which is an actual common gastrointestinal illness that may result in dangerous complications and even death. Various diseases have been treated widely by the use of oriental herbal medicines, this study aims to evaluate the antiulcerative and antioxidative effect of two doses (100 and 50 of Moringa oleifera ethanolic leaf extract; MOELE) on indomethacin plus ethanol-induced oxidative gastric mucosal injury in rats. Sixty adult males Wistar rats weighing 170 to 200 g, were divided into equal six groups. First group of rats were administered saline as a vehicle, second group of rats were given indomethacin (15 mg/kg), third and fourth groups of rats were giving MOELE 100 and 500 mg, fifth group of rats were given indomethacin+ MOELE 100 mg, and sixth group of rats were administered with indomethacin + MOELE (500 mg). To study the effect of MOELE on oxidative gastric mucosal injury in rats, two doses were administered 2 h before ulcer induction by indomethacin plus ethanol. The administration continued for two weeks. All rats were sacrificed 24 h after the last dose. Indomethacin group showed significant increases in lesion index (LI) and increase in malondialdehyde (MDA) level, while there was a decrease in superoxide dismutase (SOD), glutathione-S-transferase (GST) and glutathione peroxidase (GPx) activities when compared with the control group (G1). MOELE with two doses mentioned before (groups 5 and 6) were effective to reduce stomach LI and oxidative stress markers (MDA) while increasing significantly the antioxidant biomarkers (SOD, GST, and GPx) compared with indomethacin group (G2). A highly significant decrease in MDA accompanied by a marked increase in SOD, GST, and GPx were recorded in group 6. The results concluded that MOELE has an effective antiulcer and antioxidant activities. It can scavenge the free radicals and protect gastric against ulceration. Also, MOELE could ameliorate the ulcerative side effect of indomethacin. Key words: Moringa oleifera, antioxidant enzymes, indomethacin, lesion index, lipid peroxidation.

Comparison between early and late cholecystectomy after gallstone pancreatitis

Acute biliary pancreatitis is one of the most common gastrointestinal illnesses necessitating inpatient hospital admission. With an increasing incidence of gallstone disease, in the setting of a changing healthcare landscape, surgical indications must be carefully examined. The principles of management, including common duct clearance, bowel rest, and interval cholecystectomy to avoid recurrent disease have not changed, however with the refi nement of minimally invasive techniques, timing of intervention deserves re-examination. We seek to make evidence based recommendations on the timing of cholecystectomy following acute biliary pancreatitis.

Meta-analysis of staphylococcal diarrhea in some developing African countries

Staphylococcal diarrhea is a common gastro-intestinal illness caused by poor water supply and unhygienic food preparation. Although, about 70% of diarrheal cases per year have been attributed to the consumption of contaminated foods, in Africa, few studies have reported the incidence of Staphylococcus-related diarrhea and the implicated virulence factors. We investigated the implications of common factors such as age of children, age of mothers, maternal level of education, gender of children, overall bacteria isolated, sanitary condition status and feeding type of mothers on the burden of staphylococcal diarrhea. A literature search was performed using Pubmed, Googlescholar, American society for microbiology (ASM) journals and other sources. The quality of studies was assessed. Adjusted odds ratios with 95% confidence intervals (CI) for the occurrence of Staphylococcus aureus amongst other causes were extracted. For each study, a multivariate logistic regression analysis of the adjusted odds ratio was performed to identify the risk factors on the burden of staphylococcal diarrhea. Six case-control studies were included in the meta–analysis. Quality of individual studies rages from 0.57–0.84 (median, 0.69). meta-analysis gave pooled odds ratios 3.27 (95% CI; 2.88–4.17). The results identified inadequate sanitary conditions and type of feeding as major risk factors.