Episodes Of Diarrhea Research Articles

Diarrheal disease and associations with water access and sanitation in Indigenous Shawi children along the Armanayacu River basin in Peru.

Diarrheal disease, particularly in children under 5 years old, remains a global health challenge due to its high prevalence and chronic health consequences. Public health interventions that reduce diarrheal disease risk include improving access to water, sanitation, and hygiene. Although Peru achieved the 2015 Millennium Development Goal (MDG) indicators for water access, less progress was achieved on sanitation. Furthermore, many Indigenous Peoples were overlooked in the MDG indicators, resulting in a prioritization of Indigenous Peoples in the 2030 Sustainable Development Goals (SDGs). This study aimed to estimate the prevalence of childhood diarrhea, characterize access to water and sanitation, and determine the association of childhood diarrhea with water access and sanitation indicators in 10 Shawi Indigenous communities along the Armanayacu River in the Peruvian Amazon. A cross-sectional survey (n=82) that captured data on diarrheal disease, sociodemographic variables, and water and sanitation exposures was conducted in 10 Shawi communities. Nutritional status of children under 5 was also assessed via physical examination. Descriptive and comparative statistics were conducted. A small proportion (n=7; 8.54%) of participating children reported an episode of diarrhea in the previous month. Almost half (46.30%) of participating children had stunting, wasting, or both. Although not statistically significant, children living in households that used latrines were 4.29 times (95% confidence interval (CI) 1.01-18.19) more likely to report an episode of diarrhea than children living in households that practiced open defecation. Although not statistically significant, children living in households that used water treatment methods were 4.25 times (95%CI 0.54-33.71) more likely to report an episode of diarrhea than children living in households that did not. The prevalence of childhood diarrhea was lower for Shawi than for other Amazon areas. The higher prevalence of childhood diarrhea in households that used latrines and water treatments warrants further investigation into local risk and protective factors. These Shawi communities scored low for the WHO/UNICEF Joint Monitoring Programme indicators for water and sanitation, indicating that they should be prioritized in future water, sanitation, and hygiene initiatives. Research will be required to understand and incorporate local Indigenous values and cultural practices into water, sanitation, and hygiene initiatives to maximize intervention uptake and effectiveness.

Pellagra A forgotten sporadic clinical entity in primary health care

A 45- year- old male from an urban community, laborer, heavy alcohol consumer, exclusively on rice diet presented to outpatient department in primary health care centre with chronic diarrhea for three months. He was treated multiple times with antibiotics with no improvement. There was no family history of similar illness. He had normal vital signs and mental state. On general examination, he had typical sharply marginated symmetrical scaly hyperpigmented plaques in sun exposed areas of his forearms and hands and necklace pattern of erythematous scaly plaque around the neck popularly known as Casal’s necklace as described in figure 1. The clinical background and dermatological pattern was sufficient enough to initiate treatment of pellagra with oral Niacin 300 mg daily and vitamin B complex. He had dramatic improvement in his episodes of diarrhea. He had gradual recovery in dermatitis.

Evaluation of the frequency of gastrointestinal adverse events associated with the use of prolonged-release metformin hydrochloride

Diabetes mellitus is defined by hyperglycemia resulting from impaired insulin action or distress, or both. Metformin is widely prescribed to control the disease and the most common adverse events caused by its use are diarrhea, nausea and/or abdominal discomfort. We evaluated the frequency profile of gastrointestinal adverse events associated with the use of metformin. This is a cross-sectional observational study, in which the occurrence of diarrhea in patients with type 2 diabetes mellitus who started treatment with metformin hydrochloride at a dose of 500 mg of prolonged release was reported. 12 (41.37%) participants were male and 17 (58.62%) were female. Diarrhea was present (n=16) in more than half of the patients (55.2%) who used the drug. Patients had an average of 12 episodes of diarrhea per month. There was also the presence of abdominal discomfort (n=7), in which 24.1% reported being very high. The study showed that the extended-release drug metformin hydrochloride 500 mg can cause gastrointestinal adverse events at the start of treatment and lasts for approximately twelve days.

Determinants Of Preventing Diarrhea in Children in Siulak Gedang Puskesmas In 2022

Background: Diarrhea is a condition marked by changes in the shape and content of watery feces. It can also be accompanied by vomiting and bloody stools. Especially in the first three years of life, when the child may experience one to three episodes of severe diarrhea, this disease frequently affects children under the age of five. Aims: This study's objective was to determine the relationship between education level, knowledge, and attitudes of mothers in preventing diarrhea in toddlers in the working area of the Siulak Gedang Public Health Center, Kerinci Regency, 2022. Method: This kind of study is quantitative, cross-sectional, and uses 96 samples as its sample size. The Siulak Gedang Health Center in Kerinci Regency's operational region served as the site of this study. Proportional Random Sampling is the method of sampling. Without taking into account the strata in the population, proportional random sampling is a technique for taking samples at random. Results: According to the study's findings, 56.3% of people engage in effective actions for preventing diarrhea. According to statistical analyses, knowledge (0.000) and attitude (0.000) are the two factors that mothers' conduct in preventing diarrhea is connected with (0.000). Additionally, there is no connection between behavior used to prevent diarrhea and education level (0.338). Conclusion: There are relationship between the knowledge and attitudes of mothers with the prevention of diarrhea in children under five in the working area of the Siulak Gedang Health Center, Kerinci Regency.

Collagenous Colitis associated with Celiac Disease

Introduction: Microscopic colitis is an inflammatory GI condition whereby patients present predominantly with chronic watery diarrhea associated with other non-specific symptoms such as abdominal pain, urgency, fecal incontinence, weight loss, arthralgia, myalgia, anxiety, depression, and fatigue, which negatively impact their quality of life. Case Presentation: We present a case of a 44 -year old female with a history of hypothyroidism and celiac disease who presented to the GI clinic with a history of more than ten diarrhea episodes per day along with mild abdominal pain and bloating. Conclusion: A colonoscopy was performed, and a random colon biopsy revealed collagenous/microscopic colitis.

Prevalence and factors associated with undernutrition among children under the age of five years in Benin.

Benin ranks as one of the countries in the world with an alarmingly high prevalence of stunting, wasting, and underweight in children under five years. However, limited studies have examined the factors associated with the prevalence of these undernutrition indicators among children under five years in the country. This study aimed to fill this research gap by examining the prevalence rates and factors associated with stunting, wasting, and underweight among this specific population of interest. This quantitative study utilised data from the most recent Benin Demographic and Health Survey (BDHS) conducted in 2017-18. The survey employed a nationally representative cross-sectional design and utilised a two-stage stratified cluster sampling technique to select participants. The study included a sample of 13,589 children under the age of five years. The main analytical approach employed was binary logistic regression, which was used to explore the associations between undernutrition (the combined outcome variable representing stunting, wasting, and underweight) and various socio-demographic factors. The combined prevalence of stunting, wasting, and underweight among children under five years in Benin during the 2017-18 survey period was 14.95%. Several factors were significantly associated with these indicators of undernutrition, including female gender (AOR = 0.71, 95% CI = 0.59-0.85), birth weight of 4.1 kg and over (AOR = 0.26, 95% CI = 0.14-0.48), multiple births (AOR = 3.22, 95% CI = 2.11-4.91), and a child's experience of diarrhoea (AOR = 1.76, 95% CI = 1.40-2.20). Furthermore, the prevalence of these undernutrition indicators was higher among children whose mothers had lower levels of education (AOR = 0.82, 95% CI = 0.01-0.42) and were unmarried (AOR = 0.67, 95% CI = 0.49-0.93). This present study confirms that undernutrition rates are elevated in Benin and are closely linked to perinatal factors such as birth weights and multiple births, postnatal health conditions including diarrheal episodes, and socio-demographic determinants such as a child's gender, maternal education level, and marital status. Therefore, there is the need to consider specific modifiable factors, such as low birth weight, episodes of child diarrhoea, and maternal education as priority targets for child nutrition interventions in Benin.

Medication adjustment of afatinib and combination therapy with sitagliptin for alleviating afatinib-induced diarrhea in rats

Afatinib, as the first-line treatment for non-small cell lung cancer (NSCLC), causes severe gastrointestinal adverse reactions that greatly affect patients' quality of life and even potentially result in treatment discontinuation. Multiple dose adjustments and concomitant use of anti-diarrheal medications are commonly employed to manage diarrhea, also allowing for a recovery period between each adjustment. However, these approaches are based on empirical guidance and still have limitations. This study aims to explore reliable approaches to alleviate diarrhea by focusing on two strategies: adjusting the dosing regimen of afatinib itself and implementing combination therapy. In this study, we firstly revealed a dose-dependent relationship between afatinib-induced diarrhea and gastrointestinal epithelial damage, resulting in atrophy, reduced expression of tight junction proteins, and increased permeability. We further found that even after discontinuation of the medication, although the severity of diarrhea had improved to baseline, the tight junction proteins and permeability of the intestinal epithelium did not fully recover, and the pharmacokinetics studies showed that drug absorption significantly increased than normal. This indicated the recovery period was longer than expected and may accelerate the occurrence of subsequent episodes of diarrhea. Hence, it would be prudent to consider adjustments to the starting dose or the recovery interval. Furthermore, we initially investigated the relationship between DPP enzyme and afatinib-induced diarrhea and found a significant decrease in plasma DPP enzyme activity following afatinib-induced diarrhea. Subsequently, we conducted continuous treatment with sitagliptin and observed significant improvement in afatinib-induced diarrhea. We observed that sitagliptin can promote the production of anti-inflammatory factors, increase the expression of intestinal epithelial tight junction proteins, and improve intestinal microbiota, further validating the mechanism through the use of GLP-23-33 as GLP-2 receptor inhibitor. In conclusion, sitagliptin exhibits promising potential as a therapeutic option for managing afatinib-induced diarrhea. Taken together, our study provides valuable insights into alleviating afatinib-induced diarrhea through both afatinib medication adjustment and sitagliptin combination therapy.

A study on relationship between protein-energy malnutrition and other morbidities among under-five children in a rural area of Hooghly district, West Bengal

Background: Malnutrition affects physical growth, morbidity, and mortality of the under-five children. It is an underlying factor in many diseases for children and is particularly prevalent in developing countries, where it affects one out of every three preschool-age children. Aims and Objectives: The aims of this study were to find out the relationship between protein-energy malnutrition and other morbidities among under-five children. Materials and Methods: Community-based prospective longitudinal study was conducted in 1 year duration in a rural area of Hooghly District, West Bengal. By adopting sample size calculation formula 4 pq/L2, total 108 children were participated in the study. With the help of pre-design, pre-tested schedule data were collected by interviewing the care giver, by clinical and anthropometry examination of the children and by record review. Results: Among the study population under-weight, stunted, and wasted were 52%, 37%, and 28%, respectively, whereas malnutrition by all types of classification was 61%. Episode of diarrhea, acute respiratory infections (ARI), and worm infestation were 3.50, 4.12, and 1.38/child/year, respectively. Study shows that rate of total morbidities and prevalence of malnutrition was very much interrelated. Conclusion: Prevalence of malnutrition along with diarrhea, ARI, and worm infestations is common ailments among rural population. Special emphasis should be given for provision of health-care services and promotion and protection of optimal infant feeding practices for the improvement of nutritional as well as health status of the children.

Post-infectious irritable bowel syndrome after intercontinental travel: a prospective multicentre study.

By longitudinally following a large cohort of intercontinental travellers, this study highlights the importance of considering multiple risk factors to comprehend post-infectious Irritable Bowel Syndrome (PI-IBS). Stomach cramps, antibiotic use and nausea during travel were among the variables that predicted PI-IBS development following an episode of traveller's diarrhoea.

Briefly about Ulcerative Colitis

Ulcerative colitis is a chronic disease in which the colon is inflamed and full of ulcers, leading to episodes of bloody diarrhea, abdominal cramps, and fever. Ulcerative colitis can start at any age, but it usually starts between the ages of 15 and 30. A small group of people have their first seizure between the ages of 50 and 70. Unlike Crohn's disease, ulcerative colitis usually does not involve the full thickness of the intestine and never affects the small intestine. The disease usually begins in the rectum or sigmoid colon and eventually spreads partially or completely through the colon.

Are non-lactose-fermenting Escherichia coli important diarrhoeal pathogens in children and adults?

Diarrhoeagenic Escherichia coli (DEC) remains one of the major causes of acute diarrhoea episodes in developing countries. The percentage of acute diarrhoea cases caused by DEC is 30-40 % in these countries. Approximately 10% of E. coli isolates obtained from stool specimens have been reported to be non-lactose-fermenting (NLF). The available literature is sparse regarding the pathogenicity of NLF E. coli causing infectious diarrhoea. We aimed to elucidate the importance of NLF E. coli in causing diarrhoea in both adults and children by detecting various DEC pathotypes among NLF E. coli in stool samples taken from gastroenteritis cases. A total of 376 NLF E. coli isolates from 3110 stool samples from diarrhoea/gastroenteritis patients were included in the study. Up to three NLF colonies that were not confirmed as Vibrio cholerae , Aeromonas spp., Salmonella spp. or Shigella spp., but were identified as E. coli using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF), were carefully picked up from each MacConkey agar plate and then meticulously streaked onto freshly prepared, sterilized nutrient agar plates, and biochemical reactions were conducted. Multiplex PCR was conducted for the EAEC, EPEC, ETEC and EHEC pathotypes and PCR for the ipaH gene was conducted for EIEC. The disc diffusion method was used for antibiotic sensitivity testing. Using multiplex PCR and ipaH PCR, a total of 63 pathotypes of DEC were obtained, with EAEC being the most predominant (n=31) followed by EIEC (n=22), EPEC (n=8) and ETEC (n=2). To further differentiate EIEC from Shigella , additional biochemical tests were performed, including acetate utilization, mucate and salicin fermentation, and aesculin hydrolysis. Antimicrobial susceptibility testing (AST) showed that maximum resistance was seen against ciprofloxacin (82.5 %) followed by ampicillin (77.8 %) and cotrimoxazole (68.2 %), and minimum resistance was seen against ertapenem (4.8 %). In our study two pathotypes (EAEC, EIEC) were predominant among NLF E. coli and these were not only important aetiological agents in children, but also in adults. Our study also sheds light on the epidemiology of EIEC, which is one of the most neglected DEC pathotypes, as hardly any microbiological laboratories process NLF E. coli for EIEC.

A Comparison of Pathogen Detection and Risk Factors among Symptomatic Children with Gastroenteritis Compared with Asymptomatic Children in the Post-rotavirus Vaccine Era

To describe demographics, pathogen distribution/seasonality, and risk factors in children seeking care for acute gastroenteritis (AGE) at a midwestern US emergency department during 5 postrotavirus vaccine years (2011-2016), and further, to compare the same data with matched healthy controls (HC). AGE and HC participants <11years old enrolled in the New Vaccine Surveillance Network study between December 2011 to June 2016 were included. AGE was defined as ≥3 diarrhea episodes or ≥1 vomiting episode. Each HC's age was similar to an AGE participant's age. Pathogens were analyzed for seasonality effects. Participant risk factors for AGE illness and pathogen detections were compared between HC and a matched subset of AGE cases. One or more organisms was detected in 1159 of 2503 children (46.3%) with AGE compared with 99 of 537 HC (17.3%). Norovirus was detected most frequently among AGE (n=568 [22.7%]) and second-most frequently in HC (n=39 [6.8%]). Rotavirus was the second most frequently detected pathogen among AGE (n=196 [7.8%]). Children with AGE were significantly more likely to have reported a sick contact compared with HC, both outside the home (15.6% vs 1.4%; P<.001) and inside the home (18.6% vs 2.1%; P<.001). Daycare attendance was higher among children with AGE (41.4%) compared with HC (29.5%; P<.001). The Clostridium difficile detection rate was slightly higher among HC (7.0%) than AGE (5.3%). Norovirus was the most prevalent pathogen among children with AGE. Norovirus was detected in some HC, suggesting potential asymptomatic shedding among HC. The proportion of AGE participants with a sick contact was approximately 10 times greater than that of HC.

Risk factors for complicated course and recurrence of Clostridioides Difficile infections during COVID-19 pandemic.

The primary symptom of Clostridioides difficile infection (CDI) is diarrhea of varying severity. Both malnutrition and clinical nutrition increase the risk for contracting Clostridioides difficile (C. difficile) infection and the likelihood of relapses. Moreover, the risk for recurrence is higher if there is infection with a hypervirulent strain (NAP1/BI/027). Hypoalbuminemia predisposes to a severe course of the disease and morbidity. Analysis was carried out of the data regarding patients hospitalized at the Regional Hospital for Infectious Diseases in Warsaw from 01 January 2020 to 31 December 2021 who were diagnosed with C. difficile infection. A severe course of infection was diagnosed when a blood test showed a leukocyte count greater than or equal to 15,000/μl and/or a creatinine concentration >1.5 mg/dl (>132.6 mmol/l). Clostridioides difficile infection was the reason for 185 hospitalizations (involving 108 women and 77 men), of 167 patients aged from 22 to 93 years old. There were 68 (37%) cases of recurrent infection. Seventy-five (41%) infections met the study's criteria for severe CDI, and 12 (7%) patients died. Out of the total number of hospitalizations, 41 (22%) were due SARS-CoV-2 co-infection. PCR tests detecting binary toxin revealed 34 (18%) positive results. Infection with a hypervirulent strain was an independent risk factor for the recurrence of diarrhea which had C. difficile etiology. Overall, during an episode of diarrhea, one antibacterial drug was used in 139 cases (75%), two in 27 (15%), three in 14 (8%) situations, and four - twice (1%). Among these, drugs not recommended for the treatment of CDI were used in 21 (11%) cases. The number of antibacterial drugs administered during an episode of diarrhea was an independent risk factor for the death of the infected person. Clinical nutrition was applied during 19 hospitalizations (10%), out of which 12 (63%) cases showed a severe course of C. difficile infection, while four patients (21%) died. Using clinical nutrition methods was an independent risk factor for a severe course of the disease and patient death. Clinical nutrition and the number of antibiotics used during an episode of diarrhea are independent risk factors for the death of a patient with CDI. Infection with a hypervirulent strain increases the risk for relapse.

Prevalence, potential determinants, and treatment-seeking behavior of acute respiratory infection among children under age five in India: Findings from the National Family Health Survey, 2019-21

BackgroundAcute respiratory infections (ARI) are a major cause of mortality and morbidity among under-five children worldwide, particularly in developing countries. Current evidence using nationally representative data on determinants and care-seeking behavior for ARI is limited in the Indian context. Hence, the present study complements the existing literature by examining the prevalence, determinants, and health-care-seeking behavior regarding ARI among Indian children under age five.Study designCross-sectional study.MethodsThe data for the present study were drawn from the fifth round of the National Family Health Survey (NFHS-5) conducted in 28 states and 8 union territories of India in 2019-21. A total of 222,233 children age less than five years were selected to estimate the prevalence and determinants of ARI, and 6198 children having ARI were selected to explore the treatment-seeking behavior. Bivariate analysis and multivariable binary logistic regression analysis were employed.ResultsAmong children under five years, 2.8% suffered from ARI in the two weeks preceding the survey, and 56.1% sought treatment for ARI. Younger age, a recent episode of diarrhea, maternal asthmatic history, and tobacco smoke exposure in the household increase the risk of having ARI. Further, having a separate room as a kitchen in the household reduces the likelihood of having ARI by 14% (AOR: 0.86; CI: 0.79–0.93). Female children (AOR: 0.88; CI: 0.77-1.00) and children belonging to households having difficulty in accessing transport to health facility (AOR: 0.83; CI: 0.69–0.99) are less likely to seek treatment.ConclusionThe study identified several socio-demographic, maternal, and household characteristics associated with ARI and treatment seeking for ARI. The study also recommends making health centers more accessible to the people in terms of proximity and cost.

Impact of a prospective audit and feedback antimicrobial stewardship programme on carbapenem consumption: a quasi-experimental study (IPANEMA study).

To test the hypothesis that a prospective audit and feedback (PAF) intervention combined with electronic tools will reduce carbapenem use without negatively affecting patient outcomes. A quasi-experimental, pre-intervention and intervention study was performed conducted in the urology department of a university hospital. The intervention involved implementing a PAF within an antimicrobial stewardship programme with the aid of an electronic tool. The primary outcome was carbapenem use, assessed by DDD/100 patient-days (PD). Secondary outcomes included evaluating the effect of the intervention on overall antibiotic use measured by DDD/100 PD and days of therapy (DOT)/100 PD, as well as patient safety. The chi-squared test or t-test was used, and the Poisson model was employed to assess the association between the intervention and outcomes. A 9% decrease in carbapenem DDD/100 PD was observed during the intervention period (IR = 0.91; 95% CI = 0.85-0.97, P = 0.007). The proportion of patients who received carbapenem treatment dropped from 17.8% to 16.5% [incidence ratio (IR) = 0.95; 95% CI = 0.86-2.05, P = 0.31]. Carbapenem DOT/100 PD decreased from 12.4 to 11.0 (IR = 0.89; 95% CI = 0.83-0.94, P < 0.001). Overall antibiotic DDD/100 PD decreased by 3% (IR = 0.97; 95% CI = 0.94-0.99, P = 0.001) and DOT/100 PD by 7% (IR = 0.93; 95% CI = 0.91-0.95, P < 0.001). The incidence of infections caused by carbapenemase-producing microorganisms, Enterococcus faecium bacteraemia and Clostridioides difficile-associated diarrhoea episodes was similar in the pre-intervention and intervention periods. ESBL incidence rate decreased, but the differences were not statistically significant (3.94/1000 PD versus 2.88/1000 PD, P = 0.111). Length of hospital stay, in-hospital all-cause mortality, and 30 day readmission incidence remained unchanged. The implementation of PAF combined with an electronic tool was an effective and safe intervention for reducing carbapenem use.

Faecal microbiome transplantation improves clinical signs of chronic idiopathic large bowel diarrhoea in working dogs.

Chronic diarrhoea is a common clinical sign in dogs with chronic enteropathy, and psyllium husk has been shown to improve clinical signs in affected dogs. The aim of this study was to investigate whether faecal microbiome transplant has a similar effect in alleviating clinical signs in dogs with chronic large bowel diarrhoea. Thirty large-breed working dogs with chronic large bowel diarrhoea were divided into a psyllium group (PG) and a faecal microbiome transplant group (FMTG). To the PG, 16g/day of psyllium husk was administered for 30 days. The FMTG received faecal microbiome transplantation (FMT) once via enema. A daily log of faecal characteristics was kept, and the dogs' canine inflammatory bowel disease index (CIBDAI) and body condition scores (BCS) were determined. A Wilcoxon-Mann-Whitney test was used to compare group results. In addition, the Kaplan-Meier test was used to evaluate the occurrence rate of 1 day or more of diarrhoea and 2 days or more of diarrhoea by day 30. The sample had a mean age of 3.9±2.1 years and a bodyweight of 25.3±6.8kg. The FMTG showed a more rapid onset of CIBDAI improvement but no difference in other measures. At 30 days, the FMTG showed a greater improvement in bodyweight and BCS, but no differences were observed in faecal scores, defaecation frequency and time of appearance of episodes of diarrhoea. Time played a significant positive role in the results observed across both groups (p < 0.05). This study did not compare the microbiomes of the dogs before and after treatment, so the role of specific types of bacteria cannot be determined. Psyllium husk and FMT had similar effects in improving clinical signs of chronic large bowel diarrhoea.

Web-Based Knowledge Translation Tool About Pediatric Acute Gastroenteritis for Parents: Pilot Randomized Controlled Trial.

Acute gastroenteritis (AGE) in children is a leading cause of emergency department (ED) visits, resulting in substantial health care costs and stress for families and caregivers. The majority of pediatric AGE cases are caused by viral infections and can be managed at home using strategies to prevent dehydration. To increase knowledge of, and support health decision-making for, pediatric AGE, we developed a knowledge translation (KT) tool (fully automated web-based whiteboard animation video). The aim of this study was to assess the potential effectiveness of the web-based KT tool in terms of knowledge, health care decision-making, use of resources, and perceived benefit and value. A convenience sample of parents was recruited between December 18, 2020, and August 10, 2021. Parents were recruited in the ED of a pediatric tertiary care hospital and followed for up to 14 days after the ED visit. The eligibility criteria included parent or legal guardian of a child aged <16 years presenting to the ED with an acute episode of diarrhea or vomiting, ability to communicate in English, and agreeable to follow-up via email. Parents were randomized to receive the web-based KT tool (intervention) about AGE or a sham video (control) during their ED visit. The primary outcome was knowledge assessed before the intervention (baseline), immediately after the intervention, and at follow-up 4 to 14 days after ED discharge. Other outcomes included decision regret, health care use, and KT tool usability and satisfaction. The intervention group participants were invited to participate in a semistructured interview to gather additional feedback about the KT tool. A total of 103 parents (intervention: n=51, 49.5%, and control: n=52, 50.5%) completed the baseline and postintervention assessments. Of these 103 parents, 78 (75.7%; intervention: n=36, 46%, and control: n=42, 54%) completed the follow-up questionnaire. Knowledge scores after the intervention (mean 8.5, SD 2.6 vs mean 6.3, SD 1.7; P<.001) and at follow-up (mean 9.1, SD 2.7 vs mean 6.8, SD 1.6; P<.001) were significantly higher in the intervention group. After the intervention, parents in the intervention group reported greater confidence in knowledge than those in the control group. No significant difference in decision regret was found at any time point. Parents rated the KT tool higher than the sham video across 5 items assessing usability and satisfaction. The web-based KT tool improved parental knowledge about AGE and confidence in their knowledge, which are important precursors to behavior change. Further research is needed into understanding what information and delivery format as well as other factors influence parents' decision-making regarding their child's health. ClinicalTrials.gov NCT03234777; https://clinicaltrials.gov/ct2/show/NCT03234777. RR2-10.1186/s40814-018-0318-0.

Persisting symptoms after Cryptosporidium hominis outbreak: a 10-year follow-up from Östersund, Sweden

In late 2010, an outbreak of Cryptosporidium hominis affected 27,000 inhabitants (45%) of Östersund, Sweden. Previous research shows that abdomen and joint symptoms commonly persist up to 5 years post-infection. It is unknown whether Cryptosporidium is associated with sequelae for a longer duration, how persisting symptoms present over time, and whether sequelae are associated with prolonged infection. In this prospective cohort study, a randomly selected cohort in Östersund was surveyed about cryptosporidiosis symptoms in 2011 (response rate 69.2%). A case was defined as a respondent reporting new diarrhoea episodes during the outbreak. Follow-up questionnaires were sent after 5 and 10 years. Logistic regressions were used to examine associations between case status and symptoms reported after 10 years, with results presented as adjusted odds ratios (aOR) with 95% confidence intervals. Consistency of symptoms and associations with case status and number of days with symptoms during outbreak were analysed using X2 and Mann–Whitney U tests. The response rate after 10 years was 74% (n = 538). Case status was associated with reporting symptoms, with aOR of ~3 for abdominal symptoms and ~2 for joint symptoms. Cases were more likely to report consistent symptoms. Cases with consistent abdominal symptoms at follow-up reported 9.2 days with symptoms during the outbreak (SD 8.1), compared to 6.6 days (SD 6.1) for cases reporting varying or no symptoms (p = 0.003). We conclude that cryptosporidiosis was associated with an up to threefold risk for reporting symptoms 10 years post-infection. Consistent symptoms were associated with prolonged infection.

Butyrate supplementation in the liquid diet of dairy calves leads to a rapid recovery from diarrhea and reduces its occurrence and relapses in the preweaning period

The present study aimed to evaluate the effect of continuous butyrate administration in dairy calves' liquid diet considering diarrhea, metabolic profile, gastrointestinal development, and corporal growth. Immediately after birth, calves were randomly allocated into 2 groups of 62 calves (50 females and 12 males), with access to water and a solid feed ad libitum. The Butyrate Group (BG) received 4 g/day of sodium butyrate (Admix® Easy - Adisseo) diluted in the whole milk, and the Control Group (CG) received whole milk with no supplementation. Sodium butyrate was administered from day one of life until the weaning at 90 d. Feces consistency was assessed daily for the first 30 d of life and characterized by scores from 0 to 4 (0 and 1 for normal, and 2, 3, and 4 for abnormal feces). Diarrhea was diagnosed when the animals had abnormal feces and fever. Morbidity, recurrence, mortality, and lethality data were recorded and compared between the groups. Average daily weight gain (ADG) and corporal growth (body weight, thoracic perimeter, height at the withers, and croup width) were evaluated weekly, from the first day to the 30th, and later at the 45th, 60th, and 90th d of life. Blood samples were taken weekly for up to 30 d to determine the circulating levels of total calcium, phosphorus, chloride, bicarbonate, glucose, β-hydroxybutyrate, and nonesterified fatty acids (NEFA). The males were euthanized at 15 (n = 6 per group) and 30 d (n = 6 per group) for morphometric, histological, and gene expression analysis of the gastrointestinal tract. The results showed that the Butyrate Group had a lower rate of morbidity (BG = 30% vs. CG = 50%) and recurrence (BG = 26.7% vs. CG = 60%) of diarrhea than the Control Group. In addition, the BG had abnormal feces for a shorter period (BG = 4.64 ± 0.47 d vs. CG = 8.6 ± 0.65 d). The ADG tended to be higher in BG than CG up to 30 and 60 d. Metabolic evaluations showed the lowest levels of glucose and highest levels of NEFA in BG. On d 30 of life, rumen papillae length, papilla area, duodenum villus length, and crypt depth were higher in BG than in CG. The duodenal gene expression at 30 d showed that animals with diarrhea episodes that did not receive butyrate had the highest levels of transcripts for the LCT and GLP2 genes. In addition, in different ways, both butyrate and neonatal diarrhea affected the gene expression of IGF1, SLC5A1 and AQP3. These results allow us to conclude that continuous supplementation with sodium butyrate improves gastrointestinal development, reduces the occurrence of diarrhea, and makes clinical conditions milder with faster recovery, favoring a higher ADG in the first 30 and 60 d of life. Based on these results, we conclude that sodium butyrate can be indicated for liquid diet supplementation to accelerate gastrointestinal tract development and prevent severe cases of neonatal diarrhea, tending to improve average daily gain until the weaning.

Determinants of zinc utilisation in the management of diarrhoea among under-five children in Nigeria: a population-based, cross-sectional study.

Diarrhoea remains the foremost cause of sickness and death among children aged <5 y (under-five) in low- and middle-income countries. The WHO and UNICEF recommend that any child with diarrhoea signs be given zinc tablets as part of the treatment within 24 h. Therefore, we aimed to assess the prevalence and determinants of zinc utilisation for diarrhoea among under-five children in Nigeria. The Nigeria Demographic and Health Survey 2018 was used for this study. Data were analysed using IBM SPSS version 25.0. A multilevel analysis technique employing the generalised linear mixed model was used for analysing the data of 3956 under-five children with diarrhoea. Only 29.1% of children who experienced diarrhoea received zinc combined with other forms of treatments during the diarrhoea episode. However, mothers with a secondary or higher level of education had a 40% higher likelihood of zinc utilisation during childhood diarrhoea (AOR, 1.40; 95% CI 1.05 to 2.22). Similarly, children whose mothers were exposed to media were more likely to receive zinc during diarrhoea than those whose mothers were not (AOR, 2.50; 95% CI 1.01 to 3.87). In this study, the prevalence of zinc use among under-five children with diarrhoea in Nigeria was low. Therefore, appropriate strategies to improve zinc utilisation are needed.