Diarrhea In Hospital Research Articles

Investigation of Children with Acute Gastroenteritis by Multiplex PCR Method in Central Part of Turkey

Abstract Objective Gastroenteritis is a disease that affects all age groups, especially children, and causes high mortality and morbidity in all countries. The most common agents of acute gastroenteritis are viral agents. As a result, millions of diarrhea attacks and hospital admissions occur worldwide every year due to viral gastroenteritis. This study uses the multiplex polymerase chain reaction (PCR) method to investigate the viruses that are the causative agents of viral gastroenteritis in the pediatric patient group in Konya, Turkey. Methods Stool samples of 94 patients aged 0 to 18 years sent from Emergency clinics and Pediatric outpatient clinics, Meram Medical Faculty Hospital Pediatric clinics, Konya Necmettin Erbakan University to Medical Microbiology Laboratory with a diagnosis of gastroenteritis between February and December 2018 were included in the study. Stool samples were stored at –80°C until the time of the analysis. Deoxyribonucleic acid/ribonucleic acid isolation from stool samples was performed with EZ1 Virus Mini Kit v2.0 (Qiagen, Hilden, Germany) using an automatic extraction system (BioRobot EZ1 system, Qiagen). The presence of astrovirus, rotavirus, adenovirus, norovirus (GI, GII), and sapovirus agents was investigated by the multiplex PCR method (Fast Track Diagnostics, Luxembourg) viral gastroenteritis kit. Results Viral gastroenteritis agents were detected in 56.3% of the patients. One viral agent was detected in 47 (50%) of these patients and at least two viral agents in 6 (6.3%) of them. Norovirus GII was detected in 20 (21.2%) of the children included in the study, adenovirus in 13 (13.8%), rotavirus in 11 (12.8%), astrovirus in 11 (11.7%), sapovirus in 4 (4.2%), and norovirus GI in 1 (1.06%). When the distribution of viral agents was examined by months, the most number of agents were observed (21; 35%) in May, followed by April and June (12; 20%). Considering the distribution of the prevalence of the agents by age, it was seen to be mainly between 0 and 12 months (42%). Conclusion Considering that the most common viral agent in our region is norovirus GII, it will be useful to investigate the norovirus that is not routinely examined in children who are admitted to clinics with the complaint of gastroenteritis. It will be appropriate to examine routinely adenovirus, rotavirus, and norovirus in the laboratory, especially in children with diarrhea and vomiting in the winter and spring months.

Cost Analysis of Diagnostic Endoscopic Procedures for Chronic Diarrhoea.

Chronic diarrhoea is a common condition that affects up to 5% of the population which heavily affects the quality of life for the patient. The British Society of Gastroenterology guidelines recommend that for those who suffer with chronic diarrhoea, a colonoscopy with a biopsy is recommended to exclude microscopic colitis. This retrospective audit included 147 patients who received endoscopic procedures in 2019 at Walsall Manor Hospital for chronic diarrhoea. The results show that a total of £56,797 was incurred through endoscopic and histological investigation with four patients (2.6%) diagnosed with microscopic colitis. Given the lack of diagnostic yield, there is room for advancement in the current guidelines for managing persistent diarrhoea.

Impact of Monovalent Rotavirus Vaccine on Rotavirus Hospitalizations among Children Younger Than 5 Years of Age in the Ouest and Artibonite Departments, Haiti, 2013 to 2019.

Rotavirus is responsible for 26% of diarrheal deaths in Latin America and the Caribbean. Haiti introduced the monovalent rotavirus vaccine in April 2014. The objective of this analysis is to describe the impact of the rotavirus vaccine on hospitalizations among Haitian children younger than 5 years old during the first 5 years after introduction. This analysis includes all children with diarrhea who were enrolled as part of a sentinel surveillance system at two hospitals from May 2013 to April 2019. We compare the proportion of rotavirus-positive specimens in each post-vaccine introduction year to the pre-vaccine period. To account for the potential dilution of the proportion of rotavirus-positive specimens from a waning cholera outbreak, we also analyzed annual trends in the absolute number of positive stools, fit a two-component finite-mixture model to the negative specimens, and fit a negative binomial time series model to the pre-vaccine rotavirus-positive specimens to predict the number of rotavirus diarrhea hospital admissions in the absence of rotavirus vaccination. The overall percentage of rotavirus-positive specimens declined by 22% the first year after introduction, increased by 17% the second year, and declined by 33% to 50% the subsequent 3 years. All sensitivity analyses confirmed an overall decline. We observed a clear annual rotavirus seasonality before and after vaccine introduction, with the greatest activity in December through April, and a biennial pattern, with high sharp peaks and flatter longer periods of increased rotavirus activity in alternating years, consistent with suboptimal vaccination coverage. Overall, our study shows evidence that the introduction of the rotavirus vaccine reduced the burden of severe rotavirus diarrhea.

The multifaceted use of Lactobacillus reuteri DSM 17938 in a pediatric clinic: a retrospective observational study

Background: Lactobacillus reuteri DSM 17938 is a well-studied probiotic which colonizes many mammals. In humans, L. reuteri is found in various body sites including the gastrointestinal tract, urinary tract, skin and breast milk. It fulfills all the prerequisites of being a good probiotic as described by the world gastroenterology organization.Methods: This was a retrospective observational study, where a nutritional supplement L. reuteri DSM 17938 was given to 197 children, aged 0-16 years, along with normal diet. The participants were having complains of diarrhea, stomach pain and frequent hospitalization. Various parameters were recorded such as sex, age, anthropometry-weight and height (every visit), diagnosis, reason for outpatient visits and various demography including but not limited to- birthplace, current location, year in school, reason for hospital admission (if any). Paired t test was used to find difference in weight and height between each visit.Results: A total of 118 subjects were included in the analysis. Five drops of nutritional supplement L. reuteri DSM 17938 was given. Supplementation of L. reuteri reduced the need for hospital admissions. 96% children did not require hospital admission. It improved the overall health of the children. There was a statistical significance in the height and weight between first and second visits (p<0.001). A 7.65% weight increase was noted in between first and second visit. A 2.32% height increase was seen between first and second visit.Conclusions: L. reuteri DSM 17938 given as a nutritional supplement improved the health of the children and reduced the need for hospital admissions.

Gastrointestinal Diseases in Children Living with HIV.

Thanks to the advances in antiretroviral therapies (ART) and early diagnosis, pediatric HIV has turned into a chronic infection that requires the collaboration of all pediatric subspecialists for holistic patient management. Gastrointestinal complaints are a frequent reason for seeking access to medical care in all pediatric patients worldwide. Intestinal involvement is present in virtually all children with HIV infections. In high-prevalence settings, up to 25% of children accessing the hospital for diarrhea are diagnosed with HIV. More than half of patients with advanced disease present with gastrointestinal symptoms, from mild infectious diarrhea to severe gastrointestinal impairment, malabsorption and failure to thrive. Gastrointestinal disorders do not spare children on ART, particularly in the initial months of therapy. ART-associated pancreatitis and hepatitis are rare but potentially severe adverse events, whereas lower abdominal symptoms have been reported in more than a third of patients. The latter are usually mild and transient, but may limit ART adherence; a correct framing of the problem is necessary to minimize therapy switches while optimizing the quality of life of children on ART. This review aims to provide state-of-the-art guidance for the initial approach to gastrointestinal diseases in children living with HIV.

Statistical control charts to assess the incidence of presumably infectious diarrhea reported between 2009 and 2019 in children under 4 years of age in the macro regions of Araçatuba, Marília and Presidente Prudente, São Paulo, Brazil.

Objective: To evaluate the monthly rates of hospitalizations for childhood diarrhea in macro-regions of Araçatuba, Marília and Presidente Prudente, SP, between 2019 -June Between June 2009. Methods: The average rates and their standard deviations for admission of diarrhea in the target population were obtained from DATASUS and standardized for cases x 100,000 inhabitants. Confidence limits were established, occurrences above confidence limits were considered epidemic events. The normality of the data and serial autocorrelation were tested using the Shapiro-Wilk and Durbin-Watson method. Results: All methods detected epidemic occurrences in the three regions. Araçatuba and Marília, the peaks were concentrated in the first half of the decade and Presidente Prudente, close to the middle. The CUSUM method was more sensitive to detect epidemic periods, however the normality data and assumptions have been violated by serial autocorrelation in a few months. The EWMA method was considered the most appropriate. Conclusions: Statistical process control charts can be used to monitor and compare disease incidence between different regions.

Relationship between diarrhoea risk and the combinations of drinking water sources in the Kathmandu Valley, Nepal.

In Nepal, the number of diarrhoea hospitalizations in all ages is seriously high. According to the World Health Organization, diarrheal diseases can be substantially prevented through safe drinking water sources. In the Kathmandu Valley, because of the shortage of piped water, local residents use alternative water sources, such as groundwater, jars and tanker water. However, these alternative water sources can be contaminated. This study aimed to clarify the relationship between diarrhoea risk and the combinations of drinking water sources. A survey using multiple questionnaires on diarrhoea occurrence, water sources and water treatment was conducted three time between 2015 and 2016. The odds ratios (ORs) of developing diarrhoea were significantly high for drinking jar (OR 6.1) and tanker water (OR 8.4) compared with not drinking. The combined drinking of jar and tanker water obtained the 1 log higher OR compared with drinking only piped water. Conversely, drinking groundwater had a low OR, implying that the residents refrained from drinking polluted groundwater. In conclusion, diarrhoea occurrence was related not only to the level of water contamination, but also to a behavioural factor, i.e. people's careful management of the choice of multiple water sources.

A Rare Case of Chronic Diarrhea in a Pediatric Patient

Background: VIPoma, also known as Watery Diarrhea-Hypokalemia- achlorhydria (WDHA) Syndrome is a rare manifestation of multiple endocrine neoplasia syndrome type 1 (MEN1). Vasoactive intestinal peptide, part of the secretin-glucagon family, may be overexcreted in tumors associated with MEN1 and results in diarrhea that persists while fasting, resulting in massive secretion of water and electrolytes. First-line treatment is surgical resection. Clinical Case: We present a 13-year-old male with a past medical history of chronic diarrhea for four years who was transferred from an outside hospital for severe diarrhea and associated electrolyte derangements, including hypokalemia of <1.0 mmol/L (3.5-5.0 mmol/L), sodium of 120 (135-145 mmol/L), and chloride of 84 mmol/L (101-110 mmol/L). Family history was significant for pancreatic, breast, thyroid, stomach, parathyroid, and uterine cancer, as well as hyperparathyroidism and nephrolithiasis. The patient had been admitted to the hospital before for a similar episode of acute on chronic diarrhea but was treated for infectious diarrhea during that admission. CT enterography was obtained during this hospitalization and it revealed multiple solid and heterogeneous appearing pancreatic masses in the head and tail of the pancreas. Work-up was significant for pancreatic polypeptide of 1,523 pg/mL (92-752 pg/mL) and vasoactive intestinal peptide of 1,105 pg/mL (<75 pg/mL). Pancreatic biopsy revealed a grade 2 pancreatic neuroendocrine tumor. Genetic testing revealed a known pathogenic mutation in the menin gene p.R526 (c. 1579>T, pArg527). A pylorus-preserving total pancreatectomy, duodenectomy, cholecystectomy, and splenectomy was performed and surgical pathology revealed a well-differentiated grade 1 neuroendocrine tumor in the head of the pancreas and a well-differentiated grade 2 neuroendocrine tumor in the tail of the pancreas. Since the surgery, the patient currently has no signs of other neuroendocrine tumors associated with MEN1 but continues to follow-up for regular screening for other tumors associated with MEN1. Clinical Lessons: 1. VIPoma, also known as Watery Diarrhea- Hypokalemia- Achlorhydria Syndrome, is characterized by secretory diarrhea that persists while fasting. 2. VIPoma should be considered in patients with a history of chronic diarrhea and a significant family history of neuroendocrine tumors.

The economic burden of diarrhea in children under 5 years in Bangladesh

BackgroundDiarrhea is a leading cause of morbidity and mortality among under-five children in Bangladesh. Hospitalization for diarrhea can pose a significant burden on households and health systems. The aim of this study was to estimate the cost of illness due to diarrhea from the healthcare facility, caregiver, and societal perspectives in Bangladesh. MethodA cross-sectional study with an ingredient-based costing approach was conducted in 48 healthcare facilities in Bangladesh. In total, 899 caregivers of under-five children with diarrhea were interviewed face-to-face between August 2017 and May 2018, followed up over phone after 7–14 days of discharge, to capture all expenses and time costs related to the entire episode of diarrhea. ResultsThe average cost per episode for caregivers was US$62, with $29 direct and $34 indirect costs. From the societal perspective, average cost per episode of diarrhea was $71. In 2018, an estimated $79 million of economic costs were incurred for treating diarrhea in Bangladesh. Using 10% of income as threshold, over 46% of interviewed households faced catastrophic expenditure from diarrheal disease. ConclusionThe economic costs incurred by caregivers for treating per-episode of diarrhea was around 4% of the annual national gross domestic product per-capita. Investment in vaccination can help to reduce the prevalence of diarrheal diseases and avert this public health burden.

Rotavirus Strain Distribution before and after Introducing Rotavirus Vaccine in India.

In April 2016, an indigenous monovalent rotavirus vaccine (Rotavac) was introduced to the National Immunization Program in India. Hospital-based surveillance for acute gastroenteritis was conducted in five sentinel sites from 2012 to 2020 to monitor the vaccine impact on various genotypes and the reduction in rotavirus positivity at each site. Stool samples collected from children under 5 years of age hospitalized with diarrhea were tested for group A rotavirus using a commercial enzyme immunoassay, and rotavirus strains were characterized by RT-PCR. The proportion of diarrhea hospitalizations attributable to rotavirus at the five sites declined from a range of 56–29.4% in pre-vaccine years to 34–12% in post-vaccine years. G1P[8] was the predominant strain in the pre-vaccination period, and G3P[8] was the most common in the post-vaccination period. Circulating patterns varied throughout the study period, and increased proportions of mixed genotypes were detected in the post-vaccination phase. Continuous long-term surveillance is essential to understand the diversity and immuno-epidemiological effects of rotavirus vaccination.

Gastrointestinal: Lupus mesenteric vasculitis of the colon diagnosed using endoscopic biopsy.

A 20-year-old woman with a 6-year history of systemic lupus erythematosus (SLE) was referred to our hospital for diarrhea and epigastric pain that had lasted for 2 months. She achieved remission through pulse-steroid and intravenous cyclophosphamide therapy at disease onset. Maintenance therapy with daily doses of 5-mg prednisolone and 1-g mycophenolate mofetil prevented recurrence of SLE symptoms. The patient initially experienced diarrhea and epigastric pain 2 months prior to presentation, then experienced a gradual worsening of symptoms. Esophagogastroduodenoscopy, abdominal ultrasound, and computed tomography taken 2 weeks before presentation showed no significant findings. Colonoscopy revealed multiple aphthae throughout the large intestine (Fig. 1a). A daily dose of 30 mg oral prednisolone was administered for 13 days, but the symptoms worsened and the patient developed a fever of over 38°C. Colonoscopy at presentation revealed multiple punched-out ulcers from the ascending to the descending colon (Fig. 1b). Forceps biopsy specimens were obtained from the lesion, and histopathological examination of biopsy specimens demonstrated neutrophil infiltration around small vessels with vessel disruption (Fig. 2). We therefore diagnosed the patient with lupus mesenteric vasculitis (LMV) and treated with intravenous cyclophosphamide therapy. The symptoms improved immediately and follow-up colonosocpy taken 4 months after presentation revealed that the colonic ulcers had healed into scars (Fig. 1c). LMV is associated with critical organ involvement in SLE patients, with prevalence ranging from 0.2% to 9.7%. LMV mainly involves the jejunum and ileum, and only 0.8% of cases have colorectal lesions. The typical endoscopic findings of colonic LMV are reported to be multiple punched-out ulcers, as in our case. Delaying immunosuppressive therapy in patients with LMV can lead to fatal outcomes. In the present case, colonosocpy could reveal minimal colonic lesions (Fig. 1a), while an abdominal computed tomography, the golden standard for the diagnosis of LMV, showed no significant findings in an early stage of LMV. Colonoscopy was able to detect rapid progression to multiple punched-out ulcers (Fig. 1b) and confirm the histological diagnosis of LMV (Fig. 2). These findings allowed us to correctly diagnose LMV and immediately perform intensive therapy.

Intra-country climate variability and geographical distribution of diarrhoea among children under five in Bangladesh

BackgroundAssociations between climate and childhood diarrhoea are likely, particularly in the face of climate change. We estimated the effects of climate conditions on hospitalizations due to childhood diarrhoea across three Bangladeshi regions to assist develop regional prevention strategies.MethodsFortnightly hospital admissions (July/2012-June/2017) for diarrhoea (≥3 loose stool in a day, and symptoms lasting ≤7 days) in children under five years of age and fortnightly recordings for average maximum temperature, relative humidity and rainfall for 3 regions (i.e., Mymensingh-R1, Rajshahi-R2 and Sylhet-R3) were modelled using a Poisson regression model with distributed lag linear terms. Flexible spline functions were used to adjust models for season and trend. Lagged (delayed) effects of maximum temperature were estimated over 0-4 fortnights.ResultsHigher temperature was associated with fewer diarrhoea hospitalizations across the 3 regions (IRR 0.90-0.92, 95% CI [0.87-0.89] - [0.93-0.95]). When seasonality and long-term trends were adjusted, estimates moved towards the null. Adding relative humidity to the model did not change the effect estimates. There is evidence of an association between diarrhoea hospitalizations and maximum temperature at different fortnightly lags. When lag effects were adjusted for each other using distributed lag models, a negative association at lag 2 (IRR 0.70, 95% CI 0.55-0.90) was reported in R1.ConclusionsOur results varied from previous studies in that higher temperature is associated with increased diarrhoea hospitalizations in Bangladesh. In addition, results underscore that the relationship between maximum temperature and diarrhoea hospitalizations could be confounded by season and long-term trends. Although the unadjusted lagged effects varied between regions in terms of directions, higher temperatures could cause fewer diarrhoea hospitalizations in Mymensingh for as long as a month. Our findings inform policymakers that climate change may have variable effects in different regions, hence childhood diarrhoea prevention strategies could merit region specific considerations over generic guidelines.

Effect of Vitamin D, Selenium, or Zinc Supplementation in HIV: A Systematic Review

We conducted a systematic review to examine evidence from randomized controlled trials studying the effect of Vitamin D, selenium, or zinc supplementation in human immunodeficiency virus (HIV). An electronic literature search was carried out using Ovid Medline, Embase, CINHAL, Cochrane Center Register of Controlled Trials, Database of Systematic Reviews, Psych Info and PubMed. Eligible articles were assessed for methodological quality on the basis of the adequacy of the randomization process, concealment of allocation, blinding of intervention and outcome, and completeness of follow-up. A total of 24 single supplement trials (Vitamin D, selenium, and zinc) involving 5948 participants were included for this review. Evidence from seven Vitamin D trials showed no damaging or beneficial effect of Vitamin D supplementation on HIV disease progression in HIV-infected adults or children/adolescents. Six of the selenium studies found that providing daily selenium supplementation to HIV-infected adults' increased CD4 cell counts and reduce the risk of diarrhea morbidity and hospital admission rate for HIV-related conditions and opportunistic infection in HIV-infected adults. Evidence from eleven zinc trials showed some evidence of a potential beneficial effect of zinc supplementation on diarrhea morbidity and immune function. However, further research in larger and more diverse populations of HIV patients is required to fully investigate the effect of these nutrients on clinically relevant outcomes in HIV disease, the optimal dose, and the cost-benefit or cost-effectiveness of Vitamin D, selenium, or zinc supplementation.

Diarrhea hospitalization costs among children

BackgroundFollowing a recommendation by the World Health Organization, Madagascar introduced rotavirus vaccine in 2014. Though national rotavirus vaccine coverage has remained <80%, rotavirus hospitalizations declined by 78%. Gavi, the Vaccine Alliance, has provided financial support for rotavirus vaccine, however the Malagasy government has increasing responsibility for the financial cost. MethodsIn this evaluation, we describe the direct medical, direct non-medical, and indirect cost of illness due to diarrhea among children <5 years old at a public pediatric referral hospital. A 3-part structured questionnaire was administered during and following the hospitalization and the child’s hospital record was reviewed. ResultsIn total, 96 children were included in this analysis. The median total cost of the illness was $156.00 (IQR: 104.00, 210.86) and the median direct medical cost was $107.22. Service delivery costs represented a median of 44% of the inpatient costs; medications and diagnostic tests represented a median of 28% and 20% of the total costs of the hospitalization, respectively. The median percentage of the total illness costs paid by the household was 67%. Among households with income of <$61/month, the median costs of the illness paid by the household were $78.55, representing a median of 168% of the household’s monthly expenses. Among households earning >$303/month, the median costs paid by the household were $147.30, representing a median of 53% of the household’s monthly expenses. Among all household income levels, caregivers commonly paid these bills from savings, borrowed money, and donations. ConclusionsOur findings will be useful in assessing the cost-effectiveness of rotavirus vaccine by decisionmakers. These results may also help hospital administrators and healthcare providers better understand the financial constraints of families.

E-cigarette, or Vaping, Associated Lung and Hepatic Injury.

E-cigarette, or Vaping, Associated Lung and Hepatic Injury.

Cost estimates of diarrhea hospitalizations among children

IntroductionDiarrhoea is a leading killer of children <5 years old, accounting for 480,000 deaths in 2017.Zimbabwe introduced Rotarix into its vaccination program in 2014. In this evaluation, we estimate direct medical, direct non-medical, and indirect costs attributable to a diarrhea hospitalization in Zimbabwe after rotavirus vaccine introduction. MethodsChildren <5 years old admitted to Harare Central Hospital from June 2018 to April 2019 with acute watery diarrhea were eligible for this evaluation. A 3-part structured questionnaire was used to collect data by interview from the child’s family and by review of the medical record. A stool specimen was also collected and tested for rotavirus. Direct medical costs were the sum of medications, consumables, diagnostic tests, and service delivery costs. Direct non-medical costs were the sum of transportation, meals and lodging for caregivers. Indirect costs are the lost income for household members. ResultsA total of 202 children were enrolled with a median age of 12 months (IQR: 7–21) and 48 (24%) had malnutrition. Children were sick for a median of 2 days and most had received outpatient medical care prior to admission. The median monthly household income was higher for well-nourished children compared to malnourished children (p < 0.001). The median total cost of a diarrhea illness resulting in hospitalization was $293.74 (IQR: 188.42, 427.89). Direct medical costs, with a median of $251.74 (IQR: 155.42, 390.96), comprised the majority of the total cost. Among children who tested positive for rotavirus, the median total illness cost was $243.78 (IQR: 160.92, 323.84). The median direct medical costs were higher for malnourished than well-nourished children (p < 0.001). ConclusionDirect medical costs are the primary determinant of diarrhea illness costs in Zimbabwe. The descriptive findings from this evaluation are an important first step in calculating the cost effectiveness of rotavirus vaccine.

Evaluating the effect of village health workers on hospital admission rates and their economic impact in the Kingdom of Bhutan

BackgroundVillage health workers (VHWs) in Bhutan play an all-encompassing role in supporting the health of their communities. Recent reports from the Bhutan Ministry of Health have indicated a sharp reduction in the number of working VHWs. As such, our work attempts to estimate the cost saved and the number of averted hospital admissions onto the Bhutanese healthcare system and the individuals who are served by these health workers.MethodsWe utilized a dataset from the Bhutan Ministry of Health which encompassed over 95% of all reported disease cases within the nation. We examined the impact that VHWs have on hospital admission rates for eight diseases of interest by using multiple multivariate logistic regression models. Our model allowed us to estimate the potential disease cases averted when the average number of VHWs per health center is increased by one unit. Lastly, we utilized the 2011 “A Costing of Healthcare Services in Bhutan” to estimate the cost saved attributed to VHWs.ResultsAn average one unit increase of VHWs per health center is associated with a decrease in hospital and clinic admission for diarrhea, dysentery, wound care, depression/anxiety, dental caries, and skin infection, while a non-significant increase was observed for scabies and conjunctivitis. These findings translate to 4604 outpatient visits averted, with $28,637 saved, and 78 inpatient visits averted, with $10,711 saved. These values sum to a total of 4682 yearly averted admissions at health centers, with a total cost savings of $39,348 yearly. Additionally, we estimated a yearly savings of $13,348 in transportation costs and a total of $20,960 saved in wages to the community members that VHWs serve.ConclusionsVHWs serve as a source of cost-savings for the Kingdom of Bhutan and also act as an economic buffer for more vulnerable communities. The cost-savings associated with these health workers is likely to become more pertinent as the nation begins to develop and healthcare costs increase. It is imperative that proper action be taken to retain these health workers as every VHW who leaves the program increases healthcare costs onto the Bhutanese government.

Faecal PCR panel results and clinical findings in Western Australian dogs with diarrhoea.

To describe faecal PCR (fPCR) results and clinical findings of dogs seen at a university teaching hospital for diarrhoea. Retrospective case series (April 2015 to July 2018). Data were collected from the hospital electronic medical records. Data extracted included signalment, history, clinical signs, treatment, fPCR panel results, other faecal diagnostic test results and antimicrobial use. One hundred and sixty-eight dogs with diarrhoea had a fPCR panel submitted. Most dogs (115, 68.5%) had diarrhoea of 3 days or less duration. Clostridium perfringens alpha toxin gene was most frequently detected (156, 92.9%) by fPCR, followed by Campylobacter spp. (55, 32.7%), canine parvovirus (CPV) (29, 17.3%), Salmonella spp. (14, 8.3%) and Giardia spp. (9, 5.4%). For the 45 dogs that had a negative point-of-care CPV test, 13 were CPV fPCR positive; some of which were adult dogs with current vaccination status. A total of 94/168 (56%) dogs received antimicrobials at some time during the treatment of diarrhoea. Faecal PCR panels can identify dogs with enteric organisms in their faeces that traditional faecal diagnostics may miss, thus contributing additional information to the diagnostic process. Nonetheless, fPCR results should be interpreted in light of the clinical findings, and particular consideration given to avoiding inappropriate use of antimicrobials. This study highlights that testing for C. perfringens alpha toxin gene is not likely to be diagnostically helpful, and that adult dogs with diarrhoea might be identified as CPV positive with PCR testing, despite a negative point-of-care CPV test result and a current vaccination status.

Spatiotemporal clusters of schistosomiasis mortality and association with social determinants of health in the Northeast region of Brazil (1980–2017)

The Northeast region of Brazil includes the states with the highest prevalence for schistosomiasis mansoni (SM). This study aimed to evaluate the spatiotemporal patterns of SM mortality and to analyze this association with social determinants in health. We conducted an ecological time series study (1980–2017), using spatial analysis tools. Time trend analysis was performed by joinpoint regression. Maps representing mortality rates for SM were constructed and Moran Index was calculated to analyze spatial autocorrelation. A total of 13,720 deaths from SM were reported in this period. The states of Pernambuco (PE) (50.62%) and Alagoas (AL) (22.09%) had the highest mortality percentages. The mortality rate decreased from 1.28 to 0.63 along the time. Although most states showed a stable trend, Sergipe (SE) and Bahia (BA) showed increasing trends in the latest years. Additionally, the spatial analysis showed the concentration of municipalities that presented high risk in the coastal region of the states of PE, AL, SE, and BA. Lastly, mortality rates were correlated with social and educational indicators and hospitalizations for diarrhea. Altogether, these results demonstrate that some states showed stable or increasing trends of SM mortality in the last period of the studied time interval.

Integração de indicadores ecológicos, ambientais e de saúde humana em microbacias urbanas

The integration of ecological, environmental, and human health indicators is an innovative tool to assess the environmental quality of urban watersheds, from the perspective of the National Water Resources Policy. The city of Belo Horizonte, Minas Gerais estate, located in the upper Rio das Velhas basin, has used watersheds as territories for planning environmental sanitation at the public policies since the late 1990s. This study aimed to integrate water quality and human health indicators in 10 urban watersheds located at the Belo Horizonte Metropolitan Region. We tested the hypothesis that the health of human populations living in urban sub-basins is possibly related to water quality, and that water quality, including biotic integrity of benthic macroinvertebrate communities (richness and relative abundance) is influenced by land use. Physical and chemical parameters of water quality, biological metrics of benthic macroinvertebrate indicators, human health metrics (infant mortality and hospitalization due to childhood diarrhea), and the conditions of land use (vegetation, impervious area and proportion of streams in natural channel) were analyzed through general linear models. The results showed that the increase in cases of hospitalization for childhood diarrhea in the period from 2005 to 2008 were related to water quality (R2 = 0.35; p < 0.05), due to the decrease of dissolved oxygen in the water. The number of benthic macroinvertebrate taxa resistant to pollution varied positively with the proportion of impervious areas and with the proportion of canalization in the river beds (R2 = 0.63; p < 0.01). It was evidenced that the water quality is associated with the occurrence of diseases in the human population and with the disordered land use in the studied watersheds at the upper Rio das Velhas basin. Growing public investments in sanitation (Goal 2030) are urgent for the improvement of human and environmental health, which may bring benefits to the human population in the metropolitan region of Belo Horizonte city.