Incidence Rate Of Diarrhea Research Articles

Survey on diarrhea symptoms and diarrhea vaccination willingness of residents in Tianjin

Objective: To understand the symptoms of diarrhea of residents in Tianjin and their willingness to vaccinate, to provide reference for health education, prevention and control of infectious diarrhea. Methods: Cross-sectional study design was adopted. From September to December 2023, a questionnaire survey was conducted among some residents as subjects in Nankai District, Beichen District, Baodi District and Binhai Area of Tianjin by multistage stratified cluster random sampling,to collect information such as sociodemographic characteristics, diarrhea symptoms and vaccination intention. According to the formula n=[u2απ(1 -π)]/δ2, the estimated sample size was 3 458 cases. The logistic regression model was used to analyze the factors related to the willingness of the respondents to receive diarrhea vaccination. The software SPSS 24.0 was used for statistical analysis. Results: A total of 3 808 subjects were investigated, with the male-to-female ratio as 1∶1.11 (1 806∶2 002), the age was (42.48±21.59) years old, and the education level of middle school or below accounted for 50.84% (1 936/3 808). The incidence rate of diarrhea was 18.28% (696/3 808), and 48.84% (1 860/3 808) were willing to be vaccinated with diarrhea vaccine. The results of multivariate logistic regression analysis showed that the age was 15-59 years old and ≥60 years old (aOR=2.31, 95%CI:1.80-2.96; aOR=1.66, 95%CI:1.38-2.00), lived in Binhai Area (aOR=2.09, 95%CI:1.62-2.71), and those who knew that community health service centers can provide the vaccination (aOR=1.61,95%CI:1.34-1.92), those who walked from the address to the community health service center were less than 15 minutes (aOR=1.54, 95%CI:1.28-1.85), those who often travel or on business (aOR=1.36, 95%CI:1.07-1.73), and those who actively obtained health care information related to diarrhea prevention when going abroad (aOR=1.69,95%CI:1.43-1.98) were more willing to be vaccinated against diarrhea. Conclusions: The incidence of diarrhea symptoms of residents was slightly higher in Tianjin, but they were less willing to be vaccinated against diarrhea. People who often go outside and go abroad were more willing to be vaccinated against diarrhea. It is suggested that the popular science propaganda and health education of diarrhea vaccine should be effectively carried out by using network platform in community.

Clinical and genetic characteristics of Chinese patients with Shwachman Diamond syndrome: a literature review of Chinese publication.

Shwachman Diamond syndrome (SDS) is a rare autosomal recessive genetic disorder and due to its complex and varied clinical manifestations, diagnosis is often delayed. The purpose of this study was to investigate the clinical manifestations and genetic characteristics of SDS in Chinese patients, in order to increase pediatricians' awareness of SDS and to allow early diagnosis. We conducted a search to identify patients presenting SBDS gene pathogenic variant in two Chinese academic databases. We analyzed and summarized the epidemiology, clinical features, gene pathogenic variants, and key points in the diagnosis and treatment of SDS. We reviewed the clinical data of 39 children with SDS from previously published articles. The interval from the onset of the first symptoms to diagnosis was very long for most of our patients. The age of presentation ranged from 1day to 10years (median: 3months). However, the age of diagnosis was significantly delayed, ranging from 1month to 14years (median: 14months). Hematological abnormalities were the most common presentation, 89.7% (35/39) at the beginning and 94.9% (37/39) at diagnosis of SDS. Diarrhea was the second most common clinical abnormality at the time of diagnosis. 59% (23/39) of patients had a typical history of persistent chronic diarrhea. Furthermore, hepatic enlargement or elevation of transaminase occurred in 15 cases (38.5%). 56.4% patients (22/39) had a short stature, and 17.9% (7/39) patients showed developmental delay. Additionally, twenty patients had compound heterozygous pathogenic variants of c.258 + 2T > C and c.183_ 184TA > CT. Children with SDS in China had high incidence rates of chronic diarrhea, cytopenia, short stature, and liver damage. Furthermore, SBDS c.258 + 2T > C and c.183_ 184TA > CT were the most common pathogenic variants in patients with SDS. The diagnosis of SDS can be delayed if the clinical phenotype is not recognized by the health care provider.

Population Enumeration and Household Utilization Survey Methods in the Enterics for Global Health (EFGH): Shigella Surveillance Study.

Accurate estimation of diarrhea incidence from facility-based surveillance requires estimating the population at risk and accounting for case patients who do not seek care. The Enterics for Global Health (EFGH) Shigella surveillance study will characterize population denominators and healthcare-seeking behavior proportions to calculate incidence rates of Shigella diarrhea in children aged 6-35 months across 7 sites in Africa, Asia, and Latin America. The Enterics for Global Health (EFGH) Shigella surveillance study will use a hybrid surveillance design, supplementing facility-based surveillance with population-based surveys to estimate population size and the proportion of children with diarrhea brought for care at EFGH health facilities. Continuous data collection over a 24 month period captures seasonality and ensures representative sampling of the population at risk during the period of facility-based enrollments. Study catchment areas are broken into randomized clusters, each sized to be feasibly enumerated by individual field teams. The methods presented herein aim to minimize the challenges associated with hybrid surveillance, such as poor parity between survey area coverage and facility coverage, population fluctuations, seasonal variability, and adjustments to care-seeking behavior.

The Enterics for Global Health (EFGH) Shigella Surveillance Study in Pakistan.

The Enterics for Global Health (EFGH) Shigella surveillance study is a longitudinal multicountry study that aims to estimate incidence rates and document consequences of Shigella diarrhea within 7 countries in Africa, Asia, and Latin America. In addition to a high incidence of childhood diarrhea, Pakistan is facing a problem of antimicrobial resistance in urban and peri-urban areas of Karachi. In Pakistan, EFGH will be conducted in Karachi, which is one of the metropolitan cities bordering the Arabian Sea and has a diverse population of 1.6 million according to the 2017 population census. The study aims to enroll 1400 children aged 6-35 months over 2 years (2022-2024) from 6 health care facilities (Abbasi Shaheed Hospital, Khidmat-e-Alam Medical Centre, Sindh Government Hospital Korangi 5, Sindh Government Hospital Ibrahim Hyderi, Ali Akbar Shah VPT Center, and Bhains Colony VPT Center) situated in Nazimabad and Bin-Qasim town. Moreover, population enumeration and health care utilization surveys from a defined catchment area of health facilities will be conducted to estimate the Shigella diarrhea incidence rates. The study will provide critical data to policy-makers about the burden of Shigella and antimicrobial resistance, which is essential for planning Shigella vaccine trials.

Diarrhea Case Surveillance in the Enterics for Global Health Shigella Surveillance Study: Epidemiologic Methods.

Shigella is a leading cause of acute watery diarrhea, dysentery, and diarrhea-attributed linear growth faltering, a precursor to stunting and lifelong morbidity. Several promising Shigella vaccines are in development and field efficacy trials will require a consortium of potential vaccine trial sites with up-to-date Shigella diarrhea incidence data. The Enterics for Global Health (EFGH) Shigella surveillance study will employ facility-based enrollment of diarrhea cases aged 6-35 months with 3 months of follow-up to establish incidence rates and document clinical, anthropometric, and financial consequences of Shigella diarrhea at 7 country sites (Mali, Kenya, The Gambia, Malawi, Bangladesh, Pakistan, and Peru). Over a 24-month period between 2022 and 2024, the EFGH study aims to enroll 9800 children (1400 per country site) between 6 and 35 months of age who present to local health facilities with diarrhea. Shigella species (spp.) will be identified and serotyped from rectal swabs by conventional microbiologic methods and quantitative polymerase chain reaction. Shigella spp. isolates will undergo serotyping and antimicrobial susceptibility testing. Incorporating population and healthcare utilization estimates from contemporaneous household sampling in the catchment areas of enrollment facilities, we will estimate Shigella diarrhea incidence rates. This multicountry surveillance network will provide key incidence data needed to design Shigella vaccine trials and strengthen readiness for potential trial implementation. Data collected in EFGH will inform policy makers about the relative importance of this vaccine-preventable disease, accelerating the time to vaccine availability and uptake among children in high-burden settings.

Efficacy and safety of a synbiotic infant formula for the prevention of respiratory and gastrointestinal infections: a randomized controlled trial

BackgroundEarly life nutrition is crucial for the development of the gut microbiota that, in turn, plays an essential role in the maturation of the immune system and the prevention of infections. ObjectivesThe aim of this study was to investigate whether feeding synbiotic infants and follow-on formulas during the first year of life reduces the incidence rate (IR) of infectious diarrhea compared with standard formulas. Secondary endpoints included the IR of other infectious diseases as well as fecal milieu parameters. MethodsIn this double-blind, controlled trial, 460 healthy, 1-mo-old infants were randomly assigned to receive a synbiotic [galacto-oligosaccharides (GOS)/Limosilactobacillus fermentum CECT 5716] (IF, n = 230) or a control formula (CF, n = 230) until 12 mo of age. A reference group of breastfed infants (HM, n = 80) was included. Data on infections were recorded throughout the study period and stool samples were collected at 4 and 12 mo of age. ResultsIR of infectious diarrhea during the first year of life was 0.60 (CF), 0.56 (IF), and 0.29 (HM), with no statistically significant difference between groups. The IR of lower respiratory tract infections, 1 of the secondary endpoints, however, was lower in IF than in CF [0.79 compared with 1.01, IR ratio = 0.77 (0.60–1.00)]. Additionally, fecal pH was significantly lower at 4 mo (P < 0.0001), whereas secretory IgA was significantly higher at 12 mo of age (P = 0.015) in IF compared with CF. ConclusionsAlthough no difference is observed in the incidence of diarrhea, consumption of a synbiotic formula containing L. fermentum CECT5716 and GOS in infancy may reduce the incidence of lower respiratory tract infections and affect the immune system and fecal milieu. Additional research is warranted to further investigate the potential interaction of the gut–lung axis.This trial was registered at clinicaltrials.gov as NCT02221687

Community-based symptom reporting among agro-pastoralists and their livestock in Chad in a One Health approach

One Health Syndromic Surveillance has a high potential for detecting early epidemiological events in remote and hard-to-reach populations. Chadian pastoralists living close to their animals and being socio-economically unprivileged have an increased risk for zoonosis exposure. Engaging communities in disease surveillance could also strengthen preparedness capacities for outbreaks in rural Chad. This study describes a retrospective cross-sectional survey that collected data on clinical symptoms reported in people and livestock in Chadian agro-pastoral communities. In January-February 2018, interviews were conducted in rural households living in nomadic camps or settled villages in the Yao and Danamadji health districts. The questionnaire covered demographic data and symptoms reported in humans and animals for the hot, wet, and cold seasons over the last 12 months. Incidence rates of human and animal symptoms were comparatively analyzed at the household level. Ninety-two households with a homogeneous socio-demographic distribution were included. We observed cough and diarrhea as the most frequent symptoms reported simultaneously in humans and animals. In all species, the incidence rate of cough was significantly higher during the cold season, and diarrhea tended to occur more frequently during the wet season. However, the incidence rate of cough and diarrhea in animals did not predict the incidence rate of these symptoms in humans. Overall, the variations in reported symptoms were consistent with known seasonal, regional, and sociological influences on endemic diseases. Our retrospective study demonstrated the feasibility of collecting relevant health data in humans and animals in remote regions with low access to health services by actively involving community members. This encourages establishing real-time community-based syndromic surveillance in areas such as rural Chad.

Optimized rat models better mimic patients with irinotecan-induced severe diarrhea

Irinotecan-induced severe diarrhea (IISD) not only limits irinotecan’s application but also significantly affects patients’ quality of life. However, existing animal models often inadequately represent the dynamics of IISD development, progression, and resolution across multiple chemotherapy cycles, yielding non-reproducible and highly variable response with limited clinical translation. Our studies aim to establish a reproducible and validated IISD model that better mimics the pathophysiology progression observed in patients, enhancing translational potential. We investigated the impact of dosing regimens (including different dose, infusion time, and two cycles of irinotecan administration), sex, age, tumor-bearing conditions, and irinotecan formulation on the IISD incidence and severity in mice and rats. Lastly, we investigated above factors’ impact on pharmacokinetics of irinotecan, intestinal injury, and carboxylesterase activities. In summary, we successfully established a standard model establishment procedure for an optimized IISD model with highly reproducible severe diarrhea incidence rate (100%) and a low mortality rate (11%) in F344 rats. Additionally, the rats tolerated at least two cycles of irinotecan chemotherapy treatment. In contrast, the mouse model exhibited suboptimal IISD incidence rates (60%) and an extremely high mortality rate (100%). Notably, dosing regimen, age and tumor-bearing conditions of animals emerged as critical factors in IISD model establishment. In conclusion, our rat IISD model proves superior in mimicking pathophysiology progression and characteristics of IISD in patients, which stands as an effective tool for mechanism and efficacy studies in future chemotherapy-induced gut toxicity research.

Effects of dietary protein level on intestinal function and inflammation in nursery pigs.

High crude protein (CP; 21% to 26%) diets fed during the first 21 to 28 d postweaning are viewed negatively because of a perceived increase in the incidence rates of diarrhea due to increased intestinal protein fermentation and/or augmented enteric pathogen burden. This is thought to antagonize nursery pig health and growth performance. Therefore, our objective was to evaluate the impact of low vs. high dietary CP on 21-day postweaned pig intestinal function. Analyzed parameters included ex vivo intestinal barrier integrity (ileum and colon), ileal nutrient transport, tissue inflammation, and fecal DM. One hundred and twenty gilts and barrows (average body weight) were randomly assigned to one of two diets postweaning. Diets were fed for 21 d, in two phases. Phase 1 diets: low CP (17%) with a 1.4% standardized ileal digestible (SID) Lys (LCP), or high CP (24%) with a 1.4% SID Lysine (HCP). Phase 2: LCP (17%) and a 1.35% SID lysine, or HCP (24%) formulated to a 1.35% SID lysine. Pig growth rates, feed intakes, and fecal consistency did not differ (P > 0.05) due to dietary treatment. Six animals per treatment were euthanized for additional analyses. There were no differences in colonic epithelial barrier function as measured by transepithelial electrical resistance (TER) and fluorescein isothiocyanate (FITC)-dextran transport between treatments (P > 0.05). Interleukins (IL)-1α, IL-1β, IL-1ra, IL-2 IL-4, IL-6, and IL-12 were not different between treatments (P > 0.05). However, IL-8 and IL-18 were higher in HCP- vs. LCP-fed pigs (P < 0.05). There were no differences in fecal dry matter (DM; P > 0.05) between treatments. In the ileum, there was a tendency (P = 0.06) for TER to be higher in HCP-fed pigs, suggesting a more robust barrier. Interestingly, glucose and glutamine transport were decreased in HCP- vs. LCP-fed pigs (P < 0.05). FITC-dextran transport was not different between treatments (P > 0.05). There were also no differences in ileal cytokine concentrations between diets (P > 0.05). Taken together, the data show that low CP does not negatively impact colonic barrier function, fecal DM, or inflammation. In contrast, ileal barrier function and nutrient transport were altered, suggesting a regional effect of diet on overall intestinal function.

Trends in epidemiological characteristics and etiologies of diarrheal disease in children under five: an ecological study based on Global Burden of Disease study 2021

BackgroundDiarrhea remains a significant health threat to children under five years of age. The study aims to systematically elucidate the global burden of diarrhea in children, providing scientific insights for effective prevention and control strategies. MethodsThe data from the Global Burden of Disease (GBD) 2021 study was analyzed to assess the trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of diarrhea in children under five years across the globe, 21 geographical region, and 204 countries and territories, stratified by age group, sex, and socio-demographic index (SDI) levels. The trend of the disease burden for childhood diarrhea from 1990 to 2021 was described and estimated using the average annual percent change (AAPC), and a Bayesian age-period-cohort (BAPC) model was employed to predict the future burden of diarrhea in children. ResultsFrom 1990 to 2021, there was a significant decline in the global burden of diarrhea among children under five years of age. The AAPC for incidence (−4092.18, 95% confidence interval [CI]: −4224.60 to −3959.76), prevalence (−70.98, 95% CI: −72.67 to −69.28), mortality (−6.89, 95% CI: −6.95 to −6.83), and DALYs rate (−621.79, 95% CI: −627.20 to −616.38) of diarrhea in children all showed a marked downward trend. Diarrheal incidence (r = −0.782, P < 0.001), prevalence (r = −0.777, P < 0.001), mortality (r = −0.908, P < 0.001), and DALYs rate (r = −0.904, P < 0.001) were negatively correlated with the SDI. Between 2022 and 2035, the global incidence, prevalence, and mortality rates of diarrhea in children under five years are projected to continue declining. The leading causes of diarrheal mortality in children include wasting, underweight, and non-exclusive breastfeeding. Rotavirus remains the predominant pathogen associated with diarrhea-related mortality rate and DALY rate. ConclusionAlthough the global burden of diarrhea in children under five has steadily declined, it remains a significant health threat. Rotavirus is the leading pathogen, highlighting the importance of expanding rotavirus vaccination. Additionally, improving nutritional status, increasing exclusive breastfeeding rates, and enhancing access to sanitation and clean drinking water are crucial measures that, when widely implemented, can effectively reduce the health risks posed by diarrhea in children.

Prophylactic Lactulose Therapy in Patients with Cirrhosis and Upper Gastrointestinal Bleeding: A Meta-analysis of Randomized Trials.

Lactulose is the first-line drug for both treatment and secondary prophylaxis for overt hepatic encephalopathy (HE). The use of lactulose for the primary prophylaxis of HE in patients with cirrhosis and acute upper gastrointestinal bleeding (AUGIB) has been debated. Hence, we conducted this meta-analysis to assess the role of lactulose in HE prophylaxis in patients with cirrhosis and AUGIB. A comprehensive search of literature from inception to December 2022 was performed of three databases for randomized studies comparing lactulose and placebo in patients with cirrhosis and AUGIB. Risk ratios (RR) with 95% confidence intervals were calculated for all the dichotomous outcomes. A total of five studies were included in the final analysis, out of which three studies had a low risk of bias, and two had a moderate risk of bias. Lactulose therapy was associated with a significantly lower risk of OHE compared to placebo, with a RR of 0.38 (0.23-0.62) and a number needed to treat of 6. There was no difference in the risk of mortality between the groups, with a RR of 0.71 (0.29-1.76). The pooled incidence rates of overall adverse events (AEs) and diarrhea with the use of lactulose therapy were 53.2% (42.2- 64.2) and 34.7% (17.7-51.7), but a majority did not require drug discontinuation. The certainty of the evidence was moderate to low. Prophylactic lactulose reduces the incidence of HE after AUGIB but has no effect on mortality. Diarrhea and abdominal discomfort are common AEs but do not need drug discontinuation.

The Modified Melphalan-Cladribine-Busulfan-Cyclophosphamide (MCBC) Conditioning Regimen Improved Relapse-Free Survival after Allo-HSCT in Refractory/Relapsed AML

Background： Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the only potentially curative treatment for patients with refractory/relapsed (R/R) acute myeloid leukemia (AML). However, the long-term survival results are suboptimal. Optimization of the conditioning regimen is needed to eradicate leukemia blasts and reduce early relapse. In this study, we made refinements in the double alkylators based conditioning regimen, namely MCBC (the combination of melphalan, cladribine, busulfan, and cyclophosphamide). We aim to investigate the efficacy and safety of MCBC conditioning regimen for allo-HSCT in R/R AML patients. Methods: This prospective multi-center clinical trial was conducted in 13 tertiary hospitals in China, and enrolled R/R AML patients who underwent allo-HSCT from July 2020 to October 2022 (ChiCTR Registration ID: ChiCTR2000029936). The protocol was approved by institutional review boards at participating centers. All patients enrolled received MCBC preconditioning regimen (MCBC group): melphalan 60mg/m2/d, day -9~-8, cladribine 5mg/m2/d, day -7~-5, busulfan 3.2mg/kg/d, day -5~-3, cyclophosphamide 30mg/kg/d, day -2~-1. Rabbit ATG was added in haploid-identical and unrelated-matched donor transplantation. FK506/CsA +short course MTX±MMF was mostly used to prevent graft-versus-host disease (GVHD). We also retrospectively collected data from R/R AML patients who proceeded to allo-HSCT using the classical Bu/Cy2 based conditioning regimen, including Bu/Cy/Flu/Ara-C, Bu/Cy/Flu/IDA, et al, between Nov 2017 to Feb 2022 as history control (Bu/Cy2 group). Probabilities of OS, RFS were calculated by Kaplan-Meier method. A landmark survival analysis was performed. Results and Discussion: This multicenter MCBC trial prospectively enrolled 89 R/R AML patients, with median age 36 (ranged 11-59 years). Only 39.33% (35/89) patients achieved hematology remission at HSCT. Haplo-identical-donor HSCT (HID-HSCT) was the predominance HSCT type (n=62, 69.67%). Mucositis was the main reported regimen-related toxicity, mostly were mild and well tolerated. No graft failure was documented. All patients achieved hematology complete remission (CR) (100%) and 85.39% achieved MRD clearance on reconstitution day, indicating profound anti-leukemia capacity of MCBC regimen. The incidence of II to IV acute GVHD was 50.56%, with severe aGVHD (III to IV) only 8.99%. In comparison to the history control group, MCBC and Bu/Cy2 group were similar for age, gender, disease status, HSCT type. Notably, the incidence rate of mucositis (65.17% vs 63.48%, p=0.43) and diarrhea (87.64% vs 82.6%, p=0.57) were comparable in both groups. The median follow-up post HSCT was 431.29 days (95%CI 437.34~570.65) in MCBC group, and 1236 days (95%CI 1169.32~1302.68) in Bu/Cy2 group, respectively. The estimated one-year overall survival (OS), relapse-free survival (RFS) in MCBC and Bu/Cy2 group patients were 71.4±5.19% vs 65.2±4.45% (p=0.13), and 67.5±5.29% vs 56.2±4.62% (p=0.06, respectively. Notably, the survival advantages in MCBC group were expanded in the estimated two-year data. The estimated two-year overall survival (OS), relapse-free survival (RFS) in MCBC and Bu/Cy2 group patients were 66.9±5.87% vs 52.4±4.47%, and 62.1±6.11% vs 45.6±4.69%. We furtherly performed landmark survival analysis, and the result demonstrated the relapse-free survival superiority in MCBC group within 500 days post-HSCT, compared to Bu/Cy2 group (p=0.05). Conclusion: Our study confirms the excellent anti-leukemic capacity and good acceptable toxicity of MCBC conditioning regimen in R/R AML.

Mycophenolate mofetil increases the risk of diarrhea in allogeneic hematopoietic stem cell transplantation recipients.

Mycophenolate mofetil (MMF) was reported to be a main cause of diarrhea following organ transplantation. However, research on MMF-induced diarrhea following allogeneic hematopoietic stem cell transplantation (allo-HSCT) is currently insufficient. This retrospective study examined the incidence of MMF-induced diarrhea among allo-HSCT recipients. Recipients were divided according to the receipt of MMF and the appearance of diarrhea. The differences in clinical information, MMF usage and trough concentrations, and the occurrence of diarrhea from the first day of conditioning treatment to 100 days after transplantation were analyzed. In total, 32.9% of the recipients reported diarrhea. The incidence rate of diarrhea was higher in the MMF group than in the non-MMF group (40.0% vs. 16.7%). MMF-induced diarrhea usually occurred within 9 days of MMF initiation and persisted for 7.27 ± 3.54 days. The average body weight, MMF daily dose, and MMF trough concentration were higher in patients with diarrhea. MMF increased the risk of diarrhea in allo-HSCT recipients, and the risk was related to the MMF dose and trough concentration. The difference in onset time could be a basis for identifying the cause of diarrhea in allo-HSCT recipients.

Tirzepatide-Induced Gastrointestinal Manifestations: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysisdetermine how frequently and how seriously gastrointestinal manifestations affect people with type 2 diabetes mellituson tirzepatide. Tirzepatide is a recently developed drug that attempts to enhance type 2 diabetics' ability to regulate their blood sugar levels and promote weight reduction. Despite its potential benefits, clinical trials have revealed that the medication may lead togastrointestinal side effects, including nausea, vomiting, decreased appetite, dyspepsia, constipation, and diarrhea. Theseside effectsmay negatively affect the drug's efficacy and patient tolerance. A comprehensive search of electronic databases such as PubMed, Web of Science, and Cochrane Library, was conducted to find pertinent studies reporting on the frequency and severity of gastrointestinal symptoms in type 2 diabetes patients receiving tirzepatide. This systematic review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Study selection, data extraction, and quality assessment were performed. Six randomized controlled trials with a total of 4,586 patients were included. Most patients received tirzepatide to regulate their blood sugar levels and promote weight reduction, and the comparators were placebo, glucagon-like peptide one receptor agonistsdrugs, and insulin degludec. The dose of tirzepatide was 5mg, 10mg, and 15mgweekly. The incidence rate of nausea in patients who receive tirzepatide was 20.43%, while the incidence rate in the comparators was 10.47%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 2.90; 95% CI, 1.89 to 4.44; P≤0.00001). The incidence rate of vomiting in patients who receive tirzepatide was 9.05%, while the rate in the comparators was 4.86%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 2.69; 95% CI, 1.67 to 4.36; P≤0.0001). The incidence rate of constipation in patients who receive tirzepatide was 2.54%, while the rate in the comparators was 0.856%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 3.08; 95% CI, 1.83 to 5.20; P≤0.0001). The incidence rate of decreased appetite in patients who receive tirzepatide was 9.64%, while the rate in the comparators was 2.88%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 5.04; 95% CI, 3.01 to 8.45; P≤0.00001). The incidence rate of diarrhea in patients who receive tirzepatide was 16.24%, while the rate in the comparators was 8.63%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 2.07; 95% CI, 1.60 to 2.68; P≤0.00001). The incidence rate of dyspepsia in patients who receive tirzepatide was 7.13%, while the rate in the comparators was 3.31%, and it was significantly higher in the tirzepatide arm than in the comparators (RR, 2.52; 95% CI, 1.58 to 4.01; P≤0.0001). Tirzepatide usage is linked to a significant prevalence of gastrointestinal symptoms, including nausea, constipation, decreased appetite, dyspepsia, diarrhea, and vomiting, in people with type 2 diabetes. These findings may influence clinical decision-making and patient counseling on the use of tirzepatide and have significant implications for the medication's tolerance and efficacy. To find ways to reduce these negative effects and improve therapy for type 2 diabetes patients, more research is required.

Analysis of community perspectives regarding the hygiene-sanitation and socio-economic factors influencing the occurrence of diarrhea in toddlers: A literature review

Diarrhea is a disease that causes the second highest morbidity and mortality rate in toddlers after pneumonia. Poor and developing countries generally exhibit high incidence rates of diarrhea, thus diarrhea is often associated with poor socio-economic conditions and inadequate sanitation. Understanding the caregivers' perspectives on the factors contributing to diarrhea is crucial for the prevention and management of diarrhea, aiming to reduce the morbidity and mortality rates among toddlers. The aim of this research is to analyze the community perspectives on the factors of hygiene-sanitation and socio-economic factors influencing the occurrence of diarrhea in toddlers. The research methodology employed is a literature review, which assesses the occurrence of diarrhea in toddlers based on both hygiene-sanitation factors and socio-economic factors from the community's perspective. The data used consists of a minimum of 10 scientific journals obtained from Google Scholar and ResearchGate databases. The research findings indicate that, in terms of hygiene-sanitation, the factors contributing to diarrhea include the lack of cleanliness and hygiene practices implemented by caregivers of toddlers, untreated or unprotected water sources, inadequate availability of water, low utilization of sanitation facilities, unhygienic living conditions, and water contamination during the rainy season. Meanwhile, in terms of socio-economic factors, it is influenced by the knowledge and education of caregivers, financial status, resource limitations, and community acceptance of interventions for improving water, sanitation, and hygiene. From these results, it can be concluded that there is a correlation between the risk factors of diarrhea and the occurrence of diarrhea in toddlers, as observed from both hygiene-sanitation and socio-economic perspectives.

Incidence Rate and Risk Factors for Diarrhea in Yarsi Medical Faculty Students Batch 2019

Introduction: Diarrhea is a bowel movement with a mushy or liquid consistency, which can even be water only with a frequency more often than usual (usually three or more times) in one day (Depkes RI 2011). The prevalence of diarrhea in Indonesia according to its characteristics based on the 2018 Riskesdas recorded 18,225 (9%) children with diarrhea aged &lt;1 year, 73,188 (11.5%) children with diarrhea aged 1-4 years, 182,338 (6.2%) children with diarrhea aged 5-14 years, and 165,644 (6.7%) children with diarrhea aged 15-24 years (Ministry of Health, 2019). Diarrhea can occur due to factors such as open defecation, hand washing without soap, food and beverage management, waste safety, and liquid waste safety.Methodology: This study is a correlational study with a cross sectional design. The study population was YARSI medical students. The sampling technique was purposive sampling. The total sample was 166 students.Results: In student respondents, the results showed that the incidence rate of diarrhea in medical students of Yarsi in the last 3 months was quite high because the majority had diarrhea. It is also known that several risk factors studied have a relationship with the incidence rate of diarrhea, namely hand washing behavior and also the source of water drunk. Meanwhile, the level of knowledge, gender, and location of food purchases are not related to the incidence of diarrhea in students.Conclusion: The results of the study found the prevalence of diarrhea and several risk factors associated with the incidence of diarrhea.

The application of probiotic after antibiotics treatment promotes the recovery of pediatric bronchopneumonia infection.

We aim to investigate the treatment efficacy of combinational applications of oral probiotic with intravenous infusion of antibiotics in pediatric bronchopneumonia infection. A total of 76 pediatric patients with bronchopneumonia infection were included in the study. We divided the patients into observation group (n=38) and control group (n=38). The patients in control group received intravenous infusion of antibiotics and symptomatic treatments. In the observation group, in addition to the treatments of the control group, the patients also received oral probiotic. We compared the effective times of treatment, including the durations of wet rale in lung auscultation, cough, fever, and the total time of hospitalization. Additionally, we also recorded the occurrence of adverse reaction, including rash and gastrointestinal reaction. Meanwhile, laboratory tests for systemic inflammation were recorded at different time points. The durations of rale in lung auscultation (p=0.006), cough (p=0.019), fever (p=0.012), and the total time of hospitalization (p=0.046) in observation group were significantly shorter than those in the control group. The incidence rate of diarrhea was 10.5% (4/38) in the observation group, and 34.2% (13/38) in the control group, with a significantly statistical difference (p=0.013). In the laboratory tests, we found that blood lymphocyte (p=0.034) and high-sensitive C reactive protein (p=0.004) were significantly higher in the control group than that in the observation group at 7th day after the treatments. The combinational applications of probiotic and antibiotics in pediatric bronchopneumonia infection were safe and effective and can lower the diarrhea rate.

Etiology and risk factors for diarrheal disease amongst rural and peri-urban populations in Cambodia, 2012-2018.

Diarrheal diseases are a leading cause of mortality and morbidity, disproportionally affecting persons residing in low and middle-income countries. Accessing high-resolution surveillance data to understand community-level etiology and risk remains challenging, particularly in remote and resource limited populations. A multi-year prospective cohort study was conducted in two rural and two peri-urban villages in Cambodia from 2012 to 2018 to describe the epidemiology and etiology of acute diarrheal diseases within the population. Suspected diarrheal episodes among participants were self-reported or detected via routine weekly household visits. Fresh stool and fecal swabs were tested, and acute-illness and follow-up participant questionnaires collected. Of 5027 enrolled participants, 1450 (28.8%) reported at least one diarrheal incident. A total of 4266 individual diarrhea case events were recorded. Diarrhea incidence rate was calculated to be 281.5 persons per 1000 population per year, with an event rate of 664.3 individual diarrhea events occurring per 1000 population per year. Pathogenic Escherichia coli, Aeromonas spp., and Plesiomonas shigelloides were the most prevalent bacterial infections identified. Hookworm and Strongyloides stercoralis were the predominant helminth species, while Blastocystis hominis and Giardia lamblia were the predominant protozoan species found. Norovirus genotype 2 was the predominant virus identified. Mixed infections of two or more pathogens were detected in 36.2% of positive cases. Risk analyses identified unemployed status increased diarrhea risk by 63% (HR = 1.63 [95% CI 1.46, 1.83]). Individuals without access to protected water sources or sanitation facilities were 59% (HR = 1.59 [95% CI 1.49, 1.69]) and 19% (HR = 1.19 [95% CI 1.12, 1.28]) greater risk of contracting diarrhea, respectively. Patient-level surveillance data captured in this long-term study has generated a unique spatiotemporal profile of diarrheal disease in Cambodia. Understanding etiologies, together with associated epidemiological and community-level risk, provides valuable public health insight to support effective planning and delivery of appropriate local population-targeted interventions.

Diarrhea illness in livestock keeping households in Cambodia: An analysis using a One Health framework

BackgroundMost of human diarrheal pathogens are zoonotic, and transmission of the pathogens can occur by contaminated food, water, environment and direct contact with animals especially for livestock keepers. Yet little is known of the relative importance of different risk factors especially in under-studied countries. The objectives of this study were to identify risk factors for diarrhea in livestock keepers in Cambodia and detect diarrhea-causing pathogenic bacteria in both humans and livestock within a One Health approach. Of special interest were the links between diarrhea and food consumption and livestock-keeping.Materials and methodsWe used an existing dataset from a questionnaire survey conducted in 400 livestock farms in Prey Veng and Kampot Prefectures between February and March 2013 as well as laboratory results on bacterial isolation from fecal and swab samples from livestock and poultry, and human stool samples. Laboratory results were available for up to three animals of each species kept by a household, and for up to three human samples from households reporting at least one case of human diarrhea in the previous 2 weeks. Presence of Escherichia coli, Shigella spp. and Salmonella spp. was investigated in both animal and human samples, in addition to Aeromonas spp., Vibrio spp. and Plesiomonas spp. in animal samples and Campylobacter spp. in human samples. Univariable and multivariable risk factor analyses were performed by generalized linear mixed model.ResultsHousehold-level diarrhea incidence rate was 9.0% (36/400). The most statistically significant factor associated with diarrhea in multivariable analysis was water treatment for drinking and cooking (OR = 0.33, 95%CI: 0.16–0.69, p = 0.003), followed by number of days consuming egg within 2 weeks (OR = 1.16, 95%CI: 1.04–1.29, p = 0.008), number of children under 5 years old (OR = 1.99, 95%CI: 1.14–3.49, p = 0.016) and keeping poultry (OR = 0.36, 95%CI: 0.14–0.92, p = 0.033). Animal samples for bacterial culture test were collected at 279 cattle, 165 pig and 327 poultry farms, and bacteria were detected from 6 farms with the isolation of Escherichia coli O157 (non H7) from 1 cattle and 1 pig sample, Aeromonas caviae from 1 pig sample and Salmonella spp. from 3 chicken samples. In human samples, 17 out of 67 individual samples were positive for the culture test, detecting Escherichia coli O157 (non H7) from 7 samples and Shigella spp. from 10 samples. None of the households where target bacteria were detected from animal samples had human samples collected due to lack of diarrhea episodes in the household.ConclusionsIt has often been hypothesized that keeping livestock may increase the incidence of diarrhea through multiple pathways. Contrary to this, we found livestock-keeping was not associated with increased risk, but food-related behavior and children under 5 years of age were strongly associated with increased risk. We discuss mediating and confounding factors and make recommendations for reducing the burden of diarrheal disease in Cambodia and more widely in low- and middle-income countries.

Impact of hygiene promotion intervention on acute childhood diarrhea: evidence from a cluster-randomized trial in refugee communities in Gambella Region, Ethiopia

Abstract Background: Diarrheal illnesses are mainly linked with poverty, and hygiene promotion programs can significantly reduce childhood diarrhea when interventions are tested in stable communities. However, there is no sufficient evidence in emergency context. Methods: A cluster-randomized controlled trial was conducted in Teirkidi and Pugnido refugee camps. Intention to treat was applied in analyses of the results of this trial. Logistic, poison regression and generalized estimating equation (GEE) models were used to evaluate changes in cluster-level hygiene behaviors and period prevalence and incidence of diarrhea with its confidence intervals (95% CI) and p &amp;lt; 0.05 significant cutoff point. Results: The reported diarrhea episodes were 1,307 (15.6 episodes per 100 person-weeks observation) among the intervention households and 1,619 (18.9 episodes per 100 person-weeks observation) in the control households. Under-five children living in households that received hygiene promotion had a 15% [p &amp;lt; 0.001; adjusted IRR: 0.85, 95% CI: 0.79 0.92] and a lower incidence of diarrhea compared with children living in control households. Conclusion: The study confirms that hygiene promotion intervention significantly reduces the incidence rate of childhood diarrhea in refugee camps. Hence, gains in the reduction of childhood diarrhea can be achieved in refugee camps through an enhanced hygiene promotion program.