Diarrheal Episodes Research Articles

Postpartum Guillain-Barré syndrome: a case report.

Case of 27 years female with parity 1, living 1, on postpartum day 20 presented to the emergency department (ED) with weakness over legs and hands since 20 days following emergency lower segment cesarean section for her delivery. The weakness prevailed over the lower extremities and progressed to the upper extremities in 4-5 days, affecting her grip strength and ability to stand alone. No history of prior diarrheal or respiratory illness. Cerebrospinal fluid analysis revealed albuminocytologic dissociation. A nerve conduction study showed in-excitable bilateral radial, median, ulnar, and sural nerves. Intravenous immunoglobulin was administered at the rate of 0.4g/kg once daily for 5 days. Patient was discharged after 2 weeks with regular physiotherapy follow-up. GBS in the postpartum period is very rare. There must be a high degree of suspicion among physicians for GBS if a pregnant female or a woman during her postpartum period presents with ascending muscle paralysis, even if there is no recent antecedent history of diarrheal episodes or respiratory illness. An early diagnosis with multidisciplinary supportive measures helps improve the prognosis for both the mother and the fetus.

Diarrhea after kidney transplantation: A study of risk factors and outcomes.

Diarrhea in kidney transplant recipients (KTRs) can be associated with significant morbidity. We evaluated 198 KTRs for a history of diarrhea post-kidney transplant at a tertiary care center in western India over 1 year. A protocol-based evaluation of diarrhea was done with respect to clinical features, diagnostic evaluation, associated acute allograft dysfunction, and its impact on long-term allograft function. Primary outcomes of interest were: chronic allograft injury (CAI) and the need for mycophenolate mofetil (MMF) withdrawal. We also assessed the effect of MMF withdrawal on the risk of the development of CAI. Eighty-five of 198 (42.5%) recipients experienced diarrhea and a total of 140 diarrheal episodes were evaluated. The mean age of these 85 recipients was 38 ± 12 years and 72 (84.7%) were males. 73 of 85 recipients were on MMF at the time of diarrhea and in 35 (48%) of them MMF withdrawal was needed for chronic and persistent symptoms. Diarrhea was attributed to infective etiologies in 90 of 140 (64.2%) cases. Among the microbiologically confirmed infective diarrheal episodes, giardia and cryptosporidium were the common pathogens in 11/28 (39%) and 6/28 (21.4%) episodes respectively. One hundred and twenty-eight episodes out of 140 (91.4%) episodes were complicated by acute allograft dysfunction. Forty-one of 85 recipients (48.2%) developed chronic allograft injury and 12 (14.1%) developed allograft rejection (acute and/or chronic). Probability of chronic allograft injury was higher in those with MMF withdrawal. Diarrhea post-kidney transplant adversely affects graft function, especially after MMF withdrawal.

A Study to Assess the Knowledge on Cause, Spread, Prevention and Management of Diarrhoeal Diseases Among Mothers of Under-five Attending SDM Paediatric OPD, Dharwad

Background and Objectives Diarrhoea is a leading cause of illness and death among children in developing countries. About 80 of deaths in the first two years of life are due to diarrhoeal diseases. To assess the knowledge of mothers on cause spread prevention and management of diarrhoeal diseases and to determine the association between the knowledge of mothers and selected socio demographic variables.Methods A descriptive survey research design was used to study the population of mothers with children under-five years of age. The sample size was 60 and the subjects were selected using non-probability purposive sampling method. The Pediatric OPD at SDM College of Medical Sciences amp Hospital in Dharwad served as the studyrsquos location. Data was collected with the help of a structured knowledge questionnaire.Results The mean knowledge score of mothers regarding diarrhoea was 9.87 with a standard deviation of 2.65 and a median of 9.50. According to the findings 50 of mothers had adequate awareness of diarrhoea 48.33 had moderate knowledge and just 1.67 had poor information. Knowledge significantly correlated with socio-demographic status family income and the number of children.Conclusion The present study concluded that mothers have adequate knowledge regarding the diarrhoeal episodes

Ozone therapy: protocol for treating canine parvovirus infection.

Canine Parvovirus infection is a disease caused by Canine Parvovirus (CPV) that results in hemorrhagic gastroenteritis and secondary infections, mainly in puppies between six weeks and six months old that are not immunized. Since there is no specific treatment for the condition, supportive therapy based on antibiotics, antiemetics, and non-steroidal anti-inflammatory drugs is traditionally used. Ozone therapy is an economical treatment that has bactericidal, fungicidal, and antiviral properties, besides promoting oxygenation and tissue regeneration, as well as anti-inflammatory and analgesic effects, and was used as a complementary therapy in this study. Therefore, four mixed-breed dogs, aged between 2 and 3 months, with no previous immunization against CPV and testing positive for the virus in a rapid test were selected. The animals were randomly distributed into two groups, being 1: the control group (n=2) that received only supportive treatment; and 2: the experimental group (n=2), that in addition to conventional therapy received intravenously 500 mL of ozonized Ringer's Lactate solution. Before treatment and after 24 and 48 hours, the following clinical signs were evaluated: episodes of emesis and diarrhea, weight, hydration, blood glucose level, abdominal pain, and blood count. One control group animal died within the first hours of hospitalization. Both animals in the experimental group presented faster resolution of diarrheal episodes and shorter hospitalization time when compared to the surviving animal that received only supportive treatment. Although further studies are needed, ozone therapy showed promising results for the treatment of canine parvovirus.

Patient-reported outcomes following selpercatinib treatment in Chinese patients with advanced RET fusion-positive non-small-cell lung cancer and thyroid cancer, and RET-mutant medullary thyroid cancer in the phase II LIBRETTO-321 trial.

Patient-reported outcomes (PROs) are increasingly becoming an important part of clinical trials as they are helpful in analyzing the safety and efficacy of treatment in chronic diseases like cancer. We report PROs and health-related quality of life (HRQoL) with selpercatinib treatment among Chinese patients with rearranged in transfection (RET) fusion-positive non-small-cell lung cancer (NSCLC), RET fusion-positive thyroid cancer (TC), and RET-mutant medullary TC (MTC) as an exploratory analysis of the LIBRETTO-321 trial. A total of 77 patients (47 RET fusion-positive NSCLC, 1 RET fusion-positive TC, and 29 RET-mutant MTC) were enrolled. Compliance for European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) was 100% at baseline and >90% at each time point. PROs were assessed using the EORTC QLQ-C30, and a bowel diary assessment for MTC patients with baseline diarrhea using the Systemic Therapy-Induced Diarrhea Assessment Tool. Data were collected at pre-dose; every 8 weeks from cycle 3; and every 12 weeks after cycle 13. A >10-point change from baseline was considered clinically meaningful. PRO changes were summarized through cycle 13. Most patients with NSCLC or MTC showed improvement or remained stable on the global health status and functional subscales. For global health status, 47.4% of NSCLC and MTC patients showed definite improvement with only 19.7% showing definite worsening. For functional subscales, less than 30% of the patients showed definite worsening. For symptom subscales, more than 64% of the patients either improved or remained stable for the symptoms. For MTC patients with bowel diary assessment (n = 5), there was no severity or worsening from baseline in the diarrheal episodes observed during treatment with selpercatinib. The study demonstrated favorable PROs in Chinese patients with RET fusion-positive NSCLC, TC, and RET-mutant MTC treated with selpercatinib. HRQoL was improved or stable as assessed by EORTC QLQ-30. This study was registered at ClinicalTrials.gov (https://clinicaltrials.gov/ct2/show/NCT04280081) ClinicalTrials.gov Identifier: NCT04280081.

Influence of latrine coverage and usage on diarrhoea incidence among children under 5 living in slum areas of Douala 5th sub-division, Cameroon.

lack of adequate sanitation facilities remain a major concern in developing countries. While around 41% of Cameroonians lack access to improved sanitation facilities, the 2011 National Survey revealed a diarrhoea incidence rate of 21% in children under five years, two weeks before interview. This study aimed at evaluating the influence of latrine coverage and usage on diarrhoeic disease outcomes among children under 5. a cross-sectional study was carried out in March 2016 in pre-selected slums areas of Douala 5th district. A structured questionnaire was used to collect data from one consenting adult per household. Data analysis was carried out using Epi Info version 7.1.4.0. Pearson's chi-square and Fisher exact test were used to estimate the influence of latrine coverage on the incidence of diarrhoea. Statistical significance was set at p < 0.05. of the 384 households enrolled, 69.01% had latrine facilities, while 30.99% shared latrines with neighbouring households. Sixty point sixteen percent (60.16%) (231/384) of all households used pit latrines. Although consistent use of latrines by all adults was reported, 20.05% of children under 5 practiced open-air defecation. The incidence of diarrhoea among children under 5 years 2 weeks before interview was 29.25%, of which 26.35% were bloody stools. Diarrhoea outcome was significantly associated with use of pit latrines (p < 0.01); lack of cover on latrines hole (p < 0.0001) and proximity of latrines to household (p=0.01). poor faecal waste management and lack of improved sanitation facilities contribute significantly to diarrhoeal episodes among children under 5. A structured strategy to improve community-based sanitation considering urban planning and sanitation campaigns would promote safer environment and reduce outcome of water-borne and diarrhoeic diseases.

Use of spatial analytics and geographic information systems in childhood diarrhoea in rural areas of India: A protocol paper

Introduction and Aim: The most recent advancement in epidemiology is using Geographic Information Systems (GIS) to comprehend illness based on clustering and spatial analysis. Using spatial analysis has shown positive changes in sanitation, reducing diarrhoea's burden. This study put forwards the methodology used to analyze spatiotemporal clustering and hotspot areas of childhood diarrhea in Karkala taluk, Udupi during 2015 to 2018. Materials and Methods: This study describes the methods used to analyze the space-time clustering and local indicators of spatial association (LISA) of childhood diarrhoea using the GeoDa and SaTScan programmes. At the Karkala taluk, data on under-five diarrhoea was gathered throughout time and space to develop the geospatial models. While the timing of the onset of the diarrhoea impacts the temporal characteristics, the child's position at the time of the event determines the spatial characteristics. The child's location and time of diarrheal episode was considered for the geospatial analysis. Results: The Kulldorff scan statistic (SaTScan v10.1) was employed for geographical analysis, and GeoDa software used for LISA and hotspot analysis. The randomness distribution of childhood diarrhoea over time and space was determined using the Kulldorff scan statistic software. The SaTScan locates and evaluates the statistical significance of geographical clusters based on the number of cases inside and outside the cylinder window. The scanning window in the software uses a cylinder with an elliptical or circular base to study intervals for time, space, and space-time. The different combinations of High and Low categories of the spatial association are covered by the hotspot analysis utilizing the GeoDa software. Conclusion: To build data-driven public health decision-making, it is required to link spatial and temporal patterns of diarrheal incidence among under-five children with predictive variables derived from routine data.

Assessment of Maternal Knowledge and Practices Regarding Acute Diarrheal Illnesses in Children in Saudi Arabia: A Tertiary Care Center Survey.

Background Diarrheal illness remains one of the most common causes of death among children specifically those who live in developing countries. Appropriate mothers' knowledge and practice regarding acute diarrhea illness in children can considerably reduce diarrhea-related morbidity and mortality. So, the aim of this study was to evaluate mothers' knowledge and practice regarding acute diarrheal illness in children. Method This cross-sectional study was conducted in a tertiary hospital in Riyadh, Saudi Arabia using a newly developed questionnaire that was distributed to King Abdullah Specialist Children. The calculated sample size was 375. Results A total of 375 mothers were included in this study and the majority of them(99%) were Saudis. More than half of the participants (61%) were university graduates.The majority(96.5%) choseprevious experience as the main source of information about diarrhea while(40%) chose physician. Most of the mothers(69.6%) believed that teething is the leading cause of diarrheal illness in children. Regarding the treatment, fluid was recognized to be the major treatmentfor diarrhea as chosen by the mothers. Around (42.7%) of the respondents thought intravenous fluid is more effective than oral rehydration solution (ORS) in treating dehydration associated withdiarrheal episodes. ORS was the main type of fluid (74.1%) which was selected by the mothers to be given during the diarrheal episode. Conclusion Mothers showed good knowledge and practice overall in regard to acute diarrheal illness in children. However, this study revealed some misconceptions among the caregivers which necessitates more educational sessions to be conducted in the community and during the hospital visit.

387. Differences in frequency of C. difficile infection testing of inpatients with diarrhea at selected acute care hospitals in NY and GA, 2020.

Abstract Background Clostridioides difficile infection (CDI) incidence estimates vary between geographic regions; few studies have evaluated the impact of CDI test order frequency on estimated CDI incidence. We evaluated this impact in a sample of hospitals at two CDC Emerging Infections Program (EIP) sites. Methods Daily surveillance was conducted for diarrhea among inpatients at 5 acute care hospitals (2,379 beds) in EIP sites in NY (2 hospitals) and GA (3 hospitals) during two 10-workday periods in 2020 and 2021. Diarrhea onset, test orders, and specimen collection status were ascertained. Stools were tested by PCR/NAAT initially or after negative EIA toxin. Differences in diarrhea incidence, testing frequency, and CDI positivity across site, care locations and hospitals were compared using Wilcoxon rank sum test. Correlates of CDI testing and positivity were assessed using modified Poisson regression. Estimates of incidence using EIP methodology at 5 hospitals was compared between sites using Mantel-Hanzel summary rate ratio. Results Surveillance of 38,365 patient-days (PD) identified 860 diarrhea cases from 107 patient-care locations mapped to 26 unique NHSN defined location-types. Incidence of diarrhea was 22.4/1000 PD (medians 25.8 NY, 16.2 GA, P&amp;lt; 0.01); with similar proportions of diarrhea being hospital-onset (66%) and CDI positive (17%) by site. Overall, 35% were tested for CDI (21% NY, 49% GA, P&amp;lt; 0.01). Percent tested varied by NHSN location type (Figure). Regression models identified location-type (oncology, critical care), laxatives use, chemotherapy, and residing in EIP catchment area predictive of testing (Figure). Adjusting for these factors, NY was 49% less likely than GA to test (aRR 0.51, 95% CI 0.40-0.63). Simulation of EIP methods estimated NY had a 38% lower incidence of CDI than GA (summary rate ratio 0.62, 95% CI, 0.54-0.71). Figure Incidence of Diarrheal Episodes (A) and Proportions Tested (B) among Hospitalized Patients, 2021 (solid, ward; open, critical care; grey, oncology), and adjusted relative risk (solid circles) with 95% confidence intervals (whisker) of independent predictors of testing for CDI (C). Conclusion After adjusting for patient characteristics (e.g., location-type, laxative use), the likelihood of testing still differed between NY and GA sites; the magnitude of the differences in testing was similar to that observed in estimated CDI incidence. Testing practices likely influence surveillance data and is a consideration when comparing data across regions. Disclosures Scott Fridkin, MD, Pfizer: Grant/Research Support christopher J. Myers, MS, Infectious diseases, Pfizer: Grant/Research Support Udodirim N. Onwubiko, MBBS MPH, Pfizer: Grant/Research Support William C. Dube, MPH, Pfizer: Grant/Research Support Sahil Khanna, MBBS, MS, Pfizer: Grant/Research Support Joann M. Zamparo, MPH, Pfizer: Employee|Pfizer: Stocks/Bonds Frederick J. Angulo, DVM PhD, Pfizer Vaccines: Employee|Pfizer Vaccines: Stocks/Bonds Ghinwa Dumyati, MD, Pfizer: Grant/Research Support.

The Detailed Pharmacodynamics of the Gut Relaxant Effect and GC-MS Analysis of the Grewia tenax Fruit Extract: In Vivo and Ex Vivo Approach.

The study was performed to assess and rationalize the traditional utilization of the fruit part of Grewia tenax (G. tenax). The phytoconstituents present in the methanolic extract were analyzed using Gas-Chromatography-Mass Spectroscopy (GC-MS), while the anti-diarrheal activity was investigated in the Swiss albino mice against castor oil-provoked diarrhea in vivo. The antispasmodic effect and the possible pharmacodynamics of the observed antispasmodic effect were determined in an isolated rat ileum using the organ bath setup as an ex vivo model. GC-MS findings indicate that G. tenax is rich in alcohol (6,6-dideutero-nonen-1-ol-3) as the main constituent (20.98%), while 3-Deoxy-d-mannoic lactone (15.36%) was detected as the second major constituents whereas methyl furfural, pyranone, carboxylic acid, vitamin E, fatty acid ester, hydrocarbon, steroids, sesquiterpenes, phytosterols, and ketones were verified as added constituents in the methanolic extract. In mice, the orally administered G. tenax inhibited the diarrheal episodes significantly (p < 0.05) at 200 mg/kg (40% protection), and this protection was escalated to 80% with the next higher dose of 400 mg/kg. Loperamide (10 mg/kg), a positive control drug, imparted 100% protection, whereas no protection was shown by saline. In isolated rat ileum, G. tenax completely inhibited the carbamylcholine (CCh; 1 µM) and KCl (high K+; 80 mM)-evoked spasms in a concentrations-mediated manner (0.03 to 3 mg/mL) by expressing equal potencies (p > 0.05) against both types of evoked spasms, similar to papaverine, having dual inhibitory actions at phosphodiesterase enzyme (PDE) and Ca2+ channels (CCB). Similar to papaverine, the inhibitory effect of G. tenax on PDE was further confirmed indirectly when G. tenax (0.1 and 0.3 mg/mL) preincubated ileal tissues shifted the isoprenaline-relaxation curve towards the left. Whereas, pre-incubating the tissue with 0.3 and 1 mg/mL of G. tenax established the CCB-like effect by non-specific inhibition of CaCl2−mediated concentration-response curves towards the right with suppression of the maximum peaks, similar to verapamil, a standard CCB. Thus, the present investigation revealed the phytochemical constituents and explored the detailed pharmacodynamic basis for the curative use of G. tenax in diarrhea and hyperactive gut motility disorders.

Application of the Human Viral Surrogate Pepper Mild Mottle Virus for Wastewater Fecal Pollution Management

Global water scarcity has led to significant dependence on reclaimed or recycled water for potable uses. Effluents arising from human and animal gut microbiomes highly influence water quality. Wastewater pollution is, therefore, frequently monitored using bacterial indicators (BI). However, threats to public health arise from the frequent incidence of wastewater-mediated viral infections–undetected by BI. Moreover, the enteric viromes contaminating wastewater are characterized by high abundance, genetic diversity and persistence in various water environments. Furthermore, humans usually suffer a minimum of a single acute diarrheal episode over their lifetime arising from extraneously acquired enteric microbiomes. A wide range of management methods are employed—in particular, microbial source tracking (MST) approaches to confront infections arising from exposure to contaminated wastewater. This review elaborates the viral contamination of treated wastewater and associated public health issues. Latterly, we discuss the various management strategies of wastewater pollution using conventional fecal indicators, viral indicators and human viral surrogates, with particular interest in the pepper mild mottle virus (PMMoV). Globally, PMMoV has been detected in rivers, aquifers, irrigation systems, and coastal and marine waters at high prevalence rates and concentrations greater than 105 genome copies per liter (gc/L). PMMoV was also found in almost all untreated wastewater environments. PMMoV concentrations in wastewater vary from 103 to 107 gc/L. These values are more than the maximum recorded viral indicator concentrations in wastewater for other proposed indicators. Limited variability in the daily concentrations of PMMoV in fecal wastewater has been studied, with an estimated average concentration of 105 gc/L with insignificant seasonal variability. The information summarized in this article offers fundamental knowledge for decision making in terms of defining the suitability criteria of candidate fecal indicators, risk assessment application and efficient wastewater management.

Clinical impact of biofire gastrointestinal panel testing for hospitalised children with acute gastroenteritis.

To investigate the clinical impact of BioFire FilmArray Gastrointestinal Panel (FGP) testing in real-life diarrhoeal episodes of hospitalised paediatric patients. Children hospitalised between October 2018 and September 2020 for whom stool specimens for FGP were submitted at the clinician's discretion were retrospectively observed. For each episode, demographics, clinical information and stool tests were collected. The clinical impact for each case was evaluated by changing the antibiotic prescription, following the result of the FGP testing. Out of 140 diarrhoeal episodes, 25 pathogens were found in 24 cases using conventional methods, whereas, FGP testing identified 75 pathogens in 56 cases (p< 0.05). The pathogens more frequently identified by FGP testing were Campylobacter, Shigella, Rotavirus, Giardia lamblia and Cryptosporidium. The clinical impact of FGP testing was observed in 17/140 (12%) diarrhoeal episodes, and higher rates in previously healthy (19%) and solid organ-transplanted children (15%). We found that using FGP testing for hospitalised children with diarrhoeal episodes could increase pathogen identification and impact clinical decisions, especially in healthy and transplant patients.

Role of cooked green banana in home management of acute diarrhea in under-5 children.

Acute diarrhea is an important contributor to under-5 mortality. Green banana is traditionally used as a home-based remedy for diarrhea. To identify the effect of green banana on duration, recovery and prevention of severe dehydration in under-5 children with acute watery diarrhea with no/some dehydration. This study was conducted in the rural field practice area of a tertiary care center between January 2020 and December 2021 in under-5 children presenting with acute diarrhea with no/some dehydration. One hundred fifty-three children were divided into group A (received cooked green banana supplementation along with standard management) and group B (received only standard management). Duration of diarrhea, proportion of children recovered, requirement of hospitalization, development of persistent diarrhea and number of diarrheal episodes in 1 year follow-up period were compared between two groups. Green banana supplementation was significantly associated with reduction in duration [median (interquartile range)-4 (1.5) day versus 5.5 (1) day, P < 0.001] of diarrhea, less hospitalization (9.2% versus 22.1%, P = 0.03) and early recovery, both at day 3 (17.1% versus 3.9%, P = 0.007) and day 7 (90.8% versus 77.9%, P = 0.03). Green banana also protected children from the development of persistent diarrhea (7.9% versus 19.5%, P = 0.04). It also reduced future episodes of diarrhea by 40.5%. Green banana supplementation could be a promising adjunct therapy in acute diarrhea and thereby it might reduce under-5 mortality.

Risk factors Associated with Recurrence of Diarrheal Episodes among Children under Two Years

Risk factors Associated with Recurrence of Diarrheal Episodes among Children under Two Years

ASSOCIATION OF MATERNAL FACTORS TOWARDS ACUTE DIARRHOEAL EPISODES IN UNDER FIVE CHILDREN IN CHHINDWARA DISTRICT: A CROSS-SECTIONAL STUDY

Background: Diarrhea is widely documented as a major cause of childhood morbidity and mortality in countless developing countries, particularly in India. According to the World Health Organization (WHO) report, diarrheal diseases are still leading causes of mortality and morbidity in children below 5 years of age. Objective: The present study done to estimate the association amid maternal factors and prevalence of acute diarrheal illnesses in children below 5 years of age in Chhindwara district. Methods: This community-based and cross-sectional study conducted in the urban field practice area attached to Department of Community Medicine of Chhindwara Institute of Medical Sciences, Chhindwara, from January 2019 to December 2019 was aimed to estimate the connotation between maternal factors and prevalence of acute diarrheal diseases in children under 5 years of age in Indian locations. Study tools included a pre-structured questionnaire. Baseline information of education area was taken from the Urban Primary Health Centre in the catchment area of medical college, Chhindwara. Data were arrived in Microsoft Excel spreadsheet to perform analysis. Results: In our study, 310 mothers who used to take bath daily of which 58 (19.9%) had diarrheal episodes, whereas out of 18 mothers who do not take bath daily, 11 (61.1%) had diarrheal episodes. Further, 292 mothers of children who castoff to wash their hands daily earlier the meals of which 58 (15.8%) children had diarrheal events, whereas out of 7 (38.9%) mothers who did not wash their hands before meals, 27 (12%) children had diarrheal incidents. Conclusion: The present study indicated that maternal factors bear an important impact on morbidity caused by diarrhea.

Hand washing practice among public primary school children and associated factors in Harar town, eastern Ethiopia: An institution-based cross-sectional study.

Hand washing with soap and water reduces the risk of diarrheal episode by 28-48% and acute respiratory infection by 20-50%. However, there is limited evidence on hand washing practices among students in Eastern Ethiopia, particularly in Harari town. Therefore, this study aimed to determine hand washing practice among primary school students and associated factors in Harar town, Eastern Ethiopia. An institution-based cross-sectional study was applied among 670 students in Harar town from June 1 to 30, 2021. A multi-stage sampling was employed; 6 out of 20 schools were selected through simple random sampling, while eligible children from each school was selected by probability proportional to size sampling method. Data were collected using a pre-tested questionnaire with a face-to-face interview technique and via observation. The data were analyzed using SPSS software version 23. Binary and mult-variable analysis were used to determine the association between factors and outcome variable. Finally, a p-value of < 0.05 was considered to declare a statistically significant association. A total of 670 participants were included in the study, of which 248 (37.0%) had washed their hands [95% CI: 33.3-40.06]. Being in grade 8 Adjusted Odd Ratio[AOR = 4.9; 95% Confidence Interval (CI): 2.28-10.52], living in an urban area [AOR = 3.49; 95% CI: 1.29-9.40], having role models (parents [AOR = 4.41; 95% CI: 1.79-10.86], teachers [AOR = 3.69; 95% CI: 1.39-8.81], and health professionals [AOR = 3.17, 95% CI: 1.17-8.63]), availability of hand washing facility [AOR = 3.62; 95% CI: 1.57-8.34], access to soap and water [AOR = 2.89; 95% CI: 1.39-5.98] and being membership of water sanitation and hygiene (WASH) club [AOR = 2.39; 95% CI: 1.41-4.03] were found to be significantly associated with hand washing practice. The current study found that nearly a third of students practiced proper hand washing. Hand washing practice was influenced by students' grade level, residence, referents (role models for hand washing), presence of a hand washing facility, access to water and soap, and membership of WASH club. Therefore, the finding revealed that there is a need to improve hand-washing practices in schools by concerned agencies.

PSUN369 Glucagonoma-Associated Dilated Cardiomyopathy in a Young Female: A Case Report

Abstract Background Dilated cardiomyopathy has been reported in patients with glucagonoma. Since glucagon increases myocardial cAMP levels independent of beta adrenoreceptor blockade, thereby increasing heart rate and cardiac output, chronic excessive glucagon stimulation of the heart may lead to cardiomyopathy (Chang-Chretien, 2004). Clinical Case A 26 year old female presented with a 2-year history of palpable epigastric mass, vomiting and weight loss. Abdominal CT showed a heterogeneously enhancing, lobulated pancreatic head-body mass measuring 6.7×6.1×9.9 cm and a hypo-enhancing nodule in hepatic segment IVb, worrisome for metastasis. Endoscopy-guided FNAB of the pancreatic mass revealed a well-differentiated pNET, Grade 3. Chromogranin and synaptophysin stains were positive, Ki-67 index was 33.6%. She was lost to follow-up. After 4 months, she was admitted due to 1 week history of increased vomiting episodes up to 10x daily and abdominal discomfort with 2 day history of incomprehensible speech and right-sided weakness. On examination, she was weak-looking, tachycardic (114 bpm), underweight (BMI 17.45 kg/m2) and with palpable, hard, non-tender epigastric mass measuring 10×7 cm. She also had hyperpigmented patches on both legs initially manifesting as intermittent oozing excoriations over the past 2 years. Cranial MRI revealed subacute CVD infarct. Anticoagulation was given. On the second day, she started having diarrheal episodes. Supportive management was given. Serum glucagon was markedly elevated (&amp;gt;25,000 pg/mL, normal &amp;lt;80). Serum PP (6562 pg/mL, normal &amp;lt;228) and gastrin (621 pg/mL, normal 13-115) were elevated. Serum VIP (&amp;lt;50 pg/mL, normal &amp;lt;75) was normal. Further investigations showed prediabetes (FBS 112 mg/dL, HbA1c 5.7%) and normocytic, normochromic anemia. Screening for MEN1 was unremarkable. On the third day, she had progression of slurred speech and right-sided weakness. Cranial MRI revealed acute lacunar infarcts. As part of hypercoagulability workup, 2D-Echocardiogram showed depressed ejection fraction (20.9%), dilated LV with normal relative wall thickness, and global hypokinesia of the LV wall, confirming dilated cardiomyopathy. Carotid and Venous Duplex scans were normal. Anti-heart failure regimen was initiated. Due to her current neurologic, cardiac and metabolic conditions, she cannot proceed with surgery and chemotherapy. She was given octreotide injection 30 mg every 4 weeks for 3 doses. Post-treatment, repeat abdominal CT and 2D-Echocardiogram showed no significant change. In the meantime, she had improved appetite and no recurrence of vomiting nor diarrhea. She denies palpitations and can better tolerate walking and climbing stairs. Conclusion We reported a rare case of glucagonoma in a young female with documented constellation of symptoms and complications associated with the syndrome, prominently including dilated cardiomyopathy. It is therefore recommended that cardiovascular evaluation should be initiated at the time of glucagonoma diagnosis for timely and appropriate management. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Enteropathy Markers in Early Life Were Associated with Adipokine, Apolipoprotein, and Cytokine Profiles Consistent with an Adverse Cardiometabolic Disease Risk Profile Later in Childhood in a Peruvian Birth Cohort.

Metabolic syndrome is a cluster of risk factors for cardiovascular disease afflicting more than 1 billion people worldwide and is increasingly being identified in younger age groups and in socioeconomically disadvantaged settings in the global south. Enteropathogen exposure and environmental enteropathy in infancy may contribute to metabolic syndrome by disrupting the metabolic profile in a way that is detectable in cardiometabolic markers later in childhood. A total of 217 subjects previously enrolled in a birth cohort in Amazonian Peru were monitored annually from ages 2 to 5 years. A total of 197 blood samples collected in later childhood were analyzed for 37 cardiometabolic biomarkers, including adipokines, apolipoproteins, cytokines, which were matched to extant early-life markers of enteropathy ascertained between birth and 2 years. Multivariate and multivariable regression models were fitted to test for associations, adjusting for confounders. Fecal and urinary markers of intestinal permeability and inflammation (myeloperoxidase, lactulose, and mannitol) measured in infancy were associated with later serum concentrations of soluble CD40-ligand, a proinflammatory cytokine correlated with adverse metabolic outcomes. Fecal myeloperoxidase was also associated with later levels of omentin-1. Enteric protozoa exposure showed stronger associations with later cardiometabolic markers than viruses, bacteria, and overall diarrheal episodes. Early-life enteropathy markers were associated with altered adipokine, apolipoprotein, and cytokine profiles later in childhood consistent with an adverse cardiometabolic disease risk profile in this cohort. Markers of intestinal permeability and inflammation measured in urine (lactulose, mannitol) and stool (myeloperoxidase, protozoal infections) during infancy may predict metabolic syndrome in adulthood.

Role of antisecretory drug in treatment of children with acute watery diarrhea

Background and aim Previous studies have shown that Racecadotril is safer and more effective in treating children with acute diarrhea. This study aimed to evaluate the effect of Racecadotril as a booster to oral rehydration solution in the management of acute watery diarrhea among children aged 5 years or less. Patients and methods This random clinical trial included 50 children with acute watery diarrhea for less than or equal to 5 days with a frequency of more than or equal to three diarrheic stools in the past 24 h before admission to the hospital, with no mild-to-moderate dehydration. Our study is registered to clinicaltrials.gov (NCT05216822). Results The main findings of this study were that Racecadotril reduced the duration of the diarrheal episodes and the duration of hospitalization significantly. This study revealed that Racecadotril showed an improvement in the consistency of stool, which protects the patient from fluid loss and dehydration. Conclusion Racecadotril is an effective booster-rehydration drug that carries out its antidiarrheal effect by inhibiting intestinal enkephalinase. It is efficient in reducing the volume and frequency of stool output.

Estimating the changing burden of disease attributable to unsafe water and lack of sanitation and hygiene in South Africa for 2000, 2006 and 2012.

The incidence of diarrhoeal disease is closely linked to socioeconomic and environmental factors, household practices and access to health services. South African (SA) district health information and national survey data report wide variation in the incidence and prevalence of diarrhoeal episodes in children under 5 years of age. These differentials indicate potential for reducing the disease burden through improvements in provision of water and sanitation services and changes in hygiene behaviour. To estimate the burden of disease attributed to unsafe water, sanitation and hygiene (WASH) by province, sex and age group for SA in 2000, 2006 and 2012. Comparative risk assessment methodology was used to estimate the disease burden attributable to an exposure by comparing the observed risk factor distribution with a theoretical lowest possible population distribution. The study adapts the original World Health Organization scenario-based approach for estimating diarrhoeal disease burden from unsafe WASH, by assigning different standards of household water and sanitation-specific geographical classification to capture SA living conditions in rural, urban and informal settlements. SA experienced an improvement in water and sanitation supply in eight of the nine provinces between 2001 and 2011, with the exception of Northern Cape Province. In 2011, 41% of South Africans lived with poor water and sanitation conditions; however, wide provincial inequalities exist. In 2012, it was estimated that 84.1% of all deaths due to diarrhoeal disease were attributable to unsafe WASH; this equates to 13 757 deaths (95% uncertainty interval (UI) 13 015 - 14 300). Of these diarrhoeal disease deaths, 48.2% occurred in children under 5 years of age, accounting for 13.9% of all deaths in this age group (95% UI 13.1 - 14.4). Between 2000 and 2012, the proportion of deaths attributable to diarrhoea reduced from 3.6% to 2.6%. Gauteng and Western Cape provinces experienced much lower WASHattributable death rates than the more rural, poorer provinces. Unsafe WASH remains an important risk factor for disease in SA, especially in children. High priority needs to be given to the provision of safe and sustainable sanitation and water facilities and promoting safe hygiene behaviours. The COVID-19 pandemic has reinforced the critical importance of clean water for preventing and containing disease.