Episodes Of Diarrhea Research Articles

Audit and Feedback to Ordering Providers to Reduce Inappropriate C. difficile Testing and Hospital Onset C. difficile Rate

Background: Inappropriate Clostridioides difficile (C. difficile) laboratory testing is common in hospitals and leads to over diagnosis, unnecessary treatment, and elevated hospital onset C. difficile infection (HO-CDI) metrics. Diagnostic stewardship is essential to avoid inappropriate testing, but limited data exists on optional interventions. Methods: A diagnostic stewardship intervention targeting CDI testing comprised of education and prospective audit with feedback was performed a VA facility (inpatient, outpatient, and long-term care units). Education on appropriate indications for CDI testing was provided in pre-intervention (9/2022 to 5/2023) and intervention periods (6/2023 to 12/2023). During the intervention period, all CDI tests (positive or negative) were audited after completion in real-time by an Infectious Diseases physician and feedback was given to ordering providers and/or their supervising physician (if trainee) for all tests not meeting an appropriate indication. Appropriate indication was defined as ≥3 liquid stools in 24 hours or symptoms of fulminant disease. Testing was considered inappropriate if no clinical symptoms, patient received laxatives within 48 hours, test was performed for test-of-cure or within 7 days of a prior test with no clinical change, or delayed testing in patients with diarrhea on admission. The rate of HO-CDI per 10,000 bed days of care (BDOC) per LabID event was compared during the pre-intervention and intervention periods, and ordering appropriateness was compared for all tests and hospital onset tests before (3/2023-5/2023) and after (6/2023-12/2023) feedback was performed. Results: After starting audit and feedback, HO-CDI rate decreased from 3.92 per 10,000 BDOC to 0.99 per 10,000 BDOC (p=0.03). HO-CDI rate among tests that were inappropriate was 2.19 and 0.80 per 10,000 BDOC during the pre-intervention and intervention periods, respectively (p=0.40). Average overall tests per month decreased from 37.8 to 28.1 after the intervention. Rate of all inappropriate tests decreased from 16.25 to 7.96 per 10,000 BDOC (p=0.04) and rate of hospital onset inappropriate tests trended toward decrease from 9.29 to 4.77 tests per 10,000 BDOC (p=0.07). The most common reasons for inappropriate testing were < 3 episodes of diarrhea in 24 hours (54% pre-intervention, 65% intervention) and laxative use (57% pre-intervention, 45% intervention). No cases of delayed testing leading to worsened disease were identified during the intervention. Cost savings for decreased tests were estimated at $150-300 per month. Conclusion: An intervention comprised of education and real-time audit and feedback of all CDI tests obtained at a VA facility resulted in decreased inappropriate testing and reduced the rate of HO-CDI.

Differences in clinical manifestations and the fecal microbiome between irritable bowel syndrome and small intestinal bacterial overgrowth

BackgroundIrritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) share similar abdominal symptoms; however, their differentiation remains controversial. AimsTo illustrate the differences between the two conditions. MethodsPatients and healthy controls completed questionnaires and provided stool samples for analysis. ResultsIBS presented with the most severe symptoms and was specifically characterized by intense abdominal pain and frequent episodes of diarrhea. Patients with IBS displayed more dysregulated taxonomy within the fecal microbiota than SIBO. Opportunistic pathogens, including Lachnoclostridium, Escherichia-Shigella, and Enterobacter were enriched in the IBS group which contributed to increased bacterial pathogenicity and positively correlated with abdominal pain and bloating, meanwhile, Lachnoclostridium and Escherichia-Shigella were found to be associated with metabolites affiliated to bile acids, alcohols and derivatives. Bacteria enriched in SIBO group correlated with constipation. The bacterial co-occurrence network within the SIBO group was the most intricate. Ruminococcaceae Group were defined as core bacteria in SIBO. Differential metabolites affiliated to androstane steroids and phenylacetic acids were associated with core bacteria. ConclusionsOur study elucidates the differences between IBS and SIBO in terms of symptoms, microbiota and functions, which provides insights into a better understanding of both diseases and evidence for different treatment strategies.

Integrated Management of complex Fistula-in-Ano in a Patient with Ulcerative Colitis Using Kshara Sutra: A Unique Case Study

Introduction: Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by mucosal inflammation of the colon and rectum often leading to debilitating symptoms and complications. Fistula-in- Ano is a rare complication of UC, which is an abnormal tract connecting the anal canal to the skin surrounding the anus, further complicating management and impairing patients' quality of life which poses significant challenges in management due to its chronic and recurrent nature. Kshara Sutra, an Ayurvedic parasurgical procedure involving the use of medicated thread, has shown promising results in the treatment of complex Fistula-in-Ano in a patient with ulcerative colitis. Aim: To evaluate the efficacy of Kshara Sutra in the management of complex Fistula-in-Ano in a patient with Ulcerative colitis. Material and Methods: A Hindu, married 56 yrs. old male patient came in Shalya Department of Naradevi Ayurveda Hospital, Kathmandu Nepal with a chief complaints of recurrent episodes of bloody diarrhea, abdominal pain, and perianal discharge over a span of four years. Diagnostic workup revealed extensive colonic involvement consistent with UC on colonoscopy and imaging confirmed the presence of a fistula-in-ano. The patient was diagnosed as a case of Fistula-in Ano with clinical findings & examination done. Then Kshara sutra Ligation was planned along with internal medications. Results/Discussions: After 6 months of treatment, result was achieved remarkably. Conclusion: This case highlights the potential efficacy and safety of Kshara Sutra therapy as an adjunctive and safest treatment modality for managing complex Fistula-in-Ano in patients with underlying ulcerative colitis.

Pathological Investigation of Double–Stranded DNA Breaks and DNA Oxidation in Natural Infection with Mycobacterium avium subspecies paratuberculosis in Goats

Paratuberculosis, created by Mycobacterium avium subspecies paratuberculosis (MAP), manifests as a chronic affliction marked by persistent diarrhoea and granulomatous enteritis, pervasive in both domestic and global wild ruminants. In this investigation, DNA disruption in lesioned tissues of goat as natural infecte with MAP was pathologically assessed. Accordingly, goats manifesting symptoms suggestive to paratuberculosis, including pronounced emaciation and continual episodic diarrhoea, were subjected to an ELISA diagnostic procedure to ascertain the presence of MAP. This diagnostic approach confirmed the presence of the infectious agent in 20 patients. These patients were subsequently euthanized, and tissue samples from intestinal and regional lenf nods. It were subjected to Hematoxylin and Eosin (HE) staining for histopathological investigatıon, Ziehl Neelsen (ZN) staining to identify acid–fast mycobacteria, γ–H2AX to discern disruptions in double stranded DNA, and 8–Ohdg to detect DNA oxidation by immunohistochemical (IHC) method. Gross anatomical observation serous adipose atrophy, augmented dimensions of mesenterial lymphatic nodes, mucosal hypertrophy and non–retractable mucosal undulations. Histological assessment highlighted epithelial cellular degeneration, an abundance of epithelioid macrophages, lymphocytes, plasmocytes, infiltrating in mucosa. Acid–fast entities, discernible through ZN staining, appeared as luminescent red conglomerates in intestinal and mesenterial tissue. The immunohistochemical analyses evinced positive results for both γ–H2AX and 8–Ohdg across all sampled tissues. Intriguingly, this investigation presented the inaugural global evidence of γ–H2AX and 8–Ohdg expression in a natural MAP infection, demonstrating that this pathological agent precipitates DNA degradation and oxidation, thereby augmenting comprehension of the disease’s pathogenesis.

Ayurvedic management of IBS - A Case Study

Irritable bowel syndrome (IBS) is characterized by recurrent abdominal discomfort in association with alternate episodes of diarrhea and constipation. Physiological, luminal, behavioral and psychosocial factors are responsible for IBS. They are caused by two entirely different mechanisms. Bowels habit is disturbed by diarrhea or constipation occurring alone or alternating. A 30 years old male patient having symptoms of Muhurbaddha Muhurshithil (episode of constipated and loose stools), Apakwa Malapravritti (stool with mucus), Udarshool (abdominal pain). Patient treated with various Panchakarma (five bio-cleaning Ayurvedic therapies) procedures like Basti (herbal medicated enema), Herbal and oral medications. At the end of 50 days of treatment, patient got significant improvement.

Household food and water insecurity and its association with diarrhoea, respiratory illness, and stunting in Ecuadorian children under 5 years.

Household food and water insecurity has been previously associated with adverse health consequences in children. However, these relationships are understudied in middle-income Latin American populations such as in Ecuador, where a high prevalence of food and water insecurity has been reported. Using cross-sectional data from 2018 Ecuadorian National Health and Nutrition Survey, we examined the association of household food insecurity (HFI), household water insecurity (HWI), and concurrent HFI-HWI with diarrhoea, respiratory illness (RI), and stunting in 20,510 children aged ≤59 months. HFI was measured using the Food Insecurity Experience Scale. HWI was defined when households responded negatively to one or more of four drinking water indicators. Maternal caregivers reported on child diarrhoea and RI episodes during the previous 2 weeks. Measured length or height was used to assess stunting. We constructed log-binomial regression models to estimate the associations of HFI, HWI, and concurrent HFI-HWI with child outcomes. Moderate-severe HFI was associated with a higher prevalence of diarrhoea (PR = 1.39; 95% CI: 1.18, 1.63) and RI (PR = 1.34; 95% CI: 1.22, 1.47), HWI with a higher prevalence of RI (PR = 1.13; 95% CI: 1.04, 1.22), and concurrent HFI-HWI with a higher prevalence of diarrhoea (PR = 1.30; 95% CI: 1.05, 1.62) and RI (PR = 1.45; 95% CI: 1.29, 1.62). Stunting was not associated with HFI, HWI nor concurrent HFI-HWI. These findings suggest that HFI and HWI can independently and jointly act to negatively affect children's health. Policies and interventions aimed at alleviating both food and water insecurity are needed to bring sustained health improvements in Ecuadorian children.

Effect of nutrition assessment, counselling and support integration on mother-infant nutritional status, practices and health in Tororo and Butaleja districts, Uganda: A comparative non-equivalent quasi-experimental study

BackgroundMalnutrition remains a health challenge for women aged 15 to 49 years and their infants. While Nutrition Assessment Counselling and Support (NACS) is considered a promising strategy, evidence of its effectiveness remains scanty. This study assessed the effect of the comprehensive NACS package on the mother-infant practices, health and nutrition outcomes in two districts in Eastern Uganda.MethodsA comparative non-equivalent quasi-experimental design was employed with two groups; Comprehensive NACS (Tororo) and Routine NACS (Butaleja). Pregnant mothers were enrolled spanning various trimesters and followed through the antenatal periods and post-delivery to monitor their health and nutrition status. Infants were followed for feeding practices, health and nutritional status at birth and weeks 6, 10, 14 and at months 6, 9 and 12 post-delivery. Propensity score matching ensured study group comparability. The NACS effect was estimated by nearest neighbour matching and the logistic regression methods. Statistical analysis utilised STATA version 15 and R version 4.1.1.ResultsA total of 666/784 (85%) with complete data were analysed (routine: 412, comprehensive: 254). Both groups were comparable by mothers’ age, Mid Upper Arm Circumference, prior antenatal visits, meal frequency, micronutrient supplementation and instances of maternal headache, depression and diarrhoea. However, differences existed in gestation age, income, family size, education and other living conditions. Comprehensive NACS infants exhibited higher infant birth weights, weight-for-age z-scores at the 3rd -6th visits (p < 0.001), length-for-age z scores at the 4th -7th visits (p < 0.001) and weight-for-length z-scores at the 3rd − 5th (p < = 0.001) visits. Despite fewer episodes of diarrhoea and fever, upper respiration infections were higher.ConclusionsThe comprehensive NACS demonstrated improved mother-infant nutritional and other health outcomes suggesting the need for integrated and holistic care for better maternal, infant and child health.

A Probiotic Bacterium with Activity against the Most Frequent Bacteria and Viruses Causing Pediatric Diarrhea: Bifidobacterium longum subsp. infantis CECT 7210 (B. infantis IM1®).

The second leading cause of death in children under five years old is diarrheal disease. Probiotics, specifically bifidobacteria, have been associated with a reduction in the number of diarrhea episodes and their severity in babies. In this paper, we summarize the preclinical and clinical evidence of the efficacy of B. longum subsp. infantis IM1® against various gastrointestinal pathogens using in vitro models, animal models, and clinical studies carried out in our laboratory. The preclinical data demonstrate that IM1® effectively inhibits rotavirus replication (by up to 36.05%) in MA-104 and HT-29 cells and from infection (up to 48.50%) through the production of an 11-amino-acid peptide. IM1® displays the capability to displace pathogens from enterocytes, particularly Cronobacter sakazakii and Salmonella enterica, and to reduce the adhesion to the HT29 cells of C. sakazakii and Shigella sonnei. In animal models, the IM1® strain exhibits in vivo protection against rotavirus and improves the clinical symptomatology of bacterial gastroenteritis. A clinical study involving infants under 3 months of age revealed that IM1® reduced episodes of diarrhea, proving to be safe, well tolerated, and associated with a lower prevalence of constipation. B. infantis IM1® emerges as an effective probiotic, diminishing episodes of diarrhea caused by gastrointestinal pathogens.

Comparing the Efficacy of Anti-Secretory and Oral Immunoglobulins in Reducing the Duration of Diarrhea Episodes in Children; A Randomized Controlled Trial

Objective: To compare the efficacy of anti-secretory and oral immunoglobulins in reducing the episodes of diarrhea in children. Methodology: This randomized controlled trial, carried out at The children Hospital, Islamabad. Eighty-four children aged 6 to 36 months with acute diarrhea were included. Patients were divided into two groups: Group A patients received anti-secretory (racecadotril) and oral rehydration and zinc, while Group B was given egg solids and bovine colostrum in powdered form, ingested with water, alongside oral rehydration and zinc. Treatment efficacy was measured by time to fewer than 3 semi-solid stools within 24 hours. Outcomes were observed over 72 hours. Data was entered and analysed using SPSS version 26.0. Results: The study involved 84 children (39 males, 45 females) aged 6 to 36 months, treated for acute diarrhea with Group A (anti-secretory, racecadotril) or Group B (Bovine colostrum). Baseline characteristics including age, gender, and duration of symptoms showed no significant differences between the groups (P=0.331 for gender, P=0.194 for age, P=0.187 for symptom duration). Treatment response varied significantly between the groups (P=0.000): In Group B, 18, 12, and 6 patients responded on days 1, 2, and 3, respectively, while in Group A, 5 patients responded on day 1 and 20 on day 2, with no 3-day responses. Out of 84 patients, 36 in Group B and 25 in Group A responded positively, and treatment was overall effective for 61 patients (p-value 0.001). Conclusion: Both treatments were effective, with 85.7% efficacy in the Bovine colostrum group and 60% in the Racecadotril group after 3 days. The Bovine colostrum group demonstrated a significantly quicker treatment response compared to Racecadotril.

DIARRHEA CAUSING ENTEROBACTERIACEAE AND THEIR ANTIBIOTIC RESISTANCE PATTERNS AMONG DIARRHEA PATIENTS FROM SANA’A CITY, YEMEN

Background and aims: The rise of antibiotic-resistant strains of the bacteria causing diarrhea remains a major worldwide health concern, especially in children under five. The purpose of this surveillance study was to ascertain the prevalence and antibiotic susceptibility profile of Enterobacteriaceae, which cause diarrhea. Materials and Methods: The National Center for Public Health Laboratories (NCPHL) in Sana'a city was the site of this cross-sectional investigation. Patient stool samples exhibiting diarrhea were gathered and cultivated using standard differential/selective medium. Standard biochemical assays and serological investigations were employed to identify the isolates. With the aid of Kirby-Bauer disk diffusion, the antibiogram was identified. Results: Enterobacteriaceae isolates were obtained from 972 stool samples collected; 15.3% (149/972) were diarrheagenic Enterobacteriaceae bacteria, including E. coli, Salmonella, and Shigella. There were 8.3% (81/972) Salmonella spp., 5.7% (56/972) Shigella spp., and 1.2% (12/972) E. coli. E. coli strains were grouped, with the most prominent being serogroups O153 (3, 2%) and O25 (2, 1.4%). Fifty-six (37.6%) Shigella species were identified as Shigella boydii type 2 and Shigella bodii type 17, which were the most common Shigella isolated (11, 8.1%, and 16, 10.7%, respectively). We detected high resistance of Salmonella isolates to tetracycline (29/81, 35.8%) but relatively low resistance to ciprofloxacin (7/81, 8.6%) and ceftriaxone (5/81, 6.3%). Conclusion: The many Enterobacteriaceae linked to instances of diarrhea in Sana'a, Yemen, were demonstrated in this study, along with the necessity of differential diagnosis for improved treatment results. Salmonella, Shigella, and Escherichia coli have all been linked to episodes of diarrhea in Sana'a city. To stop Yemen's antimicrobial resistance from spreading, regular antimicrobial susceptibility testing, efficient monitoring, and national surveillance of AMR bacteria should be put into place. Peer Review History: Received 3 February 2024; Revised 12 March 2024; Accepted 20 April; Available online 15 May 2024 Academic Editor: Dr. Gehan Fawzy Abdel Raoof Kandeel, Pharmacognosy Department, National Research Centre, Dokki, 12622, Giza, Egypt, gehankandeel9@yahoo.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com Dr. Esther Marguerite Chase DJANGA, Faculty of Medicine and Biomedical Sciences. Department of Public Health. University of Yaoundé I, Cameroon. e.djanga@yahoo.com

A CROSS-SECTIONAL STUDY TO ASSESS THE PATTERN OF SELF-MEDICATION USED FOR DIARRHEA AMONG MEDICAL STUDENTS IN TERTIARY CARE TEACHING HOSPITAL OF CENTRAL INDIA

Objective: The objective of the study is to assess the drug usage pattern, personal hygiene, and sanitation practices among day scholars and hosteller medical students. Methods: A questionnaire-based cross-sectional study was conducted at MGM Medical College and M.Y. Hospital, Indore. Undergraduate and postgraduate medical students who experienced episodes of diarrhea in the past 6 months were included in the study. Diarrhea occurring due to organic causes was excluded. Data were collected using a Google or physical form and were analyzed using descriptive statistics. Results: 254 students who suffered from diarrhea in the past 6 months participated in the study, out of which 56% were hostellers. Commonly used drugs were ofloxacin, metronidazole, etc. 50.2% of them took self-medication; the majority of them were hostellers. Students were found to eat outside at least once a week. Personal hygiene and sanitation were more compromised among hostellers than day scholars. Conclusion: Personal hygiene and sanitation practices should be improved among medical students, especially hostel students. These students, despite being from medical backgrounds, still take irrational medication. Therefore, there is a need for increased awareness regarding drug usage, and self-medication should be discouraged.

Incidence of Cryptosporidium: A Neglected Parasite in Immunocompetent Adults in Swabi

Objective: To highlight the increasing incidence of Cryptosporidium in immunocompetent adults and the resultant altered epidemiology. Methodology: This study was conducted over a period of one year, from 1st January 2023 to 1st of January, 2024 at Microbiology Laboratory MTI- GKMC/BKMC, Swabi. Modified Ziehl Neelsen staining was performed on the received stool samples from patients presenting with wide range of symptoms associated with Irritable Bowel Syndrome (IBS). Abdominal pain, recurrent episodes of diarrhea and weight loss were the main symptoms. Modified ZN stain being one of the most reliable, quick and cost effective methods for the detection of cysts of Cryptosporidium using 40X and oil immersion lens was used for diagnosis. Results: A total of 62 samples were received from immunocompetent patients in the said period out of which 34% were positive for the oocysts of Cryptosporidium species. Out of a total of 21 positive samples 62% were males and 38% were females. The age range of the patients spanned between 20 to 60 years. Conclusion: Knowing this high incidence 34% of Cryptosporidium spp. in the healthy adults, necessitates to prioritize steps for the prevention of this infection by implementation of public health measures.

Prevalence of oral rehydration solution use and its determinants in the treatment of diarrhea among under-five children in sub-Saharan Africa.

Diarrhea is the second leading cause of under-five deaths claiming half a million children every year. Most of these deaths occurred in sub-Saharan Africa and South Asia. Oral rehydration solution (ORS) has been described as the most effective treatment of diarrhea. However, only 36% of children with diarrhea received ORS in sub-Saharan Africa. This study examined the factors associated with ORS use for children with diarrhea in the sub-region. Demographic and Health Surveys (DHS) data sets of 31 countries in sub-Saharan Africa were used in this study. The data involved 30,102 under-five children with diarrhea. The multivariable analysis involved binary logistic regression. Prevalence of ORS use was 38% in sub-Saharan Africa with countries such as Namibia (71.8%), Zambia (66.4%) and Malawi (63.8%) having the highest rates. Use of ORS was most common among children whose mothers had secondary or higher education (45%), were exposed to media (41%) and attended antenatal care (41%). ORS use was significantly associated with secondary or higher education (OR = 1.63; 95%CI: [1.47-1.81]; p<0.001), exposure to media (OR = 1.17; 95%CI: [1.07-1.27]; p<0.001), antenatal care attendance (OR = 2.33; 95%CI: [1.08-1.27]; p<0.001), child's age (OR = 1.46; 95%CI: [1.35-1.59]; p<0.001), child's size at birth (OR = 1.08; 95%CI: [1.00-1.17]; p<0.05), household size (OR = 1.28; 95%CI:[1.06-1.54]; p<0.05) and source of drinking water (OR = 1.18; 95%CI: [1.09-1.29]; p<0.001). This study revealed a 38% prevalence of ORS use during diarrhea episodes in sub-Saharan Africa. This is low as it is less than the 44% recorded for developing countries as a whole. While this study emphasises the need for a further study on effects of severity of diarrhea on ORS use and factors determining differences in ORS use among countries, it also calls for interventions that will increase use of ORS is sub-Saharan Africa. Such interventions should include increase in literacy rate among girls and women, increase in the proportion of women with access to media, involvement of health workers in programmes that would promote antenatal care utilization among women at community level and provision of social amenities like pipe-borne water.

Appendectomy versus antibiotic treatment for acute appendicitis.

Acute appendicitis is one of the most common emergency general surgical conditions worldwide. Uncomplicated/simple appendicitis can be treated with appendectomy or antibiotics. Some studies have suggested possible benefits with antibiotics with reduced complications, length of hospital stay, and the number of days off work. However, surgery may improve success of treatment as antibiotic treatment is associated with recurrence and future need for surgery. To assess the effects of antibiotic treatment for uncomplicated/simple acute appendicitis compared with appendectomy for resolution of symptoms and complications. We searched CENTRAL, MEDLINE, Embase, and two trial registers (World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov) on 19 July 2022. We also searched for unpublished studies in conference proceedings together with reference checking and citation search. There were no restrictions on date, publication status, or language of publication. We included parallel-group randomised controlled trials (RCTs) only. We included studies where most participants were adults with uncomplicated/simple appendicitis. Interventions included antibiotics (by any route) compared with appendectomy (open or laparoscopic). We used standard methodology expected by Cochrane. We used GRADE to assess the certainty of evidence for each outcome. Primary outcomes included mortality and success of treatment, and secondary outcomes included number of participants requiring appendectomy in the antibiotic group, complications, pain, length of hospital stay, sick leave, malignancy in the antibiotic group, negative appendectomy rate, and quality of life. Success of treatment definitions were heterogeneous although mainly based on resolution of symptoms rather than incorporation of long-term recurrence or need for surgery in the antibiotic group. We included 13 studies in the review covering 1675 participants randomised to antibiotics and 1683 participants randomised to appendectomy. One study was unpublished. All were conducted in secondary care and two studies received pharmaceutical funding. All studies used broad-spectrum antibiotic regimens expected to cover gastrointestinal bacteria. Most studies used predominantly laparoscopic surgery, but some included mainly open procedures. Six studies included adults and children. Almost all studies aimed to exclude participants with complicated appendicitis prior to randomisation, although one study included 12% with perforation. The diagnostic technique was clinical assessment and imaging in most studies. Only one study limited inclusion by sex (male only). Follow-up ranged from hospital admission only to seven years. Certainty of evidence was mainly affected by risk of bias (due to lack of blinding and loss to follow-up) and imprecision. Primary outcomes It is uncertain whether there was any difference in mortality due to the very low-certainty evidence (Peto odds ratio (OR) 0.51, 95% confidence interval (CI) 0.05 to 4.95; 1 study, 492 participants). There may be 76 more people per 1000 having unsuccessful treatment in the antibiotic group compared with surgery, which did not reach our predefined level for clinical significance (risk ratio (RR) 0.91, 95% CI 0.87 to 0.96; I2 = 69%; 7 studies, 2471 participants; low-certainty evidence). Secondary outcomes At one year, 30.7% (95% CI 24.0 to 37.8; I2 = 80%; 9 studies, 1396 participants) of participants in the antibiotic group required appendectomy or, alternatively, more than two-thirds of antibiotic-treated participants avoided surgery in the first year, but the evidence is very uncertain. Regarding complications, it is uncertain whether there is any difference in episodes of Clostridium difficile diarrhoea due to very low-certainty evidence (Peto OR 0.97, 95% CI 0.24 to 3.89; 1 study, 1332 participants). There may be a clinically significant reduction in wound infections with antibiotics (RR 0.25, 95% CI 0.09 to 0.68; I2 = 16%; 9 studies, 2606 participants; low-certainty evidence). It is uncertain whether antibiotics affect the incidence of intra-abdominal abscess or collection (RR 1.58, 95% CI 0.61 to 4.07; I2 = 19%; 6 studies, 1831 participants), or reoperation (Peto OR 0.13, 95% CI 0.01 to 2.16; 1 study, 492 participants) due to very low-certainty evidence, mainly due to rare events causing imprecision and risk of bias. It is uncertain if antibiotics prolonged length of hospital stay by half a day due to the very low-certainty evidence (MD 0.54, 95% CI 0.06 to 1.01; I2 = 97%; 11 studies, 3192 participants). The incidence of malignancy was 0.3% (95% CI 0 to 1.5; 5 studies, 403 participants) in the antibiotic group although follow-up was variable. Antibiotics probably increased the number of negative appendectomies at surgery (RR 3.16, 95% CI 1.54 to 6.49; I2 = 17%; 5 studies, 707 participants; moderate-certainty evidence). Antibiotics may be associated with higher rates of unsuccessful treatment for 76 per 1000 people, although differences may not be clinically significant. It is uncertain if antibiotics increase length of hospital stay by half a day. Antibiotics may reduce wound infections. A third of the participants initially treated with antibiotics required subsequent appendectomy or two-thirds avoided surgery within one year, but the evidence is very uncertain. There were too few data from the included studies to comment on major complications.

Influence of zinc supply on the course of infectious diarrhea in children of early age

Aim. Give a comparative characteristic of the course of infectious diarrhea in young children, residents of the Zaporizhzhia region (Ukraine), depending on their provision of zinc (Zn). Materials and methods. The study included 99 children aged 1 to 36 months with manifestations of infectious diarrhea. On the day of hospitalization, immunochromatographic and bacteriological examination of feces was performed. Also, on the first, third and fifth days of hospitalization, a general blood test and the level of Zn in the blood were determined for each patient. Results. It was found that among the examined patients with infectious diarrhea at the onset of the disease, 22 children (22.2 %) had a reduced concentration of Zn in blood serum. In these children, the zinc level ranged from 7.63 to 9.17 μmol/l. It was also noted that the level of Zn in these patients on the 5th day of inpatient treatment rose to the norm of reference indicators. After studying the anamnesis, it was found that 40.9% of children with low Zn content had episodes of acute intestinal infection before this disease. During a comparative analysis of the clinical and laboratory data of patients, it was found that the tendency to more frequent vomiting occurred in patients with Zn deficiency (p = 0.05), that Zn availability had the most significant effect on the expressiveness of the diarrheal syndrome at the onset of the disease and more than a third (n = 8, 36.4 %) of children with Zn deficiency had more than 5 episodes of diarrhea per day, among which every second had more than 10. We did not determine significant differences between the frequency of viral and bacterial causes of diarrhea in the comparison groups. As for complete blood count, patients with Zn deficiency more often had a tendency to blood neutrophilia with a reliably frequent shift of the leukocyte formula to the left (p = 0.003). At the same time, children with a reduced content of Zn in blood serum significantly more often had lymphopenia at the onset of diarrheal disease (p = 0.006). When investigating the effect of Zn deficiency on the course of the disease, we found that in children with reduced Zn, the duration of diarrhea was almost twice as long (8 [6; 9] days vs. 5 [4; 6] in children with normal Zn indicators; p = 0.0001 according to the Mann–Whitney test) and in patients with infectious diarrhea who had Zn deficiency at the onset of the disease, on the seventh day of treatment diarrhea persisted significantly more often (p = 0.03). Such symptoms were accompanied by the persistence of signs of anemia (p = 0.06 on the 5th day) and a shift of the leukocyte formula to the left (p = 0.007) without leukocytosis. Conclusions. Almost 25 % of young children with infectious diarrhea in the Zaporizhzhia region had Zn deficiency. Most likely, Zn deficiency is caused by the peculiarities of its supply with food and its metabolism. In the debut of a diarrheal disease, insufficient supply of Zn is associated with lymphopenia and a shift of the leukocyte formula to the left. Zn deficiency in infectious diarrhea leads to a long (more than 5 days) course of the disease due to prolongation of the diarrheal syndrome.

A case of severe benzalkonium chloride intoxication in a cat

BackgroundBenzalkonium chloride (BAC) is a quaternary ammonium compound (QAC), that can be found in a wide variety of household products–from disinfectants to medicaments and home fragrances–but also professional products. In pets, cats have long been reported as more sensitive than dogs to QACs; in fact, signs of irritation such as oral ulcerations, stomatitis and pharyngitis can be observed after contact with concentrations of 2% or lower. In a review of 245 cases of BAC exposure in cats, reported by the Veterinary Poisons Information Service (United Kingdom) only 1.2% of the cases died or were euthanized. Nevertheless, BAC toxidromes in cats can result in transitory CNS and respiratory distress, as well as severe mucosal and cutaneous lesions. Currently, only a few reports are available concerning BAC poisoning in this species.Case presentationA 4 month-old kitten presented with severe glossitis, lameness in the hindlimbs and episodes of vomiting and diarrhoea. The cause was unknown until the owners reported use of a BAC-containing mould remover (5%) 4 days later. The patient developed severe oral burns requiring a pharyngeal tube for feeding and severe cutaneous chemical burns. The kitten was managed with supportive therapy and required hospitalization for 10 days. The symptoms disappeared completely 3 weeks after exposure.ConclusionsBAC is a very common compound contained in several household and professional products but, to the best of our knowledge, no previous case had been reported in Italy. We hope that this report will help raise awareness on the hazards of BAC products for cats in both domestic and work contexts.

Factors Contributing to the Prevalence of Diarrhea in Children Under the age of 5 years at Hoima Regional Referral Hospital, Western Uganda

Three or more loose stools per day, or more frequent passages than is typical for an individual, are considered diarrhea. In addition to rapidly resulting in dehydration, diarrhea can negatively affect a child's growth and cognitive development. Since children have a larger surface area and lose fluids more quickly, diarrhea can lead to dehydration and mortality as well as long-term consequences like malnutrition. Even though the majority of diarrhea episodes in children are minor, acute occurrences can cause significant fluid loss and dehydration. If fluids are not replaced as soon as diarrhea appears, this might lead to death or other serious effects. Fortunately, diarrhea is curable and preventative. In this study, the causes of diarrheal illnesses in children under five who are patients at Hoima Regional Referral Hospital were evaluated. This was a cross-sectional, descriptive study. It employed both quantitative and qualitative research techniques for gatheringand analyzing data. Youngsters under the age of five who experienced diarrhea within the six months before to the study were examined. There were 241 in the sample. Children under five who visit Hoima Regional Referral Hospital have a moderately high prevalence of diarrhea. The age range of 1-3 years old, having an open spring or well as a water source, and discarding household waste within the compound have all been linked to an increase in the occurrence of diarrhea. While caregivers could accurately advice regarding preventive measures, their understanding of the proper treatment of severe diarrhea was lacking, particularly with regard to dehydration. Therefore, in order to reduce the high rate of diarrhea in children under five, the government should make it very easy for people to access safe water. Health education programs focusing on these aspects should also be strengthened in order to train caregivers in home management, which will effectively and sustainably contribute to a reduction in child mortality. Keywords: Dehydration, Diarrhea, Health education, Child mortality, Children

The Incidence and Risk Factors for Enterotoxigenic E. coli Diarrheal Disease in Children under Three Years Old in Lusaka, Zambia.

This study aimed to estimate the incidence and risk factors for Enterotoxigenic Escherichia coli (ETEC) diarrhea. This was a prospective cohort study of children recruited in a household census. Children were enrolled if they were 36 months or below. A total of 6828 children were followed up passively for 12 months to detect episodes of ETEC diarrhea. Diarrheal stool samples were tested for ETEC using colony polymerase chain reaction (cPCR). Among the 6828 eligible children enrolled, a total of 1110 presented with at least one episode of diarrhea. The overall incidence of ETEC diarrhea was estimated as 2.47 (95% confidence interval (CI): 2.10-2.92) episodes per 100 child years. Children who were HIV-positive (adjusted Hazard ratio (aHR) = 2.14, 95% CI: 1.14 to 3.99; p = 0.017) and those whose source of drinking water was public tap/borehole/well (aHR = 2.45, 95% CI: 1.48 to 4.06; p < 0.002) were at increased risk of ETEC diarrhea. This study found that children whose mothers have at least senior secondary school education (aHR = 0.49, 95% CI: 0.29 to 0.83; p = 0.008) were at decreased risk of ETEC diarrhea. Our study emphasizes the need for integrated public health strategies focusing on water supply improvement, healthcare for persons living with HIV, and maternal education.

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

In 2002, the Centre pour le Développement des Vaccins du Mali (CVD-Mali) was established as a partnership between the Mali Ministry of Health and the University of Maryland, Baltimore. Since its creation, CVD-Mali has been dedicated to describing the epidemiology of infectious diseases, supporting the development of vaccines, and training a team of local researchers. CVD-Mali participated in the Global Enteric Multicenter Study from 2007 to 2010 and the Vaccine Impact on Diarrhea in Africa study from 2015 to 2018, where the importance of Shigella as an enteric pathogen was established. In the Enterics for Global Health (EFGH) Shigella surveillance study, CVD-Mali will conduct Shigella surveillance at 4 health centers serving the population currently participating in a demographic surveillance system and will measure the local incidence of Shigella diarrhea and related outcomes in 6- to 35-month-old children. Antibiotic sensitivity patterns and the costs related to these cases will also be measured. We anticipate reporting the number of diarrhea episodes that are positive by stool culture, the antibiotic susceptibility of these isolates, and the management and outcomes of these cases. In Mali, the EFGH study will contribute valuable information to understanding the burden of Shigella in this population. These data will inform the evaluation of vaccine candidates.

Evaluation of Fecal Inflammatory Biomarkers to Identify Bacterial Diarrhea Episodes: Systematic Review and Protocol for the Enterics for Global Health Shigella Surveillance Study.

The measurement of fecal inflammatory biomarkers among individuals presenting to care with diarrhea could improve the identification of bacterial diarrheal episodes that would benefit from antibiotic therapy. We reviewed prior literature in this area and describe our proposed methods to evaluate 4 biomarkers in the Enterics for Global Health (EFGH) Shigella surveillance study. We systematically reviewed studies since 1970 from PubMed and Embase that assessed the diagnostic characteristics of inflammatory biomarkers to identify bacterial diarrhea episodes. We extracted sensitivity and specificity and summarized the evidence by biomarker and diarrhea etiology. In EFGH, we propose using commercial enzyme-linked immunosorbent assays to test for myeloperoxidase, calprotectin, lipocalin-2, and hemoglobin in stored whole stool samples collected within 24 hours of enrollment from participants in the Bangladesh, Kenya, Malawi, Pakistan, Peru, and The Gambia sites. We will develop clinical prediction scores that incorporate the inflammatory biomarkers and evaluate their ability to identify Shigella and other bacterial etiologies of diarrhea as determined by quantitative polymerase chain reaction (qPCR). Forty-nine studies that assessed fecal leukocytes (n = 39), red blood cells (n = 26), lactoferrin (n = 13), calprotectin (n = 8), and myeloperoxidase (n = 1) were included in the systematic review. Sensitivities were high for identifying Shigella, moderate for identifying any bacteria, and comparable across biomarkers. Specificities varied depending on the outcomes assessed. Prior studies were generally small, identified red and white blood cells by microscopy, and used insensitive gold standard diagnostics, such as conventional bacteriological culture for pathogen detection. Our evaluation of inflammatory biomarkers to distinguish diarrhea etiologies as determined by qPCR will provide an important addition to the prior literature, which was likely biased by the limited sensitivity of the gold standard diagnostics used. We will determine whether point-of-care biomarker tests could be a viable strategy to inform treatment decision making and increase appropriate targeting of antibiotic treatment to bacterial diarrhea episodes.