Fecal Load Research Articles

Disruption of millipede-gut microbiota in E. pulchripes and G. connexa highlights the limited role of litter fermentation and the importance of litter-associated microbes for nutrition.

Millipedes are thought to depend on their gut microbiome for processing plant-litter-cellulose through fermentation, similar to many other arthropods. However, this hypothesis lacks sufficient evidence. To investigate this, we used inhibitors to disrupt the gut microbiota of juvenile Epibolus pulchripes (tropical, CH4-emitting) and Glomeris connexa (temperate, non-CH4-emitting) and isotopic labelling. Feeding the millipedes sterile or antibiotics-treated litter reduced faecal production and microbial load without major impacts on survival or weight. Bacterial diversity remained similar, with Bacteroidota dominant in E. pulchripes and Pseudomonadota in G. connexa. Sodium-2-bromoethanesulfonate treatment halted CH4 emissions in E. pulchripes, but it resumed after returning to normal feeding. Employing 13C-labeled leaf litter and RNA-SIP revealed a slow and gradual prokaryote labelling, indicating a significant density shift only by day 21. Surprisingly, labelling of the fungal biomass was somewhat quicker. Our findings suggest that fermentation by the gut microbiota is likely not essential for the millipede's nutrition.

EP467 - Bowel obstruction due to colonic lithobezoar in a patient with PICA

Abstract A 16-year-old girl was admitted with complaints of abdominal distension, severe pain, vomiting, chest discomfort, and an inability to pass gas. She disclosed a history of PICA, regularly consuming brick and cement. She had no significant medical history but reported suffering from constipation for over two years. Physical examination revealed a markedly distended, tender abdomen with hyper-resonance. Digital rectal examination detected soft, breakable stool in the rectum. A chest X-ray demonstrated massive bowel distension, causing lung compression. Clinical impression was of bowel obstruction secondary to constipation, leading to NG tube insertion, NBM status, and analgesia administration. A CT abdomen and pelvis confirmed a markedly distended rectum with impacted faeces, proximal faecal loading, and colon dilatation consistent with severe pseudo-obstruction. Other abdominal organs were compressed but otherwise normal, with no signs of ischemia, free air, or free fluid. Patient was taken to emergency theatre for examination under anaesthesia and manual evacuation. Six litres of stool were manually evacuated, along with removal of ingested stone-like substances, leading to suspicion of lithobezoar. This was followed by a four-litre saline washout. Postoperatively, patient received regular enemas, laxatives, and monitoring. She spent three days in the Intensive Care Unit due to persistent metabolic acidosis, necessitating ventilatory support. Afterward, she was transferred to the surgical ward, where she was monitored overnight before being discharged with laxatives and dietary advice. Patient was referred to dietitians for addressing her PICA and eating habits, with plans for psychiatric follow-up initiated through a referral from her GP.

Moving beyond Symptom Criteria to Diagnose and Treat Functional Disorders: Patient-Reported Symptoms of Functional Lower Gastrointestinal Disorders Correlate Poorly with Objective Assessment of Luminal Contents Seen on Intestinal Ultrasound.

Background/Objectives: The diagnosis of lower functional gastrointestinal disorders (FGIDs) is currently based on subjective and unreliable patient-reported symptoms, with significant clinical overlap between diagnosed phenotypes. Objective biomarkers are urgently sought. Gastrointestinal ultrasound (GIUS) can objectively and non-invasively assess luminal contents. This study aimed to assess the utility of GIUS in phenotyping patients with lower FGIDs. Methods: Patients with lower FGIDs underwent a GIUS and completed the Rome IV Diagnostic Questionnaire, SAGIS questionnaire, and 100 mm VAS score for overall symptom severity. The faecal loading score (FLS) was obtained using a modified Leech score, where an FLS of >37 was consistent with clinically significant constipation. Results: Eighty-eight patients fulfilled the study requirements. In total, 56 met the Rome IV criteria for irritable bowel syndrome (IBS) subtypes, while 23 met the criteria for functional constipation (FC), 4 for functional diarrhoea (FD), and 5 for other diagnoses. Patients reporting constipation-predominant symptoms had a significantly higher median FLS than those describing diarrhoea-predominant symptoms (FLS = 40 [IQR 20.0-53.3] vs. 13.3 [IQR 6.7-40.0], respectively). However, 27% of patients describing diarrhoea had significant faecal loading on GIUS, and of those who described constipation, 34% did not have significant faecal loading. Sensitivity and specificity for the detection of FLS-indicated constipation by the Rome IV criteria were low at 59% and 66%, respectively. Conclusions: The symptom-based diagnosis of FGID subtypes based on the Rome IV criteria is a poor predictor of faecal loading. These findings should prompt further exploration of the limitations of symptom-based assessment and a shift towards physiological assessment of patients with FGIDs such as gastrointestinal ultrasound to develop more targeted therapy. Future research is underway to determine if targeting objective physiological endpoints results in improved clinical outcomes.

CrAss-like phages are suitable indicators of antibiotic resistance genes found in abundance in fecally polluted samples

Antibiotic resistance genes (ARGs) have been extensively observed in bacterial DNA, and more recently, in phage particles from various water sources and food items. The pivotal role played by ARG transmission in the proliferation of antibiotic resistance and emergence of new resistant strains calls for a thorough understanding of the underlying mechanisms. The aim of this study was to assess the suitability of the prototypical p-crAssphage, a proposed indicator of human fecal contamination, and the recently isolated crAssBcn phages, both belonging to the Crassvirales group, as potential indicators of ARGs. These crAss-like phages were evaluated alongside specific ARGs (blaTEM, blaCTX-M-1, blaCTX-M-9, blaVIM, blaOXA-48, qnrA, qnrS, tetW and sul1) within the total DNA and phage DNA fractions in water and food samples containing different levels of fecal pollution. In samples with high fecal load (>103 CFU/g or ml of E. coli or somatic coliphages), such as wastewater and sludge, positive correlations were found between both types of crAss-like phages and ARGs in both DNA fractions. The strongest correlation was observed between sul1 and crAssBcn phages (rho = 0.90) in sludge samples, followed by blaCTX-M-9 and p-crAssphage (rho = 0.86) in sewage samples, both in the phage DNA fraction. The use of crAssphage and crAssBcn as indicators of ARGs, considered to be emerging environmental contaminants of anthropogenic origin, is supported by their close association with the human gut. Monitoring ARGs can help to mitigate their dissemination and prevent the emergence of new resistant bacterial strains, thus safeguarding public health.

Is the Transrectal Diameter (TRD) Suitable for Assessing Faecal Loads and Monitoring Bowel Management in Children with Hirschsprung Disease-ReKiSo Study: Prospective Study.

Constipation and outlet obstruction may persist after successful pull-through in Hirschsprung Disease (HD). The radiographic assessment of the faecal load is widely used but exposes the child to radiation. This study aims to evaluate whether the transrectal diameter (TRD) assessed with ultrasound correlates with symptoms of faecal load and whether the TRD normalises when symptoms disappear. Children with HD after pullthrough and functional constipation presenting to our colorectal clinic between 4/23 and 4/24 were assessed for symptoms of constipation, smearing and outlet obstruction, as well as healthy controls. Ultrasound measurement of the TRD was conducted. Bowel management was initiated according to our institutional pathway using Peristeen© irrigation after an orthograde disimpaction regime. A total of 193 children underwent TRD assessment. Of 60 children with HD, 26 (43.3%) presented with obstructive symptoms, and 34 (56.7%) were asymptomatic. In asymptomatic patients with HD, the mean TRD of 2.26 cm (SD 0.61) was significantly (p < 0.001) lower than in HD with symptoms, with a mean TRD of 3.35 cm (SD 1.03). Individuals without colorectal pathology had a mean TRD of 2.04 cm (SD 0.37), and children with functional constipation and symptoms showed a mean TRD of 4.36 cm (SD 1.32). The mean TRD after symptom resolution was 2.37 cm. Children with HD without obstructive symptoms have a TRD < 3 cm, as do controls. The transrectal diameter allows the clinician to sonographically assess the faecal load in children with HD at the bedside without radiation. The TRD is useful for monitoring a bowel management program in children with HD.

The challenge of reducing the fecal indicator bacteria load and preventing spawning during depuration of Perna perna mussels

Perna perna mussels commonly spawn during depuration under water temperatures above 18°C. A previous study conducted under experimental conditions (15L aquariums) has suggested reducing the temperature to decrease the odds of spawning. This study monitored the concentrations of Escherichia coli in mussels during three 48-hour and two 72-hour depuration cycles conducted in a small (600L) commercial depuration unit, under temperatures of 14°C and 17°C. The protocol prevented mussels from spawning, as this behavior was observed only in a few mussels in one out of the four depuration cycles. The reduction of fecal indicator bacteria loads, in turn, was unsatisfactory in all depuration cycles, with at least 67% of the samples from cycles 1, 3, 4, and 5 presenting E. coli concentrations above the end product testing limit (230MPN 100g−1) after 48 hours of depuration. Moreover, none of the sample cycles showed bacterial concentrations below that limit, even after 72 hours of depuration.

Assessing fecal load with ultrasound in children with colorectal pathology: ReKiSo study

PurposeTo evaluate bowel management for children with colorectal pathology by measuring transverse rectal diameter (TRD) and assessing fecal load with transabdominal rectal ultrasound (TRU).MethodsProspective case–control study of children receiving bowel management (BM) between 04/2023 and 04/2024 was done. There was inclusion of patients with Hirschsprung disease (HD), anorectal malformation (ARM) and functional constipation (FC). Patients with other congenital or neurological conditions were excluded. Control group consisted of inpatients and outpatients without abdominal complaints. FC was diagnosed according to ROM-IV-criteria. For HD and ARM, we followed a list of symptoms. To assess fecal load, we visualized the TRD using the Klijn (Klijn et al. in J Urol 172:1986–1988, 2004) method. The bladder was moderately full. The fecal load was assessed retrograde from the rectum. Follow-up was at 1/3/6 months. Secondary data were collected from medical records. Sample size calculated a priori and follow-up group with new gathered data.Resultsp value for TRD in all groups significant with p < 0.05 and in grouped follow-up.ConclusionUltrasound is a useful tool for assessing fecal load and helps diagnose constipation and monitor BM. Irrespective of colorectal pathology, a cut-off of 3 cm seems to discriminate between children without constipation/overload symptoms and asymptomatic patients. We present a radiation-free method for monitoring bowel management.

A multi-tiered approach to assess fecal pollution in an urban watershed: Bacterial and viral indicators and sediment microbial communities

Development of effective pollution mitigation strategies require an understanding of the pollution sources and factors influencing fecal pollution loading. Fecal contamination of Turkey Creek in Gulfport, Mississippi, one of the nation's most endangered creeks, was studied through a multi-tiered approach. Over a period of approximately two years, four stations across the watershed were analyzed for nutrients, enumeration of E. coli, male-specific coliphages and bioinformatic analysis of sediment microbial communities. The results demonstrated that two stations, one adjacent to a lift station and one just upstream from the wastewater-treatment plant, were the most impacted. The station adjacent to land containing a few livestock was the least impaired. While genotyping of male-specific coliphage viruses generally revealed a mixed viral signature (human and other animals), fecal contamination at the station near the wastewater treatment plant exhibited predominant impact by municipal sewage. Fecal indicator loadings were positively associated with antecedent rainfall for three of four stations. No associations were noted between fecal indicator loadings and any of the nutrients. Taxonomic signatures of creek sediment were unique to each sample station, but the sediment microbial community did overlap somewhat following major rain events. No presence of Escherichia coli (E. coli) or enterococci were found in the sediment. At some of the stations it was evident that rainfall was not always the primary driver of fecal transport. Repeated monitoring and analysis of a variety of parameters presented in this study determined that point and non-point sources of fecal pollution varied spatially in association with treated and/or untreated sewage.

Comparative Effect of Breast Milk and Infant Formulae on Neonatal Gut Microbiome within Katsina Metropolis

Study’s Novelty/ Excerpt This study explored the impact of breast milk versus infant formula on the gut microbiota of neonates in Katsina metropolis, revealing significant differences in bacterial composition and fecal pH between the two groups. Exclusively breastfed infants exhibited a lower fecal pH (5.09±0.1) and higher weights, with similar levels of Escherichia spp. and Bifidobacterium spp., while formula-fed infants showed a higher fecal pH (5.9±0.1) and differences in Escherichia spp. loads. Despite advances in infant formula enrichment, the study underscores the distinct influence of breast milk on neonatal gut microbiota composition and health. Full Abstract Numerous studies conducted in recent years have highlighted the intricate nature of the neonatal gut microbiome, influenced by various intrinsic and extrinsic factors. One significant factor in this regard is the type of feeding, which has a substantial impact on the development of intestinal microbiota in early infancy. This study aimed to compare the effects of breast milk and infant formulae on the gut microbiota of newborns in Katsina metropolis. Faecal samples were obtained from 46 neonates (33 exclusively breastfed, 10 formula-fed, and 3 mix-fed) and analyzed using a culture-dependent method. Colony enumerations and pH measurements were conducted for comparison between the groups. The mean weight of the participants was 2.88±0.1 kg, with exclusively breastfed infants (BFI) weighing significantly more (p = 0.03) than formula-fed infants (FFI). The bacteria selected for analysis (Bifidobacterium spp., Staphylococcus spp., Escherichia spp., and Lactobacillus spp.) were present in all feeding groups. Among BFI, similar levels of Escherichia spp. and Bifidobacterium spp. (61.17 CFU/g and 61.38 CFU/g respectively) were observed. Staphylococcus spp. constituted the majority of the bacterial load (32%) in both BFI and FFI groups. Apart from Escherichia spp. (p = 0.01), no significant differences were noted in the levels of all cultured bacteria across the feeding groups. The disparity in Escherichia spp. load was evident between BFI and MFI (p = 0.01), as well as FFI and MFI (p = 0.02) only. There was no overall significant correlation between bacterial load and mode of delivery within the feeding groups (p = 0.6). The average faecal pH of breastfed infants (5.09±01) was significantly lower (p = &lt;0.001) compared to the formula-fed group (5.9±0.1). Despite advancements in enriching infant formulae with probiotics and other bifidogenic substances, subtle differences in fecal bacterial load compared to breast milk persist, highlighting the significant influence of both feeding methods on the composition and functionality of the neonatal gut microbiome

PSIV-A-6 Effects of a yeast cell wall additive on the growth performance and fecal Eimeria load of finishing lambs

Abstract Yeast-based additives have been shown to alter the rumen environment and exhibit immunomodulatory properties that can lead to enhancements in health status and subsequent performance. The objectives of this study were to evaluate the impacts of supplementing a yeast cell wall additive (Safwallâ, Phileo by Lesaffre, Milwaukee, WI) on finishing lamb growth performance and fecal Eimeria load. A total of 44 Polypay lambs were used in a 35-dexperiment at the Kansas State University Sheep and Meat Goat Center. On d 0, a fresh fecal sample was collected from each lamb and submitted to the Kansas State University Veterinary Diagnostic Lab to determine a baseline Eimeria count via quantitative fecal float. Lambs were then randomly assigned to either a control diet or diet supplemented with 1.5 g Safwallâ. Diets were fed for 35-d and contained no coccidiostat. Lambs had ad libitum access to both feed and water for the duration of the experiment. A basal lamb finisher diet was manufactured as a control diet and Safwallâ was hand-mixed into rations daily to make the treatment diet. Lambs and feeders were individually weighed weekly to track dry matter intake (DMI) and changes in body weight (BW). Data were analyzed using the GLIMMIX procedure of SAS (v.9.4, SAS Inst., Cary, NC) with an alpha set at (P &amp;lt; 0.05). From d 0 to 7 there was no evidence of a difference (P = 0.19) in DMI between treatment groups; however, during the second week of the study (d 7 to 14) lambs fed the control diet had significantly greater (P = 0.02) DMI compared with those fed a diet supplemented with yeast cell wall (Table 1). There was no evidence of differences in DMI between treatments for the remainder of the study (P &amp;gt; 0.05). Likewise, BW did not differ significantly (P &amp;gt; 0.05) between treatments on d 0 or by d 35. There was no evidence that fecal Eimeria load differed significantly (P &amp;gt; 0.05) on d 0 or 21; however, on d 35, lambs fed the control diet had a decreased Eimeria load compared with those fed a diet with yeast cell wall, but neither group had biologically relevant levels of Eimeria present in the feces. In summary, feeding a diet containing a yeast cell wall additive did not alter finishing lamb growth performance. While lambs fed the control diet had reduced fecal Eimeria at the end of the study, there was a reduction in this variable across both treatments. Further research should be conducted with younger animals with a known Eimeria challenge.

215 The effect of a Lactobacillus fermentation postbiotic on nursery pig growth performance after experimental inoculation with F18 Escherichia coli.

Abstract This study evaluated a Lactobacillus fermentation postbiotic (LFP) in nursery pigs challenged with F18 ETEC. A total of 119 three-week-old barrows and gilts were used in this study. Pigs were acclimated for a period of 7 d upon arrival at the facility before inoculation. Pigs were stocked in mixed-sex pens of 6 pigs in each pen. Four rooms were used and each room had 5 pens. One room of pigs was not challenged with F18 ETEC (NCH). Ninety pigs in the other 3 rooms were intraorally challenged for three consecutive days with F18 ETEC isolate at a concentration of ~1x109 cfu/ml (CH) Pigs in the non-challenge groups were housed in separate airspaces than those receiving ETEC inoculum to avoid contamination. All pigs, regardless of health challenge, were fed a standard two-phase dietary nursery program. Five dietary treatments were evaluated: T1) negative dietary control without feed additives (Carabox, zinc oxide, and added copper), T2) 750 ppm LFP, T3) 1,500 ppm LFP, T4) 2,250 ppm LFP, and T5) positive control (PC) with feed additives. Feces were collected at 0 and 4 d post inoculation (dpi) to evaluate fecal shedding by real time polymerase chain reaction (rtPCR). Pig body weights were collected at -7, 0, 7, 14, 21, and 42 dpi to calculate performance. Feed intake was measured at the completion of the two dietary phases at 7 and 42 dpi for calculation of average daily feed intake (ADFI) and gain to feed ratio (G:F). All pigs were negative for F18 ETEC on 0 dpi and the non-challenge pigs remained negative by 4 dpi. At 4 dpi, the pigs fed 1,500 and 2,500 ppm LFP had significantly less Cts than pigs fed the positive control (rtPCR &amp;lt; 0.819, P = 0.03). Pigs fed the negative control had significantly greater fecal bacterial load than those fed the positive control averaged across challenge treatments and dpi (Ct ratio = 0.84, P = 0.03). Total E. coli and overall bacterial load were increased at 0 dpi compared with 4 dpi (Ct ratio= 0.90, P &amp;lt; 0.02). Pigs fed the positive control grew significantly faster than those fed the other diets during the acclimation phase (P &amp;lt; 0.01). Pigs in T5 were heavier than those on T1 at 14 and 21 dpi P &amp;lt; 0.02; table 1). End weights, average daily gain (ADG), and ADFI were similar between T1 and T2-4 across dietary phases (P = 0.13) with a tendency for the pigs feed 1,500 ppm to be heavier at d 21 (linear effect, P = 0.15) Pigs fed the positive control were heavier and grew faster at the end of each phase compared with pigs fed the other diets. The F18 challenge was effective in decreasing pig performance. Preliminary evidence suggests lactobacillus fermentation postbiotic may improve nursery performance in the face of an F18 challenge, but further investigation is necessary.

Hirschsprung’s disease in adulthood: a case report

Hirschsprung’s disease (HD) is caused by a gut development anomaly that leads to functional constipation. In most cases, HD is diagnosed and treated during childhood. Abdominal pain, distension and chronic constipation are typical symptoms of adult presentation. An adult HD case is presented, using analysis of electronic medical records and literature review for diagnostic and management insights. A man in his early 40s, with a history of chronic constipation since infancy, presented to the emergency department with an intestinal obstruction. Imaging tests revealed pronounced colonic dilation along with faecal loading. Following favourable progress, the patient was referred for outpatient investigation. Endoscopy revealed rectal scars with biopsy consistent with HD. A laparoscopic Duhamel-Martin procedure was performed in two stages. The postoperative period was uneventful. Adult HD is overlooked and misdiagnosed. Therefore, a high level of suspicion is needed to diagnose and avoid urgent surgeries, often with the need of colostomy and its particularities. When feasible, appropriate management by elective surgery should be the gold standard.

Spike 1 trimer, a nanoparticle vaccine against porcine epidemic diarrhea virus induces protective immunity challenge in piglets.

Porcine epidemic diarrhea virus (PEDV) is considered the cause for porcine epidemic diarrhea (PED) outbreaks and hefty losses in pig farming. However, no effective commercial vaccines against PEDV mutant strains are available nowadays. Here, we constructed three native-like trimeric candidate nanovaccines, i.e., spike 1 trimer (S1-Trimer), collagenase equivalent domain trimer (COE-Trimer), and receptor-binding domain trimer (RBD-Trimer) for PEDV based on Trimer-Tag technology. And evaluated its physical properties and immune efficacy. The result showed that the candidate nanovaccines were safe for mice and pregnant sows, and no animal death or miscarriage occurred in our study. S1-Trimer showed stable physical properties, high cell uptake rate and receptor affinity. In the mouse, sow and piglet models, immunization of S1-Trimer induced high-level of humoral immunity containing PEDV-specific IgG and IgA. S1-Trimer-driven mucosal IgA responses and systemic IgG responses exhibited high titers of virus neutralizing antibodies (NAbs) in vitro. S1-Trimer induced Th1-biased cellular immune responses in mice. Moreover, the piglets from the S1-Trimer and inactivated vaccine groups displayed significantly fewer microscopic lesions in the intestinal tissue, with only one and two piglets showing mild diarrhea. The viral load in feces and intestines from the S1-Trimer and inactivated vaccine groups were significantly lower than those of the PBS group. For the first time, our data demonstrated the protective efficacy of Trimer-Tag-based nanovaccines used for PEDV. The S1-Trimer developed in this study was a competitive vaccine candidate, and Trimer-Tag may be an important platform for the rapid production of safe and effective subunit vaccines in the future.

Phage-specific immunity impairs efficacy of bacteriophage targeting Vancomycin Resistant Enterococcus in a murine model

Bacteriophage therapy is a promising approach to address antimicrobial infections though questions remain regarding the impact of the immune response on clinical effectiveness. Here, we develop a mouse model to assess phage treatment using a cocktail of five phages from the Myoviridae and Siphoviridae families that target Vancomycin-Resistant Enterococcus gut colonization. Phage treatment significantly reduces fecal bacterial loads of Vancomycin-Resistant Enterococcus. We also characterize immune responses elicited following administration of the phage cocktail. While minimal innate responses are observed after phage administration, two rounds of treatment induces phage-specific neutralizing antibodies and accelerate phage clearance from tissues. Interestingly, the myophages in our cocktail induce a more robust neutralizing antibody response than the siphophages. This anti-phage immunity reduces the effectiveness of the phage cocktail in our murine model. Collectively, this study shows phage-specific immune responses may be an important consideration in the development of phage cocktails for therapeutic use.

Vertical stratification and seasonality of fecal indicator bacteria in New York City playground sandboxes

Sandboxes in public play spaces afford a crucial opportunity for urban children to engage in naturalistic play that fosters development of cognitive, social, and motor skills. As open pits, sandboxes in New York City public playgrounds are potentially exposed to fecal inputs from various sources, including wild and domestic animals. A longitudinal study of thirteen sandboxes located in public playgrounds on the east side of Manhattan reveals ubiquity of the fecal indicator bacteria enterococci and Escherichia coli through all seasons. The highest concentrations of bacteria occur in surface sand (n = 42; mean enterococci 230 MPN/g and E. coli 182 MPN/g dry weight), with significantly lower levels at depths below the surface (n = 35; mean enterococci 21 MPN/g and E. coli 12 MPN/g dry weight), a stratification consistent with fecal loading at the surface. Generalized linear mixed models indicate that sand depth (surface vs. underlayers) is the most influential variable affecting bacterial levels (P <0.001 for both enterococci and E. coli), followed by sampling season (P <0.001 for both). Bacterial concentrations do not vary significantly as a function of playground location or ZIP code within the study area. Children’s exposure while playing in sandboxes likely reaches 105 enterococci and 104E. coli in a typical play period. Microbial source tracking to identify fecal hosts reveals dog, bird, and human biomarkers in low concentrations. Open sandbox microcosms installed at ground level in the urban environment of Manhattan are fouled by enterococci and E. coli within two weeks, while adjacent closed microcosms exhibit no fecal contamination over a 33-day sampling period. Collectively, our results indicate that increasing the frequency of sand refills and covering sandboxes during times of disuse would be straightforward management strategies to mitigate fecal contamination in playground sandboxes.

P620 A cost-effective Inflammatory Bowel Disease flare management pathway utilising rapid access intestinal ultrasound and nurse-led triage to achieve hospital avoidance with increased patient satisfaction

Abstract Background Timely inflammatory bowel disease (IBD) flare treatment improves outcomes, but quick differentiation from other symptom causes is challenging. We aimed to reduce unplanned hospital presentations with a novel IBD clinical care pathway (CCP) allowing appropriate early flare management, utilising nurse-led triage and objective assessment with rapid access intestinal ultrasound (RAIUS). Methods Prospective data collection from 15 November 2022 until 14 June 2023, including clinical outcomes, pre-specified criteria for healthcare utilisation impact, clinical coding data, and patient satisfaction surveys. A senior IBD nurse assessed patients using a symptom severity-based algorithm, utilising a modified partial Mayo score and Harvey-Bradshaw Index. Standardised blood and stool tests were collected. Based on clinical urgency, patients were discussed with their specialist, referred for RAIUS, or considered for planned hospitalisation if severe symptoms (bypassing emergency department (ED)). Results There were 211 episodes of care (EOCs), with 407 initial and follow up encounters. The median patient age was 34 (IQR 25-44), a majority female (66%), 54% with Crohn’s disease, and 61% bio-exposed. Most (78%, n=165) EOCs were for flare symptoms (mild 41% (n=69), moderate 49% (n=80), severe 10% (n=16)) and the remainder for non-flare concerns (n=46). Of those with flare symptoms, 36% (n=59) had medication optimisation for active disease (5% (n=11) started steroids), 41% (n=67) reassured of remission, 12% (n=19) aperients for faecal loading, 5% (n=8) referred for further investigations, 2% (n=4) seen urgently in colorectal clinic for perianal flare, 2% (n=3) electively admitted, and 3% (n=5) seen urgently in IBD clinic. RAIUS was performed in 56 EOCs (27%), showing active disease in 32% (n=18), response/remission in 43% (n=24), and faecal loading in 23% (n=13). After RAIUS, 52% (n=29) had IBD medication optimisation. Based on pre-specified criteria, unplanned hospitalisation was avoided in 10% (n=20) of EOCs, urgent clinic review avoided in 58% (n=123), and no direct impact in 32% (n=68), with a net saving of AUD$146418 (Figure 1). Clinical coding data showed lower hospital presentations (Figure 2). Only 7 patients (3%) had an unplanned hospital presentation within 30 days of CCP engagement (most after-hours) and 5 (2%) were seen urgently in IBD clinic. With the CCP, more survey respondents (n=60) were "satisfied" or "very satisfied" with the IBD service, increasing from 53% (n=32) to 85% (n=51). Conclusion Our novel CCP improved IBD care through timely assessment, with high patient satisfaction and cost savings. Better integration of nursing and intestinal ultrasound resources can improve IBD care.

The pediatric gut bacteriome and virome in response to SARS-CoV-2 infection.

Since the beginning of the SARS-CoV-2 pandemic in early 2020, it has been apparent that children were partially protected from both infection and the more severe forms of the disease. Many different mechanisms have been proposed to explain this phenomenon, including children's frequent exposure to other upper respiratory infections and vaccines, and which inflammatory cytokines they are more likely to produce in response to infection. Furthermore, given the presence of SARS-CoV-2 in the intestine and its ability to infect enterocytes, combined with the well described immunomodulatory capabilities of the microbiome, another potential contributing factor may be the presence of certain protective microbial members of the gut microbiota (GM). We performed shotgun metagenomic sequencing and profiled both the bacteriome and virome of the GM of pediatric SARS-CoV-2 patients compared to healthy, age-matched subjects. We found that, while pediatric patients do share some pro-inflammatory microbial signatures with adult patients, they also possess a distinct microbial signature of protective bacteria previously found to be negatively correlated with SARS-CoV-2 infectivity and COVID-19 severity. COVID-19 was also associated with higher fecal Cytomegalovirus load, and with shifts in the relative abundances of bacteriophages in the GM. Furthermore, we address how the preventative treatment of COVID-19 patients with antibiotics, a common practice especially in the early days of the pandemic, affected the bacteriome and virome, as well as the abundances of antimicrobial resistance and virulence genes in these patients. To our knowledge, this is the first study to address the bacteriome, virome, and resistome of pediatric patients in response to COVID-19 and to preventative antibiotics use.

Immunogenicity and protective efficacy of a trimeric full-length S protein subunit vaccine for porcine epidemic diarrhea virus

Porcine epidemic diarrhea virus (PEDV) has caused serious economic losses to the pig husbandry worldwide, and the effects of existing commercialized vaccines are suboptimal. Therefore, research to develop an efficacious vaccine for prevention and control of PEDV is essential. In this study, we designed and produced trimerized proteins of full-length PEDV spike (S) protein, S1 subunit, and a tandem of multiple epitopes of S protein using an efficient mammalian expression vector system in HEK 293F cells. The immunogenicity of two commercial adjuvants, M401 and M103, was also evaluated in mice. Enzyme-linked immunosorbent assays demonstrated that all immunized mice generated highly systemic PEDV S-specific IgG and IgA antibodies. Mice in S/M103-immunized group generated the highest neutralizing antibody titer with 1:96. Compared with control group, the subunit vaccines elicited multifunctional CD3+CD4+ and CD3+CD8+ T cells, B220+CD19+ B cells, and CD3-CD49b+ natural killer cells in the spleen. PEDV S/M103 vaccine, which had the best immune effect, was selected for further evaluation in piglets. Immunization with S/M103 vaccine induced high levels of S-specific IgG, IgA, and neutralizing antibodies, and increased the proliferation of peripheral blood mononuclear cells and the expression levels of interferon-γ and interleukin-4 in peripheral blood of piglets. Virus challenge test results showed significantly lower diarrheal index scores and fecal viral loads, and less pathological damage to the intestines in S/M103-immunized piglets than in controls, indicating that S/M103 provides good protection against the virulent virus challenge. Our findings suggest that trimeric PEDV S/M103 has potential as a clinical vaccine candidate.

Analysis of fecal pollution load factor from septic tanks of residential area (study case: Bandung City, Indonesia)

According to the Ministry of Environment and Forestry, 2017, domestic waste is the most significant contributor to pollution sources in the Citarum watershed (62.16%) and Bandung City (94.15%). To overcome the problem, planning for infrastructure development and improvement of the domestic sewage treatment system is necessary. One of the essential characteristic parameters, which is the subject of this study, is the pollutant load factor parameter in the city of Bandung. Compared to sewage pipelines, the domination of domestic wastewater treatment in Bandung is the On-site Sanitation System (OSS) (38.47%), and the most widely used type of OSS is a septic tank. For this reason, thirty fecal sludge samples were taken from two fecal disposal points in Bandung City, and the concentrations of TSS, COD, BOD, and Ammonia were then analyzed. Based on the results of the study, the range of fecal sludge pollutant load factor for TSS in Bandung City is 57.28 g / person/day – 1,064 g / person/day with an average value of 546.39 g / person/day, the range for total COD is 30.06 g / person/day – 294.99 g /person/day with an average of 294.99 g / person/day, the total BOD range is 14.05 g /person/day – 504.97 g / person/day with an average of 175.5 g / person/day, and ammonia range 1.61 g/person/day – 3.11 g/person/day with an average of 2.62 g/person/day. Based on fecal sludge data, the result can be considered a recommendation to re-determine the main domestic wastewater pollution indicator generation. The new suggestions can be used to design an adequate domestic wastewater treatment system, especially in Bandung. The pollutant load factors can also be used to estimate the pollution loading of wastewater generated by present and future populations. It is important in urban growth planning.

Stanols in lake sediments of Central Siberia as an indicator of anthropogenic impact

The bottom sediments of the lakes contain biochemical markers of fecal intake, which have been renewed interest in the last few years. This analysis is one of the newest trends in paleolimnology. Fecal markers include sterols recovered by the intestinal microflora – stanols, which are indicators of fecal intake into reservoirs. Relative to other mammals, humans produce the largest amount of coprostanol. Therefore, based on its presence in bottom sediments, the dynamics of human presence in early times can be reconstructed, as well as the fecal anthropogenic load on reservoirs. Using the gas chromatography method with mass spectrometric detection, for the first time we estimated the contents of coprostanol, epicoprostanol, 5α-cholestanol and cholesterol in the bottom sediments of Lakes Peyungda and Zapovednoye (Evenkia, Krasnoyarsk Krai), and also estimated the indices R1 and R2, reflecting the human contribution to fecal intake. The absence of an increase in the proportion of coprostanol in both lakes may indicate a slight anthropogenic impact. Both in the modern period and in earlier times (about 5000 years for Peyungda and 2500 years for Zapovednoye), there were probably no settlements near the lakes.