Frequent Loose Stools Research Articles

Ayurveda management of irritable bowel syndrome

Irritable Bowel Syndrome (IBS) is a complex and challenging Gastrointestinal (GI) disorder that can cause chronic abdominal pain or discomfort and altered bowel habits. Despite being a global health concern, a definitive treatment for IBS is currently not available. It has a significant effect on health, cost, and quality of life. In Ayurveda, it can be compared with Grahani roga (~disorders of lower GI tract), characterized by Muhurbhaddha-muhurdrava mala pravritti (~formed stools at one moment and another moment loose stools) associated with Udara shoola (~colicky abdominal pain), Adhmana (~abdominal distention), and Dourbalya (~weakness). A 22-year-old male patient reported to the outpatient department with complaints of frequent loose stools with varied consistency, foul smell, gaseous distention of the abdomen, nausea, loss of appetite, generalized weakness, and other associated complaints of reduced sleep and occasional headache since 5 years. The patient was diagnosed with Grahani roga based on the presenting symptoms. Rome IV criteria were used to establish IBS, and the IBS-unclassified was the diagnosis in this case. A combination of Hingwastaka choorna, Jeerakadyarishta, Shilajatwadi louha, Bilwavaleha, Panchamrita parpati, Brahmi vati, and Saraswatarishta were administered for a total period of 4 months along with diet modification, after which, a significant response was observed in the symptoms inferring the impact Ayurveda medicines in managing the pathology.

A case-control study of the risk factors for fistula-in-ano in infants and toddlers

BackgroundLimited data are available regarding the risk factors for fistula-in-ano (FIA) in infants and toddlers, potentially affecting their daily lives.ObjectivesThe purpose of this study was to identify potential risk factors for FIA in infants and toddlers, in order to implement early preventive interventions, avoid disease progression, and develop therapeutic strategies.Design and settingsA retrospective case-control study was conducted, comparing 41 infants and toddlers diagnosed with FIA with 41 healthy controls, between August 2020 and December 2021.Independent variables(a) maternal characteristics during pregnancy and delivery, (b) perinatal characteristics, dietary behaviors, and defecation-related behaviors in infants and toddlers, (c) family dietary behaviors.ResultsMothers of infants and toddlers with FIA had given birth more times in the past, while the infants and toddlers themselves had less mealtime, a higher rate of exclusive breastfeeding, frequent loose stools, and a larger proportion of used wipes, experiencing perianal skin anomalies. The logistic regression analysis revealed that there are four significant risk factors associated with the development of FIA in infants and toddlers, including the number of previous deliveries by the mother (OR 6.327), defecation frequency score (OR 5.351), stool consistency score (OR 5.017), and cleaning with wipes after defecation (OR 8.089).ConclusionBased on our data, it appeared that FIA in infants and toddlers could be attributed to several factors. These included an increased number of previous deliveries by mothers, frequent loose stools, and repeated wipe use. To prevent the occurrence and worsening of the disease, it is important to improve the frequency and consistency of stooling and provide proper care. Further research is required to verify these findings in other clinical settings.

Ayurvedic Management of Crohn’s Disease - A Single Case Study

Crohn’s disease is a chronic idiopathic inflammatory bowel disease condition characterized by skip lesions and transmural inflammation that can affect the entire gastrointestinal tract from the mouth to the anus. It is having variable presenting symptoms and may include diarrhoea, abdominal pain, weight loss, nausea, vomiting etc. The diagnosis is typically made with endoscopic and/or radiologic findings. A 16-year-old female patient diagnosed with Crohn’s disease having complaints of frequent loose stools, bleeding per rectum after evacuation of bowel, generalised weakness, reduced appetite and weight loss since more than 6 years approached the outpatient department of Kayachikitsa, SDM Ayurveda hospital, Kuthpady, Udupi, Karnataka, India. Patient was intervened with Vilwadi Gulika, Dadimashtaka Churna, Kutajarishta, Takra Kalpana, Parpati Kalpana, Picha Basti etc. strictly following Laja diet with Takra in 4 courses of admissions with a time gap of 2-3 months. There was marked improvement in the frequency of loose stools and rectal bleeding. Improvement in weight was noted by a gain of 12 kg and generalised weakness was completely relieved. The therapy gained confidence in the patient to stop all the steroid and immunosuppressant medications completely and continue with Ayurvedic medication. Thus, it can be concluded that Ayurvedic interventions are effective in the improvement of symptoms in Crohn’s disease.

A rare case of cardiac calcified amorphous tumor in a 34-year-old woman diagnosed at autopsy

Abstract Introduction/Objective Cardiac calcified amorphous tumor (CAT) is an uncommon, non-neoplastic heart lesion with an unknown incidence due to its rarity. Some authors have reported a female predominance of 62.5%. Many cases are associated with end-stage renal disease, diabetes mellitus and coronary artery disease. Dysfunction of calcium- phosphorus metabolism and hypercoagulability are thought to contribute to its pathogenesis. This is the first case reported from our institution. Methods/Case Report We present the case of a 34-year-old woman with a remote history of ulcerative colitis, type 1 diabetes mellitus, hypertension, Hashimoto thyroiditis, cardiomegaly, and end-stage renal disease on continuous hemodialysis. She had multiple hospitalizations for mesenteric ischemia and small bowel resections. She was admitted multiple times in 2021 for complaints of pain in bilateral thighs, shortness of breath, frequent loose stools, and abdominal pain. She was poorly compliant with hemodialysis. A chest x-ray showed severe enlargement of the cardiac silhouette. A CT angiogram of the abdomen and pelvis showed arteriosclerosis of the superior mesenteric, inferior mesenteric and celiac arteries. The patient presented to the hospital in February 2022 with continuous abdominal pain, gluteal pain, and diarrhea. Her creatinine was consistently elevated at 3.52 mg/dL. On the sixth day of admission, she was found unresponsive and was pronounced dead. Autopsy showed cardiomegaly (600 grams) with left ventricular hypertrophy, recent myocardial infarction of the posterolateral left ventricle and moderate to severe coronary artery atherosclerosis. There were lesions composed of calcified amorphous material involving the mitral valve, the endocardium and subendocardial portions of the left and right ventricles, consistent with multifocal cardiac calcified amorphous tumor. The largest lesion measured 4.0 cm. The cause of death was myocardial infarction complicating type 1 diabetes mellitus and end-stage renal disease. Results (if a Case Study enter NA) NA Conclusion CATs are usually asymptomatic but possible symptoms include dyspnea and syncope. As a result, they are often incidental findings. The calcified deposits may embolize, causing pulmonary embolism and cerebral infarction. CAT is most frequently observed in the left heart, especially on the mitral annulus; however, the right side of the heart can also be affected. End-stage renal disease is a predisposing condition, as seen in this patient.

Advances in Therapy for Irritable Bowel Syndrome with Diarrhea: Role of Rifaximin in Combination with Metronidazole

Irritable bowel syndrome (IBS) with diarrhea predominance is a subtype of IBS characterized by recurrent abdominal pain or discomfort along with frequent loose or watery stools. A significant number of individuals are impacted and are physically, socially, and emotionally impacted. Managing diarrhea-predominant IBS (IBS-D) involves a multidimensional approach due to unpredictable nature of the condition involving lifestyle modifications, dietary changes, stress management techniques, and medications. Altered gut microbiota and small intestinal bacterial overgrowth (SIBO) often precede IBS leading to dysbiosis. Systemic antibiotics and other treatment options have been reported with varied outcomes, yielding inconsistent results. Rifaximin, with its broad anti-bacterial action, along with eubiotic activity, limited systemic exposure, gut-specific action, and limited potential for drug interactions along with metronidazole is proposed as a novel treatment option for IBS-D. Rifaximin and metronidazole fixed-dose combination will not only address infectious diarrhea associated with IBS but also SIBO and postinfectious IBS with excellent efficacy and tolerability. For patients with IBS-D, rifaximin along with metronidazole can be a new treatment avenue as increasing evidence supports the hypothesis that bacterial overgrowth may be involved in the pathogenesis of IBS and parasitic infections can be a triggering factor for the exacerbation of IBS. PubMed and Google Scholar were searched through May 2023. Randomized controlled trials and reviews published in English were selected that evaluated rifaximin and/or metronidazole in patients with IBS.

Evaluation of Water Quality, Urinary Mercury & Arsenic Investigation and Survey of Diseases Associated with Drinking Water Sources

Background: Contamination of freshwater sources can be caused by both anthropogenic and natural processes. WHO reported that 1.1 billion people worldwide consume contaminated water, and the majority of diarrheal diseases (88%) are caused by it. According to Central Pollution Control Board (CPCB), Maharashtra along with two other states contribute 80% of hazardous waste, including heavy metal pollution in India. Certain dissolved heavy metals are easily absorbed by aquatic organisms and can enter the body through drinking water, skin absorption, and biological chains, posing a health risk. Hence, the main objectives of the study were, (1) surface and groundwater quality assessment, (2) to determine the association of diseases/symptoms with different sources of drinking water used, and (3) urinary Mercury (Hg) and Arsenic (As) levels investigation in the study population. Methods: The cross-sectional study was conducted in the industrialized city of Solapur, Maharashtra, India. The study area was limited to 25 km around the industrial hub. A total of 557 people were randomly selected for the survey, with consumers from all four types of water sources i.e., surface, handpump, wells, and municipal water. Spot urine samples were collected for estimating Hg and As levels after considering inclusion and exclusion criteria. People under treatment for tuberculosis, cancer, and chronic heart, lung, or kidney ailments were excluded. Also, pregnant and lactating women were not included. One surface water, one municipal water, and five handpump water samples were collected for evaluating water quality. Samples were analyzed for pH, Total Dissolved Solids (TDS), Dissolved Oxygen (DO), Biological Oxygen Demand (BOD), Chemical Oxygen Demand (COD), Fluoride, Ammonia, Mercury, Arsenic, Cadmium, Lead, Nickel, Copper, Zinc, Chromium, and Manganese. Results: The water samples were observed to be neutral to slightly basic. TDS was between 410 to 1898 mg/L for groundwater whereas for surface water was 378 & 450 mg/L. F concentration ranged between 0.4 to 0.9 mg/L, Zn from 0.32 to 0.57 mg/L, and NH3 was found to be <0.1 mg/L. Out of 557 people, 43 (7.7%) used surface water, 194 (34.8%) used handpump, 64 (11.5%) used well, and 256 (46%) used municipal water. Among surface water users, 14 (32.5%) people reported frequent loose stools (p-value <0.05), and 11 (25.5%) people reported frequent abdominal pain. Handpump and well water users majorly reported frequent abdominal pain and gastric discomfort (p-value <0.05) respectively. 47 people were selected for estimating urinary Hg and As levels after considering exclusion and inclusion criteria. The mean value of urinary Hg & As are 4.91 ± 0.280 & 42.04 ± 2.635 µg/L respectively. Conclusion: In our study frequent loose stools, abdominal pain, and gastric discomfort were associated with the various sources of drinking water. Urine Hg levels were above the permissible reference value set by NHANES (USA) Survey. Additionally, it is advised that frequent drinking water monitoring be implemented in the vicinity of the industrial hub since metal accumulation may be dangerous to consumers when it is present in excess, and if found higher, necessary action should be taken to reduce exposure.

A case study: Ayurvedic management of Pravahika with special reference to inflammatory bowel disease

A 60-year-old male patient reported to the Outpatient Department of Kayachikitsa, with the complaints of frequent loose, watery, frothy, and foul-smelling stool stained with mucous and blood with tenesmus. Other associated complaints were loss of appetite, distension and pain in the abdomen, headache, insomnia, and generalized weakness. The patient was diagnosed as Irritable Bowel Disease consistent with Ulcerative Colitis. A combination of Lavanbhaskar Churna, Yashtimadhu, Lodhra, Sariva, Patha, Dhamasa 300 mg each powder three times a day, along with tablet Praval Panchamrut 250 mg 2 tablets three times a day and tablet Kamadudha Rasa 250mg 2 tablets three times a day before food was administered for 45 days. After the 45 days of treatment, a significant response in various symptoms such as frequent defecation, blood, mucous stained stools, loss of appetite, abdomen distension, headache, and insomnia were found.

D1 MTE2 Case 4: A case of men - 1

Mr. GR, 40 year man presented to us in 2019 with frequent loose stools and generalised tiredness. He has T2DM (7 years, HbA1c-6.7%), CAD (AWMI-PTCA-2013), well-controlled hypertension and his father had primary hyperparathyroidism (all four removed), nephrolithiasis, T2DM, received renal transplant. Five years back, Mr. GR was diagnosed to have Neuroendocrine tumour following distal pancreatectomy and splenectomy on histopathology. Later in 2019, when his scans were repeated for recurrent abdominal symptoms, the new diagnosis of primary hyperparathyroidism was made (PTH-135 [14-65 pg/mL], Corrected Calcium-11.1 [8.5-10.2 mg/dL], Vitamin D-40 [30-40 ng/mL], 24-hour urinary calcium-328 [100-300 mg/day]). Sestamibi scan showed right inferior parathyroid adenoma. He had abdominal issues with elevated Chromogranin A- 6880 (<93 ng/mL) and Gastrin-730 (0-180 pg/mL), Ga 68-DOTATATE scan revealed overexpressing-somatostatin receptor peripancreatic node and pulmonary metastasis. He was started on Octreotide (2 weeks S/C TID following which monthly LAR injection was given for duration of 12 months. His latest reports showed Chromogranin A-325.7, Gastrin-346, Corrected Calcium-11, PTH-136. Presently, he is asymptomatic, improved with no abdominal issues with moderate glycaemic control (HbA1c-6.7%, FBS-121 mg/dl). How would we move forward with the management of this patient?

Human Health Risk Assessment due to Heavy Metals in Ground and Surface Water and Association of Diseases With Drinking Water Sources: A Study From Maharashtra, India.

Contamination of freshwater sources can be caused by both anthropogenic and natural processes. According to Central Pollution Control Board, Maharashtra along with 2 other states, contribute 80% of hazardous waste generated in India, including heavy metal pollution. Hence, it is important to quantify heavy metal concentrations in drinking water sources in such areas. Water samples were analyzed for toxic elements (F, As, Cd, Hg, Pb, Ni, Cu, Zn, Mn, and Cr) using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) Agilent 7500. Health risks due to ingestion and dermal contact was assessed. A total of 557 people were randomly selected, with consumers from all 4 types of water sources that is surface water, hand pump, wells, and municipal water. Spot urine samples were collected from 47 people after considering inclusion and exclusion criteria. Urine was collected for estimating mercury and arsenic levels in the study participants. Arsenic contributes the most health risk from ingestion from water. Among surface water users, 14 people (32%) reported frequent loose stool (P-value < .05) (OR 2.5), and 11 people (23%) reported frequent abdominal pain (OR 1.9). Hand pump and well water users reported frequent abdominal pain (27%) (OR 1.4) and gastric discomfort (31%) (P-value < .05) (OR 3) respectively. The mean value of urinary Hg and As were 4.91 ± 0.280 and 42.04 ± 2.635 µg/L respectively. Frequent loose stool, gastric discomfort, and frequent abdominal pain were associated with the various sources of drinking water. Urine Hg levels were found higher than the NHANES (USA) Survey. It is recommended that frequent monitoring of drinking water should be enforced around the industrial hub, so that appropriate actions can be taken if present in excess.

Is There a Role for Bismuth in Diarrhea Management?

Diarrhea, an illness of both the developed and developing world, involves the burdensome characteristics of frequent bowel movements, loose stools, and abdominal discomfort. Diarrhea is a long-standing challenge in palliative care and can have a myriad of causes, making symptomatic treatment pertinent when illness evaluation is ongoing, when there is no definitive treatment approach, or when effective treatment cannot be attained. Symptomatic therapy is a common approach in palliative care settings. Bismuth is a suitable agent for symptomatic therapy and can be effectively employed for management of chronic diarrhea. The objective of this narrative review is to examine the role of bismuth in management of diarrheal symptoms. To explore this, PubMed (including Medline) and Embase were used to search the existing literature on bismuth and diarrhea published from 1980 to 2019. It was found that bismuth has potential utility for diarrheal relief in multiple settings, including microscopic colitis, traveler’s diarrhea, gastrointestinal infection, cancer, and chemotherapy. It also has great potential for use in palliative care patients, due to its minimal side effects. Overall, the antisecretory, anti-inflammatory, and antibacterial properties of bismuth make it a suitable therapy for symptomatic treatment of diarrhea. The limited range of adverse side effects makes it an appealing option for patients with numerous comorbidities. Healthcare providers can explore bismuth as an adjunct therapy for diarrhea management in an array of conditions, especially in the palliative care setting.

High prevalence of primary bile acid diarrhoea in patients with functional diarrhoea and irritable bowel syndrome-diarrhoea, based on Rome III and Rome IV criteria.

BackgroundA high prevalence of primary bile acid diarrhoea (BAD) has been reported for Rome III defined irritable bowel syndrome (IBS)-diarrhoea and functional diarrhoea. We determined whether this still applies under the contemporaneous Rome IV criteria, given that the latter characterises IBS-diarrhoea as having more frequent abdominal pain compared with previous iterations, whilst no longer recognising abdominal discomfort.MethodsPatients referred for a 75SeHCAT test completed a baseline questionnaire comprising, i) demographic data, ii) risk factors for BAD (inflammatory bowel disease, bowel resection, cholecystectomy, microscopic colitis, celiac disease, abdominal-pelvic radiotherapy), iii) the Rome III and IV bowel disorder questionnaire, and iv) mood and somatisation scores. A diagnosis of BAD constituted a 75SeHCAT of ≤15%, with moderate to severe disease being defined as ≤10% and ≤5%, respectively.FindingsOf 300 patients with complete dataset, 184 had no risk factors for BAD and fulfilled criteria for either IBS-diarrhoea or functional diarrhoea. The prevalence of primary BAD was 38% (n = 70/184), with almost half having moderate (n = 16) to severe (n = 17) disease. Using the Rome III criteria, the prevalence of primary BAD was 36% in IBS-diarrhoea (n = 63/173) and 64% (n = 7/11) in functional diarrhoea; p = 0.11. Using the Rome IV criteria, the prevalence of primary BAD was 38% (n = 53/139) in IBS-diarrhoea and 38% (n = 17/45) in functional diarrhoea; p = 0.97. Patients with primary BAD experienced more frequent loose stools (p = 0.01) and had a higher body mass index (p<0.0001) compared to those without BAD, but otherwise no significant differences were seen in age, gender, mood, somatisation, or abdominal pain. The presence of primary BAD in patients classified as overweight or obese was approximately 40% and 60%, respectively.InterpretationOver a third of patients with Rome IV IBS-diarrhoea or functional diarrhoea have primary BAD, similar to Rome III. We therefore recommend that, in secondary care settings, generic testing for primary BAD should be considered in patients presenting with chronic diarrhoea of presumed functional origin regardless of concomitant abdominal pain. Centres that lack tests for primary BAD, and who empirically treat instead, may consider targeting patients who are overweight or obese.

SUN-492 Treatment of Uncontrolled Graves’ Disease Reveals Underlying Thyroiditis

Thyrotoxicosis is a life-threatening condition that may result from poor adherence to medical therapy. We describe the case of a patient with Graves’ disease and a history of medication non-compliance who presented with tachyarrhythmia and heart failure (HF). His protracted course after weeks of inpatient treatment with thionamides, iodine, resin and beta-blockers, was followed by a dramatic improvement within days of adding steroids, suggesting the presence of concurrent untreated thyroiditis. Case Description: A 38-year-old man with an 18-month history of known Graves’ disease presented to the endocrinology clinic requesting thyroidectomy. He complained of 3 weeks of worsening palpitations, shortness of breath, bilateral lower extremity edema, and frequent loose stools. History revealed frequent interruption of thionamide and recent discontinuation of propranolol due to patient’s perceived lack of improvement. Physical exam showed a thin male with a large goiter. He was in moderate distress due to tachypnea. He had atrial fibrillation with rapid ventricular rate (A Fib with RVR) but was not in pulmonary edema. Laboratories showed a suppressed TSH (<0.02 mIU/L [0.45 - 4.70 mIU/L]), a free T4 above the level of detection (>6.99 ng/dL [0.78 - 2.20 ng/dL], and a total T3 level of above 781 pg/mL (97.0 - 170.0 ng/dL). Methimazole 30 mg BID and propranolol 40 mg TID were started, followed within a few hours with potassium iodine (SSKI) 3 drops TID. Although the patient’s HF improved and there was down-trending of free T4, he continued to have A fib with RVR. SSKI and propranolol were increased; diltiazem 90 mg QID and cholestyramine 2g BID were later added. Despite aggressive treatment, the patient continued to have intermittent tachyarrhythmia, postponing his planned thyroidectomy for weeks. Dexamethasone 2mg Q8H was then started aiming to further decrease T4 to T3 conversion. Interestingly, within 48 hours of the start of steroid therapy, his free T4 level markedly decreased and was well within the normal range several days later when he underwent a successful thyroidectomy, with no further tachyarrhythmia recurrence. Discussion: Thyrotoxicosis is aggressively treated given its high mortality rate. Treatment algorithms guide physicians to categorize hyperthyroidism either as the type associated with increased hormone synthesis and secretion or that which results from increased hormone release due to gland destruction. This thought process may lead, as in our case, to a delay in appropriate therapy and an increased risk of disease complications. Furthermore, providers should not assume that the lack of treatment response in a patient with Graves’ disease is the result of medication non-adherence. The possibility of coexisting thyroiditis and the absence of a treatment regimen that effectively addresses both underlying processes may be the actual cause for the lack of clinical improvement.

Invasive intestinal mucormycosis in a 40-year old immunocompetent patient - a rarely reported clinical phenomenon: a case report

BackgroundMucormycosis is rare, life-threatening fungal infection. Frequently observed in those patients having underlying immunosuppression such as, diabetes, organ transplantation, Human immunodeficiency virus (HIV) infection, and elevated serum iron. However, invasive intestinal mucormycosis occurring in immunocompetent individuals without the traditional risk factors is extremely rare clinical phenomenon.Case presentationWe report a 40-year-old male patient who presented with 1 week history of diffuse abdominal pain and high grade fever, associated with vomiting and frequent loose stools. Has history of chronic alcohol ingestion. Otherwise, no past history of chronic medical illness, nor he had contact with individuals with similar illness. He was in a septic shock with multiple organ failure up on presentation to emergency room. Physical examination revealed icterus sclera with abdominal tenderness. He was immediately resuscitated using crystalloids, supported with inotrope, and antibiotics. Histopathological examination of tissue sample from colonic ulcer biopsy revealed invasive intestinal mucormycosis. Patient showed full clinical and histopathological resolution after course of parenteral Liposomal Amphotercin B.ConclusionThis case highlights the fact that, despite its life-threatening nature, it’s possible to treat patients with invasive intestinal mucormycosis with aggressive antifungal and supportive care without surgical intervention, provided that all the necessary supportive care were initiated early and the disease was diagnosed early and appropriate medical management was initiated timely. In addition, it’s important to consider intestinal mucormycosis even in patients who are immunocompetent without traditional risk factors.

Holistic treatment of chronic myeloid leukaemia with adjuvant homoeopathic therapy: A case report

Introduction: Chronic myeloid leukaemia (CML) is a clonal myeloproliferative disorder of haematopoietic stem cell. Case Summary: This is a case of a 28-year-old female having CML for 1½ years, on regular allopathic medication. The patient was suffering from ulceration in the oral cavity, frequent offensive loose stools with melena and prolonged menstrual cycle with heavy bleeding for 3 weeks. After analysing the constitutional make-up of the patient, Platinum metallicum 200C was prescribed. Over a period of 3 months, the patient reported improvement in weakness, nausea, sleeplessness, irritability, heavy menstruation, loose black stools and backache. Until the last follow-up while submitting this report, the patient was on the maintenance dose of Imatinib along with homoeopathic medication.

Effects of solution-focused approach on negative emotion and gastrointestinal symptom in patients with hepatogenic diarrhea

Objective To explore the effects of solution-focused approach on negative emotion and gastrointestinal symptom in patients with hepatogenic diarrhea. Methods Totally 86 patients with hepatogenic diarrhea admitted in the First Affiliated Hospital of Zhengzhou University from January to December 2018 were selected using convenient sampling and divided into control (n=39) and observation (n=47) groups according to the time of admission. Patients in the control group received conventional nursing care, while patients in the observation group received 5-step intervention based on solution-focused approach. Self-Anxiety Scale (SAS) , Self-Depression Scale (SDS) and Gastrointestinal Symptom Rating Scale (GSRS) were used to assess the effects of intervention. Results After intervention, the SAS, SDS and GSRS scores of the observation were lower than those of the control group, and there were statistically significant differences between the two groups (P<0.05) . The top 5 gastrointestinal symptoms in both groups were stomachache, poor stool output, frequent defecation, loose stools and fecal urgency. The incidence of sour regurgitation, abdominal pain, flatulence, poor stool output and frequent defecation, loose stools and fecal urgency was reduced after intervention in the observation group, and there were statistically significant differences between the two groups (P<0.05) . Conclusions Solution-focused approach can ameliorate negative emotions such as anxiety and depression as well as gastrointestinal symptoms in patients with hepatogenic diarrhea, which is worthy promoting in clinical practice. Key words: Anxiety; Depression; Hepatogenic diarrhea; Gastrointestinal; Solution-focused approach

Surgical treatment of idiopathic megarectum in constipated children

BackgroundChronic constipation in children is associated with primary megarectum. This study investigated outcomes of surgical treatment of idiopathic megarectum in children. MethodsThis retrospective comparative study included 52 children with idiopathic megarectum (mean age, 9.4 ± 1.7 years) treated from 2007 to 2016. Patients were divided into 2 groups. Group 1 included 23 patients who underwent a Soave pull-through operation. Group 2 included 29 children who underwent laparoscopic low anterior resection with endorectal stapled anastomosis using laparoscopic ultrasound guidance. All patients had clinical and laboratory evaluations with anorectal manometry, colonoscopy and contrast enema studies. ResultsSix patients (26.1%) in Group 1 and one (3.5%) in Group 2 experienced anastomosis leakage requiring colostomy (χ2 = 3.867, P = 0.049). In long-term follow-up, 3 children (13.1%) in Group 1 and 2 (6.9%) in Group 2 had ongoing constipation; this difference was not significant. Frequent loose stools with soiling were significantly more common in Group 1 (14 patients; 60.9%) than in Group 2 (4 patients; 13.8%) (χ2 = 10.566, P = 0.001). ConclusionsOur experience shows that laparoscopic video-assisted low anterior resection of the colon with endorectal stapled anastomosis under laparoscopic ultrasound guidance to determine the level of colon resection is the better operation then Soave for children with idiopathic megarectum and chronic constipation. This approach provides good functional results and reduces complications. Type of studyTreatment study. Level of evidenceLevel III, retrospective comparative study.

Achieving Social Bowel Continence in Children With Hypermotility After Repair of Anorectal Malformations and Hirschsprung

Children presenting to the Pediatric Colorectal Bowel Management clinic with soiling after surgical repair of anorectal malformations or Hirschsprung can be categorized into two groups: Most are constipated and managed with laxatives and/or enemas, whereas the second subset has frequent loose stools. This second group, children with multiple loose stools, presents a unique challenge for the achievement of social bowel continence. We present three case studies illustrating various clinical presentations of incontinence with loose stools, along with dietary and pharmacologic management strategies and a treatment algorithm. Children who soil with loose stools can achieve social continence using a combination approach using toileting supports, diet manipulation, fiber supplementation, medications, and small-volume enemas.

EXAMINATION STRESS AMONG MEDICAL STUDENTS: PREVALENCE CAUSES AND PREVENTION

There was executed the study including the examination of 833 students of 2-6 courses of the medical University concerning their subjective rating of the stress level on exams, its causes and the measures they used to reduce stress. 26.7% of students noted the high level of stress on examination, there was significantly increased the number of students with low-stress levels in students оf 3-4 courses, boys, and students with good and excellent grades note significantly less a high level of examination stress. The most common manifestations of stress are changes in the cardiovascular system (62% of the students) and autonomic nervous systems (48.6%), these manifestations were significantly less noted in students with good and excellent grades. In the course of training, there was discovered the increase in complaints of the frequent urination, loose stools and discomfort or pain in the abdomen. The main causes of stress at exams, according to students, there are a large amount and difficulty of exam material and the insufficient addressing of examination tasks in the classroom. In the dynamics of training, there is a significant reduction in the number of students who believe early acquaintance with the exam questions to be important, the sufficiency of the time devoted to self-education and an increase in the number of students recognizing it is necessary to reduce the waiting time of the call to the exam. Most popular methods of the reducing examination stress on younger courses are the use of rites, superstitions, and drugs, in the senior years. A growing number of individuals using the techniques of autogenic training was discovered. 49.9% of students do not fight with stress. 63.9% of students consider the introduction of elective subjects of “Prevention and correction of examination stress in students” to be necessary.

Case series with literature review: Surgical approach to megarectum and/or megasigmoid in children with unremitting constipation

BackgroundThe role of surgery in treating children with functional constipation (FC) is controversial, because of the efficacy of bowel management programs. This case series is comprised of failures: 43 children, spanning 25 years' practice, who had megarectosigmoid (MRS) and unremitting constipation.PurposeTo determine whether these children were helped by surgery, and to contribute to formulating a standard of care for children with megarectum (MR) and/or redundancy of the sigmoid colon (MS) who fail medical management.MethodWe describe our selection criteria and the procedures we utilized – mucosal proctectomy and endorectal pull-through (MP) or sigmoidectomy (SE) with colorectal anastomosis at the peritoneal reflection. The internet (social media) allowed us to contact most of these patients and obtain extremely long follow-up data.Results30/43 patients had MP and 13/43 had SE. Follow-up was obtained in 83% MP and 70% SE patients. 60% of MP and 78% of SE patients reported regular evacuations and no soiling. 20% MP patients had occasional urgency or soiling or episodic constipation. 12% MP and 22% SE patients required antegrade continence enemas (ACE) or scheduled cathartics and/or stool softeners. 4% MP had no appreciable benefit, frequent loose stools and soiling, presumably from encopresis.ConclusionMR is characterized by diminished sensation, poor compliance and defective contractility. Patients with MR do better with MP, which effectively removes the entire rectum versus SE, where normal caliber colon is anastomosed to MR at the peritoneal reflection; furthermore, MP reliably preserves continence; whereas total proctectomy (trans-anal or trans-abdominal) may cause incontinence.

Concurrent Disseminated Cryptococcus neoformans and Abdominal Tuberculosis in a Renal Transplant Recipient – Paradoxical Reaction or IRIS?

A 36 year old-man diagnosed with ESRD on hemodialysis, presented with fever, moderate abdominal pain with frequent non-bloody loose stools, headache, blurring of vision and molloscum-contagiousum like skin lesions. HIV test was negative and CT brain was normal. Blood culture grew Cryptococcus neoformans with high titer antigenemia. Amphotericin B and fluconazole were started and the patient was discharged on oral fluconazole therapy. Four weeks later, he was readmitted with persistent high spikes of temperature, profuse sweating and severe frontal headache. CT brain revealed a faint hypodense lesion at right frontal lobe with ill-defined margin and lumbar puncture was deferred. Pan-sensitive mycobacterium tuberculosis was grown from stool sample. Blood cryptococcalantigenemia was reported again and he was started on a new IV amphotericin intensive cycle and high dose fluconazole. Quadruple anti-tuberculosis treatment was initiated. The patient made a full clinical recovery including total resolution of skin lesions; laboratory and radiological recovery.