Higher Incidence Of Diarrhea Research Articles

Regional epidemiological features of infectious diseases with fecal-oral transmission in the socialist republic of Vietnam

Aim: To identify regional epidemiological features of infectious diseases spread by fecal-oral transmission and the factors influencing them in four regions of Vietnam.Materials and methods: Retrospective epidemiological analysis of data of 10 infectious diseases spread by fecal-oral transmission in Vietnam for the period 2017-2022. Maps of incidence by province was created using the QGIS 3.28 program. Correlation coefficients between the incidence of the studied diseases and socio-economic factors were established.Results: It was revealed that the incidence of the 10 studied diseases was 443.1±113.5 0 /0000 and tends to decrease. The highest incidence was recorded in Tay Nguyen. Cases of diarrheal syndrome (330.1±73.8 0 /0000) and enteroviral vesicular stomatitis (HMFD) (93.6±33.4 0 /0000) accounted for 95.65% of all registered cases. Diarrhea is distributed mainly among children under 4 years of age (1090.3±384.8 0 /0000) and 5-9 years old (60.9±18.5 0 /0000). Regional epidemiological features of diarrhea and HMFD are shown. The highest incidence of the HMFD was recorded among children under 4 years of age in Dong Thap (4635.8 0 /0000) and Ho Chi Minh City (4210.5 0 /0000), and the highest incidence of diarrheal syndrome was in Kon Tum (2621.2 0 /0000), Thai Binh (2556.6 0 /0000) and Dien Bien (1461.9 0 /0000). Relationships were established between the incidence of diarrhea and levels of access to safe water (rSpearman = – 0.393; p = 0.001), to the sanitation system (rSpearman = – 0.267; p = 0.035), average monthly income (rSpearman = – 0.424; p = 0.001), poverty levels (rSpearman = 0.403; p = 0.001).Conclusion: The high incidence of infectious diseases spread by fecal-oral transmission in Vietnam is due to the high incidence of diarrhea and HMFD. A high incidence of diarrhea is typical for provinces with low levels of access to safe water and sanitation systems, high levels of poverty and low average monthly income. Incidence of HMFD is high among children under 4 years old, especially in the southern provinces with high population density in the summer and autumn seasons.

Convergence of Stunting and Diarrhoea among Children in Peri-Urban Lusaka: A Cross-Sectional Study of Prevalence and Predictors

Background: In Zambia, stunting and diarrhoea—largely avoidable conditions—are significant contributors to death in children under five years of age. Large-scale studies commonly compare these variables between urban and rural settings, although they frequently neglect to consider the substantial socio-economic differences present within urban populations. This study sought to investigate the prevalence and co-occurrence of stunting and diarrhoea in peri-urban regions of Lusaka. Method: A cross-sectional study approach was utilized, focusing on 239 homes in Lusaka East, a peri-urban area of Zambia's capital city. The research concentrated on homes with a minimum of one kid between the ages of 6 and 23 months. Data collection utilized structured questionnaires distributed to guardians, documenting socio-demographic variables and sanitation practices. Children's anthropometric measures were standardized utilizing height-for-age z-scores (HAZ). The research employed bivariate and multivariable logistic regression analysis to investigate factors associated with malnutrition and diarrhoea. Results: The study included 232 children, with 53.8% (n=125) identified as female and 46.2% (n=107) as male. The median age of the children was 13 months (IQR ±8), whereas the median age of their guardians was 26 years (IQR ±9.5). The prevalence of stunting and diarrhoea was 24.1% (95% CI: 18.7–30.2%) and 19.4% (95% CI: 14.5–25.1%), respectively, with the highest rates observed in children aged 12 to 23 months. Significant predictors of stunting were identified as child gender (aOR: 0.45, 95% CI: 0.23–0.89), sanitation type (aOR: 2.35, 95% CI: 1.08–4.52), and the marital status of the guardian (aOR: 1.17, 95% CI: 1.01–2.88). In children with diarrhoea, gender (aOR: 0.41, 95% CI: 0.18–0.89) and the guardian's marital status (aOR: 2.80, 95% CI: 1.14–6.89) were identified as significant predictors. Conclusion: In conclusion, the study identified a significant prevalence of stunting, alongside a high incidence of diarrhoea in stunted children, potentially elevating the risk of childhood mortality. This highlights the necessity of strengthening primary healthcare services and improving community health education, with an emphasis on the early detection of stunting and the prevention of diarrhoea, especially in economically disadvantaged peri-urban areas in Zambia.

Unraveling diarrheal disease knowledge, understanding, and management practices among climate change vulnerable coastal communities in Ghana.

Diarrheal disease is a global public health concern, particularly in low-income countries. In Ghana, widespread issues like inadequate sanitation, unsafe drinking water, malnutrition, and poor hygiene practices contribute to the high incidence of diarrhea. Climate change exacerbates these challenges by increasing the frequency and severity of conditions that spread diarrheal diseases. This study explores households' knowledge, understanding, and management practices for diarrhea in climate change-vulnerable coastal communities. The study is set in Ghana's central (Mumford, Opetekwei) and eastern (Anyako, Anyanui-Atiteti) coastlines. Using a cross-sectional study design, a structured questionnaire was administered to randomly sampled households (n = 419) to collect quantitative data. The study collected qualitative data from focus group discussions (n = 8), with groups separated into men and women, key informant interviews, and observations of food, water, and sanitation conditions across the studied communities. The study found significant variations between the studied communities and socio-demographic variables except for the respondents' gender. Multivariate regression analyses identified significant associations between socio-demographic variables (especially gender and educational status) and perceptions of diarrhea causes. The most used first management action against diarrhea is 'over-the-counter drugs', followed by home-made traditional remedies. Significant differences were observed in the usage of management practices across the studied communities. Trust, affordability, and availability were identified as the main factors influencing households' use of approved pharmaceutical drugs and traditional herbal remedies for managing behavior, with significant differences being observed across communities. The study recommends a multi-sectoral approach, including improved access to regularly flowing, safe water and sanitation facilities, education on preventing diarrhea, and adequate healthcare services. Community-based interventions such as promoting good hygiene practices at homes and community settings such as schools, lorry parks, funeral grounds, and recreational areas can also effectively reduce the burden of diarrhea.

Spatial clusters and determinants of the high incidence of diarrhea in children

Spatial clusters and determinants of the high incidence of diarrhea in children

Efficacy and safety of combination therapy with pirfenidone and nintedanib in patients with idiopathic pulmonary fibrosis.

Background: Recent studies have suggested that combination therapy with pirfenidone and nintedanib is safe and tolerable in patients with idiopathic pulmonary fibrosis (IPF). However, data from real-world practice are limited. Thus, we aimed to investigate the safety and efficacy of this combination therapy in patients with IPF in a real-world setting. Methods: A multicenter retrospective cohort study was conducted to investigate the safety and efficacy of combination therapy with pirfenidone and nintedanib in 45 patients with IPF. Incidences of adverse events and rates of lung function decline were compared before and after the combination therapy. Propensity score matching was performed to compare the outcomes between the combination and monotherapy groups. Results: The mean age of the patients was 68.8years, and 82.2% of them were male. The median follow-up duration after combination therapy was 12.1months. The majority of the patients (97.8%) received nintedanib as an add-on to pirfenidone. The most common adverse events after the combination therapy were diarrhea and anorexia. Pirfenidone or nintedanib was stopped in 12 patients owing to gastrointestinal AEs, lung transplantation, or financial problems. In patients with serial lung function data, the rate of decline in the forced vital capacity was significantly reduced after the combination therapy. In the matched analysis, the combination group had a higher incidence of diarrhea than the monotherapy group without an increase in serious adverse events; however, the two groups had similar changes in forced vital capacity (FVC). Conclusion: The combination of pirfenidone and nintedanib in patients with IPF has the potential to reduce the rate of FVC decline. However, in the matched analysis, FVC decline was comparable between the patients on combination therapy and those on monotherapy. The incidence of certain adverse events, particularly diarrhea, was higher with combination therapy, but serious adverse events were similar between the groups.

Peningkatan Upaya Pemulihan Diare Menggunakan Bubur Tempe Pada Anak Usia Balita Melalui Pemberdayaan Masyrakat

This community service activity is one form of assignment for Pediatric Nursing Practicum Course. With the lecturers Mrs. Maryatun, S.Kep., Ns., M.Kes and Mrs. Zulfa M. Rasyida, M.Kep. Diarrhea is a problem that still occurs frequently in various countries, especially developing countries. The diarrhea morbidity rate in Lampung Province showed an increase, from 9.8 per 1000 population in 2005 to 18.24 per 1000 population in 2012. Children less than a year old often experience diarrhea with the highest incidence of diarrhea at the age of 6-11 months. Diarrhea is an abnormal transmission of feces characterized by an increase in the volume and dilution of feces and the frequency of defecation more than 3 times a day (in neonates more than 4 times a day) with or without blood mucus. Children affected by diarrhea will experience dehydration and will cause food substances that are still needed by the body to be wasted so that their growth cannot be optimal. The problems of the partners from the observation obtained that most people do not know the correct handling of diarrhea in children, and only give medicine when diarrhea without thinking about the recovery of nutrition and nutrition in children after losing iron and other nutrients when diarrhea occurs. The problems faced by partner communities are (1) not having knowledge about tempeh porridge (2) not knowing the skills about handling diarrhea in children properly. The objectives of this service are (1) to increase mothers' knowledge about tempe porridge (2) to improve mothers' skills in making tempe porridge. The solutions offered in this service activity are (1) providing education to mothers about tempeh porridge (2) teaching mothers to make tempeh porridge. This service activity involves students as a form of support for the implementation of the Pediatric Nursing Practicum Course assignments. The expected outputs of this activity are (1) increasing the knowledge and skills of mothers in Dukuh Wirodigdan, Ngemplak Sawah, Kartasura, Sukaharjo (2) publication in the national journal of community service.

Efficacy and safety analysis of TACE + Donafenib + Toripalimab versus TACE + Sorafenib in the treatment of unresectable hepatocellular carcinoma: a retrospective study

ObjectiveTo compare the efficacy and safety of TACE combined with Donafenib and Toripalimab versus TACE combined with Sorafenib in the treatment of unresectable hepatocellular carcinoma (HCC), aiming to guide personalized treatment strategies for HCC and improve patient prognosis.Materials and methodsA retrospective analysis was conducted on the clinical data of 169 patients with unresectable advanced-stage HCC who underwent treatment at the Interventional Department of Wuhan Union Hospital from January 2020 to December 2022. Based on the patients’ treatment strategies, they were divided into two groups: TACE + Donafenib + Toripalimab group (N = 81) and TACE + Sorafenib group (N = 88). The primary endpoints were objective response rate (ORR), disease control rate (DCR), overall survival (OS), and progression-free survival (PFS) of the two groups’ tumors. The secondary endpoint was the occurrence of treatment-related adverse events in the two groups of patients.ResultsThe TACE + Donafenib + Toripalimab group showed higher ORR and DCR compared to the TACE + Sorafenib group (66.7% vs. 38.6%, 82.6% vs. 68.2%, P < 0.05). The TACE + Donafenib + Toripalimab group also demonstrated longer median progression-free survival (mPFS) (10.9 months vs. 7.0 months, P < 0.001) and median overall survival (mOS) (19.6 months vs. 10.9 months, P < 0.001) compared to the TACE + Sorafenib group. When comparing the two groups, the TACE + Sorafenib group had a higher incidence of grade 3–4 hypertension (14.8% vs. 4.9%, P = 0.041), higher incidence of diarrhea (all grades) (18.2% vs. 7.4%, P = 0.042), and higher incidence of hand-foot syndrome (all grades) (26.1% vs. 12.3%, P = 0.032).ConclusionTACE combined with Donafenib and Toripalimab demonstrates superior efficacy and safety in treating unresectable HCC patients. This combination therapy may serve as a feasible option to improve the prognosis of unresectable HCC patients.

The effect of intermittent versus continuous enteral feeding for critically ill patients: a meta-analysis of randomized controlled trials.

The appropriate strategy for enteral feeding in critically ill patients still remains controversial. Therefore, we conducted this meta-analysis to compare the effect of intermittent versus continuous enteral feeding method for critically ill patients. Electronic databases including PubMed, Embase, Scopus, and Cochrane Library were searched up to April 10th, 2023 for randomized controlled trials evaluating the effect of intermittent versus continuous enteral feeding for critically ill patients. The primary outcomes were feeding intolerances, including diarrhea, vomiting, distension, constipation, gastric retention, and aspiration pneumonia. The secondary outcomes were mortality in intensive care unit (ICU), length of stay in ICU, and achievement of nutritional goal. Thirteen studies with a total of 884 patients were analyzed in this meta-analysis. Overall, the use of intermittent enteral feeding was associated with higher incidence of diarrhea (OR 1.66, 95%CI 1.13 to 2.43, I2 = 16%) and distension (OR 2.29, 95%CI 1.16 to 4.51, I2 = 0%), lower incidence of constipation (OR 0.58, 95%CI 0.37 to 0.90, I2 = 0%), and longer length of ICU stay (MD 1.09, 95%CI 0.53 to 1.64, I2 = 0%). Moreover, no significant difference was identified for other outcome measures. In critically ill patients, the implementation of intermittent enteral feeding was associated with higher incidence of diarrhea and distension, longer length of ICU stay, but lower occurrence of constipation. Nevertheless, the absence of sufficient high-quality randomized controlled clinical trials precludes any definitive conclusions regarding the optimal approach to enteral feeding in this population. There is an imperative need for more studies to further assess the efficacy of the two enteral feeding strategies.

Effect of postweaning feed intake on performance, intestinal morphology, and the probability of diarrhoea in piglets.

Changes in gastrointestinal architecture, high incidence of diarrhoea, and low feed intake (FI) are commonly observed around weaning of pigs, but the relationship between postweaning FI and diarrhoea is unclear. This study aimed to determine the effect of low or high FI during the first days after weaning on growth performance, diarrhoea probability, intestinal permeability, and morphology in pigs until postweaning day (PWD) 28. A total of 120 pigs (7.20±0.26kg) weaned at 28days of age (PWD 0) were randomly allocated to five diets and housed individually until PWD 28. Two diets differed in CP and three diets differed in threonine and tryptophan levels. At PWD 4, pigs with the 25% lowest accumulated FI (LOW; n=30) and 25% highest accumulated FI (HIGH; n=30) were selected for the study. Faecal consistency was evaluated daily using a 4-scale visual scoring system. Blood was collected at PWD 4, 14, 21 and 28, and small intestinal and colonic tissue was obtained at slaughter on PWD 28. Until PWD 4, LOW pigs consumed approximately 20% (35.7±5.9g/day) of the FI of HIGH pigs (181±5.75g/day; P<0.05) and their average daily gain (ADG) was -103±15.1g/day. At PWD 28, average daily feed intake, ADG, and feed conversion ratio were still negatively affected by the FI level (P<0.05) and pigs in the LOW group were on average 4.4kg lighter than HIGH pigs. Pigs in the HIGH group showed a 55% higher probability of diarrhoea compared with LOW pigs during PWD 0-28. The number of antibiotic treatment days against diarrhoea was 2.38days higher for HIGH compared with LOW pigs (P=0.04). The intestinal permeability markers diamine oxidase and D-lactate in plasma were unaffected by the level of FI (P>0.10). The systemic inflammatory markers haptoglobin and C-reactive protein were higher for HIGH pigs at PWD 4 (P=0.005), but not affected in the following periods (P>0.10). Pigs in the HIGH group had an increased area of acidic mucin-producing cells in the small intestine compared with LOW pigs (P<0.05), but other intestinal morphology measurements at PWD 28 were unaffected by the level of FI. In conclusion, high FI just after weaning was associated with higher growth performance but also higher probability of diarrhoea and more frequent use of antibiotics until PWD 28.

Dilapan-S versus Phloroglucinol for Cervical Dilatation in Operative Hysteroscopy and Polyp Resection: A Prospective Cohort Study

Background: To compare the effects of Dilapan-S versus phloroglucinol on cervical dilation in hysteroscopic polyp resection. Methods: This prospective, observational study enrolled non-menopausal patients with endometrial polyps who underwent operative hysteroscopy for transcervical polyp resection between October 2021 and October 2022. The patients were given Dilapan-S or phloroglucinol for cervical dilation. The primary outcome was cervical dilation time; secondary outcomes included cervical softening and adverse events. Non-inferiority was prespecified with a margin of 6 seconds. Results: Among 105 included patients, 55 were given phloroglucinol and 50 Dilapan-S. There were no significant differences in age, body mass index (BMI), history of vaginal delivery, hysteroscopic electrotomy, and cervical conization between the two groups (all p &gt; 0.05). The cervical dilation time in the Dilapan-S group was shorter than in the phloroglucinol group (41.74 ± 8.68 s vs. 62.04 ± 9.55 s, non-inferiority p &lt; 0.001). Also, more patients achieved highly effective cervical softening in the Dilapan-S group compared to the phloroglucinol group (44/50 vs. 1/55, p &lt; 0.001). There were 4 cases of diarrhea (p = 0.103), 12 cases of vaginal bleeding (p &lt; 0.001), and 4 cases of abdominal pain in the Dilapan-S group (p = 0.103), and none in the phloroglucinol group. There were also 5 cases of intraoperative water leakage in the phloroglucinol group and 8 cases in the Dilapan-S group (p = 0.283). Conclusions: Dilapan-S is found to be equally effective for cervical dilation as phloroglucinol; however, it is associated with a higher incidence of diarrhea, vaginal bleeding, and abdominal pain complications.

Intestinal organoids as an in vitro platform to characterize disposition, metabolism, and safety profile of small molecules

Intestinal organoids derived from LGR5+ adult stem cells allow for long-term culturing, more closely resemble human physiology than traditional intestinal models, like Caco-2, and have been established for several species.Here we evaluated intestinal organoids for drug disposition, metabolism, and safety applications. Enterocyte-enriched human duodenal organoids were cultured as monolayers to enable bidirectional transport studies. 3D enterocyte-enriched human duodenal and colonic organoids were incubated with probe substrates of major intestinal drug metabolizing enzymes (DMEs). To distinguish human intestinal toxic (high incidence of diarrhea in clinical trials and/or black box warning related to intestinal side effects) from non-intestinal toxic compounds, ATP-based cell viability was used as a readout, and compounds were ranked based on their IC50 values in relation to their 30-times maximal total plasma concentration (Cmax). To assess if rat and dog organoids reproduced the respective in vivo intestinal safety profiles, ATP-based viability was assessed in rat and dog organoids and compared to in vivo intestinal findings when available.Human duodenal monolayers discriminated high and low permeable compounds and demonstrated functional activity for the main efflux transporters Multi drug resistant protein 1 (MDR1, P-glycoprotein P-gp) and Breast cancer resistant protein (BCRP). Human 3D duodenal and colonic organoids also showed metabolic activity for the main intestinal phase I and II DMEs. Organoids derived from specific intestinal segments showed activity differences in line with reported DMEs expression. Undifferentiated human organoids accurately distinguished all but one compound from the test set of non-toxic and toxic drugs. Cytotoxicity in rat and dog organoids correlated with preclinical toxicity findings and observed species sensitivity differences between human, rat, and dog organoids.In conclusion, the data suggest intestinal organoids are suitable in vitro tools for drug disposition, metabolism, and intestinal toxicity endpoints. The possibility to use organoids from different species, and intestinal segment holds great potential for cross-species and regional comparisons.

PEMBERIAN EDUKASI KESEHATAN TENTANG PENCEGAHAN DIARE PADA BALITA

Diarrhea is still the second leading cause of death in children under five years old. Less than 80% of diarrhea-related deaths occur in the first 2 years of life. In Indonesia, the morbidity and mortality rates are still high. Recurrent diarrhea in children can cause nutritional deficiencies, dehydration and cause death. The high incidence of diarrhea in children is caused by many factors, including poor sanitation, poor hygiene facilities, poor personal hygiene, such as not washing hands before, after eating and after defecating. Diarrhea in toddlers occurs because of the problem of lack of family knowledge and lack of health or cultural information. Hand washing and proper feeding is one of the efforts to prevent and risk the transmission of diarrheal diseases. The community service program carried out aims to increase public knowledge and understanding about diarrhea and its prevention efforts through hand washing. Knowledge about the prevention and management of diarrhea is important for parents to control the incidence of diarrhea in children. The method of implementation is through outreach activities to the community, especially mothers of children under five about diarrheal disease and some of its prevention efforts. Health promotion is one way to increase knowledge to prevent diarrhea and to help prevent diarrhea from causing complications or death. This activity involves mothers who have toddlers in the Dasan Kolo neighborhood. With 30 participants. The results of the activity showed that there was an increase in participants' knowledge about how to prevent diarrhea in toddlers.

Clinical and laboratory features of SARS-CoV-2 variants across multiple rounds of pandemic waves in hospitalized children in an Iranian referral hospital

BackgroundSince the onset of the COVID-19 pandemic, SARS-CoV-2 has evolved into independent new forms, variants of concern (VOCs). While epidemiological data showed increased transmissibility of VOCs, their impact on clinical outcomes is less clear. This study aimed to investigate the differences between the clinical and laboratory features of children infected with VOCs.MethodsThis study included all cases with SARS-CoV-2-positive nasopharyngeal swabs obtained from patients referred to Children’s Medical Center (CMC), an Iranian referral hospital, between July 2021 and March 2022. The inclusion criteria for this study included all patients, regardless of age, who had a positive test anywhere in the hospital setting. Exclusion criteria for the study included those whose data was obtained from non-hospital outpatient settings, or referred from another hospital. The SARS-CoV-2 genome area encoding the S1 domain was amplified and sequenced. The type of variant in each sample was identified based on the mutations in the S1 gene. Demographic characteristics, clinical data, and laboratory findings were collected from the patient’s medical records.ResultsThis study included 87 pediatric cases with confirmed COVID-19, with a median age of 3.5 years (IQR: 1-8.12). Data from sequencing reveals the type of variants as 5 (5.7%) alpha, 53 (60.9%) Delta, and 29 (33.3%) Omicron. The incidence of seizure was higher in patients with Alpha and Omicron infection compared to the Delta group. A higher incidence of diarrhea was reported in Alpha-infected patients, and a higher risk of disease severity, distress, and myalgia was associated with Delta infection.ConclusionLaboratory parameters did not mostly differ among the patients infected with Alpha, Delta, and Omicron. However, these variants may manifest different clinical features. Further studies with larger sample sizes are required to fully understand the clinical manifestations of each variant.

Clinical features of primary sclerosing cholangitis and inflammatory bowel disease

Objective: To explore disease characteristics of primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) and compare the differences between PSC with and without IBD. Methods: Study design was cross sectional. Forty-two patients with PSC who were admitted from January 2000 to January 2021 were included. We analyzed their demographic characteristics, clinical manifestations, concomitant diseases, auxiliary examination, and treatment. Results: The 42 patients were 11-74(43±18) years of age at diagnosis. The concordance rate of PSC with IBD was 33.3%, and the age at PSC with IBD diagnosis was 12-63(42±17) years. PSC patients with IBD had higher incidences of diarrhea and lower incidences of jaundice and fatigue than in those without IBD (all P<0.05). Alanine aminotransferase, total bilirubin, direct bilirubin, total bile acid and carbohydrate antigen 19-9 levels were higher in PSC patients without IBD than in those with IBD (all P<0.05). The positive rates for antinuclear antibodies and fecal occult blood were higher in PSC patients with IBD than in those without IBD (all P<0.05). Patients with PSC complicated with ulcerative colitis mainly experienced extensive colonic involvement. The proportion of 5-aminosalicylic acid and glucocorticoid application in PSC patients with IBD was significantly increased compared with that of PSC patients without IBD (P=0.025). Conclusions: The concordance rate of PSC with IBD is lower at Peking Union Medical College Hospital than in Western countries. Colonoscopy screening may benefit PSC patients with diarrhea or fecal occult blood-positive for early detection and diagnosis of IBD.

HUBUNGAN LINGKUNGAN SEKOLAH DAN TINGKAT PENGETAHUAN SISWA SD KELAS IV-VI DENGAN CARA MENCUCI TANGAN TERHADAP KEJADIAN DIARE DI SDN 10 TALIWANG

Background: Diarrhea is a condition where bowel movements are soft or liquid, in the form of water, more frequently (usually three times or more) in one day. Poor personal hygiene behavior can make a person susceptible to diseases such as diarrhea, this condition contributes to the high incidence of diarrhea in Indonesia. Improper hand washing behavior is still high found in children aged 10 years and over above about 67.4%.This shows that the lack of knowledge about hand hygiene, the condition of hands that are not clean, contaminated food, resulting in infection (bacteria, viruses, parasites), malabsorption, food poisoning and behavior of unhygienic snacks. Research purposes: To find out the relationship between the school environment and the level of knowledge about how to wash hands of SD students in grades IVVI on the incidence of diarrhea at SDN 10 Taliwang Research methods: Observational analytic research with cross sectional research design. The sampling technique used starified random sampling. The research was conducted at SDN 10 Taliwang in August-September 2022. The research sample was 70 respondents. The data obtained were analyzed by Chi Square test. The significance value limit is (p≤0.05). Research result : The study showed that of the 70 respondents, students who did not experience diarrhea with a healthy environment were 58 respondents (82.9%). The results of the bivariate analysis show that the valuep-values&lt; 0.05 (p-values= 0.00). PR values obtained in this study PR &gt; 1 (PR + 3.00) (95% CI = 1.35 - 6.68). Based on the variable level of knowledge of hand washing, from 70 respondents, it was found that students who did not experience diarrhea with a good level of knowledge were 54 respondents (77.1%). The results of the bivariate analysis show that the valuep-values&lt; 0.05 (p-values= 0.00). The description of the observation results obtained 60 respondents (85.7%) who carried out appropriate hand washing actions based on the Indonesian Ministry of Health. Conclusion : There is a significant relationship between the school environment and the level of knowledge about how to wash hands of SD students in grades IVVI on the incidence of diarrhea at SDN 10 Taliwang.

Effects of Ambient Temperature, Relative Humidity, and Precipitation on Diarrhea Incidence in Surabaya.

Diarrhea remains a common infectious disease caused by various risk factors in developing countries. This study investigated the incidence rate and temporal associations between diarrhea and meteorological determinants in five regions of Surabaya, Indonesia. Monthly diarrhea records from local governmental health facilities in Surabaya and monthly means of weather variables, including average temperature, precipitation, and relative humidity from Meteorology, Climatology, and Geophysical Agency were collected from January 2018 to September 2020. The generalized additive model was employed to quantify the time lag association between diarrhea risk and extremely low (5th percentile) and high (95th percentile) monthly weather variations in the north, central, west, south, and east regions of Surabaya (lag of 0-2 months). The average incidence rate for diarrhea was 11.4 per 100,000 during the study period, with a higher incidence during rainy season (November to March) and in East Surabaya. This study showed that the weather condition with the lowest diarrhea risks varied with the region. The diarrhea risks were associated with extremely low and high temperatures, with the highest RR of 5.39 (95% CI 4.61, 6.17) in the east region, with 1 month of lag time following the extreme temperatures. Extremely low relative humidity increased the diarrhea risks in some regions of Surabaya, with the highest risk in the west region at lag 0 (RR = 2.13 (95% CI 1.79, 2.47)). Extremely high precipitation significantly affects the risk of diarrhea in the central region, at 0 months of lag time, with an RR of 3.05 (95% CI 2.09, 4.01). This study identified a high incidence of diarrhea in the rainy season and in the deficient developed regions of Surabaya, providing evidence that weather magnifies the adverse effects of inadequate environmental sanitation. This study suggests the local environmental and health sectors codevelop a weather-based early warning system and improve local sanitation practices as prevention measures in response to increasing risks of infectious diseases.

Lapatinib and lapatinib plus trastuzumab therapy versus trastuzumab therapy for HER2 positive breast cancer patients: an updated systematic review and meta-analysis.

Trastuzumab, as the gold standard for HER2-positive BC treatment, was the first-line HER2 targeted drug. However, some studies reported patients benefited more from lapatinib and lapatinib plus trastuzumab therapy than standard trastuzumab therapy. This study presents an update of a systematic review and meta-analysis involving comparison of lapatinib and lapatinib plus trastuzumab therapy versus trastuzumab therapy. We determined whether trastuzumab plus lapatinib or lapatinib therapy is not inferior to trastuzumab therapy in HER2-positive breast cancer patients. Relevant trials were searched in CNKI, Wanfang, VIP, Sinomed, PubMed, Embase, and Cochrane CENTRAL databases from inception until October 25, 2021. Primary outcomes were OS, DFS/EFS, and PFS while secondary outcomes were pCR (ypT0/is ypN0), pCR (ypT0/is ypN0/+), ORR, DCR, rate of BCS, RFS, cardiac toxicities, and other toxicities. Thirteen randomized controlled trials were included in this study. Trastuzumab combined with lapatinib therapy was found to be superior to standard trastuzumab therapy alone with regard to overall survival, disease-free survival/event-free survival, pathologic complete response (ypT0/is ypN0), pathologic complete response (ypT0/is ypN0/+), recurrence-free survival, higher incidences of diarrhea, and rash/skin toxicity. Lapatinib therapy was established to be inferior to trastuzumab therapy in overall survival, progression-free survival, disease-free survival/event-free survival, pathologic complete response (ypT0/is ypN0) and pathologic complete response (ypT0/is ypN0/+), diarrhea, and rash/skin toxicity and had a low incidence of left ventricular ejection fraction decline. The efficacy of trastuzumab combined with lapatinib therapy is superior to standard trastuzumab therapy alone; however, it has more non-cardiac grade III/IV toxicities. Moreover, the efficacy of lapatinib therapy is inferior to that of standard trastuzumab therapy alone.

Prognostic Value of Change in Albumin and Body Mass Index during and after Definitive Radiotherapy in Patients with Locally Advanced Cervical Cancer

<h3>Purpose/Objective(s)</h3> Definitive radiotherapy (RT) is the standard treatment in patients with locally advanced cervical cancer (LACC). Many studies have shown that in addition to the intrinsic characteristics of the tumor, there are many other factors can also affect the prognosis, such as baseline nutritional and inflammation status. However, which of these factors, or their alterations during radiotherapy, has a greater impact on prognosis is unclear on survival is unknown. Therefore, the purpose of this study was to observe changes in these factors during RT and to evaluate the prognostic impact of these factors and their changes in clinical practice. <h3>Materials/Methods</h3> A total of 229 patients were involved in this retrospective study. All patients received definitive RT at a single institution. Clinical pathological characteristics and eight inflammatory and nutritional factors (albumin, weight, Body Mass Index (BMI), neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, etc.) of patients were collected at pre-, during and post-radiation. Changes in those parameters at different radiotherapy periods were evaluated, and the association between those parameters and their changes with progression-free survival (PFS) and overall survival (OS) were assessed at 3 years. <h3>Results</h3> The median follow-up periods were 42.3 months for all patients. During RT, almost all the parameters reduced significantly, and after RT, albumin levels returned to pre-treatment levels, but the body weight was further significantly reduced compare with that during RT (p < 0.001). In univariate analysis, neither baseline nutritional nor inflammatory factor levels were shown to be associated with prognosis, whereas changes in albumin and body weight during RT were associated with prognosis. In multivariate analysis, non-SCC (HR 2.747 for PFS, <i>p</i> =0.016; HR 2.983 for OS, p=0.016), a decrease >0.2kg/m² in BMI during and post RT (HR 2.595 for PFS, <i>p</i> <0.001; HR 2.579 for OS, <i>p</i> =0.002), and albumin <35g/L (defined as hypoalbuminemia) during RT (HR 2.208 for PFS, <i>p</i> =0.004; HR 2.069 for OS, <i>p</i> =0.021), were independent predictors of poor prognosis for both PFS and OS, ranking with gradually decreased hazard ratios. Hypoalbuminemia during RT was more common in patients with older age, lower baseline hemoglobin and albumin levels, BMI <25kg/m², concurrent chemotherapy with weekly cisplatin and higher incidence of diarrhea during treatment. However, the decrease in BMI during and post RT showed no significant association with patients' baseline characteristics. <h3>Conclusion</h3> Changes in albumin and BMI during or after RT showed more prognostic value than their baseline levels or other hematological and inflammatory parameters in LACC. Therefore, prevention of hypoalbuminemia during RT and maintenance of BMI in the middle and later stages of RT are the management priorities in the clinical practice of LACC.

Dose-dependent efficacy and safety of licogliflozin on obese adults: A systematic review and meta-analysis of randomized controlled trials

Background and aimLicogliflozin is a dual SGLT1/2 inhibitor acting on the intestine and kidney by reducing glycemic and calorie content. We aimed to determine the efficacy and safety of licogliflozin on Anthropometric measurements and cardiometabolic parameters in obese participants. MethodsWe systematically searched the PubMed, Cochrane Library, Scopus, and Web of Science databases for randomized controlled trials (RCTs) relevant to our eligibility criteria. We performed a subgroup analysis based on licogliflozin doses and the diabetic state of participants. This meta-analysis was registered on PROSPERO (CRD42021286936). ResultsWe identified five RCTs with a total of 905 obese and overweight participants. All participants had a weight reduction of 2.43 kg (95% CI: −3.17 to −1.69, p < 0.00001) compared with placebo. The mean difference in HbA1c of obese diabetic patients was (MD: −0.30%; 95% CI: −0.45, −0.16); I2 = 46% in favor of licogliflozin. The incidence of serious adverse events, all-cause mortality, headache, nausea, and vomiting were similar between licogliflozin and placebo (p = 0.72, 0.97, 0.09, 0.53, and 0.89, respectively). However, there was a higher incidence of diarrhea in the licogliflozin group. ConclusionWe found that licogliflozin was safe and tolerable. It reduces body weight significantly. Moreover, it improves glycemic control and other cardiometabolic parameters.

Comparative study of different liquid diets for dairy calves and the impact on performance and the bacterial community during diarrhea

The liquid diet composition can affect dairy calves' performance and diarrhea incidence. The effect of three liquid diets on performance, incidence of diarrhea, and microbial community during diarrhea occurrence in dairy calves were evaluated. At birth, 35 dairy calves (20 male and 15 female) were randomly assigned to one of three treatments—refrigerated whole milk (WM), acidified whole milk (AWM), and milk replacer (MR). Intake, fecal score, and rectal temperature were evaluated daily, and performance and blood parameters were evaluated weekly during the preweaning period. Fecal samples from diarrheic calves were collected, and one initial and one final sample for each episode were selected. The bacterial community was assessed by sequencing the V3-V4 region of the 16S rRNA gene on the Illumina MiSeq platform and analyzed using the DADA2 pipeline. Calves fed WM had higher body weight at weaning, average daily gain, body measurements, and concentration of blood metabolites. The AWM-fed calves had a lower rectal temperature and fever days. Moreover, the MR-fed calves had lower beta-hydroxybutyrate concentration and a higher incidence of diarrhea. The fecal bacterial community of diarrheic calves showed dissimilarity among the AWM and the other treatments. At the compositional level, we observed a higher abundance of Fusobacterium and Ruminococcus genera (AWM), Prevotella (WM), and Lactobacillus (MR). In the AWM and MR diarrheic calves' feces, we also observed some beneficial bacterial genera. The performance and incidence of diarrhea of dairy calves were influenced by the liquid diet consumed and the bacterial composition of diarrhea.