Loose Stools Research Articles

Short-Term Safety and Efficacy of Onasemnogene Abeparvovec in 10 Patients with Spinal Muscular Atrophy: Cohort Study

Background. The efficacy and safety of onasemnogene abeparvovec have been demonstrated in patients with spinal muscular atrophy (SMA) in several clinical and observational studies. Gene replacement therapy results in Russian patients with SMA is not investigated yet.Objective. The aim of the study is to study the safety and efficacy of onasemnogene abeparvovec in children with SMA in real clinical practice.Methods. The study included patients with proximal 5q SMA administered with onasemnogene abeparvovec. Diagnosis was verified by biallelic deletion in the 7th exon of the SMN1 gene. Gene replacement therapy was administered according to the decision of neurologists consensus in case of the absence of antibodies to the adeno-associated serotype 9 virus. The therapy safety was estimated via clinical and laboratory data from the hospital (at least 7 days) and from outpatient departments (at least 60 days). Efficacy was estimated via CHOP INTEND scale and mastering new motor skills ≥ 6 months after therapy onset.Results. Treatment outcomes were studied in 10 SMA patients aged 19 months (15; 21). All patients developed at least one clinical manifestation (hyperthermia, vomiting, lethargy and/or loose stool) associated with drug administration during the first week of follow-up. Increased hepatic transaminases activity and monocytosis was recorded in all patients, thrombocytopenia — in 9, neutropenia — in 5, increased troponin I concentration — in 3. In three cases it was necessary to increase the oral prednisolone dose of to 2 mg/kg, in one case — the dexamethasone pulse therapy dose. The therapy efficacy was monitored ≥ 6 months after therapy onset via the CHOP INTEND scale in 2 patients (scores increased by 32 and 19 points, respectively), and via mastering new motor skills in 8 patients (positive dynamics was noted in 7 cases).Conclusion. The onasemnogene abeparvovec is relatively safe and quite effective for using in real clinical practice

Kaplan Meier's Analysis of Clinical Improvement Of Defecation Frequency In Pediatrics Patient With Diarrhea That Given Vitamin D As Adjuvant Therapy

Diarrhea is the second leading cause of death in children under 5 years after pneumonia with a mortality prevalence of 8%. Diarrhea is a digestive disease with signs of bowel movements with a sudden consistency of loose stools 3 times or more in 24 hours, mostly caused by microorganisms (bacteria and viruses). The cure rate for diarrhea after receiving fluid replacement therapy and antibiotics for diarrhea caused by bacteria is quite high, but the mortality rate due to diarrhea is still high, therefore there needs to be an effort to add therapy to improve patient clinical outcomes. Vitamin D is known to play a role in the body's defense function, both in natural and adaptive immunity and plays a role in the body's defense in cases of infections, allergies, and autoimmunity. This study is an experimental double blind randomized clinical trial which was analyzed using Kaplan Meier. The research subjects were children aged 6 months to 18 years who were divided into two groups, namely the treatment group (n = 35) and the control group (n = 35). The treatment group received vitamin D and for the control group received a placebo. The data taken includes the results of the frequency of defecation of patients. The results of this study indicate that vitamin D is effective in accelerating the reduction in the frequency of defecation in children with diarrhea. Â Keywords: Diarrhea, Vitamin D, Defecation, Kaplan Meier

Review of Medical and Surgical Management of Chronic Anal Fissure

To determine which treatment modality has the best outcome for chronic anal fissures in terms of pain relief, fissure healing, and recurrence. The main symptoms are pain while the passage of stools is acute in primary fissures but often persists in case of longstanding fissures causing significant discomfort to the patient. The management of anal fissure has progressed immensely in the last decade due to a better understanding of its pathophysiology. The main aim of the treatment is to reduce the spasm of the internal anal sphincter, thereby reducing the anal canal pressure. The Conservative approach consists of topical nitrates, calcium channel blockers, and calcium channel blockers. It is often preferred over surgical alternatives as it is not invasive. Surgeries for chronic anal fissures include anal dilatation, posterior mid-line sphincterotomy, lateral internal sphincterotomy, fistulectomy, sphincterolysis, and advancement flap repair. This narrative review article aims to review all the existing and newer complex modalities available for the management of chronic anal fissures. Currently the initial management of fissures is pharmacological therapy with topical nitroglycerin or diltiazem or botulinum toxin A injection. The following line of treatment is surgical, which is lateral internal sphincterotomy. Non-surgical therapy often proves ineffective in providing relief and healing, frequently culminating in the recurrence of fissures. On the other hand, surgical therapy has postoperative drawbacks like intestinal incontinence, commonly gas, loose stool or rarely hard stool. There is inadequate data on the latest treatment modalities like fistulotomy, sphincterolysis, flap procedures, etc. They may be considered only when conventional therapy fails to provide relief.

Associations of clinical features of functional bowel disorders with gut microbiota characteristics in adolescents: A pilot study

Background. Obesity is a multifactorial disease that is one of the important public health problems in the 21st century. Functional bowel disorders in obese children and adolescents are one of the most common pathologies of the digestive tract. The aim: to characterize the bacteriological composition of the colon microbiota in obese adolescents and identify its associations with the clinical manifestations of functional bowel disorders.Materials and methods. The study included 20 adolescents aged 11–17 years. Stool consistency was assessed using the Bristol Stool Scale. The study of biological material was carried out using standard bacteriological methods. To assess the strength of the relationship between the nominal variables, Cramer’s V test was used.Results. It has been shown that in adolescents with obesity and functional bowel disorders, there is a decrease in the number of representatives of bifidoflora, an increase in the microbial density of Escherichia coli with altered enzymatic properties and an excessive growth of potentially pathogenic enterobacteria. In obese adolescents with functional bowel disorders, abdominal pain associated with the act of defecation is associated with the presence of enterobacteria and E. coli with altered enzymatic properties. Rare bowel movements are associated with an increased abundance of Enterococcus spp. and the presence of opportunistic Enterobacteriaceae microorganisms. Frequent bowel movements are associated with the presence of E. coli with altered enzymatic properties and Clostridium spp. In the presence of loose stool, Clostridium spp. is present; unstable stool (alternation of hard and liquid stools in one patient) is associated with a decrease in the number of lactobacilli and E. coli with normal enzymatic properties, the appearance of E. coli with altered enzymatic properties, opportunistic microorganisms of Enterobacteriaceae family and Clostridium spp. Conclusion. The relationship between the clinical symptoms of functional bowel disorders and changes in the composition of the gut microbiota in obese adolescents may be a justification for conducting in-depth studies aimed at finding early predictors of functional bowel diseases associated with obesity in the adult cohort.

A Case Report on High Contagious and Rapid Spread of Severe Acute Respiratory Syndrome (SARS) in Hypertensive Client: An Agent of Emerging and Reemerging Infection

Introduction: Severe acute respiratory syndrome (SARS) is a potentially life-threatening. Severe acute respiratory syndrome (SARS) is the rapidly progressive respiratory illness which may be due to the pathogens that have potentials for large scale epidemics. MERSCOV AND H7N9 (Avian influenza) has been described by SARS. The causative organism of a SARS yet not being identified or it cannot be easily established. SARS increases morbidity and mortality which is associated with the COVID -19. COVID-19 can be complicated by severe acute respiratory syndrome (SARS) and may often cause multisystem involvement is encountered. SARS patients had mandatory needs of intensive care unit hospitalization and mechanical ventilation.
 Main Symptoms and/or Important Clinical Findings: A 50 years old female was admitted in A.V.B.R.H. with chief complaints of cold, cough (dry, non-productive, non-bloody), vomiting, loose stool, breathlessness since 3 days. The patient was hypertensive for which she was taking Tab Amlo. After undergone certain investigation like complete blood test, HRCT, ECG and diagnosed as SARS and shifted to Intensive care unit.
 The Main Diagnoses, Therapeutic Interventions, and Outcomes: A 50 years old female with severe acute respiratory syndrome (SARS) with chief complaints of cold, cough (dry, non-productive, non-bloody), vomiting, loose stool, breathlessness, the doctors manage her initially withantibiotic, steroids, vitamin C, multivitamin and anticoagulant and adequate nursing management.
 Nursing Perspectives: The nursing interventions initiated for managing present case aremonitor the vital sign i.e., blood pressure, pulse, respiration, temperature, maintain oxygen level and intake output. BIPAP site observed and ensure that the patients is comfortable. Patient assessed for GCS, Glucose level and sign of cyanosis, monitoring the ESR, D-DIMER, RT PCR, FERRITIN other investigations like HRCT. 
 Conclusion: In the Present case the patient of 50-year-old female with severe acute respiratory syndrome (SARS) it has been managed with the therapeutic treatment, right now the patient condition is worsened.

A study on effect of phototherapy in term new-born in a tertiary care centre in south Rajasthan

Background: Phototherapy is a safe and effective method for management of neonatal hyperbilirubinemia with no serious untoward side effects. Hypocalcemia is a common and lesser observed adverse effect of phototherapy.Methods: This study was a prospective observational study done in department of pediatrics, RNT Medical College, Udaipur (Rajasthan). Serum calcium level was observed in term neonates admitted for phototherapy.Results: Out of total 80 neonates included in study 40 received phototherapy and 40 were control. Neonates receiving phototherapy had significantly lower level of serum calcium. Other complication were rashes, loose stool, fever and dehydration.Conclusions: We can conclude from this study that hypocalcemia is a significant complication of phototherapy in newborn and probably monitoring of serum calcium level in babies under phototherapy is warranted.

Monitor gastrointestinal tolerance in children who have switched to an "enteral formula with food-derived ingredients": A national, multicenter retrospective chart review (RICIMIX study).

BackgroundEnteral tube feeding intolerances, such as diarrhea, are commonly reported in children. In the pediatric population, interest is growing in the use of blended diets for the management of enteral feeding intolerances. Fiber within a blended diet stimulates the growth of beneficial gut bacteria, which in turn produce short‐chain fatty acids, which are utilized as energy substrates for enterocytes. Enteral formula manufacturers have responded to this trend towards “real‐food” blended diets and developed an enteral formula with food‐derived ingredients. The aim of this study was to collect data relating to feed tolerance in children who had switched to an “enteral formula with food‐derived ingredients.”MethodsA national multicenter retrospective study.ResultsDietitians collected data from 43 medically unwell children between March 2021 and July 2021. Significant improvements were reported in children who had switched to an “enteral formula with food‐derived ingredients” in retching 17 of 18 children (95%), flatulence 6 of 8 children (85%), loose stools 10 of 11 children (90%), and constipation 10 of 11 children (90%). These improvements in gastrointestinal symptoms were reflected in weight change during the one month period measurements were collected (baseline, 19.5 kg [SD, 9]; 1 month, 20.1 kg [SD, 9]; P = 0.002).ConclusionWe have observed beneficial outcomes in medically complex children who have switched to an “enteral formula with food‐derived ingredients.” Our data should motivate healthcare professionals to implement more research to better evaluate the clinical impact and mechanisms of action of blended diets and enteral formulas with food‐derived ingredients.

Atypical Kawasaki disease in an early infant, a diagnostic challenge: Case report

A 4.5-month-old girl presented to us with continuous fever for 10 days and loose stools for 2 days. She received short courses of multiple oral antibiotics during this period however, was not relieved. Initial investigations were suggestive of urinary tract infection for which broad spectrum antibiotics were started. However, fever persisted even after 72 h of antibiotics. Blood counts showed persistently high total leukocyte count and increasing platelet count, along with high C-reactive protein. Consequently, a diagnosis of Kawasaki disease (KD) was suspected, which was supported by echocardiographic findings. After she received intravenous immunoglobulins, her fever subsided and lab parameters showed significant improvement. This case highlights an unusual presentation of KD in an uncommonly young age group without much clinical pointers except for persistent fever.

Exploring Dietary Practices, Perceptions and Knowledge of Mothers of Toddlers visiting Primary Care Physicians

Background: Mother is responsible for upbringing of infants and children as she decides their health and food. Objective: To assess the mother's beliefs and practices related to foods like bananas, dates, rice, eggs, ghee, butter, and factors influencing these practices. Methodology: A cross-sectional study was conducted between December 2020 and March 2021 among mothers of young children (up to 3 years of age). Responses were collected through interviews. Data were collected from primary health centers (Nainsukh, Gajjumata) and OPD of Fatima Memorial Hospital, Lahore, PHCs Mubarakabad, and Nehranwalaa, district Okara. Questionnaire included information, about the diet given to children such as weaning foods introduced at 6 months and food items consumed by kids up until the age of 3 years. Data were analyzed using SPSS 25. Results: Out of 333 mothers overall 239 (72%) mothers fed, carbohydrate rich diet as part of weaning, 81% of these mothers were educated up to school level (p=0.001). Bananas were avoided by 100% of mothers who had no education (p=0.000) due to their perception that their use is linked to increased risk of mucous and chest problems in child. Similarly, eggs were not introduced in children due to misconception that it causes skin rash, fever, or loose stools, with 96% of mothers with no education, 98% with school education, and 42% with higher education (p=0.000). Similar trends were use of dates (p=0.00), rice (p=0.02), and butter (p=0.002) among mothers in the 3 educational groups. Conclusion: Majority of the mothers used a carbohydrate-rich diet as weaning food, and most of these mothers were educated. Majority of the uneducated mothers avoided bananas, eggs, dates, rice, and butter due to misconceptions.

772. Effect of Selective Digestive Decontamination Using Oral Colistin on HAI Rates and All-Cause Mortality Among Cardiovascular Surgery Patients - A Single Centre Experience from India

BackgroundHospital acquired infections affect the morbidity and mortality of ICU patients considerably. Selective digestive decontamination (SDD) is defined as the prophylactic application of topical, non-absorbable antimicrobials in the oropharynx and stomach, with the goal of eradicating potentially pathogenic microorganisms but preserving the protective anaerobic microbiota. SDD has been applied in trials among critically ill patients and found to be effective in reducing HAI. MethodsThis cohort study was conducted in our cardiothoracic vascular surgery ICU of a tertiary care hospital, where patients were given oral colistin syrup (100mg 6th hourly for 5 days) in the immediate post op during the intervention period. We compared the clinical and microbiological outcomes of patients before (5 months, pre-intervention arm) and after (5 months, intervention arm) the implementation of SDD (Oral colistin syrup).ResultsA total of 78 patients were included in the interventional arm with a mean age of 58.7 years whereas the pre-interventional group consisted of 94 study participants with a median age of 57.5 years. 11 out of 94 had positive respiratory sample culture (11.7%) in the preintervention group which mandated antibiotic therapy for HAP compared to one culture positive in the interventional period (OR 0.0980, 95% CI: 0.0124 to 0.777 and P=0.0279). One patient had blood stream infection in the pre-intervention period compared to none in the intervention phase. All-cause mortality in the pre-interventional group was 7.44% (7 in 94) vs 1.28% (1 in 78) in the interventional group (OR 0.1614, 95% CI: 0.0194 to 1.3416, P= 0.0914). Adverse events (nausea, vomiting & loose stools) were observed in a total of 24 study patients, but necessitated withdrawal of regimen only in nine patients.ConclusionAn SDD regimen of Colistin alone in Cardiac Surgery patients resulted in statistically significant reduction in incidence of Hospital Acquired Pneumonia, along with a reduction in all-cause mortality (though not statistically significant). Disclosures All Authors: No reported disclosures

756. Clostridioides difficile Burden of Disease: A Prospective Population-Based Surveillance Study of Hospitalized Adults in Louisville, Kentucky

Background Clostridioides difficile (C. difficile) is an important cause of morbidity and mortality. C. difficile infection (CDI) may be frequently under-diagnosed because laboratory confirmation requires collection of a stool specimen from a patient with diarrhea and appropriate laboratory testing.MethodsA prospective population-based CDI surveillance study was launched in 8 adult hospitals in Louisville, Kentucky on September 16, 2019. Surveillance officers in each hospital identified all cases of new-onset diarrhea (≥3 loose stools in the past but not preceding 24 hours) in Louisville residents ≥50 years of age. After informed consent, stool samples were collected and tested at the University of Louisville reference laboratory for 1) glutamate dehydrogenase (GDH) and 2) Clostridioides difficile toxins A and B using C. DIFF QUIK CHEK COMPLETE®, Techlab. We defined CDI as GDH positive and toxin positive. The study was paused on April 3, 2020, due to COVID-19 restrictions.ResultsThere were 85,719 eligible patient-days during the study period. A total of 1541 patients had new-onset diarrhea corresponding to 1.8 cases of new-onset diarrhea per 100 eligible patient-days. We enrolled 84% (1291/1541) of patients with new-onset diarrhea and tested stool samples for C. difficile from 82% (1055/1291) for a testing density of 123 per 10,000 patient-days. Of the 1055 tested stool specimens, 73 (7%) were GDH positive and toxin positive (Figure 1) yielding a hospital-based CDI incidence of 8.5 CDI cases per 10,000 patient-days.Figure 1. Patient Ascertainment Flow Chart ConclusionNew-onset diarrhea was common among hospitalized adults ≥50 years of age. CDI was frequently identified through stool specimens collected from eligible inpatients with new-onset diarrhea. Further analysis of these data and additional laboratory testing will contribute to a better understanding of the frequency of CDI underdiagnosis and the burden of CDI in the United States.Disclosures Ruth Carrico, PhD, DNP, APR, CIC, Pfizer (Consultant, Research Grant or Support, Speaker's Bureau)Sanofi Pasteur (Consultant, Grant/Research Support, Speaker's Bureau) Fredrick J. Angulo, DVM, PhD, Pfizer, Inc. (Employee) Joann Zamparo, MPH, Pfizer, Inc. (Employee) Elisa Gonzalez, MS, Pfizer, Inc. (Employee) Kimbal D. Ford, PharmD, Pfizer, Inc. (Employee) Julio Ramirez, M.D., FACP, Pfizer, Inc. (Scientific Research Study Investigator, Research Grant or Support, Speaker's Bureau)

759. Impact of Clostridium difficile (CD) Nucleic Acid Amplification Test (NAAT) Approval on Hospital-Onset C. difficile Infection (HO-CDI): A Diagnostic Stewardship Intervention

BackgroundNAAT is highly sensitive in detecting toxigenic CD but if used inappropriately can lead to overdiagnosis and financial penalties. Despite diligent infection control (IC) measures, HO-CDI rates at our hospital remained above target benchmarks. We implemented mandatory CD testing approval to decrease HO-CDI rates. MethodsOn 7/1/2019, we implemented CD testing approval for stool samples collected after admission day 3 in our 129-bed community hospital. An algorithm instructed providers about approval granted by IC 7 days-a-week. The micro-lab would not process samples unless pre-approved. We prospectively collected data on demographics, ICU, laxative, antibiotic use, CDI signs/symptoms, prior CDI and outcomes (length of stay, in-hospital death) and estimated unadjusted relative risk ratios comparing those whose test was approved vs not approved. We also performed an interrupted time series analysis to assess the trend change of CD testing and HO-CDI per 1000 patient days (x 1000-PD) in the 18 months following the intervention (7/2019 - 12/2020) compared to the pre-intervention period (01/2018 - 6/2019). Lastly, using the National Healthcare Safety Network criteria, we calculated pre and post-intervention Standard Infection Ratios (SIR). ResultsA total of 72 samples required CD testing authorization; 65 (90%) were approved. Baseline demographics, in-hospital death and length of stay were similar in both groups, but approved patients were 4 times as likely to have ≥ 3 loose stools in 24h compared to not approved. The number of CD tests was 13 at baseline with a decrease of 6 tests in the 1st month of intervention (95% CI: -10.0, - 1.35), followed by an insignificant decline in the monthly trend (-0.14; 95%CI: -0.49, 0.20). There were 22 HO-CDI pre-intervention and 10 post-intervention. Pre-intervention, incidence of HO-CDI was 0.51 cases x 1000-PD and increased every month by 0.11 (95% CI: 0.07,0.16). In July 2019, there was a significant decline of 1.16 case x 1000-PD (95% CI: -1.99, -0.33), followed by monthly decline (-0.16; 95% CI: -0.23, -0.09). Our calculated SIR after the intervention decreased to 0.77 from 1.03. Trends of CD testing and HO-CDI in the pre-intervention and post-intervention period ConclusionCD testing approval is a successful strategy to optimize testing and lower HO-CDI rates, without resulting in worst outcomes even when CD test was not approved. Disclosures All Authors: No reported disclosures

749. A Nurse-Driven Protocol for Early Detection of Clostridiodes difficile Infections

Background Clostridiodes difficile infections (CDI) are a significant cause of hospital acquired infections, resulting in significant morbidity and mortality. Early detection of CDI has been shown to reduce the spread of CDI within the hospital. As nurses are frequently at the patient’s bedside, we proposed to empower the nursing staff to assess, collect stool samples, and order C. difficile testing.MethodsRates of CDI were measured by our Infection Control Department. Hospital-onset CDI (HO-CDI) was defined as a positive C. difficile PCR assay after 3 days of admission, defined as a stay of at least 3 midnights. Community-onset CDI (CO-CDI) was defined as any case that was diagnosed in the Emergency Department or inpatient ward < 3 days of hospitalization based on stool testing as above. Nursing was instructed and empowered to assess, collect stool specimens, and place an order for C. difficile testing, based on the criteria of ≥3 loose or watery stools over 24 hours. Nursing was also educated to not order a test if patients had received stool softeners, enemas, or laxatives within 24 hours. The protocol was initiated in February 2019.ResultsRates of HO-CDI increased during the intervention period, rising from 2.6 cases/10000 patient days and peaking at 17.7 cases/10000 patient days (average 6.7 vs. 12.1 monthly cases per 10,000 patient days. Rates of CO-CDI did not significantly change (12.4 vs. 11.5 monthly cases per 10000 patient days). Due to concerns of inappropriate testing, which included testing after laxatives, enemas, or sending specimens despite < 3 stools over 24 hours, the protocol was discontinued in June 2019. Although the HO-CDI rate remained elevated over the next month, the rate subsequently decreased over the next several months (12.1 vs. 8.0 cases per 10000 patient days). Overall testing also increased over the study period (148.3 vs. 169.9 cases/per 10000 patient days).Figure 1 - Clostridiodes difficile rates Figure 2 - CDI testing rates ConclusionA nursing driven protocol resulted in increased HO-CDI and overall CDI rates suggesting that the intervention may have been a factor in increasing the frequency of HO-CDI diagnoses, although the possibility of misdiagnosis of colonization for true CDI cannot be excluded. Further education of nursing staff may be a potential intervention in improving appropriate CDI testing.Disclosures All Authors: No reported disclosures

Plausibility of the implausible: is it possible that ultra-high dilutions ‘without biological activity’ cause adverse effects?

Plausibility of the implausible: is it possible that ultra-high dilutions ‘without biological activity’ cause adverse effects?

Self-medication tendencies of patients visiting out-patient departments of Government homoeopathic medical colleges and hospitals in West Bengal, India

Background and aims: Self-medication is mostly prevalent in the low- and middle-income population segments of developing countries, thus reflecting the status of health services. Self-medication has frequently been held responsible for inducing drug resistance, higher cost of further treatment, and other complications. The World Health Organization (WHO) promotes self-medication in rural and remote areas to reduce the burden of health services. In this study, the researchers sought to establish the prevalence, consequences, and causes of self-medication. Methods: Multicenter, institution-based, cross-sectional study conducted with 456 participants in May, 2013 at the outpatient clinics of 2 Government homeopathic medical colleges in West Bengal, India. A pilot-tested structured questionnaire consisting of 12 self-administered questions in local vernacular Bengali was used; 8 were close-ended questions providing multiple answer options, while 4 were open-ended. Results: Overall, 12.7% of interviewees admitted to perform self-medication; 57.7% and 66.0% had appropriate knowledge of the medicines and dose regimens, respectively. Females (64.3%) predominated and self-medication was mostly found in age range 31-45 years old (32.5%). Conventional Western medicine (82.2%) was most preferred therapy, and fever (35.7%), hyperacidity (25.4%) and loose stool (24.3%) the most frequently reported complaints. The main causes for self-medication were feeling no need to consult doctor (32.5%), busy schedule (16.4%), family members advice (16.0%), over-the-counter (OTC) availability of medicines without prescription (12.5%), direct consumer pharmaceutical advertisement (12.1%), and high expenditure in private institutes (10.1%). The chi-square distribution of determinants across the two samples differed significantly. The tendency increased proportionately with literacy (Yates’ χ2=175.731; p=0.000) and poverty (Yates’ χ2=426.817; p=0.000). Conclusion: The results reflect the knowledge, attitude, and practice of self-medication among the participants. Further studies should be undertaken in larger samples and different populations.

Risk Factors Influencing Tolerance and Clinical Features of Food Protein-Induced Allergic Proctocolitis

To examine the clinical course and risk factors of food protein-induced allergic proctocolitis (FPIAP).A total of 257 infants who presented to 5 outpatient pediatric allergy or gastroenterology clinics with rectal bleeding and were given a diagnosis of FPIAP were included in the study.After enrollment, infants had serum immunoglobulin E testing, skin-prick testing (SPT), and complete blood cell count. Clinical characteristics were prospectively managed. Patients with other known gastrointestinal illnesses were excluded. Cow’s milk elimination was trialed first in both the infant’s diet as well as the mother’s diet if breastfeeding, and, if no improvement, egg was eliminated next. Combined elimination of wheat, nuts, and soy followed, if no improvement. Eliminated foods were then reintroduced after 2 to 4 weeks, and a worsening of symptoms confirmed diagnosis.There was no sex predominance, with 50.2% being female (n = 129). The vast majority were breastfed at diagnosis (97.2%), with 66.5% exclusively breastfed. Blood in stool was present in every case, and other common complaints were mucous in stool (n = 224) and loose stool (n = 168). Cow’s milk was the most common causative food, accounting for 99.2% of cases. Comparing those with only 1 food allergy (75.9%) versus those with multiple food allergies, children with a single-food allergy more often were exclusively breastfeeding at diagnosis, had a longer duration of breastfeeding, had less antibiotic use in the first 6 months, and had higher tolerance development (P = .003, < 0.001, < 0.001, and < 0.001, respectively). Immunoglobulin E (IgE) sensitization was assessed in 239 patients, and 55 (23%) had positive test results. Sensitized children less often developed tolerance to the offending allergen compared with nonsensitized children (52.4% versus 81.2%). Only 16 patients underwent endoscopy and were continued to be treated as having FPIAP.Most patients with FPIAP resolve within a year. Infants with colic, IgE sensitization, and multiple food allergies may be at risk for delayed tolerance. Cow’s milk should be the first excluded food in infants and breastfeeding mothers, and elimination should resolve symptoms in most patients. Breastfeeding and lower antibiotic use was associated with a decrease in the development of multiple food allergies. The role of SPT and IgE testing is still unclear and may not add benefit to most cases. Endoscopy did not change management, even in severe cases.This is an important study that characterizes a common condition. The prospective nature of this study is a strength, along with high retention of subjects throughout the study. The involvement of multiple centers and specialties introduced some variability in practice. More severe cases of FPIAP are likely represented in this study because subjects had referral to allergy or gastroenterology specialists. Also, the high prevalence of breastfeeding in this cohort may limit its generalizability to other communities; regional food preferences and breastfeeding prevalence may have a large effect on the development of allergies and food sensitization.

Living in limbo: Meanings of living with fecal incontinence as narrated by women after treatment for pelvic cancer.

After pelvic radiotherapy, individuals suffer from loose stools and defecation urgency, often resulting in fecal incontinence (FI). Women who have been treated for pelvic cancer report FI as one of the most troubling symptoms, yet they avoid seeking healthcare due to shame and stigmatization. There is a lack of knowledge concerning women's lived experiences of FI in daily life after pelvic radiotherapy. The objective was to illuminate meanings of living with FI among women previously treated with radiotherapy for gynecological or rectal cancer. Interviews were performed with ten women, treated with pelvic radiotherapy. Data were analyzed with phenomenological-hermeneutic method. Living with FI, was illuminated by one overarching main theme: Living in Limbo, consisting of two themes (including three sub-themes each): Living in uncertainty and Wanting to take part in life. Living with FI means that life is no longer the same as before the disease and treatment. The new life is lived in limbo, which means a daily struggle with insecurity because of the lack of control over one's body. It is also a struggle to take part in life, keep one's human dignity intact, experience meaning in life and can be and do what one wants.

Pilot Study: Evaluation of the efficacy of homeopathic anti-tumor protocols in Ehrlich tumor

Cancer is the second leading cause of death worldwide, with breast cancer one of the tumors with the highest incidence in Brazil, with an estimated 57,120 new cases in 2014. Several forms of treatment and control of cancer symptoms has been studied, among them homeopathy. In the Banerji clinic in India, doctors have used a protocol consisting of 4 homeopathic medicines with relevant results that motivated this study. In our research the Ehrlich tumor was used, a transplantable tumor cell, whose features are similar a breast carcinoma, as discovered in 1905 by Paul Ehrlich. Objective: To analyze the clinical and immunomodulatory Ehrlich tumor in mice treated with the homeopathic medications found in the Banerji Protocol and with thymulin 5CH. Methodology: The project was approved under protocol 158/13 of the Paulista University Ethics Committee. BALB / c mice between 6 and 9 weeks old were used. Each mouse was inoculated with 1x10 7 tumor cells into the peritoneum cavity, to obtain the ascitic form of tumor. Mice were divided in 5 groups (N=6 animals per group), being the following treatments: control treated with sterile water, Conium maculatum 200CH, Thuja occidentalis 200CH, Phytolacca decandra 200CH, Carcinosinum 200CH, every day being 0.1mL/10g body weight. The animals were weighed and the consumption of water and feed was measured daily. Clinical signals and body temperature were also registered daily. The survival of each group was also analyzed. Results: All groups presented reduction of body temperature one day before death. The peak of clinical symptoms in the majority of groups was in the D18, while Carcinosinum treated group had its peak in D29. The observed clinical symptoms were apathy, prostration, cyanosis, priapism, tachydyspnea, genital edema and secretion, decreased general activity, hair bristling and trembling. The control group had loose stools as unique symptom, seen in 20% of mice; the Carcinosinum treated group showed trembling as the sole symptom, that affected 20% of mice. The group treated with Conium maculatum showed higher incidence of clinical symptoms, involving up to 80% of mice, while the group treated with Carcinosinum showed lower incidence of clinical symptoms, affecting no more than 40% of mice, with weight reduction (reduction of ascites) and longer survival, when compared to the other groups. Conclusion: The results of the pilot study directed us to the second stage of the research, in which the histopathological and immunohistochemical observation will be assessed, being Carcinosinum the treatment chosen to this next step.

Intestinal Spirochaetosis-A case series from the developing world

Spirochaetes comprise a heterogenous group of gram negative, motile, spiral shaped bacteria. Some of these pathogens are known to cause numerous human diseases such as Lyme disease, relapsing fever, syphilis and leptospirosis. However, intestinal spirochetosis is a rare condition. Patients frequently present with long-term complaints of loose stools, abdominal pain and weight loss and rectal bleeding. Hence to establish a diagnosis an endoscopy with biopsy is required. In this article, we describe four such cases, having different ages and socio- economic background, successfully treated with a short course of metronidazole.

Management of Grahani roga in Ayurveda (irritable bowel syndrome)- A case report

Grahani Roga is a common Gastro-intestinal Tract disorder of present era. In Ayurveda, Grahani is considered as the main functional part of Mahasrota which is located in between amashaya &amp; pakwashaya, also known as the 6th kala i.e., Pittadhara Kala where jatharagni resides and its main function is to hold the ahara upto the end of avasthapaka &amp; after completion passes it into pakvasaya. Symptoms like alternate passing of hard &amp; loose stool, abdominal pain, passing of foul-smelling stool, mucus in faecal matter are diagnostic of Grahani Roga. In modern science, above mentioned symptoms can be correlated with IBS (Irritable Bowel Syndrome). In IBS, the wall of the intestine becomes sensitive to even mild stimulus which causes excess abdominal cramps &amp; hence the bowel movement alters along with indigestion. In this case an effort has been made to treat 33 years male suffering from Grahani roga, at Ayurveda Teaching Hospital within 3 months by various ayurveda medicine and panchakarma procedures.