Loose Stools Research Articles

Demographic profile of patient with acute watery diarrhea during monsoon 2022: Patan Hospital, Nepal

Introduction: Diarrhea is the passage of three or more loose or liquid stools per day or more. Acute watery diarrhea is a major public health problem worldwide. In Nepal, diarrhea is among the top 10 inpatient morbidity. This study’s objective is to monitor demographic characteristics and laboratory findings of stool specimens of diarrhea. Method: This is a cross-sectional descriptive study done at Patan Hospital. Ethical approval was taken from the Ethical committee. Data for Monsoon 2022 (June to September 2022) were collected from the Patan Hospital record system. Cases from within the Lalitpur district were included. Result: Out of 119 cases, 50(42%) were male and 69(58%) were female. The mean age±SD was 33.28±25.38 (p=0.083) with maximum cases observed during June and a peak observed during the fourth week of June. Out of 119, 4(3.3%) were stool culture positive. Two cases of Vibrio cholera, one case of Shigella sonnei, and one case of Salmonella parathypi B were isolated. In the etiological profile, 14 Entamoeba histolytica were isolated. Conclusion: During the outbreak of diarrhea in Monsoon 2022, adults were affected most. The culture of acute watery diarrhea showed two cases of Vibrio cholera.

EFFECT OF KARMA BASTI AND SHIRODHARA IN GRAHANI (irritable bowel syndrome)

Irritable bowel syndrome (IBS) is a gastrointestinal disorder having a group of symptoms including abdominal pain and changes in the pattern of bowel movements without any evidence of underlying damage. The pathogenesis of IBS is not fully understood, although roles for abnormal gut motor and sensory activity, central neural dysfunction, psychological disturbances, stress and luminal factors have been proposed. About 10-15% of the people in the developed world are believed to be affected by IBS, it is estimated that 45% of people globally are affected by IBS. In Ayurveda, IBS can be correlated to Grahani Roga due to their clinical presentation. In this case an effort has been made to treat patients having symptoms of Muhurbaddha Muhurdravam (episode of difficult evacuation of bowel and loose stools), Udarashool (pain in abdomen) and Apakwa Malapravritti (sticky stool with mucus). Male Patient XYZ of age 54years treated with various Panchakarma procedures like Basti (herbal medicated enema), Taila Shirodhara (pouring Herbal medicated oil on head) and oral medications. At the end of 50 days of treatment (Kala basti-16days+ oral medication-34days) patient got significant improvement in the sign and symptoms of disease.

Prospective evaluation of bowel function and quality of life after colon cancer surgery – is it time for routine screening for late sequelae?

Aim Bowel dysfunction after colon cancer (CC) surgery is widely neglected in current follow up programmes. This study explored changes in bowel function and quality of life (QoL) from three (3 m) to twelve months (12 m) after surgery in CC patients undergoing right- or left-sided colon resection (RightSCR/LeftSCR) and investigated differences between the two groups 12 m after surgery. Method CC patients undergoing surgical resection in 2018–2020 at five surgical departments were included in this population-based prospective cohort study. Included patients completed electronic surveys consisting of a collection of validated scores 3 m and 12 m after surgery. Results A total of 708 CC patients (423 RightSCR, 285 LeftSCR) were included. In RightSCR, no improvement was observed from 3 m to 12 m in most scores/items, on the contrary, symptom worsening in flatus- and faecal incontinence and urgency was observed (p < 0.05). Also, the proportion of patients rating their bowel function as very good/good decreased (p < 0.05) in this group. In LeftSCR improvement was found in flatus and faecal incontinence, urgency and night-time defaecation (p < 0.02), while no improvement was observed in the remaining scores/items. At 12 m, higher proportions of RightSCR than LeftSCR reported loose stools, incontinence and urgency (all p < 0.001), whereas LeftSCR more often reported hard stools and flatus incontinence (p < 0.05). Among all CC patients 18.3% reported bowel-related impairment of QoL at 12 m with no differences between the two groups. Conclusion From 3 m to 12 m no significant change was observed in the majority of bowel function and QoL scores/items, however, some symptoms worsened in RightSCR, while a few improved in LeftSCR. Bowel dysfunction and impaired QoL were still common in both groups at 12 m, although the symptom pattern differed between the groups. These findings call for a systematic screening for bowel dysfunction to ensure early treatment of symptoms.

A Case Report on the Treatment of Irritable Bowel Syndrome (IBS) in Ayurveda

Introduction: Chronic functional bowel disorder known as irritable bowel syndrome is characterized by symptoms of stomach pain and/or discomfort along with irregular bowel movements. Despite the fact that several IBS biomarkers have been identified, research is still being done to improve their sensitivity, specificity, and validity to distinguish between IBS and subtypes of IBS. In conventional medical systems, it is treated with laxatives, prosecretory drugs, antispasmodics, tricyclic antidepressants (TCAs), and selective serotonin reuptake inhibitors (SSRIs). Based on its symptomatology, IBS and Grahani in Ayurveda can be connected. Due to the body's Agni (digestive components) being reduced in Grahani illness, there are abnormalities in digestion, food assimilation, and bowel motions. Case Report: In this case report, we attempt to cure a 38-year-old male patient who is experiencing weight loss, Udarashool, and Muhurbaddha Muhurdrava symptoms. Ayurvedic psychological counseling and a few oral medications, including Bilvadi Vati, Panchamrit Parpati, and panchakarma procedures, including basti (therapy enema), shirodhara (therapeutic oil-streaming over forehead), were used to treat the patient who had been diagnosed with Grahani/IBS. After 51 days of treatment, the patient displayed a 75% improvement in the passage of loose and constipated stools, a 75% improvement in abdominal distension, a 100% improvement in appetite, and a 100% improvement in the passage of mucus in stools.

Nutritional support in the complex therapy of clostridial infection after surgery

This article presents the tactics of nutritional support in a patient with pseudomembranous colitis after repeated consecutive operations on the abdominal organs, which led to significant violations of the nutritional status. Competent, individually selected correction of protein-energy deficiency in patients with pseudomembranous colitis allows achieving an effective treatment result, avoiding severe complications such as perforation, toxic dilatation, and bleeding. The peculiarity of this clinical case is that a patient with perforation of Meckels diverticulum and abdominal abscess developed a complication secondary widespread peritonitis, phlegmon, which required repeated surgical interventions. Surgical treatment and massive antibiotic therapy led to the development of Clostridium difficile infection: during the treatment the patient developed multiple loose stools and C. difficile toxins A and B were detected. Severe pseudomembranous colitis was accompanied by protein-energy deficiency (hypoproteinemia, hypoalbuminemia), severe dehydration, hypokalemia, hyponatremia, and moderately severe anemia of complex genesis. When selecting nutritional support for patients with clostridial infection, it is important to take into account severe systemic inflammation, which affects the absorption and absorption of the intestinal wall, which in turn determines the route of introduction of nutrient substrates. In this case we needed to choose the right method for correcting the patients nutritional status.

Interference of red cell parameters by an endogenous substance: An interesting case report

A 6-month-old infant was brought to the hospital with fever, vomiting, loose stools, and abdominal distension. The venous blood sample was sent to the hematology laboratory for complete blood count (CBC). Analysis of the sample on the automated hematology analyzer showed a discrepancy in red blood cell count, hemoglobin, and hematocrit values. Examination of the blood sample revealed a cherry red color appearance. On centrifugation, the plasma was lactescent. This finding provided an essential clue to the patient’s diagnosis of severe hypertriglyceridemia. Turbidity of lactescent plasma interferes with CBC. Analytical errors in the CBC using an automated hematology analyzer caused by lactescent plasma and methods to resolve the false values will be discussed in this case report.

Clinical and genetic analysis of a very early-onset inflammatory bowel disease type 28 child with atypical clinical manifestation

To explore the clinical and genetic characteristics of a very early-onset inflammatory bowel disease (VEO-IBD) type 28 child with atypical clinical manifestations. A VEO-IBD type 28 child with atypical clinical manifestations admitted to the Department of Neonatology, Children's Hospital Affiliated to Shandong University on November 5, 2021 was selected as the study subject. Clinical data of the child was collected. Peripheral venous blood samples of the child and his parents were collected for high-throughput sequencing. Candidate variants were verified by Sanger sequencing and bioinformatic analysis. The child, a 50-day-old male, had manifested bronchitis, ulcerative stomatitis, eczema and slightly loose stool. High-throughput sequencing revealed that he has harbored compound heterozygous variants of the IL-10RA gene, namely c.299T>G (p.V100G) and c.301C>T (p.R101W), which were inherited from his father and mother, respectively. Bioinformatic analysis showed that both variants have been recorded in the HGMD database, though the c.299T>G variant has not been included in the gnomAD, 1000 Genomes, ExAC and ESP6500 databases, while the c.301C>T variant has a low population frequency. Both variants were predicted to be deleterious by the online software including SIFT, PolyPhen-2 and Mutation Taster. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), both variants were predicted to be pathogenic (PS3+PM2_Supporting+PP3). The c.299T>G and c.301C>T variants of the IL-10RA gene probably underlay the VEO-IBD type 28 in this child. Above finding has expanded the phenotypic spectrum of VEO-IBD type 28 due to variants of the IL-10RA gene and provided a reference for the clinical diagnosis of this disease.

Spontaneous episodic inflammation in the intestines of mice lacking HNF4A is driven by microbiota and associated with early life microbiota alterations.

The inflammatory bowel diseases (IBD) occur in genetically susceptible individuals who mount inappropriate immune responses to their microbiota leading to chronic intestinal inflammation. Whereas IBD clinical presentation is well described, how interactions between microbiota and host genotype impact early subclinical stages of the disease remains unclear. The transcription factor hepatocyte nuclear factor 4 alpha (HNF4A) has been associated with human IBD, and deletion of Hnf4a in intestinal epithelial cells (IECs) in mice (Hnf4aΔIEC) leads to spontaneous colonic inflammation by 6-12 mo of age. Here, we tested if pathology in Hnf4aΔIEC mice begins earlier in life and if microbiota contribute to that process. Longitudinal analysis revealed that Hnf4aΔIEC mice reared in specific pathogen-free (SPF) conditions develop episodic elevated fecal lipocalin 2 (Lcn2) and loose stools beginning by 4-5 wk of age. Lifetime cumulative Lcn2 levels correlated with histopathological features of colitis at 12 mo. Antibiotic and gnotobiotic tests showed that these phenotypes in Hnf4aΔIEC mice were dependent on microbiota. Fecal 16S rRNA gene sequencing in SPF Hnf4aΔIEC and control mice disclosed that genotype significantly contributed to differences in microbiota composition by 12 mo, and longitudinal analysis of the Hnf4aΔIEC mice with the highest lifetime cumulative Lcn2 revealed that microbial community differences emerged early in life when elevated fecal Lcn2 was first detected. These microbiota differences included enrichment of a novel phylogroup of Akkermansia muciniphila in Hnf4aΔIEC mice. We conclude that HNF4A functions in IEC to shape composition of the gut microbiota and protect against episodic inflammation induced by microbiota throughout the lifespan. IMPORTANCE The inflammatory bowel diseases (IBD), characterized by chronic inflammation of the intestine, affect millions of people around the world. Although significant advances have been made in the clinical management of IBD, the early subclinical stages of IBD are not well defined and are difficult to study in humans. This work explores the subclinical stages of disease in mice lacking the IBD-associated transcription factor HNF4A in the intestinal epithelium. Whereas these mice do not develop overt disease until late in adulthood, we find that they display episodic intestinal inflammation, loose stools, and microbiota changes beginning in very early life stages. Using germ-free and antibiotic-treatment experiments, we reveal that intestinal inflammation in these mice was dependent on the presence of microbiota. These results suggest that interactions between host genotype and microbiota can drive early subclinical pathologies that precede the overt onset of IBD and describe a mouse model to explore those important processes.

Renzhu Ointment Regulates L-Type Voltage-Dependent Calcium Channel in Mice Model of Senna-Induced Diarrhea by Transdermal Administration.

In China, herbal preparation is commonly administered transdermally for treating pediatric diarrhea. However, few studies have probed into their antidiarrheal mechanisms. This study was designed to investigate the antidiarrheal effect of Renzhu ointment (Renzhuqigao, RZQG) and its underlying mechanisms via transdermal administration. The main components of RZQG were confirmed by gas chromatography-mass spectrometry (GC-MS). The effect of RZQG on L-type voltage-dependent calcium channel (L-VDCC) was evaluated by CaCl2- and ACh-induced contraction in isolated colon. The antidiarrheal efficacy of RZQG was further investigated by the senna-induced diarrhea mice based on the frequency of loose stools, diarrhea rate and index, fecal moisture content, and the basal tension of the colon. Additionally, the protein expression of CACNA1C, CACNA1D, cAMP, and PKA were detected with Western blot and immunohistochemistry (IHC). GC-MS analysis determined 14 components in RZQG. In vitro, RZQG relaxed the CaCl2- and ACh-induced tension, while nifedipine (a L-VDCC inhibitor) and H-89 (a PKA inhibitor) decreased the relaxation. In vivo, animal model showed that transdermal administration of RZQG exhibited a significant reduction in the frequency of loose stools, diarrhea rate and index, fecal moisture content and the basal tension. Compared to the model group, the colon of mice treated with RZQG showed lower expression of CACNA1C, CACNA1D, cAMP, and PKA. IHC results showed that cAMP was downregulated in colonic smooth muscle after RZQG treatment. RZQG improved diarrhea symptoms and down-regulated the expression of CACNA1C and CACNA1D via transdermal administration, which is closely associated with the cAMP/PKA signaling pathway in colonic smooth muscle.

Etiological Profile of Lower Gastrointestinal Bleeding in Children and Adolescents from Kashmir; A Tale of 5 Years.

Background: Lower gut bleeding is an alarming sign among caregivers. Determining the etiology is of utmost importance for further management. This is the first study conducted in northernmost India. Methods: This cross-sectional study was conducted at the Department of Pediatrics, Government Medical College, Srinagar. This study aimed to describe the etiology of lower gastrointestinal bleeding in the age group of 1-18 years over the past 5 years from June 2017 to June 2022. Results: A total of 310 children presented with hematochezia (53.5%), blood mixed with loose stools for > 2 weeks (39.3%), melena (1.9%), and occult blood in stools (0.3%). The mean age was 5.12 years. The age group of 1-6 years was 73.5 %. The most common findings were rectosigmoid polyps n=104 (33.5%), anal fissure n=47 (15.1%), lymphoid nodular hyperplasia (LNH) n=38 (12.2%), trichuris dysentery syndrome n=30(9.7%), cow's milk protein allergy n=27(8.7%), non-specific colitis n=18(5.8%), solitary rectal ulcer syndrome n=14(4.5%), inflammatory bowel disease n=6 (1.9%),intestinal tuberculosis n=3(0.9%), duodenal dieulafoy lesion 1(0.3%), and blue bleb nevus rubber syndrome n=1(0.3%). 21 patients had a normal colonoscopy. The colonoscopy yield was 93.3 %. Among the colonoscopy-negative patients, 6(1.6%) had Meckel's diverticulum, and 1(0.3%) had a duodenal dieulafoy lesion. Conclusion: Lower GI bleeding most commonly presents as hematochezia, and the most common cause is a rectosigmoid polyp. Colonoscopy is the procedure of choice to evaluate the etiology of lower GI bleeding. Anal fissures, LNH, Trichuris trichiura, and cow's milk protein allergy are other common causes of lower gut bleeding in Kashmir, northernmost India.

Functional Diarrhea in Children.

Functional diarrhea in children is a disease that has been focused on by both general pediatricians as well as pediatric gastroenterologists across the world. Although it is seen across the pediatric age group from late infancy to adolescence, most still believe that functional diarrhea only occurs in younger children. Recent epidemiological studies have shown that functional diarrhea is prevalent in all subcontinents. The classic clinical features include chronic loose stools with undigested food particles without growth faltering. Although known for long years, pathophysiological mechanisms and therapeutic options are not well explored, and the existing literature is outdated. In this article, authors review the available literature on functional diarrhea, with a reminder that a fresh look is needed to broaden the horizons of understanding of this disease.

Bezoar in the gastrointestinal tract: a rare case of diagnosis in the practice of a gynecologist and surgeon

Purpose. To present a clinical case of bezoar in a girl of 13 years old, with differential diagnosis of infectious, surgical and gynecological pathology.Materials and methods. The mother of a 13-year-old girl turned 26. On 10.2022, for consultation with complaints of abdominal pain, nausea, vomiting, loose stools. According to the mother, despite repeated visits to doctors, the child could not be diagnosed. Because of this, initially there was hospitalization in the infectious diseases department, re-hospitalization in the surgical department and then in the gynecological department. On 29.10.2022, the girl was operated on in a gynecological hospital, together with a pediatric surgeon.Results. During the surgical intervention, about 400.0 serous effusion was found in the abdominal cavity. During the revision of the organs of the female reproductive system, two paraovaril cysts up to 1 cm were found on both sides, removed. When revising the appendicular process, no pathology was revealed. When revising the intestine, a dense consistency of bezoar was found measuring 8 × 6 cm. The wall of the small intestine was opened over the bezoar, evacuation of a foreign body, layer-by-layer suturing. In the postoperative period, the patient received antibacterial, infusion and symptomatic therapy. The postoperative wound healed initially, without signs of inflammation. After discharge, a psychologist’s consultation is recommended.Conclusion. Bezoars are a rare type of pathology. Their diagnosis is difficult due to the absence of early specific clinical symptoms. This case from practice indicates that bezoar can simulate various pathologies of the abdominal cavity. Particular attention should be paid to pathological behavioral reactions, to consult children and adolescents with a psychologist and a neurologist. Unfortunately, the diagnosis is made when patients are admitted to the hospital with the phenomena of an “acute” abdomen, for surgical intervention.

Genetic liability for gastrointestinal inflammation disorders and association with gastrointestinal symptoms in children with and without autism.

Children with autism spectrum disorder (ASD) have a greater prevalence of gastrointestinal (GI) symptoms than children without ASD. We tested whether polygenic scores for each of three GI disorders (ulcerative colitis, inflammatory bowel disease, and Crohn's disease) were related to GI symptoms in children with and without ASD. Using genotyping data (564 ASD cases and 715 controls) and external genome-wide association study summary statistics, we computed GI polygenic scores for ulcerative colitis (UC-PGS), inflammatory bowel disease (IDB-PGS), and Crohn's disease (CD-PGS). Multivariable logistic regression models, adjusted for genetic ancestry, were used to estimate associations between each GI-PGS and (1) ASD case-control status, and (2) specific GI symptoms in neurotypical children and separately in ASD children. In children without ASD, polygenic scores for ulcerative colitis were significantly associated with experiencing any GI symptom (adjusted odds ratio (aOR) = 1.36, 95% confidence interval (CI) = 1.03-1.81, p = 0.03) and diarrhea specifically (aOR = 5.35, 95% CI = 1.77-26.20, p = 0.01). Among children without ASD, IBD-PGS, and Crohn's PGS were significantly associated with diarrhea (aOR = 3.55, 95% CI = 1.25-12.34, p = 0.02) and loose stools alternating with constipation (aOR = 2.57, 95% CI = 1.13-6.55, p = 0.03), respectively. However, the three PGS were not associated with GI symptoms in the ASD case group. Furthermore, polygenic scores for ulcerative colitis significantly interacted with ASD status on presentation of any GI symptom within a European ancestry subset (aOR = 0.42, 95% CI = 0.19-0.88, p = 0.02). Genetic risk factors for some GI symptoms differ between children with and without ASD. Furthermore, our finding that increased genetic risks for GI inflammatory disorders are associated with GI symptoms in children without ASD informs future work on the early detection of GI disorders.

A randomized controlled open labelled study to evaluate clinical efficacy of Bacillus clausii (TIL 19T, TIL 21C, TIL 28S, TIL 30R) in the management of acute diarrhoea in children

Acute Diarrhoea in children is the most frequent gastroenterological disorder and is a common cause of dehydration in children. The management of acute diarrhoea consists of the replacement of lost fluid with glucose-electrolyte oral rehydration solution. Probiotics have been used as adjunctive therapy in the treatment of acute diarrhoea. In this study we evaluated the efficacy of Bacillus clausii (TIL 19T, TIL 21C, TIL 28S, TIL 30R) in management of Acute diarrhoea in children. 48 children aged between 6 months and 15 years with acute bacterial gastroenteritis or acute viral gastroenteritis were included in the study. The study group received poly antibiotic resistant B. clausii strains (TIL 19T, TIL 21C, TIL 28S, TIL 30R)as a probiotic along with standard treatment for diarrhoea and the control group received standard treatment for diarrhoea without B. clausii. The results at the end of 48 hours showed a significant improvement in very severe and high grade diarrhoea category in the children belonging to the study group. That is, all patients had recovered to low grade or normal grade (P &amp;#60; 0.01). Analysis of diarrhoeal stool group showed 64% of children in the control group continued to have loose stools as compared to just 24% in the study group (P &amp;#60; 0.01). No serious adverse events were recorded in both the groups. The use of B. clausii strains(TIL 19T, TIL 21C, TIL 28S, TIL 30R)in Acute Diarrhoea in children has shown to improve the recovery time from the illness and improvement in stool consistency due to its probiotic effect.

Treatment of Urticaria caused by severe cryptosporidiosis in a 17-month-old child – a case report

BackgroundCryptosporidium is an intracellular protozoan that causes gastrointestinal symptoms in humans and animals. In immunocompromised patients and children under 5 years of age, the infection is severe and can be life-threatening due to severe diarrhea.Case presentationWe report a case of urticaria associated with Cryptosporidium in a 17-month-old female Iranian child. The patient had moderate diarrhea (> 3 loose, watery stools but not more than 10 diarrhea stools in a day), weight loss, and acute urticarial (rash clears completely within 6 weeks). Since the child’s father worked in livestock farming, the parasite may have been transferred from the cow or calve to the house and the child. Several Cryptosporidium oocysts were detected in the modified acid-fast staining of the child’s stool sample. The patient was successfully treated with nitazoxanide (100 mg twice daily) and became negative for parasites three days after treatment and one week after discharge from the hospital. The child was observed to produce < 3 loose stools in the previous 24 h after 1-week post-treatment and after 6 months of follow-up.ConclusionA number of parasites are associated with urticaria, but to our knowledge, there is no information on Cryptosporidium-induced urticaria. Therefore, our result may be evidence for the role of this parasite in the development of urticaria if other causes such as food allergies, autoimmune diseases and etc. don’t role in urticaria.

Overactive bladder syndrome symptoms in youth with abdominal pain-associated disorders of gut–brain interaction

The purpose of the current study was to assess the frequency of overactive bladder syndrome (OBS) symptoms and their relationship to gastrointestinal symptoms in youth with abdominal pain-associated disorders of gut–brain interaction (AP-DGBI). This is a retrospective study of 226 youth diagnosed with an AP-DGBI. As part of standard care, all patients completed a symptom questionnaire regarding gastrointestinal and non-gastrointestinal symptoms including increased urinary frequency, nighttime urination, and urinary urgency. Overall, 54% of patients reported at least one OBS symptom. Increased frequency of urination was reported by 19%, urinary urgency by 34%, and nighttime urination by 36%. Increased frequency of urination and urinary urgency were associated with a change in stool form, a change in stool frequency, and in those fulfilling criteria for IBS. Increased frequency of urination was reported more frequently in those reporting predominantly loose stools (33% vs. 12%). Urinary symptoms are common in youth with AP-DGBI. Increased urinary frequency and urinary urgency are specifically associated with IBS, with increased urinary frequency being primarily associated with diarrhea predominant IBS. Further studies are needed to determine the impact of OBS on AP-DGBI severity and quality of life, and whether they impact DGBI treatment.

A Case Report On Sepsis With Brain Stem Encephalitis In A Patient With Quadriplegia

Introduction : Every year, 1 in 10,000 people develop encephalitis, which frequently has grave neurologic repercussions. Identifying the cause and establishing the prognosis are difficult aspects of managing encephalitis patients. Presentation of case : A 20-year- Female came to a rural tertiary care hospital with the chief complaint of Fever, abnormal jerky movements of limbs and body, vomiting, and loose stools last 3 days. The patient was apparently alright 3 days ago when she developed a fever that was insidious in onset and progressive in nature not associated with chills or rigors, remitting with antipyretic medication. She also experienced abnormal jerky movements of all four limbs along with stiffness, associated with jaw lock, tongue bite, and frothing from the mouth, there was post ictal drowsiness along with it, with no involuntary bowels or bladder evacuation. History of loose stools 2 episodes, watery in nature, non-blood or mucus stained. She also complained of 2 episodes of vomiting which was projectile in nature and associated with nausea containing food particles and water. The patient had a history of 70 days PNC and delivered normally vaginally full-term delivery, without any complications. Management : Patient was intubated and was taken on a mechanical ventilator on volume control mode. Started treatment Inj meropenem 500mg iv for 7 days, INJ clindamycin 600mg iv for 5 days, injection vancomycin 500mg iv for 3 days, injection linezolid 600mg iv for 5 days, injection acyclovir 500mg iv for 14 days, injection doxy 100mg iv bd for days, injection ciprofloxacin 400mg iv for 7 days, injection colistin for 14 days, injection MPs 250mg IV od for days, injection Emset 4mg iv /sos, injection lomoh 0.6ml/od for 31 days, injection mannitol 150mg iv for 14 days, injection pan 40mg iv for 7 days, injection Emset 4mg iv for 5 days, injection levipil 500mg iv for 5 days. oral suctioning 2 hourly, physiotherapy. The patient’s general condition was stable. Conclusion : BE is a disease that advances quickly and has incapacitating effects. Significant gains were visible after receiving extensive supportive and rehabilitative therapy.

Ulcerative Colitis with Superior Sagittal Sinus Thrombosis: A Case Report

Ulcerative colitis is a chronic inflammatory, idiopathic, condition of the mucosa of the colon. Cerebral venous thrombosis is one of the serious and rare complications of inflammatory bowel disease. We report a case of a 27-year-old female patient with complaints of loose stool 5 to 6 episodes per day mixed with blood for 10 days. The patient has severe per rectal bleed, not controlled despite adequate measures and a few days later developed altered sensorium and fits. This case highlights prompt diagnosis and early treatment managing both severe ulcerative colitis and sagittal venous thrombosis. Immediate recognition of her disease improved her condition drastically and increased her survival.

Severe form of COVID-19 in a neonate with resuscitated cardio-respiratory arrest - Case presentation

SARS-CoV-2 infection is usually a self-limiting viral infection in healthy children. Still, it’s effects on the neonatal population remain largely unknown. There has been evidence of adverse events on neonates, mostly consisting in case reports of patients with severe forms of COVID-19 and also recent cohort studied of the pediatric population including the neonatal subgroup. The clinical presentation appears different in the neonatal patients in contrast with older children, and may manifest also as a life-threatening respiratory infection with systemic complications. In this paper we present a clinical case of a premature boy with a corrected age of 40 weeks at admission to the Pediatric Infectious Diseases Clinical Department IX of the National Institute of Infectious Diseases “Prof. Dr. Matei Bals” with the diagnosis of SARS-CoV-2 infection. The positive diagnosis was established on suggestive clinical picture (fever, dry couch, rhinorrhea, loose stools and inappetence) and confirmed by SARS-CoV-2 rapid antigen test. Laboratory investigations at admission showed only moderate to severe anemia, mild inflammatory syndrome and a mild neonatal hyperbilirubinemia, with normal leukocyte count, normal glycaemia, ionograme and blood gases. Chest x-ray showed moderate interstitial pneumonia. In the second day of admission, after 24h of favorable evolution, with no fever and present appetite, he suddenly presented during defecation a presumptive vasovagal syndrome, with general hypotonia and a short period of desaturation. Laboratory investigations made during the episode showed normal glycaemia, normal ionograme, normal blood gases, moderate-severe anemia and important metabolic acidosis. A new chest x-ray showed evolution of the interstitial pneumonia. We did a blood transfusion and continued antiviral treatment, antibiotic treatment and perfusions. He maintained normal pulmonary and cardiac function for another 6 hours, after which he presented a tonic-clonic seizure and after administration of intrarectal benzodiazepines he presented cardio-pulmonary arrest. He was resuscitated, intubated and sedated and transfer to a children ICU. 2 weeks later after admission in the ICU he was discharged with favorable outcome. The case presented shows that although SARS-CoV-2 infection is often a mild condition in children, COVID-19 in neonates can have an unpredicted course. Rapid evolution to sever forms can be a possible disease outcome. Preterm birth with associated complications like bronchodysplasia or anemia, can predispose to sever evolution of the disease, and this child must be kept safe. There is also a neurotropic potential of the SARS-CoV-2 virus that has to be followed.

A REVIEW OF GRAHANI ROGA

Grahani is an organ that holds the food in GIT. The Jatharagni within Grahani is the main strength and support which also gets support and strength from Grahani. Any deformity in the Agni or Agni Dosha results in diseases affected by Grahani which are called Grahani dosha, Grahani Roga, or Grahani Dushti. The pathophysiology of Grahani roga revolves around Agni dosha, which is linked to digestive fire dysfunction. Both anatomical and physiological deformity can be found in Grahani. Grahani is a critical disease of great relevance with ulcerative colitis. They have almost similar causative factors and symptoms like a loose stool with blood and mucous, constipation, dry and coated tongue, and anaemic and abdominal pain.