Loose Stools Research Articles

1363-P: Clinical Profile and Outcome of Diabetic Ketoacidosis in an Emergency Department Non-COVID ICU

The clinical profile of DKA in a 4-bedded ED ICU of a single tertiary care centre from 12 April 2022 to 4 January 2023 is presented. A total of 11 DKA events were managed, with a mean age of 45.5 ± 19.2 y with M: F ratio of 1:2.7. Type 1 in 36%, type 2 in 45% and 18% were unclassified. 55% had no comorbidities, and 45% had Hypertension, CAD, CKD, and hypothyroidism. Presented with nausea & vomiting in 6 (55 %), shortness of breath in 5 (45%), dysuria in 4 (36 %), fever & fatiguability in 3 (27%), abdominal pain, chest pain, loose stools in 2 (18%), cough, haematemesis and loss of consciousness in 1 (9%). Of the total patients, 36 % were only on OADs, 18 % on Insulin and OADs and 18 % on Insulin alone. Duration of diabetes ranged from 2 to 13 years, and 2 were first diagnosed. Reasons for DKA were Non-adherence to medication (18%), the first presentation of DM (18%), Infections (73%), CAD-ACS (18%) and Pancreatitis (9%). One patient was on Dapagliflozin 10 mg daily with blood glucose 240 mg/dL at presentation. Lab parameters are shown in Table 1. Course in ICU: All patients received the standard treatment of DKA. 27 % had AKI and 27% had Acute on CKD. ICU mortality was 36 % with definite alternative causes identified for death. Conclusions: Infections are the most important cause of precipitating events for DKA. Co-morbidities and Complications decide the outcome and early recognition and standard treatment and ICU care are important in critically ill. Disclosure C.R: None. B.N.Jami: None. A.Suresh: None. A.J.Mangaly: None.

#6180 OXALATE NEPHROPATHY SECONDARY TO ENTERIC HYPEROXALURIA: A RARE CAUSE OF END STAGE RENAL FAILURE – A REPORT OF 2 CASES

Abstract Background and Aims Oxalate nephropathy is a rare cause of renal failure which is usually due to primary or secondary hyperoxaluria. Secondary hyperoxaluria results from increased intake or increased intestinal oxalate availability (enteric hyperoxaluria), increased intestinal oxalate degradation, or increased colonic permeability to oxalate [1]. Little is known about the burden of end stage kidney disease in this group of patients as most of the initial literature was from case reports and case series. More recently, prevalence of 1- 4.01% was reported from biopsy studies suggesting that this entity is indeed a cause of kidney failure that needs to be considered [2,3]. Method We present two cases of oxalate nephropathy secondary to enteric hyperoxaluria following small bowel resections. Results CASE ONE 82 year old man with a solitary kidney who was admitted in the ED on account of a decline in renal function on a background of episodes of loose stools. This was his second admission in two months on account of decline in renal function. He had emergency laparotomy and adhesiolysis as a result small bowel obstruction from volvulus 12 months earlier. Other past medical history include left nephroureterectomy for renal cancer, transurethral resection of bladder tumour, hypertension, Barretts and appendectomy. His medications were Omeprazole(which was switched to Famotidine due to hypomagnesaemia 7 months postop), Atenolol and Adcal D3. Renal immunology and myeloma screen were negative. Urine was bland and ultrasound did not show any obstruction. His AKI was initially thought to be pre-renal and there was some improvement in renal function with fluids during his first admission although renal function didn't return to baseline. His renal function progressively worsened in a spate of a few months. He had a baseline creatinine of 130 prior to his laparotomy which worsened to 184 post surgery bur the improved to about 109 few days post op. However, his renal function was noticed to decline 9 months post op and eventually his creatinine peaked at 751, fourteen months post op. He eventually had a renal biopsy 13 months post op that showed oxalosis, acute tubular injury and patchy interstitial fibrosis. His renal function continued to deteriorate and he was eventually commenced on haemodialysis. CASE TWO A 75-year-old man who was referred to the renal clinic on account of a decline in renal function. He had a past medical history of Crohn's disease, previous right hemicolectomy 26 years ago with revision 4 years ago, ileostomy(with subsequent reversal), inguinal herniorrhaphy, hypertension and BPH. He was on Azathioprine for his Crohn's and his initial decline in renal function was thought to be attributable to Azathioprine. Other medications include: Amlodipine 5 mg, Finasteride 5 mg, Loperamide 2 mg bd, Tamsulosin 400mcg od. At referral, his renal function had progressively deteriorated over the previous few months from a baseline creatinine of 145 to 303, 44 months after his last surgery. Urinalysis showed trace of protein and + of blood however, urine ACR was normal. Vasculitis and myeloma screen were also normal. Ultrasound ruled out any obstruction. Despite pausing Azathioprine, renal function continued to deteriorate with creatinine peaking at 561 over the next 2 months. He subsequently had a renal biopsy that showed chronic damage with oxalate casts. He was subsequently commenced on haemodialysis. Conclusion These two cases highlight the need to consider enteric hyperoxaluria in patients presenting with unexplained decline in renal function who have had bowel surgery or have risk factors for fat malabsorption. This is important due to the usual poor prognosis in this group of patients [1].

Infection-Associated Mortality During Induction Chemotherapy in Group B Intermediate-Risk Pediatric Burkitt's Lymphoma.

Background Burkitt's lymphoma (BL) in the pediatric population has significantburden in developing countries. Infection-related complications during the induction chemotherapy phase pose a major challenge and contribute to high mortality rates due to a severely immunocompromised state. However, there is scarcedata on the etiologies and optimal management strategies for infection-related mortality in pediatric BL patients, especially in developing countries like Pakistan. Methods This is across-sectional study that included a total of 116 pediatric patients with intermediate-risk BL. All patients were treated based on theChildren's Cancer and Leukaemia Group (CCLG) 2020 guidelines. Data on patientdemographics, presenting symptoms, diagnosis, infectious etiologies, and outcomes were collected. Infection-related complications and mortality were monitored during the induction chemotherapy period. The results of relevant culture reports were tabulated and data were analyzed. Results Among the 116 included patients, 61.1% were males with a mean age of 4.83 ± 2.12 years. Abdominal BL was the most common anatomical location. During the induction period, 66 patients (56.9%) had culture-proven infections, resulting in 33 deaths (28.4%). Fever was the predominant presenting symptom in all patients, followed by vomiting (57.6%), loose stools (42.4%), and cough (18.2%). Neutropenic colitis, sepsis, pneumonia, and meningitis were among the diagnosed infections. Hospital-acquired bacterial infections, including multi-drug resistantgram-negative and gram-positive organisms, were the main cause of mortality, with fungal infections and cytomegalovirus viremia also identified in a few patients. Conclusions This study highlights the urgent need for improved management strategies in pediatric BL patients in Pakistan to reduce infection-related complications and mortality rates, emphasizing the importance of context-specific approaches for infection prevention and management.

Infection, Inflammation, Venous Thromboembolism: A Co-existence

Aims: Venous thromboembolism is a state of hypercoaguability occurring due to various risk factors causing a prothrombotic state. In this case series, 3 cases are discussed where patients presented as DVT revealing underlying infection later on during the progression of it’s course.
 Place of Study: Department of Medicine, ABVIMS and Dr. RML Hospital, New Delhi and VMMC and Safdarjung Hospital.
 Case Series: Case Series – In Case 1, a 25 year old male presented with DVT and was started on anticoagulants. While other risk factors were ruled out, further investigations then were suggestive of Pulmonary Tuberculosis. In Case 2, a 17 year old female with a lower limb swelling suggestive of DVT, with loose stools was found to be positive for Clostridium Difficile infection. In Case 3, a 14 year old boy presenting with a knee swelling with synovitis positive for Staphylococcus aureus also revealed popliteal vein thrombosis.
 Discussion: Infections cause a systemic inflammatory response causing increased procoagulant factors, endothelial damage further causing Venous thrombosis.
 Conclusion: In patients presenting with venous thromboembolism, infections, systemic or local should be ruled out along with all the known risk factors.

Splenic Lesions as a Soft Pointer Towards the Diagnosis of Enteric Fever: A Case Series.

To the Editors: Enteric fever is a major public health problem in developing countries.1 The highest incidence is in children between 5 and 9 years-of-age.2 Splenic abscess (SA) is a rare extra-intestinal complication of salmonellosis with a reported incidence of 0.29%–2%.3,4 Salmonella SA is rare but carries a high risk of morbidity and mortality if unrecognized and untreated.5 This case series presents 3 cases of enteric fever complicated with splenic lesions. Case 1: A 5-year-old female patient presented with fever, pain in the abdomen, vomiting and loose stools for 10 days. On examination, she had a tender abdomen with hepatomegaly. She was started on ceftriaxone due to suspicion of enteric fever. Ultrasonography (USG) of the whole abdomen on admission day was normal. Widal serology on day 11 of illness was positive (1:320 for Titre of H antibody and Titre of O antibody). Blood culture grew nalidixic acid-resistant Salmonella typhi (Table 1). Because she continued to remain febrile, azithromycin was added on day 7 of the hospital stay, and a repeat USG was performed on day 10 of the stay, showing SA (1.4 × 2.1 × 2.3 cm) at the lower pole. USG-guided needle aspiration was performed, and antibiotics continued. She became afebrile over the next few days, was started on oral cefixime and discharged. TABLE 1. - Baseline Characteristics, Clinical, Lab and Management Details of Cases Patient Characteristics Case 1 Case 2 Case 3 Age at presentation (years) 5 12 4 Symptoms (duration in days) Fever Yes (10) Yes (21) Yes (10) Pain abdomen Yes (8) Yes (18) Yes (3) Vomiting Yes (8) No Yes (3) Loose stools Yes (8) No No Per abdomen examination Tenderness Yes Yes Yes Hepatomegaly (liver span) Yes (11 cm) Yes (12 cm) Yes (12 cm) Splenomegaly No Palpable spleen tip No Investigations at admission Haemoglobin (gm/dL) 9.3 11 11.5 TLC (per mm3) 7,800 8,260 5800 DLC (N%/ L %/ M %) 74/20/3 76/14/4 56/33/10 Platelet count (per mm3) 39,000 3,69,000 1,54,00 CRP (mg/dL) 97 36 43 Widal test (titres) Positive (1:320) Negative Positive (1:320) Antibiotics (days) Ceftriaxone (14) f/b cefixime (7) Azithromycin (14) Ceftriaxone (14) f/b cefixime (7) Ceftriaxone (14) f/b cefixime (7) Follow up USG 1 × 1.06 × 1 cm abscess, 1-month postdischarge. Resolution of splenic abscess, 2-month postdischarge Resolution of splenic abscess Resolution of splenic granuloma Typhoid vaccine status Unvaccinated Unvaccinated Unvaccinated CRP, C-reactive protein; DLC, Differential leukocyte count; f/b indicates followed by; TLC, Total leukocyte count; USG, ultrasonography. Case 2: A 12-year-old male presented with 3 weeks of high-grade fever and left abdominal pain. Examination revealed tenderness and palpable spleen tip. Ceftriaxone was initiated empirically. Widal serology was negative, and the blood culture was sterile. Other investigations to evaluate for the etiology of fever, including tuberculosis, were negative. USG abdomen revealed 3 SA, the largest 2.5 × 2.2 cm in splenic parenchyma. Ultrasound-guided aspiration of the largest abscess was performed. Pus culture grew Salmonella paratyphi A. Ceftriaxone was continued as per the sensitivity report. Subsequently, he became afebrile and was started on cefixime and discharged. Case 3: A 4-year-old female presented with fever for 10 days, pain in the abdomen, and vomiting for 3 days. She was started on intravenous ceftriaxone empirically, keeping a possibility of enteric fever. Due to persistent abdominal pain, USG of the abdomen was performed, which revealed multiple hypo-echoic foci in the spleen suggestive of splenic granuloma. Blood investigations revealed a positive Widal test (1:320 dilution titers for Titre of H antibody and Titre of O antibody) and blood culture grew Salmonella typhi. She became afebrile by day 4 of the hospital stay. She was given 7 days of intravenous ceftriaxone, followed by 7 days of cefixime. USG whole abdomen repeated 1-week post-discharge, showed no splenic granuloma. Salmonella SA is rare but carries a high risk of morbidity and mortality if unrecognized and untreated.5 Diagnosis is often delayed in children due to its rarity and nonspecific symptoms. USG abdomen is usually the first investigation performed in suspected cases, and sensitivity can be as high as 90% in the hands of an experienced operator. Percutaneous needle aspiration and antibiotics for 2–3 weeks may be sufficient in many cases, though the actual duration of antibiotics required is not known. The splenic abscess could be a pointer toward the diagnosis of enteric fever in high-burden settings like India. Though radiologic clearing can require 2–3 months, patients usually become asymptomatic after 2–3 weeks of adequate antibiotics and drainage.

Incidence and Risk Factors for Antibiotic-associated Diarrhea Among Hospitalized Children.

We aimed to evaluate the incidence, clinical findings, and risk factors of antibiotic-associated diarrhea (AAD) in hospitalized children without known comorbid diseases. All hospitalized children during the 1-year period that fulfilled the inclusion criteria were included in this study (n = 358). AAD was defined as; ≥2 loose or watery stools per day for a minimum of 24 hours during antibiotic treatment caused by Clostridioides difficile or negative stool tests for identifiable infectious agents. During hospitalization, diarrhea developed in 32 (8.93%) of the 358 patients. C. difficile toxin B was positive for 1 case. No infectious agents were detected in 21 patients. Overall, AAD was observed in 22 patients (6.14%, 95% CI: 4.09-9.13). Male sex ( P = 0.027, OR: 3.36), age between 1 month and <3 years ( P = 0.01, OR: 4.23), ibuprofen use ( P = 0.044, OR: 2.63) and late administration of antibiotics ( P = 0.001, OR: 9.5) were associated with the development of AAD. The incidence of AAD is low among hospitalized children without comorbid diseases, and most diarrheal episodes are mild and self-limiting. The use of probiotics in this patient group may be limited to certain specific situations.

Plasma and Urine Pharmacokinetics of Oral Fosfomycin Tromethamine in Dogs

Fosfomycin is a broad-spectrum, bactericidal antibiotic with low toxicity. It has been used in human medicine and is a promising candidate for treating infections in veterinary medicine. Different Fosfomycin salts exhibit various degrees of bioavailability. Tromethamine salt is the most commonly used oral form due to its improved bioavailability. However, information regarding its use with dogs is limited. Therefore, this study aimed to investigate the pharmacokinetics of oral Fosfomycin tromethamine in canine plasma and urine using liquid chromatography tandem mass spectrometry (LC-MS/MS). Six healthy male beagles underwent a three-period three-treatment study: treatment 1 and 2 with single oral Fosfomycin tromethamine at 40 and 80 mg/kg (the total doses with tromethamine salt were 75 and 150 mg/kg, respectively), and treatment 3 with intravenously Fosfomycin disodium at 57 mg/kg (the total dose with disodium salt was 75 mg/kg). Dogs receiving oral Fosfomycin tromethamine at 75 and 150 mg/kg, maximal drug concentration (Cmax) in plasma produced results of 34.46 ± 12.52 and 66.40 ± 12.64 µg/mL, oral bioavailability (F) was approximately 38 and 45%, while urine Cmax was 4463.07 ± 2208.88 and 8784.93 ± 2303.46 µg/mL, respectively. No serious adverse effects were reported, except loose stool in some dogs. The tremendously high urine Fosfomycin concentrations indicate that oral Fosfomycin tromethamine is suitable as an alternative treatment for bacterial cystitis in dogs.

Discussion of Acute Deficiency Syndrome Theory and its Clinical Application

Discussion of Acute Deficiency Syndrome Theory and its Clinical Application

EFFICACITY OF COMBINATION ACID ACETYLSALICYLIC AND GLUCOCORTICOID IN TAKAYASU ATERITIS TREATMENT: A CASE CLINIC TAKAYASU ARTERITIS IN VIET NAM

Objective: This brings up the potential of medical management for patients who are diagnosed with Takayasu arteritis, instead of using invasive methods such as aortic stent placement or operations. Design and method: A young female 14 years old was diagnosed with Takayasu arteritis. Initial symptoms include fever, loss of appetite, weight loss, muscle pain, followed by palpitations and abdominal pain, and loose stools. The test showed an increased hypersensitive C-reactive protein level (CRPhs: 28.7 mg/L). Computed tomography angiography (CTA) chest with contrast shows two segments of thoracic aneurysms involving descending aorta, the aortic diameter of the superior and inferior segment aneurysms is #1.6-1.8 cm, #2x 2.1cm, respectively, and the length is #2.5cm, # 3.2cm, respectively. According to the American College Rheumatology 1994, we classified this patient as type III. The patient was treated with corticosteroid therapy consisting of: prednisolone at an initial dose of 20 mg/day, reduced to a dose of 10 mg/day at month 3, and reduced to a dose of 5 mg/day after 6 months until now. In addition, we also added low-dose aspirin (81mg/day), ACE inhibitors, and beta-blockers to increase the effectiveness of treatment Results: After 3 months, Hs-CRP levels returned to normal (from 28.7 mg/L to 1.23 mg/L) and remained below the 3 mg/L thresholds during the next 15 months. After 12 months of combined treatment with corticosteroids and aspirin as described above, the patient's aortic diameter had returned to almost normal on CTA. After that, we have reduced the patient's corticosteroid dose (prednisolone 5 mg/day) and are going to finish the treatment after 18 months. Conclusions: This successful case high value on the role of pharmacological therapy in cases of Takayasu arteritis. It also brings up a debate regarding the concept of surgery required in cases of Takayasu arteritis complicated with dilatation, aneurysm, or stenosis. The combination of glucocorticoid therapy with aspirin can reduce the cost of treatment as well as avoids the side effects of the combination of glucocorticoid with immunosuppressive drugs. This opens up great treatment opportunities for Takayasu arteritis patients in low-economic countries like Vietnam.

Management of mad honey intoxication with suspected anaphylaxis in Nepal: a case report.

The authors reported the case of a middle-aged male patient who presented with blurring of vision, passage of loose stools, vomiting, and profuse sweating after ingestion of honey. He also had a history of loss of consciousness. On presentation, he was hypotensive and tachypneic with cold, clammy extremities. His ECG showed sinus bradycardia. The authors made a diagnosis of mad honey intoxication with suspected anaphylaxis. The authors treated him with intravenous normal saline, epinephrine, and atropine. He again developed hypotension and bradycardia in a few hours, for which hydrocortisone was administered, following which his heart rate was normalized in 2h. Overall, the recovery time in our patient was 8h. The patient was counseled to avoid consuming mad honey and did well on his monthly follow-up. Our patient had signs and symptoms suggesting intoxication following ingestion of mad honey with suspicion of anaphylaxis. Similar to other reported cases, the patient had sinus bradycardia and hypotension. Epinephrine and atropine were administered to treat hypotension and bradycardia, respectively. Also, refractory hypotension was managed by intravenous hydrocortisone. Usually, atropine and saline infusion are sufficient to manage these cases, and simultaneous use of epinephrine and atropine should be avoided unless indicated. Our case highlighted the approach to diagnosing and treating mad honey intoxication with suspected anaphylaxis.

Crohn's Disease in Children: A Case Report

Background: Crohn's disease in children is a chronic inflammatory bowel disease (IBD). The incidence of this disease has tended to increase in recent decades. This case report aimed to increase clinician insight into Crohn's disease. Case: We reported a case of Crohn's disease, one of the inflammatory bowel disease (IBD) type in a 16-year-old boy. The patient came with complaints of loose stools without mucus and blood, accompanied by heartburn, nausea, vomiting, and decreased appetite. The patient had a history of changes in defecation patterns in the last 4 months and decreased appetite and weight loss in the last 1 month. There was epigastric tenderness on physical examination. Inflammatory markers and fecal calprotectin values were increased. Gastrointestinal endoscopy results found pangastritis and pancolitis with histopathological examination showing results appropriate to IBD. The patient received corticosteroid methylprednisolone 1 mg/kg/day as induction therapy and experienced improvement in symptoms and laboratory results after 7 days of therapy. Discussion: There are characteristic differences between Crohn's disease and ulcerative colitis. A definite diagnosis is made by endoscopy and histopathological examination. The current goal of Crohn's disease therapy is no longer limited to improving symptoms or optimizing growth and development, but also targeting the improvement of the gastrointestinal mucosa. Remission induction therapy can be carried out with exclusive enteral nutrition or corticosteroids which are gradually reduced. Conclusion: This case report increases clinician insight into the characteristics, approaches to IBD diagnosis, and remission induction therapy in Crohn's disease in children.

Assessment of COVID-19 RT-PCR Positive Symptomatic Patients With Clinical, Hematological, and Radiological Parameters Among Three Groups: A Comparative Study.

Nearly 70.1 million individuals have been infected by the pandemic viral disease known as coronavirus disease 2019 (COVID-19), which was first discovered in China and is caused by a novel coronavirus known as severe acute respiratory syndrome coronavirus 2(SARS‑CoV‑2). This disease is responsible for the deaths of 6 million people. India ranks third in the total number of cases. The purpose of this study was to classify COVID-19 patients according to several criteria and to determine which clinical, hematological, and radiological indicators were most important in their care. An analytical cross-sectionalstudy was conducted on a total of 70 symptomatic patients who tested positive for COVID-19 reverse transcription polymerase chain reaction(RT-PCR)and were hospitalized at the Saveetha Medical College and Hospital in Chennai, Tamil Nadu, India, for the duration of the study. Comorbidities and oxygen reliance were taken into consideration while classifying patients into one of three categories. Initial symptoms, as well as hematological (interleukin-6 (IL-6),erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), D-dimer, serum ferritin, and total cell counts) and radiographic (X-ray and computed tomography (CT) of the thorax) characteristics, were taken and analyzed among the different groups. According to our research, the symptom of fever was the most common, accounting for 84.3% of all cases. This was followed by breathlessness (55.7%), myalgia (31.4%), dry cough (27.1%), sore throat (24.3%), cough with expectoration (20%), loose stools (12.9%), loss of taste (12.9%), and smell (11.4%). Although there was a large amount of variation in D-dimer, with Category C having the highest values, there was only a minor amount of variation in ESR and CRP. The X-ray and CT scans of the chest showed substantial differences between the groups, with CT findings such as COVID-19 Reporting and Data System(CO-RADS)and CT severity score, consolidation, crazy paving pattern, and vascular dilatation showing a wide range of differences between the groups. To facilitate easier treatment and place more attention on radiological characteristics using D-dimer, treating physicians are required to categorize COVID-19 patients into several groups. Patients who need oxygen support were included in this category.

A Rare Case of Incidentally Detected Urinary Bladder Lipoma

Urinary bladder lipomas are rare benign neoplasm. These are fatty tumors made of adipose tissue. Very few cases has been documented in literature. Hence, it necessary to be know the typical imaging finding when incidentally detected in imaging. We report a case of 70 year who presented with complaints of loose stool and right iliac fossa pain. Patient gives no history of any recent urinary tract complaints or previous history of urinary tract infection or any previous urological complaint.

Immunization Practices in Children Presenting to Outpatient Department of a Tertiary Care Hospital

Background: Immunization has tremendously reduced the incidence of childhood illnesses. Aim: To identify the causes of failure of immunization in our setups and help strengthen the EPI by solving those causes. Study design: Descriptive cross-sectional study. Place and duration of study: Department of Paediatrics, CMH Quetta from July 2022 to December 2022. Methodology: Two hundred and seven children (0-24 months) of both genders with acute diarrhoea passing three or more loose stools per day for no longer than two weeks were chosen. Using EPI cards, all parents of these patients were asked about their children's vaccination status. The demographic information like name, age and gender were noted. Results: There were 104 (51%) females and 103 (49%) females with a mean age of 18±1.5 months. 91.8% received BCG and OPV0, about 82% received Penta +OPV1+Hib at 6 weeks and 157 children were vaccinated at 10 weeks. Complete vaccination was received by 137 children at the age of 14 weeks, 52% of the children received measles vaccine, however, only 32% of the children had received their second dose of the measles vaccine by the time they were 15 months old. Conclusion: The immunization practices in children were decreased with advancing age of the children. The vaccination rate was highest at birth, 6 weeks and 10 weeks but significantly reduced at 9 months and 15 months. A robust awareness campaign is needed in order to sensitize the parents regarding the immunization of their children particularly at 9 months and 15 months of age. Keywords: Immunization, EPI, Polio, Measles, Tuberculosis, Diphtheria

A STUDY OF CLINICAL PROFILE OF LEPTOSPIROSIS IN A TERTIARY CARE HOSPITAL

Introduction: Leptospirosis is a zoonotic infection that can be lethal and is common in many tropical areas. It often spreads through huge epidemics following periods of high precipitation and floods. Exposure to infected reservoir host animals either directly or indirectly transmits infection. To study the clinical profile of leptospi Aim: rosis patients admitted in a tertiary care hospital. The present electronic record based retrospective study was co Methods nducted among eighty patients admitted with a diagnosis of leptospirosis at the Saveetha Medical College Hospital for the period of one year between January 2022 and December 2022. A total of 80 patients were included in the study Results . Among the study population 53.75% of the patients were males. The median age of the patients was 41.5 years. Most of the cases presented in the rainy season. In our study. most common symptom was fever (90%). Other symptoms were myalgia (87.5%), headache (41%), Abdominal pain (35%), Vomiting (25%), Loose stools (20%) and Dyspnea (10). Comorbidities in our study population include diabetes mellitus(n=8), systemic hypertension (n=6), coronary artery disease (n=1), hypothyroidism (n=2) and asthma (n=3). Complete hemogram revealed leucocytosis in 60% (n= 48) of the patients leucopenia in 2.5% (n=2), thrombocytopenia in 60% (n= 48) of the patients. Electrolyte abnormalities include hypokalemia (60%) , hyponatremia (40%) and hyperkalemia (n=2). Liver function tests (LFT) was deranged in 47.5% of the patients. Acute kidney injury was found in 27.5% patients (n=22) among which dialysis was needed for six patients. Liver was the most common organ affected followed by kidney. Bleeding manifestations occurred in 20% of the patients. Other complications include septic shock (18.75%) , acute respiratory distress syndrome (15%), encephalopathy (6.25%) and myocarditis (5%). Death occurred in 6.25% (n= 5) of the patients. Eventhough case fatal Conclusion: ity rate in leptospirosis is low, incidence of complications are higher. severe thrombocytopenia is associated with worse outcomes. Hypokalemia and hyponatremia are the most common electrolyte abnormalities. Liver and kidney are the most common organs affected. Incidence of cardiac and pulmonary manifestations leads to fatal outcomes.

Pu’ er raw tea extract alleviates DSS-induced colitis in mice by restoring intestinal barrier function and maintaining gut microbiota homeostasis

Numerous investigations have uncovered the outstanding therapeutic effect of tea extract on ulcerative colitis (UC). However, the therapeutic potential on UC of Pu’ er raw tea extract (PRTE) remains debated and need to be investigated. In our study, PRTE (100 and 300 mg/kg) was applied to the DSS-induced colitis mice via intragastric administration. Results have shown that PRTE treatment significantly ameliorated DSS-induced weight loss, loose stool, hematochezia, colon atrophy, splenomegaly and colon pathological injury. It could also inhibit UC by down-regulating pro-inflammatory cytokines (IL-1β, IL-6 and TNF-α) and increasing the expression of tight junction protein (zonula occludens-1, ZO-1) to reinforce intestinal barrier. Fecal microbiota transplantation has further confirmed that PRTE could maintain intestinal homeostasis and relieve UC by improve the abundance of beneficial bacteria such as Lactobacillus, Muribaculum, Lachnospiraceae and Rikenellaceae, and reduce the abundance of harmful bacteria such as Turicibacter and Romboutsia. This study suggested that PRTE exhibited a noteworthy therapeutic effect on UC via restoring intestinal barrier function and maintaining gut microbiota homeostasis, which develops a safe and efficient novel strategy for UC prophylaxis and therapy, and provides theoretical support for medical application of Pu’ er raw tea in the future.

Effect of "Zhibian" (BL 54)-to-"Shuidao" (ST 28) needle insertion on the expression of Fas/FADD/Caspase-8 of death receptor pathway in rats with primary ovarian insufficiency

To explore the effect of "Zhibian" (BL 54)-to-"Shuidao" (ST 28) needle insertion on the ovarian function in the rats with primary ovarian insufficiency (POI) and the potential effect mechanism based on the Fas/FADD/Caspase-8 of death receptor pathway.Forty-eight female SD rats were randomly divided into a blank group, a model group, a medication group and an acupuncture group, with 12 rats in each group. Except in the blank group, the rats in the other groups were intraperitoneally injected with cyclophosphamide to establish the POI model. In the acupuncture group, after successful modeling, the intervention was given with "Zhibian" (BL 54)-to- "Shuidao" (ST 28) needle insertion, once daily, 30 min in each intervention; and the duration of intervention was 4 weeks. In the medication group, estradiol valerate tablets were administered intragastrically, 0.09 mg•kg-1•d-1, for 4 weeks. The general situation and the estrous cycle of the rats were compared among groups. Using ELISA, the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) in the serum were detected. HE staining was adopted to observe the morphological changes of ovarian tissue of rats. The protein expression of Fas, FADD and Caspase-8 in ovarian tissue was detected with immunohistochemistry and Western blot.After modeling, except the rats of the blank group, the rats of the other groups had dry fur, lost hair, low spirits, reduced food intake, increased urination and loose stool. After intervention, the stool became regular gradually in the acupuncture group and the medication group. The percentage of estrous cycle disturbance was increased in the rats of the model group when compared with the blank group (P<0.01); in comparison with the model group, the percentages of estrous cycle disturbance were reduced in the acupuncture group and the medication group after intervention (P<0.01). When compared with the blank group, the body mass and E2 content in the serum were lower (P<0.01), the levels of FSH and LH in the serum and the protein expression levels of Fas, FADD and Caspase-8 were increased (P<0.01) in the model group. Compared with the model group, the body mass and E2 contents in the serum were higher (P<0.01), the levels of FSH and LH in the serum and the protein expression levels of Fas, FADD and Caspase-8 were reduced (P<0.01) in the acupuncture group and the medication group."Zhibian" (BL 54)-to-"Shuidao" (ST 28) needle insertion can effectively improve the ovarian function of POI rats, and its effect mechanism may be related to regulating the serum sex hormone levels, reducing the expression of Fas, FADD and Caspase-8 in ovarian tissue and retarding apoptosis of ovarian cells.目的：基于死亡受体通路Fas/Fas相关死亡域蛋白（FADD）/半胱氨酸天冬氨酸蛋白酶-8（Caspase-8）探讨“秩边”透“水道”针刺对早发性卵巢功能不全（POI）大鼠卵巢功能的影响及可能机制。方法：将48只雌性SD大鼠随机分为空白组、模型组、药物组和针刺组，每组12只。除空白组外，其余各组大鼠均采用腹腔注射环磷酰胺制备POI模型。针刺组大鼠于造模后采用“秩边”透“水道”针刺干预4周，每日1次，每次30 min；药物组予戊酸雌二醇片（0.09 mg•kg-1•d-1）灌胃4周。比较各组大鼠一般情况和动情周期；采用ELISA法检测大鼠血清卵泡刺激素（FSH）、黄体生成素（LH）和雌二醇（E2）水平，HE染色法观察大鼠卵巢组织形态，免疫组化法和Western blot法检测大鼠卵巢组织Fas、FADD、Caspase-8蛋白表达。结果：造模后，除空白组外，其他各组大鼠毛发干焦、脱毛，精神萎靡，进食减少，小便增多，大便稀软不成形；干预后，针刺组、药物组大鼠大便逐渐成形。干预后，与空白组比较，模型组大鼠动情周期紊乱率升高（P<0.01）；与模型组比较，针刺组、药物组大鼠动情周期紊乱率降低（P<0.01）。与空白组比较，模型组大鼠体质量和血清E2水平降低（P<0.01），血清FSH、LH水平和卵巢组织Fas、FADD、Caspase-8蛋白表达升高（P<0.01）；与模型组比较，针刺组、药物组大鼠体质量和血清E2水平升高（P<0.01），血清FSH、LH水平和卵巢组织Fas、FADD、Caspase-8蛋白表达降低（P<0.01）。结论：“秩边”透“水道”针刺可有效改善POI大鼠卵巢功能，其机制可能为调节POI大鼠血清性激素水平，降低卵巢组织Fas、FADD、Caspase-8表达水平，减缓卵巢细胞凋亡。.

Effect of "Zhibian" (BL 54)-to-"Shuidao" (ST 28) needle insertion on the expression of Fas/FADD/Caspase-8 of death receptor pathway in rats with primary ovarian insufficiency

To explore the effect of "Zhibian" (BL 54)-to-"Shuidao" (ST 28) needle insertion on the ovarian function in the rats with primary ovarian insufficiency (POI) and the potential effect mechanism based on the Fas/FADD/Caspase-8 of death receptor pathway. Forty-eight female SD rats were randomly divided into a blank group, a model group, a medication group and an acupuncture group, with 12 rats in each group. Except in the blank group, the rats in the other groups were intraperitoneally injected with cyclophosphamide to establish the POI model. In the acupuncture group, after successful modeling, the intervention was given with "Zhibian" (BL 54)-to- "Shuidao" (ST 28) needle insertion, once daily, 30 min in each intervention; and the duration of intervention was 4 weeks. In the medication group, estradiol valerate tablets were administered intragastrically, 0.09 mg•kg-1•d-1, for 4 weeks. The general situation and the estrous cycle of the rats were compared among groups. Using ELISA, the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2) in the serum were detected. HE staining was adopted to observe the morphological changes of ovarian tissue of rats. The protein expression of Fas, FADD and Caspase-8 in ovarian tissue was detected with immunohistochemistry and Western blot. After modeling, except the rats of the blank group, the rats of the other groups had dry fur, lost hair, low spirits, reduced food intake, increased urination and loose stool. After intervention, the stool became regular gradually in the acupuncture group and the medication group. The percentage of estrous cycle disturbance was increased in the rats of the model group when compared with the blank group (P<0.01); in comparison with the model group, the percentages of estrous cycle disturbance were reduced in the acupuncture group and the medication group after intervention (P<0.01). When compared with the blank group, the body mass and E2 content in the serum were lower (P<0.01), the levels of FSH and LH in the serum and the protein expression levels of Fas, FADD and Caspase-8 were increased (P<0.01) in the model group. Compared with the model group, the body mass and E2 contents in the serum were higher (P<0.01), the levels of FSH and LH in the serum and the protein expression levels of Fas, FADD and Caspase-8 were reduced (P<0.01) in the acupuncture group and the medication group. "Zhibian" (BL 54)-to-"Shuidao" (ST 28) needle insertion can effectively improve the ovarian function of POI rats, and its effect mechanism may be related to regulating the serum sex hormone levels, reducing the expression of Fas, FADD and Caspase-8 in ovarian tissue and retarding apoptosis of ovarian cells.

A Case of Paratyphoid with Diarrhea as the Only Symptom in a 5 Year Old Boy from Southern Part of India

Paratyphoid fever is a systemic bacterial infection caused by bacteria Salmonella paratyphi serovars A, B, or C. It is most associated with travel to endemic areas but can occur sporadically in non-endemic areas. While the disease is more commonly seen in adults, it can occur in children, and the presentation can be variable. It is clinically difficult to differentiate Typhoid from Paratyphoid without isolation of organism. We present a case of a 5-year-old boy, from Telangana state of South India, who presented with watery diarrhea of 8 to 10 episodes per day and abdominal discomfort for 5 days. At presentation child had some dehydration and very poor oral intake. Child did not respond to standard acute gastroenteritis with some dehydration management and continued to have persistent loose watery stools. Routine blood investigations, urine and stool microscopy revealed normal study. Further evaluation in the second week of illness revealed paratyphi on stool culture, and the child started to respondwithsensitive antibiotic cefotaximeinjections after 3 days of starting. However the child did not have other classical symptoms caused by paratyphi, such as fever, vomiting, or rose spots. Other classical investigations like blood culture and urine culture were negative. This case highlights the importance of considering paratyphoid as a potential cause for persistent diarrhea, even in young children, and the importance of prompt diagnosis and treatment with appropriate antibiotics, especially in the absence of classical clinical or laboratory findings.

Prevalence and distribution of acute gastrointestinal illness in the community of China: a population-based face-to-face survey, 2014–2015

BackgroundThe true incidence of acute gastrointestinal illness in China is underrecognized by surveillance systems. The aims of this study were to estimate the incidence and prevalence of self-reported AGI in the community of China, and to investigate sociodemographic and epidemiological determinants of AGI.MethodsWe conducted a 12-months cross-sectional population-based survey in eight provinces of China during 2014–2015. The survey determined the prevalence and incidence of acute gastrointestinal illness (AGI) in the total permanent resident population in China according to the census of the population in 2010. The random multilevel population sample was stratified by geographic, population, and socioeconomic status. We used a recommended case definition of AGI, with diarrhea (three loose or watery stools) and/or any vomiting in a four-week recall. A face-to-face survey was conducted by selecting the member in the household with the most recent birthday.ResultsAmong 56,704 sampled individuals, 948 (1,134 person-time) fulfilled the case definition; 98.5% reported diarrhea. This corresponds to 2.3% (95% CI:1.9%-2.8%) of an overall standardized four-week prevalence and 0.3 (95% CI: 0.23–0.34) episodes per person-year of annual adjusted incidence rate. There was no significant difference between males and females. The incidence rates were higher among urban residents, and in the spring and summer. In the whole study period, 50% of the cases sought medical care, of which 3.9% were hospitalized and 14.3% provided a biological sample for laboratory identification of the causative agent. Children aged 0–4 and young adults aged 15–24, people living in rural areas and people who traveled frequently had higher prevalence of AGI.ConclusionResults showed that AGI represents a substantial burden in China, and will contribute to the estimation of the global burden of AGI. Complemented with data on the etiologies of AGI, these estimates will form the basis to estimate the burden of foodborne diseases in China.