Mean Duration Of Diarrhea Research Articles

FREQUENCY OF ROTAVIRUS INFECTION IN CHILDREN UNDER 2 YEARS OF AGE PRESENTING WITH DIARRHEA AT TERTIARY CARE HOSPITAL

Objective: To find out the frequency of rotavirus infection in children below 2 years of age presenting with diarrhea at Northwest General Hospital, Peshawar. Methods and material: This cross-sectional study was conducted in the Department of Pediatrics of Northwest General Hospital Peshawar from 10th August 2020 to 10th February 2021. By non-probability convenience sampling technique taking a 95% confidence interval, 5% margin of error, and population of 24% the calculated sample size was 281. The data was analyzed by SPSS V 23.0. Results: A total of 281 cases were analyzed for this study. After analysis, the mean age was calculated as 10.960±3.93 months. The mean weight was 9.253±1.54 Kgs the mean duration of diarrhea was reported as 8.409±1.99 days. 53(18.9%) out of 281 were reported as positive for rotavirus infection. Among 281 only 20 patients which is 7.1% of the sample size got vaccinated against the Rotavirus in our study. Taking the p-value below 0.05 as significant rotavirus infection has shown significance with exclusive breastfeeding and their vaccination history. Conclusion: Rotavirus is one of the major causes of acute gastroenteritis. The rotavirus has shown a significant relationship between vaccination against rotavirus and exclusive breastfeeding with a p-value of less than 0.05.

Patterns of Gastrointestinal Symptoms of Covid-19 Patients in a University Hospital of Bangladesh

The World has experienced a devastating pandemic of COVID-19 caused by SARS-CoV-2 that started at March, 2020 and ended in May, 2023. Most patients of COVID-19, presented with respiratory symptoms and signs. But the number of COVID-19 patients experiencing gastrointestinal symptoms were also significant. The spectrum of gastrointestinal symptoms in the second wave of COVID-19 was observed in this study from July 2020 to September 2020 with an aim to describe the frequency of occurrence and the possible timing of onset and duration of these symptoms. This cross-sectional study was carried out in the COVID-19 outpatient (triage of fever clinic) and COVID dedicated inpatient department of Bangabandhu Sheikh Mujib Medical University (BSMMU) involving at least 79 consecutive patients who were RT-PCR positive for coronavirus 2 (SARS-CoV-2). Gastrointestinal symptoms including anorexia, nausea, vomiting, altered taste, diarrhoea, haematemesis or melena were recorded precisely by face to face interview maintaining proper infection control protocol. Among the 79 COVID-19 patients, 70.88% patients had at least one gastrointestinal symptom & the rest had no GI symptom. Most patients suffered from anorexia (70.88%), followed by diarrhoea (62.02%), nausea (41.77%), loss of taste (36.70%), vomiting (32.90%) & abdominal pain (7.59%), melena (2.53%). Diarrhoea was mild in most cases. The mean duration of diarrhoea and dysgeusia/loss of taste was 2.83 days and 5.8 days respectively. Mean duration of exposure to COVID 19 patient and onset of diarrhoea and dysgeusia was 7.69 days and 3.8 days respectively. This study did not exhibit any association between GI symptoms and severity of the disease. Bangabandhu Sheikh Mujib Med. Coll. J. 2024;3(1):07-11

Probiotic Weizmannia coagulans MTCC 5856 as adjunct therapy in children's acute diarrhea-a randomized, double-blind, placebo-controlled study.

Acute diarrhea in children is generally managed by replacing the lost fluid with oral rehydration solution (ORS). Probiotic supplementation has been reported to reduce the severity of diarrhea. In the present study, we investigated the effect of Weizmannia coagulans (Bacillus coagulans) MTCC 5856, along with ORS on acute diarrhea of all causes in non-hospitalized children. A total of 110 children of ages between 1 and 10 were enrolled in a double-blind placebo-controlled study and were randomly allocated to receive W. coagulans MTCC 5856 (4 × 108 spores, N = 54) + ORS and zinc (Zn) or a placebo (N = 56) + ORS and (Zn) for 5 days. The consistency of the stool, mean duration of diarrhea in hours, mean diarrhea frequency per day, and the dehydration status were collected as efficacy endpoints. Safety was evaluated by the occurrence of adverse events. The mean age of the children was 5.55 ± 2.57 years (61 boys and 49 girls). The mean duration of diarrhea was 51.31 ± 20.99 h in the W. coagulans MTCC 5856 group and 62.74 ± 24.51 h in the placebo (p = 0.011) group. The frequency of diarrhea was lower in children supplemented with the probiotic, but the difference was not statistically significant. The perceived efficacy score and dehydration status improved significantly in the W. coagulans MTCC 5856 group compared with the placebo group. No adverse events were recorded. The results of the study suggest that W. coagulans MTCC 5856 could be supplemented along with ORS and zinc to reduce the duration of diarrhea in non-hospitalized children. ClinicalTrials.gov, identifier CTRI/2022/06/043239.

Clostridium difficile infection and immune mediated diarrhea and colitis in patients with cancer on immune checkpoint inhibitors.

e14683 Background: Immune checkpoint inhibitors (ICIs) have altered the landscape of cancer treatment. ICIs are associated with immune mediated diarrhea and colitis (IMDC) which can be challenging to diagnose and differentiate from other etiologies of diarrhea. Clostridium difficile infection (CDI) is a common cause of diarrhea in patients with cancer and can have similar symptoms. In a similar study, CDI was found to be relatively common in ICI-treated cancer patients and especially those with IMDC requiring immunosuppressants. Our study evaluates the incidence of CDI and IMDC in patients with ICI exposure and compares clinical characteristics between the two to determine risk factors that may predispose patients to CDI or IMDC. Methods: This is a retrospective, single-center study of cancer patients on an ICI from 1/1/2011 to 4/7/2022 who were tested for Clostridium difficile with stool nucleic acid amplification tests during or after treatment with an ICI. Patients were determined to have CDI if clinically suspected and had to have a positive stool GDH Ag along with positive C. difficile toxins A & B or a positive stool C. difficile toxin B gene. Patients with positive GDH Ag in the stool but with negative toxins A&B were determined to be colonized. The diagnosis of IMDC was based on the clinical presentation and had to be made by the treating oncologist. Results: 375 patients met our study criteria and got CDI testing at any point during or after ICI exposure. 27 patients tested positive for CDI, whereas 24 were colonized. 105 patients were determined to have IMDC and 97/105 received treatment with steroids or immunosuppressants. Among patients determined to have IMDC, 6 were colonized for clostridium difficile. There were no patients with IMDC who were also positive for clostridium difficile. 71 patients were on a dual ICI regimen whereas 304 patients were on a single ICI. In patients on the dual ICI regimen, 67.6% were diagnosed with IMDC when compared to patients on a single ICI regimen where 18.8% of patients were diagnosed with IMDC (p<0.0001). The absolute lymphocyte count on the day of CDI testing was 1.185 ± 0.066 in the IMDC group when compared to 0.948 ± 0.044 in the non-IMDC group (p=0.003). The mean duration of diarrhea was longer in the IMDC group at 16.905 ± 1.211 days when compared to the CDI group at 9.852 ± 2.387 days (p= 0.0094). Smoking status, sex, history of autoimmunity, and history of prior immune related adverse events did not impact incidence of IMDC or CDI. Conclusions: IMDC was a common cause of diarrhea in patients with ICI exposure who were tested for CDI. We did not find IMDC to be a risk factor for CDI. IMDC has a longer duration of diarrhea and colitis symptoms when compared to CDI. The absolute lymphocyte count on symptom onset is higher in patients with IMDC when compared to patients with CDI and may be useful in identifying patients with IMDC earlier.

Compare the Effect of Zinc–Probiotic versus Zinc Therapy in Acute Watery Diarrhea in Children

Background: Acute watery diarrhea still remains a major health problem among under 5 children worldwide. Apart from oral rehydration solution, continued feeding and oral zinc therapy the administration of adequate amounts of probiotics seems beneficial for acute diarrheal episodes in children in the developing world. Objective: To compare the efficacy of zinc-probiotic combination therapy versus zinc-only therapy in children with acute watery diarrhea. Materials and Methods: This was a hospital based randomized controlled clinical trial (RCT) conducted from July 2019 to June 2021 in the Department of Pediatrics, Khwaja Yunus Ali Medical College & Hospital. Total 70 children aged 6 months to 5 years admitted in hospital with acute watery diarrhea (AWD) with severe dehydration or some dehydration with intractable vomiting were included in this study. Patients were equally divided into 2 groups. Group A received oral zinc sulfate 20 mg/day for 10 days combined with oral Bacillus clausii probiotic 4million spores/day for 5 days. Group B received only oral zinc sulfate at the same dosage as group A. We also studied the relationship between mother`s education, knowledge of ORS preparation and child’s feeding practices and nutritional status with the occurrence of diarrhea in children. Results: Frequency of diarrhoea was significantly higher in group B (Zinc only) in comparison to group A (Zinc and probiotic). Mean frequency of diarrhea, Mean duration of diarrhea and Mean length of hospital stay was significantly higher in group B (Zinc) than group A (Zinc+Probiotic). Conclusion: Compared to oral Zinc therapy only; the combination of oral zinc and probiotic therapy is clinically more effective in reducing the frequency of acute watery diarrhea in under 5 years children. KYAMC Journal Vol. 13, No. 04, January 2023: 218-222

Contribution of Malnutrition and Lack of Breast Feeding in Persistent Diarrhea in Children Under 2 Years of Age

Background: Diarrhea episode lasting for greater than 14 days is known as persistent diarrhea. Aim: To find the current extent of factors leading to persistent diarrhea. Methods: It was a cross sectional study. 100 children with persistent diarrhea were included. Then parents were asked for contributing factors which were malnutrition and lack of exclusive breast-feeding up to the first four months of life. Data was analyzed on SPSS 22. Results: The mean weight of infants was 10.01±2.41kg. The mean duration of diarrhea was 15.51±1.31days. Malnutrition was found in 79(79%) infants. Lack of exclusive breast-feeding up to 4months of life was observed in 63(63%) cases. Conclusion: The most common contributing factor of chronic diarrhea in infants is malnutrition and secondly lack of breast feeding. Keywords: Chronic diarrhea, infants, malnutrition, exclusive breast feeding.

Comparison of Zinc-Probiotic Combination Therapy to Probiotic Therapy Alone in Treating Acute Diarrhea in Children

Objective: To compare the efficacy of zinc-probiotic combination therapy and probiotic therapy alone in the treatment of acute pediatric watery diarrhea. Study Design: Randomized Clinical Controlled trial. Setting: The study was completed at The Department of Pediatrics, Unit I, Bolan Medical Complex Hospital, Quetta, Pakistan from July 2021 to January 2022. Methodology: A total number of 144 children of either gender aged 3 months to 5 years presented with acute watery diarrhea were included. Patients were randomly allocated into either Group-A (zinc supplementation with probiotics) or Group-B (only probiotics) for the treatment of acute diarrhea. Relief from diarrhea and duration of diarrhea were the main study end-points. Results: In a total of 144 children, the mean age was 27.04+14.43 months while the mean duration of diarrhea was 8.05+5.18 hours. On comparison of recovery from diarrhea, all the 72 children who received combination of probiotics and zinc were recovered from diarrhea, while 4 children (5.6%) children did not recovered from diarrhea within 5 days after starting the treatment in probiotics alone group (p=0.04). Duration of diarrhea was 27.63±14.22 hours in probiotics plus zinc group and 38.86±20.70 hours in probiotics only group (p<0.001). Practical Implications: Combination of probiotics with zinc resulted in early recovery among children with acute diarrhea but further randomized controlled trial enrolling large sample size from local population are necessary to verify the findings of this study. Conclusion: Combination of probiotics and zinc was superior as compared to the probiotics alone in the treatment of acute diarrhea in children. Keywords: Diarrhea, probiotics, recovery, stool, treatment, zinc.

Randomized, direct comparison study of Saccharomyces boulardii CNCM I-745 versus multi-strained Bacillus clausii probiotics for the treatment of pediatric acute gastroenteritis.

The choice of an appropriate probiotic for pediatric acute gastroenteritis (PAGE) can be confusing. Our aim was to compare the efficacy and safety of 2 probiotics (Saccharomyces boulardii CNCM I-745 vs a 4-strain mixture of Bacillus clausii O/C, SIN, N/R, T) for the treatment of PAGE. A 2-arm parallel, randomized trial recruited children (6 months to 5 years old) with mild-moderate acute diarrhea, from 8 centers in Argentina. A total of 317 children were enrolled and blindly randomized to 5 days of either S boulardii CNCM I-745 (n = 159) or a 4-strain mixture of B clausii (n = 158), then followed for 7 days post-probiotic treatment. A stool sample was collected at inclusion for pathogen identification. The primary outcome was duration of diarrhea defined as the time from enrollment to the last loose stool followed by the first 24-hour period with stool consistency improvement. Secondary outcomes included frequency of loose stools/day, severity of diarrhea, number reporting no diarrhea at Day 6, time-to-first formed stool, recurrence of diarrhea by study end (Day 12) and safety outcomes. Three hundred twelve (98%) children completed the study. S boulardii CNCM I-745 showed a significant reduction (P = .04) in the mean duration of diarrhea (64.6 hours, 95% confidence interval [CI] 56.5-72.8) compared to those given B clausii (78.0 hours, 95% CI 69.9-86.1). Both probiotics showed improvement in secondary outcomes and were well-tolerated. In this study, S boulardii CNCM I-745 demonstrated better efficacy than B clausii mix for reducing the duration of pediatric acute diarrhea.

Lactobacillus rhamnosus GG Evaluation in Acute Diarrhea (LEAD): An Observational Study.

Background and objectiveProbiotics with documented efficacy such as Lactobacillus rhamnosus GG(LGG) and Saccharomyces boulardii might be utilized as adjuncts to rehydration for the management of acute gastroenteritis (AGE) in children. In this study, we aimed to evaluate the potential role of LGG in acute diarrhea in the Indian pediatric population.MethodsAn observational, cross-sectional study [Lactobacillus rhamnosus GG Evaluation in Acute Diarrhea (LEAD)] was conducted among children aged one month to 12 years with acute watery diarrhea. In addition to standard management of diarrhea, LGG was given as an adjuvant treatment at the discretion of treating physicians based on their routine practice. Observations were documented on days one, three, and five. Outcomes such as frequency and duration of diarrhea, time to change in consistency of stools, Bristol Stool Chart (BSC) reading, and global assessment by healthcare practitioners (HCPs) and patients were also recorded.ResultsOf the 2,080 patients enrolled, 1,900 completed the five-day follow-up. There was marked improvement observed in the number of incidences of loose stools from day one (mean: 7.33) to day five (mean: 1.6). The mean time to improvement in stool consistency was 34 hours. The mean duration of diarrhea was 44.63 hours. A relatively shorter duration of diarrhea was reported among participants in this study. There was also a significant improvement in the number of vomiting episodes. Most patients and HCPs reported the product to be excellent/very good on the global assessment scale. No adverse effects were noted in any of the groups.ConclusionBased on our findings, LGG supplementation may be a beneficial adjuvant treatment in reducing the severity and duration of acute diarrheal episodes.

Comparison of mean duration of diarrhea of two different probiotics in Acute Diarrhea among children - RCT

Background: Diarrhea is one of the leading causes of morbidity and mortality and morbidity in paediatric age group. Aim: To determine compare the mean duration of diarrhea in single strain (saccharomyces boulardii) and multiple strain probiotic in acute diarrhea in children. Study Design: Randomized controlled trial. Methodology: The current project was conducted at Department of Pediatrics, General Hospital, Lahore. The patients were randomly categorized in two groups. 5 billion lyophilized heat-killed multiple strain probiotic (Group-B) was given twice a day and 250 mg of saccharomyces boulardii (Group-A) was given twice a day. Data analyzed by using SPSS 15.0. Independent t-test was applied for comparison of mean duration of diarrhea between groups. Results: The mean age of patients were 14.3 ± 4.19 months. The mean duration of diarrhea in Group A was 78.7±13.2 hrs whereas in Group B, mean duration of diarrhea was 97.6 ± 13.6 hrs. Conclusion: Single strain saccharomyces boulardii significantly reduced the mean duration of diarrhea in children. Keywords: Probiotics, Saccharomyces Boulardii, Acute Diarrhea and Children.

The Effects of Probiotic and Prebiotic Administration in Children with Acute Diarrhea at Day-Care Centers

Prevention of diarrhea needs an appropriate immune system supported by normal microbiota composition. This study aimed to determine whether probiotic or prebiotic enriched Growing-Up Milk could significantly reduce incidence of acute diarrhea. The randomized, double-blind, placebo-controlled clinical study was conducted in Surabaya, Gresik, and Sidoarjo cities, East Java–Indonesia, between July 2007 and January 2008. This study involved healthy children aged 1–5 years at day-care centers and were randomized to receive three different Growing-Up Milk containing probiotic, prebiotic, or placebo groups (containing neither probiotic nor prebiotic). The day-care staff and parents reported the amount of milk consumed, symptoms, and duration of acute diarrhea during the observation time. A total of 162 participants were divided into probiotic (55), prebiotic (54), and placebo groups (53). The incidence of diarrhea in all the participants was 1.2%, which was the least incidence from the prebiotic group and the highest in the placebo group and significantly different (P = 0.001). The mean duration of diarrhea in all the intervention groups was lower than the placebo group, although neither was statistically nor clinically significant (P = 0.254). Administration of Growing-Up Milk enriched with probiotics or prebiotics appears to be a great opportunity in reducing the incidence of acute diarrhea in children aged 1–5 years.

A Comparative Evaluation on the effect of Zinc-Probiotic combination versus Zinc alone therapy in children (3month-5year) with acute watery diarrhea attending the outpatient clinic of Sub-District hospital, Uttarakhand

Background: Diarrhea is the major cause of morbidity and mortality among children worldwide.Various studies were done on the role of zinc therapy and probiotic therapy in reducing the durationand severity of acute watery diarrhea. This study aimed to compare the effect of Zinc –probioticcombination versus Zinc only therapy in acute watery diarrhea in pediatric patients. Material andMethods: This was an open, randomized control trial in the pediatric outpatient department of Sub-District Female Hospital, Haldwani (Uttarakhand), from June 2020 till August 2020 for three months.Total 104 children aged six months to 5 years with acute diarrhea who met the inclusion criteriawere enrolled and divided into 52 patients each. 1stGroup A (n=52) received Zinc-Probioticscombination therapy, and 2ndGroup B (n=52) received Zinc only. Measurement of disease severitywas based on the frequency of diarrhea (times/day) and duration of diarrhea (hours) after initialdrug consumption. The resolution was assessed in mean remission time (time required to form solidstool from watery stool).Result: Among the study population in group A, 62% were male, 38%were female, and in group B, 65% were male & 35% were female. Male predominance was observedin both groups. The mean frequency of diarrhea before treatment in Group A was 7.46 ± 4.1times/day as compared to 6.69 ± 3.6 times/day in Group B. Mean duration of diarrhea in Group Awas 53.5 ± 30.5 hours as compared to 57.6 ± 34.3 hours in Group B. Conclusion: Combinationtherapy was more effective than Zinc only therapy in early remission and resolution of acute waterydiarrhea in children.

Prevalence of Microscopic Colitis in Diarrhea-predominant Irittable Bowel Syndrome Patients: Cohort Study From Upper Egypt.

There is controversy about colonoscopy and taking biopsy from the normal colonic mucosa in patients with a clinical diagnosis of diarrhea-predominant irritable bowel syndrome (D-IBS). This study aims to estimate the prevalence of microscopic colitis (MC) in D-IBS patients and to select patients without the well-known alarming features who will benefit from colonoscopy and biopsies from the normal colonic mucosa. We performed a cohort cross-sectional study over 6 months duration in a total of 129 patients with Rome III criteria of D-IBS after excluding cases with features of organic diseases. Cases were subjected to colonoscopy and biopsies from the colonic mucosa that seemed normal. Histopathologic examination of biopsies taken from cases with normal colonic mucosa revealed 86 (71.66%) cases with nonspecific colitis, 26 (21.66%) cases with MC and 8 (6.66%) cases with ulcerative colitis. Concomitant immunologic diseases (P=0.00005) and triggering drugs intake (P=0.006) were significantly more common in the MC group. The mean duration of diarrhea in MC patients was significantly longer than that of nonspecific colitis and ulcerative colitis patients (P=0.0006). Prevalence of MC in D-IBS patients from Upper Egypt is relatively high (21.66%). Concomitant immunologic diseases, possible triggering drugs intake, and long duration of diarrhea are significant risk factors for undiagnosed MC in D-IBS patients.

Diarrhoea in adults with coronavirus disease—beyond incidence and mortality: a systematic review and meta-analysis

Aim Diarrhoea is a relatively common manifestation of coronavirus disease (COVID-19), but there is no systematic review which comprehensively describes it beyond its incidence and impact on prognosis. This study aims to provide a detailed systematic review of diarrhoea in adults with COVID-19. Methods A PUBMED and Scopus search (until 7 September 2020) was performed. Studies that were limited to describing incidence of diarrhoea and its effect on prognosis were excluded. Results Twenty-six papers including 7860 patients with COVID-19 were subjected to synthesis. Mean duration of diarrhoea was 4.2 (3.6–4.9) days (range 1–16 days), whereas mean bowel movement count was 4.6 (3.8–5.3) and maximum was 20 per day. Diarrhoea started on an average 5.1 (3.8–6.5) days after disease onset but was the first manifestation in 4.3% patients. Stool occult blood was detected in 6.8% of patients with diarrhoea, while 53.3% cases had watery diarrhoea. Patients with diarrhoea also had elevated faecal calprotectin. Viral genome in faeces was detected more often in patients with diarrhoea and most often in patients without respiratory symptoms. Fever, myalgia and respiratory symptoms were observed with the same incidence in patients with and without diarrhoea. Similarly, there were no differences noted in complete blood count and most inflammation biomarkers between patients with and without diarrhoea. However, nausea, vomiting abdominal pain, sneezing and headache were more common in patients with diarrhoea. Diarrhoea was the main manifestation of COVID-19 in 6.1% of cases and this form of the disease had specific features. Conclusions Diarrhoea in COVID-19 needs further investigation.

Effect of Saccharomyces boulardii CNCM-I 3799 and Bacillus subtilis CU-1 on Acute Watery Diarrhea: A Randomized Double-Blind Placebo-Controlled Study in Indian Children

PurposeTo assess the effect of combination probiotic Saccharomyces boulardii CNCM-I 3799 and Bacillus subtilis CU-1 in outpatient management of acute watery diarrhea in children.MethodsA randomized double-blind placebo-controlled study was conducted in 180 participants aged six months to five years with acute mild to moderate diarrhea. All were enrolled from six centers across India and centrally randomized to receive S. boulardii CNCM-I 3799 and B. subtilis CU-1 or a placebo along with oral rehydration salts and zinc supplementation. Each participant was followed up for three months to assess recurrence of diarrhea.ResultsThe mean duration of diarrhea in the probiotic and placebo groups were 54.16 hours and 59.48 hours, respectively. The difference in the duration of diarrhea in those administered with probiotic or placebo within 24 hours of diarrhea onset was 25.21 hours. Furthermore, the difference in duration of diarrhea was 13.84 hours (p<0.05) for participants who were administered with probiotics within 48 hours. There were no significant differences in the stool frequencies between the two arms. After three months, 15% in the probiotic group and 18.5% in the placebo group reported episodes of diarrhea. The mean duration of diarrhea was considerably lower in the probiotic group, 31.02 hours versus 48 hours in placebo (p=0.017).ConclusionS. boulardii CNCM-I 3799 and B. subtilis CU-1 combination was effective in reducing the duration of diarrhea when administered within 48 hours of diarrhea onset. Similarly, it reduced recurrence of diarrhea and its intensity in the subsequent three months.

Comparative study of lactose and lactose free milk for acute diarrheal management in children upto 1 year of age.

Objectives: The objective of this particular research was to contrast mean duration of acute diarrhea in infants taking lactose free formula versus lactose-containing formula milk along with standard treatment. Study Design: Randomized Controlled Trial. Setting: Department of Paediatric Medicine DHQ Teaching Hospital Sargodha. Period: 6 months from 29 October 2016 to 28 April 2017. Material &amp; Methods: This study included 60 infants of both genders who were between 1month to 1 year of age and presented with acute diarrhea. These infants were separated into two groups. Infants in Group-A were given lactose-free formula milk while those in Group-B received lactose-containing formula milk. Outcome variable was mean duration of diarrhea which was compared between the two groups. Consent was taken in black and white from parents of each infant. Results: The average age of the infants was 7.2±3.1 months. Majority (n=41, 68.3%) of the infants were aged 6 months and above followed by 19 (31.7%) infants aged between 1-5 months. There were 29 (48.3%) male and 31 (51.7%) female infants with a female to male ratio of 1.1:1 the weight of infants ranged from 2.6 Kg to 11.9 Kg with a mean of 8.1±2.2 Kg. Both study groups were compared in terms of mean age (p-value=0.741), mean weight (p-value=0.932) and age (p-value=0.781), gender (p-value=0.438) and weight (p-value=0.573) groups distribution. The mean period of diarrhea was notably shorter in infants taking lactose-free milk (1.7±0.8 vs. 2.7±0.8 days; p&lt;0.001) as compared to those receiving lactose-containing milk. Similar significant differences were observed across various subgroups based on patient’s age, gender and weight. Conclusion: Lactose-free formula milk reduces mean duration of diarrhoea significantly when compared to lactose-containing formula milk regardless of patient’s age, gender and weight which advocate its preferred use in future practice in infants presenting with acute diarrhea.

A combination of three probiotic strains for treatment of acute diarrhoea in hospitalised children: an open label, randomised controlled trial.

Acute diarrhoea continues to be a leading cause of morbidity, hospitalisation, and mortality worldwide, and probiotics have been proposed as a complementary therapy in the treatment of acute diarrhoea. The goal of this study is to assess the efficacy and safety of three combined probiotic strains, Bifidobacterium lactis Bi-07, Lactobacillus rhamnosus HN001, and Lactobacillus acidophilus NCFM, as an adjunct to rehydration therapy in treatment of acute watery diarrhoea in hospitalised children. Eligible diarrheal children were randomised into intervention group (IG, n=96, conventional treatment for diarrhoea in combination with probiotics) and control group (CG, n=98, conventional treatment for diarrhoea without probiotics). The primary assessments of this study were duration of diarrhoea and hospital stay and improvement in diarrhoea symptoms. Significantly more children in the IG showed improvements in diarrhoea (defined as a decrease of stool frequency to no more than four times per day and an improved stool consistency within 24-48 h after the treatment) than those in the CG (96.9 vs 79.6%, P<0.05). Children supplemented with the mixed strains had a 22.5 h shorter (121.4±13.7 h vs 143.9±19.8 h) mean duration of diarrhoea and 1.2 d shorter hospital stays (5.1±1.2 d vs 6.3±1.4 d) than children only receiving the rehydration therapy (P<0.05). The prevalence of constipation of children in the IG (3.1%) was markedly lower (P<0.05) than that of children in the CG (13.3%) after treatment. In conclusion, the mixture of three probiotic strains given to children aged 1-3 years resulted in shorter durations of diarrhoea and hospitalisation and a higher percentage of improved children.

Predictors of increased melphalan exposure correlate with overall survival, nonrelapse mortality, and toxicities in patients undergoing reduced-intensity allogeneic stem cell transplantation with fludarabine and melphalan.

The reduced-intensity conditioning regimen, fludarabine and melphalan 140 mg/m2 (FM140), is widely adopted in practice. Pharmacokinetic studies report 10-fold interpatient variability in melphalan exposure. We identified low hemoglobin (Hb) and/or creatinine clearance (CrCl), determinants of melphalan pharmacokinetic, as strong predictors of outcomes after high-dose melphalan and autologous transplant. We hypothesized that these variables could predict for outcomes after FM140. Overall survival was shorter in patients with a lower Hb (113 vs. 2536 days; p = 0.004), due to an increased rate of nonrelapse mortality (NRM) (p = 0.0005). Overall survival was also worse in patients with lower CrCl (75 vs. 317 days; p = 0.003), with a significantly worse nonrelapse mortality (p = 0.0023). In a multivariate analysis, a higher Hb and CrCl predicted for better overall survival (p = 0.017). In patients with a lower Hb, the median duration of hospitalization (p = 0.02) and the mean duration of diarrhea (p = 0.008) were longer. In patients with a lower CrCl, the median duration of hospitalization (p = 0.06) and the mean duration of diarrhea (p = 0.0009) longer, and the rate of infection was higher (p = 0.02). We show for the first time that Hb and CrCl represent important determinants of outcomes after FM140, suggesting that pharmacokinetic-directed dosing may be beneficial in achieving optimal outcomes.

Low Hemoglobin and Creatinine Clearance Correlate with Worse Overall Survival, Treatment-Related Mortality, and Regimen-Related Toxicities in Patients Receiving Allogeneic Stem Cell Transplantation with Fludarabine and Melphalan Conditioning

The reduced-intensity conditioning (RIC) regimen consisting of fludarabine and melphalan 140 mg/m2 (Flu/Mel140) has been widely adopted in clinical practice. Pharmacokinetic (PK) studies report up to 10-fold interpatient variability in melphalan exposure. We previously identified low Hgb and/or creatinine clearance (CrCl), both determinants of melphalan PK, as strong predictors of survival and toxicity after high dose melphalan and autologous transplant. We thus hypothesized that these clinical variables could also predict for outcomes after Flu/Mel140 and hematopoietic stem cell transplantation (HSCT). Day -6 Hgb was grouped as low or high relative to the median ( The median overall survival (OS) was significantly shorter in patients with a lower Hgb compared to a higher Hgb (113 vs. 2536 days; p=0.004). This difference was due to an increased rate of transplant-related mortality (TRM) (26 (81.3%) versus 11 (36.7%) patients; p=0.0005). The median OS was also worse in patients with lower CrCl (75 vs. 317 days; p=0.003), with a significantly worse TRM (10 (90.1%) versus 27 (52.9%); p=0.0023). Multivariate Cox proportional hazards model adjusted for clinical and prognostic factors found that a higher Hgb predicted for better OS (HR 0.12, 95% CI 0.03-0.52; p=0.004) and TRM (HR 0.13, 95% CI 0.03-0.53); p=0.004). A higher Hgb and CrCl predicted for better OS (HR 0.08, 95% CI 0.01-0.63; p=0.017) and trended towards a decreased rate of TRM (HR 0.16, 95% CI 0.02-1.43; p=0.102). We then analyzed toxicity. In patients with a lower Hgb, the median duration of hospitalization (35 vs. 29 days; p=0.02) and the mean duration of diarrhea (14.6 vs. 7.2 days; p=0.008) were longer. In patients with a lower CrCl, the median duration of hospitalization (40 vs. 29 days; p=0.06) and the mean duration of diarrhea (20.9 vs. 8.6 days; p=0.0009) longer, and the rate of infection was higher (90.9% vs. 49.1%; p=0.02). We show for the first time that lower Hgb and CrCl represent important determinants of toxicity and TRM after Flu/Mel140 and HSCT. These findings are consistent with PK studies showing increased melphalan exposure in patients with low Hgb and CrCl. Our data suggest that consideration of clinical factors that affect melphalan exposure and implementation of PK-directed dosing may be beneficial in achieving optimal outcomes after Flu/Mel140.

Efficacy of the Probiotic Probiotical Confirmed in Acute Gastroenteritis.

PurposeSome probiotic strains reduce the duration of acute diarrhea. Because of strain and product specificity, each product needs to be supported by clinical data. This study aimed to test the efficacy of the synbiotic food supplement Probiotical (Streptococcus thermophilus, Lactobacillus rhamnosus, Lactobacillus acidophilus, Bifidobacterium lactis, Bifidobacterium infantis, fructo-oligosaccharides) in children with acute gastroenteritis of likely infectious origin. The primary endpoint was the number of children with normal stool consistency during the treatment duration.MethodsA total of 46 children (aged 3.6 months to 12 years) with acute gastroenteritis that started less than 48 hours prior to their visit at a hospital-based emergency department were included in this prospective, randomized, placebo-controlled trial. All children were treated with oral rehydration solution and placebo (n=20) or the test product (n=26).ResultsSignificantly more children had a normal stool consistency on days 1 and 2 in the probiotic group: 5 children (20%) on day 1 in the probiotic group compared with none in the placebo group (p=0.046). On day 2, 11 children in the probiotic group (46%) and 3 (16%) in the placebo group (p=0.024) had a normal stool consistency. The mean duration of diarrhea was shorter in the probiotic group compared with that in the placebo group (3.04±1.36 vs. 4.20±1.34 days) (p=0.018).ConclusionThe test product was shown to normalize stool consistency significantly more rapidly than the placebo. These data confirm the findings from a previous study in a larger group of children performed in a primary healthcare setting.