Normal Stool Research Articles

Fibrokolium in the treatment of irritable bowel syndrome with constipation: the first experience in Ukraine

Objective — to compare the clinical efficacy of Fibrokolium (Specchiasol S.r.l, Italy) with the drug psyllium in the treatment of patients with irritable bowel syndrome and constipations (IBS-C).Materials and methods. The simple open study involved 34 patients with IBS-C. The diagnosis was set on the basis of the IV Rome diagnostic criteria. Among the patients, 29 women prevailed (72.5 %), the average age of the patients was 37.4 ± 5.2 years. The patients were divided into 2 gender- and age-matched groups: 12 subjects of the first group received Fibrokolium in a dose of 1 powder with 200 ml of water twice a day; 22 patients of the second group were administered psyllium in a dose of 1 powder (5 g) twice a day with a sufficient amount of water. All patients discontinued the intake of laxatives, spasmolytics and prokinetics 10 days before the start of investigative treatment. At the baseline and on the 14th day of therapy all patients undergone the measurements of the bowel movements frequency, the form of feces according to the Bristol scale, the severity of flatulence by ultrasound accessibility coefficient (UAC), the severity of abdominal pain according to the visual analogue scale (VAS) and the time of intestinal (oral-anal) transit were determined with carbolene probe.Results. After 2 weeks of treatment in the first group, 10 patients (84 %) had normal stools of 3— 6 types, one (8 %) had 7 type, and another one (8 %) had 2 type. In the second group, stools type 3—6 was achieved in 16 patients (73 %), type 7—8 in 2 (9 %) and in 4 (18 %) 1—2 types. The frequency of bowel movements in the first group increased by 95 % up to 3.7 ± 0.34 times a week, and in the second group by 94 % up to 3.5 ± 0.33 times a week. Intestinal transit time in the first group decreased by 31 % up to 58.6 ± 16.5 hours, in the second by 24 % up to 71.2 ± 18.9 hours. The UAC values in the first group increased by 28 % up to 51.2 ± 7.1 %, in the second by 10 % up to 49.7 ± 6.9 %. The pain severity as per VAS score decreased in the first group by 33 % up to 5.2 ± 1.1 cm, and in the second by 10 % up to 6.6 ± 1.4 cm. All differences between the groups were not statistically significant (р > 0.05). In both groups such adverse effects as profuse diarrhea, electrolyte disorders and changes in biochemical parameters were not revealed. The complaints on abdomen heaviness feeling after the drug administration, not requiring the treatment discontinuation, was reveled in one patients from the first group and two patients from the second.Conclusions. Fibrokolium, containing psyllium, tamarind, ginger, and plant enzymes is just as effective in eliminating constipation in patients with IBS, as was the psyllium preparation used for comparison. Due to the additional herbal components, Fibrokolium safely and more effectively reduced the severity of flatulence and pain in patients with IBS-C.

Fecobionics: A Novel Bionics Device for Studying Defecation.

During defecation, solid, semisolid or liquid stools are eliminated via the anus in a complex physiological process. Up to 25% of the population are affected by anorectal disorders that are poorly recognized and treated. We developed a new bionics device, a simulated stool named Fecobionics, to replace several current tests of anorectal function. Fecobionics was developed to simulate the defecation process that depends on rectal forces, the anorectal size angle, and anorectal size and sensitivity. Fecobionics provided axial pressure signatures, measurement of bending (anorectal angle) and geometric mapping in a single examination. It had the consistency and shape of normal stool. The device had a soft core with embedded electronics and a bag for distension. The paper describes the device development and validation. Furthermore, data were obtained in preliminary experiments in pigs, healthy human subjects and patients with focus on four important features of the system, i.e. measurements of pressure signatures, bending characteristics, impedance measurements and data transmission. Accurate pressure and orientation data as well as geometric profiles were successfully obtained on the bench as well as in vivo in pigs and human subjects during defecation. Fecobionics is a novel technology imitating defecation. The clinical future ultimately depends on its ability to impact on daily treatment of anorectal disorders. A potential long-term clinical application is use of the device for biofeedback training for dyssynergic defecation.

Intestinal Parasite as Cause of Abdominal Pain and Diarrhea in a Patient With Normal Labs and Stool Studies

Intestinal Parasite as Cause of Abdominal Pain and Diarrhea in a Patient With Normal Labs and Stool Studies

Gastrointestinal Symptoms in College Athletes: A Cross-Sectional Survey

Introduction: Athletes have been suspected of incurring adverse gastrointestinal (GI) symptomatology. No prior studies have evaluated GI symptoms in college athletes. The aim of our study was to investigate the GI burden of disease in college athletes. Methods: We performed a cross-sectional survey of college club sports athletes at The Ohio State University from November 2017 to January 2018 through an online survey. Tennis, swimming, men's soccer, and men's baseball club teams participated. Demographic and GI symptoms were collected. The primary outcome of interest was determining the overall burden of GI disease. Secondary outcomes included differences between sports and age groups (younger athletes: age 18-21; older athletes: age >21). Results: Twenty-nine athletes participated (13.1% response rate); men's soccer (n: 12; 70.6%) and baseball (n: 9; 17.3%) had the highest response rates. The cohort was predominately male (86.2%), white (86.2%), and did not have a previously diagnosed GI disorder (84%). Abdominal pain (Table 1) was experienced at least ‘rarely' by 62%, most commonly in the pelvic region, with a poor diet triggering the majority of symptoms. The majority reported more than one bowel movement per day, with a fairly normal stool consistency (Table 2). Blood was reported on the toilet paper in the majority of athletes, yet frank hematochezia and/or melena was infrequently reported. NSAIDs were used frequently in 31%; of NSAID users, 55.6% used 400mg at a time and 25.9% reported using 600-800mg at a time. The majority of athletes used NSAIDs on the day of or after competition (Table 3). No differences were noted between baseball and soccer players. Younger athletes trained more hours per week than older athletes, (11-30 hours/week; 81.3% vs. 30.8%). Younger athletes were also more likely to take 600mg or more of NSAIDs on the day of or after competition (40% vs. 0%, p=0.017).2783_A Figure 1 No Caption available.2783_B Figure 2 No Caption available.2783_C Figure 3 No Caption available.Conclusion: College club sport athletes appear to have mild GI symptoms. The majority of these athletes reported infrequent abdominal pain, overall normal bowel movements, and infrequent use of medications. However, many athletes reported bleeding associated with bowel movements, as well as using significant doses of NSAIDs. Further efforts investigating the degree of bleeding may discover undiagnosed GI disease. Additionally, educating college athletes, especially younger ones, on appropriate use of NSAIDs may prevent future GI pathology.

Conservative treatment of severe defecatory urgency and fecal incontinence: minor strategies with major impact.

Bowel disturbances have been identified as the most important risk factor for fecal incontinence (FI). However, few studies have evaluated the impact of fiber supplementation. Our aim was to assess the correlation between the improvement in stool consistency by fiber supplementation and the changes in urgency and number of FI episodes and in the QoL of patients with FI. Eighty-three patients who came to our institution with FI and/or fecal urgency associated with loose stools or diarrhea were prospectively included in the study The intervention included dietary advice and methylcellulose 500mg every 8h for 6weeks. All assessments were carried out at baseline and 6weeks after the start of the intervention, and included a Bristol Stool Scale, a 3-week bowel diary, the St Mark's score, the Fecal Incontinence Quality of Life scale (FIQL) and a bowel satisfaction score. Sixty-one patients completed the study. At baseline 50 reported episodes of urge incontinence, while 11 did not report FI episodes because they rarely left home to avoid leakage. The Bristol score improved to normal stools in 65.6% of patients after treatment. Bowel diaries showed a statistically significant reduction in the number of bowel movements, urge episodes, urge fecal incontinence episodes and soiling per week. The St Mark's score and the bowel satisfaction score significantly improved after methylcellulose and overall deferment time also increased. FIQL significantly improved in two subdomains (lifestyle, coping/behavior). Thirty-one patients (51.7%) were discharged with methylcellulose as the only treatment. FI may significantly improve with methylcellulose in selected cases. Assessment of fecal consistency and initial treatment with methylcellulose could be started at primary care level to reduce the need for specialist referral.

Gut Movements: A Review of the Physiology of Gastrointestinal Transit.

The well-regulated mechanisms of intestinal transit favor aboral movement of intestinal contents during the formation of normal stool. Electrical pacemakers initiate mechanical smooth muscular propulsion under regulation by the enteric nervous system-a function of the "brain-gut axis." Several unique intestinal motor patterns function in concert to enhance the activities of intestinal transit. Development of pharmacologic targets of intestinal transit mechanisms afford clinicians control in the management of functional gastrointestinal disorders. This review highlights the important physiologic events of intestinal transit, discusses selected pharmacologic and neuromodulators involved in these processes, and provides relevant clinical correlates to physiologic events.

Application of clinical nursing pathway in children with acute diarrhea

Objective To explore the effects of clinical nursing path in the nursing of children with acute diarrhea. Methods A total of 80 cases of acute diarrhea children were enrolled from August 2014 to August 2017 in the First Hospital of Jilin University as the research object, and randomly divided into 2 groups with 40 cases in each group. The control group were given routine nursing, and the observation group received clinical nursing path. The time of antidiarrheal, the time of antipyretic, the time of normal stool recovery, the time of vomiting disappearance, the time of hospitalization, the recurrence and the degree of satisfaction of the family members were compared between the two groups. Results The time of antidiarrheal, the time of antipyretic, the time of normal stool recovery, hospitalization time and recurrence rate of the observation group were all lower than those of the control group. The scores of family members' satisfaction on communication and information support, emotional support and quality nursing support of the observation group were higher than those of the control group, and the differences were statistically significant (P 0.05) . Conclusions The clinical nursing path can effectively relieve the clinical symptoms of children with acute diarrhea, improve their family satisfaction and reduce the recurrence rate. Key words: Diarrhea; Nursing path; Children; Acute

A multicenter retrospective study aiming to identify patients who respond well to adsorptive granulomonocytapheresis in moderately to severely active ulcerative colitis.

ObjectivesAdsorptive granulomonocytapheresis (GMA) with the Adacolumn has been introduced as a non-pharmacologic treatment for ulcerative colitis (UC). However, a subset of patients who might respond well to GMA needs to be targeted. This study was conducted at three IBD centers to determine factors affecting the efficacy of GMA in patients with moderately-to-severely active UC.MethodsFrom January 2008 to December 2017, a total of 894 active episodes (first attack or relapse) in 593 patients were treated with GMA. Clinical remission was defined as normal stool frequency and no rectal bleeding. Multiple clinical and laboratory parameters at entry were considered for efficacy assessment.ResultsClinical remission was achieved during 422 (47%) of the 894 treatment cases. In the multivariate analysis, predictors for favorable response to GMA were age ≤60 years, UC duration <1 year, Mayo endoscopic subscore 2 (vs. 3), steroid naïve UC, and biologic naïve UC. Clinical remission rate was 70% in patients with four of the five factors, 52% in patients with three factors, 46% in patients with two factors, 39% in patients with one factor, and 18% in patients with none of these factors. Overall, the clinical remission rate was significantly higher in patients with a greater number of the five predictors (P < 0.0001).ConclusionsGMA appeared to be effective in steroid naïve and biologic naïve patients with short duration of UC. Elderly patients (>60 years) and those with severe endoscopic activity did not respond well to GMA. Additional, well designed, prospective, controlled trials should strengthen our findings.

The Efficacy of Two Phytogenic Feed Additives in the Control of Swine Dysentery

Abstract Control of swine dysentery with antibiotics is often ineffective due to the resistance of Brachyspira hyodysenteriae. The potential of some herbal-based components against B. hyodysenteriae was previously studied in vitro. This study aims at the evaluation of in vivo efficacy of phytogenic feed additives in the control of swine dysentery The study involved 64 seven-week old weaned pigs allotted to 4 groups: two were fed on feed supplemented with either Patente Herba® or Patente Herba® Plus, the third received tiamulin (positive control), while the negative control was not given antibiotics or additives. Fecal consistency was recorded daily. The presence of B. hyodysenteriae in the feces was investigated weekly using microbiological assays and the PCR test. Weight gain and feed conversion ratio were calculated for each week, and for the whole experiment. B. hyodysenteriae was detected in all samples by both methods. The additives showed efficacy in the prevention and control of swine dysentery as only normal and soft stool was observed in the treated groups. By contrast, in the negative control all feces categories were detected. Frequencies of feces categories significantly differed (p&lt;0.001) between feed-supplemented groups and the negative control. Efficacy of both additives in the prevention of SD is comparable to tiamulin, based on insignificant differences in the frequency of the various feces categories. Beneficial effects of both additives resulted in significantly (p≤0.05) higher weight gain and lower feed conversion ratio in comparison to the negative control. The average weight gains between additive-fed groups and tiamulin-treated group did not differ significantly.

Case 1: A Well-Growing Neonate with Features of Intestinal Obstruction

A 1,555-g, first of twin female infants is born at 38 4/7 weeks to a 24-year-old primigravida in a vaginal delivery through clear amniotic fluid. The infant is small for gestational age (<10th percentile on the Fenton intrauterine growth chart) with features of intrauterine malnutrition, such as triangular facies and loose skinfolds. The antenatal period is uneventful. The infant needs only basic steps at birth, with Apgar scores of 9, 9, and 9 at 1, 5, and 10 minutes, respectively. In view of the low birthweight, the neonate is transferred to the NICU and placed under the warmer with servo skin mode. Full tube feeding is initiated under observation. The infant passes meconium on the first postnatal day at 18 hours of age and has a normal stool transition. She tolerates feeds well until day 6 after birth, with an expected weight loss of 1.2% per day. On the sixth postnatal day, she has abdominal distention (an increase in girth of 3 cm) with multiple episodes of vomiting. On evaluation, she is found to be euthermic (temperature of 98.9°F [37.2°C]), euglycemic (glucose concentration of 64 mg/dL [3.5 mmol/L]), normocalcemic (calcium concentration of 4.04 mg/dL [1.01 mmol/L]), with no evidence of any systemic illness. Hence, surgical causes like volvulus, Hirschsprung disease, meconium ileus, and acute/subacute intestinal obstruction are the …

Identification of Virulence Factors of Escherichia coli Isolates from Fecal Samples of Calves in Southern Brazil

Background: Escherichia coli (E. coli) is an enteropathogen that commonly causes diarrhea in calves. However, not all E. coli isolates are pathogenic. The aim of this study was to identify E. coli virulence factors derived from fecal samples collected in the southern region of Rio Grande do Sul state (RS) from calves with and without diarrhea, as well as investigate the antimicrobial susceptibility of E. coli isolates from calves with diarrhea.Materials, Methods &amp; Results: Forty stool samples were collected in 12 farms, each one from calves having one day to six months of age, with and without diarrhea. The total DNA of from these isolates was extracted and a PCR using primers specific for the virulence factors Stx1, Eae, F41, F5 and STa was conducted. The susceptibility testing used the disk diffusion method and the susceptibility profile was evaluated against the following antimicrobials: ampicillin, penicillin, chloramphenicol, enrofloxacin, gentamicin, trimethoprim, sulfonamide, tetracycline and streptomycin. From all calves, 15 (15/40, 37.5%) had diarrheal stools and 25 (25/40, 62.5%) had normal or semi-liquid stools. Twelve (12/40; 30%) E. coli isolates showed at least one virulence factor. These factors were found in four isolates (4/15; 26.6%) from diarrheal stools and eight isolates (8/25; 28.5%) from normal stool. The Stx1 factor was identified in five isolates (5/40; 12.5%), and the Eae and the Sta factors in one (1/40; 0.2%) and in atypical associations between Stx1 and Eae and also between Eae and F41 in two isolates (2/40; 0.5%). Also, the Eae and Sta factors were identified in one isolate (1/40; 0.2%). The susceptibility test showed resistance to penicillin and tetracycline in 93% and 80% of the tested isolates, respectively.Discussion: The identification of virulence factors is necessary because E. coli is an enterobacterium present in calves gastrointestinal tract, to prove its pathogenicity. The virulence factor most commonly found in E. coli isolates derived from feces of calves with and without diarrhea in the southern region of the RS was the Stx1 (Shiga toxin-producing E. coli STEC). It is likely that the highest occurrence of E. coli isolates positive for the Stx1 virulence factor was due to the fact that cattle were the main reservoirs of this type of bacteria. The occurrence of enterohemorrhagic E. coli (EHEC) in animals of nine and 34 days of life, respectively, is highlighted. Studies have shown that contamination of animal foods with EHEC can cause enteric disorders, hemorrhagic colitis, and uremic hemolytic syndrome (UHS) in humans. Although in the present study the identification of the Stx2 factor was not performed, authors describe that the presence of the genes encoding Stx2 and Eae is determinant in the occurrence of UHS. In the susceptibility test, it was observed that E. coli isolates from diarrheal stools showed resistance to antimicrobials penicillin (10 mg) and tetracycline (30 mg) [93% and 80%, respectively], ampicillin (10 mg) [47%], streptomycin (10 mg) [47%], trimethoprim (5 mg) [47%] and sulfonamide (300 mg) [53%]. Although the percentage of antimicrobial resistance varies among studies, it is believed that the indiscriminate use of antimicrobial therapies as a common practice among rural properties contributes to bacterial resistance to these drugs. The sensitivity profile to antimicrobials showed that the analyzed Escherichia coli isolates are resistant to the antimicrobials commonly used for diarrhea treatment in the southern region of the Rio Grande do Sul state, Southern Brazil.

Impact of prematurity and nutrition on the developing gut microbiome and preterm infant growth

BackgroundIdentification of factors that influence the neonatal gut microbiome is urgently needed to guide clinical practices that support growth of healthy preterm infants. Here, we examined the influence of nutrition and common practices on the gut microbiota and growth in a cohort of preterm infants.ResultsWith weekly gut microbiota samples spanning postmenstrual age (PMA) 24 to 46 weeks, we developed two models to test associations between the microbiota, nutrition and growth: a categorical model with three successive microbiota phases (P1, P2, and P3) and a model with two periods (early and late PMA) defined by microbiota composition and PMA, respectively. The more significant associations with phase led us to use a phase-based framework for the majority of our analyses. Phase transitions were characterized by rapid shifts in the microbiota, with transition out of P1 occurring nearly simultaneously with the change from meconium to normal stool. The rate of phase progression was positively associated with gestational age at birth, and delayed transition to a P3 microbiota was associated with growth failure. We found distinct bacterial metabolic functions in P1–3 and significant associations between nutrition, microbiota phase, and infant growth.ConclusionThe phase-dependent impact of nutrition on infant growth along with phase-specific metabolic functions suggests a pioneering potential for improving growth outcomes by tailoring nutrient intake to microbiota phase.

A Microbiomic Analysis in African Americans with Colonic Lesions Reveals Streptococcus sp.VT162 as a Marker of Neoplastic Transformation.

Increasing evidence suggests a role of the gut microbiota in colorectal carcinogenesis (CRC). To detect bacterial markers of colorectal cancer in African Americans a metabolomic analysis was performed on fecal water extracts. DNA from stool samples of adenoma and healthy subjects and from colon cancer and matched normal tissues was analyzed to determine the microbiota composition (using 16S rDNA) and genomic content (metagenomics). Metagenomic functions with discriminative power between healthy and neoplastic specimens were established. Quantitative Polymerase Chain Reaction (q-PCR) using primers and probes specific to Streptococcus sp. VT_162 were used to validate this bacterium association with neoplastic transformation in stool samples from two independent cohorts of African Americans and Chinese patients with colorectal lesions. The metabolomic analysis of adenomas revealed low amino acids content. The microbiota in both cancer vs. normal tissues and adenoma vs. normal stool samples were different at the 16S rRNA gene level. Cross-mapping of metagenomic data led to 9 markers with significant discriminative power between normal and diseased specimens. These markers identified with Streptococcus sp. VT_162. Q-PCR data showed a statistically significant presence of this bacterium in advanced adenoma and cancer samples in an independent cohort of CRC patients. We defined metagenomic functions from Streptococcus sp. VT_162 with discriminative power among cancers vs. matched normal and adenomas vs. healthy subjects’ stools. Streptococcus sp. VT_162 specific 16S rDNA was validated in an independent cohort. These findings might facilitate non-invasive screening for colorectal cancer.

Lymphogranuloma Venereum: a Croatian Case Report of a Patient with Proctitis and Concurrent Cervical Lymphadenitis

Background Lymphogranuloma venereum (LGV) can present with genital ulcers, proctitis, or femoral/inguinal lymphadenopathy with or without constitutional symptoms. There have been reports on the infection characterized by supraclavicular or cervical lymphadenopathy, although there is no published data on the detection of Chlamydia trachomatis (CT) in the affected lymph node.Methods We report a patient with pharyngitis, proctitis and cervical lymphadenitis, in whom LGV specific DNA was detected by polimerase chain reaction (PCR) in both the rectal swab and cervical lymph node fine needle aspirate.ResultsA 48-year-old Croatian HIV-positive male patient attended our outpatient HIV clinic complaining of a 10-day perianal pain, bloody rectal discharge with normal stool consistency and painful and enlarged cervical lymph node. On the first day he had fever, which subsided on the following day. Clinical examination demonstrated exudate on the right tonsil, painful, and enlarged right cervical lymph node (5 × 2 cm, Figure 1), perianal pain on palpation and rectal purulent discharge. During the preceding 10-year period, the patient was taking his antiretroviral therapy regularly and had an undetectable HIV RNA by PCR. We started treatment with ceftriaxone and doxycycline. The fine needle aspirate of the affected lymph node showed a pyogranulomatous inflammation. Indirect immunofluorescence assay on CT antibodies detected positive titers in IgG (>512) and IgA (256) classes. LGV-specific DNA was detected in both the rectal swab and the cervical lymph node fine needle aspirate. Ceftriaxone was discontinued after 5 days and doxycycline therapy was continued for a total of 6 weeks because of the persistence of the cervical lymphadenopathy. The patient came to a full recovery.Conclusion We found six published case reports on LGV with associated cervical lymphadenopathy in which the infection with CT was established by serologic testing and/or by nucleic acid amplification tests of the pharyngeal and/or rectal swabs. Some of the mentioned reports demonstrated granulomatous inflammation present in the affected cervical lymph node, as was evidenced in our patient. To our knowledge, this is the first case report of a patient with CT infection in whom LGV-specific DNA was detected in the cervical lymph node.Disclosures All authors: No reported disclosures.

ST-Producing E. coli Oppose Carcinogen-Induced Colorectal Tumorigenesis in Mice.

There is a geographic inequality in the incidence of colorectal cancer, lowest in developing countries, and greatest in developed countries. This disparity suggests an environmental contribution to cancer resistance in endemic populations. Enterotoxigenic bacteria associated with diarrheal disease are prevalent in developing countries, including enterotoxigenic E. coli (ETEC) producing heat-stable enterotoxins (STs). STs are peptides that are structurally homologous to paracrine hormones that regulate the intestinal guanylyl cyclase C (GUCY2C) receptor. Beyond secretion, GUCY2C is a tumor suppressor universally silenced by loss of expression of its paracrine hormone during carcinogenesis. Thus, the geographic imbalance in colorectal cancer, in part, may reflect chronic exposure to ST-producing organisms that restore GUCY2C signaling silenced by hormone loss during transformation. Here, mice colonized for 18 weeks with control E. coli or those engineered to secrete ST exhibited normal growth, with comparable weight gain and normal stool water content, without evidence of secretory diarrhea. Enterotoxin-producing, but not control, E. coli, generated ST that activated colonic GUCY2C signaling, cyclic guanosine monophosphate (cGMP) production, and cGMP-dependent protein phosphorylation in colonized mice. Moreover, mice colonized with ST-producing E. coli exhibited a 50% reduction in carcinogen-induced colorectal tumor burden. Thus, chronic colonization with ETEC producing ST could contribute to endemic cancer resistance in developing countries, reinforcing a novel paradigm of colorectal cancer chemoprevention with oral GUCY2C-targeted agents.

Evaluation of Metronidazole With and Without Enterococcus Faecium SF68 in Shelter Dogs With Diarrhea

Diarrhea is common in shelter dogs and nonspecific therapies like therapeutic diets, probiotics, and drugs with activity against Giardia spp. or enteric bacteria are commonly prescribed empirically. All dogs in this study were administered metronidazole, fed a standardized diet, and randomized to either receive a commercially available probiotic (Purina® Pro Plan® Veterinary Diets; FortiFlora® Probiotic Supplement, FortiFlora, Nestle Purina PetCare, St Louis, MO) or a placebo which was the commercial product without the probiotic for 7 days. A fecal score was assigned to each stool passed during the study by masked individuals. Fecal samples were evaluated for select enteric agents including nematodes, Giardia spp., Cryptosporidium spp., and Clostridium perfringens enterotoxin before and at the end of the treatment period. There were no differences between groups in regard to parasite prevalence. By day 7, a normal stool (<5) was detected in 37.5% of the dogs administered metronidazole and 68.8% of the dogs administered dual therapy, but the result was not significant (P = .1556). The percentages of days with normal stools were significantly higher (P = .0496) for dogs administered dual therapy 65.6%) when compared to those administered metronidazole alone (46.9%). Giardia cysts were eliminated and diarrhea resolved in both dogs that were infected in the SF68 group. In contrast, of the 7 Giardia positive dogs in the placebo group, 6 (85.7%) were still positive for Giardia cysts on day 7, and 4 of those dogs still had diarrhea on day 7. Addition of SF68 to this protocol of metronidazole and a standardized diet appeared to enhance clinical responses in shelter dogs with diarrhea.

Symptoms and risk factors of Cryptosporidium hominis infection in children: data from a large waterborne outbreak in Sweden

Cryptosporidium is a major cause of diarrheal disease worldwide. In developing countries, this infection is endemic and in children, associated with growth faltering and cognitive function deficits, with the most severe impact on those aged <2 years. Little has been reported about symptoms and risk factors for children in industrialized countries, although the disease incidence is increasing in such regions. In November 2010, a large waterborne outbreak of C. hominis occurred in the city of Östersund in Sweden. Approximately 27,000 of the 60,000 inhabitants were symptomatic. We aimed to describe duration of symptoms and the risk factors for infection with C. hominis in children aged <15 years in a Western setting. Within 2 months after a boil water advisory, a questionnaire was sent to randomly selected inhabitants of all ages, including 753 children aged <15 years. Those with ≥3 loose stools/day were defined as cases of diarrhoea. The response rate was 70.3%, and 211 children (39.9%) fulfilled the case definition. Mean duration of diarrhoea was 7.5 days (median 6, range 1–80 days). Recurrence, defined as a new episode of diarrhoea after ≥2 days of normal stools, occurred in 52.5% of the cases. Significant risk factors for infection, besides living within the distribution area of the contaminated water plant, included a high level of water consumption, male sex, and a previous history of loose stools. The outbreak was characterized by high attack and recurrence rates, emphasizing the necessity of water surveillance to prevent future outbreaks.

Megabacteriosis in Nymphicus hollandicus

Macrorhabdus ornithogaster, agent of yeast-like Megabacteriosis is found in the normal microbiota of the proventriculus of birds. Under non-specific conditions, the host-fungal balance is disrupted and clinical signs, called "Light Going Syndrome", manifest. M. ornithogaster has been diagnosed in the laboratory as a cause of disease in a wide diversity of bird species, with a prognosis reserved to depend on the case. This work presents a review of the literature on megabacteriosis in birds and reports a clinical case in Calopsita (Nymphicus hollandicus), a 1 year old Cara White male, where he was admitted to the Veterinary Clinic. Through history, anamnesis, clinical signs, direct examination of feces, the presumptive diagnosis of megabacteriosis was reached. For the treatment Nystatin 100,000 IU/mL / oral (VO) was prescribed at 0.4mL twice daily (Bid), for 15 days via a feeding tube attached to the insulin syringe, together with a drop of Tylosin and one drop of Glycopan Gold in two daily intakes (daily dose recommended by the manufacturer 1mL or 11 gts diluted in 100mL of water or 2 to 3 drops, once daily) directly in the beak, in addition to 5 drops of apple cider vinegar in 100 mL of drinking water. After 7 days of treatment, there was improvement of the animal, but still presented slimming and seeds in the faeces. The treatment was followed and with 16 days of treatment the animal was revaluated, presenting normal stool coloration, weight gain, absence of regurgitation and seeds in the faeces, and again singing and receiving discharge.

Defining Pediatric Diarrhea in Low-Resource Settings.

Differences in definitions of acute pediatric diarrhea result in variable estimates of morbidity and mortality, treatment coverage, and associations with risk factors and outcomes. We reviewed published literature and guidelines focused on acute pediatric diarrhea in low- and middle-income countries. Clinical guidelines most commonly defined diarrhea in terms of quantity of loose or watery stool with consideration of normal stool patterns, whereas research studies often relied exclusively on a quantitative definition. The most commonly used quantitative definition, ≥3 loose or watery stools in a 24-hour period, has been compared to gold standards of caregiver perception and visual inspection of stool, with variable agreement. Age, breast-feeding status, and setting (facility vs household-based) influence the performance of quantitative diarrhea definitions in children. Universal adoption of a set of valid gold standard definitions specifically aligned with various programmatic and research goals will lead to more accurate coverage estimates and better-informed resource prioritization.

Impact of serum-derived bovine immunoglobulin/protein isolate therapy on irritable bowel syndrome and inflammatory bowel disease: a survey of patient perspective.

BackgroundPatients with irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD) commonly experience diarrhea, abdominal pain, bloating, and urgency. These symptoms significantly compromise the patient’s quality of life (QoL) by limiting participation in normal daily activities and adversely affect work productivity and performance.PurposeThe aim of this study was to understand from the patient’s perspective how oral serum-derived bovine immunoglobulin/protein isolate (SBI) impacts bowel habits, management of condition, and basic QoL.MethodsA 1-page questionnaire was distributed randomly to >14,000 patients who were prescribed SBI (EnteraGam®) for relevant intended uses. The survey was designed to collect data related to the influence of IBS or IBD on daily life activities and the impact of SBI usage on daily stool frequency, management of their condition, and QoL. Patient-reported responses were analyzed using a paired t-test to compare mean change in daily stool output and descriptive statistics for continuous variables.ResultsA total of 1,377 patients returned the surveys. Results from 595 surveys were analyzed with a focus on patients with IBS or IBD who had provided numeric responses regarding daily stool frequency. Respondents with IBS who reported having a normal stool frequency (≤4 stools per day) increased from 35% prior to using SBI to 91% while using SBI. A similar change toward normal stool frequency was reported by IBD respondents. Mean daily stool numbers decreased for respondents in the combined IBS and IBD groups (P=0.0001) from 6.5±4.3 before SBI to 2.6±1.9 following SBI use. The majority of respondents agreed strongly or very strongly that SBI helped them manage their condition (66.9%) and helped them return to the activities they enjoyed (59.1%).ConclusionResults from this patient survey suggest that SBI use can lead to clinically relevant decreases in daily stool frequency in patients with IBS or IBD along with improvements in the overall management of their condition and aspects of QoL.