Occurrence Of Diarrhea Research Articles

MODELLING OF MITIGATING DIARRHOEA IN THE WETLAND AREA OF BANYUASIN DISTRICT, INDONESIA: A CROSS-SECTIONAL STUDY

Diarrhoea is one of the causes of high morbidity and mortality rates in developing countries that have poor environmental sanitation, inadequate water supply, high poverty rates and low levels of education. The purpose of this study was to examine diarrhoea control models in toddlers of Banyuasin District wetlands. This study used a cross-sectional study design. The study was conducted in the wetland area of Banyuasin District with a sample of 296 respondents. Data analysis was performed in univariate, bivariate and multivariate. The results showed that there was a correlation between chemical indicators (p-value = 0.035), latrine sanitation (p-value = 0.004), latrine quality (p-value = 0.005), income (p-value = 0.023), and hand washing with soap (p-value = 0.035) with the occurrence of diarrhoea in toddlers of Banyuasin District wetlands area. 51.9% of diarrhoea prevention can be explained by the water factor (19.7%), sanitation factor (15.6%), personal hygiene factor (8.2%), toddler factor (4.8%) and mother factor (3.5%) in this study. Improvements of environmental sanitation related to healthy latrines, rubbish bins, sewerage and clean / drinking water sources, as well as intensive education about personal hygiene and breastfeeding toddlers can contribute in reducing the occurrence of diarrhoea in toddlers.

Evaluation of the Expression Profile of Irinotecan-Induced Diarrhea in Patients with Colorectal Cancer.

Irinotecan (CPT-11) is widely used for the treatment of unresectable colorectal cancer in combination with fluoropyrimidines, such as 5-fluorouracil and S-1. Diarrhea is one of the adverse effects associated with CPT-11 and frequently reported by patients treated with CPT-11-containing regimens combined with oral fluoropyrimidines. However, the mechanisms involved in this process, as well as whether fluctuations in the frequency and differences in the onset time of diarrhea with each CPT-11-containing regimen are caused by drug interactions remain unclear. Therefore, we examined the incidence of diarrhea caused by each CPT-11-containing regimen in patients with colorectal cancer using data from the large voluntary reporting Japanese Adverse Drug Event Report (JADER) database. Firstly, we searched for suspected drugs related to the occurrence of diarrhea using reported odds ratio and calculated the signal score to assess drug–drug interactions. Subsequently, we conducted a time-to-onset analysis using Weibull distribution. The results showed that the combination of CPT-11 with S-1 increased the frequency of diarrhea due to a pharmacological interaction but delayed its onset. The present results may contribute to the appropriate management of drug-induced adverse effects by healthcare professionals.

Gut Microbiota and Diarrhea: An Updated Review.

Diarrhea is a common problem to the whole world and the occurrence of diarrhea is highly associated with gut microbiota, such as bacteria, fungi, and viruses. Generally, diarrheal patients or animals are characterized by gut microbiota dysbiosis and pathogen infections may lead to diarrheal phenotypes. Of relevance, reprograming gut microbiota communities by dietary probiotics or fecal bacteria transplantation are widely introduced to treat or prevent diarrhea. In this review, we discussed the influence of the gut microbiota in the infection of diarrhea pathogens, and updated the research of reshaping the gut microbiota to prevent or treat diarrhea for the past few years. Together, gut microbiota manipulation is of great significance to the prevention and treatment of diarrhea, and further insight into the function of the gut microbiota will help to discover more anti-diarrhea probiotics.

UGT1A1 Gene Polymorphisms in Patients with Small Cell Lung Cancer Treated with Irinotecan-Platinum Doublet Chemotherapy and Their Association with Gastrointestinal Toxicity and Overall Survival.

Irinotecan (CPT11) is an important drug for small cell lung cancer (SCLC) chemotherapy (CTx). UDP-glucuronosyltransferase 1A1 (UGT1A1) polymorphisms can influence CPT11-related toxicity. This study aimed to assess prevalence of UGT1A1 polymorphisms and their association with clinical outcomes in patients with SCLC on CPT11-CTx. An observational cohort of treatment-naïve patients with SCLC was given CPT11-platinum doublet at a referral center in North India over 3 years. Clinical outcomes assessed were hematological and gastrointestinal toxicity (Common Terminology Criteria for Adverse Events, version 3.0), response rates (RECIST), and overall survival (OS). Peripheral blood was drawn from all enrolled patients just prior to CPT11-CTx initiation, and genomic DNA was isolated. Genotyping was done by polymerase chain reaction (PCR)-restriction fragment length polymorphism for UGT1A1*7, UGT1A1*6, and UGT1A1*27 and by PCR-DNA sequencing for UGT1A1*28. Patients were classified as homozygous wild-type (WT/WT), heterozygous mutant (WT/M), or homozygous mutant (M/M) for each polymorphism assessed. Of 140 patients enrolled, no mutant alleles were found for UGT1A1*27 or UGT1A1*7. Frequency of UGT1A1*6 polymorphisms (n = 111) was 89.2% for WT/WT, 8.1% for WT/M, and 2.7% for M/M. For UGT1A1*28 (n = 102), this was 41.2% for WT/WT, 43.1% for WT/M, and 15.7% for M/M. UGT1A1*6 WT/WT patients tolerated >95% predicted CPT11 dose more frequently (59.6% vs. 25.0% in WT/M-M/M combined group; p = .026). The UGT1A1*6 WT/M-M/M group also experienced severe (grade ≥3) diarrhea (41.7% vs. 17.2% in WT/WT; p = .044) and mucositis (41.7% vs. 8.1% in WT/WT; p = .005) more frequently. On multivariate logistic regression analysis, UGT1A1*6 WT/M-M/M status was the only variable associated with occurrence of both mucositis (odds ratio [OR], 10.4) and severe diarrhea (OR, 4.8). UGT1A1*28 WT/M-M/M patients had better OS (320 days [95% confidence interval, 203-437] vs. 216 days [95% confidence interval, 140-292] in WT/WT group; p = .047). On multivariate Cox proportional hazards analysis, UGT1A1*28 WT/M-M/M status was independently associated with better OS (hazard ratio, 0.35), whereas lack of objective radiological response, moderate/heavy smoking, and increasing age were associated with worse OS. UGT1A1*6 and UGT1A1*28 polymorphisms were associated with increased gastrointestinal toxicity and improved OS, respectively, in North Indian patients with SCLC receiving CPT11-CTx. UGT1A1 gene polymorphisms are known to influence irinotecan-related toxicity. In this prospective cohort study of patients with small cell lung cancer receiving first-line irinotecan-platinum chemotherapy, the prevalence of UGT1A1*6 polymorphisms was found to be 10.8% UGT1A1*6 and 58.8% UGT1A1*28 homo/heterozygous mutant, respectively. UGT1A1*6 homo/heterozygous mutant status was associated with severe diarrhea and mucositis. UGT1A1*28 homo/heterozygous mutant status was independently associated with improved overall survival.

The association of socio-demographic and environmental factors on childhood diarrhea in Cambodia.

Background: Diarrhea is still the leading cause of childhood death worldwide, as well as a major cause for concern in developing countries. This study was conducted to investigate the factors related to childhood diarrhea in Cambodia. Methods: A cross-sectional study of the secondary data from the Cambodia Demographic and Health Survey 2014 was conducted using the combination of household data and children's data. A generalized linear mixed model was used to analyze the determinant factors of childhood diarrhea. Results: The surveys included 2,828 children, aged 12 to 35 months. The prevalence of diarrhea in the last 2 weeks was 16.44% (95% CI: 14.72%-18.31%). Factors with statistically significant associations with childhood diarrhea in Cambodia were: maternal unemployment, compared with being in employment (AOR = 1.43; 95% CI: 1.14-1.78); the child being male (AOR = 1.25; 95%CI: 1.02-1.53); the presence of unimproved toilet facilities (AOR = 1.17; 95%CI: 1.05-1.31) compared with improved toilet facilities; and unhygienic disposal of children's stools (AOR = 1.32; 95%CI: 1.06-1.64) compared with hygienic disposal of children's stools when controlling for other covariates. Both maternal age (one year older; AOR = 0.85; 95%CI: 0.78- 0.93) and child age (one month older; AOR = 0.86; 95%CI: 0.78-0.94) had significant negative associations with the occurrence of childhood diarrhea. Conclusion: Childhood diarrhea remains a public health concern in Cambodia. The probability of diarrhea occurring is shown to be increased by maternal unemployment, the sex of the child being male, lack of provision of improved toilet facilities, and the unhygienic disposal of children's stools; whereas increasing maternal age and child's age were associated with a reduced chance of diarrhea occurring. On the basis of these results, we recommend provision of programs focusing on reducing diarrhea through the construction of improved toilet facilities and the promotion of behavior to improve hygiene, specifically targeting younger mothers.

MALDI-TOF MS Based Typing for Rapid Screening of Multiple Antibiotic Resistance E. coli and Virulent Non-O157 Shiga Toxin-Producing E. coli Isolated from the Slaughterhouse Settings and Beef Carcasses.

Background: The emergence of multiple antibiotic resistance (MAR) Escherichia coli (E. coli) and virulent non-O157 Shiga toxin-producing Escherichia coli (STEC) poses a growing concern to the meat industry. Non-O157 STEC strains including O26, O45, O103, O111, O121, and O145 have been implicated in the occurrence of bloody diarrhea and hemolytic uremic syndrome in humans. This research assessed prevalence, matrix-assisted laser desorption/ionization-time of flight mass-spectrometry (MALDI-TOF MS) protein mass-spectra profiles, multidrug-resistance traits, polymerase chain reaction detection of virulence, and antibiotic-resistance genes of E. coli isolated from beef carcasses and slaughterhouse environments. Methods: A total of 180 convenience sponge samples were collected from two different sources-specific parts of beef carcasses and surfaces of the processing environment at the slaughterhouse of Ha′il, Saudi Arabia between September and November 2020. MALDI BioTyper and phylotype-based identification methods accurately identified and classified the samples as belonging to the genus belonging to the Escherichia coli domain of bacteria (NCBI txid: 562). Results: Expected changes were seen in the mass peak spectrum defining nine closely related isolates and four unrelated E. coli isolates. Serological typing of E. coli revealed enterotoxigenic E. coli O166 (19.10%); enteropathogenic E. coli O146 (16.36%) and O44 (18.18%); enterohemorrhagic E. coli O111 (31.18%) and O26 (14.54%). Forty-five percent of examined E. coli were resistant to seven antimicrobials; 75% of 20 selected isolates were resistant to three or more antimicrobials. phoA and blaTEM genes were detected in all selected E. coli isolates. Conclusion: This study confirmed the efficiency and validity of Matrix-assisted laser desorption/ionization time of flight mass-spectrometry in screening for multi-drug resistant E. coli isolated from slaughterhouse derived beef carcasses in Ha’il, Saudi Arabia. We contributed by revealing the distinction between related and non-related strains of E. coli in livestock. The findings in this study can inform improved policy development decision making and resource allocation related to livestock processing regarding antimicrobial use in food animals and rapid screening for effective multiple antibiotic resistance E. coli and virulent non-O157 STEC control in the slaughterhouses.

Differences in Intestinal Barrier Development between Intrauterine Growth Restricted and Normal Birth Weight Piglets.

Simple SummaryAnimals with intrauterine growth restriction (IUGR) are defined as neonates born at term but with low birth weight and a characteristic shape of the head. A number of structural and functional modifications in the IUGR intestine affecting its digestive and absorptive function and impairing intestinal barrier function have been reported in the past. Far less is known about the immune system in the gut of IUGR pigs. Therefore, the aim of the present study was to evaluate the structures of the immune system of the gut mucosa in IUGR neonates. We found that the immune deficiency in the gut mucosa that results from restricted intrauterine development occurs at postnatal day (PD) 7, but it disappears thereafter within a week. However, all examined IUGR piglets had an increased number of intraepithelial leukocytes in the gut mucosa on PD 14. We have shown that the immune system of the gut of IUGR piglets is able to quickly compensate for the immunological deficiency postnatally and hardly shows any morphological disabilities in later life.Intrauterine growth restricted (IUGR) piglets are born at term but have low birth mass and a characteristic shape of the head. Impaired general condition, especially in intestinal function, leads to an increase in the occurrence of diarrhoea and high mortality in the first days of life. So far, the mechanical and immunological gut barrier functions in IUGR are poorly understood. The aim of this study was to microscopically evaluate the early postnatal changes in the gut mucosa occurring in IUGR piglets. Whole-tissue small intestine samples were collected from littermate pairs (IUGR and normal) on postnatal day (PD) 7, 14 and 180 and analysed by light microscopy. We found that in the IUGR piglets, the percentage of intraepithelial leukocytes was reduced in the duodenum on PD 7, but it increased in the proximal and middle jejunum both on PD 7 and PD 14, which suggested the development of an inflammatory process. The number of goblet cells was also reduced on PD 14. The average size of the Peyer’s patches in the distal jejunum and ileum showed significant reduction on PD 7 as compared to normal pigs; however, on PD 14, it returned to normal. On PD 180, we did not find any differences in the measured parameters between the IUGR and the normal pigs. In conclusion, we found that in one-week-old IUGR pig neonates, the gut barrier and the immune system structures display signs of retarded development but recover within the second postnatal week of life.

A survey on the occurrence of Brachyspira pilosicoli and Brachyspira hyodysenteriae in growing-finishing pigs.

Background: The major pathogenic intestinal spirochetes affecting pigs during the growing- finishing stage of production include Brachyspira hyodysenteriae and Brachyspira pilosicoli. The aim of this study was to assess the current occurrence of B. hyodysenteriae and B. pilosicoli in Polish pig herds. Moreover, associations between the presence of diarrhea or other intestinal pathogens and occurrence of B. hyodysenteriae and B. pilosicoli in pigs were investigated. Methods: Between January 2017 and August 2019, a total of 401 samples of pig feces from 95 different herds were submitted to the National Veterinary Research Institute of Poland. These samples were obtained from pigs older than 7 weeks. All the received fecal samples were examined for the presence of B. hyodysenteriae, B. pilosicoli and Lawsonia intracellularis by real-time PCR. Results: B. pilosicoli was detected in 4.5% (95% CI, 2.5-7.0%) (18/401) of pig fecal samples. At the herd level 13.7% (95% CI, 7.5-22.3%) (13/95) of herds were positive for B. pilosicoli. B. hyodysenteriae was detected in 7.0% (95% CI, 4.7-9.9%) (28/401) of pig fecal samples and 18.9% (95% CI, 11.6-28.3%) (18/95) of pig herds were positive. Out of 18 B. pilosicoli positive samples, this pathogen was detected alone in 5 samples; simultaneously with L. intracellularis in 9 samples; simultaneously with B. hyodysenteriae in 1 sample and in 3 samples was detected simultaneously with both of these bacteria. The presence of B. hyodysenteriae in fecal samples was associated with the presence of diarrhea in pigs. Conclusions: This study confirmed that B. pilosicoli infections occur in Polish pig herds, but the prevalence is at a low level and the presence of B. pilosicoli is not associated with the development of diarrhea in pigs. B. hyodysenteriae is still a common cause of diarrhea among pigs from Polish herds.

Ocorrência de Salmonella spp. em bezerros e perfil de resistência antimicrobiana na Mesorregião do Sertão de Alagoas, Brasil

The diarrhea in calves, caused by Salmonella spp., provocates serious economic damage to cattle farming. This study aimed was to verify the occurrence of diarrhea and the isolation of strains of Salmonella spp. in diarrheal feces of calves from farms located in the Sertão from the state of Alagoas municipalities, and to characterize the in vitro resistance profile of Salmonella spp. isolated against conventional antimicrobials. The study was carried out with 431 calves from 10 to 90 days old. Of the total number of animals evaluated, 111 presented a diarrhea table, being analysed 111 samples of diarrhoeal faeces. The samples were sown in enrichment broths and selective culture media and the phenotypic and molecular characterization were performed. Among the animals evaluated, 25.75% (111/431) had diarrhea. The presence of Salmonella spp. was evidenced in 13.33% (2/15) of the studied establishments. Have been isolated 2.71% (3/111) strains of Salmonella spp. and have all been shown to be resistant to Cefotaxime and sensitive to Ciprofloxacin, Gentamicin, Amoxicillin, Ampicillin and Norfloxacin. Salmonella spp. and other infectious agents associated with diarrhea were confirmed in calves in the Sertão Alagoas mesoregion. The antimicrobial potential of the tested drugs reinforces the importance of their responsible and judicious use in the treatment of Salmonellosis, not being indicated the antibiotic therapy with Cefotaxima. The treatment based on Gentamicin, Amoxicillin, Ampicillin, Ciprofloxacin and Norfloxacin in the treatment of these animals, is recommended.

Red propolis effect analysis of dairy calves health based on Weibull regression model with long-term survivors

Diarrhea is the most common cause of mortality and morbidity in dairy calves during the first weeks of life. It is responsible for the majority of costs related to animal death and treatments, as well as lower productivity due to reduced weight gain. Therefore, studies that focus on strategies to reduce diarrhea incidence and to improve animal welfare are very important for the dairy industry. For that reason, the beneficial effects of red propolis on the health status of preweaned dairy calves was studied. Animal disease data usually present incomplete observations of interest time, so-called censored observations and one of the statistical techniques for this modeling type is the survival analysis, hence it is a set of methods for analyzing data where the response variable is the time until the occurrence of an event of interest. We propose among some methods of survival data analysis, the long-term models. The motivation to study these models is the fact that part of the population is not susceptible to the event of interest during the period of the study, considered as immune or cured. In this paper, we studied the Weibull distribution in a structure of long-term model, including the covariates in the proportion of cured through the logistic link function. Besides, we used the residual analysis to check the assumptions of the model. The reason for the choice of the Weibull distribution was that this model is very flexibility to model a variety of data sets, among them animal science and long-term survival data. We illustrate its application with a case study from an animal experiment, which examined the time till the occurrence of diarrhea in Holstein calves, where a proportion of the animals were not susceptible to this health condition. This experiment aimed to verify the efficiency of red propolis in disease prevention and the influence of that on the proportion of animals that are not susceptible to diarrhea.

#1: The Clinico-Epidemiologic Profile and the Correlation of Nutrition and Immunization Status With Outcome of Measles Patients During an Outbreak

Abstract Background Measles is a highly contagious disease that leads to substantial morbidity among pediatric patients. Vaccination has already been implemented in the Philippines, but still measles outbreak is resurgent. This study will be of importance because it can be utilized to establish the factors that lead to the recent measles outbreak. Objectives To describe the demographic and clinical profile of pediatric patients diagnosed with measles during the recent measles outbreak in a tertiary hospital in Central Luzon, Philippines; and to investigate the relationship of nutrition and measles immunization status with the outcomes of measles. Methods Cross-sectional analytic study, conducted in Tertiary training government hospital. Included in the study were less than 19 years old, admitted between January and April 2019, and manifested the following criteria for suspected measles:fever, generalized maculopapular rash, cough, coryza, conjunctivitis. Descriptive statistics was used to present data for the clinico-demographic profile of patients. A correlation study was done by determining the statistical significance of the relationship of nutrition and vaccination status with measles complications and outcomes; and the relationship of complications with outcomes of patients. Results In total, 373 patients were included in this study, 60% (224) were males; 40% (149) were females. The majority was under 0–6 months, 40% (149). Most cases came from Pampanga, 333 (89.2%). A total of 355 (95%) patients were classified as clinically compatible measles, seven (2%) were laboratory confirmed, and all seven had measles IgM antibodies, four (1%) were epidemiologically linked cases. Most of the cases manifested the classic symptoms of measles: fever 100%, rashes 99%, cough 96%, colds 84%, conjunctivitis 55%, and Koplik’s spots was seen in only 13%. As to exposure, those with exposure (49%) and without exposure (51%) are almost the same. The majority of the patients (285, 76%) had no measles vaccine and the top reason for non-immunization is the issue of the patients being too young for vaccination. The majority had normal nutritional status (72.4%). Three hundred and twelve patients reported the occurrence of clinical complications in patients with measles. Pneumonia was seen in 75% of cases and 9.3% had diarrhea. The occurrence of diarrhea is not directly correlated (P = 0.823) with the outcome of measles while Pneumonia shows a significant correlation (P < 0.001) with the outcome of measles. Death among patients was seen in cases with pneumonia. The occurrence of pneumonia is not significantly correlated with nutritional status (P = 0.083) while diarrhea is significantly correlated with nutritional status(P = 0.027). Two hundred and forty-eight patients with normal nutritional status did not develop diarrhea. Vaccination status shows a significant correlation with the occurrence of pneumonia(P =0.001). Out of the 285 non-vaccinated cases, 223 developed pneumonia. Vaccination status did not show a significant correlation with the occurrence of diarrhea (P = 0.946). Nutritional status and vaccination status was not significantly correlated with measles outcome(P = 0.605 and 0.120).In terms of outcome, 90% of the patients were discharged while 10% died. Conclusion Most were males, aged 0 to 6 months. There was a clustering of cases in Pampanga. The majority was classified as clinically compatible measles. The most common complication was pneumonia. Half had exposure to measles. The majority had no vaccine. The presence of diarrhea is significantly related to nutritional status. Pneumonia is significantly correlated with vaccination status and the outcome of measles. Most of the patients were discharged.

Bovine coronavirus: virus isolation, laboratory diagnostics and specific prevention

Diseases of young cattle of infectious etiology are the most important problem of cattle breeding. Among these diseases, the greatest economic damage is caused by diseases in calves of the digestive system, collectively called “neonatal diarrhea”. Numerous studies carried out in recent years have irrefutably proven that the main role in the occurrence of diarrhea in calves is played by rota-, coronaviruses, less often viral diarrhea-mucosal disease, as well as bacteria from the genus Escherichia (separately or in associations). These infectious agents cause a similar clinical picture of the disease; therefore only laboratory methods (detection of antigen in feces, organs, and tissues of sick or dead animals, as well as antibodies in the blood) are the basis for the diagnosis. Besides, with the help of diagnostic kits, it is possible to determine the presence of immunity to a particular disease and the need for vaccination. The article provides an overview of certified kits and vaccines for the diagnosis and prevention of coronavirus infection in cattle and discusses the benefits of a comprehensive regimen of their use.

Time series analysis of the relationship between diarrhea in children and Rota 2 vaccine in the Fanteakwa District of the eastern region of Ghana

BackgroundRotavirus is considered the main causal factor of severe gastroenteritis among infants and children globally. The association with severe rotavirus infection is mostly worse among the least developed countries, mainly due to inadequate access to medical care and poverty. This study was conducted to determine the seasonal effects in respect of diarrhea cases in children, the association between diarrhea cases and Rota2 vaccine in the Fanteakwa District of the Eastern Region of Ghana.MethodsThe study compares monthly diarrhea cases against children vaccinated with Rota2 extracted from DHIMS2 spanning May 2012 to December 2017 in Fanteakwa District. A univariate association between diarrhea cases and children vaccinated with Rota 2 was conducted using the R-software version 3.4.4 with the use of forecast, tseries and TSAPred. Pearson Correlation coefficient was also computed between monthly diarrhea cases and Rota 2 as well as lagged values of Rota 2 and Diarrhea cases.ResultsThe study shows that February recorded the highest average number of diarrhea cases (172) over the period 2012 to 2017 with a standard deviation of 59. However, a one-way analysis of variance shows a significant difference amongst the monthly averages with an F-statistic of 0.042 and P-value of 0.064. It is observed that the correlations between each of the Rota2 doses and the lagged cases are positive, showing higher Rota2 doses a month ago ((Xt − 1),0.346 to0.735), two months ago ((Xt − 2),0.383 to 0.746), three months ago ((Xt − 3), 0.330 to 0.737) and four months ago ((Xt − 4), 0.236 to 0.723) are associated with lower diarrhea cases. The results also show that an increase in the previous two month’s Rota2 figures by 100 is associated with a significant decrease in the currently expected diarrhea cases by approximately 36.ConclusionSeasonal variations exist in the occurrence of diarrhea in children, with January recording the highest number of diarrhea cases (172). There is a relationship between episodes of diarrhea in children and Rota2 (p-value = 0.064); thus, the more children are vaccinated with Rota2, the less diarrhea cases are recorded. Diarrhea cases in Fanteakwa district are generally low, except 2013 and 2016 where the cases are higher than the rest of the other years.

The role of fibroblast growth factor 19 in pathogenesis of bile acid diarrhea of the patients who underwent cholecystectomy

To determine the role of the fibroblast growth factor 19 (FGF19) level in the serum and BA concentration in feces in pathogenesis of bile acid diarrhea (ВАD) in patients after CCY. Sixty-one patients were examined at various times after CCY: 30 patients with chronic diarrhea that appeared after CCY (group 1) and 31 patients with normal stools (group 2). In all patients, the level of FGF19 in the blood serum, and the daily excretion of BA in the feces were studied. The control group consisted of 28 healthy individuals. In the 1st group we found lower concentrations of FGF19 in the blood serum 86.2 ng/ml (67.8; 117.8) compared with concentrations in the 2nd group 259 ng/ml (170.6; 318.8), p0.001. The daily excretion of bile acids with feces in the 1st group was 657.4 mg/day (524.6; 830.1), which was twice more than in the 2nd group and the control group. It was established an inverse correlation between serum concentration of the FGF19 and the BA excretion in the feces in all examined patients. It indicates a possible relationship between the low concentration of FGF19 in blood serum and malabsorption of the BA. Low level of FGF19 in the blood serum and a high excretion of BA in the feces may be one of the causes of BAD in patients undergoing cholecystectomy. Our results indicate the important role of FGF19 in the development of chronic diarrhea, which can be considered as one of the variants of postcholecystectomy syndrome.

Multilocus Genotyping of Giardia duodenalis in Mostly Asymptomatic Indigenous People from the Tapirapé Tribe, Brazilian Amazon.

Little information is available on the occurrence and genetic variability of the diarrhoea-causing enteric protozoan parasite Giardia duodenalis in indigenous communities in Brazil. This cross-sectional epidemiological survey describes the frequency, genotypes, and risk associations for this pathogen in Tapirapé people (Brazilian Amazon) at four sampling campaigns during 2008–2009. Microscopy was used as a screening test, and molecular (PCR and Sanger sequencing) assays targeting the small subunit ribosomal RNA, the glutamate dehydrogenase, the beta-giardin, and the triosephosphate isomerase genes as confirmatory/genotyping methods. Associations between G. duodenalis and sociodemographic and clinical variables were investigated using Chi-squared test and univariable/multivariable logistic regression models. Overall, 574 individuals belonging to six tribes participated in the study, with G. duodenalis prevalence rates varying from 13.5–21.7%. The infection was positively linked to younger age and tribe. Infected children <15 years old reported more frequent gastrointestinal symptoms compared to adults. Assemblage B accounted for three out of four G. duodenalis infections and showed a high genetic diversity. No association between assemblage and age or occurrence of diarrhoea was demonstrated. These data indicate that the most likely source of infection was anthropic and that different pathways (e.g., drinking water) may be involved in the transmission of the parasite.

Zootechnical and health performance of Holstein x Gir crossbred calves.

Crossbreeding is used to increase production and disease resistance in adult animals, and there is no research to assess the performance of animals in the early stages. The aim of this study was to evaluate the zootechnical and health performance of Holstein x Gir calves (½ HG: ½ Dutch ½ Gir and ¾ HG: ¾ Dutch ¼ Gir), from birth to 80 days of age, and compare metabolic parameters between groups. In this sense, calves were monitored for zootechnical parameters; epidemiological indexes such as morbidity, mortality, recurrence of diarrhea, pneumonia, and other diseases; as well as serum concentrations of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, total proteins, cholesterol, triglycerides, albumin, urea, and paraoxonase1 (PON1). ¾ HG calves showed higher morbidity for diarrhea and remained with diarrhea for longer compared to ½ HG calves, and this was reflected in the average daily weight gain until the 42nd day, with ½ HG calves performing better. There were no differences regarding passive immune transfer between groups, as well as no differences in morbidity and mortality from pneumonia. Regarding biochemical analyses, a difference was found only in the concentrations of PON1, which were higher in ¾ HG calves. The findings show that blood degree influences the occurrence and duration of diarrhea, negatively impacting the zootechnical performance of the animals. Crossbreeding bulls with zebu cattle can be an alternative to increase calf resistance and reduce diarrhea, thus lowering economic losses and improving animal performance.

Real-world safety data and differentiation of second-line (2L) 5-fluorouracil (5-FU) based regimens among patients with metastatic pancreatic ductal adenocarcinoma (mPDAC).

390 Background: Chemotherapy related adverse events (AEs) can impact the treatment of patients, reducing quality of life and leading to dose delays and treatment discontinuation. This study examined the proportion of patients (pts) with mPDAC treated with 5-FU-based regimens in the 2L setting who experienced AEs during treatment. Methods: Data were extracted for pts diagnosed with mPDAC who initiated 2L treatment between January 2016 and July 2020 from the Flatiron Health electronic health database. Pts included in the study were treated with FOLFIRINOX (FFX), FOLFOX, FOLFIRI, or a regimen containing liposomal irinotecan. The occurrence of grade 3 (G3) and grade 4 (G4) neutropenia, G3/G4 elevated alanine transaminase (ALT) and anemia where transfusion was indicated were determined using lab results and the grading criteria from the Common Terminology Criteria for Adverse Events v4.03. The occurrence of diarrhea, fatigue, nausea and vomiting (N/V), and neuropathy were identified from structured diagnosis records through ICD-10-CM codes. Duration of therapy (DOT) was assessed for each regimen. Descriptive statistics for AEs and DOT were reported. Results: Of the 804 pts included in the study, 28.4% (n=228) received FFX, 39.8% (n=320) received regimens containing liposomal irinotecan, 24.8% (n=199) received FOLFOX, and 7.1% (n=57) received FOLFIRI. The median DOT (IQR) was 86 days (d) (43 – 206), 79d (41 – 169), 72d (43 – 166), and 84d (46 – 148) for pts who received FFX, liposomal irinotecan, FOLFOX, and FOLFIRI, respectively. G3/G4 neutropenia (&lt;1000/mm3) presented in 28.1% (n=64) of pts treated with FFX, 11.9% (n=38) of pts treated with liposomal irinotecan, 17.1% (n=34) of pts treated with FOLFOX, and 36.8% (n=21) of pts treated with FOLFIRI. NV occurred in 14.9% (n=34), 13.1% (n=42), 12.6% (n=25), and 10.5% (n=6), respectively. The full AE results are summarized in the table. Conclusions: In this assessment of often dose-limiting AEs among pts with mPDAC treated in 2L, pts who received liposomal irinotecan had the lowest proportion of neutropenia. No clear pattern was noted for N/V, neuropathy, fatigue, anemia, and elevated ALT. Further research is necessary to determine the real-world cost implications of AEs in this patient population. [Table: see text]

Interim analysis of the AVETUXIRI Trial: Avelumab combined with cetuximab and irinotecan for treatment of refractory microsatellite stable (MSS) metastatic colorectal cancer (mCRC)—A proof of concept, open-label, nonrandomized phase IIa study.

80 Background: Immune checkpoint inhibitors have demonstrated poor efficacy in MSS mCRC. Previous research indicate that cetuximab (anti-EGFR chimeric monoclonal antibody) could initiate, independently from RAS mutation, an immunogenic tumor cell death and mediate antitumor immune response. In this trial, we aim to explore the clinical efficacy and safety of anti-PDL1 avelumab (AVE) combined with cetuximab (CET) and irinotecan (IRI) for treatment refractory MSS mCRC. Methods: AVETUXIRI (NCT03608046) is a multicenter academic study recruiting MSS, BRAFV600E wt, mCRC patients (pts) refractory to standard treatment (fluoropyrimidine, oxaliplatin, irinotecan and anti-EGFR treatment if RAS wt tumor) in 2 cohorts (cohort A: RAS wt – cohort B: RAS mut). In both cohorts, patients receive CET (400 mg/m2 W1, 250 mg/m2 W2, 500 mg/m2/2 weeks from W3), IRI (180 - 150 mg/m2/2 weeks from W1) and AVE (10 mg/kg/2 weeks starting from W3). Primary endpoints are overall response rate (ORR), defined as partial or complete response (PR or CR) according (i)RECIST1.1, and safety. Secondary endpoints include disease control rate (DCR), PFS and OS. Based on a Simon 2-stage design for ORR in each cohort (cohort A: P0=0.15, P1=0.33 / cohort B: P0=0.09, P1=0.25 / α = 0.1, β = 0.2 in both cohorts), 10 and 13 patients are required in the first stage of cohort A and B respectively. At least 2 pts have to reach PR or CR in each cohort to allow the continuation of the trial in the 2nd stage. Results: Between Oct 2018 and Jan 2020, 23 patients (median age 62 y-old, 86.9% male 78.3% left-sided, 91.3% synchronous mCRC) have been included in the first stage of the trial. No major or unexpected safety events were observed. 21.7% (5/23) of pts presented grade 3 diarrhea, all related to IRI, with complete resolution after IRI dose reduction or interruption. A reduced starting dose of IRI (150 mg/m2) was amended (09/2019) for the last included 8 pts without any grade 3-4 diarrhea occurrence. Grade 1-2 hypothyroidism was the only immune-related side effect. 3 PR were observed in cohort A and none in cohort B. DCR was 60.0% (6/10) and 61.5% (8/13) in cohort A and B respectively. Median PFS and OS were respectively 4.2 and 12.7 months (cohort A) and 3.8 and 14.0 months (cohort B). 6 months-PFS rate was 40.0% and 38.5% in cohort A and B. 12 months-OS rate was 53.3% and 57.7% in cohort A and B. The median follow-up of patients was 9.2 months. Conclusions: The AVETUXIRI trial met its primary efficacy endpoint for RAS wt mCRC pts justifying the study continuation in cohort A (2nd stage). No PR was observed in RAS-mut cohort. Nevertheless, encouraging data of DCR, PFS and OS observed in RAS mut cohort allow the opening of a new cohort for RAS-mut mCRC (cohort C) with PFS as primary endpoint. Clinical trial information: NCT03608046.

Molecular diversity of Giardia duodenalis in children under 5 years from the Manhiça district, Southern Mozambique enrolled in a matched case-control study on the aetiology of diarrhoea.

Giardia duodenalis is an enteric parasite commonly detected in children. Exposure to this organism may lead to asymptomatic or symptomatic infection. Additionally, early-life infections by this protozoan have been associated with impaired growth and cognitive function in poor resource settings. The Global Enteric Multicenter Study (GEMS) in Mozambique demonstrated that G. duodenalis was more frequent among controls than in diarrhoeal cases (≥3 loosing stools in the previous 24 hours). However, no molecular investigation was conducted to ascertain the molecular variability of the parasite. Therefore, we describe here the frequency and genetic diversity of G. duodenalis infections in children younger than five years of age with and without diarrhoea from the Manhiça district in southern Mozambique enrolled in the context of GEMS. Genomic DNA from 757 G. duodenalis-positive stool samples by immunoassay collected between 2007-2012, were reanalysed by multiplex PCR targeting the E1-HP and C1-P21 genes for the differentiation of assemblages A and B. Overall, 47% (353) of the samples were successfully amplified in at least one locus. Assemblage B accounted for 90% (319/353) of all positives, followed by assemblage A (8%, 29/353) and mixed A+B infections (1%, 5/353). No association between the presence of a given assemblage and the occurrence of diarrhoea could be demonstrated. A total of 351 samples were further analysed by a multi-locus sequence genotyping (MLSG) approach at the glutamate dehydrogenase (gdh), ß-giardin (bg) and triose phosphate isomerase (tpi) genes. Overall, 63% (222/351) of samples were genotyped and/or sub-genotyped in at least one of the three markers. Sequence analysis revealed the presence of assemblages A (10%; 23/222) and B (90%; 199/222) with high molecular diversity at the nucleotide level within the latter; no mixed infections were identified under the MLSG scheme. Assemblage A sequences were assigned to sub-assemblages AI (0.5%, 1/222), AII (7%, 15/222) or ambiguous AII/AIII (3%, 7/222). Within assemblage B, sequences were assigned to sub-assemblages BIII (13%, 28/222), BIV (14%, 31/222) and ambiguous BIII/BIV (59%, 132/222). BIII/BIV sequences accumulated the majority of the single nucleotide polymorphisms detected, particularly in the form of double peaks at chromatogram inspection. This study demonstrated that the occurrence of gastrointestinal illness (diarrhoea) was not associated to a given genotype of G. duodenalis in Mozambican children younger than five years of age. The assemblage B of the parasite was responsible for nine out of ten infections detected in this paediatric population. The extremely high genetic diversity observed within assemblage B isolates was compatible with an hyperendemic epidemiological scenario where infections and reinfections were common. The obtained molecular data may be indicative of high coinfection rates by different G. duodenalis assemblages/sub-assemblages and/or genetic recombination events, although the exact contribution of both mechanisms to the genetic diversity of the parasite remains unknown.

Analysis of Factors Affecting the Event of Diarrhea in Infants Age 0 to 2 Years

Diarrhea is the number 2 cause of death among children under five in the world, number 3 in infants, and number 5 for all ages. There are several factors that influence the occurrence of diarrhea in infants apart from infectious factors (bacterial infections, viral infections, parasitic infections, parenteral infections). Other contributing factors are attainment of breastfeeding, food factors, and water sources used daily. The aim of this literature review is to analyze the factors that influence the incidence of diarrhea in infants aged 0 to 2 years. a process using the search stage to conduct a literature review. A search of relevant databases as well as literature and reference lists of included studies was carried out. An analysis of 10 journals conducted by researchers showed that infants aged 10 months who were fully breastfed when associated with diarrhea had lower scores (OR = 0.59, 95% CI 0.43-0.82), while children -children who received food and candy or milk were associated with an increased prevalence of diarrhea, namely (OR = 1.64, 95% CI 1.22-2.22 and OR = 1.67, 95% CI 1.21-2.30 ). And 2.58 times higher in homes with damaged water filters (OR = 2.58, 95% CI 0.1, 10.1) compared to homes with working water filters. 15% of families with good water filters reported diarrhea, while 31% of families with damaged water filters reported diarrhea. Exclusive breastfeeding for up to 6 months can reduce the risk of diarrhea in infants.