Oral Rehydration Research Articles

Metformin Hydrochloride Significantly Inhibits Rotavirus Infection in Caco2 Cell Line, Intestinal Organoids, and Mice.

Rotavirus is one of the main pathogens that causes severe diarrhea in children under the age of 5, primarily infecting the enterocytes of the small intestine. Currently, there are no specific drugs available for oral rehydration and antiviral therapy targeting rotavirus. However, metformin hydrochloride, a drug known for its antiviral properties, shows promise as it accumulates in the small intestine and modulates the intestinal microbiota. Therefore, we formulated a hypothesis that metformin hydrochloride could inhibit rotavirus replication in the intestine. To validate the anti-rotavirus effect of metformin hydrochloride, we conducted infection experiments using different models, ranging from in vitro cells and organoids to small intestines in vivo. The findings indicate that a concentration of 0.5 mM metformin hydrochloride significantly inhibits the expression of rotavirus mRNA and protein in Caco-2 cells, small intestinal organoids, and suckling mice models. Rotavirus infections lead to noticeable pathological changes, but treatment with metformin has been observed to mitigate the lesions caused by rotavirus infection in the treated group. Our study establishes that metformin hydrochloride can inhibit rotavirus replication, while also affirming the reliability of organoids as a virus model for in vitro research.

Water, mineral, and blood acid-base balance in calves with naturally occurring diarrhea receiving two alternative oral rehydration solutions or a placebo

Quantifying the water and mineral losses in feces is essential to determine the optimal composition of oral rehydration solutions (ORS) for diarrheic animals. In a randomized complete block design, this study evaluated water, mineral, and blood acid-base balance of calves with naturally occurring diarrhea receiving ORS or a placebo. On d 0, 45 calves (age: 18 ± 3.2 d; mean ± SD) were selected based on the presence of visual signs of diarrhea, such as dirty tail or wet feces, along with clinical symptoms evaluated by measuring the skin turgor and the degree of enophthalmos. On d 1, calves were divided into blocks of 3 animals based on blood base excess (BE) measured at 0900 h, and within each block, calves were randomly assigned to 1 of 3 treatments (15 calves per treatment) including (1) a hypertonic ORS (HYPER; Na+ = 110 mmol/L; 370 mOsm/kg; strong ion difference [SID] = 60 mEq/L), (2) a hypotonic ORS with low Na+ (HYPO; Na+ = 77 mmol/L; 278 mOsm/kg; SID = 71 mEq/L), and (3) a placebo consisting of lukewarm water with 5 g/L of whey powder (CON). Milk replacer (MR) was fed through teat buckets twice daily at 0630 h and 1700 h in 2 equally sized meals of 2.5 L from d 1 to 3 and of 3.0 L on d 4 and 5. Treatments consisting of 2.0 L lukewarm solutions were administered between milk meals from d 1 to 3 at 1200 h and 2030 h through teat buckets. Refusals of MR and treatments were recorded daily, and blood samples were collected from the jugular vein once daily at arrival in the afternoon of d 0 and at 0900 h from d 1 to 5 after arrival. Urine and feces were collected quantitatively over a 48-h period from 1200 h on d 1 to 1200 h on d 3, and a representative sample of each 24-h period was stored. In addition, the volume of extracellular fluid was evaluated on d 2 by postprandial sampling over a 4-h period relative to the injection of sodium thiosulfate at 1300 h. Total daily fluid intake (MR, treatment, and water) from d 1 to 3 was greater in HYPER (LSM ± SEM; 8.9 ± 0.36 L/d) and HYPO (7.8 ± 0.34 L/d) than in CON (6.6 ± 0.34 L/d). This resulted in a greater water balance (water intake - fluid output in urine and feces) in calves receiving ORS (59.6 ± 6.28 g/kg BW per 24 h vs. 39.6 ± 6.08 g/kg BW per 24 h). Fecal Na+ losses were greater in HYPER than in the other treatments (81 ± 12.0 mg/kg BW per 24 h vs. 24 ± 11.8 mg/kg BW per 24 h). Blood pH was higher in HYPO (7.41 ± 0.016) than CON (7.35 ± 0.016) over the 5 monitoring days, whereas HYPER (7.37 ± 0.017) did not differ with other treatments. In this experimental model, diarrheic calves were likely unable to absorb the high Na+ load from HYPER, resulting in greater Na+ losses in feces, which might have impaired the alkalinizing capacity of HYPER. In contrast, HYPO significantly sustained blood acid-base balance compared with CON, whereas HYPER did not. This suggests that low tonicity ORS with a high SID are more suitable for diarrheic calves.

Calcium-sensing receptor activator cinacalcet for treatment of cyclic nucleotide-mediated secretory diarrheas

Cyclic nucleotide elevation in intestinal epithelial cells is the key pathology causing intestinal fluid loss in secretory diarrheas such as cholera. Current secretory diarrhea treatment is primarily supportive, and oral rehydration solution is the mainstay of cholera treatment. There is an unmet need for safe, simple and effective diarrhea treatments. By promoting cAMP hydrolysis, extracellular calcium-sensing receptor (CaSR) is a regulator of intestinal fluid transport. We studied the antidiarrheal mechanisms of FDA-approved CaSR activator cinacalcet and tested its efficacy in clinically relevant human cell, mouse and intestinal organoid models of secretory diarrhea. By using selective inhibitors, we found that cAMP agonists-induced secretory short-circuit currents (Isc) in human intestinal T84 cells are mediated by collective actions of apical membrane cystic fibrosis transmembrane conductance regulator (CFTR) and Clc-2 Cl− channels, and basolateral membrane K+ channels. 30 μM cinacalcet pretreatment inhibited all 3 components of forskolin and cholera toxin-induced secretory Isc by ∼75%. In mouse jejunal mucosa, cinacalcet inhibited forskolin-induced secretory Isc by ∼60% in wild type mice, with no antisecretory effect in intestinal epithelia-specific Casr knockout mice (Casr-flox; Vil1-cre). In suckling mouse model of cholera induced by oral cholera toxin, single dose (30 mg/kg) oral cinacalcet treatment reduced intestinal fluid accumulation by ∼55% at 20 hours. Lastly, cinacalcet inhibited forskolin-induced secretory Isc by ∼75% in human colonic and ileal organoids. Our findings suggest that CaSR activator cinacalcet has antidiarrheal efficacy in distinct human cell, organoid and mouse models of secretory diarrhea. Considering its excellent clinical safety profile, cinacalcet can be repurposed as a treatment for cyclic nucleotide-mediated secretory diarrheas including cholera.

Post-exercise Rehydration: Comparing The Efficacy Of Three Commercial Oral Rehydration Solutions

Post-exercise Rehydration: Comparing The Efficacy Of Three Commercial Oral Rehydration Solutions

Effect of preoperative oral rehydration before cesarean section on ultrasound assessment of gastric volume and intraoperative hemodynamic changes: a randomized controlled trial

BackgroundCesarean section often requires an urgent transfusion load due to decreased blood pressure after spinal anesthesia. This prospective randomized study aimed to investigate whether a preoperative oral rehydration solution (ORS) stabilized perioperative circulatory dynamics.MethodsSixty-three parturients scheduled for cesarean section under combined spinal epidural anesthesia (CSEA) were randomly allocated to one of three groups: Group O received 500 mL ORS before bedtime and 500 mL 2 h before CSEA; Group M received mineral water instead of ORS; and Group C had no fluid intake (controls). After entering the operating room, stomach size was measured using ultrasound. Blood samples were obtained, and CSEA was induced. Vasopressors were administered when systolic blood pressure was < 90 mmHg or decreased by > 20%. As a vasopressor, phenylephrine (0.1 mg) was administered at ≥ 60 beats/min heart rate or ephedrine (5 mg) at < 60 beats/min heart rate. The primary outcome was the total number of vasopressor boluses administered. Secondary outcomes were the cross-sectional area of the stomach antrum, maternal plasma glucose levels, serum sodium levels, total intravenous fluid, bleeding volume, urine volume, operative time, and cord blood gas values after delivery.ResultsThe total number of vasopressor boluses was lower in Group O than in Group C (P < 0.05). Group O had lower total dose of phenylephrine than Group C (P < 0.05). There were no significant differences between Group M and other groups. No differences were detected regarding secondary outcomes.ConclusionsIn women scheduled for cesarean section, preoperative ORS stabilized perioperative circulatory dynamics. Neither ORS nor mineral water consumption increased the stomach content volume.Trial RegistrationThis trial is registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000019825: Date of registration 17/11/2015).

Evaluation of antidiarrheal properties of leaf extracts of Acioa barteri (Chrysobalanaceae) in Wister albino mice

Diarrhea remains one of the most important health issues worldwide, with high morbidity and mortality rates, accounting for more than two million deaths annually. Oral rehydration therapy (ORT) is central to the management of diarrhea, and is sufficient to prevent complications due to dehydration in most patients while the disease runs its course. However, ORT has no effect on the duration of the disease or frequency of bowel motions, and any agent that could meet these needs would therefore be a useful addition to ORT. The aim of the study is to evaluate the antidiarrheal properties of the leaf extract of Acioa barteri (Chrysobalanaceae) in Winster albino mice. The pulverized leaves were extracted by cold maceration using methanol with for three (3) days.Castor oil (1ml/kg) was used to induce diarrhea in mice through the oral route of administration followed by two different doses of plant extract (250mg/kg and 500mg/kg) administered orally to the test groups while Loperamide (2mg/kg body weight) was used as the positive control. Gastrointestinal motility test (Charcoal meal test) and Castor oil induced enteropooliong were also used to evaluate the antidiarrheal activity of A. barteri. All samples were administered once, and the duration of the study was six hours. The result shows that in castor oil induced diarrhea, the extract, 250mg/kg and 500mg/kg showed significant inhibition of defecation by 43.52 % and 71.48 % respectively and 2mg/kg of loperamide showed an inhibition of 70.80 %. The gastrointestinal motility test of the extract, 250mg/kg and 500mg/kg showed significant inhibition of defecation by 40.66% and 80.48% respectively while 2mg/kg of loperamide showed an inhibition of 78.92 %. From the result of the castor oil induced enteropooling, the extract, 250mg/kg and 500mg/kg showed significant inhibition of defecation by 51.27 % and 82.41 % respectively and 2mg/kg of loperamide showed an inhibition of 79.89%. The result clearly indicates antidiarrheal properties of Acioa barteri leaf extract, which could be a therapeutic option against diarrheal disease and useful therapeautic addition to the oral rehydration therapy.

Effect of Zinc Supplementation on Duration of Acute Watery Diarrhoea in Children aged Six Months to Five Years

Background: Diarrheal disease is one of the leading causes of morbidity and mortality among young children under five years of age in developing countries. The longer duration of diarrhea increases the chance of morbidity and mortality. Zinc supplementation decreases the duration of diarrhea. It is a straightforward, acceptable, low-cost, and effective treatment that could easily be affordable in our country.&#x0D; Objective: This study aimed to determine the effect of zinc supplementation on the duration of acute watery diarrhea. Materials and Methods: A total of 106 subjects were included in this study over six months, from December 2014 to May 2015. Detailed information was obtained from each patient. A total of 106 patients were taken. Among them, 53 patients (group A) were given zinc with Oral Rehydration Salts (ORS), and 53 patients (Group B) were given ORS only. However, three patients in each group were lost during follow-up. Data were analyzed by using a standard statistical method (SPSS version 16.0).&#x0D; Results: The duration of diarrhea was three days in 56% of patients in the zinc-supplemented group, but it was only 20% in the control group. The frequency of stool gradually decreased over five days. It was more marked in zinc supplemented group. The p-value was 0.001. Vomiting occurred in 30% of patients in zinc supplemented group, and in the control group, it was only 20%. The p-value was 0.5. So we conclude that oral zinc administration in acute watery diarrhea (AWD) decreases the duration and causes early recovery and may be considered in the management of AWD.&#x0D; Conclusion: Oral zinc administration in acute watery diarrhea decreases the duration and frequency of diarrhea in children aged six months to five years by changing the natural course of acute diarrheal disease.&#x0D; TAJ 2022; 36: No-1: 107-112

Assessment of availability and challenges of WHO recommended priority life-saving medicines for under five-year children in primary public health facilities of Amhara region

BackgroundThe world health organization (WHO) priority lifesaving medicines are medicines recommended for the prevention and treatment of leading causes of under-five morbidity and mortality. They should be available in all health systems and at all times. However, the availability of these medicines and its determinants is not well studied in Ethiopia in general and in primary public health facilities Amhara region in particular.ObjectiveThe study aimed to assess the availability and challenges of the WHO-recommended priority lifesaving medicines for under-five children in primary public health facilities of the Amhara region.MethodsA cross-sectional study design was conducted from February to December 2020 in 98 health centers and 22 primary hospitals in the Amhara region, Ethiopia. Facilities were selected with a simple random sampling technique. The data were collected through a pretested and structured questionnaire. Binary logistic regression was used to identify predictors associated with availability of WHO-recommended priority lifesaving medicines for under-five children.ResultsThe availability of oral rehydration salt was high (82.5%) and the availability of vitamin A (47.5%), morphine tablet (13.3%), and artesunate rectal suppository (7.5%) were within low and very low WHO range respectively. Budget adequacy (AOR = 12.9 CI= (2.1–78.2)), periodic review of stock level ((AOR = 13.4,CI=(1.9–92.0)), training on integrated pharmaceutical logistic system ((AOR = 4.5,CI=(1.0-20.5)), inclusion of WHO priority under five children facility specific medicine list (AOR = 12.4,CI=(2.3–66.4)), lead time for EPSA(Ethiopia Pharmaceutical Supply Agency) procurement (AOR = 7.9,CI=(1.3–44.8)) were significantly associated with availability of all WHO priority lifesaving medicines for under- five children.ConclusionThe average availability of WHO-recommended priority lifesaving medicines for under-five children was low. The habit of updating bincard and adoption of the life-saving medicine list were the independent predictors of medication availability.

Clinical Profile of Acute Gastroenteritis in Children at a Tertiary Centre

Introduction: Acute gastroenteritis accounts for millions of deaths each year in young children, mostly in developing communities. diarrhoea, vomiting and fever are the most common presenting symptoms. The aim of the study was to describe the clinical profile of Acute Gastroenteritis in children at National Medical College and Teaching Hospital, Birgunj Materials and Methods: This descriptive cross-sectional study was carried out in pediatric ward and Intensive Care Unit at National Medical College and Teaching Hospital, Birgunj, Nepal for 6 months (November 2021 to April 2021). Ethical clearance and informed written consent were taken for the study. Results: Among 138 cases enrolled in the study, most common symptoms were diarrhoea, vomiting and fever. Signs of some dehydration was seen in 39.1% of the cases whereas 4.4% cases had signs of severe dehydration. Oral rehydration Solution (ORS) was mainstay of treatment along with zinc and probiotics. Antibiotics was used in 52.2% cases. Among all the cases, 75.4% cases and their caretakers did not routinely wash their hands. Conclusions: Diarrhoea, vomiting and fever are the most common symptoms in acute gastroenteritis. Use of ORS and zinc is recommended for the management in acute gastroenteritis in children. Antibiotic therapy should be used judiciously in the management of acute gastroenteritis. Increase awareness among the public about proper hand washing and hygiene can significantly reduce the incidence of diarrhoea and other infectious diseases in children.

Child Nutrition Outcomes and Maternal Nutrition-Related Knowledge in Rural Localities of Mbombela, South Africa.

Poor nutrition outcomes among children have become one of the major public health concerns in South Africa, attributed to poor feeding practices and maternal nutrition-related knowledge with conflicting data. In view of this, a cross-sectional study was conducted to determine the association of nutrition outcomes of children aged under two years with feeding practices and maternal nutrition-related knowledge in Mbombela, South Africa. Mothers' nutrition-related knowledge was estimated using an adapted structured questionnaire on colostrum, continued breastfeeding, diarrhea prevention and treatment using oral rehydration solution, immunization, and family planning, and scored as excellent (80-100), good (60-79), average (40-59), and fair (0-39). This was along with questions on socio-demographic factors and obstetric history, as well as anthropometric measurements. Child nutrition outcomes were estimated by WHO classification using z-scores for stunting (length-for-age (LAZ)), underweight (weight-for-age (WAZ)), and thinness (body mass index-for-age (BAZ)). Using STATA 17, 400 pairs of children (8 ± 6 months) and their mothers (29 ± 6 years) participated in the study and were living in a poor socio-economic status environment. Half of children were stunted (50%) and over half (54%) were obese, while mothers were underweight (39%) and overweight (34%). In addition to one third of mothers reporting obstetric complications, two thirds, initiated breastfeeding within one hour of delivery, 30% exclusively breastfed, 48% introduced early complementary feeding, and 70% practiced mixed feeding. Twenty-eight percent (28%) of mothers had fair nutrition-related knowledge, while 66% had average knowledge, 6% good knowledge, and none of the mothers had excellent knowledge. A chi-square test showed that mothers' nutrition-related knowledge was significantly associated with child stunting. The final hierarchical logistic regression showed significant associations of stunting with mothers' nutrition-related knowledge (average: AOR = 1.92, 95%CI: 1.12-3.29), child's age (6-11 months: AOR = 2.63, 95%CI: 1.53-4.53 and 12-23 months: AOR = 3.19, 95%CI: 1.41-7.25), and education (completing Grade 12: AOR = 0.36, 95%CI: 0.15-0.86). Contextual and intensified interventions on continued education for mothers to gain accurate information on nutrition-related knowledge and feeding practices could ultimately enhance child nutrition outcomes in poorer settings. Efforts should therefore be made to ensure that nutrition knowledge is appropriately provided based on the phases of child growth from 0 to 2 years, even beyond infancy into school age.

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

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

The influence of sex on the treatment of postural tachycardia syndrome in children.

There are differences in postural tachycardia syndrome (POTS) incidence and manifestations in children between the sexes. However, there is limited evidence on how the gender affects the prognosis of POTS in children. This study is aimed at exploring the differences between the sexes regarding the prognosis of children with POTS. A retrospective study was conducted on children (n = 53; aged 6-14 years) who were diagnosed with POTS. All the POTS patients were given health education and autonomic function training, their water and salt intake was increased (oral rehydration salt III, 250 mL, Bid), and they were administered oral metoprolol (1 mg/kg per day) for 3 months. The prognosis was defined by the head-up tilt test results after treatment. It was observed that male and female children exhibited different trends in POTS prognosis. Further, the sex showed a stable independent effect on prognostic in children with POTS. To elaborate, females had a 503% increased risk of poor prognosis compared to males. We hence hypothesize that there is an association between the sex and the POTS prognosis in children. Female patients have a significantly higher risk of poor prognosis compared to males. A slight increase in the dose of oral rehydration salt could help lower the risk of poor prognosis in children with POTS. A higher absorption of total metoprolol, lower local concentrations, and slower metabolic excretion are documented in research in female POTS patients during treatment. It is recommended that the optimal dose of metoprolol should be lowered in female children undergoing treatment, to limit the risk of poor prognosis.

Influence of SGLT1 Sugar Uptake Inhibitors on Water Transport.

Sodium glucose cotransporters (SGLTs) are cotransporters located in the cell membrane of various epithelia that uptake glucose or galactose and sodium into the cell. Its founding member, SGLT1, represents a major pharmaceutically relevant target protein for development of new antidiabetic drugs, in addition to being the target protein of the oral rehydration therapy. Previous studies focused primarily on the transport of substrates and ions, while our study focuses on the effect of water transport. SGLT1 is implicated in the absorption of water, yet the exact mechanism of how the water absorption occurs or how inhibitors of SGLT1, such as phlorizin, are able to inhibit it is still unclear. Here we present a comprehensive study based on molecular dynamics simulations with the aim of determining the influence of the energetic and dynamic properties of SGLT1, which are influenced by selected sugar uptake inhibitors on water permeation.

Comparative Evaluation of Maintenance of Cell Viability of an Experimental Transport Media "Ringer's Lactate" with Dextrose Normal Saline ORS Egg White and Infant Milk Formula for Transportation of an Avulsed Tooth.

The viability of the periodontal ligament (PDL) cells on the root surface of the avulsed tooth determines the prognosis of the replanted tooth, which in turn is determined by a suitable transport medium in which the tooth was stored. The aim of the present study is to evaluate and compare the effectiveness of Ringer's lactate (RL) as a storage medium for an avulsed tooth in maintaining the PDL cell viability with dextrose normal saline (DNS), oral rehydration salt (ORS), egg white (EW), and infant milk formula (IMF). A total of 85 freshly extracted human teeth were divided into five experimental groups and two control groups. The positive and negative controls corresponded to 0-minute and 8-hour dry time, respectively. The experimental teeth were stored dry for 30 minutes and then immersed in one of five experimental media (RL, DNS, ORS, EW, and IMF) for 45 minutes. The teeth were then treated with collagenase type III and trypsin for 10 minutes. The number of viable PDL cells was counted with a hemocytometer and analyzed. Statistical analysis showed that IMF, RL, and EW had no statistically significant differences among them in maintaining the viability of the PDL cells but were significantly better than DNS. No statistically significant difference between RL, EW, and ORS in the number of viable PDL cells. Infant milk formula (IMF), RL, and EW showed similar results within the parameters of the study; they can be used as alternative storage media for avulsed teeth. DNS showed poor results, and ORS could serve as short-term storage media if the other solutions are not readily available. The search for an appropriate storage media with favorable pH and osmolality along with easy availability is the basic thought behind this study. Kumar P, Kotumachagi SS, Fabi AJ, et al. Comparative Evaluation of Maintenance of Cell Viability of an Experimental Transport Media "Ringer's Lactate" with Dextrose Normal Saline ORS Egg White and Infant Milk Formula for Transportation of an Avulsed Tooth. Int J Clin Pediatr Dent 2023;16(3):453-458.

A Randomized Trial of Inpatient and Home-Based Maternal Oral Hydration Therapy in Isolated Oligohydramnios and Its Effect on Amniotic Fluid Index and Perinatal Outcome.

Background Isolated oligohydramnios, without any known fetal/maternal abnormality, may be associated with insufficient oral intake (such as water, glucose, and rehydration therapy). Therefore, the present study was conducted to assess the improvement following maternal hydration. Method A total of 50 cases of isolated oligohydramnios (other high-risk pregnancy conditions not present) were included in the study (25 in each group). Patients were encouraged for an additional 2 liters of oral rehydration solution intake daily along with regular diet. The fluid intake was unsupervised in the home group and supervised in the hospital group. Serial amniotic fluid index (AFI) measurements and fetal monitoring were performed. Birth weight and APGAR scores were recorded, and data were analyzed. Results The two groups were comparable in terms of demographics and baseline laboratory findings. AFI significantly improved in the hospital group compared to the home group (p-value: <0.001). Birth weight, placental weight, and APGAR scores were also significantly better in the hospital group than in the home group. Conclusion Maternal oral hydration therapy improves the amniotic fluid volume and subsequently improves the perinatal outcome. Due to poor compliance with home-based treatment, institution of supervised hydration therapy is recommended.

Assessment of Dispensing Malpractice in Community Drug Retail Outlets in South Gondar Zone, Northwest Ethiopia: A Simulated Patient Experience.

Pharmacy professionals in community drug retail outlets, as the most accessible personnel for the community, are engaged in consultation and responding to health problems in addition to filling prescriptions. In doing so, different dispensing malpractices are observed and much is not known on the issue in Ethiopia. The study aimed at assessing dispensing malpractice at pharmacies, drug stores and drug vendors in South Gondar zone. A cross-sectional study design with a descriptive approach was applied from April 1 to June 30. The data was collected using the simulated patient method. Seven prescription-only medicines and a diarrheal case were requested during visit. All drug retail outlets in South Gondar zone that were in service during data collection were visited. Almost all prescription-only medications were dispensed without prescription at all community drug retail outlets. Of all the dispensaries, 19 (82.6%) provided a partial dosage regimen of amoxicillin. Presence of fever and pregnancy status were asked about by dispensers in only 8% and 20% of visits for diarrhea, respectively. Medication history was also rarely requested. Medication was dispensed in 80% of visits for diarrhea, all of which included antimicrobials. Oral rehydration salt was considered in only two (10%) dispensaries. Dispensing medications without a prescription is common in community drug retail outlets in South Gondar zone in Amhara Regional State. Our findings also showed that detailed assessments of patients' signs and symptoms are not performed properly by the dispensers to understand the diarrheal case. Training of pharmacy professionals and strict regulatory control are needed.

A case report of acute food protein-induced enterocolitis syndrome to walnut

BackgroundFood protein-induced enterocolitis syndrome (FPIES) is a delayed, non-IgE-mediated food allergy. This syndrome was once thought to be rare, but emerging literature suggests an increasing incidence along with more foods being implicated. Also, with the introduction of guidelines on early peanut introduction, peanut-induced FPIES seems to be increasing in Australia and USA. Although most patients are diagnosed with FPIES within the first year of life, most commonly with food triggers to cow’s milk or soy, other phenotypes exist in comparison to this classic presentation. In this case report, we present a patient with late onset of acute FPIES at age 3 to walnut.Case PresentationWe describe a case of FPIES in a 12-year-old boy who had recurrent episodes of repetitive emesis, that began at age 3, each time after consuming walnuts. Mom does not give a history of intentional feeding (or avoidance) of walnut and/ or pecans. She also described possible reactions with pine nuts and macadamia. He was assessed with an oral food challenge to walnut, which triggered an episode of acute FPIES. He developed vomiting with onset 2 h post-ingestion, pallor, lethargy, and required an emergency department visit for anti-emetic medications and oral rehydration therapy. He improved on the therapy and now avoids cashew, pistachio, hazelnuts, walnuts, pecans, pine nuts, and macadamia nuts.ConclusionsThis case report adds to the limited literature that exists on culprit food allergens in FPIES. We present an acute FPIES triggered by the ingestion of walnuts. The diagnosis, common food triggers, and natural history of FPIES are described. There remains a lack of information on the natural history of FPIES, especially towards uncommon food triggers and on FPIES that present beyond infancy.

Estimation of Serum Zinc and Copper in Children with Acute Diarrhea

Diarrhoea is a disease related to nutrition as it involves the loss of fluid and electrolytes. The death rate in children due to diarrhoea is high because of undernutrition, even if they are well-hydrated. In this examination, we sought out the concentrations of copper and zinc in the serum of children diseased with acute diarrhoea, before and after the therapy of standard ORS (oral rehydration solution) therapy and associated it with the severity of diarrhoea and its period. Children involved in the examination were 110 in number, who were diseased with acute diarrhoea. The concentrations of zinc and copper in the serum of children with acute diarrhoea were noted before (at the time of entrance) and after treating them with standard oral rehydration solution (ORS) therapy. This research showed that the levels of zinc and copper in the serum of children diseased with acute diarrhoea, declined significantly to 13% and 12.8%, respectively, from their normal serum concentrations. After treatment with ORS therapy, a further decrease of 22.4% and 22.6% is seen in the concentration of zinc and copper, respectively. Our research showed that the children who were having a very low level of zinc and copper in the plasma were more prone to be diseased with acute diarrhoea and even more severely and with longer duration.

Drug utilization patterns in pediatric population in tertiary care hospital – an observational study

Objective: This observational study aimed to investigate the drug utilization patterns in the pediatric population at a tertiary care hospital. Methodology: The structured questionnaire was specially designed including demographic profiles, illness history, prescription regimen of pediatric group patients. Data were collected from medical records and prescriptions of pediatric patients who visited the hospital from (starting date) and (end date). The study analyzed the diagnosed condition and medication usage trends among recruited pediatric patients. Results: A total of 320 prescriptions (75% OPD and 18% IPD) of children visited in pediatric department were analyzed; with an age group of between 0 to 1 year (42%) and 1 to 2 year (32%). Among 320 participants, males were (51.2%) and females were (48.8%). The study observed the significant uses of drugs prescribed for fever (52%), acute diarrhea (48%), respiratory diseases (24.5%), gastrointestinal disorders (17.3%), and infectious diseases (15.6%). Most commonly prescribed drugs were paracetamol syrup (52%), phenylephrine (48%), zinc (41%), oral rehydration solution (44%), vitamin (46%), levocetirizine (25%), and antibiotics (34%). Most widely prescribed antibiotic group was Cephalosporins. Other prescribed medicines were domperidone, ondansetron, diazepam, etc. Conclusion: The study provided valuable insights into the drug utilization patterns, including commonly prescribing medications, adherence to guidelines and potential areas for improvement in pediatric healthcare.

Gastrointestinal tract and viral pathogens.

Viral gastroenteritis is the most common viral illness that affects the gastrointestinal (GI) tract, causing inflammation and irritation of the lining of the stomach and intestines. Common signs and symptoms associated with this condition include abdominal pain, diarrhea, and dehydration. The infections commonly involved in viral gastroenteritis are rotavirus, norovirus, and adenovirus, which spread through the fecal-oral and contact routes and cause non-bloody diarrhea. These infections can affect both immunocompetent and immunocompromised individuals. Since the pandemic in 2019, coronavirus gastroenteritis has increased in incidence and prevalence. Morbidity and mortality rates from viral gastroenteritis have declined significantly over the years due to early recognition, treatment with oral rehydration salts, and prompt vaccination. Improved sanitation measures have also played a key role in reducing the transmission of infection. In addition to viral hepatitis causing liver disease, herpes virus, and cytomegalovirus are responsible for ulcerative GI disease. They are associated with bloody diarrhea and commonly occur in im-munocompromised individuals. Hepatitis viruses, Epstein-Barr virus, herpesvirus 8, and human papillomavirus have been involved in benign and malignant diseases. This mini review aims to list different viruses affecting the GI tract. It will cover common symptoms aiding in diagnosis and various important aspects of each viral infection that can aid diagnosis and management. This will help primary care physicians and hospitalists diagnose and treat patients more easily.