Presence Of Diarrhea Research Articles

Effect of tolfenamic acid in postpartum gilts and the performance of their piglets

Postpartum dysgalactia syndrome (PPDS) is a common disorder affecting sows in intensive production systems. In most cases, hypogalactia is not clearly identified and assumes a subclinical aspect. Therefore, the present study aimed to evaluate the effect of a nonsteroidal anti-inflammatory drug (NSAID) based on tolfenamic acid as a prophylactic treatment for PPDS and the performance of suckling piglets. Gilts (n = 319) were randomly divided into two groups: a tolfenamic acid group (n = 157) and a control (n = 162). The tolfenamic acid group received a single intramuscular injection (1 ml/20 kg of 4% tolfenamic acid) after farrowing, whereas the control group received no treatment. The occurrence of PPDS was confirmed. All piglets (n = 4,466) were weighed at 1, 4, and 18 days of age. All litters were evaluated for weight gain, the occurrence of diarrhea, and mortality between 4 and 18 days of age. PPDS variables were analyzed using logistic regression. Piglet weights were analyzed based on covariance while considering the effects of initial weight and the presence of diarrhea. Tolfenamic acid had no significant effect on the incidence of PPDS. The tolfenamic acid group had a 0.41% lower piglet mortality rate until 18 days of age. Tolfenamic acid administered prophylactically to gilts after farrowing reduced piglet mortality during lactation and promoted weight gain.

Prevalence of bovine coronavirus in cattle in China: A systematic review and meta-analysis

Bovine coronavirus (BCoV) is one of the important pathogens that cause calf diarrhea (CD), winter dysentery (WD), and the bovine respiratory disease complex (BRDC), and spreads worldwide. An infection of BCoV in cattle can lead to death of young animals, stunted growth, reduced milk production, and milk quality, thus bringing serious economic losses to the bovine industry. Therefore, it is necessary to prevent and control the spread of BCoV. Here, a systematic review and meta-analysis was conducted to assess the prevalence of BCoV in cattle in China before 2022. A total of 57 articles regarding the prevalence of BCoV in cattle in China were collected from five databases (PubMed, ScienceDirect, CNKI, VIP, and Wan Fang). Based on the inclusion criteria, a total of 15,838 samples were included, and 6,136 were positive cases. The overall prevalence of BCoV was 30.8%, with the highest prevalence rate (60.5%) identified in South China and the lowest prevalence (15.6%) identified in Central China. We also analyzed other subgroup information, included sampling years, sample sources, detection methods, breeding methods, age, type of cattle, presence of diarrhea, and geographic and climatic factors. The results indicated that BCoV was widely prevalent in China. Among all subgroups, the sample sources, detection methods, breeding methods, and presence or absence of diarrheal might be potential risk factors responsible for BCoV prevalence. It is recommended to strengthen the detection of BCoV in cattle, in order to effectively control the spread of BCoV.

P139 Inflammatory bowel disease and impairment of working life

Abstract Background Inflammatory bowel disease(IBD) is a lifelong illness that mainly affects patients of working age with a significant impact on their professional life. In fact, the maintenance and promotion of employees is one of the important social goals and can be considered as a determinants of health for IBD patients. The aim of the study was to analyze the impact of disease on the working life among IBD patients and to characterize the breadth of challenges they experience in their workplace. Methods We conducted a cross-sectional study including working patients followed for IBD, over a 9-months period. We collected sociodemographic, clinico-biological and evolutionary data. We performed a survey among these patients using a self-report questionnairy on employment status, IBD-related difficulties at work and sick leave. Results We included 45 patients: 80% Crohn disease and 20% ulcerative colitis. The mean age was 44 years [20-72], the sex-ratio M/F was 0.7 and the average of follow-up was 9 years [1-18]. Civil servants represented 33% of the total population, those in the private sector 47%, and those in the liberal profession 20%. The most important socio-professional category was manual workers with 51%. Thirty-seven patients(82%) developed their disease after being employed with a mean delay of 142 months[2-648]. The average number of working hours per week was 38.84 [9-60]. The majority of the employees worked full time(84%), only seven subjects worked part-time, two of them because of their IBD. One in three patients claimed to have been exposed to at least one harmful agent during their professional career. The main complaint reported by the patients during the daily work was about physical fatigue (69%). The digestive symptoms were mainly abdominal pain(53%) evaluated according to VAS with a mean intensity of 2.8 [0 - 10], subocclusive syndrome(40%), presence of diarrhea(38%), incontinence and fecal impaction(22%) which was worsened by the absence of accessible restrooms(33%). Psychological repercussions such as anxiety and depression were mentioned in 27% of cases. The average absenteeism during the last twelve months was 49.6 days [0-240] and the average number of hospitalization days was 30.7 [0-150]. Twenty patients(44%) claimed that they were subject to a salary restriction because of their illness. Only five people had alreadỳ benefited from a contact with the occupational medicine and health service. Conclusion IBD has a negative impact on the working life of patients, due to uncomfortable symptoms, days of absenteeism, and unadapted workplaces, which can affect career plans, professional achievement, and income. Appropriate supports and accommodations to the workplace are needed in order to improve their working experience.

Gastroenterological disorders in patients with COVID-19

Introduction - It was found that the frequency of symptoms from the gastrointestinal tract (gastrointestinal tract) in COVID-19 infection varies between 11.4-50. Cases of manifestation of the disease with gastroenterological symptoms are reported, appearing on average 1-5 days before the development of respiratory symptoms. The course of the disease with the presence of diarrhea and vomiting without fever and other classical manifestations is described. The purpose is to review the scientific literature on the analysis of the leading pathogenetic factors in the formation of intestinal syndrome in a new coronavirus infection. Material and methods. The scientific literature was searched in the Web of Science, Scopus, PubMed and RSCI databases for the following keywords: coronavirus infection, intestinal syndrome. Search depth - 3 years. Results. The study revealed clinical manifestations of the gastrointestinal tract (gastrointestinal tract) in COVID-19 infection, their main mechanisms and the frequency of occurrence of certain symptoms in practice

Molecular analysis of canine circovirus in dogs from animal shelters in Belém, Pará, northern Brazil: first detection at the amazon region.

The canine circovirus (CanCV) is a single-stranded DNA virus that has become an important emerging virus associated with gastroenteritis in dogs worldwide. In the present study, the CanCV was detected by PCR in 15% (22/147) of dogs from animal shelters in Belém, between 2019 and 2020. We observed an association between the CanCV infection and the presence of diarrhea in animals younger than one year of age (p > 0.01). The Brazilian strains were grouped in Chinese genotypes, with 99.54 to 100% nucleotilde homology. The GMRF Bayesian Skyride used the molecular clock model, which was the best suited technique to plot the dataset. The most recent common ancestor (TMRCA) was estimated in 2017, with the evolution rate of 1.6 x 10-3 s/s/y. The viral family diversity was also investigated, with emphasis on the families of the enteric pathogenic viruses Parvoviridae, Picornaviridae and Astroviridae, which were detected in the CanCV positive pooled samples. This study highlights the importance of the CanCV as an emergent virus that causes diarrhea in Brazilian dogs. The results found herein contribute to the understanding of the role of CanCV in enteric diseases and in the evolutionary molecular characterization of the circulating genotypes. Furthermore, we increased the understanding of the fecal virome in dogs with diarrhea, providing data for the monitoring and prevention viral gastroenteric diseases in domestic animals.

Ocorrência de criptosporidiose bovina no Brasil – Revisão sistemática

ABSTRACT Protozoa of the genus Cryptosporidium are parasites capable of causing animal rearing losses due to diarrhea outbreaks. This review aimed to determine the prevalence of and potential risk factors for bovine cryptosporidiosis in Brazil. The search was carried out in the databases Science Direct, Scopus, Web of Science, and SciELO. The search strategy used the descriptors “Cryptosporidium,” “cryptosporidiosis,” “cattle,” “calves,” and “Brazil.” Nine studies conducted in different Brazilian states between 2008 and 2019 were selected. The age of the evaluated animals ranged from 0 to >36 months. The main risk factors were the low age of the animals, collective pens, presence of diarrhea, contact with other animals, and dairy breed. The average prevalence rate was 30.51%. The species identified were C. ryanae, C. parvum, and C. bovis. Optical microscopy was used as a diagnostic method for oocysts in fecal samples and to determine the species, and PCR was used in three studies. The average prevalence of Cryptosporidium spp. in cattle in Brazil was 30.51%, ranging from 10.2 to 62.5%. The main risk factors found were young animals, the presence of animals with diarrhea, contact with other animals, dairy breeds, and collective pens.

Indicators of improved gestation housing of sows. Part II: Effects on physiological measures, reproductive performance and health of the offspring.

Prenatal stress is the mechanism through which poor welfare of pregnant sows has detrimental effects on the health and resilience of their piglets. We compared two gestation housing systems (IMPROVED versus [conventional] CONTROL) in terms of sow stress and welfare indicators and sought to determine whether potential benefits to the sows would translate into improved offspring health. Sows were mixed into 12 stable groups (six groups per treatment, 20 sows per group) 29 days post-service in pens with free-access, full-length individual feeding/lying-stalls. CONTROL pens had fully slatted concrete floors, with two blocks of wood and two chains suspended in the group area. IMPROVED pens were the same but with rubber mats and manila rope in each stall, and straw provided in three racks in the group area. Saliva was collected from each sow on day 80 of pregnancy and analysed for haptoglobin. Hair cortisol was measured in late gestation. Sows' right and left eyes were scored for tear staining in mid lactation and at weaning. Numbers of piglets born alive, dead, mummified, and total born were recorded. Piglets were weighed and scored for vitality and intra-uterine growth restriction (IUGR) at birth. Presence of diarrhoea in farrowing pens was scored every second day throughout the suckling period. IMPROVED sows had lower haptoglobin levels and tear-stain scores during lactation. IMPROVED sows produced fewer mummified piglets, and these had significantly lower IUGR scores, and scored lower for diarrhoea than piglets of CONTROL sows. Hence, improving sow welfare during gestation improved the health and performance of their offspring.

Intestinal parasitic infections in officers of the Border Guard in East Poland.

Poland has experienced increased economic migration since 2021. Large waves of migrants, mostly from Asian and African countries, are trying to get into the European Union by crossing Poland's eastern border illegally. The influx of illegal migrants into Poland is the result of a policy adopted by the Belarusian and Russian regimes that are trying to provoke another migrant crisis in Europe. In the opinion of some Polish politicians illegal migration contributes to the spread of parasitic diseases in our country as many migrants arriving into Poland carry intestinal parasites. The aim of this study was to assess the prevalence of infections with intestinal parasites in the Polish Border Guard officers safeguarding Poland's eastern borders. Parasitological diagnostics was carried out between April and May 2023. The study involved 218 Polish Border Guard officers from the Podlaski Border Guard Unit (PBGU) and 209 officers from the Bug Border Guard Unit (BBGU), whose task is to patrol and safeguard Poland's border with Ukraine and Belarus. Faecal examinations were performed using three different light microscopy testing methods (direct smear, decantation, flotation) at the Department of Epidemiology and Tropical Medicine at the Military Institute of Medicine - National Research Institute, Warsaw, Poland. Considered to be potentially pathogenic intestinal parasites were diagnosed in 20 out of 218 officers serving in the PBGU (8.7% infected with Blastocystis spp., 0.5% with Dientamoeba fragilis) and in 9 out of 209 officers serving in the BBGU (3.8% infected with Blastocystis spp., 0.5% with Dientamoeba fragilis). There were no infections with nematodes, cestodes or trematodes in the study participants. No correlation was found between a parasitic infection and the presence of diarrhoea or other gastrointestinal symptoms within 6 months prior to the study in both groups. Although Polish Border Guard officers deployed to the eastern border are exposed to difficult environmental conditions and have frequent contacts (either directly or indirectly) with migrants arriving from countries which report high incidence of parasitic infections, the rates of infections with potentially pathogenic protozoa in officers from the PBGU and BBGU are low and mainly attributable to pathogens which are widespread in the general Polish population. Low rates of parasitic infections in officers serving in the border zone suggest that the epidemiological situation of parasitic diseases in East Poland is satisfactory and that the disease prevention strategies (including the use of personal protection gear) implemented by the Polish medical services are effective.

Small Intestinal Bacterial Overgrowths and Intestinal Methanogen Overgrowths Breath Testing in a Real-Life French Cohort.

Breath testing has become a widely used tool to diagnose small intestinal bacterial overgrowths (SIBOs) and intestinal methanogen overgrowths (IMOs) in clinical settings. Owing to the heterogeneity in clinical manifestations and lack of standardization among centers performing breath testing, SIBO and IMO can be easily overlooked by the clinician. We studied the prevalence and symptoms of SIBO/IMO in French patients referred for breath testing after seeking medical advice. Breath test data and symptoms of 331 patients were assessed for SIBO/IMO using the H 2 /CH 4 lactulose breath test (LBT). Wilcoxon test or χ 2 test were used to compare patients with SIBO/IMO with patients without SIBO/IMO. LBT positive patients (H 2 +, CH 4 +, and CH 4 +/H 2 +) were compared using Kruskal-Wallis test for continuous data or χ 2 test for categorical data. Among the 186 (68.1%) patients tested positive for an overgrowth with 40.3%, 47.3%, and 12.4% for H 2 +, CH 4 + and CH 4 +/H 2 +, respectively, the presence of diarrhea was significantly increased in hydrogen type overgrowths ( P < 0.001). No significant difference according to age, gender, and symptoms was associated with a positive test except for joint pain that was less prevalent among LBT positive patients ( P = 0.038). In 86.5% of IMOs, positivity with CH 4 values ≥10 ppm could be identified at baseline. There are little discriminating symptoms that can help the clinician to identify patients likely to have a SIBO/IMO. However, SIBO/IMOs remain a common disorder widely underdiagnosed that need further studies to better apprehend functional bowel disorders.

Diarrhea Is a Hallmark of Inflammation in Pediatric COVID-19.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a pathogen with enteric tropism. We compared the clinical, biochemical and radiological features of children hospitalized for acute SARS-CoV-2 infection, classified in two groups based on the presence of diarrhea. Logistic regression analyses were used to investigate the variables associated with diarrhea. Overall, 407 children were included in the study (226 males, 55.5%, mean age 3.9 ± 5.0 years), of whom 77 (18.9%) presented with diarrhea, which was mild in most cases. Diarrhea prevalence was higher during the Alpha (23.6%) and Delta waves (21.9%), and in children aged 5-11 y (23.8%). Other gastrointestinal symptoms were most commonly reported in children with diarrhea (p &lt; 0.05). Children with diarrhea showed an increased systemic inflammatory state (higher C-reactive protein, procalcitonin and ferritin levels, p &lt; 0.005), higher local inflammation as judged by mesenteric fat hyperechogenicity (adjusted Odds Ratio 3.31, 95%CI 1.13-9.70) and a lower chance of previous immunosuppressive state (adjusted Odds Ratio 0.19, 95%CI 0.05-0.70). Diarrhea is a frequent feature of pediatric COVID-19 and is associated with increased systemic inflammation, which is related to the local mesenteric fat inflammatory response, confirming the implication of the gut not only in multisystem inflammatory syndrome but also in the acute phase of the infection.

RELATIONSHIP OF KNOWLEDGE, DEFECATION BEHAVIOR AND FLY DENSITY WITH INCIDENCE OF DIARRHEA ON CHILDREN: A CASE CONTROL STUDY

Introduction: Diarrhea is a significant public health problem because it is the third major contributor to child morbidity and mortality in various countries, including Indonesia. This study aimed to determine the relationship between the density of flies in the geographic area, the knowledge of the mothers, their defecation behavior, and the presence of diarrhea in children in Jambi City, Indonesia Materials and Methods: This type of research is a quantitative study with a case-control approach involving 76 children under five, namely 38 cases and 38 control groups. The research data were analyzed using the Odds Ratio test. Results: Mothers who have less knowledge are 12 times more likely to have a toddler suffering from diarrhea than mothers who have good knowledge. Mothers with poor behavior in dealing with toddlers’ defecation habits will have a 5 times greater risk of having a toddler with diarrhea problems; on the other hand, if mothers behave well in dealing with children’s defecation problems, then the toddler will not be at risk of having diarrhea. The density of flies does not provide a significant risk for the incidence of diarrhea in infants. Conclusion: the incidence of diarrhea in children under five in the Putri Ayu Public Health Center in Jambi City is influenced by low parental knowledge and bad defecation behavior

Factors associated with subtherapeutic levels of oral posaconazole tablet: a detailed analysis from a tertiary care center in India

ObjectivesPosaconazole is a broad-spectrum triazole antifungal, with activity against various clinically important fungi. The delayed release (DR) tablet of posaconazole has been shown to have a superior pharmacokinetic profile in comparison with the oral suspension. MethodsWe retrospectively analyzed the factors associated with posaconazole levels <1.25 μg/ml in 164 patients receiving the DR tablet for therapeutic purposes. ResultsOf the 164 patients, 53 (32.3%) showed subtherapeutic trough levels of posaconazole. The use of proton pump inhibitors (95% CI 1.41-3.91; P-value = 0.028) and the presence of diarrhea (95% CI 1.95-6.93; P-value = 0.001) were significantly associated with subtherapeutic levels. A total of 13 of the 21 patients receiving posaconazole tablets through a nasogastric tube had therapeutic levels. ConclusionThis is the largest study from India that analyzed factors associated with subtherapeutic levels of the DR tablet of posaconazole. These findings reinforce the importance of therapeutic drug monitoring. Unlike in previous studies, obesity and hypoalbuminemia were not found to be significant factors in our settings. The use of proton pump inhibitors and diarrhea remained significant factors, as found in previous studies. Administering the DR tablet of posaconazole through a nasogastric tube may be a viable option.

Prevalence of non-coeliac gluten sensitivity and assessment of the response to gluten-free diet in a cohort of patients with fibromyalgia.

To establish the prevalence of non-coeliac gluten sensitivity (NCGS) in a cohort of fibromyalgia patients and to evaluate their clinical response to a six-week gluten-free diet (GFD), the improvement in their symptoms, the percentage of diet responders who did not fulfil the diagnostic criteria for NCGS and the baseline characteristics that were associated with diet response and diagnostic criteria fulfilment. Uncontrolled prospective experimental study in a cohort of patients with fibromyalgia from a specialized hospital unit. The percentage of patients that fulfilled the Salerno Experts' Criteria, that responded to GFD, that improved their symptomatology and baseline characteristics associated with GFD response and diagnostic criteria fulfilment was analysed. In total, 142 patients were selected and a NCGS prevalence of 5.6% was observed. A total of 21.8% responded to GFD due to their improvement in intestinal symptoms. In total, 74.2% of the responders did not fulfil the Salerno Experts' Criteria. The presence of diarrhoea and intraepithelial lymphocytosis and lower levels of anxiety were predictive factors of GFD response. No predictive factors of NCGS criteria fulfilment were found due to the low number of discriminators between gluten and placebo. A NCGS prevalence similar to that estimated in the general population was found. A GFD cannot be systematically recommended to all patients with fibromyalgia, although it could be evaluated in those with diarrhoea or intraepithelial lymphocytosis to evaluate if there are improvements in their intestinal symptoms.

Prevalence of double incontinence in patients with fecal incontinence undergoing anorectal manometry and discriminating factors.

Double incontinence (DI) is the concomitant presence of incontinence for urine and stool. Aim of this study is to assess prevalence of DI in patients with fecal incontinence (FI) undergoing Ano-Rectal Manometry (ARM) in a tertiary care center and to identify factors discriminating between both. Medical records of consecutive patients referred for ARM for FI during 2 years at University Hospital Brussels were retrospectively reviewed. Results from ARM, presence of diarrhea, diseases from recto-anal or peri-anal region, prior abdominal, proctological or urological surgery and neurological comorbidities were recorded. Of 101 enrolled patients, 77% suffered from solitary FI and 23% from DI. Diarrhea was more common in DI vs. FI (43,5% vs. 15,4%, P=.008), as was the presence of neurological comorbidities (34.8% vs. 10.3%, P=.009) and urological interventions (21.7% vs. 1.3%, P=.002). In respect to women only, more urological interventions were performed (20% vs. 0%, P=.006) and more diseases from recto-anal or peri-anal region were encountered in DI vs. FI (35.0 % vs. 12.5 %, P= .045). In men, neurological disorders were significantly more common in DI (100.0% vs. 3.3%, P=.002). This study identified gender-specific patterns of comorbidities in FI and DI. ARM had no distinctive value between FI and DI in men and women. A prospective study should provide more information on patients at risk for incontinence and help to identify distinct features between FI and DI in men and women.

The Role of Endocrine Cells of the Colon, Secreting Vasoactive Intestinal Polypeptide, Somatostatin and Motilin, in Irritable Bowel Syndrome, Occurring with Diarrhea and Constipation

Background. Disorders in the production of neuroendocrine peptides in the digestive tract can cause changes in, intestinal motility and the formation of visceral hypersensitivity, characteristic of patients with irritable bowel syndrome (IBS). From this standpoint, of particular interest is the study of the role of a number of major endocrine cells (EC) of the colon, secreting motilin, vasoactive intestinal polypeptide, and somatostatin, in IBS. Aims to evaluate the density of ECs with different hormonal activities that secrete motilin, vasoactive intestinal polypeptide and somatostatin in the mucosa of the sigmoid colon in patients with IBS that occurs with constipation and diarrhea. Materials and methods. 85 patients with IBS were examined. The first group included 44 patients with diarrhea (IBSd), the second group included 41 patients with constipation (IBSc). The comparison group consisted of 36 practically healthy people. The diagnosis of IBS was based on the Rome IV criteria. Patients and healthy people were examined according to a single program, including clinical, instrumental (colonoscopy, ultrasound examination of the abdominal organs), laboratory (clinical blood test, feces for calprotectin and antibodies to gliadin in the presence of diarrhea), morphological and immunohistochemical methods. Results. The clinical picture of IBS corresponded to the classical manifestations of this pathology. Among patients with IBSc, there was a more frequent feeling of incomplete emptying of the intestine after defecation, compared with patients with IBSd (p 0.05). Among patients with IBSd, there was a statistically significant increase in the number of ECs producing motilin and vasoactive intestinal polypeptide, as well as a lower density of ECs secreting somatostatin, compared with the control group (p 0.05). In the IBSc group, there was a decrease in the number of ECs producing motilin, vasoactive intestinal polypeptide and an increase in the number of ECs producing somatostatin, compared with the control group (p 0.05). Conclusions. An increase in the number of cells producing motilin, vasoactive intestinal polypeptide and a decrease in the number of cells observed for the production of somatostatin in the mucosa of the sigmoid colon is characteristic of the manifestation of IBSd. At the same time, an increase in ECs secreting motilin, vasoactive intestinal polypeptide and an increase in cellular elements producing somatostatin reveals manifestations of IBSс.

Diarrheal Illness

Diarrhea, qualitatively defined as an increase in stool frequency and liquid content, is a frequent complaint in patients presenting to emergency departments. Although most cases are uncomplicated viral infections, the most frequent causes of dangerous underlying entities are often not viral. In uncomplicated cases, laboratory testing for metabolic derangements is not required unless there are signs of moderate to severe dehydration or the patient has particular risks, such as chronic kidney disease. Secondary infections associated with antibiotic use (C difficile–associated diarrhea), other significant nosocomial exposures, recent international travel history, the presence of a nonintact immune system (HIV/AIDS, cancer/chemotherapy), and exposure to high-risk environments (including zoonotic exposures, outbreak-prone environments such as day care facilities) increase the likelihood of a bacterial or other infectious cause requiring either microbiologic testing or empirical antimicrobial treatments. Diarrhea is often present as a feature of clinically significant noninfectious conditions, including complications of inflammatory bowel diseases (Crohn disease and ulcerative colitis), overdoses, and withdrawal syndromes. In such cases, after hemodynamic stability has been ensured, advanced workup and treatment are guided by the underlying condition and antecedent risks, not the presence of diarrhea per se. Oral rehydration is the first step in management for mild dehydration caused by uncomplicated diarrhea. Intravenous fluids may be necessary in moderate to severe dehydration and in cases of electrolyte derangement requiring resuscitation where fluid choice and rate are paramount, as well as in patients who cannot tolerate oral intake. In cases of suspected bacteria-caused diarrhea, antibiotics, most often fluoroquinolones, reduce both the severity and duration of illness. In patients safe for home management, antidiarrheal agents such as loperamide may be used in uncomplicated and resolving cases. Probiotics appear safe in most cases and impart a small but clinically detectable decrease in the duration and severity of illness. Although there have been fears of bacterial outbreaks following natural disasters, improvements in local and global health efforts have led to decreases in cholera outbreaks, and typical viral causes of diarrhea are generally the most common causes. This review contains 4 figures, 5 tables and 32 references Key words: Clostridium difficile, diarrhea, infectious diseases, inflammatory bowel diseases, medication side effects, overdose syndromes, sepsis, traveler’s diarrhea, zoonotic infections

Diarrheal Illness

Diarrhea, qualitatively defined as an increase in stool frequency and liquid content, is a frequent complaint in patients presenting to emergency departments. Although most cases are uncomplicated viral infections, the most frequent causes of dangerous underlying entities are often not viral. In uncomplicated cases, laboratory testing for metabolic derangements is not required unless there are signs of moderate to severe dehydration or the patient has particular risks, such as chronic kidney disease. Secondary infections associated with antibiotic use (C difficile–associated diarrhea), other significant nosocomial exposures, recent international travel history, the presence of a nonintact immune system (HIV/AIDS, cancer/chemotherapy), and exposure to high-risk environments (including zoonotic exposures, outbreak-prone environments such as day care facilities) increase the likelihood of a bacterial or other infectious cause requiring either microbiologic testing or empirical antimicrobial treatments. Diarrhea is often present as a feature of clinically significant noninfectious conditions, including complications of inflammatory bowel diseases (Crohn disease and ulcerative colitis), overdoses, and withdrawal syndromes. In such cases, after hemodynamic stability has been ensured, advanced workup and treatment are guided by the underlying condition and antecedent risks, not the presence of diarrhea per se. Oral rehydration is the first step in management for mild dehydration caused by uncomplicated diarrhea. Intravenous fluids may be necessary in moderate to severe dehydration and in cases of electrolyte derangement requiring resuscitation where fluid choice and rate are paramount, as well as in patients who cannot tolerate oral intake. In cases of suspected bacteria-caused diarrhea, antibiotics, most often fluoroquinolones, reduce both the severity and duration of illness. In patients safe for home management, antidiarrheal agents such as loperamide may be used in uncomplicated and resolving cases. Probiotics appear safe in most cases and impart a small but clinically detectable decrease in the duration and severity of illness. Although there have been fears of bacterial outbreaks following natural disasters, improvements in local and global health efforts have led to decreases in cholera outbreaks, and typical viral causes of diarrhea are generally the most common causes. This review contains 4 figures, 5 tables and 32 references Key words: Clostridium difficile, diarrhea, infectious diseases, inflammatory bowel diseases, medication side effects, overdose syndromes, sepsis, traveler’s diarrhea, zoonotic infections

Nutritional status of 6\u201359\xa0months of age children is not significantly varied between households with and without home gardening practices in Zege, North West Ethiopia, 2020: community based comparative study

BackgroundMalnutrition is a critical public health issue that has been related to a significant increase in mortality and morbidity rates. Despite the fact that children are expected to benefit from home gardening products, their nutritional condition in Ethiopia, particularly in the planned study region, is not thoroughly monitored. Therefore the purpose of this is to determine the nutritional status of 6–59 months of age children between households with and without home gardening practices at Zege.MethodsA community based comparative cross-sectional study was conducted among paired mothers with 6–59 month children from February to March 2020. Data were collected using questionnaire and anthropometric measurement tools. Binary logistic regression models were used. A-p-value < 0.05 was used as cutoff point to declare statistically significant variables with the outcome variable.ResultStunting and wasting among children aged 6–59 months was high and did not show significant variation between households practicing home gardening (stunting 46.1%, at 95%, CI: 40.6–51.3 and wasting 9.1%, at 95% CI: 6.2–12.7) and not practiced home gardening (stunting 50.3%, at 95% CI: 44.5–55.8 and wasting 10.1%, 95% CI: 6.8–13.8). Having low dietary diversity (AOR = 2.7; 95% CI: 1.9–3.9), Being male (AOR = 2.1; 95% CI: 1.4–3), feeding frequency < 3/day (AOR = 1.7; 95% CI: 1.1–2.4), and presence of diarrhea (AOR = 2.6; 95% CI: 1.4–4.6) were predictors of stunting. Unprotected-drinking water (AOR = 2.1; 95% CI: 1.0–4.2), not fully-immunized (AOR = 2.6; 95% CI: 1.3–5.1) and being female (AOR = 2.4; 95% CI: 1.3–4.6) were predictors for child wasting.Conclusionstunting and wasting are highly prevalent in both home gardening and non- home gardening households’ children of the community. Promoting diversified diet, protected water source, vaccinating children, access to a healthy environment and integrated with the access of nutrition education programs are vital interventions to improve nutrition.

A machine learning approach for identification of gastrointestinal predictors for the risk of COVID-19 related hospitalization.

Background and aimCOVID-19 can be presented with various gastrointestinal symptoms. Shortly after the pandemic outbreak, several machine learning algorithms were implemented to assess new diagnostic and therapeutic methods for this disease. The aim of this study is to assess gastrointestinal and liver-related predictive factors for SARS-CoV-2 associated risk of hospitalization.MethodsData collection was based on a questionnaire from the COVID-19 outpatient test center and from the emergency department at the University Hospital in combination with the data from internal hospital information system and from a mobile application used for telemedicine follow-up of patients. For statistical analysis SARS-CoV-2 negative patients were considered as controls in three different SARS-CoV-2 positive patient groups (divided based on severity of the disease). The data were visualized and analyzed in R version 4.0.5. The Chi-squared or Fisher test was applied to test the null hypothesis of independence between the factors followed, where appropriate, by the multiple comparisons with the Benjamini Hochberg adjustment. The null hypothesis of the equality of the population medians of a continuous variable was tested by the Kruskal Wallis test, followed by the Dunn multiple comparisons test. In order to assess predictive power of the gastrointestinal parameters and other measured variables for predicting an outcome of the patient group the Random Forest machine learning algorithm was trained on the data. The predictive ability was quantified by the ROC curve, constructed from the Out-of-Bag data. Matthews correlation coefficient was used as a one-number summary of the quality of binary classification. The importance of the predictors was measured using the Variable Importance. A 2D representation of the data was obtained by means of Principal Component Analysis for mixed type of data. Findings with the p-value below 0.05 were considered statistically significant.ResultsA total of 710 patients were enrolled in the study. The presence of diarrhea and nausea was significantly higher in the emergency department group than in the COVID-19 outpatient test center. Among liver enzymes only aspartate transaminase (AST) has been significantly elevated in the hospitalized group compared to patients discharged home. Based on the Random Forest algorithm, AST has been identified as the most important predictor followed by age or diabetes mellitus. Diarrhea and bloating have also predictive importance, although much lower than AST.ConclusionSARS-CoV-2 positivity is connected with isolated AST elevation and the level is linked with the severity of the disease. Furthermore, using the machine learning Random Forest algorithm, we have identified the elevated AST as the most important predictor for COVID-19 related hospitalizations.

Everolimus and/or Nivolumab-Associated Cytomegalovirus Colitis in a Patient with Metastatic Renal Cell Carcinoma

Everolimus-associated cytomegalovirus colitis is very rare in cancer patients. We present a case of cytomegalovirus colitis that occurred on using everolimus in a 64-year-old male with metastatic renal cell carcinoma who received pazopanib, nivolumab, and everolimus treatments, respectively. Although an increasing number of nivolumab-related cytomegalovirus colitis cases are reported recently, its mechanism of development is still unknown. Our study highlights that clinicians should remember cytomegalovirus reactivation in the presence of diarrhea or colitis in patients receiving everolimus and/or nivolumab. Further studies are needed to elucidate the relationship between immune checkpoint inhibitors and cytomegalovirus reactivation, and these will also be a guide to prevent other possible viral infections.