Prevention Of Diarrhea Research Articles

Clinical Study on Prevention of Irinotecan-Induced Delayed-Onset Diarrhea by Hot Ironing with Moxa Salt Packet on Tianshu and Shangjuxu.

Objective To study the clinical efficacy of hot ironing of the Tianshu and Shangjuxu with moxa salt packet to prevent irinotecan (CPT-11)-induced delayed-onset diarrhea (IIDD). Methods A randomized controlled study was conducted on a sample of 120 patients with advanced colorectal cancer who were hospitalized in our oncology department and treated with FOLFIRI chemotherapy regimen from February 2018 to July 2021. They were equally divided into study group (n = 60) and control group (n = 60) according to whether they were treated with hot ironing with moxa salt packs or not. The general conditions, occurrence of IIDD, occurrence of delayed chemotherapy due to IIDD, time of occurrence and duration of IIDD, Karnofsky performance score (KPS) score, occurrence of leukopenia, and myelosuppression were compared between the two groups. Result The incidence of grade 1, 2, 3, and 4 diarrhea in the study group was 11.67% (7/60), 5.00% (3/60), 3.33% (2/60), and 0.00% (0/60), respectively, while the incidence of grade 1, 2, 3, and 4 diarrhea in the control group was 21.67% (13/60), 8.33% (5/60), 10.00% (6/60), and 3.33% (2/60). The incidence of severe diarrhea and total diarrhea in the study group was (3.33% and 20.00%) lower than that in the control group (13.33% and 43.33%) (P < 0.05). The incidence of delayed chemotherapy was lower in the study group (8.33%) (1/12) than in the control group (23.08%) (6/26) but the difference between the groups was not statistically significant (P > 0.05). The time to onset of IIDD in the study group (6.45 ± 1.53) days was comparable to that in the control group (6.40 ± 1.77 days) (P > 0.05), but the duration of IIDD in the study group (3.25 ± 1.05 days) was shorter than that in the control group (5.70 ± 1.72 days) (P < 0.05). After treatment, the incidence of KPS improvement, stabilization, and reduction in the study group was 38.33% (23/60), 51.67% (31/60), and 10.00% (6/60), respectively, the incidence of KPS improvement, stabilization, and reduction in the control group was 23.33% (14/60), 50.00% (30/60), and 26.67% (16/60), respectively, and the percentage of KPS reduction in the study group was less than that in the control group (P < 0.05). During the observation period after treatment, the total incidence of leucopenia in the study group was 11.67% (7/60) which is lower than 31.67% (19/60) in the control group (P < 0.05). During the observation period after treatment, the incidence of III°+°IV myelosuppression in the study group was 5.00% (3/60) which is lower than 25.00% (15/60) in the control group (P < 0.05). Conclusion The hot ironing with moxa salt packet on Tianshu and Shangjuxu was more effective in preventing IIDD, which could reduce the incidence and severity of IIDD, shorten the duration of diarrhea and significantly increase the quality of life of patients with no significant adverse effects.

Prevention, diagnosis and treatment of antibiotic-associated diarrhea

抗生素相关性腹泻是使用抗菌药物后出现的常见不良反应，与继发性肠道菌群紊乱所致肠道碳水化合物和胆汁酸代谢降低及条件致病菌感染等机制相关，儿童尤其是婴幼儿和危重症住院患儿是高危人群。本文着重介绍抗生素相关性腹泻的诊断、预防和治疗的相关知识，有助于儿科医师提高对本病的认知和防治水平。.

PENGARUH PERILAKU CUCI TANGAN PAKAI SABUN DALAM PENCEGAHAN DIARE PADA ANAK USIA SEKOLAH

Abstract: The high rate of diarrheal disease in children is caused by many factors, namely, poor hand washing habits, children consuming food that is not guaranteed to be clean, and an unhealthy school environment. One way to prevent the transmission of diarrheal disease is by washing hands with soap. The purpose of this study was to determine the effect of handwashing with soap in preventing diarrhea in school-age children. This study was conducted by searching for national and international journals that match the inclusion criteria through 2 databases, namely Google Scholar and Science Direct. The Study Design used is a Cross Sectional Study. Search articles using keywords that have been adjusted by MeSH. The selection was taken by paying attention to the PICOS framework, then the articles were analyzed one by one. Found 8 national journals and 1 international journal, then the journals were analyzed one by one. The results of the study, namely the majority of articles (8 of 9 articles) stated that there was a significant relationship between the effect of washing hands with soap in preventing diarrhea in school-age children. The conclusion of the study is that there is an effect of hand washing with soap and prevention of diarrhea in school-age children. Suggestions for future researchers are expected not to lean on only one search source and develop a more analytical PICOS design study.

Epidemic and Evolutionary Characteristics of Swine Enteric Viruses in South-Central China from 2018 to 2021.

Swine enteric viruses are a major cause of piglet diarrhea, causing a devastating impact on the pork industry. To further understand the molecular epidemiology and evolutionary diversity of swine enteric viruses, we carried out a molecular epidemiological investigation of swine enteric viruses (PEDV, PDCoV, PoRVA, and TGEV) on 7107 samples collected from pig farms in south-central China. The results demonstrated that PEDV is the predominant pathogen causing piglet diarrhea, and its infection occurs mainly in relatively cold winter and spring in Hunan and Hubei provinces. The positive rate of PEDV showed an abnormal increase from 2020 to 2021, and that of PoRVA and PDCoV exhibited gradual increases from 2018 to 2021. PEDV-PoRVA and PEDV-PDCoV were the dominant co-infection modes. A genetic evolution analysis based on the PEDV S1 gene and ORF3 gene revealed that the PEDV GII-a is currently epidemic genotype, and the ORF3 gene of DY2020 belongs to a different clade relative to other GII-a strains isolated in this study. Overall, our results indicated that the variant PEDV GII-a is the main pathogen of piglet diarrhea with a trend of outbreak. G9 is the dominant PoRVA genotype and has the possibility of outbreak as well. It is therefore critical to strengthen the surveillance of PEDV and PoRVA, and to provide technical reserves for the prevention and control of piglet diarrhea.

Education on diarrhea treatment from decoction of guava leaves at the LKSA Muawanah foundation

Diarrhea is a bowel movement (defecation) characterized by liquid or semi-liquid stools with a higher water content than usual. Microorganisms such as bacteria, viruses, and protozoa can cause diarrheal disease, depending on the etiology. A decoction of guava leaves is used in traditional medicine to treat diarrhea. The goal of the community service is to teach the LKSA Muawanah Foundation's foster children about diarrhea and how to treat it traditionally with boiled guava leaves. The definition of diarrhea, causes of diarrhea, prevention of diarrhea, treatment of diarrhea, distribution of brochures for prevention and treatment of diarrhea, games, post-test, and how to make anti-diarrhea drinks from guava leaf stew were all part of this program. Participants gain a better understanding of the causes of diarrhea, how to prevent it, and how to make traditional anti-diarrhea medicinal drinks from guava leaf stew, which is both cheaper and easier. The material presented is well understood by the participants, as evidenced by their ability to correctly answer ten questions during the post-test

Maternal Knowledge and Practices for Prevention of Acute Diarrheal Diseases in Children under 5 years of age

Background: Diarrhea is the second major cause of mortality in children worldwide. Timely interventions by caregivers who are mainly mothers, can contribute towards a favorable prognosis of this condition in children.&#x0D; Aim: The purpose of conducting this study was to assess maternal knowledge and the practices regarding prevention of diarrheal diseases in children under the age of 5 years.&#x0D; Setting: This study was carried out in three hospitals at Lahore, Pakistan.&#x0D; Methods: An analytical cross-sectional study was conducted from January to July 2020 and a convenience sampling technique was used for data collection. Data was collected from 158 mothers of children under 5 years of age by using a self-structured, pre-tested questionnaire. Chi square test was applied and p-value &lt;0.05 was taken as significant.&#x0D; Results: A total of 158 mothers responded to the study questionnaire; mean age of the participants was 28.4+ 7.6 years, 22.8% were illiterate, 84.2% were housewives, and 37.4% had income more than 31000 rupees/month. The majority (43.1%) had ‘poor’ knowledge, 24% had’ poor’ attitudes and practices while 12% had better practices. Significant associations were observed between mother’s knowledge with education (p-value=0.004), income (p-value=0.001), frequency of diarrhea in a child (p-value=0.053) and practices with education (p-value =0.039).&#x0D; Conclusion: This study showed the direct relationship between mother's literacy level and family income with better knowledge and feeding practices of children regarding prevention of diarrhea. It has highlighted the role of mothers in the management of acute diarrheal diseases.

Multispecies Probiotic for the Prevention of Antibiotic-Associated Diarrhea in Children

The efficacy of multispecies probiotic formulations in the prevention of antibiotic-associated diarrhea (AAD) remains unclear. To assess the effect of a multispecies probiotic on the risk of AAD in children. This randomized, quadruple-blind, placebo-controlled trial was conducted from February 2018 to May 2021 in a multicenter, mixed setting (inpatients and outpatients). Patients were followed up throughout the intervention period. Eligibility criteria included age 3 months to 18 years, recruitment within 24 hours following initiation of broad-spectrum systemic antibiotics, and signed informed consent. In total, 646 eligible patients were approached and 350 patients took part in the trial. A multispecies probiotic consisting of Bifidobacterium bifidum W23, Bifidobacterium lactis W51, Lactobacillus acidophilus W37, L acidophilus W55, Lacticaseibacillus paracasei W20, Lactiplantibacillus plantarum W62, Lacticaseibacillus rhamnosus W71, and Ligilactobacillus salivarius W24, for a total dose of 10 billion colony-forming units daily, for the duration of antibiotic treatment and for 7 days after. The primary outcome was AAD, defined as 3 or more loose or watery stools per day in a 24-hour period, caused either by Clostridioides difficile or of otherwise unexplained etiology, after testing for common diarrheal pathogens. The secondary outcomes included diarrhea regardless of the etiology, diarrhea duration, and predefined diarrhea complications. A total of 350 children (192 boys and 158 girls; mean [range] age, 50 [3-212] months) were randomized and 313 were included in the intention-to-treat analysis. Compared with placebo (n = 155), the probiotic (n = 158) had no effect on risk of AAD (relative risk [RR], 0.81; 95% CI, 0.49-1.33). However, children in the probiotic group had a lower risk of diarrhea regardless of the etiology (RR, 0.65; 95% CI, 0.44-0.94). No differences were observed between the groups for most of the secondary outcomes, including adverse events. A multispecies probiotic did not reduce the risk of AAD in children when analyzed according to the most stringent definition. However, it reduced the overall risk of diarrhea during and for 7 days after antibiotic treatment. Our study also shows that the AAD definition has a significant effect on clinical trial results and their interpretation. ClinicalTrials.gov Identifier: NCT03334604.

MiR-30d Inhibition Protects IPEC-J2 Cells Against Clostridium perfringens Beta2 Toxin-Induced Inflammatory Injury.

Clostridium perfringens beta2 (CPB2) toxin, one of the virulence factors of Clostridium perfringens (C. perfringens), can cause necrotizing enterocolitis in piglets. Accumulating pieces of evidence indicate that microRNAs (miRNAs) refer to the regulation of inflammatory processes. Previously, we have discovered that miR-30d was differentially expressed between the ileum of normal piglets and C. perfringens type C-infected diarrheal piglets. Here, we found that miR-30d expression was lowered in CPB2 toxin-treated intestinal porcine epithelial cells (IPEC-J2) at different time points. Subsequently, we determined that miR-30d inhibitor attenuated CPB2 toxin revulsive inflammatory damage in IPEC-J2 cells and promoted cell proliferation and cell cycle progression, whereas miR-30d mimic had opposite results. In addition, we confirmed that Proteasome activator subunit 3 (PSME3) was a downstream target gene of miR-30d via a dual luciferase reporter assay, qPCR, and western blot. We also found that overexpression of PSME3 suppressed CPB2 toxin-induced inflammatory damage and promoted cell proliferation and cycle progression. Our results demonstrate that miR-30d aggravates CPB2 toxin revulsive IPEC-J2 cells inflammatory injury via targeting PSME3, thereby providing a novel perspective for the prevention and treatment of piglet diarrhea at the molecular level.

The Problems Affecting the Implementation of Posyandu Program: A Literature Review

Integrated Health Post for Child Center/Pos Pelayanan Terpadu (Posyandu) is a form of community-based health program carried out by, from, and along with the community to empower and provide facilities for the community to obtain health services for mothers, babies, and toddlers. Posyandu activities include: KIA, family planning, immunization, nutrition, diarrhea prevention. Posyandu in Indonesia still faced several problems. This study aimed at investigating the problems that affect the implementation of Posyandu program and actions to improve Posyandu program services. The method used in this study was literature review. The literatures used in this study were the search results through national and international journals. National includes google scholar [https://scholar.google.co.id/] and international includes Pubmed [https://www.ncbi.nlm.nih.gov/pubmed] with the keyword “Problems and Posyandu Program” published in 2016-2020. Based on the search results, 8 national and 2 international articles related to the topic and in accordance with the inclusion and exclusion criteria were found. The results of 10 literature reviews show there are several fundamental problems of Posyandu program in Indonesia, namely: 1) the low role of Posyandu cadres; 2) the lack of understanding on the benefit of Posyandu program; 3) The lack of participation in Posyandu activities; 4) The lack of facilities and infrastructure for Posyandu activities; and 5) the lack of cross-program and cross-sector cooperation. In addition, there are 5 actions needed to solve the problems. The first action is to conduct a training program for Posyandu cadres. The second one is to conduct regular outreach at Posyandu for mothers and families by trained cadres. The third one is to improve the facilities and infrastructure in Posyandu. The fourth one is to provide both material and immaterial incentives for an active Posyandu’s cadre. Lastly, the fifth action is to increase advocacy efforts to related parties. Posyandu program are still facing problems affecting its implementation. Therefore, the posyandu revitalization actions are needed. The main key lies in increasing cadres' capacity through training.

Importance of Zinc Nanoparticles for the Intestinal Microbiome of Weaned Piglets.

The scientific community is closely monitoring the replacement of antibiotics with doses of ZnO in weaned piglets. Since 2022, the use of zinc in medical doses has been banned in the European Union. Therefore, pig farmers are looking for other solutions. Some studies have suggested that zinc nanoparticles might replace ZnO for the prevention of diarrhea in weaning piglets. Like ZnO, zinc nanoparticles are effective against pathogenic microorganisms, e.g., Enterobacteriaceae family in vitro and in vivo. However, the effect on probiotic Lactobacillaceae appears to differ for ZnO and zinc nanoparticles. While ZnO increases their numbers, zinc nanoparticles act in the opposite way. These phenomena have been also confirmed by in vitro studies that reported a strong antimicrobial effect of zinc nanoparticles against Lactobacillales order. Contradictory evidence makes this topic still controversial, however. In addition, zinc nanoparticles vary in their morphology and properties based on the method of their synthesis. This makes it difficult to understand the effect of zinc nanoparticles on the intestinal microbiome. This review is aimed at clarifying many circumstances that may affect the action of nanoparticles on the weaning piglets' microbiome, including a comprehensive overview of the zinc nanoparticles in vitro effects on bacterial species occurring in the digestive tract of weaned piglets.

Pyrotinib-based therapy for patients with HER2-positive breast cancer: A multicenter, real-world study.

1040 Background: Pyrotinib, an irreversible pan-ErbB inhibitor, has been approved for the treatment of HER2-positive advanced breast cancer in China. Real-world data is instructive for effect evaluation and application of the drug in clinical practice. Herein, this study was conducted to evaluate the effectiveness and safety of pyrotinib-based therapy in patients with HER2-positive breast cancer in the real-world setting. Methods: In this retrospective, multicenter, real-world study, data of patients with HER2-positive breast cancer who received pyrotinib-based therapy from 19 sites were reviewed. Disease characteristics, prior therapies, and treatment patterns were summarized. Progression-free survival (PFS) and the incidence of diarrhea were analyzed. Results: Between September 2018 and June 2021, a total of 378 patients with HER2-positive advanced breast cancer were included. Of 378 patients, 47.4% had hormone receptor (HR)-positive disease, 41.3% had HR-negative disease, and 11.4% had unknown HR status. Brain, lung, liver, and bone metastases were found in 24.9%, 35.7%, 31.7%, and 33.1% of all cases, respectively. Most of patients (83.1%) were trastuzumab-exposed, 12.7% were pertuzumab-exposed, and 8.2% had been treated with lapatinib or neratinib before receiving pyrotinib. Pyrotinib plus chemotherapy (211 [55.8%]) was the most commonly used regimen, followed by pyrotinib monotherapy (115 [30.4%]), pyrotinib plus trastuzumab and chemotherapy (29 [7.7%]), other regimens (18 [4.8%]), and unknown regimen (5 [1.3%]). Standard dose (400 mg once daily) was used in 256 (67.7%) patients. With a median follow-up duration of 20.5 months, the median PFS was 13.0 months (95%CI, 12.0-14.0). Further analyses showed that the median PFS did not differ in subgroups by age (≥65 or &lt; 65 years), HR status (positive or negative), brain metastasis (yes or no), lung metastasis (yes or no), liver metastasis (yes or no), bone metastasis (yes or no), prior exposure to trastuzumab (yes or no), treatment regimen (pyrotinib monotherapy or combination therapy). Significant variance was discovered between sufficient dosage group and non-sufficient group (13.2 months vs 10.93 months, p= 0.028). The survival advantage of sufficient dosage was also evident in brain metastasis cases (14.4 months vs 8.3 months, p= 0.043).The most common adverse event was diarrhea (85.7%), and grade ≥3 diarrhea occurred in 18.5% of patients. Diarrhea was the leading cause for does reduction of pyrotinib. Conclusions: The PFS data in our study was similar to previous clinical trials referring to HER2-positive advanced breast cancer treated with pyrotinib. Cases with brain metastasis also displayed a satisfactory survival result. Sufficient dosage is of great importance for prolonged survival, prevention of diarrhea may efficiently avoid does reduction and guarantee the drug efficacy.

Importance of tail length in sheep and the breeding for short tails

Breeding for short tails in sheep may represent a good measure in order to avoid the continuation of tail docking in lambs. Since the ancestor of domestic sheep, the mouflon, has a short, narrow tail, it may be assumed that longer tails are a result of domestication. Previous studies on the heritability of tail length in domestic sheep were able to show values of 0.38 to 0.77, depending on the breed. Breeding for short tails must however ensure the avoidance of spinal malformations and those of neighboring structures. Until breeding progress is achieved, management measures may reduce the negative effects of long and woolly tails (e. g. myiasis, dermatitis). This includes prevention of diarrhea by balanced, ruminant-friendly feeding, a farm-specific and sustainable parasite management program as well as the deliberate shearing of uncut tails.

Mothers' knowledge, attitude and home management of diarrhoea among children under five years old in Lagos, Nigeria.

BackgroundDiarrhoea is a leading cause of death among children under five years old globally. It remains a major cause of morbidity and mortality among this age group in Nigeria. Using simple home management, mothers play important roles in the prevention and control of diarrhoea among these children.AimThis study aimed to assess mothers’ knowledge, attitude and practice in the prevention and home management of diarrhoeal diseases among children under five years old in Lagos, Nigeria.SettingThis study was conducted within the communities of Kosofe local government area of Lagos State, Nigeria.MethodsA descriptive cross-sectional study design was conducted using a multistage sampling technique. Data were collected using a structured interviewer-administered questionnaire and analysed using EPI info version 7.2.1. Chi-square statistic was used to test the association between variable at the level of significance of 5%.ResultsA total of 360 respondents participated in this study. The mean age of the respondents was 32.5 ± 5.5 years. About 59.2% of respondents had good knowledge, 59.2% of them had positive attitude, and 53.1% of them had good practice towards prevention and home management of diarrhoea. Age (p = 0.007), occupation (p = 0.008) and level of education (p = 0.001) were significantly associated with practice of home management of diarrhoea among children under five years old.ConclusionEducated, employed, and married mothers were more likely to have good prevention and home management practices towards diarrhoea in their children under five years old.

Protective effect of phytogenic plus short and medium-chain fatty acids-based additives in enterotoxigenic Escherichia coli challenged piglets

Post Weaning Diarrhea (PWD) is the most important multifactorial gastroenteric disease of the weaning in pig livestock. Phytogenic (PHY) natural extracts are largely studied as alternatives to antibiotic treatments in combating the global concern of the antimicrobial resistance. The aim of this study was to evaluate the protective effect of innovative phytogenic premix with or without short and medium chain fatty acids (SCFA and MCFA) in O138 Escherichia coli challenged piglets. Twenty-seven weaned piglets were allotted into four groups fed different diets according to the following dietary treatments: CTRL (n = 13) group fed basal diet, PHY1 (n = 7) fed the basal diet supplemented with 0.2% of phytogenic premix, PHY2 (n = 7) fed the basal diet supplemented with 0.2% of phytogenic premix added with 2000 ppm of SCFA and MCFA. After 6 days of experimental diet feeding, animals were challenged (day 0) with 2 × 109 CFU of E. coli and CTRL group was divided at day 0 into positive (challenged CTRL + ; n = 6) and negative control group (unchallenged CTRL-; n = 7). Body weights were recorded at -14, -6, 0, 4 and 7 days and the feed intake was recorded daily. E. coli shedding was monitored for 4 days post-challenge by plate counting. Fecal consistency was registered daily by a four-point scale (0–3; diarrhea > 1) during the post-challenge period. Tissue samples were obtained for gene expression and histological evaluations at day 7 from four animals per group. Lower average feed intake was observed in CTRL + compared to PHY2 and CTRL during the post-challenge period. Infected groups showed higher E. coli shedding compared to CTRL- during the 4 days post-challenge (p < 0.01). PHY2 showed lower frequency of diarrhea compared to PHY1 and CTRL + from 5 to 7 days post-challenge. No significant alterations among groups were observed in histopathological evaluation. Duodenum expression of occludin tended to be lower in challenged groups compared to CTRL- at 7 days post-challenge (p = 0.066). In conclusion, dietary supplementation of PHY plus SCFA and MCFA revealed encouraging results for diarrhea prevention and growth performance in weaned piglets.

Food awareness among diarrheal children mothers

Background: Food awareness is vital in the prevention and prevalence of diarrhea in children under the age of five. Assessment of maternal food knowledge is a public health priority for children's health. Therefore, thus study aimed to assess food awareness among diarrheal children mothers and determine the associated demographic variables in The-Qar Province/ Iraq. Methods: A cross-sectional study was conducted on a sample of 200 women who had child's with diarrhea. This sample distributed throughout two hospitals include (Bint Al-Huda Teaching Hospital and Martyr Muhammad Al-Moussawi Children's Hospital). The reliability of the questionnaire was achieved through a pilot study and then presented to experts to prove its validity. The total number of items included in the questionnaire was 20-items. The data was collected by using the semi-structured interview and analyzed by the application of descriptive and inferential statistical data analysis approach. Results: The results of the study indicated that (43%) of the mothers exhibited a moderate level of food awareness. There were significant differences in food awareness with regards mothers age, education and residents (p&lt; 0.05). Conclusions: Mothers health awareness leads to decrease the prevalence of diarrhea.

Prevention of Diarrhea and Worms in Elementary School in the Pasirkaliki Health Center area, Bandung

National health development is essentially the development of quality Indonesian people where one of the strategic efforts to improve a quality generation is through education and health through the School Health Business (UKS) program. The purpose of this community service is to improve the knowledge and skills of washing hand with soap (CTPS) properly in preventing diarrhea and worms in students at the Kresna and Jatayu State Elementary Schools in the Pasirkaliki Health Center , Bandung . The method used in this activity is participatory training and mentoring for school children through discussions, questions answers, demonstrations, and direct practice simulations in groups. The respondents who took part in this program were 40 elementary school students in grades 4 and 5 who were randomly selected. The results showed an increase in the average score before and after training for elementary school students, the average knowledge (1.7 to 2.83), and the average increase in skills (1.64 to 2.88). Elementary school students showed enthusiasm and were able to demonstrate how to wash hands with soap (CTPS). This activity needs to be followed up in collaboration with the Puskesmas to map out achievements in the implementation of training on the prevention of diarrhea and helminthiasis in primary schools in other Puskesmas.

Mothers’ knowledge about prevention of diarrhea in children under five years at the Eastern AL Hamza City

The study Aim to ass Mothers’ Knowledge about Prevention of Diarrhea in Children, The study was descriptive using quantitative data collection method. In which assessment approach is applied to achieve the objectives of the study and was conducted for during the period of the study from October 2021 to March 2022,The study recommended to encouraging the holding of seminars and urging the medical staff to educate mothers regarding the prevention of diarrhea.

Inhibition of Virulence Gene Expression in Salmonella Dublin, Escherichia coli F5 and Clostridium perfringens Associated With Neonatal Calf Diarrhea by Factors Produced by Lactic Acid Bacteria During Fermentation of Cow Milk.

Diarrhea is a major health problem in neonatal and young calves worldwide. It can be caused by a variety of infectious agents, including the bacteria Salmonella enterica serovar Dublin (S. Dublin), enterotoxigenic Escherichia coli (ETEC), and Clostridium perfringens. Preventive alternatives to antibiotic treatment should be identified. As a first step toward this, the aim of the current study was to examine whether cell-free supernatants from cow milk fermented by lactic acid bacteria affects virulence-gene expression in strains of S. Dublin, ETEC E. coli F5 and C. perfringens. pH-neutralized, cell-free, spent medium of milk (nCFSM) fermented by 61 different lactic acid bacteria (LAB) and non-LAB starter cultures belonging to 17 genera was assayed for their effect on expression of important virulence factors (S. Dublin hilA, ssrB, ssaG, flhD, prgI, fliC; ETEC E. coli F5 fanC, estA, fim41a; C. perfringens cpa), when the bacteria were grown in the nCFSM. Screening was done using either a promoter-reporter expression system or RT-qPCR. nCFSM from Bifidobacterium longum BL-15955 and Limosilactobacillus reuteri LR-33016 downregulated the expression of fanC, fim41a and estA genes in the four tested ETEC E. coli F5 strains without affecting their growth, while mainly B. longum BL-15955 downregulated expression of cpa in the four tested strains of C. perfringens. nCFSM from the mixed cultures; NU-TRISH® BY-Mild (Lactobacillus delbrueckii subsp. bulgaricus, Streptococcus thermophilus and Bifidobacterium BL-15954) and COMBO4 (Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus), as well as Lactobacillus helveticus CNRZ32 downregulated the tested virulence genes in the three tested strains of S. Dublin. To enable possible downregulation of the expression of virulence genes in all three target bacteria simultaneously, nCFSM was prepared from NU-TRISH® By-Mild in combination with B. longum BL-15955 (i.e. a four-strain combination). The nCFSM from this combination downregulated the virulence genes expression in all the three species. In the future, NU-TRISH® By-Mild and B. longum BL-15955 in combination could potentially be used for prevention of neonatal calf diarrhea caused by S. Dublin, E. coli F5, and C. perfringens, reducing the need for antimicrobial treatment, however, field studies are needed to prove that.

​Burden of Diarrhoeal Diseases through Complementary Foods: A Review

Diarrhoeal disease is considered a public health problem with high morbidity and mortality worldwide, especially among children under the age of five years. In India, like other developing countries, diarrhoeal diseases are important child health problem. Food is an important factor in transmitting pathogens that cause diarrheal illness. Diarrhea can be caused by numerous pathogens and transmitted through multiple vehicles. Complementary foods prepared under unhygienic conditions are frequently heavily contaminated with pathogens and may thus be a major factor in causing diarrhoea diseases. Diarrheal diseases are major causes of malnutrition, delayed physical development and early childhood mortality. Diarrhea can cause acute wasting and is the most important infectious determinant of stunting of children’s linear growth. The prevention of diarrhoea in infants and children requires a multidisciplinary approach, including the promotion of safe preparation and handling of complementary food. Food contamination can be reduced using a Hazard Analysis and Critical Control Point (HACCP) methodology at the household level. Mothers and caregivers must wash their hands before feeding children and preparing food.

Diarrheal Disease Awareness Is Associated with Caregiver Handwashing with Soap in the Democratic Republic of the Congo (REDUCE Program).

Diarrhea is one of the leading causes of childhood illness and a major cause of infant and child mortality globally. In the Reducing Enteropathy, Undernutrition, and Contamination in the Environment (REDUCE) prospective cohort study, we investigated the association between diarrheal disease awareness and handwashing with soap among caregivers of children under 5 years of age. A total of 259 caregivers of children under 5 years of age in Walungu Territory, South Kivu, Democratic Republic of the Congo (DRC), were administered an open-ended questionnaire assessing awareness of diarrheal disease transmission and prevention, and key times to wash hands with soap. An overall diarrhea awareness score was developed based on the responses to these items. Five-hour structured observation of handwashing behaviors was conducted at the 6-month follow-up. Diarrheal disease awareness among caregivers was low. Only 32% of caregivers were able to correctly identify a method of diarrhea prevention. The median diarrhea awareness score was three out of 10 (SD: 1.7, range: 0-9). During structured observation, 9% of caregivers washed their hands with soap at a food-related event and 9% washed their hands with soap at a stool-related event. Higher diarrheal disease awareness was associated with an increased odds of handwashing with soap at food-related events (odds ratio: 1.40, 95% confidence interval: 1.03, 1.90). Our findings emphasize the need for targeted water, sanitation, and hygiene interventions to increase diarrhea awareness to facilitate handwashing with soap among caregivers of children under 5 years in rural DRC.