Risk Of Diarrhea Research Articles

Balancing risks and benefits of cannabis use: umbrella review of meta-analyses of randomised controlled trials and observational studies

ObjectiveTo systematically assess credibility and certainty of associations between cannabis, cannabinoids, and cannabis based medicines and human health, from observational studies and randomised controlled trials (RCTs).DesignUmbrella review.Data sourcesPubMed, PsychInfo, Embase,...

Optimizing Feeding Strategies for Growing Rabbits: Impact of Timing and Amount on Health and Circadian Rhythms.

Mammals exhibit circadian rhythms in their behavior and physiological activities to adapt to the diurnal changes of the environment. Improper feeding methods can disrupt the natural habits of animals and harm animal health. This study investigated the effects of feeding amount and feeding time on growing rabbits in northern China during spring. A total of 432 healthy 35-day-old weaned rabbits with similar body weight were randomly assigned to four groups: whole day diet-unrestricted feeding (WUF), whole day diet-restricted feeding (WRF), nighttime diet-unrestricted feeding (NUF), and nighttime diet-restricted feeding (NRF). The results showed that nighttime diet-unrestricted feeding improved performance, circadian rhythm of behavior, and body temperature, while reducing the risk of diarrhea and death. WRF group increased daytime body temperature but had no significant difference in feed conversion rate. The study suggests that nighttime diet-unrestricted feeding in spring can improve the growth and welfare of rabbits in northern China. Our study underscores the pivotal role of feeding timing in enhancing animal health. Future investigations should delve into the underlying mechanisms and expand the application of this strategy across seasons and regions to improve rabbit husbandry practices.

Literature Review: Hubungan Sarana Sanitasi Lingkungan dan Personal Hygiene Ibu dengan Kejadian Diare pada Balita

Background: Diarrhea is still a major health problem in developing countries and one of them is Indonesia. Having weak antibodies causes toddlers to be susceptible to viral diarrhea. Diarrhea is a contagious disease characterized by symptoms such as: increased frequency of defecation that can occur more than 3 times a day, then there is also a change in the shape or consistency of the stool which turns soft or even liquid, and this can cause vomiting that can make the sufferer have lack of body fluids (dehydration) and if it is not immediately to get help it can cause the sufferer to death. Objective: To determine the relationship between environmental sanitation facilities and mothers’ personal hygiene with cases of diarrhea in toddlers. Methods: The research design used in this study is in the form of a systematic review using secondary data. The data was searched using the PRISMA method, while the data synthesis is using the SPIDER approach. Results: There were 23 journals, the 23 journals consisted of 15 national journals and 8 international journals that were reviewed. Conclusion: There is a relationship between environmental sanitation facilities and mothers' personal hygiene with diarrhea incidence in toddlers. The importance of having sanitation facilities that meet the health requirements and the importance of conducting CTPS to reduce the risk of diarrhea in toddlers.

Multidrug resistance pattern and molecular epidemiology of pathogens among children with diarrhea in Bangladesh, 2019–2021

Antimicrobial and multidrug resistance (MDR) pathogens are becoming one of the major health threats among children. Integrated studies on the molecular epidemiology and prevalence of AMR and MDR diarrheal pathogens are lacking. A total of 404 fecal specimens were collected from children with diarrhea in Bangladesh from January 2019 to December 2021. We used conventional bacteriologic and molecular sequence analysis methods. Phenotypic and genotypic resistance were determined by disk diffusion and molecular sequencing methods. Fisher’s exact tests with 95% confidence intervals (CIs) was performed. Prevalence of bacterial infection was 63% (251 of 404) among children with diarrhea. E. coli (29%) was the most prevalent. E. coli, Shigella spp., V. cholerae, and Salmonella spp., showed the highest frequency of resistance against ceftriaxone (75–85%), and erythromycin (70–75%%). About 10–20% isolates of E. coli, V. cholerae and Shigella spp. showed MDR against cephem, macrolides, and quinolones. Significant association (p value < 0.05) was found between the phenotypic and genotypic resistance. The risk of diarrhea was the highest among the patients co-infected with E. coli and rotavirus [OR 3.6 (95% CI 1.1–5.4) (p = 0.001)] followed by Shigella spp. and rotavirus [OR 3.5 (95% CI 0.5–5.3) (p = 0.001)]. This study will provide an integrated insight of molecular epidemiology and antimicrobial resistance profiling of bacterial pathogens among children with diarrhea in Bangladesh.

Comparative Efficacy of Tegoprazan vs Esomeprazole/Sodium Bicarbonate for the Treatment of Helicobacter pylori Infection.

Potassium-competitive acid blockers and proton pump inhibitors/sodium bicarbonate can rapidly increase intragastric pH. In this study, we aimed to compare the clinical outcomes of tegoprazan-based and esomeprazole/sodium bicarbonate-based triple therapies in the treatment of Helicobacter pylori infection. We retrospectively reviewed the data of patients with H. pylori infection treated with a 14-day tegoprazan-based triple therapy or 14-day esomeprazole/sodium bicarbonate-based triple therapy. The primary end point was the H. pylori eradication rate with first-line treatment in an intention-to-treat analysis. Secondary end points included the eradication rate with first-line therapy in the per-protocol analysis and adverse events associated with eradication therapy. Of the 854 included patients, 435 were treated with tegoprazan-based therapy, and 419 received esomeprazole/sodium bicarbonate-based therapy. In the intention-to-treat population, no significant difference in eradication rate was detected between the tegoprazan-treated and esomeprazole/sodium bicarbonate-treated groups (78.6% [95% confidence interval (CI), 74.6-82.3%] vs 81.4% [95% CI, 77.4-84.9%], P = 0.313). The per-protocol analysis also revealed a similar eradication rate between groups (tegoprazan vs esomeprazole/sodium bicarbonate: 85.5% [95% CI, 81.8-87.5%] vs 87.8% [95% CI, 84.1-90.7%], P = 0.339). However, abdominal discomfort and diarrhea were more common in the esomeprazole/sodium bicarbonate-treated group than in the tegoprazan-treated group (abdominal discomfort: 1.1% vs 3.8%, P = 0.012; diarrhea: 9.9% vs 21.2%, P < 0.001). The efficacy of the esomeprazole/sodium bicarbonate-based triple therapy for H. pylori eradication was comparable with that of the tegoprazan-based triple therapy. However, esomeprazole/sodium bicarbonate-based therapy exhibited a higher risk of abdominal discomfort and diarrhea than tegoprazan-based therapy.

Population modeling of bosutinib exposure-response in patients with newly diagnosed chronic phase chronic myeloid leukemia.

The BELA and BFORE trials compared bosutinib starting doses of 500 mg once daily (QD) and 400 mg QD, respectively, with imatinib in adults with newly diagnosed chronic phase chronic myeloid leukemia (CP-CML). The B1871048 trial evaluated bosutinib 400 mg QD in Japanese patients with newly diagnosed CP-CML. This analysis assessed the impact of a lower bosutinib starting dose on key efficacy and safety outcomes. A pharmacokinetic model was used to estimate metrics of bosutinib exposure, and logistic regression was used to investigate relationships with efficacy (cumulative major molecular response [MMR] and cumulative complete cytogenetic response [CCyR]) and safety outcomes (eight prespecified adverse events). Totals of 573 and 574 patients were included in the efficacy and safety endpoint analyses, respectively. Cumulative MMR and CCyR were similar across studies. Log(Ctrough ) and log(Cavg ) were significant predictors of MMR and CCyR, and the probability of achieving MMR or CCyR increased 1.3-fold or 2.7-fold for every 1 unit increase in log(Ctrough ) or log(Cavg ), respectively. An exposure-response relationship was identified between time-to-event and risk of diarrhea, nausea, and vomiting. Significant relationships were also observed between time-to-event and log(Cavg ), Ctrough , and Cavg with diarrhea, nausea, and vomiting, respectively. A bosutinib exposure-response relationship with safety and efficacy was observed. Compared with 500 mg QD, a bosutinib starting dose of 400 mg QD improved tolerability in some patients with newly diagnosed CP-CML without compromising efficacy. gov identifiers: NCT00574873; NCT02130557; NCT03128411.

Tolerance to and Postoperative Outcomes With Early Oral Feeding Following Elective Bowel Surgery: A Systematic Review.

Although practice guidelines recommend resuming oral feeding immediately after gastrointestinal surgery, many practitioners remain reluctant to order early oral feeding (EOF). Therefore, this review aimed to clarify the tolerance to and postoperative outcomes with EOF among patients undergoing bowel surgery. A systematic review of the literature published between January 1990 and July 2022 with the time of oral intake (early or delayed until resolution of ileus) as the exposure variable was conducted using PubMed and Scopus databases. Outcomes of interest included tolerance to EOF and postoperative adverse effects or complications. After screening 1,667 research articles, 18 randomized control trials, six prospective case series, and four cohort studies met our inclusion criteria, collectively representing data from 2,647 patients in eleven countries. These studies indicate that while most patients tolerate EOF, 5-25% may not tolerate EOF until the fourth postoperative day (POD). Moreover, EOF, at best, has no advantage over delayed feeding in terms of vomiting, nausea, nasogastric tube requirement, or other postoperative complications. In addition, early return of bowel function, lower risk of diarrhea, and lower pain score with EOF are inconsistently reported, and shorter hospitalization with EOF may be limited to those who tolerate oral feeding on POD 0 or 1. Nevertheless, shorter hospitalization with EOF could reduce the cost of hospitalization. A substantial number of patients may not be able to tolerate oral feeding after bowel surgery until POD 4, and in patients who tolerate EOF, the only clear benefit is a shorter length of hospitalization.

Diarrhea Prevalence and Associated Factors among Children in Azezo Sub-City, Northwest Ethiopia: A Community-Based Cross-Sectional Study.

Globally, diarrheal disease continues to be a major cause of morbidity and mortality among children under 5 years of age, especially in low-income countries such as Ethiopia. However, there is still limited evidence in the study area quantifying the burden of diarrheal disease among children under 5 years. A community-based cross-sectional study was conducted in April 2019 to estimate the prevalence of childhood diarrhea and to identify its associated factors in Azezo sub-city, northwest Ethiopia. A simple random sampling technique was applied to recruit the eligible cluster villages with children under 5 years. Data were collected by interviewing mothers or guardians using structured questionnaires. The completed data were entered into EpiInfo version 7 and exported to SPSS version 20 for analysis. Binary logistic regression model was used to identify factors associated with diarrheal disease. Adjusted odds ratio (AOR) with 95% CI was used to measure the strength of association between the dependent and independent variable. The period prevalence of diarrheal disease among children under 5 years was 24.9% (95% CI: 20.4-29.7%). Age group between 1 and 12 months [AOR: 9.22, 95% CI: (2.93-29.04)] and 13 and 24 months [AOR: 4.44, 95% CI: (1.87-10.56)], as well as low monthly income (AOR: 3.68, 95% CI: (1.81-7.51)] and poor handwashing practice [AOR: 8.37, 95% CI: (3.12-22.52), were significantly associated with high risk of childhood diarrhea. In contrast, small family size [AOR: 0.32, 95% CI: (0.16-0.65)], and immediate consumption of prepared meals [AOR: 0.39, 95% CI: (0.19-0.81)] were significantly associated with low risk of childhood diarrhea. Diarrheal diseases were a common health problem among children under 5 years of age in Azezo sub-city. Therefore, an appropriate hygiene intervention program through health education is recommended with a focus on identified risk factors to reduce the burden of diarrheal diseases.

Association between transfer of passive immunity, health, and performance of female dairy calves from birth to weaning

The objective of this observational study was to compare calf health, average daily weight gain, and calf mortality considering the proposed categories of transfer of passive immunity (TPI) by the consensus report of Lombard et al. (2020). The consensus report defines 4 categories of passive immunity (excellent, good, fair, and poor) of calves obtained after colostrum ingestion. The association between the 4 TPI categories was analyzed on calf health (i.e., hazards for morbidity and mortality), and average daily weight gain (ADG) of female Holstein Friesian calves during the first 90 d of age. A further aim of this study was to examine the effects of calving-related factors, such as dystocia or winter season, on TPI status. We hypothesized that calves with excellent TPI have greater ADG, lower risks for infectious diseases such as neonatal diarrhea, pneumonia, and omphalitis, and lower mortality rates. This observational study was conducted from December 2017 to March 2021. Blood was collected from 3,434 female Holstein Friesian dairy calves from 1 commercial dairy farm. All female calves aged 2 to 7 d were assessed for TPI status by determination of total solids (TS) in serum via Brix refractometry by the farm personnel once a week. Passive immunity was categorized according to Lombard et al. (2020) with excellent (≥9.4% Brix), good (8.9-9.3% Brix), fair (8.1-8.8% Brix), or poor TPI (<8.1% Brix). For the analysis of ADG and calving ease 492 or 35 calves had to be excluded due to missing data. The distribution of calves according to TPI categories was as follows: 4.8% poor (n = 166), 29.5% fair (n = 1,012), 28.3% good (n = 971), and 37.4% excellent (n = 1,285). From the calving-related factors, parity of the dam, calving ease, birth month, calving assistance by different farm personnel, and day of life for TPI assessment were significantly associated with TS concentration. Out of 3,434 calves, 216 (6.3%) had diarrhea, and 31 (0.9%) and 957 (27.9%) suffered from omphalitis and pneumonia during the first 90 d of life, respectively. Overall, the morbidity during the preweaning period was 32.6% (n = 1,118), and the mortality was 3.1% (n = 107). The ADG was 0.90 ± 0.15 kg with a range of 0.32 to 1.52 kg. The Cox regression model showed that calves suffering from poor TPI tended toward a greater hazard risk (HR) for diarrhea (HR = 1.57, 95% CI: 0.92-2.69) compared with calves with excellent TPI. Calves suffering from TPI had a greater HR for pneumonia (HR = 2.00, CI: 1.53-2-61), overall morbidity (HR = 1.99, CI: 1.56-2.55), and mortality (HR = 2.47, CI: 1.25-4.86) in contrast to excellent TPI. Furthermore, calves with good and fair TPI had significantly greater HR for pneumonia (good TPI: HR = 1.35, CI: 1.15-1.59; fair TPI: HR = 1.41, CI: 1.20-1.65) and overall morbidity (good TPI: HR = 1.26, CI: 1.09-1.47; fair TPI: HR = 1.32, CI: 1.14-1.53) compared with the excellent TPI category. Average daily weight gain during the first 60 d of life was associated with TPI categories. Calves with excellent and good TPI status had ADG of 0.90 ± 0.01 kg/d and 0.92 ± 0.01 kg/d (mean ± SE), respectively. The ADG of calves with fair TPI status was 0.89 ± 0.01 kg/d, and calves suffering from poor TPI had 0.86 ± 0.01 kg/d. Average daily weight gain differed in calves with poor TPI compared with the other categories. Fair and excellent TPI differed additionally from good TPI. We found no statistical difference between the TPI categories fair and excellent. In conclusion, poor TPI was associated with higher morbidity and mortality during the first 90 d of life. Furthermore, calves with fair, good or excellent TPI had greater ADG.

Quantitative Microbial Risk Assessment (QMRA) of major drinking water sources at household level incorporating boiling treatment effect

This study conducted a quantitative microbial risk assessment (QMRA), incorporating the effect of boiling of water, on major sources of drinking water for households in Afikpo North LGA, Ebonyi State, Nigeria. Water samples were collected from12 drinking water boreholes (n =36), a popular spring water (n= 36) and four popular brands of sachet water (n= 36).The samples were analysed in the laboratory for colonies of microorganisms, coliform organisms, E. coli, Salmonella spp and Giardia lamblia. Data were analysed for specific parameters of the study population (n =1150). The parameters include daily water consumption per person per day (L/person/day), the fraction of thepopulatonexposed to the contaminated drinking water source under consideration, the percentage ofthe population vulnerableto pathogenic infection among the exposed population,the pathogen strike rate in each water source, and the probability that water is boiled before drinking. Quantitative microbial risk assessment was performed for concentrations of E. coli (CFU/L), Salmonella spp (CFU/L), and Giardia lamblia (Cyst/L) in the water samples. From the findings, the risk of diarrhea is significantly highin all the drinking water sources examined. The risk of diarrhea ranged between0.090 and 0.190 for borehole water source, 0.004 and 0.032 for spring water source, 0.039 and 0.125 for sachet water sources. The implication is an urgent need to regualte the operation of water boreholes, protect spring water source, and enforce standards on the processes of production, distribution and storage of sachet water in Afikpo North LGA.

Opinions of gastroenterologists about intestinal microbiota modulating agents: results of the survey in focus groups

Aim. To study the opinions of gastroenterologists about drugs affecting the intestinal microflora.&#x0D; Materials and methods. A qualitative survey was conducted in focus groups to study the patterns of prescribing drugs that regulate intestinal microflora in chronic gastrointestinal diseases. The survey included only outpatient gastroenterologists who managed patients with irritable bowel syndrome, an uncomplicated diverticular disease with clinical manifestations and excessive bacterial growth in the small intestine for at least 3 years.&#x0D; Results. Physicians perceive the non-absorbable antibiotic rifaximin alpha as the drug of choice for treating these diseases; they are aware of its low bioavailability and suitability for repeated use. However, with severe clinical symptoms, some doctors tend to use systemic antibiotics before infectious or inflammatory complications are confirmed. It is due to the erroneous perception of systemic antibiotics as obviously more effective drugs than non-absorbable antibiotics. When choosing a drug, it is essential to consider the risk of antibiotic-associated diarrhea, adverse changes in the microflora, and the patient's comorbidities.&#x0D; Conclusion. Surveyed gastroenterologists consider rifaximin alfa (Alfa Normix) the most suitable drug that helps in routine practice achieve the desired result with a minimum risk of adverse events. Many study participants are skeptical about the effect of probiotics due to the lack of evidence but emphasize their safety and the request for probiotics from patients. Not all doctors are aware of metabiotics. Prebiotics and dietary fibers are perceived as agents that affect both the intestinal microflora and the stool frequency. Some healthcare professionals are concerned about prebiotics and probiotics registered as dietary supplements, which can cause patient misunderstandings. Identified opinions about such agents can be used in training gastroenterologists and developing clinical guidelines.

Temperature extremes and infectious diarrhea in China: attributable risks and effect modification of urban characteristics.

Studies about the role of urban characteristics in modifying the health effect of temperature extremes are still unclear. This study is aimed at quantifying the morbidity risk of infectious diarrhea attributable to temperature extremes and the modified effect of a range of city-specific indicators. Distributed lag non-linear model and multivariate meta-regression were applied to estimate fractions of infectious diarrhea morbidity attributable to temperature extremes and to explore the effect modification of city-level characteristics. Extreme heat- and extreme cold-related infectious diarrhea amounted to 0.99% (95% CI: 0.57-1.29) and 1.05% (95% CI: 0.64-1.24) of the total cases, respectively. The attributable fraction of temperature extremes on infectious diarrhea varied between southern and northern China. Several city characteristics modified the association of extreme cold with infectious diarrhea, with a higher morbidity impact related to increased water consumption per capita and decreased latitude. Regions with higher levels of latitude or GDP per capita appeared to be more sensitive to extreme hot. In conclusion, exposure to temperature extremes was associated with increased risks of infectious diarrhea and the effect can be modified by urban characteristics. This finding can inform public health interventions to decrease the adverse effects of temperature extremes on infectious diarrhea.

The mediatory role of water quality on the association between extreme precipitation events and infectious diarrhea in the Yangtze River Basin, China

Extreme precipitation is exacerbating the burden of infectious diarrhea in the context of climate change, it is necessary to identify the critical and easy-to-intervene intermediate factors for public health strategies. Water quality may be the most important mediator, while relevant empirical evidence is limited. This study aimed to examine the role of water quality in the process of infectious diarrhea caused by extreme precipitation. Weekly infectious diarrhea cases, meteorological factors and water quality data in Yangtze River Basin in China between October 29, 2007 to February 19, 2017 were obtained. Two-stage statistical models were used to estimate city-specific extreme precipitation, water quality and infectious diarrhea relationships that were pooled to derive regional estimates. A causal mediation analysis was used to assess the mediation effect of water quality. In Yangtze River Basin, extreme precipitation events had a significant impact on infectious diarrhea (Incidence Rate Ratios [IRR]: 1.027, 95% Confidence Interval [CI]: 1.013∼1.041). After extreme precipitation events, the dissolved oxygen (DO) in surface water decreased (-0.123 mg/L, 95%CI: -0.159 mg/L∼-0.086 mg/L), while the un-ionized ammonia (NH(3)-N) increased (0.004 mg/L, 95%CI: 0.001 mg/L∼0.006 mg/L). The combined overall effect of DO and NH(3)-N on infectious diarrhea showed that both low and high concentrations were associated with an increased risk of infectious diarrhea. The causal mediation analysis showed that the mediation proportion of the two water quality indexes (DO and NH(3)-N) is 70.54% (P < 0.001). To reduce the health effects of extreme precipitation, in contrast to current population-oriented health strategies, those that take into account more direct and easy-to-intervene water quality indicators should be encouraged by future policies.

Impact of access to improved water and sanitation on diarrhea reduction among rural under-five children in low and middle-income countries: a propensity score matched analysis

BackgroundDiarrhea, the second leading cause of child morbidity and mortality worldwide, is responsible for more than 90% of deaths in children under 5 years of age in low and middle-income countries (LMICs). The high burden of diarrhea is mainly attributable to the limited access to improved water and sanitation. However, the impacts of improved sanitation and drinking water in preventing diarrheal diseases are not well understood. Therefore, this study estimated both the independent and joint effects of improved sanitation and water on diarrhea occurrence among rural under-five children in LMICs.MethodsThe current study utilized secondary data from the Demographic and Health Survey (DHS) datasets conducted between 2016 and 2021 in 27 LMICs. A total weighted sample of 330,866 under-five children was included in the study. We employed propensity score matching analysis (PSMA) to examine the effects of accessing improved water and sanitation on childhood diarrheal disease reduction.ResultsThe prevalence of diarrhea among children under 5 years of age in rural LMICs was 11.02% (95% CI; 10.91%, 11.31%). The probability of developing diarrhea among under-five children from households with improved sanitation and water was 16.6% (Average Treatment Effect on the Treated (ATT) = − 0.166) and 7.4% (ATT = − 0.074) times less likely among those from households with unimproved sanitation and water, respectively. Access to improved water and sanitation is significantly associated with a 24.5% (ATT = − 0.245) reduction of diarrheal disease among under-five children.ConclusionsImproved sanitation and drinking water source reduced the risk of diarrhea among under-five children in LMIC. The effects of both interventions (improved water and sanitation) had a larger impact on the reduction of diarrheal disease than the improvements to water or sanitation alone. Therefore, achieving Sustainable Development Goal 6 (SDG 6) is key to reducing diarrhea among rural under-five children.

Examination of water quality at the household level and its association with diarrhea among young children in Ghana: Results from UNICEF-MICS6 survey

Ghana has made significant progress in expanding water services, but microbial contamination of water is still a major public health problem. The objectives of the study were to: 1) Examine sociodemographic and water access related predictors for the point of use or drinking water quality among rural and urban households, and; 2) Determine the association between the point of use water quality and prevalence of diarrhea among young children in rural and urban households. A secondary data analysis was carried out using the Ghana UNICEF-MICS6 survey taking into account the complex survey design. Logistic regression models were used to carry out the objectives. Among the 2317 households included for water quality testing, majority reported using improved source of drinking water. However, use of unimproved source of water was more common among rural households. In examining water quality at the point of use, it was found that more than 60% of the samples had mid to high levels of E. coli count, with significantly more common among rural compared to urban households (p &lt; .0001). The prevalence of diarrhea among under 5 children was 16.9%. In estimating the risk, E. coli count was not associated with higher diarrhea prevalence. However in urban areas, water storage was associated with increased risk of caregiver-reported diarrhea in children. Also, other factors such as child’s age, maternal education, region and household wealth index predicted diarrhea prevalence. In Ghana, contaminated point of use drinking water is more common in rural household, and in urban areas, water storage is associated with increased risk of caregiver-reported diarrhea in children. In the future, investigation of living condition and environmental hygiene is warranted to further understand different pathways through which risk of diarrhea increases among children.

Incidence Rate and Risk Factors for Diarrhea in Yarsi Medical Faculty Students Batch 2019

Introduction: Diarrhea is a bowel movement with a mushy or liquid consistency, which can even be water only with a frequency more often than usual (usually three or more times) in one day (Depkes RI 2011). The prevalence of diarrhea in Indonesia according to its characteristics based on the 2018 Riskesdas recorded 18,225 (9%) children with diarrhea aged &lt;1 year, 73,188 (11.5%) children with diarrhea aged 1-4 years, 182,338 (6.2%) children with diarrhea aged 5-14 years, and 165,644 (6.7%) children with diarrhea aged 15-24 years (Ministry of Health, 2019). Diarrhea can occur due to factors such as open defecation, hand washing without soap, food and beverage management, waste safety, and liquid waste safety.Methodology: This study is a correlational study with a cross sectional design. The study population was YARSI medical students. The sampling technique was purposive sampling. The total sample was 166 students.Results: In student respondents, the results showed that the incidence rate of diarrhea in medical students of Yarsi in the last 3 months was quite high because the majority had diarrhea. It is also known that several risk factors studied have a relationship with the incidence rate of diarrhea, namely hand washing behavior and also the source of water drunk. Meanwhile, the level of knowledge, gender, and location of food purchases are not related to the incidence of diarrhea in students.Conclusion: The results of the study found the prevalence of diarrhea and several risk factors associated with the incidence of diarrhea.

Exploring dynamic change and influencing factors of TGF-β1 and MUC1 in human breast milk, and their association with infantile diseases.

Human breast milk, which comprises numerous bioactive compositions, has been well-demonstrated to be benefit to the infants in both short-term and long-term outcomes. We aim to determine the concentration of transforming growth factor beta 1 (TGF-β1) and mucin 1 (MUC1) in human breast milk, identify their influencing factors, and explore their association with infantile diseases. Ninety paired mother-infants were enrolled in this study, and their demographic and clinical information was collected and analyzed. Paired colostrum and mature milk samples were collected from the healthy mothers within 5 days and at about 42 days after delivery, respectively. The concentrations of TGF-β1 and MUC1 were determined by enzyme-linked immunosorbent assay. The results showed that the concentrations of TGF-β1 and MUC1 in human breast milk dynamically changed during lactation, and their concentrations were significantly higher in colostrum than in mature milk. Advanced maternal age was associated with a significantly increased TGF-β1 concentration in colostrum, and caesarean delivery was significantly associated with an increased MUC1 concentration in colostrum. Finally, a high concentration of TGF-β1 in colostrum was significantly associated with a higher risk of infantile diarrhea within the first 3 months after giving birth, and infantile upper respiratory infection (URI) within the first 6 months after giving birth. To the best of our knowledge, we for the first time showed that a high concentration of TGF-β1 in human breast milk was significantly associated with an increased risk of infantile diarrhea and URI, which helps to give a better understanding of the relationship between the TGF-β1 in human breast milk and infantile diseases.

Maternal Breast Milk Secretor Phenotype Does Not Affect Infant Susceptibility to Rotavirus Diarrhea.

Breast milk secretor status is associated with antibody seroconversion to oral rotavirus vaccination. Here, we were unable to detect a similar impact on risk of infant rotavirus diarrhea or vaccine efficacy through 2 years of life, underscoring limitations of immunogenicity assessment alone in evaluation of oral rotavirus vaccine response.

Adverse events (AEs) of immune checkpoint therapy (ICT) combined with vascular endothelial growth factor inhibitors (VEGFi) vs. ICT alone: A pooled meta-analysis of 1735 patients.

e14667 Background: ICT combined with VEGFi are established as approved therapies for multiple malignancies. However, added toxicities remain unclear. We hypothesized that the combination of ICT + VEGFi has higher treatment-related AEs (TRAEs) and immune-related AEs (irAEs) compared with ICT alone. Methods: We performed a meta‐analysis to identify studies evaluating toxicity profile of ICT + VEGFi as compared to ICT. Systemic search was performed across all cancer types and major databases until August 10, 2022. Search structures, subject headings, and keywords were tailored to databases by medical research librarian. Screening of studies was done by two investigators. Inclusion criteria consisted of prospective phase II or III clinical studies which included at least one arm of patients treated with ICT + VEGFi and one arm treated with ICT alone. Restricted maximum likelihood fixed effects model was used to pool AEs data; I2 was used for heterogeneity. Results: From a total of 9366 studies found, seven met inclusion criteria. A total of 808 patients were treated with ICT while 927 were treated with ICT + VEGFi. Only one study reported irAEs. Therefore, we restricted our analysis to TRAEs. The total number of TRAEs (including grade 5) was significantly higher in ICT + VEGFi group with more frequent treatment withdrawals attributed to TRAEs. The list of TRAEs and specific effect sizes are summarized. The highest TRAE effect size increases with ICT + VEGFi were noted for rash (RR 6.50), hypertension (RR 6.07), hypothyroidism (RR 5.02), and diarrhea (RR 4.94). Conclusions: Combination therapy with ICT + VEGFi confers increased risk of specific TRAEs in comparison to ICT. Clinicians should be particularly mindful of the increased risk for rash, hypertension, hypothyroidism, diarrhea, nausea, anorexia, and proteinuria with ICT + VEGFi therapies. There are insufficient data on irAEs and future trials should provide more granular details on the AE cause. [Table: see text]

Indirect treatment comparison (ITC) of momelotinib (MMB) vs fedratinib (FED) safety in patients (pts) with myelofibrosis (MF).

7065 Background: JAK inhibitors (JAKi) are a mainstay of MF treatment, with proven ability to improve symptoms and spleen volume for most pts; although safety profiles vary, some approved JAKi have associated hematologic toxicity. The JAK1/JAK2/ACVR1 inhibitor MMB has shown consistent benefit in improving anemia, symptoms, and spleen volume in pts with MF. Clinical trials have directly compared MMB with ruxolitinib, with MMB showing a more favorable hematologic toxicity profile. However, there are limited data comparing MMB vs other JAKi such as FED. We performed an ITC of safety outcomes between MMB and FED in pts with MF. Methods: A matching-adjusted indirect comparison (MAIC) was undertaken to compare outcomes from phase 2 and/or 3 MMB and FED trials. Adverse events (AEs) occurring in &gt; 10% of a treatment arm over 24 weeks were evaluated; primary outcomes were grade 3/4 anemia and thrombocytopenia. Separate analyses were performed in JAKi-naive (SIMPLIFY-1 [S1] vs JAKARTA) and JAKi-experienced (pooled SIMPLIFY-2 [S2], MOMENTUM vs JAKARTA2) pts. Evaluable outcomes were limited by published aggregate data, so not all were feasible to compare. MAIC involved reweighting MMB pt data by matching baseline characteristics prioritized by expert clinical input (DIPSS/IPSS, Total Symptom Score, platelet counts, spleen volume/length, and/or hemoglobin levels) between trial arms, and determining odds ratios (ORs), risk ratios, and risk differences (RDs) between outcomes in resulting balanced populations. As nonrandomized groups were compared, results may be biased due to unmeasured/residual confounding, despite adjusting for prognostic factors/effect modifiers. Results: Effective MMB sample sizes after adjustment were 151.1 JAKi-naive and 79.4 JAKi-experienced pts. Risk of any or grade 3/4 anemia, diarrhea, nausea, and serious AEs leading to dose reductions were statistically less likely with MMB vs FED in both populations; any or grade 3/4 thrombocytopenia was also less likely with MMB vs FED, significantly so in JAKi-naive pts. Odds/risk of other outcomes assessed varied in significance (key OR/RD results presented in the Table). No identified outcomes were statistically less likely with FED. Conclusions: MMB showed a favorable safety profile vs FED in both JAKi-naive and experienced pts, including a significantly lower risk of key hematologic AEs, diarrhea, and nausea over 24 weeks. Clinical trial information: NCT04173494 ; NCT01969838 ; NCT02101268 ; NCT01523171 ; NCT01437787 . [Table: see text]